Ovarian cyst

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From Wikipedia, the free encyclopedia

Ovarian cyst

Classification and external resources

Ovarian cyst

ICD-10

N83.0-N83.2

ICD-9

620.0-620.2

DiseasesDB

9433

eMedicine

med/1699 emerg/352

MeSH

D010048

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Anyovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange. Most ovarian cysts are functional in nature and harmless (benign).[1] In the US, ovarian cysts are found in nearly all premenopausal women, and in up to 14.8% of postmenopausal women.[citation needed] Ovarian cysts affect women of all ages. They occur most often, however, during a woman's childbearing years.

Some ovarian cysts cause problems, such as bleeding and pain. Surgery may be required to remove cysts larger than 5 centimeters in diameter.

Classification
[edit]Non-functional cysts

There are several other conditions affecting the ovary that are described as types of cysts, but are not usually grouped with the functional cysts. (Some of these are more commonly or more properly known by other names.) These include:

Dermoid cyst Chocolate cyst of ovary: An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries.

A polycystic-appearing ovary is diagnosed based on its enlarged size usually twice normal with small cysts present around the outside of the ovary. It can be found in "normal" women, and in women with endocrine disorders. An ultrasound is used to view the ovary in diagnosing the condition. Polycystic-appearing ovary is different from the polycystic ovarian syndrome, which includes other symptoms in addition to the presence of ovarian cysts.

Ovarian serous cystadenoma Ovarian mucinous cystadenoma

[edit]Signs

and symptoms

Some or all of the following symptoms[2][3] [4][5][6] may be present, though it is possible not to experience any symptoms:

Dull aching, or severe, sudden, and sharp pain or discomfort in the lower abdomen (one or both sides), pelvis, vagina, lower back, or thighs; pain may be constant or intermittentthis is the most common symptom

Fullness, heaviness, pressure, swelling, or bloating in the abdomen Breast tenderness Pain during or shortly after beginning or end of menstrual period. Irregular periods, or abnormal uterine bleeding or spotting Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy Weight gain Nausea or vomiting Fatigue

Infertility Increased level of hair growth Increased facial hair or body hair Headaches Strange pains in ribs, which feel muscular Bloating

Strange nodules that feel like bruises under the layer of skin [edit]

Diagnosis

A 2cm left ovarian cyst as seen on ultrasound

An Axial CT demonstrating a large hemorrhagic ovarian cyst. The cyst is delineated by the yellow bars with blood seen anteriorly.

A CT scan showing a 8.5 cm cyst in a 29 year old female.

Ovarian cysts are usually diagnosed by either ultrasound or CT scan.

[edit]Treatment

About 95% of ovarian cysts are benign, meaning they are not cancerous.[7] Treatment for cysts depends on the size of the cyst and symptoms. Pain caused by ovarian cysts may be treated with:

pain relievers, including acetaminophen/paracetamol (Tylenol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), or narcotic pain medicine (by prescription) may help reduce pelvic pain.[8] NSAIDs usually work best when taken at the first signs of the pain.

a warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries.[9] Bags of ice covered with towels can be used alternately as cold treatments to increase local circulation.[10]

combined methods of hormonal contraception such as the combined oral contraceptive pill the hormones in the pills may regulate the menstrual cycle, prevent the formation of follicles that can turn into cysts, and possibly shrink an existing cyst. (American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e)[8]

Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion. Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgicalbiopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumor marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.[11] For more serious cases where cysts are large and persisting, doctors may suggest surgery. Some surgeries can be performed to successfully remove the cyst(s) without hurting the ovaries, while others may require removal of one or both ovaries.[12]
[edit]

Ovarian Cysts Overview

Ovarian cysts are small fluid-filled sacs that develop in a woman's ovaries. Most cysts are harmless, but some may cause problems such as rupturing, bleeding, or pain; and surgery may be required to remove the cyst(s). It is important to understand the function of the ovaries and how these cysts may form. Women normally have two ovaries that store and release eggs. Each ovary is about the size of a walnut, and one ovary is located on each side of the uterus. One ovary produces one egg each month, and this process starts a woman's monthlymenstrual cycle. The egg is enclosed in a sac called a follicle. An egg grows inside the ovary until estrogen (a hormone), signals the uterus to prepare itself for the egg. In turn, the lining of the uterus begins to thicken and prepare for implantation of a fertilized egg resulting in pregnancy. This cycle occurs each month and usually ends when the egg is not fertilized. All contents of the uterus are then expelled if the egg is not fertilized. This is called a menstrual period.

