Patients with acute pancreatitis who experience a relapse may present with a progressive increase in abdominal pain, accompanied by nausea and vomiting. As the disease progresses, there is marked exudate in the abdominal cavity, limited peritonitis with pressure, rebound pain, muscle tension and, in severe cases, fever. Early laboratory tests show a marked increase in blood amylase, and after 48 hours of abdominal pain, there is a gradual rise in urinary amylase. In severe cases, there is also an increase in serum lipase and a decrease in serum calcium ions. At this time, blood counts are abnormally high, usually greater than 15,000, and in severe cases, leukocytes are greater than 20,000. abdominal pain progressively worsens, and there is a positive abdominal turbidity on palpation, as well as bloody fluid on laparotomy, and a marked increase in amylase on laboratory tests.