Dr. Vidi Demko

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Spitali Ushtarak

 

Ass.Prof.Dr.Aqif Gjokutaj

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Qendra radiologjike "Petrit Selenica"

Qsu "NENE TEREZA" Tirane

 

Ultrasound and clinic evaluation of acute pancreatitis

Background  :  Acute Pancreatitis was defined as an acute inflammatory disease of pancreas typically causing abdominal pain and usually associated

 

with raised pancreatic enzymes in blood or urine. There is a gradation of lesion in acute pancreatitis. In the mild form, peri pancreatic fat necrosis and interstitial edema may be recognized, but gland necrosis usually is absent. The mild form may progress to a severe form with extensive peripancreatic and intrapancreatic fat necrosis, parenchymal necrosis and haemorrhage. The process may be facal or diffuse. Occasionally, there may be little correlation between the severity of the clinical features and the morphological findings. If the primary cause and complications, such as pseudocyst, are eliminated clinical, morphological and functional restitution to normal occurs in acute pancreatitis.

Acute pancreatitis takes a mild course in approximately 70-80% of patients. according to Begel et al, most patients with acute pancreatitis suffer edematous interstitial pancreatitis, which is mild self-limited disease. Approximately 20-30% of patients have more severe clinical course. Pancreatic infection and multisystemic organ failure are the primary contributors to morbidity and mortality. More than 80% of deaths resulting from acute pancreatitis are from septic complications as a consequence of bacterial infection of pancreatic necrosis.

 

Race: For unknown reasons, the rate of pancreatitis in black Americans is 3 times higher than in white Americans. Maxson et al have reported that the prevalence of acute pancreatitis among patients with AIDS is approximately 4-22 per 100 patients. This is believed to result from increased infections of the pancreas and from HIV/AIDS Medications.

 

Sex: Frequency of pancreatitis is approximately equal in men and women. In our study we have found 57% man and 43% female. Female patients tend to have pancreatitis caused by biliary stones, while alcohol abuse is the usual cause of pancreatitis in men.

 

Age: Pancreatitis is uncommon in children, with a rate of 2.7 cases per 100,000 in children younger than 15 years. The leading cause of acute pancreatitis in children is blunt trauma, which occasionally is associated with child abuse.

Age: The median age at onset depends on the etiology

The Following are median ages of onset for various etiologies:

 

Alcohol-related- 19-62 years

 

Biliary tract- related - 39-75 years

 

Trauma- related - 34-64 years

 

Idiopathic - 26-74 years

 

 

 

Ultrasonography

 

US changes in acute pancreatitis include abnormalities in the size, contour and parenchymal texture of the pancreas, abnormalities in the caliber of the pancreatic duct and ancillary findings such as retention cyst or pseudocyst. The pancreas may be normal, atrophic or focally or diffusely enlarged. Diffuse enlargement tends to be early in the course of disease, whereas focal enlargement and atrophy are late features.

 

Evaluation of parenchymal texture patterns by US is also somewhat subjective and technique-dependent and there is wide variation in the parenchymal pattern of the normal pancreas. Echo texture in acute pancreatitis ranges from normal decreased echogenicity ( in acute exacerbations with oedema ) to increased echogenicity. Changes in echogenicity may be focal or diffuse.

 

Pancreatic duct dilatation is the most specific change to be sought in evaluating patients suspected of having chronic pancreatitis. The normal pancreatic duct can be detected by US in up 60% of patients and the dilated duct can be identified in up 90%. An irregular contour of the dilated duct or of stones identified within the duct suggests acute or chronic pancreatitis, but ductal dilatation can also be Produced by neoplastic obstruction and therefore must be interpreted with caution.

 

Retention cysts or pseudocysts may be identified as echo free smooth-walled masses that are sonolucent. Although Us findings are abnormal in themajority of cases of chronic pancreatitis, the changes in many cases are nonspecific.