Health Dictionary
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Pancreatic pseudocyst
Introduction
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Synonyms and keywords: Pseudocyst of pancreas
Overview
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Overview
A pancreatic pseudocyst is a circumscribed collection of fluid rich in amylase and other pancreatic 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 epithelial lining. This is typically a complication due to increased pressure in the pancreatic duct (e.g. stenosis, calculus, protein plugs) or pancreatic necrosis following an episode of acute pancreatitis, but may also occur following abdominal trauma. [1] Pancreatic pseudocyst generally complicates the course of chronic pancreatitis in around 30-40% of the patients.[2]
Historical Perspective
Classification
| TYPE | DESCRIPTION |
|---|---|
| I | <5cm, without symptoms, complication and neoplasia |
| II | Suspected cystic neoplasia |
| III | Location of Pancreatic Psuedocyst is Uncinate process
IIIa- Pseudocyst communicates with the pancreatic duct. IIIb- Pseudocyst does not communicate with pancreatic duct. |
| IV | Location of Pancreatic Pseudocyst is Head, Neck and Body.
IVa- Communication exist between pseudocyst and pancreatic duct (1) IVb- Distance from the cyst to the gastrointestinal wall is <1cm (2) IVc- Neither 1 nor 2 |
| V | Location of Pancreatic Pseudocyst is Tail.
Va- Splenic vein involvement or upper gastrointestinal bleeding Vb- Distance from the cyst to the gastrointestinal wall is <1cm without splenic vein involvement or upper gastrointestinal bleeding |
Pathophysiology
Pancreatic Pseudocyst, also known as “false cyst” as they do not have true epithelial lining. The pathophysiology of pancreatic pseudocyst involves trauma or episode of pancreatitis followed by extravasation of pancreatic secretions.
Causes
Differentiating Pancreatic pseudocyst overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ Cooperman AM. An overview of pancreatic pseudocysts: the emperors new clothes revisited. Surg Clin North Am. Apr 2001;81(2):391-7, xii.
- ↑ Habashi S, Draganov PV (2009). “Pancreatic pseudocyst”. World J Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.
- ↑ Pan G, Wan MH, Xie KL, Li W, Hu WM, Liu XB; et al. (2015). “Classification and Management of Pancreatic Pseudocysts”. Medicine (Baltimore). 94 (24): e960. doi:10.1097/MD.0000000000000960. PMC 4616556. PMID 26091462.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.
Historical Perspective
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Overview
Historical Perspective
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Classification
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Overview
Classification
| TYPE | DESCRIPTION |
|---|---|
| I | <5cm, without symptoms, complication and neoplasia |
| II | Suspected cystic neoplasia |
| III | Location of Pancreatic Psuedocyst is Uncinate process
IIIa- Pseudocyst communicates with the pancreatic duct. IIIb- Pseudocyst does not communicate with pancreatic duct. |
| IV | Location of Pancreatic Pseudocyst is Head, Neck and Body.
IVa- Communication exist between pseudocyst and pancreatic duct (1) IVb- Distance from the cyst to the gastrointestinal wall is <1cm (2) IVc- Neither 1 nor 2 |
| V | Location of Pancreatic Pseudocyst is Tail.
Va- Splenic vein involvement or upper gastrointestinal bleeding Vb- Distance from the cyst to the gastrointestinal wall is <1cm without splenic vein involvement or upper gastrointestinal bleeding |
References
- ↑ Pan G, Wan MH, Xie KL, Li W, Hu WM, Liu XB; et al. (2015). “Classification and Management of Pancreatic Pseudocysts”. Medicine (Baltimore). 94 (24): e960. doi:10.1097/MD.0000000000000960. PMC 4616556. PMID 26091462.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Pathophysiology
Overview
Pancreatic Pseudocyst, also known as “false cyst” as they do not have true epithelial lining. The pathophysiology of pancreatic pseudocyst involves trauma or episode of pancreatitis followed by extravasation of pancreatic secretions.
If acute pancreatitis persists more than 4-6 weeks and is seen with a wall of fibrous or granulation tissue which is well-defined, it is called formation of a pseudocyst due to acute pancreatitis which is filled with enzymatic fluid and necrotic debris.
The formation of pancreatic pseudocyst due to chronic pancreatitis is less well understood. It is still believed tp occur either due to episode of acute exacerbation in chronic pancreatitis and/or blockage of pancreatic duct by protein plug or calculus or localized fibrosis.[1]
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.
References
- ↑ Habashi S, Draganov PV (2009). “Pancreatic pseudocyst”. World J Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.
Causes
Overview
Pseudocysts formation mainly occur when the main pancreatic duct or any of its branches get blocked by direct injury or infection. It causes oozing of the pancreatic enzymes into the parenchyma and forms a cyst. Pancreatitis remain the prime cause for the formation of pseudocysts. So, the etiology of pancreatic pseudocysts remains same as the etiology of pancreatitis.
Causes
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.
Differentiating Pancreatic pseudocyst from other Diseases
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Overview
Differentiating Pancreatic pseudocyst from Other Diseases
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Epidemiology and Demographics
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Overview
Pancreatic pseudocysts account for approximately 75% of all pancreatic masses.[1]
Epidemiology and Demographics
References
- ↑ Bradley EL, Gonzalez AC, Clements JL Jr. Acute pancreatic pseudocysts: incidence and implications. Ann Surg. Dec 1976;184(6):734-7.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.
Risk Factors
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Overview
Risk Factors
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Screening
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Overview
Screening
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Natural History, Complications and Prognosis
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Overview
Natural History
Complications
- A pancreatic abscess can develop if the pseudocyst becomes infected
- Rupture of the pseudocyst
- The pseudocyst may press down on (compress) nearby organs
- Abdominal bleeding
- Shock
Prognosis
The outcome is generally good with treatment.
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.
Diagnosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.