Modified Essay Questions, MEQs in Surgery - Breast Abscess


# A 25 year lactating mother, weighing 45 kgs presents in surgical OPD with complaints of painful swelling of right breast and fever for last 12 hours, on clinical examination, breast is engorged, there is erythema, tenderness and induration in the upper inner quadrant of breast. The swelling does not yield pus on needle aspiration 
1. State the most likely diagnosis.
-  Acute lactational mastitis

2. Describe etiology of this condition.
- Infection of the ducts by Staph. aureus — clots milk- ducts
clogged- organisms multiply withing clot- mastitis- abscess (if untreated)
- Causes- cracked, fissured nipple, retracted nipple, oral cavity infection of child

3. Describe the treatment.
- Give antibiotics:

  • Tab Cloxacillin 500 mg X qid X 7-10 days 
  • Tab Ibuprofen 400 mg X tid X 3 days 

Then, s.o.s.

Good support to the breast. May breastfeed if she wants. Otherwise the breast can be drained by
manual expression or pump.

The condition doesn't resolve with your treatment 
4. Mention the treatment at this stage.
- Incision and drainage.

5. Mention the breast cancer which mimics this pathology.
-  inflammatory carcinoma of breast

6. Classify benign breast disease 
A. Congenital — Inverted nipple, Supernumerary breast/nipple, non breast disorders, Tietze disease (costochondritis), Sebaceous cyst and other skin conditions

B. Injury: Traumatic fat necrosis, hematoma

C Inflammatory, Infection: Abscess, mastitis, TB

D. Aberrations in the Normal Development  and Involution (ANDI) : Cyclical mastalgia with nodularity, Cysts, Fibroadenoma

E. Duct ecstasia/ Periductal mastitis

F. Pregnancy related: Galactocele, Puerperal abscess

7. List 2 causes of chronic inflammatory abscess.
a. Injudicious use of antibiotics or inadequate drainage
b. Chronic infections: TB or Actinomycosis

8. Mention the differential diagnoses of chronic intramammary abscess.
- Traumatic necrosis of breast, breast carcinoma, antibioma, fibroadenoma.