SIGNS AND SYMPTOMS OF ACUTE PANCREATITISBy: Siti Nur Hamizah.

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 .

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

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.

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

Respiratory system

Sign of pleural effusion, pulmonary edema & pneumonitis → cyanosis, crepitation

Central nervous system

Neurological derangement – confusion