sinh li benh

7/31/2019 Sinh Li Benh

1/78

BI GING

Sinh l bnh

KHOA NI

I TNG: H IU DNG CAO NG

(LU HNH NI B)

TRNG CAO NG Y T QUNG NAM


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BIN SON

Ths. Nguyn nh Tun KhoaNi, Trng Cao ng Y t Qung Nam

Ths. V Th Hng Hnh KhoaNi, Trng Cao ng Y t Qung Nam

Bs. V Quc Vit KhoaNi, Trng Cao ng Y t Qung Nam

Bs. Hunh Vn Ngh KhoaNi, Trng Cao ng Y t Qung Nam


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LI GII THIU

Gio trnh Sinh l hc dnh cho i tng Cao ng y t v ang theo

hc ti trng Cao ng Y t Qung Nam c cc bc s khoa Ni bin sonda trn chng trnh khung cho gio dc cao ngchuyn nghip nhm ngnh

khoa hc sc khe do B Y t ban hnh.

Cc bc s ca khoa Ni tham kho nhiu ti liu vit cc bi ging ph

hp vi i tng hc sinh v thi lng cho php ca khung chng trnh.

Trong thi gian 3 - 5, chng ti s c gng cp nht kin thc mi v ng thi

trong qu trnh ging dy, cc sai st cng s c khoa ch chnh sa. C hng

ti khuyn khch cc em sinh vin tham kho thm nhiu nhng gio trnh, sch

gio khoa, sch tham kho khc cng ch b sung thm nhng kin thc

cn cha trong gio trnh ny.

Mc d c gng nhiu nhng do kin thc v thi gian cn hn ch, chc

chn gio trnh cn nhiu thiu st. Chng ti mong nhn c s gp ca cc

ng nghip v cc em sinh vin nhng ln in sau c hon chnh hn.

Khoa Ni xin cm n s ng vin, gip nhiu t Ban gim hiu nh

trng, phng o to chng ti c th hon thnh kp tp ti liu ny a

vo ging dy.

Ban bin tp Khoa Ni


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MC LC

KHI NIM V BNH ................................................................................................. 5KHI NIM V BNH NGUYN ............................................................................... 9KHI NIM V BNH SINH .................................................................................... 13RI LON CHUYN HA GLUCID ........................................................................ 16RI LON CHUYN HA PROTID ........................................................................ 21RI LON CHUYN HA LIPID............................................................................. 26SINH L BNH H H HP..................................................................................... 29SINH L BNH H TUN HON............................................................................ 33SINH L BNH TIU HA ....................................................................................... 40SINH L BNH CHC NNG GAN ........................................................................ 46SINH L BNH CHC NNG THN...................................................................... 51SINH L BNH QU TRNH VIM ........................................................................ 56RI LON CHUYN HA NC- IN GII ...................................................... 59RI LON THNG BNG ACID BASE ............................................................... 62SINH L BNH IU HA THN NHIT ............................................................. 65RI LON CU TO MU ...................................................................................... 71


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MN SINH L BNH

I TNG:CD, CXN

TT NI DUNG LT

1. Ri lon chuyn ha glucid, protid, lipid 4

2. Ri lon chuyn ha nc-in gii, ri lon cn bng acid base 4

3. Sinh l bnh c quan tiu ha 4

4. Sinh lbnh c quan to mu 4

5. Sinh l bnh c quan h hp 4

6. Sinh l bnh c quan tit niu 47. Sinh l bnh c quan tun hon 4

8. Sinh l bnh chc nng gan 4

Tng s 32


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KHI NIM V BNH(1 tit)

MC TIU HC TP

1. Trnh by khi qut cc quan nim v bnh trong lch s y hc.

2. Trnh by c quan nim v bnh hin nay v cc thi k ca bnh.

Bnh l g?

t thi nguyn thy n nay, khi nim v bnh thay i nhiu qua thi

gian. S thay i ny ph thuc 2 yu t:

- Trnh vn minh ca x hi ng thi.

- Th gii quan (bao gm c trit hc) ca mi thi i.

Trong mt x hi, c th ng thi xut hin nhiu khi nim v bnh, k c nhng

khi nim i lp nhau. Mt quan nim v bnh bao gi cng chi phi cht ch ccnguyn tc cha bnh, phng bnh. Do vy n c vai tr rt ln trong thc hnh.

1. Mt s khi nim v bnh trong lch s

1.1. Thi mng mui

Ngi nguyn thy khi bit t duy cho rng bnh l s trng pht ca cc ng thn

linh i vi con ngi. Vi quan nim nh vy, ngi xa cha bnh ch yu bng

cch dung l vt cu xin (c th cu xin trc tip hoc qua nhng ngi hnh ngh

m tn d oan).

Tuy nhin, thi gian ny ngi nguyn thy bt u bit dng thuc t tho dc cha mt s bnh.

