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

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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 for lactostasis to occur in nursing women who have a history of lactostasis during previous births and breastfeeding. Lactostasis can occur in the presence of scar changes in the mammary gland or mastopathy. Neither the age of a nursing woman nor race influence the development of lactostasis.

In medical practice, the international classification of diseases is used. 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 – Lactostasis.

Causes of lactostasis

There are many causes for this syndrome.

1. The first and most common reason is improper attachment of the baby to the breast, which leads to incomplete emptying of the mammary gland. 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 suffering of a nursing woman.
2. The second most common cause of lactostasis is infrequent feeding or feeding by the hour. As a result of this type of feeding, lactostasis can develop in both mammary glands at once. In this case, several ducts are usually involved in the process at once.
3. Incorrect pumping. Very often, on the fourth or fifth day after birth, when there is an abundant flow of milk, and the newborn needs a very small amount of it for nutrition, the woman in labor begins to express herself, often without even having an idea how to do it. These manipulations ultimately lead to damage to the delicate ducts and the development of lactostasis.
4. Big breasts. Yes, those with large breasts are at risk for developing lactostasis, since they do not always know how to properly regulate lactation.
5. Wearing a tight, synthetic and incorrectly selected bra, which in turn can lead to compression of the ducts and stagnation of milk in them.
6. Injuries. Even a small push of the baby’s foot into the mother’s chest can lead to lactostasis due to damage to the duct.
7. Stress. Chronic lack of sleep and fatigue lead to increased nervousness, which in turn negatively affects milk production.

Pathogenesis

The mammary gland is a paired hormone-dependent organ that has a complex lobular structure with alveolar-tubular branching of the milk ducts. It is in the alveoli that milk is produced under the influence of the hormone prolactin. One gland can have up to 20 radially located lobes. All excretory ducts of one lobe are connected into a milk duct, which is directed to the nipple and ends at its apex 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 lumpy, it contains many circularly and longitudinally directed muscle fibers, which plays a very important role during 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 lactogenesis begins. It is during this period that the composition and quality of colostrum is formed, which the newborn will be fed with after birth, and therefore the quality of nutrition and lifestyle of the pregnant woman is 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 independently of feedings. Then it is released depending on the emptying of the chest.

Now knowing the structure and physiology of the mammary gland, let's understand 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 days after birth, 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 influence of hormones do not secrete it enough. This is where milk stagnation, or lactostasis, occurs. In later periods of lactation, the main pathogenetic role is played by the mechanical effect on milk secretion, creating an obstacle to its full secretion. Now the lactation process has already been established 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, which occur in the initial stage, are pain and discomfort in the mammary gland. When palpated, a small, painful area is felt among the normal breast tissue. The skin over this area becomes hyperemic. At the beginning of the development of lactostasis, pain occurs only upon contact with the mammary gland, later the painful sensations persist constantly. When several ducts are blocked, there is swelling of the tissues of the entire mammary gland; if one duct is damaged, swelling can be seen locally only over the area of ​​blockage. Locally, the skin temperature rises over the damaged area. The body temperature remains normal and the general well-being of the nursing woman, as a rule, is not affected. 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. Chills and weakness appear.

Once a blockage in the mammary gland is discovered, it is necessary to immediately begin to remove it. The best thing here is to position the baby frequently and correctly, so that his chin is directed towards the lactostasis that has formed. Since no pumping equipment, no hands can do a better job than the baby’s mouth. And you need to apply it as often as possible; it’s better to go to bed with your baby for a day, and entrust all household chores to the rest of the household. In this case, it is necessary to choose the most comfortable position for feeding, in which nothing should interfere and you can relax as much as possible. If there is prolonged blockage and pain or at the beginning of lactation, it is recommended to apply a warm, dry cloth to the affected breast before feeding and express it so that the baby does not get enough of the foremilk without reaching the problem area. You can also lightly massage the hardened area, but no special effort is required. The main task of expressing the breast during lactostasis is to free the clogged duct. To do this, you need to place four fingers of the right hand under the chest, and the thumb on the upper surface of the mammary gland. In this case, you need to clearly feel the hardening area under your fingers. Having thus grabbed the gland, your fingers make forward movements directed from the base of the gland to the nipple. These movements will cause minor pain, but it will go away immediately after the duct is emptied. 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 completing this procedure, you feel hardening under your fingers, you need to massage the blockage area again and continue expressing. After pumping, it will be more difficult for the baby to suck, but it will definitely empty all the ducts. It is recommended to carry out this procedure several feedings in a row. When the symptoms disappear, several more feedings should begin with the breast in which lactostasis was present, and end 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 family doctor. It is the doctor who will make an accurate clinical diagnosis and prescribe the correct treatment, correct the manipulations already performed and advise on the prevention of lactostasis.

Diagnosis of lactostasis

Lactostasis is diagnosed immediately upon local examination in 100%. But it is impossible to carry out a differential diagnosis on your own, since there are a number of other breast diseases that have similar symptoms to 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 - galactoceles, the treatment of which can only be treated by a doctor.

