Pemicu 1

blok Reproduksi
Felecia Christy
405140077
LO 1
ANATOMI REPRODUKSI DAN
KELENJAR PAYUDARA
Pintu Atas Panggul
Pintu Bawah Panggul
Damage to pelvic floor muscle
Female internal genital organs
 Vagina
•  musculomembranous tube (7-9 cm); extends from the
cervix of the uterus to the vestibule
• Functions
– Serves as a canal for menstrual fluid
– Forms the inferior part of the pelvic (birth) canal
– Receives the penis and ejaculate during sexual intercourse
– Communicates superiorly with the cervical canal & inferiorly
with the vestibule
• Relations
– Anterior  fundus of the urinary bladder and urethra
– Lateral  levator ani, visceral pelvic fascia, and ureters
– Posterior  the anal canal, rectum, and rectouterine pouch
• 4 muscles compress
the vagina; act as
sphincters
–  pubovaginalis,
external urethral
sphincter,
urethrovaginal
sphincter, and
bulbospongiosus
• Arterial supply
– Superior  uterine arteries
– Middle & inferior  vaginal and internal pudendal arteries
• Venous drainage
– vaginal venous plexuses
 Uterus
•  thick-walled, pear-shaped, hollow muscular
organ; usually anteverted
(7,5 cm x 5 cm x 2 cm); 90g
• Parts  body, fundus, isthmus, cervix
• The wall of uterus’ body:
– Perimetrium  serous layer consists peritoneum +
thin layer of connective tissue
– Myometrium  smooth muscle coat + blood vessel
>>
– Endometrium  inner mucous coat
• Ligaments of uterus
– ligament of the ovary
– ligament of the uterus
– broad ligament of the uterus
– suspensory ligament of the ovary

• Ligaments of servix (mobile)

– Transverse cervical (cardinal) ligaments  cervix & lateral parts of
fornix to wall of pelvis
– Uterosacral ligaments  posterior side of cervix to middle sacrum
(palpable during examination)
• Relations
– Anterior  vesicouterine pouch and superior
surface of the bladder
– Posterior  rectouterine pouch containing loops
of small intestine and the anterior surface of
rectum
– Lateral  peritoneal broad ligament flanking the
uterine body; ureters run anteriorly slightly
superior to the lateral part of the vaginal fornix
and inferior to the uterine arteries
• Arterial supply
– uterine arteries
– collateral supply from the ovarian arteries
• Venous drainage
– uterine venous plexus  internal iliac veins
• Innervation of vagina & uterus
-. Sympathetic 
lumbar splanchnic
nerves +
intermesenteric-
hypogastric-pelvic

-. Parasympathetic 
pelvic splanchnic nerves
(S2-S4) to inferior
hypogastric-
uterovaginal plexus
 Uterine tubes
•  conduct the oocyte (ovum); 10 cm; lie in mesosalpinx
• Parts
– Infundibulum
• funnel-shaped distal end of the tube that opens into the peritoneal
cavity; fimbriae
– Ampulla
• widest and longest part of the tube; medial end of the infundibulum
– Isthmus
• thick-walled part of the tube, which enters the uterine horn
– Uterine part
• short intramural segment of the tube that passes through the wall of
the uterus
 Ovaries
• almond-shaped and -sized female gonads in
which the ova develop
• endocrine glands that produce reproductive
hormones

