Felis ISSN 2398-2950

Ultrasonography: pancreas

Contributor(s): Andrew Holloway, Fraser J McConnell

Introduction

Uses

  • Investigation of:
    • Clinical symptoms suspicious of pancreatitis   Pancreatitis   (anorexia, lethargy, dehydration, hypothermia and signs of multiorgan disease (liver, kidney, pleural effusion)).
    • Vomiting   Vomiting  .
    • Abdominal pain.
    • Cranial abdominal mass.
    • Abdominal trauma.
    • Jaundice.
    • Ascites.
    • Fever.
    • Hypoglycemia   Hypoglycemia  /collapse.

Advantages

  • Low cost.
  • Non-invasive.
  • Short time requirement if experienced.
  • Examination possible without sedation.
  • No known biological risk.
  • Allows ultrasound guided fine needle aspiration or biopsy.
  • Allows evaluation of other organs for related problems, eg hepatic, intestinal and renal disease.
  • Time requirement will reduce with operator experience.

Disadvantages

  • Investigation is dependent on operator skill and suitability of ultrasonographic equipment.
  • Examination is poorly reproducible and remote interpretation difficult.
  • May require patient's coat to be clipped.
  • Normal sonographic appearance does not exclude disease.
  • Failure to identify pancreas does not exclude disease.
  • Gives no information on pancreatic function (especially exocrine pancreatic insufficiency   Exocrine pancreatic insufficiency  ).
  • Abnormal sonographic appearance does not always indicate significant disease.
  • Similar sonographic appearance with different diseases (ie no difference between acute pancreatic necrosis, chronic interstitial pancreatitis, suppurative pancreatitis). Differentiation of pancreatitis from neoplasia   Pancreas: neoplasia   may not be possible.

Potential problems

  • Poor transducer-skin contact:
    • Inadequate clipping.
    • Insufficient coupling medium.
  • Inadequate patient restraint.
  • Operator inexperience.
  • Excess intestinal gas.
  • Inadequate equipment. The superficial location of the pancreas in cats and may result in poor visualization of superficial structures due to near field artifacts.

Alternatives

  • Exploratory surgery for confirmation of extrahepatic bile duct obstruction   Bile duct: disease  .
  • CT   Computed tomography (CT)   (sensitivity for identifying pancreatitis is reported to be similar to that of ultrasound). Contrast enhanced CT may be more useful than ultrasound in differentiating necrotic/non-vascularized pancreatic tissue.

Equipment

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Patient preparation

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technique

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Normal anatomy

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Abnormalities

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Further Reading

Publications

Refereed papers
  • Recent references from PubMed.
  • Coleman M C & Robson M (2005) Pancreatic Masses Following Pancreatitis: Pancreatic Pseudocysts, Necrosis, and Abscesses. Compend Contin Educ Pract Vet27(2), 147-154.
  • Whittemore J C & Campbell V L (2005)Canine and Feline Pancreatitis. Compend Contin Educ Pract Vet27 (10), 766-776.
  • Monteiro C B, O'Brien R T (2004)A retrospective study on the sonographic findings of abdominal carcinomatosis in 14 cats. Vet Radiol Ultrasound45(6), 559-564 PubMed.
  • Ferreri J A, Hardam E, Kimmel S E, Saunders M,Van Winkle T J, Drobatz K J, Washabau R J (2003)Clinical Differentiation of Acute Necrotizing from Chronic Nonsuppurative Pancreatitis in Cats: 63 Cases (1996-2001). J Am Vet Med Assoc223 (4), 469-474 PubMed.
  • Saunders M H, VanWinkle T J, Drobatz K J, Kimmel S E, Washabau R J (2002)Ultrasonographic Findings in Cats with Clinical, Gross Pathologic, and Histologic Evidence of Acute Pancreatic Necrosis: 20 Cases (1994-2001). J Am Vet Med Assoc221(12), 1724-1730 PubMed.
  • Bennett P F, Hahn K A, Toal R L, Legendre A M (2001) Ultrasonographic and Cytopathological Diagnosis of Exocrine Pancreatic Carcinoma in the Dog and Cat.  J Am Anim Hosp Assoc37(5), 466-473 PubMed.
  • Mansfield C S & Jones B R (2001) Review of Feline Pancreatitis Part One: The Normal Feline Pancreas, The Pathophysiology, Classification, Prevalence and Aetiologies of Pancreatitis.   J Feline Med Surg3(3), 117-124 PubMed.
  • Mansfield C S & Jones B R (2001) Review of Feline Pancreatitis Part Two: Clinical Signs, Diagnosis and Treatment. J Feline Med Surg3(3), 125-132 PubMed.
  • Steiner J M, Williams D A, MA (1997)  Feline Exocrine Pancreatic Disorders: Insufficiency, Neoplasia, and Uncommon Conditions.   Compend Contin Educ Pract Vet19 (7), 836-849.
  • Leveille R,  Biller D S,  Shiroma J T (1996) Sonographic evaluation of the common bile duct in cats. J Vet Intern Med10(5), 296-299 PubMed.
  • Elie M & Zerbe C A (1995) Insulinoma in Dogs, Cats, and Ferrets. Compend Contin Educ Pract Vet17(1), 51-59.
  • Hawks D, Peterson M E, Hawkins K L, Rosebury W S (1992)Insulin-secreting pancreatic (islet cell) carcinoma in a cat. J Vet Intern Med6(3), 193-196 PubMed.
  • O'Brien T D, Norton F, DVM, Turner T M, Johnson K H (1990) Pancreatic endocrine tumor in a cat: Clinical, pathological, and immunohistochemical evaluation.   J Am Anim Hosp Assoc26(5), 453-457.

 


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