Flushing, Cyanosis, Dyspnea, n/v, Low grade feeer, Leuocytosis, Hypotension, tachycardia, Jaundice (cheolecystitis), Abd tenderenss, decreased BS, cracks, skin discoloration and shock (effect on enzymes on vessels: vasodilation), Electrolyte imbalances: Vomitting-HypoK and HypoC.
- => Abdominal pain predominant: KEY COMPLAINT
- Left upper quadrant or midepigastrium
- Radiates to the backSudden onset
=> Abdominal pain is the predominant manifestation of acute pancreatitis. The pain is due to distention of the pancreas, peritoneal irritation, and obstruction of the biliary tract.
The pain is usually located in the left upper quadrant, but it may be in the midepigastrium. It commonly radiates to the back because of the retroperitoneal location of the pancreas.
The pain has a sudden onset and is described as severe, deep, piercing, and continuous or steady. The pain is aggravated by eating, and frequently has its onset when the patient is recumbent. It is not relieved by vomiting; may be accompanied by flushing, cyanosis, and dyspnea. The patient may assume various positions involving flexion of the spine in an attempt to relieve the severe pain.
Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with guarding
Decreased or absent bowel sounds: enzymes leaking into peritoneal cavities
=> Resp: Crackles, dyspnea (shallow breathing: panc enzymes can irritate the pleural lining so as a result, pt may develop carackles/atelectasis-don't take a deep breath b/c of the pain
- Abdominal skin discoloration: Grey Turner’s spots or sign, Cullen’s sign
=> Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Paralytic ileus may occur and causes marked abdominal distention.
The lungs are frequently involved, with crackles present. Intravascular damage from circulating trypsin may cause areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall.
Other areas of ecchymoses are the flanks (Grey Turner’s spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen’s sign, a bluish periumbilical discoloration). These result from seepage of blood-stained exudate from the pancreas and may occur in severe cases. Prominent in severe or advaced
Shock may result from hemorrhage into the pancreas, toxemia from the activated pancreatic enzymes, or hypovolemia as a result of fluid shift into the retroperitoneal space (massive fluid shifts).