Chapter 10- breast - Summary Bates' Guide to Physical Examination and History Taking, 11th Ed + Bates' Visual Guide to Physical

Chapter 10: Breast and Axillae 1) Relate the anatomic structures of the breast and axillary lymph nodes to appropriate functions. * Lymphatics: * Most lymphatic vessels of breast drain into axillary nodes * Central nodes most likely to be palpable * Location: along chest wall usually high in axilla and midway b/w anterior and posterior axillary folds * 3 other groups that drain into central nodes: 1) Pectoral nodes: drain anterior chest 2) Subscapular nodes: drain posterior chest and portion of arm 3) Lateral nodes: drain most of arm 2) Conduct a history related to breast complaints. * Glactorrhea discharge of milk containing fluid unrelated to pregnancy or lactation * More likely to be pathologic when its * Bloody or serous * Unilateral * Spontaneous * Associated w/ a mass * Occuring in women > 40 yrs 3) List concerning symptoms related to the breast and relate the symptoms or clinical findings to common pathologic conditions (i.e. breast lump or mass, breast pain or discomfort, nipple discharge). 4) Incorporate health promotion concepts when performing an assessment of the breast and axillae. * Important Topics for Health Promotion and Counseling: 1) Palpable masses of the breast and breast symptoms: PALPABLE MASSES OF THE BREAST Age (in yrs) Common Lesion Characteristics 15 – 25 Fibroadenoma Usually smooth, rubbery, round, mobile * Nontender 25- 50 A) Cysts B) Fibrocystic changes C) Cancer A) Usually soft to firm, round, mobile, often tender B) Nodular, ropelike C) Irregular, firm, may be mobile or fixed to surrounding tissue Over 50 Cancer until proven otherwise As above Pregnancy/ lactation Lactating adenomas, cysts, mastitis, and cancer As above