Purulent mastitis - Causes, Symptoms and Treatment .MF .
purulent mastitis - purulent inflammation of the breast tissue.There are two stages of breast inflammation: serous and purulent itself.Depending on the cause of the disease can be mastitis and lactation nelaktatsionnym.Most often the disease occurs in women during the postpartum and lactation period (lactation).Most mastitis occurs in nulliparous women.In most cases, lactational mastitis develops in the second - the third week of the child's life, but can also develop in 10 months after delivery.
Causes of suppurative mastitis.
causative agent of suppurative lactation mastitis in most cases is Staphylococcus aureus.Gateway for infection are cracked nipples, the mouth of the milk ducts.For the development of inflammation must be a combination of infection and lactostasis (stagnation of milk), the latter serves as a triggering factor.If lactostasis not resolved within 3-4 days, developed purulent mastitis.
For reasons breast milk stagnation include the following:
• noncompliance breastfeeding,
• insufficient and irregular pumping milk after breastfeeding, violation of pumping equipment - rough pumping (squeezing milk), resulting in a closed breast trauma;
• stiffness and cracked nipples,
• congenital changes of the mammary glands (thin and convoluted milk ducts),
• previous breast surgery.
When stagnation of milk and accession infection in the breast ducts begin lactic fermentation and coagulation of milk, leading to further deterioration and outflow lactostasis weights.Develops a pathological vicious circle.Milk and fermented foods are a breeding ground for bacteria, which leads to a rapid transition in the purulent inflammation stage.In the initial stages of fever and chills are caused lactostasis.Due to the stagnation of milk and fermented products with pyrogenic action, through the damaged milk ducts are absorbed into the blood, which causes a rise in temperature.
Nelaktatsionny mastitis rarer lactation.There are the following reasons for its occurrence:
• breast trauma,
• purulent skin and subcutaneous tissue of breast (furuncle, carbuncle) with the transition of inflammation in the deeply lying tissue,
• implantation of foreign bodies in the breast tissue,
• abscess benignand malignant breast tumors.
spectrum of pathogens in this case is somewhat broader.In addition to gold and Staphylococcus epidermidis common Pseudomonas aeruginosa, enterobacteria.
Symptoms of purulent mastitis.
Festering lactational mastitis in its development passes usually serous and infiltrative stage.
When serous mastitis occurs pain and heaviness in the breast, chills and fever up to 38 ° C.The mammary gland increases in size, there is redness and soreness in the area of inflammation.It reduces the amount of expressed milk.
When entering the infiltrative stage along with these symptoms of prostate detected by palpation dense painful education (infiltration) without clear boundaries and areas of softening.
Saving lactostasis after 3 - 4 days serous and infiltrative stage pass to the stage of the development of purulent complications in most cases of abscess of mastitis.In this case, the state of health deteriorates, the temperature rises above 38 ° C.Seal (infiltration) in the breast becomes sharply painful, becomes clear boundaries, in the center of this education can be felt softening, suggesting the development of an abscess.Perhaps the development of a multitude of small abscesses in infilrate by type honeycomb filled with pus, a form called infiltrative abscess.Symptoms last a little different from breast abscess.
Acute suppurative lactation mastitis.
intoxication is more pronounced, the temperature reaches 39 ° C or higher When breast cellulitis.A distinctive feature is a pronounced swelling of the breast, which is dramatically increased in size, bluish tinge to the skin.Often the nipple pulled into the gland due to swelling.
gangrenosum form of mastitis occurs malignant, says neglect purulent process.Skin cancer bluish-purple color with areas of necrosis (black), the process covers the entire gland.The formation of epidermal blistering cloudy with bloody contents, as in burns.
If nelaktatsionnogo mastitis clinical picture is erased.At the forefront in the early stages of the disease beyond the underlying disease, such as a boil or carbuncle.Then, joined by a purulent inflammation of the tissue itself prostate.Most often develop breast abscess.
Nelaktatsionny mastitis as a complication of an abscessed boil right breast.
differentiate from the mastitis must be lactostasis, which is often preceded by purulent inflammation.The key distinction from mastitis lactostasis is no redness and swelling of glands with milk stasis.After emptying the glands at lactostasis symptoms go away, reduced body temperature.
survey with purulent mastitis.
