Continuing Medical Education Questions: July 2021
Article Title: Spontaneous internal pancreatic fistulae complicating acute pancreatitis
To review the diagnostic tests, risk factors, and complications of spontaneous internal pancreatic fistulae.
1. What is the best initial test of choice for diagnosing spontaneous pancreatic fistulae?
- A. Endoscopic ultrasound
- B. Computed tomography abdomen with oral contrast
- C. Abdominal ultrasound
- D. Endoscopic retrograde cholangiopancreatography
A 58-year-old female with a history of fentanyl and alcohol abuse presents to the emergency room with complaints of right upper quadrant abdominal pain over the past 3 weeks. Physical examination reveals a temperature of 101°F, scleral icterus, and diffuse abdominal tenderness with no guarding or rigidity.
Laboratory data: White blood cell count 10,000; Lipase 4,500; Total bilirubin 12; ALT 200; AST 467; Alkaline phosphatase 700. Abdominal imaging reveals peripancreatic fluid, cholelithiasis, and an otherwise normal biliary tree. Esophagogastroduodenoscopy reveals small gastric ulcers. What factor increases her risk of developing internal pancreatic fistulae?
- A. Female
- B. Alcohol abuse
- C. Abnormal liver function test
- D. Gastric ulcers
What is the most common location of spontaneous internal pancreatic fistulae?
© 2021 by The American College of Gastroenterology
- A. Stomach
- B. Ascending colon
- C. Transverse colon
- D. Descending colon