CHRONIC PANCREATITIS ULTRASOUND
Category: Diagnostic Radiology
Abstract : Chronic pancreatitis Patients with acute pancreatitis are at risk of repeated inflammatory episodes which eventually develop into chronic inflammation. The most common cause is alcohol abuse. In other cases, chronic pancreatitis has a gradual onset which does not seem to be associated with previous acute attacks. The normal pancreatic tissue is progressively replaced by fibrosis, which may enca
Chronic pancreatitis
Patients with acute pancreatitis are at risk of repeated inflammatory episodes which eventually develop into chronic inflammation. The most common cause is alcohol abuse. In other cases, chronic pancreatitis has a gradual onset which does not seem to be associated with previous acute attacks.
The normal pancreatic tissue is progressively replaced by fibrosis, which may encase the nerves in the coeliac plexus, causing abdominal pain, particularly post-prandially. The patient has fatty stools (steatorrhoea) due to malabsorption, as there is a decreased capacity to produce the digestive enzymes.
Diagnosis of chronic pancreatitis can be difficult, especially in the early stages. Serum enzyme levels are less elevated than in acute disease (if at all). ERCP, which detects abnormalities of the ductal system in the early stages, is increasingly contraindicated due to the risk of aggravating the pancreatitis. MRCP is promising, but is limited in assessing the smaller side ducts. Endoscopic ultrasound is currently a sensitive and accurate modality in assessing both the ductal system and the pancreatic tissue.
chronic pancreatitis ultrasound appearances
The pancreas becomes abnormally hyperechoic. This should not be confused with the normal increase in echogenicity with age. The gland may be atrophied and lobulated and the main pancreatic duct is frequently dilated and ectatic, with a beaded appearance. Calcification may be identified in the pancreatic tissue, both on ultrasound and on a plain X-ray, and there may be stones in the duct.
Generally speaking, strong shadows are cast from the calcific foci, but small flecks may be too small to shadow). As with acute inflammation, CT is the method of choice for demonstrating the complications of chronic pancreatitis. Obstruction of the duct can cause pseudocyst formation, and other complications include biliary obstruction and portal/splenic vein thrombosis.
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