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Breast > Inflammatory Breast Disease > Flashcards

Inflammatory Breast Disease Flashcards

1
Q

What is Mastitis?

A

It describes inflammation of the breast tissue, both acute or chronic.

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2
Q

What are the two types of Mastitis classed by?

A

Lactation

  • Lactational Mastitis (more common)
  • Non-lactational Mastitis
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3
Q

How common is lactational mastitis?

A

Seen in up to a third of breastfeeding women.

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4
Q

When does Lactational Mastitis usually present?

A

During the first 3 months of breastfeeding or During weaning.

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5
Q

What are the common causative organisms for Lactational Mastitis?

A

Staph Aureus
Strep Pyrogenes

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6
Q

What are the Risk factors for lactational Mastitis?

A
  • Poor breast feeding technique.
  • Nipple Damage
  • Maternal Stress
  • Previous Hx of Mastitis.
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7
Q

In women with what condition is non-lactational mastitis more common?

A

Duct Ectasia.

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8
Q

What is an important risk factor for non-lactational mastitis?

A

Tobacco smoking

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9
Q

What does smoking do to cause non-lactational mastitis?

A

Causes damage to the sub-areolar duct walls and predisposes them to infection.

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10
Q

What kind of organisms are more common causes of non-lactational mastitis?

A
  • Mixed organisms
  • Anaerobes.
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11
Q

What is the pathophysiology of lactational (peurperal) Mastitis?

A

Milk stasis leading to an inflammatory response and potential secondary infection.
Stasis due to:
- inadequate milk removal - poor breastfeeding technique or infrequent feeding.
- Cracked or sore nipples can provide a point of entry for bacteria, primarily staphylococcus aureus.

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12
Q

What are some of the Localised clinical features of Mastitis?

A
  • Painful
  • Tender
  • Red
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13
Q

What are some systemic clinical features of mastitis?

A

Fever, Rigors, myalgia, fatigue, nausea and headache.

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14
Q

Is mastitis typically Bilateral or unilateral?

A

unilateral.

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15
Q

What is a potential complication of Mastitis?

A

Breast Abscess.
- Manifesting as a fluctuant, tender mass with overlying erythema.

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16
Q

How is the diagnosis made for mastitis?

A

Clinically

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17
Q

How should mastitis be investigated if a Breast Abscess is suspected?

A

Early referral to secondary care and Ultrasound!

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18
Q

What is the first line management of Non-lactational mastitis?

A

Flucloxacillin 500mg orally for 10-14 days.

Augmentin Second line 625mg for 7 days.

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19
Q

What is the first line Tx for Lactational Mastitis?

A

Continue breastfeeding / Milk Drainage.

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20
Q

When should Lactational Mastitis be treated with antibiotics (fluclox/Augmentin)?

A
  • If systemically unwell.
  • If nipple fissure are present.
  • If Symptoms do not improve 12-24 hrs after effective milk removal.
    or if culture identifies an infection.
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21
Q

Should breastfeeding continue during the antibiotic treatment?

A

Yes.

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22
Q

What is a Breast Abscess?

A

Collection of Pus within the breast lined with granulation tissue.

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23
Q

What is the most common way for a breast abscess to form?

A

Developing from acute mastitis..

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24
Q

What are the Clinical features for a Breast Abscess?

A

Presents as a flocculent sometimes-bulging mass, usually located in the central areas of the mastitis.

  • Associated with systemic symptoms (Fever, Lethargy)
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25
Q

What is the main Investigation technique used in breast Abscess?

A

Ultrasound

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26
Q

How is a Breast Abscess Managed?

A

Aspiration
- with an 18 gauge needle.
- Aspiration sent for microbiological Analysis.

Antibiotics
- continued until all evidence of inflammation clears.

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27
Q

What is a Breast Cyst?

A

Epithelial Lined Fluid-Filled cavity.

28
Q

When does a Breast Cyst form?

A

When Lobules become distended due to blockage, usually in perimenopausal age group.

29
Q

How does a breast cyst typically present?

A
  • Singularly or with multiple lumps in one or both breasts.
  • Cysts typically palpable, clearly defined, soft, mobile and smooth.
30
Q

Are Breast Cysts sore?

A

Somewhat tender, especially before menstruation.

31
Q

How are Breast Cysts typically Investigated?

A
  • Mammogram
  • Ultrasound
32
Q

What does a Cyst look like on mammogram?

A

Typical “Halo Shape”

33
Q

If a persisting, symptomatic or undeterminable cystic breast mass is aspirated, when should it be sent for cytology?

A

If the cystic fluid contains blood.
(Query Cancer in that case)

34
Q

What is the Management of Breast Cysts?

A
  • Once diagnosed usually don’t require any further management as they self-resolve.
  • Larger cysts can be aspirated for aesthetic reasons or patient reassurance.
35
Q

What is Duct Ectasia?

