Lactational Mastitis and Breast Conditions

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Questions and Answers

What is the treatment for infective lactational mastitis?

Dicloxacillin 500 mg PO QID (correct)

Celecoxib 500 mg PO QID

Dicloxacillin 250 mg PO QID

Cephalexin 250 mg PO QID

What is a characteristic of a breast abscess?

Tender, fluctuant area (correct)

Unilateral erythema, tenderness, warmth

Bilateral breasts involved

Non-tender and no systemic findings

What is a risk factor for mastitis?

Infrequent bottle feeding

Frequent feedings

Cracked or fissured nipples (correct)

Good lactational hygiene

What is a characteristic of galactocele?

Non-tender and no systemic findings Signup and view all the answers

What should be considered if there is no resolution of mastitis symptoms?

Inflammatory breast cancer Signup and view all the answers

What is not a symptom of mastitis?

Bilateral breast involvement Signup and view all the answers

A breastfeeding mother presents with a painful, red, and swollen breast. She has had this for a week, and it has not improved with antibiotics. Upon examination, you feel a fluctuant mass. What is the most likely diagnosis?

Breast Abscess Signup and view all the answers

A breastfeeding mother presents with bilateral, burning pain in both nipples during and after breastfeeding. She also has shiny, flaky skin on her nipples. Which of the following is the most likely diagnosis?

Nipple Candidiasis Signup and view all the answers

Which of the following is NOT a typical symptom of nipple candidiasis?

Fluctuant mass Signup and view all the answers

Which of the following is a common complication of mastitis?

Breast Abscess Signup and view all the answers

A breastfeeding mother presents with a painless, firm mass in her breast. She has no other symptoms. What is the most likely diagnosis?

Galactocele Signup and view all the answers

Which of the following is a risk factor for inflammatory breast cancer?

All of the above Signup and view all the answers

What is the primary treatment for nipple candidiasis in breastfeeding mothers?

Topical miconazole or clotrimazole applied after each feeding Signup and view all the answers

Which of the following is NOT a common symptom of inflammatory breast cancer?

Rapid onset of fever Signup and view all the answers

What condition is primarily characterized by a palpable breast mass that is often filled with milk?

Galactocele Signup and view all the answers

Which of the following treatments is typically indicated for a breast abscess?

Incision and drainage with antibiotics Signup and view all the answers

What inspection finding might suggest the presence of mastitis?

Skin erythema and warmth Signup and view all the answers

Which symptom is least likely to be associated with nipple candidiasis?

Greenish nipple discharge Signup and view all the answers

In a case of mastitis that progresses to an abscess, which treatment option is usually recommended?

Immediate surgical intervention and antibiotics Signup and view all the answers

Inflammatory breast cancer may be misdiagnosed due to its similarity to which condition?

Mastitis Signup and view all the answers

What is a common risk factor for developing mastitis in breastfeeding women?

Incomplete infant feeding or milk stasis Signup and view all the answers

Breast abscess is typically caused by which type of pathogen?

Staphylococcus aureus Signup and view all the answers

Study Notes

Breastfeeding Complications: Breast Abscess

Occurs as a complication of mastitis.
Symptoms include a fluctuant mass and lack of improvement in mastitis.
Treatment options: incision and drainage (I&D) or needle aspiration.
Cultures guide antibiotic therapy.
Continue breastfeeding from the unaffected breast; express or pump milk from the affected side if unable to latch.

Breastfeeding Complications: Nipple Candidiasis

Caused by C. Albicans, affecting both nipples.
Symptoms: burning/stabbing pain, shiny/flaky skin, erythema with satellite lesions.
Bilateral involvement is typical.

Postpartum Complications: Mastitis

Most common in the initial three months of breastfeeding; prevalence is 2-20%.
Symptoms last over 12-24 hours due to bacterial infection (usually S. aureus).
Risk factors include breastfeeding difficulties, previous mastitis, stress, cracked nipples, milk stasis, and over-supply.
Symptoms include unilateral erythema, tenderness, warmth, and systemic signs in infective cases.

