Laktostasis code for microbial 10 in adults. Mastitis (breast) - description, causes, symptoms (signs), diagnosis, treatment

Short description

Mastitis (chest) - breast inflammation. Periductal mastitis (plasmocytic mastitis, subareolar abscess) - inflammation of the additional glands in the areola area. Mastitis of newborns is mastitis that occurs in the first days of life as a result of infection of hyperplastic glandular elements.

Etiology. Lactational (occurs in the postpartum period; see Breastfeeding). Bacterial (streptococci, staphylococci, pneumococci, gonococci, often combinations with other coccal flora, Escherichia coli, Proteus). Carcinomatous.

Risk factors. Lactation period: violation of the outflow of milk through the milk ducts, cracks in the nipples and the areola, improper care of the nipples, violations of personal hygiene. Purulent diseases breast skin. SD. Rheumatoid arthritis. Silicone/paraffin breast implants. GC reception. Removal of a breast tumor followed by radiotherapy. Long history of smoking.

Symptoms (signs)

Clinical picture

. Acute serous mastitis(may progress with development) purulent mastitis) .. Sudden onset .. Fever (up to 39-40 ° C) .. severe pain in the mammary gland.. The gland is enlarged, tense, the skin over the focus is hyperemic, on palpation - a painful infiltrate with fuzzy boundaries.. Regional lymphadenitis.

. Acute purulent abscess mastitis.. Fever, chills .. Pain in the gland .. Mammary gland: redness of the skin over the lesion, sharp pain on palpation, softening of the infiltrate in the center with the presence of fluctuation .. Regional lymphadenitis.

. Acute purulent phlegmonous mastitis.. Severe general condition, fever.. The mammary gland is sharply enlarged, painful, pasty, infiltrate without sharp boundaries occupies almost the entire gland, the skin over the infiltrate is hyperemic, has a bluish tint.. Lymphangitis, regional lymphadenitis.

Diagnostics

Laboratory research. Leukocytosis, increased ESR. A bacteriological examination is necessary to determine the sensitivity of microorganisms to antibiotics, bacterioscopy in case of suspected fungal infections, tuberculosis.

Special Studies. ultrasound. Mammography (if it is impossible to completely exclude breast cancer in patients with non-lactational mastitis). Biopsy of the breast.

Conservative therapy. Isolation of mother and child from other puerperas and newborns. Bandage or bra that supports the mammary gland. Dry heat on the affected mammary gland. Expression of milk from the affected gland in order to reduce its engorgement. Cessation of breastfeeding with the development of purulent mastitis. If pumping is not possible and there is a need to suppress lactation, drugs that suppress the formation of prolactin are used - cabergoline 0.25 mg 2 r / day for two days, bromocriptine 0.005 g 2 r / day for 4-8 days. Antimicrobial therapy if continued breastfeeding- semi-synthetic penicillins, cephalosporins: cephalexin 500 mg 2 r / day, cefaclor 250 mg 3 r / day, amoxicillin + clavulanic acid 250 mg 3 r / day; if anaerobic microflora is suspected, clindamycin 300 mg 3 r / day (in case of refusal to feed, any antibiotics can be used). NSAIDs. In case of termination of feeding - a solution of dimethyl sulfoxide in a dilution of 1: 5, topically.

Surgery. Fine needle aspiration of contents. With the ineffectiveness of punctures - opening and drainage of the abscess with careful separation of all bridges. Surgical incisions.. With a subareolar abscess - along the edge of the peripapillary field.. Intramammary abscess - radial.. Retromammary - along the submammary fold. With a small size of the focus of fungal or tuberculous etiology, chronic abscess, it is possible to excise it with adjacent altered tissues. With the progression of the process with the development of panmastitis - removal of the gland (simple mastectomy).

Complications. Fistula formation. Subpectoral phlegmon. Sepsis.

The course and prognosis are favorable. Full recovery occurs within 8-10 days with adequate drainage.

Prevention. Careful care of the mammary glands. Compliance with food hygiene. Use of emollient creams. Expression of milk.

ICD-10. O91.2 Non-suppurative mastitis associated with childbearing P39.0 Neonatal infectious mastitis N61 Inflammatory diseases mammary gland. P83.4 Breast swelling of newborn

Lactostasis - how it is coded in ICD 10

Not many people know that today there is the so-called International Statistical Classification (ICD) of all diseases familiar to mankind and numerous problems directly related to human health.

V English language this classification is called the International Statistical Classification (or ISC) of Diseases and Related Health Problems.

According to this classification, each disease, each pathological or physiological condition is assigned a specific code, through which scientists, doctors and just curious ordinary people can find out basic information about a particular disease in an accessible and understandable form.

But still, many people have questions about why such a classification is needed, how to use it, and where is there a place in it for such a condition as lactostasis? Let's sort it out in order.

What code should be used to find classification information for lactostasis?

The international classification system incorporates class XV, which contains information about pregnancy, childbirth and the postpartum period. This class includes almost all aspects that can be directly or even indirectly related to the life periods mentioned in the title.

Naturally, lactostasis can be assigned to this class. Further, the disease code should report information about the block in which the main data about the disease of interest to us are located. We are considering Block O85-O92.

The title of this block is “Complications associated primarily with the standard postpartum period”. So, most authors within this definition try to include the milk stagnation we are looking for (or lactostasis, milk stagnation) and other, non-infectious conditions.

It should be noted that according to the tenth International Classification of Diseases, it is customary for physicians to distinguish between the following main variants of lactation disorders (ICD code 10 from O91 to O92):

O91 refers to lactational mastitis.
Nipple cracks are encrypted in numbers O92.1.
The O92.2 value includes other, unspecified lactation disorders.
Code O92.3 speaks of primary agalactia.

The numbers O92.4 imply a state of hypogalactia.
In figures O92.5, agalactia is disclosed secondary, or arising from medical indications.
Under the numbers O92.6, such a diagnosis as postpartum galactorrhea is hidden (translated from Greek - the flow of milk).
And finally, the numbers O92.7 mean lactostasis, or polygalactia, etc.

In descriptions of stagnation breast milk you can find information that the general condition of women with lactostasis may worsen slightly. Body temperature, standard clinical tests of urine and blood can remain absolutely normal.

Most often, with the development of milk stagnation, there are no two main signs of an acute inflammatory process: firstly, this is hyperemia, and secondly, hyperthermia. However, in a number of cases, acute forms of milk stasis may be accompanied by severe fever, with a significant increase in body temperature.

It is important for women to understand that to differentiate on their own acute milk stasis from initial forms mastitis is almost impossible, and this means that even when reading medical literature, and being a very literate person, it is impossible to refuse a timely consultation with a doctor.

However, let us return to the classification of lactostasis. Why do doctors still prefer to use a certain ICD 10, and not the usual book description of the disease? The answer is found by itself when you understand what the previously mentioned classification is.

The essence of the international classification of diseases

ICD 10 is a kind of registration document that is used as a standard in the form of a leading statistical and classification basis in world health. Every ten years, the document is carefully reviewed and corrected by the employees of the World Health Organization.

