Breast Abscess/ Mastitis Flashcards
What is mastitis?
inflammation of the breast tissue
What is the most common cause of mastitis?
Breast feeding
What is a breast abscess?
A localised collection of pus occurring in the breast
What are the two types of mastitis?
1) obstructive mastitis
2) infective mastitis
What is obstructive mastitis?
Accumulation of milk blocking the ducts, causing inflammation
What is infective mastitis?
bacteria entering the nipple and moving into the ducts to cause infection
What percent of lactating women develop mastitis?
30%
When do most lactating women contract mastitis?
2-3 weeks postpartum
What percent of non-lactating women contract mastitis?
5-9%
What is the anatomy of the breast?
The breast contains breast lobules, each draining to a milk duct which empties to the surface of the nipple.
Injury to the nipple skin during breastfeeding provides an entry point for the bacteria to enter, resulting in mastitis which can progress to breast abscess. Inverted nipples predispose to breast infection due to obstruction of the ducts.
What is the most common causative bacteria of mastitis and breast abscesses?
Staphylococcus aureus
Give 5 clinical features associated with mastitis:
- Unilateral breast pain and tenderness
- Erythema in a focal area of the breast tissue
- Local warmth and inflammation
- Nipple discharge
- Fever
What are the 3 categories of breast infections?
- Lactational
- Non-lactational
- Granulomatous
What are the commonest organisms in non-lactational mastitis?
occurs in non-lactating women of any age. The infection is usually mixed, the commonest organisms are staph aureus, enterococci, and anaerobic bacteria.
What is granulomatous mastitis?
a rare breast infection which occurs in women with diabetes mellites, autoimmune diseases and sarcoidosis.
What are 4 risk factors for lactational mastitis?
- Changes in feeding regime
- Introduction of bottle feeding
- Poor attachment of the infant to the breast
- Maternal stress and fatigue
What are 6 risk factors for non-lactational mastitis?
- Smoking
- Inverted nipples
- Nipple piercings
- Skin conditions such as eczema
- Diabetes
- Immunosuppression
Name 4 differential diagnoses for mastitis?
- Engorged breasts
- Galactocele
- Breast cancer
- Fat necrosis of the breast
Describe the management for obstructive/blockage mastitis: (4)
conservative management
1) breast massage
2) heat packs
3) warm showers
4) analgesia
What antibiotic is used to treat infective mastitis?
flucloxacillin (refer to local guidelines)
What antibiotic is used to treat infective mastitis where the patient is allergic to penicillin?
erythromycin
What method can be used to identify the causative organism of mastitis and their sensitivities?
send of a milk sample to the lab for culture and sensitivity testing
Name two potential complications of mastitis:
- Breast abscess
- Candida of the nipple
How does candida of the nipple present in the mother?
bilateral sore, cracked nipples with flaky skin
When does candida of the nipple typically present?
after a course of antibiotics
How does candida of the nipple affect the baby (if breastfeeding)?
the baby may develop white patches in their mouth
How is candida of the nipple treated in the mother?
topical miconazole
What are the two categories of breast abscess?
1) lactational abscess (associated with breast feeding)
2) non-lactational abscess (unrelated to breast feeding)
What is the most common cause of breast abscesses?
matitis
Give 4 causative organisms of breast abscesses:
1) Staphylococcus aureus (most common)
2) Streptococcal species
3) Enterococcal species
4) Anaerobic bacteria
Describe the classic clinical presentation of breast abscess:
swollen, tender lump within the breast that may be fluctuant or hard
What does the term fluctuant mean?
fluid can be felt inside
What type of imaging can be used to diagnose a breast abscess?
ultrasound
Describe the management of breast abscesses:
1) antibiotics (co-amoxiclav for gram -, flucloxacillin for gram + or erythromycin if penicillin allergy)
2) drainage (often surgical)
What can non-lactational breast abscesses reoccurrence lead to?
periductal fistulas