1.2. Thi cc nn vn minh c i

1.2.1. Trung Quc c i

- Khong 2-3 ngn nm trc cng nguyn, y hc Trung Quc chu nh hng ln

ca trit hc ng thi, cho rng vn vt c cu to t 5 nguyn t (Ng hnh:

Kim, Mc, Thy, Ha, Th), tn ti di 2 mt i lp (m v Dng)trong quan h

h tr hoc ch p ln nhau (tng sinh hoc tng khc). T dn n quan nimcho rng:

+Bnh l do s mt cn bng m dng, ri lon quan h tng sinh tng khc ca

Ng hnh trong c th.

+ T , nguyn tc cha bnh l iu chnh s mt cn bng : kch thch

mt yu (b), ch p mt mnh (t).

-Nhn xt:Quan nim v bnh y l duy vt, cc th lc siu linh bt u b loi

tr khi vai tr gy bnh. Tuy nhin, y mi ch l trnh duy vtht sc th s

(cho rng vt cht ch gm 5 nguyn t); quan nim ny t ra bt bin trong nhiu

K


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ngn nm, khng vn dng c cc thnh tu v i ca khoa hc t nhin khc vo

y hc.

1.2.2. Hy Lp v La M c i

Ra i mun hn Trung Quc hng ngn nm. Gm c 2 trng phi ln:

- Trng phi Pythagore (600 nm trc cng nguyn):cho rng vn vt do 4 nguyn

t to thnh: Th (kh), Kh (m), Ha (nng), Thy (lnh). Trong c th, nu 4 yu

t ph hp v t l, tnh cht v s cn bng s to ra sc khe; nu ngc li s

sinh bnh.

- Trng phi Hippocrat (500 nm trc cng nguyn):cho rng c th c 4 dch, tn

ti theo t l ring, cn bng to ra sc khe, l:

+ Mu : do tim sn xut, mang tnh nng; ng nhn xt rng khi c th b s t th tim

p nhanh v da . l do tim tng cng sn xut mu .

+ Dch nhy: do no sn xut, mang tnh lnh; ng nhn xt rng khi c th b lnh thdch mi chy ra rt nhiu.

+ Mu en: do lch sn xut, mang tnh m.

+ Mt vng: do gan sn xut, mang tnh kh.

Hippocrat c cng lao rt ln trong vic tch y hc ra khi nh hng ca

tn gio, ch trng chn on bnh bng triu chng khch quan, cao o c y

hc.

-Nhn xt:Quan nim v bnh l duy vt v bin chng d cn th s. Nhng quan

st trc tip ca Hippocrat kh c th (4 dch l c tht) v cho php kim chngc. Chnh v vy, Hippocrat c tha nhn l ng t ca y hc ni chung (c y hc

c truyn v hin i)

1.2.3. Thi Phc hng

- Th k 16-17, x hi thot khi thn quyn, khoa hc pht trin n r vi nhiu nh

khoa hc ni ting nh Newton, Descarte, Vesali, Harvey

- Gii phu hc (Vesali, 1414-1464) v Sinh l hc (Harvey, 1578-1657) ra i t

nn mng vng chc y hc t c truyn tin vo thi k hin i.

1.2.4. Th k 18-19

y l thi k pht trin ca y hc hin i vi s vng mnh ca 2 mn Gii

phu hc v Sinh l hc. Nhiu mn ca y hc v sinh hc ra i. Rt nhiu quan

nim v bnh xut hin vi c im ni bt l da trn nhng kt qu c kim

tra bng thc nghim v khng nh nh thuyt bnh l t bo ca Wirchow (ngi

sng lp mn Gii phu bnh), thuyt ri lon hng nh ni mi ca Claud Benard

(ngi sng lp mn Y hc thc nghim l tin thn ca mn Sinh l bnh).


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2. Quan nim v bnh hin nay

2.1. Hiu v bnh qua quan nim v sc khe

- nh ngha ca WHO: Sc khe l tnh trng thoi mi v tinh thn, th cht v

giao tip x hi. y l nh ngha mang tnh cht mc tiu x hi phn u, c

chp nhn rt rng ri.

- Tuy nhin, di gc y hc, cn c nhng nh ngha ph hp v cht ch hn .

Cc nh y hc cho rng Sc khe l tnh trng lnh ln ca c th v cu trc, chc

nng cng nh kh nng iu ha, gi cn bng ni mi ph hp v thch nghi vi s

thay ica hon cnh. T i n nh ngha: Bnh l bt k s sai lch hoc tn

thng no v cu trc v chc nng ca bt k c quan, b phn, h thng no ca

c th biu hin bng mt b triu chng c hiu gip cho thy thuc c th chn

on xc nh v chn on phn bit, mc d nhiu khi cha r v nguyn nhn,

bnh l hc v tin lng (T in y hc Dorlands 2000).2.2. Xp loi bnh

Thc t, ngi ta phn loi bnh theo:

- C quan mc bnh: bnh tim, bnh gan, bnh thn,

-Nguyn nhn gy bnh: bnh nhim khun, bnh ngh nghip,

- Tui v gii: Bnh sn ph, bnh nhi, bnh tui gi,

- Sinh thi, a d: Bnh x lnh, bnh nhit i,

- Bnh sinh: bnh d ng, bnh t min,

2.3. Cc thi k ca mt bnhin hnh, mt bnh c th tri qua 4 thi k:

- Thi k bnh (tim tng):khng c biu hin lm sng. Nhiu bnh cp tnh

c th khng c thi k ny (bng, in git,).

