Ovarian Cyst And Its Complication

Dr. Miada Mahmoud Rady

EMS /473

Gynecological Emergencies 3

Ovarian Cyst

Definition : An ovarian cyst is a fluid-filled sac that forms on

or within an ovary.

Types :

1. Functional : normal .

2. Follicular .

3. Corpus luteum .

4. PCOD.

Types of Ovarian Cyst

1. Functional cyst :

The most common type of cyst .

During the menstrual cycle, the ovaries form tiny sacs

(cysts) to hold the oocytes Once the oocyte matures, the sac

breaks to releases the oocyte and then disappears .

May be the cause of abdominal heaviness and pain

female experience during menstruation.

Functional cysts are usually harmless, rarely cause pain,

and often disappear within two or three menstrual cycles

Types of Ovarian Cyst

2. Follicular cyst :

Result from failure of the follicle to rupture and release

the oocyte.

As result oocytes grows and turns into a follicle.

Normally disappears within 1 to 3 months.

Types of Ovarian Cyst

3. Corpus luteum cyst :

It occurs as result of sealing the site of oocyte release

from follicle.

As result the corpus luteum grows and starts to

accumulate fluid forming cyst .

Corpus luteum cyst secretes estrogen and progesterone.

Fertility drugs can increase the chances of corpus luteum

cysts developing.

Corpus luteum cyst

Bilateral Huge Corpus Luteum Cyst As Result of Fertility Drugs

Types of Ovarian Cyst

4. Polycystic ovarian disease ( PCOD):

• Result from repeated and excessive cyst formation with

failure of ova release .

• Exact etiology is unknown.

• It is spectrum of both clinical and morphological

abnormalities in women with an endocrine dysfunction

mainly abnormal androgen production and metabolism.

Polycystic ovarian disease ( PCOD)

Pathophysiology :

1. Increased androgen and decreased estrogen leading to

menstrual irregularities acne and excessive hair growth.

2. Insulin resistance leading to diabetes and obesity.

3. Increased incidence of hypertension and ischemic heart

disease.

Polycystic ovarian disease ( PCOD)

Clinical presentation :

1. Absent or irregular menstruation .

2. Infertility .

3. Hirsuitism .

4. Acne .

5. Obesity .

6. Insulin resistant , metabolic syndrome and D.M.

PCOD

After Drilling

Before Drilling

Clinical presentation of uncomplicated ovarian cyst

1. Dull, achy pain in the lower back and thighs.

2. Abdominal pain or pressure.

3. Nausea and vomiting.

4. Breast tenderness.

5. Abnormal bleeding and painful menstruation.

6. Painful intercourse.

OVARIAN CYST COMPLICATION

1. Rupture .

2. Torsion.

3. Abscess Formation.

Complicated ovarian cyst is a true gynecological

emergency.

Rupture of ovarian cyst

Leads to Internal Hemorrhage And Acute Abdomen.

Signs and symptoms include:

1. Sharp lower abdominal pain.

2. Abdominal distention , tenderness and rigidity.

3. Dizziness , Weakness and Syncopal episode.

Ovarian torsion

Occurs when the cyst reaches a considerable size causing the

ovary to twist which impair its blood supply .

Treatment : surgery .

Clinical presentation :

Abdominal

Pain

Criteria Of The Pain of Ovarian Torsion

1. Onset : sudden .

2. Provocation: walking .

3. Quality : sharp.

4. Radiation and reference : radiate to the back or thigh

5. Severity : sever .

6. Site : unilateral lower abdominal pain .

7. Associated symptoms : nausea and vomiting.

Abscess Formation

Called Tubo-ovarian abscess .

Most common causes :

1. Gonorrheal PID.

2. Appendicitis .

3. Diverticulitis.

Fallopian tubes or ovaries become blocked by an infectious

mass, which grows and forms an abscess.

Tuboovarian abscess

Symptoms

1. Fever .

2. Headache .

3. Anorexia .

4. Malaise .

5. Nausea and vomiting .

6. Abdominal pain .

Signs

1. Abdominal tenderness .

2. Rebound tenderness .

3. Rigidity.

4. Guarding .

5. Abdominal distension.

6. Absent intestinal sounds .

Management of complicated ovarian cyst

1. Ensure patent airway and anticipate vomiting so keep patient in

left lateral position.

2. High flow oxygen .

3. Continuously monitor vital signs and evaluate the presence of

shock.

4. Give analgesic if allowed

5. Transport rapidly and inform hospital about your diagnosis and

patient condition.

Prolapsed uterus

Definition : drop of the uterus from its normal position into

vagina .

Etiology : occurs due to weakness of muscles and ligaments

holding uterus in its position which may be due to :

1. Age .

2. Child birth .

3. Obesity .

4. Low estrogen levels .

Clinical presentation

1. Vaginal , pelvic pain and Low back pain,.

2. Dysuria and Incontinence.

3. Infection and bad smelling discharge.

4. Varying degrees of feeling like something is falling out of or

bulging from their vagina.

Management

Prehospital treatment is limited to:

1. Pain management and Treatment for shock if present

2. Do not replace any tissue and Cover with warm, moist

dressings.

3. Do not let the patient walk.

Definitive treatment includes : devices to hold the organs in

place or surgery.

Home work

Enumerate complication of ovarian cyst and mention the

clinical presentation and management of one.

Any questions??