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Obs & Gynae > Cervix conditions > Flashcards

Cervix conditions Flashcards

1
Q

What is Cervicitis? What causes it (4)? RF?

A

Inflammation of the cervix. Complications: PID

Causes:

  • STI: gonorrhoea, chlamydia, herpes, trichomoniasis, HPV
  • BV
  • Allergy: spermicides, contraceptives, douches
  • Irritation: tampons, pessaries, diaphragm

RF:
- 15-25y, high risk sex behaviour (UPSI, multiple partners etc), sexual intercourse at an early age, Hx of STIs

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2
Q

Clinical features of Cervicitis

A

Dx is made clinically

  • PV purulent discharge (most common syx)
  • Abnormal bleeding: IMB, PCB
  • Dypareunia
  • Other syx: dysuria, lower abdo pain, vulvar or vaginal irritation
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3
Q

Investigations of Cervicitis (6)

A

(1. ) Pelvic ex + speculum: check for discharge, swelling, tenderness, bleeding
- Vesicles = herpes, strawberry cervix = trichomoniasis

(2. ) Pregnancy test
(3. ) Swab: easily induced bleeding indicates cervicitis
(4. ) Microscopy: Wet mount examination of cervical discharge
(5. ) NAAT of vaginal discharge for dx of gonorrhoea or chlamydia
(6. ) OSOM trichomonas rapid test allows for detection of trichomonas

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4
Q

Management of Cervicitis

A
  • If allergy/irritation: avoid triggers
  • Abx if STI/BV. Important to finish Rx before having sex again. Sexual partners to be treated too
    BV = PO metronidazole for 5-7d
    Chlamydia = doxycycline for 7d
    Gonorrhoea = azithromycin after NAAT/swab
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5
Q

What is cervical ectropion + RF?

A
  • It is where the columnar epithelium of the endocervix (usually lines cervical canal) extends out to the ectocervix (outer area of cervix).
  • These cells are more fragile and are more likely to bleed, mucus production, infection.
  • Not associated with cervical cancer

RF:
- younger women, COCP, pregnancy

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6
Q

Clinical features of cervical ectropion

A
  • Asyx, usually found incidentally on speculum ex
  • PV bleeding, PCB
  • Dyspareunia
  • PV discharge

o/e
- Speculum = well-demarcated border (transformation zone)

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7
Q

Management of cervical ectropion

A

(1. ) No Rx if asyx.
- Typically resolves when pt older, not pregnant, not on COCP

(2. ) Colposcopy + cauterisation with silver nitrate or cold coagulation
- Stops problematic bleeding

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8
Q

What is Cervical Dysplasia?

A
  • Pre-cancerous condition in which abnormal cell growth occurs on the surface of the lining of the cervix or endocervical canal.
  • Dysplasia is graded using CIN
  • This does not mean it is cancer h/e if not treatment it may develop into cancer
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9
Q

What is Cervical Intraepithelial Neoplasia (CIN)?

A
  • Grading system to assess level of DYSPLASIA within cervix.
  • CIN/dysplasia is dx with a BIOPSY at colposcopy (note: dyskaryosis is on smear results)

Grades are:

  • CIN I = mild, likely to return to normal without Rx
  • CIN II = moderate, likely to progress to cancer if untreated
  • CIN III = severe, very likely to progress to cancer if untreated
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10
Q

Who and when is cervical screening offered?

A
  • Sexually active women 25-64
  • 3 yearly for 25-50y
  • 5 yearly for 50-64y
  • Annually for HIV
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11
Q

How is cervical smear assessed?

A
  • Smear shows if +ve or -ve HPV
  • +ve HPV are investigated further to see if there are any cell changes (dyskaryosis)
  • if cell changes present, pt is sent for colposcopy and biopsy (dysplasia).
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12
Q

Management of smear results

A
  • Inadequate sample - repeat smear after 3m
  • HPV negative = routine call (3y/5y)
  • HPV positive + normal cytology = repeat at 12m
  • HPV positive + abnormal cytology = refer for colposcopy
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13
Q

What is the most common type of cervical cancer?

