The patient with severe acute pancreatitis is still, grey and shocked.
Abdominal examination reveals signs of generalised peritonitis with extreme tenderness, guarding and rigidity. There is abdominal distension due to paralytic ileus and subcutaneous staining - in the flank (Grey-Turner's sign), peri-umbilical region (Cullen's sign), or less commonly, the infra-inguinal region (Fox's sign). Bowel sounds are absent.
Muscle twitches, cramps and spasm indicate hypocalcaemia.
The patient is hypovolaemic with sweating, tachycardia, and a decreased blood pressure and urinary output.
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