{"id":2857,"date":"2023-04-09T23:10:06","date_gmt":"2023-04-09T16:10:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2857"},"modified":"2023-04-13T18:23:28","modified_gmt":"2023-04-13T11:23:28","slug":"viem-tuy-cap-dinh-nghia-cac-the-benh-theo-atlanta-2012","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/viem-tuy-cap-dinh-nghia-cac-the-benh-theo-atlanta-2012\/","title":{"rendered":"Vi\u00eam t\u1ee5y c\u1ea5p: \u0111\u1ecbnh ngh\u0129a c\u00e1c th\u1ec3 b\u1ec7nh theo Atlanta 2012."},"content":{"rendered":"

Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t \u0111\u1ee3t vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o t\u1ee5y c\u1ea5p t\u00ednh, v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n. K\u00e8m theo t\u00ecnh tr\u1ea1ng t\u0103ng amylase ho\u1eb7c lipase v\u00e0\/ho\u1eb7c b\u1eb1ng ch\u1ee9ng tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc vi\u00eam, ph\u00f9 n\u1ec1, ho\u1eb7c ho\u1ea1i t\u1eed t\u1ee5y. Sau \u0111\u1ee3t c\u1ea5p, t\u1ee5y c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 kh\u00f4ng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n n\u1ebfu ho\u1ea1i t\u1eed t\u1ee5y nhi\u1ec1u. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u \u0111\u1ee3i vi\u00eam t\u1ee5y c\u1ea5p t\u00e1i ph\u00e1t, vi\u00eam c\u1ea5p, ho\u1ea1i t\u1eed, ch\u1ebft ch\u01b0\u01a1ng tr\u00ecnh t\u1ebf b\u00e0o c\u00f3 th\u1ec3 chuy\u1ec3n th\u00e0nh vi\u00eam m\u1ea1n v\u00e0 x\u01a1 h\u00f3a \u2013 \u0111\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam t\u1ee5y m\u1ea1n. Vi\u00eam t\u1ee5y c\u1ea5p v\u00e0 vi\u00eam t\u1ee5y m\u1ea1n n\u1eb1m trong c\u00f9ng m\u1ed9t ti\u1ebfn tr\u00ecnh t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh v\u00e0 c\u00f3 th\u1ec3 kh\u00f3 ph\u00e2n bi\u1ec7t vi\u00eam t\u1ee5y c\u1ea5p t\u00e1i ph\u00e1t v\u1edbi vi\u00eam t\u1ee5y m\u1ea1n.<\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a c\u00e1c th\u1ec3 vi\u00eam t\u1ee5y c\u1ea5p.<\/strong><\/h2>\n

Vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 th\u1ec3 chia ra 2 th\u1ec3: vi\u00eam t\u1ee5y ph\u00f9 n\u1ec1 m\u00f4 k\u1ebd v\u00e0 vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed.<\/p>\n

Vi\u00eam t\u1ee5y ph\u00f9 n\u1ec1 m\u00f4 k\u1ebd.<\/strong><\/em>
\n\u0110a s\u1ed1 b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 ph\u00f9 n\u1ec1 (t\u0103ng k\u00edch th\u01b0\u1edbc) t\u1ee5y lan t\u1ecfa (\u0111\u00f4i khi khu tr\u00fa) do vi\u00eam. Phim c\u1eaft l\u1edbp vi t\u00ednh b\u1ee5ng c\u1ea3n quang (CECT) c\u00f3 th\u1ea5y t\u1ee5y c\u00f3 \u0111\u1eadm \u0111\u1ed9 \u0111\u1ed3ng nh\u1ea5t, m\u1ee1 quanh t\u1ee5y th\u01b0\u1eddng c\u00f3 thay \u0111\u1ed5i vi\u00eam. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng h\u1ebft trong 1 tu\u1ea7n. Chi\u1ebfm kho\u1ea3ng 85% b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p, trong \u0111\u00f3 ch\u1ec9 kho\u1ea3ng 10% c\u00f3 suy t\u1ea1ng, >90% b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed.<\/strong><\/em>
\nKho\u1ea3ng 5 \u2013 10% (4-47%) b\u1ec7nh nh\u00e2n di\u1ec5n ti\u1ebfn \u0111\u1ebfn ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y, m\u00f4 quanh t\u1ee5y ho\u1eb7c c\u1ea3 hai. Th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n ho\u1ea1i t\u1eed \u1edf c\u1ea3 m\u00f4 t\u1ee5y v\u00e0 m\u00f4 quanh t\u1ee5y. Di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a ho\u1ea1i t\u1eed t\u1ee5y v\u00e0 m\u00f4 quanh t\u1ee5y r\u1ea5t thay \u0111\u1ed5i, c\u00f3 th\u1ec3 c\u00f2n m\u00f4 r\u1eafn ho\u1eb7c ho\u1ea1i t\u1eed l\u1ecfng, c\u00f3 th\u1ec3 v\u00f4 tr\u00f9ng ho\u1eb7c nhi\u1ec5m khu\u1ea9n, c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i ho\u1eb7c bi\u1ebfn m\u1ea5t theo th\u1eddi gian. Trung b\u00ecnh c\u00f3 33% (16 \u2013 47%) c\u00f3 nhi\u1ec5m khu\u1ea9n.
\nHo\u1ea1t t\u1eed c\u00f3 nhi\u1ec5m tr\u00f9ng: nghi ng\u1edd khi c\u00f3 kh\u00ed ngo\u00e0i \u1ed5 t\u1ee5y\/m\u00f4 quanh t\u1ee5y tr\u00ean CECT ho\u1eb7c khi ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf (FNA) qua da, nhu\u1ed9m Gram v\u00e0 c\u1ea5y c\u00f3 vi khu\u1ea9n v\u00e0\/ho\u1eb7c n\u1ea5m.<\/p>\n

