Characteristically, the pain, which is steady and boring in character, is located in the epigastrium and

periumbilical region and often radiates to the back as well as to the chest, flanks, and lower abdomen.
The pain is frequently more intense when the patient is supine, and patients often obtain relief by sitting
with the trunk flexed and knees drawn up. Nausea, vomiting, and abdominal distention

Exudation

Secretion

Atelectasis: xep phoi

Basilar rales

A faint blue discoloration around the umbilicus (Cullen's sign) may occur as the result of
hemoperitoneum, and a blue-red-purple or green-brown discoloration of the flanks (Turner's sign)
reflects tissue catabolism of hemoglobin. The latter two findings, which are uncommon, indicate the
presence of a severe necrotizing pancreatitis.

nonpancreatic causes of hyperamylasemia

Leukocytosis

hemoconcentration with hematocrit values >44%

Hyperglycemia

Hypocalcemia (Intraperitoneal saponification of calcium by fatty acids in areas of fat necrosis)

Hyperbilirubinemia

Serum alkaline phosphatase and aspartate aminotransferase (AST) levels are also transiently elevated

Markedly elevated serum lactic dehydrogenase (LDH) levels [>8.5 mol/L (>500 U/dL)] suggest a poor
prognosis

Serum albumin is decreased to 30 g/L (3.0 g/dL) in ~10% of patients; this finding is associated with more
severe pancreatitis and a higher mortality rate

Hypertriglyceridemia occurs in 15 to 20% of patients, and serum amylase and lipase levels in these
individuals are often spuriously normal

differential diagnosis should include the following disorders:

(1) perforated viscus, especially peptic ulcer

(2) acute cholecystitis and biliary colic ( cholelithiasis) ( colicky pain)
(3) acute intestinal obstruction ( ileus)
(4) mesenteric vascular occlusion
It may be difficult to differentiate acute cholecystitis from acute pancreatitis
x-rays of the abdomen
Acute mesenteric vascular occlusion is usually evident in elderly debilitated patients with brisk
leukocytosis, abdominal distention, and bloody diarrhea, in whom paracentesis shows
sanguineous fluid and angiography shows vascular occlusion. Serum as well as peritoneal fluid
amylase levels are increased, however, in patients with intestinal infarction
Systemic lupus erythematosus

Aggressive volume repletion with IV fluids must be undertaken

Serum electrolytes, calcium, and glucose levels should be monitored and supplemented as
necessarySerum electrolytes, calcium, and glucose levels should be monitored and
supplemented as necessary
nothing by mouth until they are free of pain and nausea
NG suction is reserved for patients with ileus or protracted emesis. TPN may be necessary when
inflammation is slow to resolve (around 7 days) or if an ileus is present. Enteral nutrition
through a tube placed distal to the ligament of Treitz is usually tolerated, and is safer and more
cost-effective than TPN

Narcotic analgesics
a reduced mortality rate but no change in complications with octreotide
A clear liquid diet is frequently started on the third to sixth day and a regular diet by the fifth to
seventh day
(1) a decrease in or resolution of abdominal pain; (2) the patient is hungry; and (3) organ
dysfunction, if present, has resolved.
peritoneal lavage
Aggressive surgical pancreatic debridement (necrosectomy) should be undertaken soon after
confirmation of the presence of infected necrosis
total parenteral nutrition (TPN) makes it possible to give nutritional support to patients with
severe, acute, or protracted pancreatitis who are unable to eat normally
enteral feeding with a nasojejunal tube