ÁP XE GAN DO AMIP Ở TRẺ EM

DANH MỤC CHIA SẼ
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1. ĐẠI CƯƠNG

   Áp xe gan do amip chiếm # 10% các trường hợp áp xe gan.

  Vị trí ở gan phải, thường là ổ mủ lớn đơn độc (trên 80%), và nó có xu hướng phát triển về phía vỏ gan.

  Chất mủ trong ổ áp xe thường có màu sô cô la, soi tươi mủ thấy amíp tỉ lệ rất thấp (dưới 15%).

2. TRIỆU CHỨNG

a. Lâm sàng:

Bệnh thường xảy ra trên người bệnh sau khi bị nhiễm trùng tiêu hóa, sau bị hội chức lỵ ( sau khi bị tiêu lỏng có đàm và mót rặn, thường gọi là kiết lỵ..).

– Sốt: khởi đầu sốt cao 39 – 40oC, vã mồ hôi hoặc có cơn lạnh run, sau đó giảm dần 37,5 – 38oC.

– Đau hạ sườn phải, có thể lan lên vùng bả vai phải, ra phía sau lưng. Đau tăng lên khi ho, hắt hơi, khi đi lại, nằm nghiêng phải, khi hít sâu vào. Đau làm người bệnh thường thở nông và thở bằng ngực.

– Có thể bệnh bị ho, nấc cụt, nôn ói do cơ hoành bị kích thích.

– Sụt cân.

– Khám: gan to, mềm, rung gan (+) (rất có giá trị trong chẩn đoán), ấn kẽ xườn (+) (dấu hiệu Ludlow (+): ấn kẽ sườn IX, đường nách trước giữa đau chói). Nghe đáy phổi phải: phế âm giảm.

– Ở một số ít trường hợp có thể bị vàng da do tế bào gan bị hủy hoại.

b. Cận lâm sàng

– XN máu: Bạch cầu tăng, tốc độ lắng máu tăng, men gan và phosphatase kiềm tăng.

– 95% trường hợp có huyết thanh chẩn đoán amip (+).

– Siêu âm: giai đoạn viêm gan chưa hình thành ổ mủ dễ bị bỏ qua, siêu âm nhiều lần có thể phát hiện ổ áp xe sớm.

– XQ tim phổi thẳng: bóng gan to, cơ hoành phải bị nâng cao, ít dịch ở góc sườn hoành phải, áp xe có thể vở lên gây tràn dịch màng phổi.

– CT-Scan: có thể phát hiện ổ áp xe dưới 1cm.

– Chẩn đoán xác định dựa vào:

   . Đau vùng hạ sườn phải

   . Gan to mềm đau

   . Rung gan (+), ấn kẽ sườn (+)

   . Huyết thanh chẩn đoán Amibe.

   . Siêu âm, chọc dò ra mủ xô cô la.

Chẩn đoán phân biệt với:

   . Nang gan bội nhiễm, áp xe gan do nhiễm trùng.

   . Nang đường mật.

   . U gan có hoại tử trong u….

3. BIẾN CHỨNG

  Ổ áp xe gan Amibe thường bội nhiễm vi trùng, số ít có thể gay nhiễm trùng huyết và sốc.

  Ổ áp xe có thể vỡ vào màng phổi gây tràn mủ màng phổi; vào màng tim gây chèn ép tim; vào phổi – phế quản gây áp xe phổi; vào ổ phúc mạc gây viêm phúc mạc.

  Ap xe gan có thể gây chảy máu đường mật…

BSCKII. NGUYỄN TRỌNG NGHĨA

apxegan
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