Mc lc

2. Gii phu 3. Nguyn nhn 1. Case 4. Triu chng 6. iu tr 5. Chn on

CASE
Nam 58 tui Nhp vin do nhi mu phi v x gan Tin s
Tiu ng, tng huyt p X gan c chn on cch y 8 nm. Tin s ung ru 1.5 2l /ngy (~ 140 190g ethanol/ ngy)

Lm sng v cn lm sng
Ph chi di, c chng Glucose tng, bilirubin tng, GGT tng, thi gian PT thng Siu m: gan lch to, x gan, c chng Cng thc mu: khng cho thy c xut huyt tiu ha hoc mt mu trc khi nhp vin Ni soi: PHG (Portal Hypertension Gastrophathy) thn v y v

Sau khi dng chn beta khng chn lc v c ch bm proton, li tiu => cho v

GII PHU
Tnh mch chc phn cht thu c t ng tiu ha v gan. Khng c van, nhiu si chun. TM lch + TM mc treo trng di + TM mc treo trng trn (TM ti mt, cnh rn, v ) Vng ni:
Vng ni di nim mc thc qun Vng ni quanh rn Vng ni di nim mc trc trng

Gin v nu tc Di 6 -10 cm, k 10 12 mm

GII PHU

BNH HC
Trn 12 mmHg (bnh thng 5-10 mmHg) Cc yu t quyt nh nguy c v:
p lc trong lng mch Kch thc dy lp ni m

BNH HC
Tng p lc tnh mch ca Tng p lc cc mao mch phc mc

Cc nhnh thng ca h ca
Pht trin ca cc knh bn Amoniac v c t t rut vo tun hon chung Bnh no gan

Lch to Thiu mu
Gim bch cu

C chng

Gim yu t ng mu Xut huyt

Mch trc trng

Xut huyt

Gin TM thc qun

NGUYN NHN
Trc gan
Huyt khi tnh mch ca. p t bn ngoi do ung th hoc hch lympho ph i

Sau gan
Tc nghn dng chy qua cc tnh mch gan qua cc thy gan Huyt khi ca cc tnh mch gan, bnh bt tc tnh mch, v suy tim phi nng

Trong gan
Tc nghn ca dng chy trong gan X gan ru, m x v cc nt x

NGUYN NHN

NGUYN NHN
Ti gan
Ph bin nht: X gan do ru hoc virus (HBV, HCV) Khc: vim gan t min, thuc, x gan mt nguyn pht v th pht, x ha ng mt nguyn pht, lng ng st (hemochromatosis) hay ng (Wilson), thiu alpha 1 antitrypsin, tc nghn TM trn gan

NGUYN NHN
Huyt khi tnh mch ca
Ph bin: bnh l c tnh gan, ng mt, ty, d dy Khc: chn thng, vim phc mc, vim ty cp, . Huyt khi tnh mch lch gy ra th tng p lc tnh mch ca pha bn tri

NGUYN NHN
Hi chng Budd-Chiari
Him Tc nghn TM gan: huyt khi (cp) hoc vim ti ch hay ton thn (mn)

BIN CHNG
Dn & v TMBH Thiu mu Ri lon ng mu Cng aldosterol C chng Vim phc mc nguyn pht Hi chng gan thn Bnh l no

NGUYN NHN

TRIU CHNG
C nng Thc th

C NNG
Kh tiu, chng bng, gy mn. Tiu chy Gim kh nng lao ng Kh chu, au thng v, HSP Chy mu ti pht Theo bin chng:
Xut huyt tiu ha au bng cp Tri gic gim st Thiu niu

THC TH
Xut huyt tiu ha:
Phn en, khm hoc mu trong phn. Nn mu

C chng Bnh no do gim chc nng gan. Bnh thn do gan Lch to Gim tiu cu, bch cu

CN LM SNG
Xt nghim mu Chn on hnh nh o lu lng tun hon tnh mch ca bng BSP

Xt nghim mu
Sinh ha
Albumin gim, thi gian PT ko di: suy t bo gan Globulin tng AST, ALT tng nh (< 300 UI/L) Bilirubin, phosphatase kim tng: tc mt Thiu mu Gim bch cu, tiu cu do cng lch

O LU LNG TUN HON BNG BSP

BSP khi qua gan b gi li trong t bo gan. o lng BSP sau tim cc thi im khc nhau => lu lng mu qua gan

CHN ON HNH NH
Chp thc qun Soi thc qun bng ng soi mm o p lc tnh mch ca Chp cn quang tnh mch ca Soi bng Siu m tnh mch ca CT & MRI

CHP THC QUN

Np nim mc ri lon Hnh gin tm dng quai vng vo Hnh khuyt chui vng c

 Chp thc qun

SOI THC QUN D DY

Gin TM hoc bi TM gin

SOI THC QUN D DY

O P LC TNH MCH CA
o p lc lch o p lc tnh mch ca qua tnh mch rn o p lc xoang gan

CHP TNH MCH CA

SOI BNG

SIU M
Tnh mch ca gin > 13mm: khng c hiu Dng chy hai pha hoc o ngc ca tnh mch ca (giai on mun) Ti thng tnh mch cnh rn Lch to Tun hon bng h C chng Nguyn nhn tng p lc: hu ht l x gan

Siu m

X gan Lch to Ti thng tnh mch rn Dch bng v x gan Gin TM rn Gin TM rn

Siu m

CT & MRI

Gin TM thcTi qun thng thng tnh mch cnh rn

MRI

IU TR
iu tr xut huyt tiu ha iu tr phng xut huyt

IU TR XUT HUYT
iu tr cp cu Cm mu

IU TR CP CU
Truyn mu, truyn dch Hct > 25% Khng nng HA v bnh thng=> tng nguy c v mc chy mu Khng sinh Ni soi tm v tr v

CM MU
Thuc co mch tng Qua ni soi
Chch x Tht bi TM thc qun

To shunt ca ch trong gan qua tnh mch cnh (TIPS transjugular intrahepatic portosystemic shunt) Cm mu bng phu thut
To shunt gim p: ton phn, bn phn, chn lc Trit mch: ct lch + phu thut Sujura (trit mch ton b b cong ln, 2/3 b cong nh, 7 cm cui ca TQ)

p v gin bng bng

Thng Minesota Thng Sengstaken- Blakemore

IU TR PHNG TI PHT
Tht bi tnh mch Chch x Propanolol Ghp gan

IU TR PHNG
c ch beta Thuc gin mch Chch x Tht bi gin Phu thut