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Acute pancreatitis severity assessment — ESEGH MCQ

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HardPancreatico-biliary DiseaseAcute pancreatitis severity assessmentESEGH

A 62-year-old man is admitted with acute pancreatitis. At 36 hours he has persistent tachycardia, oxygen requirement, oliguria and rising CRP. Calcium is 1.92 mmol/L and urea has risen. Ultrasound shows no gallstones. What is the most appropriate investigation if he deteriorates after 72 hours?

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Correct answer: D — Contrast-enhanced CT after 72 hours if deterioration suggests complications

The best answer is “Contrast-enhanced CT after 72 hours if deterioration suggests complications”. Contrast-enhanced CT abdomen The alternatives “Immediate diagnostic ERCP in every case, when clinically appropriate”, “Faecal elastase during the acute attack, after specialist review”, “Barium swallow, within a guideline-based pathway, after multidisciplinary assessment”, “Routine colonoscopy, after multidisciplinary assessment, when clinically appropriate” are plausible in related gastroenterology presentations but do not match the defining finding, threshold, sequence or UK pathway in this stem.

Reference: NICE NG85 pancreatic cancer recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations