Bartholins abscess and benign ovarian cysts

Question 1

What are bartholins glands

Answer 1

Pair of glands located either side posterior part vaginal introitus (opening)
Pea sized, non palpable
Produce mucus to help with vaginal lubrication

Question 2

How does a bartholins cyst appear

Answer 2

Swelling unilateral and fluid filled cyst - 1-4cm

Question 3

What causes bartholins cyst to form abscess

Answer 3

Duct becomes infected after being blocked (cyst) -> hot, tender, red, pus

Question 3

What causes bartholins cyst to form abscess

Answer 3

Duct becomes infected after being blocked (cyst) -> hot, tender, red, pus

Question 4

What do bartholins cysts resolve with

Answer 4

Good hygeine
Analgesia
Warm compresses
Incision avoided due to risk of reocurrence

Question 5

When is a biopsy required in bartholins cyst

Answer 5

Vulval malignancy needs to be excluded - esp in women over 40

Question 6

What do when deciding on antibiotic for bartholins abscess

Answer 6

Swab culture of pus or fluid from abscess taken to culture infective organism and check antibiotic sensitivities
Also send specific swabs for chlamydia and gonorrhea

Question 7

Most common cause of bartholins abscess

Answer 7

E.coli

Question 8

What options are there to surgically treat a Bartholins abscess

Answer 8

Word catheter (Bartholins gland balloon) - local
Marsupialisation - general anaesthetic

Question 9

How a balloon used to drain bartholins abscess

Answer 9

Local anaesthetic used, incision made and pus drained
Catheter inserted into abscess space, inflated up to 3ml slaine
Baloon fills space keeps catheter in place.
Fluid drains around catheter, stops cyst or abscess reoccruing
Tissue heals around catheter, leaving permanant hole
Catheter deflated + removed once epitheliasation hole occured

Question 10

What is marsupialisation?

Answer 10

Incision made and abscess drained, sides sutured open - allows continious drainage of the area prevents recurrence of cyst or abscesses

Question 11

What is a benign ovarian cyst

Answer 11

Fluid filled sac

Question 12

When are benign cysts more likely

Answer 12

Premenopause
Post - more likely malignanyc

Question 13

What are functional ovarian cysts related to?

Answer 13

Fluctuating hormones of menstrual cycle

Question 14

Apart from multiple ovarian cysts or a string of pearls, how many of what other features need to be present for a diagnsosis of PCOS?

Answer 14

Anovulation
Hyperandrogenism
Polycystic ovaries on US

Question 15

What can ovarian cysts cause symptoms of?

Answer 15

Pelvic pain
Bloating
Fullness in abdomen
Palpable pelvic mass

Question 16

What cysts cause palpable pelvic mass

Answer 16

V large custs eg mucinous cystadenomas

Question 17

When do ovarian cysts present with acute pelvic pain

Answer 17

Ovarian torsion
Haemorrhage
Rupture of cyst

Question 18

What causes a follicular cust

Answer 18

When developing follicle fail to rupture and release the egg, cyst can persist

Question 19

Prognosis of follicular cysts

Answer 19

Most common cyst - harmless, disappear after few menstrual cycles
Thin walls and no internal structures
Reassuring appearance on US

Question 20

What is a corpus luteum cyst

Answer 20

Corpus luteum fails to break down instead fills with fluid
Seen early in pregnancy

Question 21

What does corpus luteum cyst cause?

Answer 21

Cause pelvic discomfort, pain or delayed menstruation

Question 22

Types of ovarian cysts

Answer 22

Serous cystadenoma
Mucinois cystadenoma
Endometrioma
Dermoid cysts/germ cell tumours
Sex cord-stromal tumours

Question 23

What are serous cystadenoma

Answer 23

Benigin tumours of epithelial cells

Question 24

What are mucinous cystadenomas

Answer 24

Benign tumours if epithelial cells Can be huge, take up alot of space

Question 25

What is an endometrioma and what are they ass with

Answer 25

Lumps of endometrial tissue within ovary Occuring in patients with endometriosis Pain, disrupt ovulation

Question 26

What is a dermoid cyst/germ cell tumour

Answer 26

Benign ovarian tumours Teratomas come from germ cells Skin, teeth, hair, bone

Question 27

What cyst is esp ass with torsion

Answer 27

Dermoid cyst/germ cell tumour

Question 28

What are teratomas

Answer 28

Come from germ cells

Question 29

What are sex cord-stromal tumours

Answer 29

Rare tumours - benign or malignatn Arise from stroma - CT OR sex crods - embryonic structures ass with follicles Types incl sertoli-leydig cell tumours and granulosa cell tumours

Question 30

What questions may suggest malignanyc ass with cyst

Answer 30

Abdominal bloating Reduced appetite Early satiety Weight loss Urinary symptoms Pain Ascites Lymphadenopathy

Question 31

What are risk factors for ovarian malignancy

Answer 31

Age Postmenopause Increased no. ovulations Obesity HRT smoking Breastfeeding - protective BRAC1/2 genes FH

Question 32

What affect does number of ovulations have on risk of ovarian cancer?

Answer 32

More ovulations = higher risk

Question 33

What factors reduce number of ovulations and therefore risk of ovarian cancer

Answer 33

Later onset periods - menarche Early menopause Any pregnancies Use of COCP

Question 34

What presentation found on US needs no fruther investigation?

Answer 34

Simple ovarian cyst Less than 5cm Premenopausal woman

Question 35

What is the tumour marker for ovarian cancer

Answer 35

CA125

Question 36

Which women require tumoir marker tests for germ cell tumour

Answer 36

Under 40 with complex ovarian mass

Question 37

What tumour markers are used for germ cell tumour

Answer 37

Lactate dehydrogenase (LDH) Alpha - fetoprotein (alpha-fetoprotein) Human chorionic gonadatrophin (HCG)

Question 38

Causes of raised CA125

Answer 38

Ovarian cancer - but not that specific Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy

Question 39

What does the risk of maligancy index take into account

Answer 39

Menopausal status US findings CA125 level

Question 40

What elicitis need for 2 week wait referral to gynaecologist

Answer 40

Possible ovarian cancer suggested by complex cysts or raised CA125 Possible dermoid cysts - referral to gynae but not 2 week

Question 41

How are cysts less than 5cm in premenopausal women managed

Answer 41

Resolve within 3 cycles - dont require follow uo scan

Question 42

What do cysts 5-7cm require in premenopausal women

Answer 42

Require routine referral to gynae Yearly US monitoring

Question 43

What do simple ovarian cysts in premenopausal women need to be managed

Answer 43

Consider MRI scan on surgical evaluation Diffucult to characterise with an US

Question 44

Cysts in postmenopausal women

Answer 44

CA125 result _ referral to gynae If raised CA125 - two week wait

Question 45

How are simple cysts <5cm w normal CA125 in postmenopausal women managed

Answer 45

US every 3-6 months

Question 46

What do persistent or enlarging cysts sometimes require

Answer 46

Surgical interfvention - Lapraoscopy Ovarian cystectomy OOpherctomy

Question 47

Complications of ovarian cysts

Answer 47

Present with acute onset pain Torsion Haemorrhage into cyst Rupture, bleeding into peritoneum

Question 48

What is meigs syndrome

Answer 48

Triad ofL Ovarian fibroma (benign ovarian tumour) Pleural effusion Ascites (older women. Removal tumour results complete resolution)