Acute pancreatitis typically presents as an acute abdomen requiring emergency admission to the hospital. (1)
Upper abdominal pain is the most common presenting symptom of acute pancreatitis:
- patients complain of sudden onset severe constant upper abdominal pain
- pain is usually focused in the left upper quadrant, periumbilical region, and/or epigastrium
- pain may radiate to the back (lower thoracic area),
- associated nausea and vomiting is seen in majority of cases
- once a chemical peritonitis is established, pain is felt throughout the abdomen and may be referred to the shoulder tip with involvement of the diaphragmatic peritoneum
- acute pancreatitis may be painless in some cases
- in addition to pain, patients may complain of indigestion, abdominal fullness/distension, clay-coloured stools, decreased urine output, and frequent hiccups.
Early in the attack the patient may move around trying to find a comfortable position, obtaining relief by sitting forwards - the so-called "pancreatic position." Once generalised peritonitis supervenes, however, the patient remains still.
Examination of the patient may reveal:
- fever, hypotension, tachycardia, tachypnoea, or diaphoresis
- epigastric tenderness, with guarding on abdominal examination
- decreased bowel sounds
- jaundice - suggests choledochal obstruction from gallstone pancreatitis
- Gray-Turner’s sign - ecchymosis of the flank and Cullen sign - ecchymoses in the periumbilical region (2)
Other features are dependent upon the severity of the attack and the development of complications. Abdominal wall discolouration is almost pathognomonic and carries a mortality risk of about 40%.
Reference:
- Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 suppl 2):e1-15.
- Burland L, Green BL. A cutaneous manifestation of intra-abdominal disease. BMJ. 2014 Sep 17;349:g5492.