Congenital Anomalies and Acute Pancreatitis MCQs

The commonest organisms infecting UTI are E coli and following that, klebsiella, proteus are next commonest and then enterococci. However, following cystoscopy/instrumentation, staph epidermidis(coagulase negative staph) infection is the commonest. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 135, Pg: 1071.

In chronic pancreatitis, trypsin secretion is reduced. Trypsin is required in the release of protein bound dietary B12 which enables absorption and hence B12 deficiency is the most likely in this case. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 348, Pg: 2668

When the pancreas is damaged, enzymes such as amylase, lipase, trypsin, elastase and chymotrypsin are released into the serum. Measurement of serum amylase is the most widely used test of pancreatic damage (serum lipase is more sensitive and specific, but is not widely available). The serum amylase rises within a few hours of pancreatic damage and declines over the next 4-8 days. A markedly elevated serum level is highly suspicious but not diagnostic of acute pancreatitis. Urinary amylase and amylase-creatinine clearance ratios add little to diagnostic accuracy. If confirmation of the diagnosis is required, computed tomography (CT) of the pancreas is of greater value. Reference : Bailey & Love's short practice of surgery 27th Edition, Chapter 68, The Pancreas, Pg: 1214.

When the pancreas is damaged, enzymes such as amylase, lipase, trypsin, elastase and chymotrypsin are released into the serum. Measurement of serum amylase is the most widely used test of pancreatic damage (serum lipase is more sensitive and specific, but is not widely available). The serum amylase rises within a few hours of pancreatic damage and declines over the next 4-8 days. A markedly elevated serum level is highly suspicious but not diagnostic of acute pancreatitis. Urinary amylase and amylase-creatinine clearance ratios add little to diagnostic accuracy. If confirmation of the diagnosis is required, computed tomography (CT) of the pancreas is of greater value. Reference : Bailey & Love's short practice of surgery 27th Edition, Chapter 68, The Pancreas, Pg: 1214.

Correct Answer: A) Pancreatic pseudocyst Explanation: A pancreatic pseudocyst typically develops >2 weeks after acute pancreatitis, especially in alcoholics. Clinically, a tense, cystic epigastric mass is palpable. Common sites: between stomach & colon, or near liver/stomach. Explanation of other options: Choledochal cyst (Option B): Congenital biliary cyst, not alcohol related. Gastric duplication cyst (Option C): Congenital, near greater curvature, not epigastric. Mesenteric cyst (Option D): Congenital, usually in umbilical region. Key Takeaways: Alcoholic pancreatitis → pseudocyst after 2 weeks. Presents as tense epigastric cystic swelling. References: NCBI Bookshelf - Pancreatic Pseudocyst

The above clinical scenario suggest a case of ACUTE MESENTERIC ISCHEMIA Acute mesenteric occlusion may be either thrombotic (following atheromatous narrowing) or embolic. Embolic occlusion results in sudden, severe abdominal pain, with bowel emptying (vomiting and diarrhoea) and a source of emboli present (usually cardiac). Unfortunately, the diagnosis is often only made at laparotomy with widespread infarction of the small and large bowel present; in this situation it is often fatal. Occasionally, the degree of bowel infarction is more limited; resection of the dead bowel and embolectomy of the superior mesenteric artery, or bypass surgery, can reduce the otherwise high mortality rate in these patients. A 'second look' laparotomy 24 hours later to check the viability of the bowel may be indicated