What are the symptoms of acute pancreatitis?

From the Guidelines

Acute pancreatitis typically presents with severe epigastric pain, nausea, vomiting, and abdominal tenderness, and can be diagnosed based on the presence of two of the three following criteria: abdominal pain consistent with the disease, biochemical evidence of pancreatitis, and characteristic findings from abdominal imaging 1. The diagnosis of acute pancreatitis requires a combination of clinical evaluation, laboratory tests, and imaging studies.

• Clinical presentation: severe epigastric pain that often radiates to the back, accompanied by nausea and vomiting, abdominal tenderness, and decreased bowel sounds.
• Laboratory findings: elevated serum lipase and amylase levels (typically at least three times the upper limit of normal), leukocytosis, hypocalcemia, and elevated liver enzymes.
• Imaging studies: abdominal imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI), to evaluate the pancreas and surrounding tissues. The severity of acute pancreatitis can be classified using the Revised Atlanta Classification or the Determinant-based Classification of Acute Pancreatitis Severity, which take into account the presence of organ failure, local complications, and systemic complications 1.
• Mild acute pancreatitis: no organ failure, local or systemic complications.
• Moderate acute pancreatitis: transient organ failure, local complications, or exacerbation of co-morbid disease.
• Severe acute pancreatitis: persistent organ failure, infected necrosis, or systemic complications. Patients with severe acute pancreatitis should be admitted to an intensive care unit whenever possible, as they are at high risk of death and require close monitoring and management 1.

From the Research

Symptoms of Acute Pancreatitis

• Upper abdominal pain, often radiating to the back 2, 3
• Epigastric abdominal pain 2
• Elevated lipase 2
• Imaging findings of pancreatic inflammation 2
• Amylase/lipase ≥ 3 × upper limit of normal 3
• Cross-sectional imaging findings 3

Diagnosis of Acute Pancreatitis

• Requires two of the following three criteria: epigastric abdominal pain, an elevated lipase, and imaging findings of pancreatic inflammation 2
• Diagnosis can be made with upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 3

Common Etiologies of Acute Pancreatitis

• Gallbladder disease 2, 3
• Alcohol use 2, 3
• Hypertriglyceridaemia 3
• Drugs 3

Initial Management of Acute Pancreatitis

• Fluid resuscitation 2, 3
• Pain control 2, 3
• Intravenous opiates are generally safe if used judiciously 2
• Enteral nutrition 3
• Parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy may be necessary in some cases 3