Physical Exam & Associated Pathology Part VIII Breast & Female Pelvis

Transcription

1 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6 Physical Exam & Assciated Pathlgy Part VIII Breast & Female Pelvis By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Limits f Liability & Disclaimer f Warranty We have designed this bk t prvide infrmatin in regard t the subject matter cvered. It is made available with the understanding that the authrs are nt liable fr the miscnceptins r misuse f infrmatin prvided. The purpse f this bk is t educate. It is nt meant t be a cmprehensive surce fr the tpic cvered, and is nt intended as a substitute fr medical diagnsis r treatment, r intended as a substitute fr medical cunseling. Infrmatin cntained in this bk shuld nt be cnstrued as a claim r representatin that any treatment, prcess r interpretatin mentined cnstitutes a cure, palliative, r amelirative. The infrmatin cvered is intended t supplement the practitiner s knwledge f their patient. It shuld be cnsidered as adjunctive and supprt t ther diagnstic medical prcedures. This material cntains elements prtected under Internatinal and Federal Cpyright laws and treaties. Any unauthrized reprint r use f this material is prhibited. Functinal Medicine University; Functinal Diagnstic Medicine Training Prgram/Insider s Guide Mdule 1 * Lessn 6: Physical Exam & Assciated Pathlgy Pt VIII Cpyright 2010 Functinal Medicine University, All Rights Reserved

2 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Cntents The Breast and Axillae 2 Sme Causes f Nipple Discharge 3 Palpable Masses 4 Breast Cancer-Relative Risks 4 The Female Breast 5 Palpatin 6 Examinatin 6 The Male Breast 8 Female Pelvis 8 Terminlgy 9 References 9 1

3 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. The Breasts and Axillae The female breast The breast is divided int fur quadrants intersecting at the nipple. An axillary tail f breast tissue, called the tail f Spence extends laterally tward the axillae. The male breast The male breast cnsists f a small nipple and arela. These verlie a thin disc f undevelped breast tissue cnsisting primarily f ducts. Lymphatics Lymphatics frm mst f the breast drain tward the axilla. Pectral ndes Subscapular ndes Lateral ndes Signs and symptms Breast lump r mass Breast pain r discmfrt Nipple discharge Abut 50% f wmen have palpable lumps r ndularity Lumps may be physilgic r pathlgic, ranging frm cysts and fibradenmas t breast cancer. Ask abut any discharge frm the nipples 2

4 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. 3

5 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Palpable Masses f the Breast Cmmn lesin Fibradenma Cysts Cancer Characteristics Rund, mbile, nntender Sft t firm, rund, mbile; usually tender Irregular, stellate, firm, nt clearly defined frm the surrunding tissue; usually painless Breast cancer: factrs that increase relative risk Gender Aging Genetic risk factrs BRCA1 and BRCA2 Family histry f breast cancer Persnal histry f breast cancer Race and ethnicity Caucasian has a slightly higher risk Dense breast tissue Certain benign breast cnditins Early menstruatin Late menpause Previus chest radiatin DES expsure N histry f child bearing r late in life pregnancy Recent ral cntraceptive use Hrmne replacement therapy Nt breast feeding Alchl Obesity Lack f physical activity 4

6 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. The Female Breast Inspectin With the patient in a sitting psitin careful examine the breasts fr skin changes, symmetry, cnturs, and retractin in fur views arms at sides, arms ver head, arms pressed against hips, and leaning frward. Appearance f skin Nte the clr: redness may be frm lcal infectin r inflammatry carcinma Thickening f the skin and unusually prminent pres may accmpany lymphatic bstructin and suggest breast cancer The size and symmetry A slight difference in the size f the breasts and arelae is cmmn. The cntur f the breasts Nte any masses, dimpling, r flattening. Flattening f the nrmally cnvex breast suggests cancer Characteristics f the nipple: size and shape, directin in which they pint, rashes r ulceratins, discharge Leaning frward psitin may reveal an asymmetry f the breast r nipple nt therwise visible. Asymmetry f nipple directin and/r nipple retractin (recent r fixed flattening r depressin) suggests an underlying cancer. Dimpling r retractin suggests an underlying cancer. T bring ut dimpling r retractin that may therwise be invisible examine the breasts with arms verhead. Please visit n-line library t review the vide n Breast Examinatin (Part I and II) 5

