Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Ovarian Cyst

Evaluate breaches in the standard of care when evaluating whether or not there has been a Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Ovarian Cyst

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Lower abdominal pain/lower back pain
    Adnexal tenderness
    Palpable ovarian mass on vaginal exam
    Nausea/vomiting
    Ascites/abdominal distension
    Discomfort during sexual intercourse
    Changes in menstrual flow
    Acne/facial hair/voice deepening
    None of the above
    Not elicited/documented
    Answer unknown
    Why is this important?
    The clinical features of ovarian cyst include lower abdominal pain, adnexal tenderness and a palpable ovarian mass on vaginal examination. The presentation of cystic adnexal masses includes abdominal distension, pain, nausea and vomiting, with signs of ascites in more severe cases.
    (2012) 30 ESURGO 6 310-314

  • Was a medical history obtained? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. 

    Click here for additional information at ClinicalKey.com 



  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

    Click here for additional information at ClinicalKey.com 



  • Which of the following were not performed during a physical examination? (Choose all that apply) Why is this important?
    Answer this question
    
A complete and carefully focused physical examination serves as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. 

    Click here for additional information at ClinicalKey.com 



  • Was a pelvic examination performed? Why is this important?
    Answer this question
    
An Abdominal and a pelvic examination are critical in determining the differential diagnosis for pelvic masses. 

    (2008) 92 EMEDCN 5 1143-1161 



  • Was a pregnancy test performed? Why is this important?
    Answer this question
    
A urinary pregnancy test must always be performed in women of reproductive age with abdominal pain.
11; Diagnosis and management of ovarian cyst accidents;
    (2009) 23 EBPCOG 5 711-724 



  • Which of the following diagnostic laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    
Routine laboratory studies can provide important clues to diagnosis.

    Click here for additional information at ClinicalKey.com 



  • Which of the following diagnostic imaging studies was performed? (Choose all that apply) Why is this important?
    Answer this question
    
MRI provides unsurpassed soft tissue contrast and multiplanar capability with spatial resolution.

    Click here for additional information at ClinicalKey.com 



  • Which of the following risk factors for ovarian cancer were elicited? (Choose all that apply) Why is this important?
    Answer this question
    
Although most cystic ovarian tumors are benign, the primary goal of the diagnostic evaluation is the exclusion of malignancy. 
Differential diagnosis of peri- and postmenopausal ovarian cysts;
    (1999) 31 EMATUR 2 123-132 



  • Which of the following did the patient possess? (Choose all that apply) Why is this important?
    Answer this question
    
The most commonly used tumor marker for ovarian cancer is CA-125, which is a serum glycoprotein that is elevated in 80 percent of women with epithelial ovarian cancer. Tumor markers are used as a tool to help assess likelihood of ovarian cancer in someone found to have a suspicious mass, especially in postmenopausal patients.

    (2008) 92 EMEDCN 5 1143-1161 



  • Was a follow-up surveillance performed after 6-12 weeks, to re-evaluate the resolution of the cyst? Why is this important?
    Answer this question
    
A 6 to 12 week period would allow a functional cyst to resolve. If a lesion is persistent then surgical consultation may be warranted.

    (2013) 51 ERDCNA 6 1067-1085 



  • Did the cyst resolve spontaneously? Why is this important?
    Answer this question
    
Non-neoplastic ovarian cysts in women with menstrual cycles are the most frequently detected masses involving the adnexa. Many of these cysts are functional and resolve spontaneously within a few days to 2 weeks, but they can persist longer.
Article; Management of non-neoplastic ovarian cysts with sclerotherapy;
    (2003) 81 IJGYOB 1 41-45 



  • From which of the following complications did the patient suffer? (Choose all that apply) Why is this important?
    Answer this question
    
Ovarian cyst accidents include cyst rupture, hemorrhage and torsion.
11; Diagnosis and management of ovarian cyst accidents;
    (2009) 23 EBPCOG 5 711-724 



  • Which of the following post-operative complications did the patient develop? (Choose all that apply) Why is this important?
    Answer this question
    
In young women presenting with an ovarian cyst accident, timely diagnosis and management is prudent to avoid ovarian infarction and loss of functional ovarian tissue.

    (2012) 30 ESURGO 6 310-314 



  • Were the complications managed? Why is this important?
    Answer this question
    
Treatment of ovarian torsion in the case of ovarian infarction is a laparoscopic salpingo-oophorectomy.

    (2013) 51 ERDCNA 6 1067-1085 



  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    
Routine follow-up evaluations are necessary to offset any complications that may arise. 

    Click here for additional information at ClinicalKey.com 



  • Was an informed consent obtained? Why is this important?
    Answer this question
    
The laws of most states require that surgeons obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Which of the following treatment options were recommended? Why is this important?
    Answer this question
    
Traditional management of persisting ovarian cyst is explorative laparotomy and tumor resection. More recently, sclerotherapy of ovarian cysts has been attempted to decrease the probability of recurrence. Ultrasound-guided aspiration of an ovarian cyst has been shown to be a satisfactory alternative to surgery in selected cases.
Article; Management of non-neoplastic ovarian cysts with sclerotherapy;
    (2003) 81 IJGYOB 1 41-45 



  • Which of the following symptoms of ovarian rupture/hemorrhage did the patient develop? (Choose all that apply) Why is this important?
    Answer this question
    
Ovarian cyst rupture or hemorrhage presents with sudden lower abdominal pain, possibly associated with nausea or vomiting. Women with an ovarian cyst rupture or hemorrhage will be able to identify the exact time the pain started, as distinct from torsion where the pain may have a waxing and waning onset.
11; Diagnosis and management of ovarian cyst accidents;
    (2009) 23 EBPCOG 5 711-724