Flashcards in Cervical Ectropion Deck (38)
1
What is a cervical ectropion?
When there is eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu
2
What is a cervical ectropion also known as?
Cervical erosion (though no 'erosion' of cells actually occurs)
3
Is cervical ectropion a benign or malignant condition?
Benign
4
When is cervical ectropion commonly seen?
On examination of the cervix in adolescents, in pregnancy, and in women taking oestrogen containing contraceptives
5
What is an important differential for cervical ectropion?
Cervical cancer and cervical intraepithelial neoplasia
6
What do cervical cancer and CIN need to be excluded before?
Any treatment or reassurance to the patient is offered
7
What is the cervix?
The lower portion of the uterus
8
What is the cervix composed of?
- Ectocervix
- Endocervical canal
9
What is the endocervical canal also known as?
Endocervix
10
What is the endocervix?
The most proximal and 'inner' part of the cervix
11
What is the endocervix lined by?
Mucus secreting simple columnar epithelium
12
What is the ectocervix?
The part of the cervix that projects into the vagina
13
What is the ectocervix lined by?
Stratified squamous non-keratinised epithelium
14
What happens to the lining of the cervix in a cervical ectropion?
The stratified squamous cells of the ectocervix undergo metaplastic change to become simple columnar epithelium (same as endocervix)
15
What induces the change in the epithelium of the ectocervix in cervical ectropion?
Thought to be induced by higher oestrogen levels
16
What does the columnar epithelium contain in the endocervix?
Mucus secreting glands
17
What is the result of the cervical columnar epithelium containing mucus secreting glands?
Some women with cervical ectropion experience increased vaginal discharge
18
Why might cervical ectropion give rise to post-coital bleeding?
As fine blood vessels present within the epithelium are easily broken during intercourse
19
What are the risk factors for cervical ectropion related to?
Things that cause high levels of oestrogenn
20
What are the risk factors for cervical ectropion?
- Use of COCP
- Pregnancy
- Adolescence
- Menstruating age
21
What are the most common clinical features of cervical ectropion?
Most commonly asymptomatic
22
If symptomatic, how can cervical ectropion present?
- Post-coital bleeding
- Intermenstrual bleeding
- Non-purulent excessive discharge
23
What is found on speculum examination in cervical ectropion?
Everted columnar epithelium has reddish appearance, usually arranged in ring around external os
24
What are the differential diagnoses of cervical ectropion?
- Cervical cancer
- CIN
- Cervicitis
- Pregnancy
25
How is the diagnosis of cervical ectropion made?
Clinical diagnosis, and the main role of any investigation to exclude other potential diagnoses
26
What investigations may be done in suspected cervical ectropion?
- Pregnancy test
- Triple swabs
- Cervical smear
27
When should triple swabs be performed in suspected cervical ectropion?
If there is any suggestion of infection (e.g. purulent discharge)
28
What swabs should be taken if there is suggestion of infection in suspected cervical ectropion?
- Endocervical
- High vaginal swabs
29
Why should cervical smears be done in suspected cervical ectropion?
Rule out cervical intraepithelial neoplasia
30
What should be done if a frank lesion is observed in suspected cervical ectropion?
A biopsy should be taken
31
When is management required for cervical ectropion?
If asymptomatic
32
Why is management not required for cervical ectropion unless symptomatic?
It is regarded as a normal variant
33
What is the first line treatment for cervical ectropion?
Stop any oestrogen containing medications
34
What is the most common oestrogen containing medication taken by women with cervical ectropion?
COCP
35
What management can be employed if symptoms persist in cervical ectropion?
The columnar epithelium can be ablated
36
How can the columnar epithelium be ablated in cervical ectropion?
Typically using cryotherapy or electrocautery
37
What is the problem with ablation of the columnar epithelium in cervical ectropion?
It will result in significant vaginal discharge until healing is completed
38