History and exam

Key diagnostic factors

common

abdominal pain

Mid-epigastric or left upper quadrant pain that radiates to the back is the most common presenting symptom (sometimes band distribution, often straight through middle back; many patients describe it as being stabbed with a knife). The pain usually worsens with movement, and is alleviated when assuming the fetal position (bent over, with spine, hips, and knees flexed).[5][19]

The abdominal exam may reveal a tender and distended abdomen with voluntary guarding to palpation of the upper abdomen.

nausea and vomiting

Nausea is one of the most common presenting symptoms and is seen in 70% to 80% of cases.[12] Vomiting can lead to dehydration, electrolyte abnormalities, and hypokalemic metabolic alkalosis.[12]

anorexia

Decreased appetite secondary to nausea, pain, and general malaise is commonly seen during an acute attack of acute pancreatitis.[12]

signs of hypovolemia

May include skin turgor, dry mucous membranes, hypotension, and sweating. In more severe cases, the patient may be tachycardic and/or tachypneic.

Other diagnostic factors

uncommon

signs of organ dysfunction

Signs of early fluid loss, hypovolemic shock, and symptoms suggestive of organ dysfunction indicate a need for immediate resuscitative measures.[8][47] In particular, signs of cardiovascular, respiratory, or renal dysfunction may be present. The presence of systemic inflammatory response syndrome (SIRS) is associated with a worse prognosis, and is defined by at least two of the following criteria: pulse >90 beats per minute; respiratory rate >20 per minute or partial pressure of carbon dioxide (PaCO₂) <32 mmHg; temperature >100.4°F or <96.8ºF; WBC count >12,000 or <4000 cells/mm³, or >10% immature neutrophils (bands).[49]

Other symptoms of possible organ dysfunction include agitation and confusion.

Grey-Turner sign

Bilateral flank blue discoloration indicating hemorrhagic pancreatitis.[5]

Cullen sign

Periumbilical blue discoloration indicating hemorrhagic pancreatitis.[5]

Fox sign

Ecchymosis over the inguinal ligament area.[5]

abdominal distention

Often related to ascites from the extravasation of intravascular fluid but also may be related to associated ileus.[1] In patients with severe disease, overly aggressive hydration can lead to a compartment syndrome characterized by tense ascites and severe abdominal distention.​

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