Clinical features

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:

• (1) Quinlan JD.  Acute pancreatitis. Am Fam Physician. 2014;90(9):632-9
• (2) Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014;349:g4859