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MASTITIS : infection
of breast tissues
CMCH , L3
• COLLEGE OF MEDICINE AND HEALTH SCIENCES
• CLIN MED α COM HEALTH DEPARTMENT
• ACADEMIC YEAR 2016-2017
• YEAR THREE
• GROUP 4
• SEMESTER II
• MODULE : SUGERY
• LECTURER : Dr Alcade
3/31/2017 2
GROUP IV PRESENTATION
GROUP MEMBERS
• 215003308: NORBERT ICYIZANYE
• 215009972: TWAHIRWA GERVAIS
• 215014132: UMUKUNDWA LADEGONDE
• 215041249: NIYONKURU Ange DIVINE
3/31/2017 3
Breast anatomy
1. Chest wall
2. Pec muscles
3. Lobe
4. Nipple
5. Areolar
6. Duct
7. Fatty tissue
8. Skin
Milk is produced in the lobes, which
are subdivided into lobules, and
carried to the nipple via ducts, in
response to hormonal stimulation.
3/31/2017 4
INTRODUCTION
• Infective mastitis/breast
abscesses
• Infection of mammary
duct and breast tissues
often associated with
lactation
• usually caused by S.
aureus.
• presents as painful hot
swelling of Breast
segment.
3/31/2017 5
Breast mastitis
 Infection that commonly affects women who are
breast-feeding (especially during the first two
months after childbirth) but can occur in all
women at any time.
• In most case locational mastitis occurs within the
first six to 12 weeks postpartum .
• Mastitis is a benign condition not metastatic
3/31/2017 6
CAUSES
• Inflammation can be caused by :
infectious agents and their toxins,
 physical trauma
or chemical irritants
• Breast ducts become blocked, microorganisms enter
• 10-33% of breast feeding women
3/31/2017 7
Common causative bacteria
• Staphylococcus aureus ( the most common )
• Coagulase negative staphylococci
• Staphylococci
• Streptococci
• staph epidermidi
• peptostreptococcus
3/31/2017 8
Risk factors
• Nipple fissures, cracks and sores
• Age >30 years old
• History of mastitis
• Gestational age >41 weeks
• Poor technique, causing incomplete emptying
• One position to breast feed, which may lead to not fully drain the
breast milk
• Wearing a tightfitting or putting pressure on breast from seatbelt
or carrying a heavy bag, which may restrict milk flow
• Stresses
• Poor nutrition
3/31/2017 9
Risk factors cont.’
3/31/2017 10
Pathophysiology
• Bacterial mastitis - most common variety from skin surface
or baby’ s mouth .
• The intermediary – infant harbouring staphylococci in the
nasopharynx.
• Ascending infection from a sore and cracked nipple
3/31/2017 11
Lactiferous ducts
will first become
blocked by
epithelial debris
leading to stasis;
Once within the
ampulla of the duct,
staphylococci cause
clotting of milk and
Within this
clot, organisms
multiply and
lead to s/s.
Pathophysiology Cont.’
3/31/2017 12
Presentations
• Initially generalised
cellulitis but later an
abscess will form
• One breast affected
• Continuous hot burning
sensation
• Erythema, oedema,
tenderness
• Pus on aspiration
• Axillary lymph nodes3/31/2017 13
Clinical Investigations
• Breast milk culture
• Mammogram to exclude duct ectasia…
• Biopsy to exclude breast cancer
• Abscess suspected (tender hard breast mass, fluctuant
with oedema) -> Refer! -> Ultrasound
3/31/2017 14
Mammography screening for cancer
• Mammography to exclude cancer
• 50-70 years old
• Every 3 years
• A mammogram is just an x-ray of the breast, and is a very
useful screening tool and method of investigating potential
malignancies and other breast pathologies
• About a third of breast cancers are diagnosed via
screening
Differential diagnosis
• Breast cancer
• Fibroadenoma
• Fibrocystic breast changes
• Duct ectasia
• Duct papilloma
• Infective mastitis
3/31/2017 16
Diagnosis
• Clinical examination with :
 Wedge shaped area of redness on the breast that points
toward the nipple and is tender to the touch
 congestive mastitis (engorgement)
 Bilateral
 Clinical investigation findings
3/31/2017 17
Management
 Conservative- technique, fluids, analgesia
 early prescription- flucloxacillin or Erythromycin
• Clarithromycin
• Clindamycin
• Bactrim
• Amoxicillin clavulanate
• requires 10 to 14 days
• Surgical- incision and drainage or needle aspiration
• Investigate persisting mass
3/31/2017 18
Management cont’
 Early prescription reduces risk of abscess, sepsis and
recurrence
 Surgical intervention can be considered if the mastitis
progresses to an abscess.
 incision and drainage of abscess cavity if overlying skin is
thin or necrotic
 Needle aspiration of abscess every day is an alternative
3/31/2017 19
Management cont.’
