Can You Spot Acute Pancreatitis in the Field?

Acute abdominal pain is a familiar chief complaint.  Could this be the result of harmless indigestion, or something more severe?  Here’s some key findings to help you identify acute pancreatitis.

Patient History

  • Alcohol abuse (Most common in males)
  • Gallstones (Most common in females)

Symptoms

  • Constant epigastric pain, which radiates to the back
  • Nausea & Vomiting
  • Fever is likely

Exam Findings

  • Abdominal Tenderness
  • Guarding of the abdomen
  • Cullen’s Sign (periumbilical ecchymosis)
  • Grey-Turner’s Sign (flank ecchymosis)
  • Jaundice
  • Shock

Patients with acute pancreatitis may develop Acute Respiratory Distress Syndrome (ARDS).  This is important to keep in mind if a patient in acute respiratory distress, who has no history of such, begins to tell you about abdominal pain.  


Grey-Turner’s sign and Cullen’s sign are very rare, but possible exam findings.  Remember that these two findings are indicative of retroperitoneal hemorrhage, so keep you differential pool open.


There may be a chance of worsening the pain in a patient with acute pancreatitis if Morphine is used for analgesia.  This is thought to occur due to the tendency of Morphine to cause spasms in the sphincter of Oddi.  Hydromorphone is probably the best choice for pain control, but as always, follow local protocol.

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References

Sabatine MS. Pocket medicine. 3rd ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2004.

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