The 'Acute Pancreatitis Post-Test' assesses knowledge on the diagnosis and management of acute pancreatitis. It covers topics like bedside tests, evaluation steps for idiopathic cases, biochemical predictors, and interventions for complications like infected necrosis and sepsis.
Secretin-stimulated MRCP
Empiric cholecystectomy
Endoscopic ultrasound
ERCP
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Serum elastase
Lipase
Bilirubin
G-Glutamyltransferase
None of the above
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10 days after the onset of pancreatitis
20 days after the onset of pancreatitis
30 days after the onset of pancreatitis
40 days or later after the onset of pancreatitis
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Continued antibiotic administration and supportive therapy only
Percutaneous drainage
Endoscopic transluminal drainage
Video assisted retroperitoneal debridement
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Patients with sterile necrosis
Patients with duodenal obstruction
Patients with hemorrhage
Patients with colonic infarction
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Acute pseudocyst
Infected necrosis
SIRS as commonly seen in the acute phase of severe acute pancreatitis
Abdominal compartment syndrome
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Conservative treatment
Image-guided percutaneous or endoscopic catheter drainage
Primary open necrosectomy
Primary minimally invasive surgical necrosectomy
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20%
40%
60%
80%
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Normal saline
Ringers lactate
Dextrose saline
Gelofusine
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10-15 ml/kg/h
5-10 ml/kg/h
>15 ml/kg/h
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Haematocrit
Blood urea nitrogen
Serum creatinine
Amylase
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Elderly
Persistent SIRS
Obese patients
Drug induced pancreatitis
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Transient organ failure is the key determinant of mortality in acute pancreatitis
Transient SIRS < 48 h results in a mortality of 25.4% compared to 8% in persistent SIRS.
Fluid resuscitation can prevent necrosis formation.
Lactate Ringer’s solution reduces systemic inflammation compared to saline
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My suspicion would spontaneous bacterial peritonitis and I would treat with antibiotics and ascites drainage.
My suspicion would be an infected pancreatic collection resulting from a disrupted pancreatic duct and I would drain the collection transabdominally
My suspicion would be an infected pancreatic collection resulting from a disrupted pancreatic duct and I would drain the collection transabdominally and via the papillary route. In addition I would give antibiotics.
My suspicion would be an infected pancreatic collection resulting from a disrupted pancreatic duct and I would immediately perform a pancreatic left resection.
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Fluids, antibiotics, pain treatment
Fluids, pain treatment
Fluids, antibiotics, selective gut decontamination, pain treatment
Fluids, antibiotics, selective gut decontamination, probiotics, pain treatment
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Yes, always
No, never
Only in severe cases with a CRP> 50 mg/dl
Only in severe biliary pancreatitis with cholangitis
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Severe fungal pneumonia
Bowel ischemia
Urinary tract infections with E.coli 1917 Nissle or Lactobacillus
There is no risk of treatment
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Within the index admission
Never if ERC and endoscopic sphincterotomy is performed
After normalisation of CRP levels
Within 6 weeks after discharge
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Endoscopic sphincterotomy reduces recurrence of biliary pancreatitis
Only cholecystectomy prevents recurrence of biliary pancreatitis
Every patients should undergo cholecystectomy within index admission
There is no need for cholecystectomy in biliary pancreatitis as all stones pass within 48h hours
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I would perform cholecystectomy within the next 72 hrs
I would perform a sphincterotomy within the next 72 hrs and never perform a cholecystectomy
I would wait for the resolution of the collection and then schedule for a laparoscopic cholecystectomy
I would perform a endoscopic sphincterotomy within the index admission and schedule cholecystectomy after the pseudocysts or fluid collections either resolve or persist beyond 6 weeks at
Conservative, monitor vitals
Antibiotics, initially conservative, monitor vitals
Fine needle aspiration, if positive intervention, if negative conservative, vitals
Emergency intervention (e.g. percutaneous drainage)
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It should be performed routinely in all patients with necrotizing pancreatitis
It is mandatory prior to intervention for necrotizing pancreatitis
False negative outcome of FNA in necrotizing pancreatitis is rare, below 10%
None of the above
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May be indicated in rare cases of ‘disconnected duct syndrome’
May be indicated in cases of ongoing gastric outlet obstruction
May be indicated in patients with pancreaticopleural fistula
All of the above
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Switch tube feeding formulation
Place an NJ tube and begin elemental feeding
Initiate total parenteral nutrition
Initiate probiotics
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Elemental or polymeric feeding should be the treatment of choice
High fat formulations are acceptable to use in acute pancreatitis
There is no role for “trickle” feeding to prevent translocation of gut flora
None of the above
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Initiate clear liquid diet and advance as tolerated
Initiate low-fat diet and advance as tolerated
Initiate regular diet and advance as tolerated
A or b
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Age 62 years
Altered mental status
Hematocrit of 50
Blood urea nitrogen of 30 mg/dL
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Ranson
Glasgow-Imrie
Bedside Index of Severity in Acute Pancreatitis (BISAP)
Harmless Acute Pancreatitis Score (HAPS)
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APACHE II score with threshold of 12
SIRS with a threshold of 2
Glasgow-Imrie Score with threshold of 3
BISAP score with threshold of 3
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To definitively assess necrosis of pancreatic parenchyma.
B) To confirm the diagnosis of acute pancreatitis because of uncertainty.
To exclude a surgical condition.
To stage the severity of disease for prognostic purposes.
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At admission (day 1)
At day 2
Option A and B
At day > 3
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Contrast-enhanced CT in the pancreatic or portal venous phase (50-70 seconds delay)
Multiphasic contrast-enhanced CT (unenhanced, arterial and portal venous phase)
Contrast-enhanced CT in the arterial phase (30 seconds delay)
Non-contrast CT
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Laboratory (serum amylase > 3x upper limit of normal)
Imaging (ultrasound, CT, MRI) criteria as reported by the AGA 2007 review
Clinical (typical upper abdominal pain, nausea, ...)
2 out of the 3 criteria mentioned above
Only if all criteria mentioned are met.
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Mild biliary pancreatitis.
Biliary pancreatitis with co-existing cholangitis.
Biliary pancreatitis with no co-existing biliary obstruction
In severe biliary pancreatitis
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Within 24 hours after onset of the disease.
Within 72 hours after onset of the disease.
Within 24 hours after admission to the hospital.
Within 72 hours after admission to the hospital.
No recommendation can be given regarding the optimal timing.
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