Simulation

Acute

Breast Abscess

BYPROF GOUDA ELLABBAN

Contents • Case report.• Breast anatomy• Size and shape of the breast• Definitions and abnormalities• Breast lump• Breast abscess.• Pathogeneses Breast abscess • Types of Breast abscess

– Lactational abscesses – Non- lactational abscess

• Symptoms and signs• Risk factor • Complications of Breast

abscess• Investigation• Treatment

– Self-Care at Home – Medications– Surgery– Follow-up

• Prevention

Case report. Virtual patient (simulation)Admission date: Sunday.9-4-2006.History taking: Monday 10-4-2006ID: Sarah is 23 old year Saudi lady; she is

married house wife living in Al-khobar.Chief complaint: she was admitted

through ER on the 9th of April 2006 due to breast pain for three days duration.

History of presenting illness:Patient was in her usual state of health till

the 4th of April when she started to develop sudden continuo’s dull-aching pain, not radiating, with no aggravating or relieving factors& associated with redness & swelling .Lf- breast.

Patient is breast feeding her son who is 3monthsold. Her condition is 10

Days after last period. This condition was not associated with nipple discharge or retraction. No history of fever. No history of previous breast surgery. No history of nipple discharge.

Case report• Past history:• Medical &surgical: un- remarkable• Past family: • Her father passed away long time ago

in his 60’s with unknown cause of death

• Her mother 53 year old lady with HPN as well DM

• Her brothers and sisters are healthy and no similar disease in her family.

• Drug/allergy history: unremarkable.• History of immunization: she doesn’t

remember• Menstrual history: regular every 28

days with no disturbances.• Social history: a housewife, doesn’t

smoke, doesn’t drink & lives in toga• Finished her intermediate school. She

has been married for the laste2 years & has one child

• Systemic review: unremarkable

Cont’• Physical examination (11.4.06)• General appearance:

– The patient is young aged female laying in bed with mild pain with out respiratory distress, well developed, well nourished

– She is connected to I.V line– Apparently not cyanosed, pale or jaundiced– She conscious alert and oriented to time, place

and person• Vital sign:

– Temperature: 37.2 C PO.– B.P: 135/85 mmHg– R.R. 20/min – P.R: 89 /min

• Head and neck:– Remarkable

• Hand: remarkable• Abdomen: remarkable• Lower extremities: remarkable• Chest: • Inspection:

– . redness on left Peripheral. Area• Palpation:

– A firm, walled-off, non-tender. Worm lump

• Differential diagnosis:– Mastitis – Breast abscess – Fibrocystic breast disease:– Fibroadenoma: – Fat necrosis– Breast cancer

• • Investigation:

– Culture. Bacterial...– Simple .taken from abreast milk. To determine the

type of organism causing the infection.– +ve Staphylococcus aureus– Fine needle aspiration– Breast biopsy ( -ve Ca)– Ultrasound scanning – +ve breast abscess, +ve for deep abscesses– Mammography

• Diagnosis:– Acute breast abscess

• Treatment Rx– Deep abscess requiring surgical

treatment,Admitted to the hospital for IV antibiotics.

Breast Anatomy• Modified sweat glands.

• The nipple is usually in the 4th intercostals space in the midclavicular line.

• accessory breast/nipple tissue may develop anywhere down the nipple line (axilla to groin)

Breast Anatomy

• Breast profile:– A- Ducts– B- Lobules– C- Dilated section

of duct to hold milk– D- Nipple– E- Fat– F- Pectoralis major

muscle– G- Chest wall/rib

cage

Breast Anatomy

• Enlargement:

A. Normal duct cells

B. Basement membrane

C. Lumen (center of duct)

Axillary Lymph Nodes

A. Pectoralis major muscle

B. Axillary lymph nodes: level I

C. Axillary lymph nodes: level II

D. Axillary lymph nodes: level III

Size and shape of the breast• Amount of fat and stroma

surrounding the glandular tissue determines the size.

• During lactation, the enlargement is almost entirely glandular.

• breasts in healthy woman influences – Age.– Hereditary factors sexual

maturity.– Menstrual cycle.– Parity.– Pregnancy. – Lactation.– General state of nutrition.

Definitions and abnormalities• Breast lump: A breast lump is a

swelling, protuberance, or lump in the breast. – Benign (noncancerous) – Malignant.

• Breast pain (mastalgia): – cyclical mastalgia : related to the menstrual

cycle ,– Non cyclical mastalgia: nSkin changes:

dimpling is due to retraction of the dermis.

