Clinical features:
(1) upper gastrointestinal bleeding with melena and/or hematemesis
(2) intermittent and repetitive episodes of epigastric pain that:
(2a) radiates posteriorly
(2b) is associated with cycles of clot formation within the pancreatic duct (increasing pain) followed by lysis (pain relief)
(3) pallor, weakness and other signs of anemia
(4) variable vomiting
(5) variable intermittent jaundice (from pancreatobiliary reflux)
(6) variable pulsating epigastric mass (if caused by an aneurysm)
(7) variable weight loss
Uncommon features:
(1) massive hemorrhage with shock
Endoscopic visualization of hemorrhage from the ampulla of Vater is a key finding. The differential diagnosis is hemobilia.
Laboratory findings:
(1) reduce hemoglobin and hematocrit
(2) elevated serum amylase and/or lipase
(3) elevated serum bilirubin during periods of jaundice
