Documente Academic
Documente Profesional
Documente Cultură
MASTITIS
Lecturer:
Dr. dr. Bambang Arianto, Sp.B
By:
Brilliant Tantomo
2017.04.2.0087
Literature
Introduction -
Background
• Occurrence : 10 percent of U.S. mothers who are
breastfeeding.
• Clinical diagnosis : focal tenderness, fever, malasie.
• Treatment : changing breastfeeding technique,
antibiotics, analgesics.
• Common complication : breast abscess surgical
drainage / needle aspiration.
Definition
• Tender, hot, swollen, wedge-shaped area of breast
associated with temperature of 38.5°C / greater,
chills, flu-like aching, and systemic illness.
• An inflammation of the breast; may or may not
involve a bacterial infection.
Epidemiology
• Developing in 5– 33% of women during lactation
(usually in the early stages)
• May be unilateral or bilateral.
• Staphylococcus aureus by far acts as an etiological
agent.
Etiology
• S. aureus most commonly implicated organism
which gains entry via cracked nipple.
• Milk provides an ideal culture medium.
Risk Factors
• Cleft lip or palate • Use of a manual breast pump
• Cracked nipples • Yeast infection
• Infant attachment difficulties
• Local milk stasis
• Missed feeding
• Nipple piercing
• Plastic-backed breast pads
• Poor maternal nutrition
• Previous mastitis
• Primiparty
• Restriction from a tight bra
• Short frenulum in infant Infant with a short frenulum that, while
breastfeeding, caused nipple damage in the
• Sore nipples mother, resulting in repeated episodes of mastitis.
Classification of Mastitis
Pathophysiology
• Each breast contains appox. 15 – 25 glandular units
(breast lobules)
• Each lobule is composed of a tubuloalveolar gland
and adipose tissue, and drains into the lactiferous
duct empties onto the surface of the nipple.
• Below the nipple surface, lactiferous ducts form
large dilations called lactiferous sinuses, which act
as milk reservoirs during lactation.
• When the lactiferous duct lining undergoes
epidermalization, keratin production may cause
plugging of the duct, resulting in abscess formation.
• Lactating mastitis caused by bacterial invasion
through in irritated / fissured nipple / skin abrasion.
• Non-lactating mastitis
o Periareolar (periductal mastitis) :
• Consist of active inflammation around
nondilated subareolar breast ducts.
o Peripheral :
• Often associated with an underlying
condition, such as diabetes, RA, steroid
treatment, granulomatous lobular mastitis,
trauma, and smoking.
Sign and Symptom
• Well-defined fluctuant lump in the affected breast
• Pain in the affected breast
• Redness, swelling, and tenderness in an area of the
breast
• Fever and malaise
• Enlarged axillary lymph nodes
Diagnosis
• Usually made clinically
o Localized, unilateral breast tenderness and
erythema
o Fever
o Malaise
o Fatigue
o Body aches
o Headache
• Culture (recommended when the infection is
severe)
• USG
Mammography
Management
• Effective milk removal
• Supportive measure
o Rest
o Adequate fluid & nutrition
o Application of heat shower / a hot pack to the
breast
• Pharmacologic management
o Analgesia
o Antibiotics
Complication
• Early cessation of breastfeeding
o Mastitis may produce overwhelming acute symptoms
that prompt women to consider cessation of
breastfeeding
o Acute cessation of breastfeeding may actually
exacerbate the mastitis and increase the risk of
abscess formation
• Abscess
o An abscess should be suspected if a well-defined
area of the breast remains hard, red, and tender
despite appropriate management.
• Candida infection
o Has been associated with burning nipple pain or
radiating breast pain symptoms
Prognosis
• When treated promptly and appropriately, most
breast infections including abscess will resolve
without serious complications. Most patients will
have resolution of mastitis after 7 to 10 days of
appropriate antibiotic therapy.