7 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Palpatin Palpatin f the axillary, supraclavicular, and infraclavicular lymph ndes is best dne with the patient sitting. Breast tissue is best palpated with the patient lying dwn with their ipsilateral hand verhead t flatten the breast tissue n the chest wall. If there is nt an even distributin f breast tissue in this psitin, placing a pillw under the patient s shulder n the examining side will help. Use the fllwing landmarks t cver all the areas f the breast tissue: dwn the midaxiallary line, acrss the inframammary ridge at the 5 th /6 th rib, up the lateral edge f the sternum, acrss the clavicle, and back t the midaxilla. Using the vertical strip pattern is currently the best validated technique fr detecting breast masses. Use the fingerpads f the three middle fingers, keeping the fingers slightly flexed. Palpate with verlapping dime-sized circular mtins. Tissue at and beneath the nipple shuld be palpated and nt squeezed, which ften results in discharge as well as discmfrt. Only spntaneus discharge warrant further evaluatin. Breast tissue in the upper uter quadrant and under the arela and nipple shuld be thrughly examined, as these are the tw mst cmmn sited fr cancer. Pressure: Use light, medium, and deep pressure, accmmdating fr size, cmfrt, and implants. Psitin f Patient and Directin f Palpatin fr the CBE This tp illustratin shws the lateral prtin f the breast, and the bttm illustratin shws the medial prtin f the breast. Arrws indicate the vertical strip pattern f examinatin. 6

8 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Palpatin Technique Pads f the index, third, and furth fingers make small circular mtins, as if tracking the uter edge f a dime Levels f Pressure fr Palpatin f Breast Tissue Shwn in a Crss-sectinal View f the Right Breast The clinician shuld make three circles with the finger pads, increasing the level f pressure (subcutaneus, mid-level, and dwn t the chest wall) with each circle 7

9 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. The Male Breast Examinatin f the male breast may be brief but is imprtant. Inspect the nipple and arela fr ndules, swelling, r ulceratin and palpate the arela and breast tissue fr ndules. If the breast appears enlarged, distinguish fatty tissue and the firm disc f glandular enlargement, call gynecmastia Gynecmastia is due t hrmnal imbalance but can be drug related. A hard, irregular, eccentric r ulcerating ndule suggests breast cancer. The axillae Althugh the axillae may be examined with the patient lying dwn, a sitting psitin is preferable. Inspectin Palpatin Rash Infectin Unusual pigmentatin Deeply pigmented, velvety axillary skin suggests acanthsis nigricans ne frm is assciated with internal malignancy. Pectral ndes Lateral ndes Subscapular ndes Cmmn breast masses The three mst cmmn kinds f breast masses in males are: Female Pelvis Fibradenma (a benign tumr) Cysts Breast cancer Signs and Symptms Menarche, menstruatin, menpause, pstmenpausal bleeding Pregnancy Vulvvaginal symptms Sexual respnse 8

10 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part VIII: Breast & Female Pelvis Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Terminlgy Menarche ages at nset f menses Menpause absence f menses fr 12 cnsecutive mnths, usually ccurring between 48 and 55 years Pstmenpausal bleeding bleeding ccurring 6 mnths r mre after cessatin f menses Amenrrhea absence f menses Secndary Amenrrhea cessatin f menses after menarche. Can ccur with nutritinal deficiencies, hrmnal imbalances, and extreme athletes Dysmenrrhea pain with menses, ften with bearing dwn, aching, r cramping sensatin in the lwer abdmen r pelvis Premenstrual syndrme (PMS) a cluster f emtinal, behaviral, and physical symptms ccurring 5 days befre menses fr three cnsecutive cycles Abnrmal uterine bleeding bleeding between menses; includes infrequent, excessive, prlnged, r pstmenpausal bleeding Abnrmal uterine bleeding terminlgy Plymenrrhea: fewer than 21-day intervals between menses Oligmenrrhea: infrequent bleeding Menrrhagia: excessive flw Metrrhagia: intermenstrual bleeding Pstcital bleeding Causes vary by age grup and include pregnancy, cervical, r vaginal infectin, r cancer. Cervical r endmetrial plyps r hyperplasia, fibrids, bleeding disrders, and hrmnal cntraceptin r replacement therapy. Pstcital bleeding suggests cervical plyps r cancer. In lder wmen - atrphic vaginitis. References: All reference material is listed at the cnclusin f the Physical Examinatin and Assciated Pathlgy lessns. 9