PANCREAS

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PANCREAS

• Shaila Sheth

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Normal Pancreas
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Location of the Pancreas

• Pancreas is a retroperitonial organ extending
  from the hilum of the spleen to the duodenum
• It is found posterior to the stomach
• Pancreas has variable lie, but usually oblique
• Pancreas can be viewed longest in the transverse
  plane

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The Pancreas

• The pancreas has both endocrine exocrine
  functions
• Endocrine function produces the hormone insulin
• Exocrine function aids in digestion by producing
  pancreatic enzymes

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Patient Preparation

• The patient should be NPO for 8-12 hours prior to
  exam to reduce stomach bowel gas

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Patient Positioning

• Patient should be in supine or decubed position
• Use any patient position that helps to get the
  desired results

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Transducer Selection

• 3.0 or 3.5 MHz. transducer should be used
• 5.0 MHz for thin patient

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Sonographic Appearance

• Pancreas is homogenous, medium-level echoes with
  even texture
• It is equal or more echogenic than liver
• With age pancreas becomes more echogenic
• Normal pancreas should have smooth contour
• Pancreas is not encapsulated, and therefore
  difficult to evaluate its contour

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Breathing Technique

• Deep breaths and pushing the stomach out are the
  common tecniques usd to scan pancreas

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Scanning the Pancreas

• The pancreas is 15 to 20 cm long
• Pancreas is divided into 5 parts the head,
  uncinate process, neck, body, and the tail
• There are 2 ducts in the pancreas the Duct of
  Wirsung or the Pancreatic Duct the Duct of
  Santorini

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Imaging the Pancreas

• Pancreas is view in its longest in the transverse
  plane
• Start at the midline, inferior to the xiphoid
  process
• Angle the transducer superiorly inferiorly
• To see the pancreas in its entirety
• Start with the head and move laterally to the
  left to see each part, ending with the tail
• Scan through entire image from superior to
  inferior medial to lateral before you start
  taking images
• Adjust the TGC, Focal Zone, Depth as needed

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Landmarks of the Pancreas

• The SMA is posterior to the pancreas
• The Splenic Vein is posterior to the pancreas
• IVC, LRV, Aorta are also posterior to the
  pancreas

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Transverse pancreas with SV, SMA, IVC, Aorta
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GDA lies anterolateral border of head CBD lies
at the posterolateral border of the head
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Transverse pancreas head lies right of the SMV
anterior to the IVC
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Transverse Pancreas Body Tail
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Transverse Pancreas body lies anterior to the SV
left of the neck. Tail lies left to the
pancreas body, anterior to the SV, extends
towards the left lateral to the splenic hilum
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Tansverse Pancreas neck lies anterior to the SMV
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Transverse Pancreas Tail
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Transverse pancreas uncinate process is the
medial portion of the head that lies posterior to
the SMV. Its size varies.
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Sagittal pancreas with splenic vein, hepatic
artery, splenic artery
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Long pancreas with Aorta in long as a landmark
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Sagittal pancreas with left lobe of the liver and
long Aorta
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Scanning Tips

• If the pancreas is difficult to visualize, try to
  give the patient some water to drink to move the
  gas away, then try it again
• You can also have patient sit up and try to scan
  the pancreas
• Compare the tissue of the pancreas to that of the
  liver. The pancreas should be more echogenic

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Normal Pancreas
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The End