Cystic formations of the pancreas

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

A pancreatic cyst means a cavity formation in the parenchyma of an organ. It is completely formed from glandular tissues and contains only their "juice", as well as various cellular elements.

Pancreatic cyst: symptoms

Signs of cystic formation depend on the location and size. The larger it is, the closer to the so-called pancreatic head, the more pronounced the symptoms. The head of the gland is the anterior thickened end that lies directly under the stomach, surrounded by the duodenum.

Consider the symptoms of cysts located from the so-called tail of the organ (terminal section) to its head.

The cavity formations of the tail of the organ are characterized by pain in the left hypochondrium.

Moreover, they are often not associated with food intake. The larger the size of the cystic formation, the more pronounced the pain syndrome.

The formation of pain is associated with stretching the capsule of the pancreas, as well as pressure on the parietal (covering the inner surface of the walls of the abdominal cavity) sheet of the peritoneum. Lack of connection with food intake to speak of the fact that the cavity of the cyst has no connection with the ducts of the organ. Otherwise, after eating, the pain will intensify for a while, and then may decrease to its original state. This is due to an increase in the production of "juice" by the body at the time of absorption of food.

Formations of the body (the middle part between the tail and the head), in addition to pain, can give complications from neighboring organs. Especially if the size of the pathological formation itself exceeds the pancreas by at least 2-3 times.

Most often, the symptoms are as follows:

• pain;
• indigestion;
• jaundice.

Pain occurs according to the mechanisms already described above. But there may be additional factors. So, at a certain size, location, a cyst can squeeze the ducts. Therefore, when the production of "juice" increases, part of it, having no outlet, exerts pressure on the tissues. This causes the capsule to stretch. The pain in the right hypochondrium increases, it becomes more diffuse.

By the same mechanism, indigestion develops:

• Due to the lack of supply of pancreatic "juice" into the duodenal cavity, the degree of food digestion is reduced;
• This adversely affects parietal digestion in the lower intestine;
• As a result, the digestion process suffers in all departments.

True, one essential addition must be made here. All of the above violations are possible with significant consumption of food containing fats, "slow" (have a more complex structure) carbohydrates and proteins, since part of the "juice" of the gland still enters the duodenum.

Jaundice is less common in benign glandular neoplasms. Therefore, we will consider it below. Only one thing should be mentioned - jaundice can develop with a significant size of the cyst.

The cyst of the head (a thickened part of the organ directly in contact with the duodenum in its middle part) may have all the same symptoms. But they are much more pronounced, they come earlier. It is important that even a small cavity formation in the head region can lead to tangible complications.

Therefore, only jaundice should be mentioned, as the most typical symptom (except for pain) for cavities in the head.

Its pathogenesis is simple:

• It mechanically presses on the large duodenal papilla - the place where the pancreatic and common bile ducts flow into the duodenum;
• As a result, the outflow of bile is disrupted. The pressure rises, which leads to a slowdown in the release of bilirubin (a pigment produced by the breakdown of red blood cells) by the liver;
• Therefore, its direct fraction (not associated with glucuronic acid) begins to enter the bloodstream, due to which hyperbilirubinemia develops - the basis of jaundice.

All the above described signs of cysts characterize their uncomplicated course.

Its complications, depending on localization, can be the following conditions:

• suppuration;
• rupture without bleeding with the outflow of contents into the abdominal cavity;
• rupture with the outpouring of contents into neighboring organs;
• rupture with bleeding.

Suppuration is characterized by high temperature figures and an increase in intoxication. Pain in the right hypochondrium and other symptoms intensify.

The rupture occurs due to mechanical damage to the neoplasm. Especially when the dimensions and pressure in its cavity exceed the ultimate strength of the wall.

It is characterized by sharp pain in the left hypochondrium, which quickly spreads throughout the abdomen. Fever develops, peritonitis (inflammation of the peritoneum), paresis (lack of any muscle activity) of the intestine occurs, leading to obstruction.

