Rani has an ovarian cyst Flashcards Preview

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Flashcards in Rani has an ovarian cyst Deck (16):
1

Risk factors

Pre-menopausal
Early menarche
First trimester pregnancy
Personal history infertility/PCOS
+GnT
Smoking

2

Do you perform a vaginal examination of young person who has never been sexually active/used tampons

No

3

Presentations

Pelvic pain
Bloating/early satiety
Palpable adnexal mass

4

Development of follicular cysts

Gonadotropin stimulation
Normal physiological process variation
Lining of granulosam cell leutinise, hyalinised tissue develops into cyst

5

Development of corpus lutein cysts

Ovarian lutein cells and leutenised granulosa cells responding to bHCG or gonadotropincs.

6

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.

7

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

8

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

9

Possible complications of ovarian cysts

Torsion
Hemorrhage
Leakage
Infection
Adhesions to adjacent organs

10

Investigations if suspect malignant

Serum Ca125
Doppler US of abdomen/pelvis
MRI
CT abdomen/pelvic
Laparoscopy/laparotomy

11

Management of acutely ill

Laparoscopy/laparotomy
Resuscitation hemodynamic support
Antibiotics->cefoxitin and doxycyclin

12

Management non pregnant, premenopausal, simple cyst/complex no signs of malignancy.

Conservative:

13

Management when suspicious of malignancy

Laparotomy
Referral to gynaeoncology

14

Management solid cyst

Laparotomy
Referral to gynaeoncology

15

Post menopausal with sinple

Conservative
If +size/suspicious for malignancy->laparoscopy/laparotomy, gynaeoncology referral

16

Management in pregnant: 1. Asymptomatic, non-suspicious
2. Symptomatic, non suspicious 3. Suspicious

1. Conservative
2. Laparoscopy
3. Laparotomy + gynaeoncology referral