abnormal breast pathology Flashcards
what is lactational mastitis?
- Inflammation of breast tissue and common complication of breast feeding
can be an infection
what is the pathophys of lactational mastitis?
obstruction in duct and accumulation of milk regularly expressing breast milk can prevent this from happening
- Can be caused by infection – bacteria can enter nipple and back-track into ducts causing infection and inflammation – staph.a
how does lactational mastitis present?
- Breast pain and tenderness (unilateral)
- Erythema in focal area of breast tissue
- Local warmth and inflammation
- Nipple discharge
- Fever
what is conservative management of lactational mastitis?
Conservative: continue to breastfeed, breast massage, express milk, heat pack, warm shower, simple analgesia
what medication can be used within lactational mastitis?
- Flucloxacillin, Erythromycin if pen allergic
fluconazole if candida infection
what complication can arise from lactational mastitis?
: breast abscess is rare complication – may need incision and drainage
when would candida of the nipple likely occur?
can occur after a course of Abx
what can candida of the nipple lead to?
can occur after a course of Abx can lead to recurrent mastitis
how does candida of nipple lead to recurrent mastitis?
- Skin will crust and crack on nipple entrance for infection
what conditions in baby are linked to candida of nipple?
- Linked to oral thrush and candidal nappy rash in infant
how does candida of nipple present?
- Nipple tenderness and itching
- Cracked, flaky/ shiny areola
what are symptoms of candida in nipple in baby?
- Symptoms in baby: white patches in mouth/ tongue, candidal nappy rash
how do you manage candida of nipple?
topical miconazole 2% to each nipple after each breastfeed, baby – nystatin
what is galactorrhoea?
refers to break milk production not associated with preg/ breastfeeding
what hormone triggers galactorrheoa?
prolactin
where is prolactin produced?
: prolactin is produced in anterior pituitary can be made in breast and prostate
how does dopamine affect prolactin?
- Dopamine blocks secretion of prolactin: dopamine antagonists (antipsychotics) can increase prolactin = galactorrhoea
how does milk production in breast feeding occur?
Breast feeding: milk production may only start in small amounts during second/ third trimester and small amounts may leak oestrogen and progesterone inhibit secretion of prolactin, oxytocin stimulates breast milk excretion
- Breast milk production will taper and stop once breastfeeding stops
what can cause hyperprolactinaemia?
Hyperprolactinaemia: raised prolactin level
- Idiopathic
- Prolactinomas – hormone secreting pituitary tumours
- Endocrine disorders: hypothyroidism and polycystic ovarian syndrome
- Medications: dopamine antagonists eg antipsychotics
if prolactin is suppressed by GRH, what other symptoms can be seen?
- Menstrual irregularities eg amenorrhoea
- Reduced libido
- Erectile dysfunction
- Gynaecomastia
why might prolactin suppressed by GRH by hypothalamus have other features?
Prolactin suppressed gonadotrophin-releasing hormone by hypothalamus leading to reduced LH and FSH
how do you manage galactorrhoea?
find underlying cause
- Dopamine agonists eg bromocriptine and cabergoline can help treat symptoms blocks prolactin
- Trans-sphenoidal surgical removal of pituitary tumour: definitive management of prolactinoma
what can cause non-milk discharge?
- Mammary duct ectasia
- Duct papilloma
- Pus from breast abscess
what is mammary duct ectasia?
benign condition where there is dilation of large ducts in breasts
- Ectasia means dilation: inflame in ducts leading to intermittent discharge from nipple may be white, grey, green
