3610

BI GING
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KHOA NI
I TNG: H IU DNG CAO NG (LU HNH NI B)
TRNG CAO NG Y T QUNG NAM
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BIN SON
Nguyn nh Tun
: Bs. B mn Ni, Trng Cao ng Y t Qung Nam
V Th Hng Hnh
L Tn Ton
Khoa Ni Trng Cao ng Y t Qung Nam
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MC LC
KHI NIM V BNH ................................................................................................. 3 KHI NIM V BNH NGUYN ............................................................................... 7 KHI NIM V BNH SINH .................................................................................... 11 KHI NIM V MIN DCH HC ........................................................................... 14 RI LON CHUYN HA GLUCID ........................................................................ 24 RI LON CHUYN HA PROTID ........................................................................ 29 RI LON CHUYN HA LIPID ............................................................................. 34 SINH L BNH H H HP..................................................................................... 37 SINH L BNH H TUN HON............................................................................ 41 SINH L BNH TIU HA ....................................................................................... 48 SINH L BNH CHC NNG GAN ........................................................................ 54 SINH L BNH CHC NNG THN...................................................................... 59 SINH L BNH QU TRNH VIM ........................................................................ 64 RI LON CHUYN HA NC- IN GII ...................................................... 67 RI LON THNG BNG ACID BASE ............................................................... 70 SINH L BNH IU HA THN NHIT ............................................................. 73 RI LON CU TO MU ...................................................................................... 80
Sinh l bnh Min dch
KHI NIM V BNH

(1 tit) MC TIU BI HC 1. Trnh by khi qut cc quan nim v bnh trong lch s y hc. 2. Trnh by c quan nim v bnh hin nay v cc thi k ca bnh. Bnh l g? t thi nguyn thy n nay, khi nim v bnh thay i nhiu qua thi gian. S thay i ny ph thuc 2 yu t:
Trnh vn minh ca x hi ng thi. Th gii quan (bao gm c trit hc) ca mi thi i.
Trong mt x hi, c th ng thi xut hin nhiu khi nim v bnh, k c nhng khi nim i lp nhau. Mt quan nim v bnh bao gi cng chi phi cht ch cc nguyn tc cha bnh, phng bnh. Do vy n c vai tr rt ln trong thc hnh. 1. Mt s khi nim v bnh trong lch s 1.1. Thi mng mui Ngi nguyn thy khi bit t duy cho rng bnh l s trng pht ca cc ng thn linh i vi con ngi. Vi quan nim nh vy, ngi xa cha bnh ch yu bng cch dung l vt cu xin (c th cu xin trc tip hoc qua nhng ngi hnh ngh m tn d oan). Tuy nhin, thi gian ny ngi nguyn thy bt u bit dng thuc t tho dc cha mt s bnh. 1.2. Thi cc nn vn minh c i 1.2.1. Trung Quc c i - Khong 2-3 ngn nm trc cng nguyn, y hc Trung Quc chu nh hng ln ca trit hc ng thi, cho rng vn vt c cu to t 5 nguyn t (Ng hnh: Kim, Mc, Thy, Ha, Th), tn ti di 2 mt i lp (m v Dng) trong quan h h tr hoc ch p ln nhau (tng sinh hoc tng khc). T dn n quan nim cho rng: + Bnh l do s mt cn bng m dng, ri lon quan h tng sinh tng khc ca Ng hnh trong c th. + T , nguyn tc cha bnh l iu chnh s mt cn bng : kch thch mt yu (b), ch p mt mnh (t). - Nhn xt: Quan nim v bnh y l duy vt, cc th lc siu linh bt u b loi tr khi vai tr gy bnh. Tuy nhin, y mi ch l trnh duy vt ht sc th s (cho rng vt cht ch gm 5 nguyn t); quan nim ny t ra bt bin trong nhiu
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ngn nm, khng vn dng c cc thnh tu v i ca khoa hc t nhin khc vo y hc. 1.2.2. Hy Lp v La M c i Ra i mun hn Trung Quc hng ngn nm. Gm c 2 trng phi ln: - Trng phi Pythagore (600 nm trc cng nguyn): cho rng vn vt do 4 nguyn t to thnh: Th (kh), Kh (m), Ha (nng), Thy (lnh). Trong c th, nu 4 yu t ph hp v t l, tnh cht v s cn bng s to ra sc khe; nu ngc li s sinh bnh. - Trng phi Hippocrat (500 nm trc cng nguyn): cho rng c th c 4 dch, tn ti theo t l ring, cn bng to ra sc khe, l: + Mu : do tim sn xut, mang tnh nng; ng nhn xt rng khi c th b st th tim p nhanh v da . l do tim tng cng sn xut mu . + Dch nhy: do no sn xut, mang tnh lnh; ng nhn xt rng khi c th b lnh th dch mi chy ra rt nhiu. + Mu en: do lch sn xut, mang tnh m. + Mt vng: do gan sn xut, mang tnh kh. Hippocrat c cng lao rt ln trong vic tch y hc ra khi nh hng ca tn gio, ch trng chn on bnh bng triu chng khch quan, cao o c y hc. - Nhn xt: Quan nim v bnh l duy vt v bin chng d cn th s. Nhng quan st trc tip ca Hippocrat kh c th (4 dch l c tht) v cho php kim chng c. Chnh v vy, Hippocrat c tha nhn l ng t ca y hc ni chung (c y hc c truyn v hin i) 1.2.3. Thi Phc hng - Th k 16-17, x hi thot khi thn quyn, khoa hc pht trin n r vi nhiu nh khoa hc ni ting nh Newton, Descarte, Vesali, Harvey - Gii phu hc (Vesali, 1414-1464) v Sinh l hc (Harvey, 1578-1657) ra i t nn mng vng chc y hc t c truyn tin vo thi k hin i. 1.2.4. Th k 18-19 y l thi k pht trin ca y hc hin i vi s vng mnh ca 2 mn Gii phu hc v Sinh l hc. Nhiu mn ca y hc v sinh hc ra i. Rt nhiu quan nim v bnh xut hin vi c im ni bt l da trn nhng kt qu c kim tra bng thc nghim v khng nh nh thuyt bnh l t bo ca Wirchow (ngi sng lp mn Gii phu bnh), thuyt ri lon hng nh ni mi ca Claud Benard (ngi sng lp mn Y hc thc nghim l tin thn ca mn Sinh l bnh).
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2. Quan nim v bnh hin nay 2.1. Hiu v bnh qua quan nim v sc khe - nh ngha ca WHO: Sc khe l tnh trng thoi mi v tinh thn, th cht v giao tip x hi. y l nh ngha mang tnh cht mc tiu x hi phn u, c chp nhn rt rng ri. - Tuy nhin, di gc y hc, cn c nhng nh ngha ph hp v cht ch hn. Cc nh y hc cho rng Sc khe l tnh trng lnh ln ca c th v cu trc, chc nng cng nh kh nng iu ha, gi cn bng ni mi ph hp v thch nghi vi s thay i ca hon cnh. T i n nh ngha: Bnh l bt k s sai lch hoc tn thng no v cu trc v chc nng ca bt k c quan, b phn, h thng no ca c th biu hin bng mt b triu chng c hiu gip cho thy thuc c th chn on xc nh v chn on phn bit, mc d nhiu khi cha r v nguyn nhn, bnh l hc v tin lng (T in y hc Dorlands 2000). 2.2. Xp loi bnh Thc t, ngi ta phn loi bnh theo: - C quan mc bnh: bnh tim, bnh gan, bnh thn, - Nguyn nhn gy bnh: bnh nhim khun, bnh ngh nghip, - Tui v gii: Bnh sn ph, bnh nhi, bnh tui gi, - Sinh thi, a d: Bnh x lnh, bnh nhit i, - Bnh sinh: bnh d ng, bnh t min, 2.3. Cc thi k ca mt bnh in hnh, mt bnh c th tri qua 4 thi k: - Thi k bnh (tim tng): khng c biu hin lm sng. Nhiu bnh cp tnh c th khng c thi k ny (bng, in git,). - Thi k khi pht: xut hin mt s triu chng u tin kh chn on chnh xc (xt nghim c vai tr rt ln) - Thi k ton pht: triu chng y v in hnh nht, tuy nhin vn c nhng th khng in hnh. - Thi k kt thc: C th khc nhau ty bnh, ty c th bnh nhn: khi, cht, di chng, tr thnh mn tnh, 2.4. Kt thc mt bnh (t vong) 24.1. Cht: L mt cch kt thc ca bnh. l mt qu trnh gm nhiu giai on: - Giai on tin hp hi: ko di vi gi n vi ngy biu hin bng kh th, h huyt p, try tim mch,
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- Giai on hp hi: cc chc nng dn dn suy gim ton b, xut hin cc ri lon c quan quan trng nh ri lon nhp tim, nhp th, co git, giai on ny ko di trung bnh 2 4 pht. - Giai on cht lm sng: cc du hiu bn ngoi ca s sng khng cn na do cc trung tm sinh tn no ngng hot ng. Tuy nhin, nhiu t bo ca c th vn cn sng, k c no. V vy, nhiu trng hp cht lm sng vn cn c th hi phc, nht l nu cht t ngt mt c th khng suy kit tr khi no cht hn. - Giai on cht sinh hc: no cht hn, in no ch l ng ng in, do vy ht kh nng hi phc. Tuy nhin, nhng t bo quen chu ng tnh trng thiu Oxy vn cn sng v hot ng kh lu, c quan ni tng ly ra vn cn c th ghp cho c th khc. 2.4.2. Cp cu hi sinh - Trng hp cht t ngt mt c th khng suy kit, v d do tai nn th cn c th hi sinh khi cht lm sng, ch yu bng hi phc h hp tun hon. Tri li, cht sau mt qu trnh suy kit (thng hp hi ko di) th khng th p dng cc bin php hi sinh. - No chu c thiu Oxy khong 6 pht, do vy, nu tnh li sau 6 pht cht lm sng c th li di chng no (nh hay nng, tm thi hay vnh vin). Trng hp c bit (lnh, mt mu cp), no c th chu ng trn 6 pht.
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KHI NIM V BNH NGUYN

(1 tit) MC TIU BI HC 1. Trnh by c cc quan nim sai lm v bnh nguyn trong lch s y hc. 2. Trnh by c quan nim v bnh nguyn hc hin nay. 3. Nu c phn loi bnh nguyn. NI DUNG 1. Khi nim 1.1. nh ngha nh nguyn hc l mn hc nghin cu v nguyn nhn gy bnh vi cc c im:
- Bn cht ca nguyn nhn. - C ch tc ng ca nguyn nhn gy bnh. - iu kin thun li v khng thun li nguyn nhn pht huy tc dng. 1.2. Mt s quan nim sai lm v bnh nguyn hc trong qu kh 1.2.1. Thuyt mt nguyn nhn (Monocausalism) - Ni dung: Ra i na sau th k 19, thuyt ny cho rng mi bnh u do vi khun gy ra. - Din bin: Do nh hng ca thuyt ny, ngi ta p dng n gii thch sai lch nhiu pht minh y hc. Chng hn, mt tc gi tm ra cch cha bnh Beri-Beri (bnh thiu vitamin B1) bng cm go nhng li cho rng bnh ny do vi khun (cha tm ra), v cm go c tc dng km hm s pht trin v kh nng gy bnh ca vi khun gi nh ny! Trong thc hnh y hc thi , rt nhiu bnh khng phi do nhim khun c iu tr nh bnh nhim khun gy hu qu nghim trng. 1.2.2. Thuyt iu kin (Conditionalism) - Ni dung: Thuyt ny ra i cng thi vi thuyt mt nguyn nhn. Cho rng gy c bnh phi c mt tp hp cc iu kin, mi iu kin quan trng ngang nhau, trong nguyn nhn cng ch l mt iu kin - Din bin: Pherorn, ngi ra thuyt iu kin khng nh nguyn nhn bnh khng tn ti, tm kim n l v ch. Gy ra bnh l mt chui lin tc cc iu kin din ra cho n khi bnh pht sinh, loi b mt trong s cc iu kin ny khng em li thay i g. ng a ra bng chng l: cng mc bnh lao nhng mi c th biu hin mt khc: nng, nh hoc thm ch khng c triu chng v ring vi khun lao th khng bao gi gy c bnh v ch mi l mt iu kin trong v s iu kin gy ra bnh lao (thiu dng, lao ng qu sc, ni ti tm, m thp,...)
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1.2.3. Thuyt th tng - Ni dung: Ra i khong u th k 20, cho rng bnh c th t pht khng cn nguyn nhn, bnh pht ra nng hay nh ty tng ca mi ngi. Nhng ngi cc oan nht cn cho rng mm bnh nm sn trong c th ta (tng), do vy khng th phng trnh c. - Din bin v kt qu: Cc thnh tu y hc chng minh rng yu t th tng l c tht nhng vai tr ca n khng phi l quyt nh trong gy bnh. Ngay c nhng bnh di truyn (tng nh t pht) cng c nguyn nhn: l s t bin gen do mt tc nhn vt cht m nhiu trng hp c lm sng t (Bnh Down). Th tng ch l mt iu kin c th d mc bnh ny hay kh mc bnh kia. Ngc vi thuyt iu kin (h thp vai tr ca nguyn nhn), thuyt th tng coi iu kin l nguyn nhn. C hai u dn ti thi tiu cc, bt lc trc bnh tt. 2. Quan nim hin nay v bnh nguyn Bao gm 4 yu t sau y, c lin h mt thit vi nhau: 2.1. Quan h nguyn nhn iu kin Trong quan h gia nguyn nhn v iu kin gy bnh th nguyn nhn l yu t quyt nh, l yu t khch quan. C th: - C bnh t phi c mt nguyn nhn no , c th c tm ra hoc cha tm ra. - Nguyn nhn quyt nh tnh c hiu ca bnh. Trong hu ht cc trng hp, bnh ny biu hin khng ging bnh kia l do chng c nguyn nhn khc nhau. Nguyn nhn iu kin thun
C th
Pht bnh Khng pht bnh Bnh tim tng
iu kin khng thun li li
- iu kin h tr v to thun li cho nguyn nhn. - C nguyn nhn i hi nhiu iu kin mi pht huy c tc dng, nhng cng c nguyn nhn i hi t iu kin. Thm ch c nguyn nhn dng nh khng cn iu kin g gy bnh, v d nh trong bng. 2.2. S hon i Nguyn nhn gy bnh trong trng hp ny c th l iu kin trong trng hp khc v ngc li. V d: n ung thiu thn l nguyn nhn ca suy dinh dng, ca cc bnh do thiu vitamin nhng ch l iu kin ca bnh nhim khun nh bnh lao... 2.3. Nguyn nhn bnh - Mi bnh u phi c nguyn nhn no m y hc c nhim v phi tm ra.
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- C nguyn nhn cha hn c hu qu: do thiu iu kin hoc do th tng v s phn ng tt ca c th (c th c min dch hoc thch nghi). Nhn thc ny rt quan trng trong thc hnh: nhiu bnh cha tm ra nguyn nhn hoc cha c thuc c tr nhng ngi ta vn khng ch c chng bng cch loi tr iu kin thun li ca chng. V d: bnh AIDS do nhim HIV ang c phng chng bng cch ny hoc tiu dit c bnh u ma nh tc ng vo iu kin l tim chng vaccine rng ri. 2.4. S phn ng ca c th - Tc dng ca nguyn nhn cn ph thuc vo s phn ng ca c th, bi vy, c th coi phn ng ca c th l mt iu kin ca s hnh thnh bnh. Cng mt nguyn nhn, mi c th c th phn ng rt khc nhau, do hu qu c th khc nhau. V d ung th gy t vong trong a s cc trng hp iu tr mun nhng c ghi nhn cc trng hp t khi. 3. Phn loi bnh nguyn Hin nay, bnh nguyn c phn loi thnh 2 nhm ln: (c tnh cht tng i) 3.1. Nguyn nhn bn trong 3.1.1. Yu t di truyn c coi l nguyn nhn bn trong ca mt s bnh v bnh nhn mang sn trong nhn t bo cc gen bnh do cha m truyn cho. C nhng h tc mang bnh di truyn qua nhiu th h lin tip. n nay xc nh c nhiu nguyn nhn bn ngoi (tia x, ha cht, c t vi khun, thiu Oxy) tc ng ln nhn t bo gy ra nhng ri lon cu trc gen nhiu mc . Mt s chng v bnh di truyn xut hin hay khng, nng hay nh cn ty thuc vo iu kin. V d chng tan mu do thiu men G6PD (Glucose 6 Phosphat Dehydrogenase) mng hng cu ch xut hin khi dng mt s thuc (thuc iu tr st rt, sulfamides) 3.1.2. Th tng (Diathesis) Tng l s tng hp cc c im chc nng v hnh thi ca c th, hnh thnh trn c s di truyn, a n cc phn ng c trng ca c th vi cc yu t kch thch. Do vy, tng kh n nh mi c th v c th truyn cho th h sau. V d nh tng tit dch, tng d ng, tng co git, tng d mp Y hc cha lm sng t c bn cht ca tng cng nh ch r tn v c tnh ca cc tng khc nhau. 3.2. Nguyn nhn bn ngoi 3.2.1. Yu t c hc Ch yu gy chn thng cho m, c quan
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3.2.2. Yu t vt l - Nhit : + Nu qu cao (> 500C) c th gy bin tnh cc protein (enzyme) trong t bo, nh hng xu n chc nng hoc lm cht t bo. + Nu qu lnh: gy t cng, hoi t. - Tia x: + Gy hy cc enzyme t bo + Tc ng ln AND ca t bo khi t bo ang phn chia. - Dng in: thng gy bng, ri lon nhp tim, co git. Ty thuc vo in p, din tip xc, in tr ca c th m tn thng khc nhau c th dn n t vong. - p sut: + Nu p sut kh quyn qu cao: c th gy tn thng ti ch (ting n ln gy thng mng nh) hoc ton thn (sc p do bom n c th gy tn thng ni tng) + Nu p sut kh quyn gim thp t ngt s gy tai bin tc mch. C ch: do kh Nit vn dng ha tan trong mu s bc thnh hi to ra bt kh gy tc mch. Bnh thng gp th ln, gi l bnh thng ln. - Ting n: c th gy ic vi cng cao hoc gy suy nhc thn kinh, mt mi, tng huyt p 3.2.3. Yu t ha hc v c cht Rt nhiu ha cht (v c, hu c, dc phm qu liu, nc c,) c th gy bnh ti ch hoc bnh ton thn ( hoi t, tan mu, suy gan, suy thn, hn m, co git,) 3.2.4. Yu t sinh hc Cc loi vi khun, virus, k sinh trng, nm,l nguyn nhn gy bnh ch yu trong x hi c mc sng thp
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KHI NIM V BNH SINH

(1 tit) MC TIU BI HC 1. Trnh by c tnh phn ng trong bnh sinh. 2. Trnh by c vn ton thn v ti ch trong bnh sinh. 3. Trnh by c quan h nhn qu v vng xon bnh l trong bnh sinh. NI DUNG
nh sinh hc l mn hc v c ch pht sinh, pht trin v kt thc ca mt bnh. Bnh nguyn hc v bnh sinh hc lin quan cht ch vi nhau: bnh
nguyn hc tm hiu bnh do u m c, cn bnh sinh hc nghin cu bnh xy ra nh th no, nhn t gy bnh tc ng trn c th v qu trnh bnh l din bin ra sao, tun theo nhng quy lut g. Ni dung ca bnh sinh hc bao gm: - Tnh phn ng ca c th trong bnh sinh hc. - Vn ton thn v ti ch trong bnh sinh hc. - Quan h nhn qu v vng xon bnh l trong bnh sinh hc. 1. Vai tr ca tnh phn ng trong bnh sinh 1.1. nh ngha: Tnh phn ng l kh nng p ng ca c th i vi mi kch thch bnh thng hoc bnh l. Tnh phn ng c th do i trc truyn li v hnh thnh thm trong cuc sng. 1.2. Cc yu t nh hng n tnh phn ng ca c th: Bao gm cc yu t: 1.2.1. Yu t tm thn kinh - nh hng ca thn kinh cao cp Thn kinh cao cp nh hng r rt n tnh phn ng ca c th: - Trng thi ca v no (hng phn hay c ch) qu trnh bnh l c nhiu thay i. V d: sc do truyn nhm nhm mu c th xy ra mt cch im lng ngi bnh hn m tri hn vi triu chng rm r xy ra ngi bnh tnh to. - Loi thn kinh: ngi c loi thn kinh yu th bt c cm gic au nh no ca c th, thng qua t m th v tm l lo lng c th tng l mc bnh nghim trng. Cc cm gic ny dn c khuch i thm ln gy ra cc triu chng bnh l. y l c ch pht sinh ca chng ri lon thn kinh chc nng. - Li ni v t tng: c th lm cho bnh nng thm ln hoc lm cho bnh gim i, tng cng sc chu ng vi bnh. Bng nhng bin php tm l n gin nh an i,
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thuyt phc, ng vin thy thuc c th lm cho ngi bnh an tm, tin tng s khi bnh, t mnh u tranh cho bnh chng khi. Tm l liu php rt cn thit i vi tt c cc chuyn khoa, ngi thy thuc d rt gii v chuyn mn song khng hiu tm l ngi bnh th kt qu iu tr nht nh b hn ch. - nh hng ca thn kinh thc vt - H giao cm chi phi nhng phn ng khng tch cc, do vy rt c tc dng khi c th cn huy ng nng lng chng li cc tc nhn gy bnh. Tri li, khi c th hao cn d tr th cng giao cm s lm bnh din bin xu v lm hao ph nng lng. - H ph giao cm c vai tr quan trng trong to trng thi trn tnh, tit kim nng lng, tng chc nng tiu ha v hp thu cn thit cho c th khi suy kit. 1.2.2. Yu t ni tit - ACTH v corticosteroids: nh hng n bnh sinh thng qua tc dng chng vim, c ch thc bo, c ch to khng th, gim tnh thm thnh mch, lm chm qu trnh to so, tn to glucose t protidNh vy, 2 loi ni tit t ny gp phn quan trng khi bnh nguyn gy ra nhng trng thi vim c cng qu mnh. Tc dng s xu i vi bnh sinh khi c th suy kit, b e da nhim khun hoc nhim khun m khng c cc loi khng sinh thch hp. - Thyroxin nh hng n bnh sinh thng qua tc dng gy tng chuyn ha c bn v tng to nhit. C vai tr rt ln trong phn ng to cn st v huy ng nng lng chng li tc nhn gy bnh. 1.2.3. Gii v tui - Gii Mt s bnh hay gp v d nng ln nam gii (ung th phi, lot d dy-t trng, nhi mu c tim); mt s bnh hay gp n gii (bnh t min, ung th v) - Tui Mi tui c nhng c im phn ng ring i vi bnh tt. Tnh phn ng yu khi cn nh, tng khi trng thnh v gim lc v gi. 1.2.4. Yu t mi trng - Thi tit Nhit mi trng, m, sc gi, u nh hng n bnh sinh ca nhiu bnh, lm cho bnh d pht sinh, ti pht hoc nng ln khi c thay i thi tit.
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- Ch dinh dng - Dinh dng nng lng, nht l dinh dng protein v vitamin nh hng r n bnh sinh ca nhiu bnh. Khi d tr protein gim st th t l mc cc bnh nhim khun tng ln r rt. - Cc vitamin nh vitamin A, vitamin nhm B, vitamin C u c tc dng tng cng sc khng, chng Oxy ha, tng cng qu trnh thc bo chng li cc bnh nhim khun. 2. Vn ton thn v ti ch trong bnh sinh hc Bnh l mt phn ng ton thn m biu hin ti ch l ch yu. Qu trnh bnh l ti ch ph thuc vo tnh trng ton thn v nh hng su sc n ton thn. 3. Quan h nhn qu v vng xon bnh l trong bnh sinh hc - Nhng bnh phc tp thng din bin qua nhiu khu theo trnh t nht nh v c lin quan mt thit. V d trong s sau y ca bnh thp tim:
Lin cu Vim hng Vim mng trong tim Tn thng van Suy tim
Nh vy, trong qu trnh bnh sinh, nguyn nhn ban u gy ra nhng hu qu nht nh. Nhng thay i ny li tr thnh nguyn nhn ca nhiu ri lon tip theo kt qu l qu trnh bnh l khng ngng pht trin, bnh ngy cng nng thm. - Nhim v ca thy thuc l thy c mi quan h nhn qu gia cc hin tng bnh l, kp thi pht hin nhng thay i ch yu trong qu trnh bnh sinh c cch iu tr thch ng. l iu tr bnh sinh. V d trong suy tim, trng tm ca iu tr l phc hi sc co bp ca c tim kt hp vi ch ngh ngi gim bt gnh nng i vi c tim b suy.
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Sinh l bnh Min dch
KHI NIM V MIN DCH HC

