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
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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.
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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.
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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
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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
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8. Common causative bacteria
• Staphylococcus aureus ( the most common )
• Coagulase negative staphylococci
• Staphylococci
• Streptococci
• staph epidermidi
• peptostreptococcus
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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
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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
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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.’
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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
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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
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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
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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
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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
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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.
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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
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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
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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