Pain generally presents in 1 specific location and is

This preview shows page 16 - 18 out of 40 pages.

Pain generally presents in 1 specific location and is constant or intermittently painful. Pain is usually described as a tightness, burning or general soreness and is more commonly experiences by post-menopausal women. Etiologies may include periductal mastitis, stretching of cooper’s ligament, trauma, cyst, inflammatory cancer (ductal cancer) or idiopathic. Extra-mammary Mastalgia Chest wall pain is unrelated to the breast and referred from another source such as torn or strained muscles in the chest or shoulders, inflammation of the costal cartilage and rib injuries. Nipple Discharge Nipple discharge is also a common breast complaint among women and it is likely that you will encounter a patient presenting to your office for evaluation. Nipple discharge is categorized into 3 types:
17 1. normal lactation 2. benign physiologic nipple discharge (galactorrhea) 3. pathologic nipple discharge Physiologic Nipple Discharge Galactorrhea is a considered a physiologic nipple discharge because it is frequently the result of an excess of prolactin from the pituitary gland which stimulates milk production. Galactorrhea is usually bilateral (but may be unilateral), multi-ductal and milky in appearance in the non-lactating adult. It can occur in males as well as females. In females, absent or irregular menstrual periods are likely. Pathologic Nipple Discharge Pathologic nipple discharge on the other hand is non-milky, spontaneous, and most often unilateral and uniductal. Nipple discharge with a bloody appearance is more suggestive of intraductal malignancy or a benign intraductal papilloma and should raise a red flag to the provider. Mammary duct ectasia, on the other hand, is another source of non-milky discharge. Ectasia is the result of mammary duct dilation with surrounding inflammation and fibrosis. It can present with variable colors (green, brown or black) and may be seen in both breast and/or multiple ducts. Treatment Once a benign diagnosis or normal findings have been established by biopsy or imaging, simple reassurance is often all that is needed. Symptomatic treatment for mastalgia may also include the following recommendations: Wear a sports or supportive, wire-free bra Minimizing caffeine may provide anecdotal relief NSAIDs Evening primrose oil and vitamin E supplementation-their utility is controversial since benefits have not been shown consistently in research Danazol, bromocriptine and tamoxifen have been found effective and used for severe cases but the significant side effects have limited the acceptability of their use Changing to contraceptive pill or hormone replacement therapy with less estrogen or progesterone may offer some relief associated with cyclic mastalgia Clinical signs and symptoms of ectopic pregnancy Ectopic pregnancy is the implantation of a fertilized ovum in locations other than the uterine cavity.

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture