A 46-year-old woman with a history of alcohol abuse is admitted for acute pancreatitis due to alcohol. She is treated with supportive care but continues to deteriorate over 72 hours. A CT scan is obtained that reveals extensive pancreatic inflammation with the suggestion of necrosis. All of the following statements are correct regarding this patient's management except

Correct Answer: A

Rationale: The correct answer is A because performing an urgent ERCP is not indicated in the management of acute pancreatitis with necrosis. ERCP is typically not recommended in the acute phase of severe pancreatitis due to the risk of exacerbating pancreatitis. - B: Antibiotic therapy with imipenem may be initiated to address potential infection in necrotizing pancreatitis. - C: A CT-guided needle aspirate of the pancreas may be performed to guide antimicrobial therapy. - D: Surgical debridement may be considered if there is evidence of infection based on gram stain and cultures from a pancreatic aspirate.

Correct Answer: D

Rationale: The correct answer is D: Hepatitis A infection may have a relapsing course. Hepatitis A infection can indeed have a relapsing course, with symptoms recurring after an initial improvement. This is due to the nature of the virus and the immune response. A: Alcoholic hepatitis typically has an AST/ALT ratio less than 2 - This statement is incorrect because in alcoholic hepatitis, the AST/ALT ratio is typically greater than 2. B: Alpha-1 Antitrypsin (A1AT) deficiency is associated with arteriovenous malformations of the brain - This statement is incorrect as A1AT deficiency is primarily associated with pulmonary manifestations such as emphysema and liver disease, not brain arteriovenous malformations. C: Serum A1AT levels are diagnostic of A1AT deficiency - This is incorrect as A1AT levels can be influenced by various factors and genetic testing is needed for a definitive diagnosis of A1AT deficiency

Correct Answer: B

Rationale: The correct answer is B because the patient's presentation with cirrhosis, altered mentation, and ascites is concerning for spontaneous bacterial peritonitis (SBP). Ascitic fluid should be sampled to confirm the diagnosis and guide appropriate antibiotic therapy. Choice A is incorrect because ammonia levels can fluctuate and do not rule out hepatic encephalopathy. Choice C is incorrect as aminoglycosides are not first-line for SBP. Choice D is incorrect because lactulose is used to treat hepatic encephalopathy, not SBP. Sampling ascitic fluid is crucial in this case to diagnose and treat SBP promptly and effectively.

Correct Answer: C

Rationale: The correct answer is C: NSAIDs are known to irritate the gastric mucosa. NSAIDs can cause direct damage to the stomach lining, increasing the risk of peptic ulcers and worsening existing peptic ulcers. This is due to the inhibition of prostaglandin synthesis, which plays a protective role in maintaining the integrity of the gastric mucosa. Explanation for incorrect choices: A: NSAIDs do not increase gastric acid secretion; they primarily affect the mucosal lining. B: NSAIDs do not delay gastric emptying; this is more commonly associated with other factors like certain medications or medical conditions. D: NSAIDs and proton pump inhibitors have different mechanisms of action and do not directly interfere with each other.

Correct Answer: B

Rationale: The correct answer is B: Constipation. Antacids containing aluminum or calcium can lead to constipation due to their ability to slow down gut motility. This can cause difficulty in passing stool. Diarrhea (choice A) is not a common side effect of antacids. Weight gain (choice C) and dizziness (choice D) are also not typical side effects of antacids. Constipation is a well-known side effect of antacids, making choice B the correct answer in managing PUD.