- Thi k khi pht:xut hin mt s triu chng u tin kh chn on chnh xc

(xt nghim c vai tr rt ln)

- Thi k ton pht:triu chng y v in hnh nht, tuy nhin vn c nhng

th khng in hnh.

- Thi k kt thc:C th khc nhau ty bnh, ty c th bnh nhn: khi, cht, di

chng, tr thnh mn tnh,

2.4. Kt thc mt bnh (t vong)

24.1. Cht:

L mt cch kt thc ca bnh. l mt qu trnh gm nhiu giai on:

- Giai on tin hp hi: ko di vi gi n vi ngy biu hin bng kh th, h

huyt p, try tim mch,


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- Giai on hp hi:cc chc nng dn dn suy gim ton b, xut hin cc ri lon

c quan quan trng nh ri lon nhp tim, nhp th, co git, giai on ny ko di

trung bnh 24 pht.

- Giai on cht lm sng:cc du hiu bn ngoi ca s sng khng cn na do cc

trung tm sinh tn no ngng hot ng. Tuy nhin, nhiu t bo ca c th vn cn

sng, k c no. V vy, nhiu trng hp cht lm sng vn cn c th hi phc, nht

l nu cht t ngt mt c th khng suy kit tr khi no cht hn.

- Giai on cht sinh hc:no cht hn, in no ch l ng ng in, do vy

ht kh nng hi phc. Tuy nhin, nhng t bo quen chu ng tnh trng thiu Oxy

vn cn sng v hot ng kh lu, c quan ni tng ly ra vn cn c th ghp cho c

th khc.

2.4.2. Cp cu hi sinh

- Trng hp cht t ngt mt cth khng suy kit, v d do tai nn th cn c thhi sinh khi cht lm sng, ch yu bng hi phc h hp tun hon. Tri li, cht

sau mt qu trnh suy kit (thng hp hi ko di) th khng th p dng cc bin

php hi sinh.

- No chu c thiu Oxy khong 6 pht, do vy, nu tnh li sau 6 pht cht lm

sng c th li di chng no (nh hay nng, tm thi hay vnh vin). Trng hp

c bit (lnh, mt mu cp), no c th chu ng trn 6 pht.


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KHI NIM V BNH NGUYN(1 tit)

MC TIU HC TP

1. Trnh by c cc quan nim sai lm v bnh nguyn trong lch s y hc.

2. Trnh by c quan nim v bnh nguyn hc hin nay.

3.Nu c phn loi bnh nguyn.

NI DUNG

1. Khi nim

1.1. nh ngha

nh nguyn hc l mn hc nghin cu v nguyn nhn gy bnh vi cc c

im:

- Bn cht ca nguyn nhn.- C ch tc ng ca nguyn nhn gy bnh.

- iu kin thun li v khng thun li nguyn nhn pht huy tc dng.

1.2. Mt s quan nim sai lm v bnh nguyn hc trong qu kh

1.2.1. Thuyt mt nguyn nhn (Monocausalism)

- Ni dung:Ra i na sau th k 19, thuyt ny cho rng mi bnh u do vi khun

gy ra.

- Din bin:Do nh hng ca thuyt ny, ngi ta p dng n gii thch sai lch

nhiu pht minh y hc. Chng hn, mt tc gi tm ra cch cha bnh Beri-Beri (bnhthiu vitamin B1) bng cm go nhng li cho rng bnh ny do vi khun (cha tm

ra), v cm go c tc dng km hm s pht trin v kh nng gy bnh ca vi khun

gi nh ny!

Trong thc hnh y hc thi , rt nhiu bnh khng phi do nhim khun

c iu tr nh bnh nhim khun gy hu qu nghim trng.

1.2.2. Thuyt iu kin (Conditionalism)

-Ni dung:Thuyt ny ra i cng thi vi thuyt mt nguyn nhn. Cho rng gy c bnh phi c mt tp hp cc iu kin, mi iu kin quan trng ngang

nhau, trong nguyn nhn cng ch l mt iu kin

- Din bin: Pherorn, ngi ra thuyt iu kin khng nh nguyn nhn bnh

khng tn ti, tm kim n l v ch. Gy ra bnh l mt chui lin tc cc iu kin

din ra cho n khi bnh pht sinh, loi b mt trong s cc iu kin ny khng em

li thay i g. ng a ra bng chng l: cng mc bnh lao nhng mi c th biu

hin mt khc: nng, nh hoc thm ch khng c triu chng v ring vi khun lao th

khng bao gi gy c bnh v ch mi l mt iu kin trong v s iu kin gyra bnh lao (thiu dng, lao ng qu sc, ni ti tm, m thp,...)


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1.2.3. Thuyt th tng

- Ni dung:Ra i khong u th k 20, cho rng bnh c th t pht khng cn

nguyn nhn, bnh pht ra nng hay nh ty tng ca mi ngi. Nhng ngi cc

oan nht cn cho rng mm bnh nm sn trong c th ta (tng), do vy khng th

phng trnh c.

