1. SIGNS AND SYMPTOMS OF
ACUTE PANCREATITIS
By: Siti Nur Hamizah.

2. SYMPTOMS
PAIN
 Cardinal symptom
 Onset : sudden. Often follow heavy meal.
 Progression : develops quickly, reaching maximum intensity
within minutes and persists for hours /days
 Intensity : severe, constant, refractory to usual doses of
analgesic
 Type: penetrating → cramp-like → agonising “ilimitable
agony”
 Location : start at epigastrium → localised to upper
quadrants / diffuse throughout abdomen
 Radiating : radiates to back (50%)
 Aggravating factor : alcohol / meal /cough/ lying down.
 Relieving factor : sitting / leaning forward .

3.  Nausea, repeated vomitting : frequent and
effortless; due to pylorospasm.
 & retching : persist despite stomach being kept
empty by NG aspiration.
 Hiccough
 gastric distension
 irritation of diaphragm

4. SIGNS
GPE
 Appearance – well→ gravely ill with profound shock, toxicity
and confusion
 Vitals:
 PR: ↑
 RR: ↑
 BP: ↓
 Temp: – normal / subnormal / rises
-acute swinging pyrexia (cholangitis)
 Mild Icterus: due to biliary obstruction in gallstone
pancreatitis.
 Small, red, tender nodules on skin of leg due to subcutaneous
fat necrosis.

5. PA
 Bleeding into fascial planes causing bluish discolouration.
a) Cullen’s sign (spread of retroperitoneal
blood into the falciform ligament and subsequently to
subcutaneous umbilical tissues through the connective
tissue covering of the round ligament.)
-bluish ecchymotic discolouration seen around umbilicus
b) Grey Turner’s sign (enzyme seeps across retroperitoneum →
hemorrhagic spot & echymosis)
-bluish discolouration on flanks
 Fox sign- enzyme seep below inguinal ligament
 Distension due to ileus /rarely ascites with shifting dullness
 mass in epigastrium due to inflammation
 guarding in upper abdomen

6.  Respiratory system
Sign of pleural effusion, pulmonary edema & pneumonitis →
cyanosis, crepitation
 Central nervous system
Neurological derangement – confusion