pancreatic cyst
Introduction
Introduction to pancreatic cyst There are two types of pseudocysts and true cysts. The former is traumatic and the extravasation of pancreatic juice is surrounded by adjacent tissues. There is no pancreatic epithelial cells in the cyst wall. The latter is caused by pancreatic tissue, and the inner layer of the cyst wall is pancreatic epithelial cells. According to the cause can be divided into congenital cysts, retention cysts, degenerative cysts, neoplastic cysts and parasitic cysts. Clinically, pancreatic cysts are most common with pseudocysts. basic knowledge The proportion of illness: 0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: pancreatic abscess sepsis shock jaundice diarrhea
Cause
Causes of pancreatic cysts
About 75% of cases of pseudocysts are caused by acute pancreatitis, about 20% of cases occur after pancreatic trauma, and 5% of cases are caused by pancreatic cancer.
Prevention
Pancreatic cyst prevention
1. The disease is often secondary to acute pancreatitis and pancreatic injury. About 3/4 of the patients are caused by acute pancreatitis, and about 10% of cases of acute pancreatitis have pseudo-pancreatic cysts.
2, the key to the prevention of this disease is to make an early diagnosis of acute pancreatitis or pancreatic injury, early to take corrective measures, once diagnosed, should be scheduled for surgery.
Complication
Pancreatic cyst complications Complications pancreas abscess septic shock jaundice diarrhea
(1) Secondary infection This is the most common and most serious complication of pseudocysts. The patient's condition deteriorates rapidly and severe toxemia occurs. At this time, if it is not timely, it often develops into pancreatic abscess and sepsis. Almost without cause, it leads to death.
(B) pancreatic ascites pseudocyst inside the pancreatic juice leaking from the fistula or rupture into the abdominal cavity, stimulation of the peritoneum can cause ascites, lymphatic occlusion around the pancreas caused by lymphatic extravasation, can also cause ascites, normal peritoneum can absorb a lot of liquid, but in the pancreas In ascites due to cellulose exudation, fibrous tissue hyperplasia, inflammatory cell infiltration and elastic fiber degeneration and other diseases, the liquid can not be absorbed in large amounts, and accumulated in the abdominal cavity.
(3) About 50% of pancreatic pleural effusion and pancreatic pseudocysts coexist in the pancreatic pleural effusion. The pancreatic juice in the cyst, if passed through the lymphatic vessels of the diaphragm, diffuses into the thoracic cavity, and stimulates the formation of a fistula between the pleura or cyst and the thoracic cavity. Pleural effusion, pleural effusion on the left side.
(4) Hemorrhage is a rare but most dangerous complication of pseudocysts. Hemorrhage can be caused by:
1 pseudocyst rupture in the blood vessels;
2 cysts invade the gastrointestinal wall;
3 complicated esophageal varices due to portal vein or splenic vein obstruction;
4 cysts invade the biliary tract and bleed;
5 pseudoaneurysm rupture, in the intracapsular hemorrhage, the cysts increase sharply, and can hear the sound of blood flow, so if the cyst suddenly increases and there is a sign of systemic blood loss, angiography should be performed in time, often requiring emergency surgery, including The cyst is removed or the cyst is ligated and the bleeding is performed, and the cyst is drained.
(5) Patients with spleen involvement in pancreatic pseudocysts may have spleen involvement at the same time, possibly due to:
1 pancreatic pseudocyst erosive spleen;
2 digestive effects of pancreatic juice overflowing from the cyst on the spleen;
3 Inflammation occurs in the pancreas of the spleen;
4 complicated with splenic vein thrombosis, liquefaction in the infarct area of the spleen, in this case, early spleen resection should be performed, and as far as possible for distal pancreatectomy.
(6) Cyst rupture and perforation Pancreatic pseudocyst can spontaneously perforate or break into the adjacent viscera, often complicated by gastrointestinal bleeding, pancreatic pseudocysts break into the stomach, duodenum, colon, etc., not necessarily symptoms, at this time It is not necessarily dangerous to the patient. On the contrary, it can provide effective drainage. However, if the cyst breaks into the abdominal cavity, the mortality rate is extremely high. In this case, the patient often has shock and the mortality rate is 18% to 80%.
(7) Others
1 Astragalus: due to pseudocyst compression of the common bile duct can cause obstructive jaundice;
2 diarrhea: pseudo-pancreatic cysts can sometimes cause severe diarrhea.
Symptom
Pancreatic cyst symptoms Common symptoms Nausea upper abdominal pain bilateral intra-renal pain transverse colon displacement abdominal pain constipation vomiting bloating repeated hyperthermia peritonitis
1. Symptoms
Upper abdominal pain, fullness, nausea and vomiting, there may be compression symptoms when cysts are enlarged; constipation, jaundice, ascites, lower extremity edema, etc. When the cyst ruptures into the abdominal cavity, there is acute peritonitis; breaking into the digestive tract can form internal hemorrhoids, and Repeated high fever, abdominal pain, and even upper gastrointestinal bleeding.
2. Signs
Most patients have a round, saclike mass in the upper abdomen, which can be tender when combined.
Examine
Examination of pancreatic cysts
1 A small number of patients with serum amylase, blood sugar increased, there are more fat particles in the stool.
2 Gastrointestinal barium meal examination, duodenal intestine enlargement, stomach, duodenum, transverse colon pressure displacement.
3B type ultrasonography showed a spherical area with a smooth and clear edge, with no dark areas reflected by light spots or showing internal hemorrhoids formed between the cyst and the digestive tract.
4 angiography showed that the blood vessels were compressed by bird cages, and the capillaries were like uniform and lightly stained around the pancreatic cysts or the internal hemorrhoids of cysts and blood vessels.
5 Pancreas scan: 75Se-methionine pancreatic scintigraphy showed no aggregation.
The 6CT is visible in a circular, elliptical, low-density shadow with sharp edges, and the CT value is close to the density of water.
Diagnosis
Diagnosis and differentiation of pancreatic cyst
Differential diagnosis
1. Pancreatic cystic tumors.
2. Lymphangioma around the pancreas.
