BREAST ABSCESS Flashcards
(23 cards)
What is an abscess?
A painful collection of pus that forms in the breast.
Where do most abscesses develop?
Most abscesses develop just under the skin
What general group of organisms causes
bacterial origin
What is the typical presentation/ profile of patient?
Women. Breastfeeding. 18-50yrs.
How many women get mastitis during pregnancy? How many of these develop a breast abscess?
1/10 women get mastitis during breastfeeding, and this is linked to that. 3% of women with mastitis treated with antibiotic medicines develop a breast abscess, research suggests.
Presentation
If linked to mastitis (pain and swelling/ inflammation)
What are the most common bacteria that cause it?
Most common bacteria: staph aureus. Can also be Staphylococcus albus and streptococci or Meticillin-resistant Staphylococcus aureus (MRSA) (more common in C-sections).
How does breastfeeding cause the abscess?
• During breastfeeding bacteria can enter the breast tissue or occurs if the milk ducts become blocked –> leading to mastitis –> and if not treated becomes an abscess.
o An overgrowth of bacteria can occur if stagnant milk collects in a blocked milk duct.
How does it occur if you’re not breastfeeding?
It can also occur if you are not breastfeeding: bacteria can also enter the milk ducts through a sore or cracked nipple, or nipple piercing.
Who has an increased risk of non-breastfeeding mastitis?
Women who smoke have an increased risk of developing non-breastfeeding mastitis: known as periductal mastitis.
How are white cells involved in process?
The WBC’s that the body produces to deal with the infection, create a hollow area which becomes full with pus, and causes the abscess.
What are the risk factors?
• Infant not attaching properly during feeding i.e. technical or anatomical reasons (tongue-tie or cleft-lip)
• Less feeds, or reduced duration = accumulation of milk
o Partial bottle feeding/ changes in regime/ rapid weaning/ painful breasts/ preferred breast, leading to accumulation on one breast.
• Nipple fissures, cracks or sores
• Trauma to breast
• Blocked milk ducts.
• Smoking
Presentation
Painful swollen lumps that may be red/ hot/ cause surrounding skin to swell/ cause pyrexia.
How quickly after postpartum does it normally present?
Normally present ≥1 week postpartum, usually just in one breast.
How would the area be described?
painful/ tendor/ red and hot
What systemic features may be present?
fever, rigors, muscle pain, lethargy, depression, nausea and headache.
What would breast examination reveal?
Breast examination reveals unilateral oedema, erythema in a wedge-shaped area, and tenderness. The affected area feels firm and hot.
It is possible to distinguish clinically between infectious and non-infectious mastitis?
No
How else could it be diagnosed?
Milk cultures
If a breast abscess had developed, how would it be described?
If a breast abscess has developed, there will be a fluctuant tender lump, with overlying erythema.
What else might be palpable?
Axillary lymphadenopathy may be palpable
What differentials?
It should be distinguished from congestive mastitis (breast engorgement) which usually presents on the second or third day of breast-feeding. The complaint in this case is of swollen and tender breasts bilaterally, without fever or erythema.
What is the treatment?
Need drainage. Small abscesses with a needle + syringe. Large abscesses may need a small incision to drain. Local anaesthetic is given during both these procedures. When you think you have an abscess you should stop feeding from that side, but continue to express and discard the milk to stop swelling and engorgement.