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

Each woman has individual anatomical features of the breast, but its internal structure is the same for everyone. Inside, each mammary gland has glandular tissue divided into 15-20 large lobes. Each of them is divided into even smaller ones, which turn into ducts directed to the nipples. If a nursing woman has conditions that prevent milk from leaving the ducts, lactostasis may develop.

Lactostasis is the retention of milk in the excretory ducts of a woman’s breast during lactation. The problem can be caused by improper feeding technique, incomplete emptying of the breast, hypothermia and other factors. Most often, primiparous women suffer from lactostasis. The disease itself is not dangerous for women and children. If left untreated, the disease can cause serious complications such as mastitis or purulent inflammation.

Reasons for development

Stagnation of milk in the mammary gland usually occurs in women during the first 10 days after childbirth.

Violation of the outflow of milk from the breast through the ducts can occur for the following reasons:

• non-compliance with feeding techniques;
• incomplete emptying of the glands with active milk secretion;
• infrequent feedings;
• poor breastfeeding by the child due to his health condition (for example, central nervous system problems, prematurity);
• early weaning of the baby from the breast (the baby must let go of the breast himself when he feels full);
• transition from breastfeeding to artificial feeding;
• drinking insufficient amounts of fluid by a woman;
• increased milk viscosity;
• a lot of animal fats in the diet;
• wearing compression garments;
• habit of sleeping on your stomach;
• abnormal structure of the nipples, narrowness of the ducts.

If lactostasis occurs in a woman a month after childbirth or later, its causes may be:

• chest injuries;
• hypothermia;
• stress;
• overwork;
• persistent hormone imbalance.

Lactostasis code according to ICD 10 is O92.7.

Symptoms of the disease and its difference from mastitis

If lactostasis is suspected, it is necessary to begin treatment measures as quickly as possible. Otherwise, complications may arise, one of which is. The two conditions have some similar symptoms. But still there are differences between them.

Signs of lactostasis:

• breast enlargement, asymmetry of the glands;
• chest pain;
• feeling of fullness;
• the presence of compaction and tubercles when palpating the gland;
• in the area of ​​the problem area, the skin color is not changed;
• disruption of milk flow.

After a few days, with prolonged stagnation of milk, non-infectious mastitis can develop - persistent inflammation in the overcrowded glands.

Mastitis is accompanied by pronounced symptoms that are absent with lactostasis:

• redness of the skin around the problem area of ​​the breast;
• increase in local and general temperature;
• disturbance of general health (lethargy, weakness, muscle pain);
• enlarged lymph nodes;
• when expressing milk, relief does not occur (unlike lactostasis).

Important! After some time, without proper treatment, bacteria can penetrate into the lobules and ducts of the glands and cause infectious inflammation. Bacteria begin to actively multiply, provoking the development of a purulent process. The woman develops purulent-serous discharge from the nipples, the temperature rises, and there are signs of severe intoxication of the body.

General rules and methods of treatment

The approach to eliminating lactostasis in a nursing woman should be comprehensive. First of all, you need to free the clogged ducts from stagnant milk. You can cope with the problem without using medications. Treatment of lactostasis may include special massage, regular expression of milk, proper feeding techniques and other methods.

Breast massage

A woman can do massage for lactostasis on her own. But in order not to harm yourself, you need to follow certain rules. All movements must be careful not to injure the glands.

Movements when kneading the chest should be smooth and stroking. Move your hands to the nipple from the outside of the breast. If pain is felt, massage is carried out simultaneously with pumping.

Before the massage, it is important to wash your hands with soap and apply baby oil to the gland to facilitate movements.

Massage technique:

• Press on the chest and massage the chest in a circle for 4 seconds. Slowly move in a spiral towards the nipple.
• Lean forward and shake your chest. This will allow the milk to move down the ducts.
• Hold the nipple between 2 fingers and gently pull it back, twist it slightly.
• You can finish the massage with a warm shower, directing a stream of water under slight pressure to each breast.

If the mammary glands are hypersensitive, massage should not be done.

Expressing milk

First, stimulation of oxytocin synthesis is necessary. To do this, you need to take a warm shower, massage your back along the spinal column in the thoracic area, drink warm tea and calm down. It is better to express milk by hand.

Place the iron on 4 fingers. Place your thumb and index finger on the edge of the halo. Press your chest rhythmically. Point your fingers towards the side of the chest. Change the position of your fingers, moving around the circle of the halo.

Do not squeeze the gland tissue or squeeze it too hard. A woman can crush organ lobules with milk and aggravate the course of the disease. On average, the process of expressing milk should take 30-60 minutes. After the procedure, you can put the baby to the breast.

Compresses

As an additional means of treatment, you can apply therapeutic compresses to the problem breast:

• Beat a fresh cabbage leaf to release the juice. Apply a cabbage leaf to the sore breast for lactostasis.
• Make a flatbread from wheat flour and honey. Apply to the gland for 15-20 minutes. Should not be used by women who are allergic to honey.
• Apply low-fat cold cottage cheese to the sore spot.

On the page, read information about methods of treatment and removal of breast fibroadenoma.

