I. Diagnostic Points

I. Diagnostic Points

(1) Onset is sudden, often occurring after a heavy meal or alcohol consumption. Persistent, severe upper abdominal pain, sometimes described as knife-like, radiating to the lower back, shoulders, and left side; frequent nausea and vomiting, often accompanied by moderate fever (below 39°C). In severe cases, shock may occur.

(2) Tenderness and rebound tenderness in the upper abdomen (rebound tenderness refers to increased pain when the hand is released after pressing), with mild abdominal muscle tension. In a few severe cases, jaundice, subcutaneous bleeding around the umbilicus or on both sides of the abdomen, peritonitis, and abdominal masses may appear.

(3) Increased total white blood cell count and neutrophils in the blood. Markedly elevated amylase in blood and urine, as well as serum lipase. Serum amylase generally rises within 2–12 hours after symptom onset and returns to normal within 3–4 days; urine amylase persists for a relatively longer period, usually returning to normal after about a week. Serum lipase typically rises after 3–4 days and also remains elevated for a longer duration, so the prolonged elevation of urine and serum lipase can compensate for the rapid decline of serum amylase, providing evidence for the diagnosis of acute pancreatitis. In acute pancreatitis, the ratio of serum amylase to serum creatinine clearance is often greater than 5.3%. Additionally, hyperglycemia and hypocalcemia may occur, and serum ferritin measurement is often positive in hemorrhagic-necrotic acute pancreatitis.

(4) Ultrasonography can reveal generalized pancreatic enlargement and increased echogenicity. Abdominal X-ray plain films can show diaphragmatic elevation and intestinal paralysis, which help rule out other acute abdominal conditions.