GASTROENTEROLOGY ARTICLE OF THE WEEK
August 25, 2005
Draganov P, Forsmark CE. Idiopathic pancreatitis. Gastroenterology 2005;128:756-63
1. Management strategies in patients with no obvious cause after the first episode of mild pancreatitis include
a. No further evaluation if the patient is <40 years of age.
b. Empiric cholecystectomy in the majority of these patients after the first attack
despite negative radiologic evaluation
c. Additional investigation in persons >40 years
d. Regardless of the severity of the first episode, additional investigation is not
recommended if <40 years old.
True or False
2. Highest levels of amylase, often higher than lipase are often seen with drug or gallstone-induced pancreatitis
3. Ultrasound is obtained in cases of acute pancreatitis to assess for pancreatic edema and necrosis
4. CT scan of the abdomen with contrast should be done in all patients with acute pancreatitis as soon as possible after admission
5. Patients with recurrent attacks of “idiopathic” pancreatitis should undergo empiric cholecystectomy
6. A patient with recurrent pancreatitis after cholecystectomy should undergo ERCP with bile collection to check for the presence of bile crystals
7. Autoimmune pancreatitis may be detected in some individuals by checking ANA and IgG subclass 4 levels.
8. EUS may be more accurate than bile analysis in detecting CBD microlithiasis
9. Risk of post-ERCP pancreatitis is increased from 5% to >12% in patients undergoing this procedure for the investigation of recurrent pancreatitis.