panniculitis

 Q: In acute pancreatitis - panniculitis are most commonly found at? (select one) 

A) Chest area 

B) Flank area 

C) Upper extremities 

D) Lower extremities 

E) Perineal area 

 Answer: D

Physical exam particularly cutaneous exam can be of profound help in acute pancreatitis. 

Panniculitis are actually subcutaneous nodular fat necrosis lesions which are tender to touch and appears as reddish nodules. They are commonly found in distal areas of lower extremities, though may be present at other places in the body. 

Two other significant cutaneous findings are Cullen's sign and Grey Turner sign. Cullen's sign is ecchymotic discoloration in the periumbilical region and Grey Turner sign is ecchymotic discoloration mostly along the flanks. These two signs are due to retroperitoneal bleed subsequent to pancreatic necrosis. 

Besides above, other cutaneous findings can also be of help such as xanthomas in hyperlipidemic pancreatitis.

#physical-exam

#GI

References:

1.  Dahl PR, Su WP, Cullimore KC, Dicken CH. Pancreatic panniculitis. J Am Acad Dermatol 1995; 33:413. 

2. Bennett RG, Petrozzi JW. Nodular subcutaneous fat necrosis. A manifestation of silent pancreatitis. Arch Dermatol 1975; 111:896.

3. Mookadam F, Cikes M. Images in clinical medicine. Cullen's and Turner's signs. N Engl J Med 2005; 353:1386.