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Old 12-02-2012
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Pancreas Gall Stones Pancreatitis

A 62-year-old woman presents to the emergency department complaining of intense abdominal pain, nausea, and vomiting for the past 48 hours. On physical examination, the patient is visibly uncomfortable, with a low-grade fever, mild tachycardia, and normal blood pressure; her upper abdomen is markedly tender. Laboratory tests are remarkable for an amylase of 1150, bilirubin of 2.5, and creatinine of 2.3. Which of the following is the most useful imaging test to determine whether this patient’s pancreatitis is caused by gallstones?

A. Plain film
B. Ultrasonography
C. CT scan
D. Endoscopic retrograde cholangiopancreatography (ERCP)
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Old 12-03-2012
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Most useful test ERCP
Best Initial test USG
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ans B........
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ans B ERCP would be more invasive but i am not sure if more useful means most accurate
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Answer: B
Best Test for pancreatitis is CT but when hx changes towards gallstones then we do ultrasound
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b. sonography
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(Answer: B—Ultrasonography)
Ultrasonography is recommended in the initial evaluation of all pancreatitis to rule out obstruction caused by gallstones. It is more sensitive than CT for the diagnosis of gallstone disease, though CT is usually better at demonstrating morphologic changes in the pancreas caused by inflammation. Findings on plain film (such as the colon cutoff sign; enhancement of perirenal fat caused by retroperitoneal inflammation that creates a halo around the left kidney; or an abnormal duodenal loop) can suggest the diagnosis of pancreatitis but do not reveal its cause. ERCP does not play a role in the diagnosis of pancreatitis but can be useful in its management.
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