Mastitis

Question 1

what is lactational mastitis?

Answer 1

inflammation of the mammary glands

Question 2

what is nonlactational mastitis

Answer 2

benign inflammation of the breast, can mimic breast cancer

Question 3

s/s of mastitis

Answer 3

red, tender, swollen, painful breast, may feel lump (clogged milk duct)

+/- systematic s/s like fever, tachycardia, fatigue and malaise

Question 4

pathophys of mastitis

Answer 4

1. milk stasis
2. clogged duct
3. introduction of bacteria from nipple
4. infection
5. mastitis

Question 5

what are some common scenarios that could increase the risk of mastitis occuring?

Answer 5

Common scenarios to poor milk drainage: infrequent feeding, an oversupply of milk, rapid weaning, illness in the mother or child, and a clogged duct

Question 6

what are some RF to having mastitis?

Answer 6

1. hx of mastitis
2. Nipple cracks and fissures
3. Inadequate milk drainage – poor feeding +/- pumping
4. Maternal stress and lack of sleep
5. Tight-fitting bras
6. Antifungal nipple cream

Question 7

how to ix and tx mastitis?

Answer 7

clinical diagnosis based on s/s
- if severe s/s can consider breast milk culture and blood culture for sepsis
- if concern for abscess, consider doing an breast u/s

to treat, encourage mom to keep clean and keep feeding baby either via nipple or pump milk
- heat to encourage milk let down, and cool for edema and swelling
- NSAIDs for pain
- refer to lactation consultant

if no improvement, consider giving abx

Question 8

common bacteria for mastitis

Answer 8

staph aureus
MRSA
E.coli

Question 9

how is milk produced

Answer 9

during pregnancy, increase in progesterone, human placental lactogen, estrogen stimulate milk duct development/growth, and the beginning of milk production occurs via prolactin but is largely supressed by progesterone

dopamine can also act as a prolactin inhibitor on the level of the anterior pituitary

after pregnancy, the placenta is removed which is a large source of progesterone, and that removes the inhibition, and milk can now be released with stimulation

Question 10

explain milk let down

Answer 10

1. baby suck
2. stimulate hypothalamus
3. oxytocin release from post pitutiary and prolactin release from ant pituitary
4. milk released and continues to be produced

Question 11

explain breast feeding as a contraceptive

Answer 11

prolactin is an inhibitor of GnRH ➔ no FSH/LH ➔ no ovulation ➔ no pregnancy

Question 12

what are some contraindications to breast feeding?

Answer 12

1. infections - HIV, herpes if active lesion
2. implants
3. certain medications - chemotherapy, heroin

smoking is not recommended
if alcohol, wait 2h before feeding or dump the milk out

fetal contraindications
- PKU
- Galactosemia: unable to fully break down the simple sugar galactose