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1. CASE PRESENTATION
GENERAL DATA
•E.N.
•41 years old
•G5P5 (5-0-0-5)
•Married
•Filipino
•Roman Catholic
•Agusan Del Sur
•Consulted June 10, 2016
CHIEF COMPLAINT
Left Lower Quadrant Pain
HISTORY OF PRESENT ILLNESS
PERIPHERAL
No leg cramps, varicose veins
VASCULAR
SYMPTOMS
None
ASSOCIATED
SEXUAL HISTORY
1ST SEXUAL
18 years old
CONTACT
# OF SEXUAL
2
PARTNERS
FORMS OF Natural (Withdrawal) and Barrier
CONTRACEPTION Method (Condom)
STD None
SYMPTOMS No dyspareunia
ASSOCIATED No post-coital bleeding
OBSTETRIC HISTORY
YEAR SEX OUTCOME MODE PLACE WEIGHT FMC
41 years old
Gravida 5 Para 5 (5-0-0-5),
Ovarian cyst, left probably
Endometriotic cyst
Rule out endometrial
pathology
PLAN
• Endometrial sampling done
• For cardiopulmonary clearance
• May go home
• DAT, increase OFI
• Diagnostics for :
• Pap Smear – done
• Complete blood count with platelet count, Urinalysis, Blood
Typing with Rh, Serum Na, K, Cl, BUN, Crea, Chest Xray, 12-L
ECG
• Definitive plan: for Elective total abdominal hysterectomy, left
salpingoophorectomy, right salpingectomy
Laboratory findings: June 13
CBC Value CBC Value
• Place the spatula firmly against the ectocervix with the long
projection extending into the endocervical canal
• Spatula is then rotated several times 360 degrees around the portion
and removed
Conventional Cytology
• Transfer is best performed by using the spatula to thinly spread
the cells onto the glass slide
• Endocervical canal is then sampled, using a conical cervical brush,
which is placed in endocervical brush, which is placed in the
endocervical canal so that the last few bristles remain visible and
then gently rotated 90-180 degrees once
Liquid based cytology
• The sample of (epithelial) cells is taken from the Transitional Zone; the squamo-
columnar junction of the cervix, between the ecto and endocervix.
• Liquid-based cytology uses an arrow-shaped brush, rather than the conventional
spatula. The cells taken are suspended in a bottle of preservative for transport to
the laboratory, where using Pap stains it is analysed.
Liquid-base Cytology
• A sample is obtained using a plastic spatula with either an
endocervical brush or a cervical broom in the manner of conventional
screening
• The sample is rinsed into a vial containing preservative solution
• The sample vial is capped, labelled and sent to the laboratory where
it is placed into a processor that gently mixes the sample to disperse
cells and break up any blood, mucus or non-diagnostic debris
• The sample is either centrifuged to produce a cell pellet or drawn
through a filter under negative pressure to collect cells
• It is fixed onto a glass slide and stained by the Papanicolaou staining
method for examination under a microscope.
Preparation
• Ideally, cervical screening should be scheduled when the patient is
not menstruating
• Proceed with screening even if the patient has bleeding or cervicitis
• Avoid vaginal intercourse, douching, use of tampons, use of vaginal
cream for 24-48 hours prior to cervical screening
Doing Pap smear (Conventional)
Positioning
• Privacy
• Buttocks just off table
• Good Lighting
• Drape
Padded Stirrups
• Soft, padded stirrups
• Oven mitts
• Socks
• Battle dressings
Inspection
• Spread labia
• Discharge
• Ulcers
• Growths
Vaginal Speculum
Warm Speculum
• Warm water
• Not too hot
• Lubricates speculum
• Don’t use K-Y, Surgilube
or Vaseline to lubricate
speculum
Insert Speculum
• Spread labia
• Keep labia apart
• Blades remain closed
until fully inserted
Squamo-Columnar Junction
• Junction of pink cervical skin
and red endocervical canal
• Inherently unstable
• Key portion of the cervix to
sample
• Most likely site of dysplasia
Sample Cervix
• Use concave end
• Rotate 360 degrees
• Don’t use too much force
(bleeding, pain)
• Don’t use too little force
(inadequate sample)
Cytobrush
• Insert ~ 2 cm (until brush
is fully inside canal)
• Rotate only 180 degrees
(otherwise will cause
bleeding)
Make Pap Smear
• As thin as possible
• Properly labeled
Spray with Fixative
• Within 10-15 seconds
• Allow to fully dry
before packaging
• Cytologic Fixative
(hairspray works
acceptably also)