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Sô löôïc veà VTC

Sô löôïc veà VTC. Ñònh nghóa: VTC : laø hieän töôïng töï tieâu hoùa cuûa tuïy, nhieãm truøng laø thöù phaùt. Nguyeân nhaân: Röôïu. Soûi. Khaùc (10% ): Taêng lipid, taêng Calcium, chaán thöông, PT, ERCP, thieáu maùu cuïc boä tuïy, thuoác…. BEÄNH SINH.

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Sô löôïc veà VTC

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  1. Sô löôïc veà VTC • Ñònh nghóa: • VTC : laø hieän töôïng töï tieâu hoùa cuûa tuïy, nhieãm truøng laø thöù phaùt. • Nguyeân nhaân: • Röôïu. • Soûi. • Khaùc (10% ): Taêng lipid, taêng Calcium, chaán thöông, PT, ERCP, thieáu maùu cuïc boä tuïy, thuoác…

  2. BEÄNH SINH. • Dòch tuïy: 1500 -3000 ml/ngaøy, coù tính kieàm pH 8- 8.3. • Men tuïy ñöôïc döï tröõ döôùi daïng zymogen, daïng khoâng hoaït ñoäng: trypsinogen, chymotrypsinogen… Acid/ taù traøng  secretine Môõ, proteine  cholecystokinase • 2 chaát naøy kích thích tieát men tuïy. • Enterokinase/ taù traøng hoaït hoaù trypsinogen  trypsin  hoaït hoùa caùc men coøn laïi.

  3. BEÄNH SINH. Laøm tieâu hoaù tuyeán tuïy. Caùc men tuïy ñöôïc hoaït hoaù Lipase: môõ  Glycerin + a. beùo Kallidin, Bradykinin thoaùt huyeát töông, giaõn maïch. Trypsin/m Kích hoaït caùc yeáu toá ñoâng maùu RL ñoâng maùu.

  4. LAÂM SAØNG. • Ñau buïng ( VTC do röôïu sau 12- 24h, do soûi sau böõa aên thònh soaïn). • Noân nhieàu. • Soát, maïch taêng. • Ñeà khaùng TV, chöôùng buïng. • Khaùc: RL tuaàn hoaøn, tri giaùc, TDMP (T), RL ñoâng maùu…

  5. CLS. • Amylasemie: • Taêng treân 2.5 - 3 laàn / 24h, giaûm daàn sau 4-5 ngaøy. • 95% VTC do soûi, 85% VTC do röôïu coù Amylasemie > 1000 UI/dl. • Taêng keùo daøi > 1 tuaàn  bieán chöùng. • Amylasemie khoâng phaûi laø XN chaéc chaén VTC : • (+) giaû: 1/3 ko lieân quan VTC. • (-) giaû: 10% VTC khoâng taêng.

  6. CLS. • Ñoä thanh thaûi amylase/ creatinine: Amylase/ nieäu Creatinine/ maùu   100% = 1 – 4% Amylase/ maùu Creatinine/ nieäu Taêng > 6% laø Vieâm tuïy caáp. Taêng > 3 laàn (12%) bình thöôøng laø VTC naëng. (+) giaû: suy thaän, thuûng oå loeùt daï daøy- taù traøng.

  7. CLS. • Lipasemie: chính xaùc hôn do chæ coù nguoàn goác töø tuïy, keùo daøi hôn. Taêng trong: thuûng DDTT, Vieâm tuïy maõn, nhoài maùu ruoät. • Glycemie: taêng. • Thay ñoåi chöùc naêng gan. • Uremie: taêng. • Calcium/ maùu: giaûm.

  8. CHAÅN ÑOAÙN PHAÂN BIEÄT. • NGOAÏI KHOA: • Taéc ruoät cô hoïc. • Vieâm tuùi maät caáp, vieâm ñöôøng maät. • Thuûng taïng roãng. • Phình ñoäng maïch chuû boùc taùch. • NOÄI KHOA: • Nhoài maùu cô tim. • Vieâm phoåi.

  9. VTC do röôïu: Luùc nhaäp vieän: Tuoåi: > 55 BC: :16000/ mm3 Glycemie: > 200 mg/dl LDH: > 350 UI/l AST: > 250 UI/dl. Trong 48h ñaàu: Hct  > 10%. BUN  > 5 mg% Calcium < 8 mg% pO2 < 60 mmHg. HCO3 > 4 mEq/l Dòch öù ñoïng : > 6 l. TIEÂN LÖÔÏNG.( Tieâu chuaån Ranson/ Imrie) < 2 DH: ñ/öù toát ñtrò 5-6 DH: 50% TV 3-4 DH: 15% töû vong > 7 DH: TV raát cao

  10. VTC khoâng do röôïu: Luùc nhaäp vieän: Tuoåi: > 70 BC: :18000/ mm3 Glycemie: > 220 mg/dl LDH: > 400 UI/l AST: > 250 UI/dl. Trong 48h ñaàu: Hct  > 10%. BUN  > 2 mg% Calcium < 8 mg% pO2 < 60 mmHg. HCO3 > 5 mEq/l Dòch öù ñoïng : > 6 l. TIEÂN LÖÔÏNG.( Tieâu chuaån Ranson/ Imrie) < 2 DH: ñ/öù toát ñtrò 5-6 DH: 50% TV 3-4 DH: 15% töû vong > 7 DH: TV raát cao

  11. DIEÃN TIEÁN – ÑIEÀU TRÒ • DIEÃN TIEÁN: • 90 % dieãn tieán nheï, töï giôùi haïn. • 10-15% naëng, keùo daøi, BC töû vong cao. • NGUYEÂN TAÉC ÑIEÀU TRÒ: • Ñaët sond muõi – dd. • Boài hoaøn ñieän giaûi. • Giaûm ñau – Giaûm tieát. • Khaùng sinh: B/C nhieãm truøng, > 3 Dh Ranson, VTC HT/ CT -scanner. • Thaåm phaân phuùc maïc.

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