109) A 35 year old HIV positive male patient comes to your office with complaint of anorexia, nausea and vomiting and abdominal pain. His anti-retroviral medications include Stavudine and Didanosine. On physical examination, his temperature is 100F. His abdomen is tender in the epigastric area. Laboratory results reveal WBC count of 20k/µl, Serum amylase 500 IU/L ( N = 25 to 160 U/L) , Lipase 590 units/liter (Normal = 25 to 300U/L), AST 120 IU/L, ALT 200 IU/L, Total bilirubin 3.6gm% and Alkaline phosphatase 200IU/L . Ultrasound reveal gallstones with no cystic duct obstruction and no evidence of cholecystitis and a common bile duct diameter of 1.5cm. The most important step that will help improve the patient’s acute pancreatitis is :
a) Intravenos Imipinem/ Cilastatin
b) Endoscopic Retrograde Cholangiopancreatography ( ERCP)
c) Stop Didanosine
d) Stop Stavudine
e) Exploratory Laporotomy
c.Stop Didanosine
S/E-Didanosine cause Pancreatitis
c
C
Didanosine is the known cause of pancreatitis.
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c.
didanosine s/e pancreatitis & PNP
Yes agree is B! CBD >1.5–> obstructive cause