Pancreatic Pseudocyst - An Overview

Introduction:

Pancreatic pseudocysts are caused by acute or chronic pancreatitis (inflammation of the pancreas). The pancreas gland is located behind the stomach in close proximity to the duodenum (the initial part of the small intestine). The pancreas has two essential functions in the body, to make insulin and to produce enzymes required for the digestion of food. Pancreatic pseudocysts are the pancreas's most common cystic lesion, accounting for 75 % to 80 % of such lesions. The most common symptoms seen are abdominal pain, nausea, and vomiting. They can be asymptomatic in some cases.

What Is a Pancreatic Pseudocyst?

A pancreatic pseudocyst does not have an enclosed epithelium sac of its own. Rather, it forms within a cavity or space inside the pancreas. It is surrounded by fibrous tissue. Pancreatic pseudocysts contain inflammatory pancreatic fluid (especially the digestive enzyme amylase).

• Pancreatic pseudocysts are usually round or oval in shape.

• These are the most common pancreatic cystic lesions seen (about 75 % to 80 % of all pancreatic cystic lesions).

• They are benign (non-cancerous) in nature.

• They affect approximately 1 in 1,000 adults per year.

What Are the Symptoms of Pseudocysts?

Pancreatic pseudocysts can be asymptomatic (having no symptoms) or can produce moderate to severe symptoms. Symptoms can be seen within days or months after a pancreatitis attack. The most common symptoms seen in pancreatic cysts include:

• Severe pain in the abdomen and sometimes the back.

• Nausea.

• Vomiting.

• Abdominal bloating.

A ruptured pseudocyst may show different symptoms, such as:

• Vomiting blood.

• Fainting.

• Weak and rapid heartbeat.

• Severe abdominal pain.

• Decreased consciousness.

What Causes a Pancreatic Pseudocyst?

• Pancreatic pseudocysts are most often followed by pancreatitis. Pancreatitis is a painful condition in which inflammation of the pancreas occurs. Pancreatic enzymes help digest fats and sugars, but sometimes they overreact and start to digest the tissues of the pancreas only. This results in swelling, bleeding, and causing damage to the tissues and blood vessels of the pancreas. Cysts are usually formed when the ducts that carry the pancreatic juices to the intestine become blocked.

• Pancreatitis can be of two types- acute or chronic. Acute pancreatitis starts suddenly and can be cured with or without treatment. Chronic pancreatitis requires treatment or may even resist treatment.

• The reasons for pancreatitis may be a complication of surgery, due to certain autoimmune disorders, or alcohol usage. Alcohol use is the most common cause of both acute and chronic pancreatitis. Alcohol use disorder can increase the level of fats, or triglycerides, in the blood. The pancreas helps the body digest fats, but too much fat can cause harm to it.

• Gallstones can also cause pancreatitis. These are minute deposits that develop in the gallbladder. The gallbladder lies near the pancreas. It stores the bile juice, which is made in the liver. The growth of gallstones can be too minor or too large. Sometimes, they might obstruct the ducts that drain the pancreas, resulting in pancreatitis.

How Is a Pancreatic Pseudocyst Diagnosed?

As soon as the patient visits a doctor, the doctor may ask for the patient's history and habits, such as:

• If they have a family history of pancreatitis.

• The amount of alcohol they consume.

• Whether they met with a car accident recently.

• If they have gallstones.

Once the symptoms of pancreatic pseudocyst are suspected, the doctor suggests-

• Imaging Tests: These tests include CT (computed tomography) scans or MRIs (magnetic resonance imaging). They are done to get an image of the pancreas and more details of the cyst.

• Endoscopic Ultrasound: This procedure uses high-powered sound waves to obtain an image of the abdomen and other organs. A thin, flexible tube with a light and camera is inserted into the mouth and down into the first part of the small intestine. This instrument is known as an endoscope. In this procedure, a small amount of fluid is extracted from the cyst to examine for the presence of cancer.

• Transabdominal US (Ultrasound): It is a procedure that uses sound waves to check for pancreatic pseudocysts or gallstones, which can potentially cause a pseudocyst.

• ERCP (Endoscopic Retrograde Cholangiopancreatography): It assists the doctor in seeing the structure of the common bile duct, other bile ducts, and the pancreatic duct.

How Is Pancreatic Pseudocyst Treated?

• In case of the absence of any symptoms, they may ask to wait. It may be possible that the cyst goes away on its own. Regular imaging tests can evaluate the growth or shrinking of the cyst.

• In cases where a pseudocyst compresses other organs, the doctor drains it to decrease its size. It also needs draining if it grows so large that it can rupture. Drainage requires surgery under general anesthesia. In this process, a small incision drains the pseudocyst with a needle guided by ultrasound or an endoscopic camera. Sometimes, a larger incision is made to view the pseudocyst directly. The doctor will drain or suction out the contents of the pseudocyst. A sample of the content is sent to a laboratory to be tested for infections and the presence of cancer.

• Antibiotics are given even if the person has no infection to ensure they do not develop it.

What Can Be Done to Prevent a Pancreatic Pseudocyst?

Preventing pancreatic pseudocysts primarily involves addressing the underlying causes, especially pancreatitis. Here are some steps that can be taken to prevent pancreatic pseudocysts:

Manage Pancreatitis Risk Factors:

• Avoid Alcohol Abuse: Excessive alcohol consumption is a significant risk factor for both acute and chronic pancreatitis. If you have a history of alcohol abuse or a family history of alcohol-related issues, consider seeking treatment or counseling to reduce or eliminate alcohol consumption.

• Control Chronic Diseases: Certain chronic conditions, such as gallstones and high triglyceride levels, can increase the risk of pancreatitis. Managing these conditions effectively through medication and lifestyle changes can help reduce the risk of pancreatitis and, consequently, pseudocysts.

Maintain a Healthy Diet:

• Low-Carbohydrate, Low-Cholesterol Diet: A diet that is low in carbohydrates and cholesterol can help reduce the risk of high triglyceride levels, which are associated with pancreatitis. Focus on consuming fresh fruits, vegetables, and lean protein sources to help keep the triglyceride levels in check.

Healthy Lifestyle Choices:

• Quit Smoking: Smoking is a risk factor for both acute and chronic pancreatitis. Quitting smoking can significantly reduce the risk.

• Maintain a Healthy Weight: Obesity is another risk factor for pancreatitis. Maintaining a healthy weight through regular exercise and a balanced diet can help lower the risk.

• Early Diagnosis and Treatment: If one experiences symptoms of pancreatitis, such as severe abdominal pain, fever, nausea, and vomiting, seek medical attention promptly. Early diagnosis and treatment of pancreatitis can prevent complications, including pseudocysts.

Conclusion:

Pancreatic pseudocysts are usually developed due to pancreatitis. It can be acute or chronic. The symptoms of pancreatic pseudocyst include nausea, vomiting, abdominal pain, back pain, etc. It can be diagnosed by taking a proper history of the patient. To confirm this, imaging tests and endoscopic ultrasounds are done. Treatment can be done by draining it surgically.