Siêu âm cấp cứu bụng nhi khoa không do chấn thương

NT MCH QUA CATHETER TRONG IU TR CHY MU DO CHN THNG KHUNG CHU

LM SNG V SIU M MT S BNH L CP CU BNG NHI KHOA KHNG DO CHN THNG

Bs. Nguyn Vn Phng

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DN BIT VN .U NHC IM CA SIU M. TUI GI .BNH L NG TIU HA.BNH L MT TY.BNH L THN.BNH L KHC.KT LUN.TI LIU THAM KHO.

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T VN Bnh l cp cu bng nhi l nhm bnh rt thng gp khoa cp cu.Tin trin ca bnh kh lng trc c, i hi chn on sm v chnh xc c hng iu tr ph hp.Chn on lm sng cn gp nhiu kh khn -> vai tr ca cn lm sng.

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U IM CA SIU M Khng c bc x ion ha. Kho st tnh cht ng hc, theo thi gian thc. phn gii cu trc cao. Gn nh khng cn dng thuc an thn hay gy m. Trnh c vic dng cc loi thuc cn quang.

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U IM CA SIU M R tin, khng xm nhp, d dng chp nhn v khng gy au. Nhanh chng thc hin ti ging bnh nu bnh nhn nng D dng thc hin li v c lp i lp li nhiu ln m khng c bt k ri ro no.

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NHC IM CA SIU MNhc im chnh ca siu m l ph thuc vo ngi thc hin.Ngoi ra cn ph thuc vo bnh nhn, thit b

TUIS sinh: Rut xoay bt ton, hp ph i mn vNh nhi: Lng rutTr nh: Vim rut, vim hch mc treoTr ln: Xon thng tinh, xon bung trng, nang bung trng xut huyt, vim mo tinh honMi la tui: Rut tha vim, thot v bn

BNH L NG TIU HA

Vim d dy - rut cp. Vim rut tha. Lng rut. Rut quay bt ton v xon rut. Hp ph i mn v.

Rt thng gp khoa cp cu. Hai loi da trn c ch bnh sinh:C ch bi tit.C ch xm nhp. Lm sng: Thng trong bnh cnh vim d dy rut cp vi st, au bng, bun nn, nn, ri lon tiu ho. Chn on: Lm sng + soi ti, nui cy phn.

Vim d dy rut cp

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Siu m: Khi cn chn on phn bit.Tng tit: Tng lng dch trong lng rut, quai rut gin ( m tnh gi -> thng v cc bin chng khc.Siu m tr gip trong vic chn on xc nh v gim s lng cc ca rut tha bnh thng b phu thut. Siu m c nhy 88% v c hiu 94%. Vim rut thaDoria AS, Moineddin R, Kellenberger CJ, et al.

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Lm sng: (th in hnh)au vng thng v, sau lan xung HCP; au m khng thnh cn.Chn n. Bun nn, nn.St nh.Mc Burney, Blumberg, Rovsing (+)CTM: BC >10.000/mm3, NEU>75%. BC>20.000 l du hiu bin chng thng hoc hoi t.Vim rut tha

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Siu m c thc hin bng mt u d linear tn s cao v kt hp vi k thut nn. nn nh nhng vng h chu phi y cc quai rut bnh thng ra v xc nh v tr ca manh trng. Rut tha thng nm ngay bn cnh manh trng v pha trc b mch chu.Hnh nh ca rut tha l mt quai rut khng c nhu ng, i ra t manh trng.Vim rut tha

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Du hiu siu m: p khng xp.ng knh >6mm, thnh dy >3mm.Du hiu ngn tay.Hnh nh bia bn.Sono - Mc Burney (+).Tng tn hiu mu lp di nim trn siu m Doppler.Si phn.Vim rut tha

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Du hiu siu m (tt):Thm nhim m mc treo quanh rut tha.Hch mc treo ln.Dy thnh manh trng / hi trng on cui.Dch t do vng h chu phi.Hnh nh mt lin tc thnh rut tha, p-xe...Cm by: m tnh gi, dng tnh gi.Vim rut tha

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p-xe rut tha:Rut tha v -> cc cu trc ln cn quy li.Thnh p-xe: mc treo, mc ni, quai rut non, cc tng ln cn dch khng c hi m / ln cn hi m, c th c kh bn trong, tng cng m sau.Phn cn li ca rut tha mt gc ca p-xe.Tng tn hiu mu trn thnh p-xe.Siu m cn gip hng dn choc ht m hoc dn lu.

