General

Question 1

Advice and management in lactational mastitis

Answer 1

Continue breastfeeding or expressing
- breastfeed often
Apply cold packs after a feed to reduce swelling and relieve pain
If symptoms or signs not resolving in 24-48 hours commence abx.
- dicloxacillin 500mg qid for 5-10 days
If not resolved with abx - evaluate for abscess formation

Question 2

55 yr Male, constipated, anal pain, some bleeding on toilet paper for last 5 weeks.

Dx and rx

Answer 2

anal fissure
consider crohns, infection-proctitis , anal carcinoma if ongoing for > 8 weeks.

RX:
Conservative: treat constipation, use salt/sitz barths after bowel motion
GTN 0.2% ointment 1cm into anal canal 3-4x per day

Can use totical diltiazem
other options if ongoing> injection with botulinum toxin, surgical sphincterotomy

Question 3

35 female. Strains when passing stool. Recent lump on wiping, bleeidng and mild itch.

dx and rx

Answer 3

haemorroid most likely

Internal haemrrodis cause bleeding, pain itch, prolapse. External dont unless thrombosed.

RX: adequate hydration, fibre, avoid straining, resoind to urge to defecate not trying to initiate.

To improve pain - proctosedyl : hydrocortisone and cinchocaine &raquo_space; wash hands after use.