A

Dilation and Shortening of the major lactiferous ducts.
- “Ectasia” means “Dilation”

36
Q

in what age group is Duct Ectasia most common?

A

Peri-menopausal women.
40% of women have significant duct dilation by 70 yrs.

37
Q

What is the Pathophysiology of Duct Ectasia?

A
  • Sub-areolar duct dilation
  • Periductal inflammation and fibrosis
  • Scarring and distortion
38
Q

What are the clinical features associated with Duct Ectasia?

A

Acute episodic inflammatory changes.
- Pain
- Bloody and or Purulent Nipple discharge
- Fistulation
- Nipple Retraction and Distortion.

39
Q

What investigations are used to identify Duct Ectasia?

A

Mammography:
- Duct ectasia can be identified by mammorgaphy by dilated calcified ducts without any other features of malignancy.

Biopsy:
- Not usually necessary
- If biopsied the mass typically contains multiple plasma cells on histology.

40
Q

What is the management of Duct ectasia?

A

Can be managed conservatively, unless radiological findings cannot exclude malignancy.

  • Unremitting discharge can be treated with duct excision.
41
Q

What is Breast fat Necrosis?

A

A common condition caused by an acute inflammatory response in the breast, leading to necrosis of fat lobules.

42
Q

What is a common cause of Breast Fat necrosis?

A

Trauma (e.g. seatbelt injury) main cause.
- Others:
- Previous surgical or radiological intervention.
- Warfarin therapy.

43
Q

What is the Pathophysiology of fat Necrosis?

A
  1. Damage and Disruption of adipocytes.
  2. Infiltration by acute inflammatory cells
  3. Aggregation of ‘foamy’ macrophages
  4. Subsequent fibrosis and scarring
44
Q

How does Fat Necrosis typically present?

A

Usually Asymptomatic or presenting as a lump.

Less commonly can present with fluid discharge, skin dimpling, pain and nipple inversion.

45
Q

What happens if the acute inflammatory response persists in fat necrosis?

A

It can cause a chronic fibrotic change that subsequently develops into a solid irregular lump.

46
Q

How is Fat Necrosis usually diagnosed?

A

A positive Hx of trauma + and/or a hyperechoic mass on ultrasound.

47
Q

What is used to differentiate between more fibrotic lesions and carcinoma in Breast Fat Necrosis?

A

Mammogram would show the more fibrotic lesion.

A Core Biopsy is often taken to rule out malignancy.

48
Q

What is the management of Fat Necrosis?

A

Self-limiting and usually only requires analgesic management and reassurance.

49
Q

What type of discharge does Mamillary Duct Ectasia usually present with?

A

Thick, Green or yellow discharge

50
Q

What type of Discharge does Intraductal Palpilloma usually present with?

A

Blood tinged nipple discharge

51
Q

Does Intraductal Papilloma have any pain or lumps associated?

A

No, it is usually asymptomatic

52
Q

Where does Intraductal papilloma usually begin?

A

Within the mammory ducts of the breasts.

53
Q

What is Periductal mastitis?

A

When the Ducts behind the nipple become infected

54
Q

What is a Risk factor for Periductal Mastitis?

A

Smoking

55
Q

How doe patients with Periductal Mastitis usually present?

A
  • With a fistula occurring behind the nipple which can cause pus discharge.
  • Bloddy discharge is also common from the nipple itself.
56
Q

What is Lymphodema?

A

A distruption of Drainage from tissues back towards the nodes.

57
Q

How long after Breast Surgery with Node clearance does Lymphodema typically present?

A

18-24 months post.
- is slow in its development

58
Q

How does Lymphodema following Breast Surgery present?

A

Swollen arm which feels uncomfortable.
No change to muscle strength.

59
Q

How does Fat necrosis usually present?

A

After Trauma with a Painless, non-tender, irregular shaped lump in the breast.

60
Q

How is Fat Necrosis of the breast usually managed?

A

Conservatively - Will usually just get better on its own.

  • Surgery indicated if the breast begins to get bigger or its disrupting daily life.
61
Q

When at what age is urgent referral to the breast assessment clinic indicated in a patient with a new or unexplained breast mass?

A

Over 30 yrs old.

Under 30 will require non-urgent referral unless they have risk factors for breast cancer.

62
Q

What are risk factors for breast cancer which indicate urgent referral to the breast assessment clinic for investigation?

A
  • A first degree male relative with Breast cancer
  • A first degree relative with breast cancer diagnosed at < 40yrs old.
  • Bilateral breast cancer in a first-degree relative under 50
  • Breast cancer in two first-degree relatives
63
Q

What is a Seroma?

A

A Collection of clear fluid under the skin which usually occurs after breast surgery.

64
Q

What timeframe after surgery does a seroma present?

A

First few weeks post surgery

65
Q

How would a Seroma present clinically?

A
  • Swelling
  • Discomfort
  • Sensation of Fluid moving beneath the skin.

Breast (2 decks)

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