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4: Y4 - Gynaecology [8] > [39] Bartholin's Cyst and Abscess > Flashcards

[39] Bartholin's Cyst and Abscess Flashcards

1
Q

What is a Bartholin’s cyst?

A

A fluid-filled sac within one of the Bartholin’s glands in the vagina

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2
Q

What % of gynaecological visits in the UK per yea rare due to Bartholin’s cysts and abscesses?

A

2%

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3
Q

In what % of women do asymptomatic Bartholin’s cysts occur?

A

Up to 3%

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4
Q

What are the Bartholin’s glands also known as?

A

Greater vestibular glands

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5
Q

Where are the Bartholin’s glands located?

A

Either side of the vaginal orifice, within the vestibule of the vagina (approx 4 and 8 o’clock positions), just below the hymenal ring

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6
Q

What is the function of Bartholin’s glands?

A

They secrete mucus to lubricate the vagina

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7
Q

What can cause the Bartholin’s gland to become blocked?

A

The build-up of mucus secretions

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8
Q

What can happen to the Bartholin’s cyst?

A

It can become infected, and if untreated develop into an abscess

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9
Q

What organisms infect the Bartholin’s cyst?

A

Usually anaerobic, including;

  • E. Coli
  • MRSA
  • STIs
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10
Q

Who do Bartholin’s cysts most commonly occur in?

A

Nulliparous women of child-bearing ge

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11
Q

What are the risk factors for Bartholin’s cysts?

A
  • Personal history of Bartholin’s cyst
  • Sexually active
  • History of vulval surgery
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12
Q

When are Bartholin’s cysts often asymptomatic?

A

If they are small

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13
Q

What symptoms can large Bartholin’s cysts cause?

A
  • Vulvar pain

- Superficial dyspareunia

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14
Q

When in particular do Bartholin’s cysts cause vulvar pain?

A

When walking or sitting

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15
Q

Can Bartholin’s cysts undergo spontaneous rupture?

A

Yes

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16
Q

What is experienced when Bartholin’s cysts undergo spontaneous rupture?

A

Sudden relief of pain

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17
Q

How do Bartholin’s abscesses’ present?

A
  • Acute onset of pain

- Difficulty passing urine

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18
Q

What will be found on examination in Bartholin’s cyst?

A

Unilateral labial mass, typically arising from posterior aspect of labia major

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19
Q

What are the features of a Bartholin’s cyst on examination?

A
  • Soft
  • Fluctuant
  • Non-tender
20
Q

What are the features of a Bartholin’s abscess on examination?

A
  • Tense and hard

- Surrounding cellulitis

21
Q

What are the differential diagnoses for a mass in the labial or vulval region?

A
  • Bartholin’s gland carcinoma
  • Bartholin’s benign tumour
  • Other types of cyst
  • Other solid masses
22
Q

How common is a primary tumour of the Bartholin’s gland?

A

Rare, approx 0.1-5% of vulvar malignancies

23
Q

Give two examples of Bartholin’s benign tumours

A
  • Adenomas

- Nodular hyperplasia

24
Q

What other types of cysts are differentials for Bartholin’s cysts?

A
  • Sebaceous cyst
  • Skene’s duct cyst
  • Mucous cyst
25
Q

What other solid masses are differentials for Bartholin’s cysts?

A
  • Fibroma
  • Lipoma
  • Leiomyoma
26
Q

How is the diagnosis of Bartholin’s cyst or abscess made?

A

Often clinical. and further investigations not routinely required

27
Q

When might investigations be required in Bartholin’s cyst or abscess?

A

In women over 40 years of age

28
Q

What investigation should be considered in suspected Bartholin’s cyst/abscess in women over 40?

A

Biopsy

29
Q

When especially should biopsy of Bartholin’s cyst/abscess be considered in women over 40?

A

If there are solid components to the swelling

30
Q

Why should a biopsy be considered in women over 40 with suspected Bartholin’s cyst/abscess?

A

To exclude vulva carcinoma

31
Q

What investigation should be done if there is any indication of STI in Bartholin’s cyst/abscess?

A

Endocervical and high vaginal swabs

32
Q

What management is required in Bartholin’s cyst that are small and asymptomatic?

A

None

33
Q

What can be recommended to patients with Bartholin’s cysts that are small and asymptomatic?

A

Take warm baths, as this may stimulate spontaneous rupture

34
Q

What are the commonly used treatment options for Bartholin’s cysts?

A
  • Word Catheter

- Marsupilation

35
Q

Why is simple incision and drainage of Bartholin’s cysts not recommended?

A

As accumulation of fluid is likely to reoccur due to further outflow obstruction

36
Q

How is a Word Catheter inserted?

A

An incision is made into the cyst or abscess, and a catheter is inserted. The tip is inflated with 2-3ml of saline

37
Q

How long is a Word Catheter left in situ?

A

4-6 weeks

38
Q

Why is a Word Catheter left in situ for 4-6 weeks?

A

To allow for epithelialisation of the surgically created tract

39
Q

What kind of Bartholin’s cysts is a Word Catheter not suitable for?

A

Deep cysts or abscesses

40
Q

Does a Word Catheter require local or general anaesthetic?

A

Local

41
Q

In what setting is a Word Catheter inserted?

A

Clinic

42
Q

What are the complications of insertion of a Word Catheter?

A
  • Infection
  • Recurrence
  • Dyspareunia
  • Scarring
43
Q

How is marsupialisation performed?

A

A vertical incision is made into the cyst, behind the hymenal ring, allowing for spontaneous drainage of the cavity. The cyst wall is then everted and approximated to the end of the vaginal mucosa by sutures

44
Q

Is marsupialisation performed under local or general anaesthetic?

A

General

45
Q

What are the less commonly used treatment options for Bartholin’s cyst/abscess

A
  • Silver nitrate cautery
  • Carbon dioxide laser
  • Needle aspiration
  • Complete excision of gland
46
Q

When is complete excision of the gland performed in Bartholin’s cyst/abscess?

A

Rarely. only in cases of suspected malignancy

47
Q

Are antibiotics used in the management of Bartholin’s cyst/abscess?

A

No, but can be considered if patient is systemically unwell or immunocompromised

4: Y4 - Gynaecology [8] (52 decks)

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