Mrs L wrote me:

Hello Dr. Kavokin,

I have some of the literature and found it very informative. I have a question, maybe you can answer: If a woman ovarian cyst ruptures, (especially multiple cysts of PCOS) can be broken cysts to an infection?

Hi, MS. L

Short answer: Everything can be infected. Although I do not think broken infected ovarian cyst very often, not hear That I will be more literature and probably the answer to my site.

Yours sincerely,

Alex

Ok. I looked to the literature.

I do not have very extensive literature search. Should admit.
Anyway, a few books available that infected ovarian cyst May. However, the infection is not considered the most important complications in ovarian cyst rupture.

So, I do not remember that someone told me something else. Perhaps there are some special items, stating that the condition happens in one point three percent of cases with standard deviation of half a percent. I do not know exact percentage. We need more. PubMed Services does not give many abstracts PCOS + infection.

Anyway.

How would he look like?

A young woman comes to ER. She is premenopausal. It complains about the mild (or severe) pain in her abdomen. ER Doctor is history. The woman also mentioned changes in their menstrual cycle interval. Suppose that a regular 28 days. Last was delayed.

Doctor gloves, makes jelly on gloves. Then his two fingers in the female vagina.
The other hand is on the belly. Then he begins to feel.

It is named gynecological examination. Modest name. While it is in Russia named vaginal examination, which it is.

If it is a common type of examination? Depends. They usually get the CT (computed tomography)-scan, if it is severe abdominal pain. 1000th Batch Boom.
Done.

Close prices. Eliminating delay in the reading (and someone should interpret what is going on). Exclude radiation. CT scan is better than the Poking belly.

CT diagnosis of abdominal pain of uncertain origin. You can picture what is really going on. Although there are cases in which physical examination are further notice. Physical examination should always be. Gynecological examination is a special version.

I remember when I performed a pelvic exam in medical school. It is indeed difficult, even by only two fingers into the vagina the first time.
Female doctor asked me: "What do you feel?" "
Patients is the same, encouraged me:
"" What do you feel what you feel, you feel it? ""

I guess she felt a kind of museum artifact.
Heck, I did not feel anything.

Well. Actually, I felt something - apart from the uterus - a little long. I would say, 5 cm in diameter (it would be less likely I would not at all) and semi-solid to touch. Also, I saw that the patient grimaces. It is tender when I push hard.

He is. How to say it tuboovarian Abscess (it) for sure, I do not know.
You really need experience for this type of examination. Experienced gynecologist can tell you almost exactly what is going on.

Let us discuss, that the woman in ER. You have tenderness on one side. Doctors should be able to feel a mobile cystic mass.
(Cyst or rather cystis is Latin for bubble bath. Palpation is Latin for touch. It means you touch something and feel what it is).
What happens if the pain is severe? It often means that the cyst broken.
My impression is that modern CT ER orders immediately. If you're not quite sure what is going on, you will be less expensive method is too expensive and in the end anyway with CT. Broken cyst causing considerable pain. Here is CT.

Alternatively, they can be ultrasound examination. Transvaginal ultrasound, the probe into the vagina. Ultrasound is cheaper than CT. Ultrasound shows cysts. Although ultrasound is less information for the exclusion of other pathology. Ultrasound is also safe from the radiation of view.

In PCOS ultrasound shows increasing number of small cysts in the ovaries. In general, more than five confirmed the diagnosis.

Culdocentesis may be some useful information. The name came from dead-end. It is French, I guess. Cul-de-sac is one of the bags in the tub. Centesis means of a needle stick and pull. These days it is considered an outdated method. But if you do not have other machines, it is very useful.

If the content is blood, which was probably broken cyst corpus luteum cyst. If the contents of the purulent off was probably a tubo-ovarian abscess or pelvic inflammatory disease (PID).
Other abnormal mass fraction can be considered as well. Teratoma is oily liquid, there endometrioma "" Chocolate "" old blood.

What is a follicle?

