D VT NG N

ThS. Nguyn c Tng

 Muc tieu
+ Biet tnh hnh d vat tren the gii va Viet
Nam
+ Nam c ac iem lam sang cua d
vat ng an
+ Biet cach x tr DVA
+ Pho bien cach phong benh
 V TR
TH GII
Ming thc qun: 18%
Thc qun c: 23%
Hm c: 39%
Quai ng mch ch: 12%
Eo c hong: 8%

VIT NAM (1991 1995)

Ming thc qun: 26.7%
Thc qun c: 54%
Thc qun ngc 18.6%
Tm v: 0.7%
 Tnh hnh d vt
1. The gii
Tre em:ong xu,o chi, thc an,pin
Ngi gia:mieng bt tet..
2. Viet Nam
-Xng:ca, ga,vt,heo
-Rang gia
-Hat Sapoche
-Vien thuoc co vo boc
 D vt hng
Cac d vat: mieng nha, kim bang,
cac loai hat, xng, ong xu, rang gia
D vat gay tac nghen :qua bong
,mieng nha mem co the bien dang,
mieng thc an to
 Hoi benh nhan nuot g, a tng co tien
s ngat cha?
Tc: Cam giac d vat tren sun giap, kho
nuot, nuot au len tai, roi loan phat am
trong trng hp khong tac nghen hay
tac 1 phan
Nghi ng DVH benh nhan b ho, co rt
hay khan tieng khong chan oan c
Soi hong : lu y nen li, Amidan, xoang le
tm d vat, vet tray xc (Soi trc tiep,
gian tiep, ong mem, ong cng)
 Chan oan: Hoi tien s,kham lam sang,
Xquang
ieu tr: Lay d vt
ieu tr them: Neu au nhieu, sot cao, kho
th hay kho nuot hoac neu cam giac d
vat khong giam sau 2 ngay
Neu khong hai long: chup Xq mo mem
nghieng co the phat hien: Ap-xe sau hong,
tui tha Zenker, cng khp co nang
Co the chup can quang (Barium,Gastrographin)
Bien chng:Tac nghen ng kh, phu ne
Nghim php Heimlich
 D vt thc qun
Giai on 1
Trieu chng tac nghen
Nuot kho, nuot au
Khac nho e tong d vat ra
Giai on 2
Viem thc quan,Ap-xe di niem mac
thc quan
Sot,bo mat nhiem trung
Nuot rat au,hi th co mui hoi
Kham:
Co hi sng,an mang canh au
Loc coc thanh quan-cot song (_)
 Giai oan 3
Tui mu ngoai thc quanviem tay
quanh thc quanAp-xe canh co
Nhiem trung nang,mat nc,sot
cao,ngi gay top
Nuot au tang
Kho th t nhieu
Kho noi,khan tieng
C ong co kho khan
Co sng o
 Giai oan co bien chng

Viem tay to chc lien ket

Ap-xe quanh thc quan
Thung cac mach mau ln: m
canh, quai m chu, m chu ngc
Viem trung that,ap-xe trung that
Tran mu mang phoi,mang tim
 CHAN OAN
Tuy vao tnh chat DV, en sm hay muon
+ Tc toan than: Hc nhiem trung(muon)
+ Tc c nang: Nuot kho, nuot au, khong nuot c
+ Tc thc the : Loc coc TQ-CS mat
Mang canh sng
+ Tc X-quang : Hnh anh can quang cua d vat
Khoang Henke day
ng cong sinh ly cot song co(_)
Mc nc hi
Tran kh mang phoi, trung that; viem trung that
 D vat thc quan tai phat

