A 45-year-old woman presents with epigastric pain radiating to the back. Lipase is 1600 U/L, bilirubin 94 micromol/L, temperature 38.7°C and

Question

A 45-year-old woman presents with epigastric pain radiating to the back. Lipase is 1600 U/L, bilirubin 94 micromol/L, temperature 38.7°C and ultrasound shows gallstones with a dilated common bile duct. She is hypotensive despite initial fluids. What is the most appropriate management?

Accepted Answer

Urgent ERCP with biliary decompression plus antibiotics and resuscitation

Answer

High-dose corticosteroids for pancreatic inflammation

Answer

Early oral feeding and discharge if pain improves

Answer

Colonoscopy to exclude inflammatory bowel disease

Answer

Elective cholecystectomy after 12 months

Gallstone pancreatitis with cholangitis — RACP Adult Medicine MCQ

A 45-year-old woman presents with epigastric pain radiating to the back. Lipase is 1600 U/L, bilirubin 94 micromol/L, temperature 38.7°C and ultrasound shows gallstones with a dilated common bile duct. She is hypotensive despite initial fluids. What is the most appropriate management?