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Map 3.9 Viêm t y
VIÊM T Y C P
Viêm t y c p là gì?
Là s viêm c a nhu mô t y, kèm tăng n ng đ enzyme
amylase và lipase trong xét nghi m máu.
Tri u ch ng:
PAN
•
Đau thư ng v lan ra sau lưng (Pain)
•
Chán ăn (Anorexia)
•
Bu n nôn và nôn. (Nausea)
•
D u Grey Turner: b m vùng hông.
•
D u Cullen: b m quanh r n.
Nguyên nhân
Nh : Em Th y R ng Có Thu c B nh S S m Qua Thôi
•
ERCP: ch p m t t y ngư c dòng qua n i soi
•
T mi n
•
Rư u
VIÊM T Y M N
Viêm t y m n là gì?
Là khi tính toàn v n c u trúc c a t y b thay đ i do h u
qu tr c ti p c a tình tràng viêm m n
Tri u ch ng
Đau !
•
Kh i phát thư ng v
•
L p đi l p l i
•
Lan ra sau lưng
•
Gi m khi ng i ng ra trư c
•
Tăng khi ăn u ng th nh so n
Nguyên nhân
Nh : Sún Răng Thì X u
•
Suy dinh dư ng
•
Rư u
•
T c ng t y
•
Xơ nang t y
•
Scorpion sting (Tityus trinitatis).
•
Mumps.
•
Autoimmune disease.
•
Steroids.
•
Hyperlipidaemia/Hypercalcaemia.
•
Endoscopic retrograde cholangiopancreatography (ERCP).
•
Drugs, e.g. azathioprine.
Investigations
•
Raised serum amylase and lipase.
•
Detect cause, e.g. ultrasound scan to detect presence of
gallstones.
•
CT scan to rule out complications (not within <72 h of acute
presentation unless clinically indicated).
Treatment
•
This is usually symptomatic relief. Keep ‘nil by mouth’ (NBM),
IV fluids and analgesia, e.g. tramadol
•
Treat underlying causes, e.g. ERCP to remove gallstones.
Complications
Remember these as HDAMN:
•
Haemorrhage.
•
Disseminated intravascular coagulation (DIC).
•
Acute respiratory distress syndrome (ARDS).
•
Multiorgan failure.
•
Necrosis.
Investigations
•
Decreased faecal elastase.
•
CT scan: shows calcification (may also be seen on
abdominal X-ray).
•
Magnetic resonance cholangiopancreatography (MRCP).
Treatment
•
Conservative: alcohol cessation.
•
Medical: analgesia, e.g. tramadol and pancreatic enzyme
replacement therapy; start insulin therapy if diabetes has
developed.
Complications
Remember these as PODS:
•
Pseudocysts.
•
Obstruction (pancreatic).
•
Diabetes mellitus.
•
Steatorrhoea.
MAP 3.9 Viêm t y
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