Pancreas ultrasound: preparation,interpretation of results, causes of deviations

Update: December 2018 Into the plan of the annual survey after
25 years of age includes ultrasound of the internal organs (sonography),
including pancreatic ultrasound. This is not a simple formality.
since an outwardly healthy person can be identified in this way
various diseases. In addition, there are certain
indications for ultrasound.

The role of the pancreas in the human body can not be overestimated. It is in her
the hormone insulin is synthesized, which is responsible for glucose uptake
by cells. Through this process, the body is provided
energy, so necessary for the normal life of all
organism.

Pancreatic enzymes are formed in the pancreas,
contributing to the splitting of food into simple components,
recyclable. If this circuit fails, the process is disturbed.
digestion.

Indications for pancreas ultrasound

Clinical indications for the procedure: УЗИ поджелудочной железы, показания, подготовка

  1. Pain in the abdomen in the left hypochondrium, in the stomach, in the left
    side.
  2. Dyspeptic symptoms, frequent abdominal distention.
  3. Violations of the stool (constipation, diarrhea), detected in the analysis of feces
    undigested food residue.
  4. Unexplained weight loss.
  5. Dull abdominal trauma.
  6. Diabetes mellitus of any type.
  7. Yellowing of the skin and mucous membranes.
  8. Suspected tumor.

Preparation for the study

How to prepare for ultrasound? Iron is located near
stomach and intestines. Gases that accumulate in these organs
can significantly complicate the interpretation of the results.
The contents of the intestine – food lump, stool when applying
on the image obtained by ultrasound, also smear the picture.

The main task of the preparatory stage is as good as possible.
clean the intestines, reduce flatulence to a minimum. For her
during the preparation for the ultrasound of the pancreas
glands need to follow a few simple rules:

  • The night before (around 18.00), before conducting the study
    put a cleansing enema. For this you need an Esmarkh mug and
    1.5-2 liters of water at room temperature. The tip is greased in bold
    cream or vaseline and inserted into the anus. When raising a mug
    Esmarkh fluid from it according to the laws of physics moves into the intestines and
    fills it. When setting the enema should delay the exit
    fluid outward by arbitrary compression of the anal sphincter.
    After that, the patient goes to the toilet where the emptying takes place.
    intestine.

You can achieve the release of the intestine in another way: using
laxative drugs like senade (2-3 tablets), forlax,
Fortrans (1 bag per glass of water), guttalaks (15 drops) or
mikroklizm Mikrolaks, Norgalaks. Lactulose-based medications
(Duphalac, Normaze, Prelaksan) as a laxative before
preparation for ultrasound does not apply, as they stimulate
gas formation. This will make it difficult to interpret received
results.

  • The study should be carried out on an empty stomach (no earlier than after 12
    hours after meals), preferably in the morning. It is proved that it is in
    the morning hours in the intestines is the least amount
    gases.

In the presence of insulin-dependent diabetes mellitus after injection
insulin cannot be left without food. It may
provoke a hypoglycemic state up to entering
to whom To prevent this from happening, an ultrasound recording is made in the early
the morning hours while the insulin injection is shifted by a time after
examinations so that nothing interferes with food intake. With
diabetes can also conduct a study after lung
breakfast

  • To reduce gas formation in 2-3 days before the planned
    research should take drugs like espumizan,
    meteospamil or sorbents (activated carbon, enterosgel,
    smekta).
  • 2-3 days before the study, do not drink carbonated drinks,
    beer, champagne, as well as products that promote fermentation,
    increased gas formation (black bread, pulses, milk and
    dairy products, sweets, flour, vegetables and fruits). It is impossible
    drinking alcohol. It is allowed to eat lean types of meat, fish,
    porridge on the water, boiled eggs, white bread. Meals during this period are not
    should be abundant.
  • It is impossible курить, жевать жвачку, сосать леденцы, пить за 2 часа
    before the study, as this may occur
    involuntary swallowing of air, and the air bubble of the stomach
    будет мешать правильному считыванию results.
  • You must inform the doctor about all medications that
    the patient is constantly taking in connection with existing diseases.
    Some of them may have to be temporarily canceled.
  • Must pass at least 2 days after examining the organs.
    abdominal cavity (radiography, irrigoscopy) with contrast
    a substance such as barium. This time is enough to
    контраст полностью вышел из organism. If you conduct a study
    earlier, an ultrasound will show a barium-filled organ that
    will close the pancreas.

In emergency cases, ultrasound is performed without prior
preparation. The information content of the data this is reduced by
40%.

Procedure Procedure

The manipulation itself takes 10-15 minutes. The patient lies down on
solid flat surface, usually a couch, first on the back,
then on the side (right and left). A special gel is applied to the abdomen,
providing a sliding sensor and amplifying ultrasonic
permeability. The specialist leads the sensor in the stomach in the projection of the pancreas. AT
this time on the screen of the ultrasound machine appears a series of images.

