A prodrome of low grade fever, myalgias, or URI is followed by nausea, vomiting and diarrhea. There may be a history of similar symptoms in family or contacts. Pain is often crampy. Bowel sounds are increased. Tenderness is diffuse, without rebound or guarding.
White count is usually normal or low without left shift.
Severe pain in epigastrium with radiation to back relieved by bending forward associated with nausea and vomiting is characteristic. May have history of alcohol intake or cholecystitis. On physical exam findings often include epigastric tenderness, guarding, hypoactive bowel sounds, fever, and hypotension. Laboratory results show leukocytosis with left shift. Alk P tase, and bilirubin may be elevated over baseline.