Viªm tôy cÊp
TrÇn C«ng Hoan
BÖnh viÖn H÷u nghÞ ViÖt §øc Hµ néi
§¹i c¬ng
VTC
!"!#$
%&'()*+,
!-+*!!./!0!
$
1%23!4567$
894#.:;.*!<2!;",
++$
2:/=+>+ +-?*!@$
§¹i c¬ng
Hai thÓ l©m sµng:
1%2A=;)$
1%27+7;+, ! (15 %) 5B
!+C5D0!+.
EFG;A*!; trung gian&'H
H+F-!!.HHC5D
.
§¹i c¬ng
1*1%2>+ ;43C
5D;0!#@5D3*!@$
2*!5D>-+ 5I0!J
K2L1%2M%$$$%++1NJK
2L1%A0!=+>+ 5B
4$
N2L1%&O!/;>+ 5
B+-?; 4#3+HP5
6B5-QIR$
22M%:#;4*!.$
Gi¶i phÉu bÖnh lý
N56.G;1%2)!+HS!
C3+,T1%2)*1%2+, !$
1%2)*U&'+,V-5W;T
−
1%2S!!#)T%H55D !)$
%XC3= F !Y'0!
C3S!!#+)C3&Z$2;
+:!+, !$
−
1%2;&ZTI @-5-;$%XC
3=S!!#+)&Z
S.-$
−
1%254;!-5;*!CS+7
$
Gi¶i phÉu bÖnh lý
1%2+, !T<[:!\5
+C4$1*7;H5
FC !+74@]4^F
!B5!$%!S -++,(-+ !+7
-++,!#56PB!#&P%_
F+LH&'4@C5D$
N#!#;0! W`6C5D&[+C
4-5-#$
2 +C4T%C5D+, !$
894#CTM+,!#;4#+7C
3'+ $<#3;+,SD
$
Sinh lý bÖnh
2!#D#+H
+4a1%2-+H(/+7!$J(!
[56/41-@/+7-@
+5B+PbH!+H
..1%2$
%D#&1%2!.-+H(!Q!
!/H(!-Q5!56/�!P$
Sinh lý bÖnh
NF':.+F!
+5H+HHH
4+S-H+H+Hc-+#-5-
*:5B+ -!!"+$
%HA!.+H+$
d:!H5B+4^+&H#\
H!H+ !+& $
l©m sµng
TriÖu chøng c¬ n¨ng:
e
d!4$
e
N'4!$
e
JPTN+!.-+H(!<N56&'HP$
TriÖu chøng toµn th©n
e
%;fTN!&':=$
e
%;7T<;!+ Mc
+.7$
l©m sµng
TriÖu chøng thùc thÓ:
e
<5$
e
d!4P34$
e
d;H565!Td5B'\ghi`4^_+
j+4H+k+%'%%)-!!
+-!!0!=$
e
2 -!!& T%-@C4:
H56+70!P4;! !
0!$
k+T
- %!C > 50
- BC > 16 000/mm3
- d56 !# > 11 mmol/l
- LDH > 350 UI/l (> 1,5 x N)
- SGOT > 250 UI/l (> 6 x N)
%+lm6-:!T
-
Hématocrite > 10 %
-
%]!!# > 1,8 mmol/l
-
2S ! < 2 mmol/l
-
PaO2 < 60 mmHg
-
%#!D4 > 4 mEq/l
-
3= -@ > 6
%,+T
3 !!> 33 %
5 !!> 58 %
7 !!> 100 % .
ChØ sè Ranson
n%!Coppn<:!ogp$iiiW$
nd56!#ogi+qL$nL8Mo`iiirqL
nr!#og`+qLn2S!!#sG+qL
ntuGs`iMnc4!!#sWGqL
ncJc%UcH+nHvHVogiirqLU+7
JEu%V$
ChØ sè Imrie
Sinh hãa
cH+ !5;!]+;S @1%2
cH !]++F6:!4#5;!
H!+456cH !sGGirq
cH;!sgiiirq$N*! +wH !
wln`:1%2$2:5!awcH !&']
&'#!P+\1%2-+x0! EdcH !]
++71%2+,+4$
cH !+&'-7!+1%2;7+
--Eyrz !+4 d_2zd_
4{H!/[!$$$
LH !]+1%2 @DcH&|+-D$
NGuyªn nh©n
Hai nguyªn nh©n chÝnh:
e
J(56/!u_2!T2P0!
FH(56/1%256.-P
}/+5B/+PbH!$
e
N5B!T1A5B!5B & !
56.x$
NGuyªn nh©n
C¸c nguyªn nh©n kh¸c:
%]{+!#$
256/ $
jL/DAu $
J!Q!!/$
J!/5B-A$
J!5D$
r$
%
C¸c kü thuËt C§HA
24&'!>4@
J!.$
2L1%$
2M%$
J!.H+$
2 !$
ChÈn ®o¸n h×nh ¶nh
RÊt nhiÒu môc ®Ých:
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k~@>+ $
e
d 375B$
e
%!.$
e
%+-#; 4#3$
e
M5-Q 3*!@$
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M5-QI0!$
Chôp bông kh«ng chuÈn bÞ
−
25D^ •$
−
%[!&!}5D^d%P0!
&'D^d% $
−
%-@4$
−
I4D /!-+S.&+H!}$
−
1'$
−
2>+ .4--[!z!$
−
%8_t74 $
Siªu ©m
§-îc chØ ®Þnh5 <NM24
5#+3!-+45D<N
4|+€;5B+&+Gi•$
Môc ®Ých:
n2>+ 1%2$
nL+\}/S[! H(
!56/$
n%-@+C4$
n8+4#3 !$
n%+-?#;$
Sái OMC
J(}/
E!}/
1}/
-+H(
1}/+,
Giun OMC