I. H\u00e0nh ch\u00ednh<\/p>\n
1.H\u1ecd t\u00ean BN: L\u00ea Th\u1ecb T 2.Tu\u1ed5i:1951 3. Gi\u1edbi: N\u1eef<\/p>\n
4.Ngh\u1ec1 nghi\u1ec7p: N\u1ed9i tr\u1ee3<\/p>\n
5.\u0110\u1ecba ch\u1ec9: T\u00e2y Ninh<\/p>\n
6.NV ng\u00e0y: 11\/3\/2009<\/p>\n
II. Ph\u1ea7n chuy\u00ean m\u00f4n:
\n1. L\u00ed do nh\u1eadp vi\u1ec7n: kh\u1ed1i u th\u01b0\u1ee3ng v\u1ecb<\/p>\n
2. B\u1ec7nh s\u1eed<\/p>\n
\u2013 C\u00e1ch NV 2 th\u00e1ng: BN \u0103n c\u01a1m th\u00ec b\u1ecb ngh\u1eb9n, c\u1ea3m gi\u00e1c b\u1ecb ch\u1eb9n \u1edf ng\u1ef1c khi nu\u1ed1t th\u1ee9c \u0103n, BN \u0111i loanh quanh trong nh\u00e0 kho\u1ea3ng 5 \u2013 10 ph\u00fat th\u00ec h\u1ebft ngh\u1eb9n.<\/p>\n
\u2013 C\u00e1ch NV 50 ng\u00e0y, BN v\u1eabn nu\u1ed1t ngh\u1eb9n th\u1ee9c \u0103n \u0111\u1eb7c (c\u01a1m), v\u1eeba nu\u1ed1t v\u00e0o l\u00e0 \u00f3i ra li\u1ec1n, BN \u00f3i th\u1ee9c \u0103n kh\u00f4ng c\u00f3 m\u00e1u, \u00f3i xong c\u1ea3m th\u1ea5y kh\u1ecfe.<\/p>\n
\u2013 C\u00e1ch NV 40 ng\u00e0y, BN chuy\u1ec3n qua \u0103n ch\u00e1o \u0111\u1eb7c<\/p>\n
\u2013 C\u00e1ch NV 1 th\u00e1ng, BN \u0103n ch\u00e1o \u0111\u1eb7c c\u0169ng b\u1ecb ngh\u1eb9n v\u00e0 \u00f3i, \u00f3i th\u1ee9c \u0103n kh\u00f4ng l\u1eabn m\u00e1u, BN ph\u1ea3i \u0103n ch\u1eadm v\u00e0 \u0103n t\u1eebng ch\u00fat (d\u00f9ng mu\u1ed7ng c\u00e0 ph\u00ea \u0111\u1ec3 \u0103n)<\/p>\n
\u2013 C\u00e1ch NV 2 tu\u1ea7n, BN chuy\u1ec3n qua \u0103n ch\u00e1o l\u00f5ang. C\u00f9ng l\u00fac n\u00e0y BN th\u1ea5y \u0111au \u00e2m \u1ec9 v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, c\u01a1n \u0111au c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 nh\u1eb9, \u0111au kh\u00f4ng lan, c\u01a1n \u0111au xu\u1ea5t hi\u1ec7n khi \u0111\u00f3i, gi\u1ea3m \u0111au sau \u0103n. Sau kho\u1ea3ng 2h, BN c\u1ea3m th\u1ea5y \u0111\u00f3i l\u1ea1i, c\u01a1n \u0111au l\u1ea1i xu\u1ea5t hi\u1ec7n v\u1edbi t\u00ednh ch\u1ea5t nh\u01b0 tr\u00ean. BN \u0111i kh\u00e1m BS t\u01b0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111\u00f3an: B\u1ec7nh l\u200ey d\u1ea1 d\u00e0y (?) \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c u\u1ed1ng (?) th\u1ea5y kh\u00f4ng gi\u1ea3m \u0111au.<\/p>\n
\u2013 C\u00e1ch NV 10 ng\u00e0y, \u0111au th\u01b0\u1ee3ng v\u1ecb t\u0103ng l\u00ean, BN \u0111au \u00e2m \u1ec9 li\u00ean t\u1ee5c c\u1ea3 ng\u00e0y, kho\u1ea3ng 4 \u2013 5h chi\u1ec1u th\u00ec \u0111au nh\u00f3i l\u00ean, \u0111au kh\u00f4ng lan, sau \u0103n th\u00ec gi\u1ea3m b\u1edbt \u0111au, \u0111\u1ebfn 2 \u2013 3h s\u00e1ng th\u00ec \u0111\u1ed9t ng\u1ed9t \u0111au nh\u00f3i l\u1ea1i, k\u00e9o d\u00e0i kho\u1ea3ng 1h th\u00ec \u0111au \u00e2m \u1ec9 l\u1ea1i. Khi \u0111au nhi\u1ec1u, BN s\u1edd l\u00ean th\u01b0\u1ee3ng v\u1ecb th\u1ea5y c\u00f3 1 c\u1ee5c u, k\u00edch th\u01b0\u1edbc (?) \u1ea5n \u0111au nhi\u1ec1u.<\/p>\n
