American Board of Internal Medicine (ABIM) Certification Practice Exam

For mild acute pancreatitis, when can oral feeding begin?

1. After abdominal pain resolves

2. When pancreatic enzyme levels normalize

3. Once nausea and vomiting are absent

4. After 24 hours without IV fluids

The correct answer is: Once nausea and vomiting are absent

In mild acute pancreatitis, oral feeding can typically begin once nausea and vomiting have resolved. This is essential because the gastrointestinal tract needs to be functional and able to handle food intake without provoking symptoms. Starting oral feeding too early, especially if nausea and vomiting are present, can lead to further discomfort and complications. While resolution of abdominal pain and normalization of pancreatic enzyme levels are important considerations in the overall management and recovery from pancreatitis, they are not the primary indicators for resuming oral intake. Similarly, the absence of IV fluids alone does not necessarily indicate readiness for oral feeding; the patient's ability to tolerate food is more closely tied to the absence of gastrointestinal distress. Therefore, the absence of nausea and vomiting is the key trigger for when to start oral feeding in patients with mild acute pancreatitis.