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Reproductive Health > Bartholins abscess and benign ovarian cysts > Flashcards

Bartholins abscess and benign ovarian cysts Flashcards

1
Q

What are bartholins glands

A

Pair of glands located either side posterior part vaginal introitus (opening)
Pea sized, non palpable
Produce mucus to help with vaginal lubrication

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2
Q

How does a bartholins cyst appear

A

Swelling unilateral and fluid filled cyst - 1-4cm

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3
Q

What causes bartholins cyst to form abscess

A

Duct becomes infected after being blocked (cyst) -> hot, tender, red, pus

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3
Q

What causes bartholins cyst to form abscess

A

Duct becomes infected after being blocked (cyst) -> hot, tender, red, pus

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4
Q

What do bartholins cysts resolve with

A

Good hygeine
Analgesia
Warm compresses
Incision avoided due to risk of reocurrence

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5
Q

When is a biopsy required in bartholins cyst

A

Vulval malignancy needs to be excluded - esp in women over 40

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6
Q

What do when deciding on antibiotic for bartholins abscess

A

Swab culture of pus or fluid from abscess taken to culture infective organism and check antibiotic sensitivities
Also send specific swabs for chlamydia and gonorrhea

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7
Q

Most common cause of bartholins abscess

A

E.coli

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8
Q

What options are there to surgically treat a Bartholins abscess

A

Word catheter (Bartholins gland balloon) - local
Marsupialisation - general anaesthetic

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9
Q

How a balloon used to drain bartholins abscess

A

Local anaesthetic used, incision made and pus drained
Catheter inserted into abscess space, inflated up to 3ml slaine
Baloon fills space keeps catheter in place.
Fluid drains around catheter, stops cyst or abscess reoccruing
Tissue heals around catheter, leaving permanant hole
Catheter deflated + removed once epitheliasation hole occured

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10
Q

What is marsupialisation?

A

Incision made and abscess drained, sides sutured open - allows continious drainage of the area prevents recurrence of cyst or abscesses

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11
Q

What is a benign ovarian cyst

A

Fluid filled sac

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12
Q

When are benign cysts more likely

A

Premenopause
Post - more likely malignanyc

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13
Q

What are functional ovarian cysts related to?

A

Fluctuating hormones of menstrual cycle

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14
Q

Apart from multiple ovarian cysts or a string of pearls, how many of what other features need to be present for a diagnsosis of PCOS?

A

Anovulation
Hyperandrogenism
Polycystic ovaries on US

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15
Q

What can ovarian cysts cause symptoms of?

A

Pelvic pain
Bloating
Fullness in abdomen
Palpable pelvic mass

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16
Q

What cysts cause palpable pelvic mass

A

V large custs eg mucinous cystadenomas

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17
Q

When do ovarian cysts present with acute pelvic pain

A

Ovarian torsion
Haemorrhage
Rupture of cyst

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18
Q

What causes a follicular cust

A

When developing follicle fail to rupture and release the egg, cyst can persist

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19
Q

Prognosis of follicular cysts

A

Most common cyst - harmless, disappear after few menstrual cycles
Thin walls and no internal structures
Reassuring appearance on US

20
Q

What is a corpus luteum cyst

A

Corpus luteum fails to break down instead fills with fluid
Seen early in pregnancy

21
Q

What does corpus luteum cyst cause?

A

Cause pelvic discomfort, pain or delayed menstruation

22
Q

Types of ovarian cysts

A

Serous cystadenoma
Mucinois cystadenoma
Endometrioma
Dermoid cysts/germ cell tumours
Sex cord-stromal tumours

23
Q

What are serous cystadenoma

A

Benigin tumours of epithelial cells

24
Q

What are mucinous cystadenomas

A

Benign tumours if epithelial cells
Can be huge, take up alot of space

25
Q

What is an endometrioma and what are they ass with

A

Lumps of endometrial tissue within ovary
Occuring in patients with endometriosis
Pain, disrupt ovulation

26
Q

What is a dermoid cyst/germ cell tumour

A

Benign ovarian tumours
Teratomas come from germ cells
Skin, teeth, hair, bone

27
Q

What cyst is esp ass with torsion

A

Dermoid cyst/germ cell tumour

28
Q

What are teratomas

A

Come from germ cells

29
Q

What are sex cord-stromal tumours

A

Rare tumours - benign or malignatn
Arise from stroma - CT
OR sex crods - embryonic structures ass with follicles
Types incl sertoli-leydig cell tumours and granulosa cell tumours

30
Q

What questions may suggest malignanyc ass with cyst

A

Abdominal bloating
Reduced appetite
Early satiety
Weight loss
Urinary symptoms
Pain
Ascites
Lymphadenopathy

31
Q

What are risk factors for ovarian malignancy

A

Age
Postmenopause
Increased no. ovulations
Obesity
HRT
smoking
Breastfeeding - protective
BRAC1/2 genes FH

32
Q

What affect does number of ovulations have on risk of ovarian cancer?

A

More ovulations = higher risk

33
Q

What factors reduce number of ovulations and therefore risk of ovarian cancer

A

Later onset periods - menarche
Early menopause
Any pregnancies
Use of COCP

34
Q

What presentation found on US needs no fruther investigation?

A

Simple ovarian cyst
Less than 5cm
Premenopausal woman

35
Q

What is the tumour marker for ovarian cancer

A

CA125

36
Q

Which women require tumoir marker tests for germ cell tumour

A

Under 40 with complex ovarian mass

37
Q

What tumour markers are used for germ cell tumour

A

Lactate dehydrogenase (LDH)
Alpha - fetoprotein (alpha-fetoprotein)
Human chorionic gonadatrophin (HCG)

38
Q

Causes of raised CA125

A

Ovarian cancer - but not that specific
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy

39
Q

What does the risk of maligancy index take into account

A

Menopausal status
US findings
CA125 level

40
Q

What elicitis need for 2 week wait referral to gynaecologist

A

Possible ovarian cancer suggested by complex cysts or raised CA125
Possible dermoid cysts - referral to gynae but not 2 week

41
Q

How are cysts less than 5cm in premenopausal women managed

A

Resolve within 3 cycles - dont require follow uo scan

42
Q

What do cysts 5-7cm require in premenopausal women

A

Require routine referral to gynae
Yearly US monitoring

43
Q

What do simple ovarian cysts in premenopausal women need to be managed

A

Consider MRI scan on surgical evaluation
Diffucult to characterise with an US

44
Q

Cysts in postmenopausal women

A

CA125 result _ referral to gynae
If raised CA125 - two week wait

45
Q

How are simple cysts <5cm w normal CA125 in postmenopausal women managed

A

US every 3-6 months

46
Q

What do persistent or enlarging cysts sometimes require

A

Surgical interfvention -
Lapraoscopy
Ovarian cystectomy
OOpherctomy

47
Q

Complications of ovarian cysts

A

Present with acute onset pain
Torsion
Haemorrhage into cyst
Rupture, bleeding into peritoneum

48
Q

What is meigs syndrome

A

Triad ofL
Ovarian fibroma (benign ovarian tumour)
Pleural effusion
Ascites
(older women. Removal tumour results complete resolution)

Reproductive Health (69 decks)

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