Post on 13-Jan-2016
description
V Th M Dungvodung@ump.edu.vn
CHN ONX GAN
2MC TIU Trnh by nguyn nhn gy x gan Trnh by triu chng lm sng x gan Trnh by thay i v xt nghim mu& sinh ha trong x gan
3DN BI I CNG PHN LOI NGUYN NHN TIP CN BNH NHN X GAN BIN CHNG IU TR
4I CNGGan: thc hin nhiu chc nng sng Tch tr vitamin, mui khong Sn xut cc protein cn thit Sn xut cc yu t ng mu Chuyn ho cc cht Sn xut cc cht chng nhim trng,loi b vi khun khi dng mu
5I CNG Vim gan: gan b vim, sng phng Vim gan mn: vim gan > 6 thng X ha: m so thay t bo gan cht X gan: to so nng khp gan Suy gan: gan b tn thng nhiu,khng th thc hin cc chc nng
6X gan Giai on cui ca cc bnh gan mn M hc. t bo gan b thoi ho, hoi t. t bo gan tn sinh. hnh thnh di x
Cu trc tiu thy gan thay i thnhnnt tn sinh b bao quanh bi m x
khng c chc nng gan
7 X gan nt nh X gan nt to X gan th hn hp
PHN LOI
8PHN LOI X gan nt nh Vch u, dy, nt tng sinh < 3mm
Nghin ruSuy dinh dngThm nhim st mtTc tnh mch gan
9PHN LOI X gan nt to Vch Cc nt to nh khc nhau > 3 mm Nhiu so x ho khong ca Tn sinh cc t bo ln nhn ln XG do VGSV
Thiu 1-antitrypsinXG mt nguyn pht
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X gan th hn hp X gan nt nh + X gan nt to XG nt nh XG nt to
PHN LOI
BNH HC i th B mt khng u Nhiu nt vng Gan to do nhiu nt tng sinh Gan teo nh giai on cui
Tiu chun chn on x gan Nt tn sinh
X ho(tch t m x to tiu thu gi)
Cu trc gan bt thng T bo gan bt thng
(tinh th ho, lon sn, tng sn)
BNH HC
NGUYN NHN
5-10% NL> 90% TE
~ 20 years
30 years
Ru: ung qu nhiu, 10 nmNam > 21 n v cn/tunN > 14 n v cn/tun
NGUYN NHN
NGUYN NHN mt XG mt nguyn pht XG mt th pht Vim ng mt x ho nguyn pht
Primary sclerosing cholangitis with typicalstricturing and dilation pattern
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NGUYN NHN Chuyn ho
Thiu 1-antitrypsin Nhim st (Heamochromatosis) Thm nhim ng (Wilson) Glycogenosis IV Galactose mu Tyrosinosis bm sinh
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NGUYN NHN Mch mu
Bnh tc nghn tnh mch Hi chng Budd-Chiari X gan tim Vim mng ngoi tim co tht
Ri lon min dch Vim gan t min
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NGUYN NHN Suy dinh dng Nhim trng
Giang mai s sinh x gan Sn mng: trng gy phn ng
m x khong ca St rt X gan ?
SR & XG SDD & VGSV ?
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NGUYN NHN Sang thng dng ht
Brucellosis Lao Sarcoidosis
X gan cn nguyn n
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Phn hnh chnhCh cc c im lin quan bnh
Ngh nghip Tui: thng ln tui Gii: nam > n
TIP CN BN X GAN
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TIN S Vng da Vim gan S dng thuc Truyn mu Nghin ru Bnh di truyn gia nh
Din tin t nhin ca Bnh gan mn
Bnhganmn
Xgancnb
Xganmtb
Tvong
Gin tnh mch thc qun xut huytBng bng
Bnh no ganVng da
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LM SNG Hi chng suy t bo gan Hi chng tng p tnh mch ca
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TRIU CHNG C NNG Mt mi St cn Bing n Tiu chy Teo c Ph chn St
TRIU CHNG C NNG Da vng Bng to Xut huyt
chy mu cam, li xut huyt di da xut huyt tiu ho
Gim kh nng tnh dc bt lc lnh cm
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TRIU CHNG THC TH Gy St Vng da
t bo gan suy chc nng i sng hng cu
Tng sc t Xut huyt di da To tuyn mang tai
TRIU CHNG THC TH
Ngn tay di trng
Bn tay co kiu Dupuytren
Mng trng(Terrys nail)
34Hgjdhllflm,vbb
Muehrckes nail
TRIU CHNG THC TH Lng bn tay son Ph chn Lim mng xanh da tri (Azure lunula) Vng Kayser-Fleicher: bnh Wilson
TRIU CHNG THC TH Sao mch
c ngc cnh tay lng bn tay
N ho tuyn v nam Thay i phn b lng Teo tinh hon
TRIU CHNG THC TH
Khm bng Bng bng
TRIU CHNG THC TH
Khm bng Bng bng Tun hon bng h Lch to Gan to, gan teo
TRIU CHNG THC THKhm bng
Bng bng Tun hon bng h Lch to Gan to, gan teo
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CN LM SNGHuyt hc
Hng cu (thiu folate) i sng HC Haemoglobin Bch cu Tiu cu
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CN LM SNGCc yu t ng mu
Gan tng hpI (Fibrinogen), II (Prothrombin),V, VII, IX, X