A

squamous cell carcinoma (80%)

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14
Q

Causes + RF of cervical cancer

A
  • Most commonly caused by HPV (strains 16 + 18), it is a STI

RF:

  • Inc risk of catching HPV (multiple partners, early sexual activity, not using condoms etc)
  • Non-engagement with screening
  • Smoking
  • HIV (HIV pts offered yearly smears)
  • Inc number of full-term pregnancies
  • FH
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15
Q

CLinical features of cervical cancer

A
  • Asyx
  • Abnormal PV bleeding i.e. IMB, PCB, PMB
  • PV discharge
  • Pelvic pain
  • Dyspareunia
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16
Q

Ix of cervical ca

A

(1. ) Pelvic exam + speculum
- Abnormal cervix appearance = ulceration, inflammation, bleeding, visible tumour
- Urgent referral for colposcopy if abnormal appearance

(2. ) Smear
(3. ) Colposcopy +/- biopsy

17
Q

Mx of cervical ca

A

Based on FIGO staging

(1. ) CIN/early ca = LLETZ or Cone biopsy/trachelectomy
- LLETZ: large loop excision of the transformation zone
- Cone biopsy: cone-shaped piece of cervix removed using scalpel and sent to histology

(2. ) Stage 1B-2A = Radical hysterectomy, chemotherapy, radiotherapy
(3. ) Stage 2B-4A: Chemotherapy and radiotherapy
(4. ) Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

18
Q

What is Cervical cyst? RF? Clinical features?

A
  • AKA nabothian cysts/follicles /mucinous retention cysts
  • Mucus retention fluid-filled cysts often seen on surface of cervix. Unrelated to cervical cancer.
  • Columnar epithelium of endocervix (the canal) produces cervical mucus.
  • When the squamous epithelium of the ectocervix slightly covers the mucus-secreting columnar epithelium, the mucus becomes trapped and forms a cyst.
  • RF: after childbirth, minor trauma, cervicitis

Clinical features

  • Fluid filled cyst on cervix
  • Usually <1cm in size
  • Harmless
19
Q

Mx of Cervical cyst?

A
  • Reassure, no Rx necessary, resolves spontaneously

- Colposcopy + excision/biopsy if dx uncertainty

20
Q

What is Cervical Incompetent/ insufficiency

A
  • Weak cervical tissue causes or contribute to premature birth or miscarriage due to absence of uterine contractions or labour (painless cervical dilatation), owing to a functional or structural defect.
  • Normally, cervix dilates only when labor starts, in response to contractions of the uterus.
  • However, in some women, tissues of the cervix are weak. - As a result, the cervix may dilate long before baby is due, and baby may be delivered too early.
  • Usually occurs in 2nd or 3rd trimester
21
Q

Causes of Cervical Incompetent/ insufficiency

A
  • Defect of Mullerian ducts
  • Ehlers-Danlos syndrome or Marfans syndrome
  • Trauma = during childbirth, surgical procedures
22
Q

Clinical features of Cervical Incompetent/ insufficiency

A

Usually dx in context of miscarriage occurring after 12-14w or in premature labour. It is not identified till a women delivers.

  • Painless dilatation of the cervix
  • Second trimester deliveries
23
Q

Ix for Cervical Incompetent/ insufficiency

A

(1. ) TV USS – assess length of cervix, check if membranes are protruding through cervix
(2. ) Pelvic exam – amniotic fluid protruding through

24
Q

Mx for Cervical Incompetent/ insufficiency

A

(1. ) Promoting full term pregnancies:
- Regular prenatal care
- Healthy diet
- Manage weight
- Avoid smoking + alcohol

(2.) Cervical stitch (cerclage) - ribbon tied around cervix

Obs & Gynae (8 decks)

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