104 105 Breast Disorders and complications of gym procedures Flashcards
Lymphatic drainage of the Breast is primarily to the
Axilla
What are the systemic diseases associated with hyperprolactinemia
Chronic renal failure (diminished capacity to clear circulating prolactin), hypothyroidism, hypercortisolism, acromegaly
When do breasts normally in gorge from pregnancy,?
On the 3rd to 5th postpartum day
Association between nipple pain and topical nefedipime
Reynards phenomenon can cause nipple pain in response to this medication
When does perpeural mastitis occur
Commonly present in the second postpartum week due to milk stasis and retrograde infection
Most common pathogens associated with mastitis
Staff aureus and 40% of cases and E. coli and strep are also common species consider MRI essay with abscess
At what point can you give lactating mothers Bactrim
On the infant is greater than two months old
How often do breast abscesses complicate mastitis
Only 3% of cases
Initial first line treatment for breast abscess
Ultrasound guided drainage
Treatment for mastitis with abscess
Add clindamycin or oral cephalosporin for MOur essay, Vanco myosin is also a good choice for septic patients or inpatient hospitalization
In addition to mastitis what other conditions do you have to exclude
The car is inflammatory breast condition such as cellulitis, hidradenitis super Teva, inflammatory breast cancer
When is acute mastitis or breast abscess and a non-lactating woman most commonly seen
Diabetics, smokers, obesity.
What others tests should you consider in a patient with mastitis
Follow up mammography for patients older than 30 years old And after the acute infection phase has resolved
When should you consider inflammatory breast cancer In a patient with mastitis
If there is not an initial good response antibiotics or breast cellulitis or abscess fails to completely resolve
Characteristics of nipple discharge that is not suggestive of cancer
Bilateral, occurs with a nipple manipulation, and can be expressed from several ducts.
When is nipple discharge concerning for cancer
Originates in a single breast, emanates from a single duct, and it’s clear, the pink, bloody, or serosanguineous
Epidemiology and features of intraductal papilloma
Unilateral bloody nipple discharge in women from 20 to 40 years old
What is Mondor’s disease
It is a superficial thrombophlebitis of the breast that presents with a painful palpable quarter mass in the superficial tissue.
Treatment for Mondor’s disease
NSAIDs and possibly low molecular weight heparin after a hematology consultation
If you suspect a benign breast mass, what physical exam shines should prompt surgical surgical referral
Lymphadenopathy, skin ulceration, mass fixation to the chest wall, fixed axillary notes, in the presence of ipsilateral arm Adema
How much blood count extravasate into the traumatized breast parenchyma?
Up to 1.5 L
Rate of breast implant complications
About 6%.
Treatment for breast implant complications/infection
For sick or impatience, use vancomycin with gentamicin. For outpatient treatment tetracycline and doxycycline recommended
Silicone versus saline implant rupture
Celine is clearly detected in physical exam because it becomes deflated this is typically painless and can be done outpatient follow-up. Silicone reps is more difficult to diagnose and have to be done ultrasound and MRI. The treatment is surgical but patient should be assured that there’s no danger from silicon leakage
Postoperative fever timeline
Versus water occurring 3 to 5 days postop, Then is walking on postoperative day four to six, wound usually seven days after surgery
And patients undergoing fertility treatment why Do you defer the pelvic exam to the gynecologist
Possibility of rupturing and large ovarian follicles
Air from insufflated carbon dioxide and laparoscopic surgery should be completely absorbed by what day
Postoperative day number three
What should be the first thing on your mind with patients that have greater than expected pain after laparoscopic surgery
It is about Bowel injury until proven otherwise
What is the most easily miss complication of laparoscopic surgery
A thermal injury
What are the main complications of laparoscopic surgery
Bal injury, thermal injury, vascular injury, urinary tract injuries, such as fistula, incisional hernia’s in dehiscence, and finally wound infection.
What is the most feared complication of using carbon dioxide gas to for distention during laparoscopic
Gas embolism
Management of patients with vaginal cuff cellulitis or pelvic abscess
Admit patients for parenteral antibiotics and possible drainage by interventional radiology or colpotomy
What is the classic patient description when they describe dehiscence or evisceration?
A pop or tearing sensation
Timeline for dehiscence of abdominal surgeries and vaginal cuff dehiscence
Dehiscence after down the surgeries happens between postoperative days five and eight while vaginal cavity has occurs approximately 1.5 to 3.5 months after hysterectomy
Management of the essence or evisceration
Cover the abdomen with moist sterile towel that support the dressing the tape to prevent further got extrusion
When do you suspect a ureteral injury after surgery
And women who develop flank pain
When do vesicovaginal fistula’s normally happen after surgery
10 to 14 days after with watery vaginal discharge
How to confirm the diagnosis of vesicovaginal fistula?
Inserting a cotton tampon into the vagina and then instilling methylene blue or indigo Carmen die be a trans urethral catheter if the tampon stands blue official is present if ureterovaginal fistula is suspected, rule out by injecting 5 mL of the die IV
Prevalence of postoperative DVT
11 to 25%
How to treat septic pelvic thrombophlebitis
Anticoagulation and parenteral antibiotics
What is a proprietary solution available to control post conization bleeding
Monsell solution
What are the most common complications of induced abortion
Retail price of conception, and a traders, uterine perforation, cervical laceration
How serious is a translocated intrauterine device in the abdominal cavity
This is serious and may lead to life-threatening complications therefore urgent surgical removal by gynecology has to be done
