Gynae Flashcards
How is Fallopian tube inflammation called?
salphingitis
What is Ovarian inflammation called?
Oophritis
What is PID
Infection ascending from vagina and cervix up to uterus and Fallopian tubes, leading to inflammation (endometritis, salpingitis) and the formation of adhesions.
What are the most common organisms causing PID?
Chlamydia trachomatis and N. gonorrhoea are most common organisms in UK.
In the world: TB and schistosomiasis
What are the complication of PID?
- 10% have Fitz Hugh Curtis syndrome – RUQ pain from peri-hepatitis + “violin-string” peri- hepatic adhesions
- Infertility
- ↑Risk of ectopic pregnancy
- Bacteraemia → SEPSIS
- Tubo-ovarian abscess
- Chronic PID
- Peritonitis
- Plical fusion – fimbrial ends of fallopian tubes adhere together
What is the aetiology of sealpingitis?
Fallopian tube inflammation
Usually due to direct ascent from vacina (except TB)
What is the epidemiology of cervical cancer?
2nd most common cancer affecting women worldwide
Bipmodal age distribution:
1. 30-39
2. >70
What is the aetiology and risk factors for the development of cervical cancer?
95% are associated with HPV infection (especially type 16 and 18)
Many sexual partners, early sexual activity
smoking
immunosuppression
Which HPV tpyes cause genital warts
6& 11
Which HPV types cause cervical cancer?
16&18
What is prognosis of Cervical Cancer?
Depending on Grade:
5 year survival:
90% Grade 1
10% Garde IV
What tissue can uterine tumours arise from?
All (eptheilal/ stroma and muscular layeR)
What are tisk factors for endometrial epithelial tumours
Any that cause overstimmulation of endometirum (hormonal)
what is the most common Endometiral Cancer?
Endometrioid
How does mismattch reapir mutation lead to Carcinom?
Common mutations found
Essentially mutations and mistakes in genes are not detected and repaied –> mutation accumulate
What are the most common pathogens causing PID secondary to termination of pregancy?
S. aureus
Streptococcus
C. perfringens
Coliforms
What are the clincal symptoms of PID?
bilateral lower abdo pain
deep dyspareunia
vaginal bleeding/discharge
fever
adnexal tenderness
and cervical excitation
Name 3 organisms that have serious complications if infecting the female genital tract
Chlamydia: major cause of infertility
Gonorrhoea: major cause of infertility
Mycoplasma: causes spontaneous abortion and chorioamnionitis
HPV: implicated in cancer
What is Cervical intraepithelial neoplasia?
Dysplasia at the Transitional Zone of the Cervix as a result of infection by HPV 16 & 18
Usually epithelial cells (not glandlar cells) undergo transformation
How is CIN graded on histology?
Devided into Grades 1-3
CIN 1 = dysplasia confined to deepest 1/3 of epithelium
CIN 2 = lower 2/3
CIN 3 = full thickness, but basement membrane intact
What is the prognosis for CIN?
60-90% of CIN 1 reverts to normal over 10-23 months
30% of CIN 3 progress to cervical cancer over 10 years if left untreated
What are the two main tissue types of cervical carcinoma?
How common are they?
Majority (80%): Squamous Cell Carcinoma
20%: Adenocarcinoma
What is the difference between pruductive and non-productive HPV infection?
- Non-productive/latent (infection occured but no cellular changes + infection can only be diagnosed by molecular methods)
- Productive → cytological and histological changes (CIN or cervical carcinoma)
How does HPV infection cause Cervical carcinoma? (Molecular mechanisms)
Cervical proteins inhibit TSG
HPV encodes E6 and E7 proteins which inactivate 2 TSG
(TSGs):
1. E6 inactivatesP53→proliferation
2. E7 inactivates Retinoblastoma (Rb) gene→ proliferation
How many people with cervix infected with HPV will develop cancer?
Usually HPV becomes undetectable in 90% of cases within 2 years
10% of persistent infection are at high risk of developing malignancy
What is the frequency of cervical smears (prevention) for women in the UK?
What parameters are looked at during cervical smear screening in the UK?
How good are they?
- Cytology: 50-95% sensitiviy to detect high-grade CIN and SCC
- HPV-DNA test: RNA probe to detect presence of the most common cancer-associated HPV types
At what age is the HPV vaccine administered?
What strains does it prevent?
Offered to Girls and Boys 12-13 years
In England, they are offered
1st dose in school Year 8
2nd dose offered 6 to 24 months after the 1st dose
Vaccinating against 6,11 (warts), 16+18 (cancer) (for Gardasil9)
How is Cervical Carcinoma Staged?
Usually staged using the FIGO system
Stage 0: CIN
Stage I: ONLY Cervix (47%)
Stage II: spread into UPPER 1/3 VAGINA
Stage III: spread into PELVIC SIDE WALL and/or LOWER 1/3 VAGINA
Stage IV:
METASTASIS beyond pelvis to bladder/bowel