- Din bin v kt qu:Cc thnh tu y hc chng minh rng yu t th tng l c

tht nhng vai tr ca n khng phi l quyt nh trong gy bnh. Ngay c nhng

bnh di truyn (tng nh t pht) cng c nguyn nhn: l s t bin gen do mt

tc nhn vt cht m nhiu trng hp c lm sng t (Bnh Down).

Th tng ch l mt iu kin c th d mc bnh ny hay kh mc bnh kia.

Ngc vi thuyt iu kin (h thp vai tr ca nguyn nhn), thuyt th tng coi iu

kin l nguyn nhn. C hai u dn ti thi tiu cc, bt lc trc bnh tt.

2. Quan nim hin nay v bnh nguynBao gm 4 yu t sau y, c lin h mt thit vi nhau:

2.1. Quan h nguyn nhn iu kin

Trong quan h gia nguyn nhn v iu kin gy bnh th nguyn nhn l yu t

quyt nh, l yu t khch quan. C th:

- C bnh t phi c mt nguyn nhn no , c th c tm ra hoc cha tm ra.

-Nguyn nhn quyt nh tnh c hiu ca bnh. Trong hu ht cc trng hp, bnh

ny biu hin khng ging bnh kia l do chng c nguyn nhn khc nhau.

- iu kin h tr v to thun li cho nguyn nhn.

- C nguyn nhn i hi nhiu iu kin mi pht huy c tc dng, nhng cng c

nguyn nhn i hi t iu kin. Thm ch c nguyn nhn dng nh khng cn

iu kin g gy bnh, v d nh trong bng.

2.2. S hon i

Nguyn nhn gy bnh trong trng hp ny c th l iu kin trong trng hp

khc v ngc li. V d: n ung thiu thn l nguyn nhn ca suy dinh dng, ca

cc bnh do thiu vitamin nhng ch l iu kin ca bnh nhim khun nh bnh

lao...

2.3. Nguyn nhnbnh- Mi bnh u phi c nguyn nhn no m y hc c nhim v phi tm ra.

C

th

iu kin thun

iu kin khng thun li

Pht bnh

Khng pht bnh

Bnh tim tng

Nguyn nhn


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- C nguyn nhn cha hn c hu qu: do thiu iu kin hoc do th tng v s phn

ng tt ca c th (c th c min dch hoc thch nghi). Nhn thc ny rt quan

trng trong thc hnh: nhiu bnh cha tm ra nguyn nhn hoc cha c thuc c tr

nhngngi ta vn khng ch c chng bng cch loi tr iu kin thun li ca

chng. V d: bnh AIDS do nhim HIV ang c phng chng bng cch ny hoc

tiu dit c bnh u ma nh tc ng vo iu kin l tim chng vaccine

rng ri.

2.4. S phn ng ca c th

- Tc dng ca nguyn nhn cn ph thuc vo s phn ng ca c th, bi vy, c

th coi phn ng ca c th l mt iu kin ca s hnh thnh bnh. Cng mt

nguyn nhn, mi c th c th phn ng rt khc nhau, do hu qu c th khc

nhau. V d ung th gy t vong trong a s cc trng hp iu tr mun nhng

c ghi nhn cc trng hp t khi.3. Phn loi bnh nguyn

Hin nay, bnh nguyn c phn loi thnh 2 nhm ln: (c tnh cht tng i)

3.1. Nguyn nhn bn trong

3.1.1. Yu t di truyn

c coi l nguyn nhn bn trong ca mt s bnh v bnh nhn mang sn

trong nhn t bo cc gen bnh do cha m truyn cho. C nhng h tc mang bnh di

truyn qua nhiu th h lin tip.

n nay xc nh c nhiu nguyn nhn bn ngoi (tia x, ha cht, ct vi khun, thiu Oxy) tc ng ln nhn t bo gy ra nhng ri lon cu trc gen

nhiu mc .

Mt s chng v bnh di truyn xut hin hay khng, nng hay nh cn ty

thuc vo iu kin. V d chng tan mu do thiu men G6PD (Glucose 6

Phosphat Dehydrogenase) mng hng cu ch xut hin khi dng mt s thuc

(thuc iu tr st rt, sulfamides)

3.1.2. Th tng (Diathesis)

Tng l s tng hp cc c im chc nng v hnh thi ca c th, hnh thnh

trn c sdi truyn, a n cc phn ng c trng ca c th vi cc yu t kch

thch. Do vy, tng kh n nh mi c th v c th truyn cho th h sau. V d

nh tng tit dch, tng d ng, tng co git, tng d mp

Y hc cha lm sng t c bn cht ca tng cng nh ch r tn v c tnh

ca cc tng khc nhau.

3.2. Nguyn nhn bn ngoi

3.2.1. Yu t c hcCh yu gy chn thng cho m, c quan


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3.2.2. Yu t vt l

-Nhit :

+ Nu qu cao (> 500C) c th gy bin tnh cc protein (enzyme)trong t bo,

nh hng xu n chc nng hoc lm cht t bo.

