University of Washington乳腺炎华盛顿大学课件.ppt

Mastitis Thanks to Doug Trotter, who gave this talk 18 months ago Case Presentation Healthy 25 year-old woman, G2P2, with a 6 week-old infant Infant is fully breast-fed 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 Ill-fitting 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 l