S11C108 - Breast Disorders

Question 1

Causes of increased prolactin (resulting in galactorrhea)

Answer 1

-physiologic: pregnancy, sz, sex, sleep, stress, exercise
-chest wall stimulation: surgery, trauma, herpes
-damage to pituitary stalk
-neoplasM: prolactinoma, RCC, lympoma, hydatidiform mole
-meds: antidepressants, antihypertensives, antipsychotics
-systemic dz: chronic renal failure, hypothyroid, suching, acromegaly
(renal failure is a cause b/c of lack of clearing circulating PRL)

Question 2

Puerpal Mastitis

Answer 2

• bacterial infection of of breast glands, occurs in first few montsh of BFing
• f/c, myalgias, erythematous region on breast, well-localized, tender
• bugs: staph aureus, e coli, strep
• tx: frequent emptying, hand washing, analgesia, do not stop BFing
• if severe, give Abx (keflex x10d, or septra or clinda)
• assess for abscess

Question 3

Mastitis

Answer 3

• same as puerpal mastitis except no related BFing

- f/u with surgeon

Question 4

Periductal mastitis

Answer 4

• younger women: cellulities or recurrent subareolar abscesses
• perimenopausal women: nipple d/c, nipple retraction, or subareolar mass
• Tx: analgesia plus keflex/septra/clinda/dicloxacillin

Question 5

Hidradentis suppurativa

Answer 5

• chornic inflammatory dz involving obstruciton of sweat glands
• I+D

Question 6

Inflammatory breast cancer

Answer 6

• highest mortality and usually longest delay
• sx: breast enlargement, peau d’orange, warmth, tender, edema, erythema, discolouration
• no mass necessarily
• inditinguishable from infection
• if unsure, tx with Abx, if no good response w/in 48h then refer emergenctly

Question 7

Nipple d/c

Answer 7

• purulent: infection/mastitis
• milky: pregnancy, prolactinoma, pituitary adenoma/mass, drugs
• seriou/serosang: intraductal papilloma, ductal ectasia, cancer
• watery: papilloma, cancer
• green/black/gray/tan: duct ectasia, periductal mastitis

Question 8

Mondor dz

Answer 8

• thrombophlebitis of superficial thoracoepigastric vein
• cordlike mass, dimpling
• cause: trauma, inflm
• tender
• benign, slef-limiting
• Tx: NSAIDs

Question 9

erosive adenomatosis

Answer 9

• nipple irritation, benign proliferationo f lactiferous ducts causing eczema +/- erosion of the nipple
• refer

Question 10

Paget dz

Answer 10

• weeping, eczematous lesions of nipple

- assoc with underlying carcinoma