Cervical Erosion.pptx

 CERVICAL EROSION: • Cervical eversion is a condition in which the cells from the 'inside' of the cervical canal, known as glandular cells (or columnar epithelium), are present on the 'outside' of the vaginal portion of the cervix. The cells on the 'outside' of the cervix are called squamous epithelial cells. Where the two cells meet is called the transformation zone, also known as the stratified squamous epithelium.

 Histology of Cervix: • The endocervical mucosa is about 3 millimetres (0.12 in) thick, lined with a single layer of columnar mucous cells, and contains numerous tubular mucous glands which empty viscous alkaline mucus into the lumen. In contrast, the ectocervix is covered with nonkeratinized stratified squamous epithelium, which resembles the squamous epithelium lining the vaginal. The junction between these two types of epithelia is called the squamocolumnar junction. Underlying both types of epithelium is a tough layer of collagen. The mucosa of the endocervix is not shed during menstruation. The cervix has more fibrous tissue, including collagen and elastin, than the rest of the uterus.

• In prepubertal girls, the functional squamocolumnar junction is present just within the cervical canal. Upon entering puberty, due to hormonal influence, and during pregnancy, the columnar epithelium extends outwards over the ectocervix as the cervix everts. Hence, this also causes the squamocolumnar junction to move outwards onto the vaginal portion of the cervix, where it is exposed to the acidic vaginal environment. The exposed columnar epithelium can undergo physiological metaplasia and change to tougher metaplastic squamous epithelium in days or weeks.which is very similar to the original squamous epithelium when mature. The new squamocolumnar junction is therefore internal to the original squamocolumnar junction, and the zone of unstable epithelium between the two junctions is called the transformation zone of the cervix. After menopause, the uterine structures involute and the functional squamocolumnar junction moves into the cervical canal.

 Cervical Histology:

• Nabothian cysts (or Nabothian follicles) form in the transformation zone where the lining of metaplastic epithelium has replaced mucous epithelium and caused a strangulation of the outlet of some of the mucous glands. A build up of mucus in the glands forms Nabothian cysts, usually less than about 5 mm (0.20 in) in diameter,[3] which are considered physiological rather than pathological. Both gland openings and Nabothian cysts are helpful to identify the transformation zone.

1)Congenital Erosion: Natural process OR changes. Estrogen dependant especially in mother. Develop at birth and persist for few days. But abnormal develop at age of puberty.

2) Erosion associated with chronic cervicitis OR Infection: Due to chronic cervicitis with pus and mucus. Due to alkanity of discharge maceration of squamous epithelium and desquamtion develop. In healing process transition of columnar epithelium over desquamated area and macroscopically look smooth glistening translucent red epithelial area.(Flat erosion)

 Appearance of Cervix in Erosion:

After sometime the squamous epithelium from vaginal portion of cervix replace columnar epithelium of the erosion. Recurrent cervical erosion due to Untreated chronic cervicitis. 3).Hormonal OR Papillary Erosion: Common during pregnancy and in pill users,pessaries,tampons. Develop due to oestrogen surge. Hyperplasia of endocervical epithelium. Replaced epithelium becomes heaped up to fold inwards and outwards thats why called Papillary erosion.

• The squamo-columnar junction returns back to its normal position after 3 months following delivery and little earlier following withdrawal of pill.

 Clinical Features:  Symptoms: • Sometimes asymtomatic. However following symptoms may be present: • Vaginal discharge:Either profuse mucoid OR Mucopurulent(infection) OR Blood stained (congeston).(Cervical Leucorrhoea) • Postcoital bleeding. • During pregnancy an erosion becomes very vascular and bleed easily. • sometimes Low back pain,abdominal OR pelvic pain.

 Signs: Per speculum Examination:Reddened area around the external os with its inner margin continous with endocervical lining and with well difined outer margin.The reddened area of erosion may be slightly raised above the level of squamous epithelium of the cervix and is smooth and glistening if it is covered by columnar epithelium.The erosion is soft and bleed easily if swabbed vigorously during examination.

 Differential Diagnosis:    

Syphilitic ulcer, Tubeculosis of cervix Carcinoma in situ Cancer of the cervix.

 How to Diagnose? • All cases should be suspected to cytological examiation from the cervical smear to exclude dysplasia OR Malignancy. • In doubtful cases colposcopy OR/and cervival biopsy should be consider. • Per speculum Examination:Reddened area around the external os with its inner margin continous with endocervical lining and with well difined outer margin.

 Miasmatic Diagnosis:Syco-Syphilitic Taint.Why ? • due to process of chronic inflamation and Hyperplasia of local tissue followed by desquamation of epithelium.

• Asymptomatic chronic cervicitis and erosion do not require treatment. • Auxillary Mode of Treatment:private part hygiene,take nutritous food(hypovitaminosis) • Remove irritating device like contraceptives,tampons,pessaries. • Diathermy cauterisation. • Cryosurgery. • Laser Therapy.

 Repertory Part: 1.Kent Repertory: Chapter:-Genitalia-Female Rubrics:Swollen,Subrubrics:Uterus SubSubrubrics:Cervix 2.Repertory of Herring guidings symptoms: Chapter:Female sexual organs  Rubrics:Leucorrhoea,Subrubrics:Cervical(Cross ref.-Uterus)  Rubrics:Leucorrhoea,Uterus.Subrubrics:1)Cervical. 2)From Glandular portion of cervix 3)Leucorrhoea in pregnancy

3.Boericke's Repertory: Chapter:Female sexual organs Rubrics:Leucorrhoea in pregnant women. Concomitants:Subsubrubric:Cervical erosion,bleeding easily. Rubric Cervix:Inflammation,Redness 4.Phatak's Repertory: Rubric:Cervix,Subrubric:Erosion. 5.Clinical Repertory by Dr Clarke Chapter :Clinical repertory Rubric:Cervix,affections of.

5.Phatak's Repertory: Rubric:Cervix,Subrubric:Erosion. 6.Uterine Therapeutics by Minton: Chapter:Leucrrhoea Rubric:1)Cervical 2)Chronic 7.Murphy Repertory: Chapter:Female Rubric:Discharge,Subrubric:1)Cervical,excoriation with. 2)Pregnancy,during.

Rubrics:Cervicitis,inflammation of cervix. Subrubrics:bleeding easily Subrubrics:Excoriation with. 8.Synthesis Repertory: Chapter:Female Genitale 1)Rubrics:Inflammation,Subrubric:Cervix(Acute) Subsubrubric:Chronic 2)Rubrics:Erosion of cervix,Subrubric:bleeding easily with leucorrhoea. 3)Rubrics:Leucorrhoea,pregnancy during.