Breast Conditions Flashcards
What is galactorrhoea
Milky nipple discharge unrelated to normal milk production of breast feeding
What are the causes of nipple discharge
Hyperprolactinaemia
Mammary duct ectasia
Infection
Tumour
Fibrocystic disease
Pregnancy
Causes of hyperprolactinaemia
Prolactinoma (non cancerous tumour of pituitary gland causes increased prolactin and decreased sex hormones (testosterone and oestrogen)
Hypothyroidism
CKD
Liver disease
Drugs (anti psychotics, SSRI (selective seratonin reuptake inhibitors- antidepressants e.g. sertraline), marijuana)
Ask about mumps, fevers, colour of discharge and listed causes of prolactinoma in history
What is prolactin and what is hyperprolactinaemia
Hormone that stimulates breast milk production (lactation)
Hyperprolactinaemia- abnormally high levels of prolactin
Causes of diff coloured nipple discharge
- clear
- milky
- bloody
- brown
- yellow
- green
Clear - mammary duct ectasia (benign non proliferative breast disease)
Milky - breast feeding, hormone related, galactorrhoea
Yellow - infection
Green - fibrocystic disease
Brown - fibrocystic disease, mammary duct ectasia
Blood - RED FLAG - intraductal papilloma (benign tumour in breast ducts) - type of breast cancer
How does the cause of nipple discharge differ if discharge is unilateral vs bilateral
Bilateral - systemic cause
When do you know nipple discharge is associated to infection
Fever and chills part of associated symptoms
Investigations for nipple discharge
Age over 50 and unilateral discharge or other nipple changes = 2ww to breast clinic
Urine pregnancy test when appropriate
Serum prolactin (if elevated refer to endocrinology for pituitary MRI
TFTs
U&Es
LFTs
Breast imaging
What is mastitis
Inflammation of breast tissue
May have infective cause
What causes mastitis with infection
S aureus - present on skin and break in skin causes to get in and cause infection
Types and causes of mastitis
Lactation all - milk stains or overproduction and bacteria entering via traumatised nipple
Non lactational/non infectious - smoking, immunosuppression, underlying breast pathology, trauma
When is mastitis an emergency
If breast abscess forms
Signs and symptoms of mastitis
Malaise
myalgias
Breast redness/erythema (wedge shaped area - lactational cause)
Pain /tenderness
Warm
Swelling and firm
Purulent nipple discharge
Fever
Diagnosis and management of mastitis (lactational vs non lactational)
Clinical diagnosis
Culture and sensitivity is sever/recurrent
2ww if mass on palpating of inflamed area (inflammatory breast cancer can mimic mastitis)
Lactational mastitis management
frequent feedings/breast pumping, ibuprofen/paractetamol
Flucloxacillin (effective against s aureus) if Sx not improving after 12-24 hrs
Non lactational mastitis management
Ibuprofen/paracetamol
Warm compress
Co-amoxiclav
What is a breast abscess and how does it occur
Localised collection of pus within breast tissue secondary to infection
Usually S aureus
May follow antibiotic failure to treat mastitis or cellulitis