8/9/2019 Duoc lsang

1/40

8/9/2019 Duoc lsang

2/40

Fc ng tB qua ngi g *`: \1 E 1 lng nh4nh b4 ha tn (khi b4 h thu 'u, 't hYt+nh khi qua gan)U C nghTa l-ng: N?R tu5t i c2a 1 tB ung YMf] l cG thW ch nhKn c. N?R tu5t i c2a 1 tB ung Yt jf]: cG thW cknng th' nhK c2a tB ung 'u $ $ g *`. N?R tu5t i c2a 1 tB ung Yt Mf]: %Yng ung thng khG Yt 5Qu cu t34 khi bnh nDng, nhng t3hn5 liAu ung hi liAu tiQ' 3t nhiAu.

!. N?R t =ng i: l t l - -nh gia ! gt34 N?R c2c;ng 1 ng a tB, c;ng 1 '7c liAu nhng c2a ! nh Nkhc nhau hDc c2a ! %Yng b ch@ khc nhau.Fth7c: \t=ng i \ c2a h[ng "0 \ c2a h[ng eE khi - -nh, ngi %;ng c;ng 1 '7c liAu nQn t3Ent3Qn cG thW i@t:\]("0) "_F h[ng "0 "_F h[ng $ 1ffU C nghTa: N?R t=ng i -%&ng nhm' - -nh tB c2a nh -$ n G Zi 1 tB ang lu hnh cG u5 t+n t3Qn tht3ng (thng l %Yng ung) hDc c2a 1 %Yng iQn Zi ung %Yng lng. t34 N?R (\) lquan 'Kt thi@t @n h tan c2a ch@ ho' (c gi qua t3pc nghi' htan)

Cu 3: Th tch phn b ca t: N, cthc tnh n!h"a l#$n!%1. SJ: thW t+ch hn b (gi thW t+ch hn b biWki@n) biWu th4 1 thW t+ch cn hi cG W tn b^ lntB c a c= thW hn b P n9ng ^ bmng n9n

8/9/2019 Duoc lsang

3/40

^ t3ng hu5@t t=ng. *hW t+ch hn b khVng biWth4 1 thW t+ch -inh lC thrc, thW t+ch n5 k lquan g@n thW t+ch 'u, hu5@t t=ng, hu5@t thanh hDhn nZc c2a c= thW!. Fth7c t+nh: e% *ng lng tB a c= thW (J9ng ^ tB t3ng hu5@t t=ng R$\0F.S4 c2a e% l # hDc #0kg6. C nghTa: *s e% ch t3Zc, cG thW t+nh c liAu lg tca W Yt c 1 n9ng ^ F n G.R e% $ F0\.

R: liAu tcn a (g, 'g), \: N?R c2a t(]), F: n9n^ tt3ng hu5@t t=ng (g0l 'g0'l)

Cu 4: & thanh th'( ca t: N, cthc, n!h"a1. SJ: S^ thanh thi (^ lc) c2a tbiWu th4 knng c2a cquan n G c2a c= thW (thng l gan thKn) l-Ych t3a khi ht=ng khi 'u tun hn qua cquan thng c t+nh th/ 'l0ht hDc l0h.!. Fth7c: t+nh ^ thanh thi c2a tts tc ^ thi t3s qua nZc tiWu. R;ng tt3u5An *' liQn t&c thE l5 'u thi iW' -au khi t3u5An $ng. R;ng tg ung, tiQ'bp hDc t3u5An gin Yn thE F--Yt c -au . *t34 - Fl n9ng ^ t c t3ng ht=ng ta cG th

t+nh tc ^ t3u5An W %u5 t3E n9ng ^ thmng 4nkhi t34, tc ^ t3u5An hi tc ^ thi t3s.

Cu ): Th*( !(an b+n th'( ca tT1-1. SJ: *10! c biWu th4 th/ ! nghTa:

8/9/2019 Duoc lsang

4/40

8/9/2019 Duoc lsang

5/40

C nghTa: khi 'un tha5 th@ thi ch +t nht } $t10t3nh t+ch lu~.6.!. #q gia tgian bn thi khng cch a t: #n(F0F1)0f,z{6 $ t10!: khng cch a t(tgian cn thi@t -a ch n9ng tgi' ts '7c [ cG (Ff) @n t34 - 'ng 'un (F1)t10! %i: k0c a tcng that10! ngpn: k0c a tcng 'au.6.6. #q gia *10! ^ thanh thi (Fl), thW t+ch hb (e%)

t10! f,z{6 $ e%0 FlP nhng tng bt thng A -inh lC bnh lC, -r thai ^ thanh thi l ngu5Qn nhn k %i tgian bthi % G A hiu chnh k0c a tl bpt bu^c.Flthuc Fu $ eu0 FFlthuc: ^ thanh lc t('l0ht), Fu: n9ng ^ tP %Yn

cXn hYt t+nh t3ng nZc tiWu ('g0'l), eu: thW t+ch ntiWu 1 ht ('l0ht), F: n9ng ^ tP %Yng cXn ht+nh t3ng ht=ng ('g0'l)U Fch t+nh t3Qn khG thrc hin E g' 'u nZc tiWt3ng nhiAu gi 3t h7c tY.U *+nh ts liAu lg %in t+ch %Zi ng cng:Flthuc \ $ R0 "_F

\: N?R, R: liAu %;ng, "_F: %t+ch %Zi g cngFltn hn FlthKn$ Flgan$ Flcquan khc FlthKn$ FlganFquan khc: %a, hi, nZc bt, tu5@n ti@tan thKn l ! cquan cG knng lc t'Ynh nht.

8/9/2019 Duoc lsang

6/40

eR: th/h5lin cG Fltn hn f,zM'l0ht0kg. Sc bi@th/h5lin l tc chu5Wn h P gan {f]. FG nghTa lFlgan M{'l0ht0kg. J@u t+nh 1 ngi Mfkg thE Flgan

f,zf 'l0ht0kg $ Mfkg 6f'l0ht. FG nghTa c7 ht - cG 6f'l ht=ng c gan lc -Ych khi th/h5lin>. C nghTa ^ thanh thi c2a t: *3ng hY' i t34, khi '7c liAu cha 2 g5 b[ hh bi $ut tthE Flthucl 1 t34 - hmng 4nh. JghTl c7 -au 1 khng tgian nht 4nh lYi cG 1 t l hmn4nh c2a tc lc -Ych khi hu5@t t=ng. *c ^ b

$ut tha5 i t l thuKn Zi -r tha5 i n9ng ^ t3ng ht=ng th/ qtpc ^ng hc bKc 1 J@u liAu %;ng qu lZn c= ch@ thanh lc t b4 b[h thE qt3Enh bi $ut ttun th/ qu5 tpc ^nhc bKc f. JghTa l -au 1 khng tgian nht 4nh c1 lng tc 4nh b4 lYi khi ht=ng thE Flthuc - %a^ng *s t34 - Fl n9ng ^ t c t3ng ht=ng t+nh c tc ^ bi $ut t3a khi c= thWeFl Fl $ F ('g0ht)F: n9ng ^ tt3ng ht=ng, eFl: tc ^ bi $ut t 3khi c= thW, Fl: ^ thanh thi $4nh th/ '7c F t3Yng thi n 4nh. #c n5 F Fl0Fl (P t3Yng th

cn bmng)

Cu .: T/b$0 c+c bc c2n l$ h(u ch5nh l(6ch7 8N #u0 th9n

8/9/2019 Duoc lsang

7/40

HKu qu c2a -u5 thKn l gi' bi $ut t , g5 tng k%i n9ng ^ tt3ng 'u, %n @n qu liAu hDc ng^c khi t34 nhng tcG ^c t+nh ca t3Qn thKnJhng t3h n5 ta gi' liAu t34 - bthng ha5 n3^ng k0c gia cc ln a t. Fc bZc ti@n hnh1. S0gi '^ -u5 thKn qua t34 - Fl/a3anc/ F3/atini(Flc3): knng lc c2a thKn c gi qua Flc3. Jgi bthnt34 - n5 jf1!f'l0h. *34 - n5 gi' P J -u5 thKn`^ -u5 thKn gi qua h - \\ Flc3-thKn0 Flc3 bthng

