Pancreas

Acute Pancreatitis

• Pancreas is one of the fattier organs in the body

• Typically the pancreas appears hyper-echoic (bright) on ultrasound because it contains a lot of fat. (remember in hepatic steatosis the liver also appears bright on US). So in acute pancreatitis the pancreas will appear hypo/iso-echoic (dark) as there will be edema within and around the pancreas which makes it dark as fluid appears dark on US.

Pancreas US

• Typically bad to diagnose anything

• Pancreatic duct dilatation

  • Pancreatic duct > 3mm

    • Needs follow up CT or MRCP

  • Double duct sign

    • Abnormally dilated pancreatic and biliary duct = no bueno = concern for mass —> get CT

• Pncreatitis

  • US typically just to look for cause, specially a stone

  • Pancreas will have decreased echogenicity than normal due to the edema - pancreas normally very echogenic

  • Pay close attention to portal and splenic vein for thrombosis

  • Pancreatic necrosis —> pancreas will appear hyperechoic

Solid and Pseudopapillary Neoplasma (SPEN)

• Well defined

• Typically in tail of pancreas

• Hypoechoic on US

• Solid mass with hemorrhagic and necrotic focus

• Low risk but still some risk of malignancy

• Women, <35

Cystic Fibrosis

• Typically atrophic fatty pancreas

• Can also have numerous pancreatic cysts sometimes with calcs

  • But in a young person they should not have chronic pancreatitis already

• Biliary manifestations

  • Micro-gallbladder, I mean really fucking small

  • PSC appearance of the biliary ducts

• Distal intetsinal obstruction

• Absence of seminal vesicles in males

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