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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