acute mastitis
Introduction
Introduction to acute mastitis Acute mastitis (acutemastitis) is an acute suppurative infection of the breast. It is inflammation of the connective tissue in and around the mammary gland. It often forms abscesses in a short period of time, mostly caused by the invasion of Staphylococcus aureus or Streptococcus along the lymphatic vessels. Most women who develop during postpartum lactation, especially primiparas, are more common. The pathogen usually invades from the nipple or the cleft, and can also directly invade and cause infection. The primipara disease is 50%, and the ratio of primipara to maternal is 2.4:1. It can occur at any time during lactation, but it is most common in 3 to 4 weeks after delivery. basic knowledge Probability ratio: 2% probability of breast-feeding women Susceptible people: mostly primipara Mode of infection: non-infectious Complications: bacteremia, acute suppurative mastitis, abscess
Cause
Cause of acute mastitis
Bacterial invasion (30%):
Most of the pathogenic bacteria of this disease are Staphylococcus aureus, and a few are Streptococcus. The bacteria enter from the rupture of the nipple skin or the areola cleft, spread along the lymphatic vessels to the fat and fibrous tissues of the interlobular lobe and glandular lobules, causing acute suppuration of the breast. Sexual cellulitis, there are also a few cases of postpartum infection complications in other parts of the postpartum, bacteria spread through the blood circulation to the breast, causing disease.
Milk deposition (30%):
Milk is conducive to the invasion of bacteria, the reasons for milk deposition are:
1 The nipple is too small or invaginated and failed to correct in time before birth, making it difficult for the baby to suck the breast, or even breastfeeding.
2 too much milk, emptying is not complete, the mother does not understand the secretion of milk, excess milk can not be discharged in time and retained in the milk.
3 mammary duct obstruction makes breast drainage difficult, such as inflammation of the milk duct itself, tumor and external compression, can affect normal breastfeeding.
Chest rupture (30%)
After giving birth, the mother fails to master the correct breastfeeding skills, or the baby's sputum is abnormal, or excessive use of irritants such as soap or ethanol desiccant on the nipple and the disorder of the baby's oral movement function cause the nipple to split and the bacteria along The small nipple invades and penetrates into the subcutaneous and interlobular tissues through the lymphatic vessels to form an infection. When the nipple is cleft, the breastfeeding pain is painful, and the milk cannot be fully sucked out, causing the milk to accumulate and creating breeding conditions for the invading bacteria.
(two) pathogenesis
Milk deposition and bacterial invasion are two important factors in acute mastitis. It is reported in the literature that about 40% of normal women's milk contains Staphylococcus aureus and Staphylococcus aureus, but it does not cause disease. The primipara is prone to acute mastitis and The milk contains more detached epithelial cells and tissue debris, which is related to the obstruction of the milk duct. Blocking the milk duct can reduce the vitality of the breast tissue, and the decomposition products of the milk deposit make it more conducive to the growth and reproduction of bacteria and become bacteria. A good medium has also been reported. After breastfeeding, the breast milk is sucked out by breast pump, and the prevalence rate is twice as low as that of breast milk after sucking.
The pathogenesis of acute mastitis generally undergoes three stages of ductitis, mastitis and mastitis. The bacteria invade the milk duct and go up to the glandular lobules. They stay in the stagnant milk to grow and multiply, leading to acute inflammation of the milk duct, which in turn spreads. To the mammary gland, causing substantial mastitis, bacteria can also be from the nipple cleft palate epithelial damage along the lymphatic vessels to the mammary gland, causing interstitial mastitis, this stage is not treated in time, or improper treatment, inflammation is Diffusion of fat and fibrous tissue other than mammary gland, leading to acute mastitis, inflammation limitation, tissue necrosis, liquefaction, and infections of varying sizes form a breast abscess; if the abscess penetrates into the loose connective tissue of the posterior space of the breast , then form a post-abdominal abscess.
Pathological examination showed that the breast was swollen and the skin was flushed. After the incision, the formation of the abscess was sometimes seen, which was single-atrial or multi-atrial. Microscopically, a large amount of neutrophil infiltration was observed in the breast tissue, and an abscess was also present. Formation, sometimes inflammation involves only one or several adjacent mammary lobules.
