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 slightly eases it. Progressive loss of pancreatic enzymes leads to steatorrhoea: bulky, pale, greasy, foul-smelling stools that float and leave an oil film. Weight loss and malnutrition follow. Destruction of β-cells can produce “pancreatic” diabetes (polyuria, polydipsia, polyphagia, weight fall). Some patients present only when complications such as a pseudocyst or biliary obstruction develop.

Seek immediate care if pain lasts > 6 h, high fever, intractable vomiting or a rigid, board-like abdomen develops.

Type	Key symptoms	Typical signs	Red-flag alarms
Acute	Sudden severe epigastric pain → back, nausea, vomiting, fever	Upper-abdominal tenderness, diminished bowel sounds	Hypotension, Cullen / Grey-Turner signs
Chronic	Post-prandial upper pain, steatorrhoea, weight ↓	Pain lessens when leaning forward, oily film on stool	Jaundice, sudden severe pain (complication)