Ointments

For lactostasis, it is allowed to apply medicinal ointments to eliminate unpleasant symptoms:

• Arnica;
• Traumeel;
• Malavit.

Do not use Vishnevsky ointment, as well as warming agents based on camphor or alcohol.

Preventive measures

To avoid the development of lactostasis, nursing women are recommended:

• apply the baby to the breast correctly;
• completely and promptly empty the breasts of milk;
• do not give the baby a second breast while there is milk in the first;
• wear a special nursing bra that does not have underwires and does not compress the breasts;
• sleep on your side, not your stomach;
• rest more;
• drink more fluids;
• do not overcool the chest;
• avoid injury to the glands;
• Before each feeding, the breasts must be washed;
• if milk leaks, use special liners;
• get rid of cracked nipples in a timely manner to prevent infection;
• avoid stress.

If a nursing woman suspects the development of lactostasis, it is necessary to eliminate the problem as quickly as possible. The sooner you start to fight stagnation of milk in the breast, the faster you can restore its functionality and prevent lactostasis from turning into mastitis. Lactation is a period that requires a woman’s special attention to her breasts. It is important to prepare in advance for this moment, learn how to properly put the baby to the breast, and monitor the cleanliness and timely emptying of milk from the glands.

Video about the causes of development and features of treatment of lactostasis in nursing women:

Brief description

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

Classification. According to the flow.. Acute: serous, purulent, phlegmonous, gangrenous, abscessing.. Chronic: purulent, non-purulent. By localization: subareolar, intramammary, retromammary, diffuse (panmastitis).

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

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

Symptoms (signs)

Clinical picture

. Acute serous mastitis(can 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 in size, tense, the skin over the lesion is hyperemic, on palpation there is a painful infiltrate with unclear boundaries. Regional lymphadenitis.

. Acute purulent abscess mastitis.. Fever, chills.. Pain in the gland.. Breast: 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, the 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 study is necessary to determine the sensitivity of microorganisms to antibiotics, bacterioscopy if fungal infections or tuberculosis are suspected.

Special studies. Ultrasound. Mammography (if it is impossible to completely exclude breast cancer in patients with non-lactation mastitis). Breast biopsy.

Conservative therapy. Isolation of mother and child from other mothers and newborns. A bandage or bra that supports the mammary gland. Dry heat on the affected mammary gland. Expressing milk from the affected gland in order to reduce its engorgement. Stop breastfeeding if purulent mastitis develops. If pumping is impossible and there is a need to suppress lactation, drugs that suppress the formation of prolactin are used - cabergoline 0.25 mg 2 times / day for two days, bromocriptine 0.005 g 2 times / day for 4-8 days. Antimicrobial therapy while breastfeeding continues - semisynthetic penicillins, cephalosporins: cephalexin 500 mg 2 times a day, cefaclor 250 mg 3 times a day, amoxicillin + clavulanic acid 250 mg 3 times a day; if anaerobic microflora is suspected, clindamycin 300 mg 3 times a day (in case of refusal to feed, any antibiotics can be used). NSAIDs. In case of stopping feeding, a solution of dimethyl sulfoxide in a dilution of 1:5, topically.

Surgical treatment. Fine needle aspiration of contents. If punctures are ineffective, open and drain the abscess with careful separation of all bridges. Surgical incisions.. For a subareolar abscess - along the edge of the areola.. Intramammary abscess - radial.. Retromammary - along the submammary fold. In case of small size of the focus of fungal or tuberculous etiology, or chronic abscess, it is possible to excise it with adjacent altered tissues. As the process progresses with the development of panmastitis, the gland is removed (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. Maintaining feeding hygiene. Use of emollient creams. Expressing milk.

ICD-10. O91.2 Non-suppurative mastitis associated with childbirth. P39.0 Neonatal infectious mastitis. N61 Inflammatory diseases of the mammary gland. P83.4 Swelling of the mammary glands in a newborn

Lactostasis - how it is coded in ICD 10

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

In English, 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 simply curious ordinary people can find out basic information about a particular ailment 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 the place in it for such a condition as lactostasis? Let's sort it out in order.

What code should I use to find classification information about lactostasis?

The international classification system includes 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 classified specifically in this class. Next, the disease code must provide information about the block in which the basic data about the disease of interest to us is located. We are considering Block O85-O92.

The title of this block is “Complications associated primarily with the standard postpartum period.” So, most authors try to include within the scope of this definition 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, doctors usually distinguish the following main types of lactation disorders (ICD 10 code O91 to O92):

• The numbers O91 mean lactation mastitis.
• The numbers O92.1 encode cracks in the nipple.
• Value O92.2 includes other, unspecified lactation disorders.
• Code O92.3 indicates primary agalactia.



• The numbers O92.4 imply a state of hypogalactia.
• The numbers O92.5 reveal secondary agalactia, or one arising due to medical indications.
• Hidden under the numbers O92.6 is a diagnosis such as postpartum galactorrhea (translated from Greek as milk leakage).
• And finally, the numbers O92.7 imply lactostasis, or polygalacty, etc.

