Often you will have problems with bowel gas overlying the pancreas.

Ways to overcome :

• Inspiration
• Expiration
• Distend the abdomen against the probe(ask the patient to push their stomach out as if they are pregnant!)
• Give the patient water (2-3 glasses).The water is used as a window to look through when it is in the stomach and duodenum.
• Scan with the patient erect.

Ultrasound Appearance:
Normal appearance is usually homogeneous. It is frequently hyperechoic compared to the liver because of fatty infiltration.

Imaging:
Head of pancreas - Use both transverse & sagittal planes as the head can be quite long and continue 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 coronal approach can also be utilised.

Pathology:

• Adenocarcinoma
• Pseudocyst
• Pancreatitis
• Fatty change
• Insulinomas
• Pancreatic artery aneurysm/calcification
• Cystic fibrosis
• Congenital cysts

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