The value of this document lies in ensuring the unity of the various (in different countries ah) methodological approaches to the treatment and analysis of diseases. Today, in the global medical community, the classification document of its Tenth Revision is in force (in fact, hence the ICD-10).

This classification document allows you to systematically record data, easily analyze information received from different countries, not get confused in interpretations and compare data on the number of deaths or morbidity of a particular disease (lactostasis in particular) in different countries.

ICD 10 has become a unified international diagnostic classification that meets universal epidemiological and statistical goals. Through this classification, it has become much easier to analyze the overall health situation in different population groups.

Thanks to this document, physicians have the opportunity to count both the frequency and prevalence of certain diseases and, most importantly, to note the relationship of disease states with various external factors encountered in a particular country.

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How can they be identified?

Mastopathy mcb 10

According to ICD 10, mastopathy is under code No. 60.1. The official name of the disease is diffuse cystic mastopathy. A number of other pathologies are included in the group of breast diseases. MBC is a regulatory document that contains all medical diagnoses. The purpose of compiling such a code is to unify methodological approaches. Used by MBC in 117 countries around the world. The document is compiled by the World Health Organization. 10 means - the tenth edition, today it is valid.

MBC codes 10 from No. 60 to No. 64 - breast diseases. Mastopathy is at number 60.1. This is a disease that occurs due to hormonal imbalances. At fibrocystic mastopathy small neoplasms form in the breast, they can increase in size and even turn into cancerous tumors.

Clinical picture and symptoms

Diffuse cystic mastopathy is an overgrowth of breast tissue.

The danger of pathology is that on initial stage you may not even be aware of its development. Neoplasms of small size do not cause discomfort, do not disturb a woman for a long time. Mastopathy can begin to progress, transform into an oncological disease. That is why you should not delay a visit to a mammologist. It is best to undergo periodic examinations, which allows you to detect pathology at the very beginning of its development.

The primary symptoms of ICD 10 disease include the following:

when palpated, seals are felt;
mammary glands may increase in size;
disturbed by pain in the chest;
greenish discharge from the nipples appears.

The disease, which according to MBC 10 is under code No. 60.1, is divided into two categories. At fibrous mastopathy the amount of connective tissue begins to increase. If the form of the disease is cystic, small neoplasms appear in the mammary gland. At first, they can be very small and visible only with a specialized examination, then the cysts increase in size, they can even deform the breast. With nodular mastopathy, the lymph nodes increase.

Reasons for the development of the disease

Before you start fighting the disease, you should determine the reason why it began to develop. There are a lot of provoking factors.

The most common include the following:

overwork, nervous exhaustion, frequent stress, prolonged depression;
irregular sexual relations;
abortive termination of pregnancy;
late delivery, pregnancy with complications;
refusal to breastfeed;
gynecological pathologies;
disruption of the endocrine system;
kidney or liver failure;
mechanical damage to the mammary glands.

All these factors lead to disruption of the hormonal background, as a result of which fibrous or nodular mastopathy develops.

Treatment measures and prevention

Mastopathy (code 60.1 according to ICD 10) is a pathological process in the tissues of the breast. Its progression can lead to very undesirable consequences. In order to prevent complications, you should contact a specialist in time.

He will conduct a consultation, examination, write out a referral for tests. This will allow you to get a general picture of the woman's health, as well as determine the correct treatment regimen.

Diffuse cystic mastopathy is a serious disease of the mammary gland. It may not make itself felt for many years. Timely examinations by a specialist, proper nutrition, a healthy lifestyle will help prevent the development of the disease and avoid complications.

ICD-10, (No. 60-No. 64) breast diseases

The mammary glands are a "mirror", which indirectly reflects the entire state of the woman's body. The morphology of this organ is a close object of attention of doctors, because in many diseases it is in the chest that the first changes appear. The International Classification of Diseases of the 10th revision - ICD 10 combines diseases of the mammary glands under the code No. 60-64. This is a group of pathologies that are different in terms of reasons and mechanism of development, encrypted by doctors with special numbers. What do they mean, and how not to get lost in medical encryption in order to have full information about your health?

ICD 10 statistics

ICD 10 (No. 60-64) diseases of the mammary glands are subject to careful statistical analysis. This is one of the reasons why the unified classification was introduced. According to the latest data from the World Health Organization, up to 40% of women suffer from mastopathy among the female population of the world, and more than half of all cases (up to 58%) are combined with gynecological disorders. Of particular interest is the fact that many breast diseases are also precancerous conditions. The frequency of morbidity and mortality from breast cancer is increasing every year, even despite the huge advances in medicine in the field of their early diagnosis and effective treatment. The lion's share of cases occurs in developed countries.

Classification approaches ICD No. 10

The internationally accepted classification of ICD No. 10 is also used in our country. Based on it, there are:

· N 60 - Benign growths of the mammary gland. Mastopathy belongs to this group.

· N 61 - Inflammatory processes. Among them are carbuncle, mastitis, abscess.

· N 62 - Enlargement of the mammary gland.

N 63 - Volumetric processes in the chest, unspecified (knots and nodules).

· N64 - Other pathologies.

Each of these diseases has its own causes, characteristic clinical picture, methods of diagnosis and treatment. Let's talk about this now.

Benign breast dysplasia (N 60)

The definition of the disease was back in 1984 by the experts of the World Health Organization. It characterizes benign dysplasia as a combination of pathological mechanisms, manifested by both regressive and progressive changes in breast tissues with the appearance of abnormal relationships between the epithelium and the connective tissue. Also, according to the definition, an important sign is the formation of changes in the breast such as fibrosis, cysts and proliferations. But this is not the primary symptom for making a diagnosis, because. it is not always available.

Clinical picture

The disease can manifest itself in various ways. But the main symptoms can be distinguished:

· Dull pain in the mammary glands, which often tends to increase before the onset of menstruation. After the menstrual bleeding has passed, the pain usually subsides.

Irradiation - the spread of pain outside the breast. Often patients complain that pain is given to the shoulder, shoulder blade or arm.

The presence of education in the breast or compaction of its structure. This symptom can be determined by patients who are attentive to their state of health and regularly palpate.

Diagnostics

The doctor begins the examination with a thorough collection of anamnestic data. The doctor clarifies the patient's onset of menstruation, its nature, cyclicity, soreness, profusion. The gynecological history is also important, which consists in the age of onset of sexual activity, the number of pregnancies, miscarriages, abortions, childbirth. Genealogical data will help to understand whether there were similar diseases in blood relatives in the female line. All this information helps to establish the correct preliminary diagnosis.

An objective examination will help the doctor to identify the asymmetry of the mammary glands, and when they are palpated, to determine the presence or absence of neoplasms. Mammologists pay special attention not only to the consistency and structure of the mammary gland, but also to the color, size and condition of the nipples.

Instrumental methods confirm the correctness of the alleged diagnosis or, conversely, refute it and return the doctor to the beginning of the diagnostic search. Most often resort to mammography and ultrasound of the mammary glands. Additionally, the patient's blood and urine are studied.

