scholarly journals PANCREATIC STEATOSIS: A NEW DIAGNOSIS AND THERAPEUTIC CHALLENGE IN GASTROENTEROLOGY

2020 ◽  
Vol 57 (2) ◽  
pp. 216-220
Author(s):  
Jayanta PAUL ◽  
Ambalathu Veettil Hussain SHIHAZ
Keyword(s):  
Viral Infections ◽  
Incidental Finding ◽  
Fatty Infiltration ◽  
Abdominal Ultrasound ◽  
Pancreatic Disease ◽  
Abdominal Ultrasonography ◽  
Fatty Replacement ◽  
Lipomatous Pseudohypertrophy ◽  
New Diagnosis ◽  
Pancreatic Steatosis

ABSTRACT Fat infiltration in the pancreas is called pancreatic steatosis and it has several synonyms such as pancreatic lipomatosis, non-alcoholic fatty pancreatic disease, lipomatous pseudohypertrophy, fatty replacement, fatty pancreas and fatty infiltration. Pancreatic steatosis describes a disease ranging from infiltration of fat in the pancreas to pancreatic inflammation, and development of pancreatic fibrosis. There are multiple aetiologies of this condition, such as metabolic syndrome, alcohol intake, viral infections, toxins, congenital syndromes, etc. Pancreatic steatosis is usually diagnosed by trans-abdominal ultrasound, computed tomography scan and magnetic resonance imaging. Fatty infiltration in pancreas may lead to pancreatitis, diabetes mellitus and may be a predisposing cause of pancreatic cancer. Now a day, pancreatic steatosis is a common incidental finding during abdominal ultrasonography for other reasons and is a new challenge in Gastroenterology. But there is no guideline for pancreatic steatosis till now. In this review article, we are trying to give an overall idea (aetiologies, diagnosis, management, clinical significances) on pancreatic steatosis.

Feline abdominal ultrasonography: What’s normal? What’s abnormal? The pancreas

2020 ◽  
Vol 22 (3) ◽  
pp. 241-259
Author(s):  
Sally Griffin
Keyword(s):  
Ultrasound Examination ◽  
Abdominal Ultrasound ◽  
Evidence Base ◽  
Pancreatic Disease ◽  
Vital Role ◽  
Abdominal Ultrasonography ◽  
Operator Experience ◽  
High Resolution Images ◽  
Diagnostic Work ◽  
Work Up

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the pancreas is a vital part of the investigation into feline pancreatic disease. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings such as nodular hyperplasia and pathological changes such as neoplasia can be challenging. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination and appearance of the normal and diseased pancreas. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Equipment: Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.

scholarly journals Pancreatic steatosis: a giant step forward or recognition of ignorance

2020 ◽  
Vol 49 (4) ◽  
pp. 21-41
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
T. L. Mozhyna ◽  
N. E. Monogarova ◽  
K. N. Borodiy ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Fatty Infiltration ◽  
Exocrine Pancreatic Insufficiency ◽  
Point Of View ◽  
Alcoholic Fatty Liver ◽  
Enzyme Replacement ◽  
Fatty Replacement ◽  
Pancreatic Steatosis

This review analyzes the terminology of pancreatic steatosis, the data about the prevalence of non-alcoholic fatty pancreas disease (NAFPD) were given. The etiological factors of NAFPD are usually subdivided into hereditary, metabolic, and toxic ones. The main etiopathogenetic factor of pancreatic fatty infiltration is obesity: it causes pancreatic infiltration by adipocytes, leading to the development of NAFPD. The pathogenesis of the disease is associated with adipocytic tissue dysfunction, which induces local and systemic inflammatory response with corresponding clinical consequences. Insulin resistance and oxidative stress play major role in the pathogenesis of NAFPD. From a histological point of view, NAFPD is a heterogeneous process, characterized by excessive intracellular accumulation of lipids and fatty infiltration followed by fatty replacement of the pancreas. NAFPD clinical picture is asymptomatic and nonspecific. Diagnosis of NAFPD is based primarily on the results of imaging methods (ultrasound, CT, MRI). A consequence of NAFPD is exocrine pancreatic insufficiency requiring enzyme replacement therapy. One of the NAFPD complications is the development of pancreatic adenocarcinoma. Currently, standards for the diagnosis, treatment and management of patients with NAFPD have not been developed yet, but on used the guidelines for the treatment of non-alcoholic fatty liver disease (rational diet, exercises, weight loss). The “gold standard” of enzyme replacement therapy, such as Creon®, is used for correction of exocrine pancreatic insufficiency. The detailed analysis of the clinical case of total pancreatic steatosis with severe exocrine pancreatic insufficiency was done in this article.

