Pancreatic pseudocyst-Causes, symptoms, diagnosis, and treatment

Pancreatic pseudocysts are developed due to various reasons like pancreatitis and trauma to the pancreas. But, do you know what is pancreas? Pancreas are the organ that is located in the uppermost part of the left side of our abdomen. It is located just behind our stomach.

Pancreas play a vital role in digestion process by producing various digestive enzymes like lipase, amylase, etc. they also play an important role in controlling blood sugar levels by secreting a hormone called insulin. You all might be aware that people develop Diabetes disease due to the impaired functioning of the beta cells of the pancreas which secrete insulin.

What is pancreatic pseudocyst?

You all have seen what is the pancreas. So, let us start discussing what is pancreatic pseudocyst. Pancreatic pseudocyst appears like a cyst, but it is not a true cyst. So, it is called pancreatic pseudocyst. It is a cyst-like or well-defined collection of various enzymes produced by the pancreas and dead tissues. Sometimes blood is also present in pancreatic pseudocyst.

Pancreatic pseudocysts are most commonly seen after an episode of acute pancreatitis, which is the inflammation or the swelling of the pancreas. Pancreatitis is more commonly seen in men in comparison to the women. So, pancreatic pseudocysts are also more common amongst the men. They can affect people of any age group, ranging from kids to adults, although the reasons might vary.

What are the symptoms of pancreatic pseudocyst?

Abdominal pain or feeling uncomfortable in your abdomen is the most common symptom of pancreatic pseudocyst. But, there are many more symptoms that you might experience if you develop a pseudocyst. Let us look at some of the most common symptoms of pancreatic pseudocyst:

• Abdominal pain or discomfort
• Indigestion or abdominal bloating
• Anorexia or lack of hunger
• Fever or increased temperature
• Abdominal mass which is painful or tender
• Jaundice or yellowish of sclera
• Loss of weight
• Nausea and vomiting
• Diarrhea

What are the Complications of pancreatic pseudocyst?

Apart from the above symptoms, pancreatic pseudocyst can develop some complications too. Let us look at some of the most common complications of pancreatic pseudocyst:

Infection:

Some people with pancreatic pseudocyst tend to develop bacterial infections, due to the easy growth of the bacteria in the fluid and necrotic debris filled in the cyst. You can identify such people by observing fever and an elevated white blood cell or WBC counts. These people need to be treated with antibiotics promptly to avoid sepsis or the spread of the bacteria throughout the body leading to hypotension or low blood pressure, etc.

Bleeding:

Some bleeding into the pancreatic pseudocysts can be observed. This occurs when the blood vessel supplying the pseudocyst is damaged. In such people, there will be a sudden change in the vital signs like blood pressure, pulse and also there will be a drop in the level of RBCs in the blood or the hematocrit. They also complain of severe abdominal pain. They need to undergo emergency surgery to save their life.

Intestinal obstruction:

Occasionally, pancreatic pseudocyst can also lead to intestinal obstruction. In these cases, the patient will have nausea, vomiting, abdominal distension and colicky abdominal pain. They also need to undergo drainage of their bowel to treat the intestinal obstruction.

Jaundice:

Pancreatic pseudocyst can the block the pathway of the flow of bile. This can lead to the development of jaundice. In jaundice, you can notice a yellowishness of the sclera (called icterus), yellowishness of the skin and also you will have dark colored urine and pale colored stools due to the development of obstructive jaundice.

Portal hypertension:

This is the condition in which the blood pressure in the portal veins which carry blood from the intestines to the liver is increased. This condition needs to be treated promptly with surgery as it can lead to the development of many other complications.

Rupture of pseudocyst:

A pseudocyst of the pancreas can rupture and cause bleeding. It can also irritate the peritoneal lining of the abdomen leading to peritonitis. Peritonitis leads to hypotension or reduced blood pressure, acute abdomen signs like rigidity, guarding, etc. It is really fatal if not treated promptly.

How to diagnose pancreatic pseudocyst?

There are many tests which are involved in diagnosing pancreatic pseudocyst. But, the most useful test is CT scan or computerized tomography of the abdomen. Let us look at all the test used for the diagnosis.

Blood tests:

Amylase and lipase levels in the blood test can be elevated sometimes, but they are within the reference interval, so they are not very useful. If there is obstruction of the biliary tree leading to jaundice , then there can be the elevation of the bilirubin levels and also an alteration in the liver function tests or LFT like AST, ALT, etc. But, overall blood tests are not very useful for the diagnosis pf the condition.

