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Surgery > Breast > Flashcards

Breast Flashcards

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1
Q

characteristics of referred mastalgia

A
  • 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
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2
Q

treatment of referred mastalgia

A
  • Reassurance
  • Topical NSAIDS
  • Last resort steroids or local anesthetic
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3
Q

characteristics of true breast pain

A
  • Worse before onset of menstruation

- Exacerbated by hormones

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4
Q

treatment of true breast pain

A
  • Reassurance
  • Well fitted bra
  • Low fat diet (increased hormones)
  • Tamoxifen
  • Mammogram
  • USS for any women with focal breast pain
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5
Q

possible causes of referred breast pain

A
  • 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
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6
Q

theories for true breast pain

A
  • 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)
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7
Q

stages of breast life

A

development
cyclical activity
involution

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8
Q

what is ANDI

A

aberration of normal development and involution

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9
Q

normal breast development

A
  • 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
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10
Q

aberration in breast development stage

A

Juvenile hypertrophy

Fibroadenoma

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11
Q

cyclical activity

A
  • 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
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12
Q

involution

A

Breast stroma is replaced by fat so breast is less radiodense, softer and more droopy

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13
Q

Fibroadenoma

  • what type of abberation
  • clinical features
A

developmental

highly mobile
rubber lump

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14
Q

management of a patient with fibroadenoma who is <25

A

discharge

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15
Q

management of a patient with fibroadenoma who is 25-35

A

core biopsy and discharge if biopsy is benign

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16
Q

management of a patient with fibroadenoma who is 35

A

core biopsy and excise

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17
Q

what must you be precautious about with fibroadenomas

A

phyllodes tumour: Tumor of stroma, epithelium lining cells of glands in breast- can be malignant

  • Histology
  • Rapid growth
  • > 3cm
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18
Q

juvenile hypertrophy management

A

investigations only needed if there is sexual maturation

breast reduction if it causes pain and discomfort

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19
Q

lobular cyst

  • what type of aberration
  • clinical features
A

involution

smooth, discrete lump

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20
Q

management of lobular cyst

A

aspirate FNA

send fluid for cytology if theres blood or residual lump

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21
Q

what is duct ectasia

A

dilated shortened ducts in involution that become blocked

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22
Q

clinical features of duct ectasia

A

nipple discharge and inversion

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23
Q

management if duct ectasia

A

reassurance

surgery only if symptomatic discharge or want the nippled everted

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24
Q

nipple inversion vs retraction

A

inversion is benign and reversible

retraction is malignant and irreversible and asymmetrical

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25
Q

fluid distribution in the body

A

1/3 extracellular

2/3 intracellular

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26
Q

what consists of extracellular fluid

A

transcellular, interstitial and plasma

27
Q

characteristics of water movement in the body

A

osmosis- water moves from areas of high water concentration to low water concentration areas

28
Q

characteristics of water movement in the body

A

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

29
Q

types of passive diffusion

A

simple and facilitated

30
Q

average total body water

A

42L

31
Q

Osmolality

A

Osmolar concentration of a solution when it is expressed as osmoles/ kg of water

o Number of osmotically active partilces per kg of solvent

32
Q

Osmolarity

A

Osmolarity: osmolar concentration of a solution expressed as osmoles/ L of water
o Number of osmotically active particles per litre of solution

33
Q

Osmotic Gradient

A

difference in osmolarity of two solutions on either side of a semi permeable membrane

34
Q

what are the three types of fluids

A

hypertonic, hypotonic and isotonic

35
Q

Hypertonic fluid

A

water moves out of the cell

36
Q

hypotonic fluid

A

water moves into the cells

37
Q

isotonic

A

no movement of water

38
Q

blood colloid osmotic pressure/ oncotic pressure

A

osmotic pressure exerted by proteins in the blood vessel plasma (usually pulls water into vessels)

39
Q

filteration action and why

A

Fluid exits capillaries

Capillary hydrostatic pressure is greater than blood colloid pressure osmotic

40
Q

what are the two pressures that determine which way substances move in the body

A

hydrostatic pressure

blood colloid osmotic pressure

41
Q

no net movement action and why

A

No movement

Cap hydrostatic pressure = blood colloid pressure

42
Q

reabsorption action and why

A

Fluid re-enters capillary Capillary hydrostatic pressure is less than blood colloid odmotic pressure

43
Q

main hormone in fluid balance

A

ADH

44
Q

organs involved in fluid balance

A

o Kidneys
o Heart
o Hypothalamus
o Pituitary gland

45
Q

what happens when there is a high Na concentration in the blood (ADH)

A

osmoreceptors pick up high Na, posterior pituitary releases ADH, targets cells in collecting duct to reabsorb water

46
Q

outcome of ADH

A

reduces osmolarity, increases plasma volume and decreases urine output

47
Q

fluid balance vs fluid status

A

fluid balance: fluid in vs. out

bal

48
Q

fluid balance vs fluid status

A

fluid balance: fluid in vs. out

status: how hydrated you are in a certain point in time

49
Q

fluid input sources

A 
oOral fluids
oIV fluids
oIV medication fluid 
oIV flushes for cannula 
oEnteral/ Parenteral feed
50
Q

fluid output sources

A

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)

51
Q

assessment of fluid status

A

History
Examination
Lab results
Put in vs. out (fluid balance charts

52
Q

what is normal urine output

A
  • 0.5ml/kg/hr

- Roughly 30-35ml/hr

53
Q

anuria

A

less than 100ml urine a day

54
Q

oligouria

A

less than 400ml urine per day

55
Q

3 reasons we give fluids

A
  • Resuscitation
  • Routine maintenance
  • Replacement- replace increased losses
56
Q

causes of dehydration

A

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

57
Q

symptoms of dehydration

A

o Feeling thirsty
o Confusion
o Headache
o Dizziness

58
Q

signs of dehydration

A 
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
59
Q

complications of dehydration

A 
o	Acute Kidney Injury
o	Confusion 
o	Falls
o	Skin Wounds 
o	Infection
o	DVT
60
Q

causes of fluid overload

A

Fluid overload occurs when fluid input exceeds fluid output

o Blood products
o Too much fluid given

61
Q

symptoms of fluid overload

A

shortness of breath

62
Q

signs of fluid overload

A 
o	Increased JVP
o	Peripheral edema legs
o	Crackles at lung bases
o	Increased weight
o	Ascites
63
Q

complications of fluid overload

A

o Cardiac dysfunction (heart failure)
o Respiratory dysfunction (pulmonary edema)
o Multi-organ dysfunction

Surgery (6 decks)

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