Ovarian D/O and Infertility Flashcards by Lauren Lover

what are benign functional ovarian d/o

FYI CARDS, just know these are functional and the rest are non-functional

Follicular cyst
Corpus luteum cyst
Theca lutein cyst

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what benign non-functional ovarian d/o

MORE FYI CARDS

Cystadenoma (mucinous or serous) 
Tubo-ovarian abscess (TOA)
Endometrioma (chocolate cyst)
Mature Teratoma (Dermoid)
Paraovarian cyst or fibroid
Polycystic ovary
Ovarian/Adnexal Torsion

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what are malignant ovarian d/o

Epithelial
Non-epithelial
Germ cell/Sex Cord Stromal tumor

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___ are the most frequent cystic structure in normal ovary and usually effects ____ (age group)

Follicular Cyst

reproductive = ovulatory women

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a follicular cyst occurs with persistent (unovulated, mature) follicle fills with ____ or immature follicle failing to undergo ___

fluid

atresia

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what are s/s of follicular cysts

asymptomatic
large = heavy feeling, dull pain
delay menses

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what may severe pain with a follicilar cyst indicate

hemorrhage
rupture
torsion

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how do you dx follicular cysts

pelic exam

transvag. U/S

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what exam finding indicate a benign ovarian cyst

2-8 cm
unilateral
mobile
mild/ no pain

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What U/S findings suggest a benign ovarian cyst

<8 cm
unilocular
simple fluid flled
thin walls, no nodules

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how can you treat ovarian disorders

expectant
OCP
surgery

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____ are Less common than follicular cysts and results from intrafollicular bleeding after ovulation. They are Associated with normal endocrine function or prolonged secretion of P*

Corpus Luteum Cyst

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Corpus Luteum Cyst are usually ___-___ cm and have the same sxs and complications as follicular cysts

3-10

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_____ are the Least common physiologic ovarian cyst they are (Almost/Never) always bilateral*
Can be massive, up to __-__ cm with multiple cysts
Arise from prolonged or excess stimulation of ovaries by endogenous or exogenous Gn**

Theca Lutein Cysts

Always

20-30

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Theca Lutein Cysts;
Symptoms?
Ultrasound findings?
Complications:?
Management:?

Symptoms: pelvic pressure

Ultrasound findings: multiple thin-walled cysts bilaterally

Complications: rare incidence of torsion/rupture*

Management: conservative, spontaneously regress

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___ are Benign tumor of ovarian surface epithelium, lined by simple epithelium that is serous or mucinous. they are the MOST COMMON benign ovarian neoplasms

Cystadenoma: Serous or Mucinous

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___ are filled with pale yellow serous fluid, usually unilocular

Serous cystadenoma:

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___ are filled with sticky mucin, tend to be multiloculated

Mucinous Cystadenoma

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how do you dx Cystadenoma: Serous or Mucinous

U/S

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how do you tx Cystadenoma: Serous or Mucinous

surgical removal w/ staging

appendectomy

___ are Infectious disorder of the upper genital tract (PID) creating an inflammatory mass involving the fallopian tube and ovary
Often bilateral due to ascending infection

Tubo-ovarian abscess

Tubo-ovarian abscess s/s

Symptoms of PID

Adnexal pain and mass

complication of Tubo-ovarian abscess

sepsis 
rupture 
tubal occlusion
infertility
ectopic pregnancy
chronic pelvic pain due to adhesions

how do you tx Tubo-ovarian abscess?

IV abx

___ is a an ovarian cystic mass arising from growth of ectopic endometrial tissue within the ovary. Typically contain thick brown tar-like fluid ("chocolate cyst") and are often densely adherent to surrounding structures.

Endometrioma (Chocolate Cyst)

what are s/s of Endometrioma (Chocolate Cyst)

asymptomatic pelvic pain dysmenorrhea dyspareunia

what are complications of Endometrioma (Chocolate Cyst)

infertility | rupture

how do you tx Endometrioma (Chocolate Cyst)?

observation | surgical

___ are a benign neoplasm containing tissue from all three germ layers ie: Ectoderm (skin, appendages: hair, teeth, sebaceous material), Mesoderm And Endoderm

Mature Cystic Teratoma (Dermoid)

Mature Cystic Teratoma (Dermoid)* are the most common benign neoplasm in women ____ (age group) __-__% bilateral

< 35 y/o including adolescents 10-15% b/l

how do you tx a Mature Cystic Teratoma (Dermoid)

surgery

____ are Ovaries with multiple cysts associated with PCOS. The most common cause of hyperandrogenism and chronic anovulation.

Polycystic ovary

Polycystic ovary occurs in __-__% of reproductive age females

4-12%

what are sxs related to?

HYPERANDROGENEMIA - acne, hirsutism, alopecia REPRODUCTIVE D/O - irregular menses, anovulation, infertility, endometrial hyperplasia METABOLIC DISTURBANCES - obesity, insulin resistance, hyperinsulinemia

what re the dx criteria for Polycystic ovary

(need 2 out of 3 criteria): - Oligoovulation or anovulation - Hyperandrogenemia - Polycystic ovaries diagnosed by ultrasound

how do you treat Polycystic ovary

OCP Metformin progesterone mechanical hair removal for hirsutism

__ is a simple epithelial-lined cyst (rarely complex) or benign fibroid adjacent to the ovary, usually within the broad ligament Incidence: approx. 10% of benign adnexal cysts, most common ___-___ year old

Paraovarian cyst or fibroid 30-50y.o.

how do you tx Paraovarian cyst or fibroid

observe if small | surgery to remove

____ is the rotation of the ovary or the ovary and FT to such a degree as to occlude the vascular supply (can be partial/intermittent or complete resulting in necrosis)

Ovarian (Adnexal)Torsion

what age group is Ovarian (Adnexal)Torsion most common?

reproductive aged women

what are sx of Ovarian (Adnexal)Torsion

severe unilateral pain | N/V

T/F: Ovarian (Adnexal)Torsion can be dx using a TUS with Doppler flow studies

how do you tx Ovarian (Adnexal)Torsion

emergent surgery

what are U/S findings that suggest a malignant adnexal mass?

1. Thick septations 2. Papillary projections or nodules into the lumen of a cyst 3. Cystic and solid components 4. Increased overall volume of the ovary 5. Increased Doppler measurement of blood flow

what are serum tumor markers in ovarian d/o

CA 125 | HE4

these descriptions fit which ovarian tumor marker? Decreased specificity especially in premenopausal women Increased in many benign conditions including endometriosis, leiomyoma, PID and pregnancy

CA 125

these descriptions fit which ovarian tumor marker? Has improved specificity over CA 125 Not elevated in endometriosis or other benign conditions

HE4

what does ROMA or RMI stand for?

Risk of ovarian malignancy algorithm Risk of Malignancy Index

what clinical characteristics require a woman to be referred to a GYN oncologist

Elevated CA 125 level - >35 in postmenopausal woman - >200 in premenopausal woman Ascites Nodular or fixed pelvic mass Evidence of abdominal or distant metastasis FHx of one or more first-degree relatives with ovarian or breast cancer