Flc3-thKnl Fl/a3anc/ c3/atinin P J -u5 thKn, Flc3 bthlFl/a3anc/ c3/atinin P ngi cnng thKn bthng.!. S0gi '^ gi' bi $ut t P ngi -u5 thKn - ngbthng*+nh h - |:| 10 1/(1\)|: h - hiu chnh ch J -u5 gi' cnng thKn, /t l tc bi $ut qua thKn P %Yng cXn hYt t+nh. t l -u5 gi' cnng thKn.*hrc 3a ch hiu chnh lYi liAu c2a hn tthi t3s %Yng cXn hYt t+nh qua thKn, k t+nh c hn bi $uqua gan. R G khi cnng gan b4 -u5 gi' nQn chn k b4 chu5Wn h qua gan ' bi $ut ch2 5@u qu

thKn P %Yng cXn hYt t+nh.6. Hiu chnh liAu -au khi [ cG h - |: cG 6 cchiu chnhU i ng&5Qn k0c a t gi' liAu: R-t R* 0 |U i ngu5Qn liAu nhng nZi 3^ng k0c a t: -t $ |

8/9/2019 Duoc lsang

8/40

: k0c a t, R: liAu %;ngU esa gi' liAu sa nZi 3^ng k0c a t: nhiAu t3h %;ngi' liAu thE liAu 'Zi k 0 n9ng ^ tt3ng ht=ng

'7c t34. J@u gi ngu5Qn liAu thE thi iW' nga-au khi ung tn9ng ^ qu ca nhng -au G n9ng tW '7c t34 cng k %i. R G hqu t34 thJQn kh ! h sa gi' liAu sa nZi 3^ng k0c. Jh K$u hZng chung tK t3ung th/ %i 0 l-ng g-t n9n^ tt3ng 'u W iAu chnh liAu. *u5 nhiQn thrc t'7c liAu ch J -u5 thKn c cc nh b ch@ t+n

-On ghi hZng %n -%&ng t.

Cu : C; ch< t;n! t+c thuc = thuc > ! h?thu% N@u n!h"a t/7n! t/A% B%*=ng tc h thu ha5 $5 3a cc t%;ng g ung, Zi cg a tkhc gD khVng nhiAu.1. R tha5 i H %Y %5:thng %4ch 4 cG H ts 1!. Jhng t l' gi' ti@HFl (tkhng th& thW H!, t chn b=' 3tn) hDt3ung h HFl (cc antaci%) thE l' gi' knng hthu c2a 1 - t. eR: g3i-/ulin \/6y.Jhng tcG bn cht aci% (eR it F) thE nhng t k'bAn t3ng 't3ng aci% - b4 h hu nhiAu tYi %Y %5

Fc tlYi n5 l khng -inh nhG' lacta'in (a'icillinc/hal/$in.. ) hDc `ac3li% (/35th3'5cin).!. R tha5 i nhu ^ng ng tiQu h.Fc ttc ^ng h *? thrc Kt cG thW l' tng hDgi' nhu ^ng ng tiQu h. J@u 1 tc tng nhan

8/9/2019 Duoc lsang

9/40

3a khi %Y %5 - cG li ch ic hthu E 3u^t l t3+ hthtt 'i lYi t, ngc lYi 1 tb4 tng nhanh 3a khi 3u^t -b4 gi' h thu.*huc nhuKn t3ng, cc tkth+ch hDc hng b@ h *thrc Kt (3ani%, h5--tig'in..) l' tng nh^ng %Y %5 3u^t. JQn khi %;ng thi h cc lYi n5, hi h b4 tng nhanh 3a khi g tiQu h l' 't t%&ng. #u C khi thi h l tcG t%&ng k %i.6. R tY h7c khG h thu gia ! tkhi %;ng 9ng thHa5 $5 3a khi -% cc tcG ch7a cc in klYi h t34 ca

nh "l6y, Fa !y, `g!y, \/!y, \/6yh7c cht tY 3gia in klYi Zi t- k qua c n'Yc 3u^t nQn h thb4 cn t3P. *Y h7c ch/lat nht cc ?N nhG't/t3ac5clin, u3quinln. *=ng tc n5 ha5 gD c?N t3Qn Zi -a.>. R cn t3P c= hc, tY lZ ngn -r t$c c2a tZi n'Yng tiQu h.*hng cc tba ch/ n'Yc tiQu h nh ?alin, -'/cta-uc3aat.. tY 3a hDc % ung 9ng thi Zi -a. eKnQn ung ! lYi tn5 cch $a nhau +t nht !h

Cu D: T/b$0 c; ch< t;n! t+c t t > !7Echu0n h7+% N@u n!h"a t/7n! t/A% B

*=ng tc n5 ha5 gD khi hi h cc tchu5Wn hqua gan. Fc tcG h - chi@t $ut qua gan nh (f,6) nhY5 c' hin tng 7c ch@ hDc c' 7ng /n5'gan.

8/9/2019 Duoc lsang

10/40

Fc t%;ng 9ng thi Zi chng g5 hg hYt t+nh ga(c' 7ng hDc 7c ch@) l' tha5 i lng tb4 chu5Wh khi qua gan. Jh K5 N?R b4 tha5 i.HKu qu ch nghiQ' t3ng Zi nhng tcG i t34 hkhi ti n9ng ^ l' ti t% ha5 ^c t+nh.1. Fc t=ng tc % tng c' 7ng /n5' chu5Wn h t gan:Fc tl' c' 7ng gan l' tng knng chu5Wn h hi h c2a ch+nh nG l' gi' n9ng ^ t t3nhu5@t t=ng. eR: cc t g5 c' 7ng: h/nba3bita

h/n5tin, glut/thi'i%, '/3ba'at, ca3ba'a/in3i'i%n, -i3nlactn, g3i-/ulin, 3ia'icin, chkhc: 3u, tl, RR*.eR: %;ng 9ng thi t t3nh thai %Yng ung ia'icin l' gi' n9ng ^ tt3nh thai.i' hqu t34 c2a th/h5lin P ngi nghin thuc l!. Fc t=ng tc % 7c ch@ chu5Wn h P ganJhng tg5 7c ch@ chu5Wn h tP gan l' tnn9ng ^ c2a t hi h. eR: allu3inl, L`"d%i-ul3a', *"d,

/35th3'5cin, -a'icin, ci'/ti%in, 'icnai-niai%, /n$acin. eR: Fi'/ti%in l' tng n9ng

c2a ni/%iin, 35th3'5cin l' tng n9ng th/h5lin.R K5 cn lu C khi hi h cc thg @n hYt t+nh gan Zi cc tchu5Wn h qua gan nh h3'n (h3'tu5@n gi, c3tici%, /-t3g/n) th/h5lin, tchn

8/9/2019 Duoc lsang

11/40

^ng kinh (h/n5tin, ca3ba'a/in) thuc ti' 'Yc(ni/%iin, 3anll), tchng Vng 'u %Yng un(a3a3in), thY ng hu5@t (tlbuta'i%)

Cu F: Ghn tch u nhc ( c+c *n! thuc: un!, tbHp, TI1. Sa tqua ng ung: l ng a th bi@n nhtU u iW': %8 -%, ng %;ng t=n gin, thuKn tinht, ngi bnh tr %;ng % G l ng h bi@n nh(khng }fjf] t%;ng qua ng ung).

an tn h=n - Zi ng tiQ': %;ng tng ung +g5 -c th=n - Zi tiQ'. J@u %;ng qu liAu hDc ng^c tcG thW $w lC c c7u g5 nVn, 3wa %Y %5, th&thhYn ch@ tw ng. ?inh t@ h=n: thng tung cG gi 3 h=n cc %Yng khc (t3s 1 - b ch@ Dc bit.U Jhc: N?R 3t %a ^ng -r h thu th& thu^ nhiAu 5@u t: y t -inh lC: H %4ch 4, tgian 3nc2a %Y %5, '/n tiQu h tYi 3u^t, t^ng c2a Xng tuhn u t3ng qt3Enh tKn chu5Wn tun hchung qua tTnh 'Ych c2a gan (b4 chu5Wn h qua galn u). y t cn ngi tY 3a: nZc ung thuc, th7n, thuc hi h

*gian $ut hin t% c2a tung chK' h=n - Zi cc ng a tkhc (t3+ hthu ch+nh c2a tP tYi 3u^t nn) `^t - t3h khVng %;ng c: 3i lYn tiQu h, tp3u^t

8/9/2019 Duoc lsang

12/40

`^t - tk %;ng c g ung hDc nhiAu t khung, tkth+ch g tiQu h.HR -w %&ng: y *gian ung t- Zi ba n.y J@u %Yng iQn c iQn nn ln iQn nang, lng nZc thi nhiAu (1Mf!ff'l). R;ng nZc un -Vi W ngu^iy Zi * ngi ca tui nQn %;ng iQn ha %%, h%4ch, iQn -2i btW t3nh nghn, -Dc hDc %+nthrc qun.y k nQn ung t th@ nm' hDc ung t$ng nm' 5Qn kKn ^ng.

