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Saturday, December 21, 2013

Ovarian Cyst on Top of Gastroparesis

I went to the emergency room tonight because not only do I have an allergic reaction from adhesive tape and/or latex, but now I have a right ovarian cyst.

The allergic reaction happened after the doctor removed my Impanon. He put a strip of tape on my arm to stop the bleeding that I wasn't supposed to take off for another two days. However, I removed it when I saw this reaction:

My allergic reaction.

It was bothering me and really burning, so I called the doctor and sent him a picture on my cell phone. He wanted me to come to his other office today (more than an 1 & 1/2 away) but I wouldn't make it before he closed. I was in so much pain and I thought it was from the procedure yesterday. After I sent him the picture and waited a bit, he called me back to tell me to go to the Emergency Room.

We got there at 6pm and left at 1:30am. I thought I was going to die of boredom after my Kindle died. I didn't think to bring my charger and my husband tried his best to distract me. The nurse came in and gave me morphine and steroids in my IV. At least they got my IV on the first try but I would have loved to see my labs.

They came and got me for an ultrasound - regular and vaginal. I made them call my doctor because I didn't know if I could have the latter yet but he OK'ed it. It HURT like hell. They stopped and made me empty my bladder, so I went until I couldn't go anymore and went back in for the pelvic. That made me want to cry and jump off the table. This was around 12am, so my morphine had worn off. It was like torture and usually ultrasounds aren't bad. When they finished, they told me that the doctor would take 30 minutes to get the results.

When we got to my room, I waited more. The nurse came in and gave me Toradol, which helped with the cramping day before yesterday. Then, the doctor finally came in. He told me that I had an ovarian cyst on my right ovary and that my GYN will see me on Monday. I've seen my GYN twice this week, I should just put a cot in his office. So, I'm going Monday to see the doctor. I have an ovarian cyst on top of Gastroparesis now. I just want to scream!

The ER Doctor gave me prescriptions for codeine and for steroids. I put cortisone on the allergic reaction to speed up healing a bit.

Information about ovarian cysts can be found here: http://www.mayoclinic.com/health/ovarian-cysts/DS00129

You can read it here:

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries — each about the size and shape of an almond — located on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms. The best ways to protect your health are to know the symptoms that may signal a more significant problem, and to schedule regular pelvic examinations.


Symptoms:

Most cysts don't cause any symptoms and go away on their own. A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on your bladder, you may feel the need to urinate more frequently because bladder capacity is reduced.

The symptoms of ovarian cysts, if present, may include:

Menstrual irregularities

Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs

Pelvic pain shortly before your period begins or just before it ends

Pelvic pain during intercourse (dyspareunia)

Pain during bowel movements or pressure on your bowels

Nausea, vomiting or breast tenderness similar to that experienced during pregnancy

Fullness or heaviness in your abdomen

Pressure on your rectum or bladder that causes a need to urinate more frequently or difficulty emptying your bladder completely



When to see a doctor:

Seek immediate medical attention if you have:

Sudden, severe abdominal or pelvic pain

Pain accompanied by fever or vomiting

These signs and symptoms — or those of shock, such as cold, clammy skin, rapid breathing, and lightheadedness or weakness — indicate an emergency and mean that you need to see a doctor right away.


Treatment:

Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:

Watchful waiting. In many cases you can wait and be re-examined to see if the cyst goes away on its own within a few months. This is typically an option — regardless of your age — if you have no symptoms and an ultrasound shows you have a small, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.

Birth control pills. Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.

Surgery. Your doctor may suggest removal of a cyst if it is large, doesn't look like a functional cyst, is growing, or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed.

Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. In some circumstances, your doctor may suggest removing the affected ovary and leaving the other intact in a procedure known as oophorectomy.

If a cystic mass is cancerous, however, your doctor will likely advise a hysterectomy to remove both ovaries and your uterus. Your doctor is also likely to recommend surgery when a cystic mass develops on the ovaries after menopause.




