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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 ?

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 ?

25
what is HPV ? associated with what ?
STI that affects skin + mucous membranes - Associated with anal, vulval, vaginal , penile + throat cancers
26
which HPV strains are responsible for most cervical cancer ?
types 16 + 18
27
What is the treatment for HPV ?
no treatment for HPV infeciton - Most cases resolve spontaneously within 2 yrs
28
How does HPV increase risk of cancer ?
HPV promotes development of cancer by inhibiting tumour suppressor genes in cervical epithelial cells
29
cervical cancer RF
- increase risk of HPV (frequent, many partners, unprotected sex) - Non-compliance with screening - Other (smoking, COCP, FHx, HIV + immunosuppression)
30
Cervical cancer presentation ? most common ?
often brought up in screening in otherwise asymptomatic patients - Abnormal vaginal bleeding (most common) - Vaginal discharge - Pelvic pain - Dyspareunia
31
AVB differential ? (6)
- STI - Cervical ectropian - Polyp - Fibroid - Cervical cancer - Pregnancy related bleeding
32
What would be seen on examination in cervical cancer ?
- Speculum: ulceration, inflammation, bleeding, visible tumour
33
what does cervical screening look for ? fancy name for this ?
smear tests screen for precancerous + cancerous changes of the cervix - dyskaryosis
34
What does cervical screening involve ?
Smear test - HPV testing - Cytology (liquid based cytology): looking for dyskaryosis - also infections (BV, candidiasis can be identified + reported)
35
Smear test results: what happen in inadequate sample ?
repeat smear in at least 3 months
36
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))
37
Smear results: what happen if HPV +ve and normal cytology ?
repeat HPV test in 12 months
38
Smear results: what happen if HPV +ve and abnormal cytology ?
refer for colposcopy
39
what is the aim of colposcopy ?
to diagnose + stage the cervical intra-epithelial neoplasia (CIN)
40
What does colposcopy involve ?
- insert speculum + have a look at cervix (+ staining) - loop biopsy (diathermy): excision of transformation zone
41
cervical cancer management ?
- larte loop excision of transformation zone (LLETZ) - Core biopsy - Raiated hysterecomy - Chemo - radiotherapy
42
How is offered cervical screening ? when ?
women (+trans men with cervix) - 25-49: every 3 yrs - 50-64: every 5 yrs
43
Who is the HPv vaccine offered to ? when ?
given to girls + boys before they become sexually active (aged 11-13)
44
what does HPV vaccine protect against? which strains ?
protects against strains: - 6-11 (genital warts) - 16-18 (cervical cancer)
45
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)
46
2 most common causes of nephritis ?
- Post streptococcus glomerulonephritis - IgA nephrophathy (bergers)
47
what would make you consider post-strep glomerulonephritis in a nephritis presentation ?
evidence of a recent tonsillitis cause by streptococcus
48
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)
49
What is haemolytic uraemia syndrome ? triggered by ?
it occurs when there is thrombosis within small blood vessels throughout body - usually triggered by shiga toxin
50
what pathogens make the shiga toxin (2)
- E-Coli 0157 - Shigella
51
triad of haemolytic uraemia syndrome presentation ?
- haemolytic anaemia - AKI - Thombocytopenia (not good - medical emergency !)
52
haemolytic uraemia syndorme presentation ?
(think the triad) - e.coli/shigella cause a gastroenteritis - HUS: fever, lethargy, reduced UO, bruising, non-blanching rash, jaundice
53
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)

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