In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains only fluid and is surrounded by a very thin wall. This kind of cyst is also called a functional cyst, or simple cyst. If a follicle fails to rupture and release the egg, the fluid remains and can form a cyst in the ovary. This usually affects one of the ovaries. Small cysts (smaller than one-half inch) may be present in a normal ovary while follicles are being formed. Ovarian cysts affect women of all ages. The vast majority of ovarian cysts are considered functional (or physiologic). This means they occur normally and are not part of a disease process. Most ovarian cysts are benign, meaning they are not cancerous, and many disappear on their own in a matter of weeks without treatment. While cysts may be found in ovarian cancer, ovarian cysts typically represent a harmless (benign) condition or a normal process. Ovarian cysts occur most often during a woman's childbearing years. The most common types of ovarian cysts are the following: Follicular cyst: This type of simple cyst can form when ovulation does not occur or when a mature follicle involutes (collapses on itself). A follicular cyst usually forms at the time of ovulation and can grow to about 2.3 inches in diameter. The rupture of this type of cyst can create sharp severe pain on the side of the ovary on which the cyst appears. This sharp pain (sometimes called mittelschmerz) occurs in the middle of the menstrual cycle, during ovulation. About one-fourth of women with this type of cyst experience pain. Usually, these cysts produce no symptoms and disappear by themselves within a few months. Corpus luteum cyst: This type of functional ovarian cyst occurs after an egg has been released from a follicle. After this happens, the follicle becomes what is known as a corpus luteum. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood and persist on the ovary. Usually, this cyst is found on only one side and produces no symptoms. Hemorrhagic cyst: This type of functional cyst occurs when bleeding occurs within a cyst. Symptoms such as abdominal pain on one side of the body may be present with this type of cyst. Dermoid cyst: This is a type of benign tumor sometimes referred to as mature cystic teratoma. It is an abnormal cyst that usually affects younger women and may grow to 6 inches in diameter. A dermoid cyst can contain other types of growths of body tissues such as fat and occasionally bone, hair, and cartilage. o The ultrasound image of this cyst type can vary because of the spectrum of contents, but a CT scan and magnetic resonance imaging (MRI) can show the presence of fat and dense calcifications. These cysts can become inflamed. They can also twist around (a condition known as ovarian torsion), compromising their blood supply and causing severe abdominal pain.

Endometriomas or endometrioid cysts: Part of the condition known asendometriosis, this type of cyst is formed when endometrial tissue (the lining tissue of the uterus) is present on the ovaries. It affects women during the reproductive years and may cause chronic pelvic pain associated with menstruation. o o o Endometriosis is the presence of endometrial glands and tissue outside the uterus. Women with endometriosis may have problems with fertility. Endometrioid cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches.

Polycystic-appearing ovary: Polycystic-appearing ovary is diagnosed based on its enlarged size - usually twice that of normal - with small cysts present around the outside of the ovary. This condition can be found in healthy women and in women with hormonal (endocrine) disorders. An ultrasound is used to view the ovary in diagnosing this condition. o Polycystic-appearing ovary is different from the polycystic ovarian syndrome (PCOS), which includes other symptoms and physiological abnormalities in addition to the presence of ovarian cysts. Polycystic ovarian syndrome involves metabolic and cardiovascular risks linked toinsulin resistance. These risks include increased glucose tolerance, type 2 diabetes, and high blood pressure. Polycystic ovarian syndrome is associated with infertility, abnormal bleeding, increased incidences of miscarriage, and pregnancy-related complications. Polycystic ovarian syndrome is extremely common and is thought to occur in 4%-7% of women of reproductive age and is associated with an increased risk for endometrial cancer. The tests other than an ultrasound alone are required to diagnose polycystic ovarian syndrome.

Cystadenoma: A cystadenoma is a type of benign tumor that develops from ovarian tissue. They may be filled with a mucous-type fluid material. Cystadenomas can become very large and may measure 12 inches or more in diameter.

