Mastitis-1 - Mastitis Mastitis Lisa Rahangdale, MD RID...

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Mastitis Mastitis Lisa Rahangdale, MD Lisa Rahangdale, MD RID Seminar RID Seminar October 26, 2004 October 26, 2004
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Mastitis Mastitis An acute inflammation of the An acute inflammation of the interlobular connective tissue interlobular connective tissue within the mammary gland within the mammary gland
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Outline Outline Epidemiology Presentation Predisposing factors Microbiology Treatment Complications Effect on breast milk
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Epidemiology Epidemiology Incidence 2-33% ACOG reports 1-2% in U.S. Most common worldwide <10% Most common 2 nd -3 rd week postpartum 74-95% in first 12 weeks Can occur anytime in lactation WHO 2000
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Presentation Presentation Systemic illness: Chills, myalgias Fever of ≥ 38.5 Tender, hot, swollen wedge-shaped erythematous area of breast Usually one breast
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Differential Diagnosis Differential Diagnosis Fullness: bilateral, hot, heavy, hard, no redness Engorgement: bilateral, tender, +/- fever, minimal diffuse erythema Blocked Duct: painful lump with overlying erythema, no fever, feel well, particulate matter in milk
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Differential Diagnosis Differential Diagnosis Galactocele: smooth rounded swelling (cyst) Abscess: tender hard breast mass, +/- fluctuance, skin erythema, induration, +/- fever Inflammatory Breast Carcinoma: unilateral, diffuse and recurrent, erythema, induration
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Causes and Causes and Predispsing factors Predispsing factors
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Causes Causes Milk 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
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Causes Causes Study of 213 , 339 breasts 3 groups Milk stasis (bacteria<10^3, leuk<10^6) Noninfectious inflammation (bacteria <10^3, leuk >10^6) Infectious (bacteria >10^3, leuk>10^6) Randomized treatment No intervention Systematic emptying of breast Infectious group with 3 rd intervention: antibiotics (PCN, Amp, Erythro) and systematic emptying Thomsen 1984
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Treatment N Sx duration (mean) p value Milk Stasis No treatment 63 2.3 d Emptying 63 2.1 d Noninfectious No treatment 24 7.9 d Emptying 24 3.2 d p<.001 Infectious No treatment 55 6.7 d Emptying 55 4.2 d p<.001 Abx +Emptying 55 2.1 d p<.001 Thomsen 1984
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Causes “Poor results” Milk stasis (10) – 3 recurrences, 7 impaired lactation Noninfectious (20) – 13 recurrences Infectious (76 – only 2 in Abx group) – 6 abscesses, 21 recurrences Could not clinically tell difference between the groups without lab data. Conclusion: Treat with antibiotics
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Mastitis-1 - Mastitis Mastitis Lisa Rahangdale, MD RID...

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