What are the clinical manifestations of acute pancreatitis?

The symptoms of acute edematous pancreatitis are mostly abdominal pain, fever, vomiting, etc. Hemorrhagic necrotic pancreatitis is more serious and may cause shock, high fever, abdominal distension, subcutaneous congestion, etc. Because many patients with acute pancreatitis do not survive the first attack, if you feel that something is wrong, you must go to the hospital immediately for emergency treatment.

1. General symptoms

(1) Abdominal pain: This is the earliest symptom, often occurring after overeating or extreme fatigue. It usually occurs suddenly and is located in the middle or left side of the upper abdomen. The pain is continuous and progressive, like a knife cutting. The pain radiates to the back and flanks. If it is hemorrhagic necrotizing pancreatitis, there will be general abdominal pain and acute abdominal distension within a short period of time after the onset of the disease, and shock of varying severity will soon occur.

(2) Nausea and vomiting: The attacks are frequent. Initially, the vomitus is bile-like. The condition progressively worsens and soon turns into intestinal paralysis, and the vomitus is feces-like.

(3) Jaundice: This jaundice is less common in acute edematous pancreatitis, accounting for about 1/4 of the cases. It occurs more frequently in acute hemorrhagic pancreatitis.

(4) Dehydration: Dehydration in acute pancreatitis is mainly caused by intestinal paralysis and vomiting, while severe pancreatitis can cause severe dehydration and electrolyte imbalance in a short period of time. In hemorrhagic necrotic pancreatitis, severe dehydration, anuria or oliguria may occur within a few hours to more than ten hours after onset.

(5) Due to the massive inflammatory exudation of the pancreas, resulting in pancreatic necrosis and localized abscess, fever may occur to varying degrees. If it is mild pancreatitis, the body temperature is generally below 39°C and will drop within 3 to 5 days. In severe pancreatitis, the body temperature is often between 39 and 40°C, delirium often occurs, lasting for several weeks, and symptoms of toxemia appear.

(6) In a minority of cases of hemorrhagic necrotizing pancreatitis, pancreatic juice and even necrotic and dissolved tissues reach the subcutaneous tissues along the interstitial spaces and dissolve the subcutaneous fat, causing capillaries to rupture and bleed, making the local skin appear bluish purple. Some may melt into large pieces and appear on the anterior lower abdominal wall of the waist or around the navel.

(7) The pancreas is located deep in the abdomen. Generally, mild edematous pancreatitis will cause tenderness deep in the upper abdomen, and in a few cases, there will be obvious tenderness in the anterior abdominal wall. In acute severe pancreatitis, due to the large amount of pancreatic dissolution, necrosis, and bleeding, both the anterior and posterior peritoneum are affected, the entire abdominal muscles are tight and tender, the whole abdomen is bloated, there may be a large amount of inflammatory ascites, and mobile dullness may occur. Bowel sounds disappear and paralytic ileus occurs.

(8) Due to the inflammatory stimulation of the exudate, reactive pleural effusion may occur, which is more common on the left side. It may cause atelectasis on the same side and cause breathing difficulties.

(9) A large amount of necrotic tissue accumulates in the lesser omental bursa. A raised mass can be seen in the upper abdomen. It is tender to the touch and the boundaries of the mass are often unclear. In a few patients, signs such as abdominal tenderness are no longer obvious, but they still have high fever, increased white blood cell count and frequent symptoms similar to "partial intestinal obstruction".

2. Local complications

(1) Pancreatic abscess: usually appears 2 to 3 weeks after onset. At this time, the patient had a high fever with symptoms of poisoning, worsening abdominal pain, a mass could be felt in the upper abdomen, and a significantly increased white blood cell count. The puncture fluid was purulent and bacteria grew in culture.

(2) Pancreatic pseudocyst: usually forms 3 to 4 weeks after onset. Physical examination often reveals a mass in the upper abdomen. Large cysts can compress adjacent tissues and cause corresponding symptoms.

3. Systemic complications

Common complications include acute respiratory failure, acute renal failure, heart failure, gastrointestinal bleeding, pancreatic encephalopathy, sepsis, fungal infection, hyperglycemia, etc.