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Gallstone pancreatitis with cholangitis — ABIM Board MCQ

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HardGastroenterology/HepatologyGallstone pancreatitis with cholangitisABIM Board

A 67-year-old woman presents with severe epigastric pain radiating to the back, fever, jaundice, and confusion. Lipase is 2100 U/L, bilirubin is 5.4 mg/dL, alkaline phosphatase is elevated, and ultrasound shows gallstones with a dilated common bile duct. Which of the following is the most likely cause?

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Correct answer: A — Obstructing common bile duct stone with ascending cholangitis

Gallstones, dilated common bile duct, cholestatic jaundice, fever, and confusion indicate biliary obstruction complicated by ascending cholangitis causing gallstone pancreatitis.

Reference: ACG Acute Pancreatitis Guideline; ASGE Cholangitis Guidance