PANCREATITISUltrasound Rotation Presentation

Missy Purcell3/5/10

The Pancreasa brief overview…

The pancreas has both endocrine and exocrine functions Exocrine pancreas is made up of pancreatic

acinar cells and a duct system that opens into the proximal duodenum

Acinar cells synthesize and secrete digestive enzymes that are essential to digestion

The exocrine pancreas also secretes large amounts of bicarbonate, which buffers gastric acid

Pancreatitis

Pancreatitis is the most common exocrine pancreatic disease in both dogs and cats

Acute or chronic depending on whether or not the disease has lead to permanent changes in the pancreatic parenchyma

Either one can be severe and associated with pancreatic necrosis and systemic complications

Not always important to distinguish between the two

Pancreatitis

Many causes but most cases are idiopathic

Many different insults lead to pancreatitis by the same mechanism Secretion of pancreatic juice initially

decreases This is followed by localization of zymogen

granules and lysosomes, leading to the activation of tripsinogen

Tripsinogen activates more tripsinogen and other zymogens

Pancreatitismechanism continued…

Prematurely activated enzymes lead to local damage of the exocrine pancreas with pancreatic edema, bleeding, inflammation, necrosis, and peripancreatic fat necrosis

Inflammatory process leads to the recruitment of WBC and cytokine production

Activated enzymes and cytokines circulate in the bloodstream and lead to distant complications Inflammation, DIC, multiorgan involvement or

even failure

Pancreatitisclinical signs

Most common clinical signs in dogs include Vomiting, diarrhea, weakness, abdominal pain

Most common clinical signs in cats includelethargy, anorexia, dehydration, hypothermia, and abdominal pain

PancreatitisWhat to look for

In dogs a history of dietary indiscretion combined with vomiting and abdominal pain is suggestive, but most cats present with nonspecific histories and clinical sings

CBC, CHEM may suggest inflammatory changes, or show non specific changes in enzymes

PancreatitisDiagnostics

Imaging! ( you knew I would get to it sooner or later !)

Radiographic changes Ultrasound changes

PancreatitisImaging

Radiographic findings Both acute and chronic pancreatitis, as well as pancreatic

neoplasia can result in changes visible on survey abdominal radiographs. Potential radiographic signs include: 1. Loss of abdominal detail, primarily in the right cranial abdomen, due to focal peritonitis 2. Mass effect in the right cranial abdomen 3. Displacement of the pylorus cranially, or to the left 4. Ventral or right sided displacement of the descending duodenum 5. Caudal displacement of the transverse colon 6. Bowel loops adjacent to the pancreas (usually duodenum) may be gas-filled (ileus), or corrugated/spastic in appearance

PancreatitisRadiographs

Radiographs may also be normal in dogs and cats with clinical signs of pancreatitis

Diagnosis based on radiographs is unreliable

PancreatitisUltrasound

Abdominal ultrasound has become the imaging modality of choice to help diagnose pancreatitis

Abdominal ultrasound may be completely normal in animals with pancreatitis

Changes in ultrasound images may include: Pancreatic enlargement and fluid accumulation

around the pancreas, changes in echogenicity (hyper incases of fibrosis, hypo incases of necrosis), pancreatic mass effect, hyperechogenicity of surrounding fat, dilated panceatic duct

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The End!