Diagnosing pancreatic steatosis in obese patients

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.