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Breast Pain & Discharge

Contents
  1. Read book excerpt
  2. Restless Legs Syndrome: Introduction
  3. Restless Legs Syndrome Misdiagnosis
  4. Restless Legs Syndrome Causes
  5. Restless Legs Syndrome Complications
  6. Restless Legs Syndrome Treatments
  7. Clinical trials
  8. Diagnosis of Restless Legs Syndrome
  9. Restless Legs Syndrome Overview
  10. More book excerpts for Restless Legs Syndrome

Breast Pain & Discharge: Excerpt from In a Page: Signs and Symptoms

Breast pain (or mastalgia) is a common complaint that can often be diagnosed by a careful history and physical examination. Pain and tenderness may be normal during early pregnancy and before menses. Breast discharge, however, is rarely normal except in pregnant or lactating women, and it generally requires a full workup.

Differential Diagnosis


Breast pain

  • Fibrocystic change
    –Most common benign breast condition
    –Clinically present in 50% and histologically in 90% of women
  • Mastitis
    –Associated with lactation
  • Extramammary causes of pain (e.g., cervical radiculitis, costochondritis, herpes zoster, angina)
  • Breast cancer
    –Occurs in 1/9 women (lifetime risk)
  • Cyst
  • Breast abscess
  • Unilateral or bilateral gynecomastia
  • Phylloides tumor
  • Intraductal papilloma
  • Fat necrosis
  • Trauma
  • Fibroadenoma
  • Lipoma
  • Pregnancy
    Breast discharge
  • Duct ectasia
  • Galactorrhea
  • Mondor's disease
  • Chronic nipple stimulation
  • Pregnancy
  • Hypothyroidism
  • Sarcoidosis
  • Systemic lupus erythematosus
  • Cirrhosis or other hepatic disease
  • Breast cancer
    –Occurs in 1/9 women (lifetime risk)
  • Intraductal papilloma
  • Fibrocystic change
  • Medications (e.g., phenothiazines, metoclopramide, tricyclic antidepressants, reserpine, opiates, cimetidine, androgens)
  • Hypothalamic and pituitary abnormalities (e.g., prolactinoma, acromegaly, empty sella syndrome)
  • Pseudocyesis

Workup and Diagnosis

  • History includes past medical history, duration and pattern of pain and/or discharge, family history of breast or gynecologic cancer, and menstrual/pregnancy history
  • Breast exam 7–9 days after menstrual flow
    –Fibrocystic areas: Slightly irregular, mobile, bilateral, upper outer quadrant; compression causes tenderness
    –Breast cancer: Solitary, irregular, or stellate; hard, nontender, fixed; not clearly delineated from surrounding tissue, ± lymphadenopathy
    –Mastitis: Inflamed, edematous, erythematous, indurated, tender areas, axillary lymphadenopathy
    –Nipple discharge: Bloody or serosanguinous discharge is suspicious for cancer; oral contraceptives, estrogens, or elevated prolactin levels may result in clear, serous, or milky discharge
  • Diagnostic mammogram is indicated in patients >30 years old who present with solitary or dominant mass or asymmetric thickening
    –Compare with prior mammograms if possible
  • Ultrasound is used to distinguish solid versus cystic
  • Fine-needle aspiration, breast biopsy, cytologic exam of discharge, ductogram and/or galactogram may be indicated
  • Endocrine evaluation may include prolactin levels, TSH, FSH, and LH

Treatment

  • Fibrocystic changes
    –Caffeine avoidance is often effective in decreasing pain
    –Aspirate cysts or medical therapies (e.g., danazol, oral contraceptives, tamoxifen, bromocriptine, evening primrose oil, GnRH agonists, vitamin E) for pain relief
    –Routine follow up is sufficient unless cytologic atypia is present
  • Breast cancer: Surgery, radiation, chemotherapy, and/or hormonal therapy as indicated by stage
  • Mastitis: Warm compress, antibiotics to cover Staphylococcus aureus and streptococci (e.g., cephalexin); consider inflammatory breast cancer if no response after 5 days in a nonlactating female
  • Abscess: Incision and drainage, antibiotics
  • Cyst: Aspiration; cytology of aspirated fluid if bloody or recurrent

    • Book Source Details

    • Book Title: In a Page: Signs and Symptoms
    • Author(s): Scott Kahan, Ellen G. Smith
    • Year of Publication: 2004
    • Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

    More About Restless Legs Syndrome

    More Medical Textbooks Online about Restless Legs Syndrome

    Review other book chapters online related to Restless Legs Syndrome:

    Medical Books Excerpts
    • BACK PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • BREAST PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • CHEST PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • EYE PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • FACE PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • FLANK PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • HEEL PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • HIP PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • JAW PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • JOINT PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • Back Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Chest Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Hip Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Knee Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Toeing Out
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Toeing In
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • MYOCLONUS
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • ARM PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • EYE PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • HIP PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • Myoclonus
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Arm pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Back pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Chest pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Eye pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Flank pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Jaw pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Neck pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Rectal pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Seizures
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Back Pain
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Chest Pain
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Myoclonus
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Arm pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Back pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Chest pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Facial pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Flank pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Jaw pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Neck pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Seizures
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Chest Pain, Atypical
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Low Back Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Abdominal Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Calf Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Chronic Pelvic Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Hip Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Knee Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Neck Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Pleuritic Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Shoulder Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Scrotal Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Seizures
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Eye Pain
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Hip Pain
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Myoclonus
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Abdominal pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Back pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Chest pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Eye pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Flank pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Jaw pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Neck pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Myoclonus
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Arm pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Back pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Breast pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Chest pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Eye pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Facial pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Flank pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Jaw pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Neck pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Rectal pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Seizures
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Abdominal Pain
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Back Pain
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Chest Pain
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Myoclonus
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Arm pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Back pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Chest pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Flank pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Jaw pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Neck pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • ARM PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • EYE PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • HIP PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
     

    Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



    More About This Book:
    Title: In a Page: Signs and Symptoms
    Authors: Scott Kahan, Ellen G. Smith
    Publisher: Lippincott Williams & Wilkins
    Copyright: 2004
    ISBN: 1-4051-0368-X

     » Next page: Elbow Pain/Swelling (In a Page: Signs and Symptoms)

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