Pancreatitis Complications - Necrotizing Pancreatitis and Fluid Collections Interstitial Edematous (85%): • Acute Pancreatic Fluid Collection (APFC) → • Pancreatic Pseudocyst Necrotizing Pancreatitis (15%): • Acute necrotic collection (ANC) → • Walled-off necrosis (WON) Delayed complications of necrotizing pancreatitis: • Disconnected pancreatic duct syndrome • Exocrine pancreatic insufficiency • Pancreatogenic DM Matthew Ho, MD PhD @MatthewHoMD #Necrotizing #Pancreatitis #Complications #pseudocyst #management #gastroenterology

Classification of Pancreatic Fluid Collections Interstitial Edematous Pancreatitis: < 4 weeks - Acute (peri)panreatic fluid collection - Homogenous fluid adjacent to pancreas without a recognizable wall ≥ 4 weeks - Pancreatic pseudocyst - An encapsulated, well-defined, usually extrapancreatic fluid collection with minimal solids Necrotizing pancreatitis: < 4 weeks - Acute necrotic collection - Intra and/or extra necrotic without a well-defined wall ≥ 4 weeks - Walled off necrosis - Intra and/or extra pancreatic necrotic collection with a well-defined wall #Pancreatic #Fluid #Collections #Classification #Types #gastroenterology #pseudocyst

General algorithm for the management of inflammatory pancreatic fluid collections. ANC, acute necrotic collection; APFC, acute peripancreatic fluid collection; VARD, video-assisted retroperitoneal debridement; AP, acute pancreatitis; PC, pseuodcyst; WON, walled-off-necrosis #pancreatic #fluid #collections #pseudocyst #algorithm #management #gastroenterology

Indications for therapeutic intervention of pancreatic pseudocysts. Complicated pancreatic pseudocysts (one criterion sufficient) • Compression of large vessels (clinical symptoms or seen on CT scan) • Gastric or duodenal outlet obstruction • Stenosis of the common bile duct due to compression • Infected pancreatic pseudocysts • Haemorrhage into pancreatic pseudocyst • Pancreatico-pleural fistula Symptomatic pancreatic pseudocyst • Satiety • Nausea and vomiting • Pain • Upper gastrointestinal bleeding (10—20%) Asymptomatic pancreatic pseudocyst: • Pseudocysts >5 cm, unchanged in size and morphology for more than 6 weeks • Diameter cm and extrapancreatic complications in patients with chronic alcoholic pancreatitis • Suspected malignancy: median 5-year survival rate after resection 56% #Pancreatic #pseudocyst #Intervention #Indications #Management

this time, 33% of cysts ... of persistent cysts ... hemorrhage, and cyst

stomach when the cyst

Pancreatic Pseudocyst on Abdominal POCUS - Transverse Patient has pancreatic pseudocyst with acute severe pancreatitis. No AAA. Physical exam not perfect but still important. Dr. Robert Jones @RJonesSonoEM #Pancreatic #Pseudocyst #Abdominal #POCUS #clinical #ultrasound #transverse #Pancreatitis #Transverse

Pancreatic Fluid Collections - revised Atlanta Classification Interstitial (85%): - Collections < 4 weeks - APFC (acute pancreatic fluid collection): sterile, infected - Collections > 4 weeks - Pseudocyst: sterile, infected, no solid material Necrotizing (15%): - Collections < 4 weeks - ANC (acute necrotic collection): solid material, parenchymal and/or peripancreatic tissue, sterile/infected - Collections > 4 weeks - WON (walled-off pancreatic necrosis): mature, encapsulated necrotic collection with well defined wall, sterile/infected, parenchymal/peripancreatic/distant from pancreas #Pancreatic #Fluid #Collections #Atlanta #Classification #Types #gastroenterology #pseudocyst

Pancreatic Pseudocyst on Abdominal POCUS - Sagittal Patient has pancreatic pseudocyst with acute severe pancreatitis. No AAA. Physical exam not perfect but still important. Dr. Robert Jones @RJonesSonoEM #Pancreatic #Pseudocyst #Abdominal #POCUS #clinical #ultrasound #transverse #Pancreatitis #Sagittal

Pseudo-testis appearance ... of Epidermoid Cyst ... This is pseudo-testis ... an epidermoid cyst ... Pseudotestis #Epidermoid #Cyst