Bnh nhn n ung nghn, ti

pht nhiu ln
Ngh n ung th thc qun
 ieu tr

1. Soi thc quan lay d vat(gay te)

2. Soi thc quan gay me toan than

3. M thc quan lay d vat

4. M canh co, m trung that

Dung cu
D vat co goc canh
Vien thuoc co vo boc
D vat tu,khong goc
canh
Mieng thc an to
 D vat dai
Vat dai hn 6-10 cm
(ban chai anh
rang, muong)
Benh nhan tam
than
Pin da
 PHONG BENH
Tuyen truyen pho bien rong rai s
nguy hiem cua DV
oi vi tre nho: khong ngam cac o
vat, g ky xng
oi vi ngi ln: cai tien cach che
bien thc an, nhai ky, cham rai, tranh
ci ua
Cai tien cach lam rang gia,khong cat
nho v thuoc
Kham Ck TMH khi b hoc
 Case report
Be gai 4 tui en kham v hi th hoi a 2 nam
va tang dan
a dc chan oan va ieu tr nh la NTHHT
va NT rang nhng khong ket qua
Cay hong nhieu lan(_)
Kham hong:Thanh hong sau viem nhe,Amidan bnh
thng,co nhieu hach co nho 2 ben
Soi hong : pha tren sulcus terminalis co mt vung
nho len phu mo hat o nhe vi dch tiet hoi
t o.
Xq co nghieng: Vong kim loai mac thanh hong
sau ngang ot song co C1-C2
Truy cu tien s:Be nuot nhan vang cua me
luc 9 thang
 Benh nhan nam,19 tuoi vao khoa
cap cu v khong the nuot c
va cam giac co mot cuc g
trong hong sau ba an, Kham thay
anh ta lo lang va chay nhieu nc
bot. Khi c yeu cau uong
nc,benh nhan cho thay kho
nuot ang ke.
X Quang co nghieng
 Cau hoi
1. Chan oan la g?
2. Cac ac tnh co ien cua chan
oan nay tren X quang?
3. ieu tr ra sao?
Zenker diverticulum
 La tui tha cua niem mac hong,ngay tren
c nhan hong do Zenker at ten (1877)
Lam sang:Kho nuot,cam giac co mot
cuc trong co,ho,hi th hoi
Chan oan:Chup Xq vi Barium+Soi thc
quan
ieu tr:neu tui tha ln va co trieu
chng
 ieu tr

+ Boc tach tui cung, rach c nhan

hong
+ Noi soi: ghim inh qua noi soi
D VAT NG TH

ThS. Nguyn c Tng

 TONG QUAN
D vat ng th la 1 cap cu tai
mui hong
Neu khong chan oan va x tr kp
thi co the gay t vong
D vat ng th thng gap
tre em
D vat thng la : hat au phong,
hat da , xng ca, vo tom vo cua
 LAM SANG
HOI CHNG XAM NHAP
TRIEU CHNG LAM SANG NH
V
 HOI CHNG XAM NHAP
Tre ang ngam vat g o trong mieng
hoac ngi ln ang an
ot ngot
Ho sac sua, kho th, tm tai, va mo
hoi
(P t nhien cua c the tong d vat ra
ben ngoai)
 D VAT THANH QUAN
Kho th thanh quan: kho th cham
th ht vao, co keo cac c ho hap
phu, co tieng rt th ht vao
Khan tieng, mat tieng
Khi d vat ket thanh mon, thanh
that Morgagni co the lam benh
nhan chet ngay
 D VAT KH QUAN
Kho th ca 2 th: ht vao va th ra.

Neu d vat di ong: nghe co tieng

lat phat c bay
 D VAT PHE QUAN
Tuy theo tnh chat cua d vat , o
ln cua d vat, thi gian en benh
vien sm hay muon ma trieu chng
co khac nhau
au tc va kho chu 1 ben ngc
Neu benh nhan en tre: co dau
hieu nhiem trung cap ng ho
hap: sot, ho, kho th
 CAN LAM SANG
X quang : t the thang, t the nghieng
cuoi th ht vao va th th ra: co the thay
D vat kim loai
Kh phe thung
Xep phoi 1 ben
Ap xe phoi

Noi soi thanh kh phe quan bang ong soi

cng hoac ong soi mem
D vt ng th
D vt ng th
D vt ng th
 IEU TR

Thao tac Heimlich

M kh quan
Soi thanh kh quan lay d vat
ieu tr toan than sau soi: khang
sinh, chong phu ne, giam au ha
sot, bu nc va ien giai
HEIMLICH
HEIMLICH