+ Nu qu lnh: gy t cng, hoi t.

- Tia x:

+ Gy hy cc enzyme t bo

+ Tc ng ln AND ca t bo khi t bo ang phn chia.

-Dng in:thng gy bng, ri lon nhp tim, co git. Ty thuc vo in p, din

tip xc, in tr ca c th m tn thng khc nhau c th dn n t vong.

-p sut:

+ Nu p sut kh quyn qu cao: c th gy tn thng ti ch (ting n ln

gy thng mng nh) hoc ton thn (sc p do bom n c th gy tn thng nitng)

+ Nu p sut kh quyn gim thp t ngt s gy tai bin tc mch. C ch:

do kh Nit vn dng ha tan trong mu s bc thnh hi to ra bt kh gy tc

mch. Bnh thng gp th ln, gi l bnh thng ln.

- Ting n:c th gy ic vi cng cao hoc gy suy nhc thn kinh, mt mi,

tng huyt p

3.2.3. Yu t ha hc v c cht

Rt nhiu ha cht (v c, hu c, dc phm qu liu, nc c,) c th gy bnhti ch hoc bnh ton thn ( hoi t, tan mu, suy gan, suy thn, hn m, co git,)

3.2.4. Yu t sinh hc

Cc loi vi khun, virus, k sinh trng, nm,l nguyn nhn gy bnh ch

yu trong x hi c mc sng thp


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KHI NIM V BNH SINH(1 tit)

MC TIU HC TP

1. Trnh by c tnh phn ng trong bnh sinh.

2. Trnh by c vn ton thn v ti ch trong bnh sinh.

3. Trnh by c quan h nhn qu v vng xon bnh l trong bnh sinh.

NI DUNG

nh sinh hc l mn hc v c ch pht sinh, pht trin v kt thc ca mt bnh.

Bnh nguyn hc v bnh sinh hc lin quan cht ch vi nhau: bnh

nguyn hc tm hiu bnh do u m c, cn bnh sinh hc nghin cu bnh xy ra

nh th no, nhn t gy bnh tc ng trn c th v qu trnh bnh l din bin rasao, tun theo nhng quy lut g.

Ni dung ca bnh sinh hc bao gm:

- Tnh phn ng ca c th trong bnh sinh hc.

- Vn ton thn v ti ch trong bnh sinh hc.

- Quan h nhn qu v vng xon bnh l trong bnh sinh hc.

1. Vai tr ca tnh phn ng trong bnh sinh

1.1. nh ngha:

Tnh phn ng l kh nng p ng ca c th i vi mi kch thch bnhthng hoc bnh l. Tnh phn ng c th do i trc truyn li v hnh thnh thm

trong cuc sng.

1.2. Cc yu t nh hng n tnh phn ng ca c th:

Bao gmcc yu t:

1.2.1. Yu t tm thn kinh

- nh hng ca thn kinh cao cp

Thn kinh cao cp nh hng r rt n tnh phn ng ca c th: - Trng thi ca v no(hng phn hay c ch) qu trnh bnh l c nhiu thay i. V

d: sc do truyn nhm nhm mu c th xy ra mt cch im lng ngi bnh hn

m tri hn vi triu chng rm r xy ra ngi bnh tnh to.

-Loi thn kinh:ngi c loi thn kinh yu th bt c cm gic au nh no ca c

th, thng qua t m th v tm l lo lng c th tng l mc bnh nghim trng. Cc

cm gic ny dn c khuch i thm ln gy ra cc triu chng bnh l. y l c

ch pht sinh ca chng ri lon thn kinh chc nng.

- Li ni v t tng: c th lm cho bnh nng thm ln hoc lm cho bnh gim i,tng cng sc chu ng vi bnh. Bng nhng bin php tm l n gin nh an i,

B


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thuyt phc, ng vin thy thuc c th lm cho ngi bnh an tm, tin tng s

khi bnh, t mnh u tranh cho bnh chng khi. Tm l liu php rt cn thit i

vi tt c cc chuyn khoa, ngi thy thuc d rt gii v chuyn mn song khng

hiu tm l ngi bnh th kt qu iu tr nht nh b hn ch.

- nh hng ca thn kinh thc vt

- H giao cm chi phi nhng phn ng khng tch cc, do vy rt c tc dng kh i

c th cn huy ng nng lng chng li cc tc nhn gy bnh. Tri li, khi c th

hao cn d tr th cng giao cm s lm bnh din bin xu v lm hao ph nng

lng.

- H ph giao cm c vai tr quan trng trong to trng thi trn tnh, tit kim nng

lng, tng chc nng tiu ha v hp thu cn thit cho c th khi suy kit.

1.2.2. Yu t ni tit

- ACTH v corticosteroids:nh hng n bnh sinh thng qua tc dng chng vim, c ch thc bo, c

ch to khng th, gim tnh thm thnh mch, lm chm qu trnh to so, tn to

glucose t protidNh vy, 2 loi ni tit t ny gp phn quan trng khi bnh

nguyn gy ra nhng trng thi vim c cng qu mnh. Tc dng s xu i vi

bnh sinh khi c th suy kit, b e da nhim khun hoc nhim khun m khng c

cc loi khng sinh thch hp.