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

Most often, with the development of milk stagnation, two main signs of an acute inflammatory process are absent: firstly, hyperemia, and secondly, hyperthermia. However, in a number of cases, acute forms of milk stagnation can be accompanied by severe fever, with a significant increase in body temperature.

It is important for women to understand that it is almost impossible to differentiate acute milk stagnation from the initial forms of mastitis on their own, and this means that even reading the medical literature, and being a very literate person, you cannot refuse timely consultation with a doctor.

However, let's return to the classification of lactostasis. Why do doctors still prefer to use a certain ICD 10 rather than the usual book description of the disease? The answer comes naturally when you understand what the previously mentioned classification is.

The essence of the international classification of diseases

ICD 10 is a document of record that is routinely used as the leading statistical and classification framework in global health. Every ten years, the document is carefully reviewed and adjusted by employees of the World Health Organization.

The value of this document lies in ensuring the unity of various (in different countries) 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 (hence the ICD-10).

This classification document allows you to systematically register 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 to meet 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, doctors have the opportunity to count both the frequency and prevalence of certain diseases and, most importantly, note the relationship of painful conditions with various external factors found in a particular country.

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How can you identify them?

Mastopathy ICD 10

According to ICD 10, mastopathy is coded 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. The IBC is a normative document that contains all medical diagnoses. The purpose of drawing up such a code is to unify methodological approaches. MBC is used in 117 countries around the world. The document is compiled by the World Health Organization. 10 means the tenth edition, as of today it is valid.

IBC codes 10 from No. 60 to No. 64 – breast diseases. Mastopathy is numbered 60.1. This is a disease that occurs due to hormonal imbalance. With fibrocystic mastopathy, small tumors form in the breast, they can increase in size and even turn into cancerous tumors.

Clinical picture and symptoms

Diffuse cystic mastopathy is the proliferation of breast tissue.

The danger of the pathology is that at the initial stage you may not even be aware of its development. Small tumors do not cause discomfort and do not disturb a woman for a long time. Mastopathy can begin to progress and transform into cancer. That is why you should not delay your visit to the 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, compactions are felt;
• mammary glands may increase in size;
• painful sensations in the chest;
• greenish discharge appears from the nipples.

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

Causes of the disease

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

The most common ones include the following:

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

All these factors lead to hormonal imbalances, 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 breast tissue. Its progression can lead to very undesirable consequences. To prevent complications, you should consult a specialist in time.

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

Diffuse cystic mastopathy is a serious disease of the breast. It may not make itself felt for many years. Timely examinations by a specialist, proper nutrition, and 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” that indirectly reflects the entire state of a woman’s body. The morphology of this organ is a close object of attention for doctors, because in many diseases it is in the chest that the first changes appear. The International Classification of Diseases, 10th revision - ICD 10 combines diseases of the mammary glands under code No. 60-64. This is a group of pathologies with different causes and mechanisms of development, encrypted by doctors with special numbers. What do they mean, and how not to get confused in medical encryption in order to have complete 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 a unified classification was introduced. According to the latest data from the World Health Organization, among the female population of the world, up to 40% of women suffer from mastopathy, 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 incidence and mortality rate from breast cancer is increasing every year, even despite the enormous advances in medicine in the field of early diagnosis and effective treatment. The lion's share of cases occur in developed countries.

Classification approaches ICD No. 10

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

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

· N 61 — Inflammatory processes. These include carbuncle, mastitis, and abscess.

· N 62 - Breast enlargement.

· N 63 - Unspecified volumetric processes in the chest (nodules 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 disease was defined back in 1984 by experts from the World Health Organization. It characterizes benign dysplasia as a set of pathological mechanisms manifested by both regressive and progressive changes in the tissue of the mammary glands with the appearance of abnormal relationships between the epithelium and 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 with various signs. But the leading main symptoms can be identified:

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

· Irradiation - spread of pain beyond the breast. Patients often complain that pain radiates to the shoulder, shoulder blade or arm.

· The presence of a formation in the breast or thickening of its structure. This sign can be identified by patients who are attentive to their health and regularly palpate.

Diagnostics

The doctor begins the examination with a thorough collection of anamnestic data. The doctor asks the patient about the onset of menstruation, its nature, cyclicity, pain, and abundance. Gynecological history is also important, which includes the age at which sexual activity began, the number of pregnancies, miscarriages, abortions, and childbirth. Genealogical data will help to understand whether blood relatives on the female line had similar diseases. All this information helps to establish the correct preliminary diagnosis.

An objective examination will help the doctor identify asymmetry of the mammary glands, and by palpation, 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 they 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 options. The first is medicinal, which is used for diffuse growths. Hormonal drugs, including oral contraceptives, can achieve good results.

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

Inflammatory diseases of the breast (N 61)

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

Mastitis is an inflammatory disease. Breast involvement is often unilateral, and only in rare cases (no more than 10%) spreads 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 occurs as an aseptic (sterile) inflammation. However, very quickly, literally within a day, under conditions of stagnation of milk secretions and favorable temperatures, the microflora is activated. Thus, the stage of bacterial inflammation begins.

