What are the signs of acute pancreatitis?

From the Guidelines

Acute pancreatitis is characterized by 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, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The diagnosis of acute pancreatitis requires a combination of clinical, laboratory, and imaging findings. Key signs and symptoms include:

• Severe, persistent abdominal pain that often radiates to the back
• Nausea and vomiting
• Abdominal tenderness, distension, and reduced bowel sounds
• Fever, tachycardia, and hypotension
• Jaundice due to bile duct obstruction in severe cases
• Laboratory findings of elevated pancreatic enzymes (amylase and lipase) at least three times the upper limit of normal 1. Some patients may develop additional signs such as:
• Grey Turner's sign (flank bruising) or Cullen's sign (periumbilical bruising), indicating severe hemorrhagic pancreatitis
• Respiratory distress due to pleural effusions or acute respiratory distress syndrome
• Altered mental status, particularly in alcohol-induced pancreatitis. It is essential to recognize these signs promptly, as severe acute pancreatitis can lead to life-threatening complications, including shock, multi-organ failure, and pancreatic necrosis, with a mortality rate ranging from 13 to 35% 1.

From the Research

Signs and Symptoms of Acute Pancreatitis

• The diagnosis of acute pancreatitis requires two of the following three criteria:
  • Epigastric abdominal pain
  • An elevated lipase
  • Imaging findings of pancreatic inflammation 2, 3
• Upper abdominal pain is a common symptom, often accompanied by elevated amylase/lipase levels and/or cross-sectional imaging findings 3
• Other signs and symptoms may include:
  • Nausea and vomiting
  • Fever
  • Abdominal tenderness
  • Guarding (muscle tension)

Diagnostic Criteria

• The diagnosis of acute pancreatitis is based on a combination of clinical, laboratory, and imaging findings 2, 3, 4, 5, 6
• Laboratory tests may include:
  • Lipase and amylase levels
  • Complete blood count
  • Renal and liver function tests
  • Glucose and calcium levels
• Imaging studies may include:
  • Transabdominal ultrasound
  • Abdominal cross-sectional imaging (e.g., CT or MRI)

Etiologies and Risk Factors

• Common etiologies of acute pancreatitis include:
  • Gallbladder disease
  • Alcohol use
  • Hypertriglyceridemia
  • Certain medications
• Other risk factors may include:
  • Family history of pancreatitis
  • Certain medical conditions (e.g., diabetes, kidney disease)
  • Trauma or surgery 2, 3, 4, 5, 6