99) Diseases of the Breast скачать в хорошем качестве

99) Diseases of the Breast

The Breast (Mammary gland)- Embryology – -human breast makes its appearance in 6th week -mesenchyme underlying this depression proliferates. And makes it everted to form the nipple. -areola is slight thickening in the skin which contains a few glands of montegomery . -15to 20 milk ducks & there alveoli. Anatomy –breast is modified sweat gland. -most important structure present in the pectoral margin. -Breast both sex –male –rudimentary. Female –well developed after puberty. -Imp. accessory organs of female reproduce the system. -provides nutrition to the new born in the form of milk. Situation – -Breast lies in the superficial fascia of the pectoral region. -A small extention called ,’the axillary tw ’ of spence. Pierces the deep fascia and lies in axilla. Extent.-1)vertically ,from II nd to 6th rib. Axillary tasil external angle post fold & ant. fold of axilla. Pectoral fascia pectoral major retro mammary space Alveoli lactiferous sinus. Lactiferous labe.15-20. Cervical subclavis pectorals major. -conical projection –nipple. Nipple pierced by 15-20 lactiferous duct. -contains –circular of longitudinal smooth muscle fibres. -Skin surroundings the base of the nipple is pigmented & form circular area. =areola. -during pregnancy and lactation to form raised tubercle (of montegomery.) -oily secretion –to prevent cracking during parenchyma made up of glandular tissue. Which secretes milk. Consist of 15-20 lobes cluster of alveoli & drained by lactiferous duct. Pectorals major secretes anterior, oblique. Externals abdominal & aponeurosis. Form ant. Wall. -deep surface of the gland cross the retromammary space to the with face the pectoral fascia. i.e. ligament of cooper. Breast consist of – a)gland tissue. b)fibrous tissue. c)Fatty tissue. Blood supply- 1) oestrogen excess. 2)Androgen deficiency. 3)secondary testicular failure. 4)drugs -proliferation of fibrofarry stroma of ducts without acinor growth. Treatment- Idiopathic gynaecomazia –may resolve by itself. -due to oestrogen deficiency testosterone administrate. Cause breast regression . Surgery –Trans alveolar mastectomy. Gillard Thomas –bigger size breast. Injury – Traumatic fat necrosis due to subcutaneous infusion into the breast. Pathology – Focus of haemorrhage ↓ Liguetactiue. Nerosis of fat surroundings by a zone of inflammation occurs. ↓ Well defined nodule of grayish. ↓ Small foci of chalky with debris is formed. Histologically – central focus of necrotic fat cells ↓ Surrounded by lipid filled macrophages. ↓ Intense neurophilic infiltration ↓ Progressive fibroblastic proliferation. ↓ Whole focus replaced by scarred tissue. ↓ Walked off by collagenous tissue. Treatment.-Excision biopsy Infection – Inflammatory process in and around the breast 1)Acute intra mammary mastitis. 2)chronic intramammary mastitis. 3)sub alveolar mastitis. 4)chronic sub-alveolar mastitis. 5)Retro mammary mastitis. 6)Tuberculosis . 7)syphilis 8)Actinomycosis. 9)Mondor’s disease. 1)Acute intra mammary mastitis- -nursing mother in their first lactation. -due to incisor teeth of the infant. Aetiology- development of cracks & bruises. -infection of staphylococcus aureus. -Failure of secretion to escape due to blockage of one or more lactiferous duct with epithelial debris. -retracted nipple. -stasis. Treatment- cellulitic stage- antibiotic & Analgesic . Abcsess formation - I&D Sucking breast pump. -Weaning –stopping of milk. Stilboestrol -10 mg ₓ thrice daily. Chronic intramammary mastitis.- Due to continuous administration of antibiotics given after abscess formation the wall becomes fibrosed. And pus becomes sterile and the whole mass. Becomes firm ,which is known as ‘antibioma’. Treatment- Excision incision of abscess. 3)Sub areolar mastitis- -not true mastitis. -an infected sebaceous gland of Montgomery .of the areola. a furuncle on or near the areola. 4)Chronic sub areolar mastitis- -abscess develops usually behind the nipple and points at the edge of the areola. -the discharge is stopped ,abscess develops ,it bursts and the fistula again opens up i.e.milk ,fistula. Or a mammary fistulectomy. Treatment- Simple fistulectomy. 5)Retro mammary abscess – Infection arises from –infected haemorrhage. -empyema. -tuberculosis of the rib or spine. -osteomyelitis. 6)Tuberculosis- secondary to pulmonary tuberculosis. 7)Syphilis – All the three stages of the syphilis can be seen in the breast. 1) Primary chancre – on the nipple. 2)Mucosis patches on sub-mammary fistula. 3) -Gumma. Actinomycosis – -Similar to fascio cervical actinomycosis. -chemotherapy. 9)Mondor’s disease- Thrombophlebitis of the superficial vein of the breast. Rx- To support the breast by bandaging.