Bg 11 viem k phoi

Vim phi Vim ph qun phiUng th phi

TS. Nguyn Th Dn CN B mn Gii phu bnh H.V.Q.Y.

Vim phi (pneumonia)Nhng bnh vim phi c nhiu: - Vim ph qun (bronchitis) - Vim phi thu (lobar pneumonia) - Vim ph qun phi (bronchopneumonia) - Vim phi k (intertitial pneumonia)Phm vi bi hc: Vim phi thu, vim ph qun phi, vim phi k.

S cc loi vim phi

Vim phi thu (lobar pneumonia) Vim phi thu l mt vim cp tnh, tn thng ch yu cc ph nang.Tn thng c 2 c im: - Tn thng c kch thc ln chim ton b hoc gn ton b thu phi. - Hnh nh tn thng ging nhau trong khp khi vim tng giai onTn thng din ra theo 3 giai on k tip nhau: - Giai on xut tit - Giai on gan ho - Giai on gan ho xm

+ Tn thng giai on xut titi th: Khi vim sng to, mu tm, n tay cn thy ting lo so ph nang, Mt ct phi mu tm, c nhiu bt ln dch mu hng. Ct ming phi th vo nc thy chm.Vi th: Cc mao mch thnh ph nang xung huyt, gin rng, y mu. Lng cc ph nang cha dch ln hng cu, mt vi BCN, cc TB vch ph nang b long, i khi thy cc m vi khun.

+ Tn thng giai on gan ho i th: Khi vim cng chc mu nu, nm khng cn ting lo so ph nang. Khi vim ging nh mt t chc gan mu . Mt ct khi vim mu c nhiu nc c, hi chy ra. Vi th: Trong khp khi vim hnh nh tng t nhau. Lng ph nang cha nhiu m t huyt c ln hng cu, mt s BCN, dch ph v c thy nhng m vi khun.

+ Tn thng giai on gan ho xmi th: Khi vim vn chc nh giai on trc nhng chuyn thnh mu xm, c khi c nhng vng mu nu.Vi th: Lng ph nang cha y BCN. BCN lm tiu si t huyt. Cht t huyt tan r b tng ra ngoi theo ph qun. Cc BCN cng t dn theo m ra ngoi. Lng ph nang nh c ra sch. a s vim phi khi hon ton.

+ Tin trin vim phi thu - Khi. - p xe phi. - X ho phi.

Vim ph qun cp

Vim phi thu

H vi th vim phi thu

p xe phi

Vim ph qun phi(bronchopneumonia)Vim ph qun phi cn gi l vim phi m, ph qun ph vim, l loi vim cp tnh. Tn thng ch yu cc ph qun ri lan ra cc ph nang.

Vim ph qun phi c cc c im: - Tn thng thnh c gii hn r, phn cch nhau bi m phi tng i lnh mnh. Tn thng xut hin dn dn k tip nhau, tin trin c lp vi nhau, nng nh khc nhau. - Ngay trong mt tn thng, hnh nh tn thng cng khng ng nht m c tng vng khc nhau. - Tn thng vim c c vim ph qun ln vim ph nang.

+ i th - Hai phi ph, xung huyt, c cc vim khng u nhau nm ri rc khp thu phi. - vim ni cao, c gianh gii r,nm cng chc, kch thc bng ht , ht lc mu sm. - Mt ct c nc c hoc m chy ra. Ct ming phi th vo nc chm dn.

+ Vi thMt tn thng c cc hnh nh sau: - Ph qun vim m trung tm vim - Cc ph nang vim m xung quanh - Cc ph nang vim t huyt - Cc ph nang vim xut tit - Cc ph nang bnh thngThc t, giai on mun, cc hnh nh thng b pha trn, kh thy cc hnh nh tch bit nh trn.

+ Tin trin - Khi - p xe phi - X ho phi - Gin ph qun - X ho, gin ph qun lm gim chc nng phi, d mc lao, bnh bi phi

Vim ph qun phi

H vi th vim ph qun phi

Vim phi k (interstitial pneumonia) - Vim phi k thng do virus xm nhp vo trong TB lt lng ph nang gy hoi t TB v gy phn ng vim trong vch ph nang. - Tn thng thng lan rng i xng 2 bn phi. - Tn thng ch vch ph nang, khng c dch r vim v BCN trong lng ph nang. - Vim phi k hay tr thnh vim mn tnh, vch ph nang x ho. Phi c hnh nh ging nh t ong trn film X quang.

Phi hnh t ong do x ho k phi

Vim phi k

Hnh thnh nang phi do gin PQ, PN sau x ho phi

Ung th phi(lung cancer) - Ung th phi l bnh hay gp, t l t vong cao cc nc cng nghip pht trin. Nam mc bnh nhiu hn n, tui mc bnh 40 70 tui. - T l mc bnh cao c lin quan ht thuc l, nhng ho cht d gy ung th, ngh nghip v mi trng sng.

