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Surgery.(General 2).Breast > 6. Inflammatory conditions of female breast and duct ectasia > Flashcards

6. Inflammatory conditions of female breast and duct ectasia Flashcards

1
Q

Inflammatory Conditions of the Breast

A

Acute Inflammatory Conditions of the Breast

Chronic Inflammatory Conditions of the Breast

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2
Q

Acute Inflammatory Conditions of the Breast

A
  • Acute lactational mastitis

* Breast abscess

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3
Q

Chronic Inflammatory Conditions of the Breast

A
  • Chronic pyogenic breast abscess

* Mammary duct ectasia

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4
Q

Acute lactational mastitis

A
  • Etiology
  • Route of infection
  • Predisposing factors
  • Clinical picture
  • Treatment
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5
Q

Etiology of Acute lactational mastitis

A

Infection is caused by coagulase positive staphylococcus aureus

Less common by Streptococcus hemolyticus

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6
Q

Significance of coagulase positive staphylococcus aureus in Etiology of Acute lactational mastitis

A

The organism is claimed to induce clotting of milk in the ducts, producing obstruction and stasis

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7
Q

Route of infection in Acute lactational mastitis

A

Organisms from the mouth of the suckling infant gain access through:

  • nipple cracks
  • openings of the lactiferous ducts.
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8
Q

Predisposing factors ofAcute lactational mastitis

A
  • Milk engorgement
  • Abrasions to the nipples
  • Poor hygiene.
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9
Q

Pathogenesis of Milk engorgement in Predisposing factors ofAcute lactational mastitis

A

Caused by:

  • Inspissated milk
  • Epithelial debris that block the ducts.
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10
Q

Pathogenesis of Abrasions to the nipples in Predisposing factors ofAcute lactational mastitis

A

Caused by suckling

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11
Q

Clinical picture of acute lactational mastitis

A
  • Stage of milk engorgement صدري مزند
  • stage of acute mastitis
  • stage of acute abscess
  • stage of chronic abscess
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12
Q

Stage of milk engorgement in Clinical picture of acute lactational mastitis

A
  • Breast involvement
  • C/O
  • O/E
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13
Q

Breast involvement in Stage of milk engorgement in Clinical picture of acute lactational mastitis

A

This may affect the whole or a sector of the breast

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14
Q

C/O in Stage of milk engorgement in Clinical picture of acute lactational mastitis

A
  • Dull aching pain in the breast

* mild pyrexia.

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15
Q

O/E in Stage of milk engorgement in Clinical picture of acute lactational mastitis

A
  • Enlargement and induration of the breast

* but there are no physical signs of inflammation.

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16
Q

Stage of acute mastitis in Clinical picture of acute lactational mastitis

A
  • C/O

* O/E

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17
Q

C/O in Stage of acute mastitis in Clinical picture of acute lactational mastitis

A
  • The pain gets worse

* There is continuous higher pyrexia

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18
Q

O/E in Stage of acute mastitis in Clinical picture of acute lactational mastitis

A
  • Breast:

* Axillary L.N

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19
Q

Breast O/E in Stage of acute mastitis in Clinical picture of acute lactational mastitis

A
  • Diffuse (or localized according to immune response) swelling & induration of the breast.
  • Redness, hotness, and tenderness.
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20
Q

Axillary L.N O/E in Stage of acute mastitis in Clinical picture of acute lactational mastitis

A

Enlarged, firm & tender.

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21
Q

Stage of acute abscess in Acute lactational mastitis

A

Pain is throbbing.

Temperature is hectic.

Pitting edema is elicited in the area of the skin overlying the abscess.

Do not wait for fluctuation.

Purulent discharge may be present.

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22
Q

The reason why we don’t wait for fluctuation instage of acute abscess in acute lactational mastitis

A

Fluctuation is late as abscess is deep

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23
Q

Treatment of Acute lactational mastitis

A

(A) Before the development of an abscess )> medical treatment

(B) Abscess formation )> incision and drainage

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24
Q

Medical treatment of acute lactational mastitis

A
  • Antibiotics against staphylococci :
  • Support of the breast helps to lessen pain.
  • Local heat.
  • To wean or not
25
Q

Antibiotics against staphylococci in Medical treatment of acute lactational mastitis

A
  • Augmentin (amoxicillin/clavulanic acid)
  • 1 gm / 8 hrs better I.V.
  • No improvement > 2 days indicates abscess formation
26
Q

To wean or not in Medical treatment of acute lactational mastitis

A

if the baby has been nursed for > 9 months :

If the baby is younger than 9 months

27
Q

if the baby has been nursed for > 9 months in Medical treatment of acute lactational mastitis

A

Weaning is done by:

Bromocriptine ( Parlodel )

2.5 mg twice daily

for 10 - 14 days.