Vim rut tha

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Vim rut tha

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Vim rut tha

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Vim rut tha

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Vim rut tha

Rut tha vim + si phn

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Vim rut tha

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Vim rut tha

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Vim rut tha

Rut tha vim v

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Xy ra khi mt phn ca rut ln vo trong hoc lng vo mt phn xa ca rut, gy tc nghn.Tui: 6 thng -> 2 tuiTin lng c ci thin nu chn on sm.Siu m c nhy 98-100% v c hiu 88-100%. Lng rutDel-Pozo G, Albillos JC, Tejedor D, et al.

Lm sng:Tr ang chi a th t ngt ln cn khc tht nn v bv. Sau vi pht cn au du i tr yn tnh tr li nm thip i ri tip n cn au th hai. i tin ra mu ti.Khm bng c th s thy bi lng.Thm trc trng: Bng trc trng thng rng v c mu dnh gng (hnh nh "thch nho " - red currant jelly)

Lng rut

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Du hiu siu m:Khi m mm bng tng ng vi khi lng rut.Du "bia bn" (target sign) hay du "bnh rn" (donut sign) khi ct dc.Du "bnh kp" (sandwich sign) hoc hnh na khi ct ngang.Hnh nh gi thn (pseudokidney sign).Lng rut

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Siu m cng c th hu ch trong vic pht hin mt s du hiu c th dn ti tc rut, chng hn nh hch bch huyt, polyp, nang rut i v ti tha Meckel.

Cc dch nh v mt tn hiu mu (trn siu m Doppler) l du hiu ca thiu mu cc b rut v e da hoi t. Lng rut

Lng rut

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Lng rut

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Lng rut

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Lng rut

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Lng rut

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Lng rut

Pseudokidney

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Malrotation l mt bt thng pht trin hng u lm gim chiu di ca r mc treo rut, xy ra trong qu trnh quay ca rut gia.Di chng nguy him nht ca malrotation l xon, mt cp cu y khoa, l nguyn nhn gy tc rut, thiu mu cc b v hoi t on rut b nh hng. T l: 1/200 => 1/500 tr sng. Hu ht bnh nhn khng c triu chng; c triu chng xy ra trong khong 1/6000 tr sng.Malrotation (Rut quay bt ton) v xonWarner B. Malrotation. Oldham KT, Colombani PM, Foglia RP, eds

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Malrotation (Rut quay bt ton) v xon

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Lm sng:Cc triu chng thng gp nht l au bng ti i ti li vhi chng km hp thu.Tiu chy xen k vi to bn, khng dung np thc n rn, vng da tc mt, v tro ngc d dy.Khi c xon: au bng nhiu, c hay khng km chng bng; bun nn, nn, cht nn c dch mt; i tin phn mu / b trung i tin; scMalrotation (Rut quay bt ton) v xon

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Mc d phim chp X-quang ng tiu ho trn (Upper gastrointestinal series - UGI) l tiu chun vng v chn on hnh nh, siu m cng c th hu ch, c bit khi kt qu UGI khng r rng. Malrotation (Rut quay bt ton) v xon

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Siu m:Tng quan gii phu gia ng mch mc treo trng trn (SMA) v tnh mch mc treo trng trn (SMV) b o ngc.Du hiu "xoy nc" (whirlpool sign ) trn siu m Doppler mu.Du "tng ng SMA" (hyperdynamic pulsating SMA sign) hoc du ct ct SMA (truncated SMA sign).


