Thu11November0840AM 8

A 35-year-old male patient is admitted to HDU with acute, severe pancreatitis.

Which of the following investigations is the best way of assessing the severity of the disorder?

(Please select 1 option)

Serial measurements of the ionised plasma calcium

Diagnostic laparotomy

Contrast CT scan of the abdomen This is the correct answer

Abdominal ultrasound Incorrect answer selected

Serial measurements of the plasma amylase

Explanation

In acute severe pancreatitis the presence of pancreatic necrosis and inflammatory changes are closely related to severity, complications and prognosis. These are best assessed using serial contrast enhanced CT scans. Abdominal ultrasound has less resolution that CT scans.

Diagnostic laparotomy is not appropriate in assessing the severity of the disorder.

The wide range of clinical symptoms and signs of acute severe pancreatitis make objective assessment of severity difficult. After 24 hours, serum C reactive protein (CRP) measurements are a sensitive marker of progression from moderate to severe disease.

Other markers of severity include a rise in haematocrit and changes in serum phospholipase A2 (PLA2) - the latter changes more quickly than rises in amylase and trypsin.

Whilst changes in ionised calcium do occur, they are not useful in assessing severity.

Answer Statistics

1

30%

2

64%

3

3%

4

4%

Times answered: 287