\u2013 C\u00e1ch NV 7 ng\u00e0y, BN \u0111i kh\u00e1m H\u00f2a H\u1ea3o \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n: K d\u1ea1 d\u00e0y.<\/p>\n
\u2013 Ng\u00e0y NV, BN ti\u1ebfp t\u1ee5c nu\u1ed1t ngh\u1eb9, \u0111au \u00e2m \u1ec9 v\u00f9ng th\u01b0\u1ee3ng v\u1ecb \u201d NV BV B\u00ecnh D\u00e2n.<\/p>\n
\u2013 Trong 2 th\u00e1ng, BN s\u1ee5t 8kg (tr\u01b0\u1edbc 59kg, hi\u1ec7n nay n\u1eb7ng 51kg), \u0111i c\u1ea7u b\u00ecnh th\u01b0\u1eddng, m\u1ed7i l\u1ea7n \u0111i c\u00f3 ph\u00e2n \u0111\u1eb7c l\u1eabn v\u1edbi ph\u00e2n l\u1ecfng n\u01b0\u1edbc, m\u00e0u v\u00e0ng, kh\u00f4ng c\u00f3 m\u00e1u, kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c \u0111au bu\u1ed1t khi \u0111i c\u1ea7u. \u0110i ti\u1ec3u b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng ch\u00e1n \u0103n, kh\u00f4ng \u0111\u1ea7y b\u1ee5ng kh\u00f3 ti\u00eau, kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c s\u00f4i b\u1ee5ng.<\/p>\n
* Di\u1ec5n ti\u1ebfn t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n \u0111\u1ebfn l\u00fac kh\u00e1m<\/p>\n
\u2013 BN v\u1eabn c\u00f2n \u0111au b\u1ee5ng \u00e2m \u1ec9, v\u1eabn \u0103n ch\u00e1o lo\u00e3ng, \u0103n ch\u1eadm, \u0103n t\u1eebng ch\u00fat, v\u1eabn s\u1edd th\u1ea5y kh\u1ed1i u<\/p>\n
\u2013 Kh\u00f4ng \u0111au ng\u1ef1c, kh\u00f4ng kh\u00f3 th\u1edf.<\/p>\n
\u2013 \u0110i ti\u1ec3u b\u00ecnh th\u01b0\u1eddng.<\/p>\n
3. Ti\u1ec1n c\u0103n<\/p>\n
* B\u1ec7nh l\u00fd<\/p>\n
\u2013 T\u0103ng huy\u1ebft \u00e1p (3 n\u0103m nay, HA max = 210mmHg, \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7.)<\/p>\n
\u2013 Kh\u00f4ng \u0110T\u0110, kh\u00f4ng b\u1ec7nh l\u200ey tim m\u1ea1ch, kh\u00f4ng b\u1ec7nh ph\u1ed5i, kh\u00f4ng b\u1ec7nh ly gan th\u1eadn.<\/p>\n
\u2013 Ch\u01b0a c\u00f3 ti\u1ec1n s\u1eed ng\u1ecdai khoa.<\/p>\n
\u2013 Kh\u00f4ng d\u1ecb \u1ee9ng thu\u1ed1c, th\u1ee9c \u0103n.<\/p>\n
\u2013 PARA 6 \u2013 0 \u2013 0 \u2013 6. M\u00e3n kinh l\u00fac 46tu\u1ed5i.<\/p>\n
* Th\u00f3i quen<\/p>\n
\u2013 Kh\u00f4ng h\u00fat thu\u1ed1c<\/p>\n
\u2013 Kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u bia<\/p>\n
