Clinical Assessment and Risk Stratification – Examination

Examination usually reveals a tender upper abdomen which can be combined with guarding; typically the guarding is not as intense as you may expect for the level of pain complained of. This is due to the retroperitoneal location of the pancreas which can make abdominal signs vague.

Jaundice can be present if there is obstruction of the common bile duct in addition to the pancreatic duct.

A paralytic ileus may develop after the first 12-24 hours causing a mild abdominal distension and absent bowel sounds.

Rare and late signs of extensive destruction of the pancreas are bruising around the umbilicus (Cullen’s sign) or the left flank (Grey Turner’s sign) due to haemorrhage from the pancreas leading to blood in the abdominal cavity.

Signs of tetany, such as fasciculations, twitching and a positive Trousseau’s or Chvostek’s test, should also be looked for since hypocalcaemia can develop secondary to intra-abdominal fat necrosis.

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