• Ligaments
– suspensory ligament of the ovary
– ligament of the ovary
• Arterial supply
– ovarian arteries
• Venous drainage
– Ovaries: pampiniform plexus of veins  ovarian vein
– Uterine tubes: tubal veins  ovarian veins and uterine (uterovaginal)
venous plexus
Female external genitalia
• Arterial supply (vulva)
– internal pudendal artery supplies most of the skin,
external genitalia, and perineal muscles. The labial
arteries are branches of the internal pudendal
artery, as are those of the clitoris
• Venous & lymphatic drainage (vulva)
– labial veins are tributaries of the internal
pudendal veins
– superficial inguinal lymph nodes
• Innervation (vulva)
– Anterior  lumbar plexus: the anterior labial nerves,
derived from the ilioinguinal nerve, and the genital
branch of the genitofemoral nerve
– Posterior  derivatives of the sacral plexus: the
perineal branch of the posterior cutaneous nerve of
the thigh laterally and the pudendal nerve centrally
– posterior labial nerves  labia
– deep and muscular branches of the perineal nerve
supply the orifice of the vagina and superficial
perineal muscles
– dorsal nerve of the clitoris supplies deep perineal
muscles and sensation to the clitoris
– The bulb of the vestibule and erectile bodies of the
clitoris receive parasympathetic fibers via cavernous
nerves from the uterovaginal nerve plexus
LO 2
HISTOLOGI REPRODUKSI DAN
KELENJAR PAYUDARA
 Ovaries
• almond-shaped bodies (3 cm long, 1.5 cm
wide, and 1 cm thick)
• Ovarian follicles
• Primordial ovarian
follicles
– single layer of the
flattened follicular cells
– found in the superficial
areas of the cortex
• Primary
follicles
– simple
cuboidal
epithelium
– zona
pellucida
develops
• Secondary/antral follicles
– increasing oocyte size and
numbers of granulosa cells
– secrete follicular fluid (or
liquor folliculi)
• hyaluronate,
• growth factors,
• plasminogen,
• fibrinogen,
• the anticoagulant heparan
sulfate proteoglycans
• steroids (progesterone,
androstenedione, and
estrogens)
• Wall of the antral follicles
• Mature/graafian follicle
– diameter of 20-30 mm
– large enough to protrude
from the surface of the
ovary
– antrum increases greatly in
size by accumulating
follicular fluid
– oocyte adheres to the wall
of the follicle through the
cumulus oophorus of
granulosa cells
• Follicular atresia
• Corpus luteum
• Corpus albicans
• Uterine tubes
– folded mucosa
– thick muscularis with
somewhat interwoven
circular (or spiral) and
longitudinal layers of
smooth muscle
– thin serosa covered by
visceral peritoneum with
mesothelium
• Uterus
– Perimetrium  an outer
connective tissue layer;
adventitial in some areas,
but largely a serosa
covered by mesothelium
– Myometrium  thick tunic
of highly vascular smooth
muscle
– Endometrium  mucosa;
lined by simple columnar
epithelium
• Uterine cervix
– Endocervix  mucus-
secreting simple
columnar epithelium on
a thick lamina propria
– Exocervix  stratified
squamous epithelium
• Vagina
– mucosa, muscular,
adventitia layer
– stratified squamous
• small amount of
keratohyaline, but do
undergo keratinization to
form keratin plates as in
the epidermis
• Mammary glands
– resembling highly
modified apocrine sweat
glands persists on each
side of the chest
– 15–25 lobes of the
compound
tubuloalveolar type
• Adult ; non pregnant • Pregnancy
• Lactation
LO 3
FISIOLOGI (HORMONAL, SIKLUS
MENSTRUASI, EMBRIOLOGI)
Oogenesis
Perkembangan folikel
Peranan estrogen
 Siklus ovarium -
Siklus menstruasi
Kontrol umpan balik FSH & sekresi LH
tonik selama fase folikel
Kontrol lonjakan LH pada saat ovulasi
Mekanisme umpan balik saat fase
luteal
 Prostaglandine and Menstruation
• Progesterone withdrawal  increased
prostaglandin production and receptor
• prostaglandin F2a (PGF2) administration 
symptoms that mimic dysmenorrhea
• PGF2-induced vasoconstriction of spiral
arteries  vasoconstriction, myometrial
contractions, and upregulation of
proinflammatory responses
LO 4
TANDA-TANDA KEHAMILAN, USIA
KEHAMILAN, TBJ, KELAINAN PARTUS,
ANC, LEOPARD
 Labia majora
• Uterine weight >  rich venous plexus in
labia engorged turtous vein / small
grapelike clusters  asymptomatic
 Vagina & perineum
• > vascularity  violet color characteristic
(Chadwick sign)
• Mucosal thickness >, loosening of the
connective tissue, hypertrophy of smooth
muscle cells
• Hypertrophy of papillae of vaginal epithelium
• Secret  thick, white discharge
 Uterine
• Hypertrophy of muscle fibers
• > weight (70g  1100g)
• > volume (5L)
• Fundus  dome shape
• Round ligaments  insert at
the junction of the middle and
upper thirds of the organ
• fallopian tubes elongate
• Myometrium  marked
hypertrophy
• Contraction  Braxton Hicks
contractions are infrequent,
but they increase during the
last week or two
 Cervix
• Enlargement of the
cervix
– Band of columnar
epithelium may ring the
external os.  vaginal
acidity / reparative
healing  squamous
metaplasia  block
endocervical cleft 
mucous accumulation 
nabothian cysts
• Vascularity > + edema
within cervix stroma 
blue tint (Chadwick
sign) & softening
characteristic (Hegar
sign)
 Skin changes in pregnancy
• fetoplacental hormone production / alteration of
clearance  plasma availability of estrogens,
progesterone, and a variety of androgens >>
• concentrations of some adrenal steroids,
including cortisol, aldosterone, and
deoxycorticosterone
• melanocyte-stimulating hormone (MSH) (8 weeks
gestation)

