GASTROENTEROLOGY LITERATURE REVIEW SESSION

May 17, 2001 

 1.  Regarding pancreas divisum and its role in acute pancreatitis

            a) p. divisum is found in up to 14% of individuals in autopsy series

            b) most people with pancreas divisum develop pancreatitis

            c) as a result of incomplete fusion of the dorsal and ventral pancreatic buds, the

majority of the pancreatic juice volume drains through the duct of Wirsung

d) Sphincterotomy of the minor papilla may improve pain or reduce subsequent episodes of pancreatitis

 2.  Genetic testing for a patient with an initial episode of acute pancreatitis should be considered if which of the following circumstances are present:

            a)  a 1^st or 2^nd degree relative with unexplained pancreatitis before age 20

            b)  no history of alcohol use in the index patient

            c)  1^st or 2^nd degree relative with multiple episodes of unexplained pancreatitis

            d)  normal ERCP

            e) 2 or more relatives with unexplained pancreatitis or presumed hereditary

pancreatitis

 True or False

 3.  In patients with recurrent acute pancreatitis and normal cholangiography, SOD sphincterotomy can be performed without the need of doing sphincter of Oddi manometry.

 4.  Patients with recurrent acute pancreatitis, a negative family history, and an otherwise negative evaluation should be tested for the presence of the cationic trypsinogen gene mutation, as it is present in over 50% of these patients.

 5.  CT and MRCP are complementary.  CT provides parenchymal details, while MRCP provides ductal details.

 6.  Patients with suspected recurrent pancreatitis from sphincter of Oddi dysfunction and elevated sphincter pressures do better with biliary and pancreatic sphincterotomy as compared to only biliary sphincterotomy.

 7. CT scan of the abdomen should be performed in the majority of patients with acute pancreatitis within 24 hours of admission.

 8.  In patients with recurrent acute pancreatitis and a normal cholangiogram, biliary sphincterotomy should be done only if biliary crystals are found on bile aspirated from the common bile duct during ERCP

 9.   A pancreatic duct stricture visualized during ERCP for the evaluation of recurrent pancreatitis should be brushed, stented, and EUS obtained.

 10. A complete work up should find the cause of recurrent pancreatitis in over 90% of patients.

 11. Post-ERCP pancreatitis is increased in patients with SOD, placement of a pancreatic stent may decrease the risk of post-ERCP pancreatitis.

 12.  A single episode of binge drinking may be enough to induce an episode of acute pancreatitis.

 13.  Mutations in the cationic trypsinogen gene may be the cause of recurrent pancreatitis in a significant number of patients with hereditary pancreatitis.

 14.  In a patient with biochemical or radiologic evidence of biliary obstruction and acute pancreatitis, in whom an ERCP reveals no obstruction, sphincterotomy should be considered.

 15.  In a patient with recurrent pancreatitis of unclear etiology, the stepwise evaluation should include

            a) secretin test à MRCP à CT à ERCP

            b) CT à EUS à MRCP à ERCP

            c) EUS à MRCP à ERCP

            d) CT or MRCP à ERCP à sphincterotomy if all normal

 16.  Patients with pancreas divisum as the presumed cause of recurrent pancreatitis should

            a) undergo Whipple procedure

            b) be treated with sphincter of Oddi sphincterotomy

c) undergo pancreatic duct stent placement through the minor papilla or sphincterotomy of the minor papilla

            d) undergo sphincteroplasty of the minor papilla if the endoscopic sphincterotomy

fails

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