The clinical picture differs between acute and chronic disease, but both revolve around upper-abdominal pain and disturbed digestion. Acute pancreatitis begins with sudden, severe epigastric or left-upper-quadrant pain that bores through to the back; eating worsens it and antispasmodics give little relief. Most patients vomit repeatedly yet still feel bloated. Fever > 38 °C, tachycardia and, in severe cases, hypotension or shock may appear within 48 h. Bluish periumbilical (Cullen) or flank (Grey-Turner) bruising signals haemorrhagic-necrotic pancreatitis. Chronic pancreatitis causes recurring or persistent upper-abdominal pain that is aggravated by meals and by lying supine; sitting forward or hugging the knees... Learn more