A 40 year old man who is alcoholic is admitted to hospital with acute pancreatitis. He is now having vomiting and feels dizzy while standing. On examination, the patient has severe epigastric tenderness in the right upper quadrant and decreased bowel sounds. Bluish discolouration is seen around the umbilicus. What is the significance of this finding?
Patient with acute pancreatitis have following C/F: Low grade fever Tachycardia Hypotension Severe abdominal pain of increasing intensity which radiated to back Bowel sounds become absent Bluish discolouration present in periumbilical area (cullen's sign), occurs because of hemoperitoneum Blue-red-purple or green-brown discoloration of the flanks(Grey Turner's sign) Both of these signs are features of severe pancreatitis with hemorrhage. FIG: CT scan showing acute pancreatitis with necrosis
A CT of the abdomen is likely to show severe necrotizing pancreatitis.
Abdominal plain film is likely to show pancreatic calcification.
Concomitant appendicitis should be ruled out.
He likely has a pancreatico-aoic fistula.
Budd chiari syndrome & Pancreatitis