Mastitis - is an inflammation (usually unilateral) of the breast caused by pathogenic coccal flora (usually staphylococci).In most cases (96%) of developing mastitis in lactating women (usually after the first birth), or in the last weeks of pregnancy.Nelaktatsionny mastitis develops from non-lactating women, young girls (junior suit) and for newborns.
Women's breasts are designed to perform complex functions of education of milk and feeding the baby.In a variety of forms and sizes (women with breast same does not exist), the mammary gland in all women have a constant and a complex structure.Mammary gland is represented mainly by glandular tissue beneath the skin, surrounded by fatty tissue.Connective tissue passes through the thickness of the gland, separating it into multiple (15-20) of large fractions, each of which branches into smaller glandular structures - slices.The lobules are milky glands, which are winding rolls with extensions at the end of (the alveoli).In the alveoli
infection in the mammary gland can penetrate several ways:
- The most common and "easy" way of getting germs in the breast tissue is formed in the postpartum period.In lactating breast milk of women actively function moves, which under certain conditions of the environment from pathogenic bacteria.The so-called lactational mastitis represents the largest group of mastitis.
- Mechanical trauma of breast and nipple cracks can serve as a "gateway" of infection.
- relatively rarely an infection in the breast gets from remote foci of purulent inflammation.
inflammation can develop in the nipple or areola when bacteria penetrate through cracks in the prostate tissue (interstitial mastitis).If germs get into the glandular lobules through the milk ducts (parenchymal mastitis), inflammation develops in the prostate, and is limited by the thickness of glandular lobules.If pus from the affected breast slices evacuated on their own, self-healing occurs.Sometimes there is purulent fusion capsule gland, inflammation goes into the surrounding tissue, and interstitial parenchymal mastitis becomes.
Like any inflammatory process, mastitis has several successive stages of development, during which the inflammation passes from phase serous inflammation in severe purulent process.As the progression of the process increases and symptoms of mastitis may occur purulent abscess or cellulitis.The most common mastitis diagnosed and treated in the acute stage, therefore chronic forms of mastitis are rare.
serious purulent mastitis with severe among patients occurs at the moment is rare, and that as a result of delayed or improper treatment, or in the event of significant variations in the immune system.Purulent form of mastitis can lead to very serious complications - sepsis, threatening the life of the patient.
treat mastitis, be sure!
Mastitis is a disease that simply can not be ignored.Most often women seek help in the early stages of the disease and receive quality medical care in time.In today's women's clinics and maternity hospitals held preventive conversations with women about the prevention of mastitis.
term "mastitis breast" is not literate.The term "mastitis" is derived from the Greek word mastos - breast, hence the name of the disease and says its localization.Mastitis can not occur anywhere else besides breast.Mastitis is a breast does not exist.
Causes of mastitis Mastitis
have infectious nature.Infectious purulent mastitis develops with the participation of pyogenic flora: staphylococcus, streptococcus, E. coli and others.In the occurrence of mastitis can play the role of a pathogen or a combination thereof.In the latter case, the disease is more severe and is accompanied by a bright clinic.
Through microtrauma and cracks in the nipple, the microbes through the lymph vessels or through the milk passages fall into the breast tissue, which provokes inflammatory purulent process (abscesses and cellulitis).Toxins that produce mastitis pathogens, melted the surrounding tissue, and inflammation quite quickly begins to spread, involving a large amount of surrounding tissue.
Land purulent inflammation are classified according to the place of localization: in the areola, subcutaneous, located in the stroma (in thickness) and retromammary glands (under the breast).
Festering lactational mastitis develops on the background lactostasis (milk stagnation) in conjunction with the infection.Usually, if not eliminated lactostasis for 3 - 4 days, he is transformed into a festering lactation mastitis.Thus, the reasons are lactostasis also causes mastitis.When lactostasis in the ducts, with the participation of infectious agents begin the process of fermentation of milk.Create ideal conditions for the breeding of pyogenic bacteria, and the process is rapidly spreading breast, assuming the character of a purulent inflammation.
Predisposing factors of mastitis after childbirth are structural changes in the mammary gland (breast, scars, etc.) and violations of the rules of hygiene.The immune system of patients determines the severity of the disease.