•  skin changes
• Pigmentation
–  skin darkening from
melanin deposition into
epidermal and dermal
macrophages (90%)
– areolae, perineum,
umbilicus, axillae, inner
thighs
• Striae gravidarum
– linear lesions that
frequently appear during
pregnancy
– reddish purple
– abdomen and breasts
• Nevi
– e/  enlarged
melanocytes and
increased melanin
deposition during
pregnancy
– no evidence for
malignant
transformation
• Hair
– Pregnancy  estrogen >
 anagen (hair-growth
phase) >
– Post partum  dissipate
 telogen effluvium (1-4
mo post partum)
• Nail changes
– soft and brittle
– Darker skinned individuals  brown pigment
stripe extends the length of the nail
(melanonychia)
• Vascular changes
– minute, red elevations on the skin (face, neck,
upper chest, and arms; radicles branching out
from a central lesion)  angioma (vascular
spider)/nevus/telangiectasis
– Palmar erythema

– e/  hyperestrogenemia
 Breasts
• breast tenderness and paresthesias (early
pregnancy)
• > size, delicate veins, larger nipple; deeply
pigmented, more erected (2 mo)
• Gentle massage  thick yellowish fluid
(colostrum)
• Number elevations of glands of Montgomery
(hypertrophic sebaceous glands)
Perubahan fisiologi
wanita hamil
 Metabolic changes
• maternal basal metabolic rate  > 10-20%
– Response to the increased demands of the rapidly
growing fetus & placenta

• Weight gain
-. > uterus &
contents
-. > breast
-. > blood volume
-. > extravascular
& extracellular
fluid
• Water metabolism
–  water retention
-. fetus, placenta, and
amnionic fluid  3.5 L
-. > maternal blood
volume  3 L
-. Minimum amount of
extra water  6.5 L

The reason unclear 

contributes more
significantly to infant
birthweight
• Protein metabolism
– products of conception, the uterus, and maternal
blood are relatively rich in protein; fetus & placenta 
4 kg (500 g of protein)
– Another 500 g  uterus as contractile protein; breasts
primarily in the glands; maternal blood as hemoglobin
and plasma proteins

– Amino acid concentrations are higher in the fetal than

in the maternal compartment (placenta regulation)

– There are more efficient use of dietary protein

• Carbohydrate metabolism
mild fasting hypoglycemia,
postprandial hyperglycemia,
and hyperinsulinemia

After glucose ingestion 

prolonged hyperglycemia and
hyperinsulinemia (pregnancy-
induced state of peripheral
insulin resistance)  sustained
postprandial supply of glucose
to the fetus
• Fat metabolism
– lipids, lipoproteins, and apolipoproteins >
• e/  progesterone acts to reset a lipostat in the hypothalamus
– Fat is deposited mostly in central rather than peripheral
sites
– Triacylglycero & cholesterol levels in very-low-density
lipoprotein (VLDL), low-density lipoproteins (LDLs), and
high-density lipoproteins (HDLs) > (T III)