3. \u0110\u1ecbnh ngh\u0129a c\u00e1c bi\u1ebfn ch\u1ee9ng vi\u00eam t\u1ee5y.<\/strong><\/h2>\n

3.1. Bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7.<\/strong><\/h3>\n

\u0110\u1ed1i v\u1edbi vi\u00eam t\u1ee5y ph\u00f9 n\u1ec1:<\/strong><\/em>
\n– T\u1ee5 d\u1ecbch quanh t\u1ee5y c\u1ea5p<\/strong> (<4 tu\u1ea7n). T\u1ee5 d\u1ecbch th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a vi\u00eam t\u1ee5y. Tr\u00ean CECT, t\u1ee5 d\u1ecbch kh\u00f4ng c\u00f3 th\u00e0nh, th\u1ea5y \u1edf m\u1eb7t ph\u1eb3ng c\u00e2n c\u01a1, n\u1eb1m sau ph\u00fac m\u1ea1c, c\u00f3 th\u1ec3 nhi\u1ec1u. \u0110a s\u1ed1 t\u1ee5 d\u1ecbch v\u00f4 tr\u00f9ng v\u00e0 t\u1ef1 kh\u1ecfi kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb. Khi k\u00e9o d\u00e0i >4 tu\u1ea7n, c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh nang gi\u1ea3 t\u1ee5y. Th\u01b0\u1eddng kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 kh\u00f4ng g\u00e2y vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng. Ti\u00eau chu\u1ea9n tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc: \u0111\u1eadm \u0111\u1ed9 \u0111\u1ed3ng nh\u1ea5t, x\u00e1c \u0111\u1ecbnh tr\u00ean m\u1eb7t ph\u1eb3ng c\u00e2n c\u01a1 quanh t\u1ee5y, kh\u00f4ng th\u00e0nh, n\u1eb1m g\u1ea7n t\u1ee5y.<\/p>\n

– Nang gi\u1ea3 t\u1ee5y<\/strong> (>4 tu\u1ea7n). L\u00e0 m\u1ed9t t\u1ee5 d\u1ecbch \u1edf m\u00f4 quanh t\u1ee5y (\u0111\u00f4i khi n\u1eb1m trong t\u1ee5y m\u1ed9t ph\u1ea7n\/ho\u00e0n to\u00e0n) \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi th\u00e0nh nang. Th\u00e0nh ph\u1ea7n trong nang ch\u1ec9 c\u00f3 d\u1ecbch. Hi\u1ebfm g\u1eb7p, ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o CECT, MRI, si\u00eau \u00e2m. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n: \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi m\u1ed9t th\u00e0nh gi\u1edbi h\u1ea1n r\u00f5, tr\u00f2n ho\u1eb7c ovan, d\u1ecbch thu\u1ea7n tr\u1ea1ng, \u0111\u1ed9 tr\u01b0\u1edfng th\u00e0nh >4 tu\u1ea7n.<\/p>\n