Nelaktatsionny mastitis occurs infrequently.The reasons for its occurrence include:
- traumatic injury of the mammary glands;
- purulent processes in the skin or subcutaneous tissue of the breast (furuncle, carbuncle), when the inflammation begins to capture the underlying tissues;
- foreign bodies (eg, piercings or implant) in the breast;
- purulent inflammation of any entities chest.
The appearance of mastitis nelaktatsionnogo participate microbial associations, rather than one pathogen, as in the case of lactation.
Symptoms and signs of mastitis
Mastitis usually affects one breast.Bilateral lesion glands noted in 16-21% of all cases.
Symptoms of mastitis are increasing gradually as the spread of infection.There are acute and chronic clinical course of mastitis.The development of the next steps is usually a result of lack of attention to the status of women, or triggered the wrong therapy.
acute mastitis in the initial stage has the character of serous inflammation.Serous mastitis different unexpressed clinic and mild.Breast touch becomes uniformly dense and slightly painful to the touch.Temperature form serous mastitis can reach 38 ° C.Discovered time serous mastitis responds well to treatment, and wound up in a relatively short period of time.
In case of late diagnosis and / or lack of adequate treatment, mastitis gets infiltrative form.Pain in the affected area of the breast becomes severe, the temperature continues to rise.Breast lesions looks swelling, increase in size and become painful.At the site of inflammation appears painful dense infiltrate with fuzzy boundaries, red skin cancer.Regional lymph nodes may be enlarged.
abscessed form of acute mastitis usually begins after 3 - 4 days and is the next step in the development of inflammatory infiltrate formed when there is a formation of a purulent cavity - an abscess.Signs of intoxication - chills, fever (body temperature reaches 40 ° C), enlarged lymph nodes.The mammary gland is felt sharply delimited painful area.In contrast, infiltration, abscess "softer" to the touch (due to accumulated liquid pus in it).The structure predisposes to breast cancer spread of purulent process in the entire thickness, sometimes found in patients with multiple abscesses that look like honeycombs.Superficial abscesses may be opened independently.
If the wall is exposed abscess purulent fusion, and the process becomes diffuse character begins abscess form of mastitis.Cellulitis has no clear boundaries, so the palpation of the breast to reveal clearly delimited portion of the seal fails.The patient's condition serious, aggravated by symptoms of intoxication increases fever (temperature above 40 ° C).A characteristic feature is pronounced swelling and an increase in breast cancer, inverted nipple, and bluish skin color.
gangrenosum form of mastitis is the most severe, it is a running purulent process.The mammary gland is greatly increased in size, it becomes purple - bluish hue, foci of necrosis become black.On the surface of cancer can appear multiple bubbles, similar to the effects of burns.
threatening complication of purulent mastitis sepsis - generalized purulent infection representing a threat to the life of the patient.
Chronic mastitis occurs in the form of infiltration and often is secondary, as a result of ineffective treatment of acute process.Much less is the primary chronic mastitis.The general condition of the patient suffers slightly, breast lesions may be somewhat increased in size, it is well palpated very tight, virtually painless infiltration.It is not often you can find enlarged lymph nodes or moderately elevated temperatures.
Nelaktatsionny mastitis has no striking clinical signs, often takes place with the formation of an abscess.
mastitis in nursing mothers
In relation to the total number of births mastitis incidence ranges from 3 to 20%.In most cases, purulent inflammation in the breast in women in the postpartum period caused by S. aureus (golden stafilokkok)."Entrance gate" for pathogenic microbes are cracked nipples and microtrauma.Perhaps the penetration of infection through milk moves during feeding or pumping.Mastitis in lactating mother may be the result of improper care of the breast or develop non-compliance with the rules of personal hygiene.
puerperal mastitis, in contrast to its other forms, primarily associated with lactation (hence the name "lactation") and is diagnosed in 2-11% lactating women.Lactation mastitis is characterized by unilateral breast lesions, mainly in developing 5-6 weeks after birth and goes through all the stages of inherent acute purulent mastitis any origin.
