What are the symptoms of pancreatitis?

Symptoms of Pancreatitis

The primary symptoms of pancreatitis include upper abdominal pain radiating to the back, nausea, vomiting, and abdominal tenderness, with severe cases potentially presenting with body wall ecchymoses such as Cullen's sign at the umbilicus or Grey-Turner's sign in the flanks. 1

Clinical Presentation of Acute Pancreatitis

Cardinal Symptoms

• Upper abdominal pain, often severe and sudden in onset 1
• Pain radiating to the back 2
• Nausea and vomiting 1
• Epigastric or diffuse abdominal tenderness 1

Physical Examination Findings

• Abdominal tenderness, particularly in the epigastrium 1
• Abdominal distension in more severe cases 1
• Occasionally, body wall ecchymoses:
  • Cullen's sign (periumbilical bruising) 1
  • Grey-Turner's sign (flank bruising) 1

Systemic Manifestations

• Fever, particularly high fever in cases of infection 1
• Tachycardia 2
• Signs of dehydration 3
• Respiratory distress in severe cases 1

Symptoms Based on Severity

Mild Acute Pancreatitis

• Self-limiting abdominal pain 2
• Minimal systemic disturbance 1
• Resolution of symptoms within days 1

Severe Acute Pancreatitis

• Persistent severe pain 1
• Prolonged ileus 1
• Signs of systemic inflammatory response syndrome 4
• Multi-organ dysfunction in critical cases 1
• Pleural effusions visible on chest X-ray 1

Characteristics of Pain in Pancreatitis

• Most commonly cramping in nature (61% of cases) 5
• Pain is typically intense (70% of patients) 5
• Sharp pain is associated with increased severity and mortality 5
• Pain often begins less than 24 hours before seeking medical attention (56.7% of cases) 5
• Interestingly, about 50.9% of patients experience atypical pain (not epigastric or belt-like upper abdominal) 5

Symptoms of Chronic Pancreatitis

• Chronic, severe upper abdominal pain radiating to the back 2
• Weight loss 2
• Steatorrhea (fatty, foul-smelling stools) 2
• Development of diabetes mellitus 2
• Recurrent episodes mimicking acute pancreatitis 2

Diagnostic Considerations

Laboratory Findings

• Elevated serum amylase (≥4 times normal) 1
• Elevated serum lipase (≥2 times normal) - more specific and remains elevated longer 1
• Elevated urinary amylase may be present 1

Imaging Findings

• Ultrasound may show a swollen pancreas, though visualization is limited in 25-50% of cases 1
• CT scan may reveal pancreatic inflammation, necrosis, or fluid collections 1
• Chest X-ray may show pleural effusions or ARDS in severe cases 1

Warning Signs of Complications

• Persistent fever or sudden high fever (suggesting infection) 1
• Increasing abdominal distension 1
• Development of an epigastric mass (suggesting pseudocyst formation) 1
• Signs of cardiorespiratory or renal failure 1
• Increasing leucocyte and platelet counts 1
• Deranged clotting profile 1

Common Pitfalls in Symptom Recognition

• Pancreatitis symptoms can mimic other acute abdominal conditions, making clinical diagnosis alone unreliable 1
• The clinical picture may be obscured in postoperative patients 1
• Pancreatitis should be considered in patients with unexplained acute abdominal pain, especially after alcohol consumption or a fatty meal 2
• Recent onset diabetes in older patients without predisposing factors may be an early warning sign of pancreatic disease 1