ovarian cysts Flashcards
define rupture of ovarian cyst
common occurrence in females of reproductive age
rupture results in the release of cyst contents (eg. serous fluid, bloods, sebaceous material), that may irritate the peritoneal cavity and cause pain
normal physiological rupture of follicular cysts
in the normal menstrual cycle, physiological rupture of follicular cysts, which are typically <3cm in size, occur with every ovulatory cycle
this may be associated with midcycle pain, ie. mittelschmerz
risk factors for ovarian cyst rupture
conditions that predispose a patient to ovarian cyst formation
- ovulation induction eg. IVF cycles
- prior Hx
current known cyst
larger cyst
vaginal intercourse/strenuous activity with a known cyst
thrombocytopaenia or anticoagulation therapy
hamorrhagic ovarian cyst
may be asymptomatic or present with mild pelvic pain
haemorrhagic cysts or haemorrhagic corpus usually occur with ovulatory dysfunction
patients who are on anticoagulation are at increased risk
typically resolve within 8 weeks
benign ovarian masses
follicular/functional cysts
parafimbrial cysts
inclusion cysts
tubo-ovarian abscess
endometrioma
ovarian fibroid
tubo-ovarian abscess
1/3 of women admitted with PID are found to have TOA
rupture and sepsis may lead to mortality
risk factors for TOA
multiple sexual partners
STI in partner
age 15-25
prior Hx of PID/TOA
pelvic surgery
complicated diverticular disease
resent IUD insertion
immunosuppression
signs/symptoms of TOA
lower abdominal pain which is typically bilateral
deep dyspareunia
abnormal vaginal bleeding
abnormal vaginal or cervical discharge which is often purulent
adnexal tenderness on vaginal examination
fever >38
management principles of TOA
medical management with antibiotics, serial imaging, monitoring inflammatory markers.
imaging guided percutaneous drainage may be required
surgical management if TOA >7cm, clinically unwell, suspicion of abscess rupture, lack of response to medical management, uncertain diagnosis
TOA and IUCD
IUDs cause a slight increased risk for PID in the first 3 weeks after insertion
TOA associated with IUD is typically caused by actinomyces israelii
most women do not require the removal of IUD except Actinomyces PID, because actinomyces flourishes on foreign bodies, so removing the IUD improves treatment and recovery
risk factors for ovarian tumours
women who have never had children
lynch syndrome
BRCA1 and BRCA2 gene mutations
smoking
age
obesity
HRT
ART/IVF
?talcum powder
protective factors against ovarian tumours
first pregnancy at an early age
breastfeeding
early menopause
use of oral contraceptves
ovarian mass work-up
constitutional symptoms: early satiety, abdominal pains and bloating, change in bowel habits, urinary symptoms
family history: consider lynch, BRCA
examination: cachexia, ascites, abdominal mass, immobile uterus, adnexal masses
Investigations
Ca125, CEA, Ca19
+ young patients with concerning ovarian mass consider germ cell tumour markers as well BhCG, AFP, AMH, LDH
imaging: USS, IOTA score, CT CAP
epithelial ovarian tumours
most common form of ovarian malignancy, especially in older women
associated with tumour markers CA125
treatment for ovarian tumours
most patients present with stage 3 or 4 disease
surgical debulking - most important prognostic indicator in patients with advances stage ovarian cancer is the volume of residual disease after surgical debulking
chemotherapy
