Symptoms and signs
1.Acute simple mastitis
At the initial stage, breast swelling and pain, high skin temperature, pressure pain, and localized hard nodules with unclear borders in the breast due to stagnation of milk and poor venous and lymphatic reflux. At this stage, the inflammation can dissipate if it is handled correctly.
2.Acute purulent mastitis
The local skin is red, swollen, hot and painful, with obvious hard nodules and increased tenderness. The patient has chills, high fever, headache, weakness, rapid pulse and other symptoms of systemic toxicity. The ipsilateral axillary lymph nodes are enlarged and painful (Figure 3).
3. Abscess formation stage
Acute mastitis is confined, that is, acute breast abscess is formed. At this time, the lump fluctuates and the superficial abscess fluctuates relatively obviously. The abscess can break outward or break inward to penetrate the milk duct and discharge pus from the nipple. When the abscess breaks into the posterior breast to the loose tissue in front of the pectoralis major muscle, a posterior breast abscess is formed. Breastfeeding should be prohibited at this time (Figure 4).
Folded edit this section Medication treatment
Medication.
1, early injection rest, suspension of breast-feeding on the affected side, cleaning of the nipple and areola, promotion of milk excretion (by suction or sucking), and termination of breast-feeding in all cases requiring incision and drainage.
2, local use of 25% magnesium sulfate wet and hot compresses, physical therapy.
3, early can be used penicillin 800,000-1 million U plus 1-2% procaine 10ml dissolved in isotonic saline 10-20ml, closed around the lump injection.
4. Systemic application of antibiotics. To prevent and treat serious infection and sepsis, antibiotics should be selected according to bacterial culture and drug sensitivity, and intravenous antibiotics should be administered if necessary.
Surgical treatment.
Once an abscess is formed, surgery should be performed promptly and incision and drainage should be performed. Small superficial abscesses can be operated under local anesthesia, while large and deep abscesses should be operated under intravenous anesthesia. An incision is made in the center of the abscess, where fluctuations are most evident, but deep breast or posterior breast abscesses may not have significant fluctuations. The incision should be large enough to radiate in a direction centered on the nipple or to make an arcuate incision along the skin folds under the breast. After entering the abscess cavity, finger probing is performed to open up all intervals within the abscess to ensure unobstructed drainage. In the case of posterior breast abscesses, the fingers should be inserted deep into the posterior breast space and gently pushed apart to allow for the unobstructed flow of pus. For dumbbell abscesses, counter-oral drainage should be performed if necessary. All abscesses should be placed with drainage after incision and changed daily. Pus should be routinely cultured and tested for drug sensitivity.
Diet
Acute mastitis dietary treatment
1. 1 pig’s foot, 25 grams of yellow cauliflower, stewed and eaten without garnish, once a day. It is used in the early stage of mastitis when pus has not formed.
2, 1 pigeon, 30 grams of astragalus, 30 grams of wolfberry. The pigeon was washed, astragalus, wolfberry wrapped in gauze and stewed with the pigeon, cooked to remove the dregs, eat pigeon meat and drink soup. Used in the recovery period after the ulceration of mastitis.
3. 100 grams of round-grained rice and 50 grams of dandelion. Decoct water and juice of dandelion, add japonica rice and boil the porridge, and serve daily. Used for mastitis ulcerated pus after the residual heat is not cleared.
4, onion beard unlimited, a little alum, wash the onion beard, chopped into
Preventive care
Strengthen the prenatal and postnatal hygiene propaganda, guide the mother to protect the nipple, help breastfeeding women master the normal method of breastfeeding is an effective measure to prevent acute mastitis during lactation.
1. Breast hygiene during pregnancy
The last 2 months of pregnancy, often scrub the nipples with soapy water or water; or use 70% alcohol (or soju) cotton balls to rub the nipples, areola, to strengthen the resistance of the nipples. Because alcohol can remove the oil, long-term use can make the areola gland, sebum secretion reduced, causing nipple dryness, causing chapped, so can not be used for a long time.
2, correct nipple depression
In the middle of pregnancy should try to correct the nipple depression. A small wine cup can be used to cover the nipple and fixed with a cloth belt outside. It is also possible to massage the breast, or often pull it by hand.
3. Proper breastfeeding
Each time you breastfeed, you should take turns to feed both breasts and keep changing the position of holding the baby so that the mammary ducts are fully sucked.
4.Keep the milk discharge smooth
The accumulation of milk is an important factor in the development of the disease, so breastfeeding should be done regularly and the remaining milk should be drained after breastfeeding. You can use a breast pump or massage the milk out by hand to make the milk empty. In order to prevent the thickening of milk, the occurrence of curdled milk blocking the milk ducts, to encourage nursing women to drink soup diet several times.
5, timely treatment of cracked nipples
The first thing you need to do is to get a good idea of what you are getting into. Or coated with bismuth subcarbonate application (alkaline bismuth carbonate 4g powdered, plus vegetable oil 6mg), can also be coated with benzoin tincture, sucked out with a breast pump breast milk feeding infants.
6.Strengthen infant oral care
Pay attention to the cleanliness of the baby’s mouth, you can use water to gently wipe the baby’s oral mucosa and dental age 1-2 times a day; do not let the baby sleep with milk.
7.Indications for weaning
If the patient has high fever or abscess formation, breastfeeding should be stopped for one or both sides of weaning to prevent the infected milk from affecting the baby. Before weaning, use 30g of raw hawthorn, 30g of raw malt and 15g of loquat leaves in decoction as tea; or 5mg of hexestrol, 3 times/d, orally; or 2mg of benzyl estradiol, 2 times/d; intra-muscular injection or 30ml of 50% magnesium sulfate, all until the return of milk. Put 60g of mannitol in a gauze bag and apply it to the breast externally, changing it when wet. Put it on one breast to wean only one breast.