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RI LON TUN HON

Mc tiu bi hc 1.M t c 6 loi tn thng do ri lon tun hon gy ra 2.Phn tch c c ch gy ra cc tn thng do ri lon tun hon 3.M t c tn thng gii phu bnh do ri lon tun hon gy ra.

I. PH
1. nh ngha Ph l s tch t bt thng cc cht dch trong m m k, hay trong t bo. 1.1.i th C quan b ph thng sng to hn bnh thng, trng lng tng, mu nht, mm, n vo li vt lm. Ct ngang c dch chy ra. Dch ph cn thng gp cc khoang mng ca c th nh: khoang mng phi gi l trn dch mng mng phi; bao tim gi l trn dch mng tim; khoang mng bng gi l c chng; trong bao khp gi l trn dch mng khp. 1.2.Vi th Dch ph tng i thun nht, i khi c dng ht. -T bo ph to, nguyn sinh cht sng hn bnh thng do cha nhng hc nc nh, nhn cng c th phnh to, sng, nc ph. - m, dch ph lm phn tn cc t bo v cc si lin kt Hnh 1: Hin tng ph cc ph nang 1.3.c im ha sinh -C 2 loi dch ph: Dch tit( exsudat) Dch thm (transsudat) -Giu protein v nhng cht dng keo -Ngho protein v nhng cht dng keo - lu dch c th ng - lu dch khng ng -Nhiu t bo: BCN v lympho -t t bo -Phn ng Rivalta (+) -Phn ng Rivalta (-) 1.4. Bnh sinh Ph sinh ra do s ri lon nhng c ch iu ha s trao i dch khong k v dch trong lng mch do 2 yu t ch yu: -Ap lc thy tnh:lin quan ch yu vi sc bp ca tim, sc cn ca thnh mch... -p lc thm thu: ch yu l p lc keo huyt tng, ion Na+ . 1.5. Cc dng ph -Ph tim: l hu qu ca suy tim lm tng p lc thy tnh ca huyt tng phi hp vi tn thng ni mc mch mu do thiu oxy, ph tim thng km theo cc biu hin tn thng ca sung huyt tnh. -Ph thn: do gim p lc thm thu ca huyt tng hoc ng sodium hoc c hai.

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- Ph gan: do gim tng hp protein v tng p lc thy tnh do chn p. v d : c chng. - Ph khu tr: ph tnh mch do vim tc, chn p bi k sinh trng, u, ung th .

II. SUNG HUYT (congestion)

- L tnh trng mu qu mc trong cc mch mu ca mt m hoc c quan. c 2 loi xung huyt 1. Sung huyt ng -L hin tng mu ng mch c a ti nhiu qu mc trong cc ng mch, tiu ng mch v vi mch. -i th :Vng b xung huyt c mu , sng to do ph, nhit tng cao. Hnh 2 : sung huyt do vim -Vi th :mch mu gin, t bo ni m sng to li v trong lng mch, i khi km theo ph hoc chy mu do thot qun. -C ch: xung huyt ng xy ra kch thch thn kinh giao cm bi cc tc nhn nh: +Vt l: nng hoc lnh + Ha hc: ru, hot cht trong gia v. dc phm: atropine.v.v... + Ni tit t +Vikhun : vim cp 2. Sung huyt tnh L s tch t mu trong cc vi mch, tiu tnh mch v tnh mch do mu tnh mch tr v tim b ngn cn. -i th : Vng m, c quan b xung huyt sng ph, mu tm sm, nhit gim, khi ct ngang c dch mu en chy ra. -Vi th : Cc mch mu gin, thng km theo ph v chy mu m k. -Nguyn nhn ca xung huyt tnh: chn p tnh mch ko di do khi u v do tn thng thnh mch nh vim tc, huyt khi, suy trng lc cc van tnh mch ( varice), suy tim. -Hu qu: xung huyt tnh lm tng p lc thy tnh trong lng tiu tnh mch v vi mch, gy thiu oxy lm nh hng n nui dng t bo.V d: gan tim, nguyn nhn thng do suy tim phi hoc suy tim ton b, vim ni tm mc co tht: Gan to , mu tm, ct ngang chy nhiu mu. trn mt ct c nhng vt do xung huyt xen k vi nhng vt vng ng nh do thoi ha m t bo gan, hnh nh ging nh ht cau gi l gan ht cau. Nu suy tim gim (do iu tr) mu trong cc tnh mch lu thng lm cho gan nh li, v vy lm sng gi l gan n xp. Nu suy tim ko di, gan tr nn x cng thng gi l x gan tim.

