Disorders of the cervix Flashcards
1
Q
Are disorders of the cervix usually sx or asx? Early detection helps prevent what?
A
- asx
- early detection of abnormal cell changes and presence of HPV leads to tx that prevents the progression to cervical cancer
2
Q
Why is the SCJ so impt?
A
- this is where cancer is most likely to arise
3
Q
What cells are affected in cervicitis? Etiologies?
A
- primarily affects columnar epithelial cells
- can cause visible changes of ectocervix
etiologies: often caused by STIs - often asx local trauma malignancy, radiation therapy, chemical irritation (changing the pH), systemic inflammatory disease (Behcet's syndrome) idiopathic
4
Q
What is impt about sexual activity to ask in hx?
A
- number of partners
- use of condoms
- hx of STIs (women under 25 - 1/3 have chlamydia)
- use of pessiary, diaphragm, douches
- specific sxs (post-coital bleeding, deep pain, spotting)
- constitutional sxs (fever, malaise)
5
Q
Sxs of cervicitis?
A
- purulent or mucopurulent d/c from vagina
- intermenstrual or postcoital bleeding
- dysuria or urinary frequency
- dysparuenia
- vulvovaginal irritation
- pain and fever are atypical in the absence of upper tract infection
6
Q
PE appearance of cervicitis?
A
- purulent d/c on surface and/or exuding from the canal
- minor trauma from insertion from a cotton swab - bleeding (friability)
- diffuse vesicular lesions suggest HSV
- punctate hemorrhages consistent with trichomonas infection
- cervical motion tenderness is sign of coexisting PID
7
Q
Tx fo GC and Chlamydia?
A
- Rocephin IM and Azithro PO
- test for other STIs and HIV
8
Q
What is pathognomic for trichomonas infection?
A
- strawberry cervix (rare)
9
Q
Diff b/t primary and secondary outbreaks of genital herpes?
A
- primary: much more severe, more vesicles
- recurrence: won’t be as severe
- if you want - can test for abs (will have if recurrent)
10
Q
Dx of cervicitis?
A
- from exam and determination of risk - also test for gonorrhea, chlamydia, HSV if indicated
- tx empirically to cover gonorrhea, chlamydia, and trichomonas:
ceftriaxone, doxy, and flagyl - all pts eval for STIs should be offered counseling and testing for HIV
- if exam shows minor erythema and low risk person, or cultures are negative then other etiologies might be in play - then there may be an offending agent that needs to be stopped
11
Q
Tx of cervicitis?
A
persistent disease:
- if persists after initial round of abx then repeat testing w/ most sensitive dx tests
- re-examine possible exposure to chemical irritatants
- have sex partner(s) be examined and tested for STIss
12
Q
What are cervical polyps? Result of? May be assoc with? Most common in?
A
- benign, pedunculated growths of varying size that extend from the ectocervix of endocervical canal
- may occur singularly or may be multiple
- etiology is unknown
- believed to result from chronic inflammation
- may be assoc with hyperestrogen states
- found commonly with endometrial hyperplasia
- MC among multiparous women in their 30s and 40s
- MC benign neoplastic growth of the cervix
- occurs in 4% of all gyn pts
13
Q
When do cervical polyps commonly occur? How common are malignant changes?
A
- commonly occur during reproductive years
- usually arise from endocervical canal
- etiology is unkown
- malignant change is rare-about 1% will show neoplastic changes
- removed fairly esaily
- always send to path
14
Q
Sxs of cervical polyps?
A
- usually asx
- thick leukorrhea
- postcoital bleeding
- intermenstrual bleeding
- menorrhagia
- post-menopausal bleeding
- mucopurulent or blood tinged vaginal d/c
15
Q
PE of cervical polyps?
A
- single or multiple pear shaped growths may protrude from the cervix into the vaginal canal
- usually smooth, soft, reddish purple to cherry red
- may readily bleed when touched
- may be small or very large
16
Q
DDx for cervical polyps?
A
- endometrial polyps
- small prolapsed myomas
- cervical malignancy
17
Q
Tx of cervical polyps?
A
- tie off base
- twist off at base with forceps
- may need to cauterize site
- recurrence low
18
Q
What are nabothian cysts?
A
- mucous filled cyst on surface of the cervix
- most often caused when stratified squamous epithelium of ectocervix grows over the simple columnar epithelium of endocervix
- tissue growth can block the cervical crypts and trap mucous inside the crypts
19
Q
How do nabothian cysts appear? Are they worrisome?
A
- appear as firm bumps on the surface
- considered harmless and usually resolve on their own
- appearance may be related to menses
- not considered problematic unless they grow really large and present secondary sxs
- may be removed by electrocautery or cryotherapy
20
Q
How common is Cervical cancer? Is it increasing or decreasing?
A
- 3rd most common gyn malignancy and COD in women in US
- in past 45 yrs its incidence has decreased from 45 to 15/100,000 women due to screening from pap smears
- in US represents 1.3% of cancer deaths in women and in developed countries 75% decrease in incidence and mortality over 50 yrs
- in developing countries 2nd MC cause of cancer related morbidity and mortality among women
21
Q
Pathology of cervical cancer?
A
- squamous cell (69%)
- adenocarcinoma (25%)
- adenosquamous, rare types (sarcomas) (6%)
22
Q
Sxs of cervical cancer?
A
- frequently asx
- abnormal vaginal bleeding
- postcoital spotting
- vaginal d/c - can be watery, mucoid or purulent and malodorous
