Cervical Smear2

8/8/2019 Cervical Smear2

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have a look at this site.................

http://www.cervicalscreening.gov.hk/english/hp/hp_taking/hp_taking.php

REQUIREMENTS-good light-gloves-speculum-spatula-glass slide-pencil-fixativerequest form-slide box for transport-couch

-sheet /blanket to cover the ptEXPLANATION AND HISTORYexplain to the ptcheck menstural history,discharge,abnormal bleeding,family history-complete personal detail and history of section on request form-consider having a chaperon is present especially if examiner is a male-write name and no on glass slide and place glass slide uppermost close to hand-if slide is not used dispose of in sharp bin

POSITION OF PTask woman to lie in dorsal position-lubricate speculum e water if necessary-expose the external genitalia by flexing the hips and knees-pages r then abducted e the ankles kept close together INTRODUCING SPECULUMintroduce speculum at 45 degree to te normal opening position-insert speculum gently pointing towards the small of the back -after initial insertion rotate gently through 45 degree into the position for opening theinstrumentAPPEARANCE OF CXnote the appearance of cx,any discharge or bleeding-check for any polyps,ulceration or cysts-note the shape and appearance of external osTAKING THE SMEAR insert the endocervical brush or the long arm of Ayre s spatula into external osrotate the handle through 360 degree to collect cells from the endocervical junctionFIXING THE SMEAR the harvested cells r applied to a glass slide immediately

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-the both sides of the ends of spatula is stroked along the glass surface-if using endocervical rush this is rotated gently over the slice-the material is then covered e a cell fixative to prevent air drying of the cells-remove the speculum being careful not to trap the cx-the slide is then placed in a box for transport and sealed in a plastic bag along e

completed request form

Explanation of cervical smear results:

Cervical smear results Significance/ Meaning Possible actionsInadequate

Insufficient cells on the slide or suboptimal preparation of the slide Repeat smear Normal (negative) No abnormal cells identified Routine follow up



Inflammatory Cells could not be seen clearly due to infection, inflammation or irritationof the cervix Treatment and repeat smear in some casesASCUS (Atypical Squamous Cells of Undetermined Significance)Borderline cell changes.

This means that slight cell changes were seen but they were so near normal that they are probably nothing to worry about. Majority of these changes will revert to normal on their own Repeat smear within 3-6 months. Remember to go for your repeat smear and don¡¦tassume that these changes will go back to normal. If changes persist or become worse,you may need treatment.LSIL (Low grade Squamous Intraepithelial Lesion)

Mild cell changes in your cervix. 85% will regress spontaneously over 2 years; about15% will worsen. 0.1% will become invasive if left ignored. Need colposcopy ¡Ó biopsy.Treatment may be Necessary.

HSIL (High grade Squamous Intraepithelial Lesion)Moderate or severe cell changes. There is 1-2% chance of becoming invasive cancer if untreated. Need colposcopy ¡Óbiopsy. Treatment is usually necessary after confirmation.After successful treatment, you are unlikely to have cervical cancer, if you continue tohave regular cervical smears.Invasive carcinoma Found cells with features suggestive of invasive cervical cancer Urgent referral to gynecologist for investigation and treatmen

95 perform a cervical smear.I will greet the patient, introduce myself, and explain the procedure and purpose of it.Tell her that is not painful, but may be a bit uncomfortable, make sure that she is notmenstruating now, and she did not use spermicide or lubricant jelly in the previous 24hrs. Then:Wear gloves; prepare the slide (write the name of the patient, date and time of takingspecimen with pencil not pen, where writings disappear with fixation). And prepare thefixator (50/50 mixture of alcohol and ether).Hold Cusco’s bivalve speculum with the right hand and separate the labia with the lefthand (do not lubricate with jell). Tell the patient that you are introducing the speculumand ask her to relax. Gently insert the speculum on its lateral side and when you are inturn it up for 90؛. Handle anteriorly when patient in supine position and fix it. Try toidentify the cervix and use the notched end of spatula and rotate it 360؛ to scrape off cellsfrom cervical os. Spread the sample on the slide and fix it immediately with the preparedfixator (50/50 mixture of alcohol and ether), either put a drop or put the slide in acontainer with the fixator. You should not allow the sample to dry.Tell the patient that you finished and you are going to take speculum out. Take it out inthe same way. Give a towel to the patient to wipe herself.



N.B: If there is discharge:1. If any ulcer, take swab from base of ulcer.2. If chlamydia infection is present, take the swab from the cervix.3. If there is vaginal discharge, take swab from fornix.4. Send for cervical smear and examine under microscope (unstained for Trichomonas

vaginalis, Stained for gonorrhoea, and thrush).

