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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
VIEÂM THÖÏC QUAÛN DO NAÁM
BS NGUYEÃN THUÙY NGAPHOØNG KHAÙM MEDIC
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
CASE REPORT _ Beänh Aùn
Beänh nhaân:Leâ thò N. 45 t nöõ Ñòa chæ: Haøm Taân, Bình thuaän, Ngheà nghieäp: Noäi trôï Nhaäp vieän ngaøy 29/09/99 vôùi lyù do Nuoát ngheïn Beänh söû:Caùch ngaøy nhaäp vieän 3 tuaàn xuaát hieän nuoát
ngheïn khi aên uoáng , gia taêng nhieàu trong 1 tuaàn nay Tieàn söû:Baûn thaân:Lao phoåi ñaõ ñieàu trò caùch nay 1 naêm Gia ñình: Choàng ù chích xì ke ñaõ cai 3 naêm Thaêm khaùm:Toång traïng gaày yeáu, suy kieät, M 118 l/p, HA: 100/60 mmHg. Nghe tim bình thöôøng. Nghe phoåi aâm pheá
baøo thoâ raùp. Khaùm buïng:buïng meàm aán khoâng ñau, gan laùch khoâng sôø thaáy.
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
Xeùt Nghieäm Caän Laâm Saøng
Noäi soi Daï Daøy taù traøng:Vieâm haàu hoïng, vieâm thöïc quaûn vôùi nhieàu giaû maïc maøu traéng bao phuû daøy
Soi Töôi:Naám Candida Albicans(+) H. I. V Test 1 & 2 (+) S/C =108 (BL<1) X Quang Tim Phoåi Thaúng: Toån thöông thaâm nhieåm caû 2
phoåi. Sieâu aâm buïng: Bình thöôøng
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
ESOPHAGEAL DISEASES
1. Reflux esophagitis 2. Infectious esophagitis 3. Chemical esophagitis 4. Esophageal motility disorders 5. Tumours
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
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NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
Reflux Esophagitis
Sypmtoms:Heartburn, dysphagia, chest pain Causes :abnormalities in lower esophageal sphinter function,
esophageal acide clearance Treatment: a/Lifestyl modification:Elevation of the patient’s ead,
dietary restriction (alcohol, mints chocolate caffein, moking, medications(theophylline, Calcium blocker , nitrates, , anticholinergics, adr antagonist
b/Medical Therapy:H2 antagonist, the proton pump inhibitors, cisapride , metopropamide , Antacides
c/ Surgery: Laparoscopy Technique
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
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Infectious Esophagitis
Symptoms: Odynophagia, dysphagia, most common in patients with AIDS, diabetes, or others causes of impaired immunity
Causes:ª Candida Albiansª Herpes Simplex virus(HSV)ª Cytomegalo virus(CMV)ª Tuberculosis( very rare)
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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Infectious Esophagitis . . .
Treatment: Candida Albicans:
ª Mild:Nystatine 400. 000-600. 000 UI qid , Clotrimazole 10mg q 6h X 2 W
ª More severe:Ketoconazole 200mg bid, Fluconazole 100mg qd X 7 days Unresponsive: Amphotericin B 0. 3-0. 5mg/kg/d
HSV Esophagitis: ª Acyclovir(Zovirax) 5mg/kg IV q 8h X 7 days or 800mg PO X
5 times /d X 14 days CMV esophagitis:
ª Ganciclovir
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
Esophageal Motility Disorders(Spasm &Achalasia).
Symptoms: Noncardiac chest pain(Atypical), Intermittent dysphagia to liqids & solids . No abnormalities on Endoscopy or Barium swallow Diagnosis: Esophageal manometry Treatment:
ª Long acting Nitratesª Calcium channel blockersª Psychoactive(antidepressants & anxiolytics) Trazodone
50mg po bid-tid
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
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DSADSA
X QUANGX QUANG
MRIMRI
Others Esophageal Diseases --
1/Chemical Esophagitis: Result from the use of medications(as doxycycline, oral potassium, quinidine, , NSAIDs, VitaminC, Fluorouracil ,
2/ Tumours:Polype, Cancer. . .
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
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PHOØNG KHAÙM
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
References
ª The Washington Manual of Medical Therapeutices 29th edition - 1998
ª Theory and Practice in the Education of Gastroenterology - 1995
ª Internal Medicine - Diagnosis and Therapy - 1988 - 1989