Ovarian cyst: Difference between revisions
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| Line 9: | Line 9: | ||
*Most tend to be asymptomatic | *Most tend to be asymptomatic | ||
*Can cause: | *Can cause: | ||
**Dull pelvic pain or fullness | **Dull [[pelvic pain]] or fullness; they can be significantly painful if ruptured | ||
** | **Dyspareunia | ||
**Pressure on the bladder | **Pressure on the bladder | ||
*If there is bleeding into the cyst and it ruptures, it can be life threatening, with signs of [[peritonitis]], [[shock]] | |||
*If there is bleeding into the cyst and it ruptures, it can be life threatening | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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===Workup=== | ===Workup=== | ||
*CBC, chemistry | *CBC, chemistry | ||
*UA, urine pregnancy | *[[UA]], urine pregnancy | ||
*Pelvic ultrasound | *[[Pelvic ultrasound]] | ||
*Consider CT A/P to rule out other etiologies (e.g. [[appendicitis]]) | *Consider CT A/P to rule out other etiologies (e.g. [[appendicitis]]) | ||
| Line 40: | Line 39: | ||
==Disposition== | ==Disposition== | ||
*Home | *Home, unlessed ruptured with concern for significant blood loss | ||
*Follow up with OBGyn | *Follow up with OBGyn | ||
Revision as of 01:44, 4 October 2019
Background
- Most common are functional or follicular cysts
- Less common include PCOS, cystadenomas, and dermoid cysts
- Cysts are generally >1cm in size
- Cysts are at risk of torsion when >4cm
- Cysts <2cm are virtually risk free from torsion
Clinical Features
- Most tend to be asymptomatic
- Can cause:
- Dull pelvic pain or fullness; they can be significantly painful if ruptured
- Dyspareunia
- Pressure on the bladder
- If there is bleeding into the cyst and it ruptures, it can be life threatening, with signs of peritonitis, shock
Differential Diagnosis
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Evaluation
Workup
- CBC, chemistry
- UA, urine pregnancy
- Pelvic ultrasound
- Consider CT A/P to rule out other etiologies (e.g. appendicitis)
Diagnosis
Transvaginal ultrasound showing ovarian cyst[1]
- Typically diagnosed on ultrasound, with same side of pain and absence of other concerning etiologies (e.g. negative UA, not pregnant)
- Check hemoglobin level to assess for blood loss
Management
- NSAIDs
- Oral contraceptives
- No benefit has been found though gynecology may suggest them[2]
- Ensure that patient does not have significant anemia/free fluid in pelvis
- Consider repeat hemoglobin of observation period if concern for ruptured cyst with significant bleeding
Disposition
- Home, unlessed ruptured with concern for significant blood loss
- Follow up with OBGyn
See Also
External Links
References
- ↑ http://www.thepocusatlas.com/obgyn/
- ↑ Cochrane Database Syst Rev 2011. Sep 7;(9):CD006134.