mastitis

MASTITISMASTITISVIDULA SHEVADEVIDULA SHEVADE

603603

MastitisMastitis

An acute inflammation of the An acute inflammation of the interlobular connective tissue within interlobular connective tissue within

the mammary glandthe mammary gland

ANATOMY OF BREASTANATOMY OF BREAST

• Breast are modified sweat glands lying on pectoralis fasia and musclature of chest wall.

• It is surrounded by skin and subcutaneous fat.

• Transversely it extends from the side of sternum to near mid-axillary line.

ANATOMY OF BREAST ANATOMY OF BREAST

• Vertically it extends from 2nd to 6th rib.

Predisposing factors of mastitisPredisposing factors of mastitis

• Damaged nipple (nipple fissure)• Primiparity• Previous history of mastitis• Maternal or neonatal illness• Maternal stress• Work outside the home• Trauma• Genetic

Classification Classification

• Etiology• Infectious

• Non-infectious

• Milk stasis

• Abcess formation

INFECTIOUSINFECTIOUS

• Most comman pathogen is staphylococcus aureus

• Sometimes streptococcus is also detected

NON INFECTIOUS CAUSES NON INFECTIOUS CAUSES

• It includes carcinomatous processes which causes,

• Hyperplasia of cells.

• Leading to duct obstruction.

BREAST ABSCESSBREAST ABSCESS

• A breast abscess is a collection of pus that develops into the breast.

BREAST ABSCESSBREAST ABSCESS

• Most common in first 6 weeks

• 5-11% of mastitis cases

• Affect future lactation in 10% of affected ♀

• No differences b/t groups by age, parity, localization of infection, cracked nipples, + milk cultures.

• Duration of symptoms: only independent variable favoring abscess development

MILK STASISMILK STASIS

– Stagnant milk increases pressure in breast leading to leakage in surrounding breast tissue

– Milk, itself, causes an inflammatory response

• +/- Infection

– Milk provides medium for bacterial growth

ClassificationClassification

• Types

• Puerperal mastitis

• Non puerperal mastitis

Puerperal mastitisPuerperal mastitis• Puerperal mastitis is the inflammation of

the breast in connection with pregnancy and breastfeeding.

•  it is caused by blocked milk ducts.

Nonpuerperal mastitisNonpuerperal mastitis

• The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding.

CLINICAL FEATURESCLINICAL FEATURES

• Breast tenderness or warmth to the touch

• General malaise or feeling ill

• Swelling of the breast

• Pain or a burning sensation continuously or while breast-feeding

•

CLINICAL FEATURESCLINICAL FEATURES

• Skin redness, often in a wedge-shaped pattern

• Fever of 101 F (38.3 C) or greater

• The affected breast can then start to appear lumpy and red.

STAGESSTAGES

Cellulitic stages

In which breast as a whole becomes red and extermely painful.

Abscess

When the abscess develops redness becomes limited to area of abscess formation.

STAGESSTAGES

• Edema ,tenderness,brawny induration are the three main features of abscess formation.

TEST AND DIAGNOSISTEST AND DIAGNOSIS

• The diagnosis of mastitis and breast abscess can usually be made based on a physical examination.

•  ultrasound.

•  a clear image of the breast tissue and may be helpful in distinguishing between simple mastitis and abscess

TEST AND DIAGNOSISTEST AND DIAGNOSIS

•  In cases of infectious mastitis, cultures may be needed in order to determine what type of organism is causing the infection.

• Staph Aureus

Group A and B βhemolytic Strep, E Coli, H. flu

• MRSA

• Fungal infections

• TB where endemic – 1% of cases

TEST AND DIAGNOSISTEST AND DIAGNOSIS

• Mammograms or breast biopsies are normally performed on women who do not respond to treatment or on non-breastfeeding women.

MAMMOGRAMMAMMOGRAM

Differential DiagnosisDifferential Diagnosis

• Galactocele: smooth rounded swelling (cyst)

Inflammatory Breast Carcinoma: unilateral, diffuse and recurrent, erythema, induration.

Enlargement of regional lymph nodes.

ComplicationsComplications

Breast AbscessBreast Abscess

Other ComplicationsOther Complications

• Distortion of breast • Chronic inflammation

TREATMENTTREATMENT

• Supportive Therapy– Rest, fluids, pain medication, anti-

inflammatory agents, • lactation mastitis• -frequent emptying of both breasts by

breastfeeding is essential. Also essential is adequate fluid supply for the mother and infant

TREATMENTTREATMENT

• For breastfeeding women with light mastitis, massage and application of heat prior to feeding can help as this may aid unblocking the ducts. However in more severe cases of mastitis heat or massage could make the symptoms worse and cold compresses are better suited to contain the inflammation

TREATMENTTREATMENT

• INFECTIOUS MASTITIS

•  Dicloxacillin or cephalexin are recommended, because of the high rates of penicillin resistant staphylococci.

• Minimum treatment 10-14 days.

TREATMENTTREATMENT

• An abscess (or suspected abscess) in the breast may be treated by ultrasound-guided fine-needle aspiration (percutaneous aspiration) or by surgical incision and drainage; each of these approaches is performed under antibiotic coverage. In case of puerperal breast abscess, breastfeeding from the affected breast should be continued where possible.