Mastitis Causes and Management
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Clinical and Imaging Evaluation of Nipple Discharge
REVIEW ARTICLE Evaluation of Nipple Discharge Clinical and Imaging Evaluation of Nipple Discharge Yi-Hong Chou, Chui-Mei Tiu*, Chii-Ming Chen1 Nipple discharge, the spontaneous release of fluid from the nipple, is a common presenting finding that may be caused by an underlying intraductal or juxtaductal pathology, hormonal imbalance, or a physiologic event. Spontaneous nipple discharge must be regarded as abnormal, although the cause is usually benign in most cases. Clinical evaluation based on careful history taking and physical examination, and observation of the macroscopic appearance of the discharge can help to determine if the discharge is physiologic or pathologic. Pathologic discharge can frequently be uni-orificial, localized to a single duct and to a unilateral breast. Careful assessment of the discharge is mandatory, including testing for occult blood and cytologic study for malignant cells. If the discharge is physiologic, reassurance of its benign nature should be given. When a pathologic discharge is suspected, the main goal is to exclude the possibility of carcinoma, which accounts for only a small proportion of cases with nipple discharge. If the woman has unilateral nipple discharge, ultrasound and mammography are frequently the first investigative steps. Cytology of the discharge is routine. Ultrasound is particularly useful for localizing the dilated duct, the possible intraductal or juxtaductal pathology, and for guidance of aspiration, biopsy, or preoperative wire localization. Galactography and magnetic resonance imaging can be selectively used in patients with problematic ultrasound and mammography results. Whenever there is an imaging-detected nodule or focal pathology in the duct or breast stroma, needle aspiration cytology, core needle biopsy, or excisional biopsy should be performed for diagnosis. -
FAQ026 -- Benign Breast Problems and Conditions
AQ The American College of Obstetricians and Gynecologists FREQUENTLY ASKED QUESTIONS FAQ026 fGYNECOLOGIC PROBLEMS Benign Breast Problems and Conditions • What is breast tissue made of? • What kinds of changes occur in breast tissue throughout life? • What are benign breast problems? • What are fibrocystic breast changes? • Is there treatment for fibrocystic breast changes? • What are breast cysts? • How are breast cysts treated? • What are fibroadenomas? • How are fibroadenomas treated? • What is mastitis? • How is mastitis treated? • What should I do if I find a lump in my breast? • What is mammography? • What happens if a suspicious lump or area is found during a routine screening mammogram? • What happens if the results of the follow-up tests to my routine screening tests are abnormal? • Glossary What is breast tissue made of? Your breasts are made up of glands, fat, and fibrous tissue. Each breast has 15–20 sections called lobes. Each lobe has many smaller lobules. The lobules end in dozens of tiny glands that can produce milk. What kinds of changes occur in breast tissue throughout life? Your breasts respond to changes in levels of the hormones estrogen and progesterone during your menstrual cycle, pregnancy, breastfeeding, and menopause. Hormones cause a change in the amount of fluid in the breasts. This may make the breasts feel more sensitive or painful. You may notice changes in your breasts if you use hormonal contraception such as birth control pills or hormone therapy. What are benign breast problems? Benign breast problems are breast problems that are not cancerous. There are four common benign breast problems: 1. -
Breast Infection: a Review of Diagnosis and Management Practices
Review Eur J Breast Health 2018; 14: 136-143 DOI: 10.5152/ejbh.2018.3871 Breast Infection: A Review of Diagnosis and Management Practices Eve Boakes1 , Amy Woods2 , Natalie Johnson1 , Naim Kadoglou1 1Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Londan 2Department of Medicine, Croydon University Hospital, Croydon, London ABSTRACT Mastitis is a common condition that predominates during the puerperium. Breast abscesses are less common, however when they do develop, delays in specialist referral may occur due to lack of clear protocols. In secondary care abscesses can be diagnosed by ultrasound scan and in the past the management has been dependent on the