Pancreatic pseudocyst: Difference between revisions

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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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'''Contributors:'''  [[User:zorkun|Cafer Zorkun]] M.D., PhD.
{{Pancreatic pseudocyst}}
{{CMG}} {{AE}} [[User:Vidhipatel|Vidhi Patel]] M.B.B.S.


{{Editor Help}}
{{SK}} Pseudocyst of pancreas


==Overview==
==[[Pancreatic pseudocyst overview|Overview]]==


A '''pancreatic [[pseudocyst]]''' is a circumscribed collection of fluid rich in [[amylase]] and other pancreatic [[enzyme|enzymes]], blood and necrotic tissue typically located in the [[lesser sac]]. It has a non-epithelialised lining made of granulation tissue and hence the name pseudocyst ''(pseudo - false)''. By contrast, true cysts have an [[epithelium|epithelial]] lining. This is typically a complication of acute [[pancreatitis]], but may also occur following [[abdominal trauma]].
==[[Pancreatic pseudocyst historical perspective|Historical Perspective]]==


Pancreatic pseudocysts account for approximately 75% of all pancreatic masses.
==[[Pancreatic pseudocyst classification|Classification]]==


==Etiopathogenesis==
==[[Pancreatic pseudocyst pathophysiology|Pathophysiology]]==


Acute pancreatitis results amongst other things in the disruption of pancreatic parenchyma and the ductal system. This results in extravasation of pancreatic enzymes which in turn digest the adjoining tissues. This results in a collection of fluid containing pancreatic enzymes, hemolysed blood and necrotic debris around the pancreas. The [[lesser sac]] being a potential space, the fluid collects here preferentially. This is called an acute pancreatic collection. Some of these collections resolve on their own as the patient recovers from the acute episode. However, others become more organised and get walled-off within a thick wall of granulation tissue and fibrosis. This takes several weeks to occur and results in a pancreatic pseudocyst.
==[[Pancreatic pseudocyst causes|Causes]]==


==Diagnosis==
==[[Pancreatic pseudocyst differential diagnosis|Differentiating Pancreatic pseudocyst from other Diseases]]==


The questions that need to be answered are:
==[[Pancreatic pseudocyst epidemiology and demographics|Epidemiology and Demographics]]==
* where, how big and how many?
* is there a communication with the pancreatic ductal system? Draining such a pseudocyst carries an increased risk of pancreatic fistula.


The most useful imaging tools are;
==[[Pancreatic pseudocyst risk factors|Risk Factors]]==


* [[Ultrasonography]] - The role of ultrasonography in imaging the pancreas is limited by patient habitus, operator experience and the fact that the pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas).
==[[Pancreatic pseudocyst screening|Screening]]==
* [[Computerized tomography]] - This is the gold standard for initial assessment and follow-up


[http://www.radswiki.net Images courtesy of RadsWiki]
==[[Pancreatic pseudocyst natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


<gallery perRow="3">
==Diagnosis==
Image:Pancreatic-pseudocyst-001.jpg|Computerized tomography: Pancreatic pseudocyst
[[Pancreatic pseudocyst history and symptoms| History and Symptoms]] | [[Pancreatic pseudocyst physical examination | Physical Examination]] | [[Pancreatic pseudocyst laboratory findings|Laboratory Findings]] | [[Pancreatic pseudocyst electrocardiogram|Electrocardiogram]] | [[Pancreatic pseudocyst x ray|X Ray]] | [[Pancreatic pseudocyst CT|CT]] | [[Pancreatic pseudocyst MRI|MRI]] | [[Pancreatic pseudocyst ultrasound|Ultrasound]] | [[Pancreatic pseudocyst other imaging findings|Other Imaging Findings]] | [[Pancreatic pseudocyst other diagnostic studies|Other Diagnostic Studies]]
Image:Pancreatic-pseudocyst-002.jpg|Computerized tomography: Pancreatic pseudocyst
Image:Pancreatic-pseudocyst-003.jpg|Computerized tomography: Pancreatic pseudocyst
Image:Pancreatic-pseudocyst-004.jpg|Computerized tomography: Pancreatic pseudocyst
Image:Pancreatic-pseudocyst-005.jpg|Computerized tomography: Pancreatic pseudocyst
Image:Pancreatic-pseudocyst-006.jpg|Computerized tomography: Pancreatic pseudocyst
</gallery>
 
* [[MRCP|Magnetic Resonance Cholangio-pancreatography]] - to establish the relationship of the pseudocyst to the pancreatic ducts


==Treatment==
==Treatment==
[[Pancreatic pseudocyst medical therapy|Medical Therapy]] | [[Pancreatic pseudocyst surgery|Surgery]] | [[Pancreatic pseudocyst primary prevention|Primary Prevention]] | [[Pancreatic pseudocyst secondary prevention|Secondary Prevention]] | [[Pancreatic pseudocyst cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pancreatic pseudocyst future or investigational therapies|Future or Investigational Therapies]]


A small pseudocyst that is not causing any symptoms may be managed conservatively. However, a large proportion of them will need some form of treatment, The interventions available are:
==Case Studies==
* [[Gastroscopy|Endoscopic]] trans-gastric drainage
* Imaging guided percutaneous drainage
* Laparoscopic / open cystogastrostomy


==References & Additional Resources==
[[Pancreatic pseudocyst case study one|Case #1]]


==See Also==
==Related Chapters==


*[[Acute pancreatitis]]
*[[Acute pancreatitis]]
*[[Chronic pancreatitis]]
*[[Chronic pancreatitis]]
*[[Walled off pancreatic necrosis]]


==External Links==
*[http://goldminer.arrs.org/search.php?query=Pancreatic%20pseudocyst Goldminer: Pancreatic pseudocyst]
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[[fi:Haiman pseudokysta]]


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Latest revision as of 15:02, 13 July 2020

Pancreatic pseudocyst
Pancreatic pseudocyst.
Image courtesy of RadsWiki
ICD-10 K86.3
ICD-9 577.2
DiseasesDB 9530
MedlinePlus 000272
MeSH D010192

For patient information click here

Pancreatic pseudocyst Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pancreatic pseudocyst from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.

Synonyms and keywords: Pseudocyst of pancreas

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pancreatic pseudocyst from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

Template:Gastroenterology fi:Haiman pseudokysta


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