Vim i trng mn Danh mc

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Vim i trng mn Nguyn nhn gy vim i trng mn Triu chng bnh vim i trng mn Chun on vim i trng mn iu tr vim i trng mn

Vim i trng mn l tnh trng tn thng mn tnh ca nim mc i trng, tn thng c th khu tr mt vng hoc lan to khp i trng. Vim i trng mn l bnh hay gp kh ph bin trong nhn dn v trong qun i. I. NGUYN NHN GY VIM I TRNG MN: + Di chng ca bnh nhim khun ng rut cp, thng hn, l trc khun, l amip v cc nhim trng khc. + Nguyn nhn d ng. + Nguyn nhn bnh t min (vim i trng, lot khng c hiu). + Ri lon thn kinh thc vt (lc u l ri lon chc nng v sau thnh tn thng vim lot...) + Sau cc trng hp nhim c: thyroxin, asen, photpho, nhim toan mu, ure mu cao...

Cch bnh sinh: + Thuyt nhim khun: bnh bt u do nhim khun (thng hn, tp trng, trc khun) gy tn thng, li di chng "so" nim mc i trng. + Thuyt min dch: v mt l do no cha r vim nim mc i trng tr thnh khng nguyn nn cth to ra khng th chng li chnh nim mc i trng ca bn thn. Phn ng khng th khng nguyn xy ra mt vng hoc ton b nim mc i trng gy tn thng, l hin tng "min dch t min". + Thuyt thn kinh: sau tn thng thn kinh trung ng v nht l h thn kinh thc vt gy ri lon vn ng, bi tit lu ngy, gy tn thng nim mc i trng. + Gim sc khng ca nim mc i trng. V l do ton thn hoc ti ch dn ti nui dng nim mc i trng b km, i i vi ri lon vn ng, tit dch, sc "chng bnh" ca nim mc gim, nn vim lot xy ra. Vim i trng mn thng l s phi hp ca nhiu cch (cc cch mi ch l nhng gi thuyt) do vy vim i trng mn ngi ta mi ch iu tr n nh ch cha iu tr khi c hon ton. Gii phu bnh l: + i th: (2 loi tn thng) - Tn thng vim: Trn i th ngi ta thng thy c cc hnh nh: nim mc xung huyt, cc mch mu cng t thnh tng m, hoc nim mc i trng bc mu, mt lng bng. Tng tit nhy vng nim mc b tn thng vim. c th thy hnh nh nhng chm chy mu ri rc nim mc i trng. - Tn thng lot: Trn i th ca bnh vim i trng mn ngi ta thy hnh nh vim thng km theo vi cc lot c th ch l vt xc hoc trt nim mc, c lot thc s su, b u mm mi, y c nhy, m, mu... + Vi th:

- C hnh nh vim mn tnh: lymphoxit, t chc bo, tng bo tp trung hoc ri rc lp m ca nim mc. - Cc tuyn tng sinh hoc tha tht. - Tu theo hnh thi bnh l c th thy. T bo tng tit nhy hoc teo t. Lin bo ph: tng sinh hoc ti to khng hon ton. - C th thy tng t bo lp m. Phn loi: C nhiu cch phn loi nhng a s kin l nn chia vim i trng mn ra lm 3 loi: + Vim i trng mn sau ly amip (hay gp nht Vit nam) + Vim i trng mn sau ly trc khun. + Vim i trng mn khng c hiu. II. TRIU CHNG BNH VIM I TRNG MN: 1. Triu chng lm sng: a. Triu chng ton thn: Ngi bnh mt mi, n ng km, chn n, y bng, gim tr nh, hay cu gt, c th c st. Nu b bnh nng th cth gy st hc hc. b. Triu chng cnng: - au bng: + V tr: xut pht au thng l vng h chu hai bn hoc vng h sn phi v tri (vng i trng gan gc, gc lch). au lan dc theo khung i trng. + Tnh cht, cng au: thng au qun tng cn, c khi au m . Khi au thng mt "i ngoi" , "i ngoi" c th gim au. + Cn au d ti pht - Ri lon i tin: + Ch yu l a lng nhiu ln mt ngy, phn c nhy, mu.

