The Clinical Syndrome

Acute pancreatitis is one of the most common causes of abdominal pain, with an incidence of approximately 0.5% among the general population. The mortality rate is 1% to 1.5%. In the United States, acute pancreatitis is most commonly caused by excessive alcohol consumption ( Fig. 74.1 ); gallstones are the most frequent cause in most European countries. Acute pancreatitis has many other causes, however, including viral infection, hypertriglyceridemia, tumor, and medications Box 74.1 . Less common causes of acute pancreatitis include scorpion venom, cardiac bypass-induced ischemia, pregnancy, cystic fibrosis, and infection with Chinese liver fluke.

Excessive consumption of alcohol is one of the causes of acute pancreatitis.

Abdominal pain is a common feature of acute pancreatitis. It may range from mild to severe and is characterized by steady, boring epigastric pain that radiates to the flanks and chest. The pain is worse in the supine position, and patients with acute pancreatitis often prefer to sit with the dorsal spine flexed and the knees drawn up to the abdomen. Nausea, vomiting, and anorexia are other common features.

Signs and Symptoms

Patients with acute pancreatitis appear ill and anxious. Tachycardia and hypotension resulting from hypovolemia are common, as is low-grade fever. Saponification of subcutaneous fat is seen in approximately 15% of patients suffering from acute pancreatitis; a similar percentage of patients experiences pulmonary complications, including pleural effusion and pleuritic pain that may compromise respiration. Diffuse abdominal tenderness with peritoneal signs is invariably present. A pancreatic mass or pseudocyst secondary to pancreatic edema may be palpable. If hemorrhage occurs, periumbilical ecchymosis (Cullen’s sign) and flank ecchymosis (Turner’s sign) may be present. Both these findings suggest severe necrotizing pancreatitis and indicate a poor prognosis. If the patient has hypocalcemia, Chvostek’s or Trousseau’s sign may be present.