* Gia \u0111\u00ecnh: ch\u01b0a ghi nh\u1eadn b\u1ec7nh l\u200ey b\u1ea5t th\u01b0\u1eddng, kh\u00f4ng c\u00f3 ai b\u1ecb ung th\u01b0, b\u1ec7nh tim m\u1ea1ch, lao ph\u1ed5i<\/p>\n
4. Kh\u00e1m l\u00e2m s\u00e0ng: 9h ng\u00e0y 12\/3\/2009<\/p>\n
Sinh hi\u1ec7u:<\/p>\n
M\u1ea1ch: 86l\u1ea7n\/ph\u00fat; Huy\u1ebft \u00e1p: 130\/80mmHg; To: 36,8oC, NT 20 l\/ph<\/p>\n
* Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n<\/p>\n
\u2013 BN t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/p>\n
\u2013 T\u1ed5ng tr\u1ea1ng trung b\u00ecnh (BMI = 19.9)<\/p>\n
\u2013 Da xanh, ni\u00eam nh\u1ea1t. M\u00f3ng h\u1ed3ng nh\u1ea1t, c\u00f2n b\u00f3ng.<\/p>\n
\u2013 K\u1ebft m\u1ea1c m\u1eaft kh\u00f4ng v\u00e0ng.<\/p>\n
\u2013 Kh\u00f4ng d\u1ea5u xu\u1ea5t huy\u1ebft da ni\u00eam.<\/p>\n
\u2013 Kh\u00f4ng ph\u00f9<\/p>\n
\u2013 H\u1ea1ch ngo\u1ea1i vi (h\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n, h\u1ea1ch b\u1eb9n, h\u1ea1ch n\u00e1ch) kh\u00f4ng s\u1edd ch\u1ea1m,<\/p>\n
\u2013 Ko sao m\u1ea1ch, ko tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7<\/p>\n
* \u0110\u1ea7u m\u1eb7t c\u1ed5<\/p>\n
\u2013 L\u01b0\u1ee1i d\u01a1, c\u00f2n gai<\/p>\n
\u2013 Tuy\u1ebfn gi\u00e1p, tuy\u1ebfn mang tai kh\u00f4ng to<\/p>\n
\u2013 TM c\u1ed5 kh\u00f4ng n\u1ed5i \u1edf t\u01b0 th\u1ebf 45o<\/p>\n
* L\u1ed3ng ng\u1ef1c<\/p>\n
C\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, kh\u00f4ng u s\u1eb9o b\u1ea5t th\u01b0\u1eddng<\/p>\n
* Ph\u1ed5i<\/p>\n
\u2013 Rung thanh \u0111\u1ec1u 2 b\u00ean<\/p>\n
\u2013 G\u00f5 trong<\/p>\n
\u2013 R\u00ec r\u00e0o ph\u1ebf nang r\u00f5, \u0111\u1ec1u 2 b\u00ean, kh\u00f4ng c\u00f3 rale b\u1ea5t th\u01b0\u1eddng<\/p>\n
* Tim m\u1ea1ch<\/p>\n
\u2013 M\u1ecfm tim \u1edf khoang li\u00ean s\u01b0\u1eddn 5 \u0111\u01b0\u1eddng trung \u0111\u00f2n tr\u00e1i, kh\u00f4ng c\u00f3 \u1ed5 \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng<\/p>\n
\u2013 Kh\u00f4ng c\u00f3 rung miu<\/p>\n
\u2013 T\u1ea7n s\u1ed1 86l\u1ea7n\/ph\u00fat, kh\u00f4ng \u00e2m th\u1ed5i, T1, T2 \u0111\u1ec1u r\u00f5, kh\u00f4ng ti\u1ebfng tim b\u1ea5t th\u01b0\u1eddng<\/p>\n
\u2013 M\u1ea1ch b\u1eaft \u0111\u1ec1u, \u0111\u1ed1i x\u1ee9ng 2 b\u00ean, Nh\u1ecbp tim tr\u00f9ng v\u1edbi nh\u1ecbp m\u1ea1ch.<\/p>\n
* B\u1ee5ng<\/p>\n
\u2013 B\u1ee5ng c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, kh\u00f4ng u s\u1eb9o b\u1ea5t th\u01b0\u1eddng, kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7<\/p>\n
