suppurative mastitis
Introduction
Introduction to suppurative mastitis Suppurative mastitis is a type of mastitis, the vast majority of which occur in women who are breast-feeding, especially in primipara. The incidence is mostly 2 to 4 weeks after delivery. Often expressed as breast abscess abscess, breast abscess can be expressed as local pain and mass, but often no local redness, swelling and pulsating pain, no fever and other systemic manifestations. The treatment is to cut the drainage and discharge the empy. The key is to prevent milk deposits while avoiding nipple damage and maintaining local cleansing. In the late pregnancy, the nipples on both sides should be washed frequently with warm soapy water, such as nipple retraction, which can usually be corrected by frequent pinching and lifting. The nipple should be cleaned after breastfeeding. If the nipple is damaged or broken, it should be treated promptly. Pay attention to the oral hygiene of the baby and treat its oral inflammation in time. basic knowledge The proportion of illness: 0.003% Susceptible people: good for primipara Mode of infection: non-infectious Complications: bacteremia, breast cancer
Cause
Causes of suppurative mastitis
Milk deposition (30%):
Lack of milk or nipple invagination during breastfeeding prevents breastfeeding. Milk stasis is caused by the leakage of milk from a gland leaf during lactation, resulting in the accumulation of milk in the milk. The main clinical manifestation is the intraductal mass, which is often misdiagnosed as a breast tumor.
Bacterial invasion (20%):
The nipple is broken or chapped, and the bacteria enters the gland to cause glandular gland infection. The bacteria in the hospital directly invade the mammary gland through the baby's nasopharynx during breastfeeding. The pathogenic bacteria are mainly Staphylococcus aureus. The clinical manifestations are fever during puerperium, local swelling and pain in the breast. The breasts are found to have unclear lumps, obvious tenderness, and the surface skin is red hot. The inflammation continues to develop, and then the abscess is formed, and the axillary lymph nodes are formed. Swelling, white blood cell count is significantly increased.
Prevention
Suppurative mastitis prevention
The key to prevention of suppurative mastitis is to avoid milk deposition, prevent nipple damage, keep clean, often wash the nipple with warm water and soap during pregnancy, and correct the nipple retraction early. When sucking, the milk must be sucked up. Or massage to assist with discharge. The nipple should be treated promptly when it is damaged or chapped.
Complication
Suppurative mastitis complications Complications bacteremia breast cancer
1, breast fistula: abscess formation period, abscess can be inward or outward ulceration, the formation of skin breach and breast fistula. If improperly treated, it can form long-term unhealed purulent sputum or chyle. It can be seen that milk and pus are discharged from the fistula.
2, sepsis and bacteremia: the course of the disease into the stage of acute suppurative mastitis, patients can be complicated by sepsis and bacteremia. At this time, the patient continued to have high fever, and the complexion was flushed and sputum. A metastatic abscess can occur.
Mastitis is more than just an inflammatory reaction. After the later stages, the inflamed breasts may slowly harden and form a lump. At the same time, accompanied by high fever, chills, breast swelling and other obvious symptoms, long-term pathological changes, mastitis may turn cancer into breast cancer, this is not impossible.
Symptom
Suppurative mastitis symptoms common symptoms breast pain nipple cleft palate breast mass abscess fever
Often expressed as breast abscess abscess, breast abscess can be expressed as local pain and mass, but often no local redness, swelling and pulsating pain, no fever and other systemic manifestations, sepsis and bacteremia The course of the disease enters the stage of acute suppurative mastitis, and the patient may have sepsis and bacteremia. At this time, the patient continued to have high fever and his face was flushed. There may be a mobile abscess, the formation of the breast fistula abscess, the abscess may rupture inward or outward, forming a skin breach and a breast fistula.
Examine
Examination of suppurative 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 or areola is 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, take the supine position palpation, the same side of the breast under a pillow, the same side of the hand raised over the head, so that the breast spread evenly on the chest wall so that the fingers can easily reach the deep breast, apply the index finger, middle finger, ring finger palm Instead of fingertips for palpation. The way of palpation should be done by turning the circle, turning laterally from the nipple, and checking the breast that extends to the underarm is especially important.
Blood routine examination of white blood cells is generally elevated. There was no significant change in the initial B-ultrasound, and there was a formation of the abscess in the late stage.
Diagnosis
Diagnosis and differentiation of suppurative mastitis
diagnosis
1, often nipple rupture at the beginning, feeling nipple pain when breastfeeding, accompanied by poor milk deposition or agglomeration, sometimes one or two breast ducts blocked. Then the breast is swollen and painful, with or without agglomeration, accompanied by tenderness, skin color is not red or reddish, and the skin is not hot or slightly hot. Systemic symptoms are not obvious, or accompanied by aversion to cold fever, chest tightness headache, irritability is easy to lose temper, loss of appetite.
2, the breast mass does not disappear or gradually increase, local pain is aggravated, or there is pulsating pain, very persistent severe pain, accompanied by obvious tenderness, skin color red, skin burning, and strong heat does not retreat, thirst Thinking of drinking, nausea and anorexia, ipsilateral axillary lymph nodes swelling and tenderness. To the 10th day of breast redness and heat pain, the center of the breast lumps gradually soften, according to the sense of fluctuation, local edema fever, tenderness, puncture suction pus, sometimes pus can flow out of the chyle, the whole body The symptoms are exacerbated.
3, when the acute abscess is mature, you can rupture your own pus, or surgically open the pus. If the pus is unobstructed, the local swelling and pain reduction, fever, fear of cold symptoms disappear, the sore mouth gradually healed. If the pus is not smooth after the collapse, the swelling is not lost, the pain is not reduced, the body heat does not retreat, may form a bag of pus, or pus and other milk network to form a sac. There is also a collapse of the milk from the sore mouth, long-term cure, the formation of milk leak.
Differential diagnosis
Intramalignant breast abscess: can be expressed as local pain and lumps, but often no local redness, swelling 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 mild, and systemic venom is particularly evident. The breast parenchyma is still soft and has no inflammatory mass and 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 total white blood cells, 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, often involving 1/3 or more than 3/3 of the breast. The color is a particularly dark red or purple color, not as red as acute mastitis; swollen skin has a toughness rather than general edema. Breast cancer sometimes has an "orange peel" change in the skin.
(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: elevated body temperature of inflammatory breast cancer, increased white blood cell count is not as obvious as acute mastitis.