(4 tit) MC TIU: 1. Trnh by c cc c ch khng chuyn bit v chuyn bit tham gia vo min dch khng c hiu. 2. Trnh by c cc thuc tnh c bn ca min dch c hiu. 3. Trnh by c cc thnh phn v phng thc p ng min dch c hiu. NI DUNG 1. M u Sinh vt trong mi trng sng buc phi trao i tch cc vi mi trng tn ti, pht trin v sinh sn. S trao i ny l cn thit tuy nhin n cng thng xuyn mang li cc nguy c c hi cho sinh vt bi v mi trng sng lun cha y nhng tc nhn gy bnh, c bit l cc tc nhn vi sinh vt. that khi cc nguy c ny, trong qu trnh tin ha sinh vt a hnh thnh v hon thin dn cc h thngchc nng bo v cho chnh mnh, mt trong cc h thng l h thng min dch. Min dch hc l mn hc nghin cu nhng hot ng sinh l cng nh bnh l ca h thng min dch. H thng min dch c th chia lm h thng min dch khng c hiu (MDKH) v h thng min dch min dch c hiu (MDH). Thut ng min dch khng c hiu cn c cc tn gi khc nh min dch t nhin, min dch bm sinh. Thut ng min dch c hiu cng c cc tn gi khc nh min dch thu c, min dch thch nghi. Trong lch s tin ha ca h min dch, cc p ng min dch khng c hiu c hnh thnh rt sm v pht trin n lp ng vt c xng sng th cc p ng min dch c hiu mi c hnh thnh. thc hin c chc nng bo v cho c th, hai loi p ng min dch trn a hp tc, b tc, khuych i v iu ha hiu qu ca p ng min dch. 2. H thng min dch khng c hiu H thng min dch khng c hiu l hng ro bo v u tin ca c th chng li s xm nhp ca vi sinh vt v cc yu t l khc. Chng bao gm cc thnh phn khng chuyn bit (cn mt s chc nng khc) v chuyn bit thc hin chc nng min dch. 2.1. Cc c ch khng chuyn bit tham gia vo p ng MDKH 2.1.1. C ch c hc
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Sinh l bnh Min dch
S nguyn vn ca da nim mc l hng ro bo v, ngn chn s xm nhp ca vi sinh vt. Mi s tn thng nh trong bng, rch da hoc cc th thut tim truyn u lm tng nguy c nhim trng. Ngoi ra cn c cc hot ng c hc ca lp tim mao nhy ca h thng ng h hp trn nhm loi b v tng kh cc vi khun,
cht thi ra ngoi. Cc phn x ho, ht hi cng cho kt qu nh vy. S lu thng v nhu ng ca ng tiu ha, ng tit niu, ng mt ngn cn s pht trin ca vi khun. 2.1.2. C ch ha hc Trong cc dch tit t nhin c cha cc ha cht c tc dng dit khun khng chuyn bit. V d cc axit bo trong tuyn b, pH thp ca dch m o hn ch s tng trng ca vi khun. toan cao trong dch v c kh nng loi b hu ht cc vi khun. 2.1.3. C ch sinh hc Trn b mt da, ng tiu ha thng xuyn c mt cc vi khun cng sinh khng gy bnh. Cc vi khun ny ngn cn s pht trin ca cc vi khun gy bnh bng cch cnh tranh cht dinh dng, tit ra cc cht km khun nh colicin i vi vi khun ng rut. 2.2. Cc c ch chuyn bit tham gia vo p ng MDKH 2.2.1. Cc thnh phn dch th - Lysozym L enzym c trong nc mt, nc bt, nc mi, da (trong huyt thanh hm lng rt thp). Lysozym c kh nng ct cu ni phn t ca mng vi khun, do c kh nng lm ly gii mt s vi khun gram dng. Cc vi khun gram m nh c v bc ngoi l peptidoglican nn khng b ly gii trc tip. Tuy nhin khi v ngoi b thng do tc dng ca b th th lysozym s hip lc tn cng mng vi khun. - Cc protein vim
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Sinh l bnh Min dch
L cc protein c to ra trong pha cp ca phn ng vim nh CRP (C-Reactive Protein,

1
antitrypsin,
antichymotrypsin, haptoglobin). Trong CRP c sn
xut sm nht v c th tng gp 100 ln so vi bnh thng. V vy trong lm sng s dng nh lng CRP huyt thanh chn on v theo di vim ni chung. - Interferon (IFN) L mt nhm cc polypeptid c sn xut do cc t bo nhim virut tit ra (Interferon v ) hay do cc t bo lympho T hot ha (Interferon- ). Cc interferon c nhiu hot tnh sinh hc nh cn tr s xm nhp v s nhn ln ca virut, km hm s tng sinh ca ca mt s t chc u, c kh nng hot ha cc i thc bo v tng biu l cc khng nguyn ha hp m gip cho qu trnh nhn din khng nguyn ca t bo lympho T. Cc hot tnh ny khng c tnh c hiu vi khng nguyn, c th xy ra vi tt c loi virut nn interferon c xp vo h thng min dch khng c hiu. - B th (Complement, C) H thng b th bao gm khong 25 loi protein huyt thanh tham gia vo c ch khng t nhin ca c th v c p ng min dch c hiu. Trong huyt thanh b th c sn xut di dng khng hot ng v c hai con ng hot ha b th: - Con ng c in: bt u t C1q v khi ng bi phc hp khng nguyn v khng th (KN-KT), trong khng th thuc loi IgG hoc IgM. - Con ng tt: khng ph thuc vo c ch min dch c hiu (khng cn c s hin din ca khng th v khi ng t C3). Cc vi sinh vt v nhiu cht khc c th li hot ha b th theo con ng tt nh trc khun Gram (+) hay gr (-), virut Dengue (st xut huyt, nm, k sinh trng, v mt s cht khc nh polysaccharid vi khun (vi khun lao, ph cu). 2.2.2. Cc thnh phn t bo - Cc bch cu ht Chim a s trong bch cu mu ngoi vi (60-70%), c i sng ngn (3-4 ngy). Trong nhm ny bch cu ht trung tnh chim a s v tham gia tch cc vo phn ng vim, chng c kh nng thc bo v trong bo tng c cc ht cha nhiu enzym tiu m, enzym thy phn nh myeloperoxydase, elastase, cathepsin G, hydrolase, lactoferin, collagenase, lysozym. Cc bch cu i toan c vai tr trong khng i vi k sinh trng, phn ng d ng ti ch. Cc bch cu i kim c vai tr tng t nh t bo mast do trn b mt t bo c cc th th i vi mnh Fc ca khng th IgE (FceR). Cc t bo c hot ha khi c hin tng bt cu (lin kt cho) gia cc IgE v khng nguyn c hiu gii phng v tng hp cc hot cht trung gian nh histamin, serotonin, leucotrien.
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Sinh l bnh Min dch
- Bch cu n nhn Cc t bo ny c ngun gc t ty xng lu hnh trong h tun hon, nhng khi xm nhp vo cc t chc th bit ha thnh cc i thc bo vi cc tn gi khc nhau nh t bo Kupffer, t bo bch tuc, t bo xe ngn tay. Chng c kh nng thc bo rt mnh nn c vai tr trong dn dp cc vt l, cc t chc b ph hy, t bo gi ci. Kh nng thc bo ca cc bch cu ht trung tnh , bch cu n nhn / thc bo ph thuc vo s lin kt gia vi sinh vt i vi cc th th b mt ca t bo nh th th i vi C3b. Ngoi ra cc t bo n nhn/i thc bo cn tham gia ch ng p ng min dch c hiu bng cch bit ha thnh cc t bo c chc nng trnh din KN cho cc t bo lympho T v tit ra cc cytokin (IL1, TNF,...) m u cho p ng min dch c hiu. - T bo NK (natural killer cells) C mt trong tun hon ngoi vi v c t l t 5-15% cc t bo lympho. V hnh thi th n ging t bo lympho nhng c nhng ht ln trong bo tng, t bo NK khng c cc du n (marker) b mt ca t bo lympho T v t bo lympho B. T bo NK c kh nng dit cc t bo ung th, t bo nhim vi rut m khng cn c mn cm trc v khng b gii hn bi phc hp ha hp m (khng c tnh c hiu). 3. H thng min dch c hiu 3.1. Cc thuc tnh c bn ca MDH 3.1.1. Tnh c hiu p ng min dch c hiu c ngha l cc khng th hay cc t bo lympho T hiu qu ch c th gn vi khng nguyn hay chnh xc l cc quyt nh khng nguyn c tip xc trc . V d: nu ta tim chng phng bnh un vn th hot tnh min dch ch bo v cho c th chng li bnh un vn m thi. 3.1.2. Tnh phn bit cu trc bn thn v cu trc l Bnh thng h thng min dch khng to ra p ng min dch gy tn thng cho cc cu trc bn thn trong khi chng li c kh nng thi loi cc cu trc ngoi lai t c th khc (khng cng thuc tnh di truyn). 3.1.3. Tr nh min dch p ng min dch c to ra khi tip xc vi khng nguyn ln th nht khc vi p ng min dch khi tip xc vi chnh khng nguyn ln th hai c gi l p ng th pht : p ng min dch th pht xy ra nhanh hn, mnh hn v c th chuyn th ng bng cch truyn cc t bo lympho mn cm. 3.2. Cc yu t dch th tham gia p ng MDH
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Sinh l bnh Min dch
Khng th l yu t dch th tham gia vo p ng min dch c hiu v c hai dng: - Dng lu hnh t do trong dch th c kh nng kt hp vi cc khng nguyn (QKN) ho tan c hiu dn n cc thay i sinh hc. - Dng biu l trn b mt cc t bo lympho B, c vai tr l th th khng nguyn ca t bo B cn c gi l cc globulin b mt (sIg). V bn cht, khng th l mt globulin v chng c nhng c im cu trc thc hin c chc nng min dch nn c gi l globulin min dch (immunoglobulin). Cn c vo s di chuyn trn in trng ngi ta cn gi chng vi tn chung l globulin gamma, tuy nhin thc t cn c cc lp di chuyn trn in trng thuc c khu vc globulin v . Cc globulin min dch c kh nng nhn dng rt nhiu quyt nh khng nguyn khc nhau. Khi kt hp vi khng nguyn c hiu, khng th c kh nng hot ha b th v khi b th c hot ha s dn n nhiu hot tnh sinh hc khc nh hin tng opsonin ha to iu kin d cho thc bo, ly gii t bo ch, trung ha cc c t ca vi khun, gy c t bo ph thuc khng th (ADCC). 3.3. Cc thnh phn t bo tham gia p ng MDH Cc t bo tham gia p ng min dch c hiu ch yu l cc t bo lympho c ngun gc t t bo mm trong ty xng, sau bit ha theo hai con ng khc nhau to nn hai qun th lympho c chc nng khc nhau: t bo lympho T v t bo lympho B. T bo lympho T bit ha tuyn c, chu trch nhim v p ng min dch qua trung gian t bo trong khi t bo lympho B bit ha trong ti Fabricius loi chim v trong ty xng cc ng vt cp cao khc, khi cc th th b mt t bo lympho B kt hp vi cc khng nguyn c hiu v cng vi cc tn hiu khc s lm cho t bo lympho B tng sinh ri bit ha thnh cc tng bo sn xut ra khng th c tnh c hiu tng ng. Ngoi ra thc hin c chc nng min dch c hiu cn c cc t bo khc cng tham gia vo nh t bo trnh din khng nguyn, dng bo, bch cu ht trung tnh..v..v.. 3.4. Cc phng thc p ng MDH C ch p ng min dch c hiu c th hin hoc bng cch to ra cc khng th hoc qua trung gian ca cc t bo lympho T hoc c hai. Phng thc p ng kiu no ty thuc bn cht v v tr xm nhp ca khng nguyn. 3.4.1. Min dch dch th
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Sinh l bnh Min dch
Cc khng th c th bt ng cc vi sinh vt, ngn cn kh nng dnh ca vi sinh vt vi cc th th trn b mt ca t bo thc bo, trung ha c t, hot ha b th lm ly gii t bo ch, hin tng opsonin ha lm d cho s thc bo. Khng th c to ra bi cc tng bo do s bit ha v tng sinh dng t bo lympho B c kch thch bi cc khng nguyn. S tng tc gia khng nguyn v t bo lympho B c th xy ra bi hai c ch: Ph thuc t bo lympho T Hoc khng ph thuc t bo lympho T.
C ch hot ng ca globulin min dch i vi tc nhn gy bnh - p ng min dch dch th khng ph thuc t bo lympho T p ng ny c quyt nh bi cu trc ca khng nguyn, c bit l cc phn t c cu trc trng lp vi cc quyt nh khng nguyn lp li, v d nhim trng Streptococcus pneumoniae. Do tnh cht cu trc nh vy s lm cho cc t bo thc bo nhn din d dng cc quyt nh khng nguyn v to nn nhng lin kt cho, kch thch s hot ha t bo lympho B bit ha thnh tng bo sn xut khng th . Nh vy s hot ha t bo B lc khi u l khng ph thuc t bo lympho T, khng th to ra ch yu l IgM v khng c tr nh min dch v p ng min dch khng bn vng. - p ng min dch dch th ph thuc t bo lympho T
19
Sinh l bnh Min dch
p ng ny c vai tr rt ln trong min dch chng nhim trng c c t, v d bnh bch hu v un vn. Khi khng nguyn kt hp vi cc th th b mt t bo, s c nhp ni bo trong cc ti thc bo (phagosome). y khng nguyn s phn ct thnh cc peptid bi cc enzym t bo. Sau cc peptid s c vn chuyn n b mt t bo cng vi phn t ha hp m ch yu bc II, gi tt l MHC bc II. Phn t MHC trnh din peptid khng nguyn vi th th c hiu ca t bo lymphoTCD4+ (t boTh2) gi tt l TCR (T cell receptor).
Cc hnh thc p ng min dch dch th 3.4.2. p ng min dch qua trung gian t bo p ng min dch qua trung gian t bo c th thc hin qua hai c ch: (1) lin quan n t bo lympho TCD4+ ( t bo Th1 ) nhn din khng nguyn do phn t MHC bc II trnh din trn b mt cc i thc bo, (2) lin quan n t bo lympho TCD8+( t bo T c tay gi tt l t bo Tc), nhn din khng nguyn do phn t MHC bc I trnh din trn cc t bo c nhn . - Vi sinh vt gn ti thc bo (p ng ca t bo lympho TCD4+) Khi cc vi khun lao, vi khun phong xm nhp vo c th, vi sinh vt lp tc c thc bo. Trong t bo cc vi khun pht trin cc c ch ngn cn s ph hy ca i thc bo v d sn xut fibronectin, cc enzym kh con ng dit khun cn oxy, ngn cn ha mng vi cc th tiu bo. Cc vi khun nhn ln trong cc ti ni bo v sn xut cc peptid , cc peptid s c vn chuyn n mng v c phn t MHC bc II trnh din vi t bo Th1. T bo Th1 sn xut IL-2, IFN-g, TNF (tumour necrosis factor) tc ng tr li i thc bo, ring IFN-g v TNF-a hip ng tc ng trn hai con ng dit khun ca i thc bo (ph thuc oxy v khng ph thuc oxy). TNF-a c vai tr to u ht,
20
Sinh l bnh Min dch
yu t ha hng ng cc bch cu v bc l cc yu t dnh trn b mt cc t bo ni mc gip cc bch cu xuyn mch.
p ng min dch c hiu i vi mycobacterium - Khng nguyn vi sinh vt t do trong bo tng (p ng ca t bo TCD8+) Ph bin nht l cc khng nguyn virut, mc du mt s vi khun nh Listeria monocytogenes c th thot khi cc ti ni bo vo bo tng. Cc virut vo t bo bng cch gn vo cc th th c hiu, v d th th CD21 i vi virut EpsteinBarr, th th CD4 i vi phn t gp120 ca HIV,... V tr phn b cc th th l mt trong cc yu t quyt nh i tnh t chc ca vi sinh vt. V d : cc virut bnh di gn vi th th acetylcholin c cc tip hp thn kinh, do c kh nng truyn mm bnh n thn kinh trung ng. Mt khi vo t bo , cc virut sao chp v dch m, cc protein ca vi rut vo bo tng v vn chuyn n h li ni m th , sau chng c vn chuyn cng phn t MHC bc I n mng t bo trong nhng ci ti. Phc hp peptid KN-MHC c nhn din bi cc th th c hiu vi khng nguyn c trn t bo lympho TCD8+ (Tc), nhng t bo ny c kh nng tiu dit t bo ch bng cc enzym t t bo lympho Tc vo t bo ch v gy cht t bo (apoptosis). Ngoi ra cn c c ch th hai thng qua cc cytokin TNF-a, IFN-g do t bo lympho Tc tit ra s iu bin s tng hp protein t bo ch gy cht t bo.
21
Sinh l bnh Min dch
p ng min dch c hiu i vi cc vi rt 4. ng dng gy min dch phng nga nhim trng Ngn nga bnh bng c ch min dch a chng t s hiu bit v bnh nhim trng hoc kh nng min dch ca lch s loi ngi, v d dng vy u ma ngi nhm ngn nga bnh u ma a c nhc n t 590 nm trc cng nguyn ti Trung Quc. Ngy ra i ca ngnh min dch hc nh du bi s thnh cng ca Edward Jenner trong chng nga u ma (1798) v gn mt th k sau, ngi ta hiu bit v vn chng nga nh nhng thnh cng ca L. Pasteur. Thi k ng ghi nh cho vic gy min dch ngi l nm 1885. Cu b Joseph Meister a c tim vc xin chng bnh ch di ln u tin. 4.1. Min dch ch ng Min dch ch ng t cn bn trn c ch min dch tng ng vi s khng vi tc nhn vi sinh vt, c th thc hin c m khng c nguy c gy nhim trng cho vt ch. Mc p ng c c ph thuc vo min dch t nhin i vi bnh. V d cc khng th lu hnh trong mu trc tip i vi ph cu khun s ngn cn kh nng nhim bnh nng do chng lm cho vi khun nhy cm hn vi cc c ch thc bo. Kch thch p ng min dch c th thc hin vi polysacarid vch t bo vi khun m khng cn gy nhim vi ph cu khun thc s. Khi c gy mn cm vi khng nguyn, c th s khi ng mt lot p ng mc t bo v dch th, in hnh vi nhng tnh cht: c hiu, a dng, hiu ng phn t v c tr nh min dch.
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Sinh l bnh Min dch
4.2. Min dch th ng Min dch th ng do s dng khng th c hiu. Thc t thng dng iu tr cc bnh gy ra bi c t nh un vn, khng th chng nc c ca rn. Min dch th ng thng ngn do khng th b ging ho trong khi p ng min dch ch ng khng c to ra, khng c tr nh min dch nn vt ch khng c bo v trong ln nhim sau. Min dch th ng xy ra thi k s sinh do khng th thuc lp IgG ca m truyn qua nhau thai cung cp tm thi kh nng bo v i vi nhim trng trong thi k u sau sinh. Mt khi khng th ca m ging ho th a tr s nhy cm nhim trng tr khi n pht trin c p ng min dch ch ng. Min dch th ng s dng globulin min dch ngi, huyt thanh ng vt hoc huyt tng v cc ch phm ca chng. Cn quan tm n cc phn ng phn v, bnh huyt thanh, nhim trng km theo nh nhim vi rut vim gan B..v..v..
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Sinh l bnh Min dch
RI LON CHUYN HA GLUCID

