CHN ON VIM I TRNG MN

V Th M Dung

MC TIU
Trnh by cc nguyn nhn VTM Trnh by th lm sng VT lao Trnh by th lm sng VT amibe Trnh by th lm sng ca vim lot i trng

DN BI
I. I CNG II. NGUYN NHN III. GII PHU BNH IV. TRIU CHNG V. TH LM SNG VI. CHN ON VII. NGUYN TC IU TR

I CNG
VTM do nhiu nguyn nhn Cn phn bit: K i trng

NGUYN NHN
Nhim trng Khng r cn nguyn (autoimmune) Nguyn nhn khc t gp

NGUYN NHN
Nhim trng Khng r cn nguyn (autoimmune) Nguyn nhn khc t gp

NGUYN NHN
Khng r cn nguyn - Autoimmune Bnh vim i trng Bnh rut vim Inflammatory Bowel Disease - IBD Vim lot i trng Vim trc trng-i trng xut huyt Bnh Crohn Vim rut tng vng
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NGUYN NHN
Nguyn nhn khc VT gi mc Pseudomembranous colitis VT do vim ti tha i trng VT do x tr VT vi th VT do thiu mu cc b, d dng mch mu, x m ng mch
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GII PHU BNH

i th Nim mc: sung huyt, x ha, mng gi Cc t chc m ht Ti tha i trng D tiu ha Vi th Tn thng khng c hiu: vim Tn thng c hiu: lao, amibe
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TRIU CHNG
Lm sng au bng Ri lon thi quen i tiu Phn bt thng Cm gic tiu khng ht phn Khi u h chu P Biu hin ngoi ng tiu ha Thm trc trng
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TRIU CHNG
Cn lm sng Kho st phn Chp X quang i trng cn quang Ni soi i trng - sinh thit Thm d ty theo nguyn nhn

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VIM I TRNG DO LAO

TNGB: M. tuberculosis TCLS Hi chng nhim lao chung Triu chng nhim lao ti ch Tiu chy, phn nhy, mu (him) Khi u au bng m , au qun g cc du Koenig, tc rut
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LAO HI MANH TRNG

CLS Phn: nhum, cy tm BK LB: Manh trng dy cng Hi trng ch hp ch phnh NST & sinh thit Cc xt nghim thm d nhim lao ton thn, lao phi hp
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VIM I TRNG DO LAO (LAO HI MANH TRNG)

VIM I TRNG DO LAO

VIM I TRNG DO LAO

Bin chng Tc rut Thng rut D Lao mng bng

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Vim i trng do amibe

khng xm ln bnh ng rut bnh ngoi rut

VIM I TRNG DO AMIBE

Entamoeba histolytica TCLS au bng, qun tng cn Mt rn: manh trng, sigma Tiu nhiu ln, phn t, nhy mu St: bi nhim vi trng
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VIM I TRNG DO AMIBE

Phn: a-mp th hot ng, kn, HC, BC Huyt thanh chn on amibe NST: tn thng hnh du n ngn tay LB: vt lot to nh li dng c chai

VIM I TRNG DO AMIBE

Bin chng Abcs gan U amibe Xut huyt Thng Lng rut Abcs no
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BNH VIM I TRNG

Inflammatory Bowel Disease - IBD Khng r cn nguyn T min - Autoimmune Vim lot i trng
Vim trc trng-i trng xut huyt

Bnh Crohn Vim rut tng vng

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Cng trng Crohn 67% UC 20% Sinh i khc trng Crohn 8% 1 b (m), nguy c con 10% C hai b m, nguy c con 36%

Yu t nguy c
15-30 & 60-80 VLT Ht thuc l/khng ht nguy c 40% Tin cn ht thuc/khng ht 1,7 ln Bnh Crohn Ht thuc/khng ht nguy c gp 2 ln

VIM LOT I TRNG

20%
40-50%

30-40%

VIM LOT I TRNG

TCLS

au bng: dc khung i trng,

r nht: i trng di ng, au m , cn d di, sau tiu

Tiu phn ln mu, tiu ton mu TR: rt au, gng dnh mu Ton thn
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Vim ming Lot dng Aphth Vim cng mc Vim mng b o

Gan nhim m Si thn Thn nc D Nhim trng tiu Hng ban dng nt M da hoi th Si mt Vim ng mt x ha

Vim ct sng Vim khp chu Vim khp ngoi vi Vim tnh mch

Biu hin ngoi rut

CN LM SNG
X quang bng KSS, vim nh:
mt np, rut ngn, nng: T gin

XQ khung i trng, cp: khng nn

Giai on u: Tn thng nim mc dng ht lan ta, mt np, ph n, lot, gi polyp, teo hp do x ha

NST - sinh thit Kho st min dch d ng

KHO ST MIN DCH D NG

VLT pANCA - perinuclear AntiNeutrophil 60-70% Cytoplasmic Antiboby ASCA - Khng th khng 10-15% Saccharomyces cerevisiae T khng th khng t bo dng ly 39% biu m i trng Khng th khng i trng 36% Khng th khng t bo nang tuyn ty 4%
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VIM LOT I TRNG

