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3a > WH: Cervical Disorders > Flashcards

WH: Cervical Disorders Flashcards

1
Q

What is cervical ectropion ? induced by ?

A

Eversion of the endocervix on the ectoervix induced by high levels of oestrogen

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2
Q

what histology (cell type) is the endocervix ?

A

mucus-secreting simple columnar epithelium

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3
Q

what history (cell type) is the ectocervix ?

A

stratified squamous non-keratinising epthelium
(squamous)

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4
Q

where should the cervical transformation zone be and where is it cervical ecotopian ?

A

in cervical ectropion it is located outside the Endocervix

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5
Q

explain how the pathophysiology of cervical ectropion explains the symptoms ?

A
  • endocervix more fragile + prone to trauma => post-coital bleeding
  • Endocervix contains mucus secreting glands => vaginal discharge
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6
Q

Cervical ectorpian RF ? (4)

A

things that increase the levels of oestrogen
- COCP
- Pregnancy
- Adoleschence
- Menstruating
(uncommon in PM women)

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7
Q

Cervical ectropion presentation ? (6)

A
  • Asymptomatic
  • Increased vaginal discharge
  • Vaginal bleeding
  • Post-coital bleeding
  • Dyspareunia
  • Intermenstrula bleeding
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8
Q

Cervical ectropain investigations?

A
  • Pregnancy test
  • Cervical smear
  • Triple swab (if infection suspected)
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9
Q

cervical ectropion management

A
  • asymptomatic: no treatment
  • problematic bleeding: stop oestrogen containing meds (COCP)
  • cauterisation of ectropain (ablate columnar epithelium)
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10
Q

Nam non-cancerous tumours of the cervix ? (3)

A
  • Cervical polyps
  • Nabathion cyst
  • Cervical fibroid
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11
Q

What are cervical polyps ?

A

abnormal growths that appear in the cervix usually protruding for the surface of the cervical canal (1% malignancy risk)

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12
Q

are cervical polyps being or malignant ?

A

usually benign
- malignant in 0.5%- 1% cases

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13
Q

cervical polyps pathophysiology ?

A

due to focal hyperplasia of the columnar epithelium of endocervix

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14
Q

cervical polyps presentation ?

A
  • asymptomatic 2/3 of the time
  • usually abnormal vaginal bleeding if symptomatic
  • Increased vaginal discharge
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15
Q

cervical polyps investigations ? diagnostic ?

A

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

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16
Q

cervical polyps management ?

A

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)

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17
Q

What are nabothian cysts ?

A

they are fluid filled sacs seen on the surface of the cervix (really common)
- Harmless + unrelated to cervical cancer

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18
Q

nabothian cysts pathophysiology ?

A

when squamous epithelium of ectopic certix cover mucu-secreting columnar of endocervix => much becomes trapped => cyst

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19
Q

nabothian cysts presentation ?

A

incidentally on speculum exam
(pretty much symptomless)

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20
Q

Nabothian cyst management ?

A

reassure woman + no treatment required
- If uncertain: colposcopy

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21
Q

What is cervical cancer ? related to what ?

A

human papilloma virus-related malignancy of uterine cervical mucosa

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22
Q

peak age of cervical cancer ?

A

25-29

23
Q

what is the most common type of cervical cancer ? second most common ?

A
  • 80% are squamous cell carcinoma
  • next most common: adenocarcinoma
24
Q

what is the most common cause of cervical cancer ?

A

HPV

25
Q

what is HPV ? associated with what ?

A

STI that affects skin + mucous membranes
- Associated with anal, vulval, vaginal , penile + throat cancers

26
Q

which HPV strains are responsible for most cervical cancer ?

A

types 16 + 18

27
Q

What is the treatment for HPV ?

A

no treatment for HPV infeciton
- Most cases resolve spontaneously within 2 yrs

28
Q

How does HPV increase risk of cancer ?