Differential Diagnosis of Mastitis

Severe engorgement: bilateral symptoms.
Breast abscess: tender, fluctuating mass.
Plugged duct: no systemic findings.
Galactocele: painless, milk-filled cyst.
Inflammatory breast cancer: consider if unresolved with peau d’orange.

Treatment of Mastitis

Maintain breastfeeding, manage pain with ibuprofen or acetaminophen, and apply cold/warm compresses.
Antibiotics for infective mastitis: Dicloxacillin or Cephalexin.
Diagnosis involves imaging or culture confirmation.

Hematologic Complications: Anemia

Considered in cases of early postpartum hemorrhage and chronic diseases like lupus or RA.
Symptoms: fatigue, dyspnea at rest, pale gums.
Treatment: iron supplements if hemoglobin >7; transfusion for severe anemia.

Symptoms and Treatment for DVT and PE

DVT symptoms: leg pain, unilateral edema, tenderness, and erythema.
PE symptoms: chest pain, pressure, and shortness of breath.
DVT treatment: 6 months of anticoagulation; safe for breastfeeding.

Secondary Postpartum Hemorrhage

Occurs over 24 hours post-delivery; evaluate for uterine atony, infection, or retained placental fragments.
Symptoms: increased bleeding (>1 pad/hour), presence of large clots, hypovolemic shock.
Management includes ultrasound, OB/GYN consult, and medications like ergotamine.

Postpartum Infections: Endometritis

Typically occurs 24 hours to 2-3 weeks post-delivery.
Risk factors: operative delivery methods, PPH, prolonged ROM, and retained placenta.
Symptoms: fever, uterine tenderness, abnormal lochia.
Treatment: hospitalization with IV antibiotics (clindamycin and gentamicin).

Urinary Tract Infection

Common postpartum complication presenting as urgency, frequency, and pain.
Untreated can evolve to pyelonephritis; requires antibiotic therapy.

Endocrine Complications: Thyroiditis

Can manifest as hypo- or hyper-thyroidism postpartum (1-4 months).
Diagnosis: TSH and Free T4 testing; treatment based on symptoms.

Cardiac Complications: HTN

May peak around 3-6 days postpartum; can occur in 20% of patients within 6 weeks.
Symptoms and treatment are similar to pre-pregnancy hypertensive management.
Follow up to monitor blood pressure parameters.

Cardiac Complications: Preeclampsia

Can occur 24-48 hours post-delivery; symptoms include severe headache and vision changes.
Requires urgent evaluation and possible emergency intervention.

GU Complications

Postpartum urinary and vaginal issues: stress incontinence requires pelvic floor PT; fistula needs GYN referral.
Dyspareunia symptoms include vaginal dryness; treatments include lubrication and GYN referral if nerve damage is suspected.

GI Complications

Common issues post-delivery: constipation, hemorrhoids, and laceration complications.
Treatments vary from dietary changes for constipation to surgical referrals for severe cases.

Postpartum Mood and Anxiety Disorders

Common occurrence (5-25%) often reported by 2 months postpartum.
Risk factors: young age, single-parent status, and prior PMAD history.
Screening tools: EPDS and PHQ-9.

Baby Blues vs. Postpartum Depression

Baby blues affect 80% of women, presenting within 2-3 days of delivery and resolving in 2 weeks.
Postpartum depression lasts longer than 2 weeks, often displaying mood fluctuations and potential harm thoughts.

Postpartum Psychosis

Immediately concerning and often presents within 4 weeks postpartum.
Symptoms include hallucinations and rapid mood changes, necessitating urgent inpatient treatment.

Abnormal Uterine Bleeding and Dysmenorrhea

Normal menstrual patterns and complications related to postpartum experiences.

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Description

Test your knowledge on lactational mastitis, breast abscesses, galactoceles, and more. Learn about risk factors, symptoms, and treatment options for these common breast conditions.