Tip cn bnh nhn au bng cp ti phng cp cu ni.

1. Phn loi v x l:
- Kim tra ABC, v x l thch hp.C th: huyt ng n khng. Nu huyt ng khng n, i tm
nguyn nhn.
- Trc tin cn phn bit au bng ngoi khoa hay ni khoa. Ngoi khoa chuyn ngoi. c bit
ch n cc du hiu: Vim phc mc, tc rut, du hiu PUTB, vim ty hoi t c ch nh
m.
- Cho thuc gim au, ch khng lm nh hng n cc du hiu: vpm chng hn.
- Nu ni khoa cn phn bit: au bng cp nguy him v khng nguy him.
- au bng cp nguy him: cn loi tr cc nguyn nhn ny, Phn cn li tip tc theo di, c th
cha cn chn on ra nguyn nhn. au bng cp nguy him n tnh mang do nguyn nhn ni
khoa:
+ au vng thng v: ch NMCT.
+ au bng trn loi tr cc nguyn nhn ph bin: ch tc mch phi.
+ U tuyn thng thn.
+ Thiu mu mc treo cp tnh, hoc nhi mu mc treo, thiu mu mc treo trng mn.
+ Phnh hoc phnh tch dng mch ch bng.
+ Cc bnh v mu: hng cu hnh lim, hemophilia.
+ Ng c.
2. Chn on nguyn nhn (ci ny kt hp c ni v ngoi).
chn on nguyn nhn: trc mt cn au bng, cn phn bit au bng cp tnh hay mn tnh.

+ au t hn so vi mt thi gian vi ngy tng dn cho n khi thi gian gn y r rng l "cp
tnh".
+ au m vn khng thay i trong nhiu thng hoc nhiu nm c th c phn loi mt cch an
ton l mn tnh.
+ au khng r rng ph hp vi mt trong hai loi c th c gi l bn cp v cn phi xem xt
cc chn on khc bit gia cc cn au cp v mn tnh.
+ au mt bnh nhn b bnh hoc khng n nh ni chung nn c coi nh cp tnh, k t khi
bnh nhn au bng mn tnh c th th hin vi mt tnh trng cp tnh ca mt vn mn tnh
hoc mt vn mi v khng lin quan.

Vi mt cn au bng cp: Cn phn khu bng chn on:

1. Vng h sn phi:
a. Gii phu:
* Thy gan phi
* Ti mt
* Gc i trng phi
* Tuyn thng thn phi, cc trn thn phi.
b. bnh l.
- Bnh l gan mt: si mt ( si gan, si ng gan chung, si OMC, si ti mt), vim ng mt
cp ( vim ng mt, vim ti mt), Ri lon chc nng c oddi => co tht ng mt.
- Vim ty cp.
- Vim rut tha (kh pb vi vim ti mt).
- U tuyn thng thn, si cc trn thn phi.
 - Vim phi thy di phi tc mch phi (Vim phi - Vim phi lin quan n cc thy di
ca phi l mt nguyn nhn ph bin ca hi chng au bng, c l lin quan n kch thch c
honh, v c th b nhm ln vi vim ti mt cp, him khi, au bng cp).
- Trong au h sn phi, bnh s cn tp trung vo vic phn bit cn au ca h h hp,
tit niu v gan mt (S 2). Nu nghi ng nhim trng ng niu hoc si thn, xt
nghim nc tiu l cn thit. Bnh nhn c au qun, st, i phn m hay du Murphy
dng tnh nn c siu m.

S 2.Thut ton nh gi cn au gc phn t trn phi

2. Vng thng v:

a. Gii phu:

* Thy gan tri

* Phn ln d dy k c tm v, mn v.
* Mc ni, gan, d dy trong c mch mu v ng mt
* T trng
* Ty tng
 * m ri thi dng
* ng mch ch bng, ng mch thn tng.
* Tnh mch ch bng
* H thng bch huyt.

b. Bnh l.

- Cha loi tr cc bnh gan mt: Si kt c ti mt, giun chui ti mt, si gan tri.
- Bnh d dy: Vim lot d dy, t trng; thng d dy, t trng.
- Bnh l ty tng: vim ty cp.
-Nhi mu c tim -Bt k bnh nhn vi cc yu t nguy c tim nn c mt in tm .

3. Vng h sn tri:

a. Gii phu.
* Lch.
* Mt phn d dy.
* Gc i trng tri.
* ui ty.
* Tuyn thng thn tri, cc trn thn tri.

