Chapter 20 Pathology Flashcards
Allodynia
Pain sensitization (increased responsiveness) following normally non-painful and often repetitive stimulation.
Ankyloglossia
Tongue tie, and then usually short, text, or type band of tissue the tethers the bottom of the tongue to the floor of the mouth and restricts the tongues range of motion
Areola
The pigmented portion of the breast surrounding the nipple
Axilla
Armpit
Cooper’s ligaments
Fibrous bands that fix the breast to underline pectoral fascia
Eczema
Skin condition characterized by itching, typically occurs in response to a topical irritant
Erythema
Abnormal redness in the skin
Exudate
Fluid that extrude or seeps out of injured tissue
Fissure
A division, split, or grove in tissue (in Lactation, the term specifically refers to the nipple)
Fluctuant
Subject to change, variable, movable, compressible
Inferior pedicle technique
Breast reduction surgery in which some portion of the breast remains intact
Mastitis
Inflammation of the breast
Montgomery glands
Sebaceous glands within the areola, surrounding the nipple
Nipple bleb
A small white spot on the tip of the nipple that looks like a tiny milk filled blister
Nipple translocation
Surgery in which the nipple is removed, the breast tissue is reduced, and the nipple is reattached
Plugged duct
Localized area of milk stasis, with distention of the breast tissue
Psoriasis
Skin condition with clearly demarcated plaques
Vesicle
A small fluid filled sac or blister
Breast evaluation
When there are concerns about milk production good to ask if there was a noticeable change in breast size during pregnancy and after birth.
It is normal for there to be minor differences in breast sides with the left breast often larger than the right.
The breast forms along the embryologic milk line which extends from the axilla to the groin.
Approximately 2 to 6% of women have accessory mammory tissue.
Polythelia refers to accessory nipple tissue and polymastia refers to accessory breast tissue.
The breast is fixed to the underlined pectoral fascia by Cooper‘s ligaments. Weakening of the bands may result in breast sagging. Sagging may occur because of breast changes during pregnancy and does not affect lactation.
There is great diversity in the size of the nipple and areola.
Inverted nipples result when the epithelial pit (during development) fails to revert. Nipples that appear flatten may not actually be inverted and can be observed and protruding when compression is applied behind the areola.
It is important to assess the nipple for any lesions which may suggest infection or trauma. Nipple fissuring is suggestive of sub optimal latch and should prompt further observation and assessment of infant feeding.
Macgomery glands
Ductile openings of lactiferous and sebaceous glands that appear on the areola. May become more prominent in Pregnancy and Lactation. Some secretion from these glands may occur this is normal. Rare circumstances glands may become obstructed and painful.
Prior breast surgery
Should pay attention to the location of scars. Those in the periareolar region are most concerning for potential insufficient milk production. Breast biopsy scars are typically small and can be either in the periareolar region or elsewhere. Breast biopsies for benign disease can usually breast-feed fine.
Breast augmentation can be performed using a variety of incisions. Implants can be placed via laparoscopic tunneling from the Periumbilical region so there are no visible breast scars. More commonly breast implants are placed from incisions in the axilla or inframmatory fold (under the breast) or periarolar incisions are use. Inquire about breast augmentation because there may be implants because of developmental failure if there is no underlying breast tissue. Most are for aesthetic reasons. Silicone implants are not a contraindication to breast-feeding.
Breast reduction surgery can be performed with a number of different techniques. One technique includes nipple translocation and then the nipple is reattached in this procedure there is circumferential periareolar incision. All ducts and nerves to the nipple are severed. With this procedure milk may still exit the nipples personally due to re-canalization.
Another method is to use the inferior pedicle technique. This can be identified by surgical scars around the edges of the areola and additional scar line extending downward from the inferior areola to the mid breast. Breast reduction is routinely associated with decreased milk production although it may still be possible.
Observation of breast and all four categories should be done too
Divide the breast in four quadrants. Document findings according to observations noted in the upper outer upper inner lower outer and lower inner. Note any significant breast asymmetry, wide spacing of nipples or breast tissue, nipples or areola that appear disproportionately large in relation to the breast, visible scars, piercings, or skin retraction.
Some parents may not mention prior breast surgery because they are not aware of its potential.
Observing the breasts can be very important in assessing infection. Mastitis typically results in breast erythema and cellulitis over laying the affected portion of the breast. Early mastitis may have a subtle color change so useful to gently touch and release skin. The red color the blanches upon release suggest erythema.
Warmth of the overlying skin can be useful in assessing for infection.
Palpitation
Palpating the breast will says for any masses that could result in a plug duct or an abscess. Useful to document the size, location, and mobility of the mass in addition to noting if any of the masses are tender.
Nipple pain
A common reason many women end breast-feeding earlier than intended.
There are many causes of nipple pain: during early breast-feeding some degree of breast as comfort is common, 73% of breast-feeding mothers experience pain on the first day of breast-feeding. Unclear why so many experience pain but it is likely that hormones and trauma related to learning correct latch and positioning are contributors.
Trauma to the nipples worsen pain and predisposed to paired to other complications. If persist pass the first few weeks of breast-feeding it deserves further evaluation. Optimizing latch and positioning remains the mainstay of nipple pain management. If parents are pumping or manually expressing milk it is important to assess their technique.
There is not sufficient evidence to support a particular treatment for nipple pain.
A careful history should be done: when did the pain begin and the nature in details of the pain. History of medical and pregnancy complications. History of prior breast-feeding experiences. History about the infant. Assessment should include: examination of the breast. Examination of the infants oral anatomy and a suck assessment.
An observation of a breast-feeding session or pumping.
Other causes of pain include nipple damage and trauma, dermatologic conditions, infections, vasa spasm, pain syndrome’s and breast drainage tissues such as plug ducts and over supply.