Mastitis

Question 1

Nevn seks problemer relatert til amming som fører til mastitt

Answer 1

• Poor latch and position
• Nipple excoriation or cracking
• Blocked milk ducts
• Oversupply of milk
• Infrequent feedings/rapid weaning
• Pressure on the breast (tight brasserie, car seatbelt)

Question 2

Hva er lactogenesis II og når oppstår det?

Answer 2

Normal fysiologisk tilstand.

Oppstår mellom 2-4 dager postpartum.

Swelling of the mother’s breasts and the onset of copious milk production.

Question 3

Hva forårsaker lactogenesis II?

Answer 3

Venøs og lymfatisk stase pga økt blodsirkulasjon, IKKE pga excessive milk volume

Question 4

Symptomer på lactogenesis II

Answer 4

o Bilateral general swelling
o Tenderness – sometimes subfebrilia
o Engorgement makes good latch difficult

+ pain?

Question 5

Behandling av lactogenesis II

Answer 5

o Frequent suckling – good latch
o Stimulate the nipple to start the ejection reflex
o Hand expression before breastfeeding makes the breast a little softer and improves the chance for a good latch

Question 6

Kjennetegn på inflammatorisk mastitt uten patogen

Answer 6

o Milkstasis
o Blocked milk ducts
o Inflammatory mastitis/severe engorgement

Question 7

Kjennetegn på infeksiøs mastitt

Answer 7

o Infection of the milk ducts and glands
o Interstitial infection with cellulitis
o Abscess

Question 8

Behandling på inflammatorisk og infeksiøs mastitt

Answer 8

• Complete emptying of the breast

- Supportive care of the woman

Question 9

Nevn de 5 stadiene ved mastitt

Answer 9

• Milkstasis
• blocked milk ducts
• inflammatory mastitis
• infectious mastitis
• abscess

Question 10

Inflammatory mastitis - symptomer og funn

Answer 10

Red, tender, mild-moderate pain

Temp > 38.5 occurs

Malaise, nausea, flu-like symptoms

CRP slightly or moderately elevated

Question 11

Behandling av inflammatory mastitis

Answer 11

Symptomatisk: Ibuprofen, paracetamol

Emptying of the breasts until soft every 2. hour.

Ongoing breastfeeding - hand expression and pumping.

Culture of the breastmilk

Supportive care and lactation support by lactation consultant

Question 12

Skal det gis antibiotikabehandling ved inflammatorisk mastitt? Hvis ja, når?

Answer 12

• Emptying of the breast might resolve the problem
• Antibiotics if emptying for 12-24 hours doesn’t help – wait and see prescription? Or..
• Follow up visit or if condition worsens
• Follow up on result of breastmilk culture
• Antibiotics if duration of symptoms more than 24 hours and/or systemic affection, high temperature

Question 13

Hvilken antibiotika mot inflammatorisk mastitt?

Answer 13

• Staph. Aureus (E. coli, Streptoccoccus)

- Prescribe a penicillinase resistant penicllin

Question 14

Symptomer og tegn på infectious mastitis

Answer 14

• Occurs in the setting of breastfeeding problems that result in prolonged engorgement or poor drainage: blocked ducts, nipple trauma
• Pathogenic organisms gain access to stagnant milk through the nipple cracks and excoriations
• Pain, redness, fever, myalgias, malaise
• Langvarig problem – ikke noe som kommer over natten