breast drainage and lymphatic drainage: Flashcards Preview

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Flashcards in breast drainage and lymphatic drainage: Deck (46)
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1
Q

what are the two main regions of the breast?

A
  • circular body largest part of the breast - axillary tail smaller part
2
Q

what is the surface anatomy of the breast on the anterior thoracic wall?

A
  • horizontally = from the lateral border of the sternum to the mid axillary line vertically = between the 2nd and the 6th intercostal cartilages
3
Q

what is the breast superficial to?

A
  • the pectoralis major muscle - the serratus anterior muscle
4
Q

what is the nipple the areolae sebaceous glands

A

nipple: smooth muscle fibres the areolae: pigmented skin sebaceous glands : around the areolae these enlarge during pregnancy and secrete a lubricate for the nipples

5
Q

what are the mammary glands?

A
  • ducts and secretory lobules - alveoli are drained by a single lactiferous duct - All ducts converge at nipple
6
Q

what is the connective tissue stroma?

A
  • Supporting structure which surrounds the mammary glands - Has a fibrous and a fatty component:
7
Q

what is fibrous stroma?

A
  • condenses to form suspensory ligaments of cooper - attaches and secures the breast to the dermis and the underlying pectoral fascia
8
Q

what is the pectoral fascia?

A
  • the base of the breast lies on the pectoral fascia - there is a flat sheet of connective tissue associated with the pectoralis major muscle - It acts as an attachment point for the suspensory ligaments
9
Q

what is the overall structure of the breast?

A
  • modified sweat gland - under hormonal influence to make milk post partum - made of glandular tissue, fat, ductal and fibrous tissue
10
Q

how many lobules does the breast have?

A
  • 15- 20 these contain alveoli
11
Q

what happens during lactation?

A
  • the alveoli produce milk - the milk is carried to the alveoli in the lactiferous ducts - inside the alveoli, there are myoepithelial cells that contract in response to oxytocin to push the milk along - the lactiferous sinuses are duct expansions that are squeezed during suckling
12
Q

what are the spaces surrounding the lobules?

A

fat, ligament and connective tissue

13
Q

what is breast size determined by?

A

determined by amount of fat not the lobules

14
Q

compare younger womens breasts to older womens breasts?

A

younger women = denser less fatty older women = less dense more fatty

15
Q

structure of a lobule ?

A

sections of breast branching out of the nipple contains alveoli

16
Q

structure of a alveoli ?

A
  • tiny hollow sacs lined with milk secreting cuboidal cells surrounded by myoepithelial cells
17
Q

structure of a lactiferous duct?

A

Carry milk from the alveoli toward the areola when lactating

18
Q

structure of a areola?

A

Dark pigmented area of skin at the centre of the breast

19
Q

structure of suspensory ligament

A

Separates lobules, strong, maintains breast shape

20
Q

what is the vasculature of the medial aspect of the breast?

A

Internal thoracic artery Branches from Intercostal artery

21
Q

what is the vasculature of the lateral aspect of the breast?

A

Lateral thoracic artery

Thoraco-acromia artery

Thoracodorsal artery

intercostal artery

22
Q

show the vasculature of the breast :

A
23
Q

what nerve is breat skin supplied by?

A

subdermal plexus

communicates with deep parenchymal vessels

24
Q

what artery does the nipple-areola region receive?

A
  • branch from internal thoracic artery
25
Q

what branches of intercostal nerves innervate the breast?

A

T2 - T6

•Anterolateral and anteromedial branches

26
Q

what nerves supply the upper and lateral parts of the breast?

A

supraclavicular nerves

27
Q

what nerve innervates the nipple?

A

•lateral cutaneous branch of T4

28
Q

show a diagram of the innervation of the breast

A
29
Q
A
30
Q

what is the basis of lympathatics?

A
  • arterial blood enters the capillaries
  • substances move out of the blood vessel at the arterial end of the capillary into the interstitial fluid

due to high hydrostatic pressure

  • —Substances move in the blood vessel at the venous end of capillaries using oncotic pressure
  • substance moving out > substance moving in

Excess fluid and solutes are removed by draining lymph vessels

the lympth fluid eventually returns to the general blood circulation

31
Q

what is lymph normally like?

A
  • clear
  • odourless
32
Q

what is the lymph from the small intestine like?

A
  • opaque & milky due to absorption of fats
33
Q

how does lymph move?

A
  • there is no real direct pump
  • the movement of lymph is done via adjacent structures like skeletal muscle, arterial pulses
  • valves are also important for unidirectional movement
34
Q

what are potential causes of an enlarged lymph node?

A

infection

cancer

tuberculosis

35
Q

where does the lymphatic system cover?

where are the most lymph nodes?

A
  • covers everywhere apart from the brain
  • the largest collection of lymph nodes is found at the bifurcation of the trachea
  • Highly extensive lymphatic system in the Head & Neck especially
36
Q

where does the upper right quadrant drain into?

where does the rest of the brain drain into?

A
  • the upper right quadrant - drains into the right subclavian vein
  • the rest of the body - drains into the left subclavian vein
37
Q

show where the thoracic duct and the right subclavian vein is located?

A
38
Q

what are the three groups of lymph nodes that receive lymph from the breast tissue?

A
  • axillary nodes ( 75% )
  • parasternal nodes (20%)
  • posterior intercostal nodes (5%)
39
Q

how is the skin of the breast lymphatically drained?

A
  • skin = drains to the axillary, inferior deep cervical and infraclavicular nodes
  • the nipple and areola = drains to the subareolar lymphatic plexus.
40
Q

where do the superficial parts of the breast drain to?

A

superficial parts of the breast drain to sub areolar plexus

Deep parts of Breast drain to the Sub-mammary plexus

41
Q

where are the most common sites of breast cancer metastasis ?

A
  • bone
  • regional LNs
  • the brain
  • the lungs
  • the liver
42
Q

what are the lymphatics of the thoracic wall?

A

lymph drains to the

  • parasternal nodes
  • Upper & Lower intercostal nodes
  • Diaphragmatic nodes
  • Superficial nodes

these are all superficial to the organs

43
Q

how is the incidence and mortality of breast cancer changing?

A

the incidence is increasing

the mortality is going down

44
Q

what is a mammogram?

advantages and disadvantages?

A
  • it is an xray
    ads: diagnostic and screening

disads:

—Ionising radiation

—False negative rate of at least 10%

—High false positive - over treatment

45
Q

what is an ultrasound for?

what is an MRI for?

A

ultrasound - further evaluation of masses

  • measures the size and location of the mass
  • it shows the difference between a solid mass and a cyst filled with fluid

the MRI is for further evaluation of the tumor

this is for pre-surgical evaluation

there is good soft tissue differentiation

46
Q
A