Brief drawing of the cyst that I have. Image found: http://www.mayoclinic.com/images/image_popup/r7_follicularovary.jpg




According to http://www.medicinenet.com/ovarian_cysts/article.htm#what_is_the_ovary_and_what_are_ovarian_cysts

Ovarian cysts facts:

Ovarian cysts are closed, sac-like structures within the ovary that are filled with a liquid or semisolid substance.

Ovarian cysts form for numerous reasons.

Pain in the abdomen or pelvis is the most common symptom of an ovarian cyst, but most are asymptomatic.

Most cysts are diagnosed by ultrasound or physical exam.

The treatment of an ovarian cyst depends upon its likely diagnosis and varies from observation and monitoring to surgical treatment.


What is the ovary and what are ovarian cysts?

The ovary is one of a pair of reproductive glands in women that are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of a walnut. The ovaries produce eggs (ova) and female hormones estrogen and progesterone. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy. Ovarian cysts are closed, sac-like structures within an ovary that contain a liquid, gaseous, or semisolid substance. "Cyst" is merely a general term for a fluid-filled structure, which may or may not represent a tumor or neoplasm (new growth). If it is a tumor, it may be benign or malignant. The ovary is also referred to as the female gonad.



What causes ovarian cysts?

Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve spontaneously over the course of days to months. Cysts can contain blood (hemorrhagic cysts) from leakage of blood into the egg sac.

Another type of ovarian cyst that is related to the menstrual cycle is a corpus luteum cyst. The corpus luteum is an area of tissue within the ovary that occurs after an egg has been released from a follicle. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood and persist as a cyst on the ovary. Usually, this cyst is found on only one side, produces no symptomsand resolves spontaneously.

Endometriosis is a condition in which cells that normally grow inside as a lining of the uterus (womb), instead grow outside of the uterus in other locations. The ovary is a common site for endometriosis. When endometriosis involves the ovary, the area of endometrial tissue may grow and bleed over time, forming a blood-filled cyst with red- or brown-colored contents called an endometrioma, sometimes referred to as a chocolate cyst or endometrioma. The condition known as polycystic ovarian syndrome (PCOS) is characterized by the presence of multiple small cysts within both ovaries. PCOS is associated with a number of hormonal problems and is the most common cause of infertility in women.

Both benign and malignant tumors of the ovary may also be cystic. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are really tumors called denign cystic teratomas or dermoid cysts.

Infections of the pelvic organs can involve the ovaries and Fallopian tubes. In severe cases, pus-filled cystic spaces may be present on or around the ovary or tubes. These are known as tubo-ovarian abscesses.



How are Ovarian Cysts Treated:

Most ovarian cysts in women of childbearing age are follicular or corpus luteum cysts (functional cysts) that disappear naturally in one to three months, although they can rupture and cause pain. They are benign and have no long-term medical consequence. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed.

Ultrasound is useful to determine if the cyst is simple (just fluid with no solid tissue, suggesting a benign condition) or compound (with solid components that often required surgical resection).

In summary, the ideal treatment of ovarian cysts depends on what the cyst is likely to be. The woman's age, the size (and any change in size) of the cyst, and the cyst's appearance on ultrasound to help determine the treatment. Cysts that are functional are usually observed unless they rupture and cause significant bleeding, in which case, surgical treatment is required. Benign and malignant tumors require operation.

Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above).

The tumor can be surgically removed either with laparoscopy,, or if needed, an open abdominal incision (laparotomy) if it is causing severe pain, not resolving, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst present.




What are the risks of ovarian cysts during pregnancy?

Ovarian cysts are sometimes discovered during pregnancy. In most cases, they are an incidental finding at the time of routine prenatal ultrasound screening. The majority of ovarian cysts found during pregnancy are benign conditions that do not require surgical intervention. However, surgery may be indicated if there is a suspicion of malignancy, if an acute complication such as rupture or torsion (twisting of the cyst, disrupting the blood supply) develops, or if the size of the cyst is likely to present problems with the pregnancy.

Medically reviewed by Edmund Petrilli, MD; American Board of Obstetrics and Gynecology with subspecialty in Gynecologic Oncology
REFERENCE: eMedicine.com. Ovarian Cysts.
http://emedicine.medscape.com/article/255865-overview

Previous contributing author: Carolyn Crandall, MD, FACP




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