Week 10 - Breasts and Genitalia Flashcards
Axillary Tail of Spence
Axillary Process
Breast tissue projecting laterally and up into the axilla
Areola
Surrounds nipple for 1-2cm radius
Contain Montgomery’s glands (aka areolar glands)
Contain muscle fibres causing nipple erection when stimulated
Montgomery’s glands
Areolar Glands
Small, sebaceous glands
Secrete protective lipid material during lactation
Location of the breasts
Between the 2nd and 6th ribs
Composition of the breast (4)
- glandular tissue
- fibrous tissue
- suspensory ligaments
- adipose tissue
The proportion of these tissues varies depending on age, cycle, pregnancy, lactation, and nutritional state
Breast Alveoli
Milk glands in the breast lobules
Lactiferous ducts
Milk collecting system from the lobes that converges (15-20 ducts) at the nipple
Cooper’s ligaments
Suspensory ligaments that attach the breast to the chest wall
Become contracted during breast cancer
Adipose tissue
Provide most of the bulk of the breast
Four (five) quadrants of the breast
Upper inner quadrant
Lower inner quadrant
Upper outer quadrant
Lower outer quadrant
Axillary process
4 Axillary Lymph Nodes
Central Axillary
Pectoral
Subscapular (posterior)
Lateral
Supernumerary nipple
Extra nipple
Tanner Staging of puberty
Five stages of breast development
Thelarche
Signals the beginning of puberty at 8-10 years of age
Beginning of breast development
Menarche
Beginning of menstruation
About 2 years after breasts
Colostrum
Thick, yellow fluid appears after 4th month of pregnancy
Precedes milk production
Gynecomastia
Temporary enlargement of male breast tissue in male adolescence
Andrenarche/Pubarche
Second development of puberty
Axillary and Pubic Hair Development
GnRH
(Gonadotropin Releasing Hormone)
Stimulates lutenizing hormone and folicular stimulating hormone in the pituirary gland
Produce testosterone in testicles and estrogen in the ovaries
Considerations fo Pregnancy (5)
- Change in breast and nipple size and shape
- Blue vascular pattern becomes visible
- Stretch marks
- Darker, more erect nipples
- Expression of colostrum (4th month)
Age-related breast changes (5)
Decrease in ovarian secretion of estrogen and progesterone
- Glandular tissue atrophies, replaced with fibrous connective tissues
- Fat atrophies
- Reduced breast size and elasticity
- Masses/lumps may become palpable
- Lactiferous ducts more palpable (firm and stringy from fibrosis)
Age-related breast changes (5)
Decrease in ovarian secretion of estrogen and progesterone
- Glandular tissue atrophies, replaced with fibrous connective tissues
- Fat atrophies
- Reduced breast size, density and elasticity
- Masses/lumps may become palpable
- Lactiferous ducts more palpable (firm and stringy from fibrosis)
Male breasts
Rudimentary
Small nipples, large areola
Milk ducts and mammary tissues
Oxytocin and prolactin
Approach for breast inspection
LACE
Look
Arm positions
Check lymph nodes
Examine breast tissue
“Look”
In the LACE breast exam
- Symmetry/contour/size/shape
- Skin changes: mass fixation, dimpling, depressions, skin colour, swelling, venous patterns, edema
- Nipple changes: size/shape, inversion (new or hx)
- Discharge: scaling, ulceration, bleeding, discharge
“Arm positions”
In the LACE breast exam
- Raised
- Akimbo
- Lean forward
*helps contract underlying pectoralis muscle
“Check the lymph nodes”
In the LACE breast exam
Check for:
Inflammation/swelling of lymph nodes
Check in supraclavicular and axillary regions
*Palpation
“Examine breast tissue”
In the LACE breast exam
*Palpation for:
- Consistency
- Elasticity
- Tenderness
- Thickening
- Masses/lumps
- Erythema
Describe location, size, shape, consistency, movability of mass. Also describe the nipple.
