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52 terms

1145 Breast & regional lymphatics

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What are the 4 quadrants of the breast?
Upper inner, Upper outer, lower inner, lower outer
What are Montgomrey's glands?
Sebaceous glands located on the areola
What is the tail of Spence?
The axillary portion of the breast
BSE
Breast Self Examination
CBE
Clinical Breast Examination
What are some problems or chief complaints about the breast/axillary?
Pain, tenderness, lumps, nipple discharge,
When asking problem based what do we always ask?
OLD CARTS
Gynecomastia
Enlargement of the male breasts
What are the causes of Gynecomastia?
Testerone disorders, Testicular cancer & other cancers, puberty, & obesity, or hormonal disorders.
Upon inspection what are some normal findings of the breast?
Symmetrical or slightly off, contour is smooth, convex, & even, even pigmentation, skin is smooth, abscess, erythemia, rash, venous patterns are bilaterally the same, Venous patterns may be pronounced in the obese, or pregnancy, & a rough/thickened skin.
What could marked asymmetry be an indication of?
Inflammation, or a growth
Unilateral rash could be an indication of what?
Paget's Disease a form of breast cancer
Unilateral venous patterns could be an indication of what?
Supply of blood to a malignancy
What does peau d' orange mean?
A term used to describe the orange-like texture of breasts that have edema
Upon inspection what are some abnormal findings of the breast?
Uneven venous patterns, marked asymmetry, dimpling, retraction, or bulging
Upon inspection what are some normal findings of the areola?
Color pink-black, Montgomrey's glands/tubercles, round or oval & hair.
Upon inspection what are some abnormal findings of the areola?
Oddly shaped, unsymmetrical, lesions, or changes in pigment.
Upon inspection what are some normal findings of the nipple?
Protruded, inverted, flat,
Upon inspection what are some abnormal findings of the nipple?
Point in different directions (malignancy), recent nipple inversion or retraction, discharge
What are Supernumerary nipples?
Nipples that resemble small pink or brown moles, they are sometimes found on the embryonic milk line.
Serous discharge
Yellowish: Normal
Serosanguineous
Straw colored: Carcinoma, Ductal ectasia, Bloody: intraductal papiloma, Ductal ectasia, Carcinoma,, prepartum women from vascular engorgement
Clear/watery
Carcinoma, medications
Milky
Pituitary adenoma, medications, Galactorrhea,
Purulent
Puss: Infection, Ductal ectasia
Multicolored
Green, Brown, or Grey: Ductal ectasia, carcinoma, Infection, & fibrocytic changes
Infections of the breast have what effect on the Axillary region?
Lymphatic drainage into the area
What are some abnormal findings when palpating the axillary?
Enlargement & tenderness of lymph nodes, hard masses, or fixed nodules.
What can be cause hard masses or fixed nodules in the axillary region?
Tumors, metastatic carcinoma, or Lymphoma.
What are the four methods of breast palpation?
Sweeping, Wedge, Circular, or the Vertical strip method
When palpating what should a normal breast fell like?
Firm, smooth, & elastic.
What are abnormal finding upon palpation of the breasts?
Loss of elasticity, & thick nipple tissue, & well as lumps.
Upon inspection of a mastectomy & axillary site what are we looking for?
Color changes, redness, rash, irritation, edema, thickening, lumps, muscle retraction, or Lymphedema
What is Lymphedema?
A collection of lymph in the interstitial spaces caused by the removal of lymph nodes.
What kind of palpation should be used on a patient with a mastectomy?
Sweeping or circular
surface anatomy
• Location of breasts on chest wall
• Axillary tail of Spence
• Nipple and areola
Internal anatomy: 3 tissues
1. Glandular tissue =
• lobes, lobules,& alveoli
• lactiferous ducts & sinuses
2. Fibrous tissue =
• suspensory ligaments or Cooper's ligaments
3. Adipose tissue
lymphatics: Axillary nodes (4)
- Central
- Pectoral (anterior)
- Subscapular (posterior)
- Lateral
Health history questions: Breast
- Pain
- Lump
- Discharge
- Rash (under arm as well)
- Swelling
- Trauma
- abnormal mammogram
- History of breast disease
- Surgery (implants, lumps)
- Self‐care behaviors
• Breast self‐examination • Last mammogram
Health history questions: Axilla
- Tenderness, lump, or swelling
- Rash
physical exam: breasts
• General appearance
• Skin
• Lymphatic drainage areas
• Nipple
• Maneuvers to screen for retraction
physical exam: Axillae
Inspect and Palpate
• Skin
• Palpation technique
• Lymph nodes
Palpate: Breasts
• Position
• Palpation patterns
• Expected findings
• Nipple
• Bimanual palpation or one handed
Patterns of breast exams (3)
1. circular
2. Wedge
3. Vertical strip
**Be sure to go up into the axilla (tail of Spence)
If a lump is present, note:
- Location = which quadrant
- Size
- Shape
- Consistency = soft, firm, etc.
- Mobility
- Distinctness = part of tissue or separate
- Nipple retraction
- Overlying skin = is it different than surrounding
- Tenderness
- Lymphadenopathy
abnormal findings
Signs of Retraction and Inflammation
• Dimpling
• Fixation
• Edema (peau d'orange)
• Deviation in nipple pointing
• Nipple retraction
Ductal ectasia
= benign disease → inflammation & dilation of subareolar ducts
• sticky nipple discharge that is commonly dark green or black. as progresses → burning, itching, edema
fibrocystic disease
= benign masses
• cysts that are palpable masses.
• round, well delineated, mobile and tender
• often fluctuate with menses
galactorrhea
=inappropriate lactation
• milky appearing discharge
mastitis
= inflammation of breast
• usually in one area of the breast
• red, edematous, tender, warm & hard
• axillary lymph nodes often enlarged & tender
• common in breast feeding
malignancy
• solitary, unilateral, non-tender lump, thickening or mass
• as tumor grows there may be asymmetry, discoloration, unilateral vein prominence, peak d'orange, ulceration, dimpling, puckering, retraction of skin
• borders irregular, nipple may be inverted
intraductal papilloma
= small, benign, warlike tumor in major ducts w/in 1-2cm of areolar edge
• a spontaneous bloody discharge from the nipples.
• sometimes a mass is palpated