Incision and drainage recommended
If:
• the infection did not resolve
within 48 hours
• after being emptied of milk
there was an area of tense
induration or other evidence
of an underlying abscess.
3/31/2017 20
COMPLICATIONS
• Anesthesia related
complications
• Breast cancer
• Recurrence of mastitis
• Breast abscess which
require drainage
• Poor or refuse to
breast feed the baby
3/31/2017 21
Health education
• Concerning the appropriate ways to take antibiotics
and other prescribed medications
• Self care with good rest and continue breast feeding
with extra fluids and balanced diet
• Feeding from the affected side and change the position
used in breastfeeding
• Fully drain the milk from the breast while
breastfeeding
• personal hygiene improvement
3/31/2017 22
Referrences
• LONGMORE, M. et al., 2014. Index to emergency topics. ,
9, p.621.
• Principles of Anatomy and Physiology (Tortora and
Derrickson), 13th ed.
• Medicine at a Glance (Davey) 3rd ed
• Clinical Medicine (Kumar and Clark) 7th ed
3/31/2017 23
Oxygenate and Resuscitate Before You Operate
“Failure to promptly recognize and treat simple life-threatening injuries is the
tragedy of trauma, not the inability to handle the catastrophic or complicated
injury.”
(F.William Blaisdell)
GOOD JUDGMENT COMES FROM EXPERIENCE
EXPERIENCE COMES FROM BAD JUDGMENT
• THIS IS THE END OF
OUR
PRESENTATION
• HAVE A NICE DAY :
LADIES AND
GENTLEMEN

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Mastitis BY Norbert at UR- CMHS - CLINICAL MEDICINE

  • 1. MASTITIS : infection of breast tissues CMCH , L3
  • 2. • COLLEGE OF MEDICINE AND HEALTH SCIENCES • CLIN MED α COM HEALTH DEPARTMENT • ACADEMIC YEAR 2016-2017 • YEAR THREE • GROUP 4 • SEMESTER II • MODULE : SUGERY • LECTURER : Dr Alcade 3/31/2017 2
  • 3. GROUP IV PRESENTATION GROUP MEMBERS • 215003308: NORBERT ICYIZANYE • 215009972: TWAHIRWA GERVAIS • 215014132: UMUKUNDWA LADEGONDE • 215041249: NIYONKURU Ange DIVINE 3/31/2017 3
  • 4. Breast anatomy 1. Chest wall 2. Pec muscles 3. Lobe 4. Nipple 5. Areolar 6. Duct 7. Fatty tissue 8. Skin Milk is produced in the lobes, which are subdivided into lobules, and carried to the nipple via ducts, in response to hormonal stimulation. 3/31/2017 4
  • 5. INTRODUCTION • Infective mastitis/breast abscesses • Infection of mammary duct and breast tissues often associated with lactation • usually caused by S. aureus. • presents as painful hot swelling of Breast segment. 3/31/2017 5
  • 6. Breast mastitis  Infection that commonly affects women who are breast-feeding (especially during the first two months after childbirth) but can occur in all women at any time. • In most case locational mastitis occurs within the first six to 12 weeks postpartum . • Mastitis is a benign condition not metastatic 3/31/2017 6
  • 7. CAUSES • Inflammation can be caused by : infectious agents and their toxins,  physical trauma or chemical irritants • Breast ducts become blocked, microorganisms enter • 10-33% of breast feeding women 3/31/2017 7
  • 8. Common causative bacteria • Staphylococcus aureus ( the most common ) • Coagulase negative staphylococci • Staphylococci • Streptococci • staph epidermidi • peptostreptococcus 3/31/2017 8
  • 9. Risk factors • Nipple fissures, cracks and sores • Age >30 years old • History of mastitis • Gestational age >41 weeks • Poor technique, causing incomplete emptying • One position to breast feed, which may lead to not fully drain the breast milk • Wearing a tightfitting or putting pressure on breast from seatbelt or carrying a heavy bag, which may restrict milk flow • Stresses • Poor nutrition 3/31/2017 9
