breast history and examination.final.pptx

Ca breast

1. HISTORY AND EXAMINATION ACHUTA SAI DHANUSHA S1 UNIT

2. HISTORY TAKING AGE: -Fibroadenoma-< 35 years of age -fibroadenosis - any age -intra mammary breast abscess-young lactating women[MASTITIS OF LACTATION] -carcinoma of breast-> 40 years of age SEX: -most common cancer in women SOCIAL STATUS: common in developed world

3. COMPLAINTS 1.LUMP: -side -quadrant involved -onset -progression benign-long history and slow growing carcinoma-short history and fast growing

4. COMPLAINTS 2.PAIN: PAINLESS CONDITIONS:carcinoma breast PAINFULL CONDITIONS: -acute mastitis-throbbing type -fibroadenosis-cyclical type,aggravates during menstruation -breast abscess -musculoskeletal pain

5. COMPLAINTS 3.DISCHARGE FROM NIPPLE: -Duration -quantity -quality fresh blood or altered blood-duct papilloma pus-mammary abscess milk-galactocele,mammary fistula due to chronic subareolar abscess serous and green-fibro adenosis and mammary duct ectasia

6. COMPLAINTS 4.RETRACTION OF NIPPLE: -duration: long duration-developmental recent-underlying carcinoma -type: slit like-duct ectasia,chronic periductal mastitis circumferential-underlying carcinoma

7. COMPLAINTS COMPLAINTS DUE TO METASTASIS -lungs-dyspnoea/pleuritic chest pain -liver-ascites/jaundice -bone-back pain/bone pain -CNS-vomiting/seizures OTHER COMPLAINTS -fever -trauma

8. PAST HISTORY SURGICAL HISTORY: breast surgeries-recurrence of fibroadenosis and abcess in congenital retraction of nipple -recurrence of carcinoma in the other breast COMORBID HISTORY: -hypertesion and daibetes-increased risk of carcinoma -tuberculosis of breast OTHER -ocp consumption

9. MENSTRUAL HISTORY -menarche -regular/irregular cycles -obstretic score -age at 1st child birth and full term or not -BREAST FEEDING -menopause

10. PERSONAL HISTORY -diet-high fat diet -smoking and alcohol consumption-risk factors for carcinoma FAMILY HISTORY -recurrence of breast carcinoma in the family

11. EXAMINATION Built,nourishment,consciousness,orientation pallor,icterus,cyanosis,clubbing,pedal edema,generalized lymphadenpathy VITALS: pulse temperature blood pressure respiratory rate

12. INSPECTION POSITION OF EXAMINATION: 1.arms by the side of the body 2.arms raised straight above the head 3.hands on the hips 4.bending farwards from waist so that the breasts fall away from the body

13. INSPECTION 1.BREAST: -position: whether displaced in any direction -symmetry -any obvious lump -size and shape -any swelling or ulcer

14. INSPECTION 2.SKIN OVER THE BREAST -color and texture -engorged veins-large soft fibroadenoma,rapidly growing sarcoma,acute lactational mastitis with huge breast abscess -dimpling-infiltration of single ligament of cooper -puckering/tethering-multiple ligament of cooper involvement -peau d` orange-due to obstruction of dermal lymphatics,openings of sebaceous glands and hair follicles get burried in the oedema -nodules-often metastatic

15. INSPECTION

16. INSPECTION 3.NIPPLE: -presence -position -number -size and shape-prominent/flattened/retracted -surface -discharge

17. INSPECTION 4.AREOLA - Color: young girls-pale pink adults-slightly darker pregnancy-brown -Size:large in case of huge swelling of soft fibroadenoma -Surface and Texture: crack,fissure,ulcer,eczema,swelling,discharge

18. INSPECTION 5.ARM AND THORAX -cancer en cuirasse -Brawny oedema-extensive neoplastic infiltartion of axillary lymph nodes 6.AXILLA AND SUPRACLAVICULAR FOSSA 7.THE PATIENT IS ASKED TO RAISE THEIR ARMS ABOVE THEIR HEAD

