Mastitis - Mastitis Mastitis Joe Breuner, M.D. Thanks to...

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Unformatted text preview: Mastitis Mastitis Joe Breuner, M.D. Thanks to Doug Trotter, who gave this talk 18 Doug Trotter, who gave this talk 18 months ago Case Presentation Case Healthy 25 year­old woman, G2P2, with a 6 week­old infant Infant is fully breast­fed Patient is fatigued due to caring for 2 young children Husband is Boeing engineer, stressed because of likely upcoming layoff Case Presentation At 6 week visit, she reports 2 episodes of moderately painful swelling in upper inner quadrant of R breast; it occurred once in L breast It usually resolves, but she wants to know why it happens, and what to do Case Presentation Exam: Afebrile Looks tired but otherwise well Normal nipple and breast; no lumps or indurated areas No skin changes or lymphadenopathy Case Presentation Exam: Afebrile Looks tired but otherwise well Normal nipple and breast; no lumps or indurated areas No skin changes or lymphadenopathy Dx: Milk stasis or “plugged duct” Milk stasis Risk factors for milk stasis: Fatigue, stress Infrequent feeding Incomplete emptying of breast Ill­fitting bra Pumps, shields Prior breast trauma or infection Milk stasis Treatment for milk stasis: Heat application Massage toward nipple Frequent, relaxed nursing Change position to promote emptying Avoid pumps, shields Case Presentation Pt calls you Sunday afternoon, 3 PM, now 7 weeks postpartum Had recurrent swelling of upper inner quadrant R breast yesterday, but didn’t resolve Now 2 hrs of fever, chills, increased tenderness Case Presentation Pt calls you Sunday afternoon, 3 PM, now 7 weeks postpartum Had recurrent swelling of upper inner quadrant R breast yesterday, but didn’t resolve Now 2 hrs of fever, chills, increased tenderness Dx: Acute mastitis Mastitis Incidence: 2 ­ 3% of lactating women Mastitis Incidence: 2 ­ 3% of lactating women More common at 2 ­ 6 weeks post­ partum, but can occur at any time Mastitis Incidence: 2 ­ 3% of lactating women More common at 2 ­ 6 weeks post­ partum, but can occur at any time More common in primiparas, but probably due to bias Mastitis Incidence: 2 ­ 3% of lactating women More common at 2 ­ 6 weeks post­ partum, but can occur at any time More common in primiparas, but probably due to bias Risk factors: milk stasis, age > 30, stress, fatigue, professional employment of mother or father Mastitis Normal breast Normal breast architecture Mastitis 1970 Series: 71 cases of acute lactational mastitis Peak incidence at 2­3 weeks postpartum No infants weaned; none became ill 11% developed abscesses; 75% of those required surgical drainage Abscess more likely if antibiotics delayed 8% developed mastitis in a later pg Mastitis 1975 Series: 65 cases in 2,534 women: 2.5% incidence Average onset 5 weeks postpartum 14% had missed feed or rapidly weaned 12% had nipple fissure beforehand 74% had been nursing normally 5% developed abscesses, all in pts who chose to wean Mastitis 1978 Series: Similar results to prior studies No abscesses if prompt antibiotic treatment and continued nursing Mastitis Etiology: 50% or more: S. Aureus Other organisms: E. Coli, S. pyogenes Mastitis Etiology: 50% or more: S. Aureus Other organisms: E. Coli, S. pyogenes Source: infant nasopharynx (?) Mastitis Etiology: 50% or more: S. Aureus Other organisms: E. Coli, S. pyogenes Source: infant nasopharynx (?) Mechanism: via milk ducts or nipple fissure Mastitis Treatment: Prompt antibiotics: PO: Dicloxacillin, cephalexin, erythromycin IV: Nafcillin, cefazolin Continued frequent nursing Heat application Massage toward nipple Antipyretics Mastitis Mastitis In non lactating or pregnant women, consider early referral, as cancer is much more common. Breast Abscess Breast Breast Abscess Breast abscess Breast abscess with early skin necrosis Breast abcess Breast Consider diagnosis in mastitis which fails to respond to antibiotics after 2­ 3d (may not feel fluctuant) refer to breast surgeon for incisional drainage and biopsy­­ 10­15% of breast carcinomas in women<40 are found during pregnancy or lactation Breast Abscess Inflammatory Inflammatory breast cancer Neonatal Mastitis Neonatal Neonatal Mastitis Occurs up to 5 weeks of age Girls outnumber boys 2 : 1 Etiology: 85% S. aureus, also E. coli, group D Streptococcus Neonatal Mastitis Occurs up to 5 weeks of age Girls outnumber boys 2 : 1 Etiology: 85% S. aureus, also E. coli, group D Streptococcus Treatment: Prompt antibiotics (IV?) Careful needle aspiration if abscess Candida Infection Candida Candida Infection Burning pain with nursing Mild erythema & pruritis of nipple; findings may be subtle Associated with thrush in the baby May be intraductal Candida Infection Treat mother and baby with topical antifungals or Gentian violet May be recurrent If no response to topical therapy, may use oral fluconazole 150 mg qd X 5d Mastitis Mastitis ...
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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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