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Siu m:C th thy du hiu ca tc ng tiu ho cao: D dy, t trng (D1-3) gin ln v tng trng lc.Gc Treitz khng nm bn tri ct sng.Dy thnh t trng v rut.Dch, hi t do khoang phc mc.Malrotation (Rut quay bt ton) v xon

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Ct ct SMA

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Rut tha h sn tri

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Khi c mn v ph i gy hp ng mn v.Nguyn nhn ph bin nht ca tc nghn d dy v l nguyn nhn gy nn cn phu thut ph bin nht tr s sinh. Du hiu lm sng: thy c 3-4 tun tui.Tip xc vi azithromycin sm c th lm tng nguy c hp mn v.Tn sut 1,5-4/1000 tr sinh sng ngi M, t gp hn ngi chu , Phi.Hp ph i mn vEbery MD, Eide MB, Nylund CM. 2014

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Hp ph i mn v

Lm sng: Nn khng c dch mt, c th c t mu. Tr i bng thng xuyn v i b ngay sau nn. Thm khm: c th pht hin mt khi hnh oval gc phn t pha trn bn phi ca bng. Du hiu giai on mun: mt nc, tng cn chm, suy dinh dng, ri lon chuyn ha v hn m.

Hp ph i mn v

Siu m: Tiu chun chn on chnh: dy lp c o c thnh ca mn v > 3mm (tr 14mm cng c bo co nh l mt du hiu bt thng, nhng t tin cy hn.Du hiu khc: D dy cng ln, tng nhu ng v nim mc pht trin di ra dc theo hang v .Hp ph i mn v

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Mt s thao tc k thut c th hu ch khi siu m:t bnh nhn nm nghing phi Ung nc ng / Cho b.o cc ch s khi thc n t d dy qua ng mn v.Hp ph i mn v

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Hp ph i mn v

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Hp ph i mn v

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Hp ph i mn v

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Hp ph i mn v

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Hp ph i mn v

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BNH L BN - BU

Xon thng tinh. Xon phn ph tinh hon. Vim tinh hon mo tinh hon. Thot v bn bu.

L hu qu khi tinh hon quay bt thng quanh thng tinh, lm cn tr vic ti mu ca n.L mt cp cu ngoi khoa, tinh hon c th hoi t v khng th phc hi nu khng iu tr trong vng 6 gi sau khi pht triu chng.L mt chn on lm sng.Thng gp nht tui t 12 16.T l khong 1/4000 nam gii di 25 tui.Siu m c nhy v c hiu cao.Xon thng tinhKar A, Ozden E, Yakupoglu YK, Kefeli M, S Sarikaya, Yilmaz AF

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Lm sng:au t ngt v d di bu.Sng bu. au bng. Bun nn v i ma.Mt tinh hon v tr cao hn bnh thng hoc quay mt gc bt thng.i tiu au. St.Phn x da bu gim hoc mt bn au.

Xon thng tinh

Siu m: H tr lm sng nhng khng c lm chm tr thi gian phu thut.Thc hin vi u d linear tn s cao (7-14 MHz). Tinh hon khng c triu chng c qut trc hiu chnh cc thit lp cho dng chy thp, tr khng v vn tc. Khi thu c hnh nh tt bn lnh, bn au s c thm khm m khng thay i cc thit lp my.Khm ng thi c hai tinh hon mt ct ngang.

Xon thng tinh

Siu m: (tt)Tinh hon gim m, ph i. (sau 6h)Gim hoc mt tn hiu mch mu trong tinh hon trong khi bn ngoi tinh hon th bnh thng trn siu m Doppler mu.Tng tr khng ng mch tinh hon.Du xoy nc c gi tr chn on rt cao.

Xon thng tinh

Cm by:Tn hiu mch mu thng rt kh pht hin tr cha dy th bnh thng.Xon tinh hon c th khng hon ton hoc khng lin tc nn tn hiu dng chy khng nht thit s mt. Cc tinh hon cng c th t tho xon; v thiu mu cc b tinh hon c th th pht do cc nguyn nhn khc (vim mch, chn thng, vim mo tinh hon-tinh hon) m khng phi xon.Trn dch mng tinh hon v dy da bu l nhng biu hin nhiu bnh v do khng c hiu.Xon thng tinh

