➟ ADDITIONAL BREAST NIPPLES ➟ BREAST TENDERNESS OR FULLNESS

(SUPERNUMERARY NIPPLES) - Many women notice a day or two of

premenstrual breast fullness &

tenderness each month

- If a lump or tenderness persist

beyond menstrual flow and

adolescent should consult a

healthcare provider for additional

assessment & care

➟ ABNORMAL ENLARGEMENT OF BREAST
➟ FAT NECROSIS
TISSUE

➟ BREAST HYPOPLASIA

- If a breast tissue is struck during a fall

or other traumatic incident - tender ,

painful , inflamed or reddened &

possibly bruised.

- Less than average breast size

CCCHAN,SN | 1
➟ BREAST FIBROCYSTIC DISEASE - A needle is used to draw

sample fluid & tissue from a

lump to be studied.

● Relieved : simple analgesic ,

Acetaminophen (Tylenol) or warm

compresses , avoidance of trauma ,

and firm bra support.

- Breast tissue with multiple cysts ● Avoid coffee,sola drinks , tea ,

- The most common benign breast chocolate , some toffee candy &

condition in woman of all ages medications such as aspirin

- Round , fluid-filled cysts form in the compound or excedrin

connective breast tissue ● Cyst may be aspirated under local

- May feel painful , the breast may feel anesthesia.

tender & stretched interfering with ● Danazol (Danocrine) - Synthetic

active sports & other strenuous Androgen - help reduce symptoms by

activity. suppressing estrogen formation in

THERAPEUTIC MANAGEMENT the ovaries.

● Needle Biopsy - FNAB (Fine Needle

Aspiration Biopsy)

CCCHAN,SN | 2
➞ FIBROADENOMA ❖ Changed nipple sensation

❖ Discharge

❖ Itching

❖ Tenderness

❖ Breast lump

- Are tumors that consist of both

fibrotic & glandular components &

occur in response to estrogen

stimulation

- Round & well delineated , feeling

firmer and more rubbery than

fluid-filled cyst.

- Do not become malignant - Vaginal infection caused by

- Surgically incised the fungus candida

- Signs and symptoms :

➞ MASTITIS ● Vulvar and vaginal

- Inflammation or infection of the reddening

breast ● Burning & itching

- Symptoms : ● Bleeding from hairline

❖ Breast pain fissures

❖ Swelling ● White patches on the

❖ Redness walls (vaginal)

❖ Fever ● Thick ,cream-cheese

❖ Enlargement like discharge

CCCHAN,SN | 3
 ● Pain on coitus

● Maybe present in the

oral cavity or a moist

area such as the

umbilicus

- Management :

● Vaginal suppository or

cream applications of

antifungal preparation

such as

Miconazole(Monistat)

or Clotrimazole

(Lotrimin) , once a day

for 3-7 days

● Oral fluconazole - A single cell protozoan that is spread

(Diflucan) through coitus

- One time oral - Signs and symptoms :

dose ● Vaginal irritation & frothy

● Antifungal creams or white or grayish-green

suppositories - vaginal discharge

bedtime ● vagina -reddened , pinpoint

● Wear sanitary pad at petechiae

daytime - Management :

● Oral metronidazole (Flagyl)

CCCHAN,SN | 4
 - Transmitted by neisseria

- Common cause of rectal cancer gonorrhoeae

- Genital warts - Signs and symptoms :

- Caused by fibrous tissue overgrowth ● Males - urethritis & urethral

on the external vulva,vagina or cervix discharge

- Signs and symptoms : ● Females - not visible, slightly

✦ Cauliflower like lesions yellowish vaginal

- Management : discharge,bartholinitis gland

● Small lesions - may become inflamed &

Podophyllin(Podofin) painful

● Large lesions - laser therapy , - Management :

cryocautery , knife excision ● Amoxicillin & Probenecid

● Healing will be complete in ● Recommended therapy : Oral

4-6 weeks without slight Cefixime (Suprax) , IM

depigmentation Ceftriaxone (Rocephin) plus

● Sitz bath with Lidocaine oral Doxycycline (Vibramycin)

cream for 7 days is a current

recommended therapy

CCCHAN,SN | 5
 ● Final stage - destructive

neurologic disease -

blindness,paralysis,crippling

neurologic deformities,mental

confusion,slurred speech &

lack of coordination

- Management :

● Benzathine penicillin G - IM in

- Is a systemic disease caused by the 2 sites

spirochete treponema pallidum ● Oral erythromycin or

- Signs and symptoms : tetracycline (10-15 days)

● Incubation period -10-90 days

● Typical lesion on the genitalia

or on mouth , lips , rectal area

from ora-genital or

genital-anal contact

● Lesion-chancre

● 2-4 weeks after chancre

disappears , a generalized ,

macular, copper-colored rash

appears.

