Pancreatic Cysts - ben

[ArchivalUser]

A 60 y/o woman has a long hx of subumbilical abdominal pain occurring during periods of stress and sometimes aggravated by ingesting coffee, nuts, or chocolate and by constipation. Recently, the pain has become worse on the left side of the abdomen. The results of barium enema and upper GI series are normal, and a CT of the abdomen and pelvis shows a 3 x 3-cm loculated cyst in the tail of the pancreas. There are no cysts in the liver or kidneys. The results of all blood tests, including the test for amylase, are normal. The best management of this patient is:
A. Surgical removal of the cyst
B. Three monthly CT scans to determine whether the cyst enlarges or subsides
C. Reassurance and no further evaluation
D. ERCP to determine whether the cyst communicates with the pancreatic duct
E. Needle aspiration of the cyst and examination of the cyst fluid

[ArchivalUser]

Ok I'm between B and E
i think i'll go for E

[ArchivalUser]

A)

[ArchivalUser]

cystenterostomy

[ArchivalUser]

bijar can you explain ur answer? How do you appraoch cysts as a complication of acute or chronic pancreatits if Pt is Sxmatic or Asymptomatic and depending of size of cyst?

[ArchivalUser]

old age, long history and now symptomatic, cysts on the tale which is more common site of pancreatic Ca, (I don't remember now the exact criteria size for cyst, but 3cm is big enough), among the choices surgical exploration seems to be more reasonable.

[ArchivalUser]

size for cysts less 5 cm --follow up 6 wks later to see if it regresses or gets larger as there is more risk of rupturr & infection

But I can't remeber that You go striaght for surgery in Sx Pt proir to confriming pancreatic cancer or finding out what type of cyst it is.

[ArchivalUser]

and diff in Rx for Sx or Asx cyst

[ArchivalUser]

will do c..ist..
<6 cm..follow regularly..

[ArchivalUser]

The problem w/ C is = no further evaluation which should have said Reasurance & Follow Up