Inflammation of the pancreas

Classifications

Acute

Hemorrhagic

Phlegmonous

Chronic

Related to biliary disease and alcoholism

Damage to acinar tissue results in pancreatic juices leaking into glandular tissue, lesser sac and surrounding pararenal area

Clinical signs and symptoms

US findings would present an enlarged gland that is less echogenic than the liver parenchyma

Complications

Hemorrhagic Pancreatitis

Rapid progression of acute pancreatitis

Diffuse enzymatic destruction of the pancreatic substance

Clinical signs and symptoms

US findings

Depends on hemorrhage age

Mass in pancreas area

A spreading area of diffuse inflammatory edema of soft tissues that may proceed to necrosis and suppuration

US findings of tissue that appears hypoechoic with good through-transmission

Usually involves the lesser sac, left anterior pararenal space, and transverse mesocolon

Develops secondary to pancreatitis that develops from post-operative procedures

High mortality rate if left untreated

Clinical signs and symptoms

US findings

Hypoechoic mass with smooth or irregular thick walls which may be echo-free to echodense

Result of recurring attacks of acute pancreatitis

Usually associated with alcoholism or chronic biliary disease

Clinical signs and symptoms

US findings

Increased echogenicity of the gland

Irregular borders

Possible dilated pancreatic duct due to obstruction

Clinical signs and symptoms:  epigastric pain worsening with disease progression, GI problems, jaundice secondary to CBD obstruction

Complications of pseudocyst, thrombosis of splenic vein, portal vein or both

Clinical signs and symptoms: persistent fever and leukocytosis, possible  chills,  hypotension and tender abdomen with growing mass

US findings:  if gas is present may have “dirty” shadows

Related to biliary disease( #1 cause in the US) and alcoholism

Other causes: trauma, peptic ulcer dx, abdominal infection, vascular thrombosis and embolism, drugs

S & S  patient presents with moderate to severe epigastric tenderness that radiates to the back, fever, leukocytosis 

  serum amylase increases within 24 hours on severe pain onset, serum lipase value increases within 72 to 94 hours

Complications:  may develop pseudocyst, phlegmon, abscess, hemorrhage or duodenal obsruction

is the best modality for imaging the pancreas due to the development of ileus (dilated bowel)

Clinical signs and symptoms:  intense, severe pain radiating to the back with shock and ileus, decreased hematocrit and serum calcium levels

Usually involved in the lesser sac, left anterior pararenal space, and transverse mesocolon

Types

True cysts and pseudocysts

May be unilocular or multilocular

may be congenital or acquired

Made up of microscopic sacs

are always acquired as a result of trauma to the gland or pancreatitis

Most common location is in the lesser sac

Occurs when pancreatic juices escape the duct and break down surrounding tissues

US findings appear as well-defined masses with almost sonolucent, echo-free interior

Cystadenomas, Cystadenocarcinomas, Adenocarcinoma, Islet cell tumors, Metastatic disease to the pancreas, Are all types of _________?

Also known as microcystic adenoma

Rare, benign disease with female predominance

Tiny cysts found primarily in the body and tail of the gland

US findings of thick walled cysts that can mimic pseudocysts in appearance

A.k.a. macrocystic adenoma (larger)

Rare

Arises as a cystic neoplasm from the ducts

Irregular, lobulated cystic tumor with thick cellular walls

Most common primary neoplasm of the pancreas

Fatal

Involves the exocrine portion of the gland

Occur most often in 60-80 year old males

60-70% occur in the pancreas head

Signs and symptoms

US findings of loss of normal parenchyma texture,enlargement of area, tumor is hypoechoic to the liver, may result in Courvoisier syndrome/sign

S & S:  may be silent, fatal within 2 years;  pain radiating to the back or a dull, steady mid-epigastric pain, weight loss, painless jaundice, N/V, stool changes

Courvoisier’s law:  palpable mass, dilate GB

May be functional or non-functional

May be benign adenomas or malignant tumor

One-third are non-functional and 92% of those are malignant

Most common is the insulinoma

US findings of a small mass

Most common insulinoma, then gastrinoma

Lymphoma presents as a hypoechoic mass in the pancreas