(2 tit) MC TIU BI HC 1. Trnh by c chuyn ha bnh thng ca glucid trong c th. 2. Trnh by c cc ri lon chuyn ha glucid thng gp. NI DUNG 1. i cng v chuyn ha Glucid 1.1. ng i - Glucid l ngun nng lng ch yu v trc tip ca c th, ngoi ra n cng c vai tr cu to v chc nng. Trong c th ngi, glucid tn ti di 3 dng ch yu: + Dng d tr: Glycogen, tp trung nhiu gan v c.
Rut Acid lactic Glucid Gan Glycogen 1,4 Nc tiu Glucose 1,2 M m 1,0 Glucose Glucose 0,8 1,6 T bo c 1,8
Hnh 1: B sung v tiu th Glucose trong mu Mu
+ Dng vn chuyn: Glucose trong mu v cc dch ngoi bo. + Dng tham gia cu to t bo v cc cht khc: Pentose trong thnh phn acid nucleic (AND, ARN), glucid phc tp tham gia cu to mng t bo, mng cc bo quan (glycoprotein, glycolipid), Heparin l mt mucopolysaccarid c tc dng chng ng mu - Nh cc men ca ty v rut, cc polysaccarid v disaccarid ca thc n bin thnh monosaccarid (ch yu l glucose, fructose v galactose) ri c hp thu.
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Sinh l bnh Min dch
- Theo tnh mch ca, glucid qua gan v b gi li phn ln y. Gan l c quan d tr glucid (di dng cao phn t l glycogen) quan trng nht ca c th duy tr cn bng ng huyt. Ngoi ra, gan cn sn xut mt lng glucid t cc acid amin ca thc n hoc do s thoi bin protein trong c th: gi l s tn to glucid. D thu nhn loi monosaccarid no, khi thoi bin glycogen, gan ch phng thch glucose vo mu. - C d tr ti 250g glucid cho nhu cu ring ca mnh. Sau co c, c b sung glucid t mu v c th lm mc glucose trong mu gim r rt. - Glucose mu khuch tn t do qua vch mao mch vo gian bo. Mt s t bo cho glucose thm d dng vo trong t bo m khng cn c insulin (t bo no, gan, hng cu), a s t bo cn li i hi phi c insulin mi thu nhn c glucose. Trong t bo, glucose ch yu bin thnh nng lng ATP dng cho hot ng ca t bo. - Nu c th c b sung nhiu glucid, phn tha s c bin thnh acid bo v mt s acid amin. Nu thiu, c th s thoi bin m v protid b p phn nng lng thiu ht. Khi glucose trong mu > 1,8g/ lt, s xut hin glucose trong nc tiu v qu kh nng hp thu ca ng thn. (Hnh 1) 1.2. Chuyn ha
Glycogen Galactose Glucose Fructose
G.1.P G.6.P F.6.P
Chu trnh Pentose
Phosphoglyceraldehyd Acid pyruvic Protid Acid amin
Acid lactic
Acetyl CoA
Acid bo
Lipid
Th Ceton Acid oxalo acetic Cholesterol
Chu trnh Krebs t bo

Acid cetoglutaric Acid citric
Hnh 2: Cc bc ch yu ca chuyn ha glucid trong t bo Khoa Ni Trng Cao ng Y t Qung Nam
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Sinh l bnh Min dch
Vo t bo, lp tc glucose (c fructose v galactose) bin thnh glucose-6-phosphat (G.6.P) di tc dng ca men hexokinase. T y, ty theo nhu cu v ty loi t bo m G.6.P c th theo cc con ng sau: - Tng hp thnh Glycogen d tr ch yu xy ra gan v c. - Kh phosphate cung cp li glucose cho mu xy ra gan. - Thoi bin thnh Acid pyruvic ri Acetyl CoA vo chu trnh Krebs cho nng lng, CO2, H2O xy ra ty lp th ca mi t bo: gi l con ng ng phn. - Tham gia chu trnh Pentose to ra acid bo xy ra gan, m m trong trng hp tha G.6.P v vi s h tr ca insulin. (Hnh 2) 1.3. iu ha glucose mu - Bnh thng, mc glucose mu khong 1g/lt. - Khi c th tng cng s dng glucid (st, lao ng nng, hng phn thn kinh), glucose mu s tng n 1,2 1,5g/lt. Khi c th ngh ngi, glucose mu gim cn khong 0,8g/lt. - Khi glucose mu > 1,8g/lt, c th xut hin glucose trong nc tiu do vt qu ngng hp thu ca thn. - Khi glucose mu < 0,6g/lt, cc t bo ca c th nht l t bo thn kinh b thiu nng lng, c th dn n hn m v t vong nu khng x tr kp thi. C 2 yu t chnh tham gia iu ha v n nh glucose mu: 1.3.1. Yu t ni tit - Insulin Insulin lm gim glucose mu rt nhanh v mnh nh 2 tc dng chnh: - Lm glucose nhanh chng vo t bo v nhanh chng c s dng (tng hp glycogen, m, acid amin v thoi bin) - Lm gim thoi bin cc cht to ra glucose (glycogen, protid, lipid) - Adrenalin C vai tr hot ha men phosphorylase ca gan, do lm thoi bin glycogen gy tng glucose mu. - Glucagon C ch tc dng tng t nh Adrenalin nhng lm tng glucose mu ko di hn. - Glucocorticoid ca v thng thn Lm tng glucose mu do ngn cn glucose thm vo t bo (tr t bo no) v tng tn to glucose t protid. - Growth Hormone (GH, STH) c ch men hexokinase, tng thoi bin glycogen, hot ha men Insulinase (hy Insulin), do lm tng glucose mu
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Sinh l bnh Min dch
1.3.2. Yu t thn kinh - Th nghim c in ca Claude Bernard chm kim vo sn no tht 4 lm tng ng huyt v th nghim ca Bykov gy tng ng huyt bng phn x c iu kin. - S hng phn ca v no v h giao cm (stress) lm tng glucose mu. - Vai tr ca vng di i thng qua h ni tit iu ha glucose mu: + Ngi ta pht hin mt trung tm vng di i (gi l trung tm A) gm nhng t bo thn kinh khng cn Insulin cng thu nhn c y glucose t mu nng 0,8g/lt. Khi glucose mu gim, trung tm A kch thch tit adrenalin, glucagons, lm tng glucose mu + Trung tm B: i din cho ton b t bo cn li ca c th cn insulin mi s dng c glucose mc 0,8 1,0g/lt. Mt khc, t bo loi ny s dng c th ceton nh mt ngun nng lng b sung quan trng. Khi thiu insulin, trung tm B s huy ng mi c ch ni tit lm tng glucose mu rt cao thm vo t bo nh s chnh lch ln ca nng (do s thi ra ngoi qua nc tiu), mt khc n huy ng m rt mnh (thoi bin m, tng tng hp th ceton) v huy ng protid to glucose lm tng glucose mu. 2. Ri lon chuyn ha glucid 2.1. Gim glucose mu Khi glucose mu gim di 0,8g/lt 2.1.1. Nguyn nhn - Ri lon kh nng hp thu glucid - Thiu men phn gii glucid ca ty v rut. - Gim hp thu rut: ct on rut, vim rut, - Ri lon d tr gan - Gim d tr gan: trong vim gan, x gan, suy gan, - Thiu bm sinh mt s men gan gy ng glycogen lm h glucose mu khi i. - Tng mc tiu th Tiu th glucid tng trong tt c cc trng hp i hi tng nng lng ca c th nh: co c, run, st ko di, - Ri lon iu ha thn kinh ni tit - Cng ph giao cm hoc c ch giao cm. - Gim tit cc ni tit t c tc dng lm tng glucose mu nh adrenalin, glucagons, GH, hoc tng tit insulin trong u t bo ca o ty. 2.1.2. Hu qu - Thiu G6P trong t bo gy cm gic i. - Run tay chn, nhp tim nhanh, v m hi do kch thch h giao cm.
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Sinh l bnh Min dch
- Rut tng co bp, d dy tng tit dch (cm gic cn co), hoa mt, yu tay chn, - Khi glucose mu gim nng < 0,6g/ lt, cc t bo thiu nng lng, cc chc phn b ri lon nht l t bo no, tim,c th dn n hn m v t vong. 2.2. Tng glucose mu Khi lng glucose mu > 1,2g/lt. 2.2.1. Nguyn nhn - Cc nguyn nhn ngc vi tnh trng gim glucose mu trn. - Xy ra trong v sau ba n nhiu glucid. - Gim tiu th glucose trong trng hp thiu oxy (ngt, gy m). - Thiu vitamin B1 gy tr acid pyruvic lm glucose khng c tiu th trong t bo. - Cng giao cm, u no lm trung tm B km nhy cm vi insulin, bnh ni tit lm gim tit insulin, tng tit cc hormone lm tng ng mu hoc tng hot tnh ca insulinase, c khng th khng insulin trong mu. 2.2.2. Hu qu - Tng glucose mu ni chung khng c g c cho t bo nhng n lm tng p lc thm thu gy tiu nhiu ng thi gy mt Natri, Kali v xut hin ng trong nc tiu khi vt qu ngng hp thu ca thn. - Tng glucose mu do ri lon ni tit nht l ri lon bi tit insulin ca t bo o ty th ri lon chuyn ha glucid rt trm trng gp trong bnh i tho ng (s hc trong iu dng ni khoa).
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Sinh l bnh Min dch
RI LON CHUYN HA PROTID

(2 tit) MC TIU BI HC 1. Trnh by c chuyn ha bnh thng ca protid trong c th. 2. Trnh by c cc ri lon chuyn ha protid thng gp. NI DUNG 1. i cng v chuyn ha Protid 1.1. Vai tr ca protid trong c th Protid l cht to hnh quan trng ca c th. Qu trnh sng l qu trnh thoi ha v tn to thng xuyn ca protid. Cc chc nng chnh ca protid l: 1.1.1. Chc nng cu trc - Protid l cht to nn nhn, nguyn sinh cht, mng t bo. - Protid xy dng cc m, c quan, gip c th vn ng v chng c hc. 1.1.2. Chc nng iu ha, cn bng ni mi - Tt c cc phn ng ha hc, cc qu trnh sinh hc nh ng mu, chy mutrong c th u c hot ha v iu ha bi cc protid c bit gi l enzyme. - Cc hormone tham gia iu ha v thng nht hot ng ca cc h c quan cng l protid. - Protid tham gia kim sot thng tin di truyn gip cho cc t bo trng thnh. 1.1.3. Chc nng vn chuyn Cc thnh phn protid c chc nng vn chuyn trong c th rt nhiu, c th k nh Hemoglobin vn chuyn O2 v CO2, albumin vn chuyn bilirubin v acid bo, transferin vn chuyn st, 1.1.4. Chc nng bo v Cc khng th, i thc bo, vi thc bo cng l protid chng li s xm nhp ca khng nguyn bo v c th. 1.1.5. Chc nng cung cp nng lng Protid cng c vai tr l ngun nng lng cho c th khi khng c lipid v glucid. 1.2. Ngun gc - n v cu to ca protid l cc acid amin. C 20 acid amin tham gia cu to nn protid ca c th trong 12 loi c th c th t tng hp nh phn ng chuyn amin, cn li 8 acid amin phi c b sung t thc n - Trong ng tiu ha, nh cc men tiu protid ca ty v rut, thc n protid b thoi ha thnh cc acid amin v c hp thu. Qua gan, vi h thng men kh amin, kh
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Sinh l bnh Min dch
carboxyl v transaminase, cc acid amin c iu chnh cho ph hp vi nhu cu ca c th. - Nim mc ng tiu ha thng ch hp thu acid amin nhng trong mt s trng hp, mt s dipeptid thm ch polypeptid cng lt qua c v c th tr thnh khng nguyn gy d ng vi protid l qua ng tiu ha. 1.3. Tng hp protid Ngun acid amin tng hp protid ca c th l: - Acid amin ca thc n (chim 1/10 nhu cu). - Acid amin ti s dng ca qu trnh ging ha (chim 9/10 nhu cu). - Mt s acid amin do c th t tng hp bng phn ng chuyn amin. y l nhng acid amin thuc nhm khng thit yu. 1.4. Ging ha protid Cc acid amin ca qu trnh ging ha protid: - 90% c ti s dng tng hp protid ca c th. - 10% cn li c oxy ha cho nng lng hoc tham gia tng hp lipid, glucid. Khu phn n hng ngy phi b p c s hao ht ny. Qu trnh ging ha protid qua nhiu khu trung gian phc tp: - Cc enzyme ca cc m nh catepsin, protease phn hy protid ca cc t bo b thoi ha cung cp acid amin c th ti s dng. - Phn ng chuyn amin (do enzyme Transaminase m nhim) gip c th t tng hp hoc phc hi mt s acid amin. - Phn ng kh carboxyl (do enzyme Decarboxylase m nhim) lm mt nhm carboxyl to CO2, cn li l mt s amin c hot tnh nh: histamine, serotonin, 2. Ri lon chuyn ha protid 2.1. Ri lon tng hp v lng 2.1.1. Tng tng hp chung Khi qu trnh ng ha acid amin mnh hn d ha, cn bng nit dng tnh, gp trong: Sinh l: thi k trng thnh, ang tp luyn, thi k ang bnh phc bnh. Bnh l: cng tuyn yn. 2.1.2. Gim tng hp chung Cn bng nit m tnh gp trong i trng din, suy dinh dng, i ng, ung th, bng, st ko di, 2.1.3. Tng tng hp ti ch Gp trong ph i c quan, ung th, ang lin vt thng, phc hi thiu mu, 2.1.4. Gim tng hp ti ch Gp trong tc mch c quan, teo hoc hoi t c quan.
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Sinh l bnh Min dch
2.2. Ri lon protid huyt tng Protid huyt tng c hm lng khong 75 80g/lt, c ngun gc ch yu t gan (95% albumin, 85% globulin). 2.2.1. Vai tr ca protid huyt tng - Cung cp acid amin cho c th. - To p lc keo gi nc trong lng mch, iu ha chuyn ha nc v in gii. - Tham gia chuyn ha, vn chuyn cc cht nh hormone, st, chng nhim khun, nhim c. 2.2.2. Gim lng protid huyt tng 2.2.2.1. Nguyn nhn - Do cung cp khng : i - Do gim tng hp: trong x gan, suy gan. - Do gim hp thu: vim rut, x ty - Do tng s dng: gp trong mt s trng hp nh ang lin vt thng, ung th, ri lon chuyn ha glucid. - Do mt ra ngoi: bng, hi chng thn h, l d, 2.2.2.2. Hu qu Lm sng: st cn, teo c, thiu mu, c th b ph. Tr em chm ln. Xt nghim: - Protid huyt tng gim trong albumin thng gim nhanh v nhiu hn globulin. Do , t l A/G thng b o ngc (bnh thng t l A/G >1, tr thnh <1). - Tc lng ca hng cu tng. 2.2.3. Tng lng protid huyt tng - Rt him gp. Hu ht cc trng hp tng protid huyt tng l tng gi do mt nc gy c c mu. - Trng hp tht s tng protid huyt tng c th gp l bnh u ty. l s pht trin c tnh ca t bo lympho B lm lng khng th tng rt cao trong mu c th thi qua nc tiu. 2.2.4. Thay i thnh phn protid huyt tng ngi Vit Nam trng thnh, kt qu in di protid huyt tng trung bnh nh sau: Thnh phn protid huyt tng T l trung bnh % Albumin 57
1 -globulin 2-
5 7
globulin
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-globulin -globulin
12 19
Albumin: m bo 80% p lc keo ca mu, gim trong tt c cc trng hp gim protid huyt tng. Albumin huyt tng thng gim nhiu trong trng hp suy dinh dng, hi chng thn h. -globulin: tng trong cc trng hp vim cp, vim mn, hoi t t chc, ri lon chuyn ha (hi chng thn h, thn nhim bt). ca mu, tc lng mu tng. -globulin: c vai tr quan trng trong vn chuyn lipid. Do , cc trng hp tng lipid mu nh trong i ng, tc mt, hi chng thn h, x va ng mch u c tng -globulin. -globulin: l khng th, do vy tng trong mu khi nhim khun, qu mn, u tng bo, 2.3. Ri lon tng hp protein v cht C nhiu gen tham gia iu ha, chi phi sinh tng hp protid nhng gen cu trc v gen iu ha l 2 gen quan trng nht. Chnh v vy, ri lon 2 gen ny gy ra nhiu bnh l phc tp. 2.3.1. Ri lon gen cu trc - Gen cu trc mang thng tin quy nh trnh t cht ch cc acid amin trong mch polypeptide. Mi mt acid amin tng ng vi mt b ba nucleotide nht nh, v d b ba GAA m ha cho glutamin. - Bnh l do ri lon gen cu trc thng gp l: 2.3.1.1. Bnh ri lon cu trc Hemoglobin: - Bnh thiu mu hng cu hnh lim: do thay th acid amin th 6 trong chui ca HbA ngi bnh thng l Glutamin bng Valin nn HbA s chuyn thnh HbS lm hng cu b bin dng hnh lim, sc cng b mt gim nn d v gy thiu mu do tan mu. - Bnh thiu mu hng cu hnh bia: tng t nh trn nhng Glutamin b thay bng Lysin nn HbA s chuyn thnh HbC, hng cu d v khi thiu oxy gy thiu mu tan mu. 2.3.1.2. Bnh do thiu men trong chui chuyn ha - Bnh bch tng: do thiu men tyrosinase nn khng to c sc t melanin. - Bnh ng glycogen gan -globulin tng lm tng qunh
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Sinh l bnh Min dch
2.3.2. Ri lon gen iu ha Nu hot ng ca gen iu ha b ri lon th cc protid c tng hp ra mt cn i v t l (qu tha hoc qu thiu) hoc vn tng hp mt protid m c th khng cn n na. Bnh thng gp l bnh huyt sc t F (Thalassemia). C ch sinh bnh nh sau: - bo thai, c 2 gen cu trc tng hp 2 chui peptid thai l HbF (
2 2).
v to nn huyt sc t bo
HbF rt nhy cm vi bt gi oxy lm cho thai d ly oxy t mu
m nhng hng cu cha HbF d v. - Khi tr ra i, gen iu ha km hm vnh vin gen cu trc ca chui peptid , gii phng gen tng hp peptid . Do vy, huyt sc t ca ngi trng thnh bnh thng s l HbA ( 2 2). Nu HbF vn tn ti vi lng ln ngi trng thnh s gy bnh l Thalassemia. 2.4. Ri lon chuyn ha acid nucleic in hnh l bnh Goute. Trong bnh Goute, nng acid uric tng cao trong mu v trong nc tiu, lng ng tinh th urat sn, khp, thn, da, c,biu hin triu chng lm sng rt sm cc khp ngn tay, ngn chn gy au, bin dng khp. C ch sinh bnh: do thiu men hypoxanthin-guanin phosphoribosyl transferase nn hypoxanthin v guanine khng tham gia tng hp nucleotide tng ng m b thoi ha thnh acid uric vi s lng ln m thn khng c kh nng o thi ht.
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RI LON CHUYN HA LIPID