Analysis of the cyst fluid:

The fluid is aspirated from the pancreatic pseudocyst and tested for various parameters. In the cyst fluid of pancreatic pseudocyst, CEA or carcinoembryonic antigen levels and the fluid viscosity is reduced. Amylase enzyme level is elevated in the pseudocyst.

Ultrasound:

An ultrasound exam can be done on the abdomen called abdominal ultrasound or USG and it can also be done endoscopically. Abdominal ultrasound can show cyst like fluid collections in the pancreas, but it is not very accurate. Endoscopic ultrasound is better than regular ultrasound in diagnosing pancreatic pseudocyst, but it is done rarely. It is done when some procedure like drainage is called on the pancreatic pseudocyst.

CT scan of the abdomen:

CT scan of the abdomen is the gold standard investigation or test for the diagnosis of the pancreatic pseudocyst. It has a high sensitivity for its diagnosis. Generally, a single large cavity is found in the pancreas. But, sometimes many small cavities or cysts can also be found. Sometimes, calcifications or the deposition of calcium substances can also be seen in the pancreatic pseudocyst.

ERCP:

The full form of ERCP is endoscopic retrograde cholangiopancreatography. It is generally not used for the diagnosis of the pancreatic pseudocyst. This test is used when some treatment is planned over the pseudocyst.

MRI:

MRI or magnetic resonance imaging is only used when we need to differentiate between the dead tissue and the fluid collection in the pancreatic pseudocyst. This might be needed very rarely when doing drainage procedure of the pseudocyst.

Biopsy:

If you take a biopsy of the pancreatic pseudocyst and examine it for histological features, you can see the deposition of various cells and pigments in the pseudocysts in various regions of the cyst-like hemosiderin, fibrous tissue, cells denoting inflammatory changes, etc. But, this is not done regularly.

How is pancreatic pseudocyst treated?

Earlier, the treatment protocol of the pancreatic pseudocyst was based just on the size of the cyst and on the duration of the pseudocyst presence. If the pancreatic pseudocyst was present for more than 6 weeks and its size is more than 6 cm, then it was treated, mostly with surgery. Otherwise, it was left alone to heal or resolve by itself.

But, now the criteria for the treatment of pancreatic pseudocyst have changed. A pancreatic pseudocyst is treated only if it shows any symptoms. It is not treated if it is asymptomatic and detected accidentally. The pseudocyst is monitored with regular CT scans in asymptomatic patients to see if they resolve by themselves.

If any symptoms like abdominal pain, bleeding, indigestion, fever, signs of infection or any any other symptom of pancreatic pseudocyst develops, they are managed by drainage procedures. These drainage procedures can be done surgically and also non-surgically by using MRI and ERCP. They are also treated if any complications mentioned above develop.

The patients are advised to eat foods with very low levels of fat. Percutaneous catheter drainage of the pseudocyst of the pancreas is done to alleviate the symptoms temporarily. But, the permanent treatment option is either endoscopic drainage or open surgical drainage.

Studies have shown that open surgical drainage with laparoscopic technique is very good as it helps the wound to heal better, has fewer complications in the patient. This surgery is done under general anesthesia.

Patients receiving general anesthesia are not conscious while getting operated. These patients are also prescribed antibiotics after the surgery to prevent the development of any infections. These patients are also given somatostatin analogs like octreotide to regulate the secretion of growth hormone.

Prognosis of pancreatic pseudocyst:

Pancreatic pseudocyst can be treated very well with the drainage procedures. You jus need to be cautious about the symptoms and complications to receive treatment at the correct time. There is no need to worry about the pancreatic pseudocyst as it has good prognosis due to timely and appropriate treatments available today.

Prevention of pancreatic pseudocyst:

A pancreatic pseudocyst is mainly caused by pancreatitis and sometimes due to abdominal trauma. Avoid getting any trauma to your abdomen. Also, make sure to avoid all the risk factors of the development of pancreatic pseudocyst like alcohol abuse.

Keep your lipid or cholesterol levels under control. Also, if you have any problems like gallstones or cholelithiasis, get it treated with the removal of gallbladder or cholecystectomy as it is one of the most common causes of pancreatitis.