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A - MSRA Gynaecology > Cervical Ectropion > Flashcards

Cervical Ectropion Flashcards

1
Q

What is a cervical ectropion?

A

When there is eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu

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2
Q

What is a cervical ectropion also known as?

A

Cervical erosion (though no ‘erosion’ of cells actually occurs)

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3
Q

Is cervical ectropion a benign or malignant condition?

A

Benign

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4
Q

When is cervical ectropion commonly seen?

A

On examination of the cervix in adolescents, in pregnancy, and in women taking oestrogen containing contraceptives

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5
Q

What is an important differential for cervical ectropion?

A

Cervical cancer and cervical intraepithelial neoplasia

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6
Q

What do cervical cancer and CIN need to be excluded before?

A

Any treatment or reassurance to the patient is offered

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7
Q

What is the cervix?

A

The lower portion of the uterus

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8
Q

What is the cervix composed of?

A
  • Ectocervix

- Endocervical canal

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9
Q

What is the endocervical canal also known as?

A

Endocervix

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10
Q

What is the endocervix?

A

The most proximal and ‘inner’ part of the cervix

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11
Q

What is the endocervix lined by?

A

Mucus secreting simple columnar epithelium

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12
Q

What is the ectocervix?

A

The part of the cervix that projects into the vagina

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13
Q

What is the ectocervix lined by?

A

Stratified squamous non-keratinised epithelium

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14
Q

What happens to the lining of the cervix in a cervical ectropion?

A

The stratified squamous cells of the ectocervix undergo metaplastic change to become simple columnar epithelium (same as endocervix)

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15
Q

What induces the change in the epithelium of the ectocervix in cervical ectropion?

A

Thought to be induced by higher oestrogen levels

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16
Q

What does the columnar epithelium contain in the endocervix?

A

Mucus secreting glands

17
Q

What is the result of the cervical columnar epithelium containing mucus secreting glands?

A

Some women with cervical ectropion experience increased vaginal discharge

18
Q

Why might cervical ectropion give rise to post-coital bleeding?

A

As fine blood vessels present within the epithelium are easily broken during intercourse

19
Q

What are the risk factors for cervical ectropion related to?

A

Things that cause high levels of oestrogenn

20
Q

What are the risk factors for cervical ectropion?

A
  • Use of COCP
  • Pregnancy
  • Adolescence
  • Menstruating age
21
Q

What are the most common clinical features of cervical ectropion?

A

Most commonly asymptomatic

22
Q

If symptomatic, how can cervical ectropion present?

A
  • Post-coital bleeding
  • Intermenstrual bleeding
  • Non-purulent excessive discharge
23
Q

What is found on speculum examination in cervical ectropion?

A

Everted columnar epithelium has reddish appearance, usually arranged in ring around external os

24
Q

What are the differential diagnoses of cervical ectropion?

A
  • Cervical cancer
  • CIN
  • Cervicitis
  • Pregnancy
25
Q

How is the diagnosis of cervical ectropion made?

A

Clinical diagnosis, and the main role of any investigation to exclude other potential diagnoses

26
Q

What investigations may be done in suspected cervical ectropion?

A
  • Pregnancy test
  • Triple swabs
  • Cervical smear
27
Q

When should triple swabs be performed in suspected cervical ectropion?

A

If there is any suggestion of infection (e.g. purulent discharge)

28
Q

What swabs should be taken if there is suggestion of infection in suspected cervical ectropion?

A
  • Endocervical

- High vaginal swabs

29
Q

Why should cervical smears be done in suspected cervical ectropion?

A

Rule out cervical intraepithelial neoplasia

30
Q

What should be done if a frank lesion is observed in suspected cervical ectropion?

A

A biopsy should be taken

31
Q

When is management required for cervical ectropion?

A

If asymptomatic

32
Q

Why is management not required for cervical ectropion unless symptomatic?

A

It is regarded as a normal variant

33
Q

What is the first line treatment for cervical ectropion?

A

Stop any oestrogen containing medications

34
Q

What is the most common oestrogen containing medication taken by women with cervical ectropion?

A

COCP

35
Q

What management can be employed if symptoms persist in cervical ectropion?

A

The columnar epithelium can be ablated

36
Q

How can the columnar epithelium be ablated in cervical ectropion?

A

Typically using cryotherapy or electrocautery

37
Q

What is the problem with ablation of the columnar epithelium in cervical ectropion?

A

It will result in significant vaginal discharge until healing is completed

38
Q

What medications have been suggested to be useful in cervical ectropion?

A

Medication to acidify vaginal pH, such as boric acid pessaries

A - MSRA Gynaecology (52 decks)

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