breast Flashcards
who gets breast abscesses?
3-11% of women with mastitis
who gets mastitis?
lactating women
causes of breast abscess
complication of mastitis
why do lactating women get mastitis?
milk stasis causes inflammatory response - may or may not progress to infection
2 catagories of infection accompanying mastitis
central/subareolar - secondary to periductal mastitis or duct ectasia
peripjeral nonlactating infection - associated w DM, RA, trauma, corticosteorids treatment and granulomatoius lobulsr mastitis
risk factors obreast abscess
risk of mastitis:
- lactating women w poro infant attahcment, reduced feed numbers
smoking, nipple damage, trauma, breast abnormality, immunosuppression, shaving, foreign body
previous mastitis cessation of breast feeding staph A carriage poor socioeconomic status poor hygiene
presentation of breast abscess
prev hsitory of mastitis
fever or general malaise
painful swollen breast lump
redness heat and swelling of overlying skin
signs on examination of breats abscess
lump may be fluctuant with skin discolouration
investigations for breast abscess
USS
culture fluid from asbcess
tretment of breast abscess
drainage of abscess by US guided needle aspiration or surgcal drainage
advise lactating women to continue breastfeeding if possible - or with hand or pump
who gets fibrocystic disease
women on child bearing age
30-60% women, 70-90% lifetime prevlence
causes of fibrocystic disease
hormone levels probably as susbsides after menopause
risk factors for fibrocytsic disease
women 30-50 yo
birth control lowers liklihood
HRT increases risk
presentation of fibrocystic disease
non cancerous breast lumps sometimes discomfort periodically - related to menstrual cycle breast or nipples tender or itchy thickening of tissue
signs on examiantion of fibrocystic disease
smooth lumps with defined edges and free moving
found upper outer section of breast
investigations of fibrocystuc disease
possibly mammogram or MRI if really suspicisus
treamtent of fibrocystic disease
most dont require invasive treatment
symptomatic treatment mainly - painjillers, supportive bra, warm or cold compression
ductal papilloma - who gets it
2-3% incidence
women over 40 yo
develop naturall as breast changes
what is ductal papilloma
benign breast tumour
causes of ductal papilloma
breast aging and changes 0- small benign tumour forms in milk duct in breast
made of gland and fibrous tissue as well as blood vessels
risk factors of ductal papilloma
central types develop near the nipple
women nearing menopause
peipheral types are often multiple papillomas in younger omwne
presentation fo ductal pailloma
bloody nipple discharge (20-40yo)
dont show up on mamography de to size + cant be palpated
notice small lump or discharge or blood stained fluid from nipple
intraductal papillomas arent normally painful
dont increase risk of breast cancer
investigations for ductal papilloma
found by chance on routine breast screening
refer for triple assessment
FNA or core needle biopsy
treatment of ductal papilloma
excision sometimes
microdochectomy (removal of breast duct) is treatment of choice
total duct excision is possibility to find all ducts
who gets breast carcinoma
200x more in females
50,000 new cases per year in UK
v common
risk factors of breast carcinoma
family history increasing age alcohol diethylstilboestrol (syntheitc oestrogen - prostate cancer) oestrogen-progesterone contraceptives HRT radiation obesity genetics - BRCA1/2 early menarche short or longer cycles first baby over 30 yo
what reduces risk of breast carcinoma
breast feeding
presentation of breast carcinoma
breast lump
- painless (most of time)
- nipple symptoms - changes in shape, nipple bleeding
- changes in skin - tethering, peau d’orange
signs on examination of breast carcinoma
breast lump or thickening
change in size, shape or appearanc eof breast
changes in skin - dimpling
newly inverted nipple
peeling, scaling or flaking of areola or breast
redness or pitting of skin
investigations for breast carcinoma
triple assessment
imaging
FNA or biopsy
clinical examination
P1-5
Examination - inspection , palpation
M1-5
imaging - mammogrpahy, ultrasound
B1-5
histology - core biopsy, invasive vs in situ
treatment of breast carcinoma
excision - wide or local or mastectomy
followed by chemo and/or radiotherapy
tamoxifen for 5 years after - competitively competes w oestrogen for ER in breast tissue
aromatase inhibitors instead which block production of oestrogen