• LDL-C (267 ± 30 mg/dL);

• HDL-C (136 ± 33 mg/dL);
• triglyceride (245 ± 73 mg/dL)

– Leptin >  regulation of body fat and energy expenditure

– Ghreline >  fetal growth and cell proliferation; regulates
growth hormone secretion
• Electrolyte & mineral metabolism
– 1000 mEq of sodium + 300 mEq of potassium 
retained
• Enhanced tubular activity  GFR >, but excretion
unchanged
– Total serum calcium levels <, because albumin <,
ionized calcium  unchanged
•  fetal skeleton  doubling of maternal intestinal
calcium absorption + dietary
– Serum magnesium levels <
– Serum phosphate levels are within the
nonpregnant range
– increased requirement for iron
 Hematologic changes
• Blood volume
– > 40-45% after 32-34 weeks
Purposes
-. metabolic demands of the
enlarged uterus +
hypertrophied vascular
-. provide an abundance of
nutrients and elements 
growing placenta and fetus
-. protect the mother and in
turn the fetus
-. safeguard the mother
against the adverse effects
of blood loss associated with
parturition
• Hemoglobin concentration & hematocrit
– Hb  +/- 12.5 g/dL; < 11.0 g/dL (5% 
concerned)

• Iron requirements
1000 mg of iron
required  300 mg are
actively transferred to
the fetus and placenta,
200 mg are lost

 requires another 500

mg because 1 mL of
erythrocytes contains
1.1 mg of iron
• Immunological function
– suppression of a variety of humoral and cell-mediated
immunological functions to accommodate the "foreign"
semiallogeneic fetal graft
• suppression of Th1 & Tc1 cells  Il-2, IFN-gamma, TNF-B <

• Leukocytes
– chemotaxis and adherence functions <  T II
– leukocyte count  5000 to 12,000/microL

• Inflammatory markers
– Many tests performed to diagnose inflammation cannot be
used reliably during pregnancy
• leukocyte alkaline phosphatase  >
• C-reactive protein  >
• erythrocyte sedimentation rate (ESR)  >
• Coagulation & Fibrinolysis
–  maintain hemostasis
– more enhanced in multifetal gestation
• Platelets
– decreased slightly during pregnancy 
213,000/microL
•  effects of hemodilution

–  increased platelet consumption  greater

proportion of younger, and therefore, larger
platelets

– thromboxane A2 >  platelet aggregation

 Cardiovascular system
• Hemodynamic changes
-. systemic vascular resistance
< + heart rate >  cardiac
output > (5 weeks)

-. Ventricular performance
influenced by both the
decrease in systemic vascular
resistance and changes in
pulsatile arterial flow
• Heart
-. Elevating of diapraghm 
displaced to the left and
upward; rotated somewhat on
its long axis

-. benign pericardial effusion

-. Altered cardiac sound (systolic

murmur  90%
• Cardiac output
-. Late pregnancy  large
pregnant uterus compress
venous return from the lower
body / compress aorta 
cardiac filling <  cardiac
output < (supine position)

-. Standing position  normal

• Central hemodynamic changes
• Circulation & blood pressure
• Renin, angiotensin II, plasma volume
– RAA axis >
– Progesteron >  refractoriness to angiotensin II >

• Cardiac natriuretic peptide

– ANP & BNP  normal range; > when severe preeclampsia

• Prostaglandin
– > prostaglandin  control of vascular tone, blood pressure, and sodium
balance; natriuretic

• Endotelin
– Vascular sensitivity to endothelin-1 is not altered during normal pregnancy

• Nitric oxide
– important implications for modifying vascular resistance during pregnancy
 Respiratory tract
• Pulmonary function

Elevated diaphragm
• Acid-base equilibrium
– Tidal volume >  PCO2 <  dyspnea
– Progesterone  lowers the threshold and
increases the sensitivity of the chemoreflex
response to CO2
– Compensation  plasma bicarbonate levels
decrease from 26 to approximately 22 mmol/L
– PCO2 <  carbon dioxide (waste) transfer from
the fetus to the mother while also facilitating
oxygen release to the fetus
 Urinary system
• Kidney
 Urinary frequency
• Loss of nutrients
– increased amounts of various nutrients lost in the
urine (Amino acids and water-soluble vitamins lost
>)

