Etiology and pathogenesis LACTATIONAL MASTITIS SEROUS, PURULENT (MASTITIS SEROSA, PURULENTA POST PARTUM)
The etiology. Getting into the mammary gland mainly through the cracks of nipples (see) infection, most often staph.
The pathogenesis. The infection spreads or moves dairy (interstitial mastitis) or lymphatic (parenchymatous mastitis), often at the same time both ways. In some cases there is a metastatic mastitis (if septicopyemia).
Symptoms and course LACTATIONAL MASTITIS SEROUS, PURULENT (MASTITIS SEROSA, PURULENTA POST PARTUM)
Symptoms. Engorgement of the breast, fever, flushing of the skin, the formation of infiltration, softening.
For and recognition. The disease usually begins on 10 - 15th, at least 7 - 8 - 9-th day after birth. Initially, there is a engorgement of one lobules of the gland, palpation of the gland painful. The temperature rises rapidly, occasionally have the chills. After 3 - 4 days in the planned infiltration softening. Suffering and General condition of the patient.
In the course of the disease should be distinguished:
Serous mastitis: sudden fever, increasing the tingling pain. The child is fully gland is not empty. In the depth it revealed a poorly contoured infiltration, oblong oblong. The skin over the infiltration compacted, several hyperemic.
Abstemiously mastitis: temperature up to 39 - 40C large remissions, and occasionally chills. Overall health is disturbed. Feeding the child becomes painful. Mammary gland increased in volume, the skin is hyperemic, with a bluish tinge. Infiltration has clear boundaries, palpation him sharply painful. Saphenous vein dilated. It is noted clear fluctuation.
Abscess mastitis. The picture is the same as when abscess mastitis, but more pronounced. Chills occur more frequently; sometimes the condition is similar septic defeat, from which must be differentsirovanno. Mammary gland is enlarged, pasty. Infiltration is differentiated not, the skin over it, creamy, brilliant, color it red, bluish, sometimes with a yellowish tinge. In some areas determined by the fluctuation.
In all cases, you should avoid the stagnation of milk: the absence of increased temperature, the complaints of heaviness in the affected gland, sometimes the pain; palpation reveals a well ogranichivshisj oblong infiltrate with granular surface.
Complications. Multiple abscesses, phlegmon of the entire gland.
Predictions LACTATIONAL MASTITIS SEROUS, PURULENT (MASTITIS SEROSA, PURULENTA POST PARTUM)
The prediction is good.
Prevention LACTATIONAL MASTITIS SEROUS, PURULENT (MASTITIS SEROSA, PURULENTA POST PARTUM)
Prevention is to prevent cracked nipples (see), and the strict observance of hygienic rules, especially hands are clean and linen, proper feeding of the child.
Treatment of LACTATIONAL MASTITIS SEROUS, PURULENT (MASTITIS SEROSA, PURULENTA POST PARTUM)
Engorgement: a thorough emptying of the breast (right breast), with failure of this pumping apparatus (water jet vacuum); in the absence of the latter, hands, following a thorough asepsis, avoiding massage. Wearing a bra that lifts gland.
Treatment witharsnova mastitis: cold (icepack) for 24 hours (and night) without interruption. Any kind of cold lotions, cold compresses are not effective. Simultaneously, the mammary glands are highly tied with bandages width of 15 - 20 cm, covering with a piece of sterile gauze nipple only. Rounds of bandage conduct in a particular order: one round, lifting, goes through the sore breast on the opposite shoulder girdle, second round, pressing through the diseased mammary gland under the second well. In the presence of bilateral lesions of each breast tied up separately. Invalid circular (through both Breasts) bandage, suspension from cancer patient on the same shoulder girdle, replacing the bandages swaddling clothes, bras, scarves. With increasing temperature, sulfonamide 1.0 six times a day (at night break to do). After 24 hours the bandage and ice is removed, the child is given the newly freed Breasts and then continue feeding as usual. The affected gland slightly podunavac. Between feedings appoint a cold (the big break). If the child milk is not completely fucked, the rest of the milk to decant (but not hands). Receiving sulfonamides continued for 2 to 3 days. If the breast is still palpable infiltration, it is administered in 50 000 units of penicillin daily, 2 - 3 days, used twice-thrice (2 days) transfusion of 50 to 75 ml of blood (or autohemotherapy 10 - 15 ml a day, just 3 - 4 times), short block Vishnevsky in the mammary gland under the infiltrate (75 to 100 ml of 0.25% solution of novocaine with 100,000 units of penicillin) with the simultaneous imposition of the affected gland bandage with ointment Vishnevskogo, leaving a window for breastfeeding.
Treatment andabszediruuschem mastitis: after local anesthesia of the skin of 0.25% solution of novocaine thick needle is made to puncture the abscess on the border of healthy tissue infiltration with subsequent aspiration of pus, and then injected into the cavity 50 000 units of penicillin dissolved in 5 to 10 ml of 0.25% solution of novocaine. Novocaine alleviate pain and reduce the effectiveness of penicillin. The puncture is performed daily until then, until it is possible to aspirate pus. Breast-feeding is not interrupted. If you have large infiltrates around the abscess on the whole breast bandage with ointment Vishnevskogo. In order to more rapid elimination of purulent process simultaneous introduction of penicillin in the cavity of the abscess is hemotherapy by repeated transfusions .blood in the amount of 75 - 100 ml after 3 - 4 days. Contraindications to penicillin: 1) phlegmonous form of mastitis, 2) the presence of large infiltrates with separate cavities and necrosis of the gland tissue, 3) the appearance of thinning microtiterplate of the skin over the lesion fluctuations, 4) presence of sinus tracts.
Treatment flemanskogo mastitis: operation (one radiarnuû incision, destruction finger all partitions in the wound and opening all pockets or separate cavities, tight tamponade gauze wads with ointment Vishnevskogo, overlaying the whole breast gauze, impregnated with the same ointment). Ligation of one every 7 - 9 days to extract all the swabs and subsequent loose gauze tamponade, also impregnated with ointment Vishnevskogo. At the same time autohemotherapy or (better) a blood transfusion (100 ml, 3 to 4 times). In very severe cases, with a sharp violation of the General condition - intramuscular penicillin conventional schemes. The child from the breast is not to take away.