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

Mastitis;Thanks to ;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;Exam: Afebrile Looks tired but otherwise well Normal nipple and breast; no lumps or indurated areas No skin changes or lymphadenopathy;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”;Risk factors for milk stasis: Fatigue, stress Infrequent feeding Incomplete emptying of breast Ill-fitting bra Pumps, shields Prior breast trauma or infection;Treatment for milk stasis: Heat application Massage toward nipple Frequent, relaxed nursing Change position to promote emptying Avoid pumps, shields;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;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;Incidence: 2 - 3% of lactating women;Incidence: 2 - 3% of lactating women More common at 2 - 6 weeks post-partum, but can occur at any time;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;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;Normal breast architecture;1970 Series: 71 cases of acute lactational mastitis Peak incidence at 2-3 weeks postpartum No infants weaned; none became ill 11% developed abscesses; 75