B. bnh l.

- Bnh l ca lch: v lch, p xe lch- nhi mu lch. p xe lch thng c kt hp vi st v au

phn t pha trn bn tri v cng c th c kt hp vi nhi mu lch. Nhi mu lch cng biu hin
au h sn tri. Hi chng ny cn c xem xt trong bt k bnh nhn b rung tm nh hoc cc iu
kin khc lin quan n tc mch ngoi vi.

- Bnh l d dy: Vim lot d dy, t trng, thng d dy.

- Bnh l ty tng: Vim ty cp (ui ty).

- Bnh l tuyn thng thn: u tuyn thng thn tri.

- Cc trn thn tri: si cc trn thn tri.

- Vim phi thy di tri tc mch phi (Vim phi - Vim phi lin quan n cc thy di ca phi
l mt nguyn nhn ph bin ca hi chng au bng, c l lin quan n kch thch c honh, v c th
b nhm ln vi vim ti mt cp, him khi, au bng cp.)
4. H chu phi:

a. Gii phu.
* Manh trng
* Rut non, ch yu l rut cui.
* Rut tha
* Bung trng phi
* ng, tnh mch chu gc phi
* H thng hch bch huyt
* Mt phn c y chu
b. Bnh l.
- Bnh l rut tha: Vim rut tha.

- Bnh l bung trng n: Vim bung trng, nang bung trng xon, cha ngoi t cung v, apxe c
y chu.

- bnh l manh trng: ?????

Vic nh gi cn au h chu phi phi hi bnh s k cng (S 3). Bnh nhn c cc triu
chng (v d: st, ti khu tr) hay du hiu (v d c tht lng chu, co cng thnh bng,
khng thnh bng, phn ng di) c tnh cht gi vim rut tha nn c CT v t vn phu
thut khn cp. Nu kt qu CT bnh thng nn kim tra nc tiu, i trng v vng chu.

S 3. Thut ton nh gi cn au gc phn t di phi

5. H v.

a. Gi phu.

* Rut non
* Trc trng v i trng sigma
* Bng quang
* on cui ca niu qun
* ph n c thm b phn sinh dc: t cung, 2 i trng, dy chng rng, dy chng trn, ng tnh
mch t cung.

b. Bnh l:
 - Bnh l bang quang: cn au bang quang cp.
- Si niu qun phn thp.
- Cha ngoi t cung v.
- Nhm bnh l ca ng tit niu di v sinh dc.
6. Vng mn sn.
a. Gii phu.
* i trng ln (bn phi) v xung (bn tri).
* Thn
* Rut non
b. Bnh l.
- Bnh l ca thn: si thn, si niu qun.
7. Vng rn.
a. Gii phu.

* Mc ni ln: khng ch vng ny m ta i nhiu vng trong bng

* i trng ngang
* Rut non
* Mc treo rut, trong c mch mu ca rut
* H thng hch mc treo v cc hch ngoi mc treo
* ng mch ch bng, ng mch thn 2 bn
* Tnh mch ch bng

b. Bnh l.
- Tc rut.
- Vim rut.
8. H chu tri.
a. Gii phu.
* i trng sigma.
* Rut non (on c ti tha Meckel).
* Bung trng tri.
* ng, tnh mch chu gc tri.
* H thng hch bch huyt.
* Mt phn c y chu.
b. Bnh l.
- Bnh l phn ph ph n: u nang bung trng xon, vim phn ph.
- Rut tha.
- Si tit niu.

