What are the signs and symptoms of pancreatitis?

Signs and Symptoms of Pancreatitis

The classic presentation of acute pancreatitis includes upper abdominal pain radiating to the back, nausea, vomiting, and tenderness in the epigastric region. 1, 2

Clinical Manifestations of Acute Pancreatitis

Cardinal Symptoms

• Pain

  • Location: Upper abdominal/epigastric
  • Radiation: Often radiates to the back
  • Character: Severe, persistent
  • Exacerbating factors: May worsen after eating, especially fatty meals 3

• Nausea and vomiting - Present in most cases 2

• Physical examination findings

  • Epigastric or diffuse abdominal tenderness
  • Tachycardia in severe cases
  • Fever (low to moderate grade is common in necrotizing pancreatitis) 1

Less Common but Important Signs

• Jaundice - May indicate biliary obstruction from gallstones or pancreatic head inflammation

• Cullen's sign - Periumbilical ecchymosis

• Grey-Turner's sign - Flank ecchymosis

  • Both signs indicate retroperitoneal hemorrhage and severe disease 1

• Abdominal distension - Suggests ileus, which is an adverse clinical feature 1

• Epigastric mass - May indicate development of a fluid collection or pseudocyst 1

Laboratory Findings

• Elevated serum lipase - More specific than amylase and remains elevated longer 1, 4
• Elevated serum amylase - Typically >3 times the upper limit of normal 2
• Increasing leucocyte and platelet counts - May indicate developing infection 1
• Deranged clotting - Associated with severe disease 1

Imaging Findings

• Ultrasound - May show a swollen pancreas, gallstones, or fluid collections 1
• CT scan - Shows pancreatic inflammation, necrosis, or fluid collections 1, 3
• Chest x-ray - May reveal pleural effusions or features of ARDS in severe cases 1

Signs of Severe Acute Pancreatitis

• Persistent organ failure - Respiratory, cardiovascular, or renal
• Local complications - Necrosis, pseudocyst, abscess
• Systemic inflammatory response syndrome (SIRS) - Helps identify high-risk patients 2
• "Failure to thrive" - Continued need for system support with hypermetabolism and catabolic state 1

Atypical Presentations

• Isolated left flank pain can rarely be the sole manifestation of acute pancreatitis, particularly when inflammation affects the tail of the pancreas 5
• Recent onset diabetes mellitus in older patients without predisposing factors may be an early warning sign of pancreatic cancer or pancreatitis 1
• An unexplained attack of acute pancreatitis may be the presenting feature of pancreatic cancer in approximately 5% of cases 1

Chronic Pancreatitis Manifestations

• Chronic, severe upper abdominal pain radiating to the back
• Weight loss and malnutrition
• Steatorrhea - Fatty, foul-smelling stools due to exocrine insufficiency
• Diabetes mellitus - Due to endocrine insufficiency 3
• Recurrent episodes that may mimic acute pancreatitis 3

Diagnostic Criteria

Diagnosis of acute pancreatitis requires at least two of the following three criteria:

1. Characteristic abdominal pain
2. Serum lipase or amylase >3 times the upper limit of normal
3. Characteristic findings on imaging studies 2

Warning Signs of Complications

• Sudden high fever - May indicate infection
• Onset of cardiorespiratory or renal failure - Signs of septic complications
• Prolonged ileus and abdominal distension - Adverse clinical features
• Multiple fluid collections (three or more) - Associated with higher risk of complications and death 1

Early recognition of these signs and symptoms is crucial for prompt diagnosis and appropriate management of pancreatitis to reduce morbidity and mortality.