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Continuing Medical Education Questions: July 2021

Asombang, Akwi W. MD, MPH, FACG

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The American Journal of Gastroenterology: July 2021 - Volume 116 - Issue 7 - p 1379
doi: 10.14309/ajg.0000000000001340
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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?

  • A. Stomach
  • B. Ascending colon
  • C. Transverse colon
  • D. Descending colon

© 2021 by The American College of Gastroenterology