Pediatric Sonography- Pancreas

how does the appearance of the normal pancreas differ in children compared to adults?

panc is more homogenous and hyperechoic in kids

the normal main pancreatic duct should measure under ___mm

1

what is the common demographic affected by cystic fibrosis?

caucasians

what organs are affected by cystic fibrosis?

mainly lungs

panc

liver

kidneys

intestine

cystic fibrosis involves the exocrine glands producing an excess amount of what substance?

mucus

what is the sonographic appearance of cystic fibrosis?

hyperechoic and small panc

Small cysts and Ca2+ may be present

Liver disease and gallstones

what is the sonographic appearance of pancreatic carcinoma?

Large at presentation

Hypoechoic mass

Mets to the liver, lymph nodes, and lungs typically has occurred

is pancreatic carcinoma common in children?

no

are islet cell tumours usually functioning or non-functioning?

functioning

will functioning islet cell tumors be large or small?

small

large non-functioning islet cells tumours can cause what complication?

obstructions (due to large size)

what is the sonographic appearance of islet cell tumors?

Well circumscribed

Anechoic

Mets might be present

ultrasound is used to localized islet cell tumours, but how is it actually diagnosed?

blood work

where in the pancreas are insulinomas usually located?

body and tail

what are the clinical presentations of insulinomas?

hypoglycemia

erratic behaviour

seizures

what is the sonographic appearance of insulinoma?

small in size

hypoechoic

well defined

what are some causes of acute pancreatitis?

Blunt abdo trauma

Infections, usually viral

Drug toxicity

Hereditary

Idiopathic

what is Pathogenesis?

when pancreatic enzymes escape into surrounding tissue

what are the clinical presentations of acute pancreatitis?

N&V

Abdo pain

Fever, tachycardia, abdo distention

what is the sonographic appearance of acute pancreatitis?

enlarged edematous panc

dilated main panc duct

where can a pseudocyst form?

mostly around pancreas, but can be anywhere in abdo and pelvis

what are the signs/symptoms of a pseudocyst?

Abdo pain

Bowel/biliary system obstruction

N&V

what lab value is elevated with pseudocysts?

amylase

what is the sonographic appearance of pseudocysts?

Anechoic / TT

Sharp walls

Single or multiple

Simple or complex (internal echoes from pus or debris)

what is a complication of acute pancreatitis that is described as the disruption of panc vessels, can be lethal and may produce a large panc hematoma?

panc hemorrhage

what is the sonographic appearance of panc hemorrhage?

Inhomogenous mass

will go from anechoic to echogenic

what is a complication of acute pancreatitis that is described as a solid inflammatory mass and consists of necrotic tissue, inflammatory exudate and tissue edema?

phlegmon

what is the sonographic appearance of phlegmon?

anechoic

what pathology is an infected pseudocyst or phlegmon?

abscess

what are the signs/symptoms of a panc abscess?

Spiking fevers

Chills

Abdo pain

what is the sonographic appearance of an abscess?

Large anechoic mass in panc bed

Debris / purulent material

Thick, irregular, echogenic walls

If air present (gas forming bacteria) - shadowing

what is the treatment for a panc abscess?

percutaneous drainage

what causes chronic pancreatitis?

multiple bouts of acute pancreatitis

what is the sonographic appearance of early stage chronic pancreatitis?

less echogenic panc than liver

dilated panc duct/CBD

what is the sonographic appearance of late stage chronic pancreatitis?

shrunken echogenic panc

irregular borders

calcifications