Symptoms of Pancreatitis

The clinical picture of acute pancreatitis is usually very vague. Thus, a whole set of special methods were devised to diagnose this problem.

The main symptoms include:

• Epigastric pain – is caused by the severe inflammation and necrosis of the pancreatic cells and especially the capsule of the pancreas, which has the most nerve endings.
• Bloating – is caused by dyskinesia and even paresis of gastrointestinal tract, preventing the food from being digested properly.
• Nausea and relentless vomiting – is the body’s response to severe intoxication caused by the substances released into the bloodstream as a result of necrosis of pancreatic cells.

The massive amount of toxins (released into the bloodstream due to necrosis of pancreatic cells) causes severe dehydration. This plays an important role in pathogenesis of the disease, resulting in symptoms such as:

• Hemodynamic instability (including shock) – sudden drop in volume of the blood due to dehydration makes it impossible for the blood vessels and interstitial (tissue) fluid to compensate for it. This leads to a decreased systolic volume, hypoxia (lack of oxygen within the bloodstream), and metabolic acidosis (lowering of pH of the blood).
• Tachycardia – is a response of the body, which is trying to compensate for the decrease in blood volume. It can also be attributed to hypocalcaemia.
• Respiratory distress – the breathing is quickened in order to compensate for acidosis (CO₂ that we breathe out is one of causes of acidosis) and hypoxia.

There are also symptoms described by a number of authors which researched this disease. All these symptoms are caused by irradiation of pain, severe intoxication/inflammation, and/or necrosis of the pancreas.
They include:

• Grey Turner’s sign – bruising which appears along the flanks of the patient. It takes 24-48 hours for this symptom to appear, and it is a worrying sign since the mortality of patients with this symptom rises from 8-10% to 40%.
• Cullen’s sign – often accompanies Grey Turner’s sign – is a superficial bruising and edema within the fatty tissues around the umbilicus. Just like Grey Turner’s sign, it results from pancreatic necrosis with intra abdominal or retroperitoneal bleeding.
• Pleural effusions (accumulation of liquid at the bottom of the pleural cavity) – is caused by severe inflammation in the region.
• Grünwald sign – appearance of multiple subcutaneous hematomas (accumulation of blood within the subcutaneous tissues) and purpur as (red or purple discoloration of the skin) around the umbilicus, which happens as a result of toxic lesion of the blood vessels.
• Körte's sign – resistance or pain in the zone 6-7 cm higher than umbilicus, where the head of the pancreas is located. It is caused by inflammation and, possibly, by local peritonitis.
• Kamenchik’s sign – pain that appears when the pressure is applied to the point under the xiphoid process.

Although the symptoms mentioned above are common, they might not appear at all, with the sole symptom of acute pancreatitis being abdominal pain.