Benign Conditions of Ovary and Pelvis

Question 1

Ovarian torsion Ix

Answer 1

FBC (? raised WCC)
Pregnancy test
Speculum (if ?PID)
Bimanual for masses
Urinalysis (rule out colic)
TVUSS w/Doppler
 - may give false -Ve bc. dual blood supply
 - 25% occur in children (to transabdominal)
 - Torsion of NORMAL ovary v unlikely
- Necrosis can -> lactic acidosis

Question 2

Ovarian cysts likely hood of tortion?

Answer 2

Dermoid cyst>Endometrioma

Any cyst >5cm at risk (elective surgery offered)

Question 3

Mx of Ovarian Cyst

Answer 3

1st Line: Laparoscopic detortion
2nd Line: Salpingo-opherectomy
If cyst present: cystectomy
If surgery is not prompt you must remove necrotic ovary

Question 4

PACES counselling of Ovarian Tortion

Answer 4

RF: cyst, tumour, pregnancy, tubal ligation, long ligaments
Dx: ovary has twisted
Mx: surgery, likely to be a cyst which will be removed
risk of necrosis if left

Question 5

Functional Ovarian Cyst Ix

Answer 5

TVUSS
CA125
RF: fertility rx, tamoxifen, pregnancy, hypothyoidism, smoking

Question 6

Functional Ovarian cyst Mx

Answer 6

C: analgesia and observation, address predisposition,
- if hamorrhagic cyst follow up with TVUSS
- if simple repeat USS in 4-6wk
M: COCP prevents ovulation
S: TVUSS vital before (RMI), Laparoscopy if indicated

Question 7

RMI of functional cysts

Answer 7

USS features + menopausal status + CA125

If malignant: refer gynae onc, will require TAH w/BSO

Question 8

Indication for laparoscopy in Functional Ovarian Cyst

Answer 8

Hb compromise
Likely for torsion
No symptom relief within 48hrs
- Young: cysts >5cm risk of tortion
 - Older: suspicious cysts (multiloculated due to risk ca.)

Question 9

Ovarian cyst Rupture

Answer 9

Functional most common

Spontaneous or trauma

Question 10

Ovarian cyst rupture Mx

Answer 10

Analgesia
if active bleed: laparoscopy and cautery
Admit for obs if severe pn
recurrent -> elective cystectomy

Question 11

Germ Cell Tumour

Answer 11

Ovarian cystectomy needed, necessary if:
 - symptom
 - >5 cm
 - Enlarging
Surgery prevents tortion and allows histological analysis