benign condition of ovary and pelvis Flashcards
What are the types of ovarian cyst
Functional Germ cell Epithelial Inflammatory Sex cord stromal
types of functional ovarian cyst
follicular
thecal luteal
corpus luteum
types of germ cell cyst
benign teratoma (dermoid)
types of inflammatory cyst
tubo-ovarian abscess
endometrioma
types of epithelial cyst
serous cystadenoma
mucinous cystadenoma
brenner tumour
types of sex cord stromal cyst
fibroma
thecoma
Ix of suspected torsion of cyst
TVUSS (TAUSS if never been sexually active)
MRI
Pregnancy test
INF markers to rule out appendicitis and tubo-ovarian abscess
How big does it have to be for cyst diagnosis
> 3cm
ovulatory follicle can be 2.5cm
Mx of ovarian cyst
If asymptomatic:
Simple and small (<50mm) - likely to be physiological, will resolve in 3 menstrual cycles. Don’t require follow up
simple and 50-70mm - yearly US follow up
>70mm - further ix either MRI or surgery (if dermoid take it out)
If acutely unwell:
urgent surgical exploration + Abx
Post-menopausal w/ solid or complex cyst:
suspicious so do TVUSS RMI
What are corpus luteal cysts associated with
Occur after ovulation
Can rupture and be painful
What are thecal luteal cyst associated w/
pregnancy (especially multiple)
resolve spontaneously
What are inflammatory cysts associated with
PID
endometrioma are chocolate cyst with ground glass appearance on USS
Indications for cystectomy of germ cell tumour
greater than 5cm
growing
symptomatic
NB - low risk of malignant transformation
differences between serous and mucinous cystadenoma
Serous unilateral and unilocular
mucinous usually bilateral
Epidemiology of epithelial cysts
Increase with age
who gets sex cord stromal cysts
older women
What is meig’s syndrome
ascites, ovarian fibromas, pleural effusion
NB. - fibromas often tort
Features of thecoma
Oestrogen secreting
in older women can be a cause of PMB
Physical examination findings suggestive of endometriosis
Thickening of uterosacral ligaments
Adnexal mass
fixed retroverted uterus
tenderness in pouch of douglas
Use of imaging in endometriosis
TVUSS - see endometriomas (diagnostic for ovarian disease)
Can see rectal involvement
MRI - can see lesions >5mm
Appearances of endometriosis on laparascopy
red
black matchstick
white fibrous
medical mx of endometriosis
NSAIDs for pain (avoid codeine cause it can worsen co-existing IBS)
COCP (can take with pill free or continuously to induce amenorrhea til you want to conceive)
Progestogens (if COCP contraindicated) to induce amenorrhea
GnRH agonist (only use 6 months at a time or you will get osteoporosis)
Surgical mx of endometriosis
fertility sparing:
laparascopic, will probably need medical adjunct to help
Hysterectomy +oophorectomy if they have finished family
may not cure everything
then start on oestrogen only HRT
Causes of chronic pelvic pain
gynae
urological
GI
neuro
RF for endometriosis
early menarche FHx nulliparity prolonged menstruation (>5 days) short menstrual cycles (<28 days)