+ To bn, sau bi phn c nhy, mu. + To lng xen k nhau (vim i trng khu vc). + Mt rn, a gi, sau "i ngoi" au trong hu mn. c. Triu chng thc th: - n h chu c th c ting c ch, chng hi, n dc khung i trng au. - C th s thy "thng xch ma" nhmt ng chc, t di ng. 2. Triu chng xt nghim: a. Xt nghim phn: - C th thy hng cu, t bo m. - Anbumin ho tan (+). - Trng k sinh trng, amip, lamblia. - Cy phn tm vi khun gy bnh, c th (+). b. Soi trc trng (xem chi tit phn gii phu bnh). c. Chp khung i trng c chun b - Cn phi chp 2 ln. - C th thy hnh nh vim i trng mn. + Hnh xp a. + Hnh b thng, b khng r. + Hnh hai b. - Cn phn bit vi cc hnh d thng ca i trng: i trng to, di qu mc, cc hnh khuyt (trong ung th), hnh ti tha, cc polip i trng. d. Xt nghim mu: Hng cu, huyt sc t, bch cu, mu lng t thay i. III. CHUN ON BNH VIM I TRNG MN: 1. Chun on xc nh:

+ Da vo tin s: b kit l, cc vim rut cp. + au bng: xut pht t vng h chu, au qun, hay ti pht. + Ri lon i tin: mt rn, a lng, phn c nhy, mu. + Xt nghim phn: - C t bo m. - C anbumin ho tan. - Cy phn tm vi khun gy bnh. + X-quang chp khung i trng c hnh xp a. + Soi v sinh thit i trng: thy tn thng vim, lot (du hiu c gi tr nht). 2. Chn on phn bit: a. Ri lon chc nng i trng - C au bng. - Phn to, lng, khng c mu. Xt nghim Anbumin ho tan (-). - Soi v sinh thit i trng: khng thy tn thng vim, lot. b. Polyp i trng - nam gp nhiu hn n, thng gp nhng bnh nhn trn 50 tui. - Thng khng c triu chng. - C th tnh c xt nghim phn thy mu vi th hoc a ra mu. - Soi i trng thy polyp (du hiu xc nh) c. Ung th i trng, trc trng - Gp nam nhiu hn n, tui ngoi 40 tui. - Cc bnh nhn ca i trng d dn ti ung th: + Polyp loi lan to. + Cc polyp gi, vim i trng xut huyt, sau l amip. - V tr ung ththng gp trc trng, i trng xch ma.

- Triu chng ph thuc vo khi u. + au bng khng c khu tr r rt. + Chn n, bun nn, xen k to lng, thng c mu trong phn. + Nu ung th i trng xch ma "i ngoi" gi, tc rut. - Khm bng: s thy u rn - Thm trc trng, m o thy mt khi u c nh. - Xt nghim mu: hng cu, huyt sc t gim. - Xt nghim phn c mu (vi th) - Chp khung i trng c baryt thy hnh nh p, khuyt cng. d. Lao rut (lao hi manh trng): - C hi chng nhim lao. - Ri lon cnng rut: a lng 2-3 ln mt ngy, phn sn st, tnh trng i lng ko di, c khi , c khi xen k a to. - au bng lm rm "i ngoi" c th au. V tr au khng c nh, khi au quanh rn, khi au h chu phi. - Bing n, si bng. - Trong th hp rut, cn au bng c tnh cht c bit. + Sau khi n bnh nhn thy au bng, khi bng ni ln cc u cc v c du hiu rn b. + Sau 15 pht nghe r ting hi di ng trong rut v c cm gic nh hi i qua ch hp, ng thi trung tin c th au (hi chng Koenig). - Khm c im au h chu phi, ti ay c mt khi u mm khng nhn, hi au v di ng theo chiu ngang. - X-quang: vch manh trng dy cng to ra v nhim m nn khng nhn thy, ch c mt ng nh ca thuc cn quang i qua (du hiu Starlinh). - Xt nghim phn khng c g c bit: c mu, c m.

