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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
Ovarian cyst with calcifications on USS
brenner tumour
26
Types of sex cord stromal cysts
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)
27
Type of sex cord stromal cyst that is benign and doesn't produce any hormones
Fibroma May, occasionally, present with Meig syndrome (pleural effusion, ascites and ovarian fibroma)   USS Appearance: solid and hypoechoic mass
28
What may fibromas ovvasionally present with? (type of sex cord stromal cyst)
Meig syndrome (pleural effusion, ascites and ovarian fibroma)  
29
Meig syndrome 
pleural effusion, ascites and ovarian fibroma) 
30
Type of ovarian cyst that presents with pleural effusion and ascites? What is resultant syndrome called?
Fibroma, Meig syndrome
31
What sex cord stromal cysts produce oestrogens? How to differentiate?
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
Presentation of ovarian cysts
Often asymptomatic and found incidentally Pelvic pain Abdominal fullness May produce with sudden pain Due to torsion, cyst rupture or bleed
33
Why may ovarian cysts present with sudden pain?
Due to torsion, cyst rupture or bleed
34
Investigations for ovarian cysts
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
What scan is preffered in girls and woman who have never been sexually active with ovarian cysts?
Transabdominal US
36
Management of ovarian cyst
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
How to manage complex ovarian cyst or raised CA123?
Refer via 2-week-wait to a specialist
38
Management of 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
39
Surgical intervention for ovarian cysts
Laparoscopic cystectomy
40
What is ovarian hyperstimulation syndrome
Complication of ovarian stimulation during IVF treatment.
41
Complication of ovarian stimulation during IVF treatment.
Ovarian hyperstimulation syndrome
42
RFs for ovarian hyperstimulation syndrome
Younger age Low BMI Polycystic ovarian syndrome Previous ovarian hyperstimulation syndrome
43
Presentation of ovarian hyperstimulation syndrome
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
Why may you get SOB in ovarian hyperstimulation syndrome?
due to accumulation of fluid in the chest
45
Investigations for ovarian hyperstimulation syndrome
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
What is TVUSS likely to show in ovarian hyperstimulation syndrome?
Likely to show bilaterally enlarged ovaries Also used to visualise free fluid within the abdomen
47
When do CXR in ovarian hyperstimulation syndrome?
If concerned about pleural effusion or ARDS
48
Management of ovarian hyperstimulation syndrome
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
BIG COMPLICATION OF OVARIAN HYPERSTIMULATION SYNDROME
VTE --> SUPPORT STOCKINGS AND HEPARIN INJECTIONS GIVEN
50
What may ascites be treated with in ovarian hyperstimulation syndrome?
Paracentesis
51
Defintion of ovarian torsion
Rare condition in which the ovary rotates upon its vascular pedicle, resulting in compression of its blood supply.
52
What does the ovary rotate upon in torsion? What does this result in?
upon its vascular pedicle, resulting in compression of its blood supply
53
What does ovarian torsion usually occur in the context of?
structurally abnormal ovary (e.g. cyst)
54
Which cyst is at biggest risk of causing a torsion
dermoid cyst
55
RF sfor ovarian torsion
Ovarian Mass or Cyst - In particular, dermoid cysts Pregnancy Ovarian Hyperstimulation Syndrome
56
Presentatiion of ovarian cyst
Acute-onset severe lower abdominal pain Nausea and vomiting Adnexal tenderness upon examination
57
What is seen on examination in ovarian cyst
Adenexal tenderness
58
Adnexal tenderness upon examinaation
Ovarian trorsion
59
Investigations for ovarian torsion
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
IMPORTANT DIFFERENTIAL FOR OVARIAN TROSION
ECTROPIC PREGNANCY
61
What may be palpated on bimanual examination?
adnexal mass
62
Why is speculum examination done in torsion
PID is an important differential
63
What may TVUSS show in ovarian torsion?
whirlpool signw
64
whirlpool sign
ovarian torsion
65
Management of ovarian torsion
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
1st line managemnt in ovarian torsion
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

Gynae (8 decks)

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