BARTHOLIN’S CYST/ABCESS

BARTHOLIN’S CYST/ABCESS

A fluid-filled swelling (cyst) in the Bartholin's glands.

Bartholin’s glands are pea sized glands, found in the labia minora. The glands are typically non palpable. Bartholin’s glands secrete mucus into duct emerging into vestibule on either side of vaginal orifice. Its main function is to maintain moisture of vaginal mucosa.

CAUSE :

The most common cause of Bartholin's cyst is a gonococcal infection that causes obstruction. However, another probable cause is congenital narrowing of the duct. 

The Abscess may arise from a primary gland infection, or an infected cyst. Infection may be caused by N. gonorrheae, C. trachomatis. Other normal flora e.g. Staph spp., E. coli may also play a role.

PATHOPHYSIOLOGY :

Bartholin's cyst occurs when duct becomes obstructed hence distension of duct or gland with fluid. Obstruction is secondary to non-specific inflammation or trauma. The cyst is usually painless. However, if the cyst is very large, one may experience pain, dyspareunia. It may rupture and produce non-purulent discharge.

SIGNS & SYMPTOMS :

~Acute valvular pain

~Labial swelling

~Dyspareunia

~Fever

~Purulent discharge on rupture

MANAGEMENT :

✓Cyst

• Sitz bath result in rupture and spontaneous healing’

• If pain present, give analgesics.

✓Abscess

• Incision and drainage to prevent rapid fluid accumulation pack cavity and remove after 24-48hours.

• Marsupialization- for recurrent abscesses to facilitate proper drainage of pus. This is where a Wide incision is made and inner edges sutured to external mucosa

• The drained pus should be sent for culture and sensitivity to detect any gonococcal infections.

• The patient should be put on appropriate antibiotics

TRACHOMA

TRACHOMA

This is a chronic inflammation of the conjunctiva and the cornea of the eye. It is caused by an organism called Chlamydia trachomatis. Chlamydia trachomatis is also known to cause ophthalmia neonatorum, urethritis, cervicitis and salpingitis.

Trachoma is a major cause of blindness especially where water is scarce, such as among the pastoralist communities who inhabit the drier grasslands.

MODE OF TRANSMISSION

Trachoma is very common among communities living in dry areas where there is scarcity of water. Transmission of trachoma is by direct contact with the eye discharge of an infected person. Flies and fingers are important in the transmission of the disease.

CLINICAL PICTURE

Trachoma develops in 4 stages.

✓Stage 1: Early Trachoma

Initially the eyes are red and watery (as in ordinary conjunctivitis). After 30 or more days, follicles (small pinkish-grey lumps) form inside the upper eyelids.

✓Stage 2: Pannus Formation

Normally, the cornea has no blood capillaries on it. But during this stage, many tiny blood vessels are found to be growing towards the edge of the cornea. These tiny blood vessels which grow in the cornea are called pannus

✓Stage 3: Scarring of the Conjunctiva

After several years the follicles on the conjunctiva slowly begin to disappear leaving behind whitish scars on the conjunctiva. In the cornea, the small blood vessels degenerate. The vision becomes hazy.

✓Stage 4: Entropion and Trichiasis Formation

Due to this scarring, the scar tissue retracts (shortens), thereby causing the eyelids to become thick and to turn inwards. This is called entropion. As the thick, rough eyelids turn inwards, the eyelashes point inwards and rub against the cornea. This is called trichiasis. trichiasis adds to the damage already done to the eye and results in blindness

MANAGEMENT

• The drug of choice for the first three stages is 3% tetracycline topical eye ointment. 

• Stage four of the disease with entropion must be treated surgically.

PREVENTION & CONTROL

Trachoma is through supply of adequate water to the community. Regular bathing and washing of children's faces with water and soap should be encouraged. Reducing the fly population in the community through proper disposal of refuse and waste. Early treatment of infected individuals.

By : ummedsaini_