It refers to a series of local and systemic multi-organ damages caused by necrosis, hemorrhage, and fat necrosis of the pancreatic parenchyma. This condition is critical and has an extremely high mortality rate.

bubble_chart Diagnosis

1. History Taking

Onset Initial stage [first stage] Similar to acute pancreatitis. If the condition progresses, abdominal pain persists without relief, accompanied by high fever, and may present with pale complexion, rapid breathing, dysphoria, restlessness, decreased blood pressure, oliguria, and other signs of shock. Further progression may lead to mental confusion, hematemesis, melena, and manifestations of multiple organ failure. Due to the critical nature of the condition, a small number of patients may die shortly after onset. For detailed history-taking, refer to acute pancreatitis.

2. Physical Examination Findings

Elevated body temperature, increased heart rate, rapid breathing, decreased blood pressure, tenderness and rebound tenderness in the upper abdomen, abdominal muscle rigidity, weakened borborygmus, and other signs of acute peritonitis. Some patients may have a palpable mass in the upper abdomen. A few patients may exhibit subcutaneous bleeding, presenting as bluish discoloration around the umbilicus (Cullen’s sign) or on both sides of the abdomen (Grey Turner’s sign). Shifting dullness may be positive. Wet rales may be heard on lung auscultation, and localized breath sounds may weaken or disappear if pleural effusion is present. Severe dyspnea may lead to cyanosis.

3. Laboratory Tests

Significant increase in total white blood cell count and neutrophils. Blood and urine amylase levels may be elevated or normal. Serum methemalbumin is positive. Hypocalcemia and hyperglycemia may occur. Ascites is bloody, and pleural ascites amylase levels are significantly higher than blood levels. Respiratory system may show decreased PaO₂, potentially leading to ARDS in severe cases. Renal function may present with elevated BUN and hematuria or proteinuria. Liver function abnormalities may occur, and stool occult blood may be positive. Blood cultures may be positive in cases of sepsis. ECG may show arrhythmias, myocardial ischemia, and other abnormalities. Chest X-ray may reveal pleural effusion, atelectasis, pneumonia, or cardiomegaly. Abdominal plain films may show air-fluid levels in the upper abdomen in cases of pancreatic abscess. Ultrasound and CT can assess pancreatic size, morphology, presence of abscess or cyst formation, and pleural, ascites, or pericardial effusion.

bubble_chart Treatment Measures

If the patient meets the above clinical manifestations, oxygen should be administered immediately, intravenous access established, and emergency admission to the ward arranged after vital signs stabilize.