Ch : nhng bnh nhn c st v chiu, gy st ng thi c du hiu ri lon tiu ho ko di th cn phi ngh ti lao manh trng. Tin lng: - Nu iu tr khng tt th s a n tnh trng cth gy yu, n km, c th dn ti suy kit t vong. - Bnh d ti pht, dai dng, kh iu tr khi hon hon. Mi khi c nhng sai lm n ung, lo ngh th bnh li vng ln. IV. IU TR VIM I TRNG MN: 1. H l cp 2-3. a. Ch n: - n cc cht d tiu giu nng lng. - Gim cc cht kch thch. - Khng n cc cht i thui, cc cht c nhiu x. b. Lm vic nghngi hp l. Ngh hn khi c t ti pht. c. n ung ng gigic. i tin ng gi gic. 2. Thuc men: a. iu trnguyn nhn (tu theo tng nguyn nhn): * Do nhim khun cn cho khng sinh: - Klion (Flagyl) 0,25: liu 2-4mg/kg/24 gi. Mt t dng 8 - 10 ngy (hiu qu vi ly amip) - Hoc Enterosepton 0,25: vi liu 2mg/kg/24 gi. Mt t dng 7 - 10 ngy. - Chlorocid 0,25: vi liu 20mg/kg/24 gi. Mt t dng 6 - 8 ngy. - Biseptol 0,25: vi liu 2mg/kg/24 gi. Mt t dng 8- 10 ngy. - Ganidan 0,5: vi liu 6 - 8 vin/50kg/24 gi. Mi t dng 5 - 7 ngy. - Tht gi dung dch: Mixiot 1g, Streptomycin 1g, Novocain 0,25% 250ml. Tht gi sau tht tho, 1 t 7 ln.

* Nu vim i trng do bnh "tmin"th dng: - Corticoid liu php: + Liu dng: 30 - 40mg/50kg/24 gi. + V d: Prednisolon (vin 5mg): . Bt u 6 vin/24 gi x 7 ngy . Sau 5 vin/24 gi x 7 ngy. . Tip 4 vin/24 gi x 7 ngy . Cui cng 2 vin/24 gi x 7 ngy Ch cho ung thuc vo lc no, khng dng khi c lot d dy - t trng, i tho ng, cao huyt p. b. iu trtriu chng: * Chng a lng: - Sousnitratbismuth: 2 - 4g/24 gi chia 2 - 3 ln ung. - Tanalbin: 2 - 5g/24 gi cho n khi ht a lng. - Opiroic 0,5: liu 1 - 2 vin/24 gi/ 50kg, ht a lng th ngng ung thuc. * Chng to bn: - Parafin 10ml/24 gi chia 2 ln ung trong 3 - 5 ngy. - Magiesunfat 5 - 10g/24 gi, trong 3 - 4 ngy - Tht tho phn khi cn thit. * Gim au chng co tht: - Atropin 1/2mg: ngy 1 - 2 ng tim di da trong 5 - 7 ngy. - Papaverin 0,04 : dng 4 vin/24 gi hoc 0,02 x 1 - 2 ng tim di da. * Thuc an thn: - Seduxen 5mg x 1 - 2 vin/24 gi ung vo ti. - Gacdenal 0,1 x 1vin/24 gi ung vo ti. c. Tng sc bn cho nim mc:

- Vitamin B1 x 6 vin/24 gi t dng 15 - 30 ngy. - Vitamin C 0,10 x 6 vin/24 gi t dng 25 - 30 ngy. d. Cc thuc ng nam y (theo kinh nghim dn gian) - L mlng (mtam th) - trng g: cha l amip. - Bp sim, bp ch, bp i: chng a lng. - Cao Actiso: nhun trng, li mt. e. L liu php: xoa bp. Hng ngy trc khi ng hoc sng ng dy nn xoa nn dc khung i trng (xut pht t h chu phi sang tri). ng tc nh nhng va xoa va day nh) Phng php ny rt tt trong vim i trng co tht. B sung: Chng to: Circanaten: 100mg x 4 vin; Microlax tuyp: 5g. Khng sinh: Flagentyl: 0,5 x 2 vin/ngy dit amip; Intestrix: 4 nang/ngy cha a chy cp. iu chnh nhu ng rut: Debriat 100mg x 2 vin/ngy.