receiving surgeon. Management options include aspiration under local anesthetic or more invasive incision and drainage (I&D). Over recent years the availability of bedside/clinic based ultrasound scan has made diagnosis easier and minimally invasive procedures have become the cornerstone of breast abscess management. We review the diagnosis and management of breast infection in the primary and secondary care setting, highlighting the importance of early referral for severe infection/breast abscesses. As a clear guideline on the manage- ment of breast infection is lacking, this review provides useful guidance for those who rarely see breast infection to help avoid long-term morbidity. Keywords: Mastitis, abscess, infection, lactation Cite this article as: Boakes E, Woods A, Johnson N, Kadoglou. Breast Infection: A Review of Diagnosis and Management Practices. Eur J Breast Health 2018; 14: 136-143. Introduction Mastitis is a relatively common breast condition; it can affect patients at any time but predominates in women during the breast-feeding period (1). -
Breast Infection
Breast infection Definition A breast infection is an infection in the tissue of the breast. Alternative Names Mastitis; Infection - breast tissue; Breast abscess Causes Breast infections are usually caused by a common bacteria found on normal skin (Staphylococcus aureus). The bacteria enter through a break or crack in the skin, usually the nipple. The infection takes place in the parenchymal (fatty) tissue of the breast and causes swelling. This swelling pushes on the milk ducts. The result is pain and swelling of the infected breast. Breast infections usually occur in women who are breast-feeding. Breast infections that are not related to breast-feeding must be distinguished from a rare form of breast cancer. Symptoms z Breast pain z Breast lump z Breast enlargement on one side only z Swelling, tenderness, redness, and warmth in breast tissue z Nipple discharge (may contain pus) z Nipple sensation changes z Itching z Tender or enlarged lymph nodes in armpit on the same side z Fever Exams and Tests In women who are not breast-feeding, testing may include mammography or breast biopsy. Otherwise, tests are usually not necessary. Treatment Self-care may include applying moist heat to the infected breast tissue for 15 to 20 minutes four times a day. Antibiotic medications are usually very effective in treating a breast infection. You are encouraged to continue to breast-feed or to pump to relieve breast engorgement (from milk production) while receiving treatment. Outlook (Prognosis) The condition usually clears quickly with antibiotic therapy. Possible Complications In severe infections, an abscess may develop. Abscesses require more extensive treatment, including surgery to drain the area. -
Common Breast Problems BROOKE SALZMAN, MD; STEPHENIE FLEEGLE, MD; and AMBER S
Common Breast Problems BROOKE SALZMAN, MD; STEPHENIE FLEEGLE, MD; and AMBER S. TULLY, MD Thomas Jefferson University Hospital, Philadelphia, Pennsylvania A palpable mass, mastalgia, and nipple discharge are common breast symptoms for which patients seek medical atten- tion. Patients should be evaluated initially with a detailed clinical history and physical examination. Most women pre- senting with a breast mass will require imaging and further workup to exclude cancer. Diagnostic mammography is usually the imaging study of choice, but ultrasonography is more sensitive in women younger than 30 years. Any sus- picious mass that is detected on physical examination, mammography, or ultrasonography should be biopsied. Biopsy options include fine-needle aspiration, core needle biopsy, and excisional biopsy. Mastalgia is usually not an indica- tion of underlying malignancy. Oral contraceptives, hormone therapy, psychotropic drugs, and some cardiovascular agents have been associated with mastalgia. Focal breast pain should be evaluated with diagnostic imaging. Targeted ultrasonography can be used alone to evaluate focal breast pain in women younger than 30 years, and as an adjunct to mammography in women 30 years and older. Treatment options include acetaminophen and nonsteroidal anti- inflammatory drugs. The first step in the diagnostic workup for patients with nipple discharge is classification of the discharge as pathologic or physiologic. Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilat- eral, or associated with a breast mass. Patients with pathologic discharge should be referred to a surgeon. Galactorrhea is the most common cause of physiologic discharge not associated with pregnancy or lactation. Prolactin and thyroid- stimulating hormone levels should be checked in patients with galactorrhea. -