scholarly journals PANCREATIC STEATOSIS AND ITS ASSOCIATION WITH NONALCOHOLIC FATTY LIVER DISEASE EVALUATED BY ULTRASONOGRAPHY

2015 ◽  
Vol 3 (2) ◽  
Author(s):  
Luis Jesuino De Oliveira Andrade ◽  
Laryssa Rocha Guimarães ◽  
Raissa Brito Fernandes Cadete ◽  
Hudson Sá Sodré ◽  
Paulo Roberto Santana de Melo ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Abdominal Ultrasound ◽  
Cross Sectional ◽  
Nonalcoholic Fatty Liver ◽  
Fatty Replacement ◽  
Ultrasound Findings ◽  
Pancreatic Steatosis

Introduction: Pancreatic steatosis (PS) is the fatty replacement of pancreatic parenchyma, being often associated with obesity and aging. Similar to this condition in pancreas, any excessive lipidic deposition in the liver tissue are referred to as nonalcoholic fatty liver disease (NAFLD). Objective: The objective of this study was to explore associations between PS and the NAFLD grade, as evaluated by ultrasonography. Methods: This was a cross-sectional study. Diagnosis of the PS and NAFLD was based on ultrasound findings, and 576 ultrasonography exams were evaluated. The chi-square test was used for evaluation of the relationship between PS and NAFLD. Results: A total of 576 individuals were included, 217 (or 37.7%) were male and 359 (or 62.3%) were female. The median age of the patients was 47.04 (11.8) years-old (mean ± standard error). Among them, 243 were diagnosed with PS and 245 were diagnosed with NAFLD according to the trans-abdominal ultrasound findings. There was an association between male sex and PS (P 0.012), and between female sex and NAFLD (P 0.0001). As compared to the normal group, the PS and NAFLD group was characterized by a significantly higher median age. There was also a statistically significant association between the degree of PS and the degree of NAFLD, with the following characteristics: mild PS and mild NAFLD (P 0.0001), moderate PS and moderate and severe NAFLD (P 0.0001) and between severe PS and moderate and severe NAFLD (P 0.0001). Conclusion: Our findings demonstrated that fat accumulation in pancreas is significantly correlated to NAFLD. It was also shown that the ultrasound is very resourceful when it comes evaluation of fat grade.

scholarly journals Diagnosing pancreatic steatosis in obese patients

2019 ◽  
Vol 45 (4) ◽  
pp. 30-33 ◽  
Author(s):  
A. V. Starodubova ◽  
S. D. Kosyura ◽  
E. N. Livantsova ◽  
Yu. R. Varaeva ◽  
A. A. Krasilova
Keyword(s):  
Superior Mesenteric Artery ◽  
Pancreatic Duct ◽  
Mesenteric Artery ◽  
Pancreatic Insufficiency ◽  
Fatty Infiltration ◽  
Splenic Vein ◽  
Clinical Manifestations ◽  
Triglyceride Accumulation ◽  
Fatty Replacement ◽  
Pancreatic Steatosis