III. CHY MU
1.nh ngha Chy mu l hin tng hng cu thot ra khi lng mch do nhiu tc nhn khc nhau gy ra. 2.V tr chy mu Mu c th chy ra ngoi c th gi l chy mu ngoi, hoc tch t trong

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c th gi l chy mu ni 2.1.Chy mu ngoi Ty theo v tr chy mu c nhng tn gi khc nhau: chy mu mi, ho ra mu, nn ra mu, i ra mu, a ra mu v rong kinh. 2.2.Chy mu ni Mu c th nm trong m k hoc trong cc khoang thanh mc hoc cc ng t nhin ( nh ng th, ng tiu ha, ng tit niu) 3.Gii phu bnh 3.1. i th 3.1.1. da Hnh nh ca chy mu kh a dng: Hnh 3: Chy mu vi trng -Chm xut huyt( ptchie): l nhng im chy mu nh trn da hoc nim mc, khng lan rng. V d chm chy mu trong st xut huyt dengue. Bm mu( ecchymose): khi mu t xm ln vo cc m di da( v d bm mu do va ng). -Bu mu( hematome): khi mu t thnh khi c ranh gii rli hn trn mt da. 3.1.2. Ph tng C th gp: -Chm mu: khi c im chy mu nh nm nng trn thanh mc. -Chy mu m:khi mu xm nhp vo cc ph tng lm phn tn cc t bo, trng hp nng ngi ta gi l ngp huyt( apoplxie) cc h t nhin( mng bng, mng phi, b thn bng quang).Khi chy mu nhiu,mu c th ng thnh cc. 3.2.Vi th -Tn thng mch mu: +Mch mu thng ph, dy, c th thoi ha hoc hoi t . t bo ni m phnh to, li vo trong lng mch mu sinh ra nhng k h hng cu v huyt tng thot ra. +Lng mch mu thng gin rng, y hng cu. +Xung quanh mch mu c nhiu nc ph, hng cu xut ngoi. -Tn thng m +Khi nh v mi: m k nc ph, t bo to v sng, c th c thoi ha nhiu hay t. -Trong nhiu trng hp chy mu nng, m c th hoi t hon ton do thiu dinh dng. Trong m c nhiu hng cu thoi ha v huyt cu t, ngi ta cn gi l hoi t huyt.

IV. HUYT KHI

l s hnh thnh cc mu trong lng ng b my tun hon ca mt c th sng. huyt khi c th sinh ra ng mch , tnh mch , vi mch hoc bung tim.c 2 loi huyt khi - huyt khi lp: khi lp hon ton lng mch hay bung tim. - huyt khi thnh: khi ch c mt mng huyt khi bm vo thnh mch hoc ni tm mc. 1.Hnh thi Da vo thnh phn cu to cc huyt c th phn bit cc loi sau y:

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1.1.Cc huyt khi t gp, l mt cc mu ng ln, gm mng li t huyt cha hng cu , bch cu v tiu cu. Thng gp huyt khi trong bnh tr sau khi tim thuc gy x ha iu tr. 1.2. Cc huyt khi trng: thng gp hn, kch thc nh, trong m, nhy v rt dnh; bao gm nhng m tiu cu ln vi si t huyt v t bch cu. Cc tiu cu t hy nhanh, to thnh mt khi dng ht, a toan. 1.3.Cc huyt khi hn hp: rt hay gp, gm 3 phn: -u: gm nhng m tiu cu gn cht vo thnh mch. -Thn: thng gc vi thnh mch nu l huyt khi lp, song song vi thnh mch nu huyt khi thnh. Cu to ca thn gm nhng vch trng v vch xen ln nhau. Vch trng gm nhng m tiu cu ( cn gi l vch Zahn),vch do t huyt ng c. -ui: l cc mu ng , mu thun nht, mnh d, t dnh, bi l lng trong lng mch, d bong di p lc ca dng mu. 2.Bnh sinh 3 yu t gy nn huyt khi: 2.1.Tn thng ni m L yu t quyt nh. Ni mc c cu trc mng manh, d b bong ra hoc sinh ra cc khe nt. C nhiu nguyn nhn gy nn cc tn thng: x va ng mch, c t vi khun, phc hp khng nguyn - khng th, chn thng, phu thut v.v...Hu qu l tiu cu dnh vo ni ni m b tn thng, khi u cho s hnh thnh huyt khi. 2.2.Tng tnh ng ca mu Bnh thng c s cn bng gia yu t to ng mu v chng ng. Tnh trng tng ng mu c th do hot ng qu mc ca yu t to ng mu hoc thiu ht cc cht chng ng. V d: hoi t , m ung th u sinh ra cc yu t to ng mu. Cc yu t khc gy tng ng mu nh: - qunh ca mu tng sau chy mu nng hoc mt nc, bnh a hng cu nguyn pht. -Cc bnh nhim khun nng, cc bnh min dch thng km theo tng fibrin, fibrinogen, polysaccharide, globulin... lm tng kh nng kt dnh t bo mu -Cc thuc trnh thai cng c cnh bo v nguy c gy huyt khi 2.3.Ri lon huyt ng hc Khi mu chy chm hoc ng th d gy huyt khi do: cc t bo mu gn nhau nn d kt dnh, tiu cu , bch cu chy st thnh mch d b tn thng do thiu oxy nn d c iu kin bm dnh. Nguyn nhn : chn p tnh mch, suy thnh tnh mch, suy tim, nm bt ng qu lu. v d: i my bay ng di hn 8 h. 3.Tin trin -M ha: thng thng, cc huyt khi c chuyn thnh m lin kt do m bo v t bo si non ca lp o trong xm nhp vo huyt khi. cc vi mch mi c ti to. cc huyt khi lc ny c gn cht vo thnh mch thuyn thnh mt m lin kt -huyt qun. Cc huyt khi c th ngm calcito nn si tnh mch (phlebolithe ). -Nhuyn ha dng m v khun: thng xy ra cc huyt khi ln, cha nhiu bch cu, khi t hy, n gii phng ra nhiu men lm tiu lng t huyt. -Nhuyn ha m nhim khun. -Di chuyn: cc huyt khi c th tch ri ton b hay mt phn di chuyn theo dng tun hon, dng li mt ni khc gy nn tc mch do huyt khi .

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V. TC MCH ( embolie)
1. nh ngha Tc mch l hin tng mch mu nui dng b t ngt lp kn do d vt t ni khc a ti gy nhi mu ph tng. 2.Nguyn nhn - 99% cc nghn l cn mu. - 1% cn li do t bo i,t bo K, git m, khng kh. 3. Gii phu bnh Tn thng gii phu bnh ca c quan ph tng b tc mch l cc loi nhi mu: nhi mu v nhi mu trng. S hnh thnh cc nhi mu ny ph thuc vo tnh cht ca vt tc, tnh cht ca m b tc giu hay ngho huyt qun ph. Di y l bng so snh gia 2 loi nhi mu: Hnh 5: tc mch phi
So snh v Bnh sinh: Nhi mu Mch mu b lp cn c tun hon ph Nhi mu trng Mch mu b lp l mch tn, khng c tun hon ph. tng c nh tim thn no t gp hn Trng xm hoc hi vng Nh nhi mu L mt hoi t c t hng cu thoi ha

V tr Tn xut Mu sc Hnh dng Vi th

ph tng xp nh phi, lch Hay gp tm Hnh nn ct,nh hng v ni b tc, y xoay ra ngoi L mt hoi t c nhiu hng cu thoi ha

VI.SC (Shock)
1. nh ngha L trng thi suy tun hon cp tnh dn n tnh trng h huyt p din bin nhanh d dng a n t vong do cc tc nhn mnh tc ng vo c th. 2. Nguyn nhn C rt nhiu nguyn nhn gy sc, cc nguyn nhn ny c th ring r hoc hoc phi hp vi nhau nh: sc chy mu, sc chn thng, sc phu thut ( trong phu thut ln, cng ko t chc nhiu), sc tim( do nhi mu c tim), sc nhim trng, sc phn v ( d ng thuc) 3. Gii phu bnh 3.1.i th Da: thng nht nht, cc mao mch di da co hay gin nhng khng cha mu. Ni tng: cc ph tng sung huyt, ph to, chy mu nhiu mc khc nhau: t chm chy mu cho n chy mu m lan ta trn b mt ph tng. 3.2. Vi th Mi ph tng u tn thng thun nht, ging nhau nh ph xung huyt, xut huyt.

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4.C ch ca sc Ngi ta cho rng: sc sinh ra do s mt cn bng gia khi lng mu trong c th ch c hn ( 5 lt) vi dung lng h tim mch khi b sc c th tng gp mt trm ln. S thiu oxy nng ca t bo( v oxy) ko theo mt lot nhng ri lon chuyn ha phc tp lm trm trng thm tnh trng thiu oxy to ra mt vng xon mi dn n sc khng hi phc.