Ultrasound, Pancreas

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Ultrasound, Pancreas

Synonym/acronym: Pancreatic ultrasonography.

Common use

To visualize and assess the pancreas toward diagnosing disorders such as tumor, cancer, obstruction, and cysts. Also used as a tool for biopsy and to evaluate the effectiveness of therapeutic interventions.

Area of application

Pancreas and upper abdomen.

Contrast

Done without contrast.

Description

Ultrasound (US) procedures are diagnostic, noninvasive, and relatively inexpensive. They take a short time to complete, do not use radiation, and cause no harm to the patient. High-frequency sound waves of various intensities are delivered by a transducer, a flashlight-shaped device, pressed against the skin. The waves are bounced back off internal anatomical structures and fluids, converted to electrical energy, amplified by the transducer, and displayed as images on a monitor. US is often used as a diagnostic and therapeutic tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration. The contraindications and complications for biopsy and fluid aspiration are discussed in detail in the individual monographs.

Pancreatic US is used to determine the size, shape, and position of the pancreas; determine the presence of masses or other abnormalities of the pancreas; and examine the surrounding viscera. Pancreatic US is usually done in combination with computed tomography (CT) or magnetic resonance imaging (MRI) of the pancreas.

This procedure is contraindicated for

    N/A

Indications

  • Detect anatomic abnormalities as a consequence of pancreatitis
  • Detect pancreatic cancer, as evidenced by a poorly defined mass or a mass in the head of the pancreas that obstructs the pancreatic duct
  • Detect pancreatitis, as evidenced by pancreatic enlargement with increased echoes
  • Detect pseudocysts, as evidenced by a well-defined mass with absence of echoes from the interior
  • Monitor therapeutic response to tumor treatment
  • Provide guidance for percutaneous aspiration and fine-needle biopsy of the pancreas

Potential diagnosis

Normal findings

  • Normal size, position, contour, and texture of the pancreas

Abnormal findings related to

  • Acute pancreatitis
  • Calculi
  • Pancreatic duct obstruction
  • Pancreatic tumor
  • Pseudocysts

Critical findings

    N/A

Interfering factors

  • Factors that may impair clear imaging

    • Attenuation of the sound waves by the ribs, which can impair clear imaging of the right lobe of the pancreas
    • Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status
    • Gas or feces in the gastrointestinal (GI) tract resulting from inadequate cleansing or failure to restrict food intake before the study
    • Retained barium from a previous radiological procedure
  • Other considerations

    • Failure to follow dietary and fluid restrictions and other pretesting preparations may cause the procedure to be canceled or repeated.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing pancreatic function.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s gastrointestinal system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hr between administration of barium and this test.
  • Endoscopic retrograde cholangiopancreatography, colonoscopy, and CT of the abdomen, if ordered, should be scheduled after this procedure.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a US department, usually by a health-care provider (HCP) specializing in this procedure, with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Instruct the patient to fast and restrict fluids for 8 hr prior to the procedure. Protocols may vary among facilities.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that food and fluids have been restricted for at least 8 hr prior to the procedure.
  • Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Instruct the patient to void and change into the gown, robe, and foot coverings provided.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Ask the patient to remain still throughout the procedure because movement produces unreliable results.
  • Place the patient in the supine position on an examination table. The right- or left-side-up position may be used to allow gravity to reposition the liver, gas, and fluid to facilitate better organ visualization.
  • Expose the abdominal area and drape the patient.
  • Conductive gel is applied to the skin, and a transducer is moved over the skin to obtain images of the area of interest.
  • Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • When the study is completed, remove the gel from the skin.
  • Instruct the patient to resume usual diet and fluids, as directed by the HCP.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include amylase, cancer antigens, CT abdomen, CT pancreas, C peptide, ERCP, KUB study, laparoscopy abdominal, lipase, MRI abdomen, MRI pancreas, peritoneal fluid analysis, and US abdomen.
  • Refer to the Gastrointestinal System table at the end of the book for related tests by body system.
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