抗生素PPT课件（英文精品）Pancreatic .pptVIP

Pancreatic Pseudocyst Kashaf Sherafgan, MD Surgery IV Conference May 5th 2006 Pancreatic Pseudocyst A fluid collection contained within a well-defined capsule of fibrous or granulation tissue or a combination of both Does not possess an epithelial lining Persists 4 weeks May develop in the setting of acute or chronic pancreatitis Pancreatic Pseudocyst Most common cystic lesions of the pancreas, accounting for 75-80% of such masses Location Lesser peritoneal sac in proximity to the pancreas Large pseudocysts can extend into the paracolic gutters, pelvis, mediastinum, neck or scrotum May be loculated Composition Thick fibrous capsule – not a true epithelial lining Pseudocyst fluid Similar electrolyte concentrations to plasma High concentration of amylase, lipase, and enterokinases such as trypsin Pathophysiology Pancreatic ductal disruption 2? to Acute pancreatitis – Necrosis Chronic pancreatitis – Elevated pancreatic duct pressures from strictures or ductal calculi Trauma Ductal obstruction and pancreatic neoplasms Presentation Symptoms Abdominal pain 3 weeks (80 – 90%) Nausea / vomiting Early satiety Bloating, indigestion Signs Tenderness Abdominal fullness Diagnosis CT scan MRI / MRCP Ultrasonography Endoscopic Ultrasonography (EUS) ERCP Pseudocyst compressing the stomach wall posteriorly Sonographic evaluation EUS showing pseudocyst Complications Infection S/S – Fever, worsening abd pain, systemic signs of sepsis CT – Thickening of fibrous wall or air within the cavity GI obstruction Perforation Hemorrhage Thrombosis – SV (most common) Pseudoaneurysm formation – Splenic artery (most common), GDA, PDA Treatment Initial NPO TPN Octreotide Antibiotics if infected 1/3 – 1/2 resolve spontaneously Intervention Indications for drainage Presence of symptoms ( 6 wks) Enlargement of pseudocyst ( 6 cm) Complications Suspicion of malignancy Intervention Percutaneous drainage Endoscopic drainage Surgical drainage Percutaneous Drainage Continuous drainage until output