Xon thng tinh

TINH HON HAI BN BNH THNG

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Xon thng tinh

Xon thng tinh phi

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Xon thng tinh

Xon thng tinh tri

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Xon thng tinh

Du xoy nc

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mt a tr au bu cp, xon phn ph tinh hon l mt nguyn nhn ph bin nht.Phn ph tinh hon (Appendix testis) l vt tch ca ng Muller, nm cc trn ca tinh hon (gia tinh hon v phn u ca mo tinh), bnh thng c hnh oval, di 1 7 mm.Bnh thng gp di 13 tui v nhng cn au thng t t hn so vi xon tinh hon; do , bnh nhn thng vo vin vi ngy sau khi c triu chng. Xon phn ph tinh honBaldisserotto M, de Souza JCK, Pertence AP, Dora MD

Lm sng:au bu (thng t t tng dn), thng au vng cc trn tinh hon.St.Phn x da bu bnh thng.Thng khng c sng bu hay cc triu chng tiu ha, tit niu.

Xon phn ph tinh hon

Siu m:Mt cu trc v mch trong mt vng tng ti mu, tch bit khi tinh hon v mo tinh hon.C th tng ti mu mo tinh v tinh hon (ging nh vim mo tinh hon v / hoc vim tinh hon).Cc phn ph b xon theo thi gian dn tr nn tng m hn v cui cng c th vi ha hoc bong ra nh mt th vi ha gia cc lp ca bao tinh hon; c gi l mt "vin ngc bu" (scrotal pearl).Xon phn ph tinh hon

Xon phn ph tinh hon

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Xon phn ph tinh hon

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Xon phn ph tinh hon

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Xon phn ph tinh hon

Scrotal pearl

Ph bin hn thanh nin, th pht sau cc bnh ly truyn qua ng tnh dc.Cng xy ra tr em v thng l t pht, do nhim trng ngc dng ng tit niu hoc c th lin quan n mt s bt thng sinh dc ng tit niu di.Vim tinh hon m khng c vim mo tinh hon l in hnh ca nhim cc paramyxovirus, gy bnh quai b.Cc bin chng bao gm p xe v nhi mu, c hai u c th d nhm ln vi xon.

Vim mo tinh hon tinh hon

Lm sng:au, sng bu.St.Bun nn, nn.Ri lon tiu tin.Xt nghim:Tng bch cu ht.Bch cu trong nc tiu.


Siu m:Trong cc trng hp vim cp tnh, mo tinh hon tr nn ph i v hi m khng ng nht trn siu m B-mode v tng ti mu trn siu m Doppler mu.Tinh hon cng bn c th b nh hng trong 20% cc trng hp, thng xy ra hn ngi ln.Tinh hon khng ng nht, ph i v xung huyt l c trng ca vim tinh hon. Vim mo tinh hon tinh hon


Vim mo tinh hon phi

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Vim tinh hon tri

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Vim tinh hon tri

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Thot v bn - bu xy ra thng do cc ng phc tinh mc v ng bn khng ng kn.Thot v nght c th dn n nhiu bin chng nghim trng, thm ch t vong.T l mc khng r nhng thng gp hn tr sinh non.Thot v bn - bu

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Lm sng: Thm khm siu m nn bt u vi cho bnh nhn nm nga v sau l ng.Khi phnh vng bn bu. Thng xut hin sau khc hoc gng sc, thoi lui khi ngh ngi hoc ng.C th c au hoc khng.Silk sign.

Thot v bn - bu

Siu m:Rut hoc/v mc ni c thy trong ng bn v tch bit vi tinh hon v mo tinh hon bnh thng.Nhu ng rut c th c hoc mt. S mt nhu ng l du hiu cnh bo nght, mt nguyn nhn ca au bu cp tnh.Thot v bn - bu

Thot v bn - bu

Thot v bn - bu

Thot v bn - bu

BNH L PH KHOA

Xon bung trng. dch mu m o, t cung. Nang bung trng xut huyt.

