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comes with acute abdominal pain radiating to the back, nausea, vomiting and fever. He had a similar attack two years ago and was treated for acute pancreatitis. He is a non-alcoholic and his ultrasonogram of abdomen shows no gallstones. He is not taking any drugs and his lipid profile is normal. His family history and past medical history are insignificant. He is admitted and laboratory report shows marked elevation of amylase and lipase. He is treated for acute pancreatitis and his symptoms resolve over 5 days with serum amylase and lipase returning to normal.
What would be the next best step in the evaluation of this patient?
A. Do a CT scan of the abdomen.
B. Endoscopic retrograde cholangiopancreatography.
C. Do a HIDA scan.
D. Do an endoscopic ultrasonography.
E. Regular follow up of the patient.
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A. Do a CT scan of the abdomen.
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cud u give reason too bededoktor
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B.........to know the cause of recurrent pancreatitis.....may be microlithiasis in CBD.......if this is not positive then go with D........
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yea, i thought b too... okt3 answers please.
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Explanation:
This patient has recurrent pancreatitis for which no obvious cause is identified. In this situation ERCP would be the best investigation to search for the underlying cause (Choice B). ERCP in this case would help to diagnose ductal abnormalities including pancreatic divisum, choledochal cysts, and common bile duct stones. It would also allow for gall bladder aspiration of bile to look for biliary crystals or microlithiasis.
Choice A: CT scan can tell about hepatobiliary pathology but it is not as sensitive as ERCP to study the pancreatic and biliary duct and also would miss the microlithiasis which is present in more than 70 % of such patients.
Choice C: HIDA scan is a very sensitive tool for diagnosis of cholecystitis or sphincter of Oddi dysfunction but it will not be useful in the present scenario.
Choice D: Endoscopic ultrasonography can be used to look for ductal pathology or pancreatic lesion but ERCP is a better tool in this scenario.
Choice E: Patients with recurrent acute pancreatitis are at risk of further attacks if the underlying cause is not sought and corrected, therefore simply following up the patient is not appropriate.
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this is the second time when he get an acute pancreatitis and usg shows no gallstones
I would check on CT if any complications occured and how the pancreas looks like
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oops, the answer is B
thanks okt3
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but it says it hs resolved bededoktorem. so ercp to find out etiology like it says in explanation.
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yes,
I was thinking about asymptomatic pseudocysts which are formed sometimes after acute pancreatitis,
but I agree, ERCP is the best next step to find the cause