Therapy

Treatment of diseases of the mammary glands No. 60 ICD10 is possible in 2 versions. The first is medication, which is used for diffuse growths. A good result can be achieved by hormonal agents, including oral contraceptives.

The second method is surgical, which is indicated for the nodular form. The remote formation is subject to mandatory histological examination to exclude the presence of atypical cancer cells. The prognosis after treatment is favorable.

Inflammatory diseases of the mammary gland (N 61)

ICD-10 No. 61 breast diseases included: abscess, carbuncle and mastitis, which is considered the most common pathology in this group.

Mastitis is an inflammatory disease. Breast lesions are often unilateral, and only in rare cases(not more than 10%) extends to both mammary glands. The cause of the disease is two main factors that overlap one another:

The first is a violation of the outflow of milk;

The second is the addition of pathogenic or conditionally pathogenic microflora.

Initially, the disease proceeds according to the type of aseptic (sterile) inflammation. However, very quickly, literally in a day, in conditions of stagnation of milk secretion and a favorable temperature, the microflora is activated. Thus begins the stage of bacterial inflammation.

Main symptoms

The clinical picture is almost the same in all women. The first symptom is a sharp rise in temperature to high values (38 - 39 ° C). Further, redness of the skin of one of the mammary glands joins, and then severe pain. As time goes by, they only get stronger. With severe inflammation and the absence of timely treatment, sepsis develops very quickly - a deadly complication.

The diagnosis is established on the basis of anamnestic, objective and laboratory data. From the anamnesis it turns out that the woman is breastfeeding. As a rule, the risks increase if you constantly apply the child in the same position. In this case, incomplete emptying of the gland occurs. An objective examination shows hyperemia of the inflamed gland, its slight increase, as well as sharp pain on palpation. At laboratory research in the blood, leukocytosis with high values is detected.

In the early stages, conservative (drug) treatment is also effective. The main condition is the thorough expression of milk. For these purposes, a breast pump is not the best solution; it is best to do it by hand. The patient can perform the procedure on her own, but often, due to severe pain, it is necessary to turn to specially trained people. Of the drugs resort to the help of broad-spectrum antibiotics. Usually these measures are enough for a complete recovery and further restoration of breastfeeding.

In severe forms of the disease, before the appointment of an operative method of treatment, attempts are made to temporarily stop lactation with the help of special medicines. If this method was ineffective, then surgeons take up the treatment.

Other inflammatory diseases of the breast

Carbuncles and abscesses of the mammary gland also occur in clinical practice but now they are becoming rarer and rarer. Carbuncle of the mammary gland, as in any other part of the skin, is a purulent inflammation hair follicle and sebaceous gland. An abscess is a purulent fusion of the mammary gland limited from healthy tissues.

The cause of the disease in carbuncle is a blockage of the sebaceous gland, against which the pathogenic microflora has joined. An abscess can develop as a result of hematogenous or lymphogenous infection from other foci.

Both diseases occur with an increase in temperature, an increase in soreness in one of the mammary glands.

Treatment is often performed surgically. The abscess is opened, freed from purulent contents, treated with an antiseptic solution, and then drainage is established for a while. The patient is prescribed a course of broad-spectrum antibiotics. With timely treatment, the prognosis is always favorable.

ICD 10 No. 62 - diseases of the mammary glands. Hypertrophy

In this group, it is customary to single out gynecomastia, which occurs only in men. It is characterized by the growth of breast tissue and, accordingly, its increase. Among women this process called breast hypertrophy, and also belongs to this group.

The risk of hypertrophy increases the consumption of beer, because. This drink contains plant estrogens. They also stimulate active cell division.

ICD 10 - N 63 - diseases of the mammary glands. Education, unspecified

It is worth noting that such a diagnosis is established not only in women, but also in men, but their ratio to each other is 1:18. Mostly women aged 20 to 85 are ill, but it is more common in 40-45 years. Mortality from the disease is 0%.

Causes

The etiology of the disease is not fully understood.

Clinical picture

The first time the disease has no symptoms at all, this is the so-called latent phase of the disease. The duration of this period is individual and can vary from several months to a year or more. The first symptom is periodic pain in the breast, which may increase before the onset of menstruation. Pain, as a rule, subsides immediately after the end of menstruation.

The biggest mistake of patients is that they do not pay attention to changes in their own body and do not go to doctors, attributing ailments to hormonal imbalances, the beginning of a new cycle, or intimacy. menopause. Over time, the pain takes on a constant aching character. With careful self-palpation, the patient can detect a formation in the chest, which often serves as a reason to see a doctor.

Main research methods:

Collection of complaints

assessment of anamnestic data;

laboratory research methods (general clinical analysis blood, general analysis urine, biochemical analysis blood test or study for tumor markers);

Treatment

All breast neoplasms are subject to surgical treatment. After removal, the biological material in 100% of cases is sent for histological examination, which establishes an accurate diagnosis and the need for further treatment.

Other diseases of the breast (N64) ICD10

This group includes:

galactocele - a cyst in the thickness of the mammary gland, filled with milk;

involutive change after breastfeeding;

secretion from the nipple outside the lactation period;

Inverted nipple

Mastodynia is a condition that is perceived subjectively. It is characterized by discomfort in the chest. They may be present continuously or intermittently.

Prevention of breast diseases

A priority place in the working tactics among gynecologists and oncologists is propaganda for the prevention of breast diseases. These include social advertising, various medical brochures, preventive conversations with patients at the reception, the increase in the popularity of a healthy lifestyle, as well as the approval of World Breast Cancer Day.

To minimize the risk of developing the disease, and also not to miss it on early stage the following rules must be followed:

Refusal to smoke and drink alcohol;

· treatment acute diseases, as well as prolongation of the remission phase in chronic;

passing preventive examinations, especially over the age of 35 years;

Performing self-palpation of the mammary glands at home at least once every 4-6 months.

Benign breast dysplasia according to ICD-10 or mastopathy

ICD-10, (No. 60-No. 64) breast diseases. Benign breast dysplasia according to ICD-10 or mastopathy is a disease of the mammary glands (benign tumor). It appears as a result of tissue growth during various hormonal disorders and there are 2 types: nodular (single compaction) and diffuse mastopathy(With multiple nodes). Mastopathy occurs mainly in women of reproductive age. This phenomenon is easy to explain. Every month in a young body, periodic changes occur under the influence of the hormones estrogen and progesterone, which affect not only menstrual cycle, but also breast tissue (stimulation and inhibition of cell division, respectively). Hormonal imbalance. causing an excess of estrogen, leads to tissue proliferation, i.e. to mastitis. ICD-10, (No. 60-No. 64) breast diseases. Also, the untimely production of prolactin, the hormone of lactation, can lead to the disease (it normally appears during pregnancy and lactation). The development of mastopathy can provoke vitamin deficiency, trauma, abortion, hereditary predisposition, chronic diseases etc. You can feel the appearance of mastopathy on your own. It causes pain in the mammary gland, accompanied by breast enlargement, swelling and induration. Sometimes there may be discharge from the nipples. If you find such signs, you should immediately contact a specialist.