19. PALPATION POSITION OF EXAMINATION: 1.sitting position 2.semi-recumbent 3.recumbent

20. PALPATION - palpate the normal breast first -should be done with palmar surface of the fingers with hand flat and not with the ‘flat of the hand’ -palpation should also be done between pulps of the fingers and thumb to know about te swelling -normal breast gives a firm and lobulated impression

21. PALPATION PALPATION OF THE AFFECTED SIDE - four quadrants should be palpated systamatically -axillary tail -behind the nipple

22. PALPATION If a lump is detected:- 1.local temperature and tenderness 2.situation - fibroadenosis-upper outer quadrant and axillary tail -carcinoma-upper outer quadrant and axillary tail -fibroadenoma-lower half 3.number -majority of breast lesions are solitary -fibroadenosis-multiple

23. PALPATION 4.SIZE AND SHAPE -globular:fibroadenoma -uneven:carcinoma 5.SURFACE -smooth:benign -uneven:carcinoma 6.MARGIN -fibroadenosis:ill-defined -fibroadenoma:regular,well-defined -carcinoma:irregular,well-defined

24. PALPATION 7.CONSISTENCY -fibroadenosis:firm,rubbery -fibroadenoma:firm,encapsulated -carcinoma:stony hard -sarcoma:varied consistency 8.FLUCTUATION -done for cystic swellings[very tense cyst may not show flucuation] -it is also positive for chronic abscess and lipoma

25. PALPATION 9.TRANSILLUMINATION TEST 10.FIXITY TO THE SKIN -attempt to move the tumor up and down or side to side:appearance of dimpling and tethering -skin is made to slide over the tumor -skin over tumor is pinched up -wide area over tumor pinchged up:peau d` orange will become prominent

26. PALPATION 11.FIXITY TO THE BREAST TISSUE -hold the breast tisuue with one hand and gently move the tumor with the other hand -fibroadenoma:easily moved -carcinoma:fixed 12.FIXITY TO THE UNDERLYING FASCIA AND MUSCLES 13.FIXITY TO UNDERLYING CHEST WALL

27. EXAMINATION OF LYMPH NODES AXILLARY GROUP OF LYMPH NODES Pectoral Brachial Subscapular Central Apical 1.PECTORAL GROUP Arm should be made to rest on the clinician’s Forearm >>> Relax the Pectoralis Minor Use Right hand for left side Lump Fingers are Insinuated behind the pectoralis Major Palpate the Lymph node by using Pulp of the Fingers

28. 2.BRACHIAL GROUP LOCATION:lateral wall of axilla Left hand is used to examine the left sided Lump Palpate laterally against the upper end of the Humerus 3.SUBSCAPULAR GROUP LOCATION:posterior axillary fold Stand behind the patient Semi lift the arm as seen in the picture Palpate – Anterior internal surface of the Posterior fold

29. 4.CENTRAL GROUP Right hand - left sided Lump first Patient’s arm should be slightly abducted position Pass the extended finger upto Apex of the Axilla Now the patient’s arm is brought to the side of her body Rest the patient’s forearm on the Clinician’s Forearm Steady the patient’s shoulder by using the clinician’s opposite hand Palpate the lymph node aginast the lateral chest wall

30. 5.APICAL GROUP Examination carried out in the manner as the previous one ,But the fingers are pushed further up Enlarged lymph nodes are felt through the Pectoralis Major just below the Clavicle 6.SUPRACLAVICULAR GROUP Stand behind the patient Dip the fingers down behind the Middle of the Clavicle { Ask the patient to Flex the neck for better Palpation } Both the sides should be palpated

31. SYSTEMIC EXAMINATION RESPIRATORY SYSTEM: -breath sounds,added sounds -pleural effusion ABDOMEN -ascites

32. THANK YOU