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Severe acute pancreatitis — SCE Acute Medicine MCQ

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HardAcute GI PresentationsSevere acute pancreatitisSCE Acute Medicine

A 46-year-old man presents with severe epigastric pain radiating to the back after heavy alcohol intake. Amylase is 1460 IU/L. At 48 hours, CRP is 236 mg/L, PaO2 is 8.0 kPa on air, urea has risen to 13.2 mmol/L and CT shows peripancreatic inflammation without necrosis. What is the most appropriate next step in management?

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Correct answer: C — Manage as severe acute pancreatitis with high-dependency monitoring and supportive care

Persistent organ dysfunction and high inflammatory markers indicate severe acute pancreatitis needing close monitoring and aggressive supportive care. Prophylactic antibiotics are not used for sterile necrosis or uncomplicated inflammation. ERCP is indicated for cholangitis or persistent biliary obstruction, not alcohol-related pancreatitis without obstruction. Severity comes from physiology, not just CT necrosis.

Reference: NICE NG104, BSG acute pancreatitis guidance