Gynaecological core conditions Flashcards
1
Q
Symptoms of bartholins abscess
A
- A tender lump on one side of the vagina where the ducts are situated.
- Surrounding area that looks red, swollen and hot to touch.
- Discomfort and/or pain that is worse when pressure is applied e.g. when sitting or walking.
- Pain during sexual intercourse.
- Pus oozing from the abscess (sometimes foul smelling).
- Discomfort when passing urine (stinging sensation).
2
Q
Bartholins glands
A
- Located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule
- The Bartholins gland has a long duct, when this gets blocked it’s a Bartholins cysts. When the cyst is infected its Bartholin’s abscess
3
Q
Bartholins abscess- presentation
A
- Polymicrobial- Neisseria gonorrhoea is the most common agent, Chylamydia trachomatis can also cause it
- May present acutely and require surgical drainage
- May discharge spontaneously and resolve without surgical intervention
- Can reoccur on the same or contralateral site
4
Q
Bartholins abscess- treatment
A
- Cyst can be aspirated with a needle, reoccurrence rate is high
- An abscess requires surgical intervention in order to drain it, release of pus causes significant reduction in pain
- Word catheter- used in the out patient setting, a tiny catheter inserted under local anaesthetic into the abscess cavity in order to drain it
- Marsupialisation- an insiscion is made into the abscess and after drainage the internal aspect of the cyst wall is sutured to the skin to form a pouch, reduce recurrence. Done in theatre under general or spinal anesthetic
- Small abscesses <3cm can be cured with antibiotics
5
Q
Functional ovarian cysts
A
- These include follicular, theca and corpus luteal cysts. Diagnosis is made when the cyst is over 30mm.
- They are also called “physiological cysts” and rarely grow over 100mm.
- Theca luteal cysts are usually bilateral and are associated with pregnancy, particularly twin pregnancy and molar pregnancy.
6
Q
Functional ovarian cysts follow up
A
- Asymptomatic women with small (less than 50 mm diameter) simple ovarian cysts generally do not require follow-up as these cysts are very likely to be physiological and almost always resolve within 3 menstrual cycles.
- Women with simple ovarian cysts of 50–70 mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention.
7
Q
Functional cysts- follicular cyst
A
- Most common type of ovarian cysts
- Due to non rupture of the dominant follicle or failure of atresia in a non dominant follicle
- Commonly regress after several menstrual cycles
8
Q
Functional cyst- corpus luteum cyst
A
- During the menstrual cysle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If it doesn’t it may fill with blood or fluid and form a corpus luteal cysts
- More likely to present with intraperitoneal bleeding than follicular cysts
9
Q
Dermoid cyst
A
- Most common ovarian tumour in women aged 20-40 years. The peak incidence is at 20 years.
- 10% are bilateral and malignant transformation is rare (<2%, usually occurring in women over 40 years)).
- It contains fully differentiated tissue types derived from all three embryonic germ cell layers (epithelial, mesenchymal and stromal).
- Also called mature cystic teratomas, usually lined with epithelial tissue so may contain skin appendages, hair and teeth
- Benign germ cell tumour
10
Q
Dermoid cysts- diagnosis, treatment, symptoms
A
- Diagnosis is usually by ultrasound scan; an MRI may be useful if there is uncertainty.
- A struma ovarii is a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism.
- In general treatment is surgical (cystectomy or oophorectomy), particularly if more than 50mm as these cysts can tort (twist around the pedicle).
- Usually asymptomatic. Torsion more likely than with other ovarian tumours
11
Q
Endometriotic cysts (endometrioma)
A
- Arises from the ectopic endometrial tissue. It contains thick, brown, tar-like fluid, which may be referred to as a “chocolate cyst.” Endometriomas are often densely adherent to surrounding structures, such as the peritoneum, fallopian tubes, and bowel.
- Endometriomas are seen in 17-44% of women who have endometriosis. 28% of endometriomas are bilateral.
- Endometriomas are usually associated with deep infiltrating endometriosis.
- Women with endometriomas have many of the same symptoms as those with endometriosis, including dyspareunia and/or subfertility.
12
Q
Endometriotic cysts- treatment
A
- Surgical treatment (cystectomy) is a procedure where is the cyst wall is stripped away from the ovary. The inside on the cyst can be cauterised using laser or electricity. The drawback of these techniques is that healthy ovarian cortex and follicles may get damaged.
- The other procedure is a cyst aspiration. The three common risks with aspiration are recurrence, infection and adhesion formation.
- Expectant management is an option if the endometrioma is less than 4cm and the patient is asymptomatic
13
Q
Serous cystadenoma
A
- The most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
- Bilateral in around 20%
- Arises from the ovarian surface epithelium
14
Q
Mucinous cystadenoma
A
- Second most common benign epithelial tumour
- They are typically large and may become massive
- If ruptures may cause pseudomyxoma peritonei- secretes mucin in the abdominal cavity
- Arises from the ovarian surface epithelium
15
Q
Ovarian cyst rupture
A
- Ovarian cyst accidents include cyst rupture, haemorrhage and torsion.
- Rupture of an ovarian cyst is a common occurrence in women of reproductive age.
- Most women with a ruptured ovarian cyst may be managed with observation, analgesics, and rest, but some women require surgery. Surgical management is usually required for rupture of a dermoid cyst.
16
Q
Ovarian cyst- complications
A
- A bleed into a cyst can cause acute onset pain from peritoneal stretching. This gradually settles over time. The management is like that of a ruptured ovarian cyst.
- Ovarian torsion is when an ovary twists around its own ligaments. The larger the cyst, the more likely that ovarian torsion will occur. Sometimes the Fallopian tube will also be twisted along with the ovary.
- Treatment for ovarian torsion is usually surgical involving either untwisting the ovary (and removing the cyst) or removing the affected ovary and tube (if gangrenous).
17
Q
Polycystic ovary syndrome
A
- Affects 5-20% of women of reproductive age
- Both Hyperinsulinaemia and high levels of luteinizing hormone are seen
- Overlap with metabolic disorders
18
Q
Polystic ovary syndrome- features
A
- Subfertility and infertility
- Menstrual disturbances: oligomenorrhoea and amenorrhoea
- Hirsutism, acne (due to hyperandrogenism)
- Obesity
- Acanthosis nigricans (due to insulin resistance)
19
Q
Polycstic ovary syndrome- Investigations
A
- Pelvic ultrasound: multiple cysts on the ovaries
- Baseline investigations: FSH, LH, prolactin, TSH, testosterone and sex hormone binding globulin
- Classical feature- raised LH:FSH ratio
- Prolactin may be normal or mildly elevated
- Testosterone may be normal or mildly elevated, if markedly raised consider other causes
- SHBG is normal to low
- Check for impaired glucose tolerance
