From the Guidelines
Pancreatitis presents with a range of clinical manifestations, including severe epigastric abdominal pain, nausea, vomiting, fever, tachycardia, hypotension, and abdominal distension, with laboratory findings of elevated pancreatic enzymes, such as amylase and lipase, often more than three times the upper limit of normal 1. The clinical manifestations of pancreatitis vary depending on whether the condition is acute or chronic. In acute pancreatitis, patients may develop:
- Severe epigastric abdominal pain that often radiates to the back and typically worsens after eating
- Nausea and vomiting
- Fever
- Tachycardia
- Hypotension
- Abdominal distension with tenderness and guarding
- Severe cases can present with Cullen's sign (periumbilical bruising) or Grey Turner's sign (flank bruising), indicating hemorrhagic pancreatitis Chronic pancreatitis may additionally present with:
- Weight loss
- Steatorrhea (fatty, foul-smelling stools)
- Diabetes mellitus due to progressive pancreatic damage affecting both exocrine and endocrine functions These manifestations occur because inflammation of the pancreas leads to autodigestion of pancreatic tissue by inappropriately activated digestive enzymes, causing local and systemic inflammatory responses 1. In severe cases, complications such as pancreatic pseudocysts, abscess formation, or systemic inflammatory response syndrome may develop, potentially leading to multi-organ failure 1. The diagnosis of acute pancreatitis should be established within 48 hours of admission, based on compatible clinical features and elevations in amylase or lipase levels, with elevations greater than 3 times the upper limit of normal being most consistent with acute pancreatitis 1. The Revised Atlanta Classification and Determinant-based Classification of Acute Pancreatitis Severity are similar in establishing the diagnosis and severity of acute pancreatitis, and patients with persistent organ failure and infected necrosis have the highest risk of death 1.
From the Research
Clinical Manifestations of Pancreatitis
The clinical manifestations of pancreatitis can vary, but common signs and symptoms include:
- Abdominal pain, which is often severe and persistent 2
- Abdominal bloating and distension, as seen in a case report where a patient presented with these symptoms and was later diagnosed with acute pancreatitis 3
- Elevated levels of serum amylase and/or lipase, although normal levels do not rule out the diagnosis 4, 5
- Nausea and vomiting
- Fever
- Organ dysfunction and/or local complications, such as those requiring intensive care 2
Diagnostic Challenges
Diagnosing pancreatitis can be challenging, especially when serum lipase and amylase levels are normal 5, 3. In such cases, diagnostic imaging, such as contrast-enhanced computed tomography (CT) or magnetic resonance imaging, may be essential to confirm the diagnosis 3. The revised Atlanta classification provides a framework for diagnosing acute pancreatitis, which includes abdominal pain, serum lipase (or amylase) activity at least 3 times the upper limit of normal, and characteristic findings on imaging studies 3.
Laboratory Tests
Laboratory tests, such as serum lipase and amylase, play a crucial role in diagnosing pancreatitis. However, the choice between lipase and amylase as a diagnostic biomarker is still debated. Some studies suggest that lipase offers a higher sensitivity and a larger diagnostic window than amylase 4, 6. Nevertheless, both lipase and amylase alone lack the ability to determine the severity and etiology of acute pancreatitis 6.