Breast Flashcards
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characteristics of referred mastalgia
- Exacerbated by exercise
- Unilateral
- Chest wall tenderness
- Pain is very lateral/ medial in the breast
- Can be reproduced by pressure in area of chest wall
treatment of referred mastalgia
- Reassurance
- Topical NSAIDS
- Last resort steroids or local anesthetic
characteristics of true breast pain
- Worse before onset of menstruation
- Exacerbated by hormones
treatment of true breast pain
- Reassurance
- Well fitted bra
- Low fat diet (increased hormones)
- Tamoxifen
- Mammogram
- USS for any women with focal breast pain
possible causes of referred breast pain
- Intercostobrachial nerve to inner aspect of arm
- T3-T5 nerve irritation
Chronic Breast Pain from Surgery: Neuropathic pain from scar tissue, intercostobrachial neuralgia - Gabapentin - Amitriptyline - Pregabalin - Electrical current
theories for true breast pain
- Too much estrogen/ prolactin
- Not enough progesterone
- Increased receptor sensitivity in breast tissue/ abnormal fatty acids
(more sensitive to effects of estrogen) - High caffeine intake? (overstimulation of breast cells by methylxathines)
stages of breast life
development
cyclical activity
involution
what is ANDI
aberration of normal development and involution
normal breast development
- Breast tissue is identical until puberty in males and females
- Growth begins at 10
- Initially asymmetrical
- No biopsy at young age damage to breast bud
- Lobules and ducts and glandular tissue are supported by fibrous tissue and stroma
aberration in breast development stage
Juvenile hypertrophy
Fibroadenoma
cyclical activity
- Normal hormonal changes cause localized benign nodularity
- Common reason for referral as ‘lump’
- Peak age 30-40
- Old terms: fibroadenosis/ fibrocystic disease
- Pregnancy results in doubling of breast mass
- Breast involutes after pregnancy
involution
Breast stroma is replaced by fat so breast is less radiodense, softer and more droopy
Fibroadenoma
- what type of abberation
- clinical features
developmental
highly mobile
rubber lump
management of a patient with fibroadenoma who is <25
discharge
management of a patient with fibroadenoma who is 25-35
core biopsy and discharge if biopsy is benign
management of a patient with fibroadenoma who is 35
core biopsy and excise
what must you be precautious about with fibroadenomas
phyllodes tumour: Tumor of stroma, epithelium lining cells of glands in breast- can be malignant
- Histology
- Rapid growth
- > 3cm
juvenile hypertrophy management
investigations only needed if there is sexual maturation
breast reduction if it causes pain and discomfort
lobular cyst
- what type of aberration
- clinical features
involution
smooth, discrete lump
management of lobular cyst
aspirate FNA
send fluid for cytology if theres blood or residual lump
what is duct ectasia
dilated shortened ducts in involution that become blocked
clinical features of duct ectasia
nipple discharge and inversion
management if duct ectasia
reassurance
surgery only if symptomatic discharge or want the nippled everted
nipple inversion vs retraction
inversion is benign and reversible
retraction is malignant and irreversible and asymmetrical
fluid distribution in the body
1/3 extracellular
2/3 intracellular
what consists of extracellular fluid
transcellular, interstitial and plasma
characteristics of water movement in the body
osmosis- water moves from areas of high water concentration to low water concentration areas
characteristics of water movement in the body
osmosis- water moves from areas of high water concentration to low water concentration areas through a semipermaeble membrane equalizing solute concentrations on either side of the membrane
types of passive diffusion
simple and facilitated
average total body water
42L
Osmolality
Osmolar concentration of a solution when it is expressed as osmoles/ kg of water
o Number of osmotically active partilces per kg of solvent
Osmolarity
Osmolarity: osmolar concentration of a solution expressed as osmoles/ L of water
o Number of osmotically active particles per litre of solution
Osmotic Gradient
difference in osmolarity of two solutions on either side of a semi permeable membrane
what are the three types of fluids
hypertonic, hypotonic and isotonic
Hypertonic fluid
water moves out of the cell
hypotonic fluid
water moves into the cells
isotonic
no movement of water
blood colloid osmotic pressure/ oncotic pressure
osmotic pressure exerted by proteins in the blood vessel plasma (usually pulls water into vessels)
filteration action and why
Fluid exits capillaries
Capillary hydrostatic pressure is greater than blood colloid pressure osmotic
what are the two pressures that determine which way substances move in the body
hydrostatic pressure
blood colloid osmotic pressure
no net movement action and why
No movement
Cap hydrostatic pressure = blood colloid pressure
reabsorption action and why
Fluid re-enters capillary Capillary hydrostatic pressure is less than blood colloid odmotic pressure
main hormone in fluid balance
ADH
organs involved in fluid balance
o Kidneys
o Heart
o Hypothalamus
o Pituitary gland
what happens when there is a high Na concentration in the blood (ADH)
osmoreceptors pick up high Na, posterior pituitary releases ADH, targets cells in collecting duct to reabsorb water
outcome of ADH
reduces osmolarity, increases plasma volume and decreases urine output
fluid balance vs fluid status
fluid balance: fluid in vs. out
bal
fluid balance vs fluid status
fluid balance: fluid in vs. out
status: how hydrated you are in a certain point in time
fluid input sources
oOral fluids oIV fluids oIV medication fluid oIV flushes for cannula oEnteral/ Parenteral feed
fluid output sources
oUrine output
- Urine appearance (urine darkens with time so not always accurate if youre checking their catheter bag)
oDrains, stomas, NG tubes
oFaeces
oSerial weights
oInsensible losses (sweat etc- can loose upto 600ml in good health)
assessment of fluid status
History
Examination
Lab results
Put in vs. out (fluid balance charts
what is normal urine output
- 0.5ml/kg/hr
- Roughly 30-35ml/hr
anuria
less than 100ml urine a day
oligouria
less than 400ml urine per day
3 reasons we give fluids
- Resuscitation
- Routine maintenance
- Replacement- replace increased losses
causes of dehydration
output of fluid is greater than input
o Not taking in enough fluids (unable to tolerate oral fluids)
o Loosing too much fluid
- Stomas
- Diaherria
- Insensible losses like sweating with fever
symptoms of dehydration
o Feeling thirsty
o Confusion
o Headache
o Dizziness
signs of dehydration
o Sunken eyes o Sunken fontanelles in babies o Skin mottling o Dry skin o Delayed cap refill o Skin turgor o Tachycardia o Hypotension o Pyrexia o Orthostatic hypotension
complications of dehydration
o Acute Kidney Injury o Confusion o Falls o Skin Wounds o Infection o DVT
causes of fluid overload
Fluid overload occurs when fluid input exceeds fluid output
o Blood products
o Too much fluid given
symptoms of fluid overload
shortness of breath
signs of fluid overload
o Increased JVP o Peripheral edema legs o Crackles at lung bases o Increased weight o Ascites
complications of fluid overload
o Cardiac dysfunction (heart failure)
o Respiratory dysfunction (pulmonary edema)
o Multi-organ dysfunction