!. Sa tqua g tiQ' bp.U u: N?R n 4nh % k b4 ahg bPi cc 5t g tiQh *gian $hin t% c2a tnhanh h=n - Zi g ung ? b4 chu5Wn h qua gan ln u *3nh c -r ha h&t khi hi Kn chu5Wn t3ng ntiQu h *3nh c ^c t+nh lQn n'Yc tiQu h (1 - t chng 7c ch@ -r t3iWn n'Yc ng tiQu h. R;ng c ch nhiAu tk h thu, khi ung nhng g5 k+ch 7ng tiQu h. Sg tiQ' bp %8 thrc hin h=n - Zi ng tiQ' khc Hu h@t cc tP %Yng tiQ' Au cG thW a qua

tiQ' bp, Dc bit u tiQn cc lYi %4ch %u, hn %4chcc %Yng ttiQ' t% k %i.U Jhc: g5 au n=i tiQ', thK' ch+ $/, %8 nhi8't3;ng S^ an tn th h=n g ung

8/9/2019 Duoc lsang

13/40

SXi hi kin V t3;ng nghiQ' ngDt -r gi c2cn b^ chu5Qn 'Vn, nQn J khG cG thW tr -%. ?t@: tn k' h=n tung E tn tiAn ?*, ttiQ' thng pt h=n tung.HRNR: ?hVng c tiQ' bp: y Jhng cht cG t% k+c7ng 'Ynh t ch7c hDc g5 hYi tw (eR: calc/nicillin ), cc %% u t3=ng (eR: gluc-/ 6f]), %% cH qu aci% hDc qu kiA'.y J@u J ang -% tchng Vng 'u hDc cc ttiQb3in.

y Jhng J ang P t3Yng thi -c, cG htg gi' tZi 'ngYi i.y *3ng %'Vi tiQ' bp: thng ch thQ' li%cain (f,Mf,j]) hDc alcl b/n5lic (6]) t3ng t3h tiQ' cc tc^ k+ch 7ng 'Ynh, g5 au (eR: ?- nhG' lacta').y ? nQn tiQ' 1f'l (Zi J#) 1 ch E %8 g5 $/.y ? nQn tiQ' bp ch t3 -= -inh E c= bp c2a tnh cha t3iWn 5 2 nQn -r h thu c2a t - bt thng, ha5 g5 tn th=ng c= (u tiQn tiQ' *`).y J@u ttiQ' cG %'Vi k hi l nZc thE k c W lt3ng b=' tiQ' nhra, tt nht nQn %;ng b=' tiQ' thutinh.

6. Sa tqua ng tiQ' *`U u: N?R b ' (\1) 1ff] *% nhanh (gn nh t7c thE) E K5 3t h; h ch ct3h c c7u. *3nh c -r h hu c2a t% cc 5t g tiQu h.

8/9/2019 Duoc lsang

14/40

*3nh c chu5Wn h qua gan ln u. *3nh c ha h&t khi hi chu5Wn t3ng ng tiQu h *3nh c ^c t+nh t3Qn n'Yc tiQu h R;ng c ch nhiAu tk h thu khi ung, nhng g5 k+ch 7ng g tiQu h, g5 hYi tw, k+ch 7ng khtiQ' bp Sc lra chn n@u ttiQ' cn a liAu lZn (1f'l)U Jhc: % t% qu nhanh nQn ^ an tn th, %8 g-c SXi hi kin V t3;ng nghiQ' ngDt.

?~ thuKt tiQ' h7c tY nht, ngi bnh k thW tr -% R8 g5 tai bi@n nh iQ' tpc *`, t&t H" (thng %tiQ' qu nhanh), t3n %4ch 3a ngi 'Ych (ngu5 hiW'Zi cc tg5 hYi tw 'V) nhi8' khuon hu5@t, t& 'ch tiQ'. ? %;ng Zi nhng tcG %Yng %% %u, hn %4chHRNR: Jhng tha5 %;ng qua g *` cc hYt cht c^ k+ch 7ng ca, g5 au hDc g5 hYi tw c= khtiQ' bp (/nicillin , Falci) cc %% u t3=ng (gluc-6f]) cc cht b; thW t+ch %4ch lu hnh (%4ch t3u5Antinh thW, %% g/latin, a'i%n, %/$t3an, albu'in) nh%4ch lii%. Jhng t3h k c a qua ng *`: cc %% %u, h

%4ch Fc cch a t *`: y *iQ' *` t3rc ti@: t %;ng Zi 1 lng nh %ung 'Vi (M1f'l) c b='thng *` t3ng 6} ht. #u C tc ^ tiQ' (n@qu nhanh 1 ht %8 g5 -c).

8/9/2019 Duoc lsang

15/40

y *iQ' *` qu[ng ngpn: tc ha l[ng Mf!ff'l %4ct3u5An 39i t3u5An t3ng khng 6fzf. `+ch: t3nh tqu k+ch 7ng lQn thnh 'Ych c2a 1 - t linc'5cing/nta'icin) %n @n t&t H".y *3u5An *` k %i: `+ch: %u5 t3E n9ng ^ t t3n'u t3ng 1 tgian %i lng %4ch t3u5An %;ng W ha cG thW nhiAu l+t, tu thu^c qu[ng t3u5An n9ng ^ cn %u5 t3E.Fc t ?N ha5 t3u5An th/ kiWu n5 l a'icillin/nicillin .

Cu 1J: Kc (, n!h"a l#$n! ca ch5 # LN#(nh h7+: c/Mat(n(n, !luc7#M, OT, PT1. F3/atinin: `7c bthng c3/atinin hthanh f,z1,! 'g0%l. NL Mf11f'l0l F3/. # -ho' thi h c2a h-hc3/atin, 1 cht %t3 nng lng qt3ng cG t3ng c=. Nr tY thnh c3/. t=ni hmng 4nh, h& thu^c ch2 5@u khi lng c= c2a ngi. R K5 P n giZi c3/. 'u th h=n na' giZi. H' lng c3/. t3ng hu5@t thanh +t tha5 i, k hthuc cc 5t ngYi lai nh ch@ ^ n F3/. thi 3a ngi nZc tiWu ch2 5@u % lc P c

thKn bi ti@t bPi ng thKn ti h thu 3t +t, ci kng kW. F3/. hu5@t thanh c ci l 1 ch - A thKn tt h=- Zi u3Q hu5@t. J9ng ^ c3/. t3ng 'u tng khi cnn

8/9/2019 Duoc lsang

16/40

lc cn thKn gi'. ?hi c3/. hu5@t thanh 16f 'c ci l -u5 thKn. bi@t c ch - c3/. hu5@t thanh cG thW -u5 3a h -

thanh thi c3/.Flc3 (1>f tui)$ thW t3ng0 (c3/atinin $ }!)*ui: n', thW t3ng: kg, c3/atinin hu5@t thanh: 'g0%lS5 l t34 - c2a na' giZi. %&ng n giZi thE nhkqu Zi f,jM. Fth7c t3Qn k %;ng c Zi J -u5 gan.thng: Ja' Flc3 }M1!M 'l0h hDc 1,!>!,zj 'l0-J jM{f c2a na'.