Female body is responsible for the reproduction and childbearing. Oocyte is the start of a new people in the ovaries. Several layers of specialized membranes surrounding an oocyte.

The membranes protect the egg when the feeding and care of the small cell.
One of the layers has a beautiful name Zona pellucida. Pellucida is brilliant in Latin.

When the egg matures, a small bladder (follicles) is filled with fluid around.
In the middle of the cycle of follicle bursts and the egg begins in peritoneal cavity, close to the ovarian tubes (fallopian tubes). The tubes lead into the uterus. Pipes, by the way, have special small hair-like things inside - fimbria. They suggest, in one direction. They drive the oocyte into the uterus.

I remember I read somewhere that there are 11,000 follicles. If a girl is born, there is no propagation of oocytes. After the birth of the follicles are dormant. If the women in her age, the follicles begin to grow and mature (one after the other).

Only 400 of them mature.

Yes, it should be like this. Calculate. Average cycle of 28 days. There are about 12 cycles per year. Women begin to menstruate at 13-15 years old. Menopause is about 45-55 years. Overall, 30-40 years

Multiply everything together. It should be around 400th
By the way, an interesting idea.
All the discussion on abortion and stem cell research.
Somewhere in the nineteen century, the child was a baby when it was born. The church itself was struggling to admit the existence of some cells, etc. Rare baby actually survived on the first year.
Heck, the hypothesis that people from small cells were actually admitted in general not so long ago. Perhaps a hundred years. Then all that research is done. The people learned how the fetus is and how it grows. Now the public presentation is that the fertilized ovum is already a baby.
Have you seen any egg under microscope? Even a human hair in the vicinity of an egg looks like a skyscraper in the vicinity of a real man.
Well, if the public perception was that way in several decades, we should not punish all the women that they recklessly lose 400 potential babies during lifetime. Is not it a crime?
Then, maybe we should punish everyone for losing millions of sperm - and potential baby.
Where is this idea that the fertilized egg is a baby and non-fertilized egg is not?
If we do not limit a little sooner?
Need to think, dass

Anyway.
Ovarian follicle (follicle means in Latin small bladder) is usually mature, rupture and release of the ovum, which in this follicle. Eventually the break delays. Then delay ovulation. (Ovulation is broken and the release of the oocyte. Oocyte is the cell, which ultimately led to the fetus after semen contains the genetic material).
Normal cycle is divided into follicular phase (when the follicle grows) and luteal phase.
Luteum yellow means in Latin.
When the follicle ruptures (by the way broken means burst or tearing), the oocyte goes.
The cave that is behind (remember them small bladder) is filled with blood and special cells that produce hormones. These special cells grow in volume and fill that cavity. These cells produce hormones involved in the fertilized egg to attach and grow in the uterus. Because they grow in quantity, they create a yellowish body in the ovary. It is literally yellowish. The name is the corpus luteum (corpus = body, luteum = yellow).
This is normal cycle.
As we said before, the follicles do not break at some point (there are a number of reasons). A doctor should clarify various conditions. This is an abnormal cycle.
If follicle rupture is not 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, the cyst does not rupture. What happens then?
Well. If cyst is not broken, it usually disappears. This fluid in the cyst is up and the cyst together.
However, if the cyst ruptures, it causes acute pain. The pain comes from irritation of the peritoneum (lining of the abdominal cavity) with blood, and cyst contents.
Why is it not painful when a regular follicle ruptures and the egg? Probably a regular follicle is too small. Moreover, it is not too much bleeding.
In contrast, the cyst is a really big bubble (about 5-10 cm in diameter). If it breaks, it immediately release specific quantity of liquid. Plus, there is significant bleeding, there are many blood vessels to feed.
Essential is, of course, relative.
For example, 5-10-20 ml of blood from the vein of the patient in a hospital every day. He complains about the pain of the needle often.
But if you use the same 10 ml of blood in peritoneum ... Wow.
You will cry. There are a multitude of nerve endings. Peritoneum is too touchy-feely. Tender.
In addition to the cyst is high concentration of prostaglandins. Prostaglandins, which are mediators of inflammation. They should be significant pain directly and indirectly.
From the other side bleeding could really important. Then it becomes really dangerous.
A doctor should also be an ectopic pregnancy. Doctor will order a pregnancy test this. If an ectopic pregnancy starts to bleed, that's really worrying. It seems as if your blood is not left your body. But the blood in the abdominal cavity. There are the blood vessels. There is internal bleeding. They die quickly.
Polycystic ovarian syndrome is a slightly 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 men.
So PCOS is the amount of bubbles in the ovaries. The follicles do not break on time, as they should. Oligo means a little. Meno is from menses. Rrhea funds in Latin
So olygomenorrhea = flow a little (less than it should).
A-is a prefix that means "No". " Sun, amenorrhea = not at all.
Hirsutism. I can not remember where they came from, but means hairy or hair. Actually, excessive hairiness.
Causes of PCOS or PCOD (disease or syndrome) are overweight, genetic predisposition and certain other causes of luteinizing hormone (LH) on.

