Inflammation of the Pancreas: Symptoms, Complaints, Signs

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