Pseudocyst Of Pancreas Flashcards
(16 cards)
What is a pancreatic pseudocyst?
A localized collection of amylase-rich pancreatic fluid enclosed in a fibrous or granulation tissue wall, without an epithelial lining.
When does a pancreatic pseudocyst typically arise?
4–8 weeks after acute pancreatitis or trauma.
What are the common etiologies of pancreatic pseudocysts?
- Acute pancreatitis
- Chronic pancreatitis
- Pancreatic trauma
- Pancreatic ductal disruption or stricture
How does the fibrotic capsule of a pancreatic pseudocyst form?
Due to granulation tissue and collagen deposition, requiring 4–8 weeks post inflammation.
What proportion of pseudocysts communicate with the main pancreatic duct?
More than half.
What are common clinical features of pancreatic pseudocysts?
- Persistent epigastric pain
- Early satiety, nausea, vomiting
- Weight loss
- Palpable abdominal mass (in some cases)
- Elevated plasma pancreatic enzyme levels
What is the primary modality for diagnosing pancreatic pseudocysts?
Contrast-enhanced CT scan.
What alternative imaging modalities can be used for pancreatic pseudocysts?
- MRI
- EUS with FNA
What laboratory findings suggest a pancreatic pseudocyst?
High amylase, low CEA, absence of mucin in aspirated fluid.
What is the management approach for asymptomatic cysts less than 4 cm?
Observation, as up to 70% may regress spontaneously.
What are the indications for intervention in pancreatic pseudocysts?
- Symptoms (pain, vomiting, jaundice)
- Diagnostic uncertainty (rule out neoplasm)
- Complications (infection, rupture, hemorrhage)
What are preferred endoscopic approaches for managing pancreatic pseudocysts?
- Transgastric/transduodenal drainage (if cyst is <1 cm from GI wall)
- Transpapillary drainage if duct communicates with cyst
- Endoscopic stenting for pancreatic duct stricture
When is surgical drainage reserved in the management of pancreatic pseudocysts?
For failed endoscopic therapy or anatomical constraints.
What are some surgical options for draining pancreatic pseudocysts?
- Cystogastrostomy
- Cystoduodenostomy
- Roux-en-Y cystojejunostomy
- Open or laparoscopic approaches possible
What complications can arise from pancreatic pseudocysts?
- Infection → Abscess, systemic sepsis
- Rupture → GI bleeding, internal fistula, peritonitis
- Pressure effects → Obstructive jaundice, bowel obstruction
- Erosion into vessel → Hemorrhage into cyst, haemoperitoneum
- Pancreaticopleural fistula
What do recurrent fluid collections, pleural effusions, or ascites indicate?
Ductal disruption with stricture or stone, often requiring surgical resection and/or drainage.
