L woman wrote to me:
Hello Dr. Kavokin,
I read some of the literature and found it very informative. I have a question, the answer can perhaps be able to: If a woman has ovarian cyst ruptures, (), above all multiple cysts of PCOS that ruptured cyst may cause an infection?
Hello, MS. L
Short answer: everything can be infected. Although I believe is not ruptured ovarian cyst infected very often, did not hear about it. I want to lookLiterature, and probably place the answer on my website.
Sincerely,
Alex
Ok. I saw the literature.
I'm not looking for the very extensive literature. Should admit.
However, some books that may be mentioned are available ovarian cyst to become infected. But the infection is not described as the most common complication of ovarian cyst rupture.
Nor do I remember that someone else is said. Perhaps there are some special items, which says the condition occurs in aPoint three percent of cases with standard deviation of half a percent. I do not know exact percentage. Do you see more. PubMed service will not be many abstracts PCOS + infection.
Anyway.
So, how it would look the same?
A young woman comes ER. It is the menopause. She complains about the mild (or perhaps severe) pain in the abdomen. ER Doctor takes history. The woman also mentioned changes in their menstrual cycle interval. Suppose a regular basis for 28 days. Last was delayed.
Physicianprovides gloves, makes jelly on gloves. Then he puts two fingers into the female vagina.
The other hand rests on his stomach. Then he starts to grope.
It is named gynecological examination. Modest name. Although it is called in Russia, vaginal examination, what it is.
Is it a common type of examination? Depends. Typically, you send the CT (computed tomography) scan, when severe abdominal pain. 1000th Batch Boom.
Done.
Close the price. Exclusive delay in the reading (and someone should lookto interpret what is going on). Premium radiation. CT scan will give better picture than just poking your belly.
CT scan helps to diagnose abdominal pain of unknown origin. You can picture what's really going on. Although there are cases in which physical examination are helpful hints. The physical examination must always be carried out. At the gynecological examination is something very special.
I remember how I performed a gynecological examination in medical school. It is indeed difficult to insert two fingers into the vagina firstTime.
Gynecologist asked me: "So, what do you feel?"
Patient walks the same, I am encouraged:
"What do you feel what you feel, you feel it?"
I think she felt like a museum artifact.
Heck, I did not feel anything.
Well. Actually, I felt something - apart from the uterus - something round. I would say, 5 cm in diameter (it would be less likely I would not feel it at all) and semi-solid to the touch. I also saw that the patient faces. It is tender whenI push hard.
It's him. As you say, it was tuboovarian abscess, (it) for sure, I do not know.
You really need experience to perform this type of testing. Experienced gynecologists can say almost exactly what is going on.
Let's talk about the woman in the ER. It is tenderness on one side. Physicians should feel in a position to a mobile cystic.
(Cyst, or rather cystis Latin for bladder. Palpated is Latin for touch. It means you touch something and feel what itis).
What if the pain much? This often means that the cyst is torn.
My impression is that modern IT CT orders immediately. If you're not quite sure what's going on, you will go on less expensive methods to more expensive and end up with CT anyway. Ruptured cyst leads to severe pain. Here, CT is indicated.
Alternatively, they may order ultrasound examination. Transvaginal ultrasound uses the probe inserted into the vagina. Ultrasound is cheaper than CT. Ultrasound visualized cystsclear. Although ultrasound is less information for the exclusion of other pathology. Ultrasound is also safe from the radiation term.
In PCOS, ultrasound, the number of small cysts are increased in both ovaries. In general, more than five confirmed the diagnosis.
Culdocentesis can give some useful information. The name came from Cul-de-sac. It's French I guess. Cul-de-sac is one of the bags in the pelvis. Centesis means to attract and stick a needle. These days it is considered aoutdated method. But if you do not have other machines, it is very useful.
If the content is the blood of the ruptured cyst was probably the corpus luteum cyst. If the contents of the purulent matter was probably a ruptured tubo-ovarian abscess or other pelvic inflammatory disease (PID).
Other abnormal masses or broken. Teratomas are oily liquid endometrioma is "chocolate" old blood.
What is a follicle?
