A.Acute lactational Mastitis


Definition:
Acute bacterial inflammation of the breast which occurs during lactation.

Incidence:
Most common type of mastitis.

Etiology:

Causative organism:
  ~staph aureus "coagulase positive"
  ~The organism produce clotting of milk in ducts producing obstruction &stasis.

Route of infection:
~Direct spread :from mouth of suckling infant through nipple cracks & opening of lactiferous duct.
~Blood spread:from a septic focus.

Predisposing Factors:
~Milk engorgement due to blockage of ducts by inspissated milk & epithelial debris.
~Nipple cracks & fissure caused by suckling.
~Retracted nipple is more likely to be injured by the baby (who tries to get hold of it).
~Bad hygiene.
~Bad general condition as diabetes,steroid therapy.

Pathology:
-At 1st infection is usually diffuse.
-Milk engorgement ...not treated well....acute mastitis....necrosis by staph.....multilocular abscess.

Clinical Picture:

1-Stage of milk engorgement:

symptoms:
-Dull aching pain.
-Mild persistent pyrexia.

Signs: enlargement &  induration of the breast with no signs of inflammation.

2-Stage of Cellulitis :

Symptoms:
-The pain worsens.
-Continuous high pyrexia.

Signs :
-Diffuse redness,hotness&tenderness of the breast.
-Enlarged elastic tender lymph nodes.

3-Stage of Acute abscess :

Symptoms:
-Throbbing pain.
-Discharge (pus).

Signs :
-Hectic fever at night it may reach 40 or more due to absorbtion of toxins due to vasodilatation.
-Edema of the overlying skin.
-No response to medical treatment.
-Fluctuation is a late sign.

4-Stage of Chronic Abscess :

-Attacks of remission and exacerbation.
-Tender swelling with yielding center .