(1 tit) MC TIU BI HC 1. Trnh by c chuyn ha bnh thng ca lipid trong c th. 2. Trnh by c cc ri lon chuyn ha lipid thng gp. NI DUNG 1. i cng Lipid trong c th ngi gm 3 nhm chnh: - Triglycerid - Phospholipid - Cholesterol Ngun cung cp chnh lipid cho c th l t thc n, ng thi n l mi trng ha tan cc vitamin tan trong du m c th c th hp thu. Lipid thc n c tiu ha ngay t t trng nh men lipase ca ty, rut v c bit l nh mui mt c tc dng bin lipid thnh dng nh tng gi l Chylomicron c ng knh ht khong 0,4 micron. Sau , lipid c chuyn ha ny hp thu theo 2 ng: tnh mch ca qua gan hoc hp thu theo ng bch mch rut vo tun hon chung. Ba n nhiu lipid c th lm huyt tng tr thnh c v lng Chylomicron rt cao. 2. Ri lon chuyn ha lipid 2.1. Tng lipid mu Bnh thng, lipid ton phn trong mu n nh trong khong 600-800mg% l nh s cn bng gia cung cp (hp thu, tng hp) v tiu th.
2.1.1. Tng lipid mu sinh l Gp sau ba n. Triglycerid tng sm v cao nht, sau l phospholipid v cui cng l cholesterol. Sau khi n 2 gi th lipid bt u tng, cao nht sau 4-5 gi v tr
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Sinh l bnh Min dch
v bnh thng sau 7-8 gi. Du thc vt lm lipid mu tng nhanh nhng cng gim nhanh v d hp thu. Ngc li, m ng vt lm lipid mu tng chm nhng ko di. Lipid mu tng sau khi n thng dng ht nh (chylomicron) lm cho huyt tng c. Do , ly mu xt nghim thng tin hnh vo bui sng khi cha n g khi sai lch kt qu. 2.1.2. Tng lipid mu do huy ng - Khi tc huy ng cao hn bnh thng, hu ht trng hp u c vai tr ca hormone. - Trong trng hp u nng mt s tuyn (tuyn yn, tuyn gip, tuyn thng thn; hoc tim adrenalin, corticoids) u c tng lipid mu v chng hot ha men lipase m m. Thnh phn tng ch yu l acid bo - Tng huy ng cn gp khi ngun nng lng t glucose t ra khng m bo nhu cu: gp trong i, st, bnh tiu ng - Do gim s dng v chuyn ha lipid lm tng lipid mu gp trong vim gan cp, vng da tc mt, ng c rulipid t m m ch huy ng mc bnh thng nhng khng c gan tip nhn v do gan gim sn xut cht vn chuyn m l apoprotein. - C th ngi gi thng c tng lipid mu do h lipase m b gim hot tnh. 2.1.3. Tng lipid mu gia nh Do mt gen tri quy nh. 2.1.4. Hu qu Tng lipid mu nu ngn hn khng gy hu qu g nghim trng nhng nu tng ko di s gy bnh. V d: ch n qu nhiu m, tha nng lng c th gy bo ph, suy chc nng gan, tng cholesterol mu gy x va ng mch 2.2. Ri lon lipo-protein (LP) Thng gp bnh l tng LP mu. Gim LP him gp v thng l bnh di truyn. - Tng chung gp trong suy gip, thn h nhim m, suy thng thn hoc do ch n - Tng tng loi: + Tng do thiu men lipo-protein lipase thng gp ngi gi, c a x va, tiu ng + Tng ring l cc thnh phn lipo-protein: nh tng lipo-protein, tin lipo-protein hoc lipo-protein thng gp trong bnh tiu ng, x va ng mch, u vng (xanthoma) 2.3. Ri lon chuyn ha cholesterol - Trong c th, cholesterol c xut pht t 2 ngun: t thc n v t tng hp.
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Sinh l bnh Min dch
- Khong 50% lng cholesterol c o thi theo ng mt xung phn sau khi c chuyn thnh acid mt, 50% cn li c o thi di dng sterol trung tnh. 2.3.1. Tng cholesterol mu - Nguyn nhn - Do n nhiu cc thc n giu cholesterol, m ng vt, gan, no, - Do km o thi: tc mt - Tng huy ng: tng cng vi lipid mu trong i ng ty, hi chng thn h - Hu qu Cholesterol mu tng cao v ko di s xm nhp t bo gy ri lon chc phn t bo 2.3.2. Gim cholesterol mu Do tng o thi hoc gim hp thu gp trong vim rut, Basedow. C trng hp gim cholesterol bm sinh do mt gen ln gy ra. 2.4. Bnh x va ng mch - Thnh ng mch c nhiu lp, lp chun gip ng mch c tnh n hi iu ha p lc v lu lng mu. Lp c gip ng mch thu hp ng knh khi cn nng huyt p, lp v x tng sc bn thnh mch v lp ni mc trn nhn c vai tr bo v v chng ng mu t pht. - X va ng mch l s tch ng cholesterol di lp o trong ca ng mch lm thnh mch dy ln, thu hp lng mch. Tip , s lng ng canxi a n thoi ha, lot si do thiu nui dng (va) v lm m x pht trin ti ch; - S lot si khin ni mc ca lng mch mt trn nhn, to iu kin cho tiu cu bm vo v khi ng qu trnh ng mu (gy tc mch). - X va l bnh ca cc mch mu tng i ln khc vi tng huyt p l bnh ca h thng ng mch tn, hai bnh ny c th to thun li cho nhau pht trin - LDL c vai tr bnh sinh quan trng nht trong x va ng mch: l dng gan a cholesterol ti cc t bo s dng; trong khi HDL c vai tr mang cholesterol t cc m tr v gan. Khi tng LDL th tng kh nng b x va ng mch do lng ng cholesterol thnh mch. Khi tng HDL th gim kh nng b x va ng mch do HDL c tc dng bo v thnh mch v chuyn cholesterol tha v gan. - iu kin thun li gip cholesterol tng lng ng: + Thiu vitamin C + Gim st h men heparin-lipase ngi gi. + Lipid mu tng cao ko di. + Tng huyt p. + Nghin thuc l, ru, t vn ng
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Sinh l bnh Min dch
SINH L BNH H H HP
(2 tit) MC TIU BI HC 1. Trnh by c cc hnh thi ca thiu oxy trong bnh l h hp. 2. Trnh by c cc kiu ri lon thng kh. 3. Trnh by c cc biu hin ca suy h hp v s thch nghi ca c th trong suy h hp. NI DUNG 1. Thiu oxy: 1.1. Khi nim: Thiu oxy t bo l tnh trng cc t bo c th khng thu nhn lng oxy theo nhu cu. a s trng hp l do ri lon b my h hp hay tun hon nhng cn c th gp trong cc trng hp: - Thiu oxy khi bn giai on h hp hon ton bnh thng: l do thnh phn v p lc khng kh b thay i. - Thiu oxy khi pO2 mu vn bnh thng: l do ri lon chc nng ca cc enzym h hp trong t bo. 1.2. Phn loi thiu oxy: - Thiu oxy do thay i thnh phn v p sut kh th. - Thiu oxy do ri lon qu trnh thng kh. - Thiu oxy do ri lon qu trnh khuch tn. - Thiu oxy do ri lon giai on vn chuyn. - Thiu oxy do ri lon giai on h hp t bo. 1.2.1. Thiu oxy do kh th Nu phn p oxy trong kh th khng cao hn phn p oxy trong mu tiu tun hon do ng mch phi a n, th khng th c s trao i ca vch ph nang. Trng hp trong khng kh th c ln cc cht kh c i lc cao vi hemoglobin (Hb) s xy ra tranh chp Hb, cng c th a n thiu oxy. Trong trng hp ny c nhng nguyn nhn sau y: - Thiu oxy do cao. - Thiu oxy do khng kh b t hm hoc b ngt. - Thiu oxy do kh CO (c i lc cao i vi Hb) 1.2.2. Thiu oxy do ri lon thng kh - C ch: do gim khi lng nhu m phi, gim lu lng kh trao i gia phi vi mi trng bn ngoi.
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Sinh l bnh Min dch
- Hu qu: tt c cc giai on sau (khuch tn, vn chuyn v h hp t bo) u thiu oxy v tng pCO2. 1.2.3. Thiu oxy do ri lon khuch tn - C ch: gim din tch khuch tn; c th tht s (v mt gii phu) hoc ch gim v chc nng din tch ny (do din tch khng tip xc vi mao mch thc hin s trao i kh)...Trn thc t rt hay gp gim v chc nng. Dy mng khuch tn v gim hiu s p lc khuch tn cng l c ch hay gp. - Hu qu: gim lng kh trao i gia mu v ph nang, do vy cc giai on sau khuch tn u thiu oxy v ng CO2. 1.2.4. Thiu oxy do ri lon vn chuyn - C ch: ri lon v lng hoc cht ca hemoglobin c trong mu, khin n khng bt gi v mang ti c y lng oxy do phi cung cp. - Hu qu: gim lu lng v p lc tun hon, d l i tun hon hay tiu tun hon u a n thiu oxy cho t bo. 1.2.5. Thiu oxy do ri lon h hp t bo - nh ngha: H hp t bo l giai on cui ca qu trnh h hp. u vo ca n gm oxy v cc cht dinh dng cha nng lng, c hai u do tun hon a n. u ra ca n gm nng lng, kh CO2, v nc. Ri lon h hp t bo do thiu mt s yu t sau y: - Khi thiu c cht: c th l khu cung cp thiu cht dinh dng cho c th. - Gim hot tnh ca mt s enzym h hp: c th do: + Gim sn xut enzym h hp c th xy ra nu c th thiu protein cung cp tng hp phn apoenzym; nhng hay gp nht l cc trng hp gim sn xut cc coenzym m thnh phn quan trng nht ca chng l cc vitamin. Do vy, mt trong nhng c ch ca bnh thiu vitamin l gim sn xut cc enzym t bo m quan trng nht l cc coenzym h hp. Cc vitamin bao gm vitamin nhm B (B1, B2, B6, PP). + Thiu st + Ng c t bo: nhiu cht c tc dng ln h enzym h hp trong t bo khin t bo b ngt, mc d mu rt nhiu oxy, chng hn thuc ng, thuc m,lm c ch hoc t lit cc enzym tch hydro. 2. Ri lon chc nng h hp ngoi: 2.1. Theo c ch bnh sinh V sinh l bnh v lm sng: c hai ri lon thng kh, t cng c hai loi suy h hp: 2.2.1. Ri lon thng kh do hn ch: Do gim khi lng nhu m phi tham gia trao i kh vi mi trng bn ngoi.
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Sinh l bnh Min dch
- S lng ph nang b gim tht s v d b ct b thy phi, teo phi do tc nhnh ph qun, xp phi... - Cc ph nang b xp khin mt vng phi b xp, hon ton khng cha kh b loi tr ra khi qu trnh thng kh v khuch tn. - C th gim v chc nng ca ph nang: do tn thng khuyt tt ca lng ngc hoc do bnh l tn thng ca nhu m phi. 2.2.2. Ri lon thng kh do tc nghn: Khi c s cht hp ca ng dn kh nh hng n s trao i kh ca s ln ph nang, c th chia ri lon tc nghn ra cc dng sau: - Do ng dn kh cao: ph thanh qun, bch hu, tht c, d vt ln, - ng h hp sn b d vt nh, u gy chn p... - Do ng h hp mng, do thnh ph nang ph i hoc tit dch.. 2.2. Phn loi theo v tr tn thng: 2.2.1. Bnh l v thn kinh- c: - Do trung tm h hp b c ch hoc t lit, thm ch b hy hoi. V d do chn thng s no vng hnh- cu, mt s th vim no, ng c. - Do dn truyn t trung tm n c h hp: chn thng t sng c, vim thn kinh lin sn, bnh bi lit th cao. - Do bn thn c h hp: chn thng lng ngc, vim c h hp. 2.2.2. Bnh l v khung xng: - Tt ca khung xng: qu nh so vi chiu cao. - Khp cng lm gim n lng ngc khi th. 2.2.3. Bnh l phi - mng phi: - Phi: c th a n ri lon thng kh khi mc cc bnh nh sau: km sn xut surfactant, bnh phi thm nhim lan ta. - Mng phi: dy v dnh gy co ko lm phi km dn n 2.2.4. Bnh l v ng dn kh: - Tc nghn do hp ng dn kh nh. - Tc nghn kh qun v cc ph qun ln. 2.2.5. Bnh l ngoi ng h hp: C trng, gan to, chng d dy.. 3. Suy h hp 3.1. nh ngha L trnh trng chc nng h hp ngoi khng m bo c yu cu cung cp oxy v o thi kh CO2 cho c th. 3.2. Cc biu hin ca suy h hp: 3.2.1. H hp chu k
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Sinh l bnh Min dch
L kiu th bt thng, lp i lp li c chu k, c th gp trong mt s bnh. Bnh nhn th su mt s nhp lin tip ri chuyn sang th nng hoc tm ngng, ri lp li. Hay gp nht l kiu th ca Cheyne v Stokes m t, c trng bng nhng t ko di t 40- 60 giy th su xen k nhng t th nng. 3.2.2. Tm ti L tnh trng hemoglobin kh mu mao mch t 10- 20% tng ln mc hemoglobin kh tnh mch 30%, khin da nim mc v nhng vng giu mao mch ng da c mu tm nh mu tnh mch. 3.2.3. Kh th C th kh th tht s do tc nghn ng h hp khin bnh nhn phi huy ng cc c h hp gng sc v thy r cm gic vt nng trn ngc. 3.3. Thch nghi ca c th trong suy h hp: Di y l cc bin php thch nghi thng thng m c th bnh thng c th p dng, nhng mt c th suy h hp ch thc hin c mt phn no. Thch nghi ca phi: Tng cng thng kh c ch do tr CO2 , kt hp vi thiu oxy kch thch trung tm h hp. Thch nghi ca tun hon: do tng cng h hp to p lc m tnh trong lng ngc c tc dng ht mu v tim. Mt khc cc th quan ca tim v thnh mch cng nhy cm vi thiu oxy lm tng hot ng ca tim mch. Thch nghi ca mu: thiu oxy thn lm tng sn xut erythropoietin, qua kch thch ty xng sn xut ra hng cu. Trc mt khi thiu oxy, c th huy ng mu cn tn ng trong cc xoang gan, lch v cc mao mch ngh vo vng tun hon. Thch nghi ca t bo v c: tng cng khi thiu oxy, tn dng ti a lng oxy sn c mu ng mch. Tng ion H+ cng nh CO2 gip phn ly nhanh HbO2 cc m.
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Sinh l bnh Min dch
SINH L BNH H TUN HON

(2 tit) MC TIU BI HC 1. Trnh by c kh nng thch nghi ca h tun hon. 2. Trnh by c cc ri lon bnh l trong suy tim. 3. Trnh by c cc ri lon hot ng ca h mch mu H thng tun hon ca c th gm c tim v cc mch, c chc nng ti mu cho t bo, m ... em n cho t chc cc cht dinh dng nh oxy, glucose, hormone ... v nhn cc cht cn o thi nh ur, CO2 .. 1. KH NNG THCH NGHI CA H TUN HON Nhu cu trao i cht ca c th lun lun thay i nn chc nng ca h tun hon phi lun lun thch nghi: tng hay gim cho ph hp yu cu c th; kh nng thch nghi ca h tun hon rt ln. 1.1. Kh nng thch nghi ca tim: Hiu sut ca tim rt cao v tim c kh nng tng nng sut ln rt nhiu ln khi cn p ng nhu cu c bit. Nng sut ca tim c th tng ln 5 - 10 ln lc c th lao ng cc nng hoc lc st, so vi lc ngh ngi hon ton: bnh thng lu lng mu/pht ca tim l 4,0 - 4,2 lt c th tng ln 20 - 24 lt trong lao ng nng; thi gian mu i 1 vng t 1 pht c th rt ngn cn 0,2 pht (12 giy). 1.2. Kh nng thch nghi ca mch: Xung huyt ng mch lm tng lng mu ti cho c quan: - S mao mch c chc nng tng ln cung cp mu cho m. - Tc mu tng gp 3 - 5 ln. - Mu qua tim tng ln, mu qua ni tng gim. - Co mch gan lch, tng mu d tr vo vng tun hon. 1.3. Kh nng thch nghi ca h h hp: Tng cng trao i kh phi v mao mch. Lc ngh c 30% lng oxy mu ng mch (6ml), trong lao ng nng, s lng ny c th tng ln 60 - 70% (12 14ml). 1.4. Cc bin php thch nghi ca tim: Khi nhu cu oxy bt cht tng ln th tim p nhanh ln. Dn tim v ph i c tim l cc bin php thch nghi chm hn khi nhu cu oxy tng ko di. 1.4.1. Tim p nhanh: L mt bin php xy ra rt nhanh, nhy khi nhu cu tng ln i hi phi tng lu lng tim. Nhp tim c th t 60 - 80 ln/pht ln 140 - 160 ln/pht.
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Sinh l bnh Min dch
Tim p nhanh ch c tc dng tm thi gip hi phc huyt p, tng mu ti c tim. Nu ko di s c hi cho c tim, lm suy yu dn c tim do: - Thi gian tm trng ngn li, c tim khng c ngh ngi y . - Tun hon vnh b km (mu chy vo ng mch vnh trong th tm trng). Khng th tng nhp qu cao m khng c nguy c suy tim cp. - Thi gian tm trng qu ngn, lng mu ht v tht cha , khin cung lng tim gim d c tng nhp. 1.4.2. Dn tim: L tnh trng t bo c tim dn di ra lm tng dung tch bung tim, cha c nhiu mu hn. Dn tim c th xy ra th ng sau suy tim, do c tim mm nho trc, sc co bp gim nn khng tng c mu ra khi bung tim, mu li lm dn tim. 1.4.3. Ph i tim: L tnh trng cc si c tim to ra, c tim s dy ln song s lng si c khng tng ln. Kh nng lm vic ca si c tim lc ny tng ln, sc bp khe hn, tng c nhiu mu hn lm cung lng tim tng, lu lng tim tng. Ph i c th l: - Sinh l: gp ngi luyn tp, lao ng nng nhc ko di. Ph i sinh l l c gii hn. - Bnh l: gp trong cc bnh tim mch nh hp van ng mch ch, cao huyt p... Do tim lm vic tng trong mt thi gian di nn ph i qu mc. Ph i bnh l n mt gii han nht nh c th phc hi c.. Ph i qu mc gii hn s gy suy tim. 2. SUY TIM 2.1. nh ngha: L tnh trng tim mt mt phn hay ton b kh nng co bp bo m lu lng mu cho nhu cu c th. 2.2. C ch suy tim: Suy tim xy ra khi c ri lon cc yu t trn lm gim sc co bp ca si c tim hay do c ri lon chuyn ha trong t bo c tim. Quan trng nht trong suy tim l s ri lon chuyn ha t bo c tim. 2.3. Nguyn nhn gy suy tim: 2.3.1. Tn thng c tim khng phi do bnh mch vnh: Gp trong - Ri lon van tim; c tim b qu ti lu ngy. - Thiu oxy mn tnh (trong bnh l phi mn tnh, thiu mu nng).
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Sinh l bnh Min dch
- Do ng c: ng c in gii nh K+, Ca++ (nng vo t bo c tim qu cao c th thy do tai bin iu tr, ng c gip, ng c thuc gy m nh clorofoc, xyclopropan. - Do nhim c, nhim khun (thng hn, cm,) - Do suy mch, h huyt p, gim khi lng mu lu thng. 2.3.2. Tn thng c tim do mch vnh: - Co tht mch vnh - Tc mch vnh sau qu trnh x va hay do huyt khi gy hoi t vng c tim tng ng gi l nhi mu c tim (NMCT). - Cao huyt p, hp ng mch ch ... lng mu tng vo ng mch ch gim lm tr mu tiu tun hon vi cc triu chng kh th, ph phi mn hoc cp, 2.4. Ri lon hot ng khi tim suy: 2.4.1. Gim lu lng: Khi tim suy, tc l kh nng co bp ca c tim gim, tim khng y ht lng mu vo ng mch (60ml) do cung lng tim (lu lng tm thu) gim. 2.4.2. Tng th tch mu: Trong suy tim, th tch mu tng. Tim suy co bp yu, khng y ht mu ra khi tim cho nn mu v tim khng y s li h tnh mch. Mu tr nn qua thn t, chc nng lc ca cu thn gim dn ti gi nc v in gii do th tch mu tng. Mc khc trong suy tim c th lun lun b thiu oxy, ty xng b kch thch nn tng sinh hng cu cng lm tng th tch mu. 2.4.3. Gim tc mu chy: Trong suy tim, kh nng co bp ca c tim gim nn mu chy chm, c bit h tnh mch do mu phi trong suy tim tri v mu h tnh mch ngoi vi trong suy tim phi. 2.4.4. Thay i huyt p: Huyt p ph thuc vo lu lng tim v sc cn ngoi vi. Trong suy tim, lu lng tim gim, sc co bp c tim gim, ng thi sc cn ngoi vi cng gim do c dn mch (do thiu oxy v tun hon chm) cho nn trong suy tim thng thy huyt p ng mch gim. Huyt p tnh mch th tng do tim co bp yu, mu chy chm. 3. RI LON HOT NG H MCH MU Bnh l mch mu c th gp nh : - X va ng mch. - Tng huyt p. - Gim huyt p gy cc trng thi bnh l try mch sc, ngt.
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Sinh l bnh Min dch
3.1. X va ng mch: (XVM) (XVM) l tnh trng vch mch dy ln do lng ng cholesterol vo cc lp o trong ca mch mu gy tn thng thoi ha, lon dng, trn s lng ng canxi, vim, lot, si, huyt khi, hp lng mch v ng mch khng co dn c nh bnh thng trc cc bin i sinh l v bnh l. 3.1.1. C ch bnh sinh : XVM l do ri lon chuyn ha lipoprotein. Lipid c vn chuyn trong mu di dng kt hp vi cc protein c hiu (apoprotein) gi l lipoprotein (LP). Cc LP gm 2 phn : - Lipid gm cc cht nh cholesterol ton phn (CT), cholesterol este ha (CE) cc phospholipid (PL) v triglyxrit (TG). - Apoprotein. Theo t trng t thp n cao cc LP c chia thnh cc loi sau: + Chylomicron + VLDL (Very Low Density LP) : LP c t trng rt thp. + IDL (Intermediate Density LP) : LP c t trng trung bnh. + LDL (Low Density LP) : LP c t trng thp. + HDL (High Density LP) : LP c t trng cao. LDL - C (Cholesterol ca LDL) c tc dng chnh trong vic gy VXM. HDL - C (Cholesterol trong HDL) khng gy VXM, l loi cholesterol tt, c tc dng chng li s lng ng LDL - C thnh mch. 3.1.2. Nguyn nhn VXM: Ch yu do : - Di truyn: khng tng hp c cc receptor c hiu vi LDL-C; hoc do di truyn tng enzym HMG CoA reductaza - Do n nhiu m nht l m ng vt nh lng trng, gan, tm, cua lm tng cholesterol, s lng ng thnh mch. 3.1.3. Cc iu kin thun li cho s lng ng cholesterol thnh mch. - Thiu vitamin C, tyroxin lm gim ging ha cholesterol. - Cc stress lm huy ng m, ko di tnh trng lm tng m trong mu. Cc stress cn lm tng tit adrenalin, gim ng huyt ko di cng gy tng m trong mu. - Tng huyt p cng d VXM, c th hnh thnh vng xon bnh l. - Tn thng vch mch do ha cht (nicotin, tng cholesterol trong mu...) hay do c hc (thng cung ng mch ch, ch ng mch phn nhnh hay cc ni ng mch t di ng nh thnh sau ng mch ch - Tng ng huyt v i ng. - Bo ph bnh l. - t hot ng th lc.
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Sinh l bnh Min dch
3.1.4. Hu qu VXM : - Tnh n hi ca thnh mch gim do tnh chu lc ca mch gim, d v mch chy mu, d gy tng huyt p. - Kh nng co gin cng gim : Khng thch nghi c vi cc tc nhn sinh l hoc bnh l, d chy mu khng cm c (ch trong m ngi gi, chy mu ln ng tiu ha ca ngi gi) d gy tng huyt p. - Hp lng ng mch (suy tun hon no, tim), tc mch do huyt khi (nu tim c th gy bin chng nguy him l NMCT) hay bong ra tri i gy tc mch ni khc. 3.2. Tng huyt p: Tng huyt p khi huyt p ti a cao hn hay bng 160mmHg v/hoc ti thiu cao hn hay bng 90mmHg. 3.2.1. Huyt p c hai c ch iu ha : iu ha huyt p thng qua cc yu t sau: th tch mu - Renin - Angiotensin Aldosterone. Khi trng lc h giao cm tng lm co mch v thn, renin c tit ra lm angiotensinogen chuyn thnh angiotensin I ri thnh angiotensin II gy co mch nn tng huyt p. Renin cn lm tng tit aldosterone gy tng ti hp ... thu Na+, lm thay i tnh thm mng t bo, lm tng tnh kch thch ca c trn v tng huyt p. Prostaglandin iu chnh th tch mu ng ln gn, c tc dng gy li tiu. Khi Renin - Aldosterone tng tit lm huyt p tng ln, lu lng mu n ty thn s tng ln lm tng tit prostaglandin (PG) c bit PGA v PGE, gy dn mch v thn li tiu, huyt p do s tr li bnh thng. 3.2.2.Nguyn nhn Tng huyt p c th l mt triu chng ca nhiu bnh hay l mt bnh ring bit bnh tng huyt p (khng tm c cc nguyn nhn) 3.2.2.1. Tng huyt p triu chng: Gp trong cc bnh sau: - Tng huyt p do thn: Do bnh nhu m thn hay do mch thn. Bnh nhu m thn lm tng huyt p nh vim cu thn mn (sau nhim lin cu hay do cc nguyn nhn min dch khc), vim i b thn mn. - Tng huyt p do ni tit : Thng gp trong u ty thng thn hay u hch giao cm Hi chng Conn: tng aldosterone mu nguyn pht do tng tit cc hormone v thng thn. Tng huyt p trong hi chng Cushing: do tng cc glucocorticoit v cc mineralocorticoit, c tc dng gi Na+. - Tng huyt p do VXM:
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Sinh l bnh Min dch
Trong lm sng thy huyt p tng cao nhiu ngi c tui b VXM, cholesterol ng trong lp di ni m ng mch ch, cc ng ln, ng mch vnh tim, ng mch no. 3.2.2.2. Bnh tng huyt p: Khng tm c nguyn nhn gy tng huyt p. Do ri lon hot ng ca thn kinh trung ng, ri lon hot ng ca cc h thng iu ha huyt p (ngoi vi v trung ng: h giao cm, thn, ni tit, mch v ri lon mi lin quan gia cc h thng iu ha ni trn). Cc thuc an thn dn mch c tc dng tt vi nhng bnh nhn ny. Yu t di truyn c vai tr quan trng trong bnh sinh ca bnh cao huyt p ny. 3.2.3. Hu qu v bin chng ca tng huyt p: 3.2.3.1. Suy tim: Tng huyt p gy dn tim v ph i tht tri; p lc nh tri v p lc mao mch phi u tng ln; ph phi (c bit ph phi cp) xy ra khi p lc mao mch phi ln hn tng s p lc keo mu; dn dn suy tim tri. V sau, tng p lc ng mch phi, suy tht phi gy ph i tht phi, tng p lc nh phi v p lc tnh mch, i n suy tim ton b. 3.2.3.2. Suy mch vnh: - Tng huyt p to iu kin cho VXM vnh pht trin . - Tng huyt p gy co tht hay tc mch vnh a n tai bin mch vnh. 3.2.3.3. Bin chng no: - Mch mu x nn d v, nguy him nht l v, chy mu no, lt no. 3.2.3.4. Gim th lc do ri lon nh xut huyt, ph n ng mch vng mc do tng huyt p. 3.3. Gim huyt p: Gp trong sc, tru mch. 3.3.1. Try mch: 3.3.1.1. nh ngha: Try mch l tnh trng dn t ngt h tiu ng mch v c bit l h tnh mch, huyt p tt t ngt, c th xung s khng. Tim bp rng, cng vi cc du hiu thiu oxy no nghim trng (xy xm mt my, ti mt ) 3.3.1.2. Nguyn nhn : - Trung tm vn mch b c ch trong nhim khun, nhim c. Ngoi c t vi khun cn b nhim c do sn phm chuyn ha trong tnh trng thiu oxy. - Thay i t th t ngt (t nm sang ng) c th xy ra mt s ngi c bit cc bnh nhn nng, c th yu nm lu, khi ng ln, mu theo trng lng dn xung phn di c th, tnh mch ni tng, mu khng ln c no.
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Sinh l bnh Min dch
- Chc tho bng qu nhanh v nhiu gy dn qu mc cc mch mu ni tng lm gim khi lng mu lu thng, gy thiu mu ln no. 3.3.2. Sc: 3.3.2.1. nh ngha: Sc l mt hi chng suy tim mch cp tnh. Du hiu xc nhn sc l c ri lon vi tun hon, do cc c quan trng yu ca c th (no, tim) khng c ti mu y . Khc vi try mch, sc din bin khng t ngt, c mt qu trnh chia nhiu giai on trong c th c th huy ng cc phn ng b. 3.3.2.2. Phn loi sc: - C th chia theo nguyn nhn: sc chn thng, sc chy mu, sc bng, phn v, nhim khun ... - Thng phn loi sc theo c ch bnh sinh: sc c gim hay tng huyt ng: nh lu lng tim, sc khng ngoi vi, paCO2, pH, paO2.... 3.3.2.3. C ch bnh sinh ca sc: - Hin tng u tin ca sc (nhim trng, chn thng, mt mu ln, phn v, bng ...) l gim khi lng mu lu thng (KLMLT). Trong sc, nhiu li mao mch lc bnh thng khng c ti mu, nay dn rng v mt lng mu ln tp trung vo . Do gim KLMLT l do ri lon phn b mu trong c th. Trong sc nhim khun, cc c t c vai tr trong vic khi pht s gim KLMLT. Cc c t ca vi khun to ra c t phn v hay tc ng trc tip gy co cc tiu ng mch ni tng, da v co tht h tiu tnh mch lm ng mu mao mch, ri lon mu v tnh mch gy nn gim KLMLT, v lm gim huyt p. V li gim huyt p cn do suy mch cp tnh do lit trung tm vn mch. - Thiu oxy trong t chc: Do KLMLT gim nn lng mu n cc c quan trng yu cng t i. Lu lng tim gim kt hp vi s tng sc khng ngoi vi cng lm gim mu ti cho t chc.
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Sinh l bnh Min dch
SINH L BNH TIU HA

