VIM PHC MC

Lp: Cao Hc Chn on Hnh nh

 NI
Mc tiu DUNG
nh ngha, Gii phu v sinh l hc

Phn loi v nguyn nhn

Triu chng lm sng v cn lm sng

Chn on v iu tr
 MC TIU
1. Trieu chng c nang, thc the va toan than cua
VPM toan the
2. Trnh bay c cac the VPM theo dien tien, theo mc
o lan tran
3. Ke ra c mot so nguyen nhan thng gap cua
VPM
4. Cac trieu chng chan oan lam sang, chan oan
nguyen nhan
5. Cach s dung cac phng tien can lam sang

6. Nguyen tac ieu tr noi khoa phoi hp

 L tnh trng vim ca l
NH NGHA phc mc do m, gi mc,
dch mt, dch tiu ha,
phn, dch ty.

VPM rt nhiu nguyn nhn:

-Vpm nguyn pht: ng mu, bch
huyt, ng t nhin
-Vpm th pht: do ly t nhim
trng khc
 - c cu to bi mt lp t bo trung m
GII PHU (mesothelial cells) c nhiu vi lng mao c
L PM
chiu di t 1 n 3 m lm tng din tch tip
xc
- Lt mt trong thnh bng, bc kn hoc che
ph 1 phn cc tng
- Din tch ~ 1,8 2,2 m2

- L mt khoang o cha ~ 75100ml dch

giu protein (3g/l) gm c:
+ Ti nh hay hu cung mc ni: sau d dy,
ni thng vi ti ln qua khe winslow
Xoang PM + Ti ln: l phn cn li gm: Tng trn, tng
di mc treo kt trng ngang v tiu khung
GII PHU
 - Chc nng c hc:
+ Lm trn cc tng bng dch snh trong khoang phc
mc
+ Treo cc tng trong xoang phc mc vi thnh bng

-Chc nng bo v: do mc ni ln c c hc v sinh hc

+ Cung cp i thc bo
SINH L + Cng vi cc tng ln cn khu tr vim nhim khng
cho lan trn vo khoang bng

-Chc nng hp thu: trao i cht thun li v mnh m:

+ Ti hp thu dch, mu, khng kh v cc cht kh
 Cm gic phc mc: ty theo tng vng
PM thanh bung trc: nhay cam nhat, cho
cam giac cu the ve v tr (he than kinh
hng than - somatic).
PM thanh bung sau - tieu khung: nhay cam kem
hn.
Phuc mac tang gan nh vo cam, thng b
kch thch do s cang dan.
Re mac treo : nhay cam oi vi s cang keo.
 Phn loi theo tc nhn:
+ Nhim khun
+ Ha Hc
Phn loi theo din tin:
+ Cp tnh
+ Mn tnh
PHN LOI
Phn loi theo mc lan trn:
+ Khu tr
+ Ton th

Phn loi theo nguyn nhn:

+ Nguyn pht
+ Th pht
 Vim rut tha:
+ Xut hin sau 24 48h
+ VPM khu tr hoc ton th
Thng d dy t trng:
+ Ch yu l do lot
NGUYN NHN + Mt s do chn thng, ung th...
ng tiu ha Thng hi trng:
+ Thng hn, thng cc mng
payer, thng vo ngy th 7 - 10

Thng v hoi t i trng:

+ Ch yu do ung th, do amip
+ Do v ti tha
NGUYN NHN TIU HA
 - p xe gan do amip, do nhim khun t
ng mt v:
+ Trc y hay gp
+ Thng v khun bi nhim
GAN V
NG MT
-VPM do ng mt:
+ Thm mt phc mc
+ Vim phc mc mt
 Thng t cung sau no ph thai:
+ Xut hin sau 24 48h

p xe phn ph v:
+ Ch yu l gy VPM vng chu
NGUYN NHN
KHC Chn thng v vt thng bng:
+ Chn thng v cc tng trong
bng hoc vt thng thu bng

Sau phu thut:

+ Thng kh chn on
+ Thng sai st do li k thut
TRIU CHNG LM SNG
Triu chng c nng

Triu chng thc th

Triu chng ton thn

 TRIU CHNG C NNG
au
TRIU CHNG
 TRIU CHNG THC TH
Co
KHM THC TH
 TRIU CHNG TON THN
Nhim
XtCN
nghimLM
mu, haSNG
sinh

X quang

Siu m
Ct lp vi tnh, MRI
 - Bach cau tang cao15.000-
20.000/mm3
HUYT - Bach cau a nhan trung tnh chiem
HC a so
- So lng bach cau > 25.000/mm3
hoac < 4.000/ mm3 la yeu to tien
lng xau, t vong cao.

HA - Ure mau va creatinine mau tang

cao
SINH - Nhiem toan chuyen hoa, thieu hut
cac ion Na+, K+, Cl.
 X QUANG
- Chup bung khong sa soan t the ng hoac nam
nghieng, hoac t the na nam na ngoi neu benh
nhan qua yeu.
- Hnh anh chung :
Toan the bung m hoac thanh ruot day v trong
xoang bung co dch.
Vai quai ruot gian cha ay hi v liet.
ng sang hai ben bung mat i hay ngat quang
(dau hieu Laurell).