\"Nang<\/p>\n

Vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed:<\/em><\/strong>
\n– T\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u1ea5p<\/strong> (<4 tu\u1ea7n). L\u00e0 t\u00ecnh tr\u1ea1ng t\u1ee5 d\u1ecbch v\u00e0 m\u00f4 ho\u1ea1i t\u1eed c\u1ee7a m\u00f4 t\u1ee5y v\u00e0\/ho\u1eb7c m\u00f4 quanh t\u1ee5y trong 4 tu\u1ea7n \u0111\u1ea7u. Kh\u00e1c v\u1edbi t\u1ee5 d\u1ecbch quanh t\u1ee5y \u1edf ch\u1ed7 ch\u1ee9a th\u00e0nh ph\u1ea7n \u0111\u1eb7c, c\u00f3 th\u1ec3 li\u00ean quan v\u1ee1 \u1ed1ng t\u1ee5y ch\u00ednh trong nhu m\u00f4 g\u00e2y ho\u1ea1i t\u1eed v\u00e0 c\u00f3 th\u1ec3 nhi\u1ec5m tr\u00f9ng. Trong tu\u1ea7n \u0111\u1ea7u c\u00f3 th\u1ec3 kh\u00f3 ph\u00e2n bi\u1ec7t do c\u00f9ng \u0111\u1eadm \u0111\u1ed9 d\u1ecbch. Sau tu\u1ea7n \u0111\u1ea7u ti\u00ean, c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t d\u1ef1a tr\u00ean xu\u1ea5t hi\u1ec7n m\u00f4 ho\u1ea1i t\u1eed th\u1ea5y tr\u00ean CECT, MRI, si\u00eau \u00e2m. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n: ch\u1ec9 x\u1ea3y ra trong vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed c\u1ea5p, d\u1ecbch kh\u00f4ng thu\u1ea7n tr\u1ea1ng, kh\u00f4ng c\u00f3 th\u00e0nh r\u00f5, v\u1ecb tr\u00ed t\u1ea1i t\u1ee5y ho\u1eb7c ngo\u00e0i t\u1ee5y.<\/p>\n

– Ho\u1ea1i t\u1eed th\u00e0nh h\u00f3a<\/strong> (>4 tu\u1ea7n). M\u00f4 ho\u1ea1i t\u1eed \u0111\u01b0\u1ee3c bao xung quanh b\u1edfi th\u00e0nh vi\u00eam gi\u1edbi h\u1ea1n r\u00f5 l\u00e0 m\u00f4 t\u0103ng sinh do ph\u1ea3n \u1ee9ng, th\u01b0\u1eddng c\u00f3 t\u1eeb 4 tu\u1ea7n. ho\u1ea1i t\u1eed th\u00e0nh h\u00f3a b\u1eaft ngu\u1ed3n t\u1eeb m\u00f4 t\u1ee5y v\u00e0\/quanh t\u1ee5y ho\u1ea1i t\u1eed, c\u00f3 th\u1ec3 nhi\u1ec5m tr\u00f9ng v\u00e0 c\u00f3 th\u1ec3 n\u1eb1m xa t\u1ee5y. CECT c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c th\u00e0nh ph\u1ea7n \u0111\u1eb7c\/d\u1ecbch trong nang v\u00e0 c\u00f3 th\u1ec3 l\u1ea7m th\u00e0nh nang gi\u1ea3 t\u1ee5y. MRI v\u00e0 si\u00eau \u00e2m c\u00f3 th\u1ec3 gi\u00fap ph\u00e2n bi\u1ec7t. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n: C\u00f3 \u0111\u1eadm \u0111\u1ed9 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, th\u00e0nh gi\u1edbi h\u1ea1n r\u00f5, \u0111\u01b0\u1ee3c bao b\u1ecdc ho\u00e0n to\u00e0n, c\u00f3 th\u1ec3 n\u1eb1m \u1edf t\u1ee5y ho\u1eb7c ngo\u00e0i t\u1ee5y.<\/p>\n

– Ho\u1ea1i t\u1eed nhi\u1ec5m khu\u1ea9n<\/strong>. Nghi ng\u1edd khi di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng n\u1eb7ng, c\u00f3 kh\u00ed trong t\u1ee5 d\u1ecbch tr\u00ean CECT, c\u00f3 th\u1ec3 c\u00f3 m\u1ee9c kh\u00ed d\u1ecbch ho\u1eb7c kh\u00f4ng.
\n– T\u1eafc t\u00e1 tr\u00e0ng v\u00e0 \u0111\u01b0\u1eddng m\u1eadt.
\n– Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a: lo\u00e9t do stress, gi\u1ea3 ph\u00ecnh m\u1ea1ch.<\/p>\n