H - thanh thi c2a 1 cht n G (c3/atinin, thucl e ht=ng ' thKn cG knng lc -Ych cht G t3ng ht.Fl _ $ e0Fl: h - thanh thi 'l0h, _: n9ng ^ cht G t3nnZc tiWu, : n9ng ^ cht G t3ng hu5@t t=ng , e: thWt+ch nZc tiWu t3ng 1 ht.H - thanh thi 0gi cnng lc c2a cu thKn tt h=c3/atinin, nhng khG thrc hin P l-ng.Flc3 jf 'l0h ci -u5 thKn. Flc3 Mf'l0h -u5 thKnh, Flc3 ts 1MMf'l0h: -u5 thKn t3ung bEnh, Flc31M'l0h: -u5 thKn nDng.H - thanh thi c3/. l cn c7 gi ch ic iA

chnh liAu lng tth+ch h Zi nhng tc thhn tn hDc hn lZn P %Yng cXn hYt t+nh quthKn.!. luc-/:

8/9/2019 Duoc lsang

17/40

`7c gluc-/ bthng t3ng 'u lc Gi }f11f 'g0%NL 6,{ z,1 ''l0l luc-/ l ngu9n nng lng ch2 5@u c2a n[, c=luc-/ hu5@t luVn hmng 4nh % c= ch@ iAu hthn kinh n^i ti@t.Fc h3'n iAu h gluc-/ hu5@t c chia ! nhG'i lK:y l' gi' gluc-/ hu5@t: in-uliny l' tng gluc-/ hu5@t: a%3/nalin, glucagnglucc3tici%, -'a-t-tatin.

Ha5 gD nht l tng ng hu5@t % i th ng. J9ng ^ gluc-/ hu5@t lc Gi ca h=n 1>f 'g0%(},} 'l0l) c ci bnh lC. Sng hu5@t ca tZi !{f 61'g0%l (1z1} 'l0l) cG ngu5 c= hVn 'Q i th ng HY ng hu5@t %Zi >M 'g0%l (!,M 'l0l) cng 3t nguhiW'. Jgu5Qn nhn thng lquan @n nh' ln %;nqu liAu in-ulin t3ng t34 i th ng. Jgi S*S tng ng hu5@t cXn % 1 - bnh n^i ti@khc: hc Fu-hing, bnh t crc, tng nng tu5@n gi, %thuc c3tici%, tli tiWu thiai%, tchn b/ta, h/nitinU HY g hu5@t cXn % 1 - ngnhn nh: u tu tYng, -ugan, thiWu nng tu5@n 5Qn, tu5@n gi, thng thKn.6. "N"* "#"*:

n5' khu t3 t3ng cc 'V l' n& $c tc cc chu5Wn h cc cht t3ng tb. ?hi tb b4 h hu lng lZn /n5' c gii hGng hu5@t thanh.S hYt ^ c2a nhng /n5' n5 gi gi tn th=nc2a 'V. *n th=ng cng 3^ng c t+nh thE ln/n5' ghGng 'u cng nhiAu. *n th=ng 'Y

8/9/2019 Duoc lsang

18/40

t+nh ' thng ch ghGng /n5' Zi lng sa hn5' t5 thW cG t3ng 'u, '7c ^ tn th=ng tbnDng h=n /n5' b t=ng cG P t3ng 'u.U "N"* (d*): a-a3tat a'in t3an-t/3a-/ (glut'$alac/tat t3an-a'ina-/) l /n5' chu5Wn nhG'a'in.`7c bthng t3ng 'u: f6,M _0l NL: f f,Mj?at0lFG nhiAu P 'V ti' ganJggc: P b t=ng t5 thW*ng t3ng: nh9i 'u c= ti': tng bpt u -au zjh

Yt ti a -au !>h 39i t3P A bthng -au >z ng5. cc bnh A gan, bit t3ng iQ' gan i3u- hDc %nhi8' ^c tng sa hi tu th/ '^ tiQu hu tbt3ng iQ' gan 'Yn, $= gan hDc 7 'KtU "#"* (*): alanin a'in t3an-t/3a-/ (gluta'a53uat t3an-a'ina-/) l /n5' chu5Wn nhG' a'inthng: f6,M _0l NL: ff,Mj?at0l.FG nhiAu P gan h=n P ti' (ch2 5@u P gan)Jg0gc: b t=ng tng t3ng: cc bnh A gan, Dc hiu A gan h="N"* E thng +t khi tng t3ng cc bnh khc ngnhu 'V gan.U * - "N"*0"#"*: t3ng nh9i 'u c= ti' 1 iQ' ga

c 1, $= gan 1

Cu 11: N, pl7E( Q RSM/#M S/u! /Mact(7n p b?l( ca t

8/9/2019 Duoc lsang

19/40

1.SJ: Hd !ff! a 3a SJ bt li c2a t: l 1 ^c hYk c 4nh t3Zc $hin P liAu thng %;ng ch ngW hXng bnh, chon n hDc cha bnh hDl' tha5 i 1 cnng -inh lC. SJ n5 k ba g9'nhng %;ng -ai t, %;ng -ai liAu, %;ng liQ; ca cG ch4nh hDc V tEnh. *3ng SJ n5 5t 7ng c thW3t qt3ng.!. lYi:!.1. lYi th/ tn -ut gD:. *hng gD: "R 101ff

. +t gD: 101fff "R 101ff. hi@' gD: "R 101fff!.!. lYi th/ '^ nDng c2a bnh % bt li g5 3a Jh: k cn t34, k cn gii ^c tgian nm' ik k %i *3ung bEnh: cn cG tha5 i t3ng t34, cn t3Dc hiu hDc k %i tgian nm' in +t nht 1 ng JDng: cG thW / %Y t+nh 'Yng, g5 bnh tKt l%i hDc cn ch' -Gc t+ch crc. *w ng: t3ti@ hDc gin ti@ lquan @n tw ng c2J!.6. lYi th/ t5U *5 ": *iQn lng c

thng h& thu^c liAu %;ng (nQn cc "R t5 " thngD Zi cc tcG i h) t%&ng %c lC qu '7c c2a 1 biWu hin c2a t%&ng %c lP 1 t3+ khcU *5 : thng k tiQn lng c thng k lquan @n Dc t+nh %c lC [ bi@t c2a t

8/9/2019 Duoc lsang

20/40

thng cG lquan tZi 5t %i t3u5An hDc 'i8n %4ch, u bZu hDc cc 5t g5 qui thai. eR: %4 7ng t

Cu 1-: UV0 ptch c+c 0t lWuan

8/9/2019 Duoc lsang

21/40

%;ng a3a3in, h/a3in P ngi cG -On thi@u h&t A 5tVng 'u.1.M. *iAn -w %4 7ng hDc Zi t: J cG t-w %4 7ng Zi tcng cG thW gD %4 7ng Zi 1 t khc cG cu t3c t=ntr. eR: %4 7ng k-inh /nicillin cG thW %4 7ng ch kc/hal-3in!. Fc 5t thu^c A t:!.1. St34 nhiAu t: tn -ut "R tng th/ c - nhZi - lng tcG t3ng 1 ln t34. *=ng tc t: t=ng tbt li c2a tg5 tha5 i N?R hDc %c lrc hc g

3a "R.!.!. #iu t3Enh t34 k %i: JhiAu "R +t $hin kh%;ng ttgian ngpn nhng t l tng khi %;ng %i ng5eR: $ut hu5@t tiQu h % %;ng t JN"LR hDc c3ticik %i.!.6. SDc t+nh c2a t: y k~ thuKt b ch@, y Fht ln-n ho'

Cu 13: N@u c+c bph+p hEn ch< Q1. HYn ch@ - t%;ng: ch kQ =n cc tthKt -r cthi@t n@u J ang %;ng 9ng thi qu nhiAu t thE cnhpc W tY' ngsng nhng lYi tcha thKt -r cn thi@

Fn gi cG t=ng tc bt li k t3Zc khi kQ =n hDht t. kt3a hi J A nhng tJ ang %;ng!. Jp' ng thVng tin A lYi tang %;ng ch J:

8/9/2019 Duoc lsang

22/40

HiWu 3 tcht %c lC, t=ng tc, c= ch@ chu5Wn h "R c2a tch nQn kQ nhng t[ bi@t 5 2 thVntin. *hng $u5Qn tha' kh, cK nhKt cc thVng tin A t=ng tc t. *hKn t3ng khi kQ =n nhng t%8 $5 3a t=ng tcDc bit cc t=ng tc % V tEnh nh t=ng tc c2a t*, 3u.6. Jp' ng thVng tin A cc i tng J cG ngu5 cca: *, ngi ca tui, c= 4a %4 7ng, bnh lC A gan

thKn cc J cG bt thng A g/n.>. *h/ %i -t J, ht hin -Z' cc biWu hin c2a bt li % t cG nhng $w lC k4 thi.

