BREAST & PELVIC EXAM Flashcards
the breast runs from the __________ to the _____________
clavicle to the 6th rib generally
grape like clusters of tissue that secrete milk
alveoli cells
route of milk in the breast to the nipple
alveoli > duct > intralobar duct > lactiferous duct & reservoir > nipple
the breast structurally consists of ____, ______________________, & _____________
fat
fibrous connective tissue
glandular tissue
role of estrogen in the breast
stimulates growth and proliferation of the ductile system
role of progesterone in the breast
stimulates growth and development of ductile and alveolar secretory epithelium
each breast has ______ - _________ lobes
15-25
Cooper’s ligaments
fibrous tissue ligaments that extend from the outer boundaries of the breast to the nipple area in a radial manner (like spokes on a wheel).
Help maintain structural integrity.
Provide support to the breasts and help them maintain their shape.
They fix the breast from the skin to the pectoral fascia
each lobe has grapelike clusters (alveoli or glands) which are connected by
ducts
the alveoli are lined with __________ which produce ______________ under the proper hormonal influences
secretory cells
produce milk under the proper hormonal influences
lactiferous ducts EACH communicate to the nipple
- The lactiferous ducts EACH communicate to the nipple - the do NOT combine to a single duct before arriving at the nipple (this is important because this allows ducts to still release milk even if one duct is blocked - therefore won’t affect entire nipple)
Montgomery’s Tubercles
small bumps or projections on the areolar surface (these are sebaceous glands that keep the nipple area soft and elastic)
BREAST EXAM TECHNIQUES
Before starting, have:
- Adequate lighting
- Ruler/tape measure if needed
- Small pillow or folded towel (especially helpful with large breasted women)
- If nipple discharge is present, guaiac testing. (Cytology not recommended)
- Patient with gown opening down back
- Warm hands !!
LYMPH NODE PALPATION
⦁ make sure pt is in a comfortable position with their arm relaxed; use your other forearm to support her arm (gown can be covering the chest
⦁ don’t forget to palpate supra & infraclavicular nodes
upon inspection of the breasts
- first have patient in sitting position with arms hanging loosely to the sides
⦁ inspect & compare breasts for size, symmetry, contour, skin color & texture, venous patterns, and lesions
⦁ life breasts to inspect lower & lateral aspects
⦁ inspect nipples for inversion or retraction
⦁ inspect areolas for color & contour
inversion vs retraction of nipple
Inversion=tethered by single duct
Retraction= entire nipple
reinspecting the breasts in varied positions
1) seated with arms flexed above head or at neck
2) seated with arms at waist and shoulders rolled forward
3) seated and leaning forward at waist
seated & leaning forward at waist helps with
this can be particularly helpful in assessing contour and symmetry of large breasts
seated with arms flexed above head helps with
adds tension to the suspensory ligaments and may accentuate dimpling in a pt with breast CA
Bimanual digital palpation of the breast
Palpation performed while patient is seated. One hand is placed, palmar surface facing up, underneath the breast. The other hand then palpates the tissue feeling for masses while compressing the tissue between fingers and flat hand
- using a towel or small pillow is especially helpful in
large breasted women
supine position (preferred) breast palpation
Patient lies on back and places one arm behind her head. A small pillow or folded towel can be placed under the shoulder to spread the breast tissue more evenly over the chest wall. Breasts then palpated each individually. Extend exam peripheral to where you think is edge of breast. (Clavicle, upper axilla, lateral sidewall, sternum and lower anterior chest wall)
EXAM TECHNIQUES
- concentric circles
- lawnmower
- radial spokes
If you discover a mass, do more than just palpation with fingerpads to delineate; Once you find a lesion,
try to compress the lesion between fingerpads & feel for mobility (this may be easier with the woman sitting up)
the ___________ are more sensitive for palpation than the ___________
fingerpads are more sensitive than fingertips
most nipples are
everted
but one or both nipples may be inverted (in these circumstances it is important to ask about lifetime history of inversion)
breast shape (3)
- conical
- convex
- pendulous
supernumerary nipples
Supernumerary nipples and tissue may arise along the “milk line”
a good way to write a note regarding masses
= “no dominant masses palpable bilaterally”
Most women have “lumpiness” referred to as
nodularity
define the mass in relationship to the
time on the clock
peau d’orange
edema of the breast which occurs from blocked lymph drainage in advanced or inflammatory carcinoma
what causes peau d’orange
have advanced or inflammatory carcinoma, and lymph node drainage is blocked –> orange peel like appearance of breast
Paget’s disease of the nipple
Paget’s disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola
PREPARING FOR THE PELVIC EXAM (3)
Empty bladder - remind the patient ahead of time to pee before coming; consider offering the patient another opportunity prior to exam
Warm speculum (but not too warm - don’t want to burn the patient)
Appropriate position; The more abducted the hips, the easier the exam. NEVER force the legs apart
hip flexion & abduction position
lithotomy position
butterfly position; legs bowed like a frog, feet touching
diamond shaped position
ducts/glands between the vagina & the anus
Bartholin’s glands / ducts
ducts/glands between urethral orifice & the vagina
Skene’s glands / ducts
In many women, you won’t be able to inspect the labia minora well unless
you spread apart the labia majora
placing the speculum
1) retract the labia minora laterally
2) avoid the urethra by downward pressure on the posterior vaginal introitus
3) angle the speculum about 30-40 degrees downward towards the sacral promontory - “scoop”