Female body is created for the reproduction and pregnancy.Egg is the start of a new man in the ovaries. Surrounded by several layers of specialized membranes, an egg.
The membranes protect the egg, the help with the feeding and care of these small cells.
One of the layers has a beautiful name zona pellucida. Pellucida does brilliantly in Latin.
If the egg matures, a small bubble (follicles) is filled with special fluid formed around him.
In the middle of the cycle, the follicle ruptures and the egg the first time in the abdominal cavity, nearOvarian cancer in tubes (fallopian tubes). The pipes leading into the uterus. Pipes, by the way, were special small hair-like things inside - fimbria. They pitched in one direction. You push the egg into the uterus.
I remember reading somewhere that 11,000 follicles. If a girl is born, there is no increase in the oocytes. After the birth of the follicles are sitting dormant. When the female is in her reproductive age, the follicles begin to grow and mature, and (one after the other).
Only400 mature of them.
Yes, it should be. Calculate. Average cycle is 28 days. Thus, there are about 12 cycles per year. Women are 13-15 years old on menstruation. Menopause is about 45-55 years. A total of 30-40 years is
Multiply everything together. It should be about 400
By the way, an interesting thought.
All the discussion about abortion and stem cell research.
Somewhere in nineteen century of the child when the child was when it was born. TheChurch itself struggling to admit such a thing as existence of cells, etc. Rare baby actually survived the first year.
Heck, the hypothesis was that people were actually composed of small cells widely acknowledged not so long ago. Perhaps a hundred years ago. Then, that research has been done. People learned how the fetus is created and how it grows. Now the public can be idea that fertilized egg is already the child.
Do you already have an egg under the microscope? Even a human hair in the vicinity of an egg provideslike a skyscraper next to a real person.
Well, if the public perception had shifted in this way in several decades, we should not be punished for all women that they are losing potential recklessly 400 babies in his lifetime. Is not it a crime?
Then, maybe we should all be punished for losing millions of sperm - even potential babies.
Where this idea has come from the fertilized egg is not fertilized egg, the baby is not it?
Should not we move the line a little sooner?
Needthink about it.
Anyway.
Ovarian follicle (follicle means small bubble in Latin) is usually mature, rupture and release of the egg that was in that follicle. Eventually, the fracture delays. Then ovulation delay. (Ovulation is the rupture and release of the egg. Oocyte is the cell that ultimately the fetus is there for the seeds of the genetic material).
Normal cycle is in follicular phase (divided if the follicles) to grow and luteal phase.
Luteum ie, yellowLatin.
When the follicle bursts (by the way broken ie burst or tear), voids the egg.
The cave, consider the left (it was small bubble) is filled with blood and special cells that produce hormones. These special cells grow in number and fill the cavity. These cells produce hormones that help the fertilized egg to attach and grow in the uterus. Because they grow in the crowd, they create a yellow body in the ovaries. It is literally yellow. The nameis yellow body (corpus = body, luteum = yellow).
That's normal cycle.
As I said, the follicles do not break at some point (there are a number of reasons). A physician should determine, based on several conditions. This is an abnormal cycle.
When follicles it will not break the follicular cyst. Cysts also means bubble in Latin. There are actually many different types of bubbles in medical Latin. Large and small. Normal and abnormal.
OK, does not have the cystBreakage. What happens then?
Well. When cysts do not rupture, it triggers a rule. The absorbed fluid inside the cyst and the cyst together.
However, if the cyst breaks, it causes acute pain. The pain comes from irritation of the peritoneum (lining of the abdominal cavity) with blood and cyst contents.
Why it is not painful when a regular follicle ruptures and the egg is? Probably a regular follicle is too small. Moreover, it is not too much bleeding.
InContrast of the cyst is a really big bubble () at some 5-10 cm in diameter. If it breaks, it immediately release some special liquid. Plus, there is significant bleeding, there are a variety of blood vessels to feed them.
It is significant, of course, relative.
Take, for example 5-10-20 ml of blood from the vein of a patient day in a hospital. He complains about the pain of the needle often.
But if you have the same 10 ml of blood into the abdominal cavity ... Wow.
You will cry.There are many nerve endings. Peritoneum feely. Tender.
