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CHAN THNG

VET THNG BUNG

VA

PGS.TS.Vo Tan Long ai Hoc Y Dc TP Ho Ch Minh

MUC TIEU
1. Trnh bay c cac ac iem thng ton. 2. Trnh bay c cach kham va theo doi mot benh nhan chan thng 3. Chan oan c mot benh nhan co thng ton c quan trong o bung.

NGUYEN NHAN VA C CHE


A. Chan thng kn vung bung -Tai nan giao thong - Tai nan lao ong - Tai nan sinh hoat, the thao C che trc tiep hay gian tiep B. Vet thng bung:hoa kh va bach kh - Thau bung va khong thau bung - VT xuyen - VT chot - Tiep tuyen

ac iem thng ton


Tnh pho bien: CTBK: tang ac Tang rong : v khi cang ay: da day, ruot, bang quang. Vet thng Tang sinh mon thung tang o bung Vet thng thung c hoanh vao bung khi vet thong ngc

ac iem thng ton


Tnh ket hp: Cac chan thng vet thng khac:So nao, long ngc, tiet nieu , chnh hnh.de bo sot Tang ac + tang rong Nang ne .

THNG TON GIAI PHAU TANG AC


1. GAN: Chan thng va vet thng -Phan o thng ton theo Moore: 6 mc o: 1.Tu mau di bao <10% dien tch rach bao gan va nhu mo < 1cm chieu sau. 2.Tu mau di bao 10-50%DT hay trong nhu mo <10cmk v gan 1-3 cm be sau va <10 cm chieu dai 3.Tu mau di bao lan rong >50%DT hay trong nhu mo > 10cm k v gan > 3cm be sau 4. V gan 25 -75 %thuy gan hay t 1-3 ha phan thuy trong 1 thuy gan 5.V > 75% thuy gan hay tren 3 ha phan thuy trong 1 thuy gan 6.Gan b bt ra khoi cac day chang treo gan, cuong gan.

TU MAU

Ton thng gan o I

Ton thng gan o II

Ton thng gan o III

Ton thng gan o IV

Ton thng gan o IV

Ton thng gan o V

THNG TON GIAI PHAU LACH


Phan o thng ton theo Moore: 5 mc o
1.Tu mau di bao <10% dien tch rach bao lach va v nhu mo < 1cm chieu sau. 2.Tu mau di bao 10-50%DT hay trong nhu mo <5 cmbe sau v nhu mo 1-3 cm be sau khong anh hng en mach mau be 3.Tu mau di bao >50%DT; v khoi mau tu di bao; tu mau trong nhu mo > 5 cm be sau v nhu mo > 3cm be sau hay co anh hng mach mau be 4. V thuy lach hay t mach mau ron lach chi phoi >25% lach. 5 .V nat hay t cuong lach.

THNG TON GIAI PHAU TUY


Phan o chan thng tuy theo Moore: 4 o: 1. Dap, v tuy khong co thng ton ong tuy 2. t la uoi tuy va/hoac CT mo tuy co thng ton ong tuy. 3. t la au tuy hay CT tuy co kem tt ong tuy 4. CT khoi ta tuy, co hay khong thng ton bong Vater

THNG TON GIAI PHAU THAN


Dap V di bao hay mot phan tao thanh khoi mau tu quanh than V nat t cuong than

THNG TON GIAI PHAU TANG RONG

Da day Ta trang Ruot non ai trang va trc trang Bang quang C hoanh

THNG TON GIAI PHAU TA TRANG

Phan o v ta trang theo Moore: 5 o

1. Rach lp thanh c khong thung, tu mau mot oan ta trang. 2. V < 50% chu vi, tu mau > 1 oan 3. V 50-75%chu vi TT2; 50-100% chu vi TT1,TT3,TT4 4. V > 75% chu vi TT2, thng ton bong Vater hay oan xa OMC 5 .V nang khoi ta tuy Ta trang b triet mach

KHAM LAM SANG


Chay mau trong o bung? Thng ton tang trong bung can phai mo ngay? Tnh trang BN can theo doi va can s dung cac phng tien CLS e chan oan? Kham nhieu lan 10- 15 phut.

BENH S

C che T the BN luc b tai nan Chieu hng cua lc tac ong- an ao Thi gian Non mau, tieu mau? au bung? Khu tru hay lan toa Cac x tr cua tuyen trc.

TNH TRANG TOAN THAN

Ch so cua cac chc nang song:M,HA.NT,tri giac theo thang iem Glasgow, mau sac da niem Kham xet nhanh thng ton e doa mang song: ho hap, mat mau.. Soc chan thng: can hoi sc cap cu

KHAM BUNG
T m va he thong, ghi ho s benh an 1.Nhn 2.Nghe 3.Go 4.S nan 5.Kham trc trang am ao 6.Kham vung bu va tang sinh mon

HOI CHNG CHAY MAU TRONG


1.M nhanh nho,t chi lanh, am 2. HA ha thap, tut dan 3.au bung khu tru va tang dan lan khap bung -Bung trng dan; go uc vung thap -e khang va PPM -Tui cung Douglas cang rat au 4. Dung tch hong cau Hct ha thap - Choc do o bung: mau khong ong - Sieu am co dch trong o bung

HOI CHNG VIEM PHUC MAC


1.Ve mat hoc hac, nhiem trung. 2. au bung: lien tuc, vung au co nh va lan dan ra khap bung -Bung khong tham gia nhp th, e khang, gong cng - Bung trng dan, liet ruot, go mat vung uc trc gan 3.Tham trc trang: tui cung Douglas au choi. 4. Bach cau tang cao X quang bung khong chuan b: liem hi di c hoanh Sieu am co hi t do, liet ruot, dch o bung t

CAN LAM SANG


A.XN sinh hoa huyet hoc BChan oan hnh anh: 1.Xquang qui c: -khong chuan b - Chup can quang 2.Sieu am bung 3.Chup cat lp ien toan(CT scan)bung 4. Soi o bung chan oan C. Choc do va choc ra o bung

HNG X TR
CTBK: -anh gia CN song:M,HA,HH,TG - Phat hien cac thng ton phoi hp -Kham bung+ XN CLS 1.Soc hay huyet ong khong on nh: mo 2. Huyet ong on nh: theo doi va xac nh them da cac CLS VET THNG BUNG - mo ngay: loi, chay mau, PPM - theo doi : khong ro rang

HNG X TR
VT bung do an ban thang: m bung tham do Vet thng bung do bach kh: 20-40% m bung tran 1.M bung tham do khi: -Soc khong hoi phuc -Phan ng phuc mac -Oi mau hay ra mau ong mui da day. 2. Tham sat tai phong mo: Khong thau bung: theo doi Thau bung: + MBTD 15% trang + Theo doi, mo khi PPM 3. Soi o bung

M gia bung vung thng v

X quang bung

Hnh anh CT scan V than tuy

Sieu am

V oi than tuy

V oi eo tuy + ta trang DI- DII

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