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Gallstone pancreatitis with cholangitis — RCPSC IM MCQ

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HardGastroenterology/HepatologyGallstone pancreatitis with cholangitisRCPSC IM

A patient with gallstone pancreatitis develops fever, jaundice, rising bilirubin and a dilated common bile duct. What is the best next step?

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Correct answer: B — Give antibiotics and arrange urgent ERCP

The best answer is “Give antibiotics and arrange urgent ERCP”. This is acute cholangitis with persistent obstruction complicating pancreatitis. Prompt antimicrobial therapy and biliary drainage are required; cholecystectomy follows stabilization and duct management. Supportive pancreatitis care continues, but it cannot clear an infected obstructed duct, which is the immediately reversible driver of deterioration.

Reference: Canadian Association of Gastroenterology guideline library: https://www.cag-acg.org/guideline-library.html