T TIU HA

ALT tng trn 150 gi c tc nghn. ALT gim nhanh sau 48 gi iu tr cng ng h
chn on.
Vim ty cp v ngh xt nghim:
nh gi d on hoi t ty cp: cng thc mu (s lm li lc 24h), CRP (lm lc 48h).
Chn on: amylase mu, amylase nc tiu, triglyceride (lm tr th s tt xung), AST,
ALT (ALT m tng trn 150 th gi si mt).
Chn on BISAP: BUN
Nhng xt nghim khc: ion (quan tm n Na (h gi tng Tri) v K (gim trong
bnh cnh nn i nhiu mt H+), creatinin, ng huyt.
Phi theo di Creatinin, ion , cng thc mu mi ngy.
Nu bnh nhn c st phi tm sot cc nhim trng khc: XQ lng ngc, tng phn
tch nc tiu, cy mu c khng ta?)
Cho n khi: ht au, ht chng, thm n tr li, n tr li m khng au.
Vim ty cp nng nm ICU, trung bnh nng v nh nm phng thng. Thi gian
nm vin ca vim ty cp th nng bng trung bnh nng, cn t l t vong th trung bnh
nng bng vi nh.
Khi no cho xut vin: khi ngy khng sinh phng nga (ch nh khi c nghi ng
hoi t), bnh nhn khe v sinh hot bnh thng tr li.
Nu trong vng 2 tun m nhim trng khng ci thin, chun b can thip ngoi khoa
(can thip ngoi khoa ch lm sau 28 ngy).
Khi hi bnh s bnh nhn b au bng, hi tin cn tng huyt p, i tho ng, ri
lon m mu v bnh tim mch trc l rt quan trng.
Trong vim ty cp, gim kali l do nn i hay do truyn ng.
Du hiu XQ bng khng cn quang trong vim ty cp: vi ha ty, quai rut canh gc,
i trng ct ct, si cn quang.
Khi khm vim ty cp (v c xut huyt tiu ha) nh nghe nhu ng rut => rt quan
trng. Ngoi ra cn phi khm du hiu mt nc.

Vai tr ca PPI trong vim ty cp: chng lot do stress (th my, suy h hp, suy a c
quan) => khng dng ba bi. Bnh thng c dng Ranitidine l .
Bnh nhn x gan khng c chng ch nh dng Paracetamol (dng < 2g/ngy, ngi
bnh thng < 4g/ngy)
HAPS l g:
BISAP l g:
Gim au: Meperidine 100mg ng x 3 (mi 8 ting), tim bp
Truyn dch:
Glucose 10% 250ml x 4 chai TTM XXX git/pht
NaCl 0.9% 500ml x 2 chai TTM XXX git/pht
Truyn 1 ngy 2l
Truyn Kali:
KCl 10% 1.5 ng
NaCl 0.9% 500ml