NCM 109 MODULE 2

• Adult breast


  • 15-20 lobes in each breast
  • Each lobe has 20-40 lobules
  • Small milk ducts are attached to the lobules
  • Duct systems in each breast have their own opening at the nipple
  • Breast tissue remains inactive until pregnancy

  
• Pregnancy and breastfeeding


  1. Lobules grow and begin to produce milk which is then released into the ducts

  2. Muscle tissue in the nipples allows them to become erect in response to stimulation or breastfeeding

  3. Muscle tissue around the lobules helps squeeze milk into the ducts

  4. Montgomery's glands on the areola release small amounts of fluid during breastfeeding to lubricate the nipple

  
• Breast changes after menopause

  • Number of lobules decreases and those that remain shrink in size
  • Breast density may decrease as breast tissue decreases and fat increases
  • Breasts have more fat than breast tissue after menopause
  • Lower breast density makes it easier to read a woman's screening mammograms after menopause
• Benign breast disorder


  Any non cancerous breast abnormality

  
• Fibrocystic breast changes


  Benign breast disease (BBD) representing a variety of changes in the glandular and structural tissues of the breast

  
• Nipple discharge characteristics


  • Bilateral; upper outer quadrant
  • Round, smooth, several lesions, cyclic, palpable

  
• Fibroadenomas

  Common benign solid breast tumors that occur in about 25% of all women and account for up to half of all breast biopsies

  
• Fibroadenoma characteristics


  • Unilateral; nipple area or upper outer quadrant
  • Round, firm, movable, palpable, rubber, well delineated single lesion

  
• Hyperplasia of the breast

  • Overgrowth of the cells
  • Ductal hyperplasia is an overgrowth of the cells that line the ducts
  • Lobular hyperplasia is an overgrowth of cell lining the milk glands (lobules)
  • Usual hyperplasia has cells that look very close to normal
  • Atypical hyperplasia has more distorted cells

  
• Hypoplasia of the breast


  Also known as insufficient glandular tissue or IGT, a very uncommon condition that can cause low or no milk production
• Signs of breast hypoplasia

  • Narrow, widely spaced breasts
  • Areolas appear swollen or puffy
  • Asymmetrical breasts, where one is much larger than the other
  • Breasts do not grow or change during pregnancy, and milk never "comes in" around 3 days after giving birth
• Risk factors for breast hypoplasia

  • Genetics - Hormonal Imbalances
  • Low Body Fat; Poor nutrition
  • Medications
  • Turner syndrome
  • Poland syndrome
• Mastitis


  Infection or inflammation of the connective tissue in the breast that occurs primarily in lactating or engorged women

  
• Types of mastitis


  • Lactational mastitis
  • Periductal mastitis
  • Granulomatous mastitis
• Common symptoms of mastitis


  • Breast pain, warmth, and swelling
  • Redness: triangle- or wedge-shaped pattern
  • A lump or thickening in the breast
  • Fever
  • Flu-like symptoms - body aches or chills
  • Tiredness
  • Swollen or tender lymph nodes in the armpit on the same side as the affected breast
  • Itching

  
• Breast cancer


  A neoplastic disease in which normal body cells are transformed into malignant ones, the most common cancer in women and the second leading cause of cancer deaths among American women

  
• Amenorrhea


  The absence of menses during the reproductive years, normal in prepubertal, pregnant, postpartum, and postmenopausal females
• Dysmenorrhea


  Painful menstruation, may affect more than half of menstruating women
• Premenstrual syndrome (PMS)


  A constellation of recurrent symptoms that occur during the luteal phase or last half of the menstrual cycle and resolve with the onset of menstruation
• Premenstrual dysphoric disorder (PMDD)


  A more severe variant of PMS affecting 3% to 6% of premenopausal women, markedly interferes with work, school, social activities, and relationships with others
• Endometriosis


  One of the most common gynecologic diseases, affecting more than 6 million women in the United States, about 10% of the adult women population, bits of functioning endometrial tissue are located outside of their normal site, the uterine cavity

  
• Treatment for endometriosis


  • Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics
  • Hormonal medicines like GnRH-analogues and contraceptive methods
  • Surgery
• Infertility


  The inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception
• Risk factors for infertility in women

  • Overweight or underweight
  • Hormonal imbalances leading to irregular ovulation
  • Uterine fibroids
  • Tubal blockages
  • Cervical stenosis
  • Reduced oocyte quality
  • Chromosomal abnormalities
  • Congenital anomalies of the uterus
  • Immune system disorders
  • Chronic illnesses such as diabetes, thyroid disease, asthma
  • STIs
  • Age older than 27
  • Endometriosis
  • Turner syndrome
  • History of PID
  • Smoking and alcohol consumption
  • Multiple miscarriages
  • Exposure to chemotherapeutic agents
  • Psychological stress
• Risk factors for infertility in men

  • Exposure to toxic substances
  • Cigarette or marijuana smoke
  • Heavy alcohol consumption
  • Use of prescription drugs for ulcers or psoriasis
  • Exposure of the genitals to high temperatures
  • Hernia repair
  • Obesity
  • Cushing syndrome
  • Frequent long-distance cycling or running
  • STIs
  • Undescended testicles (cryptorchidism)
  • Mumps after puberty
• Abortion


  The expulsion of an embryo or fetus before it is viable, can be a medical or surgical procedure, the purpose is to terminate a pregnancy
• Menopausal transition


  The point in time at which menses and fertility end
• Causes of decreased sperm quality


  • Exposure of the genitals to high temperatures (hot tubs or saunas)
  • Hernia repair
  • Obesity
  • Cushing syndrome
  • Frequent long-distance cycling or running
  • Undescended testicles (cryptorchidism)
  • Mumps after puberty
• Abortion


  The expulsion of an embryo or fetus before it is viable
• Abortion can be a medical or surgical procedure
• The purpose of abortion is to terminate a pregnancy
• Both medical and surgical abortions are safe and legal in the United States; an abortion is considered a woman's constitutional right based on the fundamental right to privacy
• Eighty-nine percent of abortions occur in the first 12 weeks of pregnancy
• Menopausal transition


  The transition from a woman's reproductive phase of her life to her final menstrual period
• The average age of natural menopause—defined as 1 year without a menstrual period—is 51.4 years old
• Pelvic organ prolapse


  The abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis

  
• Cystocele


  The posterior bladder wall protrudes downward through the anterior vaginal wall
• Rectocele


  The rectum sags and pushes against or into the posterior vaginal wall
• Enterocele


  The small intestine bulges through the posterior vaginal wall (especially common when straining)

  
• Uterine prolapse


  The uterus descends through the pelvic floor and into the vaginal canal