lactational mastitis

Question 1

Lactational mastitis is …

Answer 1

inflammatory condition of interlobular connective tissue

Question 2

incidence of lactational mastitis

Answer 2

10% breastfeeding women

Question 3

complication of lactational mastitis is

Answer 3

breast abscess

Question 4

causes of mastitis

Answer 4

milk stasis caused either by i) overproduction of milk or ii) insufficient removal of milk

Question 5

leading cause of mastitis in breastfeeding women

Answer 5

milk stasis: accumulation of milk causes an inflammatory response

Question 6

(2) causes of mastitis in non breastfeeding women

Answer 6

• central/subareolar infection - peripheral infection

Question 7

risk factors for infection causing mastitis

Answer 7

• Diabetes - RA - trauma - corticosteroids - immunosuppression

Question 8

symptoms of mastitis

Answer 8

• painful, tender, erythematous - tiredness/feeling unwell

Question 9

most common causative organism in infectious mastitis

Answer 9

Staphylococcus aureus

Question 10

most common causative organisms in infectious mastitis in non breast feeding women

Answer 10

• staph aureus - enterococci

Question 11

risk factors in lactating women

Answer 11

a) Poor infant attachment to nipple b) Reduced no. + duration of feeds c) Pressure on breast d) Age

Question 12

causes of poor infant attachment to nipple

Answer 12

• infant mouth abnormalities: cleft lip/palate - short frenulum in infant

Question 13

age RF for lactational mastitis

Answer 13

21-35 years

Question 14

non lactational risk factors

Answer 14

• smoking - nipple damage - breast trauma - immunosuppression (HIV, DM, therapy) - nulliparity

Question 15

4 causes of nipple damage

Answer 15

• piercing - eczema - infection - raynauds disease

Question 16

underlying breast abnormalities that can cause mastitis

Answer 16

cyst + tumour –> persistent poor drainage of part of breast leading to infection

Question 17

complications of mastitis

Answer 17

• inability to breastfeed in future - scarring e.g. from needle aspiration - sepsis: espec in immunocompromised patients

Question 18

management of mastitis

Answer 18

• continue breastfeeding

Question 19

management of mastitis if breastfeeding is too painful

Answer 19

express milk by hand from both breasts

Question 20

3% of women with mastitis develop –>

Answer 20

Breast abscess

Question 21

breast abscess are:

Answer 21

localised collection of pus within the breast.

Question 22

location of lactational abscesses

Answer 22

peripheral breast, commonly upper + outer quadrant

Question 23

location of non lactational breasts

Answer 23

lower quadrants of breast

Question 24

symptoms/signs of breast abscess (skin + palpation + systemically)

Answer 24

skin = erythematous, visibly swollen, small fissure on nipple palpation: tender mass, warm systemic: fever

Question 25

risk factors for breast abscess

Answer 25

- previous mastitis - sudden cessation breastfeeding in women with lactational mastitis - immunosuppression (DM, HIV) - S aureus carriage - poor hygiene

Question 26

investigation of choice for breast abscesses

Answer 26

ultrasound

Question 27

management of breast abscesses

Answer 27

- ultrasound guided needle aspiration (under local) - Flucloxacillin

Question 28

Answer 28

skin overlying: thickened surrounding oedema fluid collection within breast in keeping with a breast abscess