28
Q

If the baby is younger than 9 months

A

a. The patient is asked:
1. to use the healthy breast for feeding and
2. to regularly empty the inflamed breast by squeezing or by a breast pump.
b. After resolution of infection the baby can be re-fed by both sides.

29
Q

No improvement with medical treatment in acute lactational mastitis more than 2 days indicates

A

abscess formation

30
Q

Treatment of abscess in acute lactational mastitis

A
  • Incision and drainage

* Antibiotic therapy may be continued for a few days.

31
Q

Incision and drainage in Treatment of abscess in acute lactational mastitis

A

Types of incisions

Procedures

32
Q

Types of incisions in Treatment of abscess in acute lactational mastitis

A
  • Radial incision
  • Circumareolar incision
  • Counter incision
33
Q

Procedures of Incision and drainage in Treatment of abscess in acute lactational mastitis

A

Under general anesthesia.

Radial or the more cosmetic circumareolar incision is made over the most tender area.

Counter incision must be done in non dependable area.

The surgeon’s finger breaks down the septa between the loculi to form single cavity.

A drain is brought out through the wound.

34
Q

Indication of Counter incision in Procedures of Incision and drainage in Treatment of abscess in acute lactational mastitis

A

In deep abscess

35
Q

Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A
  • Alternative name
  • Pathogenesis
  • Clinical picture
  • Differential Diagnosis
  • Investigations
  • Treatment
36
Q

Alternative name for Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

37
Q

Pathogenesis of Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A
  • This results of improper treatment of an acute abscess

* The bacteria are killed, yet the sterile pus remains in the abscess cavity with excess fibrous tissue formation.

38
Q

Improper treatment of an acute abscess in Pathogenesis of Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A

by prolonged use of antibiotics

or

drained by a small incision instead of adequate surgical incision

39
Q

Clinical picture of Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A

Hard breast mass.

Nipple retraction or skin puckering.

40
Q

Differential Diagnosis of Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A

Breast carcinoma

41
Q

difference between cancer breast andchronic pyogenic breast abscess

A

a chronic breast abscess is:

  • more painful
  • accompanied by low grade pyrexia.
42
Q

Investigations of Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A

Triple assessment

43
Q

Treatment of Chronic pyogenic breast abscess in Chronic Inflammatory Conditions of the Breast

A

Excision and sent for histopathology.

44
Q

Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A
  • Alternative name
  • Etiology
  • Pathology
  • Clinical picture
  • Differential Diagnosis
  • Investigations
  • Treatment
45
Q

Alternative name for Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

plasma cell mastitis

46
Q

Etiology of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

Unknown but found to be more common in smokers.

47
Q

Pathology of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A
  • Dilatation of the major ducts beneath the areola

* associated with periductal inflammatory reaction

48
Q

Pathogenesis of Dilatation of the major ducts beneath the areola in Pathology of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

filled with pultaceous creamy secretions

49
Q

Pathogenesis of periductal inflammatory reaction in Pathology of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

in the form of:

  • plasma cell infiltration
  • fibrous tissue reaction
50
Q

Clinical picture of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A
  • Age
  • Breast lump
    .
  • Nipple discharge
  • Acute inflammation (less common)
51
Q

Age in Clinical picture of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

45-60 years old

52
Q

Breast lump in Clinical picture of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A
  • The affected area is hard

* may be associated with skin dimpling and nipple retraction simulating carcinoma.

53
Q

Nipple discharge in Clinical picture of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

The discharge is creamy, pultaceous & is of any colour

54
Q

Acute inflammation in Clinical picture of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A
  • Less common

* Small abscess and mammary fistulae (Associated with anaerobic bacteria).

55
Q

Differential Diagnosis of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

breast carcinoma

56
Q

Investigations of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

triple assessment

57
Q

Treatment of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A

Hadfield’s operation

58
Q

Hadfield’s operation in Treatment of Mammary duct ectasia in Chronic Inflammatory Conditions of the Breast

A
  • Major duct excision through a circumareolar incision

* Sent for histopathology

Surgery.(General 2).Breast (8 decks)

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