Diagnosis And Management Of White Discharge Pv

DIAGNOSIS AND MANAGEMENT OF WHITE DISCHARGE PV K PRASHANTH

CAUSES • DYSPLASIAS&CA CERVIX- 80% of all genital cancers: 2nd most common cancer in females • CERVICITIS • EROSIONS • MUCOUS POLYPI • ECTROPION • INFECTIONS - PURULENT

APPROACH TO DIAGNOSIS • HISTORY • CLINICAL EXAMINATION ABDOMINAL PER SPECULUM PER VAGINAL • INVESTIGATIONS

INVESTIGATIONS • SECRETIONS vaginal swab microscopy culture & sensitivity • PART WHICH SECRETES per speculum colposcopy

TREATMENT • DYSPLASIA biopsy & decide • EROSIONS & CERVICITIS sologyn solution diathermy, cryotherapy conisation, laser therapy • ECTROPION - excision • POLYPI - avulsion

COLPOSCOPY • Endoscopic examination of the vagina & cervix with a magnification between 5 & 50x • aid in diagnosis, treatment, as well as follow up

Light source Individually moveable binocular eye pieces

Green filter to view blood vessels in detail Optics carrier

Objective lens Knob for tilt adjustment of optic carrier Height adjustment handle

Handle for fine focus and tilting* arrangement Colposcopic stand

Power cord of the examination lamp

Transformer Light switch

Dimmer for adjusting the brightness of the light

5-leg rolling pedestal

Swivel casters *for tilting the optics carrier

INDICATIONS • • • • •

Unhealthy cervix abnormal pap smear to obtain biopsy conservative treatment of CIN follow up of patients

METHODOLOGY • • • • • •

Lithotomy position Introduction of speculum mucus over the cervix swabbed with saline application of 5%acetic acid biopsy if needed cryo/conisation

ABNORMALITIES • • • • • •

Aceto white areas congestion punctation mosaic pattern cuffed gland openings changes in vascularity- cork screw pattern, etc

Modified Reid Colposcopic index A score of 0-3 indicates probable low-grade lesion; 4-8 indicates probable high-grade lesion.

Feature

0 point

1 point

2 points

Colour of acetowhite area (AW)

Low intensity acetowhitenting; snowwhite, shiny AW; indistinct AW; transparent AW; AW beyond the transformation zone

Gray-white AW with shiny surface

Dull, oyster-white; Gray

AW lesion margin and surface configuration

Feathered margins; angular, jagged lesions; Flat lesions with indistinct margins;microcondylomatous or micropapillary surface

Regular lesions with smooth, straight outlines

Rolled, peeling edges; internal demarcations (a central area of high grade change and peripheral area of low-grade change)

Vessels

Fine/uniform vessels; poorly formed patterns of fine and/or fine mosaic; vessels beyond the margin of transformation zone; fine vessels within microcondylomatous or micropapillary lesions

Absent vessels

Well defined coarse punctation or coarse mosaic

Iodine staining

Positive iodine uptake giving mahogany brown colour; Negative uptake of lesions scoring 3 points or less on above three categories

Partial iodine uptakevariegated, speckled appearance

Negative iodine uptake by a lesion scoring 4 or more points on the above three criteria

-

IDEAL PROTOCOL • • • • • • •

History & examination course of antibiotics if persistent, do colposcopy take biopsy of abnormal areas wait for histo-path report if CIN give cryo/conisation if invasive, radical surgery

PROTOCOL FOLLOWED • History & examination • do colposcopy • if abnormal areas present, assess the lesion clinically • take biopsy • give cryo/conisation • send them home with a course of antibiotics • if histo-path report says invasive, go for radical

DIFFERENCE one sitting in place of two immediate symptomatic relief better compliance better long term follow up

COLPOSCOPIC FEATURES OF NORMAL CERVIX

COLPOSCOPIC FEATURES OF PRECLINICAL AND CLINICAL INVASIVE CERVICAL CANCER

Bourgeon, surface du col désorganisée. Cancer invasif

No of colposcopies

12

Age group

30-50

Colpo positive

6

No. of biopsies taken

6

Positive biopsy, CIN I, CIN II

5 , 3 ,2

No of people given cryotherapy

5

ALSO... • Conisation can be done if the lesion is large • post cryotherapy profuse watery discharge usually occurs - reassure the patient • send the patient with a course of antibiotics • review with the histo-path report • try your level best for long term follow up

Cryotherapy equipment

Cryoprobes

1 0

1. Probe 2. Trigger 7

1

3

2

3. Handle Grip (Fiberglass) 4. Yoke 5. Instrument Inlet of Gas from Cylinder

8

6. Tightening Knob 7. Pressure Gauge Showing Cylinder Pressure 8. Silencer (Outlet)

SC J

Cryotip

SC J

9. Gas Conveying Tube 10. Probe Tip 6

4

5

8

9

Cervix Endocervix (cervical canal) SC J

Cryotherapy equipment components

Cryoprobe

SC J

Probe

Positioning of the cryoprobe tip on the ectocervix