In addition, the cyst has a high concentration of prostaglandins. Prostaglandins, which in turn are inflammatory mediators. They should a lot of pain directly and indirectly.
On the other hand, bleeding could really important. Then it gets really dangerous.
A doctor should not miss a tubal pregnancy. Doctor through a pregnancy test for it. When starting an ectopic pregnancybleed, which is really very disturbing. It seems as if your blood is not left your body. However, the blood in the abdominal cavity. He left the blood vessels. It is internal bleeding. They die quickly.
Polycystic ovary syndrome is a different animal indeed. Here are some genetic predisposition.
Classically: an overweight young female presents with oligomenorrhea or amenorrhea, anovulation, acne, hirsutism, and / or infertility.
What is what? Poly =many. Many, many, many people.
Thus, PCOS does this pile of bubbles in the ovaries. The follicles do not break over time, as they should. Oligo means a little bit. Meno is derived from the menstrual period. Rrhea funding goes to Latin
Thus olygomenorrhea = a little (flows less than it should be).
A-is a prefix that means "no." So, amenorrhea = no flow at all.
Hirsutism. I do not remember where she came from, but means hairy or hairy. Actually, excessive hairiness.
Causes of the PCO or PCOS(Disease or syndrome) are obesity, genetic predisposition and other causes luteinizing hormone (LH).
It is a self-reinforcing cycle:
LH stimulates theca luteal cells. Theca mean sort of capsule. Really does not matter, just an anatomical term.
These cells are an exception. They produce androstenedione and testosterone. Androstenedione and testosterone actually male hormones. You know, bodybuilders use these hormones to get muscle mass. You have probably heardthe hormones. Sport testosterone doping used.
Thus, athletes build their muscles and liver trash.
Rumor has it that a famous Hollywood actor who used hormones. Later, he received a liver transplant.
Although he always denied using it.
However, female body converts) into androstenedione estrone (a weak estrogen. Fat cells do. Estrone is a female hormone already.
In principle, any body produces androgens (Andros =) People and) estrogens (female hormones.Only the portion of hormones makes us male or female.
The cycle happens in a normal person too.
The estrone stimulates pituitary secretion of LH.
Pituitary gland is a small gland in the brain you. Pea size.
It's small, but it sooooo powerful.
Pituitary gland has a different name - pituitary gland. Hypo means down, phys means growth, so that this gland grows from below the rest of the brain. Pituitary is pounds of hypothalamus.
Hypothalamus, ie,"Below the thalamus.
These two areas of the brain regulates almost all hormone production in the body.
Higher hierarchy in the brain to regulate them.
Pituitary gland is a command. Then generates an intermediate neurotransmitters and hormones.
The hormones get into the blood and control the whole body.
Hormones are like commands, such as messages to the rest of the body.
Brain can quickly give commands: signals pass through the nerves. It's like an order by telephone or telegram.
BrainIn addition, the organism regulates the hormones. It's like an e-mail order.
Kind, when the brain sends letters by post. The pituitary gland is the mail in this case.
PCOS occurs when a woman is obese. There are more fat cells to convert
Androstenedione to estrone. Estrone has such an effect that it stimulates secretion of pituitary LH.
LH in turn goes back to the theca luteal cells, we discussed and makes it up again to produce more androstenedione, which inconverted back to estrone.
Self-amplification cycle
Moreover, that testosterone causes increased hirsutism (she becomes like a hairy male) and acne in women.
In a normal person this cycle is well developed to support the development of the fetus.
Estrogen helps the placenta to grow. Placenta support fetal growth.
But in a person with PCOD the cycle goes from normal controls. In this case, LH causes the growth of cysts in theOvaries.
Why?
Since the corpus luteum cyst is partially made from overgrowth of whom theca luteal cells. LH stimulates theca luteal cells.
In addition, women with PCOS have cause intolerance to glucose (sugar) and insulin resistance.
That means there are a lot of insulin (hormone use this, help), especially glucose.
However, excessive insulin secretion is not working. Either receptors to insulin or not something else, but the glucose is not used. Therefore energy inside theCells decreases. Therefore, a large pile of other problems increases. As if it is diabetes mellitus. Diabetes is another topic of discussion. For us, it is worthwhile to mention that people with diabetes are very susceptible to infections.