L nguyn nhn ph bit ca au bng cp tnh tr n.Thng gp ph n >20 tui (nhng vn gp tr em).Nguyn nhn ch yu l do tnh di ng qu mc ca bung trng. Hu ht xy ra trn nhng bung trng c sn cc khi u.Xon ban u lm tc nghn tun hon tnh mch, v nu khng c iu tr, s dn n tc nghn tun hon ng mch.Xon bung trngRody A, Jackish C, Klockenbusch W, et al.

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Lm sng: Thng nhm ln vi cc bnh bng cp khc.Khi pht t ngt vi mt cn au d di, lin tc vng bng di. C th c i ma.S thy mt khi vng chu.St (+/-).

Xon bung trngRody A, Jackish C, Klockenbusch W, et al.

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Siu m:Bung trng to ra vi nhiu nang ngoi vi.Mt tn hiu dng chy trn Doppler mu.C th thy du xoy nc, rt c gi tr trong chn on.Khi hi m t ng nht vng chu.Dch t do ti cng Douglas.Xon bung trng

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Xon bung trng

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Xon bung trng

Xon bung trng phi

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Xon bung trng

Xon bung trng tri

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Xon bung trng

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Xon bung trng

Du xoy nc

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Xon bung trng

Du xoy nc

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Khng thng xuyn gp phi ED nh l mt nguyn nhn gy ra cn au tr n hoc tr v thnh nin n.Nguyn nhn thng gp l d tt mng trinh bt kn. Ngoi ra c th do tt c vch ngn m o, hp m o, hp c t cungC th lin quan vi mt xoang niu sinh dc hoc d dng nhp.Thng b b st khi kim tra s sinh.

Hydrometrocolpos v Haematometrocolpos

Lm sng:Mt khi phng ln gia m h, y phng mng trinh.V kinh nguyn pht v au bng di theo chu k tr n v thnh nin.Mass vng h v.Nhim trng ng tiu, tc nghn niu qun, bng quang.au lng, to bn.


Siu m:m ov/hoc t cung cng ln, y dch, cho hnh nh mt cu trc dng nang nm ng gia, gia bng quang v trc trng.C th c mc dch-mu.



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Haematometrocolpos

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Haematometrocolpos

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109

Nang bung trng c nng l kt qu ca s tht bi trong qu trnh to hoc rng trng trong chu k kinh nguyt bnh thng.Chy mu hoc v ca nang l mt nguyn nhn gy au cp tnh v c th ging vim rut tha cp.Hu ht cc nang l nh v t thoi trin khng cn iu tr, nhng mt s c th ln (ln n 6 cm), trong trng hp ny theo di c khuyn co c hng iu tr an ton.Nang bung trng xut huyt

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Lm sng:au vng chu t ngt khi pht / au m ko di.Mass vng ha v.C th khng c triu chng, c pht hin ngu nhin khi khm sc khe.Nang bung trng xut huyt

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Siu m: Hnh nh siu m ph thuc vo thi gian chy ca muKhi dng nang v mch phn ph vi rt nhiu vch mng (lace-like).Dch bn trong c hi m.C th c mc dch dch.Bt tn hiu mch v nang trn siu m Doppler. Nang bung trng xut huyt

Nang bung trng xut huyt




BNH L MT TY

Vim ty cp Nang ng mt ch

D t gp tr em, nhng c t l dn ti t vong.Lm sng thng t c hiu so vi ngi ln.Nguyn nhn rt a dng, thng gp nht l do chn thng.Khong 25% trng hp khng r nguyn nhn.Vim ty cpLi H, Qian Z, Z Liu, Liu X, Han X, Kang H.

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Lm sng: au bng , nn, bng cng v chng. St, nhp tim nhanh, h huyt p, vng da. Phn ng thnh bng v gim nhu ng rut. Sc. Tr c th nm sp, gp hng v u gi.Cn au thng tng cng trong 24-48 gi. Din bin lm sng kh xc nh.Cn lm sng: lipase, amylase, siu m, CLVT.Vim ty cp

Siu m:Ty ln khu tr hay lan ta, gim m hoc trng m, hoc ty ph n.ng ty gin.Khi bt thng ty.T dch khu tr hoc lan ta quanh ty.p-xe, nang gi ty.Vim ty cp