Breast Cancer (signs)
Ages 30-80 Irregular star-shaped mass that is hard, dense, and fixed Usually painless Often nipple retraction Skin tethering Peau d'orange Constant growth
Right upper quadrant is most common
Paget’s disease
Cancer of the areola
Non-modifiable risk factors for Breast Cancer (10)
- F
- Age (50-69)
- PHx or FHx
- Dense breasts
- BRCA
- Ashkenazi Jews
- previous breast biopsies with atypical hyperplasia
- breast irradiation
- menarche pre 11 or menopause after age 55 (high estrogen exposure)
- tall adult height
Modifiable risk factors for Breast Cancer (7)
- nulliparity or first parity post age 30
- hormonal contraceptive use
- postmenopausal hormone therapies
- not breastfeeding
- more than one alcoholic drink daily
- obesity
- high socioeconomic status
POSSIBLE risk factors for Breast Cancer (5)
- physical inactivity
- adult weight gain
- smoking and 2nd hand
- high birth weight
- night shift work
BREAST Mnemonic
For breast examination
B- Breast mass R- Retraction E- Edema (peau d'orange) A- Axillary mass S- Skin changes / scaly nipple T- Tender breasts
External male genitalia
- penis
- glans
- urethra
- foreskin
- scrotum
- cremaster muscle
Internal male genitalia
- testis
- spermatic cord
- epididymus
- vas deferens
- prostate gland
- seminal vesicles
- vulval-urethra gland
Male lymphatic genitalia
- Scrotum drain into inguinal lymph nodes
- Testes drain into abdominal lymph nodes
Subjective assessment of male genitourinary system (11)
Hx:
- urinary patterns, colour, frequency, control
- kidney disease/stones
- flank pain
- UTIs
- prostate concerns
- penis pain, lesions, discharge
- scrotum pain or swelling, change in size
- sexual history and STIs
- testicular self-exam
- hernias
- abuse
Describing testicular masses
- size, contour, nodularity
- tenderness
- location
- transilluminance
- do things change when supine
Palpation for hernia
- pt is standing
- palpate external inguinal ring
- palpate in femoral canal area
Male Genitourinary age considerations for infants
Testes descend along inguinal canal to scrotum before birth
Uncircumcised vs. circumcised
Male Genitourinary age considerations for Older Adults
- decrease in pubic hair
- penis size decreases
- testes decrease in size, less firm
- diminished sexual response
Risk factors for testicular cancer
age 15-49
undescended testicles
family history
Lu
Signs of testicular cancer
lumps or swelling
“heaviness” in abdomen or scrotum
Risk factors for prostate cancer
over 65
family history
African ancestry
high fat diet
Signs of prostate cancer
urinary symptoms
painful ejaculation
Objective assessment of male genitalia (5)
- Inspect and palpate the penis
- Inspect and palpate the scrotum
- If a mass exists, transilluminate
- Palpate for inguinal hernia
- Palpate inguinal lymph nodes
Subjective assessment of female genitourinary system (10)
Obstetrical history Menstruation history Menopause Urinary symptoms Vaginal discharge GU history Sexual activity Contraceptive use STI contact STI risk reduction
Objective assessment of female genitalia
Inspect:
skin colour, hair distribution
pubic area for discoloration or irritation
external anatomy for colour, lesions, masses, discharge
perineum for colour, lesions, masses, scars
Skene’s gland
periurethral glands
Bartholin’s gland
greater vestibular gland
Female Genitourinary age considerations for infants
Engorgment of external genitalia
Female Genitourinary age considerations for pregnancy
- cervical softening (Goodell)
- discoloration of cervix and vagina (Chadwick)
- uterine softening (Hegar)
- uterus increases in size and capacity
Female Genitourinary age considerations for older adults
- reduction in menses
- uterus and cervix shrink
- ovaries atrophy
- ovulation becomes sporadic
- pelvic musculature weakens
- vagina shortens, narrows, skin thins
Risk Factors for Cervical Cancer
- sex at an early age
- multiple sexual partners
- history of STIs
- aging
- immunocompromised
- HPV
- smoking
- low socioeconomic status
Risk Factors for Ovarian Cancer
- age >50
- PHx of cancer
- genetics (BRCA)
- nulliparous
