Ultrasound examination (ultrasound) of the pancreas

The pancreas is located behind the small intestine and the transverse colon, below and behind the stomach, making it less accessible to palpation. You can palpate or, in other words, feel it only during a pathological process, when the gland increases in size or changes its structure. This condition is always accompanied by a vivid clinical picture and a qualified doctor will immediately be able to understand what the problem is and which organ needs to be examined.

Ultrasound or ultrasonography is the safest and most painless diagnostic method that reproduces an image of the internal parts of the body, in particular the pancreas, using sound waves. Ultrasound imaging, also called an ultrasound scan or sonography, involves the use of a small probe (transducer) and ultrasound gel that a doctor applies directly to the skin of a specific organ or system during the examination. High frequency sound waves are transmitted from the probe through the gel onto the tissue. The transducer collects the reflected sound waves and a computer program then uses them to create an image. Ultrasound examinations do not use ionizing radiation (as in fluoroscopy), so there is no radiation exposure to the patient. Since ultrasound images are captured in real time, they can show the structure and with it the movement of the internal organs as well as the blood flowing through the blood vessels.

This study is a non-invasive and reliable method of clinical diagnostics of the pancreas, which visualizes the organ in various projections, assesses the condition, structure during movements in real time. It helps therapists, surgeons, oncologists, pediatricians, gastroenterologists and many other doctors to diagnose and treat pathological processes of the pancreas in time.

Clinical signs and symptoms such as pain, weight loss, jaundice, diarrhoea, bloating or diabetes mellitus may require special attention to the pancreas. Pain is usually in the epigastric or left-sided abdominal region, which may radiate to the back. Weight loss, jaundice, and diabetes may herald malignancy in the pancreas. Ultrasonography helps to recognize solid tumors (ductal adenocarcinomas and neuroendocrine tumors) and cystic tumors (serous and mucinous neoplasms). Signs of pancreatic insufficiency, such as diarrhea or bloating, may raise the suspicion of chronic pancreatitis, especially in alcoholism or gallstone disease. The sudden onset of characteristic pain in the mesogastrium, radiating to the back, most often indicates acute pancreatitis. Ultrasonography is particularly useful in diagnosing acute disease, monitoring chronic pancreatitis, or monitoring the pancreas during treatment.

Anatomy of the pancreas

Normally, the pancreas in an adult weighs about 80 grams, has a length of 14-18 cm, a width of about 3-9 cm and a thickness of about 2-3 cm.

The pancreas is located in the retroperitoneal space, in the epigastric region, at the level of the first and second lumbar vertebrae, and has an oblong shape, approximately transverse to the midline. With various pathologies determined by ultrasound, it can have an annular, spiral, split shape, or it can have doubled separate parts, an additional lobule.

The main parts of the pancreas are the head, the body in the middle, and the tail, at the far left. The longest part of the pancreas is located to the left of the midline, and the tail near the splenic muscle is usually slightly above the head. The rather complex shape of the pancreas and its proximity to nearby structures can make it difficult to recognize, but experienced ultrasound technicians are able to use the surrounding structures to define some of the borders of the pancreas. For example, the head and body of the pancreas are located below the liver, in front of the inferior vena cava and the aorta behind the distal stomach. In the extreme left corner, the tail of the pancreas is located below the spleen and, accordingly, above the left kidney.

The pancreas has a structure of small lobules that produce enzymes for digestion, and pancreatic islets that secrete an important hormone, insulin, into the bloodstream. It is he who helps to provide energy to every cell of the human body due to its active participation in carbohydrate metabolism. Digestive enzymes or pancreatic juice takes part in the process of digestion and is excreted into the duodenum.

Indications for an ultrasound

Ultrasound examination of the pancreas is usually included in a comprehensive examination of the abdominal organs. After all, it is closely related to the functions of other internal organs, mainly with the liver. An indication for research is any pathological condition of the digestive system. Many diseases can be asymptomatic, so once a year it is necessary to conduct an ultrasound examination of the abdominal cavity for early detection of many diseases.

The most common conditions in which it is recommended to conduct an ultrasound:

• prolonged or recurrent pain, discomfort in the upper abdomen or in the left hypochondrium;
• tension of the anterior abdominal wall or local pain in the epigastric region, which was detected during palpation;
• frequent bloating (flatulence), nausea and vomiting that do not give relief;
• diarrhea (stool disorders), constipation, detection of undigested parts of food in the feces;
• the presence of subfebrile temperature for a long time;
• when observing a patient with yellowness of the skin and mucous membranes, deviations of laboratory parameters from the norm;
• with a sharp increase in blood sugar levels and an unreasonable decrease in body weight;
• after the radiography of the abdominal organs and the detection of changes in size, shape, structure, distortion of contours, detection of pneumatosis of the pancreas;
• if you suspect the presence of a cyst, tumor, hematoma, stones, abscess in the gland.

Mandatory conduct is shown for injuries of the abdominal cavity and planned operations.

