adnexal mass Flashcards
when are simple cysts physiologic and okay?
during the reproductive years. we don’t typically worry about them unless they are complex
when do we worry about cysts in ovaries?
pre and postmenopasual women —these are usually cancerous
what test for cysts?
transvaginal ultrasound (MRI is too expensive).
what does a simple cyst look like on ultrasound
no septations, anechoic, only one color and homogenous. SMALL. <3cm ignore
<10cm probably nothing, watch it. if fails to resolve, then remove.
looks like a bag of black fluid. NOTHING ELSE.
what does a complex cyst look like?
BIG. septations, disconinuous and discolored. multilocular and echoic. multiple structure.
large >10cm
what don’t we do with simple cysts
1) aspiration
2) contraceptives
3) MRI (not needed)
what are th types of complex cysts
endometrioma, teratoma, ectopic, tubo-ovarian abscess, and cancers
what is a Teratoma and when do we see it?
large benign tumors usually in young women that complain of weight gain –typically asymptomatic. These usally contain hair and teeth. We only remove the cyst since mostly these are found in younger women so we want to protect fertility. cystectomy
what is endometrioma
chocolate cyst. Is a complex cyst.
what is endometriosis and what causes it?
dysplaced endometrial tissue. estrogen responsive, so recurs with cycles. retrograde flow of menses?
peritoneal seeding.
how does endometriosis present?
dysperunia, infertility, dysmenorrhea
what is the diagnosis of chocolate cyst?
endometrioma and endometriosis. also treating with OCon and it if it improves then the diagnosis is endometriosis
treatment for endometriosis
managing pelvic/abdominal pain (NSAIDs). gain control of the axis –OCPs/GNRH analogs-luprolide/danosol.
what is the treatment of endometrioma?
find the chocolate cyst with laproscopy with ablation. burn it away after finding it
what causes ectopic pregnancy
early implantation –usually something causing stricture. PID
most common region of ectopic
ampulla.
how does this present?
pregnancy. abdominal pain, UPT positive, amenorrhea.
what is the discriminatory zone
b-hCG measurement >2000 this is the level of b-hCG expected to correlate with findings on ultrasound
what are the treatments for ectopic
1) salpingostomy (suck out zygote, leave the tube)
2) salpingectomy (remove the tube –typically used when ruptured)
3) methotrexate –early
when to use methotrexate
1) b-hCG <5,000
2) no fetal cardiac activity
3) size <3-4cm
how does ovarian torsion presents
typically with sudden crushing abdominal pain that comes out of no where
how to diagnose ovarian torsion
with dopler ultrasound
this is a surgical emergency
what is a tuboovarian abscess
essential PID
what causes PID
gonorrhea and chlamydia
how is tuboovarian treated?
same as PID.
how does TOA present
cervical motion tenderness, adnexal tenderness, uterine tenderness. abdominal/pelvic pain. fever and leukocytosis –not needed to meet criteria.
presence of white cells on wet prep increases the chances that PID is there.
how do we identify the abscess?
ultrasound.
treatment of PID/TOA
IV –cefoxiton + doxcycline + metranidazole.
or clindamyocin + metranidazole
what happens if the TOA does not improve
surgical draining.
