WH: Cervical Disorders Flashcards
What is cervical ectropion ? induced by ?
Eversion of the endocervix on the ectoervix induced by high levels of oestrogen
what histology (cell type) is the endocervix ?
mucus-secreting simple columnar epithelium
what history (cell type) is the ectocervix ?
stratified squamous non-keratinising epthelium
(squamous)
where should the cervical transformation zone be and where is it cervical ecotopian ?
in cervical ectropion it is located outside the Endocervix
explain how the pathophysiology of cervical ectropion explains the symptoms ?
- endocervix more fragile + prone to trauma => post-coital bleeding
- Endocervix contains mucus secreting glands => vaginal discharge
Cervical ectorpian RF ? (4)
things that increase the levels of oestrogen
- COCP
- Pregnancy
- Adoleschence
- Menstruating
(uncommon in PM women)
Cervical ectropion presentation ? (6)
- Asymptomatic
- Increased vaginal discharge
- Vaginal bleeding
- Post-coital bleeding
- Dyspareunia
- Intermenstrula bleeding
Cervical ectropain investigations?
- Pregnancy test
- Cervical smear
- Triple swab (if infection suspected)
cervical ectropion management
- asymptomatic: no treatment
- problematic bleeding: stop oestrogen containing meds (COCP)
- cauterisation of ectropain (ablate columnar epithelium)
Nam non-cancerous tumours of the cervix ? (3)
- Cervical polyps
- Nabathion cyst
- Cervical fibroid
What are cervical polyps ?
abnormal growths that appear in the cervix usually protruding for the surface of the cervical canal (1% malignancy risk)
are cervical polyps being or malignant ?
usually benign
- malignant in 0.5%- 1% cases
cervical polyps pathophysiology ?
due to focal hyperplasia of the columnar epithelium of endocervix
cervical polyps presentation ?
- asymptomatic 2/3 of the time
- usually abnormal vaginal bleeding if symptomatic
- Increased vaginal discharge
cervical polyps investigations ? diagnostic ?
can only diagnose on histology after removal so role of investigations is to exclude other causes
- triple swabs (infection), cervical smear, pregnancy test, pelvic US
cervical polyps management ?
0.5% risk of malignant transformation so removal
- Small polyp: primary care (twisted off + cauterised)
- Larger: diathermy incolposcopy clinic (and sent off for histological examination to exclude malignancy)
What are nabothian cysts ?
they are fluid filled sacs seen on the surface of the cervix (really common)
- Harmless + unrelated to cervical cancer
nabothian cysts pathophysiology ?
when squamous epithelium of ectopic certix cover mucu-secreting columnar of endocervix => much becomes trapped => cyst
nabothian cysts presentation ?
incidentally on speculum exam
(pretty much symptomless)
Nabothian cyst management ?
reassure woman + no treatment required
- If uncertain: colposcopy
What is cervical cancer ? related to what ?
human papilloma virus-related malignancy of uterine cervical mucosa
peak age of cervical cancer ?
25-29
what is the most common type of cervical cancer ? second most common ?
- 80% are squamous cell carcinoma
- next most common: adenocarcinoma
what is the most common cause of cervical cancer ?
HPV
what is HPV ? associated with what ?
STI that affects skin + mucous membranes
- Associated with anal, vulval, vaginal , penile + throat cancers
which HPV strains are responsible for most cervical cancer ?
types 16 + 18
What is the treatment for HPV ?
no treatment for HPV infeciton
- Most cases resolve spontaneously within 2 yrs
How does HPV increase risk of cancer ?
HPV promotes development of cancer by inhibiting tumour suppressor genes in cervical epithelial cells
cervical cancer RF
- increase risk of HPV (frequent, many partners, unprotected sex)
- Non-compliance with screening
- Other (smoking, COCP, FHx, HIV + immunosuppression)
Cervical cancer presentation ? most common ?
often brought up in screening in otherwise asymptomatic patients
- Abnormal vaginal bleeding (most common)
- Vaginal discharge
- Pelvic pain
- Dyspareunia
AVB differential ? (6)
- STI
- Cervical ectropian
- Polyp
- Fibroid
- Cervical cancer
- Pregnancy related bleeding
What would be seen on examination in cervical cancer ?
- Speculum: ulceration, inflammation, bleeding, visible tumour
what does cervical screening look for ? fancy name for this ?
smear tests screen for precancerous + cancerous changes of the cervix
- dyskaryosis
What does cervical screening involve ?
Smear test
- HPV testing
- Cytology (liquid based cytology): looking for dyskaryosis
- also infections (BV, candidiasis can be identified + reported)
Smear test results: what happen in inadequate sample ?
repeat smear in at least 3 months
smear test results: what happen if HPV -ve ?
(good sign)
continue with routine screening
(continue every 3 yrs (25-49))
(continue every 5 yrs (50-640))
Smear results: what happen if HPV +ve and normal cytology ?
repeat HPV test in 12 months
Smear results: what happen if HPV +ve and abnormal cytology ?
refer for colposcopy
what is the aim of colposcopy ?
to diagnose + stage the cervical intra-epithelial neoplasia (CIN)
What does colposcopy involve ?
- insert speculum + have a look at cervix (+ staining)
- loop biopsy (diathermy): excision of transformation zone
cervical cancer management ?
- larte loop excision of transformation zone (LLETZ)
- Core biopsy
- Raiated hysterecomy
- Chemo
- radiotherapy
How is offered cervical screening ? when ?
women (+trans men with cervix)
- 25-49: every 3 yrs
- 50-64: every 5 yrs
Who is the HPv vaccine offered to ? when ?
given to girls + boys before they become sexually active (aged 11-13)
what does HPV vaccine protect against? which strains ?
protects against strains:
- 6-11 (genital warts)
- 16-18 (cervical cancer)
What is nephritis ? triad symptoms ?
Inflammation within the nephrons of ht kidneys:
- Reduction in kidney function
- Haematuria (invisible or visible)
- Proteinuria (but less than nephrotic)
2 most common causes of nephritis ?
- Post streptococcus glomerulonephritis
- IgA nephrophathy (bergers)
what would make you consider post-strep glomerulonephritis in a nephritis presentation ?
evidence of a recent tonsillitis cause by streptococcus
What other condition is IgA nephropathy (burgers disease) related to ? how does it cause nephritis ?
related to HSP (IgA vasculitis)
- IgA deposits in nephrons => inflam (nephritis)
What is haemolytic uraemia syndrome ? triggered by ?
it occurs when there is thrombosis within small blood vessels throughout body
- usually triggered by shiga toxin
what pathogens make the shiga toxin (2)
- E-Coli 0157
- Shigella
triad of haemolytic uraemia syndrome presentation ?
- haemolytic anaemia
- AKI
- Thombocytopenia
(not good - medical emergency !)
haemolytic uraemia syndorme presentation ?
(think the triad)
- e.coli/shigella cause a gastroenteritis
- HUS: fever, lethargy, reduced UO, bruising, non-blanching rash, jaundice
Haemolytic uraemia syndrome management ?
medical emergency (10% mortality)
- stool culture: to establish causative organism
- Hospital admission + supportive management: IV fluids, transfusion (if anaemic), harm-dialysis (if sever renal failure)
