B8.024 - Big Case Cystic Ovaries Flashcards
what is an essential part of an work up of a woman presenting with abdominal tenderness
beta HCG
Differential dx for RLQ pain with negative beta HCG
acute appendicitis, gastroenteritis, diverticulitis, IBD, ileus, ovarian cyst, tubo ovarian abscess
presentation of appendicitis
pain around umbilicus that progresses to right lower abdomen, vomiting, fever, tachycardia
gastroenteritis presentation
diarrhea, vomiting, abdominal pain, fever, lack of engery, dehydration
diverticulitis/perf presntation
abdominal pain. nausea, vomiting, fever, bloating or gas, constipation
IBD presentation
abdominal pain, cramping, diarrhea, blood in stool maybe, fever, chills fatigue. dehydration
ileus presentation
abdominal discomfort, loss of appetite, feeling of fullness, constipation, inability to pass gas bloating, abdominal discomfort excessive belching, nausea, vomiting
ovarian cyst presentation
lower abdominal pain, fullness or heaviness, bloating or swelling, severe pain before or during menstrual cycles, dyspareunia
tubo ovarian abscess presentation
presents with fever, chandelier sign
types of functional cysts
follicular or corpus luteal, common and may rupture. Often hemorrhagic
what is a mucinous cystadenoma
benign tumor of the ovary, torsion can occur with greater than 4 cm
what is a mature teratoma
ovarian germ cell tumor, torsion can occur when greater than 4 cm
complication of ovarian cancer
torsion
endometrioma presents
with chronic pain, common
what is an ovarian cyst
solid or fluid filled sac or pocket within or on the surface of an ovary most common in reproductive aged women
how do you diagnose ovarian cyst
pelvic ultrasound
sx of ovarian cyst
irregular menstrual cycles, pelvic pain or pressure, dyspareunia sometimes asx
types of ovarian cysts
follicular, corpus luteum, hemorrhagic, mucinous cystadenoma, mature teratoma, endometrioid
follicular cysts
follicle fails to rupture, often resolves spontaneously
corpus luteum cyst
CL fails to regress, may produce progesterone, may be hemorrhagic
hemorrhagic cysts
blood filled follicular or luteal
mucinous cystadenoma
lined by columnar epithelium, typically similar to endocervical epithelium, secrete gelatinous mucin
mature teratoma
germ cell tumor, may contain ectoderm, endoderm derived tissues
endometrioid
manifestation of endometriosis, endometrial tissue on ovary, chocolate cyst
diagnostic test for ovarian cysts
transvaginal ultrasound
what are the clinically important parameters that transvaginal ultrasound can help with
eval of small masses, origin of mass, torsion, internal consistency, presence of septae
imaging of mature teratoma
hyperechoic interfaces in a cystic mass
imaging of a simple/follicular cyst
thin smooth wall, anechoic contetns, no or only few septa
typical endometrioma on imaging
thick wall, homogenous low level internal echoes, occasionally wall calcifications
mucinous cystadenoma on imaging
thin septations, may demonstrate echogenic material (mucin)
what does the presence of complex septations on ovarian cyst imaging mean
could be malignant
basically not a good sign
imaging of hemorrhagic cyst
fishnet weave/fine reticular pattern
how do you rule in / out torsion
torsion can be dx on doppler ultrasound bc you can see if blood flow has been restricted or nott
management of ruptured corpus luteal cyst
surgery. need exogenous progesterone support after surgery to prevent miscarriage
diangostic workup for amenorrhea hyperandrogenism
thyroid - TSH
rare enzyme defects - 17 - OHP CAH
stress hormomne - cushing 24 hr free cortisol
tumors - testosterone, DHEAS, prolactin
excessive growth hormone - IGF -1
what is PCOS
polycystic ovaries
high androgen levels
irregular periods
how do you diagnose polycystic ovaries
strand of pearls, 12 or more follicles seen on ovary
how do you diagnose high androgen levels
signs like acne, hair (growth, loss)
Labs (DHEAS, T)
what is an irregular period
35 day or longer cycle
heavy bleeding
problems with ovulation
what causes PCOS?
endocrine disruptors, genetic, diff in androgen receptors or SHBG, gestational hyperglycemia, in utero exposure to androgen. evolutionary paradox
how do you manage high androgen levels
tx acne with bonzoyl peroxide, siacylic acid, topical/oral antibiotics, OC, retinoids
tx MPB with rogaine, spironolactone, combined estrogen and progesterone, ketoconazole, propecia (blocks DHT), metformin, flutamide, vaniqa
health problems with PCOS
heart disease, obesity, DM, mood/sleep disorders, cx, liver disease, infertility
metabolic syndrome
dx with 3/5:
HTN (>130/85)
WC >35 in
fasting glucose >100
HDL <50
TG >150
tx of PCOS and high cholestrol
statins - cause birth defects
dangers of high BP
systolic >140 diastolic >90
risk of heart disease, renal failure, stroke
narrowed blood vessels from damaged lining increases pressures
how do you assess glycemic control in PCOS
HbA1c
2h glucose tolerance
use of metformin in PCOS
biguanide, improves bodys ability to process insulin
decreases androgen levels, improves ovulation but does not improve chance of live birth
can cause lactic acidosis, GI distress, wt loss
PCOS affect on mood and sleep
more likely to have depression and anxiety
5x more likely to have sleep apnea
PCOS affect on cancer risk
2-3x more likely to have endometrial uterine cancer
increased endometrial growth in anovulation