Preparation for research

Ultrasound of the pancreas can be performed both in a planned manner and in an emergency in acute conditions. With a planned conduct, it is necessary to follow some rules and prepare for this procedure. After all, the most problematic in ultrasound is the presence of air in neighboring hollow organs. It is he who can interfere with a detailed study, distort visualization and contribute to an incorrect diagnosis in a patient. Doctors recommend undergoing a pancreatic diagnosis, preferably in the morning. After all, it is in this half of the day, following all the rules and recommendations, that you can get the most accurate results.

With planned diagnostics, it is necessary to follow a sparing diet three days before the date of the procedure. It is advisable to exclude foods that cause fermentation and bloating in the intestines, do not eat foods rich in fiber and whole milk. The day before the study, it is recommended to take a laxative to cleanse the stomach and intestines. Within twelve hours before the planned ultrasound examination, it is necessary to refrain from eating and drinking, to exclude the use of drugs and smoking is prohibited. Carbonated drinks should not be consumed as they cause excess gas production, which can affect the results and visualization of the ultrasound.

In case of emergency indications for ultrasound of the pancreas, the patient does not need to be prepared. But this can reduce information content by up to about 40%.

The technique of ultrasound of the pancreas

Pancreatic sonography is a completely painless, highly informative and affordable procedure for most patients. In addition, it takes very little time – about ten minutes. It is necessary to free the abdominal area from clothing, it is on this area that the doctor will apply a special gel called mediagel and conduct an examination using an ultrasound sensor. The patient should lie still, at first on his back, and later, with the permission of the doctor, turn on his right and left side, for a comprehensive examination of the pancreas. The doctor of ultrasound diagnostics examines the gland while holding the breath while inhaling to the maximum and with the patient breathing calmly. He must also decipher the results of the diagnosis and give the patient a complete conclusion and pictures of the pancreas.

During this procedure, the positions of the pancreas relative to the vessels and the spinal column, the structure of the pancreatic ducts and the gland itself, the shape and size are studied.

The doctor will immediately be able to see the compaction or swelling of the gland, the presence of calcifications, inflammation, the presence of pathological formations, cysts and pseudocysts.

If the inflammatory process has already been present for a long time, then the pancreas can significantly decrease in size, scar tissue can grow, fat deposits increase, the capsule of the internal organ thickens, and the echogenicity of the gland increases.

Normal parameters of the pancreas

On an ultrasound scan, the doctor will normally see a “sausage-like”, S-shaped pancreas. It will have clear and even edges, a homogeneous, fine-grained or coarse-grained structure, the vascular pattern will be visible on the screen without deformation, the central duct of the gland – the Wirsung duct will not be enlarged (normal – 1,5-2,5 mm). It has the appearance of a thin hypoechoic tube, may decrease in diameter in the tail and be larger in the head of the gland.

The size of this organ varies depending on the age, body weight and body fat of patients. The older the person, the less iron and the more echogenic it will be when scanning. A study was conducted in which 50% of people had an increased echogenicity of the pancreas, while in children, on the contrary, it was reduced. An indicator of a healthy pancreas is its homogeneous structure.

In an adult, the size of the head of the gland can be from 18 to 30 millimeters, the body – from 10 to 22 millimeters, and the tail – from 20 to 30 millimeters. In children, everything will depend on the height, weight and age of the child: the body is from 7 to 14 mm, the head of the gland is from 12 to 21 mm, and the tail is from 11 to 25 mm.

Ultrasound of the pancreas in various pathologies

With pancreatitis

Pancreatitis is an inflammation of the pancreas and can be easily detected with an ultrasound scan. After all, it is the acute onset of this disease that greatly affects the structure, size, and structure of the tissues of the gland. The disease proceeds in several stages and each stage, of course, will have its own characteristics.

Pancreatitis is total, focal, segmental. You can distinguish them from each other by determining the echogenicity of the organ. A change in echogenicity can be both in the entire gland, and only in a certain part of it.

At first, the pancreas will actively increase in size, the contours will be distorted, and the central duct will expand. As the gland increases, compression of large vessels will occur and the nutrition of neighboring organs will be disturbed, with an increase in echogenicity in them. The liver and gallbladder will also increase.

In the last stages of this serious disease, an experienced doctor will be able to consider when the necrotic stage progresses, the tissues of the organ will disintegrate, the presence of pseudocysts or foci with abscesses in the abdominal wall area is possible.

For benign and malignant tumors

There are many types of benign neoplasms. These are insulinomas, gastrinomas, which develop from the cells of the endocrine system. Lipomas and fibromas developing from connective tissues. There may also be tumors of a mixed type, such as neurofibroma, hemangioma, neurinoma, adenoma, and others.

It is very difficult to suspect them with ultrasound. Their characteristic features are a change in the structure and an increase in the gland.

The abnormal neoplasm has the appearance of a hypoechoic vascularized round or oval mass with an echo-inhomogeneous structure. Cancer is most often localized in the tail of the gland, the most difficult to access site for diagnosis. When the head is affected, the main clinical sign in the patient will be yellowness of the skin and mucous membranes. It develops due to a mechanical obstruction with the free release of bile into the duodenum.

It can be concluded that ultrasonography is probably the most widely used medical examination. In fact, its non-invasiveness, good tolerability, widespread use, and accurate clinical results have made it the imaging modality of choice in patients with a variety of clinical presentations.

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