Pain is severe, often requiring large doses of parenteral narcotics. The pain is steady and boring and persists without relief for many hours and usually for several days. Sitting up and leaning forward may reduce pain, but coughing, vigorous movement, and deep breathing may accentuate it. Most patients experience nausea and vomiting, at times to the point of dry heaves. The patient appears acutely ill and is sweating.
Respirations are shallow and rapid.
BP may be transiently high or low, with significant postural hypotension. Sensorium may be blunted to the point of semicoma. Scleral icterus is occasionally present. Examination of the lungs may reveal limited diaphragmatic excursion and evidence of atelectasis. Abdominal tenderness always occurs and is often severe in the upper abdomen and less severe in the lower abdomen.