Pancreatitis (Acute and Chronic) — MCQs
A 25-year-old obese woman who denies any history of alcohol abuse presents with severe abdominal pain radiating to the back. Laboratory results indicate an increase in serum amylase and lipase, with a marked decrease in calcium. Which of the following likely has caused this condition?
Which of the following is a common cause of acute pancreatitis?
What is the echogenic lesion size criterion for chronic pancreatitis?
Which of the following is not a recognized complication of chronic pancreatitis?
A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
Common cause of chronic pancreatitis
A chronic alcoholic patient came to emergency with severe pain in epigastrium and multiple episodes of vomiting. On examination, guarding was present in upper epigastrium. Chest X-ray was normal. What is the next best step?
A 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:
Which of the following are local complications of acute pancreatitis? 1. Pseudocyst 2. Pleural effusion 3. Ileus 4. Acute fluid collection Select the correct answer using the code given below.
The Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except
Pancreatitis (Acute and Chronic) Indian Medical PG Practice Questions and MCQs
Question 1: A 25-year-old obese woman who denies any history of alcohol abuse presents with severe abdominal pain radiating to the back. Laboratory results indicate an increase in serum amylase and lipase, with a marked decrease in calcium. Which of the following likely has caused this condition?
- A. Abetalipoproteinemia
- B. Cholelithiasis (Correct Answer)
- C. Cystic fibrosis
- D. Alcohol
Explanation: **Cholelithiasis** - **Obesity** is a significant risk factor for gallstone formation [2], which can obstruct the pancreatic duct and lead to **pancreatitis** [1]. - The classic presentation of severe abdominal pain radiating to the back, elevated **amylase** and **lipase**, and **hypocalcemia** (due to fat saponification in severe pancreatitis) is highly consistent with pancreatitis secondary to gallstones [1]. *Abetalipoproteinemia* - This is a rare genetic disorder characterized by the inability to synthesize apolipoprotein B, leading to severe **malabsorption** and **neurological deficits**, not pancreatitis. - While it involves lipid abnormalities, it typically presents with steatorrhea, growth failure, and ataxia, not acute abdominal pain. *Cystic fibrosis* - Individuals with **cystic fibrosis** can develop pancreatic insufficiency and chronic pancreatitis due to thick secretions blocking pancreatic ducts, but **acute severe pancreatitis with hypocalcemia** is less typical as an initial presentation in a 25-year-old without a prior diagnosis. - Features like **recurrent respiratory infections** and **failure to thrive** would usually precede or accompany pancreatic issues. *Alcohol* - Although **alcohol abuse** is a very common cause of pancreatitis, the patient explicitly **denies any history of alcohol abuse**, making this etiology less likely in this specific case. - Clinically, alcohol-induced pancreatitis presents similarly, but the absence of positive history rules it out as the primary cause.
Question 2: Which of the following is a common cause of acute pancreatitis?
- A. Gallstones (Correct Answer)
- B. Acute alcohol consumption
- C. Elevated serum amylase levels
- D. None of the options
Explanation: ***Gallstones*** - **Gallstones** are the most common cause of acute pancreatitis, as they can **obstruct the common bile duct** at the ampulla of Vater, leading to reflux of bile into the pancreatic duct [1]. - This obstruction causes **pancreatic enzyme activation** within the gland, leading to autodigestion and inflammation [1]. *Elevated serum amylase levels* - **Elevated serum amylase levels** are a diagnostic marker for acute pancreatitis, not a cause. - They indicate pancreatic injury and enzyme release but do not initiate the condition. *Acute alcohol consumption* - **Acute alcohol consumption** is a significant cause of acute pancreatitis but is the second leading cause after gallstones. - While alcohol triggers premature activation of pancreatic enzymes, it is not the *most common* cause. *None of the options* - This option is incorrect because **gallstones** are a well-established and the most common cause of acute pancreatitis [1].
Question 3: What is the echogenic lesion size criterion for chronic pancreatitis?
- A. > 2 mm
- B. > 3 mm (Correct Answer)
- C. > 1 mm
- D. > 4 mm
Explanation: ***> 3 mm*** - An echogenic lesion **greater than 3 mm** in size is a diagnostic criterion for **chronic pancreatitis** when observed on ultrasound imaging. - This represents one of the **major features** in ultrasound diagnosis of chronic pancreatitis, particularly when echogenic foci demonstrate acoustic shadowing (suggesting calcifications). - This criterion is part of established diagnostic frameworks and helps differentiate pathological calcifications from minor, non-specific findings. *> 4 mm* - While a **4 mm threshold** would indicate significant findings, the established diagnostic criterion for chronic pancreatitis uses **> 3 mm** as the cutoff. - Using a higher threshold would reduce sensitivity for detecting chronic pancreatitis. *> 2 mm* - A lesion larger than **2 mm** is generally considered below the established diagnostic threshold for **chronic pancreatitis**. - This size may represent early changes or incidental findings that are not yet definitive for diagnosis. *> 1 mm* - A lesion **greater than 1 mm** is too small to be a definitive criterion for **chronic pancreatitis** and could represent minor, non-pathological findings. - Such small echogenic foci lack sufficient specificity for diagnosing chronic pancreatic disease.