A

HPV promotes development of cancer by inhibiting tumour suppressor genes in cervical epithelial cells

29
Q

cervical cancer RF

A
  • increase risk of HPV (frequent, many partners, unprotected sex)
  • Non-compliance with screening
  • Other (smoking, COCP, FHx, HIV + immunosuppression)
30
Q

Cervical cancer presentation ? most common ?

A

often brought up in screening in otherwise asymptomatic patients
- Abnormal vaginal bleeding (most common)
- Vaginal discharge
- Pelvic pain
- Dyspareunia

31
Q

AVB differential ? (6)

A
  • STI
  • Cervical ectropian
  • Polyp
  • Fibroid
  • Cervical cancer
  • Pregnancy related bleeding
32
Q

What would be seen on examination in cervical cancer ?

A
  • Speculum: ulceration, inflammation, bleeding, visible tumour
33
Q

what does cervical screening look for ? fancy name for this ?

A

smear tests screen for precancerous + cancerous changes of the cervix
- dyskaryosis

34
Q

What does cervical screening involve ?

A

Smear test
- HPV testing
- Cytology (liquid based cytology): looking for dyskaryosis

  • also infections (BV, candidiasis can be identified + reported)
35
Q

Smear test results: what happen in inadequate sample ?

A

repeat smear in at least 3 months

36
Q

smear test results: what happen if HPV -ve ?

A

(good sign)
continue with routine screening
(continue every 3 yrs (25-49))
(continue every 5 yrs (50-640))

37
Q

Smear results: what happen if HPV +ve and normal cytology ?

A

repeat HPV test in 12 months

38
Q

Smear results: what happen if HPV +ve and abnormal cytology ?

A

refer for colposcopy

39
Q

what is the aim of colposcopy ?

A

to diagnose + stage the cervical intra-epithelial neoplasia (CIN)

40
Q

What does colposcopy involve ?

A
  • insert speculum + have a look at cervix (+ staining)
  • loop biopsy (diathermy): excision of transformation zone
41
Q

cervical cancer management ?

A
  • larte loop excision of transformation zone (LLETZ)
  • Core biopsy
  • Raiated hysterecomy
  • Chemo
  • radiotherapy
42
Q

How is offered cervical screening ? when ?

A

women (+trans men with cervix)
- 25-49: every 3 yrs
- 50-64: every 5 yrs

43
Q

Who is the HPv vaccine offered to ? when ?

A

given to girls + boys before they become sexually active (aged 11-13)

44
Q

what does HPV vaccine protect against? which strains ?

A

protects against strains:
- 6-11 (genital warts)
- 16-18 (cervical cancer)

45
Q

What is nephritis ? triad symptoms ?

A

Inflammation within the nephrons of ht kidneys:
- Reduction in kidney function
- Haematuria (invisible or visible)
- Proteinuria (but less than nephrotic)

46
Q

2 most common causes of nephritis ?

A
  • Post streptococcus glomerulonephritis
  • IgA nephrophathy (bergers)
47
Q

what would make you consider post-strep glomerulonephritis in a nephritis presentation ?

A

evidence of a recent tonsillitis cause by streptococcus

48
Q

What other condition is IgA nephropathy (burgers disease) related to ? how does it cause nephritis ?

A

related to HSP (IgA vasculitis)
- IgA deposits in nephrons => inflam (nephritis)

49
Q

What is haemolytic uraemia syndrome ? triggered by ?

A

it occurs when there is thrombosis within small blood vessels throughout body
- usually triggered by shiga toxin

50
Q

what pathogens make the shiga toxin (2)

A
  • E-Coli 0157
  • Shigella
51
Q

triad of haemolytic uraemia syndrome presentation ?

A
  • haemolytic anaemia
  • AKI
  • Thombocytopenia

(not good - medical emergency !)

52
Q

haemolytic uraemia syndorme presentation ?

A

(think the triad)
- e.coli/shigella cause a gastroenteritis
- HUS: fever, lethargy, reduced UO, bruising, non-blanching rash, jaundice

53
Q

Haemolytic uraemia syndrome management ?

A

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)

3a (43 decks)

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