I. Definition.
Acute mastitis is an acute inflammation of the breast caused by bacterial infection, often forming abscesses within a short period of time, mostly due to invasion of Staphylococcus aureus or streptococcus along the lymphatic vessels. It is most commonly seen in breastfeeding women 2 to 6 weeks postpartum, especially in primiparous women. The germs usually invade from the nipple rupture or chancre, but can also directly invade and cause infection. Although there is a special treatment for this disease, but the onset of pain, breast tissue destruction caused by breast deformation, affecting breastfeeding. Therefore, the prevention of this disease is more important than the treatment.
II. Etiology.
Three conditions must be present for the formation of acute mastitis.
1. The causative organism is mainly Staphylococcus aureus, which invades in the following two ways.
a invasion through a break in the skin of the nipple. The new mothers often have varying degrees of chafing, erosion or tiny ulcers when the infant sucks the nipple. Creating a convenient doorway for bacterial invasion. Bacteria can spread through this entrance and along the lymphatic ducts to the breast parenchyma, forming foci of infection.
b Through the opening of the milk ducts, up to the lobules of the breast, in spreading to the interstitial breast.
2. lactation depression.
It is an important factor in the etiology. Invagination of the nipple, acute, congenital incompetence of the ducts, and inexperienced maternal lactation often do not allow the milk to be fully emptied, resulting in the accumulation of milk and creating conditions for the reproduction of bacteria.
3. Decline in the immunity of the organism.
The immunity of the body decreases: the postpartum decline in the body’s systemic and local immunity also creates the conditions for infection, the nipples are moist and the temperature rises, more likely to cause bacterial infection, good immunity, the lesion can stay in the mild inflammation or cellulitis period, can be absorbed on its own. For those with poor immunity, the infection is likely to spread, forming abscesses and even sepsis.
Three, the main clinical symptoms.
1. Pain in the affected breast, redness, swelling, hardening and pressure pain in the inflamed area (mostly located in the outer lower quadrant of the breast), and abscess formation later. Abscesses are often located under the areola, in the milk ducts, in the mammary glands or behind the mammary glands, and deep abscesses do not fluctuate significantly.
2.Local redness, swelling, heat pain, painful hard lumps are touched, and there may be fluctuating sensation after abscess formation.
3.The ipsilateral axillary lymph nodes are enlarged and often suppurate within a few days. Painful pressure.
4.Chills, high fever, lethargy and poor appetite may be present. Blood leukocytosis. Most have a history of nipple injury, cracking or milk accumulation.
5. Ultrasound examination with fluid level segment, puncture to extract pus.
IV. Ancillary examinations.
Blood leukocyte count and neutrophil ratio are elevated.
Diagnostic abscess with pus aspiration by puncture.
V. Treatment principles.
1. Pay attention to rest, clean the nipple, suck out the milk, prop up the breast, stop breastfeeding on the affected side, and suck out the milk with a breast pump. The appropriate use of lactation drugs, oral vinyl estradiol.
2. Apply local heat compresses and use a wide cloth belt or breast shield to support the breast.
3. Use broad-spectrum antibiotics orally or intravenously. And available penicillin 1 million units dissolved in 20 ml of saline, injected in the inflammatory lumps around.
4, early inflammation is limited to myocardial injection of penicillin, streptozotocin and local physical therapy. If an abscess has formed, an incision should be made to drain the pus. The incision should be made in a radial direction with the nipple, avoiding the areola. For post-mammary abscess or deep abscess on the lower side of the breast, an arc-shaped incision can be made at the breast fold under the breast.
VI. Nursing measures.
1. Condition observation.
Measure temperature, pulse and respiration regularly, understand blood leukocyte count and classification changes, and do bacterial culture and drug allergy test if necessary.
2. Prevent the accumulation of emulsion.
Suspend breast-feeding of the affected breast, regularly empty the milk with a breast pump, or massage with pressure by hand or the back of a comb along the direction of the milk duct.
3.Promote local blood circulation.
Local hot compress or use loose bra to hold up both breasts to reduce pain and promote blood circulation.
4.Symptomatic treatment.
Physical cooling should be given to those with high fever, and antipyretic and analgesic drugs should be applied if necessary.
5.Drainage treatment.
After the abscess is incised, keep the drainage unobstructed and change the dressing in time.
VII. Preventive care.
The main measures to prevent mastitis are to prevent milk stasis and bacterial infection.
1. Prevent nipple rupture. The nipple rupture is both prone to milk stasis and possible bacterial infection due to the wound.
(1) After 6 months of pregnancy, scrub the nipple with a towel dipped in water and stuffed into the child every day to avoid biting through.
(2) Do not let the child develop the habit of sleeping with the nipple.
(3) After breastfeeding, wash the nipple with water and use a fine soft cloth lined between the nipple clothes to avoid abrasions.
2.Actively treat nipple rupture to prevent complications.
(1) Mild nipple rupture can still be nursed, but after nursing local application of 10% compound benzoin acid tincture, or 10% cod liver oil bismuth, wash before the next pu breast.
(2) Severe nipple rupture and severe pain when breastfeeding, indirect breastfeeding with a nipple shield; or bottle-feeding the child after sucking out with a breast pump.
(3) For scabs on the nipples, do not forcefully tear them off. Apply vegetable oil, wait for them to soften and tear them off slowly.
(4) appropriate amount of lard, with a light fire
3.Prevent milk stagnation.
(1) breastfeeding should be done as early as possible after delivery.
(2) Apply hot compresses to the breasts before breastfeeding to promote the smooth flow of milk. If the mother feels breast swelling and pain, it is necessary to apply hot compresses in a timely manner, and after applying hot compresses, press and pinch the breasts by hand to lift the nipples.
(3) If the infant is not able to suck or if the infant has a small amount of food and produces a lot of milk, use a breast pump to suck up all the milk.
(4) Pay attention to cleaning the nipples and washing away the dirt at the mouth of the mammary glands.
4. Keep the breasts clean to prevent bacterial infection.
Wash your breasts before delivery to remove mucus and dirt from the nipples; wash your nipples before breastfeeding, especially if they are ruptured; avoid squeezing your breasts and wear loose clothing.
5, it is advisable to often make self-massage.
Maternity to develop the habit of self-massage breast. Method: one hand with a hot towel to hold the breast, the other hand on the upper side of the breast, in a clockwise direction to turn the massage. If the breasts feel swollen and painful, or if there is a lump on the breast, the technique can be heavier. In the self-massage at the same time, you can slightly squeeze the breast, the milk from the nipple, after several repetitions, the milk ducts will be smooth. General massage once a day, 15-20 minutes each time.
6, eat less stimulating food.
Such as onion, ginger, garlic, etc. The Chinese medicine believes that acute mastitis is due to internal heat, heat poison congestion. Therefore, it is important to eat less hot food in the diet so as not to help the fire to produce sores.
7. Food medicine prevention.
You can always eat some kelp, kelp has a soft and loose effect, eat cold or stewed chicken to eat, can prevent acute mastitis; have acute mastitis first symptoms, available dandelion 30 grams, Chen Pi 6 grams, water decoction, 1 dose daily.