Prevention
• Effective management of breast fullness and
engorgement
• Prompt attention to any signs of milk stasis
• Prompt attention to other difficulties with
breastfeeding
• Rest
• Good hygiene
Case Report
Identitas pasien
• Nama : Nn. NL
• Umur : 24 tahun
• Jenis kelamin : Perempuan
• Agama : Islam
• Alamat : Surabaya
• Tanggal Pemeriksaan : 6 Desember 2018
Anamnesa
• Keluhan utama
o Nyeri dan bengkak pada payudara kiri
• Keluhan tambahan
o Terasa panas di payudara kiri,
Riwayat Penyakit
Sekarang
• Penderita datang ke Poli Bedah Umum RSU Haji
Surabaya dengan keluhan bengkak dan nyeri
pada payudara kiri sejak 1 minggu yang lalu.
Payudara kiri teraba hangat dan nyeri pada
perabaan; serta terasa nyeri saat menyusui.
Keluhan demam disangkal. 1,5 tahun yang lalu
pasien melahirkan anak pertamanya dan
memberikan ASI. Pasien menyusui, namun hanya
sekitar 6 bulan. Pasien berhenti menyusui sejak 1
tahun yang lalu.
Riwayat Penyakit Dahulu
• -
Riwayat Penyakit
Keluarga
• -
Anamnesa Makanan &
Minuman
• Sumber makanan dan minuman berasal dari nasi,
ikan/daging, sayur, buah dan air putih
Pemeriksaan Fisik
• Status Generalis
o Keadaan Umum : Tampak sakit sedang
o Kesadaran : Compos mentis (GCS 4-5-6)
o Status Gizi : TB : 155 cm BB : 65 kg
BMI: 27
o Vital Sign : TD : 120/80 mmHg
Nadi : 80 x/menit
Suhu : 36,6oC (axiller)
RR : 20 x/menit
oA/I/C/D : –/–/–/–
• Kepala
o Konjungtiva anemia (-)
o Sklera ikterus (-)
• Leher
o Pembesaran KGB dan Tiroid (-)
• Thorax
Pulmo : I : Normochest, gerak nafas simetris
P : Gerak nafas simetris, fremitus raba simetris
P : Sonor seluruh lapangan paru
A : Suara nafas dasar vesikuler, ronkhi –/–,
wheezing – /–
Cor :I : Ictus cordis tak tampak
P : Ictus cordis teraba 2 jari pada MCL sinistra
ICS V, tidak kuat angkat
P : Batas jantung normal
A : S1 S2 tunggal, murmur (–), gallop (–)
• Abdomen : I : Cembung simetris
P : Bising usus (+) normal
P : Soepel; H/L/R tak teraba, nyeri
tekan (-)
P : Timpani
• Ekstremitas
o Akral hangat (+)
o Edema (-)
Status Lokalis
• Regio Mammae Sinistra
o Inspeksi : Tampak pembengkakan pada
mammae sinistra, pus (-), darah (-)
o Palpasi : Teraba hangat dan nyeri
o Movement : -
Pemeriksaan Penunjang
• Darah Lengkap
o Hb 10,4 g/dl
o Leukosit 14,429 /mm3
o Trombosit 512,000 /mm3
o HCT 33,3 %
• Foto Thorax
• USG Mammae
USG Mammae kanan dan kiri:
o Parenchym mammae homogen, fibroglandular type
o Tampak gambaran pemadatan heterogen, batas tegas,
vascular intra lesi (-) , ukuran 18x54 mm di retroareolar kiri
o Tidak didapatkan pembesaran KGB di kedua axilla
o Kesimpulan : Gambaran proses radang retro areolar
mammae kiri
Mammography
• Mamma kanan:
o Parencym mammae firbo glandular type
o Tidak didapatkan bentukan massa /
kalsifikasi spiculate sign / penebalan kulit
o Retraksi papila mammae (-)
o Tidak didapatkan nodule di daerah axilla
• Mamma kiri:
o Parencym mamma firbro glandular type
o Didapatkan bentukan perselubungan
homogen di retroareolar, batas tegas,
tepi tak rata, masih terlihat gambaran
pattern parencyhm.
o Retraksi papilla mammae (-)
o Tidak didapatkan nodule di daerah
axilla.