Nhm sinh vin thc hin: Nguyn Th Thu Thy MSV: 1002262 Ng Th Kim Yn MSV: 1002334 Trn Quang

Tng MSV: 1002

Bnh nhn n 62 tui, vo vin sau 2 ngy t ngt au bng m vng thng v, chua, nn nhiu, nn ton nc, khng st. Khi thm khm: huyt p 120/80mmHg, mch 66l/pht, khng s thy gan. Bnh nhn c tin s vim a khp, c iu tr n nh t cui 2011.

Vi nhng du hiu trn bn ngh n bnh g? Nu nhng du hiu m bn ngh n bnh ?

A. B. C. D.

Vim d dy mn Lot cp d dy-t trng Vim ty cp Si ng mt ch

Bnh nhn ang b lot cp d dy-t trng

V bnh nhn: au bng vng thng v y l ln au u tin chua Nn nhiu

Vim d dy mn: triu chng au bng vng thng v xy ra nhiu ln trc

Vim ty cp: bnh nhn cng au d di vng thng v, bun nn. Nhng km theo st 39-40C, mch nhanh

Si ng mt ch: au vng h sn phi, st cao 39-40 C, gan to di b sn

 Theo

bn, bc s cn lm g chn on xc nh ? A. Xt nghim mu B. Siu m bng C. Xt nghim ha sinh mu D. Ni soi d dy t trng

Tr li: Ni soi d dy-t trng

 Theo

bn nguyn nhn chnh dn n tnh trng lot cp d dy t trng ca bnh nhn ny l g ? Tr li: Do thuc i tr vim a khp: corticoid v NSAIDs Chng c tc dng c ch tng hp prostaglandin (c vai tr kch thch cht nhy v bicacbonat) do lm gim kh nng bo v ca nim mc d dy-t trng

 Bn

hy a ra phng php iu tr c th cho bnh nhn ny? Tr li: Ch n: + n lng cc cht d tiu, chia lm nhiu ba + Khng n nhng cht d gy kch thch: chui tiu, t cay,

Clarithromycin 500mg: ung sau n sng 1 vin, chiu 1 vin (iu tr trong 7 ngy) Omeprazol 20mg:

sng 1 vin (trc n), ti 1 vin (trc ng) (iu tr trong 8 tun)

Dogmatil 50mg:

sng 1 vin, chiu 1 vin

Vitamin B1, Vitamin B6, Vitamin PP

 Dng

thuc: Sucralfate 5ml: ung lc i

sng 1 gi, chiu 1 gi (iu tr trong 8 tun)

Phosphalugel: 3 gi/ ngy

Amoxyciclin 500mg: ung sau n sng 2 vinchiu 2 vin (iu tr trong 7 ngy)

Bn hy nu tc dng chnh cc thuc m bn dng? Tr li: - Phosphalugel: trung ha acid dch v - Omeprazol: c ch bi tit HCL (c ch bm proton) - Sucralfate: bng b lot - Amoxicilin, clarythromycin: chng nhim khun do vt lot - Dogmatil: tc dng trn thn kinh TW c tc dng an thn