- Thyroxin

nh hng n bnh sinh thng qua tc dng gy tng chuyn ha c bn vtng to nhit. C vai tr rt ln trong phn ng to cn st v huy ng nng lng

chng li tc nhn gy bnh.

1.2.3. Gii v tui

- Gii

Mt s bnh hay gp v d nng ln nam gii (ung th phi, lot d dy -t

trng, nhi mu c tim); mt s bnh hay gp n gii (bnh t min, ung th

v)

- Tui

Mi tui c nhng c im phn ng ring i vi bnh tt. Tnh phn ng

yu khi cn nh, tng khi trng thnh v gim lc v gi.

1.2.4. Yu t mi trng

- Thi tit

Nhit mi trng, m, sc gi, u nh hng n bnh sinh ca nhiu

bnh, lm cho bnh d pht sinh, ti pht hoc nng ln khi c thay i thi tit.


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- Ch dinh dng

- Dinh dng nng lng, nht l dinh dng protein v vitamin nh hng r n

bnh sinh ca nhiu bnh. Khi d tr protein gim st th t l mc cc bnh nhim

khun tng ln r rt.

- Cc vitamin nh vitamin A, vitamin nhm B, vitamin C u c tc dng tng cng

sc khng, chng Oxy ha, tng cng qu trnh thc bo chng li cc bnh

nhim khun.

2. Vn ton thn v ti ch trong bnh sinh hc

Bnh l mt phn ng ton thn m biu hin ti ch l ch yu. Qu trnh

bnh l ti ch ph thuc vo tnh trng ton thn v nh hng su sc n ton thn.

3. Quan h nhn qu v vng xon bnh l trong bnh sinh hc

-Nhng bnh phc tp thng din bin qua nhiu khu theo trnh t nht nh v c

lin quan mt thit. V d trong s sau y ca bnh thp tim:

Nh vy, trong qu trnh bnh sinh, nguyn nhn ban u gy ra nhng hu qu nht

nh. Nhng thay i ny li tr thnh nguyn nhn ca nhiu ri lon tip theo kt

qu l qu trnh bnh l khng ngng pht trin, bnh ngy cng nng thm.

- Nhim v ca thy thuc l thy c mi quan h nhn qu gia cc hin tng

bnh l, kp thi pht hin nhng thay i ch yu trongqu trnh bnh sinh c

cch iu tr thch ng. l iu tr bnh sinh. V d trong suy tim, trng tm caiu tr l phc hi sc co bp ca c tim kt hp vi ch ngh ngi gim bt

gnh nng i vi c tim b suy.

Lin cu Vim hng Vim mng trong tim Tn thng van Suy tim


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RI LON CHUYN HA GLUCID

(2 tit)

MC TIU HC TP

1. Trnh by c chuyn ha bnh thng ca glucid trong c th. 2. Trnh by c cc ri lon chuyn ha glucid thng gp.

NI DUNG

1. i cng v chuyn ha Glucid

1.1. ng i

- Glucid l ngun nng lng ch yu v trc tip ca c th, ngoi ra n cng c vai

tr cu to v chc nng. Trong c th ngi, glucid tn ti di 3 dng ch yu:

+ Dng d tr: Glycogen, tp trung nhiu gan v c.

+ Dng vn chuyn: Glucose trong mu v cc dch ngoi bo.

+ Dng tham gia cu to t bo v cc cht khc: Pentose trong thnh phn acid

nucleic (AND, ARN), glucid phc tp tham gia cu to mng t bo, mng cc bo

quan (glycoprotein, glycolipid), Heparin l mt mucopolysaccarid c tc dng chng

ng mu

-Nh cc men ca ty v rut, cc polysaccarid v disaccarid ca thc n bin thnh

monosaccarid (ch yu l glucose, fructose v galactose) ri c hp thu.

Rut

Glucid

Glucose

Glucose

Mu

Gan

Glycogen

Glucose

0,8

1,0

1,2

1,4

1,6

1,8

Nc tiu

M m

T bo

c

Acid lactic

Hnh 1: B sung v tiu th Glucose trong mu


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- Theo tnh mch ca, glucid qua gan v b gi li phn ln y. Gan l c quand

tr glucid (di dng cao phn t l glycogen) quan trng nht ca c th duy tr

cn bng ng huyt. Ngoi ra, gan cn sn xut mt lng glucid t cc acid amin

ca thc n hoc do s thoi bin protein trong c th: gi l s tn to glucid. D thu

nhn loi monosaccarid no, khi thoi bin glycogen, gan ch phng thch glucose vo

mu.

- C d tr ti 250g glucid cho nhu cu ring ca mnh. Sau co c, c b sung glucid

t mu v c th lm mc glucose trong mu gim r rt.

- Glucose mu khuch tn t do qua vch mao mch vo gian bo. Mt s t bo

cho glucose thm d dng vo trong t bo m khng cn c insulin (t bo no, gan,

hng cu), a s t bo cn li i hi phi c insulin mi thu nhn c glucose.

