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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Acute pancreatitis typically presents as an acute abdomen requiring emergency admission to the hospital.

  • 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 (1,2).

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, tachypnea, 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

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:


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