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Ultrasound of the Pancreas. Wendy Blount, DVM. Free PowerPoint Templates. Landmarks for Pancreas. Right Limb – Between the right kidney and the duodenum Body - between the pylorus and the portal vein/colon Left Limb – caudal to greater curvature of the stomach

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  1. Ultrasound of the Pancreas Wendy Blount, DVM Free PowerPoint Templates

  2. Landmarks for Pancreas • Right Limb – Between the right kidney and the duodenum • Body - between the pylorus and the portal vein/colon • Left Limb – caudal to greater curvature of the stomach • Between stomach & transverse colon • In triangle between stomach, spleen, kidney Free PowerPoint Templates

  3. Image Views Right Limb (2) - right kidney, duodenum Short Axis (transverse) Long Axis (sagittal) Body (2) - gall bladder, portal vein, stomach Sagittal Transverse Left Limb (2) - stomach, spleen, left kidney Short Axis (sagittal) Long Axis (transverse) Free PowerPoint Templates

  4. Image Views Right Limb (2) - right kidney, duodenum Short Axis (transverse) Long Axis (sagittal) Body (2) - gall bladder, portal vein, stomach Sagittal Transverse Left Limb (2) - stomach, spleen, left kidney Short Axis (sagittal) Long Axis (transverse) Free PowerPoint Templates

  5. Telemedicine Videos • Left limb of the pancreas • Place probe in the left cranial abdomen • Find the triangle between: • Fundus of the stomach (transverse) • head of the spleen • Cranial pole of the left kidney (long) • Orient the probe in the sagittal plane • Fan medially to laterally • Don’t worry if you don’t see the pancreas Free PowerPoint Templates

  6. Telemedicine Videos • Left limb of the pancreas • Place probe in the left cranial abdomen • Find the triangle between: • Fundus of the stomach • head of the spleen • Cranial pole of the left kidney • Orient the probe in the sagittal plane • Fan medially to laterally • Don’t worry if you don’t see the pancreas Left limb of pancreas Left limb of pancreas Free PowerPoint Templates

  7. Telemedicine Videos • Left limb of the pancreas • Place probe in the left cranial abdomen • Find the triangle between: • Fundus of the stomach • head of the spleen • Cranial pole of the left kidney • Orient the probe in the sagittal plane • Fan medially to laterally • Don’t worry if you don’t see the pancreas Left limb of pancreas Free PowerPoint Templates

  8. Telemedicine Videos • Right limb of the pancreas • Place probe in the right cranial abdomen • Find the triangle between: • Descending Duodenum (transverse) • Right kidney (transverse) • Ascending Duodenum or Colon • (transverse) • Orient the probe in the transverse plane • Fan cranially to caudally Free PowerPoint Templates

  9. Telemedicine Videos • Right limb of the pancreas • Place probe in the right cranial abdomen • Find the triangle between: • Descending Duodenum (transverse) • Right kidney (transverse) • Ascending Duodenum or Colon • (transverse) • Orient the probe in the transverse plane • Fan cranially to caudally Right limb of pancreas Right limb of pancreas Free PowerPoint Templates

  10. Telemedicine Videos • Right limb of the pancreas • Place probe in the right cranial abdomen • Find the triangle between: • Descending Duodenum (transverse) • Right kidney (transverse) • Ascending Duodenum or Colon • (transverse) • Orient the probe in the transverse plane • Fan cranially to caudally Right limb of pancreas Free PowerPoint Templates

  11. Goals – Pancreatic Ultrasound • Identify pancreatitis in sick patients, to begin therapy that might be life saving • Assess echogenicity relative to fat • isoechoic or slightly hypoechoic relative to mesenteric fat • Echotexture may be more lobular • Normal pancreas may not be visible • very thin (mm), obscured by GI gas, isoechoic to mesenteric fat • Identify masses in the pancreas Free PowerPoint Templates

  12. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: pain at the scan site • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas, enlarged gall bladder • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites (hypoechoic halo) • Duodenal ileus and/or corrugation Free PowerPoint Templates

  13. Clifton Bradshaw – Mineola TX

  14. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites (hypoechoic halo) • Duodenal ileus and/or corrugation pancreatitis Free PowerPoint Templates

  15. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites • Duodenal ileus and/or corrugation pancreatitis Free PowerPoint Templates

  16. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites • Duodenal ileus and/or corrugation pancreatitis Free PowerPoint Templates

  17. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites • Duodenal ileus and/or corrugation pancreatitis Free PowerPoint Templates

  18. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites • Duodenal ileus and/or corrugation Tortuous bile duct and bifid gallbladder Free PowerPoint Templates

  19. Tips – Pancreatic Ultrasound • Left limb larger and easier to find in the cat • Along the greater curvature (caudal to) the stomach • Cranial to the transverse colon • Signs of pancreatitis: • Amorphous hyperechoic peripancreatic fat (steatitis) • May throw an acoustic shadow (saponification) • Hypoechoic pancreas • Tortuous common bile duct (some think normal variation) • Peripancreatic fluid or local ascites • Duodenal ileus and/or corrugation Pancreatic neoplasia metastasized to the spleen Free PowerPoint Templates

  20. Tips – Pancreatic Ultrasound • Pancreatic adenocarcinoma can resemble pancreatitis • Use a light touch when looking for the right limb near the duodenum • Pressure can displace the duodenum from the right kidney • Pressure tends to move the duodenum laterally • Ultrasound is the most sensitive test for diagnosing pancreatitis in the cat • Still only 60-80% sensitive • Sonographic changes lag 1-2 days behind symptoms Free PowerPoint Templates

  21. Pitfalls – Pancreas Ultrasound • Gain set too high will make the pancreas difficult to see • Pancreatic masses are often too small to be seen on ultrasound • Insulinoma • Adenocarcinoma • Hepatic metastasis may be the main sonographic clue • Cannot rule out pancreatitis based on normal pancreatic ultrasound • Or even not finding the pancreas at all Free PowerPoint Templates

  22. Summary • PowerPoints – Ultrasound of the Pancreas, • .pdf of PowerPoint – 1 & 6 slides per page • Pancreas Ultrasound TIPs Sheet • Video: Ultrasound of the Pancreas • Animated PowerPoint – Scanning the Pancreas

  23. Summary • Hidden slides: indications, patient preparation, landmarks, transition adjustments, video on ultrasound of the pancreas

  24. Acknowledgments Soren Boysen & Jennifer Gambino Chapter 7: Focused or COAST3 – Gastrointestinal and PancreasFocused Ultrasound Techniques for the Small Animal PractitionerEditor Greg Lisciandro John P. Graham, MVB, MSc, DVR, MRCVS Diplomate, ECVDI, Diplomate, ACVRDiagnostic Imaging in Dogs and CatsNestle Purina – Clinical Handbook Series

  25. Acknowledgments John Mattoon, Danelle Auld, Thomas Nyland Chapter 4: Abdominal Ultrasound Scanning TechniquesSmall Animal Diagnostic UltrasoundEditors Nyland and Mattoon – 3rd Edition 2014 Thomas Nyland, John Mattoon, Eric Herrgesell, Erik Wisner Chapter 8: PancreasSmall Animal Diagnostic UltrasoundEditors Nyland and Mattoon – 3rd Edition 2014

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