GASTROENTEROLOGY ARTICLE OF THE WEEK

February 3, 2000 

1Urgent ERCP (within 24-48 hours) should be strongly considered in which of the following circumstances associated with acute biliary pancreatitis

            a.      all cases of biliary pancreatitis

b.      mild hyperbilirubinemia that resolves

c.      jaundice

d.      cholangitis

e.      dilated CBD

f.        severe pancreatitis

g.      smoldering or deteriorating course of acute biliary pancreatitis

 2.  Surgery for biliary pancreatitis

a.      should be performed as soon as the diagnosis is established

b.      should be performed 6-12 weeks later, after the patient has been discharged and has recovered from the pancreatitis

c.      early surgery results in significantly increased complications and mortality in those with severe pancreatitis

d.      should be performed during the initial hospitalization, after acute signs and symptoms of pancreatitis have abated.

True or False

 3.  Biliary pancreatitis is usually a mild illness; mortality rate is <1%

 4.  Common bile duct stones are found more commonly in patients with severe gallstone pancreatitis than in those with mild pancreatitis.

 5.  Published data clearly supports that early endoscopy with sphincterotomy is helpful in patients with acute biliary pancreatitis.

 6.  Biliary pancreatitis, in contrast to alcoholic pancreatitis:

a.      typically presents with  higher serum amylase levels

b.      is more commonly associated with elevations of bilirubin, alkaline phosphatase and GT

c.      can be excluded in patients with normal liver enzyme and bilirubin levels

d.      may be associated with elevations of serum transaminases to 3X ULN

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