OVARIAN CYST
1.
INTRODUCTION
The
ovary is complex in its embryology, histology, steroidogenesis and has the
potential to develop malignancy. Ovary
is the second most common site for development of gynaecological malignancies
and the prognosis remains poor.
2. DEFINITION
Ovarian
cyst is defined as non neoplastic enlargement of the ovary mainly the griffin
follicle or corpus lutem due to accumulation of fluid in the functional unit of
the ovary.
3. TYPES:
The
main type of ovarian cyst are:-
a.
Follicular
cysts.
b.
Corpus
luteum cysts
c.
Theca
– luteum and granulose lutein cysts.
d.
Polycystic
ovarian syndrome
e.
Endometrial
cyst
A.
FOLLICULAR CYST
Follicular
cysts are the commonest functional cysts.
They are usually multiple and small an isolated cyst may be formed in
unraptured griffin follicle which may be enlarged but not exceeding 5 cm.
CAUSES
a. Incompletely developed follicle
b. Hyperoestrinism
CLINICAL
FEATURES
Cyst may remain asymptomatic or may produce
pain
a.
Pelvic
pain
b.
Dyspareunia
c.
Irregular
bleeding
DIAGNOSIS
a.
Take
the consent from the mother and relatives.
b.
Bimanual
examination
c.
Transvaginal
sonography
d.
Laporoscopy
or laparotomy
MEDICAL
MANAGEMENT
1.
Administration
oral medroxyprogestrone 10mg 3 times a day over a period 5 to 7 days in case of
prolonged amenorrhaoea.
2.
Clomophene
citrate 50mg given orally or 5 consecutive days help to induce ovulation.
3.
Intracystic
haemorrhage and rupture causing acute abdominal pain, laprotomy in indicated.
NURSING
MANAGEMENT
1.
Advice
to adequate bed rest for at least one week to prevent the complication.
2.
If
any complication is there, advice the mother for regular checks up for about 3
months.
3.
Check
the vital signs daily.
4.
Maintain
input and output chart.
5.
Application
of heat of the lower abdomen will relieve pain.
6.
Avoid
sexual activity for 6 weeks or as physician order to prevent infection.
7.
Combined
steroidal contraceptive pill may be prescribed if not contraindicated.
B.
CORPUS LUTEUM CYSTS
Corpus
luteum cysts are functional non –neoplastic enlargement of ovary.
It
usually occurs due to overactivity of the corpus luteum there is excessive
bleeding inside the corpus luteum. The
progesterone and oestrogen secretion continues.
As a result the menstrual cycle is prolonged followed by heavy or
continued bleeding.
CAUSES
1.
Overactivity
of corpus luteum
2.
Excessive
bleeding inside the corpus luteum.
3.
Excessive
secretion of progesterone and oestrogen
CLINICAL
FEATURES
1.
Prolonged
menstrual cycle
2.
Local
pain
3.
Tenderness
4.
Acute
intraperitoneal haemorrhage
5.
Tubal
pregnancy
DIAGNOSIS
1.
Laprotomy
with enucleation of the cyst
2.
X-ray
of the abdomen
MEDICAL
MANAGEMENT
1.
If
the features of acute intra periotoneal haemorrhage appears, laprotomy with
enucleation of the cyst is to be done.
2.
Resuscitative
measures as in disturbed tubal pregnancy.
3.
Complications
like torsion as rupture lead to an acute abdomen requiring surgical treatment.
NURSING
MANAGMENT
1.
Proved
adequate rest and sleep
2.
Administer
antibiotics as per order ex. Taxim.
3.
Explain
the purpose of treatment and accompanying procedures.
4.
Keep
the perineal area clean and dry with a solution of peroxide and water.
5.
Advice
the patient to follow the regimen of drugs administration.
6.
Through
observation as recommended.
7.
Application
of heat in the lower abdomen will be helpful in relieving the pain.
8.
Periodic
ultrasound for identifying tubal pregnancy.
Theca Lutein cysts
Lutein cysts are usually bilateral and filled
with straw coloured fluid. It is caused
by excessive secretion of chrionic gonoadotrophin . It is found in association with hydatidiform
mole, choriocarcinoma and gonadotrophin [hCG] or clomiphene therapy.
CAUSES
a.
Excessive
secretion of chronic gonadotrophin secreted in cause of gestational
trophoblastic tumors.
b.
Administration
of gonadotrophin or clompihen to induce ovulation.
CLINICAL
FEATURES
a.
Bilateral
and filled with straw coloured fluid.
b.