3.2. Bi\u1ebfn ch\u1ee9ng h\u1ec7 th\u1ed1ng.<\/strong><\/h3>\n

– G\u00e2y \u0111\u1ee3t c\u1ea5p c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc nh\u01b0 b\u1ec7nh m\u1ea1ch v\u00e0nh ho\u1eb7c b\u1ec7nh ph\u1ed5i m\u1ea1n kh\u1edfi ph\u00e1t.
\n– Suy t\u1ea1ng tho\u00e1ng qua ho\u1eb7c k\u00e9o d\u00e0i. X\u00e1c \u0111\u1ecbnh suy t\u1ea1ng d\u1ef1a v\u00e0o h\u1ec7 th\u1ed1ng ph\u00e2n \u0111\u1ed9 Marshall s\u1eeda \u0111\u1ed5i, suy t\u1ea1ng tho\u00e1ng qua khi h\u1ed3i ph\u1ee5c trong 48h v\u00e0 k\u00e9o d\u00e0i h\u01a1n 48h. Suy >1 t\u1ea1ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 suy \u0111a t\u1ea1ng. M\u1ee9c \u0111\u1ed9 suy t\u1ea1ng l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p giai \u0111o\u1ea1n s\u1edbm (tu\u1ea7n \u0111\u1ea7u).
\nThang \u0111i\u1ec3m Marshall d\u1ef1a tr\u00ean 3 ti\u00eau ch\u00ed: h\u00f4 h\u1ea5p (PaO2\/FiO2), th\u1eadn (creatinine huy\u1ebft thanh) v\u00e0 tim m\u1ea1ch (huy\u1ebft \u00e1p t\u00e2m thu).
\n– C\u1ee5 th\u1ec3:<\/strong>
\n+ H\u1ea1 huy\u1ebft \u00e1p v\u00e0 cho\u00e1ng.
\n+ H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p ng\u01b0\u1eddi l\u1edbn.
\n+ Suy th\u1eadn c\u1ea5p.
\n+ \u0110\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa.
\n+ H\u1ea1 Calci m\u00e1u.
\n+ T\u0103ng triglycerid m\u00e1u.
\n+ T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft.
\n+ B\u1ec7nh l\u00fd n\u00e3o v\u00e0 h\u00f4n m\u00ea.<\/p>\n

Tr\u00ean 80% b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n kh\u00f4ng di\u1ec5n ti\u1ebfn \u0111\u1ebfn vi\u00eam t\u1ee5y m\u1ea1n. T\u1ec9 vong th\u01b0\u1eddng do suy \u0111a t\u1ea1ng ti\u1ebfn tri\u1ec3n, do b\u1ea3n th\u00e2n vi\u00eam t\u1ee5y c\u1ea5p ho\u1eb7c do nhi\u1ec5m tr\u00f9ng b\u1ec7nh vi\u1ec7n, bao g\u1ed3m nhi\u1ec5m tr\u00f9ng c\u1ee7a t\u1ee5 d\u1ecbch t\u1ee5y ho\u1eb7c ho\u1ea1i t\u1eed m\u00f4 t\u1ee5y.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:
\nClassification of acute pancreatitis\u20142012: revision of the Atlanta classification and definitions by international consensus<\/p>\n

Goldman-Cecil Medicine, 26e.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t \u0111\u1ee3t vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o t\u1ee5y c\u1ea5p t\u00ednh, v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n. K\u00e8m theo t\u00ecnh tr\u1ea1ng t\u0103ng amylase ho\u1eb7c lipase v\u00e0\/ho\u1eb7c b\u1eb1ng ch\u1ee9ng tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc vi\u00eam, ph\u00f9 n\u1ec1, ho\u1eb7c ho\u1ea1i t\u1eed t\u1ee5y. Sau \u0111\u1ee3t c\u1ea5p, t\u1ee5y c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i ch\u1ee9c […]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nVi\u00eam t\u1ee5y c\u1ea5p: \u0111\u1ecbnh ngh\u0129a c\u00e1c th\u1ec3 b\u1ec7nh theo Atlanta 2012. - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t \u0111\u1ee3t vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o c\u1ea5p. 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