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Gynae > Ovarian Disease > Flashcards

Ovarian Disease Flashcards

1
Q

What does a functional ovarian cyst mean?

A

relating to fluctuating hormone levels

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2
Q

Who are ovarian cysts very commin in?

A

pre-menopausal women

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3
Q

What are ovarian cysts?

A

Fluid-filled sacs found within the ovary.

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4
Q

Types of ovarian cysts

A

Functional (relating to fluctauating hormone levels)
Inflammatory
Germ cell
Epithelial
Sex cord stromal

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5
Q

Types of functional ovarian cysts

A

Follicular (MOST COMMON type of functional cyst)
USS Appearance: thin-walled, unilocular, anechoic

Corpus Luteal
Occurs after ovulation and may rupture at the end of the menstrual cycle
USS Appearance: diffusely thick wall, < 3 cm, lacey pattern

Theca Lutein
Associated with pregnancy (high levels of gonadotrophins)
Resolve spontaneously
USS Appearance: bilaterally enlarged, multicystic ovaries. The cysts are thin-walled and anechoic

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6
Q

Most common type of functional ovarian cyst

A

Follicular

USS Appearance: thin-walled, unilocular, anechoic

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7
Q

What type of functional cysts occurs after ovulation? What happens to it at the end of the menstrual cycle?

A

Corpus luteal cysts occur after ovulation and may rupture at the end of the menstrual cycle

USS Appearance: diffusely thick wall, < 3 cm, lacey pattern

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8
Q

functional cyst that Occurs after ovulation and may rupture at the end of the menstrual cycle

A

corpus luteal

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9
Q

What type of functional cyst is associated with pregnancy? why?

A

Associated with pregnancy (high levels of gonadotrophins)
Resolve spontaneously

USS Appearance: bilaterally enlarged, multicystic ovaries. The cysts are thin-walled and anechoic

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10
Q

Functional cyst that is associated with pregnancy and resolves spontaneously

A

Theca lutein

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11
Q

Inflammatory cyst that is associated with PID

A

tubo-ovarian abscess

USS Appearance: ovary and tube cannot be distinguished from the mass

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12
Q

types of inflammatory ovarian cysts

A

Tubo-Ovarian Abscess
Associated with pelvic inflammatory disease
USS Appearance: ovary and tube cannot be distinguished from the mass

Endometrioma
Also known as a chocolate cyst
Associated with endometriosis
USS Appearance: unilocular with ground-glass echoes

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13
Q

endometrioma AKA

A

chocolate cyst

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14
Q

Inflammatory cyst associated with endometriosis

A

endometrioma

USS Appearance: unilocular with ground-glass echoes

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15
Q

ground glass echoes on USS

A

endometrioma

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16
Q

Germ cell cyst

A

Dermoid
USS Appearance: unilocular, diffusely or partially echogenic mass that may contain teeth and hair
Described as mature (benign, solid or cystic) or immature (contains embryonic elements and is malignant)

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17
Q

What can dermoid cysts be described as? (type of germ cell cyst)

A

Described as mature (benign, solid or cystic) or immature (contains embryonic elements and is malignant)

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18
Q

What may dermoid cysts contain?

A

teeth and hair

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19
Q

Types of epithelial cysts

A

Serous Cystadenoma (MOST COMMON ovarian neoplasm)
Usually unilocular and often bilateral
USS Appearance: unilocular, anechoic, no flow on colour Doppler

Mucinous Cystadenoma
Often large
USS Appearance: multiloculated, many thin separations, low echogenicity due to mucin production

Brenner Tumour
Small and contain urothelial-like epithelium
USS Appearance: hypoechoic but occasionally calcification may be seen

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20
Q

Most common ovarian neoplasm

A

serous cystadenoma (type of epithelial cyst)

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21
Q

type of epithelial cyst that is usually unilocular and often bilateral

A

Serous Cystadenoma (MOST COMMON ovarian neoplasm)

USS Appearance: unilocular, anechoic, no flow on colour Doppler

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22
Q

ovarian cyst with no flow on colour doppler

A

serous cystadenoma (most common)