It is common to look for ovarian cancer statistics to find out what the chances of something happening to you are, whether its the risk of getting the disease or the chances of dying from it. Below are various statistics from a few different countries, to give you an idea of the incidence, survival and mortality for ovarian cancer. It is important to remember that these ovarian cancer statistics are general information that applies to a population, i.e. a large number of people, and wont fit your situation exactly. You and your circumstances are unique, and if a statistic doesnt look very good, it does not mean that this will be your outcome. As always, if you have been diagnosed with cancer, it is important to keep a positive outlook on things to give you the best chance possible of overcoming the disease. Worldwide More than 204,000 cases are diagnosed each year. It is estimated that 125,000 women with ovarian cancer die each year. The ovarian cancer statistics for incidence indicate it is highest in the USA and Northern Europe and lowest in Africa and Asia. United States According to the American cancer Society, an estimated 21,500 new cases of ovarian cancer are expected in the US in 2009. Approximately 14,600 deaths are expected to be caused by ovarian cancer in 2009. Ovarian canceraccounts for about 3% of all cancers among women and ranks second among the gynaecological cancers, following uterine cancer. Overall, it is the 5th leading cause of cancer deaths in women, despite being the 9th most commonly diagnosed. The 1-year and 5-year overall survival (all stages combined) is 75% and 46% respectively. If diagnosed at the localised stage (that is, confined to the ovary) the 5-year survival rate is 93%, however only 19% of all cases are diagnosed at this stage. The 10-year relative survival rate for all stages combined is 39%. United Kingdom There are around 6,600 new cases of ovarian cancer diagnosed each year in the UK. Ovarian cancer is the fourth most common cause of cancer death in women in the UK and the most common cause of gynaecological cancer death. Around 4,300 women die of ovarian cancer each year in the UK. For patients diagnosed between 2000 and 2001 the 1-year and 5-year overall survival (all stages combined) was 70% and 41% respectively. Europe

The ovarian cancer statistics for Europe indicate that around 43,000 cases occur each year. Within the European Union the lowest rates are in the Southern European countries of Greece, Portugal and Cyprus, while the highest are in the Northern and Eastern European countries of Lithuania, Denmark, Czech Republic and Estonia. Australia Among Australian women, ovarian cancer is the 9th most common cancer diagnosed, and the 6th most common cause of cancer death. One in 77 women will be diagnosed with ovarian cancer before the age of 85. In 2005, the ovarian cancer statistics show that 1,205 women were diagnosed with the disease, with the projected figure for 2010 to be 1,378 new cases. The median age at diagnosis is 64 years, which is similar to that in other countries. The 5-year survival rate during 1998-2004 was 39.8%

Pathophysiology
Follicular cysts develop in response to gonadotrophic stimulation and as a variation of the normal physiological process of follicle growth and atresia. It is unclear whether a dominant follicle fails to rupture or an immature follicle fails to undergo atresia. [11] The lining granulosa cells undergo luteinisation, and hyalinised connective tissue envelopes the growing cyst. [7] Corpus luteum cysts evolve from mature Graafian follicles approximately 2 to 4 days after ovulation occurs. Vascularisation takes place and a spontaneous capillary bleed fills the cystic cavity, creating pressure. [7] Rupture is possible at this point. Eventually, the blood is replaced by clear serous fluid. Theca lutein cysts arise from ovarian theca lutein cells and luteinised granulosa cells responding to stimulation by gonadotrophins or beta-hCG. Fibromas represent neoplastic growth of undifferentiated fibrous stroma. [12] Transitional cell (Brenner) tumours arise from metaplasia of celomic epithelium into uroepithelium, which may result in an inclusion-type cyst. Benign and malignant ovarian tumours stain immunohistochemically for somatostatin. [11]
http://bestpractice.bmj.com/best-practice/monograph/660/basics/pathophysiology.html

Clear liquid diet

Definition
A clear liquid diet consists of clear liquids, such as water, broth and plain gelatin, that are easily digested and leave no undigested residue in your intestinal tract. Your doctor may prescribe a clear liquid diet before certain medical procedures or if you have certain digestive problems. Because a clear liquid diet can't provide you with adequate calories and nutrients, it shouldn't be continued for more than a few days.

Purpose
A clear liquid diet is often used before tests, procedures or surgeries that require no food in your stomach or intestines, such as before colonoscopy. It may also be recommended as a short-term diet if you have certain digestive problems, such as nausea, vomiting or diarrhea, or after certain types of surgery.