Trong t bo, glucose ch yu bin thnh nng lng ATP dng cho hot ng ca t

bo.-Nu c th c b sung nhiu glucid, phn tha s c bin thnh acid bo v mt

s acid amin. Nu thiu, c th s thoi bin m v protid b p phn nng lng

thiu ht. Khi glucose trong mu > 1,8g/ lt, s xut hin glucose trong nc tiu v

qu kh nng hp thu ca ng thn. (Hnh 1)

1.2. Chuyn ha

Lipid

Glycogen

G.1.P

G.6.P

F.6.P

Galactose Glucose

Fructose

Phosphoglyceraldehyd

Chu trnh Pentose

Acid pyruvic Acid lactic

Acetyl CoAAcid bo Th Ceton

Cholesterol

Acid citric

Acid cetoglutaric

Acid oxalo acetic

Chu trnh Krebs

t bo

Protid

Acid amin

Hnh 2: Cc bc ch yu ca chuyn ha glucid trong t bo


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Vo t bo, lp tc glucose (c fructose v galactose) bin thnh glucose -6-phosphat

(G.6.P) di tc dng ca men hexokinase. T y, ty theo nhu cu v ty loit bo

m G.6.P c th theo cc con ng sau:

- Tng hp thnh Glycogen d tr ch yu xy ra gan v c.

- Kh phosphate cung cp li glucose cho mu xy ra gan.

- Thoi bin thnh Acid pyruvic ri Acetyl CoA vo chu trnh Krebs cho nng lng,

CO2, H2O xy ra ty lp th ca mi t bo: gi l con ng ng phn.

- Tham gia chu trnh Pentose to ra acid bo xy ra gan, m m trong trng hp

tha G.6.P v vi s h tr ca insulin. (Hnh 2)

1.3. iu ha glucose mu

- Bnh thng, mc glucose mu khong 1g/lt.

- Khi c th tng cng s dng glucid (st, lao ng nng, hng phn thn kinh),glucose mu s tng n 1,2 1,5g/lt. Khi c th ngh ngi, glucose mu gim cn

khong 0,8g/lt.

- Khi glucose mu > 1,8g/lt, c th xut hin glucose trong nc tiu do vt qu

ngng hp thu ca thn.

- Khi glucose mu < 0,6g/lt, cc t bo ca c th nht l t bo thn kinh b thiu

nng lng, c th dn n hn m v t vong nu khng x tr kp thi.

C 2 yu t chnh tham gia iu ha v n nh glucose mu:

1.3.1. Yu t ni tit- Insulin

Insulin lm gim glucose mu rt nhanh v mnh nh 2 tc dng chnh:

- Lm glucose nhanh chng vo t bo v nhanh chng c s dng (tng hp

glycogen, m, acid amin v thoi bin)

- Lm gim thoi bin cc cht to ra glucose (glycogen, protid, lipid)

- Adrenalin

C vai tr hot ha men phosphorylase ca gan, do lm thoi bin glycogen gy

tng glucose mu.

- Glucagon

C ch tc dng tng t nh Adrenalin nhng lm tng glucose mu ko di hn.

- Glucocorticoid ca v thng thn

Lm tng glucose mu do ngn cn glucose thm vo t bo (tr t bo no) v tng

tn to glucose t protid.

- Growth Hormone (GH, STH)

c ch men hexokinase, tng thoi bin glycogen, hot ha men Insulinase (hyInsulin), do lm tng glucose mu


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1.3.2. Yu t thn kinh

- Th nghim c in ca Claude Bernard chm kim vo sn no tht 4 lm tng

ng huyt v th nghim ca Bykov gy tng ng huyt bng phn x c iu

kin.

- S hng phn ca v no v h giao cm (stress) lm tng glucose mu.

- Vai tr ca vng di i thng qua h ni tit iu ha glucose mu:

+ Ngi ta pht hin mt trung tm vng di i (gi l trung tm A) gm

nhng t bo thn kinh khng cn Insulin cng thu nhn c y glucose t mu

nng 0,8g/lt. Khi glucose mu gim, trung tm A kch thch tit adrenalin,

glucagons, lm tng glucose mu

+ Trung tm B: i din cho ton b t bo cn li ca c th cn insulin mi s dng

c glucose mc 0,8 1,0g/lt. Mt khc, t bo loi ny s dng c th ceton

nh mt ngun nng lng b sung quan trng. Khi thiu insulin, trung tm B s huyng mi c ch ni tit lm tng glucose mu rt cao thm vo t bo nh s

chnh lch ln ca nng (do s thi ra ngoi qua nc tiu), mt khc n huy

ng m rt mnh (thoi bin m, tng tng hp th ceton) v huy ng protid

to glucose lm tng glucose mu.

2. Ri lon chuyn ha glucid

2.1. Gim glucose mu

Khi glucose mu gim di 0,8g/lt

2.1.1. Nguyn nhn- Ri lon kh nng hp thu glucid

- Thiu men phn gii glucid ca ty v rut.