?ICD-10, (No. 60-No. 64) diseases of the mammary glands according to the International Classification of Diseases

Trophic ulcer of the lower extremities - according to ICD-10

A trophic ulcer is a purulent wound. Most often, it appears on the lower extremities, namely, on the lower leg or foot. This disease progresses rapidly and prevents the patient from leading a full life. Without proper treatment, a trophic defect can lead to serious consequences.

Causes

According to the International Classification of Diseases (ICD 10), trophic ulcers have the code L98.4. The development of purulent wounds is associated with a violation of normal blood flow, a lack of oxygen and nutrients in the tissues. Trophic ulcers lower extremities develop against the backdrop of:

venous insufficiency;

Trophic ulcer is listed in the ICD-10 classifier and has the code L98.4

violations of lymphatic drainage;
arterial diseases (thrombangiitis, Martorel's syndrome, macroangiopathy and atherosclerosis obliterans);
injuries;
skin damage.

Trophic wounds, according to ICD 10, can develop against the background diabetes or autoimmune diseases. The causative factor may be kidney disease, liver disease, heart disease or excess weight.

Purulent formations can develop for various reasons. They do not act as an independent disease and are always the result of the harmful effects of external and internal environment. Trophic defects are presented as a special form of soft tissue damage. As a result, wounds do not heal well. A complete diagnosis allows you to identify the root cause of the development of ulcers. Without an appropriate examination, therapy does not bring the desired result.

Trophic formations can be hereditary. In this case, the weakness of the connective tissue and the formation of the leaflets of the venous valves by it is transmitted from close relatives.

Trophic ulcers are purulent wounds that occur on human skin as a result of a number of reasons.

Kinds

In medical practice, trophic defects according to ICD 10 have several types:

venous;
arterial;
pyogenic;
diabetic.

Varicose veins without treatment leads to the development of chronic venous insufficiency. Blood circulation in the lower extremities is disturbed. As a result, tissue nutrition deteriorates. The first symptoms of insufficiency are a feeling of heaviness and pain in the legs. Over time, cramps and swelling appear. Skin covering takes on a dark brown color. Against the background of these changes, weeping wounds form in the lowest parts of the limbs. In the affected area, stagnation of blood is observed. Tissues do not receive proper nutrition and accumulate toxic substances in themselves. The venous wound is accompanied by skin itching. When injured, the trophic ulcer increases and does not heal.

Arterial defects develop as a result of tissue necrosis and impaired arterial blood flow in the lower extremities. If the patient is not given timely medical care, the affected limb is rarely salvageable.

Arterial purulent formations mainly appear on the nail phalanges, foot, heel or fingers. Purulent wounds have uneven borders. The bottom of the ulcers is covered with fibrinous plaque.

The problem can occur in any area of the body, but most often affects the feet, lower legs

The pyogenic type develops as a result of infection. Most often it is formed on the lower leg. Purulent defects are caused by hemolytic streptococci, staphylococci or Escherichia coli. Pyogenic ulcers are not deep, with a flat bottom, covered with a scab. They never get crusty. To the touch, purulent wounds are soft and painful.

The diabetic type is a complication of type 2 diabetes. Trophic formations appear in places of strong friction. The feet and ankles are most commonly affected. The ulcer has a purulent discharge. When a bacterium or infection is attached, purulent elements may increase in size.

Stages of development

The trophic ulcer of the lower leg has four stages of development:

Appearance.
Cleansing.
Granulation.
Scarring.

It is very important to recognize the disease in time and not to start it, but to start timely treatment.

The initial stage is characterized by the appearance of "lacquered" skin. There is redness and swelling. Liquid seeps through the "lacquered" skin. Over time, dead skin areas form whitish spots, under which a scab forms. The first stage can last for several weeks.

A rapid increase in a purulent defect can cause a microbial infection. Symptoms include fever, chills, and general weakness. With the formation of several defects, the ulcers merge into one large one. These changes may be accompanied by severe pain and high temperature body.

At the second stage of development, the ulcer has a bloody or mucopurulent discharge. If it has an unpleasant pungent odor, then this indicates the presence of an infection. At the stage of cleansing, itching appears. As a rule, the second stage lasts about 1-1.5 months.

The healing process of a trophic wound depends on the quality of treatment. Subject to all the doctor's recommendations, nutrition and tissue repair in the area of the ulcer is enhanced. Otherwise, a relapse occurs. Repeated trophic wounds respond worse to treatment. In the third stage, the wound surface begins to decrease.

The last phase can last several months. The healing process is long. Whitish areas of young skin are formed on the wound surface. The scarring process begins.

The main reason why trophic ulcers form on the body (according to the ICD-10 classification) is a violation of normal blood circulation

Trophic ulcers with ICD code 10 L98.4 progress rapidly, therefore, in order to avoid serious complications, it is necessary to start treatment immediately. Among possible complications, which may lead to lethal outcome, can be attributed to sepsis, gangrene or skin cancer.

Therapy

Treatment is prescribed for each patient strictly individually. Before proceeding with treatment, the root cause and type of defect should be identified. For this purpose, doctors conduct a bacteriological, histological and cytological examination. Treatment includes:

drug therapy;
surgical intervention.

At the initial stage of the development of a purulent wound, doctors prescribe antibiotics, anti-inflammatory drugs (Diclofenac, Ketoprofen), antiallergic drugs (Suprastin, Tavegil) and antiplatelet agents (Reopoglyukin and Pentoxifylline).

Conservative treatment includes cleansing the wound surface from pathogenic bacteria. Purulent formations are washed with a solution of potassium permanganate, chlorhexidine. As an antiseptic at home, you can prepare a decoction of chamomile, string or celandine. After treating the wound, a therapeutic bandage based on Levomekol or Dioxicol should be applied.

Physiotherapy will help to strengthen the result of local treatment. Effective is ultraviolet irradiation, laser and magnetic therapy. Physiotherapy procedures will relieve swelling, expand blood vessels and stimulate epidermal cells to regenerate.

With the ineffectiveness of drug therapy, doctors are forced to resort to radical methods of treatment. V modern medicine vacuum therapy is performed. The principle of treatment is the use of special sponge dressings. With the help of low pressure, sponge dressings remove purulent exudate from the wound, which leads to a decrease in edema and restoration of blood microcirculation in the soft tissues. With large areas of damage, skin grafting is performed from the thighs or buttocks.

Postpartum lactostasis or physiological characteristics of the body with. Gynecomastia - its ICD code 10 The problem of adenosis of the mammary glands.

Postpartum diseases. Lactation as a function of the female body. In the chain of a single biological reproduction of a species, lactation is one of the successive stages. For a woman's body, lactation is a genetically programmed type of hormonal activity.

