Hinh 12.1. Hinh 12.1. Hdi b trong thanh ruot do viem ruot hoai tdf
5. PHAN LOAI VIEM PHUC MAC
- Viem phuc mac toan the: khi co mu d toan bo khoang bung.
- Viem phuc mac khu tru: khi mu khu tru tai mot vung trdng khoang bung: nhu ap xe du6i cd hdanh, ap xe ruot thCfa, ap xe Douglas, ap xe d mac treo ruot.
5.2. Phan loai theo dirdng vao - Dudng mau, bach huyet.
- Dudng ke can.
- NgUdc ddng tii dudng tiet nieu, sinh due.
5.3. Phan loai theo tuoi
- Viem phuc mac bao thai: la hau qua cua thung dudng tieu hoa trong thdi ky bao thai. Day la viem phuc mac vo khuan do hoa chat.
- Viem phuc mac sd sinh: xay ra trong thang d iu sau de. Do thung dudng tieu hoa, hay benh canh nhilm khu^n toan than.
- Viem phuc mac b tre bu me (1 thang -> 24 thang).
- Viem phuc mac b tre nho v& tre ldn.
6. TRIEU CHLfNG Vl£M PHUC MAC TOAN Th£ 6.1. Lam sang
6.1.1. C a n in g - Dau bung:
Tuy theo nguyen nhan gay viem phuc mac ma vi tri luc dau cua dau bung, hudng lan toa va cUdng do dau khac nhau, vi du viem phuc mac do viem ruot thifa thi dau am y vung ho" ch&u phai roi lan toa kh&p o bung. Xo&n ruot hoai tii gay viem phuc mac thi dau bung dut doi vung giiia ron roi lan toa kh&p o bung.
Dau bung thudng lien tuc, dau theo nhip thd, khi di chuyen, khi ho lam dda tre nftm yen khdng dam cvt dong.
Vdi tre nho: dfiu hieu dau bung thudng chi bieu hien b&ng dau hi$u qutfy khoc.
- N6n:
Ra thtfc fin, hofic ch&'t non cd dich m&t, dich ruot ho&c chi muon ndn mil khdng ndn.
- Roi loan dai ti$n:
Thudng 1& bf trung d^i ti£n, nhung cd th i bi ia long,
Co the ia mau.
- Roi loan tieu tien:
Dai ft, co the bieu hien dai rSt, dai buot.
6.1.2. Toan than
Co the con tinh tao, tiep xuc tot hoac met la, tiep xuc cham.
- The trang nhiem khuan: sot cao.
- Dau hieu mat nUdc: da kho, mat trung, khat nUdc, dai it ho&c thieu nieu.
- Roi loan tuan hoan d cac mtic do khac nhau, tii nhe tdi n&ng.
+ Huyet ap cd the ha.
+ Mach nhanh nho, thd nhanh.
+ Cd the roi loan van mach: noi van tim tren da toan than.
+ Cd the trong tinh trang shock.
6.1.3. Thi/c t h i
La quan trong ch£n doan viem phuc m^c.
• Nhin:
- TrUdng bung: thudng gap, trudng diu.
- Thanh bung di dong len xuong theo nhip thd hoac khdng cti dong.
• Sd ndn:
- Co cting thanh bung: thtidng chi gap b tre ldn, ngudi ldn + Cling thudng xuyen.
+ Cd the co ciing khu tru tai mot vung hoac lan toa khap bung.
+ Thd hoan toan bang ngUc, bung khong cti dong.
- Phan ting thanh bung:
+ Thanh bung v ln di dong len xuong theo nhip thd.
+ Khong cd hien tUdng co ciing lien tuc d cac cd thanh bung.
Thanh bung cd phan ting: kham cd the nan mem, khi nan sau xuong thi cd cam giac nhu cd stic chong dd tay ngUdi kham va benh nhan dau.
Phan ting thanh bung thudng gap khi viem phuc mac cdn khu tru: nhu trong viem phuc mac ruot thtia luc dau thudng dau ntia bung phai va v i sau mdi dau khap cac vung bung.
- Cam ting phtic mac:
+ Nan dau khap cac vting b\mg.
+ Bung v&n co the di d6ng theo nhip thd.
Dau hieu n&y thtfdng g&p b tre nho ho&c giai doan muon cua viem phuc mac.
- C ln ltfu y: b tre nho, trong tinh trang hon me ho&c shock thi r&'t kho danh gia dung tinh trang thanh bung.
• Go thanh bung:
- M&'t vung dvc trtfdc gan (thung tang rong).
- Go due vung thSfp: trong bung c6 nhieu dich.
• Tham trtfc trang:
- An nhe vao tui vting Douglas b th&nh trtfdc: benh nhan dau.
- Co the co mau theo g&ng tay.
6.2. Can lam sang 6.2.1. X4t nghiem m iu
- C6ng thtic mau: Huy£t s&c tti, hematocrit.
- Bach ciu : binh thudng tti 5.000 => 15.000 BC/mm3.BC thtfdng cao tren 15.000BC/mm3.
- Tilu ciu mau ngo?i bien dtfdi 100.000/mm3 1& ha tieu ciu.
- Dien giai do mau: c6 th i bj. r6i loan.
- Protein mau: c6 th i giam ho&c binh thtidng.
- C&y m&u.
6.2.2. X4t nghi$m nu&c tiiu : Protein, te bao.
6.2.3. X quang 6 byng: khong chuan bi, cln xem co: liem hdi trong o bung: c6 thung t$ng rong.
- B6ng hdi b thanh ruot: viem ruot hoai tti.
- Hinh anh mtic ntfdc * hdi: t&c ruQt, liet ruot cd n&ng.
- Md vting th&p.
- Quai ru6t dan Trong 6’ byng c6 dich.
- Th&nh ruot d&y.