1. Normal pancreas

4. Pathology of pancreas

5. 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 .

6. Acute pancreatitis Causes :-
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 )

7. Acute pancreatitis Clinical 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

8. Acute pancreatitis What is the role of ultrasound :_
The main role of U.S in cases of acute pancreatitis try to detect the cause of pancreatitis .

9. 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 .

10. 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

11. Acute pancreatitis
Enlarged edematous pancreas “P” 4cm pseudocyst “C”

12. Acute pancreatitis
The 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

13. Chronic pancreatitis Causes :-
May be occur on top of acute pancreatitis
Alcohol abuse
The normal pancreatic tissue is replaced by fibrosis .

14. Chronic pancreatitis Clinical picture :- Pain Steatorrhoea
Serum enzyme levels are less elevated than in acute disease.

15. Chronic pancreatitis Ultrasound appearance :-
Abnormally hyperechogenicity of pancreas
Atrophied and lobulation of pancreas
Dilatation of the pancreatic duct
Pancreatic calcification

16. Chronic pancreatitis
Chronic Pancreatitis, echogenic irregular appearance to the body of the pancreas

17. Pancreatic carcinoma Clinical picture
Pancreatic 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 .

18. Pancreatic carcinoma Ultrasound appearance :-
Solid hypoechoic or mixed echogenicity with an irregular border
Cystic carcinoma appear as multiseptate cystic masses with associated solid components

19. Pancreatic cysts The pancreatic cysts may be Benign pancreatic cysts
Cystic carcinoma ( rare )
Pseudocyst associated with acute pancreatitis .

20. Benign pancreatic cysts
Rare and tend to associated with other conditions as polycystic disease .
Single or multiple
Echo free small cavities filled with fluid

21. 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

22. Calcification in the pancreas
Calcification 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 .

23. Calcification in the pancreas

24. Dilatation of pancreatic duct
The 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

25. Dilatation of pancreatic duct

26. Diffuse enlargement of the pancreas
Causes :-
Acute pancreatitis
Acute on top of chronic pancreatitis

27. 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

28. Small pancreas
Old age
Chronic pancreatitis

29. Thank you