Definitions and abnormalitiesSkin changes: dimpling is due to

retraction of the dermis.

Nipple changes: Inversion: retraction of the nipple Discharge: A small amount of fluid expressed

from multiple ducts of breast on massage.

Gynarecomastia: Is enlargement of the male breast and often occurs in pubertal boys.

Breast lump

• Breast cancer: – One of commonest malignancies in the world. – Mostly are solid masses with an irregular outline.

• Fat necrosis:– Mostly cause by Trauma.– Bruising is occasionally noted near the lump – The mass may be associated with skin or nipple

retraction.– A fat necrosis mass cannot be distinguished from

breast cancer without biopsy.

Breast lump

• Fibroadenoma: – Benign lumps due to over growth of part of

the terminal duct lobules.– Rarely develop after age 30. – Single or multiple fibroadenomas may

develop in one or both breasts.

• Fibrocystic breast disease:– Fibrocystic changes or irregular modularity of the

breast is common.– Upper outer quadrant in young woman.

Breast lump

• Breast abscess: Swollen inflamed area of the breast in which pus

collects. Results from infection via the duct system.

• Breast biopsy the best way to determine the etiology of breast (80% to 85% of all biopsies are benign.

Breast abscess• A firm, walled-off, non-

tender abscess

• Mastitis does not cause cancer,

• acute mastitis most occur 1-3 months after the delivery of a baby.

• inflammatory carcinoma a rare chronic mastitis of Cancer

Types of Breast abscess.

• Lactational abscesses – Is related to nursing (breastfeeding).  – Usually peripheral.

• Non- lactational abscess – a subareolar abscess (in the pigmented area

surrounding the nipple)– Unrelated to nursing.– occur as an extension of periductal mastitis – usually at the edge of or under the areola – Associated with nipple inversion.

Pathogeneses Breast abscess>Breast infections are usually caused by common

bacteria found on normal skin (Staphylococcus aureus).– >The bacteria enter through a break or crack in the

skin, usually the nipple. The infection then takes place in the parenchymal (fatty) tissue and causes swelling of the parenchymal tissue outside the milk ducts.

– >This swelling compresses on the milk ducts, and the result is pain and swelling of the infected breast.

superficial small area of inflammation (frequently from a streptococcal germ) Deeper walled-off infection or abscess (frequently from

a staphylococcal germ).

Symptoms and signs of Breast abscess

• Pain(mastodynia)

• Tenderness

• Pus draining

• Collection ("mass") of pus

• Fever

• Skin redness

• Generally unwell

• nipple discharge (may contain pus)

• nipple sensation change

• itching

Complications of Breast abscess

–• more serious abscess infection – Pus draining from the nipple Persistent fever – No improvement of symptoms within 48-72 hours of

treatment.• Loss of breast feeding

• Risk factor list– Childbirth.– Breast feeding.– cracked nipples

Investigation • fine needle aspiration Breast biopsy ( best way to determine

the etiology of breast)• Culture

– taken from abreast milk – material aspirated (taken out through

a syringe) from an abscess • Ultrasound scanning• mammography

Treatment• Self-Care at Home (Helps breast infection heal

well.)

• Medications• For simple mastitis without an abscess, oral

antibiotics are prescribed• (Cephalexin (Keflex) and dicloxacillin (Dycill)

are two of the most common antibiotics)• Chronic mastitis in nonbreastfeeding women

can be complicated. Recurrent episodes of mastitis are common poorly to antibiotics.

• If the infection worsens in spite of oral antibiotics or if you have a deep abscess requiring surgical treatment

Treatment• Surgery

• If abscess not deep Surgery can be done in the OPD or emergency department

• Deep abscess require surgical drainage in the operating room

• Antibiotics and heat on the area are also used to treat abscesses

Treatment

• Follow-up • Take all antibiotics as prescribed• Follow up with Her doctor every in 1-2 weeks to

make sure that the infection has gone away

Prevention

• Sometimes mastitis is unavoidable. Some women are more susceptible than others, especially those who are breastfeeding for the first time. In general, good habits to prevent mastitis include the following:

• Breastfeed equally from both breasts. • Empty breasts completely to prevent engorgement

and blocked ducts. • Use good breastfeeding techniques to prevent sore,

cracked nipples. • Avoid dehydration by drinking plenty of fluids. • Practice careful hygiene: Hand washing, cleaning the

nipples, keeping your baby clean.

Thanks For listening