Question 4: Which of the following is not a recognized complication of chronic pancreatitis?
- A. Renal artery thrombosis (Correct Answer)
- B. Pancreatic pseudocyst
- C. Splenic vein thrombosis
- D. Pancreatic fistula
Explanation: ***Renal artery thrombosis*** - **Renal artery thrombosis** is generally associated with conditions like **atherosclerosis**, atrial fibrillation, or vasculitis, not directly with chronic pancreatitis. - While chronic pancreatitis can lead to systemic complications, direct renal arterial clotting is an atypical and **uncommon sequela**. *Pancreatic pseudocyst* - **Pancreatic pseudocysts** are common complications of chronic pancreatitis, occurring when fluid collections around the pancreas become walled off by fibrous tissue [1]. - They can cause pain, obstruction, and even rupture if left untreated [2]. *Splenic vein thrombosis* - **Splenic vein thrombosis** can result from inflammation and compression of the splenic vein by the diseased pancreatic tissue in chronic pancreatitis [1]. - This can lead to **splenomegaly** and **gastric varices** due to increased pressure in the portal system. *Pancreatic fistula* - A **pancreatic fistula** occurs when pancreatic fluid leaks from the gland, often forming a connection to another organ or the skin [2]. - This is a well-recognized complication of both acute and chronic pancreatitis, usually due to ductal disruption.
Question 5: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
- A. Serum GGT (Correct Answer)
- B. Serum LDH
- C. Base deficit
- D. Age
Explanation: ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.
Question 6: Common cause of chronic pancreatitis
- A. Chronic alcohol (Correct Answer)
- B. Chronic pancreatic calculi
- C. pancreas divisum
- D. Gall bladder stones
Explanation: ***Chronic alcohol*** - **Chronic alcohol consumption** is the most common cause of **chronic pancreatitis** due to its toxic effects on pancreatic cells and stimulation of premature enzyme activation [1]. - Alcohol induces protein plugs in small pancreatic ducts, leading to obstruction, atrophy, and eventually **fibrosis** of the gland [1]. *Chronic pancreatic calculi* - While **pancreatic calculi** are a feature of chronic pancreatitis, they are typically a *consequence* of the disease process rather than the primary cause for most cases. - The formation of calculi is often promoted by changes in pancreatic fluid composition, often exacerbated by underlying causes like alcohol abuse. *Pancreas divisum* - **Pancreas divisum** is a congenital anatomical variant where the dorsal and ventral pancreatic ducts fail to fuse. - Although it can predispose to **recurrent acute pancreatitis** or chronic pancreatitis in some individuals, it is a relatively rare cause compared to chronic alcohol use and is more often associated with recurrent acute episodes due to inadequate drainage of the dorsal pancreatic duct. *Gallbladder stones* - **Gallbladder stones (cholelithiasis)** are a common cause of *acute pancreatitis* if they obstruct the common bile duct or pancreatic duct. - In comparison, they are rarely the sole or primary cause of *chronic pancreatitis*; recurrent episodes of acute pancreatitis due to gallstones can, however, sometimes lead to chronic changes.
Question 7: A chronic alcoholic patient came to emergency with severe pain in epigastrium and multiple episodes of vomiting. On examination, guarding was present in upper epigastrium. Chest X-ray was normal. What is the next best step?
- A. Alcohol breath test
- B. Upper GI endoscopy
- C. CECT
- D. Serum lipase (Correct Answer)
Explanation: ***Serum lipase*** - The symptoms of **epigastric pain**, **vomiting**, and **guarding** in a chronic alcoholic patient are highly suggestive of **acute pancreatitis** [1]. - **Serum lipase** is a highly specific and sensitive marker for acute pancreatitis and is the initial diagnostic test of choice. *Alcohol breath test* - An alcohol breath test would indicate current alcohol intoxication but would not help in diagnosing the underlying cause of the patient's severe abdominal pain. - While relevant to his history, it will not guide immediate management of his acute symptoms. *Upper GI endoscopy* - **Upper GI endoscopy** is an invasive procedure and is typically reserved for investigating upper gastrointestinal bleeding or structural abnormalities of the esophagus, stomach, or duodenum, often after initial diagnostic tests. - It is not the initial test for suspected acute pancreatitis. *CECT* - **CECT (Contrast-Enhanced Computed Tomography)** of the abdomen is useful for assessing the severity and complications of pancreatitis, and for confirming the diagnosis if serum lipase is equivocal, but it is not the first-line diagnostic test [1]. - It is generally performed after initial laboratory tests confirm suspicion of pancreatitis, or if complications are suspected [1].