PCOS also causes acanthosis nigricans. Acantocytes are special skin cells.
Nigricans means black in latin. That thing looks like thickened pigmented skin. If you touch it, it feels like velvet. In general, occur in the armpit, neck, chest, bottom, in the innerThighs and vulva. So, especially those places where the skin folds.
The treatment of PCOS is comprised of various drugs: oral contraceptives, progesterone,
Glucocorticoids, ketoconazole, spironolactone, cyproterone, flutamide, cimetidine, finasteride, ovarian wedge resection, laparoscopic electoracutery, mechanical hair removal, etc.
All methods to break the cycle of overproduction. The drugs are either themself hormones or hormone-like substances that occupy the receptor andavoid working regular hormone.
The drugs work on different levels. Normal Hormone very complicated system. There are loops and feedbacks in the path.
To a hormone that give suppress the production or action, you like hormone or another hormone or non-hormone in general that the feedback loop goes and breaks it, and so on. It really is a long separate discussion.
Basically you can either drop in hormone production or transfer money to womenHormones.
Another possibility is probably the best weight loss. No fat cells - no conversion of andrgoens etc ... You can make your own conclusions.
It is the first line of treatment.
For a simple follicular ovarian cyst (not PCOS) Doctor concludes ectopic pregnancy. Patients can then send them home, and repeat gynecologic examination in 6-8 weeks. Especially if the cyst was small, less than five centimeters in diameter.
Would be for larger cysts, doctor to the pelvic ultrasound.
Most follicular cystwill resolve on their own in six to eight weeks. Although, a doctor can give oral contraceptives. This also suppressed stimulation of cyst of hormones from the pituitary. The hormones are called gonadotropins.
If the cyst is still there after 6-8 weeks, the suspicion arises that the cyst may be malignant. Then a doctor orders other studies. CT. Doctor may also surgical procedures. He sees what this cyst really.
Corpus luteum cyst is usually not treated. However,oral contraceptives are used.
Breaking all kinds of the cysts leads to another story. Acute pain, bleeding into the abdominal cavity.
At some bleeding is very strict and true emergency. You have to differentiate to other procedures in the abdomen. For example, appendicitis is similar. You can treat mild cases are not complicated cyst rupture with just observation. Appendicitis almost always sets an operation.
There are many other problems occur. Surgeon scratches his head: What isgoing on? Is this it or is it? Here is the CT examination is of great advantage.
Now back to the question of Mrs L.
If the cyst was infected, I know not "see any reason why a ruptured cyst would not be infected.
Cyst content is very rich in nutrients. Remember? All of these cells and their products are dedicated to feeding the oocyte (future baby). Should be very tasty for all bacteria.
The rupture can also lead to significant bleeding. This blood is also different from theBlood in the vessels.
This blood is sitting in the pelvis, not moving, fast blood clotting. Coagulation prevented entry of white blood cells. "No Flow" prevents the entry of antibodies. Lack of flow prevents entry of other protective chemicals (supplements, etc.).
So it is very nutrient-rich media for the growth of bacteria.
You can run riot. Why not?
If a female had another pelvic infection before, the infection can flare up again. In a normal person should be abdominal cavitysterile. However, can any gynecological or gastrointestinal infection, delivering bacteria. Now, mix these bacteria with the contents of leaking cyst. It can be infected just determined.
Actually, Ms L then answered her own question in another e-mail. She had cysts on several occasions and they have been infected several times.
So to answer the question:
If infected ruptured cyst? Not necessarily. Probably not. Can itinfected?
Yes.
Aleksandr Kavokin MD / PhD, Phila appendicitis_disease@yahoo.com http://www.appendicitis.uni.cc/ Aleksandr Kavokin, MD1994 Russia, PhD1997 Russia - Immunology and Allergy, postdoc at Cancer Center at Med U of South Carolina, postdoc at Yale - Cardiology, Molecular Medicine. http://kavokin.com [http://www.geocities.com/aging_rejuvenation/] [http://www.geocities.com/appendicitis_disease/]
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