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Pancreatic pseudocysts (PP)
Discuss pancreatic pseudocysts?
Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Pseudocysts are localized fluid collection that is rich in amylase and other pancreatic enzymes and is surrounded by a wall of fibrous tissue that is not lined by epithelium.
What are the different types of pseudocysts?
D’Egidio and Schein define three distinct types of pseudocysts.
Discuss the aetiology of pseudocysts?
Pseudocysts seems to form from disruptions of the pancreatic duct due to pancreatitis
or trauma followed by extravasation of pancreatic secretions. Majority of patients with pseudocysts have demonstrable connections between the cyst and the pancreatic duct. In other patients, an inflammatory reaction most likely sealed the connection so that it is
not demonstrable.
Discuss the clinical features of pseudocysts?
They can be asymptomatic or present with one of the complications. The most common symptoms are nausea, vomiting and abdominal pain.
Discuss the complications of pseudocyst?
Discuss the diagnosis of pseudocyst?
Diagnosis is by USS or CT scan.
Once a pancreatic cyst is diagnosed, a pseudocyst will need to be differentiated from other cystic lesions like cystic neoplasm, a benign or an incidental cyst. The clues which favour a pseudocyst are: evidence of chronic pancreatitis, preceding h/o acute pancreatitis, extra pancreatic location, communication with PD and high fluid amylase content. EUS and analysis of the aspirated cyst fluid may help differentiate pseudocysts from cystic tumours of the pancreas
Discuss the management of pancreatic pseudocyst?
40% of pts with pancreatitis will have acute fluid collection. 80% of them resolve on their own- hence only follow up scan needed in 3-4 weeks after discharge. 20% will go on form a pseudocyst. 50% of these pseudocysts will stabilise or disappear and the other 50% will be clinically relevant.
Initial management consists of supportive care. Persistent symptoms and the development of complications warrant invasive intervention.
What are the indications for intervention in pancreatic pseudocyst?
Absolute size of 6cm is no longer a sole indication for intervention. However, treatment is needed if they are causing symptoms or if there is any sign of complications like infection, obstruction or bleeding.
How do you choose an appropriate therapy?
Pseudocysts can be treated by various methods: surgical, percutaneous or endoscopic. There are no randomized trials comparing any of these approaches. As a result, the management varies based on local expertise but in general endoscopic drainage is becoming the preferred approach.
Discuss the supportive medical care for pancreatic pseudocysts?
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