• Urinalysis
– Glucosuria, proteinuria, hematuria
• Ureters
– uterus rises completely out of the pelvis  rests
upon the ureters  displacing and compressing
them at the pelvic brim  ureteral dilatation
(effects of progesteron)

• Bladder
– increased uterine size  hyperplasia of the
bladder's muscle + elevates the bladder trigone
and causes thickening of its posterior
 Gastrointestinal tract
• stomach and intestines are displaced by the
enlarging uterus
– Gastric emptying time  unchanged
– Pyrosis (heartburn)
• altered position of the stomach  esophageal sphincter
tone <
– The gums may become hyperemic and softened 
focal, highly vascular swelling of the gums (epulis of
pregnancy)
• Mild trauma  bleeding
– Hemorrhoids
• Liver
– no distinct morphological changes
– alkaline phosphatase activity almost > 2x; AST, ALT,
GGT, bilirubin <
– Leucine aminopeptidase (proteolytic liver enzyme) 
> in liver disease; > in pregnant woman

• Gallblader
– contractility of the gallbladder <  stasis 
cholesterol gallstones (multiparous woman)
 Endocrine system
• Pituitary gland
– enlarges by approximately 135 percent  compress the
optic chiasma  reduce visual fields

– Growth hormone
• > slowly from approximately 3.5 ng/mL at 10 weeks to plateau
after 28 weeks at approximately 14 ng/mL
• 17 weeks  placenta produces GH (peak: 14 to 15 weeks ) 
influence on fetal growth & preeclampsia
– Prolactin
• > markedly  10x
• decrease after delivery even in women who are breast feeding
• Thyroid gland
-. thyroid gland enlarge
-. thyroid hormones > 40-100%
• Parathyroid glands
– PTH & calcium
• < during the first trimester and then increase progressively
throughout the remainder of pregnancy
• Estrogens  block the action of parathyroid hormone on
bone resorption  another mechanism to increase
parathyroid hormone during pregnancy  physiological
hyperparathyroidism ( supply fetus)
– Calcitonin & calcium
• > calcitonin levels
– Vit D & calcium
• > increased during normal pregnancy
• Adrenal glands
–-. serum
Cortisol
concentration >
-. metabolic clearance
rate of cortisol <

-. Progesterone > 
cortisol > to maintain
homeostasis (normal
increase plasma volume
during late pregnancy)
– Aldosterone
• > (15 weeks); T III  1 mg/day
•  affords protection against the natriuretic effect of
progesterone and atrial natriuretic peptide
– Deoxycorticosterone
• > progressively during pregnancy (1500 pg/mL by term
/ 15x)
– Dehydroepiandrosterone Sulfate
• < during normal pregnancy
• e/  increased metabolic clearance through extensive
maternal hepatic 16-hydroxylation and placental
conversion to estrogen
– Androstenedione and Testosterone
• > during pregnancy
• Converted to estradiol in placenta
 Musculoskeletal system
• Progressive lordosis
• sacroiliac, sacrococcygeal, and pubic joints
mobility >
–  alteration of maternal posture and in turn may
cause discomfort in the lower back
• The bones and ligaments of the pelvis
undergo remarkable adaptation during
pregnancy
 Eyes
• < intraocular pressure
• < corneal sensitivity; > corneal thickness
(edema)
• Brownish-red opacities on the posterior
surface of the cornea (Krukenberg spindles)
 CNS & sleep
• problems with attention, concentration, and
memory
• blood flow in the middle and posterior cerebral
arteries <<  from 147 and 56 mL/min