Interpretation of indicators

Decoding the results of ultrasound of the pancreas is carried out by
specific pattern. It should include information about the structure
organ, its location, shape, echogenicity, contours, sizes.
Norm ultrasound of the pancreas:

  • S – figurative form;
  • homogeneous structure, single inclusions 1,5 – 3 are permissible
    mm;
  • pancreas echogenicity is close to liver and spleen echogenicity;
  • the contours of the body are clear;
    components of the pancreas (head, neck, body, tail);
  • pancreas size according to ultrasound is normal in adults:
    head 32 mm, body 21 mm, tail 35 mm, diameter of duct 2 mm.

ATсе эти сведения врач оформляет в виде заключения УЗИ, которое
along with the images then backed up in an outpatient card or
case history. Slight deviations of indicators in that
or other side.

Duplex scanning helps to see the state of the blood vessels.
located near the pancreas. Using this method you can evaluate
blood flow in the inferior vena cava, in the superior mesenteric artery and vein,
celiac trunk and splenic vein.

Особое значение имеет состояние протока ПЖ (ATирсунгова протока).
With нарушении его проходимости возникает подозрение на воспаление
pancreas (pancreatitis), swelling of the pancreatic head.

Ultrasound for pancreatitis

Ultrasound in inflammation of the pancreas has a different picture in
depending on the stage of the disease. There are 3 known forms of pancreatitis:
total, focal and segmental.

  • AT начале патологии отмечается: увеличение размеров железы,
    появляется нечеткость, размытость контуров, расширение ATирсунгова
    duct.
  • Changes can also affect nearby organs.
    There is an increase in their echogenicity (increase in density for ultrasound
    waves).
  • Due to the increase in the size of the pancreas are compressed
    main vessels, which is well traced in duplex
    examination.
  • With переходе панкреатита в некротическую стадию образуются
    pseudocyst pancreas.
  • AT запущенных случаях образуются абсцессы с уровнем жидкости в
    abdominal cavity.

With хроническом воспалительном процессе с помощью УЗИ удается
detect calcified sites (calcinates) in the pancreas
gland. They are defined as high density areas. With
With prolonged inflammation, glandular tissue is replaced by
connective, scars are formed. Using ultrasound can reveal
overgrowth of adipose tissue in the pancreas – lipomatosis.

Ultrasound for pancreatic tumors

With новообразованиях ПЖ прежде всего изменяется эхогенность
organ, visible areas of compaction with uneven, uneven contours.
In the picture they are defined as light formations of a rounded shape.
According to the ultrasound can determine the size and location of the tumor. With
tumors of the pancreas may occur changes in other
organs. Therefore, ultrasound examination of the pancreas is carried out most often together
with ultrasound of other organs (liver, gallbladder, spleen). So,
for example, if a pancreatic head tumor occurs, blockage (obturation) occurs
biliary tract and mechanical jaundice develops. With этом
there is an increase in the size of the liver, gallbladder.

Determine the nature of the neoplasm (it is benign or
malignant) by ultrasound impossible. This requires to hold
histological examination of the tumor. To this end, held
biopsy – a small piece of tissue is pinned from the neoplasm,
A slice is prepared and examined under a microscope.

In addition to the tumor, ultrasound can detect the presence of stones
cysts of the pancreas, anomalies of the structure (doubling, splitting, changing shape)
and location.

The most common malformations of the pancreas,
diagnosed by ultrasound

  1. Total or partial hypoplasia (agenesis) of the gland. On ultrasound
    орган не визуализируется  или определяется в зачаточном
    condition. Absolute agenesis is not compatible with life. With такой
    pathology is the death of a child at an early age. Partial
    agenesis combined with diabetes mellitus, congenital anomalies
    heart structure, pancreatitis.
  2. Ring-shaped pancreas – pancreas covers
    The duodenum is in the form of a ring. Often combined with chronic
    панкреатитом, непроходимостью intestine.
  3. Anomalously (ectopically) located pancreatic sites
    glands. Such fragments are found in the stomach and 12-perstnoy
    the gut.
  4. Dividing the pancreas is obtained as a result of a fusion violation
    rudiments of pancreas. Due to impaired digestive enzyme outflow
    accompanied by chronic pancreatitis.
  5. Common bile duct cysts on ultrasound are defined as areas
    low echogenicity round shape. They look in the picture more
    darker than the pancreas tissue.
  6. Calcinates – white round formations with clear contours in
    pancreas fabric.

Результат УЗИ ПЖ  оценивают совместно с данными
laboratory research and clinical picture.

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