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1、BREAST DISEASE(Lecture#80085)?Breast AnatomyBreast profile:?A:?ducts?B:?lobules?C:?dilated?section?of?duct?to?hold?milkD:?nipple?E:?fat?F:?pectoralis?major?muscle?G:?chest?wall/rib?cage?Enlargement:?A:?normal?duct?cells?B:?basement?membrane?C:?lumen?(center?of?duct)?Benign Breast DiseaseVery?commonl
2、y?encountered?in?primary?care?practiceBenign?breast?symptoms?and?findings?occur?in?approximately?50%?of?women15?million?office?visits/yr90%?visits?for?breast?sx?result?in?benign?findings,?but?breast?cancer?can?mimic?benign?disease,?so?prudent?approach?is?to?always?exclude?cancer subtext,?anyone?CYAP
3、rotect?your?patients,?protect?yourselfAlways?have?cancer?on?your?ddx,?and?always?rule?it?outIf?unsure,?you?must?referBreast?disease?is?an?extremely?litigious?areaBreast HistoryDuration?of?symptomsRelation?of?sx?to?menstrual?periodPresence/type?of?painNipple?dischargeSkin?changesMeds/drugsLast?MMGPMH
4、X?or?FHx?breast?cancerMastalgia/MastodyniaOnly?recently?defined?as?a?medical?problemIncidence:?60%?presented?with?complaint?to?breast?clinic,?but?only?3.4%?sought?medical?treatment.So?how?would?the?provider?know?Cyclic Breast PainAssociated?with?FCBC,?PMSUsually?benignWorsens?in?luteal?phase When?is
5、?that?May?be?unilateral?or?bilateralUOQ?most?common?site What?else?is?common?in?UOQ?Hormonal?influenceCyclic Breast PainEvaluation:?Thorough?history?and?physical?exam.?Optimal?time?-?days?7-9?after?LNMP?(why?)?If?no?obvious?abnormalities?noted,?obtain?2?month?breast?pain?calendar?to?verify?cyclic?na
6、ture.Treatment options:?Reassurance?and?mechanical?support?(well?fitted?bras),?diuretics,?low?fat?diet,?evening?primrose?oil,?oral?contraceptives,?thyroid?hormone,?and?NSAIDsNon-cyclic painIncidence:?10%?of?women?30-40?years?of?age?with?severe?breast?painCause:More?likely?to?be?non-hormonal;?(post-?
7、surgical,?musculoskeletal,?trauma,?infection,?cancer)?Symptoms:?“burning”?pain,?“aching”,?“sore”Physical Exam:?7-10%?have?underlying?carcinomaMastitisDefinition:Inflammation?of?the?breast?tissue?usually?occurring?during?lactationIncidence:?7%-10%,?usually?first-timersSymptoms:Severe?breast?tendernes
8、s,?induration,?erythema,?heat,?and?swelling?of?the?breast,?with?fever?(38-40C/101-103F)?and?chills Usually?unilateralMastitisCauses:?failure?to?empty?breasts?completely?of?milk?at?each?nursing,?pathogens?(usually?from?the?babys?mouth)?gaining?entrance?into?the?milk?ducts?through?a?crack?or?fissure?i
9、n?the?nipple?lowered?resistance?in?the?mother?due?to?stress,?fatigue,?and?inadequate?nutritionMastitis TreatmentBed?restAntibiotics?that?cover?resistant?S.?Aureus?(eg.?dicloxacilllin)?Pain?relievers,?increased?fluid?intake,?and?ice?or?moist?heat?applicationsContinue?to?nurse!Breast abscessIf?tendern
10、ess?and?erythema?of?mastitis?persist?after?antibiotic?therapy,?the?presence?of?an?abscess?should?be?suspectedFindings:?Usually?singular?and?multilocular?abscess?seen?on?ultrasoundTreatment:Incision?and?drainage?or?aspirationNipple DischargeHistory to?obtain:?Onset,?duration,?color,?consistency,?odor
11、,?amount,?associated?symptoms,?medicationsIncidence:10?-?50%?of?women?with?benign?breast?disease 3%?of?women?with?breast?cancer 7%?of?breast?surgeries?are?for?nipple?dischargeGalactorrheaDefinition:?non-puerperal?secretion?of?milkSymptoms:?1.?Spontaneous?or?expressible?milky?discharge?from?nipple2.?
12、May?have?headache,?menstrual?irregularities,?infection,?osteoporosis,?hirsutismGalactorrheaUsually?multiple?ducts?bilaterally.?Verify?that?it?is?milk?microscopically?by?identifying?multiple?fat?droplets?under?low?magnificationGalactorrheaIdiopathic:1/3?of?all?casesDrug Induced:?Important?to?review?a
13、ll?current?medications?and?then?check?for?possible?side?effects.Pituitary Adenoma:?galactorrhea,?hyperprolactinema,?and?amenorrhea?Treatment:?Bromocriptine?Measure?effectiveness?by?return?of?menses?and?normal?prolactin?levelSurgical?resection?if?unresponsive?to?medicationsOther Nipple dischargeIncid
14、ence:?9%?of?women?with?benign?breast?diseaseTypes:?watery?33%;?sanguinous?27%;?serosanguinous?13%;?serous?6%Physical findings:?source?and?type?of?discharge?important,?as?is?presence?or?absence?of?masses.One?or?several?ducts?If?only?1?duct,?4xRR?cancer How?do?you?figure?that?out?Nipple DischargePhysi
15、cal Findings:Technique:?press?index?finger?around?periphery?of?areola?to?locate?affected?quadrant?Differential diagnosis of palpable mass and nipple discharge:?Intraductal?papilloma,?severe?fibrocystic?breast?changes,?mammary?duct?ectasia,?cancer?Intraductal PapillomaDefinition:?Benign?breast?mass?v
16、arying?in?size?from?microscopic?to?2-3?mm?in?diameterIncidence:?Accounts?for?75%of all non-puerperal pathological nipple discharge Usually?occurs?in?later?reproductive?years?(30-50?years?old)?Intraductal PapillomaSymptoms:?Spontaneous?nipple?discharge?from?a?single?duct?opening?May?be?clear,?serous,?serosanguinous,?bloody?or?turbidMass?usually?.5?cm?and?located?within?1?cm?of?areolaFindings:?Soft?non-tender?mass?in?subareolar?area.?Intraductal papillomaMammogram:?Dilated?duct?with?or?without?a?m