Cui cng, nh gi cn au gc phn t di tri tp trung vo vim ti tha (s 4). St,

bnh ti tha trc , hay cc pht hin thc th c tnh cht gi (sng au, mu trc trng)
nn lm theo kinh nghim iu tr hoc CT. Mt nh gi bnh thng nn c xem xt thm
bnh l tit niu hoc ph khoa. Bnh nhn c cn au khng chn on c nn c theo di
cht ch v nn tham kho kin bc s chuyn khoa.
S 4. Thut ton nh gi cn au gc phn t di tri.
9. au khp bng: thng i din cho bnh nng v e da tnh mng. V d nh thiu mu cc b
v nhi mu mc treo, phnh ng mch ch v bng, v vim phc mc ton th.
- Thiu mu mc treo cp tnh v thiu mu mc treo trng mn tnh. Nhi mu mc treo. (thng
do mng x va hoc do huyt khi). Mc treo trng thiu mu cc b v nhi mu c nhi mu
mc treo trnh by vi s khi u cp tnh v nng ca au bng lan ta v dai dng, trong khi
thiu mu cc b mc treo trng mn tnh c th biu hin bng mt lot cc triu chng bao gm
au bng sau khi n, gim cn, bun nn, nn, tiu chy. Chp ng mch hoc MRI chp ng
mch ca ng mch l cc xt nghim chn on.
- V phnh ng mch v phnh ng mch ch bng c th trnh by vi cc triu chng bng
lan ta hoc bn a ha v c th bt chc cc iu kin khc nh thn au bng, vim ti tha,
vim ty, tng vnh km thiu mu cc b, thiu mu cc b mc treo rut, hoc bnh ng
mt cp tnh. Bnh nhn vi mt phnh ng mch ch bng b v, nhng ngi sng st lu
n phng cp cu c in biu hin au bng hay lng, h huyt p, v mt khi lng ung
ku bng. V phnh ng mch thng gy ra exsanguinating xut huyt v su sc, h huyt p
khng n nh.
- Phnh tch ng mch ch bng.
- Vim phc mc ton th.
- Tc rut nghim trng, au bng cp tnh khuch tn c th c gy ra bi hoc l tc nghn
mt phn hoc ton b rut.
10. au bng trong cc nhm bnh nhn c bit: ph n, ngi ln tui , bnh nhn AIDS, bnh hay
chy mu, v bnh nhn b bnh hng cu hnh lim.
Nn ch thm khi nh gi cc nhm i tng ny, nh ph n, ngi cao tui b au
bng (S 1).
S 1. Thut ton nh gi cn au bng cc nhm i tng c bit.

au bng ph n c th lin quan n bnh l ca cc c quan vng chu. U nang

bung trng, u x t cung, p xe bung trng v lc ni mc t cung l nhng nguyn
nhn ph bin ca cn au bng di ph n. ph n tui sinh , s quan tm c
bit n vic mang thai bao gm thai ngoi t cung v sy thai l rt quan trng trong
vic thnh lp mt chn on phn bit. Kh nng mang thai lm thay i kh nng ca
bnh v thay i ng k cch tip cn chn on (v d trnh tip xc bc x trong cc
xt nghim chn on).
Bnh nhn ln tui c cn au bng l mt thch thc chn on c bit. Tn s mc
bnh v nng c th tng cao nhm ngi ny (v d: mt t l cao hn bnh l ti
tha hay nhim trng ng niu). Biu hin c th khc ngi ln tui, v s ti khm
khng y hoc s gim nh ca cc triu chng nghim trng c th gy chn on
nhm. Mt s bnh cn c xem xt tt c cc bnh nhn ln tui c au bng bi v
t l gia tng v nguy c mc bnh v t vong nhng ngi ny. Nhim trng niu n,
thng tng rng, v bnh thiu mu rut l nhng nguy c t vong tim n ph bin
thng b b qua hay chn on mun nhng bnh nhn ln tui.
Ph n

- au bng di (au vng chu) ph n thng xuyn gy ra ri lon ca c quan sinh sn n.

Cc cn nguyn chnh ca au cp tnh l: vim vng chu, u nang phn ph chy mu, v xon, thai
ngoi t cung v au t cung do nhim trng hoc do s thoi ha, nhi mu, hoc xon leiomyomas.

- Bnh l phn ph - U nang v u bung trng, ng dn trng, hoc paraovarian hoc cc khu vc
paratubal c th gy au do v, chy mu, hoc xon.
+ Mi khi pht au gia chu k ph din ca mt u nang sinh l (nang trng hoc corpus luteum).
n tin mn kinh cho thy s hin
+ Giao hp au ngay lp tc sau y l gi ca u nang v.
+ t nhin au nng, thng i km vi bun nn v nn, l gi ca bung trng xon hoc mt
leiomyoma thoi ha. Cp tnh au m phng vim rut tha hoc vim phc mc cng c th l kt
qu ca nhi mu, thng hoc xut huyt vo hoc t mt khi u bung trng.
+ au km theo st cho thy mt nhim trng nh PID, vim rut tha, hay vim ti tha, nhng n
c th c lin kt vi xon (bung trng hoc leiomyoma) hoc thoi ha (leiomyoma).
+ Lc ni mc t cung triu chng thng gp ca bnh lc ni mc t cung bao gm au vng chu
mn tnh (m thng l nghim trng trong sut chu k kinh nguyt), au bng kinh, giao hp au,
chy mu kinh nguyt bt thng, v v sinh. au cp tnh, tuy nhin, c th xy ra do v ca
endometrioma.