Plugged Duct Or Mastitis
Treatment Tips: Plugged Duct or Mastitis Signs & Symptoms of a Plugged Duct While breastfeeding: • Breastfeed on the affected breast first; if it hurts too • A plugged duct usually appears gradually, in one much to do this, switch to the affected breast directly breast only (although the location may shift). after let-down. • A hard lump or wedge-shaped area of engorgement • Ensure good positioning and latch. Use whatever is usually present in the vicinity of the plug. It may feel positioning is most comfortable and/or allows the tender, hot, swollen or look reddened. plugged area to be massaged. • Occasionally you will notice only localized tenderness • Use breast compressions. or pain, without an obvious lump or area of • Massage gently but firmly from the plugged area engorgement. toward the nipple. • A low-grade fever (less than 101.3°F / 38.5°C) is • Try breastfeeding while leaning over baby so that occasionally--but not usually--present. gravity aids in dislodging the plug. • The plugged area is typically more painful before a feeding and less tender/less lumpy/smaller after. After breastfeeding: • Breastfeeding on the affected side may be painful, • Pump or hand express after breastfeeding to aid milk particularly at letdown. drainage and speed healing. • Milk supply & pumping output from the affected • Use cold compresses (ice packs over a layer of cloth) breast may decrease temporarily. between feedings for pain and inflammation. • After a plugged duct or mastitis has resolved, it is common for redness and/or tenderness (a “bruised” feeling) to persist for a week or so afterwards. Do not decrease or stop breastfeeding, as this increases your risk of complications (including abscess). -
Drugs Affecting Milk Supply During Lactation
VOLUME 41 : NUMBER 1 : FEBRUARY 2018 ARTICLE Drugs affecting milk supply during lactation Treasure M McGuire SUMMARY Assistant director Practice and Development There are morbidity and mortality benefits for infants who are breastfed for longer periods. Mater Pharmacy Services Occasionally, drugs are used to improve the milk supply. Mater Health Services Brisbane Maternal perception of an insufficient milk supply is the commonest reason for ceasing Conjoint senior lecturer breastfeeding. Maternal stress or pain can also reduce milk supply. School of Pharmacy University of Queensland Galactagogues to improve milk supply are more likely to be effective if commenced within three weeks of delivery. The adverse effects of metoclopramide and domperidone must be Associate professor Pharmacology weighed against the benefits of breastfeeding. Faculty of Health Sciences Dopamine agonists have been used to suppress lactation. They have significant adverse effects and Medicine and bromocriptine should not be used because of an association with maternal deaths. Bond University Gold Coast nipple stimulation. Its release is inhibited by dopamine Introduction Keywords Breast milk is a complex, living nutritional fluid from the hypothalamus. Within a month of delivery, breastfeeding, that contains antibodies, enzymes, nutrients and basal prolactin returns to pre-pregnant levels in non- cabergoline, domperidone, galactagogues, lactation, hormones. Breastfeeding has many benefits for breastfeeding mothers. It remains elevated in nursing metoclopramide, prolactin babies such as fewer infections, increased intelligence, mothers, with peaks in response to infant suckling. probable protection against overweight and diabetes Drugs that act on dopamine can affect lactation. and, for mothers, cancer prevention.1 The World In response to suckling, oxytocin is released from Aust Prescr 2018;41:7-9 Health Organization recommends mothers breastfeed the posterior pituitary to enable the breast to https://doi.org/10.18773/ exclusively for six months postpartum. -
Multiple Nodules of Pseudoangiomatous Stromal Hyperplasia (PASH) in a Menacme Patient: a Case Report