+ i thTrn i th c 4 loi: - Ung th phi th trung tm (K ph qun gc) - Ung th phi th ngoi vi (K ph qun nh v ph qun tn) - Ung th phi th lan to (K ph qun tn v ph nang). - Ung th mng phi (mesotheliomas)

+ Vi thChia 4 loi: - Ung th biu m gai (squamous cell carcinoma) 30%. - Ung th biu m tuyn (adenocarcinoma) 30%. - Ung th t bo nh (small cell carcinoma) 20%. - Ung th t bo ln (large cell carcinoma) 10%.Ngoi ra cn cc khi u hn hp chim 10%.

UT biu m gai (squamous cell carcinoma) - Thng ph qun ln vng rn phi (th trung tm). Cc TB ung th l nhng TB biu m tr b d sn gai, thng do hu qu ht thuc l. Lc u l UT biu m gai ti ch, sau chuyn thnh UT biu m gai xm nhp, d gy tc ph qun. - Cc TB ung th hnh a din, c th c gai ni, ng thnh m thnh di. nhng UT bit ho cao, gia cc m cc di TB c th c hnh cu sng. Trong khi UT hay c hoi t chy mu.

UT biu m tuyn (adenocarcinoma) - Thng ph qun nh hay th ngoi vi. - TB ung th c ngun gc l nhng TB tr ca biu m ph qun, c khi UT xut pht t nhng so c trong phi (scar cancers). - Cc TB xp thnh hnh ng tuyn. Cc tuyn to nh khng u, ch mt hng TB, ch nhiu hng TB. Cc TB K c th tit nhy, c hnh nhn chia, nhn qui. - C 4 hnh thi: hnh tuyn ng (acinar), tuyn nh (papillary), tuyn ch nhy (solid carcinoma with mucin production), UT biu m vch ph nang (bronchioloalveolar carcinoma).

UT t bo nh (small cell carcinoma) - TB UT c ngun gc t cc TB thn kinh ni tit (neuroendocrine cell) nm st mng y, xen gia cc TB biu m tr. - Cc TB K trn hoc bu dc, nh, bo tng t, u nhau bt mu m (oat - cell carcinoma), ging TB lympho, ng thnh m ln. - UT TB nh c hnh nh khc bit vi cc th UT phi khc nn c tc gi chia UT phi thnh 2 loi: UT TB nh v khng TB nh. - UT TB nh c tin lng xu, di cn sm, c th ch tit hormon v c iu tr theo phng php ring.

UT t bo ln (large cell carcinoma) - UT xut pht t TB vch ph nang hoc ph qun tn, tng ng th lan trn hoc ngoi vi. - TB UT km bit ho, kch thc ln, c s a dng v nhn (nuclear pleomorphism). Cc TB c th dng thnh m hoc to thnh hnh ging tuyn. - U pht trin nhanh, tin lng xu.

Di cn UT phiUng th phi di cn theo 4 ng: - Xm nhp ti ch: UT xm nhp ra m phi xung quanh dc theo ph qun, xm lm mng phi v trung tht. - Di cn theo ng lympho n hch rn phi. Hch di cn p m xung quanh gy cc hi chng lm sng. - Di cn trong khoang mng phi gy trn dch. - Di cn theo ng mu n no, xng, gan, tuyn thng thn. Di cn xng thng xng sn, ct sng, xng i, xng chy. Hay gy gy xng bnh l.

Biu hin lm sng UT phi + UT phi t c triu chng sm + Nhng biu hin lm sng sau vi nm khi c u, UT TB nh pht trin nhanh nht, UT tuyn pht trin chm nht. + Biu hin lm sng gm: - Ho (80%) - Ho ra mu (70%) - Kh th (60%) - au ngc (40%) - Th rt, th ngy (Wheeze) (15%)

UT phi th trung tm

UT phi th ngoi vi

Ung th biu m gai(Squamous cell Carcinoma)

UT biu m gai (squamous cell carcinoma)

Ung th biu m tuyn(Adenocarcinoma)

UT biu m tuyn (adenocarcinoma)

UT biu m tuyn ch nhy(Mucinous bronchioalveolar carcinoma)

UT t bo nh (small cell carcinoma)

Ung th t bo nh (Small cell carcinoma)

UT t bo ln (large cell carcinoma)

Ung th t bo nh, ln phi hp (Mixed small cell/large cell carcinoma)

T bo UT di cn trong mch lympho (lymphagitis carcinomatosa)

Cc giai on UT phi

UT phi xm ln trung tht

Health & Medicine

Bg 11 viem k phoi