Acute pancreatitis

Most common causes of acute pancreatitis are

A. Gallstones, alcohol use, and hypertriglyceridemia
B. Drug-induced, gallstones and Trauma
C. Alcohol use, organophosphate poisoning and gallstones
D. Smoking, alcohol and gallstones

The Atlanta classification broadly classifies acute pancreatitis into

A. Mild, moderate and severe variety
B. Infective and Toxin induced types
C. Interstitial edema and necrotising variety
D. Exocrine and endocrine types

Not a causative organism of acute pancreatitis

A. Rubella
B. Mycoplasma
C. Epstein-Barr virus
D. Pseudomonas

Not true regarding evaluation of acute pancreatitis

A. MRCP lacks sensitivity for detecting chronic pancreatitis
B. Endoscopic ultrasound (EUS) is preferred over MRCP for detecting biliary stones less than 3 mm
C. Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) is a routine in all cases of acute pancreatitis
D. If MRCP and EUS are unavailable, then computed tomography with pancreatic protocol can be chosen

All are true regarding treatment of acute pancreatitis except

A. The fluid of choice is Lactated Ringer’s solution
B. Early feeding in mild pancreatitis can be considered safe
C. In severe pancreatitis parenteral nutrition is considered superior to nasojejunal feeding
D. The analgesics of choices are opioids fentanyl and meperidine, and non-steroid anti-inflammatory drugs

In short

Grey-Turners sign

In extreme cases of acute pancreatitis where retroperitoneal bleeding has occurred, the Grey-Turners sign may be present as ecchymosis at the flanks. 

Cullen’s sign

Cullen’s sign appears as periumbilical ecchymosis secondary to peritoneal hemorrhage.

Revised Atlanta Classification

Revised Atlanta Classification, the diagnosis of acute pancreatitis requires meeting at least 2 of 3 criteria:

  1. A lipase or amylase level is three times the normal
  2. Abdominal pain is consistent with pancreatitis
  3. Abdominal imaging is consistent with acute pancreatitis

Gallstone pancreatitis

In gallstone pancreatitis, there is a strong recommendation for early cholecystectomy.


In hypertriglyceridemia, specific treatment aims to reduce triglyceride levels to less than 500 mg/dL. This goal is achieved by apheresis and insulin drip with or without glucose.

Pseudocysts Drainage

Drainage of pseudocysts after pancreatitis is only recommended in case of infection and rapid enlargement.

Bedside Index for Severity in Acute Pancreatitis ( BISAP ) score

Bedside Index for Severity in Acute Pancreatitis ( BISAP ) score – 

0-2 points indicate lower mortality of less than 2%,

3-5 points indicate higher mortality more significant than 15%.

Compared with other scoring systems like Ranson criteria and APACHE II score, the BISAP score outperforms in specificity but has a suboptimal sensitivity for mortality and SAP.

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