Postpartum lactostasis or physiological characteristics of the body with. Gynecomastia - its ICD code 10 The problem of adenosis of the mammary glands. An ordinary person, having seen the ICD 10 code in his medical card, first of all ask himself How to treat lactostasis with the help of folk remedies? ICD CODE -10, however, the accuracy of these figures is doubtful, since some experts include lactostasis here, and a significant number of patients.

With the development of pregnancy, changes occur in the ducts and alveoli of the mammary gland, aimed at preparing the gland for lactation. These changes develop gradually and are closely related to the levels of hormones produced during pregnancy.

After childbirth, when the woman's neurohormonal system switches, the mammary gland switches to a new mode of operation, determining lactation as a function consisting of three complex processes. secretion of milk.

its accumulation in the mammary gland (in the capacitive system of the gland, which is a collection of milk ducts and sinuses capable of accumulating milk). and periodic milk transfer during feeding and pumping, carried out by the milk evacuation system. The formation of lactation occurs gradually from 2-3 days and ends mainly by the 10th day of the postpartum period. By this time, each system comes to full compliance in the rhythm of its processes, which is especially important in interaction with each other. If this interdependence of the processes that make up lactation is violated, the so-called “physiological” lactostasis occurs. Critical in this regard are 3-4 days after birth, although such lactostasis can occur on any other day of the lactation period. Lactostasis, in turn, triggers other unfavorable processes, ultimately leading to the development of lactational mastitis and hypogalactia, which require either suppression of lactation or its regulation.

Etiology of lactostasis. Currently, there is no unity of views on the cause of the development of lactostasis. According to some authors, lactostasis occurs due to a primary decrease in the milk ejection reflex, according to others, due to the low excitability of the neuromuscular apparatus of the areolar-nipple region (primary, or as a result of injury - nipple cracks), leading to a delay in milk evacuation and I will stop it. There are indications of the role in the formation of lactostasis of a disorder of the neuro-endocrine support of the function of the gland, edema of the interstitial tissue and accumulation of fluid in the interstitial space, which reduce the elastic capacity of myoepithelial cells. Classification of lactostasis. Lactostasis can be primary or “physiological”, which occurs during the formation of lactation function, and secondary, pathological (inflammatory).

The first refers to lactostasis, which is easily amenable to corrective therapy. N. Volkov (1976) puts this term in quotation marks, because he believes that it is impossible to call a physiological phenomenon that requires treatment. Primary lactostasis, if not eliminated in the next few hours, leads to inflammation.

Secondary (pathological) lactostasis is an obligatory, pathogenetically determined symptom of inflammation. In some cases, it is expressed significantly and dominates in clinical manifestation diseases, in others it is hardly noticeable, is local in nature and is detected only with ultrasound diagnostics.

But always lactostasis contributes to the intensification and spread of infection. An increase in lactostasis leads to inflammatory edema and narrowing of the lumen of the milk ducts, a decrease in the contractility of the myoepithelial cells of the mammary gland. Lactostasis contributes to the appearance of nipple cracks and intense bacterial contamination of milk. Pathological lactostasis is considered as premastitis. L.

Vanina et al. (1973) propose to consider pathological lactostasis as a subclinical stage of mastitis. This allocation of premastitis is justified by the fact that the detection of pathological lactostasis allows you to start treatment in full.

The pathogenesis of lactostasis. Primary lactostasis occurs most often in nulliparous women as a result of the uneven formation of a new function of the female body - lactation. Therefore, lactational mastitis in nulliparous women is more common than in those who give birth again. Lactation consists of processes representing independent functions of the mammary gland. These are secretory, capacitive and evacuation functions, which are formed in the period from 2 to 10 days of the postpartum period. From how becoming secretory function will correspond to the ability of the gland to accumulate (capacitive function) and secrete (evacuation function) milk, the correct course of lactation depends.

Primary lactostasis occurs when the formation of the secretory function of the mammary gland is ahead of the process of the formation of capacitive and evacuation functions. The pathogenesis of “physiological” lactostasis is as follows: a rapid increase in the rate of milk secretion outstrips the formation of a capacitive system, which is manifested in breast engorgement. There is a feedback between the secretory and capacitive functions of the organ. It has been established that the capacity of the gland depends not only on its purely anatomical abilities, but is regulated by the neurophysiological system by reflex changes in the tone of myoepithelial cells located in the walls of the ducts and alveoli. As the gland fills with a secret, the tone of these cells decreases, due to which it is possible to accumulate a significant amount of milk without a significant increase in pressure. A rapid increase in the rate of milk secretion, with a well-established interaction of lactation processes, serves as a signal to inhibit secretion until the elastic tension in the mammary gland stabilizes and the milk excretion function reaches the proper level, which is facilitated by the act of feeding.

However, this does not always work out. With a lag in the development of the capacitive and evacuation function from the secretory (which starts the whole thing), a rapid increase in milk secretion, its accumulation, a sudden stretching of the milk ducts insufficiently prepared for this lead to paralysis of the capacitive and evacuation system of the gland. The child "does not take" such a breast, milk is excreted with difficulty during decantation. The mammary gland becomes dense, tuberous, painful.

This is the beginning of lactostasis. Lactostasis, both primary and secondary, is accompanied by an increase in the viscosity of milk, which enhances congestion in the mammary gland, contributing to the manifestation of the "hyperviscosity syndrome" in the focus of inflammation with all the negative phenomena inherent in this rheological disorder. Stagnation of milk very quickly causes venous and lymphatic stasis, resulting in swelling of the alveoli, ducts and stroma of the gland.

It creates favorable conditions for the rapid reproduction of microorganisms entering the gland and an increase in their number to a critical level, after which it is already very difficult to stop inflammation (V.N.

Serov et al. 1980).

In 20-35% of lactating women with mastitis, hypergalactia occurs. Hypergalactia, as an independent disease, should be discussed from the 10th day of the postpartum period. In case of hypergalactia, capacitive and evacuation functions are developed quite well, but increased secretion of milk, prolonged mechanical impact on the mammary gland lead to traumatization of the epithelium of the milk ducts and infection. Treatment of lactostasis. is a method of prevention of lactational mastitis and the core of the method of treatment of all stages of mastitis, because lactostasis is very conducive to infection of the mammary gland with all the ensuing consequences of delaying the excretion of milk. For a long time, there are many ways to eliminate lactostasis. So far, breast massage and the use of heat or alcohol compresses have been widely popular.

The essence of their action and the secret of popularity lies in the simplicity and visible relief that the action of heat brings to a sore chest. Under its influence, the milk ducts expand, the tension in the gland subsides and the pain subsides.

Complemented by vigorous massage, the compress promotes the emptying of the gland from milk, which was almost impossible before. The effect on lactation is obvious, the result of exposure to the gland does not affect immediately. B. L.

