wk 13, lec 3 Flashcards
mammary gland is what type of gland
Modified sudiferous (sweat) glands
milk is made in
terminal duct lobular unit (TDLU)
where does milk go from and to
Milk is made in the terminal duct lobular unit (TDLU) which
consists of smaller lobules and terminal ducts→drain into a
lactiferous duct → lactiferous sinus → collecting ducts →
open to the nipple
milk secretion vs milk ejection
suckling and mechanoreceptors to hypothalamus
milk ejection: from oxytocin in posterior pituitary
milk secretion: from prolactin in anterior pituitary
areola
pigment skin around nipple; pigment increases with pregnancy
lacks hair and sweat glands
what glands are in areola and what do they secrete
Contains areolar glands AKA Glands of
Montgomery
secrete oily substance to lubricate areola and nipple, also olfactory so babies can smell
function of Montgomery glands/tubercles on the areola
- Lubrication and Protection
- Antimicrobial Properties
- Neonatal Olfactory Cue
- Hormonal Influence
lymphatics in breast
axillary or lateral pathway get 75% of lymph from boobs
suspensory ligament in breast for shape
coopers ligaments
changes during menstrual cycle in the terminal duct lobular unit TDLU
follicular phase: fewer terminal ducts, ..
literal phase: myoepithelial cells more prominent; causes fullness and tenderness
menses: return to follicular state
tanner stages of breast development
stage 1: prepubertal; elevation of nipple
stage 2 (begin puberty): breast bud stage, elevation of breast and nipple as small mound, enlarge areolar diameter
stage 3 (11-13yoa): further enlargement and elevation of breast and areola, no separation of contours
stage 4 (13-15yoa): projection of areola and nipple to form secondary mound above the level of the breast
stage 5 (15+ yoa): mature; projection of nipple only, areola has receded to general contour of breast
breast in pregnancy
increase nipple and areola pigmentation
TDLU grows, increase stoma vascularity
more secretions from lobular epithelial cells for lactation
breast in menopause
TDLU atrophy
increase adipose > fibrous tissue
acute mastitis
from breastfeeding
nipple cracks let strept and staph (bacteria) enter
blocked milk discharge
sx: pain, edema, erythema, fever, malaise, unilateral
periductal mastitis
unrelated to pregnancy
squamous metaplasia of ducts –> keratin plugs, duct obstruction, bacterial infection
cigarettes!!!
sx: painful sub-areolar mass, keratin plugs, inflammed, fistula
granulomatous mastitis
granulomas
from infection (mycobacteria, parasite, fungi) or autoimmune or breast implant
sx: large tender lump, granuloma, seems like malignancy, erythema, ulceration
ductal ectasia of breast
peri/post menopause, previous trauma and blocks of ducts, smoking, obesity
ductal dilation and periductal inflammation
fibrosis of ducts; fibrosis can obliterate ducts
thick secretions; debris, foamy macrophage
ducts rupture and cause granulomas
sx: serous or bloody discharge, mass, pain, nipple retraction (from duct wall fibrosis)
nipple retraction and in menopause in which breast condition
duct ectasia
fat necrosis of the breast
necrotic fat cells
hemorrhage –> foamy macrophage and lipid droplets –> fibrosis and calcification
history of trauma to area
hard mass, skin tethering (retraction or dimpling of skin over breast; mimic carcinoma)
which breast pathoglogy has skin tethering which mimics carcinoma (retraction or dimpling of skin over breast)
usually from trauma
fat necrosis
fibrocystic breasts (benign)
gross and microscopic cysts
apocrine metaplasia
fibrous stoma
from homronal fluctuations (estrogen and progesterone) in ages 20-50 typically
asymptomatic, nodules, pain, swelling, nipple discharge is cyst rupture
**cyclical- worse in luteal phase (bc hormones)
firboademona (bening- breast)
stromal and epithelial elements
not malignnat
hormonal cause (but dont change throuhgh menstural cycle like fibrocystic breast do); grow in prengnacy
silent, painless, calcified, bilateral
malignant; great carcinoma
90% sporadic, 10% familial
