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Thumbnail imagePancreatitis, Pancreatic Pseudocyst
Pancreatitis causes:

  • Common (70%) Alchol, cholilithiasis
  • Less Common (30%) Postoperative, hyperlipidemia, hypercalcemia, drugs, inflammation (PUD), pregnancy

Clinical: Mild pancreatitis usually presents with pain, vomiting, and tenderness. Severe, acute pancreatitis is manifested by shock, pulmonary insufficiency, renal failure, GI hemorrhage, metabolic abnormalities, flank and/or periumbilical ecchymosis 

Imaging Findings:
US: Pancreas appears hypoechoic relative to the liver, reversal of normal appearance, due to edema
CT: Fluid and inflammatory change around pancreas may be hypoatenuated due to edema

Complications:

  • Pancreatic Necrosis: diffuse or focal areas of nonviable parenchyma, peripancreatic fat necrosis and fluid accumulation
  • Acute fluid collections: Such collections occur in 40%. No fibrous capsule (in contradistinction to pseudocyst). Most common location is within and around the periphery of the pancreas. 50% resolve spontaneously
  • Pseudocyst: Encapsulated collection of pancreatic fluid. Surgical definition of pseudocyst requires persistence at least six weeks from the onset of pancreatitis. 50% resolve spontaneously and or not clinically significant, 20% are stable, 30% result in further complications (dissection into adjacent organs, hemorrhage, peritonitis, obstruction of duodenum and/or bile ducts, infrection)

Patients with fluid collections which appear after an episode of acute pancreatitis are typically initially treated with supportive care and observation

The two primary indications of draining a pseudocyst (1) suspicion for infection and (2) persistent pain for at least six weeks following initial pancreatitis episode




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