Ovarian Disorders (Cyst, Torsion, Rupture)

Ovarian Disorders (Cyst, Torsion, Rupture)

Definition/Etiology:

Ovarian Cyst – A fluid-filled sack that develops on or inside the ovary. Cysts are common among women of childbearing age. Related to cyclic changes and are usually asymptomatic and self-limiting. Resolve without intervention in most cases.

Ovarian Torsion – occurs when the ovary twists on the tissue that supports it. May also include the fallopian tube.

Pathophysiology:

Ruptured Ovarian Cyst –Rupture is most likely to occur during strenuous exercise or sexual intercourse

Ovarian torsion – blood supply is cut off to the ovary which can cause tissue death. Having an ovarian cyst is a huge risk factor for torsion as it can make the ovary or fallopian tube unbalanced and ultimately twist on itself

Clinical Presentation:

Ruptured ovarian cyst

• Unilateral pain
• Sudden and sharp
• May follow sexual intercourse or trauma but not always

Ovarian Torsion

• Severe pelvic pain, maybe unilateral and often sudden nausea/vomiting

Collaborative Management:

Ruptured ovarian cyst:

• RULE OUT PREGNANCY – MAKE SURE NO BABIES WERE INVOLVED IN THE MAKING OF THE RUPTURE OVARIAN CYST
• (Urine or beta hCG)
• Pelvic examination
• Transvaginal US
• CT

Interventions:

• Pain management
• Fluid
• Hemodynamic monitoring for possible shock
• OR prep

Ovarian Torsion:

• Transvaginal ultrasound

Evaluation | Patient Monitoring | Education:

• Pain management!
• Hemodynamic monitoring for signs of shock
• Monitor for vaginal bleeding or any change in condition.

Linchpins: (Key Points)

• Women of childbearing age with pelvic pain are pregnant until proven otherwise.
• Time is tissue – get imaging ASAP to ensure there is not a ruptured cyst or torsion.
• A pelvic emergency patient is usually fixed from the inside out – prep for the OR.