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Peri-op > Breast Diseases with Discharge > Flashcards

Breast Diseases with Discharge Flashcards

1
Q

What is Mammary duct ectasia?

A

Benign condition of inflammation and dilation of the large ducts in the breasts

Leads to intermittent discharge from the nipple which may be white, grey or green

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2
Q

List 2 key risk factors for mammary duct ectasia

A
  1. Smoking
  2. Perimenopausal women
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3
Q

How does mammary duct ectasia present?

A
  • Nipple discharge
  • Tenderness or pain
  • Nipple retraction or inversion
  • Breast lump (pressure on lump may produce discharge)
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4
Q

How is a diagnosis of mammary duct ectasia made?

A
  1. Tripple assessment to exclude breast cancer (they present similarly)
  2. Ductography
  3. Nipple discharge cytology
  4. Ductoscopy
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5
Q

Key finding of mammogram of mammary duct ectasia

A

Microcalcifications

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6
Q

Management of Mammary duct ectasia?

A
  1. Reassurance after excluding cancer
  2. Symptomatic management of mastalgia
  3. Antibiotics if infection
  4. Surgical excision of affected duct (microdochectomy) in problematic cases
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7
Q

What is a intraductal papilloma?

A

Benign warty lesion that grows within one of the ducts in the breast due to proliferation of epithelial cells

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8
Q

How does an intraductal papilloma present?

A

Clear or blood-stained nipple discharge

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9
Q

How do intraductal papillomas present?

A
  1. Nipple discharge (clear or blood-stained)
  2. Tenderness or pain
  3. A palpable lump
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10
Q

How is a diagnosis of Intraductal papillomas made?

A
  1. Tripple assessment
  2. Ductography - papilloma will be seen in area with a “filling defect”
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11
Q

Management of Intraductal papillomas?

A

Complete surgical excision

After removal, tissues examined for things which may not have been picked up on the biopsy

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12
Q

Mastitis?

A

Inflammation of breast tissue

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13
Q

List the 2 key causes of Mastitis

A

Breastfeeding ‘lactational mastitis’ - obstruction and accumulation of milk in the ducts. Regularly expressing breast milk can help prevent this

Infection - Staphylococcus aureus is most common

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14
Q

What is a key risk factor for infective mastitis?

A

Smoking!!!

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15
Q

Typical presentation of mastitis or a breast abscess?

A
  1. Unilateral breast pain and tenderness
  2. Erythema, swelling, warmth and inflammation
  3. Purulent nipple discharge
  4. Hardening of the skin or breast tissue
  5. Fever
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16
Q

Management of lactational mastitis

A

Managed conservatively → conti breastfeeding, expressing milk and breast massage. Heat packs, warm showers and simple analgesia can help symptoms

Antibiotics if infection is suspected or symptoms do not improve

17
Q

Management of non lactational mastitis?

A
  1. Analgesia
  2. Antibiotics
  3. Treatment of underlying cause
18
Q

Antibiotics of choice in non-lactational mastitis?

A

Flucloxacillin for 10-14 day

(Erythromycin if penicillan allergic)

19
Q

What advise regarding breast feeding should you give regarding mastitis or a breast abscesses

A

Continue breastfeeding

It will not harm the baby and will help resolve the mastitis or abscess by encouraging flow

20
Q

Rare complication of mastitis is not adequately treated?

A

Breast abscess - may need surgical incision and drainage

21
Q

What infection may cause recurrent mastitis?

A

Candidal infection of the nipple, often after a course of antibiotics

Can lead to recurrent mastitis, as it causes cracked skin on the nipple that creates an entrance for infection

22
Q

What effect may candida of the nipple have in the infant?

A

Oral thrush and candidal nappy rash

23
Q

How may candida of the nipple present?

A
  • Sore nipples bilaterally, particularly after feeding
  • Nipple tenderness and itching
  • Cracked, flaky or shiny areola
  • Symptoms in the baby
24
Q

Treatment of candida of the nipple?

A

Treatment for BOTH mother are baby with:

  • Topical miconazole 2% to the nipple, after each breastfeed
  • Treatment for the baby eg. oral miconazole gel or nystatin
25
Q

What is a breast abscess and what are the two types?

A

Collection of pus within an area of the breast, usually due to a bacterial infection. May be a:

  • Lactational abscess (associated with breastfeeding)
  • Non-lactational abscess (unrelated to breastfeeding)
26
Q

List the most common bacterial causes of a breast abscess?

A
  • Staphylococcus aureus
  • Streptococcal species
  • Enterococcal species
  • Anaerobic bacteria
27
Q

Key presenting features of a breast abscess?

A

Swollen, fluctuant, tender lump within the breast

+/- muscle aches, fatigue, fever, sepsis

28
Q

Management of a breast abscess

A
  1. Referral to the on-call surgical team
  2. Antibiotics
  3. USS
  4. Drainage
  5. MC&S of drained fluid

Peri-op (22 decks)

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