![Page 1: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/1.jpg)
Normal pancreas
![Page 2: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/2.jpg)
![Page 3: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/3.jpg)
![Page 4: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/4.jpg)
Pathology of pancreas
![Page 5: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/5.jpg)
Pancreatitis • Inflammation of the pancreas• May be diffuse or focal • Acute or chronic• Occur due to response to the destruction of pancreatic tissue by its own digestive enzymes ( autodigestion ) which have been released from damaged pancreatic cells .
![Page 6: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/6.jpg)
Acute pancreatitis Acute inflammation causes the pancreatic tissue
necrosed , releasing the pancreatic enzymes which destroy the pancreatic tissue and the capillary walls and entering the blood stream.
Causes-: 1 -Biliary calculi , it is the most common cause
2 -Alcoholism 3 -Trauma
4 -Drug induced (rare cause)5 -Infection e.g mumps ( rare cause )
![Page 7: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/7.jpg)
Acute pancreatitisClinical picture-:
• Sever epigastric pain • Abdominal distension • Nausea or vomiting • In mild cases the patient may recover spontaneously • Untreated cases may lead to peritonitis • Raised levels of amylase and lipase •
![Page 8: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/8.jpg)
Acute pancreatitisWhat is the role of ultrasound_:
The main role of U.S in cases of acute pancreatitis try to detect the cause of pancreatitis.
![Page 9: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/9.jpg)
Ultrasound appearance-:
In mild cases there are no changes by ultrasound.In sever cases
• Hypoechoic enlarged pancreas• CBD dilatation if there is enlargment of pancreatic head
•A collection or pseudocyst due to leakage out of digestive pancreatic enzymes
• Pseudocyst May be seen in the lesser sac near the tail of pancreas , within the pancreatic tissue itself , anywhere in the abdomen .
![Page 10: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/10.jpg)
Acute pancreatitis • Pseudocyst may be echofree but may contain echoes from tissue debris and may be loculated .
•Pancreatic abscess may be occur due to infection
![Page 11: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/11.jpg)
Acute pancreatitisEnlarged edematous pancreas “P” 4cm pseudocyst “C”
![Page 12: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/12.jpg)
Acute pancreatitisThe pancreas (P) is draped over the splenic vein (SV), which is hypoechoic and swollen, with a rim of fluid around its edge (white arrows). A is the aorta and IVC the inferior vena cava
![Page 13: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/13.jpg)
Chronic pancreatitis Causes-:
• May be occur on top of acute pancreatitis • Alcohol abuse • The normal pancreatic tissue is replaced by fibrosis .
![Page 14: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/14.jpg)
Chronic pancreatitis Clinical picture-:
• Pain • Steatorrhoea • Serum enzyme levels are less elevated than in acute disease.
![Page 15: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/15.jpg)
Chronic pancreatitis Ultrasound appearance-:
• Abnormally hyperechogenicity of pancreas • Atrophied and lobulation of pancreas • Dilatation of the pancreatic duct • Pancreatic calcification
![Page 16: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/16.jpg)
Chronic pancreatitis Chronic Pancreatitis, echogenic irregular appearance to the body of the pancreas
![Page 17: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/17.jpg)
Pancreatic carcinomaPancreatic carcinoma is a major cause of cancer related death
Clinical picture • Presenting symptoms depends on the size of the lesion ,and its position within the pancreas
• Most pancreatic tumor ( 60% ) are found in the head of the pancreas and the patient present by obstructive jaundice ……Why ?
• Carcinoma which located in the body and tail of pancreas do not cause obstructive jaundice .
![Page 18: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/18.jpg)
Pancreatic carcinomaUltrasound appearance-:
• Solid hypoechoic or mixed echogenicity with an irregular border • Cystic carcinoma appear as multiseptate cystic masses with associated solid components
![Page 19: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/19.jpg)
Pancreatic cysts The pancreatic cysts may be • Benign pancreatic cysts• Cystic carcinoma ( rare )• Pseudocyst associated with acute pancreatitis .
![Page 20: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/20.jpg)
Benign pancreatic cysts• Rare and tend to associated with other conditions as polycystic disease .
• Single or multiple
• Echo free small cavities filled with fluid
![Page 21: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/21.jpg)
Trauma of pancreas Pancreas is exposed to trauma especially in road traffic
accidents Ultasound is senstive to detect leakage of pancreatic
juice into the abdominal cavity (caused by rupture of pancreatic duct) and hematoma caused by laceration of
the pancreas
![Page 22: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/22.jpg)
Calcification in the pancreasCalcification within the pancreas can produce acoustic shadowing but if it is very small there may only be bright descrete echoes without shadowing Causes of pancreatic calcifications • Chronic pancreatitis• Calculi in the pancreatic dust • Biliary calculi in the distal common bile duct can be mistaken for pancreatic calcification , there is usually dilatation of the proximal bile duct .
![Page 24: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/24.jpg)
Dilatation of pancreatic ductThe maximal internal diameter of pancreatic duct is 2 mm
Causes of dilatation of pancreatic duct-:• Tumor of head of the pancreas • Calculus in the CBD • Calculus in the pancreatic duct• Chronic pancreatitis
![Page 26: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/26.jpg)
Diffuse enlargement of the pancreas
Causes-: • Acute pancreatitis• Acute on top of chronic pancreatitis
![Page 27: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/27.jpg)
Focal enlargement of pancreas
Causes-: • Focal pancreatitis • Pancreatic tumor
How can you differentiate • Serum amylaze is elevated with pancreatitis • In some cases biopsy is needed to differentiate
• Previous history of pancreatitis Normal tumor marker level
![Page 28: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/28.jpg)
Small pancreas• Old age • Chronic pancreatitis
![Page 29: Normal pancreas. Inflammation of the pancreas May be diffuse or focal Acute or chronic Occur due to response to the destruction of pancreatic tissue](https://reader035.vdocuments.net/reader035/viewer/2022062408/56649eb15503460f94bb7264/html5/thumbnails/29.jpg)
Thank you