If you find the above symptoms should consult a doctor, surgeon or clinic attendant surgical hospital.After the inspection, you will need to pass a general analysis of blood and urine tests, a blood test for sugar levels to exclude the presence of diabetes.The clinical analysis of urine marked increase in the number of leukocytes with a shift to the left leykoformuly, increased erythrocyte sedimentation rate.From the instrumental methods for the diagnosis of an abscess in the breast is the most informative method of ultrasound.The latter allows you to diagnose the accumulation of pus in the breast tissue, to determine the location and size of the purulent center, perform a puncture followed by bacteriological examination punctate.
treatment of mastitis.
In the initial stages of the development of inflammation in serous mastitis lactostasis and prescribe conservative treatment.
should be regular pumping of milk every 3 hours.Milk first decanted from a healthy breast, then from the patient.To remove the mammary ducts with spasm and facilitate decanting 3 times per day administered intramuscularly spasmolytics (e.g. Nospanum 2 ml).Assign intramuscular antihistamines for desensitization (eg, suprastin 3 times a day) and antibacterial broad-spectrum drugs.Spend poluspirtovye wraps the breast, ultrasound or UHF therapy.
With the ineffectiveness of conservative treatment and the development of purulent inflammation in step - opening and drainage of purulent focus under general anesthesia.
Postoperatively continue antibiotic therapy, perform lavage the abscess cavity with antiseptic solutions (chlorhexidine, furatsillin, dioxidine) daily spend dressings.
Breastfeeding can be continued only if the relief of inflammation and negative bacteriological examinations of milk.In this case the child can not be put to any health or to patients with breast.Milk expressed from patients with breast, do not use, but from the healthy breast is subjected to pasteurization and bottle fed.Such milk must not be stored.
with recurrent and severe mastitis after knocking lactostasis interrupt lactation.Interruption of lactation produced medication using such preparations as, for example, and dostineks Parlodelum.
Complications of suppurative mastitis.
Complications of suppurative mastitis are divided into complications of the disease and postoperative complications.Complications
proper development purulent mastitis include cellulitis and gangrene of the breast, where the clinical picture is described above, the latter, in turn, can lead to sepsis (blood infection).
to postoperative complications include the development of dairy fistula.Usually it closes for a month after recovery and is not a contraindication to breastfeeding.It is also possible postoperative wound festering and purulent mastitis recurrence.After the operation can be maintained cosmetic defect, and the operative trauma with subsequent scarring and deformation of the breast increases the likelihood of repeated episodes of the disease in the next pregnancy and breastfeeding.
Prevention of suppurative mastitis.
Prevention of suppurative mastitis involves a number of activities.
• Increase body resistance through proper nutrition rich in proteins, carbohydrates and vitamins.
• Compliance with the rules of personal hygiene.It should be twice a day to take a warm shower, change underwear.After feeding, the breast is necessary to wash with warm water without soap, wipe with a towel and left open for 15 minutes.Between nipple bra and lay sterile gauze, which varies with the impregnation of milk.The bra should be made of cotton, it should be washed every day, wear after ironing with a hot iron.It should not squeeze the breast.
• It is timely treat cracked nipples, when they appear, you must stop breast-feeding with a sore hand, express the milk in the bottle and feed through the nipple.The hole in the teat should do a sewing needle, a red-hot in the fire.The resulting hole should be small, otherwise the child may refuse to take the breast.For the treatment of cracked nipples using various wound healing ointments and creams (eg, solkoserilovaya ointment, cream Bepanten).
• Preference should be given Hand expression of milk, especially from the outer quadrants of the breast, where there is often stagnant milk.
With the development of these symptoms should seek medical advice.This will be the best prevention of complications of purulent mastitis, because timely treatment prescribed will avoid surgery or to perform it as soon as possible with the least severe cosmetic defect in the future.
better to overestimate the severity of your symptoms, rather than later, seek medical attention.
Surgeon Thews DS