Adolescence CH 4 Flashcards
(38 cards)
When should breast exams begin
as soon as breast budding occurs
Organic causes of breast asymmetry
Asymmetry is common; caused by unilateral breast hypoplasia, amastia, absence of pectoralis major muscle, unilateral juvenile hypertrophy (rapid overgrowth of breast tissue after thelarche)
What makes young women at increased risk for breast CA
hx of malignancy, adolescents who are at least 10 years postradiation therapy to the chest, adolescents 18-21 years of age whose mothers carry BRCA1 or BRCA2 gene (all of these reasons mean they should do monthly exams)
Fibroadenoma, what are they, describe them
most common breast mass in adolescents, made of glandular and fibrous tissue. typically non tender and described as rubbery, smooth, well circumscribed mobile mass often in upper outer quadrant of breast
Mammogram results of fibroadenoma
fibroglandular tissue of adolescent breast may cause false positive results on mammo, use US instead
Fibroadenoma monitoring (under 5cm)
fibroadenomas less than 5 cm can be monitored for growth or regression over 3-4 months. Further eval will be dictated by semiannual clinical evals for a few years.
Fibroadenoma monitoring (over 5cm)
fibroadenomas that are over 5 cm, enlarging, have overlying skin changes, or hx of previous malignancy should be referred to breast specialist
Symptoms of fibrocystic breast changes
more common in advancing age, mild swelling, palpable nodularity in upper outer quadrants. Mastalgia just before menstruation.
tx of fibrocystic breast changes
reassure pt that is is benign, NSAIDs for pain. Oral contraceptive may beneficial. Supportive bra and decreased caffeine for symptomatic relief
Breast abscess symptoms and causes
associated with mastitis and purulent discharge; caused by breast feeding, shaving and plucking periareolar hair, nipple piercing, and trauma during secual activity. causative organisms are normal skin flora. pt will have unilateral breast pain and inflammatory changes
breast abscess tx
culture fluid (may need incision and drainage) before giving antibiotics. give broad spectrum antibiotics that cover staph aureus until cultures come back and more specific antibiotic can be given
complications of breast abscess secondary to nipple piercing
endocarditis, cardiac calve injury, cardiac prosthesis infection, metal foreign body reaction, and recurrent infection
clinical findings of Giant Juvenile fibroadenoma and tx
large >5 cm fibroadenoma with overlying skin stretching and dilated superficial veins. Benign but requires excision for confirmation of diagnosis and for cosmetic reasons
Cystosarcoma phyllodes clinical findings and tx
large rapidly growing tumor associated with overlying skin changes, dilated veins, skin necrosis, requires excision. Usually benign but can be malignant
Intraductal papilloma clinical findings and tx
palpable intraductal tumor, often subareolar with nipple discharge (bloody or serosanguineous). may be in periphery of breast in adolescents. requires surgical excision. associated with increased risk of malignancy in adults
Juvenile papillomatosis clinical findings and tx
rare breast tumor characterized by grossly nodular breast mass described as having swiss cheese appearance. requires surgical excision
Fat necrosis clinical findings and tx
localized inflammatory process in the breast; typically follows trauma (sports or seat belt). subsequent scarring may be confused with changes similar to those associated with malignancy.
Ductal ectasia symptoms
common cause of nipple discharge in developing breast. Symptoms: dilation of mammary ducts, periductal fibrosis, and inflammation, nipple discharge can be bloody, brown, or sticky multicolored, may have cystic breast mass usually in the subareolar region. pt will have erythema, warmth, tenderness, and mastitis
ductal ectasia tx
oral antibiotics to cover normal skin flora if infection suspected. but should resolve spontaneously.
Galactorrhea characteristics and common causes
milky nipple discharge usually from both breasts. usually benign. common cause: chronic stimulation or irritation of nipple, medications and illicit drugs, pregnancy, childbirth, abortion, prolactin secreting tumor, hypothyroidism, tumors of hypothalamus and pituitary.
Testing for galactorrhea
breast US, pregnancy test, prolactin level, thyroid function test. look for fat staining of discharge to confirm. Elevated TSH (hypothyroidism), Elevated prolactin and normal TSH accompanied by amenorrhea in the abscense of medication suggests hypothalamic or pituitary tumor (do MRI and send to peds endocrinologist)
galactorrhea tx for those with breast mass
observation with serial examination for nipple discharge associated with breast mass (unless its papilloma). tx underlying cause. if hypothyroidism give thyroid hormone replacement.
galactorrhea tx for those without breast mass
follow clinically if prolactin and TSH are normal. teach to avoid nipple stimulation, stress reduction, and monitoring for oligomenorrhea (could indicate hyperprolactinemia). symptoms should resolve spontaneously. may give dopamine agonist like bromocriptine
gynecomastia, what is it, when does it start
benign subareolar glandular breast enlargement, affects up to 65% of adolescent males. starts at least 6 months after onset of secondary sex characteristics with peak incidence during SMR stages 3 and 4