Pelvic
pain
c.
Irregular
bleeding
DIAGNOSIS
a.
Sonography
b.
Laproscopy
MEDICAL
MANGEMENT
a.
Discontinuation
of gonadotrophin therapy and return back to its normal level.
b.
Elimination
of more, destruction of choriocarcinoma.
NURING
MANAGEMENT
a.
Maintain
intake and output charts.
b.
Check
the weight of the patient daily.
c.
Periodic
monitoring of vital signs.
d.
Application
of heat to relieve pain.
e.
Provide
intravenous fluid for hypovolemia.
f.
Check
the haemoglobin, WBC, Platelet count.
g.
Repeated
ultrasound to monitor resolution of ovarian cyst.
h.
Administer
the antibiotics as per order
POLYCYSTIC
OVARIAN SYNDROME
This
complex disorder is characterized by excessive androgen production by the
ovaries which enterfeve with the growth of the ovarian follicle.
CAUSES
a.
Excessive
androgen production
b.
Raised
level of luteinizing hormone.
c.
Diminished
level of follicle stimulating hormone
CLINICLA
FEATURES
a.
Obesity
associated with enlarged polycystic ovaries.
b.
Menstrual
abnormalities in the form of.
a.
Oligomenorrhoae
b.
Amenorrhoea
c.
Hirsutism
rare
d.
Virilism
Diagnosis
a.
Ultrasound
shows necklace appearance.
b.
Laporoscopic
examination
c.
C.T.Scan
Medical
Management
a.
Dexamethasome
0.5mg or prednisone 5mg at bed time to reduce androgen production.
b.
Infertility
is treated with clomiphene
c.
Reduction
of weight.
Nursing
Management
a.
Check
the weight of the patient daily
b.
Periodic
monitoring of vital signs
c.
Avoid
her for periodic checkups.
d.
Avoid
sexual intercourse for 6 months.
e.
Advice
the patient to follow the drug regimen.
f.
Assess
the level of follicle stimulating hormone and lutensing hormone.
g.
Administer
antibiotics as per order
ENDOMETRIAL
CYST
Endometrial
cyst is also known as chocolate cyst ovary is the most common site for
endometriosis. It starts with the
superficial endometriotic implantation over the ovarian surface. The endometric tissue gradually invades over
ovaran stomacyst formation is due to periodic shedding and bleeding from the
implant. Epithelial living of the cyst
contains endometrial glands and stoma.
Due to pressure effects the living epithelium may be flattened. When the cyst ruptures the characteristic
thick, tarry fluid (Chocolate material) escapes.
Causes
a.
Superficial
endometric implant over ovarian surface
b.
Hormonal
influence
Clinical
Features
a.
Low
abdominal pain
b.
Dysmenorrhoea
c.
Menorrhagia
d.
Dyspareunia
e.
Tender
nodules felt in the posterior fornix
f.
Infertility
Diagnosis
a.
Ultraound
b.
Laproscopic
examination
Medical Management
a.
Drain
the chocolate cyst with the help of laparoscopy.
b.
Surgical
removal of chocolate cyst by laparotomy if the cyst is huge.
c.
Gonadotrophin
releasing hormone as administerec continuously to suppress pituitary
gonadotrophin and cause atrophy of endometriotic tissues.
NURSING
MANAGEMENT
a.
Explain
the purpose of treatment and accompanying procedures.
b.
Check
the vital signs periodically.
c.
Avoid
the sexual intercourse for 6 months.
d.
Ensure
adequate bed rest for minimum one month.
e.
Provide
analygesics for relieving the pain.
f.
Avoid
alcohol and tobacco intake.
g.
Advice
to take small frequent meals nutritious
snacks.
h.
Provide
psychological support to the patient.
i.
Maintain
good personal hygiene
COMPLICATIONS
a.
Intracystic
haemorrhage
b.
Infection
c.
Rupture
d.
Malignancy
e.
Torsion
of the pedicle
CONCLUSION
Functional
and inflammatory enlargement of the ovary almost exclusively during the child
bearing years. They may be asymptomatic
or produce local discomfort, menstrual disturbance, infertility rarely cause
symptoms due to complication like haemorrhage rupture or torsion.
BIBLIOGRAPHY
1.
Dutta.D.C.
‘Textbook of Gynaecology Lucluding Contraception’, New Central book agency (P)
Ltd., Pg.No.270-275.
2.
Padubidiri.V.G.Daftary
N.Shirish ‘shaws Text book of Gynaecology’,
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