Bin chng Cp: xut huyt toxic megacolon thng Lu di: ti pht, K ha K ha: 5% sau 10 nm, P > T 10%: 10-20 nm 50%: sau 35 nm
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BNH CROHN
Khng r nguyn nhn 30-40% tn thng rut non n thun 40-55% tn thng rut non & rut gi 15-25% tn thng rut gi n thun

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BNH CROHN
Triu chng lm sng au bng: m thng HC P khng sau khi i tiu TC: phn ln mu, ton mu: him khi u HC P Tn thng hu mn-trc trng: # l Ngoi ng tiu ha: ging VLT
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VIM I TRNG M HT
Cn lm sng Kho st min dch d ng XQ bng KSS: , mt np, hp LB: ph n, hp do x ha, d Ni soi i trng & sinh thit Ni soi ng tiu ha trn XQ ng tiu ha trn, rut non
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KHO ST MIN DCH D NG

VLT pANCA ASCA T khng th khng t bo dng ly biu m i trng Khng th khng i trng Khng th khng t bo nang tuyn ty 60-70% CROHN 5-10%

10-15% 60-70% 39% 36% 4% 30% 13% 31%

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VIM I TRNG M HT
CLS Kho st min dch d ng XQ bng KSS: , mt np, hp LB: ph n, hp do x ha, d Ni soi i trng & sinh thit Ni soi ng tiu ha trn XQ ng tiu ha trn, rut non
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BNH CROHN: bin chng

Hp D tiu ha Thng Phnh i trng nhim c Ung th ha (him) iu tr
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VIM I TRNG GI MC
Sinh bnh hc s dng KS di ngy (Lincomycin) s dng Bismuth, thy ngn chn thng tm l

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VIM I TRNG GI MC
TCLS au bng: vng thp, h chu T Tiu chy, st CLS XQ T: vim khng c hiu Ni soi: mng gi Cy phn: Clostridium difficile
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VIM I TRNG GI MC

VIM TI THA

VIM TI THA
Bnh ti tha: 90% khng triu chng au HC T, au bng di cp st tiu chy phn nhy, mu du vim phc mc khu tr s: khi abcs hoc m qunh nhu ng rut hoc , mt TR: nh v abcs, khi vim
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CN LM SNG
CTM: BC , BC chuyn tri, Hct-Hb Nc tiu: BC, HC
D BQ-T: tiu kh, BC (+++), VK, phn XQ bng KSS: lit rut, tc rut, thng

SAB: pht hin khi vim, abcs; Ni soi i trng XQ i trng cn quang
au bng di cp, st & bch cu/ ti tha i trng vim ti tha
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VIM TI THA
Bin chng Xut huyt ti tha Abcs R tiu ha Thng vim phc mc X ha teo hp
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CHN ON XC NH
1. TCLS au bng Ri lon thi quen i cu Phn bt thng Cc triu chng gi nguyn nhn 2. CLS Kho st phn X quang i trng Ni soi i trng Thm d theo nguyn nhn
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 UNG TH I TRNG
C a > 50 tui Gia nh: K i trc trng, polyp Ch n: nhiu bo, t x TC: mu/ phn, thay i thi quen i tiu, s thy u, thiu mu, st cn, bing n, gy yu Thm d cn lm sng sm X quang i trng Ni soi i trng - sinh thit

 HI CHNG RUT KCH THCH

Bnh l i trng chc nng Hi chng i trng kch thch Hi chng rut co tht Vim i trng co tht Vim nim mc i trng Bnh l rut do tm thn kinh
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HI CHNG RUT KCH THICH

C a: n, 30-50 tui, tm l, thn kinh TCLS au qun bng, sau khi i cu

To bn - Tiu chy Nhu ng rut Phn: nhy, khng mu hi, tro ngc DD-TQ, kh tiu:
CLS: khng tn thng thc th
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 HI CHNG KM HP THU
TS: ct d dy-rut, vim ty mn Tiu chy mn: suy dinh dng, thiu mu, thiu vit B, C, D Phn: m > 1,5 g/L; m > 3,5 g/L Schilling test: bi tit B12 nh du/ NT 24 gi thiu IF: thiu mu c tnh, teo d dy

Cho IF + B12 nh gi: hi trng, ty

XQ rut non: mt hnh rng ca Sinh thit nim mc rut non
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NGUYN TC IU TR
Cc bin php chung 1. Tit ch n ung: trnh cc cht kch thch nim mc (cht bo, rau sng) 2. iu chnh tnh trng i tiu 3. iu tr h tr: an thn, thuc iu ha vn ng ng rut iu tr theo nguyn nhn
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KT LUN
Vim i trng mn Vit Nam Nguyn nhn: nhim amibe, lao loi tr sm ung th i trng

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