● Secondary - Genitalia that are not clearly defined

symptoms-generalized in a newborn

illness, low grade fever - Diagnosis : external sexual organs in

● Latency period - last for a few the child did not follow the normal

years course of development, so at birth

they are so incompletely or

CCCHAN,SN | 6
 abnormally formed that it is

impossible to clearly determine the

child’s gender by simple observation. ✧ Caused by early production of

- ASSESSMENT : gonadotropins by the pituitary gland.

● Karyotyping - establish ASSESSMENT

whether the child is ● Increased breast & genital

genetically male or female development and accelerated skeletal

- Drawing a specimen maturation

of blood,allowing the ● Girls have menstrual bleeding with

WBC to reach a little pubic or axillary hair because of

division stage & then still low androgen secretion

examining them ● Boys have obvious genital growth

● Laparoscopy or possibly ● Diagnosis : serum analysis for

exploratory surgery - estrogen or androgen

determine if ovaries or THERAPEUTIC MANAGEMENT

undescended testes may be ● Synthetic analog to GnRH is available

present as Leuprolide acetate (Lupron) - halts

● IVP(Intravenous Pyelogram) sexual maturation at the point to

may also be used. which it has advanced

- THERAPEUTIC MANAGEMENT : ● Preparation : administered

● True chromosomal gender has subcutaneously everyday

been documented - necessary ● After it is discontinued at age 12-12

constructive surgery is years of age - puberty progresses

determined. normally.

● Removal of labial adhesions ,

surgical removal of enlarged

clitoris.

CCCHAN,SN | 7
 - Secondary sex characteristics are ❖ Prepuce & glans become red and

normally present by age 14 years in swollen, purulent discharge may be present

girls & 15 years old in boys ❖ Boy - may have difficulty voiding

- Failure of pubertal changes to occur (crusting of the meatal opening & because

at the usual age acidic urine touching the denuded surface of

- If girls have not begun to menstruate the glans)

by age 17 - menstrual cycles can be

initiated by administering estrogen ● Medical treatment : local application

- Boys who are distressed by their lack of heat (warm wet soaks or warm

of development may receive baths)

testosterone supplements to ● Local antibiotic may be prescribed

stimulate pubic hair and genital ● Phimosis in relation to balanitis -

growth circumcision

● Painful but may tolerate the

discomfort for several days

● Any discharge may be ruled out for

STI such as gonorrhea

- Inflammation of the glans & prepuce

of the penis ❖ Phimosis - inability to retract the foreskin

from the glans of the penis

CCCHAN,SN | 8
 ● Foreskin is tight at birth ● Both maybe given chorionic

● Circumcision relieves symptoms gonadotropin hormone for 5 days to

❖ Paraphimosis - is the inability to replace stimulate testicular descent

the prepuce over the glans once it has ● Orchiopexy - restoration

retracted

- Emergency situation to address

before circulation to the glans is

impaired

- Undescended testes - Fluid collects in the processus

- Failure of one or both testes to vaginalis

descend from abdominal cavity into - THERAPEUTIC MANAGEMENT:

the scrotum ● Injection of a drug to

ASSESSMENT decrease fluid

● Laparoscopy production

● Karyotype to determine true gender (Sclerotherapy)

THERAPEUTIC MANAGEMENT

● Treatment is delayed 6-12 months

CCCHAN,SN | 9
 - Twisting of the spermatic cord

- Abnormal dilation of the veins of the - Surgical emergency

spermatic cord - Usually results from a sport activity

- No treatment is necessary unless - Severe scrotal pain,nausea and

fertility is a concern vomiting

- May report some local tenderness & - Testis - tender on palpation

edema for a few days after surgery - Edema begins to develop

- Edema can be minimized by applying - Not recognized within 4 hours -

ice for the 1st few hours irreversible change in the testis can

postoperatively. occur from lack of circulation in to the

organ

- Torsion can be reduced manually

under ultrasound guidance

- Laparoscopic surgery - reduce torsion

& re-establish circulation

CCCHAN,SN | 10
 - After surgery - a gel filled prosthesis

can be inserted to provide a

symmetric appearance to the

scrotum.

- Occurs between ages 15 & 35

- Symptoms : painless testicular

enlargement , feeling of heaviness in

the scrotum

- Disease metastasizes rapidly -

leading to abdominal & back pain due

to retroperitoneal node extension ,

weight loss & general weakness

- hCG and AFP - detected in the blood

serum

- Gynecomastia (enlargement of

breast)

- Orchiectomy (removal of testes)

followed by radiation or

chemotherapy

CCCHAN,SN | 11