  • 11. Pathophysiology • Bacterial mastitis - most common variety from skin surface or baby’ s mouth . • The intermediary – infant harbouring staphylococci in the nasopharynx. • Ascending infection from a sore and cracked nipple 3/31/2017 11
  • 12. Lactiferous ducts will first become blocked by epithelial debris leading to stasis; Once within the ampulla of the duct, staphylococci cause clotting of milk and Within this clot, organisms multiply and lead to s/s. Pathophysiology Cont.’ 3/31/2017 12
  • 13. Presentations • Initially generalised cellulitis but later an abscess will form • One breast affected • Continuous hot burning sensation • Erythema, oedema, tenderness • Pus on aspiration • Axillary lymph nodes3/31/2017 13
  • 14. Clinical Investigations • Breast milk culture • Mammogram to exclude duct ectasia… • Biopsy to exclude breast cancer • Abscess suspected (tender hard breast mass, fluctuant with oedema) -> Refer! -> Ultrasound 3/31/2017 14
  • 15. Mammography screening for cancer • Mammography to exclude cancer • 50-70 years old • Every 3 years • A mammogram is just an x-ray of the breast, and is a very useful screening tool and method of investigating potential malignancies and other breast pathologies • About a third of breast cancers are diagnosed via screening
  • 16. Differential diagnosis • Breast cancer • Fibroadenoma • Fibrocystic breast changes • Duct ectasia • Duct papilloma • Infective mastitis 3/31/2017 16
  • 17. Diagnosis • Clinical examination with :  Wedge shaped area of redness on the breast that points toward the nipple and is tender to the touch  congestive mastitis (engorgement)  Bilateral  Clinical investigation findings 3/31/2017 17
  • 18. Management  Conservative- technique, fluids, analgesia  early prescription- flucloxacillin or Erythromycin • Clarithromycin • Clindamycin • Bactrim • Amoxicillin clavulanate • requires 10 to 14 days • Surgical- incision and drainage or needle aspiration • Investigate persisting mass 3/31/2017 18
  • 19. Management cont’  Early prescription reduces risk of abscess, sepsis and recurrence  Surgical intervention can be considered if the mastitis progresses to an abscess.  incision and drainage of abscess cavity if overlying skin is thin or necrotic  Needle aspiration of abscess every day is an alternative 3/31/2017 19
  • 20. Management cont.’ Incision and drainage recommended If: • the infection did not resolve within 48 hours • after being emptied of milk there was an area of tense induration or other evidence of an underlying abscess. 3/31/2017 20
  • 21. COMPLICATIONS • Anesthesia related complications • Breast cancer • Recurrence of mastitis • Breast abscess which require drainage • Poor or refuse to breast feed the baby 3/31/2017 21
  • 22. Health education • Concerning the appropriate ways to take antibiotics and other prescribed medications • Self care with good rest and continue breast feeding with extra fluids and balanced diet • Feeding from the affected side and change the position used in breastfeeding • Fully drain the milk from the breast while breastfeeding • personal hygiene improvement 3/31/2017 22
  • 23. Referrences • LONGMORE, M. et al., 2014. Index to emergency topics. , 9, p.621. • Principles of Anatomy and Physiology (Tortora and Derrickson), 13th ed. • Medicine at a Glance (Davey) 3rd ed • Clinical Medicine (Kumar and Clark) 7th ed 3/31/2017 23
  • 24. Oxygenate and Resuscitate Before You Operate
  • 25. “Failure to promptly recognize and treat simple life-threatening injuries is the tragedy of trauma, not the inability to handle the catastrophic or complicated injury.” (F.William Blaisdell) GOOD JUDGMENT COMES FROM EXPERIENCE EXPERIENCE COMES FROM BAD JUDGMENT
  • 26. • THIS IS THE END OF OUR PRESENTATION • HAVE A NICE DAY : LADIES AND GENTLEMEN