phổi lâm sàng
DESCRIPTION
Phổi lâm sàngTRANSCRIPT
-
Tip cn lm sng
-
Trng hp lm sng
HNH CHNH :
Bnh nhn nam, 57 tui, a ch Bn Tre
Ngh nghip : nng dn
L DO NHP VIN: au ngc
BNH S :
Bnh nhn au ngc (T) m , iu tr bng thuc
gim au ti trm y t, nhng khng gim. au ngc ngy
cng tng dn, khm ti BV Bn Tre, chp X quang pht
hin bu phi nn chuyn BV Ung Bu
-
Trng hp lm sng
TIN CN:
- Ht thuc l: gi/ ngy x 30 nm
- Ung ru: thnh thong, khi c tic.
- Khng bnh l ni ngoi khoa.
VN CA BNH NHN:
au ngc
Bu phi
-
Chn on ung th
1. Chn on c quan mang bu
2. Chn on bn cht bu
3. Chn on giai on bnh
4. Chn on bn cht sinh hc bu
Lm sng Cn lm sng
-
Tnh hung lm sng
1. Pht hin tnh c
2. Triu chng ca bu nguyn pht
- Ho
- Ho mu
- Nng ngc
- Kh th
- Kh kh
- Vim phi
-
Tnh hung lm sng
3. Triu chng ca bu lan rng
trong lng ngc
- au ngc
- Hi chng tnh mch ch trn
- Khn ting
- Nut kh
- U Pancoast: au vai, cnh tay,
hi chng Horner
-
Tnh hung lm sng
4.Triu chng di cn:
- Ni hch c, hch nch.
- au xng, gy xng bnh l.
- Gan to, bng bng.
- Hi chng tng p lc ni s, du thn kinh khu tr.
- Ni cc u, cc di da.
-
Tnh hung lm sng
5. Triu chng tng qut:
- St cn
- Chn n
- Yu sc
- Hi chng cn ung th.
Bnh nhn thng n giai on tr, do c rt t triu chng giai on sm Ung th phi l k git ngi thm lng
-
Chn on Tnh hung lm sng
1. Chn on c quan mang bu
X quang ngc
-
Chn on Tnh hung lm sng
1. Chn on c quan mang bu
CT scan ngc
-
Chn on
1. Chn on c quan mang bu
CT ngc
- Pht hin bu.
- nh gi kh qun, ph qun chnh.
- Pht hin xm ln thnh ngc.
- nh gi xm ln mch mu.
- Pht hin di cn.
- nh v v hng dn sinh thit
bu
-
Chn on
1. Chn on c quan mang buMRI ngc
- Pht hin bu nm trong
vng phi xp
- Chng ch nh tim thuc cn
quang/ chp CT
-
Chn on
2. Chn on bn cht bu
Xquang ngcCT ngcMRI ngcPET_CT
Bu ngoi vi Bu trung tm
- Sinh thit qua da- Ni soi lng ngc- Ni soi ph qun- M ngc thm st
- T bo hc/ m.- Ni soi ph qun- M ngc thm st
-
Chn on
-
Chn on
2. Chn on bn cht bu
Ni soi ph qun
-
Chn on Tnh hung lm sng
2. Chn on bn cht bu
FNA xuyn thnh ngc : Carcinm tuyn
-
Chn on
2. Chn on bn cht bu
Ung th phi khng t bo nh (80%)
Ung th phi t bo nh (20%)
Carcinm
tuynCarcinm
t bo gaiCarcinm
t bo ln
10 15% 35 - 40% 30%
-
Chn on
2. Chn on giai on bnh
-
Chn on
2. Chn on giai on bnh
PET _CT
nhy : 89% c hiu 94%
-
Chn on Tnh hung lm sng
2. Chn on giai on bnh
- Siu m:
Hch trn n (P) 10 mm, ngh hch di cnGan bnh thng. Khng thy di cn tuyn thng thn.
- X hnh xng: bnh thng.
- MRI no: bnh thng
FNA hch trn n (P): hch vim
-
Chn on
- Kch thc bu.- V tr bu so vi Carena.- Xp phi, vim phi.- Xm ln: mng phi, trung tht, tim,
mch mu ln, kh qun, thc qun, ct sng, carena.
- Bu cc thy phi
- V tr hch di cn- Hch cng bn/ i bn.- Hch trn n
- Trn dch mng phi, mng tim.- Bu thy phi i bn- Di cn xa
T
N
M
-
Chn on
4. Chn on bn cht sinh hc
-
Chn on
Carcinm tuyn phi (T) cT3N0M0
-
KT LUN
- Triu chng ung th phi rt m h. Khi triu chng
r th bnh giai on tr.
- Chn on ch yu da vo cc phng tin cn lm
sng
- Cc phng tin chn on gii phu bnh ph thuc
vo v tr bu.
- Thng gp ung th phi khng t bo nh.
- Carcinm tuyn : ch bn cht sinh hc bu
-
Chn thnh cm n