stimulated by estrogen (risks; early monarche, late menopause, old first pregnancy), radiation, alcohol, obese, smoking
decrease with anti-estrogen therapy
genes for familial breast carcinoma
BRCA1 and BRCA2
tumor suppressor genes which are autosomal dominant (also for ovarian cancer, pancreatic, prostate…)
Majority of cancer will be ER/PR/HER2 negative, and often
involves p53 mutations
BRCA2 are often ER (estrogen receptor) positive and less aggressive than BRCA1
breast carcinoma in situ
in situ: ductal carcinoma in situ (DCIS) involves the ducts or if
affects the lobules is called lobular carcinoma in situ
(LCIS)
mostly in upper outer quadrant
invasive ductal carcinoma (breast)
ER and PR (estrogen and progesterone receptor positive, some HER2 positive)
dense masses on mammography
DCIS in 80%
invasive lobular carcinoma
patients often have clinically silent disease
grossly and by mammography
more are ER positive than ductal
e-cadherin absent
spread to the peritoneum, retroperitoneum, ovary
and uterus, leptomeninges, and gastrointestinal tract
invasive lobular vs ductal carcinaom
lobular: grossly and mammography silent
ductal: masses found easily
Paget disease of the nipple (malignant)
rare; glandular in nipple (erythema, edema, retraction)
Associated with underlying DCIS, with or without invasive ductal carcinoma
3 botanical actions for cramps
antispasmodic
analgesic
hepatic
why do an antispasmodic in cramps
reduce muscle spasms and smooth muscle tension, help with any digestive spasms, help calm the nervous system and relax the smooth muscle in the blood vessels
why do an analgesic in cramps
help with pain and discomfrot. help with menstural cramps, help with discomfort and muscle aches
why do a hepatic in cramps
liver for hormone metabolism and detoxification. can help clear excess hormones (estrogen) which can effect cramps and menses. Helps with any hormonal imbalances that worsen sx. help to metabolize estrogen. help with associated sx of an overburdened liver ie bloating, discomfort, fatigue
4 herbs and % for cramps
cramp-bark 30%
jamaican dogwood 30%
wild yam 30%
california poppy 10%
why choose cramp-bark for cramps
antispasmodic, anti-inflammatory. Helps relax smooth muscle to help with cramps or GI pain. calming effect on nervous system to relief stress and anxiety. helps regulate blood flow and relieve tension
why chose jamaican dog wood for crmaps
antispasmodic, analgesic, sedative. Helps relax muscles, relieve pain, calm nervous system.
why choose California poppy for cramps
antispasmodic, analgesic, sedative. good to help with uterine muscle contractions, muscle pain . sedative to calm nervous system, stress, anxiety. help improve sleep, which can be disrupted by cramps
why choose wild yam for cramps
hepatic, antispasmodic, anti-inflammatory. a “female herb” (progesterone precurosr in vitro). phytoestrogens which can help with hormonal imbalances causing cramps. relax muscles to help cramps and low back and ab. support uterine health via relax uterus muscles and promote blood flow to the area. help normalize cycles. reduce inflammation
dose and duration for cramp prescription
tincture 1-2tbsp; acutely as needed
contraindications for cramp formula
all safe- dont use in pregnacy but wouldnt be the case
some sedatives but should be ok (i.e. driving, heavy machinery)
2 other recommendations for cramps
- moderate intensity cardiovascular exercise and yoga 2-5x/wk
- diet: anti inflmmatory (omega 3, tumeric, ginger, berries), and magenisum rich foods, avoid inflammatory and refined foods, food rich in iron
why do exercise and yoga for cramps
cardio to relieve cramps via increasing blood to pelvic area and promote relaxation (i.e. walk, swim, cycle). yoga for calming, relaxation, control breathing
why do anti inflammatory diet and avoid processed, eat iron for cramps
anti inflam (omegas, tumeric, ginger) to reduec infalmmation. Mg rich to relax muscles (i.e. nuts, seeds, leafy vegetables), avoid sugar, caffeien, processed. have high iron to restore blood loss