Question 8: A 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:
- A. Pseudocyst pancreas (Correct Answer)
- B. Cancer colon
- C. Splenic cyst
- D. Cancer stomach
Explanation: Pseudocyst pancreas - The history of **acute severe upper abdominal pain** followed by a progressively enlarging, firm, smooth-surfaced upper abdominal mass points strongly towards a pancreatic pseudocyst, a common complication of **pancreatitis** [1]. - **Early satiety** can occur due to the mass effect of the pseudocyst compressing the stomach [1]. *Cancer colon* - A rapidly growing upper abdominal mass is **not a typical presentation** of colon cancer, which usually presents with changes in bowel habits, rectal bleeding, or weight loss. - Colon cancer does not typically cause a history of **acute, severe generalized abdominal pain** preceding mass formation in this manner. *Splenic cyst* - While a splenic cyst could present as an abdominal mass, it is **less likely to follow a history of acute severe abdominal pain** (unless trauma-related). - A history of acute pancreatitis is a strong indicator away from a splenic cyst as the primary diagnosis [1]. *Cancer stomach* - Gastric cancer can present with early satiety and an upper abdominal mass, but the specific history of **acute severe pain followed by a mass** is less characteristic of gastric cancer's typical insidious onset. - The "firm, smooth surfaced, not moving with respiration" description, especially in the context of prior pancreatitis, is more aligned with a **pancreatic pseudocyst** [1].
Question 9: Which of the following are local complications of acute pancreatitis? 1. Pseudocyst 2. Pleural effusion 3. Ileus 4. Acute fluid collection Select the correct answer using the code given below.
- A. 2, 3 and 4
- B. 1, 3 and 4
- C. 1, 2 and 4 (Correct Answer)
- D. 1, 2 and 3
Explanation: ***1, 2 and 4*** - **Pseudocyst**, **acute fluid collections**, and **pleural effusions** are all recognized **local complications** of acute pancreatitis due to their direct anatomical proximity or fluid spread from the pancreas [1]. - **Ileus** is a common **systemic complication** rather than a local one, and it arises from inflammation and irritation of the bowel. *2, 3 and 4* - This option correctly identifies **pleural effusion** and **acute fluid collection** as local complications, but **ileus** is typically classified as a **systemic complication** of acute pancreatitis. - While it includes two correct local complications, the inclusion of ileus makes it incorrect as a complete list of local complications. *1, 3 and 4* - This option correctly identifies **pseudocyst** and **acute fluid collection** as local complications, but incorrectly lists **ileus** as a local complication when it is a **systemic complication** [1]. - It also fails to include **pleural effusion**, which is a significant local complication. *1, 2 and 3* - This option correctly identifies **pseudocyst** and **pleural effusion** as local complications but incorrectly includes **ileus**, which is a **systemic complication**. - It also omits **acute fluid collection**, an important local complication of acute pancreatitis.
Question 10: The Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except
- A. Blood glucose more than 200 mg/100 mL
- B. WBC count more than 16,000/mm3
- C. Serum calcium < 2.0 mmol/L (Correct Answer)
- D. Age more than 55 years
Explanation: ***Serum calcium < 2.0 mmol/L*** - This option refers to a low serum calcium level, which is part of the **Ranson criteria measured 48 hours after admission**, not at admission. - The initial Ranson criteria (on admission) focus on demographic and immediate lab results. *Blood glucose more than 200 mg/100 mL* - An elevated **blood glucose > 200 mg/100 mL** is one of the five Ranson criteria assessed at the time of admission. - High glucose indicates significant physiological stress and typically a more severe illness. *WBC count more than 16,000/mm3* - An elevated **white blood cell count > 16,000/mm3** is one of the Ranson criteria assessed at admission. - This indicates a significant inflammatory response, suggesting severe pancreatitis. *Age more than 55 years* - **Age > 55 years** is one of the Ranson criteria assessed at the time of admission [1]. - Older age is a recognized risk factor for more severe outcomes in acute pancreatitis [1].
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