Symptoms of Pancreatitis
The primary symptoms of pancreatitis include upper abdominal pain radiating to the back, nausea, vomiting, and tenderness in the epigastric region. 1 These symptoms vary between acute and chronic forms of the disease.
Acute Pancreatitis Symptoms
Cardinal Symptoms
- Abdominal pain:
- Located in the upper abdomen/epigastric region
- Radiates to the back
- Often severe and sudden in onset
- May worsen after eating or drinking
- Can be triggered by alcohol binge or fatty meals 2
Associated Symptoms
- Nausea and vomiting 3
- Fever
- Tachycardia
- Exquisite tenderness in the upper abdomen 2
- Abdominal distension
- Jaundice (when biliary obstruction occurs)
Severe Presentation Signs
- Persistent back pain (indicates retroperitoneal infiltration) 4
- Severe and rapid weight loss 4
- Palpable and fixed epigastric mass (sign of inoperability) 4
- Ascites (sign of inoperability) 4
- Enlarged supraclavicular lymph node (Virchow's node - sign of inoperability) 4
- Cullen's sign (periumbilical ecchymosis) 4
- Grey-Turner's sign (flank ecchymosis) 4
Chronic Pancreatitis Symptoms
Cardinal Symptoms
- Chronic, severe upper abdominal pain:
- Radiates to the back
- Insidious progression
- Caused by pancreatic destruction, inflammation, and duct obstruction 2
Associated Symptoms
- Weight loss 2
- Steatorrhea (fatty, foul-smelling stools) 2
- Diabetes mellitus (due to endocrine pancreatic insufficiency) 3
- Recurrent episodes mimicking acute pancreatitis 2
- Malabsorption symptoms due to exocrine insufficiency
Diagnostic Criteria
Diagnosis of acute pancreatitis requires at least two of three criteria 3:
- Characteristic upper abdominal pain
- Serum lipase or amylase elevation >3 times the upper limit of normal
- Imaging findings consistent with pancreatitis
Special Considerations
- Approximately 5% of pancreatic cancer patients present with an atypical attack of acute or subacute pancreatitis 4
- Recent onset diabetes mellitus (within previous two years) may be a warning sign of pancreatic cancer in older patients 4
- Migratory thrombophlebitis is a rare initial symptom 4
- In gallstone pancreatitis, jaundice and a palpable gallbladder (Courvoisier's sign) may be present 4
Severity Assessment
- Severe acute pancreatitis (10-25% of cases) has a mortality rate of 7.5% 2
- APACHE II score ≥6 is the most sensitive indicator for predicting severe acute pancreatitis (95% sensitivity) 1
- Peak CRP level >210 mg/L in the first four days or >150 mg/L at 48 hours indicates severe disease (80% accuracy) 1
Early recognition of pancreatitis symptoms is crucial for prompt diagnosis and management, as delayed treatment can lead to increased morbidity and mortality, particularly in severe cases.