Acute Pancreatitis — Surgical

A 52-year-old woman with gallstone-induced acute pancreatitis is being risk-stratified. Which single feature best distinguishes acute pancreatitis with organ failure from uncomplicated acute pancreatitis without systemic complications?

A 42-year-old man from Delhi presents to the emergency department with severe epigastric pain radiating to the back for 6 hours, associated with vomiting. He has a history of alcohol abuse (40 units/week). On examination, he is febrile (38.5°C), tachycardic (110/min), and has severe epigastric tenderness with guarding. Serum amylase is 1200 U/L (normal <100), lipase 1800 U/L, and WBC 16,000/μL. Contrast-enhanced CT abdomen shows pancreatic edema with peripancreatic fluid collection and no necrosis. He is started on aggressive fluid resuscitation, NPO status, and broad-spectrum antibiotics. On day 5 of admission, despite optimal medical management, his clinical condition deteriorates: fever spikes to 39.2°C, abdominal pain worsens, and he develops signs of sepsis (lactate 4.2 mmol/L, BP 95/60). Repeat CT shows a 6 cm fluid collection with gas bubbles and rim enhancement. What is the most appropriate next step in management?

A 42-year-old man with acute pancreatitis secondary to gallstones presents with severe epigastric pain, elevated amylase, and imaging showing pancreatic necrosis with organ dysfunction. Regarding the management of acute pancreatitis, all of the following are correct EXCEPT:

A 38-year-old woman with acute necrotizing pancreatitis secondary to biliary obstruction is being managed conservatively. Regarding indications for surgical intervention in acute pancreatitis, all of the following are correct EXCEPT:

A 52-year-old man with chronic alcoholism presents with acute severe epigastric pain, fever (38.5°C), and tachycardia (HR 110/min). Laboratory values show lipase 2800 U/L, WBC 16,000/μL, and creatinine 1.8 mg/dL (baseline 0.9). Contrast-enhanced CT abdomen reveals extensive pancreatic necrosis involving >50% of the gland with peripancreatic fluid collection. Blood cultures are pending. What is the most appropriate next step in management?