Cu 14: Gtch ah! ca th*( ( SXn! t t/7ntha( YZ t( c+c tS b?t l( ca tRQ [( tha( nhYh( SXn! ch7 GNCT1. *k tiAn hVi (hDc ha hn Yn): k %i 1ng5 -au khi t37ng th& tinh, thng k nhY5 c' Zi c5@u t cG hYi E cc tb cha bpt u bit h. S^c t+nh c2a tZi thai nhi tun th/ qu5 luKt *c hDc k cG gEt7c l hVi b ch@t hDc ti@ t&t3iWn hn tn bthng. Fh+nh E K5 cc bthng

hEnh thi thai nhi hi@' $5 3a, t3s t3h tgian bn thc2a tk %i tcXn ti@ t&c ahg @n tk hVi.!. *k hVi: ts ng5 1jMz hu h@t cc cquan c2a cthW thai nhi c hthnh. Nr tY hEnh $5 3a 3t nhanE cc tb ang nhn lQn 'Ynh.

8/9/2019 Duoc lsang

23/40

P gYn n5 ^ nhY5 c' c2a thai nhi Zi ^c t+nc2a tl lZn nht, %;ng tt3ng gYn n5 cG thW g5 3nhng bt thng nDng nAn A hEnh thi ch t3. `cquan cG 1 gYn nht 4nh nhY5 c' nht Zi ^t+nh c2a t. eR: *k * 6M ng5, *i' 6z ng5, *achn >} ng5, `pt >j ng5, ng zj ng5.6. *hi k thai: tun j{ t3P i k %i tZi lc -inh*3ng tk n5 cc bhKn t3ng c= thW ti@ t&c t3iW hYn thin. *hai +t nhY5 c' h=n Zi cht ^c. Fcht cG hYi ch thai nhi thng l' gi' t+nh hn thi

A cu t3c cnng c2a cc cquan. Fc bhKn c= ththai nhi cXn ngu5 c= ca l: h *?*, 'pt, 3ng, tai bhKn NR ngi. eR: F| NR ngi hEnh thnh ts tu} hn thin tZi lc -inh. J@u ' %;ng %anal l 1 cG hYt t+nh an%3g/n 5@u bk lc n t3ng kh'ang thai cng cG thW g5 na' h thai nhi n.

Cu 1): N!u0@n tHc #\ S]n! t ch7 GNCT [GNCC8^1. Jgtpc -% tch JF* HYn ch@ ti a %;ng t, nQn lra chn cc t34 k%;ng t. *3nh k %;ng tt3ng 6 thng u thai k

R;ng tZi liAu th nht cG hqu Zi tgian ngpn nht #ra chn t[ c ch7ng 'inh l an tn, t3nh %;ng cha c -% 3^ng 3[i ch JF*!. Jtpc -% tch JFF HYn ch@ ti a %;ng t

8/9/2019 Duoc lsang

24/40

Fhn tan tn ch t3 b ', tcG n9ng ^ -ahu5@t t=ng th, thi t3s nhanh *3nh %;ng tliAu ca, nQn %;ng t3ng tgian ngpn nh ngsng nga5 khi Yt hqu *hi iW' %;ng tnQn chn nga5 -au khi ch t3 b$ng J@u k c h ch t3 b ' t3ng khi %;ng t , cpt -a b i %;ng -a ngi tha5 th@. Nau khngsng tcn ch thQ' 1 tgian th+ch h (> ln t10!) 39'Zi ch t3 b lYi

Fn nhpc li +ch0ngu5 c= ch c ' cn t3Zc khqu5@t 4nh %;ng t.

Cu 1.: T/b$0 Kc ( Sc &n! hc ca tT_ [$ NCT1. SiW' RSH c2a tP *: Jhng bi@n i RSH $5 3ch2 5@u Zi t3 -= -inh t3 1 tui. P l7a tui nnhiAu cquan t3ng c= thW cha hn chnh A 'Dcnng, % G qt3Enh h thu, hn b chu5Wn h bi $ut t cG nhiAu iW' khc bit - tui t3Pnthnh. *s 1 tui t3P lQn, cc khc bit A RSH - Zi nglZn khVng nhiAu nQn ahg +t cG C nghTa l-ng.1.1. H thu t:

U Sng ung: S^ H %Y %5 ca h=n t3 lZn (lg HFl chti@t 5 2), -r c bG tng cht ch7a 3a khi %Y %5@u nQn tlu P %Y %5 lu h=n. F ! 5t n5 ahg knnh thu nhiAu tcG bn cht aci% 5@u nh h/nba3bita

8/9/2019 Duoc lsang

25/40

a-i3in (hthu k') hDc ba-/ 5@u nh th/h5lincl3quin (h thu tt) Jhu ^ng 3u^t 'Ynh h=n nQn tc ^ %i chu5Wn t3ng ng tiQu h nhanh, l' gi' tgian lu c2a t t3u^t, ahg tZi knng hthu t3it W cc tt%&ng k %i. H /n5' hn hu t P * z thng cha hchnh, % G 1 - t %Yng /-t/3 h nchl3a'h/nicl, al'itat k tch c gc /-t/3 ghGng t%Yng tr %, l' cn t3P h thu %c cht.U Sng tiQ': h c= bp * cXn nh, cha c tZi '

5 2 nQn hYn ch@ tiQ' bp, khu5@n kh+ch tiQ' *`U Sng qua %a: %a * 'ng nQn knng th' t'Ynh h=- Zi J#. Fh C th thu nhiAu qua %a nh c3ticihi thKn t3ng bVi E t% t=ng =ng %;ng tn thnk $a %u '/ntl, lng n[ 'i hDc lQn %a g5 kth+ch ngn *? c' th& g5 ngYt % lit hV h.1.!. hn b t: `^ hn b tt3ng c= thW biWu th4 qua thW t+chn b e%. e% h& thu^c knng lk@t c2a tZi 3t/in hu5@t t=ng P *, lng "lbu'in glbulin k' c cht lng, RG t l tlk@t th. HKu qu n9ng ^ tP %Yng tr %t3ng 'u tng g5 tng t% ^c t+nh. RYng tk liQ

k@t %8 i qua hng 3 -inh hc hn tn @n c'V, % G e% t3 nh e% J#. *u5 nhiQn nhng tcG h - lii%0nZc lZn cG e% +t khbit - Zi J# t3ng khi ttan nhiAu t3ng nZc cG -r khbit 3 3t.

