It is the main manifestation and first symptom of this disease, most of which are sudden onset and acute abdominal pain, which often occurs after drinking alcohol and eating a meal. It can be dull pain, knife-like pain, drilling pain or colic, which is persistent and may have bursts. When the disease gets worse, it can radiate to the lower back in a band-like manner. The pain can be relieved by bending over and holding the knees, and can be aggravated by eating. The pain is mostly in the middle and upper abdomen. Edema-type abdominal pain will be relieved in 3 to 5 days. In the hemorrhagic and necrotic type, severe abdominal pain lasts for a long time and can cause general abdominal pain.

The abdominal pain does not subside after vomiting. Hemorrhagic and necrotic type may also cause abdominal pain or even paralytic intestinal obstruction.

Upper abdominal tenderness, no abdominal muscle tension and rebound tenderness, and bowel sounds may be reduced

Abdominal muscle rigidity, obvious tenderness throughout the abdomen, positive rebound tenderness, and weakened or disappeared bowel sounds suggest acute peritonitis.

If the skin around the umbilicus appears blue, it is called Cullen's sign

The skin on both waists is dark gray-blue, which is called Grey-Turner sign. It is caused by pancreatic enzymes, necrotic tissue and bleeding infiltrating into the abdominal wall along the peritoneal space and muscle layer.

Complicated by pancreatic and surrounding abscess or pseudocyst, an obviously tender mass can be palpated in the upper abdomen

If the mass compresses the common bile duct, jaundice may occur

Jaundice can be caused by stones in the common bile duct or ampulla, inflammatory edema of the head of the pancreas that compresses the common bile duct, or damage to liver cells caused by pancreatitis.

Once a cyst forms in APFC that persists after 4 weeks, it is called a pancreatic pseudocyst

ANC enclosed by the cyst wall is called encapsulated necrosis WON

Meets the diagnostic criteria for AP and is not accompanied by organ failure or local or systemic complications

Accompanied by transient organ failure (can recover within 48 hours), or accompanied by local/systemic complications

With persistent (>48h) organ failure

① When the diagnosis is unclear and difficult to differentiate from other acute abdominal diseases such as gastric perforation

② Hemorrhagic necrotizing pancreatitis that is ineffective after medical treatment

③When pancreatitis is complicated by abscess, pseudocyst, diffuse peritonitis, intestinal paralysis and necrosis

④ Biliary pancreatitis is in an acute state