Frequency of pancreatic steatosis in adults of general population is up to 35%. Causes of triglyceride accumulation in the pancreas include aging, obesity, type 2 diabetes mellitus, metabolic syndrome, hypertriglyceridemia (genetically determined or secondary one). Nomenclature by M. M. Smits is used for diagnosing, which sets out pancreatic steatosis, lipomatous pseudohypertrophy of the pancreas, fatty replacement of the pancreas, fatty infiltration of the pancreas, non-alcoholic fatty pancreatic disease, non-alcoholic pancreatic steatosis, non-alcoholic steatopancreatitis. Pancreatic steatosis usually does not have any clinical manifestations, as it is characterized by an asymptomatic course. It is diagnosed on the basis of results of imaging methods (ultrasound, computed or magnetic resonance imaging). According to the ultrasound, there are 3 degrees of pancreatic steatosis: Degree I — pancreatic echogenicity is equal to the echogenicity of adipose tissue in area of superior mesenteric artery. Pancreas is not enlarged, echogenicity is uniformly increased, contour is smooth, splenic vein, superior mesenteric artery and pancreatic duct are well-visualized; Degree II — increased echogenicity on the background of weak signal in the remote, dorsal part of the pancreas (reduced acoustic signal conductivity, attenuation of the ultrasonic signal behind the posterior surface of the pancreas), indistinct edges of splenic vein and pancreatic duct with almost non-visualized area of superior mesenteric artery; Degree III — reduction of ultrasound conductivity of the pancreas, undulating (convoluted), indistinct contours, splenic vein, area of superior mesenteric artery and pancreatic duct are not visualized. Main feature of the pancreas lesion in obesity is the absence of changes in biochemical indices or their minor changes. Exocrine and endocrine pancreatic insufficiency, hyperlipidemia may develop.

scholarly journals Feline abdominal ultrasonography: what’s normal? what’s abnormal? The adrenal glands

2021 ◽  
Vol 23 (1) ◽  
pp. 33-49 ◽  
Author(s):  
Sally Griffin
Keyword(s):  
Adrenal Glands ◽  
Ultrasound Examination ◽  
Abdominal Ultrasound ◽  
Evidence Base ◽  
Vital Role ◽  
Abdominal Ultrasonography ◽  
Operator Experience ◽  
High Resolution Images ◽  
Clinically Significant ◽  
Diagnostic Work

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Equipment: Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.

scholarly journals Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

2017 ◽  
Vol 44 (6) ◽  
pp. 626-632 ◽  
Author(s):  
Flávia Helena Barbosa Moura ◽  
José Gustavo Parreira ◽  
Thiara Mattos ◽  
Giovanna Zucchini Rondini ◽  
Cristiano Below ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Abdominal Ultrasound ◽  
Physical Exam ◽  
Trauma Patients ◽  
Abdominal Injuries ◽  
Hemodynamic Stability ◽  
Abdominal Ultrasonography ◽  
Clinical Criteria ◽  
Clinical Variables ◽  
Abdominal Lesions

ABSTRACT Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

Tonic Pupil

2019 ◽  
pp. 199-204
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Viral Infections ◽  
Incidental Finding ◽  
Eye Drops ◽  
Sphincter Muscle ◽  
Management Options ◽  
Orbital Surgery ◽  
Fisher Syndrome ◽  
Tonic Pupil ◽  
Pupil Reaction ◽  
Characteristic Features

A tonic pupil is caused by a lesion affecting the postganglionic parasympathetic innervation of the pupil. It can be an incidental finding on examination or associated with visual symptoms, such as photophobia. In this chapter, we begin by briefly reviewing the differential diagnosis of photophobia. We next review the characteristic features of tonic pupil, which include poor pupil reaction to light, segmental palsy of the iris sphincter muscle, accommodation palsy, and tonic pupil reaction to near. We then review the causes of tonic pupil, which include viral infections, trauma, orbital surgery, or neurologic diseases, such as Miller Fisher syndrome. We then go on to discuss the clinical features, diagnostic evaluation, and prognosis of idiopathic tonic pupil, which is also known as an Adie pupil. Lastly, we briefly discuss the management options for tonic pupil, which include use of sunglasses and dilute pilocarpine eye drops.