- Hnh anh ac trng

Liem hi di hoanh trong thung ng tieu hoa.
Bong gan to trong ap xe gan v.
 LIM HI
DI C HONH

QUAI RUT GC
LIT RUT
 SIU M - CT
- Cho thay co dch trong xoang bung, xac
nh v tr, so lng va theo doi tu dch,
xc nh l dch n thun hay dch c
mu v m c bit l trn chp ct lp
vi tnh
- Hng dan cho choc do dch tu.
- Gip pht hin, xc nh nguyn nhn
dn n vim phc mc
VIM TI MT C BIN CHNG
 CHN ON XC NH

au bng

Co cng thnh bng v cm ng phc mc

Hi chng nhim trng

 Mt s trng hp kh chn on
H tr ca cn
lm sng
- Tr nh
- Ngi gi X quang
- Thnh bng qu dy hoc qu nhiu m
- Sn ph trong thi k chuyn d sinh
- Bnh nhn ang c iu tr khng sinh Chc d dch bng
- Vim phc mc sau m
- Bnh nhn c dng thuc gim au
- Bnh nhn nghin thuc phin
CHN ON NGUYN NHN

Triu chng au lc khi u

Ni au nhiu nht

Ni thnh bng co cng nhiu nht

Bnh s
 IU TR

NGUYN TC

VPM th pht, cp tnh l s kt hp ngoi khoa vi ni khoa. Ch nh

m tuyt i nhng bao gi cng c ni khoa h tr

VPM mn tnh khng m tr khi c bin chng tc rut

VPM nguyn pht, xoang bng t dch cng khng m, ch iu tr ni

khoa
 IU TR NI KHOA
Hi sc H st

- iu chnh nc, in gii

- Hi sc tim mch

Chng nhim trng t ng Levin ht d dy

- Nhim trng cha xc nh:
khng sinh ph rng v kt hp
- Nhim trng xc nh: theo Rut bt cng au, bnh
nhn d th
khng sinh
 Thi gian iu tr ni khoa trc m

Ph thuc vo tnh trng bnh nhn khi vo vin

Hi sc ph thuc kt qu hi sc
 NGOI KHOA

Loi b nguyn nhn

Thanh ton nhim trng trong khoang bng

 Cc bc tin hnh phu thut

Chn ng m Lm sch khoang bng ng bng

1 2 3 4 5 6

V cm X l nguyn nhn Dn lu
V cm

Gy m ni kh qun

Bnh nng, nhim c, gi yu,

nhiu bnh phi hp th gy t
v lm phu thut ti thiu
 Chn ng m

Thm st v x l thng tn d

Lau ra khoang bng sch

Vt m t nhim trng
 X l nguyn nhn

Kim sot nhim khun: ct b phn bnh, a phn ra ngoi,

dn lu, ct lc, hu mn nhn to gii p ng tiu ha
 Lm sch khoang bng

Nu khng lm sch s to p xe ti cng Douglas, di honh, gia cc

quai rut, to dy dnh tc rut

VPM ton th: ra bng dung dch nc mui sinh l n khi dch trong

VPM khu tr: lau chm, sch ti ch bng gc t

Ht ra bng bng nc mui sinh l
 Dn lu

Cho dch, m trong lc m cha ly ht

chy ra ngoi

Ch : nhim trng ngc dng, thng

ng mch, lm try xc thanh mc
ng bng
 CHM SC SAU M

Ton thn

Bi ph nc, in gii

nh gi cc ri lon chc nng tim, gan, phi nu c

Suy thn do VPM n tr c khi cn chy thn nhn to

Dinh dng: truyn ng, m, mu. Khi trung tin th

cho n bng ng ming
 CHM SC SAU M

Ti ch

Ht lin tc vi p sut nh (20 30 cm H20)

ng dn lu
Theo di tnh cht dch mi ngy nh ngy
rt b ng ng lc.

Nu nhim trng th ct ch
Vt m
Nu ng bng mt lp, ct ch mun ngy th
14-15
 CHM SC SAU M

Vn ng sm

Kch thch nhu ng rut

Ngy u sau m: cho bnh nhn ln tr trn ging

Sau: cho tp ngi dy, i li

Phng nga cc bin chng v phi, nhim trng ng tiu, huyt

khi tnh mch v cn to tm l mau lnh bnh
 CHM SC SAU M

Pht hin bin chng

Nguyn nhn: ra bng khng sch, khng ht dch bn, dn

lu khng ng cch, nguyn nhn VPM cha c loi tr

- p xe tn lu
- Bc, x, d ng khu
- Tc rut sau m
- Bin chng mun: tc rut
 Cm n s lng nghe
ca thy c v cc bn!!!