Gurtova (1978, 1979, 1980, 1981, 1984), consistently analyzing the importance of lactation in the occurrence and maintenance of inflammation, believes that, depending on the situation, lactation should be prevented, inhibited or suppressed. For this purpose, there are various means: hormonal (estrogens), non-hormonal (saluretic diuretics, saline laxatives, camphor preparations, cardiac - difrim, falikor), special preparations - dopamine receptor agonists, parlodel and lazuride. Speaking about the regulation of lactation should be distinguished. prevention of lactation - taking measures immediately after childbirth so that lactation does not appear; inhibition of lactation - taking measures to reduce the synthesis and secretion of milk in the corrective therapy of lactostasis and hypergalactia;

turning off lactation is a reversible process when it is required to eliminate lactation for the duration of the treatment of some cases of mastitis; lactation suppression is an irreversible process, complete cessation of lactation processes; stimulation of lactation - increased processes of milk formation during hypogalactia. Considering that breastfeeding is most effective during lactation, when 2/3 of milk is excreted due to the recoil effect and only 1/3 through pumping, it makes sense to influence all lactation processes involved in lactostasis: inhibition of secretion and stimulation of the capacity and evacuation abilities of the gland.

At the same time, it is necessary to take into account the ultimate goal of regulation. Among medicinal methods treatment of lactostasis should be highlighted. the long-standing use of small doses of estrogens, either alone or in combination with dopamine receptor agonists for 6-12 days. The mechanism of the lactation-inhibiting action of estrogens can be explained by the peculiarities of the onset and development of lactation. It is believed that the trigger for milk secretion is a sharp decrease in the level of estrogen and progesterone in the blood of a woman, while increasing the level of prolactin.

Therefore, the appointment of estrogens, an increase in their concentration in the blood, inhibits the production of prolactin and milk production. Moreover, the effect occurs very quickly, and after stopping the drug, it is quickly excreted from the body, and lactation is disinhibited.

The effect of the rapid stimulating or inhibitory action of estrogens on the production of prolactin is explained by the fact that estrogens act both directly on the pituitary gland and indirectly through the hypothalamus. The decisive factor in the prolactin-inhibiting effect of the action is the dosage. Small doses of estrogen actively stimulate the synthesis of prolactin in the pituitary gland, causing it to increase threefold. At the same time, fluctuations in the level of prolactin in the blood maintain a daily cycle. At the same time, milk production increases. Large doses of estrogens do not affect the level of circulating prolactin in the blood, but contribute to its rapid binding in the tissues of the mammary gland. This explains the rapid inhibitory effect of large doses of estrogen on lactation, and the fact that suppression of lactation does not occur is also explained by this.

Prolactin circulating in the blood, after the cessation of the inhibitory effect of estrogens, is replaced by tissue-bound prolactin, and lactation resumes. for the complete suppression of lactation - the use of direct simulators of prolactin inhibition, which are ergot preparations. They can cause a direct decrease in the level of prolactin in the blood. This explains the more persistent, than estrogen, pressor effect on lactation in lactating women and in the treatment of galactorrhea in patients with galactorrhea-amenorrhea syndrome. to increase the evacuation function of lactation - the use of hormones of the posterior pituitary gland on the "acetylcholine background". An increase in the evacuation function of lactation is necessary to remove milk accumulated in the milk ducts and alveoli, which leads to an increase in intracapacitive pressure, hyperextension of the walls of the milk ducts, a decrease in the level of elastic tension in this area of the gland, impaired blood circulation and difficulty in the entry of hormones from the posterior pituitary gland into myoepithelial cells, resulting in is a violation of homeostasis in the mammary gland and increased growth of the bacterial flora.

Taking into account the data proving the presence in the mammary gland of not only adrenergic, but also cholinergic nerve endings that are directly involved in the implementation of the milk ejection reflex, the creation of an acetylcholine background is a necessary condition for the manifestation of milk ejection.

lactostasis- this is the stagnation of milk in one or more areas of the mammary gland. This condition is manifested by compaction of the gland tissue and pain - especially during palpation. A network of dilated veins is visible on the skin of the corresponding chest area. The tension and soreness of the areas of the gland can persist even after it has been emptied. Body temperature is usually normal or subfebrile.

Causes of lactostasis

The occurrence of lactostasis is usually caused by two reasons: increased milk production and a violation of its outflow from any area or from the gland as a whole as a result of blockage or narrowness of the milk ducts.

Factors predisposing to the development of lactostasis are:

discrepancy between the active functioning of the glandular tissue that produces milk, and the diameter of the lumen of the lactiferous passages (more often this happens after the first birth);
flat nipple, the presence of cracks on the nipple, which makes it difficult to breastfeed;
refusal to breastfeed and the transition to artificial feeding;
stress and excessive physical activity, which lead to spasms of the ducts of the mammary glands;
injuries and bruises of the chest;
improper attachment to the breast, in which the child sucks ineffectively, does not empty the breast enough;
squeezing the mammary glands with tight clothing or the mother's fingers during feeding, sleeping on the stomach;
difficult outflow of milk from the lower part of a large breast when it sags;
hypothermia or being in a draft, as a result of which the mammary glands "catch cold".

Increased milk production, as a rule, takes place in the first days when lactation is established. At the first birth, milk arrives on the third, sometimes on the fourth day, with repeated births, about a day earlier. The baby at this time still sucks very little, and the breast is not completely emptied during feeding. With repeated births (or, more precisely, with repeated breastfeeding), the development of congestion is associated, perhaps, only with this. In the case of the first birth, moreover, the outflow of milk is often difficult, since the "undeveloped" ducts of the mammary glands in a primiparous woman are narrow and more tortuous.

Insufficient emptying of the mammary gland leads to an increase in pressure in the lumen of its ducts and inside the lobules. This causes some swelling and infiltration of the tissue of the corresponding area, which leads to irritation of pain receptors and is manifested by local pain. In addition, an increase in pressure in the secretory sections of the gland inhibits further lactation.

Lactostasis in the ICD classification:

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Specialization: Obstetrician-gynecologist

Anastasia: 03/15/2015
Hello! I am 20 weeks pregnant, on ultrasound they said that I have fetal ascites, there is fluid in his tummy! please tell me how to fix it? what are the consequences for the child?

