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Rakshan.pptx
1. Academic case Presentation:
FIBROADENOMA
OF BREAST
🩺 Dr. RAKSHAN TARIQ KHAN, DR SAKIYA BASHIR
🎓 Intern Doctor,
💊 Department of Surgery,
🏥 Tairunnessa Memorial Medical College and Hospital.
3. Particulars of the Patient:
Name: Khadiza
Age: 20 years.
Sex: Female.
Addressee: Tmmc girls hostel, Gazipur.
Occupation: student
Religion: Islam.
Marital Status: Unmarried.
Date & Time of Admission: 14/05/2023 @ 10.40 AM
Date & Time of Examination: 14/05/2023 @ 10.45 AM
5. History of Present Illness:
According to the statement of the patient, she was
reasonably well 1 year back. Then she suddenly
developed swelling in right breast which is not
associated with pain in this region. His bowel and
bladder habit is normal .She is normotensive and non
diabetic .Now he is admitted In the hospital for
better management.
6. Continue...
Past History: Nothing significant.
Family History: He has total 5 family members and
all are at good heath.
Drugs & Treatment History: Nothing significant.
Personal History: Nothing significant.
7. Continue...
Allergy & Immunization History: He has no
any allergic history. He has been immunized
as per current EPI schedule of Bangladesh.
Socioeconomic History: He belongs to lower
middle class family & lives with good water
supply & well sanitization.
Menstural History: MC/MP -regular/ 5 days
L.M.P 20/04/2023
11. Continue...
Neck Vein: Not engorged.
Thyroid Gland: No thyromegaly.
Lymph Nodes: No lymphedenopathy.
Bony Tenderness: No bony-tenderness.
Pigmentation: No pigmentation were seen.
Body Hair Distribution: Normal as like female pattern according to
age.
Torniquet test : Negative
15. Continue...
Abdomen:
A. Inspection: abdomen is scaphoid in shape, flunks are empty
and there is no visible pulsation, scar mark is seen.
B. Palpation:
★ Soft & Non-tender.
★ Liver- not palpable.
★ Spleen- not palpable.
★ Kidneys- not Ballotable.
C. Percussion: Tympanic.
D. Auscultation: Bowel sound present.
16. Respiratory system:
Inspection: Chest shape is normal, chest movement is
symmetrical & intercostal spaces were full.
Palpation: Trachea is centrally placed, Chest expandability is
normal and symmetrical, vocal fremitus was normal.
Percussion: Resonant.
Auscultation: Breath sound is vesicular and no added sound is
found.
17. Cardiovascular System:
Inspection: There is no visible carotid & epigastric pulsation and
no cardiac impulse were seen.
Palpation:
★ Apex beat was found at left 5th intercostal space which was
9cm away from mid line.
★ Thrill- Absent.
★ Palpable P2: Found in Pulmonary area.
★ Left Parasternal Heave: Absent.
Auscultation: 1st & 2nd heart sounds were audible at all
auscultatory area of precordium and there is no murmur present.
19. Salient Feature:
Khadiza, 20 years old female hailing from tmmc girls hostel,
Gazipur admitted at this hospital with the complaints of swelling
in the right breast for 1 year . On general examinations, we found
his pulse- 80 beats/min, blood pressure- 120/80 mmHg,
respiratory rate 18 breaths/min and temperature- 98*F and all
other vital parameters were normal.
20. Salient Feature:
On local examination, we found Swelling in Right side breast in
lower outer quadrant which is smooth ,firm and localized
21. Salient Feature:
On systemic examinations, we found abdomen was scaphoid in
shape and soft & non-tender, bowel sound was present, bladder
was empty. Other systemic examination revels nothing
abnormalities.
He has no sign of appearance of any rashes and no history of
itching. Patient is normotensive, non-diabetic. His bowel &
bladder habit is normal.
24. Investigations:
USG of Both Breast
FNAC of right breast lump
Blood grouping and Rh typing
ECG
CBC with ESR
Random blood sugar
Serum creatinine
TSH
31. Pre operative order
Bed rest
Diet –NPO
Inf- H/S (1L) I/V @ 30 drops /min
Inj –Arixon (1gm)
1 vial i/v ----------- stat
Inj – Exum (40 mg)
1 vial i/v ----------- stat
Inj – Emistat (8mg)
1 vial i/v ----------- stat
32. Ot note
Time and date of operation- 15/05/23 @ 11:00 am
Name of operation – Excision of fibroadenoma of
breast
Indication – Fibroadenoma of right side breast
Name of surgeon : Dr Munny Momtaz
Name of assistant : Dr prity ,Dr lima
Name of anaesthesiologist Dr Motiur rahman
Name of anaesthesia : under GA
33. Ot note
Procedure : With all aseptic precautions under GA, area
was cleaned with povicef solution. Then an elliptical
incison was given over the swelling which was identified
and excised .Then drain tube was placed in situ and asin
was closed .All bleeding points were secured and
haemostasis was achieved . After operation patient was
uneventful.
34. Post operative order
Bed rest
NPO for 6 hours then sips of water
Inf H/S (1L) + 5% DNS(2L)
i/v @30 drops/min
Inj –Dicephin (1gm)
1vial i/v --------BD
Inj –Etorac (30 mg)
1 amp I/m ----------Stat and BD
Inj Proton P (40 mg)
1 vial i/v ---------------BD
Inj Traxyl (500 mg)
1 amp i/v Stat and BD
Inj Emistat (8mg)
1 amp i/v -------SOS if vomiting
35. Treatment & Management at ward:
Fresh Order :
1. Bed rest.
2. Diet: liquid then semisolid then normal
3. Inj –Dicephin (1gm) 1vial i/v --------BD
4. Tab. Remmo (20mg)- 1+0+1 (B/M)
5. Tab. Rolac (10mg)- 1+1+1 (A/M)
6. Cap. Clindacin (300mg)- 1+1+1
7.Supp. Voltalin (50mg): 1 stick P/R (if pain)
37. Fibroadenoma of breast
Definition – it is a benign encapsulated tumor
occurring commonly in young females 15 to 25
years age group
presently it is considered as hyperplasia of single
lobule of breast
39. Clinical features
Usually occurs in the upper outer quadrant but
can occur in any part of the breast
Presents as painless lump in the breast usually
smooth, firm, non-tender well localized and
moves freely within the breast tissue
They usually grow up to 2-3 cm in size and are
surrounded by well marked capsule
41. Treatment
In patient under 30 years and size of the lump less
than 3 cm can be left alone with regular follow up
and USG with 6 monthly intervals
Surgery -
Excision through elliptical incision or sub
mammary incision under GA
