Ultrasound examination of pancreas and spleen.

1. Lorem Ipsum Dolor
KRAGANDA STATE
MEDICAL UNIVERSITY
Topic- Ultrasound of pancrease and spleen.
Submitted by -vikas yadav

2. Lorem Ipsum Dolor
Ultrasound imaging of the abdomen uses sound waves to produce
pictures of the structures within the upper abdomen. It is used to help
diagnose pain or distention (enlargement) and evaluate the kidneys,
liver, gallbladder, bile ducts, pancreas, spleen and abdominal aorta.
Ultrasound is safe, noninvasive and does not use ionizing radiation.

3. Ultrasound of the Pancreas - Protocol
Role of Ultrasound
Always tailor your scan to the clinical signs.
Always take a thorough history including previous
cancer,diseases,blood results,family history and past surgery.
Perform an initial overall scan without imaging to get an idea what
pathology there might be and how it might relate to the patients
current complaint.
Limitations
Often you will have problems with bowel gas overlying the pancreas.
Ways to overcome this include :
Deep inspiration / expiration
Distend the abdomen against the probe. (ask the patient to push their
stomach out as if they are pregnant!)
Give the patient an oral waterload (2-3 glasses).The water is used as a
window to look through when it is in the stomach and duodenum.

4. Patient position
Generally the pancreas can be viewed with the patient supine.
Erect views may be useful if colon gas is obscuring the view.
If the patient has been given an oral waterload, a right semi-
decubitus position will displace gas away from the pancreas.
Patient Preparation
Fast for 6 hours. No food or drink.No smoking.
Preferably book the appointment in the morning to reduce bowel
gas.

5. Scanning Technique
Technique
Begin transversely, high in the epigastrum.
You may need to apply enough pressure to help displace bowel
gas.
Adjust image depth so the aorta is at the bottom of the screen.
Head of pancreas - Use both transverse & sagittal planes as the
head can be quite long and continue left caudally for several
centimeters.
Body of Pancreas - Transverse probe. Use the splenic vein to
help identify the pancreas superficial to this.
Tail of pancreas - Start with the probe transverse then angle the
heel of the probe cephalad and left as the tail can be sitting up
under the spleen. Thus the spleen can be used as a window and
a left intercostal coronal approach can also be utilised.

6. Ultrasound Appearances
Normal appearance is usually homogeneous and almost isoechoic with the
liver.
It is frequently hyperechoic compared to the liver because of fatty infiltration.
Size
• Varies with age and history.
Approximate normal
measurements are:
• Head 35mm (anterior to
posterior)
• Neck 10-15mm
• Tail 20mm

7. Common Pathology
• Adenocarcinoma
• Pseudocyst
• Pancreatitis
• Fatty change
• Insulinomas
• Pancreatic artery
aneurysm/calcification
• Cystic fibrosis
• Congenital / acquired cysts

8. Lorem Ipsum Dolor
ULTRASOUND OF THE SPLEEN - Normal

9. Ultrasound of the Spleen - Protocol
Role of Ultrasound
To assess the size, shape, texture and vascularity of the spleen.
Indications include:
Trauma
Liver disease
Malignancy

10. The size of the spleen can be
extremely variable ranging from
7cm- 14cm.
Accesory spleens or splenunculi are
common.
(singular = splenunculus)

11. Ultrasound Appearances
The spleen has a homogeneous, "inverted comma" appearance.
When it becomes enlarged it loses this shape and, as it expands, it
becomes very rounded and sometimes appears as an egg shape
extending beyond the Left kidney.
Measurement:
Normal Spleen Size
<13 cm superior to inferior axis
6-7cm in the medial to lateral axis
5 to 6cm in the anterior to posterior plane. Average volume is
approximately 350mls

12. Scanning Technique
Patient position
Start with the pt supine.
Angle the probe between the ribs intercostally from a posterolateral
approach.
Overlying bowel gas, overlying lung base or rib shadows can cause
problems. Slowly roll the patient, to improve visualistaion.
Try inspiration,expiration,distended abdomen,erect
Rarely the left lobe of the liver (if enlarged) may be used as a window
to assess to superoanterior portion of the spleen.

13. Common Pathology
Splenomegaly >12-14 cm (or Volume >500cc)and becomes rounded.
Infection- multiple echogenic foci (granulomata)
Haemangioma
Cysts
Metastases
Lymphoma
Varices - portal hypertension
Haematomas-intraparenchymal, subcapsular and pericapsular
Abscess
Splenic infarction

14. THANKYOU