Best initial test for Pancreatitis - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-13-2011
iron's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 229
Threads: 43
Thanked 51 Times in 42 Posts
Reputation: 61
Pancreas Best initial test for Pancreatitis

From my understanding, first initial test for a patient presenting with jaundice is ultrasound.
1st initial/most accurate diagnostic test for pancreatitis/pancreatic pathology is CT-scan but if the pt is non-alcoholic, with suspicion of gallstones, then the best initial test is ultrasound of right upper quadrant to look for gallstones as a cause of pancreatitis.
also it is given in uworld that best initial test is RUQ ultrasound for pt presenting with 1st attack of acute pancreatitis (which maybe due to alcohol/gallstones), so my question is what will be the answer for 1st initial test for acute pancreatitis -USG or CT-scan with the above information?

I am not sure, what do u think guys ?USG is basically when we want to know the etiology of pancreatitis but when it comes to diagnosis it is CT scan, so whether best or initial, I think CT will be appropriate if there is no mention to identify the etiology.

Last edited by iron; 09-13-2011 at 12:23 PM.
Reply With Quote Quick reply to this message



  #2  
Old 09-13-2011
USMLE Forums Guru
 
Steps History: 1 + CK
Posts: 373
Threads: 30
Thanked 374 Times in 160 Posts
Reputation: 384
Default

Quote:
Originally Posted by iron View Post
From my understanding ,first intial test for pt presenting with jaundice is ultrasound.
1st intial /most accurate test for pancreatitis/pancreatic pathology is CT-scan but if the pt is non-alcoholic ,with suspicion of gallstones ,then the best intial test is ultrasound of rt upper quadrant to look for gallstones as a cause of pancreatitis.
also it is given in uworld that best intial test is RUQ ultrasound for pt presenting with 1st attack of acute pancreatitis(which may be due to alchol/gallstones)
Hmmm I still havn't taken the exam so cannot say for sure wat should be the right approach. But i think we should not over generalize.

It depends a lot on the given scenario & options. So, we should proceed accordingly, like if a person presents with jaundice,
The best initial test would be to get bilirubin levels, to differentiate if direct bilirubin is raised or undirect.
If it's obstructive jaundice then USG would be the next best step.
We can directly go for ultrasound only if the option to test for bilirubin is not given.

To visualize pancreas we go for CT as in case of acute pancreatitis, but for other pancreatic pathologies the most accurate is ERCP. We can rule out other related pathologies, remove stones & put a stent to relive symptoms and also perform a biopsy (u can't get anything better than that.... )

Quote:
so my question is what will be the answer for 1st intial test for acute pancreatitis -USG or CT-scan with the above informations?
i m not sure ,what do u think guys ?
if u want to check the severity then CT if u want to look for etiology then u can go for USG if u r suspecting gallstones.
But if somebody had acute pancreatitis, CT was done at that time. Now presents for follow up. We should not go for USG in this case, because earlier CT would have picked if any stones were present. So no need for a USG.
__________________
Knowing is not enough; we must apply.
Willing is not enough; we must do.
Reply With Quote Quick reply to this message
The above post was thanked by:
ag2011n (09-14-2011), iron (09-13-2011)
  #3  
Old 09-13-2011
iron's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 229
Threads: 43
Thanked 51 Times in 42 Posts
Reputation: 61
Default

U r right ,it depends in clincal scenario presented .Actually i was confused regarding the next step after u are done with serum bilirubin , as in uworld they have mentioned ,usg is intial test for jaundice pt n the best/intial test is CT-scan for pancreatic pathology.
so basically i m having trouble choosing between USG n CTscan for pancreatitis for intial test. i hope there will be enough clues to point out the right choice in exam question.
regarding gallstones ,they r isodense due to bile ,so they might not be picked by CTscan most of the times ,so in non-alcholic it is better to go for USG as alchol n gallstone r two most common causes for pancreatitis .ERCP is basically for cause ,extent n location of bilary obstruction plus it has therapeutic advantages u have already mentioned n when CT is non-diasgnostic regarding pancreatitis.

Last edited by iron; 09-13-2011 at 01:34 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (09-13-2011)
  #4  
Old 09-14-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 505 Times in 231 Posts
Reputation: 515
Default

Just to add to you guys
The diagnosis of acute pancreatitis is usually made based on clinical presentation, lab studies are supportive, but CT is confirmatory (most accurate test for diagnosis of acute pancreatitis & for identifying the complications of the disease).
Indication for ERCP: 1. Sever gallstone with biliary obstruction. 2. Recurrent acute pancreatitis to identify uncommon causes.
But remember: the best initial tests: amylase & lipase.
The most specific test: CT
The severity of the disease is not related to the levels of amylase & lipase or the degree of pain, But strongly correlates with the degree of necrosis seen by CT.
Reply With Quote Quick reply to this message
The above post was thanked by:
iron (09-14-2011), step1an (09-14-2011)
  #5  
Old 09-14-2011
iron's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 229
Threads: 43
Thanked 51 Times in 42 Posts
Reputation: 61
Default

and one moere imp. pt regarding pancreatic ca is that alcohol n gallstones r not risk factors for pancreatic ca.
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (09-14-2011)



Reply

Tags
Gastroenterology-, Surgery-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Best Initial Test and Most Accurate Test! usmledee USMLE Step 2 CK Forum 7 08-26-2011 08:08 AM
pheochromocytoma what best initial test? kemoo USMLE Step 2 CK Forum 2 07-05-2011 10:59 AM
Initial and confirmatory diagnositic steps for acute pancreatitis? USMLE-Syndrome USMLE Step 2 CK Forum 2 06-23-2011 06:13 PM
PJP Diagnosis; Best Initial Test! Salwan85 USMLE Step 2 CK Forum 2 03-25-2010 04:10 PM
Initial Test is the Final Test? Hohepa USMLE Step 2 CK Forum 4 03-23-2010 12:49 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)