GIUN CHUI UNG MAT
1. NGUYEN NHAN GIUN CHUI ONG MAT
Ttf 1 tdi 15 tuoi, thtfdng gap tti 3-7 tuoi. Tuoi nho nhat ma chung toi da g&p la 15 thang.
1.2. Gidi: Khong khac nhau giiia 2 gidi.
1.3. Nguyen nhan thuan ldi
- Dieu kien ve sinh, dinh dtfdng kem.
- Do toan dich vi thap.
- Sau tay giun khong du lieu va d 1 so loai thuoic nhtf santonin.
2. GIAI PHAU BENH: Tuy theo giai doan cua giun chui ong mat.
2.1. Giun mdi chui len
- Dtfdng mat dan tuy thed so ltfdng giun len, giun con song.
- Gan, tui mat binh thtfdng trti trtfdng hdp giun chui vao co tui m&t co the lam hoai tti tui mat.
- Ntfdc mat co trting giun, vi khuan dtfdng ruot nhtfng chtfa co mu.
2.2. Viem dtfdng mat do giun
- Ong mat viem, dan chtia giun song hay chet.
- Ntfdc m&t vang hoac xanh due, cd mu.
- Cay ntfdc mat: vi khuan dtfdng ruot.
2.3. Ap xe gan
Thtfdng d thu^ gan trai ho&c phan thuy sau.
- Gan to. xung huyet hoac mau s&m tf mat, co cac o ap xe dudng kinh ttf 1-3 cm n&m rai rac d be mat gan 2 thuy hoac cd d mat dudi gan. Cac o ap xe c6 vo xd boc, chtfa mu va xac giun, cd the thong vdi dtfdng mat.
- Dtfdng mat ngoai gan: viem day, dan to, cd the cd cho bi hoai ttf. Trong dtfdng mat cd giun chet, song so ltfdng ttf vai con tdi vai chuc.
- Ntfdc mat due, lan mu, cd the cd mui thoi.
- Cay ntfdc mat: E.coli, trtfc khuan giun, trtfc khuan mu xanh.
3. TRIEU CHlfNG 3.1. Lam sang
3.1.1. d giai do$n sdm
- Dau bung dfl doi ttfng cdn, thtfdng dau dot ngot, luc dau tre v&t va, chong mong. Ctfdng do cdn dau thtfdng phu thuoc v&o so ltfdng giun: cang ft giun ctfdng do dau cang dtf doi.
- Non: ra thtfc an, co the ra giun dua.
- Kham bung:
+ N&n dau va phan tfng 6 diem canh tfc phai, diem stfdn ltfng trai rift dau.
+ Gan, tui m&t khong to.
- Toan than: the trying chtfa thay doi, khdng sot, khdng v&ng da.
3.1.2. Giai d o fn viBm dudng mat: thtfdng sau trieu chtfng d iu tien khoang mpt tuan le
- Dau bung giam hdn, it cdn dau dtf doi nhtfng v&n dau £m y vung gan.
- Trieu chtfng nhiem khuan toan than: sot cao dao dong, moi kho. ltfdi ban, mat hoc hac.
- Kham bung:
+ Gan cd the to, nan dau.
+ Cd phan tfng d vung dtfdi stfdn phai dtfdi tic.
- Toan than: + An uong kem.
+ Gay sut, giam can.
+ Khong vang m&t, vang da.
3.1.3. Giai doan Ap xe gan: xay ra 2, 3 tuan sau khi co cdn dau dau tien - Toan than:
+ Gay sut, co the co phu nhe ho&c suy kift.
+ Da xanh, thieu mau.
+ An ud'ng kem, dai ft.
+ Sot cao dao dong 39°- 40°C.
- Kham bung:
+ Gan to ca 2 thuy,n&n dau. Dau hieu rung gan hoac an ke lien stfdn dtfdng tmh.
+ Tui mat: co the cang, to.
3.2. Can 13m sang
3.2.1. Xet nghiem: cong thtic mau, mau lin g va m6t so xet nghiem khac - CJ giai doan sdm: chtfa thay doi.
- & giai doan viem dtfdng mat va ap xe gan:
+ C6 thieu mau: huyet sic to', hong ciu giam.
+ Bach c iu cao, d^c bi§t da nhan trung tmh va ai toan.
+ Mau lin g tfing ra't cao.
+ Trong giai do$n ap xe gan: ure cao, bilirubin mau c6 th i tang, protein huyet thanh giam, di$n di protein: ty 1$ AJG dao ngtf<?c, chtic nang gan bi anh htfdng, ty 1§ prothrombin giam, transaminase va photphatase kilm tang.
3.2.2. X quang: d giai do$n viem dtfdng m$t va ip xe gan.
- Chup gan, xa:
+ Bong gan to.
+ Co the c6 phan ting mang phoi, goc stfdn hdanh tu.
+ C6 the c6 mtic ntfdc hdi trong gan (dd o ap xe co vi khuan sinh hdi dtfdng ruot).
+ Co the co mtic ntfdc* hdi cl dtfdi vom hoanh do ap xe gan vd.
- Chup X quang c6 chuin bi:
+ Chup dtfdng mat bang ti§m thufi'c can quang c6 iod bai ti£t qua dtfdng mat, s€ tha'y hinh dtfdng m£t va hinh giun trong dtfdng m^t la vet den kh6ng nga'm thuoc nhtf hinh dtfdng ray xe ltia
+ Chup dtfdng mat ngtfdc dong qua n6i soi tfng soi mlra dtfdng ti&u hoa tha'y hinh anh dtfdng m^t va hinh giun.
3.2.3. S liu im
C6 gia trj quytft djnh trong ch in doan, d i thtfc hi$n, nhanh, sifiu ftm phai d&nh gi&:
- Tlnh t r f ng d in , vi tri din.
- Thanh dtfdng mat day.
- Co hinh anh giun trong dtfdng mat neu c it doc the hien hinh dtfdng ray xe ltfa,neu cit ngang co hinh anh vong tron dong tam.
- Tinh trang gan: Kich thtfdc gan va co cac o ap xe.
- Sieu am can dtfdc chi dinh sdm, rong rai trong dau bung cap d tre em c6 nghi ngd giun chui ong mat.