Main symptoms

The clinical picture is almost the same in all women. The first symptom is a sharp increase in temperature to high values ​​(38 - 39 °C). Next comes redness of the skin of one of the mammary glands, and then severe pain. Over time they only intensify. With severe inflammation and lack of timely treatment, sepsis develops very quickly - a deadly complication.

The diagnosis is established on the basis of anamnestic, objective and laboratory data. The medical history reveals that the woman is breastfeeding. As a rule, the risks increase if you constantly attach the baby in the same position. In this case, incomplete emptying of the gland occurs. An objective examination reveals hyperemia of the inflamed gland, its slight enlargement, as well as sharp pain on palpation. A laboratory test in the blood reveals leukocytosis with high values.

In the early stages, conservative (medicinal) treatment is also effective. The main condition is careful expression of milk. For these purposes, a breast pump is not the best solution; it is best to do it with your hands. The patient can perform the procedure on her own, but often due to severe pain she has to turn to specially trained people. Among the drugs, broad-spectrum antibiotics are used. Usually these measures are enough for a complete recovery and further restoration of breastfeeding.

In severe forms of the disease, before prescribing surgical treatment, attempts are made to temporarily stop lactation with the help of special medications. If this method was ineffective, then surgeons take over the treatment.

Other inflammatory diseases of the breast

Carbuncles and abscesses of the mammary gland also occur in clinical practice, but are now becoming less and less common. A carbuncle of the mammary gland, as in any other area of ​​the skin, is a purulent inflammation of the hair follicle and sebaceous gland. An abscess is a purulent melting of the mammary gland limited from healthy tissue.

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

Both diseases occur with an increase in temperature and an increase in pain in one of the mammary glands.

Treatment is most often performed surgically. The abscess is opened, freed from purulent contents, treated with an antiseptic solution, and then drainage is installed 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 distinguish gynecomastia, which occurs only in men. It is characterized by the proliferation of breast tissue and, accordingly, its enlargement. In women, this process is called mammary hypertrophy, and also belongs to this group.

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

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

It is worth noting that this 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 years are affected, but it is more common between 40 and 45 years old. The mortality rate from the disease is 0%.

Reasons

The etiology of the disease is not fully understood.

Clinical picture

At first, the disease has no symptoms at all; this is the so-called latent phase of the disease. The duration of this period varies from person to person and can vary from several months to a year or more. The first symptom is periodic pain in the mammary gland, which may intensify before the onset of menstruation. The pain usually subsides immediately after the end of menstruation.

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

Basic research methods:

· collection of complaints;

· assessment of anamnestic data;

· laboratory research methods (general clinical blood test, general urinalysis, biochemical blood test or test for tumor markers);

Treatment

All breast tumors are subject to surgical treatment. After removal, the biological material in 100% of cases is sent for histological examination, thereby establishing 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 period of lactation;

· inverted nipple;

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

Prevention of breast diseases

Propaganda for the prevention of breast diseases occupies a priority place in working tactics among gynecologists and oncologists. This should include social advertising, various medical brochures, preventive conversations with patients at appointments, increasing 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 not to miss it at an early stage, you should adhere to the following rules:

· refusal of smoking and drinking alcohol;

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

· undergoing preventive examinations, especially over the age of 35;

· performing independent 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 mammary dysplasia according to ICD-10 or mastopathy is a disease of the mammary glands (benign tumor). It appears as a result of tissue proliferation due to 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, periodic changes occur in a young body under the influence of the hormones estrogen and progesterone, which affect not only the menstrual cycle, but also the tissue of the mammary glands (stimulation and inhibition of cell division, respectively). Hormonal imbalance. causing excess estrogen, leads to tissue proliferation, i.e. to mastopathy. ICD-10, (No. 60-No. 64) breast diseases. The disease can also be caused by untimely production of prolactin, the lactation hormone (normally it appears during pregnancy and breastfeeding). The development of mastopathy can be provoked by vitamin deficiency, trauma, abortion, hereditary predisposition, chronic diseases, etc. You can feel the appearance of mastopathy yourself. It causes pain in the mammary gland, accompanied by breast enlargement, swelling and hardening. Sometimes there may be discharge from the nipples. If such signs are detected, you should urgently 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 appropriate treatment, a trophic defect can lead to serious consequences.

Reasons

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

• venous insufficiency;

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

• lymphatic drainage disorders;
• arterial diseases (thrombangitis, Martorell syndrome, macroangiopathy and obliterating atherosclerosis);
• injuries;
• skin damage.

Trophic wounds, according to ICD 10, can develop against the background of diabetes mellitus 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 the external and internal environment. Trophic defects are presented as a special form of soft tissue damage. As a result, wounds heal poorly. A complete diagnosis allows us to identify the root cause of the development of ulcers. Without 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 venous valves by it is transmitted from close relatives.

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

Species

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

• venous;
• arterial;
• pyogenic;
• diabetic.

Untreated varicose veins lead to the development of chronic venous insufficiency. Blood circulation in the lower extremities is impaired. 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. The skin becomes dark brown in color. Against the background of these changes, weeping wounds form in the lowest parts of the limbs. There is stagnation of blood in the affected area. The tissues do not receive adequate nutrition and accumulate toxic substances. A venous wound is accompanied by skin itching. When injured, the trophic ulcer enlarges and does not heal.

