Chapter 54: Pancreas- Pancreatic Pseudocyst Flashcards
What is it?
Encapsulated collection of pancreatic fluid
What makes it a “pseudo” cyst?
Wall is formed by inflammatory fibrosis, NOT epithelial cell lining
What is the incidence?
≈1 in 10 after alcoholic pancreatitis
What are the associated risk factors?
Acute pancreatitis < chronic pancreatitis from alcohol
What is the most common cause of pancreatic pseudocyst in the
United States?
Chronic alcoholic pancreatitis
What are the symptoms?
- Epigastric pain/mass
- Emesis
- Mild fever
- Weight loss
Note:Should be suspected when a patient with acute pancreatitis fails to resolve pain
What are the signs?
- Palpable epigastric mass
- tender epigastrium
- ileus
What is the differential diagnosis of a pseudocyst?
- Cystadenocarcinoma
- cystadenoma
What are the possible complications of a pancreatic pseudocyst?
- Infection
- bleeding into the cyst
- fistula
- pancreatic ascites
- gastric outlet obstruction
- SBO
- biliary obstruction
What is the treatment?
Drainage of the cyst or observation
What is the waiting period before a pseudocyst should be drained?
It takes 6 weeks for pseudocyst walls to “mature” or become firm enough to hold sutures, and most will resolve during this period if they are going to
What percentage of pseudocysts resolve spontaneously?
≈50%
What is the treatment for pseudocyst with bleeding into cyst?
Angiogram and embolization
What is the treatment for pseudocyst with infection?
Percutaneous external drainage/IV antibiotics
What size pseudocyst should be drained?
Most experts say:
- Pseudocysts >5 cm have a small chance of resolving and have a higher chance of complications
- Calcified cyst wall
- Thick cyst wall
