Rani has an ovarian cyst Flashcards
Risk factors
Pre-menopausal Early menarche First trimester pregnancy Personal history infertility/PCOS \+GnT Smoking
Do you perform a vaginal examination of young person who has never been sexually active/used tampons
No
Presentations
Pelvic pain
Bloating/early satiety
Palpable adnexal mass
Development of follicular cysts
Gonadotropin stimulation
Normal physiological process variation
Lining of granulosam cell leutinise, hyalinised tissue develops into cyst
Development of corpus lutein cysts
Ovarian lutein cells and leutenised granulosa cells responding to bHCG or gonadotropincs.
Aetiological classification
Several classification systems exist; however, ovarian cysts are commonly categorised according to cause:
Physiological: cyst development as an exaggerated response to normal physiological processes; includes follicular, endometriotic, corpus luteum, and theca lutein cysts
Infectious: an abscess or cystic collection of cellular debris
Benign neoplastic: excessive growth of normal ovarian tissue types without dysplasia; includes serous cystadenoma, mucinous cystadenoma, adenofibroma, fibroma, thecoma, mature cystic teratoma (dermoid cyst), and Brenner’s tumour
Malignant neoplastic: includes serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometrioid carcinoma, and immature teratoma
Metastatic: invasion and growth of neoplastic tissue from another malignant source, most commonly ovarian, endometrial, colonic, or gastric cancers.
Investigations and management- female, repro age, lower abdominal pain
Fluids, morphine/analgesia + metoclopramide.
Keep NBM
FBC MSU bHCG UEC Cervical swabs if indicated by history TAUS/TVUS
Differential for acute lower abdominal pain in young woman
Pregnancy/ectopic Physiologic pelvic pain ->Mittelschmertz Ovarian pathology-> rupture, torsion, hemorrhage Pelvic infections->STI's, PID UTI GIT->appendicitis
Possible complications of ovarian cysts
Torsion Hemorrhage Leakage Infection Adhesions to adjacent organs
Investigations if suspect malignant
Serum Ca125 Doppler US of abdomen/pelvis MRI CT abdomen/pelvic Laparoscopy/laparotomy
Management of acutely ill
Laparoscopy/laparotomy
Resuscitation hemodynamic support
Antibiotics->cefoxitin and doxycyclin
Management non pregnant, premenopausal, simple cyst/complex no signs of malignancy.
Conservative:
Management when suspicious of malignancy
Laparotomy
Referral to gynaeoncology
Management solid cyst
Laparotomy
Referral to gynaeoncology
Post menopausal with sinple
Conservative
If +size/suspicious for malignancy->laparoscopy/laparotomy, gynaeoncology referral
