Dear dr, pt has pain in rt iliac fossa with diagnosed rt ova cyst ,which is cystic goes in favour of 15%serous cyst,60%mucinous cyst,15 chocolate cyst clinically take more history so if cho cyst h/o such episodes common during every menses. mucinious or serous can be short onset. if pain is not severe put pt on antiinflammatory for 5days, follow USG after 15 days . If pain is more or agrevates then rule out torsion (twisted ov cyst) Sos diagnostic as well operative laparoscopy any time as per the need.
Most probably benign ovarian cyst. Might be Mucinous/serous. Give her anti biotic. And inflammatory drugs. If pain a
Aggregated, look for any twisted ovary. Do CA 125.go for laproscopy, removal. Then send ovarian cyst and fluid for hpe
simple benign ovarian cysts are usually functional, and disappeared after periods,if the cystic constant, seviority of pain is same,R/O for Ca 125, take the cystic fluid for aspiration and send for. hpe, wait for reports till then give the antibiotics , antiinflamatory and analgesics
Cause of pain is rt cystic ovary menstrual history not given try oral progesterone tablet 3 month then asses otherwise surgical rupture of cyst
vth usg showing 43cms of rt ovarian cyst ,m/c it is serous_mucinous type.hws her menstrual history? As it is symptomatic, gv her some antiinflamatories for 5 days&i sujjest a course of Antibiotics for 7 days. reassess the size once her pain subsides. if pain is same&no change in size go for diagnostic laproscopy. reassess &go for therupatic treatment under same sitting which will help her in her future conception rate also.
what is the age of the patient. looking into the size of cyst this is relatively small. can be functional cyst. give her a course of ocp for 3months and antibiotics and antiinflamatoty
what is her LMP.r/o haemorrhagic corpusluteum at the time of ovulation.if it is ovulatory simple analgesics may suffice.pain may subside in 2 or 3 days.less than 5cm is usually functional.
mention size of cyst .if simple ovarian cyst with size less than 5cm it will resolve with antibiotic and anti inflammatory drugs.
if cyst persists,do ROMA.risk of ovarian malignancy algorithm. combined test HE4 & CA125. helps to diagnose benign from malignant
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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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today a female pt aged 39 yrs....came with complaint of pain in abdomen. pain is mild, continuous, in rt iliac fossa. she has h/o laproscopic surgery for ovarian cysts 4 yrs back. this time she had been to a gynaecologist and came to me with USG report. agni- mand, nidra- khandit mala pravrutti- baddha mutra pravrutti- samanya manobal- hin, thinks excessively and negatively. m/h- irregular o/h- 2 LSCS, 1 male-20yr;1 female-17 yr, 2 abortions, gynecologist has suggested operative. here is the scan report. kindly suggest line of treatment as among 2 growths observed ,one is ovarian cyst which can be managed very well by ayurveda. the other is hydrosalpinx. few of pts relatives r allopathic doctors and are against ayurvedic treatment. but pt is willing for only ayurvedic treatment. pls suggest good ayurvedic line of treatment.Dr. Aditi Mangsuli3 Likes10 Answers