Pancreatitis - Abdominal Examination

Abdominal Examination — Acute Pancreatitis

General Inspection

• Patient appears acutely ill, restless, often sitting up and leaning forward for pain relief.
• Facial distress, mild tachycardia and tachypnea may be evident.
• Skin may be flushed; in severe cases, pallor or mild jaundice noted.
• Grey Turner’s or Cullen’s sign (bluish discoloration of flanks or umbilicus) may appear in severe necrotizing pancreatitis.

Inspection of the Abdomen

• Upper abdominal fullness or distension may be present.
• No visible peristalsis or pulsations.
• Movements with respiration may be reduced due to guarding.

Palpation

• Light palpation reveals marked tenderness in epigastrium and left hypochondrium.
• Guarding and mild rigidity may be present.
• No palpable organomegaly initially, but pancreatic pseudocyst may present later as a palpable mass.
• Murphy’s sign negative (helps differentiate from cholecystitis).

Percussion

• Localized tenderness on percussion over upper abdomen.
• Dullness may indicate fluid collection or paralytic ileus.

Auscultation

• Bowel sounds may be sluggish or absent in paralytic ileus secondary to pancreatitis.

Special Tests

• Grey Turner’s sign (flank ecchymosis) and Cullen’s sign (umbilical ecchymosis) — suggest retroperitoneal hemorrhage.
• Examine for associated pleural effusion (especially left-sided).
• Assess for dehydration and shock signs — poor skin turgor, dry tongue, hypotension.

Findings consistent with acute pancreatitis — epigastric tenderness with guarding, diminished bowel sounds, and possible Grey Turner/Cullen’s sign. Suggest confirmatory investigations: serum amylase/lipase, ultrasound or CT abdomen.

Clinical Tips:

• Leaning forward may relieve pain — a classic feature.
• Always examine flanks and umbilicus for hemorrhagic signs.
• In severe cases, note tachycardia and hypotension suggesting SIRS or shock.
• Differentiate from perforated peptic ulcer (board-like rigidity and air under diaphragm).
• Grey Turner’s and Cullen’s signs indicate severe necrotizing (hemorrhagic) pancreatitis.
• Rebound tenderness suggests peritonitic spread.
• Always document vitals and hydration status in conclusion for surgical discussion.