pancreas

Pancreas Anatomy and Function

  • The pancreas is an important organ with both exocrine and endocrine functions.

Congenital Anomalies

  • Agenesis: Absence of body and tail, hypertrophy of head.

  • Pancreas divisum: Dorsal and ventral duct systems fail to fuse.

  • Annular pancreas: Pancreas surrounds the duodenum.

  • Ectopic pancreatic tissue: Occurs in various gastrointestinal locations.

Laboratory Values

  • Serum amylase: Elevated in acute pancreatitis (remains elevated for 24 hours).

  • Urine amylase: Elevated longer than serum amylase in acute pancreatitis.

  • Serum lipase: Elevated in pancreatitis and persists for up to 14 days.

  • Glucose: Normal fasting ≤100 mg/dL; increases with severe diabetes mellitus.

Acute Pancreatitis

  • Inflammation caused by leakage of enzymes.

  • Common causes: Biliary obstruction, alcoholism, trauma.

  • Clinical findings: Abdominal pain, fever, nausea, elevated amylase and lipase.

  • Complications: Pseudocyst, abscess, pancreatic necrosis.

  • Sonographic findings: Edema, focal or diffuse hypoechoic areas, possible dilated duct.

Pancreatic Pseudocysts

  • Accumulation of fluid and necrotic debris, often a result of acute pancreatitis.

  • High amylase content; sonographically appear as anechoic masses.

Chronic Pancreatitis

  • Irreversible damage due to repeated inflammation.

  • Causes: Alcoholism, congenital defects, trauma.

  • Clinical findings: Often asymptomatic, can have pain and jaundice.

  • Sonographic findings: Heterogeneous, echogenic gland, calcifications, possible pseudocysts.

Pancreatic Adenocarcinoma

  • Most common pancreatic malignancy; usually found in the head of the pancreas.

  • Clinical findings: Weight loss, jaundice, pain, nausea.

  • Sonographic findings: Hypoechoic mass, may require Whipple procedure for treatment.

Pancreatic Cystadenomas

  • Commonly found in body/tail; Serous cystadenoma is benign, Mucinous cystadenoma may be malignant.

Islet Cell Tumors

  • Include insulinomas (benign) and gastrinomas (malignant).

  • Appear as small, hypoechoic masses on ultrasound.

Pancreatic Cysts

  • Rare benign true cysts, associated with conditions like polycystic disease.

Focal Fatty Sparing

  • May appear hypoechoic in the uncinate process; a normal variant and not a mass.