With lactostasis, it is necessary to ensure the maximum possible emptying of the mammary gland. Expansion of the ducts is facilitated by moderate warming, breast massage. To reduce the likelihood of reflex stasis, a quality rest, the exclusion of stress, and the restriction of wearing underwear compressing the chest are recommended. It is recommended to sleep not on the back and stomach, but on the side.
Feeding should be done as often as possible (but not more than once every two hours). At the beginning of feeding, it is immediately necessary to attach the child to the "sick" breast. The fact is that in order to suck milk out of the stagnant area, the child has to exert maximum sucking efforts, and when he has already eaten, he can be lazy and refuse to suck. However, healthy breasts also require careful emptying. Feeding should be carried out in a position that is convenient and comfortable for the baby, providing the child with maximum contact with the nipple and facilitating sucking. If the baby does not breastfeed often enough and intensively, it is necessary to express the excess milk.
Strengthening the outflow is facilitated by massaging the breast with stroking movements in the direction of the nipple.
Breast massage, pumping and feeding must be carried out, overcoming soreness until the symptoms of lactostasis subside. Persistence of efforts contributes to the qualitative emptying of the glands and long-term full lactation. Sometimes, when opening a spasmodic duct during feeding, there may be some tingling and burning in the chest.
Expressed milk may contain inclusions ("milk grains"), threadlike fibers, and be excessively fatty in appearance. This is the normal, healthy consistency of breast milk, providing the baby with good nutrition. Between feedings and pumping, soreness can be relieved by applying local cold compresses.
Before pumping or feeding, the gland must be kept warm. If necessary, the chest can be warmed with a towel soaked in warm water, take a warm shower. The use of hot water and warm compresses is dangerous due to the possibility of infection, so sudden excessive warming is not recommended.
After warming up, the breast is massaged in a circular motion from its base to the nipple. When massaging the lobule, where lactostasis is localized, it is quite well defined by touch, differing from the surrounding tissue in increased density. The seal must be massaged with particular care. It is the compacted painful area that needs to be expressed first. After pumping, you can attach to the baby's breast and let him suck the rest of the milk.
Prolonged lactostasis (more than a day) and after decanting can retain pain for 1-2 days in the area of stagnation that has taken place. If even after the pain does not subside, but intensifies, fever, hyperemia occurs, it can be assumed that mastitis has developed (inflammation of the mammary gland). It is necessary to stop heating the gland (heat contributes to the progression of the infection) and urgently consult a doctor.
With lactostasis, any warming compresses are harmful, and alcohol compresses, in addition to the possibility of stimulating the bacterial flora, interfere with the hormonal regulation of lactation, which only contributes to the development of lactostasis. Excessively active massage can also lead to negative consequences: mechanical damage to the lobules and ducts, the appearance of new foci of stagnation and an increase in body temperature (with intense reabsorption of milk and infiltration of surrounding tissues in damaged lobules).
Treatment of lactostasis folk remedies without consulting a doctor, it is categorically not recommended, especially for mothers who are lactating for the first time. Improper implementation of therapeutic measures contributes to the development of complications of lactostasis and a decrease in the quality of milk up to the complete cessation of lactation. Self pumping is often very painful and may not be effective. The midwife can help with straining and developing the ducts. A good specialist can make pumping completely painless. Hardware pumping with a breast pump is not inferior to manual pumping in its effectiveness, but with lactostasis, it is necessary to carefully massage the affected area before using the breast pump.
One of the effective methods of resorption of stagnation of milk is ultrasound massage of the mammary gland. Promotes contraction of the milk ducts oxytocin. It is prescribed by injection and administered intramuscularly 20-30 minutes before feeding.

Code according to the international classification of diseases ICD-10:

O91.2
P39.0
P83.4

Classification. Downstream .. Acute: serous, purulent, phlegmonous, gangrenous, abscessing .. Chronic: purulent, non-purulent. By localization: subareolar, intramammary, retromammary, spilled (panmastitis).
Etiology. Lactational (occurs in the postpartum period; see Breastfeeding). Bacterial (streptococci, staphylococci, pneumococci, gonococci, often combinations with other coccal flora, Escherichia coli, Proteus). Carcinomatous.

Causes

Risk factors. Lactation period: violation of the outflow of milk through the milk ducts, cracks in the nipples and the areola, improper care of the nipples, violations of personal hygiene. Purulent diseases of the skin of the breast. SD. Rheumatoid arthritis. Silicone/paraffin breast implants. GC reception. Removal of a breast tumor followed by radiotherapy. Long history of smoking.

Symptoms (signs)

Clinical picture
. Acute serous mastitis(may progress with the development of purulent mastitis) .. Sudden onset .. Fever (up to 39-40 ° C) .. Severe pain in the mammary gland .. The gland is enlarged, tense, the skin over the focus is hyperemic, on palpation - a painful infiltrate with fuzzy borders .. Regional lymphadenitis.
. Acute purulent abscess mastitis.. Fever, chills .. Pain in the gland .. Mammary gland: redness of the skin over the lesion, sharp pain on palpation, softening of the infiltrate in the center with the presence of fluctuation .. Regional lymphadenitis.
. Acute purulent phlegmonous mastitis.. Severe general condition, fever.. The mammary gland is sharply enlarged, painful, pasty, infiltrate without sharp boundaries occupies almost the entire gland, the skin over the infiltrate is hyperemic, has a bluish tint.. Lymphangitis, regional lymphadenitis.

Diagnostics

Treatment

TREATMENT
Conservative therapy. Isolation of mother and child from other puerperas and newborns. Bandage or bra that supports the mammary gland. Dry heat on the affected mammary gland. Expression of milk from the affected gland in order to reduce its engorgement. Cessation of breastfeeding with the development of purulent mastitis. If pumping is not possible and there is a need to suppress lactation, drugs that suppress the formation of prolactin are used - cabergoline 0.25 mg 2 r / day for two days, bromocriptine 0.005 g 2 r / day for 4-8 days. Antimicrobial therapy with continued breastfeeding - semi-synthetic penicillins, cephalosporins: cephalexin 500 mg 2 r / day, cefaclor 250 mg 3 r / day, amoxicillin + clavulanic acid 250 mg 3 r / day; if anaerobic microflora is suspected, clindamycin 300 mg 3 r / day (in case of refusal to feed, any antibiotics can be used). NSAIDs. In case of termination of feeding - a solution of dimethyl sulfoxide in a dilution of 1: 5, topically.

Complications. Fistula formation. Subpectoral phlegmon. Sepsis.
The course and prognosis are favorable. Full recovery occurs within 8-10 days with adequate drainage.
Prevention. Careful care of the mammary glands. Compliance with food hygiene. Use of emollient creams. Expression of milk.

ICD-10. O91.2 Non-suppurative mastitis associated with childbearing P39.0 Neonatal infectious mastitis N61 Inflammatory diseases of the mammary gland. P83.4 Breast swelling of newborn

Lactostasis is the stagnation of milk in the ducts of the mammary gland of a nursing woman. In order to understand the causes of lactostasis, it is necessary to understand how the mammary gland is arranged, what are its main functions in lactogenesis.

, , ,

ICD-10 code

O92 Other breast changes and lactation disorders associated with childbearing

Epidemiology

Most often, lactostasis occurs during the first lactation. There is also a tendency to develop lactostasis in lactating women who have already had a history of lactostasis during previous births and breastfeeding. Lactostasis can occur in the presence of cicatricial changes in the mammary gland or mastopathy. Neither the age of a nursing woman, nor race affect the development of lactostasis.

Used in medical practice international classification diseases. In accordance with it, the following forms of the disease are distinguished:

O92 - Other changes in the mammary gland, as well as lactation disorders that are associated with the birth of a child.
O92.7 - Other and unspecified lactation disorders
O92.7.0 - Laktostasis.

Causes of lactostasis

There are many causes for this syndrome.

