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Inflammatory Breast Disease Flashcards

(65 cards)

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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
What is the main Investigation technique used in breast Abscess?
Ultrasound
26
How is a Breast Abscess Managed?
Aspiration - with an 18 gauge needle. - Aspiration sent for microbiological Analysis. Antibiotics - continued until all evidence of inflammation clears.
27
What is a Breast Cyst?
Epithelial Lined Fluid-Filled cavity.
28
When does a Breast Cyst form?
When Lobules become distended due to blockage, usually in perimenopausal age group.
29
How does a breast cyst typically present?
- Singularly or with multiple lumps in one or both breasts. - Cysts typically palpable, clearly defined, soft, mobile and smooth.
30
Are Breast Cysts sore?
Somewhat tender, especially before menstruation.
31
How are Breast Cysts typically Investigated?
- Mammogram - Ultrasound
32
What does a Cyst look like on mammogram?
Typical "Halo Shape"
33
If a persisting, symptomatic or undeterminable cystic breast mass is aspirated, when should it be sent for cytology?
If the cystic fluid contains blood. (Query Cancer in that case)
34
What is the Management of Breast Cysts?
- 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
What is Duct Ectasia?
Dilation and Shortening of the major lactiferous ducts. - "Ectasia" means "Dilation"
36
in what age group is Duct Ectasia most common?
Peri-menopausal women. 40% of women have significant duct dilation by 70 yrs.
37
What is the Pathophysiology of Duct Ectasia?
- Sub-areolar duct dilation - Periductal inflammation and fibrosis - Scarring and distortion
38
What are the clinical features associated with Duct Ectasia?
Acute episodic inflammatory changes. - Pain - Bloody and or Purulent Nipple discharge - Fistulation - Nipple Retraction and Distortion.
39
What investigations are used to identify Duct Ectasia?
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
What is the management of Duct ectasia?
Can be managed conservatively, unless radiological findings cannot exclude malignancy. - Unremitting discharge can be treated with duct excision.
41
What is Breast fat Necrosis?
A common condition caused by an acute inflammatory response in the breast, leading to necrosis of fat lobules.
42
What is a common cause of Breast Fat necrosis?
Trauma (e.g. seatbelt injury) main cause. - Others: - Previous surgical or radiological intervention. - Warfarin therapy.
43
What is the Pathophysiology of fat Necrosis?
1. Damage and Disruption of adipocytes. 2. Infiltration by acute inflammatory cells 3. Aggregation of ‘foamy’ macrophages 4. Subsequent fibrosis and scarring
44
How does Fat Necrosis typically present?
Usually Asymptomatic or presenting as a lump. Less commonly can present with fluid discharge, skin dimpling, pain and nipple inversion.
45
What happens if the acute inflammatory response persists in fat necrosis?
It can cause a chronic fibrotic change that subsequently develops into a solid irregular lump.
46
How is Fat Necrosis usually diagnosed?
A positive Hx of trauma + and/or a hyperechoic mass on ultrasound.
47
What is used to differentiate between more fibrotic lesions and carcinoma in Breast Fat Necrosis?
Mammogram would show the more fibrotic lesion. A Core Biopsy is often taken to rule out malignancy.
48
What is the management of Fat Necrosis?
Self-limiting and usually only requires analgesic management and reassurance.
49
What type of discharge does Mamillary Duct Ectasia usually present with?
Thick, Green or yellow discharge
50
What type of Discharge does Intraductal Palpilloma usually present with?
Blood tinged nipple discharge
51
Does Intraductal Papilloma have any pain or lumps associated?
No, it is usually asymptomatic
52
Where does Intraductal papilloma usually begin?
Within the mammory ducts of the breasts.
53
What is Periductal mastitis?
When the Ducts behind the nipple become infected
54
What is a Risk factor for Periductal Mastitis?
Smoking
55
How doe patients with Periductal Mastitis usually present?
- With a fistula occurring behind the nipple which can cause pus discharge. - Bloddy discharge is also common from the nipple itself.
56
What is Lymphodema?
A distruption of Drainage from tissues back towards the nodes.
57
How long after Breast Surgery with Node clearance does Lymphodema typically present?
18-24 months post. - is slow in its development
58
How does Lymphodema following Breast Surgery present?
Swollen arm which feels uncomfortable. No change to muscle strength.
59
How does Fat necrosis usually present?
After Trauma with a Painless, non-tender, irregular shaped lump in the breast.
60
How is Fat Necrosis of the breast usually managed?
Conservatively - Will usually just get better on its own. - Surgery indicated if the breast begins to get bigger or its disrupting daily life.
61
When at what age is urgent referral to the breast assessment clinic indicated in a patient with a new or unexplained breast mass?
Over 30 yrs old. Under 30 will require non-urgent referral unless they have risk factors for breast cancer.
62
What are risk factors for breast cancer which indicate urgent referral to the breast assessment clinic for investigation?
- 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
What is a Seroma?
A Collection of clear fluid under the skin which usually occurs after breast surgery.
64
What timeframe after surgery does a seroma present?
First few weeks post surgery
65
How would a Seroma present clinically?
- Swelling - Discomfort - Sensation of Fluid moving beneath the skin.

Breast (2 decks)

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