8/9/2019 Duoc lsang

26/40

1.6. chu5Wn h t qua gan: Fc t c= thW bchu5Wn h qua gan thng t3i qua ! ha: ha L: ba g9' cc $5 h khw, thu hn. Fc n5 P t3 -= -inh, t3 1 tui $5 3a 3t 5@u E h/n5' chu5Wn h tcha 5 2 c A cnng -lg. ha LL: g9' cc liQn h, tY thnh cc cht cG t+nhn crc 'Ynh, %8 thi qua 'Kt hDc nZc tiWu. P *h /n5' n5 cng k'.R G tc ^ chu5Wn h tP * 1 tui, bit t3 --inh 5@u h=n hn - Zi J# t10! k %i h=n, %

cn ch C kcch %;ng tP * %i h=n - Zi J#.1.>. i $ut tqua thKn:Fnng thKn P * k' h=n J# (eR: lc 'Zi -inh tc lc c2a cu thKn bi ti@t qua ng thKn 66] J#knng bi $ut tqua ng thKn P * 5@u nQn tgian t9n tYi t3ng c= thW k %i h=n, thW hin qua -r tn

Fl t10!. JQn lu C t

cG i t34 h, cn nZi 3^nkcch a tW t3nh t+ch lu~.!. SDc iW' RSH c2a tP ngi ca tui:!.1. H thu t:U Sg ung: JF*, cnng -inh lC ng tiQu h Au gi' gi' tc ^ th 3ng %Y %5 (l' tng tgian lu t tRR tng knng h hu tk' bAn t3ng 't3ng aci

nh a'i, /35 hDc chK' tgian $hin t% t %Yng ba tat3ng 3u^t, tng knng k+ch 7ng g5 lt %Y %5 c2tchng iQ' khVng -t/3i%.

8/9/2019 Duoc lsang

27/40

i' hYt ^ng ti@t HFl c2a tb iAn P thnh %Y %tng H thi N?R c2a tcG bn cht aci% 5@u c2ba-/ 5@u.

i' lu lng 'u tZi 3u^t gi' %in t+ch bA 'Dh thu -r l[ h c2a n'Yc 3u^t l' gi' hthu c2a nhng hthu th/ c= ch@ chu5Wn t+ch crc nh -pt, calca.a'in, it. i' Vng 'u qua tYng.U Sg tiQ' bp: khi c= gi' -r tZi 'u gi' gi'

h thu k n 4nh.U Sg qua %a: %a khV, thn lii% gi', khG th' hthu tqua %a gi'.!.!. hn b t: i' tng lg nZc t3ng c= thW gi' e b c2nhiAu t tan t3ng nZc (%ig$in, '3hin, lithi) tn

n9ng ^ t3ng 'u 'V * l 'P t3ng c= thW tng tng e b c2a nhng tan t3ng ' (ba3bitu3at, thi/ntan, %ia/a')%@n k %i tgian t%&ng, t+ch lu~ nhiAu P 'V '. 3t/in hu5@t t=ng gi' , ch2 5@u albu'in % hKqu c2a -r -u5 gi' cnng gan, tng lng tP %Yng t

% tng t% %c lC ^c t+nh. *hng $5 3a t

cG bcht aci% (l nhng tgpn Zi albu'in hu5@t t=ng nci'/ti%in, u3-/'i%, a3a3in) -u5 ti', 't nZc % a ch5, nVn nhiAu, h; % -uthKn, -u5 %%, -u5 thKn, -u5 gan cng l ngnhn gti b t.

8/9/2019 Duoc lsang

28/40

!.6. Fhu5Wn h ttYi gan: i' klng gan lu lng 'u qua gan k %i tgiat% tchu5Wn h qua gan, %8 t+ch lu~ ng^ ^c

i' hYt t+nh cc /n5' chu5Wn h t

P gan (ch5@u P ha L) % G nhiAu tchng c giKt JN"LR, chng Vng 'u g ung, t hY ng hu5@t ungch2 5@u chu5Wn h th/ cn g n5 b4 k%i tgian t9n tYi t3ng c= thW (*10! tng). ha LL (liQh) k b4 ahg nhng tb4 chu5Wn h ch2 5@u P hn5: $a/a', l3a/a', ac/ta'inh/n k b4 t+c

lu~ Fc tb4 chu5Wn h 'Ynh P Xng tun hn u khqua gan cG thW tng N?R % gi' hYt t+nh /n5' gangi' kthZc gan, gi' lu lng 'u qua gan P ngi catui (eR: la/tall, chl3a'h/nicl, ni/%iin, nit3a3anll, /3aa'il)*chu5Wn h nhiAu qua gan, %;ng JF* nQn gi' 10!106 liAu th/ %i chDt ch t34!.>. *hi t3s tqua thKn: % -r l[ h cqua bi $ut ba g9': i' %Xng 'u qua thKn i' -7c lc cu thKn i' -r ti@t qua ng thKn

i' klng thKngi' thi t3s tqua thKn^ thanh thi c2a nhiAu tgi', '^ lc c2a cu thKgi' khng 6M] - Zi tui t3

8/9/2019 Duoc lsang

29/40

bit qt3ng Zi nhng t bi $ut zf] P %Ynngu5Qn n qua thKn cG ^c t+nh ca nh ?N nhG'a'in-i%, c/hal-3in, %ig$in, '/tht/$at. S^ than

thi gi' tng t+ch lu~ (*10! tng) hiu chnh liAn@u cn.

Cu 1: Gtch ntHc #S]n! `O ch5 #S `O Yh( cnh( YhunFc tc nhn g5 bnh ch ngi cG thW l e?, i3un', -Kt =n b, kC -inh Kt (giun). Fc ?N thVn

%&ng ch t%&ng Zi e?, 3t +t k- t% i3ut, n' gbnh, -Kt =n b. `i ?N cG t% Zi 1 - lYi e? nh4nh, % G t3Zc khi q4nh -%&ng 1 lYi ?N n cn l' qua cc bZc -au 5:1. *h' kh' l' -ng: ba g9' nhit ^ Jhng n kh' bnh. S5 l bZc quan t3ng nh

cn hi l' t3ng 'i t3h. eE -t l %u hiu iWhEnh khi cG nhi8' khuon. JQn tfW khng 4nnhi8' khuon. Nt % e? thng g5 tng thn nhit3Qn 6{fF, t3ng khi -t % e thng 6j6j,MfF. Jhnt3h ngYi l: Jhi8' khuon J -u5 gi' 'i8n %4ch, J gi 5@u: cthW -t nh

Jhi8' e nh J quai b4, thu Ku, NIH, bYi lit.. cthW 6{f.*h' kh' hng n gi th5 thuc %r n tnhn g5 bnh, qua ng $' nhK c2a e?, qua c%u hiu Dc t3ng

8/9/2019 Duoc lsang

30/40

!. Fc IJ l-ng thng qu5: F*` (F a nhn t3ung t+nh tng l cG nhi8'khuon) Iquang cc ch - -inh h - gG hn khn4nh chon n6. *E' e? g5 bnh: l bh c$c tE' 3a tc nhg5 bnh nhng k hi 'i t3h Au cn *hrc hin khi nhi8' khuon nDng nh nhi8' khuo'u, iQ' 'ng n[, th=ng hn.. ?hi th' kh' l-ng k tE' th5 %u hiu Dc t3n

hDc nhi8' khuon 'pc hi P e, J -u5 gi' 'i8%4ch k cG -t hDc ch -t nh. eic hn lK e? k hi P u cng l' c, 'tgian, tn k', 'Dc %u c$c, nhng $@ hng th7 -au th' kh' l-ng. J@u J ts tu5@n %Zi chu5Wn lQna hn [ -%&ng ?N thE th' kh' l-ng l' Ithng qu5 l c= bn. *3ng t3h n5 -% ?N h 3^ng h; h ?N W t34 l h lC cn thi@t.