(4 tit) MC TIU BI HC 1. Trnh by c c ch bnh sinh ca lot d dy-t trng. 2. Trnh by c cc ri lon tit dch, co bp v hp thu ti rut. NI DUNG Bnh l ca tiu ha c th xy ra bt c on no biu hin thay i cu trc v ri lon chc nng: thng gp v quan trng nht l nhng ri lon ti d dy v ti rut. 1. Ri lon tit dch trong bnh sinh ca lot d dy - t trng: 1.1. i cng: Theo Schwartz 1910 ngoi tc dng tiu ha thc n, bn thn dch v cn c tc dng ph hy nim mc d dy- t trng nhng tc dng ny b cc yu t bo v chng li lm mt hiu lc do vy bnh d dy t trng khng xut hin ngi bnh thng. Schwartz xut quan nim cho n nay vn cha c chng minh l ng: lot DD- TT l hu qu ca s mt cn bng gia cc yu t tn cng v cc yu t bo v trong cc yu t tn cng chim u th. Cho n nay ngi ta xc nh c: Cc yu t tn cng Cc acid Men pepsinogen Cc yu t bo v Cht nhy HCO3S ti to nim mc Chnh v vy khi bnh lot d dy t trng l do yu t tn cng tri hn hay yu t bo v gim i. Gn y ngi ta pht hin ra vi khun Helicobacter pylori l mt tc nhn mch m h tr yu t tn cng v lm suy yu yu t bo v a n lot. 1.2. Cc yu t bo v: * Lp nhy: ph trn b mc nim mc, n tn ti di dng gel v mang tnh cht kim, n khng thch hp vi s phn hy ca pepsine, ng thi khng cho php acid t dch v khuch tn su vo trong. * T bo biu m nim mc: ti sinh rt nhanh mi khi tn thng, ng thi sn xut c mt s ion bicarbonat trung ha vi acid.
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Sinh l bnh Min dch
* S ti mu phong ph: mang i cc ion H+ v hn gn cc tn thng. * Prostaglandine: c sn xut ti ch. Prostaglandine c tc dng khuch i v iu phi cc yu t bo v ni trn, gip qu trnh ti to xy ra lp tc. * S ti to v hn gn: Nhng tn thng do yu t tn cng gy ra cho nim mc d dy c hn gn tc khc, k c khi nng ca acid H+ tng ln gp nm ln. Khi cc yu t bo v ni trn t ra bt cp, khin tn thng vt qu lp mng y ca biu m ti lp di nim mc th s ti to tc thi ca biu m khng c thc hin. Qa trnh sa cha din bin chm li, v phi c cc t bo t bn ngoi xm nhp v tng sinh vng tn thng lp ch. Vai tr phi hp ca Prostaglandine lc ny cng t ra quan trng. y, cn c vai tr ca yu t tng trng EGF. N c bi tit trong nc bt v t trng, c tc dng gim tit acid, kch thch s xm nhp v tng sinh t bo vng tn thng. 1.3. Cc yu t tn cng: * Pepsinogen: Trong lot pepsine to iu kin cho ion H+ ca acid khuch tn su vo lp gel tip cn lp biu m nim mc d dy. Mt khi lp nhy b ph v v nim mc b H+ lm tn thng th pepsin c iu kin phi hp lm nng thm cc tn thng ti lot. * Acid HCl: ngi ta chng minh c s khuch tn ngc ca ion H + t lng d dy thm qua lp gel vo tn cu trc di nin mc. Ion H + c gy tn thng hay khng cn ty thuc vo nng ca ion H+ thm vo v kh nng bo v. Cc cu trc tn thng do ion H+ gy ra gm: biu m nim mc, cc nron mch mu, kt hp vi s xm nhim ca cc t bo vim gy mt chui hu qu nh sau: + Gii phng cc cht dn truyn thn kinh (cng gy tng acid). + Xm nhp cc thnh phn mu cng gy nn tn thng, to nn hn hp peptit v acid amine gy kch thch tit thm acid HCl. + Hot ha cc t bo vim trc tip kch thch t bo thnh tit thm acid HCl. 1.4. Nhng tc nhn gy tng acid v lm gim kh nng bo v bao gm: - Yu t di truyn. - Thuc khng vim khng steroid. - Thuc l - Ru - Cafe. - Acid mt - Vi khun Helicobacter pylori (H.P) - Stress
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Sinh l bnh Min dch
1.5. Ri lon chc nng co bp: - Co bp d dy c tc dng nho trn v chuyn thc n xung t trng trong . - Trng lc: gip cho thnh d dy p st vo nhau, gip cho sc cha ca d dy thch ng vi th tch thay i vi lng thc n a vo. - Nhu ng: l cc cn co chu k tc dng trn v chuyn thc n - Hai yu t lm co bp d dy l: thn kinh ph v v histamine. + Gim co bp: c th xut hin tm l lo lng, cn tr c hc ko di, mt thng bng thn kinh thc vt, hu qu l triu chng y hi, tc bng, kh tiu nng nht l sa d dy khi khi c d dy b lit. + Tng co bp: c th gp; vim d dy, tc mn v giai on sm, mt thng bng thn kinh thc vt, thc n c cht kch thch nh ru, cafe, thuc l, cc gia v...hoc dng cc loi thuc kch thch d dy nh histamine. Hu qu vch d dy p cht vo nhau gy tng p ti hi v thc n b y nhanh xung t trng. 2. Sinh l bnh chc nng rut: 2.1. Ri lon tit dch v co bp ti rut: Chc nng quan trng nht ca rut l tit dch, co bp v hp thu. 2.1.1. Ri lon dch mt: Mi ngy gan tit ra khong 500ml mt, trong tc nhn tiu ha lipit l mui mt vi cc tnh cht nh ha m hn hp enzym lipase ca dch rut. Gim tit dch mt c th lp li khi thiu nng gan, tc ng mt ch, bnh hi trng lm km hp thu mui mt. Hu qu c th 60% m khng c hp thu. 2.1.2. Ri lon v dch ty: Tuyn ty tit ra enzym ch lc tiu ha protid, glucid v ngoi ra cn tit lipase tiu ha lipid. Suy chc nng ty bao gi cng gy ra ri lon tiu ha nng. * Thiu nng ty: thng gp trong vim ty mn, gy ri lon tiu ha v gy kch thch rut, nu ko di c th gy ra suy dinh dng. C th c nhng ri lon do thiu cc insuline. Ngoi ra cn gp si v giun gy tc bng Vater hay ng Wirsung. * Vim ty cp: y l bnh l vim hoi t cp din, gy au n d di, dn n sc nng, t l t vong cao. Vim ty cp thng xy ra ngi bo sau mt ba n qa nhiu m v protein. Cc nh nghin cu cho rng tnh trng trn khin lng dch ty tit ra nhiu lm tng p lc trong ng dn ty gy tt, dch ty c iu kin trn ln vi mt v do vy cc tin enzym b hot ha lm tiu hy m ty. Enzym ty do s hoi t cn thot khi ty ra bng gy tnh trng hy hoi quanh ty, gii phng cc cht gy ri lon huyt ng hc ti ch v ton thn dn n sc. 2.1.3. Hi chng tiu chy:
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- Tiu chy cp: nu i tin nhiu ln lin tip trong mt thi gian ngn, khin c th mt nhiu nc theo phn. - Tiu chy mn: phn nho ko di trong nhiu tun, nhiu thng; khng mt nc m hu qu ch yu l km dinh dng do gim hp thu. * Nguyn nhn: - Tn thng thc th t bo nim mc, vim (do vi khun, k sinh vt, c t ca chng), do c cht gy d ng rut. - Thiu dch v enzym tiu ha. - U rut - Bnh l rut vim phc mc, vim rut tha. * C ch bnh sinh gy tiu chy: - C ch tng tit dch: c ch ny hay gp trong vim rut, nc t nim mc rut tit ra c th gp hng chc ln bnh thng, nht l do vim cp trong ng c( c t vi khun, t, thc n i thiu..) gy mt nc cp . - C ch gy tng co bp: lm thc n qua rut nhanh khi cha kp tiu ha v hp thu y . Du hiu c trng l y bng, phn sng. C ch ny cng gp trong vim rut, ri lon vi khun ch rut. - C ch gim hp thu: khin lng nc thi theo phn tng ln. Gp trong vim rut khc nhau trong ct on rut, hoc ri lon vi khun trong nhng on rut khc nhau. * Hu qu: - Tiu chy cp: biu hin bng hai hi chng: ri lon huyt ng( mu c c v gim khi lng tun hon v gy tt huyt p v to nn gnh nng cho tim); nhim c v nhim acid (do mt d tr km theo phn, t bo chuyn ha ym kh, ng thi ngng o thi nc tiu) 2.1.4. Hi chng rut d kch thch: L ri lon chc nng mn tnh rut m khng c tn thng thc th. cc nc n chim gn na s trng hp ti khm chuyn khoa tiu ha v a s l n vi cc triu chng: + Cm gic kh chu vng bng (ti pht t nht sau 3 thng), tm gim sau khi i tin. + C t nht 2 trong 5 du hiu sau: thay i s ln i tin trong ngy, phn khng thnh khun, thay i khi tng phn, phn c nhy nht, chng bng. Bnh nguyn v bnh sinh cha hon ton sng t, k c gi thuyt trc y cho rng ch n khng cht x. 2.1.5. Hi chng tc rut:
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l mt on rut mt lu thng, khin phn trn dn to do tr thc n v cht dch. * Nguyn nhn: tc rut c hc v tc rut chc nng( lit rut do cng ph giao cm). * Hu qu: ty theo v tr cao hay thp: - Tc rut cao: biu hin ni bt l mt nc do nn. - Tc rut t trng, nn ra dch rut, dn n mt nc km nhim acid. - Tc thp: biu hin nhim c sm hn v nng hn so vi nhim c mt nc thy nhim c nng hn. 2.1.6. To bn: l tnh trng kh hoc khng i tin c do khi phn tr nn rn chc, nm lu trong i trng lu hn bnh thng. Thnh phn ch yu l phn, cht x, nc v xc ca vi khun. * C ch v nguyn nhn: - Tc nghn c hc i trng, rut xichma, trc trng, khin phn nm lu trong trc trng. Gp trong trng hp u, so, co tht ko di i trng v di . - Gim trng lc rut gi, do vy gim co bp y phn i. Gp nhng ngi bo, ngi gi sng tnh lng, nhng ngi do ngh nghip ngi lu ti ch. - Thi quen nhn i tin . * Hu qu: bnh nhn khc phc to bn bng c rn i tin s dn n phng tnh mch hu mn v trc trng (gi l tr). C th thiu mu do mt mu, cn c th nhim khun ti ch hay ton thn tiu im t cc bi tr b v. 2.2. Ri lon hp thu: 2.2.1. i cng: Hp thu l chc nng quan trng nht ca rut v cng l ton b h tiu ha. l mc ch cui cng ca tiu ha ni chung. tiu ha tt, cn c s hon thnh cc chc nng khc nh co bp, tit dch. Cc iu kin hp thu: - Thc n c th c bin ha thnh dng c th hp thu c; iu ny ph thuc vo cht lng tiu ha v thi gian tn ti ca thc n trong rut non. - Nim mc hp thu phi ton vn, rng v cp mu y . - Tnh trng ton thn lin quan n tiu ha phi c m bo. 2.2.2. Bnh nguyn v bnh sinh ca ri lon hp thu tiu ha: Km hp thu ch a n hu qu r rng nu xy ra trong mt thi gian di lin tc hoc lp i lp li nhiu ln: c th chia thnh hai nhm ln sau y: * Nguyn nhn ti ng tiu ha: gm nguyn nhn ti rut, nguyn nhn ngoi rut nh (d dy, gan, ty..) * Nguyn nhn ngoi ng tiu ha.
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Sinh l bnh Min dch
- Ri lon ti rut a n km hp thu gm: nhim khun, nhim c tiu ha, gim tit enzym tiu ha, gim din tch hp thu. - Ri lon ngoi rut a n gim hp thu gm: bnh d dy (vim lot d dy, ung th, ct on d dy..), suy gan (gy thiu mui mt gim hp thu lipid), suy ty lm gim hp thu v thiu enzym tiu ha quan trng. 2.2.3. Hu qu ca gim hp thu: - C th a n thiu dinh dng nu thiu calo v protein. - C th thiu mt vi hay nhiu vitamine v yu t vi lng, kt hp suy dinh dng hay c lp. Ty theo thiu cht g m biu hin bnh l c trng.
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SINH L BNH CHC NNG GAN

