INTRODUCTION TO HISTORY AND PHYSICAL EXAMINATION OF …
Transcript of INTRODUCTION TO HISTORY AND PHYSICAL EXAMINATION OF …
INTRODUCTION TO
HISTORY AND PHYSICAL
EXAMINATION OF THE
BREAST
Dr- Tayseer Al-Tawarah MD. MRCS
Anatomy
Most common site for breast cancer
Approach to the patient
Triple assessment ❖ History and physical examination
❖ Imaging study
❖ Tissue biopsy
Common presenting symptoms
Breast lump
✓ Most common presenting symptoms
✓ Benign or malignant
✓ May be discovered incidentally during screening mammogram
✓ Ask about site, single or multiple , tenderness, symptoms during
menstrual cycle , nipple discharge
✓ fibroadenoma , breast cyst , cancer
✓ Breast abscess ( lactational Vs non – lactational )
❖Women who are breast
feeding.
❖Peripheral in the breast
❖Extension of periductal mastitis
❖Under the areola
❖Smoking
❖Fistula
Intra-operative picture of
fibroadenoma
Breast abscess
Breast pain (mastalgia)
❖ Cyclical
✓ Worse in the later half of the menstrual cycle
✓ Relived by menstruation
❖ Non cyclical
✓ Should be distinguish from chest wall pain
Skin changes
❖ Simple skin dimpling
❖ Indrawing of the skin
❖ Lymphedema of the breast
▪ Peau d’orange
▪ Infection vs malignancy
▪ Redness , hotness, tenderness not responding to antibiotic
❖ Eczema of the nipple
▪ Generalized skin disorder
▪ Paget’s disease of the nipple
▪ Dermal invasion by intraductal cancer
Peau d’orange
Paget disease of the nipple
Skin dimpling
Inflammatory breast cancer
Nipple changes
❖ Nipp le in vers io n
➢ Often benign
➢ It can be first sign of malignancy (asymmetrical )
❖ Nipp le d is c h arg e
➢ Clear or yellow, Green
➢ Bloody
• duct ectesia
• periductal mastitis
• intraductal papilloma(most common cause )
• intraductal cancer
❖ Galac to rrh oea
✓ Milky discharge from multiple ducts in both breast
✓ Drugs
✓ Hyperprolactinaemia
✓ Breast feeding
✓ Hyperplasia of Montgomery's tubercles
Nipple discharge
Gynecomastia
❖ Enlargement of male breast
❖ Often occurs in pubertal boys
Your history should include :
✓ Description and duration of sign and symptoms and
their relation to menstrual cycle and pregnancy
✓ Age
✓ Gynecological
• Nulliparity
• Age of menarche and menopause
• Pregnancy with first child , number of children ,breast feeding
✓ Drug history : OCP, TAD, Cimetidine …etc
➢ Family and personal history of breast , ovarian .
Uterine ,and colon cancer
➢ History of radiation
➢ Social history ( smoking ,obesity)
➢ Surgical history ( previous breast biopsies )
Physical examination
❖ Introduce yourself
❖ Explain to the patient
❖ Privacy
❖ Good illumination
❖ Exposure : ask the patient to undress to the waist
❖ Position : supine , sitting
Chaperon
Chaperon
Chaperon
Inspection
❖ Rest the patient hand on the thigh and inspect for
Asymmetry
Local swelling
Skin changes
• Edema
• Ulceration
• Dimpling
• Scars
Nipple changes (7 D’s)
o Deviation
o Destruction
o Duplication
o Discharge
o Displacement
o Depression ( deviation, inversion )
o Discoloration
Ask the patient to press her hand firmly on her hips
▪ Contraction of pectoral muscle
▪ Inspect again
❑ Ask the patient to raise her arm above her head
and then lean forward
▪ Expose whole breast
▪ Exacerbate skin dimpling
Palpation
Supine with her head on one pillow
Her hand under her head on the side to be
examined
With flat of the finger not palm of the hand
Ask the patient to contract and relax pectoral
muscle alternately by pushing into her hip
Nipple :
➢ gently hold it between index and thumb for
discharge
Lymph node examination
▪ Axillary
▪ Supracalvicular
▪ Cervical
Assess for ➢ Texture of both breast
➢ Tenderness
➢ Temperature
➢ Nipple discharge (color , amount )
➢ Masses
o Size
o Consistency
o Fixation
Thank you