Cu 1D: C+c t/hp ph( hp `O c Yhu0

8/9/2019 Duoc lsang

31/40

!. i' knng khng thDc t3nh tY nhng ch2ng eA khng. *hng %&ng khi t34 cc nhi8' khuon k %i. eRhi h ?N t3ng t34 la, iQ' 'ng t3ng ti', iQ'$=ng, hng, iQ' 'ng n[. ?hi ?N %;ng 1 'Enh %8 khng tthE cng nQn hi h?N. eR: 6 ?N %8 khng a'in-i%, 3ia'icin, quinlnHa5 hi h W 't hqu c2a nhng k- n56. JZi 3^ng h t% c2a k-: ch2 5@u nZi 3^ng h k kkh+. Sa - k- thVng %&ng f cG t% hDc t% 5@u lQn k k

kh+, Dc bit ch2ng k kh+ g3(), nh . 3agili-, % ic h k- ch2 5@u %it k k khi% Zi cc nk cG nguc= nhi8' k kh+ ca. eR h '/t3ni%al Zi cc kkhc t3ng nk ;ng b&ng, chKu E '/t3ni%al l thu%it k k kh+ 'Ynh thu^c nhG' Mnit3i'i%al. Jg'+ch t3Qn ic nZi 3^ng h thng k cn thi@t>. SiAu t34 ch bn -u5 gi' '%4ch: J -u5 gi' '% 3hY5 b4 nt3;ng, khi G ha5 h k- % c= 4a 5@u kthW tng liAu k- nQn h k- W /' lYi hquM. hi h khi iAu t34 cc nkhuon tYi t ch7c khth' k-: eR iQ' 'ng n[, iQ' $=ng cn h k- Wt34 c bQn t3ng bQn ngi t ch7c E k- nYt 2 cc tchuon sa th' tt sa t% 'Ynh

Cu 1F: T/nh b$0 c+c bph+p YhHc ph]c tS Y ca !luc7c7/t(c7(S:1. *% lQn -r tng t3w=ng P t3 /': 5 chK' lZn, g3i lYn -inh %&c t3Zc tui %K5 thE ?hpc h&c: y hYch@ kQ =n nhG' glu y Fc ch@ ho' tr nhiQn +t h

8/9/2019 Duoc lsang

32/40

@n ^ lZn (ch@ ho' tng h) y?hi %;ng thE nQ%;ng liAu '7c th nht cG hqu t3ng th=E giangpn nht cG thW y ?hi hi %;ng k %i thE nQ%;ng kiWu iAu t34 cch ng5 W gi' bZt hin tng 7ch@ tu5@n thng thKn, -%&c tgi y ?hu5@n kh+ct3 ^ng, thW %&c, tng ch@ ^ %% giu Y', calc%;ng -a!. 5 $ $=ng: glu tng cng hu $=ng, ch@ qt3EntY $=ng, % G ngn cn -r i 'Zi c2a 'V $=ng l' tng qt3Enh tiQu $=ng

?hpc h&c: y -ung calci it R, ch a '7c liAth/ nhu cu hng ng5, n@u a ca qu - l' tncalci 'u, ngu5 c= -i ti@t niuy tng ^ng W kth+ch tY $=ng, tng %inh %ng.y Zi JF*: b -ung h3'n -%&c (% gi' lg h3'-%&c nQn t34 cng %8 $ $=ng). ? %;ng ch J tu5@n N%&c, n '[n kinh 1M n', cG thW %;ng cc chho' u3i% hDc calcitniny %;ng al/n%3nat (1 bih-hat) W hXng t3l[ng $=ng % -%&ng c3tici%. Fh C: % t g5 k+c7ng tYi ch 'Ynh nQn k nm' ung, ch nm' -Z' nh6f-au ung.6. #t %Y %5 t t3ng

t l k nhiAu (1,j]) nhng n@u gD thng 3t nDng thng gD nhiAu J ca tui a hn tng th/ liAu ^ %i t34. lt th2ng $5 3a c khi %;ng tngi g tiQu h.?hpc h&c: %;ng tt3ung h %4ch 4 (antaci%) nhng kc ung 9ng thi glucc3tici%.

8/9/2019 Duoc lsang

33/40

>. *c %&ng h& % %;ng tYi ch c3tici% chng ch 4nh %Yng %;ng nh 'pt (g5 &c thutinh thW hDc tng nh[n ), k nh 'pt cc ch@ ho'ch7a glucc3tici% khi nhi8' i3ut, n' hYn ch@ bVi k %i kh' k~ J t3Zc khi kQ =n k tr C %;ng tM. Hin tng 7c ch@ t3&c %Zi 9i tu5@n 5Qn thnthKn (H")?hpc h&c: Fhn tF cG tgian t%&ng ngpn (*10! ngpn)

N% F 1 liAu %u5 nht bui -ng *3ng t34 k %i nQn %;ng li ung cch ng5 JQn %;ng liAu th nht cG t% (liAu cng ca t3&c cnb4 7c ch@) S^ %i t t34, cng ngpn cng tt pt bu^c ngsng tts ts -au khi t34 k %i, gi'%n liAu %&ng c ch@ ho' bVi ngi. ?hi %;ng bVngi t3nh bng W gi' knng th' tqua %a. i' -t chDt ch -au khi ngsng tz. *Enh t3Yng thsa c3tici% bnh Fu-hing % t: Jgsng ttun th/ qu5 tpc gi' liAu Nau khi ngsng tn@u ti ht thE nQn -%&ng cc Dc hiu t34 t3ch7ng.

Cu -J: C+c bph+p YhHc ph]c T`II ca nht!(' au Td

8/9/2019 Duoc lsang

34/40

1. u9n nVn, nVn, t bGn: l t% h& thng gD nht kh%;ng cc tgi' au *, t% h& k h& thu^c liAu. ?hph&c: #ra chn ch@ ho' h; h (ch@ ho' tng h +g5 t% h& h=n) i' t bGn: y ung nhiAu nZc, tng cht $=, tnKn ^ng. y cG thW hi h tnhuKn t3ng. u9n nVn, nVn: % tkth+ch t3t' nVn P n[. nQn hh thQ' tchng nVn nh hal/3i%l, '/tcl3a'i%, chng nVn nhG' khng hi-ta'in H1.

!. F thpt c= Xng: c c= t3=n kh+ qun, c= d%%i (n'Kt), c= Xng ng %n niu. R G cn t3P khi %;ngi' au % -i 'Kt, -i niu qun. ?hpc h&c: R;ng ch@ ho' tng h W gi' t% h&.y hi h tgi[n c= Xng nh at3iny J@u gD c= kh+ qun b4 c thpt g5 ngsng th^t ng^t cG thW %;ng t 'A' c= nh -uccin5lchlinnal$n..6. 5 nghin: t% gi' au t% g5 nghin tng tl thuKn. ?hpc h&c:y %;ng liAu th nht cG hiu lrc Zi tgian ngpn nhty ch -% khi au P '^ nDng khi nhG' gi' angYi i k 2 hiu lrc

y khi %;ng k %i, nQn gi' liAu ts ts khi ngsng t3nh hch7ng cai t.>. 7c ch@ hV h: ngu5 c= n5 tng th/ liAu %;ng thng gD khi -% iat ch J au nh, %8 gD t3 M tui

8/9/2019 Duoc lsang

35/40

FFS t3 6f thng tui, t3ng t3h bpt bu^c thE np'ng liAu %;ng cch %;ng h th/ %i c c7khi b4 ngYt. %;ng thKn t3ng JF*, ngi cG bnh t' h@ 'Yn t+nE cG thW $5 3a lit hV h tgii ^c Dc hiu: nal$nM. *&t H": %8 gD khi tiQ' *` ?hi -% g tiQ' *` nQn ha l[ng %ung %4ch chuob4 -On h=ng tin c c7u: hV h nhn tY, t gi^c Dc hiu nal3hin

nQn W J t th@ nm' khi tiQ' W t3nh hin tng t&H" th@ 7ng.

