Gastroenterology Acute and Chronic Pancreatitis: Review Questions Douglas G. Adler, MD Dr. Adler is a Fellow in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Todd H. Baron, MD, FACP Dr. Baron is an Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Choose the single best answer for each question.
	Questions 1 and 2 refer to the following case study. A 49-year-old woman has a 24-hour history of nausea, vomiting, escalating epigastric pain radiating to her back, and fever (temperature to 101.3°F). Medical history is remarkable for depression, cholecystectomy (because of gallstones) 5 months ago, and appendectomy during childhood. She takes fluoxetine 20 mg daily for depression. Physical examination reveals a tender epigastrium as well as tenderness in the right upper quadrant. Laboratory studies reveal the following serum levels: amylase, 14,500 U/L; lipase, 9300 U/L; aspartate aminotransferase, 500 U/L; alanine aminotransferase, 449 U/L; alkaline phosphatase, 420 U/L; total bilirubin, 1.9 mg/dL; calcium, 9.7 mg/dL; triglycerides, 430 mg/dL; and leukocyte count, 16 x 103/mm3. 1. Which of the following is the most likely cause of this patient’s pancreatitis? Alcohol abuse Fluoxetine administration Gallstones Hypercalcemia Hypertriglyceridemia Click here to compare your answer. 2. Which of the following diagnostic tests is most appropriate to determine if gallstones are the cause of the patient’s pancreatitis? Endoscopic retrograde cholangiopancreatography Contrast-enhanced computed tomographic (CT) scan of the abdomen Percutaneous cholangiogram Plain radiographs of the abdomen Ultrasonography of the right upper quadrant Click here to compare your answer.		3. A contrast-enhanced CT scan of the abdomen in a 51-year-old man with a history of alcohol abuse confirms the presence of renal calculi and incidentally reveals a 4-cm pancreatic pseudocyst near the tail of the pancreas that does not appear to communicate with the pancreatic duct. The patient has had 3 successive attacks of acute pancreatitis over the past 2 years, the most recent occurring 4 months ago, and has recovered from each attack with conservative measures. He no longer consumes alcohol and currently feels well. Which of the following is the most appropriate next step in managing this patient’s pancreatitis? Observation Endoscopic drainage of the cyst Percutaneous drainage of the cyst Surgical drainage of the cyst Distal pancreatectomy with cyst removal Click here to compare your answer. 4. A 62-year-old man with known chronic pancreatitis caused by alcoholism reports a 20-pound weight loss over the past 3 months and frequent, greasy, and malodorous stools. A 72-hour fecal fat collection confirms steatorrhea. The patient no longer consumes alcohol and reports no abdominal pain. Which of the following is the most appropriate first-line treatment for this patient? Administration of enteric-coated pancreatic enzyme replacement tablets with meals and snacks and concurrent use of calcium-containing antacids Administration of non-enteric-coated pancreatic enzyme replacement tablets with meals and snacks with concurrent dosing with a histamine2 blocker Endoscopic placement of a pancreatic duct stent Institution of a low-fat diet (less than 20 g fat/day) Subcutaneous administration of octreotide 200 µg 3 times daily Click here to compare your answer.
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