What are the signs and symptoms of pancreatitis?

Signs and Symptoms of Pancreatitis

The cardinal presentation of acute pancreatitis consists of epigastric abdominal pain (often radiating to the back), nausea and vomiting, with epigastric or diffuse abdominal tenderness on examination. 1

Primary Clinical Features

Pain Characteristics

• Epigastric pain radiating to the back is the classic and most distinguishing feature of pancreatitis 2, 3
• Pain is typically severe and sudden in onset 2
• Pain may be diffuse throughout the abdomen in more severe cases 2
• The pain can be sharp, dull, or cramping in nature, with sharp pain associated with higher severity and mortality 4
• Most patients present with pain starting less than 24 hours prior to admission (56.7% of cases) 4

Associated Gastrointestinal Symptoms

• Nausea and vomiting are common accompanying symptoms 3
• Prolonged ileus and abdominal distension indicate more severe disease 1
• An epigastric mass with vomiting suggests an acute fluid collection that may develop into a pseudocyst 1

Physical Examination Findings

Abdominal Signs

• Epigastric or diffuse abdominal tenderness is the most consistent finding 1, 3
• Abdominal distension may be present, particularly in severe cases 1

Rare but Specific Signs

• Cullen's sign (periumbilical ecchymosis) may be evident in severe cases 1
• Grey-Turner's sign (flank ecchymoses) can occur in severe hemorrhagic pancreatitis 1
• These body wall ecchymoses are uncommon but highly specific when present 1

Signs of Severity and Complications

Systemic Manifestations

• Persistent fever (low to moderate grade) is common in necrotizing pancreatitis and does not necessarily indicate deterioration 1
• Sudden high fever may indicate development of infection, though it can arise from non-pancreatic sources 1
• Persistent organ failure (cardiovascular, respiratory, and/or renal) lasting more than 48 hours defines severe acute pancreatitis 1

Clinical Deterioration Indicators

• "Failure to thrive" describes patients requiring continued system support with hypermetabolism and catabolic state, suggesting complications 1
• Onset of cardio-respiratory or renal failure are signs of septic complications 1
• Prolonged ileus with abdominal distension and tenderness are adverse clinical features 1

Important Clinical Pitfalls

Diagnostic Challenges

• Clinical findings alone are unreliable for diagnosis, as these features occur in several other acute abdominal diseases 1
• The clinical picture may be obscured in postoperative patients, making diagnosis more difficult 1
• Atypical pain presentations occur in 50.9% of patients (pain other than epigastric or belt-like upper abdominal) 4

Diagnostic Criteria

• Diagnosis requires at least two of three criteria: (1) abdominal pain consistent with pancreatitis, (2) serum amylase/lipase greater than 3 times upper limit of normal, and (3) characteristic imaging findings 1, 5
• Serum lipase is more specific than amylase and remains elevated longer 3, 5

Respiratory and Systemic Signs

Chest Findings

• Pleural effusions are the most common chest x-ray finding 1
• Diffuse alveolar interstitial shadowing may suggest acute respiratory distress syndrome (ARDS) in severe cases 1
• Pneumonic consolidation can be seen on chest x-ray 1

Laboratory Indicators of Severity

• Increasing leucocyte and platelet counts indicate possible sepsis 1
• Deranged clotting suggests severe disease 1
• Biochemical features of multiple organ failure indicate need for urgent reassessment 1