(2 tit) MC TIU BI HC 1. Gii thch c ch ri lon chc phn gan v chuyn ha protid, glucid, lipid, mui v nc. 2. Gii thch c ch chc phn chng c ca gan. 3. Trnh by ri lon chc phn cu to v bi tit mt ca gan. 4. Trnh by c cc mc ri lon chc nng gan trong suy gan. NI DUNG 1. i cng: Gan l mt c quan ln nht trong c th, m nhim nhiu chc nng quan trng v phc tp. Gan ng v tr ca ng, ni lin ng tiu ha vi ton b c th, gan tch ly v chuyn ha hu ht cc cht c hp thu rut vo v cung cp cc cht cn thit cho c th. Cc chc nng ca gan c thc hin nh hai loi t bo (t bo nhu m gan v t bo Kuffer thuc h thng lin vng ni mc) v nh c mt lng mu qua gan rt ln (mi pht gan nhn khong 1500ml mu). 2. Nguyn nhn ri lon chc nng gan 2.1. Cc yu t gy bnh 2.1.1. Cc yu t bn ngoi - Nhim khun ( vi rt, vi khun, k sinh trng), c t tc ng trc tip trn nhu m gan v gin tip khi tnh trng nhim khun gy suy sp ton thn trong c gan. - Nhim k sinh trng: cc loi KST c th gy x gan bao gm: k sinh trng st rt, sn l gan. - Nhim c cp tnh: nhim ch, ng, phospho, cacbon... - Nhim c mn tnh nh ru. 2.1.2. Yu t bn trong: - mt: tn thng gan do mt c th nguyn pht hay th pht din bin lu ngy dn n x gan. - tr tun hon: tc tnh mch trn gan do chn p t bn ngoi ca cc khi u c tnh, p xe gan do amip, t mu... - Ri lon chuyn ha: gan l kho d tr ca nhiu cht ng thi l ni chuyn ha ca cc cht din ra rt mnh. Cc phn ng chuyn ha gan nh h thng enzym
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ni bo. Ri lon chc phn chuyn ha gan c th do thiu hoc tha enzym hoc cc cht chuyn ha. 2.2. ng xm nhp ca cc yu t gy bnh 2.2.1. ng tnh mch ca Yu t gy bnh t ng tiu ha (vi khun, cht c t thc n). y l ng chnh v quan trng nht, v d vim gan do trc khun coli, thoi ha m gan do ng c phospho, ru... 2.2.2. ng ng dn mt Vim ng dn mt do vi khun dn n ri lon chc nng gan v x gan. 2.2.3. ng tun hon mu Cc vi khun v virut theo ng tun hon mu tii gan nh lao, nhim khun huyt, vim gan do virut, ng c thuc m. 2.2.4. Theo ng bch huyt Cc yu t gy bnh t ng tiu ha theo ng bch huyt ti gan nh amp gy ti m gan. 3. Ri lon chc nng ca gan 3.1. Ri lon chuyn ha do bnh gan Mi chc nng chuyn ha u c thc hin bi t bo nhu m, nh mt h thng enzym phong ph c trong t bo ny. 3.1.1. Ri lon chuyn ha protid - Gim kh nng tng hp protid, mi s bnh gan gy gim kh nng tng hp protid, trc nht l albumine, globuline. - Gim tng hp cc protid tham gia phn ng gy ng mu, nh cc yu t II, VII, IX, X... cc yu t gy chng chy mu A, B, C, phc hp prothrombine, fibrinogen. Do vy bnh nhn suy gan, d b xut huyt di da v gy chy mu. 3.1.2. Ri lon chuyn ha lipid Gan khng nhng gip cho c th tng hp m qua ng tiu ha m nh mt ca n bi tit ra m cn c nhim v chuyn ha nhng m hp thu a n gan qua ng mu. V vy khi chc phn chuyn ha lipid ca gan b ri lon th c nhng biu hin sau y. - Lng m d tr trong gan gim nhanh do gim hp thu v gim tn to m t protid v glucid. - M lu hnh trong cc thnh phn ca lipoproteine huyt tng cng vi cc cht vn chuyn m do t bo gan tng hp v cc cholesterol t do v cc este ha cng gim.
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- Gim hp thu cc vitamine tan trong m nh: Vitamine A, D, E, K v gim hp thu m ni chung. Hu qu ca thiu cc vitamine ny nh bnh kh mt do thiu vitamine A, chy mu do thiu vitamine K, ci xng do thiu vitamine D. 3.1.3. Ri lon chuyn ha glucid Gim kh nng chuyn ng mi hp thu t ng tiu ha v ng glycogen d tr. Gim kh nng d tr glycogen, ngi bnh d b h ng huyt sau ba n. 3.1.4. Ri lon chuyn ha nc mui Th hin ri lon chuyn ha mui nc trong suy gan l ph. Ph do gim p lc keo, do tng p lc thy tnh (trong trng hp c tng p lc tnh mch ca) nc b y ra ngoi lng mch v gim kh nng phn hy mt s hormon nh ADH c tc dng gi nc, Aldosteron gi mui v ko theo gi nc. 3.2. Ri lon chc nng chng c Ri lon chc nng chng c ca th hin: + Gim phn hy mt s hormone: kch t sinh dc, kch t v thng thn, bnh nhn suy gan c hin tng mui v nc. + Gim kh nng chuyn cht c thnh cht khng c hoc km c bng phng php ha hc. 3.3. Ri lon chc phn cu to v bi tit mt Vng da do tnh trng bnh l xy ra khi sc t mt trong mu cao hn bnh thng v ngm vo da v nim mc. * Vng da do nguyn nhn trc gan: - L vng da do tng tan mu nn hemoglobine c chuyn thnh bilirubine t do qu nhiu. - Nguyn nhn c th l: nhim khun, k sinh trng, nhim c, do truyn nhm nhm mu. * Vng da do tn thng gan: nguyn nhn gy vng da ny do nhim c, nhim vi khun (nhim khun huyt, giang mai) * Vng da do nguyn nhn sau gan: mt khng xung c rut, vo mu gy vng da, phn trng, nc tiu vng. Nguyn nhn: c hc do si, giun chui ng mt, u u ty, hch to chn p ng dn mt.... 3.4. Ri lon tun hon v chc phn to mu 3.4.1. Ri lon tun hon 3.4.1.1. mu ti gan Tt c cc nguyn nhn mu tun hon v tim phi, u lm cho mu gan, nh suy tim phi, vim ngoi tm mc co tht, bnh phi mn tnh, tc tnh mch ch di, tnh mch gan do vim hoc do chn p u lm ri lon chc nng gan.
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* Hu qu: ty theo thi gian mt. u tin gan c th to, tnh trng gan lc ny gi l gan n xp. Khi mu gan lu ngy, gan s b thiu oxy ko di dn ti hoi t t bo nhu m gan quanh tnh mch trung tm tiu thy, t chc x pht trin dn ti hnh thi bnh l gan ht cau. 3.4.1.2.Tng p lc tnh mch ca Nguyn nhn gy tng p lc tnh mch ca do huyt p tnh mch ton thn tng, do h thng tnh mch ca b tc mt on no trc hoc sau xoang, do x gan, do u chn p. - Hu qu ca tng p lc tnh mch ca: T chc x ca gan d pht trin do trung tm tiu thy thiu dinh dng, tun hon bn ngoi gan pht trin gy nn: + Nn ra mu do tng p lc vng ni thc qun gia tnh mch vnh v ca h thng ca vi tnh mch n ca h thng ch, v tnh mch ch trn. + Tr do tng p lc vng ni trc trng gia tnh mch tr trn ca h thng ca vi tnh mch tr gia v di ca h thng ch v tnh mch ch di. + Tun hon bng h do tng p lc vng ni quanh rn ca h thng ca vi tnh mch thng v, h v ca tnh mch ch di, biu hin lm sng l nhng chm tnh mch ngon ngoo ni di da bng. Bng nc l kt qu phi hp ca nhiu ri lon: - Do tng p lc thy tnh ca h thng tnh mch ca. - Do tng tnh thm ca thnh mch v tnh trng thiu oxy v nhim c mn tnh bnh nhn suy gan. - Do gim p lc keo huyt tng (gan gim chc nng tng hp protid). - Do gan khng phn hy mt s hormone gi mui nh aldosteron v gi nc nh ADH. Bng nc trong x gan l bng nc nhiu nc, mu vng chanh v hi snh. Bng nc c th gy chn p cc tng trong bng, nh hng n hot ng c honh gy kh th. 3.4.2. Ri lon chc phn trong cu to mu Trong mt s bnh l ca gan thng c nhng biu hin thiu mu do thiu protein, st, vitamine. Chy mu do thiu cc yu t ng mu v chng ng mu. Hi chng chy mu trong suy gan cn do tng p lc tnh mch ca, dn tnh mch lm tng tnh thm thnh mch v lch x. 4. Suy gan Suy gan l tnh trng bnh l trong gan khng lm trn cc chc nng ca n v nh hng cc hot ng ca cc c quan khc. Biu hin lm sng v mc ri lon cc chc nng ty thuc vo suy gan cp hoc suy gan mn tnh.
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4.1. Suy gan cp Ty theo thi gian xut hin ca du hiu suy gan sm hay mun, gan teo nh k t khi c vng da m chia ra ba loi: - Suy gan ti cp nu bnh nhn din bin trong thi gian mt tun. - Suy gan cp nu bnh din bin trong thi gian ba tun. - Suy gan bn cp nu bnh din bin trong vng 2- 3 thng. 4.1.1. Nguyn nhn Tt c cc nguyn nhn lm gan b nhim c nng nh phospho, thuc m hoc nhim khun nng nh vim gan do virut. 4.1.2. Biu hin lm sng Bnh nhn c nhng du hiu nng ngay t u, hnh thnh rt y v nhanh ty theo mc ca x gan: du hiu nn v du hiu thn kinh xut hin sm, xut huyt di da hoc d dy.. - Xt nghim mu: glucose huyt gim, cholesterol este ha gim nhiu, amoniac tng cao. - Gii phu bnh: nhu m gan b hoi t ton b hoc kiu mi gm, hoc hoi t c cu ni nht l hoi t vng trung tm tiu thy. 4.2. Suy gan mn tnh 4.2.1. Nguyn nhn Suy gan mn tnh thng gp nhng ngi b bnh gan ko di, nhu m gan b tn thng lm nh hng n chc nng gan. 4.2.2. Biu hin lm sng Thng qua cc ri lon chc nng sau y: - Ri lon chc nng tiu ha: chn n, bun nn, chng hi, y bng, a lng.. - Ri lon chc nng tun han: thiu nng tim mch do tng lu lng tun hon do ng c c tim v cc cht c chung cho ton c th. - Ri lon chc nng thn: gy ra hi chng gan thn c thiu niu, c ur mu cao.. - Ri lon chc nng thn kinh: run tay, ri lon tr nh hoc nng hn l hn m.. 4.3. Hn m gan Hn m l do suy gan bt u t nhng ri lon thn kinh nh run tay, phn x tng, thc gim st, m mng, ni lp bp, co git v cui cng l hn m. C ch c th l do: tng amoniac trong mu, hoc tng cc dn truyn thn kinh gi.
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SINH L BNH CHC NNG THN

(2 tit) MC TIU Sau khi hc xong bi ny sinh vin c kh nng: 1. Trnh by nguyn nhn, c ch, ca ri lon chc nng cu thn. 2. Trnh by c ch suy thn cp v suy thn mn. 3. Trnh by nguyn nhn, c ch, ca ri lon chc nng ng thn. NI DUNG 1. i cng v chc nng thn: Thn c chc nng o thi ra khi c th nhiu cht nng ca chng khi tng ln trong huyt tng (chc nng ngoi tit). ng thi cn sn xut ra mt s hot cht a vo mu (chc nng ni tit) duy tr s lng hng cu v huyt p. - Chc nng ni tit bao gm: + Tit ra renin: c vai tr duy tr n nh huyt p. + Tit ra erythropoietin: c vai tr duy tr s lng hng cu do kch thch s pht trin v trng thnh ca hng cu trong ty xng. - Chc nng ngoi tit: + Lc cu thn o thi ra khi huyt tng. + Cc sn phm cui cng ca qu trnh chuyn ha cht trong c th. + Cc cht c ni sinh (bilirubine, kt hp vi acid, gy nhim toan) v mt s cht c ngoi sinh (i vo bng ng tiu ha hoc ng mu). - Bi tit v ti hp thu: + Bi tit mt s cht, ngoi s lng c o thi bng lc, cn c bi tit gp nm ln ng thn. + Ti hp thu: thu hi v tr li huyt tng nhiu cht cn thit cho c th trc b thot ra t cu thn do ln vo cc cht o thi. 2. Cc biu hin bnh l nc tiu v mu 2.1. Nc tiu Trong bnh l nc tiu c th thay i v lng hoc v thnh phn. Nhng thay i ny c th do nguyn nhn ti hoc ngoi h tit niu. 2.1.1. Thay i v s lng nc tiu: S lng nc tiu trong 24 gi ca ngi bnh thng rt thay i, c th dao ng trong khong 500ml - 2000ml, trung bnh khong 1000ml - 1500ml. iu ny ph thuc vo lng nc o thi theo hi th hay theo m hi tng hoc gim, lng nc tiu chu nh hng r rt ca: - Ch n ung: nhiu hay t nc.
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- Thi tit nng hay lnh. - Lao ng c bp cng cao hay thp. * a niu: l lng nc tiu trn 2000ml/ ngy m khng do ung nhiu. C th do nguyn nhn ti thn nh: + X thn: a s gp ngi gi hoc bnh nhn vim k thn mn tnh, vim b thn mn... + Bnh tiu nht: t bo ng thn km nhy cm vi vi ADH. C th do nguyn nhn ngoi thn nh: + Bnh tiu nht: lng ADH gim st do vng di i v tuyn yn km sn xut. C th bi tit 25 lt nc tiu/ ngy do ng ln xa hu nh khng ti hp thu nc. + a niu thm thu: do tng p sut thm thu trong lng ng thn gy cn tr s hp thu nc. C th gp trong bnh tiu ng, khi truyn dch manitol hoc khi s dng cc thuc li tiu thm thu. * Thiu niu: Khi lng nc tiu di 400ml/ngy, nu khng phi gim lu lng mu ti thn a n gim lc (nguyn nhn trc thn) th thng do nguyn nhn ti thn hoc do nguyn nhn tc ng dn niu (sau thn). - Trc thn: do mt mu, x va ng mch thn... dn ti gim p lc lc v lu lng mu n thn. - Ti thn: trong bnh vim cu thn, c ch thiu niu do cc cu thn ng mu, cn huyt tng ti ch hnh thnh dch lc. Trong khi kh nng hp thu trong ng thn hon ton bnh thng; trong vim ng thn, t bo ng sng ph n hoc bong ra gy hp hoc tc ng thn khi lu lng qua thn rt km. - Sau thn: c th do si, u c th gy tc ng tit niu. * V niu: l lng nc tiu di 100ml/ngy. V niu c th do nguyn nhn: + Trc thn (mt nc nng). + Ti thn (vim cu thn cp din, vim ng thn nng n). + Nguyn nhn sau thn: tc t i b thn tr xung. 2.1.2. Thay i thnh phn ca nc tiu * Protein niu: Bnh thng: lng protein mt theo nc tiu khng ng k (150mg), khng pht hin c bng cc xt nghim n gin. Nguyn nhn: - Trc thn: gp trong bnh a u ty xng, mt s bnh c ri lon sn xut khng th.
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- Ti thn: ch yu gp trong cc bnh vim cu thn, hoc ng lu.. - Sau thn: l do tn thng hoc vim ng dn niu khin protein t tn thng, hoc t mu trong vim lc vo. Tuy nhin trong trng hp ny triu chng protein niu t quan trng m ni bt l cc thnh phn bt thng khc trong nc tiu nh: hng cu, bch cu, t bo vim v t bo m.. * Hng cu niu: Bnh thng s lng hng cu trong nc tiu 24 gi khng ng k. Nguyn nhn gy ra hng cu niu: - Trc thn: rt him, c th gp trong bi cnh ri lon ng mu nng n, xut huyt ton thn hoc ni tng, gm c thn. - Ti thn: khi c tn thng on bt k no ca nephron u c th lm mu chy vo trong lng ng thn, Trong vim cu thn, vim k thn. vim ng thn... hng cu niu l mt triu chng ca b phc hp gm tr niu, protein niu v bch cu niu. Trong trng hp c vim m thn th hng cu niu triu chng i km vi triu chng chnh l c bch cu, bch cu thoi ha v t bo m nc tiu. - Sau thn: do v mch mu vo ng dn niu hay gp khi c si, vim nhim ( b i thn, niu qun, bng quang v niu o) hoc do chn thng. * Tr niu: L cu trc vi th trong nc tiu c hnh tr, do protein b ng vn li theo khung ca lng ng thn. iu kin xut hin tr: - Nng protein trong nc tiu cao. - Lng nc tiu tng i thp chy theo trong ng thn c thi gian hnh thnh tr. - C th thay i l ha trong nc tiu gip cho protein d ng li. Hay gp tr niu trong cc bnh vim cu thn, thn h nhim m. 3. Thay i mu trong bnh thn: - Tng ur huyt: (hi chng tng ur huyt). - Nhim acid mu - Thiu mu. - Tng huyt p 4. Sinh l bnh cu thn v ng thn 4.1. Vim cu thn cp 4.1.1. Nguyn nhn: L hu qu ca ri lon min dch, hay gp tr em do mt nhim khun ko di, do lin cu tan huyt A gy nn. Sau vi ba tun b nhim khun, lng khng th xut hin hnh thnh phc hp min dch lu hnh lu trong mu th d b bin
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chng vim cu thn cp. C ch l do phc hp min dch b o thi v lng ng cc lp ca mng lc cu thn. 4.1.2. C ch bnh sinh: S lng ng ca phc hp min dch gy ra mt s hu qu: - Xc trong phc hp min dch hp dn mt s ln bch cu tp trung to cu thn lm nhim v thc bo v phng thch cc enzym gy tiu hy. - Phi hp vi bch cu l s hot ha b th ti ch. l hai tc dng gy vim ch yu, m i tng ph hy l cc lp t bo ca mng lc. 4.1.3. Biu hin lm sng: Bnh nhn thng c v niu, tiu mu, ph.. 4.2. Vim cu thn mn 4.2.1. Nguyn nhn: - Vim cu thn cp dn n vim cu thn mn. - Bnh v mch thn. - Bnh t min. - Bnh h thng. 4.2.2. Bnh sinh: Din bin chung sau khi pht trin, cu thn b x ha, mt dn cu trc, do vy ton b nephron thoi ha theo gm ng thn v mao mch quanh n. Ban u ch c mt s nephron thoi ha khng phc hi. 4.3. Vim ng thn cp Rt nhiu nguyn nhn c th gy vim ng thn v ch vim cp m khng c vim mn. Chung quy, cc nguyn nhn u thng qua mt s c ch gy tn thng v hoi t cho ng thn, trong c hai c ch quan trng nht: - Thiu mu, thiu nui dng. - Mt s c cht c i tnh vi enzym ht sc phong ph t bo ng thn, mui kim loi nng, c tnh trong gan cc, nhim khun gram m, mt s thuc... 5. Suy thn Suy thn mn l hu qu ca nhiu bnh khc nhau, trong thn khng thc hin y cc chc nng ca n, trc ht l chc nng o thi, biu hin bng s ng trong c th cc cht cn b v cc cht tha khc. Suy thn nu ko di, cn biu hin bng tng huyt p v thiu mu. 5.1. Suy thn cp 5.1.1. Nguyn nhn trc thn: - Gim th tch mu. - Gim cung lng tim. - Do tt huyt p nng v ko di. - Do cc bnh h thng a n.
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5.1.2. Nguyn nhn ti thn: - Do mch ln cu thn: huyt khi ng mch thn, huyt khi tnh mch thn, vim mch thn x va.. - Do cu thn: vim cu thn cp - Vim thn k thn cp din, d ng, thuc (khng sinh, li tiu..). 5.1.3. Nguyn nhn sau thn: rt him gp. 5.1.4. C ch bnh sinh: T bo ng thn tn thng, thoi ha v hoi t a li cc hu qu: - T bo phng to lm cht hp hoc tc ng thn - T bo hoi t, bong ra lm tc ng thn v quan trng nht lm nc tiu chy trc tip vo mu em theo cht o thi. - S tr cp din nhiu sn phm c nh hp cht ca nit.. - Cc cht c hot tnh ca vim gii phng vo trong mu. 5.2. Suy thn mn Chc nng thn gim dn, din bin ko di, do s cu thn gim i, tuy nhin khi triu chng suy thn biu l trn lm sng v trn xt nghim th thi im c ti 70% s cu thn b x ha v hon ton khng cn hot ng chc nng.
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Sinh l bnh Min dch
SINH L BNH QU TRNH VIM

(2 tit) MC TIU Sau khi hc xong bi ny sinh vin c kh nng: 1. M t bn phn ng ca ri lon vn mch trong vim. 2. Trnh by cc phn ng t bo trong vim . 3. Phn tch hu qu ca phn ng tun hon trong vim. 4. Phn tch mi quan h gia phn ng vim vi c th. NI DUNG 1. Khi nim l phn ng bo th chng cc yu t gy phn ng Vim va v qu trnh vimv c tn thng,lihoi t, ri lon bnh va lc quan... bnh l gy chc nng c th mc rt nng n nguy him. Vim l qu trnh bnh l rt ph bin v: c v s yu t c th gy vim, bt c c quan m no cng c th b vim. 2. Nguyn nhn gy vim Mi nguyn nhn dn ti tn thng v lm cht mt lng ti thiu t bo ti ch u c th gy vim ti ch c th xp thnh hai nhm ln: 2.1. Nguyn nhn bn ngoi - C hc: t xy st nh ti chn thng nng ... gy ph hy t bo v m l phng thch ra nhng cht gy vim ni sinh. - Vt l: nhit qu cao hay qu thp lm thoi ha protid t bo gy tn thng enzym: tia X do to ra cc gc oxy t do gy ph hy mt s enzym oxy ha, cn gy tn thng ADN. - Ha hc: cc acid, kim mnh, cc cht ha hc khc, gy hy hoi t bo hoc phong b cc enzym ch yu. - Sinh hc: l nguyn nhn ch yu nht gm: vi rt, vi khun, k sinh trng n bo, a bo hay nm. 2.2. Nguyn nhn bn trong C th gp nh thiu oxy ti ch, hoi t m xut huyt, ri lon thn kinh dinh dng. Ngoi ra vim c th gy phn ng kt hp khng nguyn khng th nh vim cu thn. 3. Nhng bin i ch yu trong vim 3.1. Ri lon tun hon ti vim Thng sm d thy nht: xy ra ngay khi cc yu t gy vim tc ng ln c th. C th nhn thy bn hin tng sau y:
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Sinh l bnh Min dch
3.1.1. Ri lon vn mch: Ngay khi cc yu t gy vim tc ng, ti ch ln lt c cc hin tng: - Co mch. - Xung huyt ng mch. - Xung huyt tnh mch. - mu. 3.1.2. Hnh thnh dch r vim: Dch r vim l cc sn phm xut tit ti vim xut hin ngay t khi sung huyt ng mch bao gm nc v cc thnh phn hu hnh v thnh phn ha tan. 3.1.3. Bch cu xuyn mch: Khi tnh thm xuyn mch tng, c s thot mch, mu chy chm, lc bch cu ri khi dng trc, tin v pha ngoi vi ti b mt m thnh mch. Ti y chng trn theo vch mch, bm dnh v xuyn mch. Ty thuc vo bn cht ca tc nhn vim, giai on vim, m loi bch cu ti v tr vim khc nhau. hu ht cc vim cp, giai on cu ch yu l cc bch cu trung tnh (6 - 24gi), tip theo l monocyte (24 - 48 gi) cui cng l lymphocyte. 3.1.4. Bch cu thc bo: Thc bo l hin tng bch cu bt u gi (n) v tiu ha i tng. Chng phn hy tt c cc yu t gy vim v cng c th c t bo thc bo khi enzym ny thot ra khi cc hc thc bo. 3.2. Ri lon chuyn ha 3.2.1. Ri lon chuyn ha glucid: Glucid l ngun nng lng ch yu trong thc hin phn ng vim. Khi b vim nng tnh trng nhim toan c th lan ra ton c th. Thm vo vim thng c st v l nguyn nhn tng chuyn ha ton thn, tng s dng glucose cng lm xut hin toan mu. 3.2.2. Ri lon chuyn ha lipid: - Ri lon chuyn ha glucid ko theo ri lon chuyn ha lipid. Ti ch vim acid bo, lipid, v ceton u tng cao. Nguyn nhn tng ging ha lipid ngoi hu qu ca ri lon chuyn ha glucid cn do enzym chuyn ha lipid t t bo vim v t cc vi khun phng thch ra. - Ti ni vim di tc dng ca cc yu t gy vim cn thy mng t bo ca t bo vim c s chuyn ha acid arachidonic thnh prostaglandine v leucotrien l nhng cht gy dn mch, gy st, iu nay lm ri lon vn mch v ri lon chuyn ha cng nng. 3.2.3. Ri lon chuyn ha protid:
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Sinh l bnh Min dch
Chuyn ha protid tng do hot tnh cao ca cc enzym protease v ca TNF song cng khng c hon ton. Cc cht chuyn ha d dang nh polypeptide v acid amine tng ln v tch li. 3.3. Tn thng m: Ti vim thng thy hai dng tn thng: - Tn thng tin pht: Do nguyn nhn gy vim to ra. - Tn thng th pht: do nhng ri lon ti ch gy nn, rt quan trng v n ph thuc khng nhng vo cng ca nguyn nhn m cn ph thuc vo mc phn ng ca c th. 3.4. Tng sinh t bo - qu trnh lm lnh vt thng: Ngay trong giai on u c tng sinh t bo, v cui s tng sinh vt mc hoi t khin vim c sa cha. Cc t bo nhu m ca c quan vim c th c ti sinh y khin cu trc v chc nng c quan vn c phc hi; nu khng c nh vy th mt phn nhu m c thay th bng m x (so). 3.5. Vim mn tnh: Vim cp tnh c th loi tr hon ton khng li hu qu ng k no v cu trc hay chc nng cho c quan v nhu m b vim; nhng cng c th chuyn sang vim mn tnh, trong cc du hiu bn ngoi nh: sng, nng, , au khng cn na. Biu hin ca vim mn tnh bao gm: - Tit dch nhng sng, , nng khng r hoc khng c. - Chc nng m hoc c quan t nh hng hoc ch suy gim chm. - Hin tng huy ng bch cu vn cn nhng khng ln . 4. Quan h gia phn ng vim v c th 4.1. nh hng ca c th i vi phn ng vim - nh hng ca trng thi thn kinh i vi phn ng vim. Trng thi thn kinh c nh hng su sc n qu trnh pht sinh, pht trin ca vim. Ngi gi phn ng vim yu hn ngi tr. Trng thi thn kinh c nh hng r n qu trnh tit dch r vim v hin tng thc bo. - nh hng ni tit n phn ng vim: Cc ni tit t c nh hng n r rt n phn ng vim, nht l ni tit ca tuyn yn v thng thn, nh hng ni tit c hai mt: loi lm tng phn ng vim, loi lm gim phn ng vim. 4. 2. Phn ng vim nh hng ti ton thn Vim nng v cp gy au n, khin bnh nhn gim n ngon, mt ng Cc sn phm ca vim gii phng vo mu gy nhng bin i ton thn; tng bch cu, st, tng min dch v tng lng mu.
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Sinh l bnh Min dch
RI LON CHUYN HA NC- IN GII

