breast abscess/mastitis

Question 1

what is mastitis?

Answer 1

Mastitis is the inflammation of the breast tissue, which can be with or without an infection. When associated with lactation in postpartum women, the condition is specified as puerperal mastitis. Alternatively, mastitis can be seen in women who are not breastfeeding.

Question 2

is non-factional or lactational mastitis more common?

Answer 2

lactational

Question 3

RF for non lactational mastitis?

Answer 3

Cigarette smoking
Nipple rings
Diabetes mellitus
Immunocompromise

Question 4

what causes mastitis unrelated to preganacy and breastfeeding?

Answer 4

due to obstruction of the ducts from cellular debris. This can result in a local inflammatory response in non-infectious mastitis.

Question 5

what causes infectious mastitis?

Answer 5

In infectious mastitis, bacteria from the skin can then enter the ducts, causing inflammation and may progress to peri-areolar abscesses. The most common causative pathogen is Staphylococcus aureus.

Question 6

features of mastitis?

Answer 6

Localised symptoms: Painful, tender, red, and hot breast.
Systemic symptoms: Fever, rigours, myalgia, fatigue, nausea, and headache.
The condition is usually unilateral and tends to present within the first week postpartum.

In some cases, mastitis may develop into a breast abscess, manifesting as a fluctuant, tender mass with overlying erythema.

Question 7

what ix can you do for mastitis??

Answer 7

Ultrasound: Utilised to identify a potential abscess, appearing as a collection of pus.
Additional information: Early referral to secondary care is vital if an abscess is suspected.

Question 8

how do you manage mastitis?

Answer 8

analgesia, warm compress
abx - oral or IV
antifungals

Question 9

when should abx be considered in mastitis?
what abx given?

Answer 9

Antibiotics may be considered if acute pain, severe symptoms or symptoms lasting more than 12-24 hours, fever or positive cultures
Flucloxacillin or clindamycin for those with penicillin allergy
Treatment is indicated for 10-14 days.

In cases where the condition does not improve, consider intravenous antibiotics (i.e. vancomycin) or ultrasound to evaluate for the presence of a breast abscess.

Question 10

what anti fungal may be given for mastitis/?

Answer 10

nystatin for concomitant nipple candidiasis

Question 11

complications of mastitis?

Answer 11

Breast abscess
Recurrence:
More common if treatment is delayed or too short in duration