\u2013 B\u1ee5ng m\u1ec1m, \u1ea5n \u0111au th\u01b0\u1ee3ng v\u1ecb h\u01a1i l\u1ec7ch (T), Gan l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m, b\u1edd tr\u00ean gan \u1edf khoang li\u00ean s\u01b0\u1eddn 6 \u0111\u01b0\u1eddng trung \u0111\u00f2n ph\u1ea3i, cao kho\u1ea3ng 12cm<\/p>\n
\u2013 S\u1edd th\u1ea5y 1 kh\u1ed1i u tr\u00f2n v\u00f9ng th\u01b0\u1ee3ng v\u1ecb h\u01a1i l\u1ec7ch (T), b\u1ec1 m\u1eb7t tr\u01a1n l\u00e1ng, gi\u1edbi h\u1ea1n r\u00f5, m\u1eadt \u0111\u1ed9 ch\u1eafc, k\u00edch th\u01b0\u1edbc 3x5cm, ch\u1ec9 di \u0111\u1ed9ng xu\u1ed1ng d\u01b0\u1edbi khi BN h\u00edt s\u00e2u<\/p>\n
\u2013 G\u00f5 trong<\/p>\n
\u2013 Nhu \u0111\u1ed9ng ru\u1ed9t 3l\u1ea7n\/ph\u00fat, kh\u00f4ng \u00e2m th\u1ed5i \u1edf \u0110M ch\u1ee7 b\u1ee5ng<\/p>\n
* Ti\u1ebft ni\u1ec7u<\/p>\n
\u2013 C\u1ea7u b\u00e0ng quang (-), kh\u00f4ng c\u00f3 \u0111i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n<\/p>\n
\u2013 Ch\u1ea1m th\u1eadn (-), B\u1eadp b\u1ec1nh th\u1eadn (-)<\/p>\n
* Th\u1ea7n kinh \u2013 C\u01a1 x\u01b0\u01a1ng kh\u1edbp<\/p>\n
\u2013 h\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa<\/p>\n
\u2013 V\u1eadn \u0111\u1ed9ng kh\u00f4ng gi\u1edbi h\u1ea1n, s\u1ee9c c\u01a1 5\/5, C\u1ed9t s\u1ed1ng kh\u00f4ng bi\u1ebfn d\u1ea1ng<\/p>\n
\u2013 Kh\u00f4ng s\u01b0ng \u0111au kh\u1edbp.<\/p>\n
5.T\u00f3m t\u1eaft b\u1ec7nh \u00e1n:<\/p>\n
\u2013 BN n\u1eef, 58 tu\u1ed5i, NV v\u00ec kh\u1ed1i u v\u00f9ng th\u01b0\u1ee3ng v\u1ecb<\/p>\n
\u2013 TCCN:<\/p>\n
+ C\u00e1ch NV 2 th\u00e1ng: nu\u1ed1t ngh\u1eb9n t\u0103ng d\u1ea7n k\u00e8m \u00f3i th\u1ee9c \u0103n.<\/p>\n
+ C\u00e1ch NV 2 tu\u1ea7n: \u0111au \u00e2m \u1ec9 v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, kh\u00f4ng lan.<\/p>\n
+ C\u00e1ch NV 10 ng\u00e0y: \u0111au \u00e2m \u1ec9 t\u0103ng l\u00ean, th\u1ec9nh tho\u1ea3ng \u0111au nh\u00f3i. S\u1edd th\u1ea5y kh\u1ed1i u th\u01b0\u1ee3ng v\u1ecb, \u1ea5n \u0111au.<\/p>\n
+ S\u1ee5t 8kg trong 2 th\u00e1ng. RL t\u00ednh ch\u1ea5t ph\u00e2n<\/p>\n
\u2013 TCTT:<\/p>\n
+ Da xanh, ni\u00eam nh\u1ea1t, m\u00f3ng h\u1ed3ng nh\u1ea1t<\/p>\n
+ H\u1ea1ch ngo\u1ea1i vi (-)<\/p>\n
+ Kh\u00e1m b\u1ee5ng: kh\u1ed1i u tr\u00f2n v\u00f9ng th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch (T), b\u1ec1 m\u1eb7t tr\u01a1n l\u00e1ng, m\u1eadt \u0111\u1ed9 ch\u1eafc, gi\u1edbi h\u1ea1n r\u00f5, k\u00edch th\u01b0\u1edbc # 3x5cm, di \u0111\u1ed9ng xu\u1ed1ng d\u01b0\u1edbi khi h\u00edt s\u00e2u<\/p>\n
6. \u0110\u1eb7t v\u1ea5n \u0111\u1ec1:<\/p>\n
HC thi\u1ebfu m\u00e1u<\/p>\n
