ROSH Gastrointestinal Practice Exam

For a patient with severe abdominal pain and high lipase levels, what is the best next step in management?

1. CT scan of the abdomen and pelvis

2. Discharge home if patient tolerates oral fluids

3. Intravenous antibiotics and admission

4. Right upper quadrant ultrasound

The correct answer is: Intravenous antibiotics and admission

In the context of severe abdominal pain and elevated lipase levels, the clinical suspicion for pancreatitis is high. Intravenous antibiotics and admission to a hospital setting are crucial next steps in management, particularly because the patient may need further evaluation and treatment for this potentially serious condition. Severe pancreatitis can lead to complications such as infected necrosis, which often requires aggressive management including antibiotics and supportive care in a monitored environment. Admission allows for appropriate hydration, pain management, and close monitoring for any evolving complications such as organ failure. In contrast, imaging studies, such as a CT scan or right upper quadrant ultrasound, while useful for assessing the underlying causes of abdominal pain and confirming pancreatitis, can often be deferred unless the patient shows signs of complications or does not improve with initial management. Discharging a patient home, even if they tolerate oral fluids, would not be advisable in cases of severe pain combined with high lipase levels, as those present a higher risk for progression or complications from pancreatitis. Immediate admission and treatment are deemed more appropriate in this clinical scenario.