Arterial defects develop as a result of tissue necrosis and disruption of arterial blood flow in the lower extremities. If medical care is not provided to the patient in a timely manner, the affected limb can rarely be saved.

Arterial purulent formations mainly appear on the nail phalanges, foot, heel or toes. 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 and legs

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

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

Stages of development

Trophic ulcer of the leg has four stages of development:

• Appearance.
• Cleansing.
• Granulation.
• Scarring.

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

The initial stage is characterized by the appearance of “varnish” skin. Redness and swelling appears. Liquid seeps through the “varnished” skin. Over time, the dead skin forms whitish spots, under which a scab forms. The first stage can last for several weeks.

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

At the second stage of development, the ulcer has a bloody or mucopurulent discharge. If it has an unpleasant, pungent odor, this indicates the presence of an infection. During the cleansing stage, skin 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. If you follow all the doctor’s recommendations, nutrition and tissue restoration in the area of ​​the ulcer are enhanced. Otherwise, a relapse occurs. Repeated trophic wounds are less susceptible to treatment. At 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 form 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 10 code L98.4 progress rapidly, so in order to avoid serious complications it is necessary to begin treatment immediately. Possible complications that can be fatal include sepsis, gangrene or skin cancer.

Therapy

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

• drug therapy;
• surgical intervention.

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

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

Physiotherapy will help enhance the results of local treatment. Ultraviolet irradiation, laser and magnetic therapy are effective. Physiotherapeutic procedures will relieve swelling, dilate blood vessels and stimulate epidermal cells to regenerate.

If drug therapy is ineffective, doctors are forced to resort to radical methods of treatment. In modern medicine, vacuum therapy is performed. The principle of treatment is to use special sponge dressings. Using low pressure, sponge dressings remove purulent exudate from the wound, which leads to a reduction in swelling and restoration of blood microcirculation in the soft tissues. For large areas of damage, skin transplantation from the thighs or buttocks is performed.

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

As pregnancy progresses, 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 level of hormones produced during pregnancy.

After childbirth, when a woman’s neurohormonal system switches, the mammary gland switches to a new mode of operation, defining 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 release during feeding and pumping, carried out by the milk evacuation system. The formation of lactation occurs gradually from 2-3 days and is completed 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. When this interdependence of the processes that make up lactation is violated, so-called “physiological” lactostasis occurs. The 3-4th day after birth is critical in this regard, although such lactostasis can occur on any other day during the formation of lactation. Lactostasis, in turn, triggers other unfavorable processes, ultimately leading to the development of lactation mastitis and hypogalactia, which require either suppression of lactation or its regulation.

Etiology of lactostasis. Currently, there is no consensus on the cause of the development of lactostasis. According to some authors, lactostasis occurs due to a primary decrease in the milk-releasing reflex, according to others - due to low excitability of the neuromuscular system of the areolar-nipple area (primary, or due to trauma - cracked nipples), leading to a delay in the evacuation of milk and I will stagnate it. There are indications of the role in the formation of lactostasis of disorders of the neuro-endocrine function of the gland, edema of interstitial tissue and accumulation of fluid in the interstitial space, reducing the elastic capacity of myoepithelial cells. Classification of lactostasis. Lactostasis can be primary or “physiological”, occurring 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, i.e., he believes that a phenomenon that requires treatment cannot be called physiological. Primary lactostasis, if not eliminated within the next few hours, leads to inflammation.

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

But lactostasis always contributes to the strengthening 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 myoepithelial cells of the mammary gland. Lactostasis contributes to the appearance of cracked nipples 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 distinction of premastitis is justified by the fact that the identification of pathological lactostasis makes it possible to begin treatment in full.

Pathogenesis of lactostasis. Primary lactostasis occurs most often in primiparous women as a consequence of the uneven development of a new function of the female body - lactation. Therefore, lactation mastitis occurs more often in primiparous women than in women giving birth again. Lactation consists of processes that represent 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. The correct course of lactation depends on how well the development of the secretory function corresponds to the ability of the gland to accumulate (capacitive function) and secrete (evacuation function) milk.

Primary lactostasis occurs when the formation of the secretory function of the mammary gland precedes 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 the capacitive system, which manifests itself in engorgement of the mammary glands. There is an inverse relationship 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 through a reflex change in the tone of myoepithelial cells located in the walls of the ducts and alveoli. As the gland fills with secretion, the tone of these cells decreases, thereby creating the possibility of accumulating 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 function of milk excretion reaches the proper level, which is facilitated by the act of feeding.

However, this does not always happen. When the development of the capacitive and evacuation function lags behind the secretory one (which starts the whole thing), the rapid increase in milk secretion, its accumulation, and sudden stretching of the milk ducts that are not sufficiently prepared for this lead to paralysis of the capacitive and evacuation system of the gland. The baby does not “take” such a breast; milk is released with difficulty when expressing. The mammary gland becomes dense, lumpy, and painful.