Nu\u1ed1t ngh\u1eb9n t\u0103ng d\u1ea7n + \u00d3i ngay sau khi nu\u1ed1t<\/p>\n
Kh\u1ed1i u th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch (T)<\/p>\n
S\u1ee5t c\u00e2n<\/p>\n
R\u1ed1i lo\u1ea1n t\u00ednh ch\u1ea5t ph\u00e2n<\/p>\n
7. Bi\u1ec7n lu\u1eadn l\u00e2m s\u00e0ng:<\/p>\n
\u2013 BN c\u00f3 kh\u1ed1i u \u1edf b\u1ee5ng, thi\u1ebfu m\u00e1u, s\u1ee5t c\u00e2n => ngh\u0129 nhi\u1ec1u t\u1edbi ung th\u01b0 1 t\u1ea1ng trong \u1ed5 b\u1ee5ng.<\/p>\n
\u2013 Kh\u1ed1i u n\u1eb1m \u1edf th\u01b0\u1ee3ng v\u1ecb h\u01a1i l\u1ec7ch tr\u00e1i, di \u0111\u1ed9ng xu\u1ed1ng d\u01b0\u1edbi khi h\u00edt s\u00e2u => c\u00e1c u \u1edf t\u1ea1ng c\u00f3 th\u1ec3 ngh\u0129 \u0111\u1ebfn: d\u1ea1 d\u00e0y, gan (T), \u0111\u1ea7u t\u1ee5y, \u0111\u1ea1i tr\u00e0ng ngang.<\/p>\n
\u2013 BN kh\u00f4ng c\u00f3 v\u00e0ng da, v\u00e0ng m\u1eaft, n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng s\u1eadm m\u00e0u => kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7n ch\u00e8n \u00e9p \u0111\u01b0\u1eddng m\u1eadt nghi do u \u0111\u1ea7u t\u1ee5y hay u gan<\/p>\n
\u2013 BN c\u00f3 tri\u1ec7u ch\u1ee9ng nu\u1ed1t ngh\u1eb9n => c\u00f3 th\u1ec3 l\u00e0 ung th\u01b0 d\u1ea1 d\u00e0y v\u00f9ng t\u00e2m v\u1ecb l\u00e0m h\u1eb9p t\u00e2m v\u1ecb g\u00e2y tri\u1ec7u ch\u1ee9ng nu\u1ed1t ngh\u1eb9n. Nh\u01b0ng s\u1edd th\u1ea5y kh\u1ed1i u \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch (T) n\u00ean ngh\u0129 nhi\u1ec1u \u0111\u1ebfn K v\u00f9ng th\u00e2n v\u1ecb di c\u0103n th\u1ef1c qu\u1ea3n g\u00e2y nu\u1ed1t ngh\u1eb9n, ho\u1eb7c c\u00f3 th\u1ec3 l\u00e0 K th\u1ef1c qu\u1ea3n di c\u0103n d\u1ea1 d\u00e0y (v\u00f9ng th\u00e2n v\u1ecb)<\/p>\n
\u2013 Tuy nhi\u00ean, BN l\u1ea1i c\u00f3 thay \u0111\u1ed5i t\u00ednh ch\u1ea5t ph\u00e2n n\u00ean kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb K \u0111\u1ea1i tr\u00e0ng ngang di c\u0103n d\u1ea1 d\u00e0y, th\u1ef1c qu\u1ea3n ho\u1eb7c K d\u1ea1 d\u00e0y di c\u0103n th\u1ef1c qu\u1ea3n v\u00e0 \u0111\u1ea1i tr\u00e0ng ngang.<\/p>\n
8. Ch\u1ea9n \u0111o\u00e1n:
\n\u2013 Ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9: K d\u1ea1 d\u00e0y di c\u0103n th\u1ef1c qu\u1ea3n v\u00e0 \u0111\u1ea1i tr\u00e0ng ngang<\/p>\n
\u2013 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/p>\n
K th\u1ef1c qu\u1ea3n x\u00e2m l\u1ea5n xu\u1ed1ng d\u1ea1 d\u00e0y<\/p>\n
K \u0111\u1ea1i tr\u00e0ng ngang x\u00e2m l\u1ea5n d\u1ea1 d\u00e0y (v\u00f9ng th\u00e2n v\u1ecb)<\/p>\n
K \u0111\u1ea1i tr\u00e0ng ngang x\u00e2m l\u1ea5n d\u1ea1 d\u00e0y, th\u1ef1c qu\u1ea3<\/p>\n
