American Board of Internal Medicine (ABIM) Certification Practice Exam

What procedure should patients with uncomplicated gallstone-induced acute pancreatitis undergo before hospital discharge?

1. Endoscopic retrograde cholangiopancreatography

2. Percutaneous drainage

3. Cholecystectomy

4. Pancreatic resection

The correct answer is: Cholecystectomy

Patients who experience uncomplicated gallstone-induced acute pancreatitis should undergo cholecystectomy before hospital discharge because it addresses the underlying cause of the pancreatitis—gallstones. Gallstones can continue to obstruct the bile duct, leading to recurrent episodes of pancreatitis and other complications. Performing a cholecystectomy, which is the surgical removal of the gallbladder, helps prevent future episodes by eliminating the source of the gallstones. In cases of uncomplicated acute pancreatitis, this procedure is often safely performed shortly after the acute episode has stabilized, typically within a few days to a week of the first presentation. Other procedures, such as endoscopic retrograde cholangiopancreatography, are mainly used for biliary obstruction relief or when there are complications such as cholangitis or common bile duct stones. Percutaneous drainage is utilized for abscesses or fluid collections, while pancreatic resection is a more invasive procedure reserved for severe complications like necrotizing pancreatitis or pancreatic cancer. Thus, cholecystectomy is the most appropriate intervention for those with uncomplicated cases, ensuring both immediate and long-term management of the condition.