Thursday, September 29, 2016

An infraumbilical lump in a child

Clinical introduction

A 13-month-old boy was brought to the emergency department by his mother with a 2-day history of a painless, firm lump located in the midline of his abdomen, just inferior to the umbilicus. The lump was skin coloured, not hyperaemic and non-reducible.

The patient was afebrile without any change in bowel habits or any preceding illness. Apart from a history of being born at 32 weeks’ gestational age and spending some time under obs…
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Ovarian cyst- பெண்கள் இனப் பெருக்க மண்டல பிரச்சனை

Ovarian cyst
Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary.
Types:
Functional cysts
• Follicular cyst. A follicular cyst begins when something goes wrong and the follicle doesn’t rupture or release its egg. Instead it grows and turns into a cyst.
• Corpus luteum cyst. When a follicle releases its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone for conception. This follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.
Other cysts
Dermoid cysts. These cysts may contain tissue, such as hair, skin or teeth, because they form from cells that produce human eggs..
• Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
• Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Signs and symtoms
• abdominal bloating or swelling
• painful bowel movements
• pelvic pain before or during the menstrual cycle
• painful intercourse
• pain in the lower back or thighs
• breast tenderness
• nausea and vomiting
• changes in menstrual cycle
• ongoing pelvic pain
• loss of appetite
• unexplained weight loss
• abdominal fullness
Complications
• Ovarian torsion. Cysts that become large may cause the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of ovary, called ovarian torsion.
• Rupture. A cyst that ruptures may cause severe pain and lead to internal bleeding.
• severe or sharp pelvic pain
• fever
• faintness or dizziness
• rapid breathing
• Diagnosis
• Ultrasound: an imaging device used to visualize the ovary
• CT scan: a body imaging device used to create cross-sectional images of internal organs
• MRI: a test that uses magnetic fields to produce in-depth images of internal organs
• pregnancy test: to determine whether or not pregnant
• hormone level test: to check for hormone-related issues, such as too much estrogen or progesterone
• CA 125 Blood test: to screen for ovarian cancer
• Laparoscopy

Treatment
pain relievers, including acetaminophen, nonsteroidal anti-inflammatory drugs ,or narcotic pain medicine.
• A warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping,
• chamomile herbal tea can reduce ovarian cyst pain and soothe tense muscles,urinating as soon as the urge presents itself.
• Avoiding constipation, which does not cause ovarian cysts but may further increase pelvic discomfort.
• In diet, eliminating caffeine and alcohol, reducing sugars, increasing foods rich in vitamin A and carotenoids (e.g., carrots, tomatoes, and salad greens) and B vitamins Combined methods of hormonal contraception such as the combined oral contraceptive pill
Aloevera, amla, green vegetables, garlic, bread, and oats helps to prevent ovarian cyst. Cake and frozen items to be avoided. Stress, sleeplessness, thyroid problem to be corrected.

Laparotomy
A hysterectomy to remove ovaries and uterus.
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An infraumbilical lump in a child




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