4.. BREAST CONDITIONS.pptx

Breast conditions

1. BREAST CONDITIONS DR RUKIA (MD)

2. MASTITIS Is an acute inflammation of the interlobular connective tissue within the mammary gland . The incidence of mastitis is 2–5 percent in lactating and less than 1 percent in nonlactating women The common organisms involved are Staphylococcus aureus , S. epidermidis and Streptococci viridans

3. Risk factors for mastitis Poor nursing. Poor hygiene. Maternal fatigue . Cracked nipple. Milk stasis. Previous history of mastitis Maternal or neonatal illness Trauma primeparity

4. Clinical Presentation. Fever Chills Myalgia. Severe pain and tender swelling in one quadrant Warmth, swelling of breast. The overlying skin is red, hot and flushed and feels tense and tender Exam Findings Area of the breast that is warm, red, and tender

5. Mastitis

6. Treatment Breast support. Plenty of oral fluids. Rest. The infected side is emptied manually. Proper positioning of the infant during nursing Nursing is initiated on the uninfected side Analgesics eg . Ibuprofen 200mgtds 3/7 or paracetamol 1gms tds 3/7. Antibiotics eg . Ampiclox 500mg tds 7/7 or Erythromycin 500mg tds 7/7.

7. Complications: Breast abscess. Prevention. Thorough hand washing. Cleaning the nipples and keeping them dry. General good hygiene.

8. BREAST ABSCESS Features are. Flushed breasts not responding to antibiotics promptly. Brawny edema of the overlying skin. Marked tenderness with fluctuation. Swinging temperature.

9. Breast abscess

10. Management. Incision and drained under general anesthesia. Breast feeding is continued in the uninvolved side. The infected breast is mechanically emptied. Antibiotics intravenous preferable. Analgesics.

11. Breast Engorgement Caused by exaggerated normal venous and lymphatic engorgement of the breasts which precedes lactation. This in turn prevents escape of milk from the lacteal system. The primiparous patient and the patient with inelastic breasts are likely to be involved. It usually manifests after the milk secretion starts (3rd or 4th day postpartum).

12. Symptoms pain and feeling of tenseness or heaviness in both the breasts Generalised malaise. transient rise of temperature. Painful breast feeding.

13. Treatment: To support the breasts with a binder or brassiere. Manual expression of any remaining milk after each feed. To administer analgesics for pain. The baby should be put to the breast regularly at frequent intervals.

14. Prevention. To initiate breast feeding early and unrestricted. Exclusive breast feeding on demand. Feeding in correct position.

15. Cracked nipple The nipple may become painful due to Loss of surface epithelium with the formation of a raw area on the nipple. Due to a fissure situated either at the tip or the base of the nipple. Cracked nipple commonly caused by incorrect positioning and poor attachment. It is caused by Poor hygiene . Retracted nipple. Trauma from baby’s mouth .

16. Cracked nipple

17. Treatment : Correct attachment will provide immediate relief from pain and rapid healing. When it is severe, mother should use a breast pump and the infant is fed with the expressed milk. Rest to affected nipple . The persistence of a nipple ulcer needs biopsy . Prevention. Help the mother to correct position Local cleanliness during pregnancy and in the Puerperium before and after each breast.

18. Retracted and flat nipple. It is commonly met in primegravida. It is usually acquired. Babies are able to attach to the breast correctly and are able to suck adequately. In difficult cases, manual expression of milk can initiate lactation. Gradually breast tissue becomes soft and more protractile.

19. LACTATION FAILURE (INADEQUATE MILK PRODUCTION): The causes are : Infrequent suckling, Depression or anxiety state in the Puerperium Reluctance or apprehension to nursing (4) Ill development of the nipples , Painful breast lesion , Endogenous suppression of prolactin (retained placental bits ) Prolactin inhibition (ergot preparations, diuretics , pyridoxin ).

20. Management Antenatal : To counsel the mother regarding the advantages of nursing her baby with breast milk, To take care of any breast abnormality specially a retracted nipple and to maintain adequate breast hygiene specially in the last two months of pregnancy. Puerperium: To encourage adequate fluid intake To nurse the baby regularly Painful local lesion is to be treated to prevent development of nursing phobia Metoclopramide , intranasal oxytocin and sulpiride (selective dopamine antagonist) have been found to increase milk production. They act by stimulating prolactin secretion. Metoclopramide given in a dose of 10 mg thrice daily is found helpful.