mengenali hasil abnormal pap dan iva (teori) dr.rizal s
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MENGENALI HASIL ABNORMAL PAP SMEAR DAN IVA
Dr. H. RIZAL SANIF, SpOG(K)
DEVISI ONKOLOGI BAGIAN/ DEPARTEMEN
OBSGIN FK UNSRI / RSMH
PALEMBANG
PASIEN EKSTRIM RISIKO RENDAH TES PAP (-)
VIRGIN
HISTEREKTOMI PENYAKIT BENIGNA
USIA > 65 TAHUN DAN LEBIH 10 KALI PAP
NORMAL
PASIEN RISIKO RENDAH KRITERIA:
1. SEKSUAL AKTIF USIA > 20 TAHUN : MULAI PAP 3 TAHUN SETELAH INTERCOURE PERTAMA
2. USIA < 21 TAHUN : PAP 3 TAHUN SETELAH INTERCOURSE PERTAMA:
a. PASANGAN SEKSUAL <3
b. KONSISTEN MEMAKAI BARIER KONTRA
c. TIDAK MEROKOK
d. PAP SEBELUMNYA NORMAL
e. TIDAK ADA RIWAYAT STD
PROTOKOL RISIKO RENDAH
1. PENAPISAN AWAL : TES PAP SETIAP TAHUN NORMAL SAMPAI 3 TAHUN
2. SELANJUTNYA (BILA PENAPISAN NORMAL) : SETIAP 2 ATAU 3 TAHUN
PASIEN RISIKO TINGGI
1. AKTIFITAS SEKSUAL USIA < 20 TAHUN
2. TIGA ATAU LEBIH PASANGAN
3. RIWAYAT HVP ATAU PENYAKIT AKIBAT HUBUNGAN KELAMIN (STD)
4. TES PAP SEBELUMNYA ABNORMAL
5. PECANDU ROKOK
PROTOKOL RISIKO TINGGI
PENAPISAN AWAL : 2 KALI SETAHUN
SELANJUTNYA SETIAP TAHUN
SETELAH HISTEREKTOMI REKOMENDASI UMUM : SITOLOGI VAGINA• TIDAK ADA RIWAYAT PAP ABNORMAL :
a. TIDAK PERLU PENAPISAN ATAU
b. PENAPISAN SETIAP 10 TAHUN
2. ABNORMAL PAP SEBELUMNYA :
a. PENAPISAN AWAL 3 TAHUN SETELAH
HISTEREKTOMI
b. SELANJUTNYA SETIAP 5 TAHUN
Inspeksi Visual dengan Asam Asetat (IVA)
Melihat serviks untuk mendeteksi abnormalitas setelah pemakaian asam
asetat
TEHNIK IVA
BANTUAN SPEKULUM SERVIKS
DITAMPAKKAN
SERVIKS DIPULAS DENGAN ASAM ASETAT 3 – 5 %
DINILAI: BERCAK PUTIH ( ACETO WHITE EPITHELIUM) POSITIF : LESI PREKANKER
Inspeksi Visual dengan Asam Asetat (IVA)Inspeksi Visual dengan Asam Asetat (IVA)
Epitel putih dengan asam asetatEpitel putih dengan asam asetat
Asam asetat
3-5%
Visualisasi
NIS
P. Osmolar
HipertonikEkstra seluler
Membrankolaps
DNA
Epitel putihasetat
SERVIKS NORMALASAM ASETTA TERKUMPUL
PADA JAM 6
TIDAK PERLU INTERVENSI MEDIK
PERLU PENAPISAN ULANG
Normal cervix, negative Acetic Acid Test (AAT), small condyloma
acuminatum on left vaginal wall (9 o'clock)
No medical intervention required.Call for re-screening according to established policy.
Normal cervix, negative AAT. Some degree of ectopy is visible and
subsequently, the squamo-columnar junction line is clearly visible. White
endocervical mucous is present.
No medical intervention required.Call for re-screening according to established policy
Severe postmenopausal atrophy of the squamous
epithelium, negative AAT.
Refer the patient to Primary Health Clinic for treatment if patient symptomatic.
Cervical polyp, negative AAT.
No medical intervention required.Call for re-screening according to established policy.
Normal cervix, negative AAT. Ectopy is present with metaplastic
epitheliumgrowing medially at 12 o'clock (containing crypt openings).
Posteriorly several "bands" of metaplastic epithelium are visible.
Outside the squamo-columnar junction line the transformation zone is visible
as a slightly white circular area.
Marked ectopy, negative AAT.
No medical intervention required.Call for re-screening according to established policy.
Nabothian cyst at 5 o'clock. Atypical acetowhite lesion at 11 o'clock extending up into
the canal - colposcopy indicated.
Take swab for culture (if facilities available).Refer the patient to Primary Health Clinic.
Atypical lesion anteriorly, positive AAT - repeat screening
in 6 month's time.
Refer the patient to Primary Health Clinic.
Acetowhite metaplastic epithelium anterior and
posterior. Atypical lesion at 12 o'clock (at the periphery)
Refer the patient to Primary Health Clinic.
Condylomata acuminata at 10 o'clock.
Refer the patient to Primary Health Clinic.
Negative with acetowhite metaplasia. Crypt openings are present within
metaplastic epithelium. At 1 o'clock Nabothian cyst is present (yellow).
False negative AAT
Refer the patient to Primary Health Clinic.
Normal with acetowhite metaplasia in the
transformation zone. False positive AAT.
Refer the patient to Primary Health Clinic.
Condylomata acuminata at 6 o'clock, acetowhite metaplasia
anterior.
Refer the patient to Primary Health Clinic.
Atypical acetowhite lesion extending up into the canal -
colposcopy and biopsy indicated.
Refer the patient to Primary Health Clinic.
Positive AAT. Probably normal, but a biopsy is desired in order
to rule out cancer.
Refer the patient to Primary Health Clinic.
Positive AAT. Probably normal, but abnormal blood vessels
indicate biopsy.
Refer the patient to Primary Health Clinic.
Low grade SIL (CIN I) at 12 o'clock with acetowhite metaplastic epithelium
posterior
Refer the patient to Primary Health Clinic.
Positive AAT, low grade SIL (condylomata acuminata).
Refer the patient to Primary Health Clinic.
Positive AAT, high grade SIL anterior (CIN II).
Refer the patient to Primary Health Clinic.
Positive AAT, high grade SIL (CIN III) at 5 o'clock. Acetowhite metaplastic
epithelium anterior.
Refer the patient to Primary Health Clinic.
Leukoplakia before application of acetic acid;
probably high grade SIL (CIN III).
Refer the patient to Oncology Centre.
Infiltrating cancer.
Refer the patient to Oncology Centre.
Infiltrating cancer.
Refer the patient to Oncology Centre.