Violation of the regime and / or breast-feeding rules provokes stagnation of milk in the mammary gland, which stimulates the development of local non-infectious inflammation.
As the trigger of inflammation is lactostasis, at the beginning of the disease in women there is a sense of tension in the mammary gland.The stagnation of milk leads to the fact that the mammary gland increases in size, and overflowing milk ducts may be palpable as painful seals without marked boundaries.The amount of expressed milk is significantly reduced, the body temperature rises.
If lactostasis not eliminate in the next 3 - 4 days, there is a connection of secondary pathogens that cause decomposition of milk and dairy damage moves, that is, the process takes on the character of acute purulent inflammation.Mammary gland looks edematous and reddened, discharge from the nipple becomes a festering, growing signs of intoxication.Trying to empty the breast is not possible because of severe pain.A further scenario of the disease depends on how quickly the patient to seek skilled care: if a woman does not go to a specialist, making it too late or trying to cope with the disease on their own, the possibility of severe infection becomes very high.
Nelaktatsionny mastitis after childbirth is much rarer, it develops without the participation of the lactation and non-breastfeeding similar to that of women.
Mastitis in newborns
purulent mastitis in infants develops infrequently.Sometimes women confuse mastitis and physiological mastitis in newborns.
Physiological breast (breast tenderness) occurs in approximately 70% of newborns and is absolutely normal.For proper development of the fetus and continuing pregnancy women need estrogen.During pregnancy, they produced so much that they penetrate to the fetus in utero through the placenta and accumulate in his body.After the birth (usually within the first month of life) newborn body begins to get rid of unnecessary estrogen mother.The sharp decline in hormone levels leads to the so-called "gender-Crease", leading to changes in the mammary glands.
Physiological breast is considered to be an indicator of a healthy newborn adaptation to extrauterine life.The sexual crisis is most pronounced in those infants, bearing and birth which took place without any serious complications.All changes in the glands at the physiological and mastitis are reversible within 2 - 4 weeks are alone.
Paul newborn is not related to hormonal sexual crisis, but a physiological disease of the breast is more characteristic of a newborn female.
Physiological breast newborn begins to manifest itself in two days after the birth, at the end of the first week of life and reduced symptoms may disappear completely within a month.Mammary glands are increased in size evenly, sometimes the process may be unilateral in nature.Do not panic if the milk ducts of the negligible amount of fluid similar to colostrum.The skin of the mammary glands has no signs of inflammation and engorgement of the baby does not deliver any inconvenience.
Mastopatia newborn requires no intervention.Attempts to parents "to treat" the child can trigger the transformation of a simple physiological condition in the pathological infectious process.Excessive hygiene, all kinds of packs and lubrication, heating, squeezing the contents of the mammary glands leads to the fact that at the tender skin of the breast (especially the nipples) appear all kinds of mechanical damage - cracks, scratches, irritation and so on. Through such damage microbes get deeper and provoke developmentsevere septic complications - mastitis newborn.
Mastitis newborn may develop as a result of improper care of the baby.It is important to bathe the child in a timely manner and prevent the development of prickly heat.
As in the case of mastitis, mastitis can develop children of both sexes.It is developing the disease at a time when the physiological symptoms of mastitis are beginning to disappear.Instead of extinction observed rapid development of clinic of acute infectious process, in most cases, having a one-sided character.
mammary gland becomes painful and increases in size.As the disease progresses, the skin reddens and breast becomes hot, it is possible to test the seal at the site of inflammation.The child's condition deteriorates as worsening infection.If you do not start treatment on time, at the base of the infiltrate breast abscess is formed.At this stage of the disease to children require urgent surgical care: abscess cavity must be opened, and the pus evacuated.With hands-purulent process can be developed further and go to the generalized form - sepsis.
purulent mastitis in newborns should be treated only in a surgical hospital.Treatment options depend on the stage of the process and the status of the child.
diagnosis of mastitis
mastitis Diagnosis begins with a study of patient complaints, such as pain in the affected gland, and the deterioration of health.May include the purulent discharge from the nipple and fever.Breastfeeding women often show symptoms lactostasis prior to the development of acute mastitis, and / or the presence of cracked nipples.