26yr unmarried girl with pain over RIF, moderate dysmenorrhoea for 2 days,Reg menses, USG report attached,no bladder and bowel symptoms, with hypothyroidism,kindly tell me how to proceed,do I have to do beta hcg and Alfa feto protein also? .repeat USG+Doppler for ? twisted ovarian cyst? dermoid cyst,or direct CECT .CA125 report awaited,

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First advised expert Doppler for confirming twisted ovarian cyst if it is need urgent attention . If chocolate cyst it must be removed with preserving as much as healthy tissue . Symptomatic Antibiotics+ antiinfalmaory durgs. OC pills want help much in such case CA125 is has prognosis velue so donot much confirmratory in such young patient

Thanks Dr Patel,do I need to repeat her USG to confirm type of ovarian cyst?
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In a unmarried girl hemorrhagic cyst, endometriosis are the possibilities. Give OC pills. Endometriosis is quite common. Laproscopy can be done if no reponse

Three months ocp, followed by repeat USG, if findings remain same, diagnostic as well as operative laproscopy. En bag removal or morcellation if it's dermoid or chocolate cyst on scopy. If it's chocolate cyst shd be followed by GnRh antagonist, as early as possible marriage and coception

Please tell me the drug and doses of GnRH antagonist in this pt
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Rt ovarian cyst 45×47mm with internal echoes? hemorrhagic?? endometriotic

45 mm cyst....Symptomatic Rx, Ocps for 3 months, repeat usg after 3 months. Explain findings & plan to the patient.

Ok ,repeat USG to confirm? required or not,and if it's endometriotic then laparoscopic cystectomy required or ocpills will take care of it
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Patient's pulse rate? If it s normal , conservative and symptomatic. Or else laparotomy. Twisted ovarian is a differential. . . So

Thanks Dr
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I believe it to be a dermoid. Let the report come. CECT to be done.

Ok, please tell me which investigations are required to diagnose dermoid cyst
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Give analgesic if pain relieved then could b just hgic cyst, start ocps 3months later rpt scan,,, if pain doesn't get relief then go for CT scan n treat accordingly

Twisted ovary cannot be diagnosed by any marker any CST more than 3cms needs surgery so laparoscopy is the treatment

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