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    The most common symptoms and signs include: severe epigastric pain (upper abdominal pain) radiating to the back nausea vomiting loss of appetite Fever chills (shivering) hemodynamic instability, which include shock tachycardia (rapid heartbeat) respiratory distress peritonitis .Elevated serum amylase and lipase levels, in combination with severe abdominal pain, often trigger the initial diagnosis of acute pancreatitis

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