Prevention
Acute mastitis prevention
Strengthening prenatal and postnatal hygiene publicity, guiding maternal protection of nipples, and helping lactating women to master normal breastfeeding methods are effective measures to prevent acute mastitis during lactation.
1. Breastfeeding during pregnancy The last 2 months of pregnancy, often wash the nipple with soapy water or water; or use 70% alcohol (or shochu) cotton ball to wipe the nipple, areola, to strengthen the resistance of the nipple, because the alcohol can be removed Oil and fat, long-term use can reduce the secretion of sebaceous glands and sebum, causing dryness of the nipple, causing chapped, so it can not be used for a long time.
2, correction of nipple depression in the second trimester should try to correct the nipple depression, can be used to buckle the nipple with a small wine cellar, external cloth tape fixation, or use a breast pump to attract, 1 or 2 times / d, it is also feasible breast massage, or often with hands Pulling.
3, correct breastfeeding each time breastfeeding should be bilateral breast feeding, and constantly change the posture of the baby, so that the breast tube is fully empty.
4, to maintain the milk discharge unobstructed milk siltation is an important factor in the incidence, it should be regularly breastfeeding, after breastfeeding to drain the remaining milk, can be squeezed out with a breast pump or hand massage, so that the milk is empty, in order to prevent milk too thick, occur Curd clogging the milk duct, women breastfeeding women should be encouraged to drink soup water several times.
5, timely treatment of nipple cleft palate cleavage, can cause pain, affecting breastfeeding, can be used for cork, white peony, half of the end of the study, and then scented with sesame oil or honey and then apply the affected area, or coated with bismuth subcarbonate (basic cesium carbonate 4g research At the end, add 6mg of vegetable oil, you can also apply benzoin, and suck the milk with a breast pump to feed the baby.
6, strengthen the baby oral care pay attention to the baby's oral cleansing, can lightly wipe the baby's oral mucosa and tooth age 1 or 2 times a day; do not let the baby sleep with milk.
7. Weaning indications If the patient has high fever or abscess formation, breastfeeding should be stopped for one or both sides of the weaning to prevent the infection of the milk from affecting the baby. Before weaning, 30 g of raw hawthorn, 30 g of raw malt, 15 g of loquat leaves can be used. Decoction on behalf of tea; or diethylstilbestrol 5mg, 3 times / d, orally; or with benzestrol 2mg, 2 times / d; intramuscular injection or 50% magnesium sulfate 30ml, until the milk, use Glauber's 60g is placed in a gauze bag, the breast is applied externally, replaced when wet, placed on one side of the breast, and only one side of the breast is weaned.
Complication
Acute mastitis complications Complications bacteremia acute suppurative mastitis abscess
1. The course of sepsis and bacteremia enters the stage of acute suppurative mastitis. The patient may have sepsis and bacteremia. At this time, the patient continues to have high fever, flushing and flushing, and metastatic abscess may occur.
2, breast fistula abscess formation period, abscess can be inward or outward rupture, the formation of skin breach and breast fistula, if improper treatment can form long-term unhealed purulent sputum or chyle, clinically visible milk and pus discharge from the fistula .
Symptom
Acute mastitis symptoms Common symptoms Lactation disorders Lactation duct obstruction of milk deposits Lack of milk secretion Reduce lymph nodes Hyperthermia nipple splitting abscess Milk stagnation
Papillary rupture, depression, breast enlargement, acute inflammation of the skin and sinus, carefully check the location and extent of breast lumps and tenderness, with or without fluctuations, axillary lymph nodes and tenderness.
Examine
Examination of acute mastitis
1. Breast examination should first observe the development of the breast, whether the breasts on both sides are symmetrical, whether the size is similar, whether the nipples on both sides are at the same level, whether the nipple has a retraction depression; whether the nipple, the areola are eroded, and how the color of the breast skin is. There are no edema and orange peel changes, whether there is inflammatory and other inflammatory manifestations, whether the superficial veins in the breast area are angry.
