Mastitis课件.ppt

Mastitis Lisa Rahangdale, MD RID Seminar October 26, 2004 Mastitis An acute inflammation of the interlobular connective tissue within the mammary gland Outline Epidemiology Presentation Predisposing factors Microbiology Treatment Complications Effect on breast milk Epidemiology Incidence 2-33% ACOG reports 1-2% in U.S. Most common worldwide 10% Most common 2nd-3rd week postpartum 74-95% in first 12 weeks Can occur anytime in lactation Presentation Systemic illness: Chills, myalgias Fever of ≥ 38.5 Tender, hot, swollen wedge-shaped erythematous area of breast Usually one breast 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 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 Causes and Predispsing factors 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 Causes Study of 213 ♀, 339 breasts 3 groups Milk stasis (bacteria10^3, leuk10^6) Noninfectious inflammation (bacteria 10^3, leuk 10^6) Infectious (bacteria 10^3, leuk10^6) Randomized treatment No intervention Systematic emptying of breast Infectious group with 3rd intervention: antibiotics (PCN, Amp, Erythro) and systematic emptying 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 Predisposing factors Improper nursing technique Timing of