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23
Q

type of epithelial cyst which has low echogenicity on USS due to mucin production

A

Mucinous Cystadenoma

USS Appearance: multiloculated, many thin separations, low echogenicity due to mucin production

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24
Q

Type of epithelial cyst that is small and contain urothelial-like epithelium

A

Brenner tumour

USS Appearance: hypoechoic but occasionally calcification may be seen

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25
Q

Ovarian cyst with calcifications on USS

A

brenner tumour

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26
Q

Types of sex cord stromal cysts

A

Fibroma
Benign and do not produce any hormones
May, occasionally, present with Meig syndrome (pleural effusion, ascites and ovarian fibroma)  
USS Appearance: solid and hypoechoic mass

Thecoma
Benign and may produce oestrogens
USS Appearance: variable (may be echogenic, hypoechoic or anechoic)

Granulosa Cell
Produces oestrogen
USS Appearance: variable (may be cystic or solid)

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27
Q

Type of sex cord stromal cyst that is benign and doesn’t produce any hormones

A

Fibroma

May, occasionally, present with Meig syndrome (pleural effusion, ascites and ovarian fibroma)  
USS Appearance: solid and hypoechoic mass

28
Q

What may fibromas ovvasionally present with? (type of sex cord stromal cyst)

A

Meig syndrome (pleural effusion, ascites and ovarian fibroma)  

29
Q

Meig syndrome 

A

pleural effusion, ascites and ovarian fibroma) 

30
Q

Type of ovarian cyst that presents with pleural effusion and ascites? What is resultant syndrome called?

A

Fibroma, Meig syndrome

31
Q

What sex cord stromal cysts produce oestrogens? How to differentiate?

A

Thecoma
Benign and may produce oestrogens
USS Appearance: variable (may be echogenic, hypoechoic or anechoic)

Granulosa Cell
Produces oestrogen
USS Appearance: variable (may be cystic or solid)

32
Q

Presentation of ovarian cysts

A

Often asymptomatic and found incidentally
Pelvic pain
Abdominal fullness
May produce with sudden pain
Due to torsion, cyst rupture or bleed

33
Q

Why may ovarian cysts present with sudden pain?

A

Due to torsion, cyst rupture or bleed

34
Q

Investigations for ovarian cysts

A

Bedside
Urine Pregnancy Test
Urine Dipstick and MSU
Bimanual Examination
Speculum Examination

Bloods
Serum hCG
CA125
LDG
aFP

Imaging & Other
Transvaginal Ultrasound Scan
NOTE: transabdominal ultrasound scan is preferred in girls and women who have never been sexually active

35
Q

What scan is preffered in girls and woman who have never been sexually active with ovarian cysts?

A

Transabdominal US

36
Q

Management of ovarian cyst

A

Complex Ovarian Cyst or Raised CA125
Refer via 2-week-wait to a specialist

Simple Ovarian Cyst in Premenopausal Women
< 5 cm: no further investigation, usually resolves within 3 cycles
5-7 cm: routine referral to gynaecologist with yearly monitoring
> 7 cm: MRI scan and surgical evaluation

Surgical Intervention
Laparoscopic cystectomy

37
Q

How to manage complex ovarian cyst or raised CA123?

A

Refer via 2-week-wait to a specialist

38
Q

Management of simple ovarian cyst in premenopausal women

A

< 5 cm: no further investigation, usually resolves within 3 cycles
5-7 cm: routine referral to gynaecologist with yearly monitoring
> 7 cm: MRI scan and surgical evaluation

39
Q

Surgical intervention for ovarian cysts

A

Laparoscopic cystectomy

40
Q

What is ovarian hyperstimulation syndrome

A

Complication of ovarian stimulation during IVF treatment.

41
Q

Complication of ovarian stimulation during IVF treatment.

A

Ovarian hyperstimulation syndrome

42
Q

RFs for ovarian hyperstimulation syndrome

A

Younger age
Low BMI
Polycystic ovarian syndrome
Previous ovarian hyperstimulation syndrome

43
Q

Presentation of ovarian hyperstimulation syndrome

A

Abdominal swelling
Vulval, pedal and sacral sweling
Nausea and vomiting
Shortness of breath (due to accumulation of fluid in the chest)
DVT and PE

44
Q

Why may you get SOB in ovarian hyperstimulation syndrome?

