What happens to the gland
The pancreas consists of cells that produce digestive enzymes and islets that produce insulin. When there is excess energy in the body, fat is deposited not only under the skin, but also inside the organs. In the pancreas, it accumulates between the lobules and inside the cells themselves, gradually displacing the working tissue. On ultrasound, such a gland looks lighter than usual, with blurred contours. The degree of substitution varies: from small, which does not affect digestion in any way, to pronounced.
- First degree - fat occupies a small part of the gland
- Second degree - moderate replacement, mild complaints are possible
- Third degree - pronounced substitution with a risk of dysfunction
- Focal form - isolated fatty areas
- Diffuse form - uniform change in the entire gland
Causes and risk factors
The main reason is excess body weight and associated metabolic disorders. Pancreatic lipomatosis usually occurs in conjunction with fatty liver disease and is included in the range of manifestations of metabolic syndrome. Type 2 diabetes, high triglyceride levels, regular alcohol consumption and a sedentary lifestyle all contribute. With age, the proportion of adipose tissue in the gland naturally increases, so in the elderly, moderate lipomatosis is often considered a variant of age-related changes. Less commonly, the cause is pancreatitis, taking glucocorticoids, or cystic fibrosis.
- Overweight and abdominal obesity
- Type 2 diabetes mellitus and prediabetes
- Fatty liver disease
- High blood triglycerides
- Alcohol abuse
- Sedentary lifestyle and excess fast carbohydrates
- Past pancreatitis
- Long-term use of glucocorticoids
Symptoms
In most cases, lipomatosis is asymptomatic and remains an incidental finding. Complaints appear either with pronounced tissue replacement, or due to concomitant conditions - pancreatitis, cholelithiasis, gastritis. Typical manifestations are nonspecific: heaviness in the upper abdomen after a fatty meal, bloating, unstable stool. Signs of serious decline in function - fatty stools and weight loss - are uncommon and require separate examination. An increase in blood sugar may be the first objective signal that the islet system is suffering.
- Most often there are no complaints
- Heaviness and discomfort in the epigastric region
- Bloating and increased gas production
- Unstable chair
- Poor tolerance to fatty foods
- Increased blood glucose
- Fatty stools and weight loss in severe form
What examinations are needed
Conclusion Ultrasound alone does not complete the diagnosis. The doctor’s task is to assess whether there is a dysfunction of the gland and what metabolic problems are behind the finding. Therefore, they check fasting sugar and glycated hemoglobin, lipid profile, liver tests, and also exclude chronic pancreatitis based on clinical history and history. If there are complaints about bowel movements, the coprogram is assessed. More accurately, fat replacement is shown by CT and MRI, but they are not prescribed to everyone, but only when the picture is unclear or to exclude a space-occupying lesion.
- Ultrasound of the pancreas and abdominal organs
- Fasting blood glucose and glycated hemoglobin
- Lipid profile, primarily triglycerides
- Liver tests ALT and AST, liver ultrasound
- Amylase and lipase in pain syndrome
- Coprogram for stool disorders
- CT or MRI with questionable ultrasound picture
What to do and how to treat
There is no special cure for lipomatosis, and drugs “for cleaning the pancreas” or dietary supplements are useless. The same thing works as for fatty liver disease: gradual weight loss, regular physical activity, limiting simple carbohydrates, fatty foods and alcohol. Even moderate weight loss reduces the amount of fat in the organ. At the same time, diabetes and high triglycerides are treated - this is the doctor’s task. Enzyme preparations are prescribed only when there is a proven lack of enzymes, and not to everyone in a row based on the fact that it is recorded in the ultrasound protocol.
- Smooth weight loss without severe fasting
- Regular aerobic activity of at least 150 minutes per week
- Limiting sugar, baked goods, sugary drinks and fatty meats
- Complete abstinence from alcohol
- Control and treatment of diabetes mellitus
- Correction of triglyceride levels as prescribed by a doctor
- Enzyme preparations only for confirmed deficiency
- Repeat ultrasound and tests after 6–12 months