9. C\u1eadn l\u1ea7m s\u00e0ng:
\n\u2013 \u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng:<\/p>\n
C\u00f4ng th\u1ee9c m\u00e1u<\/p>\n
XN sinh h\u00f3a m\u00e1u (men gan, Bil (TP, TT, GT), amylase)<\/p>\n
Si\u00eau \u00e2m b\u1ee5ng<\/p>\n
Ch\u1ee5p d\u1ea1 d\u00e0y c\u1ea3n quang<\/p>\n
Tumor Markers (AFP, CEA, CA 19.9)<\/p>\n
CT scan<\/p>\n
N\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean<\/p>\n
N\u1ed9i soi ti\u00eau h\u00f3a d\u01b0\u1edbi<\/p>\n
T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u<\/p>\n
ECG<\/p>\n
XQ ng\u1ef1c th\u1eb3ng<\/p>\n
\u2013 C\u1eadn l\u00e2m s\u00e0ng \u0111\u00e3 c\u00f3:<\/p>\n
* C\u00f4ng th\u1ee9c m\u00e1u<\/p>\n
WBC 8.5 k\/uL<\/p>\n
Neu 5,57 k\/uL 65.5%N<\/p>\n
Lym 2,25 k\/uL 26.5%L<\/p>\n
Mono 0.419 k\/uL 4.93%M<\/p>\n
Eos 0.238 k\/uL 2.8%E<\/p>\n
Baso 0,026 k\/uL 0.309%B DFLT(NLMEB)<\/p>\n
RBC 3.83M\/Ul (4.04 \u2013 6.13)<\/p>\n
Hgb 12.2 g\/dL<\/p>\n
Hct 35.3% (37.7 \u2013 48)<\/p>\n
MCV 92.1fL<\/p>\n
MCH 31.9pg (27 \u2013 31.2)<\/p>\n
MCHC 34,6 g\/dL<\/p>\n
RDW 14.9%<\/p>\n
PLT 308 k\/uL<\/p>\n
* Sinh h\u00f3a m\u00e1u<\/p>\n
Urea 3,4mmol\/L<\/p>\n
Glucose 4,1mmol\/L<\/p>\n
Creatinin 60 umol\/L<\/p>\n
Protein Total 63g\/L<\/p>\n
HbsAg (-)<\/p>\n
HIV (-)<\/p>\n
CA 19.9 0 U\/mL<\/p>\n
CEA 1.42 ng\/mL<\/p>\n
* Si\u00eau \u00e2m b\u1ee5ng<\/p>\n
Th\u00e2m nhi\u1ec5m d\u00e0y v\u00e1ch bao t\u1eed d = 10mm, ph\u1ea3n \u00e2m k\u00e9m, lan 1\/3 d\u01b0\u1edbi th\u1ef1c qu\u1ea3n, c\u00f3 h\u1ea1ch b\u1edd cong nh\u1ecf 7 \u2013 8 mm<\/p>\n
K\u1ebft lu\u1eadn: Th\u00e2m nhi\u1ec5m v\u00e1ch d\u1ea1 d\u00e0y lan 1\/3 d\u01b0\u1edbi th\u1ef1c qu\u1ea3n + h\u1ea1ch b\u1edd cong nh\u1ecf<\/p>\n
* Ch\u1ee5p d\u1ea1 d\u00e0y c\u1ea3n quang<\/p>\n
T\u1ed5n th\u01b0\u01a1ng th\u00e2m nhi\u1ec5m c\u1ee9ng to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y v\u00e0 1\/3 d\u01b0\u1edbi th\u1ef1c qu\u1ea3n<\/p>\n
* XQ d\u1ea1 d\u00e0y \u2013 th\u1ef1c qu\u1ea3n<\/p>\n
Theo d\u00f5i u ph\u00ecnh v\u1ecb x\u00e2m l\u1ea5n t\u00e2m v\u1ecb g\u00e2y h\u1eb9p v\u00e0 l\u00e0m d\u00e3n th\u1ef1c qu\u1ea3n \u0111\u1ecdan tr\u00ean ch\u1ed7 h\u1eb9p<\/p>\n
* N\u1ed9i soi TQ \u2013 DD \u2013 TT<\/p>\n
Th\u1ef1c qu\u1ea3n: ni\u00eam m\u1ea1c b\u00ecnh th\u01b0\u1eddng<\/p>\n
D\u1ea1 d\u00e0y: to\u00e0n b\u1ed9 ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y th\u00e2m nh\u1ec5im c\u1ee9ng teo h\u1eb9p l\u1ea1i. Soi t\u1edbi hang m\u00f4n v\u1ecb b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng th\u1ea5y h\u1eb9p m\u00f4n v\u1ecb.<\/p>\n
