Acute pancreatitis (AP)
The following symptoms and complaints may indicate acute pancreatitis (inflammation of the pancreas):
- Acute abdominal pain (abdominal pain) most important symptom. Typically, there is a severe, probing and persistent visceral pain in the upper abdomen (epigastrium), which may also radiate to the back (girdled), thorax (chest), flanks or lower abdomen and improves in a sitting or crouching position
- Nausea (nausea)
- Vomiting
- Possibly fever
- Rubber belly – elastic abdominal wall tension due toincipient peritonitic irritation and meteorism.
- Meteorism (flatulence) – due to reduced intestinal motility.
- Possibly icterus (jaundice; in biliary genesis/”bile-related”).
- Possibly subileus (precursor of ileus), possibly ileus (intestinal obstruction) (paralytic).
- Abdominal tension (peritonism; peritonitis).
- Tachycardia – heartbeat too fast: > 100 beats per minute.
- Hypotension – low blood pressure
- Cullen’s sign, i.e. periumbilical (around the belly button) hemorrhage as a sign of abdominal hemorrhage (clinical sign of severe acute pancreatitis)
- Irritation of peritoneum (peritoneum) and pleura (pleura of the lungs) → ascites (abdominal dropsy) and pleural effusion
- Circulatory shock, with subsequent oliguria (< 500 ml urine/ 24 hr) or anuria (< 100 ml urine/ 24 hr).
* Meteorism + peritonitic irritation (irritation) = abdomen with a turgid consistency, resembling an inflated rubber tube = “rubber belly”).
Further indications
A retrospective survey included patients with severe AP who received intensive care. The diagnosis of AP was made if 2 of the following 3 criteria were met:
- Clinical symptoms consistent with AP (see above) with sudden onset and persistent fever and epigastric pain that also radiates to the back (strap-like), thorax (chest), flanks, or lower abdomen.
- Evidence of at least a 3-fold increase in serum lipase or amylase.
- Presence of characteristic features on an imaging modality (computed tomography CT), magnetic resonance imaging (MRI), or sonography/ultrasound) [eg. E.g., diffuse enlargement of the pancreas, peripancreatic fluid, parenchymal or peripancreatic necrosis(s); possibly indication of biliary (gallbladder-related) cause].
Chronic pancreatitis
The following symptoms and complaints may indicate chronic pancreatitis:
- Severe upper abdominal pain, recurrent [main symptom!]
- Localization: radiating in the depth of the abdomen and into the back in a belt-like manner.
- Duration: hours to days
- Triggered by food intake
- Weight loss triggered by
- Food reduction due to pain
- Diarrhea (diarrhea)/steatorrhea (fatty stools) in exocrine pancreatic insufficiency (disease of the pancreas denotes associated with insufficient production of digestive enzymes) [occurs only when lipase secretion is reduced by more than 90-95%] Note: Endocrine pancreatic insufficiency presents itself only after several years: this affects the islets of Langerhans, which are primarily responsible for the regulation of glucose serum levels (blood glucose levels) – via the hormones insulin and glucagon – and digestive processes
- Malnutrition
- possibly jaundice (jaundice) due to.
- Pseudocyst
- Inflammatory swollen pancreatic head