This is the beginning of lactostasis. Lactostasis, both primary and secondary, is accompanied by an increase in milk viscosity, which increases congestion in the mammary gland, contributing to the manifestation of “hyperviscosity syndrome” at the site of inflammation with all the negative phenomena characteristic of 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 proliferation of microorganisms entering the gland and increasing their number to a critical level, after which it is 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 hypergalactia, the capacitive and evacuation functions are developed quite well, but increased secretion of milk and prolonged mechanical impact on the mammary gland lead to trauma to the epithelium of the milk ducts and infection. Treatment of lactostasis. is a method of preventing lactation mastitis and the core of the method of treating all stages of mastitis because lactostasis is highly conducive to infection of the mammary gland with all the ensuing consequences when milk is delayed. For a long time, there have been many ways to eliminate lactostasis. To date, breast massage and the use of heat or alcohol compresses are 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 the sore breast. Under its influence, the milk ducts expand, the tension in the gland subsides and the pain subsides.

Supplemented with vigorous massage, the compress helps empty the gland of milk, which was previously almost impossible. The effect on lactation is obvious; the effect on the gland does not appear 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 drugs: hormonal (estrogens), non-hormonal (saluretic diuretics, saline laxatives, camphor preparations, cardiac drugs - difrim, falicor), special drugs - dopamine receptor agonists, parlodel and lazuride. When talking about the regulation of lactation, a distinction should be made. prevention of lactation - taking measures immediately after childbirth to prevent lactation from appearing; inhibition of lactation - taking measures to reduce the synthesis and secretion of milk during corrective therapy for lactostasis and hypergalactia;

turning off lactation is a reversible process when it is necessary to eliminate lactation during the treatment of some cases of mastitis; suppression of lactation is an irreversible process, complete cessation of lactation processes; stimulation of lactation - strengthening of milk formation processes during hypogalactia. Considering that breastfeeding is most effective during lactation when 2/3 of the milk is excreted due to the rebound 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 capacitive and evacuation abilities of the gland.

In this case, it is necessary to take into account the ultimate goal of regulation. Among the medicinal methods for treating lactostasis, it is worth highlighting. long-used 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 effect of estrogens can be explained by the peculiarities of the emergence 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 a woman’s blood while the level of prolactin increases.

Therefore, the administration of estrogens and 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 eliminated from the body, and lactation is disinhibited.

The effect of the rapid stimulating or inhibitory effect of estrogens on prolactin production 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-inhibitory effect of action is the dosage. Small doses of estrogen actively stimulate the synthesis of prolactin in the pituitary gland, causing its threefold increase. At the same time, fluctuations in the level of prolactin in the blood maintain the daily cycle. At the same time, milk production increases. Large doses of estrogen do not affect the level of prolactin circulating in the blood, but contribute to its rapid binding in breast tissue. This explains the rapid inhibitory effect of large doses of estrogens on lactation, and this can also explain the fact that suppression of lactation does not occur.

Prolactin circulating in the blood, after the cessation of the inhibitory effect of estrogens, is replaced by tissue-bound prolactin, and lactation resumes. for complete suppression of lactation - the use of direct simulators of prolactin inhibition, which are ergot preparations. They can cause a direct decrease in prolactin levels in the blood. This explains the more persistent pressor effect on lactation than estrogen 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 lobe of the pituitary gland on an “acetylcholine background”. Increasing 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, overstretching of the walls of the milk ducts, a decrease in the level of elastic tension in this area of ​​the gland, impaired circulation and difficulty in the entry of hormones of the posterior lobe of the pituitary gland into the myoepithelial cells, resulting in is a disruption of homeostasis in the mammary gland and increased growth of 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.

With lactostasis, it is necessary to ensure the maximum possible emptying of the mammary gland. The expansion of the ducts is facilitated by moderate warming and chest massage. To reduce the likelihood of reflex stasis, quality rest, avoidance of stress, and limiting the wearing of underwear that compresses the chest are recommended. It is recommended to sleep not on your back and stomach, but on your side.
  You should try to feed as often as possible (but not more than once every two hours). When you start feeding, you must immediately attach the baby to the “sick” breast. The fact is that in order to suck milk out of the stagnant area, the child has to make maximum sucking efforts, and when he has already eaten, he may become lazy and refuse to suck. However, healthy breasts also require careful emptying. Feeding should be done in a position that is convenient and comfortable for the baby, providing the baby with maximum contact with the nipple and facilitating sucking. If the baby does not suckle frequently and intensively enough, it is necessary to express excess milk.
  Massaging the breast with stroking movements in the direction of the nipple helps increase the outflow.
  Breast massage, pumping and feeding must be carried out, overcoming pain until the symptoms of lactostasis subside. Persistence of effort contributes to high-quality emptying of the glands and long-term, full lactation. Sometimes, when a spasmodic duct opens during feeding, some tingling and burning in the chest may be noted.
  Expressed milk may contain inclusions (“milk grains”), thread-like fibers, and appear excessively fatty. This is the normal, healthy consistency of breast milk and provides adequate nutrition to the baby. Between feedings and pumping, pain can be relieved by applying local cold compresses.
  Before pumping or feeding, the gland must be kept warm. If necessary, you can warm your chest with a towel soaked in warm water and take a warm shower. The use of hot water and warming compresses is dangerous due to possible 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 is quite well defined to the touch, differing from the surrounding tissue by its increased density. The seal must be massaged with special care. It is the thickened, painful area that needs pumping first. After pumping, you can put your baby to your breast and let him suck out the remaining milk.
  Prolonged lactostasis (more than a day) and after decanting can remain sore for 1-2 days in the area of ​​stagnation. If even after the pain does not subside, but intensifies, fever and hyperemia occur, it can be assumed that mastitis has developed (inflammation of the mammary gland). It is necessary to stop warming the gland (heat contributes to the progression of the infection) and immediately consult a doctor.
  With lactostasis, any warming compresses are harmful, and alcohol compresses, in addition to the likelihood 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 the damaged lobules).
  Treatment of lactostasis with folk remedies without consulting a doctor is strictly not recommended, especially for mothers 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. Expressing on your own is often quite painful and may not be effective. The midwife can help with pumping and developing the ducts. A good specialist can make pumping completely painless. Hardware expression with a breast pump is not inferior in its effectiveness to manual expression, but in case of lactostasis, before using the breast pump, it is necessary to thoroughly massage the sore area.
  One of the effective methods for resolving milk stagnation is ultrasonic massage of the mammary gland. Oxytocin helps contract the milk ducts. It is prescribed by injection and administered intramuscularly 20-30 minutes before feeding.

