a 45-year-old alcoholic man presents with abdominal pain

Discussion in 'MRCS Forum' started by Joseph., May 31, 2008.

  1. Joseph.

    Joseph. Guest

    After a weekend drinking binge, a 45-year-old alcoholic man presents to the hospital with abdominal pain, nausea, and vomiting. On physical examination, the patient is afebrile and is noted to have a palpable tender mass in the epigastrium. Laboratory teats reveal an amylase of 250 U/dl (normal < 180). A CT scan done on the second hospital day is pictured below. Which of the following statements concerning this patient’s condition is true?

    a- The mass may cause gastric outlet or extrahepatic biliary obstruction
    b- Spontaneous resolution almost never occurs
    c- The mass is seen only with acute pancreatitis
    d- The mass has an epithelial lining
    e- Malignant degeneration occurs in about 25% of cases if left untreated
  2. Joseph.

    Joseph. Guest

    Answer: a. (Schwartz, 7/e, pp 1485-1487) Pancreatic pseudocysts can develop in the setting of acute and chronic pancreatitis. They are cystic collections that do not have an epithelial lining and therefore have no malignant potential. Most pseudocysts spontaneously resolve. Therapy should not be considered for 6 weeks to allow for the possibility of spontaneous resolution as well as to allow for maturation of the cyst wall if the cyst persists. Complications of pseudocysts include gastric outlet and extrahepatic biliary obstructions as well as spontaneous rupture and hemorrhage. Pseudocysts can be excised, externally drained, or internally drained into the gastrointestinal tract (most commonly the stomach or a Roux-en-Y limb of jejunum)

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