• difficulty going to sleep, frequent awakenings,

fewer hours of night sleep, and reduced sleep
efficiency (12weeks – 2 mo post partum) 
decreased significantly in pregnant women
LO 5
PEMERIKSAAN PENUNJANG IBU
HAMIL
 Prenatal care
Kessner index criteria
 Effectiveness of Prenatal Care
• early 1900s  lowering the extremely high
maternal mortality rates
• lower rates of preterm births as well as
neonatal death
 Pemeriksaan ante natal
• Lengkap  K1, K2, K3, K4
– Min 1x hingga usia kehamilan 28 minggu
– 1x kunjungan selama kehamilan 28-36 minggu
– 2x kunjungan pd waktu usia kehamilan > 36 minggu

• Identifikasi & riwayat kesehatan

– Data umum pribadi
– Keluhan saat ini
– Riwayat haid (HPHT; usia kehamilan dan taksiran persalinan)
– Riwayat kehamilan & persalinan
– Riyawat kehamilan saat ini
– Riwayat penyakit dalam keluarga
– Riwayat penyakit ibu
– Riwayat penyakit yg memerlukan tindakan pembedahan
– Riwayat mengikuti KB, imunisasi, menyusui
 Diagnosis of pregnancy
• Sign & symptoms
– Cessation of Menses (uncertain)
• amenorrhea is not a reliable indication of
pregnancy until 10 days or more after
expected menses onset
• second menstrual period is missed 
greater probability
– Changes in Cervical Mucus
• Mucus crystallization  mucus rich in
NaCl when estrogen is being produced,
not progesterone (7th to the 18th day of
the cycle)
• progesterone secretion  beaded or
cellular appearance (21st day)  usually
encountered during pregnancy
– Breast changes
• Anatomical changes + contain a small amount of milky
material or colostrum for months
– Vaginal mucosa (uncertain)
• dark bluish- or purplish-red and congested (Chadwick sign)
– Skin changes (uncertain)
• Increased pigmentation + abdominal striae
– Changes in uterus
• increase in uterine size  anteroposterior
• Bimanual examination  doughy or elastic & exceedingly
soft
• softer fundus and compressible interposed softened isthmus
(Hegar sign)
• Auscultation  uterine souffle (later month of pregnancy)
– soft, blowing sound that is synchronous with the maternal pulse;
passage of blood through the dilated uterine vessels; lower
portion of uterus
– Cervical changes
• increased cervical softening
• external cervical os and cervical canal may become
sufficiently patulous to admit the fingertip
– Perception fetal movement
• 16-18 weeks; 18-20 weeks (primigravida)
• 20 weeks  examiner can begin to detect fetal
movements
• Pregnancy tests
– Detection of hCG in maternal blood and urine
-. hormone can be detected
in maternal plasma or urine
by 8 to 9 days after
ovulation

-. hCG levels increase from

the day of implantation and
reach peak levels at 60 to 70
days; declines slowly until a
nadir is reached at about 16
weeks
• Sonographic Recognition of Pregnancy
–  gestational sac (4 to 5 weeks' menstrual age)
– 35 days  normal sac
– 6 weeks  heart motion
– 12 weeks  crown-rump length is predictive of
gestational age within 4 days
Nutrisi wanita hamil
 Callories
• additional 80,000 kcal  most are
accumulated in the last 20 weeks
–  caloric increase of 100 to 300 kcal per day is
recommended
• Protein
– added the demands for growth and remodeling of
the fetus, placenta, uterus, and breasts, as well as
increased maternal blood volume
– second half of pregnancy  1000 g of protein are
deposited; amounting to 5 to 6 g/day
• ornithine, glycine, taurine, and proline <
• glutamic acid and alanine >

