Pancreas divisum is an established cause of recurrent acute pancreatitis
The need for ERCP after a single episode of unexplained pancreatitis is not established
Further studies are needed before wide acceptance of sphincter manometry and sphincterotomy as therapy in patients with abdominal pain without pancreatic enzyme elevation or ductal dilatation
More than 90% of patients with typical biliary colic, abnormal liver chemistries and with dilated bile duct will have resolution of pain after biliary sphincterotomy
>95% of patients have no symptoms
Is seen in ~7% of the Western population
Tests for minor papilla narrowing (e.g., ductal dilatation following secretin) correlate very well with a response to therapy
Only 25% of patients with abdominal pain without documented pancreatic disease will experience at least a 50% reduction in pain after minor papilla sphincterotomy
It is easy to differentiate type III SOD from disorders such as irritable bowel syndrome and chronic functional abdominal pain
Endoscopic sphincterotomy should be offered to patients with type III SOD
Type I SOD should be referred for endoscopic manometry followed by sphincterotomy if pressures are high
The role of nitrates in the management of SOD has not yet been established by well-designed controlled trials
Performing a biliary and pancreatic sphincterotomy prevents future episodes of pancreatitis
Randomized trials have proven that endoscopic treatment is better than sham therapy in patients with iRAP
Patients with underlying sphincter of Oddi dysfunction have better clinical outcomes after pancreatic sphincterotomy.
In patients with normal sphincter of Oddi manometry, performing an empiric biliary sphincterotomy is superior to not performing any treatment.
None of the above is true.
In patients undergoing pancreatic sphincterotomy, the incidence of developing chronic pancreatitis is negligible.
Nearly 8-17% of patients with iRAP on long-term follow-up develop chronic pancreatitis irrespective of whether they undergo any treatment.
There is no relationship between iRAP and chronic pancreatitis
None of the above is true
Perform an empiric biliary sphincterotomy
Inject botox into the minor papilla
Reattempt ERCP another day or refer to an expert center
Surgical minor papiila sphincteroplasty
A normal pancreatic duct
Bile duct consistent with primary sclerosing cholangitis
Pancreas divisum with a Santorinicele
Placement of a pancreatic stent will reduce the risk of post-ERCP pancreatitis
Administration of indomethacin suppository will not reduce the risk of post-ERCP pancreatitis more than placement of a pancreatic stent alone.
Performance of a pancreatic sphincterotomy in addition to biliary sphincterotomy has been shown to result in greater reduction of frequency of pancreatitis attacks than biliary sphincterotomy alone.
Minor papillotomy will reduce frequency of pancreatitis attacks.
The patient has a pseudocyst
The patient has walled off necrosis
The best therapy would be open drainage of this collection
Empirical cholecystectomy is likely to prevent another attack of pancreatitis.
A dilated bile duct
A bifid pancreas
Most drug induced pancreatitis is idiosyncratic
Resumption of a drug that has caused pancreatitis predictably causes recurrence
Drug induced pancreatitis is dose dependent
Answer option 4
Abdominal pain especially in the epigastric region
Elevation of amylase and or lipase to > 3 times the normal range
Imaging (CT/MRI) suggestive of inflammation
Any 2 of the above 3 criteria
Therapy with URSO
A or d
An increased prevalence of biliary stone disease
Idiosyncratic reactions to medications used for treatment of IBD
Possible immunological disturbances
All of the above
A 55 year old male with jaundice, a diffusely swollen pancreas on CT and a markedly elevated serum IgG4 level.
A 30 year old female with IBDa diffusely strictured small caliber pancreatic duct by MRCP, a normal serum IgG4, and a presumptive diagnosis of type 2 autoimmune pancreatitis.
A 56 year old woman with cholestatic liver enzymes and MRCP showing multifocal diffuse intrahepatic strictures, with an intraductal biopsy of the bile duct staining strongly for IgG4 postitive plasma cells.
Answer option 4
Recurrence rates of acute pancreatitis in children are lower than for adults
There is good evidence that use of pancreatic enzyme supplements and antioxidants prevent recurrent episodes.
Genetic testing is the first line investigation.
The most common etiologies are biliary, trauma and metabolic
There is no significant impairment since the patients have only intermittent episodes of pain
Pancreatic enzymes and antioxidants are useful in improvement of quality of life
Most endoscopic therapy data have shown improvement of quality of life especially in patients with pancreas divisum or sphincter of Oddi dysfunction
No validated instruments are available at the moment
No significant difference, only a matter of semantics
Differ in appearance but similar clinical connotation
Similar pathophysiology, differ in clinical context
Different in appearance, pathophysiology and clinical relevance