If the contents of the neoplasm enters a neighboring organ, in the first place, in addition to sharp pain, there are signs of its defeat. The pathological cavity of the pancreas can burst into the pleural cavity (the receptacle of the lungs), which leads to pain in the left side of the chest, cough, the development of pleurisy and even pneumonia. When a breakthrough occurs in the intestine, its inflammation occurs, in the stomach - gastritis.

When a tumor ruptures with bleeding, in addition to symptoms of peritonitis, there are signs of intra-abdominal bleeding. This is a rapid increase in hypotension (decrease in blood pressure) up to shock, depression of consciousness.

Causes and pathogenesis

For the reasons for the development of cystic formations, they are all divided into 2 groups: true and false.

The former are congenital, the latter acquired:

• Congenital arises with developmental anomalies even in the prenatal stage of a person's life, most often, if the mother suffers infectious diseases during pregnancy, is carried away by teratogenic (causing abnormalities in the development of the fetus up to deformities) substances. Their main distinguishing feature is the inner lining. It is composed of epithelial cells;
• Acquired (false or pseudocysts) develop as a result of the outcome of pancreatitis, trauma to the pancreas. They appear at the site of necrotic (foci of cell death) areas. They differ from congenital ones in that the inner lining is fibrous tissue. It does not contain any cellular elements.

Moreover, despite the differences in origin and structure, both types of cavities contain pancreatic secretions and single cells. Some have a connection with the ducts of the gland, some do not. Therefore, both congenital and acquired can increase after a meal.

The development of true ones goes along with the formation of the pancreas. Whereas pseudocysts can form after the full formation of the organ.

Therefore, developmental stages are allocated only for acquired:

1. The appearance of the initial cavity. Usually, 4-5 weeks after the onset of acute pancreatitis, a cavity forms in the center of the development of necrosis. It is filled with liquid secretion, consists of a mixture of the "juice" of the gland and intercellular fluid;
2. Formation of the capsule. After 2-4 months after the appearance of the cavity, it begins to separate from the glandular tissue by fibrous tissue. But at this stage, the walls of the formation are loose, easily torn from the slightest impact;
3. The wall is compacted by fibrous tissue fibers. Becomes denser and more resistant to external influences;
4. The cyst is detached from the surrounding tissue. It is relatively mobile and can move easily.

The last two stages correspond to the period of the so-called mature cyst. This name suggests that the reverse process is no longer possible.

Treatment and prevention

How the cyst will be treated depends on two conditions: the nature of the pathological cavity, the individual characteristics of the patient. Both conservative and surgical treatment is possible.

But many experts are inclined to consider the first a measure that complements and / or precedes surgical methods of treatment.

The fact is that conservative treatment of pseudocysts can only slow down their development, reduce their size. But a positive prognosis for a complete cure is extremely rare.

The cyst is completely absorbed only when they are initially small in size, if therapy is started at the first stage.

Non-surgical treatment is indicated in the absence of complications, small in size. First of all, the patient is transferred to a diet that is limited to fats and proteins.

The following groups are used as drugs for conservative therapy:

• enzyme preparations (creon, pancreatin, mezim);
• drugs that reduce the secretion of gastric acid hydrochloric acid (omez, pariet, famotidine);
• antibiotics (tetracyclines and cephalosporins).

With a complicated course, dimensions more than 2 cm in diameter, the absence of the effect of conservative therapy for a month, surgical treatment is indicated. It can be performed both open access and laparoscopically. Possible options for excision of education, its hardening (freezing). A congenital cyst can only be treated surgically.

Prevention of formations, their recurrence is to prevent diseases and conditions that can lead to the formation of pathological cavities of the gland.

According to statistics, the risk of cystic formations is high in the following individuals:

• alcohol abusers;
• patients with cholelithiasis;
• obese;
• having diseases of the gastrointestinal tract and having undergone surgery for them;
• patients with diabetes mellitus.

In any case, a healthy lifestyle and diet reduce the risk of pancreatic pseudocyst formation in any pathology.