The first and most common cause is improper attachment of the baby to the breast, which leads to incomplete emptying of the breast. As a result of the accumulation of milk in a certain area and the absence of its discharge after an indefinite period of time, a clot of curdled milk is formed, which is the cause of the torment of a nursing woman.
The second most common cause of lactostasis is rare attachment or feeding by the hour. As a result of this type of feeding, lactostasis can develop immediately in both mammary glands. In this case, several ducts are usually involved in the process at once.
Incorrect expression. Very often, on the fourth or fifth day after childbirth, when there is a plentiful flow of milk, and the newborn needs a very small amount of it for nutrition, the woman in labor begins to express herself, while often not even having an idea how to do it. These manipulations ultimately lead to damage to the delicate ducts and the development of lactostasis.
Big chest. Yes, the owners of lush breasts are at risk for the development of lactostasis, as they do not always know how to properly adjust lactation.
Wearing a tight, synthetic and improperly fitted bra, which in turn can lead to squeezing of the ducts and stagnation of milk in them.
Injuries. Even a small push of the baby's leg into the mother's breast can lead to lactostasis due to damage to the duct.
Stress. Chronic lack of sleep, fatigue lead to increased nervousness, which in turn negatively affects milk production.

Pathogenesis

The mammary gland is a paired hormone-dependent organ with a complex lobular structure with alveolar-tubular branching of the milk ducts. It is in the alveoli that milk is produced, under the action of the hormone prolactin. One gland can have up to 20 radially arranged lobes. All the excretory ducts of one lobe are connected to the milk duct, which goes to the nipple and ends at its top with a small hole - the milk pore. In this case, the network of milk ducts branches closer to the nipple. The skin of the nipple is bumpy, it contains many circular and longitudinally directed muscle fibers, which plays an important role in sucking. The content of subcutaneous fat at the base of the nipple is minimal.

The main function of the mammary gland is the synthesis and secretion of milk. Since the mammary gland is a hormone-dependent organ, during pregnancy, its structure changes under the influence of placental hormones. In the mammary gland, there is a rapid increase in the number of ducts and their branches. From the 28th week of pregnancy, the mammary glands begin to produce colostrum. From this moment begins lactogenesis. It is during this period that the composition and quality of colostrum is formed, which the newborn will feed after childbirth, and therefore the quality of nutrition and the lifestyle of a pregnant woman are important. But lactation itself begins only after childbirth and separation of the placenta, when, under the influence of hormones such as prolactin and oxytocin, colostrum is replaced by milk. This milk is rich for the baby in minerals, vitamins, fats, proteins and carbohydrates necessary for its growth and development in this particular period of the newborn. At first, milk is produced regardless of feedings. Then it is released depending on the emptying of the chest.

Now knowing the structure and physiology of the mammary gland, we will deal with the pathogenesis of lactostasis. So at the beginning of lactation, when all the mechanisms of a complex process have not yet been established, the pathogenetic link is the lack of interaction between the secretory, storage and excretory functions of the mammary gland. Thus, on the second - third day after childbirth, when milk is abundantly produced by the glands, the alveoli are not able to retain a large amount of it, and the ducts, under the action of hormones, secrete it insufficiently. This is where milk stasis, or lactostasis, forms. In the later periods of lactation, the main pathogenetic role is played by the mechanical influence on the release of milk, which creates an obstacle to its full release. Now the process of lactation has already been debugged and milk is produced under autocrine control, and not due to the direct action of the hormone.

Symptoms of lactostasis

The main first signs of lactostasis that occur in the initial stage are soreness and discomfort in the mammary gland. On palpation, a small, painful area is felt among the normal breast tissue. The skin over this area becomes hyperemic. At first, the development of lactostasis pain occurs only upon contact with the mammary gland, later the pain persists constantly. When several ducts are blocked, swelling of the tissues of the entire mammary gland is present, if one duct is damaged, swelling can be traced locally only above the blockage site. Locally over the damaged area, the skin temperature rises. At the same time, the body temperature remains normal and the general well-being of a nursing woman, as a rule, is not disturbed. In the late stage of the disease, when opportunistic microflora is involved in the process, body temperature rises, the mammary gland becomes swollen and painful, and the patient's general condition worsens. There is chills and weakness.

After finding a site of blockage of the mammary gland, it is necessary to immediately begin to eliminate it. The best thing here is the frequent and correct attachment of the baby, so that his chin is directed towards the resulting lactostasis. Since no pumps, no hands can do a better job than a baby's mouth. And it is necessary to apply as often as possible, it is better to lie down with the baby for a day in bed, and entrust all household chores to the rest of the household. At the same time, it is necessary to choose the most comfortable position for feeding, in which nothing should interfere and it is possible to relax as much as possible. In the presence of prolonged blockage and soreness, or at the beginning of the formation of lactation, it is recommended to apply a warm, dry cloth to the affected breast before feeding and pump it so that the child does not get enough of the foremilk without reaching the problem area. You can also lightly massage the hardened area, with no special effort required. The main task of decanting the breast with lactostasis is to release the clogged duct. To do this, you need to place four fingers of the right hand under the chest, and thumb on the upper surface of the breast. In this case, it is necessary to clearly feel the hardening area under the fingers. Having captured the gland in this way, translational movements are made with the fingers directed from the base of the gland to the nipple. These movements will provide a slight soreness, but it will immediately pass after the duct is empty. The main thing is not to overdo it with the force of pressure on the gland, as you can damage it and thereby aggravate the situation. If, after doing this procedure, hardening is felt under the fingers, it is necessary to massage the blockage again and continue pumping. After pumping, it will be more difficult for the child to suck, but he will definitely empty all the ducts. This procedure is recommended to carry out several feedings in a row. With the disappearance of symptoms, a few more feedings should be started from the breast in which there was lactostasis, and finished with the other breast. In any case, whether you managed to cope with this problem on your own or not, you should definitely visit a specialized specialist - a mammologist, and in his absence - a surgeon or a family doctor. It is the doctor who will make an accurate clinical diagnosis and prescribe proper treatment, will correct the already performed manipulations and advise on the prevention of lactostasis.

Diagnosis of lactostasis

Lactostasis is diagnosed immediately upon local examination at 100%. But you can't do it on your own differential diagnosis, since there are a number of other breast diseases that have similar symptoms with lactostasis. The main difference from mastitis is the absence of a rise in body temperature to high numbers and a deterioration in the general well-being of a nursing woman. With prolonged accumulation of milk in the ducts, cysts can form - galactocele, which can only be treated by a doctor.

As a rule, with lactostasis, a detailed blood test is prescribed to assess the neglect of the process. Evaluated indicators such as: the level of erythrocyte sedimentation rate, the number of leukocytes and leukocyte formula. The main instrumental research method is ultrasound diagnostics. It is on ultrasound that the doctor has the opportunity to see the number, volume and location of the blocked ducts. Availability purulent complication or cystic formations can also be diagnosed using ultrasound. At the same time, the procedure is painless, not expensive, absolutely safe for health, and most importantly, 100% informative. Sometimes, in rare cases, mammography is prescribed, which is just as informative, but carries a radiation load, which is not good for a nursing mother and her child.