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Cadernos Espinosanos (E-Journal) Rev Med (São Paulo). 2017;96(Suppl. 1):1-35. Awards of the XXXVI COMU 2017. Multiple nodules of Pseudoangiomatous Stromal Hyperplasia (PASH) in a menacme patient: a case report Academic authors: Matheus Belloni Torsani Academic advisors: Gabriela Boufelli de Freitas, Edmund Chada Baracat, José Roberto Filassi, Sergio Masili-Oku Introduction: Pseudoangiomatous Stromal Hyperplasia (PASH) is a rare benign proliferating breast condition. It was first described in 1986 and less than 200 cases have been described ever since in the English literature. In the majority of cases, PASH is an incidental histological finding, but it can also be found in the physical examination as one typical single nodule (palpable, circumscribed, non-hemorrhagic), mostly on pre-menopausal women. It is frequently misdiagnosed as a fibroadenoma. PASH’s etiology remains unclear, although it is related to different benign breast entities. Objectives: This report aims to describe a case of multiple PASH nodules in a 31-year-old woman, its diagnosis and management. Case report: VSS, female, 31 years old, previously healthy, presented with increased right breast volume (swelling) for the last six months. She denied local pain and fever at the spot. When examined, right breast was bigger than the left one and showed discrete hyperemia. There were neither palpable nodules on the breasts nor axillary lymph nodes. The attending physician ruled the diagnosis as mastitis and prescribed clyndamicin for 7 days. He also ordered an ultrasound for complementary information. The exam result (ACR BI-RADS: 2) showed swelling, simple cysts (the biggest one measured 1.2 cm) and confirmed the diagnostic hypothesis for the right breast. -
Journal of Clinical Review & Case Reports
ISSN: 2573-9565 Case Report Journal of Clinical Review & Case Reports Pseudo Angiomatous Stromal Hyperplasia of the Breast: A Case of A 19-Year-Old Asian Girl Yuzhu Zhang1, Weihong Zhang2# , Yijia Bao1, Yongxi Yuan1,3* 1Department of Mammary gland, Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai, China *Corresponding author 2Department of Mammary gland, Baoshan branch of Shuguang Yongxi Yuan, Department of Mammary gland, Longhua Hospital Hospital Affiliated to Shanghai University of TCM, Shanghai,201900, Affiliated to Shanghai University of TCM & Huashan Hospital, China. Shanghai Medical College, Fudan University, Shanghai, China. Tel: +8602164383725; Email: [email protected] 3Department of Mammary gland, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Submitted: 11 Oct 2017; Accepted: 20 Oct 2017; Published: 04 Nov 2017 #co-first author Abstract Pseudoangiomatous stromal hyperplasia (PASH), a benign disease with extremely low incidence, is manifested as giant breasts, frequent relapse after surgery, or endocrine disorder. Cases with unilateral breast and undetailed endocrine condition have been reported in African and American. In this case, a 19-year-old Asian girl suffered from bilateral breast PASH after the human placenta and progesterone treatment for 3-month delayed menstruation. Her breasts enlarged remarkably 1 month after the treatment, with extensive inflammatory swell in bilateral mammary glands and subcutaneous edema in retromammary space. The patient received the bilateral quadrantectomy plus breast reduction and suspension surgery to terminate the progressive hyperplasia of breast. During the whole treatment period, the patient was given tamoxifen treatment for 4 months, and endocrine levels were intensively recorded. The follow-up after 4 months showed recovered breast with normal shape and size, and there was no distending pain, a tendency toward breast hyperplasia, or menstrual disorder. -
Suppressing Lactation and Weaning
LOCAL OPERATING PROCEDURE CLINICAL POLICIES, PROCEDURES & GUIDELINES Approved by Quality & Patient Care Committee 3 March 2016 SUPPRESSING LACTATION AND WEANING This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP. 1. AIM • Assist and support woman who decides to suppress lactation and choose to formula feed their infants. • Support woman who has experienced a stillbirth, perinatal loss or neonatal death with lactation suppression • Support woman who suppresses lactation for an acceptable medical indication • Provide education and support for woman who wishes to wean early in their postpartum period. 