The initial manifestation of acute pancreatitis is most commonly which finding?

• A. Generalized pruritus
• B. Epigastric pain
• C. Epigastric mass
• D. Anorexia

Answer: (B)

Severe epigastric abdominal pain is the hallmark initial finding in acute pancreatitis. The pancreas sits behind the stomach in the upper abdomen, and when inflamed, its enzymes start digesting pancreatic tissue and nearby structures, causing intense, persistent pain that commonly localizes to the epigastric region and often radiates to the back. The pain is typically constant and may be accompanied by nausea and vomiting; patients often prefer to sit up and lean forward to relieve it.

Generalized itching (pruritus) is more characteristic of cholestasis or biliary obstruction, not the first sign of pancreatitis. A palpable epigastric mass can occur later if a pseudocyst or large inflammatory process develops, not as the initial presentation. Anorexia can occur but is not as specific or predictive as the characteristic epigastric pain.

Thus, epigastric pain best captures the typical early presentation of acute pancreatitis.