0071643192.pdf

OBSTETRICS AND GYNECOLOGY

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OVARIAN TORSION

Most cases result from a mass or large cyst on an ovary or fallopian tube that

stretches the pedicle and causes a rotation on its axis leading to decreased

blood flow. This can occur at any age.

SYMPTOMS/EXAM

■ Recurrent intermittent attacks of colicky pain with nausea, vomiting, and

low-grade fever

■ The abdominal pain can also be sharp and have peritoneal signs.

■ Pelvic exam usually reveals adnexal fullness and tenderness.

DIFFERENTIAL

■ Appendicitis

■ Ruptured ovarian cyst

■ Ovarian tumor

■ Renal stone

■ Ectopic pregnancy

DIAGNOSIS

Transvaginal ultrasound to look for ovarian cyst/mass and color flow Doppler

to assess ovarian blood flow; test for pregnancy

TREATMENT

Laparoscopy or laparotomy is indicated. Failure to surgically correct the tor-

sion can result in ischemia and necrosis of the involved ovary.

AMENORRHEA

Defined as absence of menstruation for 3 or more months during the repro-

ductive years. This is a symptom and not a diagnosis!

■ 1 °amenorrhea: Failure of menses by age 16 or within 2 years of full sec-

ondary sexual characteristic development; see Table 12.7

■ 2 °amenorrhea: Lack of menses for >3 months in a woman who previously

had normal menstruation; mostly caused by ovarian dysfunction or ovarian

failure; ovarian dysfunction (polycystic ovaries [PCOS]) due to increased

androgen from the ovaries or adrenal glands that converts to excess estrogen

in adipose tissue

SYMPTOMS/EXAM

■ Symptoms of decreased estrogen include hot flashes, night sweats, and dys-

pareunia.

■ Increased androgens can manifest with acne, decreased breast size, hir-

sutism, voice deepening, balding, and increased muscle mass.

DIAGNOSIS

Careful history and physical will help determine which organ is primarily re-

sponsible for amenorrhea. Check levels of TSH, LH, FSH, prolactin, and

estradiol.

Rule out pregnancy as a cause

of amenorrhea.