2, blood routine
The total number of white blood cells and the number of neutrophils increased. When sepsis occurred, the total number of white blood cells was often 1.5×1000/L, and neutrophils often reached 0.8 or more.
3, bacteriological examination
(1) Pus smear: Sputum is taken for smear examination. Gram-positive cocci are generally seen, and acid-fast bacilli can also be detected by acid-fast staining to help determine the pathogen type.
(2) pus culture and drug susceptibility test: guide clinical use of antibiotics.
(3) blood bacterial culture: acute mastitis complicated with sepsis sepsis, usually should be taken every other day, blood is taken for bacterial culture until the negative, blood sampling time is best selected in the expected chill, high fever, can increase positive Rate, for clinical manifestations of bacteremia and blood culture multiple negative, should consider the possibility of anaerobic infection, blood can be used for anaerobic culture.
4, local puncture pus on the deep abscess of the breast, inflammation is obvious and no fluctuations, feasible puncture pus, help to determine the location of deep breast abscess.
5, X-ray molybdenum target film breast skin swelling and thickening, interstitial shadow hyperplasia, blood vessel shadow increased significantly, the change of inflammation after application of antibiotics significantly changed.
6, B-ultrasound
The first choice for non-invasive inspection, sound image features:
1 Inflammable mass, the boundary is not clear, the internal echo is thickened and the spot is uneven.
2 milk retention, a small dark area without echo.
3 Abscess formation, the sound image shows the internal dark area of the uneven liquid, the edge is blurred, the part of the mass is thickened, sometimes there is stratification, and the echo behind the abs is enhanced.
Diagnosis
Diagnosis and differentiation of acute mastitis
diagnosis
1, medical history asked whether it occurred during pregnancy or lactation, whether the patient is a primipara, whether there is nipple cleft palate or milk stagnation before the onset, to understand the time and process of local and systemic symptoms, whether there has been breast abscess in the past.
2, physical examination attention to the nipple with or without cleft palate, depression, breast swelling, skin with or without acute inflammation and sinus, carefully check the location and extent of breast lumps and tenderness, with or without fluctuations, axillary lymph nodes with swelling and tenderness .
3, body temperature to measure body temperature, check white blood cell count, pay attention to general nutritional status and whether there are other chronic diseases.
4, special examination suspected deep breast abscess, can be used for B-ultrasound to help diagnosis and positioning, or for diagnostic puncture.
Differential diagnosis
1. Breast hyperplasia Breast lobular hyperplasia, also known as cystic breast disease, is one of the most common diseases in women. It is common between 25 and 40 years old. The occurrence of this disease is closely related to endocrine dysfunction, especially ovarian dysfunction.
2, acute breast cancer (inflammatory breast cancer) This disease is a special type of breast cancer, mostly in young women, especially during pregnancy or breastfeeding, because cancer cells quickly infiltrate the entire breast, quickly in the lymphatic network of the breast skin Diffusion, thus causing inflammation-like signs, but inflammatory breast cancer skin lesions are more extensive, often involving the entire breast 1/3 or more than 1/2, especially in the lower half of the breast, its skin color is a special Dark red or purple, the skin is swollen, "orange peel", the patient's breast generally has no obvious pain and tenderness, the systemic symptoms are mild, the white blood cell count is increased and the symptoms of infection are mild, or completely absent. Mastitis can sometimes touch a lump that is not specifically tender, especially lymph nodes that have obvious enlarged metastases in the ipsilateral armpit.
3, advanced breast cancer superficial breast cancer due to subcutaneous lymphatic vessels blocked by cancer cells may have skin edema, cancer tissue necrosis will be near collapse, the surface of the skin is often red and swollen, and sometimes can be misdiagnosed as low-infection Breast abscess, however, advanced breast cancer generally does not occur during lactation, except for skin redness and subcutaneous induration, there is no other local inflammation, especially no systemic reaction of mastitis, local manifestations of advanced breast cancer are often very prominent, such as skin Adhesion, nipple depression and direction change, axillary lymph node enlargement, more prominent than axillary lymph node inflammatory swelling of acute mastitis, puncture cytology or cut small pieces of tissue and abscess wall for pathological biopsy, you can confirm the diagnosis .