T\u00e1 tr\u00e0ng: kh\u00f4ng th\u1ea5y t\u1ed5n th\u01b0\u01a1ng, c\u00f3 d\u1ecbch m\u1eadt<\/p>\n
K\u1ebft lu\u1eadn: U th\u00e2n d\u1ea1 d\u00e0y (tip Linitis Lastique)<\/p>\n
* T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u<\/p>\n
Leu 2+ (75leu\/uL) Blood (-)<\/p>\n
Nitrit (-) SG 1,025<\/p>\n
Urobilinogen (-) Ketones +++ (300mg\/dL)<\/p>\n
Protein (-) Bil + (1mg\/dL)<\/p>\n
pH 5 Glucose (-)<\/p>\n
* ECG<\/p>\n
D\u00e0y th\u1ea5t (T), t\u0103ng g\u00e1nh th\u1ea5t (T).<\/p>\n
Theo d\u00f5i thi\u1ec3u n\u0103ng v\u00e0nh<\/p>\n
* Si\u00eau \u00e2m tim<\/p>\n
B\u1ec7nh tim do THA v\u00e0 TMCB.<\/p>\n
Th\u1ea5t (T) d\u00e0y nh\u1eb9, b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng t\u00e2m thu<\/p>\n
H\u1edf van 2 l\u00e1 \u00bc, h\u1edf van \u0110MC 2\/4<\/p>\n
XQ ng\u1ef1c th\u1eb3ng: Tim ph\u1ed5i b\u00ecnh th\u01b0\u1eddng<\/p>\n
10. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/p>\n
K d\u1ea1 d\u00e0y x\u00e2m l\u1ea5n th\u1ef1c qu\u1ea3n v\u00e0 \u0111\u1ea1i tr\u00e0ng ngang tr\u00ean BN THA, h\u1edf van 2 l\u00e1 v\u00e0 van \u0110MC.<\/p>\n","protected":false},"excerpt":{"rendered":"
I. H\u00e0nh ch\u00ednh 1.H\u1ecd t\u00ean BN: L\u00ea Th\u1ecb T 2.Tu\u1ed5i:1951 3. Gi\u1edbi: N\u1eef 4.Ngh\u1ec1 nghi\u1ec7p: N\u1ed9i tr\u1ee3 5.\u0110\u1ecba ch\u1ec9: T\u00e2y Ninh 6.NV ng\u00e0y: 11\/3\/2009 II. Ph\u1ea7n chuy\u00ean m\u00f4n: 1. L\u00ed do nh\u1eadp vi\u1ec7n: kh\u1ed1i u th\u01b0\u1ee3ng v\u1ecb 2. B\u1ec7nh s\u1eed \u2013 C\u00e1ch NV 2 th\u00e1ng: BN \u0103n c\u01a1m th\u00ec b\u1ecb ngh\u1eb9n, c\u1ea3m gi\u00e1c b\u1ecb ch\u1eb9n …<\/p>\n","protected":false},"author":10,"featured_media":2128,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[91],"tags":[],"class_list":["post-2327","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-benh-an"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2327","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2327"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2327\/revisions"}],"predecessor-version":[{"id":2328,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2327\/revisions\/2328"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/2128"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2327"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2327"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2327"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}