2. PATIENT • Newly birthed or lactating woman 3. STAFF • Medical and nursing and midwifery staff • Enrolled/Endorsed/Mother craft nurses 4. EQUIPMENT (as required) • Firm (not tight) and Supportive bra or top • Cool cloths or chilled clean cabbage leaves 5. CLINICAL PRACTICE • Discuss strategies to manage suppression that are relevant and acceptable to the woman depending upon her circumstances • Provide written information appropriate to woman’s situation • Identify if suppression is going to occur in the immediate postpartum period or the woman has established lactation IMMEDIATE SUPPRESSION OF LACTATION POST BIRTH: • Avoid unnecessary breast stimulation. • Express breast only for comfort • Wear a firm supportive bra or top • Apply cool cloths, gel packs or cabbage leaves as required • Maintain normal fluid intake • Allow leakage -
Evaluation of the Symptomatic Male Breast
Revised 2018 American College of Radiology ACR Appropriateness Criteria® Evaluation of the Symptomatic Male Breast Variant 1: Male patient of any age with symptoms of gynecomastia and physical examination consistent with gynecomastia or pseudogynecomastia. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Mammography diagnostic Usually Not Appropriate ☢☢ Digital breast tomosynthesis diagnostic Usually Not Appropriate ☢☢ US breast Usually Not Appropriate O MRI breast without and with IV contrast Usually Not Appropriate O MRI breast without IV contrast Usually Not Appropriate O Variant 2: Male younger than 25 years of age with indeterminate palpable breast mass. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US breast Usually Appropriate O Mammography diagnostic May Be Appropriate ☢☢ Digital breast tomosynthesis diagnostic May Be Appropriate ☢☢ MRI breast without and with IV contrast Usually Not Appropriate O MRI breast without IV contrast Usually Not Appropriate O Variant 3: Male 25 years of age or older with indeterminate palpable breast mass. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Mammography diagnostic Usually Appropriate ☢☢ Digital breast tomosynthesis diagnostic Usually Appropriate ☢☢ US breast May Be Appropriate O MRI breast without and with IV contrast Usually Not Appropriate O MRI breast without IV contrast Usually Not Appropriate O Variant 4: Male 25 years of age or older with indeterminate palpable breast mass. Mammography or digital breast tomosynthesis indeterminate or suspicious. Procedure Appropriateness Category Relative Radiation Level US breast Usually Appropriate O MRI breast without and with IV contrast Usually Not Appropriate O MRI breast without IV contrast Usually Not Appropriate O ACR Appropriateness Criteria® 1 Evaluation of the Symptomatic Male Breast Variant 5: Male of any age with physical examination suspicious for breast cancer (suspicious palpable breast mass, axillary adenopathy, nipple discharge, or nipple retraction). -
Non-Cancerous Breast Conditions Fibrosis and Simple Cysts in The
cancer.org | 1.800.227.2345 Non-cancerous Breast Conditions ● Fibrosis and Simple Cysts ● Ductal or Lobular Hyperplasia ● Lobular Carcinoma in Situ (LCIS) ● Adenosis ● Fibroadenomas ● Phyllodes Tumors ● Intraductal Papillomas ● Granular Cell Tumors ● Fat Necrosis and Oil Cysts ● Mastitis ● Duct Ectasia ● Other Non-cancerous Breast Conditions Fibrosis and Simple Cysts in the Breast Many breast lumps turn out to be caused by fibrosis and/or cysts, which are non- cancerous (benign) changes in breast tissue that many women get at some time in their lives. These changes are sometimes called fibrocystic changes, and used to be called fibrocystic disease. 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 Fibrosis and cysts are most common in women of child-bearing age, but they can affect women of any age. They may be found in different parts of the breast and in both breasts at the same time. Fibrosis Fibrosis refers to a large amount of fibrous tissue, the same tissue that ligaments and scar tissue are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch. Cysts Cysts are fluid-filled, round or oval sacs within the breasts. They are often felt as a round, movable lump, which might also be tender to the touch. They are most often found in women in their 40s, but they can occur in women of any age. Monthly hormone changes often cause cysts to get bigger and become painful and sometimes more noticeable just before the menstrual period. Cysts begin when fluid starts to build up inside the breast glands. Microcysts (tiny, microscopic cysts) are too small to feel and are found only when tissue is looked at under a microscope.