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Nipple discharge

Overview
  • Definition: The release of fluid from the nipple, outside of breastfeeding.
  • Can be physiological or pathological in nature.
Types of Discharge
  • Colour: Clear, milky, green, yellow, blood-stained, or pus-like.
  • Consistency: Thick, sticky, thin, or watery.
  • Origin: Single duct or multiple ducts.
Common Causes
  • Physiological: Pregnancy, lactation, nipple stimulation.
  • Infections & Inflammations: Mastitis, breast abscess.
  • Ductal ectasia: Blockage of milk ducts leading to inflammation and possible abscess formation.
  • Intraductal papilloma: Benign tumour of the milk ducts causing blood-stained discharge.
  • Galactorrhoea: Milky discharge due to high prolactin levels.
  • Breast cancer: Especially if associated with a lump and blood-stained discharge.
Investigations
  • Clinical examination: To assess the discharge and any associated lumps.
  • Mammography: Especially in women > 40 years or with suspicious symptoms.
  • Ultrasound: Especially useful in younger women.
  • Ductography: Injection of contrast into the nipple duct to identify the cause of discharge.
  • Cytology: Examination of discharge under the microscope.
  • Blood tests: Checking prolactin levels if galactorrhoea is suspected.
Management
  • Dependent on the cause; benign causes may not require treatment.
  • Surgery: For intraductal papillomas or ductal ectasia.
  • Medications to reduce prolactin levels in cases of galactorrhoea.
  • Antibiotics for infections.
Key Points
  • Blood-stained nipple discharge needs urgent investigation to rule out malignancy.
  • Discharge from multiple ducts is usually benign, whereas single duct discharge can be more concerning.
  • Physiological and benign causes are more common than malignant causes of nipple discharge.

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