1 / 11

Sô löôïc veà VTC

Sô löôïc veà VTC. Ñònh nghóa: VTC : laø hieän töôïng töï tieâu hoùa cuûa tuïy, nhieãm truøng laø thöù phaùt. Nguyeân nhaân: Röôïu. Soûi. Khaùc (10% ): Taêng lipid, taêng Calcium, chaán thöông, PT, ERCP, thieáu maùu cuïc boä tuïy, thuoác…. BEÄNH SINH.

montague-santos
Télécharger la présentation

Sô löôïc veà VTC

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sô löôïc veà VTC • Ñònh nghóa: • VTC : laø hieän töôïng töï tieâu hoùa cuûa tuïy, nhieãm truøng laø thöù phaùt. • Nguyeân nhaân: • Röôïu. • Soûi. • Khaùc (10% ): Taêng lipid, taêng Calcium, chaán thöông, PT, ERCP, thieáu maùu cuïc boä tuïy, thuoác…

  2. BEÄNH SINH. • Dòch tuïy: 1500 -3000 ml/ngaøy, coù tính kieàm pH 8- 8.3. • Men tuïy ñöôïc döï tröõ döôùi daïng zymogen, daïng khoâng hoaït ñoäng: trypsinogen, chymotrypsinogen… Acid/ taù traøng  secretine Môõ, proteine  cholecystokinase • 2 chaát naøy kích thích tieát men tuïy. • Enterokinase/ taù traøng hoaït hoaù trypsinogen  trypsin  hoaït hoùa caùc men coøn laïi.

  3. BEÄNH SINH. Laøm tieâu hoaù tuyeán tuïy. Caùc men tuïy ñöôïc hoaït hoaù Lipase: môõ  Glycerin + a. beùo Kallidin, Bradykinin thoaùt huyeát töông, giaõn maïch. Trypsin/m Kích hoaït caùc yeáu toá ñoâng maùu RL ñoâng maùu.

  4. LAÂM SAØNG. • Ñau buïng ( VTC do röôïu sau 12- 24h, do soûi sau böõa aên thònh soaïn). • Noân nhieàu. • Soát, maïch taêng. • Ñeà khaùng TV, chöôùng buïng. • Khaùc: RL tuaàn hoaøn, tri giaùc, TDMP (T), RL ñoâng maùu…

  5. CLS. • Amylasemie: • Taêng treân 2.5 - 3 laàn / 24h, giaûm daàn sau 4-5 ngaøy. • 95% VTC do soûi, 85% VTC do röôïu coù Amylasemie > 1000 UI/dl. • Taêng keùo daøi > 1 tuaàn  bieán chöùng. • Amylasemie khoâng phaûi laø XN chaéc chaén VTC : • (+) giaû: 1/3 ko lieân quan VTC. • (-) giaû: 10% VTC khoâng taêng.

  6. CLS. • Ñoä thanh thaûi amylase/ creatinine: Amylase/ nieäu Creatinine/ maùu   100% = 1 – 4% Amylase/ maùu Creatinine/ nieäu Taêng > 6% laø Vieâm tuïy caáp. Taêng > 3 laàn (12%) bình thöôøng laø VTC naëng. (+) giaû: suy thaän, thuûng oå loeùt daï daøy- taù traøng.

  7. CLS. • Lipasemie: chính xaùc hôn do chæ coù nguoàn goác töø tuïy, keùo daøi hôn. Taêng trong: thuûng DDTT, Vieâm tuïy maõn, nhoài maùu ruoät. • Glycemie: taêng. • Thay ñoåi chöùc naêng gan. • Uremie: taêng. • Calcium/ maùu: giaûm.

  8. CHAÅN ÑOAÙN PHAÂN BIEÄT. • NGOAÏI KHOA: • Taéc ruoät cô hoïc. • Vieâm tuùi maät caáp, vieâm ñöôøng maät. • Thuûng taïng roãng. • Phình ñoäng maïch chuû boùc taùch. • NOÄI KHOA: • Nhoài maùu cô tim. • Vieâm phoåi.

  9. VTC do röôïu: Luùc nhaäp vieän: Tuoåi: > 55 BC: :16000/ mm3 Glycemie: > 200 mg/dl LDH: > 350 UI/l AST: > 250 UI/dl. Trong 48h ñaàu: Hct  > 10%. BUN  > 5 mg% Calcium < 8 mg% pO2 < 60 mmHg. HCO3 > 4 mEq/l Dòch öù ñoïng : > 6 l. TIEÂN LÖÔÏNG.( Tieâu chuaån Ranson/ Imrie) < 2 DH: ñ/öù toát ñtrò 5-6 DH: 50% TV 3-4 DH: 15% töû vong > 7 DH: TV raát cao

  10. VTC khoâng do röôïu: Luùc nhaäp vieän: Tuoåi: > 70 BC: :18000/ mm3 Glycemie: > 220 mg/dl LDH: > 400 UI/l AST: > 250 UI/dl. Trong 48h ñaàu: Hct  > 10%. BUN  > 2 mg% Calcium < 8 mg% pO2 < 60 mmHg. HCO3 > 5 mEq/l Dòch öù ñoïng : > 6 l. TIEÂN LÖÔÏNG.( Tieâu chuaån Ranson/ Imrie) < 2 DH: ñ/öù toát ñtrò 5-6 DH: 50% TV 3-4 DH: 15% töû vong > 7 DH: TV raát cao

  11. DIEÃN TIEÁN – ÑIEÀU TRÒ • DIEÃN TIEÁN: • 90 % dieãn tieán nheï, töï giôùi haïn. • 10-15% naëng, keùo daøi, BC töû vong cao. • NGUYEÂN TAÉC ÑIEÀU TRÒ: • Ñaët sond muõi – dd. • Boài hoaøn ñieän giaûi. • Giaûm ñau – Giaûm tieát. • Khaùng sinh: B/C nhieãm truøng, > 3 Dh Ranson, VTC HT/ CT -scanner. • Thaåm phaân phuùc maïc.

More Related