+ Thai ngoi t cung.

Ngi gi:
Cc nguyn nhn ph bin ca au bng ngi gi bao gm vim rut tha, bnh phnh mch, thiu
mu cc b mc treo rut, vim ti tha, tc rut.
Nhim HIV: cc triu chng tiu ha v gan mt thng gp nht.

Bnh v mu:

Hemophilia - bnh hay chy mu mt cch t nhin c th pht trin mu t thnh rut, c th gy ra
cc triu chng ging nh vim rut tha cp. Vic chn on ca "gi vim rut tha" thng c th
c thc hin vi hnh nh CT, ln, phu thut l cn thit xc nh chn on.

Bnh t bo hnh lim - Bnh nhn b bnh hng cu hnh lim c th b au bng nh l mt phn
ca mt cuc khng hong vasoocclusive. Nhng cn au c th kh phn bit vi mt bng ngoi
khoa cp tnh (v d, vim rut tha, vim ti mt) v c th l do cc bnh nh si mt, nhi mu
lch, vim ty, vim i trng thiu mu cc b, v cc ri lon sinh dc khng phu thut. c bit
hay h sn phi.
11. bt k v tr no.

- RLTH: "Ri lon tiu ha l au bng dai dng hoc ti pht hoc kh chu vng bng trung
vng bng trn kh chu cp n mt cm gic ch quan tiu cc, iu khng t c mc
au theo bnh nhn. Tp trung cp n au hoc kh chu ch yu l a phng vng
 bng trn , n khng loi tr nhng bnh nhn c au hoc kh chu ni khc, tr khi h ch b
au nhng ni khc ". Chn on phn bit ca ri lon tiu ha bao gm bnh tro ngc d
dy, lot d dy, bnh ng mt, hi chng rut kch thch, vim ty mn tnh, ung th d dy,
ri lon tiu ha do thuc, bnh tm thn, gastroparesis tiu ng, bnh chuyn ha, tiu ha v
cc khi u c tnh tuyn ty, bnh tim thiu mu cc b, v au bng bc tng. M t chi tit
ca mt bnh nhn vi nhng hi chng c tho lun ni khc.
- Ng c.
- Thot v nght.
- Vim rut tha.
11. Nhm bnh l ngoi bng.

Ch : au bng khng phi lun lun c v tr c trng: trn bn phi, pha di bn phi, thng v,
rn, bn tri pha trn, bn tri, v lan ta khp bng. nhng v tr khng r rng cn loi tr v tr
cc vng ln cn.

D em c kin th ny:

Tip cn t au hsp: Bn ny au th ny l au cp tnh ri. Sau loi tr nguyn nhn nguy him, c cc
nhm cn ch : 1. H hp. 2. Tit niu. 3. Tiu ha ( gan mt, vim rut tha, vim ty cp).

Bn ny c them HCNT rt rm r, hi chng tc mt khng r, tin s ct ti mt. Do khu tr li, t

mun hi:

1. Bn nay c kh th khng? Nhp th bn l bao nhiu? C du hiu ho, khc m hay au ngc
gn y?
2. Tnh cht cn au ln ny? L cn au qun bng? Liu c ngh n si cc trn thn? Trung
tin? Liu c ngh n vim ty cp.
- Tm li, nu vn h hp loi c, t khu tr:
+ Vim ty cp: t c thy vim ty cp t st, hi i ngoi cng qun mt ri. huhu.
+ NT gan mt.
+ Vim rut tha: c m bn c m si mt ri, chc k nn t vn rut tha lc ch ln y
nh.
- C ni bn ny c Putb. Ci ny theo t cn phi xem li. Nu c tht nn xem xt vim ty cp,
vim rut tha. CUpm th th no?
- Nu hai ci trn loi tr, t ngh vn nn lm amylase xem c vtc khng? Km theo ngh n
bnh NT gan mt: Bn ny au st ti i ti li => ngh n si mt. vn na l apxe gan: n k
sn th no? Ci tnh cht au ca bn rt quan trng.

Hi