GASTROENTEROLOGY ARTICLE OF THE WEEK
October 2, 2008
Rhim AD, Kochman ML. A young woman with gallstone pancreatitis and abnormal liver tests: When is endoscopic retrograde cholangiopancreatography needed? Clin Gastroenterol Hepatol 2008;6:741-745.
1. Which of the following patients with gallstone pancreatitis should have an urgent ERCP
a. 23 y/o female with normal CBD, resolved pain, no fever, t. bili 0.4, ALT 43, Ranson 0
b. 39 y/o female with CBD 1.0, ALT 75, T. bili 2.2/ d bili 0.1, no fever, severe pain, Ranson 1
c. 59 y/o male with CBD 0.9, ALT 250, t. bili 3.5, temperature 102, severe RUQ tenderness, Ranson 2 chills, disorientation
d. 87 y/o female with CBD 1.9, ALT 40, t. bili 2.8, Alk Phos 780, no pain, normal WBC, no Ranson 1.
e. a 49 y/o female with CBD 1.9, ALT 95, t. bili 3.0, Ranson 5.
True or False
2. The presence of a Murphy’s sign indicates cholangitis
3. Intervention with ERCP in cases of gallstone pancreatitis has been shown to be helpful only in those cases with “severe” pancreatitis
4. The presence of a dilated CBD in a patient with acute gallstone pancreatitis and no radiographic evidence of choledoclithiasis requires urgent ERCP
5. An MRCP is the best alternate test to look for CBD stones if an ERCP is not available or feasible.