(1 tit) MC TIU 1. Trnh by c vai tr ca nc v cc cht in gii trong c th. 2. Trnh by c cc ri lon sinh l bnh trong mt nc. 3. Trnh by c cc ri lon sinh l bnh trong nc (ph). NI DUNG 1. i cng 1.1. Vai tr ca nc - S cn bng xut nhp 1.1.1. Vai tr ca nc, in gii trong c th + Nc chim 60 80 % trng lng c th. C th cng tr cng cha nhiu nc (bo thai chim 90 97 % nc, tr s sinh chim 85 % nc, ngi ln chim 65 70 %, ngi gi chim 60 65 %). Trong c th c quan no cng hot ng cng cha nhiu nc ( no, gan, tim, thn, phicha nhiu nc hn m lin kt, sn, xng) + Vai tr ca nc l: Duy tr khi lng tun han, do gp phn duy tr huyt p Lm dung mi cho mi cht dinh dng, vn chuyn cc cht trong c th Lm mi trng cho mi phn ng ha hc, ng thi trc tip tham gia mt s phn ng (thy phn, oxy ha, s ngm nc ca protein) Lm gim ma st gia cc mng Tham gia iu ha nhit + Vai tr ca cht in gii Quyt nh ch yu p lc thm thu ca c th, m quan trng l Na+, K+. Cl-, HPO4- Tham gia cc h thng m ca c th iu ha pH ni mi Mt s cht c vai tr ring nh Ca ++ trong dn truyn thn kinh, Cl- trong toan d dy 1.1.2. S cn bng xut nhp Hng ngy c th o thi trung bnh 2,5lt nc. Gm: Hi th: 0,5 lt Nc thm qua da: 0,5 lt Nc tiu: 1,4lt Phn: 0,1lt
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Sinh l bnh Min dch
Cc cht in gii c trong thc n khi vo c th s lm tng p lc thm thu. u tin c th s ung mt lng nc iu chnh p lc thm thu ( l cm gic khc), sau nc v cc cht in gii s c o thi ra ngoi ch yu qua thn. 1.2. S phn b nc trong c th Nc chim 70% trng lng c th, chia thnh 3 khu vc: - Nc trong t bo: chim 50% trng lng c th - Nc gian bo: - Nc lng mch: 15 % 5%
Nc gian bo v nc lng mch gi chung l nc ngoi t bo (ngoi bo) 2. Ri lon chuyn ha nc in gii 2.1. Mt nc 2.1.1. Phn loi + Mt nc u trng khi mt nc nhiu hn mt in gii: mt nc do i nht, do hi th, m hi, st + Mt nc nhc trng khi mt mui nhiu hn mt nc: suy thng thn, bnh Addison, ra d dy ko di bng nc nhc trng + Mt nc ng trng l mt nc v mui tng ng nh nn ma, a chy + Mt nc ngoi bo vi du hiu gim khi lng tun hon (gim 1/3: nguy him, gim 2/3: t vong): huyt p gim, thn gim bi tit c th tn thng thc th ng thn, ri lon chuyn ha, nhim toan, nhim c, thiu oxy t bo thn kinh + Mt nc ni bo: do tnh trng u trng ngoi bo nc trong t bo ra ngoi gian bo: b khng nc trong st, trong phu thut ng tiu ha, gim chc nng thn lm gi Na, u nng thng thn gy tng Aldosteron, i nht 2.1.2. Mt s trng hp mt nc - Mt nc do m hi: Lng m hi mt thay i rt ln, ty theo thi tit, iu kin v cng lao ng. M hi c tnh nhc trng. M hi c th mt n 4 lt/ gi, b nc d dng bng ng ung, tuy nhin khi mt 5 lt m hi tr ln ngoi b nc phi b thm mui nu khng dch ngoi bo nhc trng, gy nc t bo. - Mt nc trong st: Trong st do tng thng kh v tng nhit , lng nc mt theo hi th c th gp 10 ln bnh thng; nu khng b p s a li tnh trng mt nc u trng. - Mt nc do nn: Km theo mt HCl, v vy d gy nhim kim. S lng khng nhiu nhng do kh b p v thng ko di nn d gy ri lon chuyn ha, tch li nhiu sn phm acid che lp nhim kim v tr thnh nhim toan.
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Sinh l bnh Min dch
- Mt nc do thn: Gp trong bnh i nht, vic b nc v in gii d dng, t gy ri lon chuyn ha nc in gii v thng bng acid base. - Mt nc do a chy: Dch tiu ha bi tit khong 8 lt mi ngy, km nhiu cht in gii, dch tiu ha l ng trng. Dch tiu ha s c hp thu ton b cng vi thc n. Khi cn ng tiu ha c th hp thu ti 30 lt mi ngy, ngc li khi b vim hoc ng c, ng tiu ha c th tit phn ng 30 40 lt. Do vy mt nc tiu ha c c im: + Rt cp din, vi lng nc mt rt ln. + Mt dch tiu ha: dch rut, mt, ty lm mt kim gy nhim toan rt nng. 2.2. nc (Ph ) 2.2.1. Cc c ch gy ph - Tng p lc thy tnh: Tng p lc thy tnh lm cho nc b y ra ngoi lng mch nhiu hn nc tr v do p lc keo. Gp trong ph do suy tim phi (ph chn, vng thp), suy tim tri (ph phi), do chn p tnh mch (vim tc, c thai), bng bng (cn tr tnh mch ca do x gan) - Gim p lc keo huyt tng (p lc keo 80% do albumin chi phi): C ch ngc vi trn. Gp trong ph suy dinh dng, x gan, hi chng thn h - Tng tnh thm thnh mch (vi protein): Protein ra ngoi gian bo, lm p lc keo 2 bn bng nhau, p lc thy tnh y nc ra. Gp trong ph do d ng, vim, ph phi, thiu oxy, ng c - Do mui v in gii: C quan o thi ch yu l thn. Gp trong ph do vim thn, hi chng Conn 2.2.2. Phn loi - Ph ton thn: do c ch gy ph ton thn nh tng p lc thu tnh trong suy tim phi, gim p lc keo trong suy dinh dng, x gan, tng p lc thm thu trong vim thn - Ph cc b: nh d ng cn trng t, vim, gar, ph phi - Ph ngoi bo: ph ngoi bo (cc loi ph trn) - Ph ni bo: khi mt Natri, nc ngoa bo nc vo trong t bo gy nc ni bo. Gp trong suy thng thn, b nc nhc trng khi mt in gii ng k
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Sinh l bnh Min dch
RI LON THNG BNG ACID BASE

(1 tit) MC TIU 1. Trnh by c ngha ca pH mu v c ch iu ha pH mu. 2. Trnh by c cc bnh l thng gp gy nhim acid v kim mu. NI DUNG 1. i cng 1.1. ngha ca pH mu pH cn thit cho cc phn ng chuyn ha; cc phn ng ch xy ra pH thch hp. pH mu lun thay i v: + Nhn sn phm acid t chuyn ha t bo. + Nhn cc acid, kim t thc n. +Trao i acid, kim vi dch tiu ha. Do mu lun din ra qu trnh iu ha pH duy tr hng nh pH (7,4). Mu iu ha pH bng: + Cc h thng m + o thi CO2 qua phi + o thi cc acid khng bay hi qua thn 1.2. Cc c ch iu ha pH mu 1.2.1. H thng m: - H thng m trong huyt tng v trong t bo gm mt acid yu v mui ca n vi mt base mnh (Na+ hay K +). Khi t bo o thi acid, mui kim ca h thng s tham gia phn ng bin thnh mui trung tnh v acid ca h thng m l acid yu do vy pH khng b gim nhiu. Nu mt cht kim vo huyt tng, s b acid ca h thng m trung ha ng thi xut hin mui yu lm pH t tng. - Cc h thng m ca mu: + H bicacbonat H2CO3 / NaHCO3 c hiu sut thp, nhng dung lng ln nht trong huyt tng. Dung lng ln nn NaHCO3 c xem l d tr kim ca mu. + H photphat NaH2PO4 / Na2HPO4 c hiu sut ln hn nhng dung lng km, nn kh nng m hn ch. Tuy vy trong t bo c vai tr rt quan trng, nht l t bo ng thn. + H protein / proteinat: mi trung acid protein th hin tnh kim v ngc li v vy chng c vai tr m yu. Vi lng ln trong huyt tng n c vai tr m ng k. + H HHb / KHb v HHbO2 / KHbO2 ca hng cu c dung lng rt ln v c vai tr quan trng trong o thi acid cacbonic.
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Sinh l bnh Min dch
1.2.2. Vai tr ca h hp Lng acid cacbonic do t bo sn ra hng ngy cng vi acid cacbonic sinh ra do phn ng m, c h thng m hemoglobin ca hng cu mang thi ra phi. - cc m: pH thp v cc cht thi t bo, s c mt ca hng to ra qu trnh kim ha rt mnh KHbO2 phn ly to ra KHb v O2, O2 vo t bo ng thi CO2 t huyt tng vo hng cu to ra H2CO3 kt hph vi KHb to ra HHb v KHCO3. Cht ny phn ly cho HCO3- ra huyt tng to ra mui kim NaHCO3 v n nhn Cl- vo hng cu, lm tng pH huyt tng. - phi: s o thi mnh m CO2 lm pH tng ln nhng c iu chnh bng cc phn ng ngc li. + Oxy vo hng cu to acid mnh HhbO2, cht ny y H2CO3 ra khi mui ca n KHCO3 v phn ly thnh CO2 thi ra phi. Cl- ra khi hng cu lm toan ha huyt tng - Trung tm h hp rt nhy cm vi CO2. Khi c th tch nhiu CO2 trung tm ny b kch thch, tng thng kh v CO2 c o thi. Ngc li kh CO2 gim hoc NaHCO3 tng, pH tng trung tm h hp b c ch. 1.2.3. Vai tr ca thn T bo ng thn c c im: - Nhiu men cacbonic anhydraza nn d dng to ra H 2CO3 v phn ly n thnh
HCO3 v H
+
- Nhiu men glutaminaza to ra c cc nhm NH4 t glutamin 2. Ri lon cn bng acid-base S ri lon a n nhim acid hoc nhim base. 2.1. Nhim acid 2.1.1. Nhim acid l tnh trng cc acid t t bo hoc ngoi mi vo huyt tng lm pH h thp, cc h thng m s tham gia iu ha. 2.1.2. Phn loi - Theo mc , ta c nhim acid cn b v mt b. Nhim acid cn b khi cc h thng m trung ha c acid, lm pH acid khng gim; nhim acid mt b khi pH gim . - Theo nguyn nhn, ta c nhim acid hi v nhim acid c nh. + Nhim acid hi hay nhim acid h hp: Do acid cacbonic ng, lm tng NaHCO3. Gp trong dng thuc c ch h hp (thuc m, thuc ng, morphin), khi c cc bnh ng h hp lm cn tr khng kh (hen, x phi, vim phi, hp ph qun, lit c h hp), khi ngt khi th trong mi trng kn.
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Sinh l bnh Min dch
Hu qu l thn tng hp thu d tr kim, o thi Cl-, hng cu thu nhn Cl- (phng ln) + Nhim acid c nh Do nhim acid chuyn ha (ni sinh) hoc acid t ngoi mi (thuc, truyn dch) v do khng o thi c acid hoc mt nhiu kim. Gp trong * Lao ng nng, chuyn ha ym kh (sinh acid lactic), i ng (sinh th xeton), i, st, nhim khun (ri lon chuyn ha gluxit v lipit) * Suy thn (km o thi acid v hp thu d tr kim), a chy nng (mt kim) v ri lon chuyn ha, mt nc (km o thi v ri lon chuyn ha) Hu qu l d tr kim gim, tng o thi CO2 2.2. Nhim kim (base) Him xy ra v c th chu ng tng i d dng hn so vi nhim acid cng mc 2.2.1. Nhim kim hi - Xy ra khi c tng thng kh lm mt nhiu H2CO3 (khi ln cao, trong nghim php th nhanh, st u no, vim no - C th b tr bng cch gim d tr kim( tng o thi thn, gim Ca ++ huyt tng) v tng Cl- ( hp thu thn). 2.2.2. Nhim kim c nh - Gp trong sau khi n (tit nhiu HCl d dy), ung nhiu thuc kim, truyn nhiu dch kim, khi nn (mt HCl), mt Cl- theo nc tiu (khi dng thuc li tiu, teo thn). - Hu qu l tng d tr kim trong mu, ko theo gim thng kh v gi li H2CO3 ; nc tiu o thi nhiu d tr kim
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Sinh l bnh Min dch
SINH L BNH IU HA THN NHIT

