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Accompanying symptoms may include: Nausea and vomiting that is persistent and does not respond to usual remedies Possible fever and elevated heart rate Abdominal tenderness when the area is touched Abdominal distension or bloating In severe cases, signs of systemic illness including confusion, shortness of breath, or low blood pressure Diagnosis of acute pancreatitis typically requires at least two of three criteria: characteristic abdominal pain, elevated pancreatic enzymes (lipase or amylase) greater than three times the upper limit of normal, and imaging findings consistent with pancreatic inflammation