A 15-year-old boy is admitted to the hospital for his fourth episode of pancreatitis. Two years ago, he had a cholecystectomy. His mother reports that she struggles with pancreatitis. Hereditary pancreatitis is associated with inappropriate activation of pancreatic enzymes. What is the most common gene mutation associated with autosomal dominant hereditary pancreatitis?
A. BRCA1
B. SPINK1
C. CFTR
D. PRSS1
E. APC
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A 65-year-old man who is 5 days status post–pancreaticoduodenectomy has ongoing clear output from his surgical drain—a volume of 500 mL over 24 hours and is otherwise recovering uneventfully. Drain amylase is 8000 U/L and serum amylase is 75 U/L. The most appropriate next step in management of this pancreatic fistula is which of the following?
A. Computed tomography scan of the abdomen and pelvis
B. Observation, maintenance of the surgical drain, nothing by mouth (NPO; nil per os), and total parenteral nutrition
C. Broad-spectrum antibiotics
D. Return to the operating room for revision of the pancreaticojejunostomy
E. Observation and maintenance of the drain
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