From the Guidelines
Pancreatitis typically presents with severe upper abdominal pain, nausea, vomiting, fever, 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 pancreatitis requires a combination of clinical evaluation, laboratory tests, and imaging studies.
- The most common signs and symptoms include:
- Severe upper abdominal pain that radiates to the back
- Nausea and vomiting
- Fever
- Rapid pulse
- Tenderness when touching the abdomen
- Swollen or distended abdomen
- In severe cases, patients may develop:
- Jaundice (yellowing of the skin and eyes)
- Low blood pressure
- Confusion
- Physical examination might reveal:
- Grey Turner's sign (bruising on the flanks)
- Cullen's sign (bruising around the navel)
- Blood tests typically show elevated pancreatic enzymes (amylase and lipase), which are released when the pancreas is inflamed 1. According to the Revised Atlanta Classification 2012, the diagnosis of acute pancreatitis requires at least two of the three following criteria: (i) abdominal pain consistent with the disease, (ii) biochemical evidence of pancreatitis (serum amylase and/or lipase greater than three times the upper limit of normal), and (iii) characteristic findings from abdominal imaging 1. The severity of pancreatitis can be classified as mild, moderate, or severe, based on the presence of organ failure and local or systemic complications, and patients with persistent organ failure and infected necrosis have the highest risk of death 1.
From the Research
Signs of Pancreatitis
The signs of pancreatitis can vary depending on the type and severity of the condition. Some common signs include:
- Upper abdominal pain radiating to the back, which can be severe and worsen with eating 2, 3, 4
- Nausea and vomiting 3, 4
- Weight loss and steatorrhoea (fatty stools) in chronic pancreatitis 2
- Diabetes in chronic pancreatitis due to pancreatic destruction and inflammation 2, 3, 4
- Exquisite tenderness in the upper abdomen 2
- Tachycardia (rapid heart rate) 2
- Fever and chills in cases of infected pancreatic necrosis 5
Pain Characteristics
Pain is a common symptom of pancreatitis, and its characteristics can vary:
- Intense pain is common in acute pancreatitis, with 70% of patients experiencing intense pain 6
- Cramping pain is also common, with 61% of patients experiencing this type of pain 6
- Sharp pain is associated with increased severity and mortality in acute pancreatitis 6
- Atypical pain (pain other than epigastric or belt-like upper abdominal pain) is experienced by 50.9% of patients 6
Diagnostic Criteria
The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria: