curs amg 2013 vaginite,cervicite
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7/21/2019 Curs Amg 2013 Vaginite,Cervicite
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f.f. frecvente
dificultati terapeutice
frecvent forme cronice
Determinanti
*Germeni patogeni comuni – bacterii: gonococ, stafilococ, colibacil, enterococ,
anaerobi, perfringens,Chlamidia trachomatis
- virusuri: herpetic, limfogranulomatos, condiloma ac.
- paraziti: Trichomonas vaginalis- fungi: Candida albicans
*Infectii specifice – TBC, sifilis
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Favorizanti
*de mediu extern: frig, umezeala (congestie), traumatism (sexual),
ef. fizice, ortostatism, oboseala, subnutritie (anergie
*de mediu intern: congestia pelvina (M), org. vecine (constipatie cr.,
inf. urinare, b. hepatice, compresiuni), b. infect. ac/c
Sursele
a. Endogena: germeni saprofiti→patogeni b. Exogena: ag. Patogeni inoculati
S,N,L: EVD repetate, travalii lungi, interventii obstetricale, traumatisme
Avorturile: ± resturi, chiuretaj
Raporturi sexuale: BTS
Explorari: histerometria, dilatatia colului, HSG, extragerea/montarea DIU, BE
Caile: canaliculara (mucoase), sanguina, limfatica, contiguitate ←dig.
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Clasificare *infectii joase: vulvo-vaginita, cervicita
*infectii inalte: metrita, anexita, pelviperitonita,
celulita pelvina, peritonita generalizata
nexista mec. biol. de aparare (integritatea epiteliului vaginal, pH acid ← flora fiziol.
= bacili Döderlein, cel. epiteliale bogate in glicogen ← E)
epiteliu pluristratificat in continua descuamare superficiala (activitate sexuala)
Tulburarea echilibrului prin:
- traumatisme repetate (rap. sex, masturbare
- rupturi vulvoperineale, cervicale
- tumori
- corpuri straine
- disfunctii hormonale (pubertate,
menopauza)
- b. gen. (diabet)
- lipsa de igiena sau excesele
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Vulvita acuta: usturime, prurit, congestie, edem, secretie
cronica: leucoree
Ex. bacteriologic al secretiei + antibiograma
Vulvita acuta catarala – fetite
“ purulenta ← gonococ
Bartholinita
Vulvita TBC
Sifilis vulvar
Herpes
Zona zoster
Limfogranulomatoza benigna
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Frecvent asocieri vulva + vagin
Simptome.: leucoree, durere, arsura, prurit, dispareunie
FCB
Vaginita simpla eritematoasa
Vaginita granuloasa
Vaginita ulceroasa
Vaginita senila
Acuta
Cronica: papilomatoasa
*Trichomonas vaginalis ← Metronidazol (Flagyl) per os 1 g (4 cp) /zi,
10 zile, ambii parteneri, cp. vaginale 1/zi, 10 zilesau Fasigyn 2g doza unica ambii parteneri
*Candida albicans: favorizata de pH acid, Ab, CO, S,N, diabet, contact
sexual ← local irigatii Na2CO3, Stamicin, Canesten, Nistatin, Nizoral +
gen. Stamicin
*flora polimorfacreionase vaginale+ E in carente hormonale
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Clasificare
•Topografica: exo, endo, metrita
•Clinica: acuta, cronica
•Etiologica: nespecifica (bacterii, virusuri HPV, CMV)
specifica (TBC,sifilis,sancrul moale,limfogranulomatoza,actinomicoza,chist hidatic)
Etiopatogenie
Particularitati ale colului ← substratul histologic
*exocolul: epiteliu pavimentos nekeratinizat
*endocolul: epiteliu cilindric unistratificat
*zona de tranzitie: mare instabilitate celulara, atipii
Factori determinanti = ag. patogeni
Factori favorizanti: sex, avort, N + ruptura colului, M, prolaps, carente hormonale,
agresiuni fizico-chimice, igiena precara, contraceptie chimica sau mecanica
Cai de propagare:descendenta
ascendenta
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rara
eritematoasa
catarala
purulenta
fibrinoasa
ulcero-necroticamembranoasa
gangrenoasa
Simptome: leucoreegonococica
difterica
trichomoniazica
puerperala (streptococ, stafilococ)
foarte
frecventa
Simptome: leucoree
+ forme asimptomatice
eritematoasa
eroziva (ulcerata)
granulara (lenticulara)
ulcerovegetanta
chistica oua Naboth
scleroasa (atrofica)
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FCBCitologia cervico vaginala (FCD, test Babes Papanicolaou, Pap-test)
Test Hinselmann (acid acetic 3%)
Test Lahm Schiller (sol. Iodo-iodurata 1%)
Colposcopia
BiopsiaAspecte colposcopice:
Eroziunea
Ectopia = proliferarea mucoasei
endocervicale → epiteliul
pav. inlocuit cu cilindric
Zona de transformare
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1. Infectii specifice cervicaleTBC colului, sifilis (primar – sancrul dur, sec. - cel
mai contagios, tertiar – goma), sancrul moale (b.
Ducrey), limfogranulomatoza inghinala virala,
actinomicoza (abcese cu granule de sulf), chist hidatic
2. Displazii (= modificarea arhitecturii, aspectului cel.,
rap. normale) simple sau agravate (atipii);
colposcopic: leucoplazia, baza de leucoplazie, mozaic,zona rosie
3. Cancerul de col uterin
4. Endometrioza colului
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LentaPropagarea infectiei, sterilitate
Displazii, cancer
Profilactic
Curativ: gen.in inf. cu gonococ, trichomonas, candida;
local: ovule, DC
Formele rebele la trat.: conizatia, amputatia colului