It is a self-reinforcing cycle:
LH stimulates theca lutein cells. Theca means type capsule. Does not really matter, only an anatomical term.
These cells are special. They produce testosterone and androstendione. Androstendione actually male and testosterone hormones. You know, bodybuilders use of these hormones to muscle volume. You probably heard about these hormones. Sports doping is used testosterone.
Thus, athletes their muscles and their livers trash.
Rumors say that a famous Hollywood actor, the hormones used. Later he got the liver transplant.
Although he always denied the use.
Anyway, androstendione female body converts into estrone (a weak estrogen). Fat cells do. Oestrone is a female hormone already.
Basically any body produces androgens (Andros = man) and estrogens (female hormones). Only the portion of hormones makes us male or female.
The cycle happens in a normal human being.
The oestrone stimulates pituitary secretion of LH.
Pituitary gland is a small gland in your brain. Pea size.
It is small, but it sooooo powerful.
Pituitary gland has a different name - hypophysis. Hypo means determining, Phys indicates growth, so that this gland grows from the bottom of the rest of the brain. Hypophyse will pile connections from hypothalamus.
Hypothalamus means "under the thalamus.
These two areas of the brain regulate almost all hormone production in the organism.
Higher hierarchy in the brain to regulate.
Pituitary is a command. Then produces some intermediate objectives neurotransmitters and hormones.
The hormones in the blood and control the whole body.
Hormones are like orders, such as news on the rest of the body.
Brain can be quickly decided by the nerve signals. It is like a phone or cablegram.
Brain also regulates the body through hormones. It's like an e-mail.
Sorting, when the brain is sending letters by post. The pituitary is the post office in this case.
PCOS intervenes when a woman is obese. There are more fat cells to convert
androstendione to oestrone. Oestrone has such impact that it stimulates the secretion of pituitary LH.
LH in turn goes back to the theca lutein cells, and we discussed it again, for more androstendione, which in turn oestrone.
Self-amp circuit cycle
Furthermore, that increased testosterone causes the hirsutism (she is treated as a hairy male) and acne in women.
In a normal person this cycle is likely to support the development of the fetus.
Estrogen helps the placenta to grow. Placenta supports fetal growth.
But in a person with PCOD the cycle is derived from the normal control. In this case, LH causes the growth of the cysts in the ovaries.
Why?
Since the corpus luteum cyst is part of this overgrowth theca lutein cells. LH stimulates theca lutein cells.
Even women with PCOS have intolerance to glucose (sugar) and insulin resistance.
This means there is a lot of insulin (hormone that is to use mainly glucose).
However, excessive insulin is not working. Either on insulin receptors do not work or something else, but the glucose is not used. Therefore, the energy inside the cells decreases. It is a big pile of other problems mounts. As if diabetes mellitus. Diabetes is another matter. For us, it is useful to mention that people with diabetes are very susceptible to infections.
PCOS also causes acanthosis nigricans. Acantocytes are special skin cells.
Nigricans is black in Latin. The thing looks like thickened skin pigmentation. If you touch it feels like velvet. Normally it is in the axilla, neck, under the breast, in the inner thighs and vulva. So, especially those places where the skin folds.
The treatment of PCOS includes different medications: oral contraceptives, progesterone,
Glucocorticoids, ketoconazole, spironolactone, cyproterone, FLUTAMIDE, cimetidine, finasteride, ovarian wedge resection, laparascopic electoracutery, mechanical hair removal, etc.