– Sources  meat, milk, eggs, cheese, poultry, and

fish
• Vitamins
 Vitamin
• Folic Acid
•  400 microg daily (prevent neural tube defect); 100 microg
per day (childbearing age)
– Prevent neural-tube defects
– the month before conception and during the first
trimester
• Vitamin A
– routine supplementation during pregnancy is not
recommended  birth defect
– produced by the vitamin A derivative isotretinoin 
potent teratogen
– precursor of vitamin A found in fruits and vegetables,
has not been shown to produce vitamin A toxicity
• Vitamin B12
– strict vegetarians may give birth to infants whose
B12 stores are low
– may increase the risk of neural-tube defects
– Excessive ingestion of vitamin C also can lead to a
functional deficiency of vitamin B12
• Vitamin B6
– combined with the antihistamine doxylamine 
helpful in many cases of nausea and vomiting of
pregnancy
• Minerals
LO 6
KELAINAN PAYUDARA
Benjolan Payudara
Diagnosis banding benjolan payudara :
1) Pembengkakan seluruh payudara
• i. Bilateral :
– - Kehamilan, laktasi
– - Hipertrofi idiopatik
– - Induksi oleh obat-obatan, misalnya stilboestrol,
simetidin
• ii. Unilateral :
– - Pembesaran saat baru lahir
– - Pubertas
2) Pembengkakan terlokalisasi pada payudara
• i. Mastitis/abses payudara :
– - Selama laktasi : merah, panas, benjolan yang nyeri tekan, gejala
sistemik
– - Abses tuberkulosis : kronis, ‘dingin’, rekuren, sinus yang
mngeluarkan sekret
• ii. Kista :
– - Galaktokel : lebih sering setelah melahirkan, nyeri tekan tetapi tidak
meradang, berisi air susu
– - Penyakit fibrokistik : ireguler, batas tidak tegas, seringkali nyeri
tekan
• iii. Benjolan padat jinak :
– - Fibroadenoma : menyebar, keras, batas tegas, regular, sangat
mudah digerakkan
– - Nekrosis lemak : ireguler, batas tidak tegas, keras, penarikan kulit
– - Lipoma : batas tegas, lunak, tidak nyeri tekan, dapat digerakkan
– - Kistosarkoma filoides : eksisi bedah luas (10% ganas)
• iv. Benjolan padat ganas :
– - Karsinoma : batas tidak tegas, keras, ireguler, penarikan kulit
Mastalgia
Mastalgia adalah nyeri yang terasa di payudara.
Mastalgia siklikel adalah nyeri payudara yang bervariasi
sesuai siklus menstruasi. Mastalgia nonsiklikal adalah
nyeri yang hilang timbul atau tidak memiliki pola

1) Keadaan yang bukan berasal dari payudara

• i. Penyakit kostokondritis : nyeri tekan sepanjang tepi
medial iga, tidak terbatas pada daerah payudara di
dinding dada, dapat menghilang dengan OAINS (Obat
AntiInflamasi Non Steroid).
• ii. Penyakit Bornholm (pleurodinia epidemik) : nyeri
nyata tanpa tanda fisik payudara, memburuk saat
inspirasi, tidak didasari oleh penyakit pada dada,
dapat menghilang dengan OAINS
• iii. Pleuritis
• iv. Angina : terdapat riwayat penyakit vaskular
2) Mastalgia akibat kelainan payudara
• i. Mastitis/abses payudara :
– - Sistem laktasi : merah, panas, benjolan yang nyeri
tekan, gejala sistemik
– - Abses nonlaktasi : rekuren, berhubungan dengan
merokok dan ektasia duktal yang mendasari
• ii. Kista sebasea terinfeksi : Benjolan tunggal pada
kulit di daerah periareola, memiliki riwayat
benjolan kistik yang tidak nyeri.
• iii. Penyakit fibrokistik : Ireguler, batas tidak tegas,
mungkin berhubungan dengan benjolan, nyeri
tekan lebih hebat daripada rasa nyeri.
3) Mastalgia tanpa kelainan payudara
• Nyeri biasanya terasa di seluruh payudara, sering
memberat pada aksila, nyeri pada pemeriksaan
Nipple Discharge
Didefinisikan setiap cairan baik fisiologis atau
patologis yang keluar dari payudara. Diagnosis
banding nipple discharge, antara lain :
1) Sekret fisiologis
• i. Seperti susu atau jernih : laktasi, laktorea saat
baru melahirkan dan pubertas.
2) Sekret patologis
• i. Hijau kekuningan serosa : penyakit fibrokistik,
ektasia duktus mammaria.
• ii. Berdarah : papiloma duktal, karsinoma, ektasia
duktus mammaria.
• iii. Pus ± susu : mastitis supuratif akut,
tuberculosis (jarang) (Grace dan Borley, 2007).