Bartholins abscess and benign ovarian cysts Flashcards
What are bartholins glands
Pair of glands located either side posterior part vaginal introitus (opening)
Pea sized, non palpable
Produce mucus to help with vaginal lubrication
How does a bartholins cyst appear
Swelling unilateral and fluid filled cyst - 1-4cm
What causes bartholins cyst to form abscess
Duct becomes infected after being blocked (cyst) -> hot, tender, red, pus
What causes bartholins cyst to form abscess
Duct becomes infected after being blocked (cyst) -> hot, tender, red, pus
What do bartholins cysts resolve with
Good hygeine
Analgesia
Warm compresses
Incision avoided due to risk of reocurrence
When is a biopsy required in bartholins cyst
Vulval malignancy needs to be excluded - esp in women over 40
What do when deciding on antibiotic for bartholins abscess
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
Most common cause of bartholins abscess
E.coli
What options are there to surgically treat a Bartholins abscess
Word catheter (Bartholins gland balloon) - local
Marsupialisation - general anaesthetic
How a balloon used to drain bartholins abscess
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
What is marsupialisation?
Incision made and abscess drained, sides sutured open - allows continious drainage of the area prevents recurrence of cyst or abscesses
What is a benign ovarian cyst
Fluid filled sac
When are benign cysts more likely
Premenopause
Post - more likely malignanyc
What are functional ovarian cysts related to?
Fluctuating hormones of menstrual cycle
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?
Anovulation
Hyperandrogenism
Polycystic ovaries on US
What can ovarian cysts cause symptoms of?
Pelvic pain
Bloating
Fullness in abdomen
Palpable pelvic mass
What cysts cause palpable pelvic mass
V large custs eg mucinous cystadenomas
When do ovarian cysts present with acute pelvic pain
Ovarian torsion
Haemorrhage
Rupture of cyst
What causes a follicular cust
When developing follicle fail to rupture and release the egg, cyst can persist
Prognosis of follicular cysts
Most common cyst - harmless, disappear after few menstrual cycles
Thin walls and no internal structures
Reassuring appearance on US
What is a corpus luteum cyst
Corpus luteum fails to break down instead fills with fluid
Seen early in pregnancy
What does corpus luteum cyst cause?
Cause pelvic discomfort, pain or delayed menstruation
Types of ovarian cysts
Serous cystadenoma
Mucinois cystadenoma
Endometrioma
Dermoid cysts/germ cell tumours
Sex cord-stromal tumours
What are serous cystadenoma
Benigin tumours of epithelial cells
What are mucinous cystadenomas
Benign tumours if epithelial cells
Can be huge, take up alot of space
What is an endometrioma and what are they ass with
Lumps of endometrial tissue within ovary
Occuring in patients with endometriosis
Pain, disrupt ovulation
What is a dermoid cyst/germ cell tumour
Benign ovarian tumours
Teratomas come from germ cells
Skin, teeth, hair, bone
What cyst is esp ass with torsion
Dermoid cyst/germ cell tumour
What are teratomas
Come from germ cells
What are sex cord-stromal tumours
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
What questions may suggest malignanyc ass with cyst
Abdominal bloating
Reduced appetite
Early satiety
Weight loss
Urinary symptoms
Pain
Ascites
Lymphadenopathy
What are risk factors for ovarian malignancy
Age
Postmenopause
Increased no. ovulations
Obesity
HRT
smoking
Breastfeeding - protective
BRAC1/2 genes FH
What affect does number of ovulations have on risk of ovarian cancer?
More ovulations = higher risk
What factors reduce number of ovulations and therefore risk of ovarian cancer
Later onset periods - menarche
Early menopause
Any pregnancies
Use of COCP
What presentation found on US needs no fruther investigation?
Simple ovarian cyst
Less than 5cm
Premenopausal woman
What is the tumour marker for ovarian cancer
CA125
Which women require tumoir marker tests for germ cell tumour
Under 40 with complex ovarian mass
What tumour markers are used for germ cell tumour
Lactate dehydrogenase (LDH)
Alpha - fetoprotein (alpha-fetoprotein)
Human chorionic gonadatrophin (HCG)
Causes of raised CA125
Ovarian cancer - but not that specific
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
What does the risk of maligancy index take into account
Menopausal status
US findings
CA125 level
What elicitis need for 2 week wait referral to gynaecologist
Possible ovarian cancer suggested by complex cysts or raised CA125
Possible dermoid cysts - referral to gynae but not 2 week
How are cysts less than 5cm in premenopausal women managed
Resolve within 3 cycles - dont require follow uo scan
What do cysts 5-7cm require in premenopausal women
Require routine referral to gynae
Yearly US monitoring
What do simple ovarian cysts in premenopausal women need to be managed
Consider MRI scan on surgical evaluation
Diffucult to characterise with an US
Cysts in postmenopausal women
CA125 result _ referral to gynae
If raised CA125 - two week wait
How are simple cysts <5cm w normal CA125 in postmenopausal women managed
US every 3-6 months
What do persistent or enlarging cysts sometimes require
Surgical interfvention -
Lapraoscopy
Ovarian cystectomy
OOpherctomy
Complications of ovarian cysts
Present with acute onset pain
Torsion
Haemorrhage into cyst
Rupture, bleeding into peritoneum
What is meigs syndrome
Triad ofL
Ovarian fibroma (benign ovarian tumour)
Pleural effusion
Ascites
(older women. Removal tumour results complete resolution)
