Pancreatic steatosis



Pancreatic steatosis is an accumulation of the fats in the pancreas. This definition means the same thing as fatty pancreas or pancreatic lipomatosis. The most common reasons are obesity and the metabolic syndrome. This desease can be complicated by the acute pancreatitis, its relation to the malignant pancreatic cancer is now a subject of the studies. Pancreatic steatosis can be successfully detected with help of the invasive methods of medical imaging.

= Etiology = Etiology of the pancreatic steatosis contains some different factors. Obesity is highly associated with pancreatic steatosis. Some hereditary disorders can be also related to the pancreatic steatosis either directly (for example Shwachman-Diamond syndrome) or as the result of the progression of pathological alteration (for example cystic fibrosis). Hemochromatosis leads to the progressive damage of the exocrine part of the pancreas and replacement of the pancreatic tissue by the fibrosis and adipose tissue. The effect of the toxic substances and medications can also cause steatosis, however this effect has been determided for a small group of medicaments yet (gemcitabine, rosiglitazone). Kwashiorkor and AIDS can be also provided by this desease.

Symptomatology
Accumulation of the small amount of fats in the pancreatic parenchyma is condidered as normal, because it's not associated with any clinical manifestations. The pancreatic steatosis is associated with these conditions:
 * Metabolic syndrome,
 * diabetes mellitus type II,
 * exocrine pancreatic insufficiency,
 * acute pancreatitis,
 * pancreatic cancers,
 * pancreatic fistula.

The pancreatic steatosis is relatively often diagnosed during the autopsy or the radiology investigation indicated due to other reasons.

Histological investigation
In the pancreatic tissue occures the multiplication of the adipocytes. Accumulation of the fats can be detected in the acinar and insular cells with help of the electron microscope and immunochemical methonds, the damage of the epithelium occures before the multiplication of the fats inside the adipocytes. Findings of the lymphocytic infiltration are contradictory.

Medical imaging
The pancreatic steatosis is hypoechogenic (comparing to the liver and kidneys) on images in medical ultrasonography. Limited possibility of investigation, particularly in obese patients, and almost identical findings in many of other disorders stand for insufficiency of the sensitivity and specificity of the ultrasound for diagnosing the pancreatic steatosis.

On CT scan images the pancreas appears as a hypodense structure, completely developed steatosis has the same density as the adipose tissue. The decrease of the density correlates with steatosis extent.

MRI is able to identify the adipose tissue, particularly with application of the special techniques. Magnetic resonance spectroscopy enables the quantification of the ectopic triglycerides.