MASTITIS : infection of breast tissues

CMCH , L3

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• COLLEGE OF MEDICINE AND HEALTH SCIENCES • CLIN MED α COM HEALTH DEPARTMENT • ACADEMIC YEAR 2016-2017 • YEAR THREE • GROUP 4 • SEMESTER II • MODULE : SUGERY• LECTURER : Dr Alcade

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GROUP IV PRESENTATION

GROUP MEMBERS

• 215003308: NORBERT ICYIZANYE • 215009972: TWAHIRWA GERVAIS • 215014132: UMUKUNDWA LADEGONDE • 215041249: NIYONKURU Ange DIVINE

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Breast anatomy

1. Chest wall2. Pec muscles3. Lobe4. Nipple5. Areolar6. Duct7. Fatty tissue8. SkinMilk is produced in the lobes, which are subdivided into lobules, and carried to the nipple via ducts, in response to hormonal stimulation.

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INTRODUCTION

• Infective mastitis/breast abscesses

• Infection of mammary duct and breast tissues often associated with lactation

• usually caused by S. aureus.

• presents as painful hot swelling of Breast segment.

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Breast mastitis

Infection that commonly affects women who are breast-feeding (especially during the first two months after childbirth) but can occur in all women at any time.

• In most case locational mastitis occurs within the first six to 12 weeks postpartum . 

• Mastitis is a benign condition not metastatic

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CAUSES

• Inflammation can be caused by :infectious agents and their toxins, physical trauma or chemical irritants

• Breast ducts become blocked, microorganisms enter• 10-33% of breast feeding women

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Common causative bacteria

• Staphylococcus aureus ( the most common ) • Coagulase negative staphylococci • Staphylococci • Streptococci • staph epidermidi• peptostreptococcus

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Risk factors

• Nipple fissures, cracks and sores • Age >30 years old• History of mastitis• Gestational age >41 weeks• Poor technique, causing incomplete emptying• One position to breast feed, which may lead to not fully drain

the breast milk • Wearing a tightfitting or putting pressure on breast from seatbelt

or carrying a heavy bag, which may restrict milk flow • Stresses • Poor nutrition

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Risk factors cont.’

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Pathophysiology

• Bacterial mastitis - most common variety from skin surface or baby’ s mouth .

• The intermediary – infant harbouring staphylococci in the nasopharynx.

• Ascending infection from a sore and cracked nipple

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Lactiferous ducts will first become

blocked by epithelial debris

leading to stasis;

Once within the ampulla of the

duct, staphylococci cause clotting of

milk and

Within this clot, organisms multiply

and lead to s/s.

Pathophysiology Cont.’

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Presentations

• Initially generalised cellulitis but later an abscess will form

• One breast affected• Continuous hot burning

sensation • Erythema, oedema,

tenderness• Pus on aspiration• Axillary lymph nodes

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Clinical Investigations

• Breast milk culture• Mammogram to exclude duct ectasia… • Biopsy to exclude breast cancer • Abscess suspected (tender hard breast mass, fluctuant

with oedema) -> Refer! -> Ultrasound

Mammography screening for cancer

• Mammography to exclude cancer • 50-70 years old• Every 3 years

• A mammogram is just an x-ray of the breast, and is a very useful screening tool and method of investigating potential malignancies and other breast pathologies

• About a third of breast cancers are diagnosed via screening

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Differential diagnosis

• Breast cancer• Fibroadenoma• Fibrocystic breast changes• Duct ectasia• Duct papilloma• Infective mastitis

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Diagnosis

• Clinical examination with : Wedge shaped area of redness on the breast that points

toward the nipple and is tender to the touch congestive mastitis (engorgement) Bilateral Clinical investigation findings

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Management

Conservative- technique, fluids, analgesia early prescription- flucloxacillin or Erythromycin• Clarithromycin • Clindamycin • Bactrim • Amoxicillin clavulanate• requires 10 to 14 days • Surgical- incision and drainage or needle aspiration• Investigate persisting mass

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Management cont’

Early prescription reduces risk of abscess, sepsis and recurrence

Surgical intervention can be considered if the mastitis progresses to an abscess.

incision and drainage of abscess cavity if overlying skin is thin or necrotic

Needle aspiration of abscess every day is an alternative

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Management cont.’

Incision and drainage recommended

If:

• the infection did not resolve

within 48 hours

• after being emptied of milk

there was an area of tense

induration or other evidence

of an underlying abscess.

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COMPLICATIONS

• Anesthesia related complications

• Breast cancer • Recurrence of mastitis • Breast abscess which

require drainage • Poor or refuse to

breast feed the baby

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Health education

• Concerning the appropriate ways to take antibiotics

and other prescribed medications

• Self care with good rest and continue breast feeding

with extra fluids and balanced diet

• Feeding from the affected side and change the position

used in breastfeeding

• Fully drain the milk from the breast while

breastfeeding

• personal hygiene improvement

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Referrences

• LONGMORE, M. et al., 2014. Index to emergency topics. , 9, p.621.

• Principles of Anatomy and Physiology (Tortora and Derrickson), 13th ed.

• Medicine at a Glance (Davey) 3rd ed• Clinical Medicine (Kumar and Clark) 7th ed

Oxygenate and Resuscitate Before You Operate

“Failure to promptly recognize and treat simple life-threatening injuries is the tragedy of trauma, not the inability to handle the catastrophic or complicated injury.”(F.William Blaisdell)

GOOD JUDGMENT COMES FROM EXPERIENCE

EXPERIENCE COMES FROM BAD JUDGMENT

• THIS IS THE END OF OUR PRESENTATION

• HAVE A NICE DAY : LADIES AND GENTLEMEN