Vim ty cp

Ty bnh thngTr em Ngi ln

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Vim ty cp

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Vim ty cp

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Vim ty cp

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Vim ty cp

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Vim ty cp

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Nang ng mt ch l d tt bm sinh dng nang ca ng mt.Bnh gp ch yu n.c phn thnh 5 loi (Theo Todani v cs).Lm sng:au bng.Vng da.S thy khi bngNang ng mt ch

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Siu m c th nh v v o lng mc dn ng mt v phn bit 5 th ca nang ng mt ch.Kho st siu m cng gip pht hin bin chng ca bnh: Si, bin i ty, c tnh ha..Nang ng mt ch

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Nang ng mt ch

Type I

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Nang ng mt ch

Type IVa

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Nang ng mt ch

Type IVa

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Nang ng mt ch

Type IVa

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Nang ng mt ch

Type V

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BNH L THN TIT NIU

Vim thn-b thn cp

L qu trnh vim - nhim trng do vi khun m k - ng thn mt hoc hai bn. tr s sinh thng t ng mu, tr ln hn thng do nhim khun ngc dng.Tr nh thng gp hn nam, khng ct bao quy u; sau dy th thng gp tr gi hn.Tin lng: p ng tt vi iu tr khng sinh.

Vim thn b thn cp

Lm sng: Thay i theo tui bnh nhn.Tr 48h, b km, nn ma, tiu chy, chm ln. Nc tiu c th hi, c th tiu mu.Tr nh: St >48 gi. au bng hoc au mn sn; nn ma, tiu chy, chn n c th gp. Nc tiu thng hi, c th tiu mu.

Vim thn b thn cp

Lm sng: (tt)Tr v thnh nin: Tng t ngi ln vi st, thng vi n lnh, rt run v au mn sn. C th c au bng v trn khp mu, ri lon tiu ha, tiu kh, tiu au. Nc tiu hi gp rt thng xuyn v c th tiu mu.

Vim thn b thn cp

Siu m:Thn vim to ra vi vng hi m bt thng khu tr hoc lan to (thng l gim m) v mt phn bit ty v.C th gin i b thn.Gim ti mu vng thn b nh hng trn siu m Doppler.Mc d nhy ca siu m trong vic pht hin vim thn - b thn cp l thp, nhng nhy ca n i vi cc bin chng, bao gm p xe v thn m, l kh cao.

Vim thn b thn cp

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Vim thn b thn cp

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Vim thn b thn cp

RL

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Vim thn b thn cp

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Vim thn b thn cp

p-xe thn

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Vim thn b thn cp

p-xe thn

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BNH L KHC

Vim hch mc treo rut.

L tnh trng vim t gii hn ca cc hch bch huyt mc treo.Thng nhm ln vi rut tha vim.Tui: Thng = 3 hch vi ng knh ngang >=5mm, b u r, cu trc hch bnh thng. Dy thnh hi manh trng. Rut tha bnh thng.

Vim hch mc treo rut

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Vim hch mc treo rut

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Vim hch mc treo rut

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Vim hch mc treo rut

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Vim hch mc treo rut

151

Chn on lm sng l quyt nh, tuy nhin thng b nhm ln bi nhiu yu t.Siu m c nhiu ng dng trong vic nh gi bnh nhi ti ED.Bi v s nhanh chng, d s dng v khng c cc bc x ion ha ca n, siu m tr thnh k thut hnh nh c la chn c hai nhm bnh nhi n nh v khng n nh ti ED nhm gip bc s lm sng a ra chn on hoc loi tr chn on.KT LUN

Bnh hc ngoi khoa H Y Dc Hu.Gio trnh ging dy sau i hc Hong Minh Li.Siu m bng tng qut Nguyn Phc Bo Qun.Medscape.com,Appliedradiology.com; Mayoclinic.orgRadiopaedia.org; Radiologyassistant.nlNcbi.nlm.nih.gov; Ultrasoundcases.info

TI LIU THAM KHO

Xin chn thnh cm n s lng nghe ca qu thy c, anh ch v cc bn!

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Health & Medicine

Siêu âm cấp cứu bụng nhi khoa không do chấn thương