A

due to accumulation of fluid in the chest

45
Q

Investigations for ovarian hyperstimulation syndrome

A

Bedside
Measure abdominal circumference

Bloods
U&E (dehydration can cause an AKI)
hCG
FBC (haemoconcentration)
Serum osmolality

Imaging & Other
Transvaginal Ultrasound Scan
Likely to show bilaterally enlarged ovaries
Also used to visualise free fluid within the abdomen
Chest X-Ray
If concerned about pleural effusion or ARDS

46
Q

What is TVUSS likely to show in ovarian hyperstimulation syndrome?

A

Likely to show bilaterally enlarged ovaries
Also used to visualise free fluid within the abdomen

47
Q

When do CXR in ovarian hyperstimulation syndrome?

A

If concerned about pleural effusion or ARDS

48
Q

Management of ovarian hyperstimulation syndrome

A

Usually improves with time

Symptomatic Management
Analgesia
Antiemetics
Encourage oral fluids (and IV fluids if required)
Support stockings and heparin injections
Paracentesis (if significant ascites present)

49
Q

BIG COMPLICATION OF OVARIAN HYPERSTIMULATION SYNDROME

A

VTE –> SUPPORT STOCKINGS AND HEPARIN INJECTIONS GIVEN

50
Q

What may ascites be treated with in ovarian hyperstimulation syndrome?

A

Paracentesis

51
Q

Defintion of ovarian torsion

A

Rare condition in which the ovary rotates upon its vascular pedicle, resulting in compression of its blood supply.

52
Q

What does the ovary rotate upon in torsion? What does this result in?

A

upon its vascular pedicle, resulting in compression of its blood supply

53
Q

What does ovarian torsion usually occur in the context of?

A

structurally abnormal ovary (e.g. cyst)

54
Q

Which cyst is at biggest risk of causing a torsion

A

dermoid cyst

55
Q

RF sfor ovarian torsion

A

Ovarian Mass or Cyst - In particular, dermoid cysts
Pregnancy
Ovarian Hyperstimulation Syndrome

56
Q

Presentatiion of ovarian cyst

A

Acute-onset severe lower abdominal pain
Nausea and vomiting
Adnexal tenderness upon examination

57
Q

What is seen on examination in ovarian cyst

A

Adenexal tenderness

58
Q

Adnexal tenderness upon examinaation

A

Ovarian trorsion

59
Q

Investigations for ovarian torsion

A

Bedside
Urine Pregnancy Test (exclude pregnancy as an ectopic pregnancy is an important differential)
Bimanual Examination (palpate an adnexal mass)
Urinalysis (rule out other differentials like UTI or ureteric colic)
Speculum Examination (as pelvic inflammatory disease is an important differential)

Bloods
Serum hCG

Imaging & Other
Transvaginal Ultrasound Scan (with Doppler measurement of blood flow)
May show Whirlpool sign and free fluid in the pelvis

60
Q

IMPORTANT DIFFERENTIAL FOR OVARIAN TROSION

A

ECTROPIC PREGNANCY

61
Q

What may be palpated on bimanual examination?

A

adnexal mass

62
Q

Why is speculum examination done in torsion

A

PID is an important differential

63
Q

What may TVUSS show in ovarian torsion?

A

whirlpool signw

64
Q

whirlpool sign

A

ovarian torsion

65
Q

Management of ovarian torsion

A

1st Line: Laparoscopic Detortion
If surgery is not performed in time, may require removal of necrotic ovary

2nd Line: Salpingo-oophorectomy
If cyst present: cystectomy

66
Q

1st line managemnt in ovarian torsion

A

1st Line: Laparoscopic Detorsion
If surgery is not performed in time, may require removal of necrotic ovary

Followed by:
2nd Line: Salpingo-oophorectomy
If cyst present: cystectomy

67
Q
A

Gynae (8 decks)

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