ENARE Practice Questions - ENARE - Exame Nacional De Residências (Brazil) Exam

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A 52-year-old female presents to the emergency department with severe, constant epigastric pain radiating band-like to her back, accompanied by persistent vomiting. Serum amylase is 1,480 U/L and lipase is 2,150 U/L (more than three times the upper limit of normal). Transabdominal ultrasound reveals multiple gallstones in the gallbladder, a normal common bile duct diameter (4 mm), and no signs of acute cholecystitis. Contrast CT performed on admission shows homogeneous pancreatic enlargement without necrosis or peripancreatic fluid collections (mild acute biliary pancreatitis). In accordance with Brazilian and international pancreatitis guidelines, what is the appropriate definitive management regarding the gallstones?

Index admission laparoscopic cholecystectomy prior to hospital discharge once clinical symptoms and pancreatic enzymes resolve. Discharge home and perform elective outpatient cholecystectomy after 6 months. Routine urgent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy within 24 hours regardless of cholangitis status. Lifelong oral ursodeoxycholic acid therapy avoiding any surgical intervention.

Correct Answer:

Index admission laparoscopic cholecystectomy prior to hospital discharge once clinical symptoms and pancreatic enzymes resolve.

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