WH: Ovarian Disorders Flashcards
What is PCOS ? characterised by what ? (5)
PCOS is a common condition causing metabolic and reproductive problems in women.
characterised by:
- multiple ovarian cysts
- infertility
- oligomenorrhea,
- hyperandrogenism
- insulin resistance.
What criteria is used for PCOS diagnosis ? describe it ? (3)
Rotterdam criteria triad (2/3)
- oligo/anovulation (irregular or absent menstrual periods)
- Hyperandrogenism (hirsutism/acne or on bloods)
- Polycystic ovaries on US (or increased ovarian size)
PCOS differential ?
- hypothyroidism
- hyerprolactinaemia
- bushings disease
other PCOS presentation ? (5)
(oligo/amenohrrhea, infertility, obesity, hirsutism, acne, hair loss)
- insulin resistance/diabetes
- CVD
- Raised cholesterol
- sexual problems
- acanthoses nigricans
describe the relationship between insulin and PCOS ?
insulin resistance => increase levels of insulin form pancreas => insulin promote release of androgens form ovaries + adrenal PLUS insulin surpasses SHBG form liver => hyperandorogenism
- insulin halts development of follicles in ovaries => annovulation
Hirsutism differential ? (5)
- Medications (corticosteroids, testosterone, anabolic steroids)
- ovarian + adrenal tumours
- Cushings syndrome
- Congenital adrenal hyperplasia
- PCOS
PCOS investigations ?
- Blood test (testosterone, SHBG, LH, FSH, prolactin, TSH)
- US
- diabetes screening (OGGT)
what would blood tests show in PCOS ? (5)
- high LH: FSH ratio (remember)
- raised LH
- raised testosterone
- raised insulin
- raised oestrogen
what is the gold standard PCOS investigation ? what would it show ?
TVUS
- string of pearls appearance
What does PCS management involve (overview) ? (6)
- weight loss
- exercise
- smoking cessation
- managing infertiliyt
- managing hirsutism
- managing acne
How is PCOS infertility managed ? (3)
- Weight loss (reduce insulin resistance)
- Clomifene
- IVF
How is PCOS hirsutism managed ? (3)
- electrolysis
- Laser hair removal
- Finasteride
How is PCOS acne managed ? (2)
- COCP
- topical adcipalene
what cancer does PCOS increase the risk of ? explain this ?
endo cancer risk
- PCOS => anovvulation => no corpus luteum => low progesterone => continue oestrogen production + no regular menstruation => endo proliferation => endo hyperplasia = Endo cancer risk
- plus associated RF (obesity, diabetes)
What are ovarian cysts ?
fluid filled sac within the ovary
- generally small cysts should not raised concern unless symptomatic
Patient presents with string of pearls sign on US. What is this ?
multiple ovarian cysts
(if have annulation or hyperandrogegism => PCOS)
name some cyst types ? (5) most common ?
- follicular cyst (most common)
- corpus luteum cyst
- serous cyst adenoma
- endometrioma
- teratoma
what is a follicular cysts ? how does it form ?
(non-neoplastic)
developing follicle fail to rupture + release egg => cyst persist => follicular cyst
what is a corpus luteum cyst ?
(non-neoplastic)
corpus luteum filas to break down => fills with fluid = > corpus luteum cyst
ovarian cyst RF ?
more frequent ovulation => increase surface epithelial irritation => increase risk of developing malignant
- nulliparity, early monarch, late menopause, smoking, obesity
(common in reproductive years)
ovarian cyst presentation ? (3)
- mostly asymptomattic (found incidentally on pelvic US)
- vague symptoms: pelvic pain, bloating, flyness in abdo, palpable pelvic mass
- acute pelvic pain (ovarian torsion, haemorrhage, rupture of cysts)
What investigations would you do for an ovarian cyst ? do work out what ?
need to establish of behind or malignant
- blood tests: lactate dehydrogenase, alpha fetoprotein
- risk of malignancy index
- Ca125
what is in the risk of malignancy index for ovarian cancer ? (3)
- menopausal status
- US finding
- Ca125 level
ovarian cyst managment ? premenopausal woman with simple ovarian cyst on US (<5cm) ?
no further investigations
what would indicate possible ovarian cancer in a cyst presentation ? (2)
complex cyst
raised Ca125
clmplicaitons of ovarian cyst ?
- torsion
- haemorrgae
- rupture
- megs syndrome
Older woman presents with pleural effusion + ovarian mass. what is this ?
Meig’s syndrome
- ovarian fibroma
- pleural effusion
- ascites
What is the most common cell type in ovarian cancer ? where ?
malignant transformation of the epithelium covering the ovarian capsule + distal Fallopian tube
ovarian cancer RF ? (6) describe the logic
- factors that increase no. ovulations: early onset periods, late menopause, nulliparity
- age (60)
- BRCA1/2 genes (FHx)
- Obesity
- Smoking
- Clomifene (infertility Tx)
name some protective factors for ovarian cancer ? (3)
(decrease ovulations)
- OCP
- more pregnancies
- breastfeeding
Ovarian cancer présentation ?
vague/non-specific + GI related (often presents late) (65 ish yrs)
- adobo blating, early satiety, loss of appetite
- weight loss
- ascites
- abdo or pelvic mass
when would you have a 2 week wait for ovarian cancer ? (presentation)
2 week wait: (urgent referal to specialist)
- ascites
- pelvic/abdo mass
- US scan shows abnormal lump (/possible ovarian mass)
(suspect a women >50 with new onset IBS symtpoms)
ovarian cancer Ix ?
- Ca125 blood tes
- Pelvic US
what could raised Ca125 indicate ? (6)
- Ovarian Cancer
- endometriosis
- fibroids
- adenomyosis
- Pelvic infection
- pregnancy
what is RMI ? and would are the 3 things ?which cancer ?
risk of malignancy index (ovarian cancer)
- menopausal status
- US finding
- Ca125 level
ovarian cancer managment ?
surgery + chemo
(MDT approach)
What is ovarian torsion?
Where the ovary twists in relation to surround connective tissue, fallopian tube + blood supply ?
what is the adenexa ?
- fallopian tube
- connective tissue
- blood supply
ovarian torsion presentation ?
- sudden onset, severe unilateral pelvic pain (constant, gets worse, or intermittent (if untwists/twists)
what might be seen OE in ovarian torsion ?
localised tenderness
- possible palpable mass
ovarian torsion Ix ? diagnostic ?
- pelvic US (TV or abdo): whirlpool sin
- definitive: laparoscopic surgery
ovarian torsion Mx ?
emergency admission + surgery (de-torsion or oophorectomy)
ovarian torsion complications ?
- loss of function of ocary
- necrotic ovary => abcsess => sepsis
- Rupture => peritonitis => intraabdominal adhesions
