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’, New Delhi, B.J.Churchill Living stone publication, 2002, pg.No.328-331.

 

 

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