Cu -1: C+c bph+p YhHc ph]c T`II t/@n t(@u h7+ ca nh NOeJN"LR thu^c nhG' t gi' au ngYi i. Fc JN"LAu 7c ch@ FdI1 l' gi' -rc tY 3-taglan%in gi' -r tY cht nh5 JaHFd6 P %Y %5, l' tnngu5 c= g5 lt ng tiQu h, ch2 5@u ha5 gD l%Y %5. *% h& n5 gD c khi %;ng g tiQ' hDc bVngi t3Qn %in 3^ng. JN"LR cXn g5 tn th=ng P ntiQu h %Zi (Yn cui c2a 3u^t nn 3u^t gi) tpng tiQu h % tY thnh cc ch+t h (Dc t3ng t

th=ng % JN"LR). *ai bi@n n5 ha5 gD Zi cc %Yng hGng th+ch chK' %Yng iQn ba tan 3u^t. in hkhpc h&c: eZi iQn nn t3n (k cG 'ng ba bit): ung ba n nhai iQn t, ung k' 1 cc nZc t !ff'l

8/9/2019 Duoc lsang

36/40

#Yi iQn ba tan t3ng 3u^t ung $a ba n Fc %Yng b ch@ -%&ng cc t %c ch/ chP nh c5cl%/$t3in nhm' gi' -r t$c t3ti@ c2a tw t

n'Yc ng tiQu h. lng nZc ung hi lZn (!ffMff'l) hYn ch@ %;ng antaci% cht ba bc n'Yc E hquk' g5 t=ng tc %n @n gi' n9ng ^ JN"LR 3-taglan%in (F5tt/$ !ff'g) l cht hi h tt gi' knng g5 lt RR c2a cc JN"LR. Jhng g5 k %;ng na % cG nhiAu t% bt li, bit g5

ch5 P 1 t l lZn J. * 7c ch@ chn lc FdI! nh '/l$ica' (`bicc/l/c$ib (F/l/b3/$), 3t/c$ib (ei$$) cng gi'ng kW (khng Mf]) t l lt RR nhng t+nh u ic2a nhG' n5 cXn cn cG tgian kiW' ch7ng E cG "Rkhc ngu5 hiW' (eR: tai bi@n t3Qn ti' 'Ych, ^t quei$$)

Cu --: T/b$0 c+c n!nhn !0 thfa B(t [$ ch?Yh7+n!% 8ph+p1. Fc ngnhn g5 thsa eit cht khng:a. *hsa % ch@ ^ n: nGi chung +t gD % c= thW cthW tr iAu chnh t3ng qt3Enh hthu qua g tiQu h

*hsa it " % n gan gu t3png P th %n h=npc *hsa ca3tt/n % n k %i nhng tho' giu chn5.

8/9/2019 Duoc lsang

37/40

b. *hsa % lY' %&ng it cht khng %Zi %Yng t: Sl ngnhn hng u ha5 gD nht. Jhng ngi kh'Ynh k cG 3i lYn hthu, ch@ ^ n 2 cc cht thE khi %;ng thQ' it hDc cht khng %Zi %Yng t. * 1 tui: thsa it R n@u b -ung thng $u5Qn it Zi liAu >ff_L0ng5 (g5 tng Fa 'u, -u5 thKn, tng) * > tui thng $u5Qn ung it " h' lnMfff_L0ng5 cG thW b4 ng^ ^c 'Yn t+nh Zi t3ch7nau $=ng, ban , iQ' %a t3Gc 5, iQ' 'ing. J@

%;ng it " 1ff.fff_L0ng5: g5 h9ng thG, c giKtng lrc - n[. JF* %;ng k %i it " Mfff_L0ng5 t3ng khi ung 5 2 hthu tt - g5 thsa ita g5 quthai. it F %;ng thng $u5Qn, bit liAu ca cng g5 thsatai bi@n: a ch5, lt g tiQu h, -i thKn.. cc ch@ ho' it (hn h 6) liAu ca g5 thsa z (bhin 3i lYn *? c' gic) thsa it 1! (tng -tu5@n gi, bnh c= ti', tng h9ng cu qu '7c) *hsa -pt: % ung qu liAu, bit t3 M tui. Hqutw ng thsa L%: -%&ng z'g0ng5 g5 7c ch@ hYt ^n

tu5@n gi, g5 nhc nang gi a thsa 1 i cht n G cng g5 3a -r thi@u h&t i cht khc th/ c= ch@ cYnh t3anh. *hsa i lng g5 hKu qu nghiQ' t3ng h=n - thsa it E chng cG hY' i t34 h!. Fc bh t3nh thsa it khng cht:

8/9/2019 Duoc lsang

38/40

*hKn t3ng khi -% ch@ ho' h' lng M ln _NR"J@u thrc -r cn thi@t nQn %;ng %Yng =n l W t3nthsa cc it tan t3ng %u. ?hi %;ng t%Yng hn h it cht khng hi hbit cc cVng th7c %nh ch t3 1 tui, > tui ch J#. JuVi %ng nhn tY hn tn ngi g tiQu h (*Jic b -ung it l bpt bu^c W %u5 t3E knnchu5Wn h cc cht nh liAu lng cn c t+nh tn %rt3Qn tEnh t3Yng bnh lC c2a tsng J.

J tho' t+ch 'u ch nQn %;ng b -ung hn h tan t3ng nZc. Sng a tu tiQn t3ng 'i t3h l g ung t3nc ngu5 c= thsa nh qt3Enh tr iAu chnh khi hthc2a ng tiQu h thVng qua cht 'ang. Sg tiQ' ch %;ng t3ng t3h c= thW hthu qua ng tiQh b4 tn th=ng (nVn nhiAu, a ch5) hDc khi cb -ung g i cht, t3ng nuVi %ng nhn tY ngg tiQu h (*J)Cu -3: C+c n!nhn !0 th(

8/9/2019 Duoc lsang

39/40

R cht t ngu9n nZc P tsng 4a h=ng: y ;nni Vi g5 thsa calci, thi@u i%, y h' lng LhDc u3 g5 bZu c 4a h=ng, hng 3ng. R n kiQng: thi@u 1 - i cht cG ng0gc ts K1!, it R, -pt, n kiQng gi' cn: thi@u gn nh tb^ i cht. Jghin 3u: thi@u c A cht lng t3ng ba n: gi' knng hthu it nhG' , y g5 $= gan, gi'knng %r t3 it c2a gan, g5 tpc 3u^t, gi' hthu tan t3ng %u, y thi@u albu'in l' gi' hthu it "..

1.!. R 3i lYn hthu: NRR, a ch5 k %i, nghin 3u, tpc 'Kt P JF*, thi@u i cht % gi' cnng c2a h tiQu hgi' ti@t %4ch 4, %4ch 'Kt, %4ch tu, -r h^ng k'hqu c2a cc c= ch@ hthu t+ch crc qua n'Yc 3u^t, %%;ng tnhuKn t3ng k %i. 3lYn hthu % 1 - bnh tiQu h nh iQ' tu, tpc 'Klt RR **1.6. R nhu cu c= thW tng nhng cung c k 2:JF*, ch cn b, thi@u niQn tui %K5 thE, J -au '%K5. Nau ', nhi8' bon k %iAu cG nhu cu i cht %% tng h=n bthng. J@u c b -ung tt ch^ n ung thE k cn %;ng thQ' it %Yng t

1.>. Fc ngnhn bit khc: J c nuVi %ng nhn tY hn tn ngi g tiQh (*J) J cG khu5@t tKt %i t3u5An *3 -= -inh, Dc bit -= -inh thi@u thng ha5 thi@it ?

8/9/2019 Duoc lsang

40/40

*hi@u % t=ng tc t: y cc cht l' gi' hthu it (khng lat l' gi' hthu it nhG' , tnhuKn t3n%Yng %u khng, tantaci% cn t3P hthu it ") R -r cYnh t3anh khi hthu: #iAu ca it cYn kit %t3 it ", *hsa `l5%/n tng thi Fu, *hsa cn t3P hthu -%&ng Fu, \/!. Iw lC khi thi@u it khng cht ht hin ngnhn g5 thi@u lYi b nG. eR: n@thsa % 3i lYn h thu thE hi t34 cc bnh lquanthi@u % cung c k 2 % nhu cu (tng khou h

n hDc -%&ng thQ' it khng cht khi thi@u t3't3ng) -ung u tiQn ts thrc ho' b -ung %Zi %Yng tbch khi thi@u t3' t3ng hDc cha cG kin -wa lYi ch@ ^ n. +t cG htng thi@u =n ^c 1 cht (t3s % %i t3u5An

% t=ng tc t

). E K5 b -ung it %Zi %Yng hn h chqu h=n %;ng cc cht =n l. * l hi h cc cVnth7c khc nhau nQn khi lra chn hi cn c7 ngnhn g5 thi@u W b -ung ch h; h.