What are the signs and symptoms of pancreatitis?

Signs and Symptoms of Pancreatitis

The cardinal presentation of acute pancreatitis is sudden onset of severe upper abdominal pain radiating to the back, accompanied by nausea and vomiting, with epigastric or diffuse abdominal tenderness on examination. 1

Primary Clinical Features

Pain Characteristics

• Upper abdominal pain is the hallmark symptom, typically severe enough to prompt urgent medical attention 2
• Radiation to the back is characteristic and helps distinguish pancreatitis from other acute abdominal conditions 1, 2
• Pain onset may follow a recent alcohol binge or fatty meal 2
• Pain severity is typically constant and severe, warranting immediate evaluation 3, 4

Associated Symptoms

• Nausea and vomiting are common presenting features 1, 4
• Pain worsens with eating, which is a distinguishing feature 4
• Patients typically appear acutely unwell on presentation 2

Physical Examination Findings

Common Signs

• Epigastric or diffuse abdominal tenderness is the most consistent finding 1
• Tachycardia frequently accompanies the acute presentation 2
• Exquisite upper abdominal tenderness on palpation 2

Severe Disease Indicators

• Body wall ecchymoses indicate severe hemorrhagic pancreatitis:
  • Cullen's sign (periumbilical ecchymosis) 1
  • Grey-Turner's sign (flank ecchymosis) 1
• These signs are rare but highly specific for severe necrotizing pancreatitis 1

Progressive and Complicated Disease Features

Ongoing Clinical Deterioration

• Prolonged ileus with persistent abdominal distension 1
• Persistent abdominal tenderness beyond expected recovery time 1
• Epigastric mass suggests acute fluid collection or developing pseudocyst 1
• Persistent vomiting indicates possible fluid collection 1

Fever Patterns (Important Nuance)

• Low to moderate grade fever is common in necrotizing pancreatitis and does NOT necessarily indicate deterioration 1
• Sudden high fever suggests development of infection and requires urgent investigation 1

Signs of Systemic Complications

• Cardiorespiratory failure indicates septic complications 1
• Renal failure signals severe systemic involvement 1
• "Failure to thrive" pattern: continued system support requirements with hypermetabolism and catabolic state 1

Chronic Pancreatitis Presentation (Distinct Pattern)

• Insidious progression of chronic, severe upper abdominal pain radiating to the back 2
• Weight loss from malabsorption 2
• Steatorrhea (fatty stools) from exocrine insufficiency 2
• Diabetes develops later from endocrine failure 2
• May present with recurrent acute episodes mimicking acute pancreatitis 2

Critical Diagnostic Pitfalls

Common Errors to Avoid

• Do NOT rely on clinical findings alone for diagnosis—pancreatitis mimics many other acute abdominal conditions 1
• Do NOT dismiss the diagnosis in postoperative patients where clinical picture may be obscured 1
• Do NOT assume infection based solely on persistent low-grade fever in necrotizing pancreatitis 1
• Consider pancreatitis in all upper abdominal pain until biochemical testing rules it out 5

When to Suspect Severe Disease

• Presence of body wall ecchymoses (Cullen's or Grey-Turner's signs) 1
• Sudden clinical deterioration with high fever 1
• Development of organ failure (respiratory, renal, cardiovascular) 1
• Persistent systemic symptoms beyond 48-72 hours despite supportive care 1

Biochemical and Laboratory Correlates

While not strictly "signs and symptoms," these findings accompany the clinical presentation:

• Elevated serum amylase (>4 times normal) or lipase (>2 times normal) confirms diagnosis when clinical features are present 1, 3
• Increasing leukocyte counts suggest developing complications 1
• Elevated CRP and rising APACHE II scores indicate worsening severity 1