But this opinion is erroneous, since it can appear in women who have never given birth to children, as well as in men and even in newborn babies.

What is mastitis (ICD code 10), what it is like and what are the reasons for the development of the disease - let's talk about it.

Signs

This disease is characterized by inflammation of one, and in some cases both, mammary glands.

In this case, the person experiences pain, the breast becomes heterogeneous, lumps appear in it, it becomes rough, the skin turns red, body temperature rises, and sometimes unusual discharge (pus) appears.

When the first signs of this disease appear, you should consult a specialist, especially if we are talking about a nursing mother .

Important to know: You cannot continue breastfeeding if you have a purulent form of mastitis, as this can harm the health of the newborn baby.

Based on the clinical course of the disease, mastitis can be:

1. Acute is a form of the disease in which the inflammatory process affects the breast tissue. In most cases, it affects women who have become mothers for the first time, whose children are breastfed;
2. Chronic is a form of disease observed over a long period of time, and sometimes throughout life. One of its varieties is plasmacytic mastitis, which occurs mainly in older women.

Causes of lactation mastitis:

1. Insufficient expression of milk, resulting in stagnation. This can be combated by careful hand expression or a breast pump. Otherwise, such stagnation can lead to the formation of mastitis;
2. Damage to the mammary glands by infections through wounds and cracks that arose as a result of improper attachment of the child to the breast. A striking example is Staphylococcus aureus.

Doctor's comment: various diseases of the thyroid gland, hypertension also contribute to the development of mastitis.

Causes of non-lactation mastitis:

1. Damage to the mammary glands by infection;
2. Poor health in adults or the perinatal period in newborns.

What is the main purpose of classification

There is an international classification of absolutely all diseases, the main purpose of which is to assign a class and code to each specific human condition.

Knowing him, another doctor, scientist or relative can find out what kind of disease the patient has and draw appropriate conclusions about his health. This document is periodically updated, supplemented and each time given a revision number.

The number 10 is the number of the latest revision, and this is what specialists should be guided by in their practice.

Disease code

Breast diseases are characterized by a disease class from N60 - N64, mastitis corresponds to N 61. Next comes a block of codes from 085 to 092, which describes the main complications that arose after standard childbirth.

In accordance with the International Classification of Diseases, 10th revision (ICD 10), mastitis corresponds to the following codes 091-092:

1. Mastitis, the appearance of which is caused by the birth of a child – 091;
   • Purulent – ​​091.1;
   • Non-purulent – ​​091.2.
2. The causes of the disease can be determined by the following code:
   • Wound or crack of the nipple – 092.1;
   • Violation of an unspecified nature 092.2;
   • Disorders resulting in initially little or no milk 092.3;
   • Decreased breast milk production 092.4;
   • The absence of milk or its production in insufficient quantities after normal feeding is sometimes associated with the mother’s health 092.5;
   • Disorders associated with excess milk production, and sometimes the development of lactostasis. Codes 092.6 and 092.7 respectively.

Disease code for children

The block of codes P00-P96 characterizes the condition of newborn children. Mastitis in newborns is classified by code P39.0.

Occurs in infants as a result of increased levels of hormones passed to them through the mother’s blood. Treatment in this case is not required, since the disease goes away within a few weeks from the moment the child is born without the intervention of specialists.

Take note: a child who has been diagnosed with this disease is the most vulnerable, so it is necessary to make special demands on the cleanliness of the house, as well as ensure compliance with hygiene rules for all family members.

Using the codes of this classification of diseases, doctors summarize information from all over the world about the number of sick people, the most effective ways and methods of providing care, as well as an analysis of the patient’s condition.

Watch the following video about the features of a disease such as mastitis: