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

Pain Characteristics

• Upper abdominal pain is often severe and sudden in onset, representing the most common presenting symptom of acute pancreatitis 1, 2
• The pain typically radiates to the back, which is a classic feature that helps distinguish pancreatitis from other causes of acute abdominal pain 2
• Pain may be epigastric, periumbilical, or diffuse throughout the abdomen in more severe cases 2
• Most patients (70%) report intense pain rather than mild pain 3
• Cramping pain is the most common type (61%), though sharp pain is associated with increased disease severity and mortality 3
• Pain onset is typically within 24 hours prior to seeking medical attention 3
• Pain may be exacerbated by eating and may follow a recent alcohol binge or rich, fatty meal 4

Gastrointestinal Symptoms

• Nausea and vomiting are common accompanying symptoms 1, 5
• Abdominal tenderness, particularly in the epigastrium, is a typical physical examination finding 1
• Abdominal distension may occur in more severe cases 1
• Prolonged ileus is characteristic of severe acute pancreatitis 1

Systemic Manifestations

• Fever, particularly high fever in cases of infection, may be present 1
• Respiratory distress can occur in severe cases 1
• Minimal systemic disturbance is typically seen in mild acute pancreatitis 1
• Signs of systemic inflammatory response syndrome are characteristic of severe acute pancreatitis 1, 2
• Multi-organ dysfunction may occur in critical cases 1

Physical Examination Findings

• Cullen's sign (periumbilical bruising) and Grey-Turner's sign (flank bruising) may be present in severe cases, indicating hemorrhagic pancreatitis 1, 6
• These signs suggest intra-abdominal or retroperitoneal hemorrhage and carry a higher mortality risk 6
• The patient may appear unwell and be tachycardic 4
• Weight loss may be observed in chronic pancreatitis 4, 5

Chronic Pancreatitis Specific Symptoms

• Chronic, severe, upper abdominal pain radiating to the back that progresses insidiously 4
• Steatorrhea (fatty, foul-smelling stools) due to exocrine pancreatic insufficiency 4, 5
• Development of diabetes mellitus due to endocrine pancreatic insufficiency 4, 5
• Patients may also present with recurrent episodes mimicking acute pancreatitis 4

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
• Pleural effusions visible on chest X-ray 1

Common Pitfalls in Symptom Recognition

• Pancreatitis symptoms can mimic other acute abdominal conditions, making clinical diagnosis alone unreliable 1, 6
• The clinical picture may be obscured in postoperative patients 1
• Recent onset diabetes in older patients without predisposing factors may be an early warning sign of pancreatic disease 1
• Atypical pain (not epigastric or belt-like upper abdominal) occurs in approximately 51% of patients, which can lead to diagnostic confusion 3