Acute pancreatitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Physical examination findings in acute pancreatitis can include fever, tachycardia, abdominal tenderness and distension, jaundice, pallor, and discoloration of the flanks and umbilicus.

Physical Examination

Appearance of the patient

• Patient appears to be pale and in distress because of the abdominal pain.

Vitals

Temperature

• Elevated body temperature is present.

Pulse

Rate

• Tachycardia may be present.

Rhythm

• The pulse is regular.

Strength

• The pulse may be weak.

Blood Pressure

• Hypotension may be present.

Respiratory Rate

• Tachypnea may be present.

Skin

• Grey-Turner's sign - hemorrhagic discoloration of the flanks.
• Cullen's sign - hemorrhagic discoloration of the umbilicus.
• Grünwald sign - appearance of ecchymosis, large bruise, around the umbilicus due to local toxic lesion of the vessels.
• Jaundice may be present.
• Pallor may be present.
• Erythematous skin nodules of size less than 1 cm may be seen due to subcutaneous fat necrosis.

Eye

• Ischemic changes in the retina on ophthalmoscopic exam - Purtscher retinopathy. Caused by the activation of complement system.

Lung

• Rapid shallow breaths are seen.
• Reduced breath sounds when auscultated due to possible pleural effusion.
• Basilar rales may be present.

Abdomen

• Abdominal distention may be present.
• Abdominal tenderness may be present.
• Rebound may be present.
• An acute abdomen is present.
• An abdominal mass may be present.
• Guarding is present.
• Körte's sign (pain or resistance in the zone where the head of pancreas is located (in epigastrium, 6–7 cm above the umbilicus).
• Kamenchik's sign (pain with pressure under the xiphoid process).
• Mayo-Robson's sign (pain while pressing at the top of the angle lateral to the Erector spinae muscles and below the left 12th rib (left costovertebral angle (CVA).
• Mayo-Robson's point - a point on border of inner 2/3 with the external 1/3 of the line that represents the bisection of the left upper abdominal quadrant, where tenderness on pressure exists in disease of the pancreas. At this point the tail of pancreas is projected on the abdominal wall.

Extremities

• Muscular spasms may be noted - due to hypocalcemia.