Image Based Questions On Pancreas

Signs in Acute Pancreatitis 

Cullen's sign: Periumbilical Ecchymosis (bluish discoloration around umbilical region) · Grey-Turner's Sign: Flank Ecchymosis · Fox Sign: Ecchymosis in the Inguinal Region.

X- Ray Signs of Acute Pancreas 

Acute pancreatitis can lead to ileus which can be generalized or localized and most of the X-ray signs are because of ileus · Various signs include - Gasless Abdomen, Ground Glass appearance, Sennel Loop: Localized ileus involving duodenum or proximal part of jejunum.

CECT Findings in Acute Pancreatitis

Edematous pancreas, Peripancreatic inflammatory changes, Fluid collection. Sometime associated with necrosis k/a Pancreatic necrosis, initially it is sterile and sometimes it is infected. So on CT you can find presence of air in the form of impacted gas bubbles.

Diagnosis – USG of Pseudocyst of Pancreas 

On USG you can see a Cystic lesion in relation to pancreas · IOC for diagnosis of Pseudocyst is CEC.

CECT Findings of Pancreatic Pseudocyst

On CECT you can see there is close relation between anterior wall of cyst and posterior wall of stomach. · Preferred Surgery is Cysto-gastrostomy · TOC is Cysto-Jejunostomy.

Diagnosis: Chronic Pancreatitis

Triad of chronic pancreas include Diabetic mellitus + Pancreatic calcification + Steatorrhea (DPS) · It is the combination of exocrine insufficiency + endocrine insufficiency and permanent radiological change.

X-Ray finding of chronic pancreas. You can notice presence of stones and calcification in relation to pancreas.

CT finding of chronic pancreas. In relation to pancreas you can see calcification.

ERCP findings: · On ERCP you can find Beaded appearance aka Chain of lakes appearance aka String of pearl appearance · IOC for diagnosis in chronic pancreas = MRCP (changes in ducts are visualized nicely) · Gold standard investigaon = ERCP because it is both diagnostic and therapeutic.

Also Read: Biliary Tree Pathophysiology & Investigations

Diagnosis: Intraductal Papillary Mucinous Neoplasm

Characteristic appearance of IPMN is Mucus extruding through fish mouth papillary orifice Radiological Signs of carcinoma Pancreas · In carcinoma head of pancreas - Widening of 'C' loop, Double duct sign., Antral pad sign, Reverse '3' sign of Frostberg · Rose thorning of medial wall of 2nd part of duodenum – Because of puckering of medial wall · Scrambled egg appearance – Because of mucosal irregularity · Double contour of medial border of duodenum.

In the below ERCP image. Both pancreatic duct as well as bile duct are visualized separately so k/a Double duct sign seen in Carcinoma head of pancreas.

In the below image - barium study, you can notice splaying of Antral fold k/a Antral pad sign seen in Carcinoma head of pancreas.

In the below  barium study, you can see reverse '3' sign of Frostberg. [The inflammatory changes are marked over the medial part of 2 part of duodenum].

Diagnosis: Necrolytic Erythema Migrants 

These are Migratory Erythematous lesions with central necrosis · This is the most common symptom of Glucagonoma aka [4D] syndrome - Diabetes Mellitus,  Dermas i.e. NEM and it is the M/C symptom of Glucagonoma , DVT,  Depression.

Also read: High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

Hope you found this blog helpful for your GIT, Hepatobiliary and Pancreatic Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.