5. VO HOANH DO CHAN THlfONG 5.1. Cd che
Do hoa khi, dao...
Do chan thtfdng kin: ap ltfc o bung tang dot ngot.
5.2. Lam sang
- Chay mau cd quan trong bung, ngtfc gay soc mat mau.
- Khothd.
- Dau d vung bung, ngtfc lan len vai.
- Non.
- Roi loan nhip tim.
5.3. X Quang
- Chup bung - ngtfc thdng:
Khong con vom hoanh.
Di lech trung that.
Hinh hdi cua da day- ruot tren ngtfc.
- Chup bung - ngtfc nghieng - Chup can qu&ng ong tieu hod:
Thay ong tieu hoa len tren khoang mang phoi
5.4. Dieu trj: phiu thuat, tuy the trang va thtfdng ton ma chi dinh thdi diem mo va xtf ly.
- Chi dinh md:
Cap citu: khi co bieu hien vd tang.
Chan doan muon: Vd tang thi hai. Mo khi co chan doan.
- Ky thuat:
Dtfa cac tang trd lai o bung, khau cho vd cd hoanh bang chi khong tieu. Xtt ly cac tang thtfdng ton kem theo.
5.5. Bien chung
- Nghet da day- ruot gay dau bung, trtfdng bung, non.
- Vd cd hoanh: gay tran dich khoang mang phoi, xep thu£ dtfdi, vom hoanh bi day cao (do chan doan muon).
6. THOAT V| MORGAGNY 6.1. Giai phau benh ly
Do con khe LARREY. Thtfdng co tui thoat vi.
Tui thoat vi thtfdng co gan ben trong, it khi co ruot non va dai trang.
6.2. Lam sang
Roi loan tieu hoa: it gap.
Chan doan dtfdc thtfdng la tinh cd nhd chup X Quang.
6.3. Chan doan hinh anh *
- Chup bung - ngtfc thdng, nghieng khong chudn bi:
Thay bong md canh tfc ben phai ho&c trai, hoac hai ben. Co the ket hdp bdm hdi vao o bung roi chup bung - ngtfc.
- Sieu dm va chup cat ldp: de chan doan.
6.4. Dieu tri
Dtfdng md la dtfdng giiia tr3h ron tdi sat mui tfc. Md phuc mac se th&y lo thoat vi. Keo tang thoat vi xuong, thtfdng la mot phan cua thu^ gan trai ho&c mot doan cua dai trang ngang. Vdi tui thoat vi thi v ln de nguyen ho&c cSt bo. Dung chi khong tieu khau mep bd sau lo thoat vi vdi ldp can cua dtfdng rach hay vdi bao cua cd th&ng to d phia trtfdc. Neu c&t bo tui thoat vi thi dat mot d in ltfu trung th&'t hut lien tuc trong 24 gid.
Hinh 2.5. Md chCra thoat vj sau mui Ore - stfdn, con khe Larrey
7. THOAT VI QUA KHE THl/C QUAN 7.1. The loai va nguyen nhan
- Thoat vi qua khe thtfc quan do trtfdt:
Do thUc quan bung khong dtfdc co' dinh nen thtfc quan bung va da day bj keo trtfdt len long ngtfc qua khe thtfc quan bi md rong. Loai thoat vi nay g&p la chu yeu.
- Thoat vi canh thtfc quan hay thoat vi qua khe thtfc quan do cuon:
Thtfc quan bung dtfdc cd dinh mot cach binh thtfdng, da day bi keo-cuon qua khe thtfc quan len tren va d ben canh thtfc quan. Loai thoat vi nay hiem gdp d tre em, neu co thi thtfdng la bien chtfng sau mo chtfa thoat vi qua khe thtfc quan do trtfdt.
7.2. Thoat v] qua khe thtfc quan do trtfdt 7.2.1. Sinh ly benh hoc
Do mat goc His va stf chenh ap ltfc giiia o bung va long ngtfc nen gay ra luong trao ngtfdc da day- thtfc quan, rdi gay viem thtfc quan, lo6t va chay mau. Viem loet co the gay xd hoa gay hep long thtfc quan hoSc gay co rut lam ng&n thtfc quan.
7.2.2. Lam sang cua thoat vj qua khe thut quan do trupt 7.2.2.1. Th$ lim sang
Hinh 2.6. Cac dang giai phiu cua thoat vi qua khe thtfc quan do trtfdt 1. Thtfc quan - da day binh thtfdng.
2. Goc tam vi - da day (goc His) md rong.
3. Mot phan da day trtfdt len tren long ngtfc nhtfng khdng thtfdng xuyen.
4+ 5. Tui da day l§n co djnh ben tren lo thtfc quan.
6. Da day len het tren cd hoanh.
Dtfdc chia lam bon the lam sang:
- Goc tam vj md rong.
- Mot phan tui da day len tren cd hoanh khong lien tuc (len va xuong qua khe thtfc quan theo nhip thd).
- Mot ph^n tui da day len co dinh phi'a tren cd hoanh.
- Toan bo da day len tren cd hoanh va dtfdc goi la "da day Ion ngtfdc"
(upside-down stomach).
7.2.2.2. Tri&u chifng ISm sang
Tuy theo the benh va tien trien ma co cac trieu chtfng sau.
- Trieu chtfng dtfdng tieu hoa:
+ Non: Co the xuat hien rat sdm, ngay sau de. Chat non 1& stfa, dich tr&ng due, khong co mat, cung c6 the co mau.
+ An kem.
+ Cham tang can.
+ Co dau hieu thieu mau.
- Trieu chtfng dtfdng ho hap:
Co dau hieu viem phoi va hay tai phat do hit phai ch&'t non. C6 the kh6 thd do chen ep khi da day len nhieu tren ngtfc.
7.2.3. Chan doan hinh anh - X quang:
+ Chup btfng-ngtfc thfing khdng chu£n bi:
6 the benh nhe thtfdng khong thay hinh anh benh ly. d the benh ndng th&y dtfdc bong hdi ho&c mtfc ntfdc-hdi d trung that thtfdng nlim lech ben phai bdng tim.
+ Chup thtfc quan-d^ day co thuoc can quang: Dung Hypaque hoac Telebrix, khong dung baryte. Thay dtfdc hinh anh luong trao ngtfdc da day-thtfc quan, hinh anh da day len cao tren cd hoanh, nhtfng d the benh nhe cung chtfa xac dinh dtfdc chan doan.
- Sieu dm:
Do dtfdc chieu dai thtfc quan btfng, phat hien dtfdc luong trio ngtfdc da day- thtfc quan.
7.2.4. N$i soi th & quin - d? ctty
Xac djnh viem lo6t thtfc quan, h$p thtfc quan.