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Breasts and Axillae - Coggle Diagram
Breasts and Axillae
Physical Exam
Nipples and areolae
5 D's
discharge
depression or inversion - recent inversion may indicate breast ca
discoloration
dermatologic changes
deviation -
Mongtomery tubercles: nontender, nonsuppurative tubercles = normal variant
Palpation
Seated
Chest wall sweep: down from clavicle to nipple line
Bimanual digital palpation: compress with bottom hand and walk top hand across breast tissue
lymph node palpation
Supine
Palpate all areas for lumps/nodules
Breast:
peau d'orange= edema of breast caused by blocked lymph drainage = breast ca
Venous networks
more pronounced in pregnant or obese
If unilateral, suspect malignancy
Lump differential
Fibrocystic Changes
Bilateral
Multiple or single
Consistency: soft to firm
mobile
usually tender
well delineated borders
Fibroadenoma
bilateral
single, maybe multiple
firm, rubbery
mobile
Usually nontender
well delineated border
Cancer
usually unilateral
single
irregular shape
hard, stonelike
Fixed, non-mobile
Retractions present
Usually non-tender
Poorly delineated borders
Abnormalities
Breasts
Fibrocystic changes: benign fluid-filled
cyst formation caused by ductal enlargement
Subjective: tender painful breasts and/or lumps; fluctuate with menses
Objective: round soft-to-firm, mobile masses, tender, bilateral, multiple or single
Fibroadenoma: benign tumors composed of stromal and epithelial elements that =hyperplastic process in single ductal unit
Subjective: painless lumps that do not fluctuate with menses
Objective: found or discoid, firm, rubbery, mobile masses, nontender, bilat
Malignant Breast tumors: ductal carcinoma
Subjective: painless lump, axilla may be tender if lymph nodes involved
Objective: may have palpable mass that is usu single, unilateral, irregular poorly delineated borders; fixed; hard
Fat necrosis: benign breast lump d/t
inflammatory response to local injury
Subjective: hx of trauma to breast (incl surgery), painless
Objective: firm, irregular mass, discolored, may mimic breast ca
Nipples and areolae
Intraducal Papillomas and papillomatosis: benign tumors of the subareolar ducts (wart-like tumor in lactiferous duct)
Subjective: spontaneous nipple discharge, usu unilateral, serous or bloody
Objective: single-duct, provoked on physical exam
Duct Ectasia: benign condition of the subareolar ducts that produces nipple discharge
Subjective: spontaneous nipple discharge, unilat or bilat, green or brown in color, sticky
Objective: single or multiductal, provoked on physical exam, nipple retraction may be present
Galactorrhea: lactation not associated with childbearing: d/t elevated prolactin (pituitary-secreting tumors, systemic diseases)
Subjective: spontaneous nipple discharge, usually bilat, serous or milky, possibly hx post abortion, hypothyroid, cushing syndrome, renal failure, medications
Objective: multiductal, may or may not be provoked on physical exam, no mass
Paget Disease: surface manifestation of underlying ductal carcinoma (tumor cells disrupt the epithelial barrier, allowing extracellular fluid to leak out)
Subjective: crustiness of the nipple, areola; pruritus of the nipple
objective: red, scalin, crusty patch on nipple, aeola; may be unilateral or bilat; appears eczematous but does not respond to steroids
Mastitis: most often staph aureus
Subjective: sudden-onset swelling, tenderness, redness, heat; chills, fever
Objective: tender, hard mass, erythema, may have discharge/pus, may have underlying abscess
Gynecomastia: breast enlargement in male breasts: hormone imbalance, testicular or pituitary tumor, increased body fat
Subjective: breast enlargement, relavant medication hx
Objective: smooth, firm, mobile disk of breast tissue; nontender,
Children: premature thelarche (breast enlargement in girls younger than 8
Unk cause, most cases are onset <2 yrs
Objective: bilaterally, other sins of sexual maturation may be present