scholarly journals Trans-abdominal ultrasonic findings correlated with CD4+ counts in adult HIV-infected patients in Benin, Nigeria

2009 ◽  
Vol 13 (2) ◽  
pp. 34 ◽  
Author(s):  
B O-E Igbinedion ◽  
T T Marchie ◽  
E Ogbeide
Keyword(s):  
Abdominal Ultrasound ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Abdominal Ultrasonography ◽  
Cd4 Counts ◽  
Splenic Parenchyma ◽  
Ultrasound Findings ◽  
The Common ◽  
Classification Index ◽  
The University

Objective: The objective of this study is to document the abdominal ultrasound findings in HIV infected patients and compare it with their CD4+ count. Patients and method: 300 confirmed HIV positive patients had abdominal ultrasonography done at the University of Benin Teaching Hospital from November 2007 to January 2008. Each patient’s sonographic findings were correlated with their CD4+ category using the WHO’s HIV classification index. Result: Splenomegaly, hepatomegaly, renomegaly, hyperechoic splenic parenchyma, increased renal echogenicity and lymphadenopathy are among the common sonographic findings. However, few of these findings correlated statistically with the CD4+ count. Conclusion: The versatile diagnostic tool, ultrasound, should continue to be an important imaging equipment in several impoverished communities. In the evaluation of HIV infected patients, its use is invaluable and should be promoted.

Pancreatic injury, genetic variation of PNPLA3, and risk of pancreatic cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 141-141
Author(s):  
Mohammed Aly ◽  
Ibrahim Halil Sahin ◽  
Donghui Li ◽  
Mohamed Fahd Khalil ◽  
Ping Chang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Liver Cancer ◽  
Fatty Liver ◽  
Genetic Susceptibility ◽  
Fatty Infiltration ◽  
A Genome ◽  
Increased Risk ◽  
History Of ◽  
History Of Obesity ◽  
Pancreatic Steatosis

141 Background: Similar to primary liver cancer, obesity, diabetes mellitus and hepatitis B virus infection have been associated with increased risk of pancreatic cancer (PC) development. A genome-wide association study has reported that a polymorphic variant of the patatin-like phospholipase domain containing 3 (PNPLA3) gene was associated with a higher susceptibility to fatty liver and liver cancer. The relationship between this variation and PC has not been previously examined. We investigated the correlation in the degree of organ damage between the liver and the pancreas in patients with PC. In addition, we examined the effect of PNPLA3genetic variation (rs738409: C>G) on PC development. Methods: Using resources of our case-control study in MD Anderson Cancer Center, we analyzed 544 pathologically confirmed PC patients and 498 healthy controls. Cases and controls were frequency matched by age, gender, and race. Multivariate logistic regression analysis was performed to adjust for the confounding factors. Medical records of PC patients were reviewed for pancreatic and liver fatty changes. Results: We found that 18.8% of PC patients had evidence of pancreatic steatosis, fibrosis, or pancreatitis. Fatty liver was observed in 14.5% of PC patients which was frequently detected in patients with pancreatitis (p=0.002). A significant correlation between pancreatitis and cirrhosis was observed in PC patients with a prior history of obesity but not in patients without a history of obesity (p=0.001). On the other hand, we observed no significant association between PNPLA3 genotype and risk of PC. The adjusted odds ratio (OR) was 1.4 (95% confidence interval [CI], 0.7-2.7) for the homozygous variant GG genotype compared with the CC/CG genotypes. Conclusions: We concluded that despite the similarities between the liver and the pancreas, genetic susceptibility to fatty infiltration and its effect on cancer development may differ between the two organs. Evaluation and assessment of nonalcoholic fatty pancreatic disease (NAFPD) in PC patients and genetic susceptibility of NAFPD may be warranted in future research.

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