(2 tit) MC TIU 1. Trnh by c cc hnh thi ca ri lon thn nhit. 2. Trnh by c cc giai on ca st. 3. Nu c cc nh hng ca st i vi c th. 4. Trnh by c ngha ca st trong bnh l v thi ca ngi thy thuc trc bnh nhn b st. NI DUNG 1. KHI NIM IU HA THN NHIT V PHN NG ST 1.1. Thn nhit ngi, thn nhit lun hng nh mc 370C, l nh hai qu trnh: sinh nhit v thi nhit. Sinh nhit cn gi l iu ha ha hc, do chuyn ha cc cht to nn. Thi nhit cn gi l iu ha vt l l do truyn nhit v bay hi nc Khi nhit mi trng thp hn nhit c th th truyn nhit l quan trng, nhng khi nhit bn ngoi cao hn th thi nhit bng bay hi nc l ch yu: qua da v nim mc ng h hp (m hi, hi th). Thi nhit qua da ph thuc vo nhiu iu kin: lu thng khng kh, m, qun o, b mt lp m di da, v kh nng co gin ca cc lp mch mu ngoi vi. 1.2. Trung tm iu ha nhit Bnh thng 2 qu trnh sinh nhit v thi nhit hot ng cn bng nhau. iu ha s cn bng l trung tm iu nhit, trung tm ny nm vng di i, gm c hai b phn hot ng i lp: trung tm chng nng v trung tm chng lnh. Khi mt cn bng ca 2 qu trnh trn s lm ri lon thn nhit. 1.3. Ri lon thn nhit 1.3.1. H thn nhit H thn nhit l trng thi thn nhit gim ti gii hn nhit thp ca s sng (khong t 35 - 310C). nhit ny s pht sinh cc phn ng t cng (ti ch), ton thn nhim lnh. Ty theo mc , ngi ta chia 3 loi h thn nhit: - H thn nhit sinh l: gp vt ng ng, ngi gi. - H thn nhit nhn to: l phng php lm lnh cha bnh, nhit gim xung mc c th c th hi phc c cc chc nng sng m khng gy tc hi. Hin nay phng php ny ang c p dng trong cc phu thut ln, c bit l phu thut gan, v phu thut tim mch. Ngoi ra, gim thn nhit nhn to cn c
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Sinh l bnh Min dch
dng trong iu tr mt s bnh nh un vn, st cao, vim no, chy mu, bng, nhim c nng, v.v... - H thn nhit bnh l: c th gp trong cc trng hp ri lon chuyn ha nng nh gim chuyn ha c bn, suy gan, i ng, suy dinh dng hoc do mt qu nhiu nhit trong nhim lnh, bng gi, p lnh v.v... (phng php p lnh hin nay ang p dng rng ri bo qun cc c quan ghp, vi khun, gi cc chng t bo, v.v) 1.3.2. Tng thn nhit Tng thn nhit l trng thi nhit c th tng ln qu mc bnh thng do cc nguyn nhn sau y: - Do tng sinh nhit: gp trong bnh tng chuyn ha c bn, trong vim. - Do gim thi nhit: khi nhit mi trng qu cao, m cao, iu kin thng kh km lm gim nghim trng qu trnh bay hi nc, hoc truyn nhit, do thn nhit b tng ln. Trng thi ny thng gp trong say nng, say nng. - Do tng sinh nhit v gim thi nhit: y l trang thi c bit do do hu qu ca ri lon trung tm iu ha nhit, gp trong st. St l trng thi bnh l thng gp trong rt nhiu bnh khc nhau. 2. SINH L BNH QU TRNH ST 2.1. nh ngha St l trng thi tng thn nhit do trung tm iu ha nhit b ri lon bi cc nhn t gy bnh, thng gp nht l nhim khun. l mt phn ng thch ng ca c th. 2.2. Nguyn nhn gy st 2.2.1. Do nhim khun Nhim khun l nguyn nhn ph bin nht, phn ln cc bnh nhim khun v nhim virus u gy st. Trong trng hp nhim khun, th ch yu l c t ca vi khun tc ng ln trung tm iu ha nhit. Tuy nhin mt s trng hp nhim khun li khng gy st nh giang mai, l amip, hoc mt s li lm gim thn nhit nh t. 2.2.2. Khng do nhim khun Nguyn nhn ny c th do nhiu loi khc nhau nh: - Protid l: c hai loi protid l; loi t ngoi a vo nh a cc protid l gy st iu tr bnh, cn loi protid ni sinh do sn phm hy hoi m ca c th nh xut huyt ni, hoi t t chc (bng, gy xng, tan mu, hy hoi bch cu). - Thuc: mt s thuc c tc dng kch thch sinh nhit nh thyroxin. S khc li c tc dng c ch thi nhit nh cafein, adrenalin, phenamin, v.v...
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Sinh l bnh Min dch
- Thn kinh: st do phn x thn kinh nh au n qu mc gp trong si thn, si mt, si bng quang. St do tn thng h thn kinh nh u no, chy mu no. C hai u gy ri lon trung tm iu ha nhit, gy st. 2.3. Cc giai on ca qu trnh st 2.3.1 Giai on st tng Trong giai on ny sinh nhit (SN) tng, thi nhit (TN) gim lm mt cn bng nhit, t l
SN > 1. Biu hin lm sng nh bnh nhn rt run, sn gai c, co mch TN
ngoi vi, da nht, gim bi tit m hi, tng huyt p nh . 2.3.2. Giai on st ng Sang giai on ny, sinh nhit khng tng, thi nhit bt u hnh thnh, nn t l
SN = 1 cn bng thn nhit mc cao. Biu hin lm sng thy mch ngoi bin TN
bt u gin, h hp tng, nhit vn cao, nhng cha c m hi, da bnh nhn vn kh. 2.3.3. Giai on st lui Sang giai on ny sinh nhit b c ch dn tr v mc bnh thng, cn thi nhit tng r rt, lm cho t s
SN < 1. Trn lm sng thy bnh nhn ra m hi nhiu, TN
gin mch ngoi bin, i i nhiu cn gi l i gii thot. Cn ch i gii thot v ra m hi nhiu c th gy mt nhit, lm gim thn nhit t ngt, mt nc, lm gim khi lng tun hon c th gy try tim mch. 2.4. C ch gy st 2.4.1. St l ri lon trung tm iu ha nhit Giai on u ca st c th tng sinh nhit v gim thi nhit nng nhit , v khi nhit ca mu cao, th nhit cao s lm thay i phn ng ca trung tm: tnh nhy vi lnh li gim xung, vi nng tng ln do sinh nhit b c ch, thi nhit c tng cng, v thn nhit dn dn gim xung v mc bnh thng. 2.4.2. C ch tc dng ca cht gy st ln trung tm iu ha nhit Cho ti nay c ch tc dng ca cht gy st ln trung tm iu ha nhit vn cha c gii thch r rng, c kin cho rng cc cht gy st khi tc dng ln trung tm iu ha nhit l do mt cht ni sinh t bch cu a nhn trung tnh tit ra. Nhng trong thc nghim th c ch cng cha c xc minh. Cho nn ngi ta li nu ln vai tr ca h thn kinh. Theo quan im ny, th cht gy st tc ng ln trung tm iu ha nhit thng qua ng phn x thn kinh. Ngha l, cht gy st tc ng vo c quan nhn cm ti ch, t gy mt lung xung ng theo dy thn
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Sinh l bnh Min dch
kinh hng tm ln trung tm iu ha nhit, lm ri lon cn bng ca 2 qu trnh sinh nhit v thi nhit. 2.4.3. Vai tr ca v no trong c ch st Trng thi thn kinh ca v no nh hng rt r n c ch st, thn kinh cng trong trng thi kch thch phn ng st cng mnh. Trn lm sng, nhng ngi c trng thi thn kinh c ch (lm l) th phn ng st yu, cn ngi trng thi thn kinh hng phn phn ng st rm r hn. tr em do v no cha pht trin y , phn ng st cng mnh hn. Ngi gi phn ng st yu hn ngi tr. 2.4.4. Vai tr ni tit Vai tr ca cc tuyn ni tit trong c ch st cha r. Tuy nhin vic ct b 1 tuyn nh h no, tuyn gip, th thy phn ng st gim. Tm li, nguyn nhn gy st khi tc ng vo h thn kinh iu ha nhit vng di i gy nn ri lon cn bng nhit, tng sinh nhit, gim thi nhit, lm tng thn nhit, gy phn ng st 2.5. nh hng ca st i vi c th 2.5.1. St gy ri lon chuyn ha 2.5.1.1. Chuyn ha nng lng Do nhu cu tng thn nhit nn chuyn ha nng lng tng kh r rt, thng nhit tng 10C th chuyn ha tng 3,3%. Do nhu cu oxy tng ln t 5 - 10%. 2.5.1.2. Chuyn ha ng Tng ging ha ng do lng glycogen d tr gim, glucose mu tng, c khi c ng niu. Lng acid lactic tng, gy nhim toan. V nhu cu ng trong st rt tng cho nn st cao v ko di cn cung cp ng cho bnh nhn. 2.5.1.3. Chuyn ha m Chuyn ha m ch tng mnh trong st cao v ko di, khi lng d tr glycogen gim, lm cho lipid mu tng, xut hin th ceton. 2.5.1.4. Chuyn ha protid Ri lon chuyn ha protid do 3 nguyn nhn: nhim c, nhim trng v ch yu l i n. i n l tnh trng c th s dng ht ng d tr, ht ng nn c th t tiu m v m, cho nn sau cn st bnh nhn gy, gim cn.. V vy trong trng hp st cao v ko di cn cung cp cho bnh nhn thc n d tiu c nhiu cht dinh dng nhm hn ch t thc m ca c th. 2.5.1.5. Nhu cu vitamin Do tng chuyn ha nn nhu cu vitamin, nht l vitamin B1 v vitamin C tng rt mnh. Khi st cn cung cp cc vitamin ny cho bnh nhn phng ri lon chuyn ha.
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Sinh l bnh Min dch
2.5.1.6. Chuyn ha nc mui v thng bng kim toan Chuyn ha nc v mui thay i theo din bin ca st. giai on u chuyn ha nc v mui hi tng. Sang giai on hai v do tng cc ni tit gi nc v mui, trong quan trng nht l aldosteron v ADH cho nc gi li trong c th. Sang giai on st lui, do nhu cu thi nhit, nn o thi nc tng ln r rt: bnh nhn ra m hi, tng bi tit nc tiu. V mui, giai on st tng th thy gim bi tit natri clorua, ngc li kali li tng. Khi st lui th ngc li natri b o thi nhiu, c th dn n nhim toan Trong st, do ri lon chuyn ha cc cht, ri lon chuyn ha nc v mui, nn thay i toan - kim l mt ri lon rt ng lu . Tng cc sn phm toan. Tnh trng ny thng gp cc bnh nhn st cao v ko di. Trong trng hp ny vic nh lng cc cht in gii, b sung cho bnh nhn nc v cc cht kim l cn thit. 2.5.2. Ri lon cc c quan trong st Do hu qu ca c t vi trng, v cc sn phm ca ri lon chuyn ha v tn thng t chc, do thn nhit tng cao dn n ri lon nhiu chc phn trong c th. 2.5.2.1. Ri lon thn kinh Giai on u thn kinh trng thi hng phn, giai on sau thn kinh b c ch vi cc triu chng nhc u, chng mt, au ngi nng hn th co git v m sng. Ri lon thn kinh ph thuc vo tnh phn ng c th ( tr em st nh cng d co git, ngi gi st nng cng khng co git), v ph thuc vo bn cht gy st. Nh st ban d st nh cng c th m sng, cn trong st do lao th mc d nhit tng cao m vn khng c c im 2.5.2.2. Ri lon tun hon Mc ri lon tun hon ph thuc vo cng st. Thng c nhit tng 10C th mch tng 20 nhp. C ch tng nhp tim l do hng phn thn kinh giao cm, do nhit cao v do nhu cu oxy cho tng chuyn ha. Hot ng tim cn ph thuc vo yu t nhim trng, nhim c, nh trong vim mng no, thn nhit tng rt cao nhng mch li chm. Ngc li, trong st thng hn th mch rt chm nhng nhit li tng cao (mch nhit phn ly) ri lon hot ng tim trong trng hp ny l do c ch thn kinh, trong c trung tm iu ha nhit. Ngoi cc thay i v nhp tim, st cn lm thay i huyt p. giai on u, huyt p hi tng do co mch ngoi bin, sang giai on 2 v nht l giai on 3, do gin mch ngoi bin, huyt p gim r rt, c khi gim qu mnh gy try tim mch.
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2.5.2.3. Ri lon h hp Tng h hp thng i i vi tng tun hon. Nguyn nhn tng h hp trong st l do nhu cu oxy tng, do tng nhit , do tng axit mu, do nhu cu iu ha thn nhit. 2.5.2.4. Ri lon tiu ha C ch ri lon tiu ha trong st l do ri lon thn kinh giao cm v do thiu nng lng cung cp cho c th hot ng. Biu hin, bnh nhn ng ming, chn n, gim tit dch tiu ha, gim tng hp cc men tiu ha, chng bng, to bn... 2.5.2.5. Ri lon tit niu Ri lon bi tit nc tiu trong st din bin nh sau. giai on u do tng tun hon cho nn tng bi tit nh, sang giai on II, do nhu cu tng thn nhit, gim thi nhit cho nn nc tiu gim. giai on III, do nhu cu thi nhit tng nn tng bi tit nc tiu, c th c tnh trng i qu nhiu. 2.5.2.6. Ri lon ni tit St lm tng mt s ni tit t nh tng ni tit t chuyn ha (thyroxin), tng ni tit gi mui v nc (aldosteron, ADH), tng ni tit t tin yn v thng thn c tc dng chng vim, chng d ng (coctison, ACTH). Li dng c im ny, ngi ta gy st iu tr bnh hen d ng, vim thn d ng 2.5.2.7. Tng chc nng gan St lm tng chc phn chng c v kh c ca gan, tng chc phn tng hp cht l tng hp ur t amoniac, tng fibrinogen, tng chuyn ha nit... C tc dng tng sc khng ca c th. 2.5.2.8. Tng chc nng min dch Trong st, bch cu tng kh nng thc bo, tng sinh t chc lin vng, tng to khng th. 2.6. ngha ca st - St l mt phn ng bo v, v st lm: + Tng s lng bch cu, + Tng kh nng thc bo ca bch cu, + Tng t bo ca lin vng, tng sinh khng th, + Tng chuyn ha nng lng gan, tng chc nng bo v ca gan, tng chc nng tng hp m, tng hp ur, tng sn xut fibrinogen + St cn c tc dng c ch s sinh sn ca mt s virus (cm, bi lit). + St cn lm tng ni tit t c tc dng chng vim v chng d ng, tng kh nng phn hy vi khun, tng cc chc nng sinh l, v.v... - Nhng nu st cao v ko di, c th dn n ri lon chuyn ha cc cht, dn n ri lon cc chc phn c quan, to nn vng xon bnh l.
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Trc trng thi st, ngi thy thuc phi tn trng v bo v st va, khng nn vi v cho thuc h st, v c th do m lm thay i din bin ca bnh. Tt nht l phi tch cc tm nguyn nhn, iu tr theo nguyn nhn. Ch iu tr triu chng khi st cao v ko di v cn ct cc khu hnh thnh vng xon bnh l.
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Sinh l bnh Min dch
RI LON CU TO MU
(2 tit) MC TIU 1. Trnh by c cc hnh thi bnh l ca ri lon sinh hng cu. 2. Nu c phn loi thiu mu theo c ch bnh sinh. 3. Trnh by c cc nguyn nhn chnh gy gim v tng bch cu. 4. Trnh by c nhng nguyn nhn chnh gy ri lon ng mu. NI DUNG 1. RI LON CU TO HNG CU 1.1. T chc hng cu - Hng cu c sn xut trong ty xng, khi trng thnh c a vo lu thng trong h thng tun hon. - Hng cu li l nhng hng cu trung gian gia non v trng thnh, c mt trong ty xng ln mu ngoi vi: Bnh thng mu ngoi vi, hng cu li chim t 0,5-1,5% tng s hng cu. Khi hng cu li tng trong mu chng t t chc hng cu c tng sinh. - Trung bnh mi ngy c th hy mt th tch mu khong 40ml (hng cu gi) v c thay th bng nhng hng cu mi phn ln hng cu gi hy trong h ni mc vng m (ch yu lch, gan, ty xng), hemoglobin c thoi ha hnh thnh bilirubin, st c gii phng v c ty xng ti s dng, hemoglobin gii phng trc tip vo mu, kt hp vi globulin huyt tng l haptoglobin. Hin tng i ra hemoglobin ch xy ra khi no lng hemoglobin trong huyt tng qu cao, vt kh nng kt hp ca haptoglobin, cc hemoglobin cn li s qua mng lc cu thn ra ngoi. - Qu trnh to hng cu p ng nhu cu c th c thc hin l do nng oxy trong mu gin tip tc ng ti ty xng thng qua cht erythropoietin do thn tit khi b thiu oxy. 1.2. Ri lon to hng cu 1.2.1. Tng sinh hng cu 1.2.1.1. Tng sinh hng cu bnh l Ngi ta coi y l bnh c tnh ca dng hng cu. Bnh Vaquez : thng gp la tui 50 60. S lng hng cu tng ti 6 9 triu, ty xng tng sinh ton b (hng cu, bch cu v tiu cu u tng), hematocrit tng r rt, nht ca mu tng, mt v da bnh nhn thng . Bnh thng gy t vong v tc mch, huyt p cao hoc chuyn sang bnh bch cu kinh din.
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Sinh l bnh Min dch
1.2.1.2. Tng sinh hng cu phn ng nhng ngi sng lu trn vng cao hay mt s bnh nhn suy tun hon, suy h hp, kh nng bo ha oxy ca mu ng mch gim gy thiu oxy t chc, hng cu phi c tng sinh b sung cho tnh trng thiu oxy. 1.2.2. Gim sinh hng cu Gim sinh hng cu dn n thiu mu l hin tng bnh l thng gp. 1.2.2.1. nh ngha thiu mu Thiu mu l tnh trng mu b gim s lng hng cu v nng hemoglobin trong mu. 1.2.2.2. Xp loi thiu mu v c ch bnh sinh C rt nhiu cch xp loi thiu mu, theo c ch sinh bnh, c th xp thnh ba nhm chnh: * THIU MU DO CHY MU C hai hnh thi: - Cp tnh : gp trong b thng, sau phu thut. khi chy mu nhiu c th phn ng tc thi bng nhng phn x co mch, tng nhp v tng sc co bp ca tim, phn phi li mu, tng h hp. Nhng nu mt mu nng ( 30 - 40% th tch mu c th) th thch ng khng ni v c th ri vo tnh trng sc do chy mu. - Mn tnh: l nhng trng hp mt mu t mt nhng ko di nh tr, bnh giun mc, rong kinh... * THIU MU DO V HNG CU C hai nguyn nhn chnh sau y: - Do bnh l ca bn thn hng cu nn d v. - Do trong huyt tng xut hin nhng cht lm hy hng cu. V hng cu do tn thng hng cu. - Do ri lon mng hng cu. - Do ri lon cu to hemoglobin bm sinh: thng gp nht l bnh Thalassemia (bnh thiu mu vng bin a Trung Hi) do ri lon gen iu ha tng hp protein ca hemoglobin. Hng cu c hnh bia. - Do ri lon men ca hng cu. Hay gp nht l thiu ht men Glucose - 6 - Dehydrogenaza (G6PD) v men pyruvat kinaza. Ngi bnh b ngoi bnh thng nhng khi ung hoc tim mt s thuc (thuc chng st rt, sunfamit, PAS, vitamin K, vitamin C .....) th b cn v hng cu. V hng cu do huyt tng + Trong huyt tng xut hin nhng yu t lm dung gii hng cu nh khng th chng hng cu, cht c, k sinh vt, vi khun, do tn thng ng tun hon, do cng lch.
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Sinh l bnh Min dch
+ Do truyn nhm nhm mu. + Do bt ng nhm mu Rhesus (Rh), gp ngi m Rh (15% ngi da trng) m c thai con Rh+ (do di truyn ca b). * THIU MU DO RI LON CHC PHN TO MU Qu trnh to mu cn nhng nguyn liu nh st, protid, vitamin v s hot ng bnh thng ca c quan to mu. Thiu mu do thiu nguyn liu + Do thiu st : st tham gia to Hb. Thiu st c th do thiu dinh dng, vim teo d dy, ct on d dy, nhim khun ko di, chy mu ko di + Do thiu protid: protein ng vai tr c bn trong cu to hng cu, n tham gia cu to nucleoprotein ca nhn v bo tng hng cu, globin ca hemoglobin, thnh phn ca protein ca hng cu. Thiu protein s gy nn thiu mu r rt. + do thiu vitamin: cn cho qu trnh to mu nh cc vitamin nhm B (B2, B6, B12, acid folic), vitamin C cn cho hp thu st. Thiu mu do ty xng km hoc khng hot ng Gp trong cc trng hp: ct ha ty xng, di cn ca u c tnh, ng c thuc v ha cht (piramidon, cloroxit, sunfamit, ch, benzen, tia Roentgen), trong bnh thn mn tnh (do thiu erythyropoietin). 2. RI LON CU TO BCH CU 2.1. Ri lon v s lng bch cu 2.2.1.Tng bch cu Khi s lng bch cu trn 10.000/mm3 gi l tng bch cu. C th tng dng bch cu ht trung tnh, bch cu a axit, bch cu a baz, hoc lymphoxit, monoxit. - Tng bch cu ht trung tnh + Trong nhng iu kin sinh l (cm xc, vn ng c, sau ba n, c thai, thay i v kh hu v cao) + Trong iu kin bnh l (thiu oxy, trong hu ht cc bnh nhim khun, sau chy mu, khi u c tnh, nung m). - Tng bch cu a axit gp trong cc trng hp d ng, nhim k sinh trng, bnh ngoi da, hen, bnh phong, khi u, tng sinh ty xng, sau chiu tia x, bnh tng bch cu a axit ... - Tng bch cu ht a baz gp trong cc bnh bch cu c tnh dng bch cu ht, d sn ty,. - Tng bch cu lymphoxit gp trong nhim virus, bnh tinh hng nhit, quai b, si, nhim khun mn tnh (lao, giang mai thi k 2, bnh do brucella), vim gan - Tng monoxit gp trong cc trng hp nhim khun: thng hn, lao, giang mai, nhim Brucella, st rt, bnh bch cu c tnh dng monoxit.
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2.2.2. Gim bch cu - Gim s lng bch cu c gim bch cu ht trung tnh gp trong nhim trng huyt, nhim cc vi khun mnh, lao k, thng hn, bnh Brucella, st rt... - Gim bch cu trung tnh nng trong nhng trng hp nhim c benzen, asen, thy ngn, bismuth, sulfonamit, piramidon, sau chiu tia x v sau khi dng ha cht km hm t bo. - Thiu hn bch cu ht trung tnh (v sinh) gy nn hin tng lot, hoi t nim mc ming, hng, amian, da, cc ni tng ... do s xm nhp ca vi khun c th khng c hng ro bo v. V sinh bch cu ht trung tnh gp trong nhng trng hp ty xng b tn thng nng do nhim trng, nhim c, phn ng tng mn cm vi thuc (piramidon, barbituric). - Gim s lng bch cu ht a axit trong trng hp stress, nhim trng nng, v sinh dng bch cu ht, sau khi dng ACTH v glucocorticosteroid. - Gim s lng bch cu ht a baz trong bnh cng tuyn gip, s dng heparin lu di, sau khi dng ACTH v glucocorticosteroid. - Gim lymphoxit v monoxit ni chung t gp. C th thy trong st rt, sau khi tim cortison,gim lymphoxit. 2.2.Ri lon v cht lng bch cu. - Bnh bch cu: Bnh bch cu (leucose, leucmie) l bnh c tnh ca c quan to bch cu, thng km theo hin tng tng s lng v thay i cht lng ca bch cu trong mu. Nguyn nhn gy nn bnh bch cu n nay ch mi bit r mt phn, yu t kch thch gy bnh bch cu c th l chiu x, chiu tia nhiu ln trong qu trnh iu tr c bit vng xng, ha cht c: benzen, asen, amin thm, virus.. 3. RI LON CU TO TIU CU V QU TRNH NG MU 3.1. Nhng ri lon qu trnh ng mu v chng ng 3.1.1. Nguyn nhn t mch mu Tn thng mch mu c th gy chy mu hay ng mu. - Nhng bnh gy chy mu hay gp + Bnh bm sinh: thnh mch khng bn vng, gin mch xut huyt di truyn do d dng mch (Rendu - Osler). + Bnh mc phi Thiu vitamin C gy chy mu chn rng, nim mc mi, nhim khun do no m cu, bnh ban huyt xut dng thp (Schnlein-Henoch). cc bnh trn du hiu dy tht thng dng tnh. - Tn thng mch gy ng mu hay gp trong bnh vim nghn tnh mch, vim ni ng mch nghn.
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3.1.2. Nguyn nhn t tiu cu - Do thay i v s lng + Tng s lng tiu cu qu 400.000/mm3 phi hp vi s tng fibrinogen c th gy bin chng vim nghn mch, hay gp ph n sau kh, bnh nhn sau ct lch. + Gim s lng tiu cu trn di 50.000/mm3 mu s kh ng, cc mu khng co li c, thnh mch s km co tht khi cm mu, hay c bin chng chy mu di da v vim mc. Gim tiu cu c th gp trong bnh Werlhoff (ban xut huyt gim tiu cu t pht), ng mu ri rc trong lng mch gim tiu cu, suy ty, bnh bch cu cp, nhim c nhim khun nng, nhim phng x. - Do thay i v cht lng S lng tiu cu vn bnh thng nhng hnh thi thay i : c nhiu tiu cu cha hon chnh, nguyn sinh cht c l hng, c ht bt thng, c kh khng u. Xt nghim thng thy s lng tiu cu bnh thng nhng thi gian chy mu ko di. Thng gp trong bnh suy nhc tiu cu Glanzmann. 3.1.3. Nguyn nhn do ri lon cc yu t ng mu. - Ri lon phc h prothrombin: + Bm sinh: do suy gim mt trong nhng yu t VII, X, V, II. + Gim cc yu t trn do bnh l gan mt, ng tiu ha, vitamin K, hoc do dng nhiu thuc chng ng loi dicumaron v c ch tng hp prothrombin, loi chng thrombin. - Ri lon phc h thromboplastin. Do thiu mt trong cc yu t XII, XI, IX, VIII ... Hay gp nht l bnh Hemophilie A, B (do thiu yu t VIII hoc IX). y l bnh di truyn m n l ngi mang gen bnh v nam l ngi b mc bnh. Ngoi ra cn gp khi trong mu xut hin cht chng ng lu hnh (chng yu t VIII, IX, chng thromboplastin). - Bnh tiu si huyt (fibrinolyse). Hi chng ng mu ri rc trong lng mch l hi chng in hnh. Bnh nhn c mt hi chng chy mu khng cm li c . Hi chng ny hay gp trong cc bnh x gan, nhim c, thai nghn, tc mch phi, bnh thn, vim a khp dng thp; lupus ban ; can thip ngoi khoa vng gan mt, lng ngc, tit niu. Do s tiu th qu mc cc yu t ng mu v tiu cu, cng vi s gii phng mt s sn phm ging ha ca fibrin c c tnh chng ng, nh vy tiu si fibrin l th pht i vi qu trnh ng mu ri rc.
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C ch ny c gii thch qua mi lin quan gia qu trnh ng mu v tiu cc mu theo s sau: Cc c quan nh phi, t cung, tuyn tin lit, khi b hy hoi gii phng ra nhiu cht hot ha hay tin hot ha (nh cc men kinaza: urokinaza, streptokinaza, trypain ...) tng chuyn plasminogen thnh plasmin. Plasmin tc dng ln fibrinogen v fibrin, ct chng thnh cc sn phm ging ha c tc dng chng li thrombin, chng s trng hp ca finbin, c ch s hnh thnh thromboplastin v c ch cc chc nng ca tiu cu do cc mu s b tiu ngay khi n mi hnh thnh.
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TI LIU THAM KHO

1. V Triu An. 2000. i cng Sinh l bnh hc. NXB Y Hc, H Ni. 2. B mn Min dch hc - Sinh l bnh trng i hc Y khoa H Ni (2002). Sinh l bnh. Nh xut bn Y hc 3. B mn Min dch hc - Sinh l bnh trng i hc Y khoa TPHCM. (2000). Sinh l bnh. Nh xut bn Y hc. 4. B mn Min dch hc-Sinh l bnh trng i hc Y Dc Hu (2006). Bi ging Sinh l bnh. 5. B mn Min dch hc-Sinh l bnh trng i hc Y Dc Hu (2006). Bi ging Min dch hc. 6. Nguyn Ngc Lanh. 2002. Khi nim v bnh. Trong: Sinh l bnh (Nguyn Ngc Lanh ch bin). Trang 16-30. NXB Y Hc, H Ni.
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BI GING

Sinh l bnh Min dch

TRNG CAO NG Y T QUNG NAM

Sinh l bnh Min dch

: Bs. B mn Ni, Trng Cao ng Y t Qung Nam

: Bs. B mn Ni, Trng Cao ng Y t Qung Nam

: Bs. B mn Ni, Trng Cao ng Y t Qung Nam

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

KHI NIM V BNH

Trnh vn minh ca x hi ng thi. Th gii quan (bao gm c trit hc) ca mi thi i.

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

KHI NIM V BNH NGUYN

Sinh l bnh Min dch

Pht bnh Khng pht bnh Bnh tim tng

iu kin khng thun li li

Sinh l bnh Min dch

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

KHI NIM V BNH SINH

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

KHI NIM V MIN DCH HC

Sinh l bnh Min dch

Sinh l bnh Min dch

L cc protein c to ra trong pha cp ca phn ng vim nh CRP (C-Reactive Protein,

antichymotrypsin, haptoglobin). Trong CRP c sn

Sinh l bnh Min dch

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Sinh l bnh Min dch

yu t ha hng ng cc bch cu v bc l cc yu t dnh trn b mt cc t bo ni mc gip cc bch cu xuyn mch.

Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Sinh l bnh Min dch

Khoa Ni Trng Cao ng Y t Qung Nam

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RI LON CHUYN HA GLUCID

Hnh 1: B sung v tiu th Glucose trong mu Mu

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G.1.P G.6.P F.6.P

Chu trnh Pentose

Phosphoglyceraldehyd Acid pyruvic Protid Acid amin

Th Ceton Acid oxalo acetic Cholesterol

Chu trnh Krebs t bo

Hnh 2: Cc bc ch yu ca chuyn ha glucid trong t bo Khoa Ni Trng Cao ng Y t Qung Nam

Sinh l bnh Min dch

Sinh l bnh Min dch