Doctor, is she married? pain abdomen. back ache. nausea. white discharge. complex ovarian cyst 3 cms. mostly a hemorrhagic cyst . resolves on it's own. can give tab ceftum 250 mg bd for five days &tab thrize plus bd for five days. give vagi wash for wd. repeat scan after a month. if she is married, then take a vaginal smear for cytology. if it is candidiasis, add fluconozole 150 mg / day for a week. cap pre pro for a week. clingen vaginal suppositories for a week.
It's mentioned to be a haemorrhagic cyst,so it will resolve on its own Put her on anti-inflammatory for 5_7 days Vomitting , nausea is mentioned it can be because of the torsion of the cyst-- rule out with Doppler If twisted ovarian cyst the surgery is warranted. But in Twisted cyst (h'agic) then onset is going to be acute. Rule out h/o worm infestation. Deworming Add calcium Put on a course of Antifungal
I agree with Saigaonkar mam...start with conservative management..by ocp,antibiotics n antispasmodics.rept scan after next periods..if persisting..size decreasing..give ocp...3 months then rept USG..if still present go for lap removal..
This appears to be a simple corpus luteal cyst,if colour Doppler show no vascularisation ,it is more likely to be benign,do CA-125 & CEA to confirm the benign nature,repeat scan on day 3 of menses and many times physiological CL cyst disappear without any treatment ,if still persistent can give a course of OCPills and review again post menses ,If still present only then can opt for Laproscopic removal,do not give vaginal therapy for discharge as she is unmarried and may be a virgin,nausea and pain is not related to cyst as it is long standing and cyst is not big enough to cause twist or pain or internal rupture and haemorrhage ,all the above treatment should be done by a qualified gyn only
CA125 to r/o ovarian cancer if non conclusive then laparoscopic aspiration cytology to arrive at the diagnosis.FAS3 kit to treat pv discharge along with clingen vag suppository for local insertion at night for 7 nights.Ondensetron orally to control nausia
Haemorrhagic cyst may be physiological, antibiotics and anti spasmodic tablets will do,if still patient not getting relieved with pain,then go for laproscopic excision, see that ovary is preserved.
Initially choose conservative treatment - Antibiotics & Anti-spam drugs , symptoms doesn't reduce r reoccurring go for Lap . aspiration & exertion of cyst .
please refer to gynaecologist for further management...
Refer to Gynaecologist.
should be careful while aspiration , to avoid spillage ...and could be cystadenocarinoma....leading to peritoneal spread
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ABC OF : ENDOMETRIOSIS. MAY BE USEFUL. ***** ENDOMETRIOSIS :- MORE THAN 1 MILLION CASES PER YEAR (INDIA)....... TREATABLE BY A MEDICAL PROFESSIONALS....... REQUIRES A MEDICAL DIAGNOSIS....... LAB TESTS OR IMAGING OFTEN REQUIRED....... CHRONIC: CAN LAST FOR YEARS OR BE LIFELONG....... ** CONSULT A DOCTOR FOR MEDICAL ADVICE....... *** ENDOMETRIOSIS is an estrogen-dependent disease wherein endometrial-like tissue is found outside the uterus inducing a chronic inflammatory response....... Pelvic organs (esp ovaries) & peritoneum are frequently affected....... *** SYMPTOMS :- MAIN CLINICAL FEATURES INCLUDE: CHRONIC PELVIC PAIN (found in 70-80% of patients) DYSPAREUNIA (suggests deep posterior infiltration) INFERTILITY (21% prevalence rate) OTHER SYMPTOMS may include severe dysmenorrhea, pain on ovulation, noncyclical pelvic pain, cyclical bowel or bladder symptoms w/ or w/o abnormal bleeding or pain, chronic fatigue, or dyschezia....... IN ADOLESCENTS, endometriosis is the most common cause of SECONDARY DYSMENORRHOEA....... Although it is vital to consider the patient's complaints affecting physical, mental & social well-being, it should be noted that patients w/ endometriosis may be completely ASYMPTOMATIC (w/ 2-22% prevalence rate)....... ***** DIAGNOSIS :- Diagnosis of endometriosis is made after taking the PATIENT'S HISTORY & doing PHYSICAL EXAMINATION LABORATORY TESTS, LAPAROSCOPY, & IMAGING studies are performed as well to confirm diagnosis. *** PATIENT'S HISTORY :- Should include: Age (reproductive year, most commonly at 25-29 yr old) In utero exposure to environmental toxins like diethylstilbestrol which increases the incidence of endometriosis Family history of endometriosis (7x higher risk than w/ no family history) *** PHYSICAL EXAMINATION :- Ideally done during early menses because endometrial implants are likely to be largest & deep infiltrating, hence more easily detectable Diagnosis is more definite if deeply infiltrative nodules are found on the uterosacral ligaments or in pouch of Douglas, &/or lesions are directly seen in the vagina or cervix Note that there may be no abnormal findings on physical exam For patients who are not sexually active, a rectal-abdominal exam may be better tolerated than a vag-abdominal exam A cotton swab can be inserted into the vagina to document patency & exclude complete or partially obstructive anomalies such as a transverse vaginal septum, imperforate or microperforate hymen, or an obstructed hemivagina OTHER FREQUENT FINDINGS : Pain w/ uterine movement or pelvic tenderness Tender, enlarged adnexal masses Fixation of adnexa or uterus in a retroverted position *** LABORATORY TESTS :- Urinalysis & urine culture to identify pain originating in the urinary tract (eg cystitis, stones) Pregnancy test & tests for sexually transmitted infection (STI) like gonorrhea, chlamydia, when appropriate....... *** LAPAROSCOPY :- Gold standard for diagnosis, unless lesions are visible in the vagina May also be used for therapeutic purposes Should not be done during or w/in 3 mth of hormonal treatment to avoid under-diagnosis Biopsy & histopathologic study of at least one lesion is ideal 3 cardinal features (ie ectopic endometrial glands, ectopic endometrial stroma, & hemorrhage into adjacent tissue) should be present In adolescents, features of endometriosis may be atypical (ie clear vesicles & red lesions) A negative laparoscopy does not exclude the diagnosis of endometriosis Depending on the severity of the disease found, it is best to remove the endometriotic lesion at the same time Differential diagnoses (eg endosalpingiosis, mesothelial hyperplasia, hemosiderin deposition, hemangiomas, adrenal rests, inflammatory changes, splenosis & reactions to oil-based radiographic dyes) can be excluded by biopsy Laparoscopic Classification (based on location, extent & severity of lesions) : Stages based on American Fertility Society (AFS) Minimal disease (stage I) - characterized by isolated implants & no significant adhesions Mild endometriosis (stage II) - consists of superficial implants <5 cm in aggregate, scattered on the peritoneum & ovaries; 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