Diet details
A clear liquid diet helps maintain adequate hydration, provides some important electrolytes, such as sodium and potassium, and gives some energy at a time when a full diet isn't possible or recommended. The following foods are allowed in a clear liquid diet: Plain water Fruit juices without pulp, such as apple juice, grape juice or cranberry juice Strained lemonade or fruit punch Clear, fat-free broth (bouillon or consomme) Clear sodas Plain gelatin Honey Ice pops without bits of fruit or fruit pulp Tea or coffee without milk or cream Any foods not on the above list should be avoided. Also, for certain tests, such as colon exams, your doctor may ask you to avoid liquids or gelatin with red coloring. A typical menu on the clear liquid diet may look like this.

Breakfast: 1 glass fruit juice 1 cup coffee or tea (without dairy products) 1 cup broth 1 bowl gelatin Snack: 1 glass fruit juice 1 bowl gelatin Lunch: 1 glass fruit juice 1 glass water 1 cup broth 1 bowl gelatin Snack: 1 ice pop (without fruit pulp) 1 cup coffee or tea (without dairy products) or a soft drink Dinner: 1 cup juice or water 1 cup broth 1 bowl gelatin 1 cup coffee or tea

Results
Although the clear liquid diet may not be very exciting, it does fulfill its purpose. It's designed to keep your stomach and intestines clear, limit strain to your digestive system, but keep your body hydrated as you prepare for or recover from a medical procedure.

Risks
Because a clear liquid diet can't provide you with adequate calories and nutrients, it shouldn't be used for more than a few days. Only use the clear liquid diet as directed by your doctor. If your doctor prescribes a clear liquid diet before a medical test, be sure to follow the diet instructions exactly. If you don't follow the diet exactly, you risk an inaccurate test and may have to reschedule the procedure for another time.

http://www.mayoclinic.com/health/clear-liquid-diet/my00742

A clear liquid diet is made up of clear liquids and foods that are liquid at room temperature. Some examples of these foods or liquids are apple juice, clear broth, gelatin dessert, and weak tea. The clear liquid diet provides liquids, salt, and some nutrients for a few days until you can eat normal food. The clear liquid diet does not provide all the nutrients, vitamins, minerals, or calories that your body needs. A clear liquid diet may be used before a test or surgery to make sure your digestive tract is empty. The digestive tract is the path that food takes through your body as it is digested. You may also need this diet after stomach or bowel (small and large intestines) surgery, or if you have problems with eating solid food. The goal of this diet is to provide liquids and part of the calories you need until you can eat solid food. Clear liquids are easily digested (broken down) and do not put a strain on your stomach or intesti

Uterus: The uterus of an adult woman (who has not yet borne children) is 3 inches in length, 2 inches across at the upper end and 1 inches at the lower end. It is pear shaped. The lining of the uterine cavity, is called the endometrium (uterine lining). At the lower end it opens into the vagina through the cervical canal. Cervix: The neck of the uterus is called the cervix. The passage through the cervix is called the cervical canal. The mucus membrane lining the cervical canal extends inwards to form complex pouches called crypts. These crypts secrete an alkaline mucus, that starts flowing about 4-5 days before the actual day of ovulation. Vagina: It is an elastic muscular canal, 3 inches long, extending from the cervix (mouth of the uterus) to the vulva. It is lined by mucous membrane which has folds that give it a wrinkled appearance. It is the female organ of sexual intercourse. It receives the seminal fluid deposited by the penis during the marital act and it serves as the birth canal, a passage for the baby during birth. At the opening of the vagina is a thin membrane called hymen. Fallopian Tubes: The upper end of the uterus on either side, is connected to the fallopian tubes (uterine tubes). Each tube is 4 inches in length. It is a muscular hollow tube which allows the ovum (egg) to pass from the ovary to the uterine cavity (space inside the uterus). The outer end is funnel shaped with a number of finger like processes called fimbriae. In the sterilisation procedure called tubectomy, resection of a segment of both the fallopian tubes is done. Ovary: These are two in number and are the female sex glands. Each one is 4 cms long and 2 cms wide and less than 1 cm thick. It is connected to the uterus with the help of a ligament and lies suspended close to the outer end of the funnel shaped part of the fallopian tube. The ovaries have the following two functions.