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Case 8 > Anatomy of Breast > Flashcards

Anatomy of Breast Flashcards

1
Q

Which quadrant is most likely to have cancerous tumours?

A

Superior lateral

Due to axillary process making it the largest quadrant

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2
Q

What is the arterial supply of the breast?

A
  • Perforating branches of internal thoracic
  • Mammary branches of lateral thoracic
  • Mammary branches of intercostal arteries
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3
Q

Where do the veins of breast drain into?

A

Axillary + internal thoracic vein

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4
Q

Where do the lymphatic from breast drain?

A

Mostly axillary nodes

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5
Q

What is the innervation of the breast?

A

Anterior + lateral cutaneous branches of 4th-6th intercostal nerves
N.B Nerves DO NOT control milk secretion

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6
Q

Which connective tissues support the breast?

A

Fibrous CT = Coopers ligaments

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7
Q

What tissues are the breast made of?

A

Glandular + adipose

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8
Q

Why is it easier to pick up tumour shadows in elderly females?

A

As females age, breast loses some glandular elements + becomes less dense on mammogram

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9
Q

Describe breast development

A
  • Until puberty, immature breast = rudimentary lactiferous ducts
  • Oestrogen stimulates ductal elongation + bifurcation
  • Progesterone stimulates formation of spherical masses of epithelial cells at end of each duct
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10
Q

What is the lobes, lobules and duct system of the breast?

A
  • Each breast divided into lobes by fibrous septa
  • Lobes drain into 10 major lactiferous ducts
  • Lobes divide into lobules - each contains certain no. alveoli + ducts
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11
Q

Which cells produce milk?

A

Acini cells in alveoli

Contraction of myoepithelial cells squeezes alveoli and ejects milk

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12
Q

How many lactiferous ducts are there?

A

10 major ones

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13
Q

What changes take place during pregnancy?

A
  • Increased size due to hypertrophy + prolif. of ducts (oestrogen) + alveoli (oestrogen + progesterone)
  • Terminal alveolar cell differentiate into secretory cells
  • Sebaceous glands become hypertrophied = Montgomery’s tubercles
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14
Q

What happens in stage 1 of lactogenesis?

A
  • Prolactin usually inhibited by dopamine
  • Oestrogen acts at hypothalamic level to increase prolactin secretion
  • Lactose, casein and alpha-lactalbumin
  • Full milk secretion prevented by increased levels of progesterone (interferes with prolactin)
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15
Q

How do you treat breasts engorged with milk due to termination after week 22?

A

Administer dopamine agonist

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16
Q

What happens in stage 2 of lactogenesis?

A
  • Birth = sudden drop in oestrogen, progesterone + hPL
  • Increase prolactin = cue
  • Increase milk vol
  • Increase in lactose, IgA, lactoferrin + oligosaccharide
17
Q

What happens in stage 3 (glactopoiesis) of lactogenesis?

A
  • Suckling coordinates release of prolactin (anterior pituitary) + oxytocin (posterior pituitary)
  • Switch from endocrine to autocrine control (due to placental removal)
18
Q

What is galactokinesis?

A
  • Discharge of milk during suckling + contractile mechanism expresses milk from alveoli > ducts
  • Suckling increases release of prolactin + oxytocin
19
Q

How is the release of oxytocin from posterior pituitary stimulated?

A

Impulses passes via spinal cord + brainstem to hypothalamus

20
Q

How is excess milk production prevented in galactopoiesis?

A

Prolactin uptake inhibited in full alveoli

Alveolus full of milk > walls expand + alter shape of prolactin receptors > reduced milk synthesis

21
Q

What is the fat content of milk determined by?

A

How empty breast is

Emptier breast = high fat milk

22
Q

What infant risk factors impair lactation?

A
  • Birth by vacuum
  • Tongue tie
  • Hyperbilirubinemia
  • Hypoglycemia
23
Q

What maternal risk factors impair lactation?

A
  • Total labour 14+ hours
  • C-section
  • Inverted nipples
  • T1D
  • Obesity
  • Multiple births
  • Smoking
24
Q

How can breastfeeding act as a contraceptive?

A
  • Lactational amenorrhea
  • Supresses ovulation
  • Disrupts pulsatile release GnRH from hypothalamus and therefore LH from pituitary
25
Q

What is the composition of milk at 1 week?

A
  • Colostrum
  • Sticky, yellowish, low in fats + lactose
  • Rich in proteins, minerals and Vit A,D,E,K
  • Immunoglobulins
  • Laxative (to remove babys meconium)
26
Q

What is the composition of milk at 3 weeks?

A
  • Mature composition
  • Calorific value increases
  • High in fats, sugar and amino acids
27
Q

Why do babies find it hard to digest cows milk?

A

Contains proteins = caesein hard cuts

28
Q

What is the most abundant sugar in milk and how is it synthesised?

A
  • Lactose
  • Synthesis depends on alpha-lactalbumin
  • Promotes growth intestinal flora
29
Q

What are the immunological benefits of breast milk?

A
  • Antimicrobial
  • Anti-inflam
  • Immunomodulating
  • Large amounts of IgA prevent bacterial + viral colonisation of GIT
  • IgM responsible for early stages of immunity (before sufficient IgG)
30
Q

What causes infants immunity to be vulnerable in the first year?

A
  • During preg, maternal transfer of IgG protects baby

- After birth - period of time where baby’s own IgG hasn’t been exposed to anything yet so no own antibodies

31
Q

What are the functions of lactoferrin?

A
  • Blocks adsorption/penetration of virus and adhesion bacteria
  • Intestinal growth + repair
  • Decreases production IL-1,2,6 and TNF-alpha
32
Q

Compare the immunological components of breastmilk vs formula

A

Breast: IG’s, lysozyme, lactoferrin, alpha-lactalbumin, casein + GF’s, cytokines + chemokines
Formula: alpha-lactalbumin + casein

33
Q

What are the elevated risks for infants not being breastfed?

A
  • Childhood obesity
  • T1/2D
  • Leukaemia
  • SIDS
  • Diarrhoea or Constipation
  • Infections
  • Allergic diseases
34
Q

What are the elevated risks for mothers who don’t breastfeed?

A
  • Premenopausal breast cancer
  • Ovarian cancer
  • Retained gestational weight gain
  • T2D
  • Myocardial infarction
  • Metabolic syndrome
35
Q

What are the risks of formula feeding for babies under 1?

A
  • Increased risk lower resp tract infection (lipids in human milk appear to have antiviral activity against RSV)
  • Increased risk otitis media

Case 8 (8 decks)

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