ovarian cyst

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it includes its definition, classification, causes, stages, sign and symptoms, treatment.

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Ovarian cyst :

Ovarian cyst Presented By , Jyoti k. Gavit, 3 rd year GNM

INTRODUCTION:

INTRODUCTION Ovarian cysts can occur in early childhood ( 3-8 years of age ) but are more common in neonatal and adolescent periods . The incidence is <5 % between birth and age 8 . Small cysts are more frequent than large cysts. In pregnancy : Corpus luteal cysts : 70% . Benign mucous or serous cyst adenoma : 20% dermoid cyst5% malignant tumour 1%

OVARIAN CYST:

OVARIAN CYST DEFINITION an ovarian cyst is any collection of fluid surrounded by a very thin wall within an ovary. Any ovarian follicle larger than 2 cm is known as cyst . It may be as smaller as a pea or as larger as orange.

Con……:

Con…… INCIDENCE The incidence is 15 cases 1 lakh/year.

CLASSIFICATION:

CLASSIFICATION Functional cysts ( simple cysts ) there are three types: graafian, corpus luteal, hemorrhagic. this type of cysts occur during ovulation. If the egg is not released. Ovary can fill up with fluid . Usually these types of cyst will go away after a few period cycle . graafian follicle cyst : it is most common type of cyst

Con…….:

Con……. b) Corpus luteum cyst : it may rupture about the time of menstruation and take up to 3 month to disappear. c) Hemorrhagic cyst : it occurs when a very small blood vessels in the wall of the cyst breaks the blood enters the cyst . The bleeding may occur quickly and rapid stretch the covering the ovary. causing pain most hemorrhagic cysts are self limiting . Some need surgical intervention.

CON…..:

CON….. 2) Dermoid cyst : a non – malignant cystic tumor containing extra –cysto dermal elements like skin , hair. 3) Endometroid cyst : it is caused by the endometriosis & formed when a tiny patch of endometrial tissue ( mucus membrane that makes up . the inner large of the uterine wall ) bleeds , become transplanted & grows & enlarges inside the ovary.

FACTORS:

FACTORS Hereditary. Endocrine. Environmental factor. Who are living in industrialized area . Diet high in meat and animal fats and high risk milk consumption. Infertile women.

STAGE:

STAGE stages 1 : limited to ovaries stages 2 : involving one or both ovaries with pelvic extentions . Stage 3 : involving one or both ovaries with peritoneum metastasis outside pelvic or pelvic lymph nodes 4) Stage 4 : involving one or both ovaries with distant metastasis metastasis e . g liver lungs .

CLINICAL MAIFETATIONS:

CLINICAL MAIFETATIONS Asymptomatic cyst Severe sudden and sharp pain Fatigue Pressure in pelvis Breast tenderness Nausea and vomiting Fullness or pressure in the abdomen Irregular periods

Con….:

Con…. 8) Urinary frequency 9) Anorexia 10) Bloating 11) Abdomen girth 12) Abnormal uterine bleeding or spotting.

DIAGNOSTIC EVALUATION:

DIAGNOSTIC EVALUATION History taking physical examination CT scan laparoscopy ultrasonography color Doppler for vascularization

MANAGEMENT:

MANAGEMENT TREATMENT FOR CYST DEPENDS ON THE SIZE OF THE CYST AND SYMPTOMS Pain relievers : acetaminophen, ibuprofen or narcotic drugs may be given to reduce pelvic pain combined oral contraceptive : oral contraceptive pill may be given to shrink the size of the cyst or it may help to regulate menstrual cycle

Con……..:

Con…….. 3) Adjuvant therapy is often employed based on the stages of the disease of follows: stage 1: chemotherapy stage 2: combined chemotherapy stage 3: or 4 : surgical removal of tumor

SURGICAL MANAGEMENT:

SURGICAL MANAGEMENT Surgical management for more serious cases where cysts are large and persisting ,the surgery may be performed successfully to remove the cysts without hurting the ovaries . While others may require removal of one or both ovaries laproscopic : simple surgery may be done Oophorectomy : removal of ovary TAH BSO : total abdominal hystetrectomy with bilateral slappingo , Oophorectomy

COMPLICATION:

COMPLICATION Rupture of cysts torsion of cysts bleeding into cysts obstruction in labour (rare)

DIAGNOSIS:

DIAGNOSIS Acute pain related to cyst surgical procedure. activity intolerance related surgical procedure. altered elimination pattern related to pressure on the pelvis. anxiety related surgical procedure. altered nutrition related to nausea and vomiting

CON……….:

CON………. If the mother cannot take oral therapy or if the oral therapy is contraindicated ,then go for parenteral therapy . It includes Total dose infusions or iv routes. intramuscular injections . 11) The total dose infusions eleminate painful intramuscular injections and are less costly .

CON……..:

CON…….. FOR THIS THE PT IS ADMITTED IN THE MORING The required iron is mixed with 500ml of 0.9% saline if the required amount of iron is more than 50 ml (1ml =50 mg elemental iron ) then, the total dose is to be infused in two conse cutive days infusing half the total amount in each day.

CON………:

CON……… During the first 20 minutes . The drop rate should be 10 drop /minute then .it may be increased to 40 drop /ml depending upon the severity . 13) While administration of parenteral iron check for adverse reactions like rior chest pain, hypotension etc If the mother chooses intramuscular therapy then ,the used compounds are:

CON………..:

CON……….. Iron –dextron (imferon) iron – sorbitol citric acid complex in dextrin's The above both preparations include 50 mg of elemental iron in one milliliter . Total dose in calculated as in intravenous therapy . avoid oral iron at least 24 hrs prior to therapy to avoid reaction.

CON…………:

CON………… 17) The injections are given using a 1 technique using a2 inch deep needle and on upper outer quadrant of the buttock to avoid or prevent dark staining of skin and to minimize pain . 18) If the mother is anemic due to blood loss i.e. in conditions like PPH then the blood transfusion should be done.

CON………:

CON……… The blood to be transfused should be fresh, properly typed and grouped , only packed cells are trans fused. the quantity of blood should be between 80- 100 ml at a time with a drip rate of about 10 drops per minute and not to be repeated within24 hours.

CON………:

CON……… During labour the anemic mother should be : comfortable. light analgesics should be given to relief pain to diminish the risk of hypoxia (fetal ) keep O2 ready. maintain strict asepsis to minimize puerperial infection. 21) Following delivery of anterior shoulder give intravenous methergin o.2 mg

CON………:

CON……… Dietary advice must be emphasised and reinforced as told earlier like richer sources of iron and folic acid are to be taken before during and after pregnancy . These include: Fresh green leafy vegetables yams .liver. Kidney meat ( contains folic acid ) liver (contains iron ) beef (contains iron)

CON……….:

CON………. Muscle (contains iron) eggs ( contains iron ) dry fruit ( contains iron ) 23) All pregnant women should have the values as given in the tablet. Hemoglobin in pregnancy 11- 14 gm.

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