T: VII ngn nht, X, IX V khng ph thuc vit K Vit K 10 mg PT (TQ) ci thin t nht 30%
S ng cm mu- thiu VII- thiu vit K
- iu tr Warfarin- bnh gan
PT / aPTT
S ng cm mu- thiu VIII, IX, XI, XII- Lupus anticoagulant- iu tr Heparin- gim prekallikrein- gim kininogen trnglng phn t cao
PT / aPTT
S ng cm mu
- thiu V, X- fibrinogen, II- thiu vit K
- iu tr Warfarin- bnh gan
PT & aPTT
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CN LM SNGSinh ho mu
Bilirubin TP, TT > GT , 50% Phosphatase kim Glutamyl Transpeptidase 5-nucleotidase ng huyt
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CN LM SNG
Sinh ho mu Transaminase
AST ALT
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CN LM SNG Albumin ( 65% Pr, t: 3 tun) T l Alb/Glo < 1 in di Globulin: -Glo
XGM: 2-Glo, -Glo Glo min dch
IgA : X gan ru (Laennec) IgM : X gan mt tin pht IgG : Vim gan t min
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CN LM SNG XN dch bng Rivalta () Protein DMB < 2,5 g/dL SAAG > 1,1g%: tng p ca
Alb HT Alb DMB
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CN LM SNG Khng th khng c trn Khng th khng nhn Khng th khng ti lp th HBsAg, anti-HCV St, Ferritin, Ceruloplasmin, Cu -Fetoprotein
CN LM SNG Siu m & CT scan Gan teo Cu trc nt
Ni soi Gin tnh mch trc trng Gin tnh mch thc qun
Sinh thit ganTiu chun vng
CN LM SNG
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Phn loi theo Child
kmttrt ttDinh dnghn mnhkhngRi lon
thn kinh
khkim sot
dkim sot
khngBng bng< 33-3,5> 3,5 g%Albumin mu> 32-3< 2 mg%Bilirubin muCBA
Phn loi Child-Turcotte-Pugh
C: 10-15B: 7-9A: 104-10Bili < 4XG mt> 2,21,7 - 2,2< 1,7Hoc INR> 64-6< 4TQ ko di< 2,82,8 - 3,5> 3,5 g%Albumin mu> 32 - 3< 2 mg%Bilirubin mu
TB, nhiunhkhngBng bng 3-4 1-2khngBnh no gan
321
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BIN CHNG XHTH do v TM thc qun gin
Vim phc mc nhim khun nguyn pht Hi chng gan thn
Hn m gan Ung th ho Bng bng
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Vim phc mc nhim khunnguyn pht
au bng St Bnh no gan Tiu chy Chong nhim trng Xut huyt tiu ho Nn
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VPMNKNP
(+)(-)(+)
> 250/mm3> 250/mm3< 250/mm3
VPMNKNP cy (+)VPMNKNP cy (-)Du khun bng
Cydch bng
BCNTTdch bng
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VPMNKNP Nguy c VPMNKNP: Protein DMB < 1 g% VPMNK th pht
BCNTT 250/mm3 Cy nhiu loi vi khun Protein > 1 g/dL Glucose < 50 mg/dL LDH dch bng > LDH huyt thanh
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TIN LNG Yu t tin lng Bt thng chc nng thn Ri lon huyt ng Mc p ng iu tr
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Tin lng Tin lng x gan c bng bng km < 50% sng 2 nm sau t bng u Sng > 10 nm: rt him Thi gian sng trung v
- 2-5 nm: x gan c bng bng- 6 thng: bng bng kh cha- 2 tun: hi chng gan thn type 1
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Kh nng sng cnChild-Turcotte-Pugh
85%100%A5-6Kh nngsng 2 nm
Kh nngsng 1 nm
Nhmim
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Kh nng sng cnChild-Turcotte-Pugh
57%81%B7-985%100%A5-6
Kh nngsng 2 nm
Kh nngsng 1 nm
Nhmim
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Kh nng sng cnChild-Turcotte-Pugh
57%81%B7-985%100%A5-6
35%45%C10-15
Kh nngsng 2 nm
Kh nngsng 1 nm
Nhmim
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Tin lng sng Nguy c phu thutChild-Turcotte-Pugh
803010T vong chu phu (%)1-34-1415-20Tui th (nm)
CTP C10-15 im
CTP B7-9 im
CTP A5-6 im
Schuppan D, Afdhal NH. Liver cirrhosis 2008
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IU TR X gan: bnh e da i sng Khng c tr liu no
cha lnh x gan hocphc hi m so gan
iu tr nhmngn nga hoclm chm tn thng gan
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IU TR iu tr nguyn nhn Trnh lm tn thng gan iu tr nng
Nhu cu dinh dng iu tr bng bng
iu tr bin chng Ghp gan
Take home message Nguyn nhn x gan Triu chng lm sng ca x gan Triu chng cn lm sng ca x gan
V Th M Dungvodung@ump.edu.vn
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