Cervical Smears

The idea of a cervical smear is to detect pre-cancerous cells so that they can be removed before they become dangerous.

A doctor or nurse using a spatula takes a scraping of cells from the cervix (neck of thewomb) and "smears" the cells in a thin layer on a glass slide. After staining with aPapanicolaou stain ("Pap" - named after George Nicholaus Papanicolaou 1883-1962, whointroduced the system), the cells are examined by a cytologist in a laboratory who willcheck for signs of pre-cancerous change. Each slide contains between 300,000 to 400,000cells and takes about 10 minutes to scrutinise.

A new 'Pap' smear technique such as "ThinPrep", which originated in the USA and isnow available in the UK, involves placing the cells in a small vial of preservative rather than smearing them on a slide. The vial goes to the laboratory where a high quality slideis prepared after impurities, such as red and white blood cells, are filtered out. The cellsin the preserving fluid can also be tested for human papillomavirus (HPV) to look for high risk sub-types.

The doctor or nurse will try to obtain cells from the cervix where the skin (squamous)cells on the outside meet the gland (columnar) cells on the inside of the canal. This junction is called the Transformation Zone (T.Z.) and it is here that cancers most oftenstart. A good quality smear will therefore contain both sorts of cells to prove that the T.Z.has been sampled correctly.

Five to ten percent of all smears may be inadequate or unsatisfactory, usually becausethere are not enough cells on the slide for a comprehensive report. The cells may beobscured by blood if the smear was taken near to a period or covered in debris and white blood cells if some inflammation is present. In these cases, the smear is repeated,sometimes after any infection is treated.

Rarely, the smear will contain cells which suggest that precancerous changes havealready progressed into cancer, or that there is disease in the glandular lining of thecervical canal, and urgent investigations are required.



Dysplasia/DyskaryosisThe cytologist examining the slide will look for pre-cancerous changes in the cells knownas dyskaryosis or dysplasia. There are four types:

BorderlineMildModerateSevereIn borderline smears there is a slight abnormality of the cells and their nuclei. A repeatsmear after an interval of around 6 months is usually requested. In the United States borderline changes are known as 'Atypical Squamous Cells of Uncertain Significance'(ASCUS).

Essentially, the nucleus in the centre of the cell gets bigger and the jelly around thenucleus (cytoplasm) gets smaller. These changes are sometimes caused by certain strains

of the Human Papilloma Virus (HPV) or "wart" virus.Mild Dysplasia/DyskaryosisAbout 50% of women with mild dysplasia will have their changes revert to normal if youwait 6 months. So women with a smear showing mild changes will be asked to have arepeat smear 6 months later. If mild changes persist on the second smear, those womenwill undergo further assessment by colposcopy. Mild dyskaryosis in the United States isknown as a 'Low-grade Squamous Intraepithelial Lesion' (LSIL).

Moderate or Severe Dysplasia/DyskaryosisWomen with smears showing moderate or severe pre-cancerous changes will be referredfor colposcopy as they have a significant risk of proceeding to cervical cancer if leftuntreated. Moderate or severe dyskaryosis is known in the United States as a 'High-gradeSquamous Intraepithelial Lesion' (HSIL).

Cells showing pre-cancerous changes show no special features to the naked eye. A cervixwhich contains these cells will look normal. Pre-cancerous cells do not cause anysymptoms, and may remain dormant for several years before proceeding to cancerouschange i.e. start nibbling into the tissue beneath.

InfectionsOccasionally, cervical/Pap. smears show up infections such as candida (thrush) or trichomonas (T.V.). However, smears are not used to look for infections. They are usedto screen large populations of women for signs of pre-cancerous changes.

Sometimes, red or white blood cells obscure the cells on the smear and may be reportedas "bloodstained" or "inflammatory" respectively.



H.P.V. ("wart virus") changes may also result in inflammatory or unsatisfactory smearsand the cytologist may request a repeat smear to be taken at a later date.

DO WE NEED TO DRAPE?

2.CAN WE THANK AT THE END?3.SHOULD THE SPECULUM BE RUN UNDER HOT WATER awnsers.1.no2.not to manikin, but can mention to examiner that i will thank the pt.3.mention that if it was a real pt. i had run it under warn water to normalise temp. close to body temp.

never forget chaperon + ask her to empty bladder b4 doing pv+smear

CUSCO VAGINAL SPECULUM WITH SIDE CREW

BI-Cusco Speculum

Cusco Speculum



ProSpec Disposable Vaginal Speculum

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Cervical Smear2