VA Pearls 7/6: Biliary Sludge and Microlithiasis in Acute Pancreatitis

Take Home Points

  • Biliary sludge and microlithiasis are common causes of “idiopathic” acute pancreatitis.
  • Gallbladder and biliary microlithiasis is usually missed on transcutaneous ultrasound.
  • In the absence of any other etiology, biliary sludge/microlithiasis should be suspected as the cause in patients with acute pancreatitis and transient elevations in LFTs.
  • There may be benefit to empiric endoscopic intervention (sphincterotomy/stenting) and/or cholecystectomy in these cases.

Complications of Acute Pancreatitis
Acute fluid collections: shortly after acute episode
Sterile pancreatic necrosis: shortly after acute episode – usually managed medically
Infected pancreatic fluid collection: within 1-3 weeks
Infected pancreatic necrosis: within 1-3 weeks
Acute pseudocyst (fluid collection walled off by granulation tissue): >4 weeks to develop
Infected pancreatic pseudocyst/abscess formation: 3-6 weeks
Common bile duct obstruction (2/2 pancreatic abscess, pseudocyst, biliary stone)
Intestinal obstruction
Hemorrhage 2/2 erosion of large vessels

Conditions associated with high serum lipase
Acute pancreatitis
Chronic pancreatitis
Pancreatic calculus
Pancreatic tumors
Acute cholecystitis
Bowel obstruction/infarction
DKA
HIV disease
Post-ERCP/trauma
Celiac disease
Renal failure
Drugs
Idiopathic

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