All methods to break the vicious circle of overproduction. The drugs are either hormones or hormone-like substances, demonstrating receptor and prevent hormone regularly to work.
The drugs act at different levels. Normal hormones have a very complicated system. There are loops and reviews under way.
For the production of a hormone or actions that you or another similar hormone or hormone-stimulating hormone at all, that goes to the feedback loop and breaks it, and so on. It is really long discussed separately.
Basically, you can either decline or shift in hormone production relative to female hormones.
Another possibility, probably the best, is weight loss. No fat cells - no conversion of andrgoens etc ... You can even conclusions.
It is the first line of treatment.
For a simple follicular ovarian cyst (not PCOS) Doctor exclude ectopic pregnancy. Then he can patients at home, and repeat pelvic exam in 6-8 weeks. Especially if the cyst was small, less than five cm in diameter.
For larger cysts, physician for ultrasound pelvis.
Most follicular cysts will resolve on their own in six to eight weeks. Although a doctor can oral contraceptives. This stimulation of cyst suppressed by hormones from the pituitary gland. The gonadotropin hormones are named.
If the cyst is still there after 6-8 weeks, the suspicion arises that the cyst may be malignant. Then a doctor other studies. CT-scan. Doctor may also surgery. He sees what is really the cyst.
Corpus luteum cyst is usually not treated. However, oral contraceptives may be used.
Fraction of each type of cysts leads to another story. Acute pain, bleeding into peritoneum.
Sometime bleeding is very heavy and is true to an emergency. You also need to distinguish other in the stomach. For example, appendicitis looks similar. You can use in the treatment of mild non-complicated cyst rupture with just observation. Appendicitis is almost always an operation.
There are many other problems. Surgeon scratches his head: What is going on? Is this or that? Here is the CT scan provides great advantages.
Now, go back to the question of Mrs. L.
If the cyst was infected, I do not see a reason why a broken cyst would not be infected.
Cyst is very nutrient rich. Remember? All of these cells and their products are in the diet of the egg (child). Should be very tasty for all bacteria.
Fracture may cause significant bleeding gut. The blood is also different than the blood in your vessels.
The blood is in the meeting of the basin, which is not to move quickly clotting. Clotting prevents infiltration of white blood cells. "" No-Flow "" prevents the penetration of antibodies. The lack of flow to prevent ingress of other protective chemicals (supplements etc).
Well, it is very nutrient-rich media for bacterial growth.
You can go wild. Why not?
If a woman had another pelvic infection, the infection can flare up. In a normal person should be sterile abdominal cavity. However, a gynecological or gastrointestinal infection can deliver bacteria. Now, mix these bacteria with the contents of the cyst leaks. It determines infected.
Actually, Ms. L later answered their own question in another e-mail. She had multiple cysts and their infection several times.
So, to answer the question:
If the infected cyst broken? Not necessarily. Rather not. Can it become infected?
Yes.
Alexander Kavokin MD / PhD, Phila appendicitis_disease@yahoo.com http://www.appendicitis.uni.cc/ Alexander Kavokin, MD1994 Russia, PhD1997 Russia - Immunology and Allergy, postdoc at Cancer Center at Med U South Carolina, postdoc at Yale - Cardiology, Molecular Medicine. http://kavokin.com http://www.geocities.com/aging_rejuvenation/ http://www.geocities.com/appendicitis_disease/