Signs and Symptoms of Acute Pancreatitis
Acute pancreatitis presents with sudden onset of severe upper abdominal pain radiating to the back, typically accompanied by nausea and vomiting, with pain often severe enough to prompt urgent medical attention. 1, 2, 3
Cardinal Clinical Features
Primary Symptom: Abdominal Pain
- Severe, steady upper abdominal (epigastric) pain that radiates to the back is the hallmark presenting symptom 1, 3, 4, 5
- Pain onset may be related to a recent alcohol binge or consumption of a rich, fatty meal 1
- Pain typically worsens with eating 4
Associated Gastrointestinal Symptoms
- Nausea and vomiting are common presenting features 3, 4
- Anorexia and malaise frequently accompany the pain 6
- Prolonged ileus and abdominal distension indicate more severe disease 6
Physical Examination Findings
General Appearance and Vital Signs
- Patients typically appear unwell and may be tachycardic 1
- Exquisite tenderness in the upper abdomen on palpation 1
- Abdominal distension and tenderness suggest adverse clinical features 6
Signs of Severity and Complications
- An epigastric mass with vomiting suggests an acute fluid collection that may progress to pseudocyst formation 6
- Persistent abdominal tenderness indicates ongoing inflammation 6
- Fever patterns vary: unremitting low-to-moderate grade fever is common in necrotizing pancreatitis, while sudden high fever may indicate infection development 6
Signs of Severe Disease and Poor Prognosis
Clinical Red Flags
- Persistent back pain indicates retroperitoneal infiltration and typically signals more severe disease 6
- Severe and rapid weight loss are features usually associated with complications 6
- Failure to thrive—requiring continued system support with hypermetabolism and catabolic state—suggests complication development 6
Signs of Organ Failure
- Onset of cardiorespiratory failure indicates septic complications 6
- Renal failure development signals severe disease 6
- Persistent or progressive organ failure, particularly multiorgan failure, is the strongest predictor of mortality 7
Associated Systemic Findings
Respiratory Manifestations
- Chest x-ray may reveal pneumonic consolidation, pleural effusions, or features of acute respiratory distress syndrome (ARDS) 6
Hematological Changes
- Increasing leucocyte and platelet counts suggest possible sepsis 6
- Deranged clotting parameters indicate severe disease 6
Diagnostic Criteria Context
Diagnosis requires two of three findings: characteristic abdominal pain, serum amylase/lipase levels at least three times the upper limit of normal, and imaging findings consistent with pancreatitis. 2, 3 The clinical presentation alone, while highly suggestive, must be confirmed with laboratory or imaging findings to establish the diagnosis definitively.
Common Clinical Pitfalls
- Not all patients with severe pancreatitis will have dramatic initial presentations—some may have relatively subtle findings that progress rapidly 6
- Low-grade fever alone does not necessarily indicate deterioration in necrotizing pancreatitis, but sudden high fever warrants immediate investigation for infection 6
- Asymptomatic fluid collections should not be drained, as unnecessary percutaneous procedures risk introducing infection 6