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12 Cards in this Set
- Front
- Back
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Blood supply to the breast:
Explain superficial lymph nodes: Explain deep lymphatics: |
perforating breanch of internal thoracic a., intercostal a., axillary a. branches
drains the skin, more palpable when enlarged, supraclavicular, midaxillary/central lateral - ant axillary, pectoral nodes medial - int thoracic, posterior nodes |
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40-50% drains to where? Then where?
5 phases of lactation: |
axillary nodes (primary drainage); then to supraclavicular nodes
embryogenesis mammogenesis - puberty, pregnancy lactogenesis - milk secretion (Stage 1 - pregnancy to birth; Stage 2 - birth to 4 days) galactopoiesis - stage 3 - >4 days involution - cessation of lactation |
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Organization of mammary gland: epithelium, type of CT, muscle organization:
Explain nulliparous breast anatomy: |
ducts/tubules empty to nipple, epithelium is K Str Sq., elastic CT, circular/longitudinal muscle fibers
poorly developed ductal elements, main feature is ducts, mostly dense CT, surrounded by fibroblasts, adipocytes, vessels, nerves |
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Changes during pregnancy:
Explain lactogenesis in pregnancy: Why prevents prolactin from working during pregnancy? |
ducts/alveoli increase 2-3x; myoepithelial hypertrophy; increased IgA plasma cells
1st trimester - mammogenesis - E, P 2nd trimester - lactogenesis progesterone |
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What happens in Stage I?
Explain colostrum: Hear baby cry. What happens to make milk? |
proliferation of alveoli, CT compressed
low fat, high carbs, protein, Ab's - easy to digest, low volume, concentrated - laxative effect to hypothal --> AP (prolactin) --> milk production; PP (oxytocin) --> mammary gland, uterus |
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What do you need for Stage III of lactation? (letdown)
Effect of insulin, PTHrp, TRH, TSH, GH: |
intact HPA axis, regulate PL, oxytocin
insulin - stimulates alveoli, glucose uptake PTHrp - mobilizes Ca for milk TRH - stimulates PL release, metabolic effects TSH - promotes mammary growth, lactation GH - enhances milk yields |
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Where does most of the H2O, vitamins, lytes glucose come from?
What does Stage III look like histologically? Differences between breast milk, formula: |
maternal plasma
vacuoles from lipid-rich secretions breast milk - more whey, iron, Zn, Ca, selenium, lipase, amylase, immune cells formula - more casein |
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Why are nursing moms so drained?
Rules for breast milk storage: |
1.5L/day; 50 g fat, 100 g lactose, 2-3 g CaPO4 lost per day
defrost under warm water, leave in fridge, only up to 24h; discard leftovers, never refreeze, never microwave 10 hours - room temp, fridge - 3-7d, freezer - 2 weeks; deep freeze - 6-12 months |
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Nutritional supplements recommended for breastfeeding infants:
WHO and AAP recommendations: |
iron, fluoride, Vit D
WHO - 2 years AAP - exclusively breastfeed - 6 months; then add complementary foods |
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How to palpate for a breast exam:
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chaperone, one at a time, supine, pads of 2-3-4 fingers, work like a record player; press firmly, check 4 Q's, tail of spance, axillary lymph nodes
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Highest risk for breast ca?
Explain fibrocystic disease characteristics: Explain fibroadenoma: |
previous cancer in the other breast
benign cyst formation, long follicular/luteal phase, fluid filled, tender, painful prior to menses benign neoplasm, young females; usually asymptomatic, no change w/ menses |
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Peak incidence of malignant tumors, and breast changes:
underlying ductal carcinoma, red, scaly, crusty patch on nipple; might look like eczema: Take home messages: |
40-60 y/o, painless lump, mass/thickening of breast, asymmetry, prominent veins
discoloration, nipple deviation, ulceration Paget's do exam, be consistent, remember risk factors, encourage BSE, recheck often |
