acute suppurative mastitis
Introduction
Introduction to acute suppurative mastitis Acute mastitis is an acute suppurative infection of the breast, commonly known as "milk sores" or "milk mites." Almost all patients are pregnant women who are breast-feeding after childbirth, especially in primipara. If the milk is not deposited in the breast, and bacteria enter the breast from the broken part of the nipple, it may cause inflammation. In the initial stage, the patient has swelling and pain in the breast. The affected area has tender lumps, the surface of the skin is red and hot, and there are systemic symptoms such as fever. The inflammation continues to develop, and the above symptoms are aggravated. At this time, the pain is pulsating, and the patient may have chills, high fever, and pulse. Accelerated, the affected axillary lymph nodes often enlarged, and tenderness, white blood cell count increased significantly and the left side of the nucleus, inflammation of the mass often softened within a few days to form an abscess, superficial abscess can be affected by fluctuations, deep abscess need to puncture to determine, Breast abscess can be single-atrial, or it can be expanded into multiple atriality due to not draining in time, or wear the skin from the outside, or the abscess can be broken into the milk duct to form a nipple overflowing pus; the same breast can also exist several times at the same time. A plurality of abscesses are formed in the lesion, and the deep abscess can be worn deep into the loose tissue between the breast and the pectoral muscle to form a post-abdominal abscess. Severe acute mastitis can lead to massive necrosis of the breast tissue, and even Concurrent sepsis. basic knowledge The proportion of illness: 0.13% Susceptible population: more common in primipara Mode of infection: non-infectious Complications: sepsis
Cause
Causes of acute suppurative mastitis
Milk deposition (30%):
This is an important cause of the disease. The causes of milk deposition are: nipple dysplasia (too small or invagination) hinders breastfeeding; excessive milk or low sucking of the baby, the milk can not be completely empty; the milk duct is impassable, affecting milk discharge.
Bacterial invasion (30%):
The nipple is ruptured and the skin around the areola is erosive. This is the main route of infection. Infant oral infection, breast pumping or nipple-containing sleep, which causes bacteria to enter the milk duct directly is also one of the ways of infection.
Prevention
Acute suppurative mastitis prevention
The key to preventing acute mastitis is to avoid milk deposition, but also to prevent nipple damage and maintain breast health. Specific preventive measures are:
(1) In the late pregnancy, always warm the water, often scrub the breasts, nipples, and develop habits to strengthen their skin.
(2) pregnant women with nipple retraction, can often try to squeeze the lifting method to correct, or take a piece of walnut into two halves, go to the meat, the edges are polished, respectively, buckled on the two nipples, and then shrink with a bandage Tight (do not use too much force to avoid avascular necrosis of the nipple), so that the nipple is exposed.
(3) Develop the habit of regular breastfeeding, pay attention to the cleansing of the nipple, and suck the milk every time you breastfeed. If there is siltation, you can use a hot towel to iron, or use a breast pump to help discharge the milk. After breastfeeding, apply milk to the nipple and On the skin around the areola.
(4) If the maternal milk is too much, and it has not been exhausted after breastfeeding, it can be squeezed with a breast pump or by hand to drain the milk and prevent siltation.
(5) If the nipple is broken or chapped, use sesame oil, egg butter or white jade cream.
(6) When weaning, we should first reduce the number of breastfeeding, and then weaning. Before weaning, we use malt, 60 grams of hawthorn, or 15 grams of fried soup for the sake of breast; if the breast is aggravated, it can be applied externally with skin nitrate. Promote its dissipation.
Complication
Acute suppurative mastitis complications Complications sepsis
Severe acute mastitis can lead to massive necrosis of the breast tissue, and even complicated sepsis.
Symptom
Acute suppurative mastitis symptoms Common symptoms Milk duct obstruction of milk secretion reduces the superficiality of female breasts... Hyperthermia chills abscess Breast tissue massive necrosis
In the initial stage, the patient has swelling and pain in the breast. The affected area has tender lumps, the surface of the skin is red and hot, and there are systemic symptoms such as fever. The inflammation continues to develop, and the above symptoms are aggravated. At this time, the pain is pulsating, and the patient may have chills, high fever, and pulse. Accelerated, the affected axillary lymph nodes often enlarged, and tenderness, white blood cell count increased significantly and the left side of the nucleus, inflammation of the mass often softened within a few days to form an abscess, superficial abscess can be affected by fluctuations, deep abscess need to puncture to determine, Breast abscess can be single-atrial, or it can be expanded into multiple atriality due to not draining in time, or wear the skin from the outside, or the abscess can be broken into the milk duct to form a nipple overflowing pus; the same breast can also exist several times at the same time. A plurality of abscesses are formed in the lesion, and the deep abscess can be worn deep into the loose tissue between the breast and the pectoral muscle to form a post-abdominal abscess. Severe acute mastitis can lead to massive necrosis of the breast tissue, and even Concurrent sepsis.
Examine
Examination of acute suppurative mastitis
Blood routine examination of white blood cells generally increased, initial B-ultrasound did not change significantly, late stage may have abscess formation.
Breast examination should first observe the development of the mammary gland, 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 nipples have retracted depressions; whether the nipples, areola are erosive, how the skin color of the breasts is, whether or not there is Edema and orange peel-like changes, whether there is inflammatory and other inflammatory manifestations, whether the superficial veins in the breast area are angry.
Diagnosis
Diagnosis and diagnosis of acute suppurative mastitis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Breast abscess in the breast: can be expressed as local pain and mass, but often no local red, swollen and pulsating pain, no fever and other systemic manifestations, can be identified.
Breast skin erysipelas: relatively rare, there are red, swollen, hot, painful skin, and there are clear boundaries, local pain is lighter, and systemic venom is particularly obvious, the breast parenchyma is still soft, no inflammatory masses, This can be identified.
Inflammatory breast cancer can occur during lactation or pregnancy, and the surface of the lesion may also have flushing, fever, edema, pain, increased white blood cell count, axillary lymphadenopathy, etc., which are very similar to acute mastitis symptoms. The point is:
(1) to see the extent of skin lesions: inflammatory breast cancer skin lesions are extensive, often involving 1/3 or 2/3 of the breast, the color is a particularly dark red or purple, not as bright red as acute mastitis; swollen skin There is a sense of resilience, rather than general depression edema, which sometimes changes to the skin as "orange peel".
(2) Touching lymph nodes: Lymph node metastasis of inflammatory breast cancer increases the hardness of swollen lymph nodes, while swollen lymph nodes are soft, with a smooth surface and good activity.
(3) changes in body temperature: the body temperature of inflammatory breast cancer increases, and the increase in white blood cell count is not as obvious as acute mastitis.