- Gim hp thu rut: ct on rut, vim rut,

- Ri lon d tr gan

- Gim d tr gan: trong vim gan, x gan, suy gan,

- Thiu bm sinh mt s men gan gy ng glycogen lmh glucose mu khi i.

- Tng mc tiu th

Tiu th glucid tng trong tt c cc trng hp i hi tng nng lng ca c th

nh: co c, run, st ko di,

- Ri lon iu ha thn kinh ni tit

- Cng ph giao cm hoc c ch giao cm.

- Gim tit cc ni tit t c tc dng lm tng glucose mu nh adrenalin, glucagons,

GH, hoc tng tit insulin trong u t bo ca o ty.

2.1.2. Hu qu

- Thiu G6P trong t bo gy cm gic i.

- Run tay chn, nhp tim nhanh, v m hi do kch thch h giao cm.


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- Rut tng co bp, d dy tng tit dch (cm gic cn co), hoa mt, yu tay chn,

- Khi glucose mu gim nng < 0,6g/ lt, cc t bo thiu nng lng, cc chc phn

b ri lon nht l t bo no, tim,c th dn n hn m v t vong.

2.2. Tng glucose mu

Khi lng glucose mu > 1,2g/lt.

2.2.1. Nguyn nhn

- Cc nguyn nhn ngc vi tnh trng gim glucose mu trn.

- Xy ra trong v sau ba n nhiu glucid.

- Gim tiu th glucose trong trng hp thiu oxy (ngt, gy m).

- Thiu vitamin B1gy tr acid pyruvic lm glucose khng c tiu th trong t

bo.

- Cng giao cm, u no lm trung tm B km nhy cm vi insulin, bnh ni tit lm

gim tit insulin, tng tit cc hormone lm tng ng mu hoc tng hot tnh cainsulinase, c khng th khng insulin trong mu.

2.2.2. Hu qu

- Tng glucose mu ni chung khng c g c cho t bo nhng n lm tng p lc

thm thu gy tiu nhiu ng thi gy mt Natri, Kali v xut hin ng trong nc

tiu khi vt qu ngng hp thu ca thn.

- Tng glucose mu do ri lon ni tit nht l ri lon bi tit insulin ca t bo o

ty th ri lon chuyn ha glucid rt trm trng gp trong bnh i tho ng (s

hc trong iu dng ni khoa).


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RI LON CHUYN HA PROTID(2 tit)

MC TIU HC TP

1. Trnh by c chuyn ha bnh thng ca protid trong c th.

2. Trnh by c cc ri lon chuyn ha protid thng gp.

NI DUNG

1. i cng v chuyn ha Protid

1.1. Vai tr ca protid trong c th

Protid l cht to hnh quan trng ca c th. Qu trnh sng l qu trnh thoi ha v

tn to thng xuyn ca protid. Cc chc nng chnh ca protid l:

1.1.1. Chc nng cu trc

- Protid l cht to nn nhn, nguyn sinh cht, mng t bo.- Protid xy dng cc m, c quan, gip c th vn ng v chng c hc.

1.1.2. Chc nng iu ha, cn bng ni mi

- Tt c cc phn ng ha hc, cc qu trnh sinh hc nh ng mu, chy

mutrong c th u c hot ha v iu ha bi cc protid c bit gi l

enzyme.

- Cc hormone tham gia iu ha v thng nht hot ng ca cc h c quan cng l

protid.

- Protid tham gia kim sot thng tin di truyn gip cho cc t bo trng thnh.

1.1.3. Chc nng vn chuyn

Cc thnh phn protid c chc nng vn chuyn trong c th rt nhiu, c th k nh

Hemoglobin vn chuyn O2 v CO2, albumin vn chuyn bilirubin v acid bo,

transferin vn chuyn st,

1.1.4. Chc nng bo v

Cc khng th, i thc bo, vi thc bo cng l protid chng li s xm nhp ca

khng nguyn bo v c th.1.1.5. Chc nng cung cp nng lng

Protid cng c vai tr l ngun nng lng cho c th khi khng c lipid v glucid.

1.2. Ngun gc

- n v cu to ca protid l cc acid amin. C 20 acid amin tham gia cu to nn

protid ca c th trong 12 loi c th c th t tng hp nh phn ng chuyn

amin, cn li 8 acid amin phi c b sung t thc n

- Trong ng tiu ha, nh cc men tiu protid ca ty v rut, thc n protid b thoi

ha thnh cc acid amin v c hp thu. Qua gan, vi h thng men kh amin, kh


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carboxyl v transaminase, cc acid amin c iu chnh cho ph hp vi nhu cu ca

c th.

- Nim mc ng tiu ha thng ch hp thu acid amin nhng trong mt s trng

hp, mt s dipeptid thm ch polypeptid cng lt qua c v c th tr thnh khng

nguyn gy d ng vi protid l qua ng tiu ha.

1.3. Tng hp protid

Ngun acid amin tng hp protid ca c th l:

- Acid amin ca thc n (chim 1/10 nhu cu).

- Acid amin ti s dng ca qu trnh ging ha (chim 9/10 nhu cu).

- Mt s acid amin do c th t tng hp bng phn ng chuyn amin. y l nhng

acid amin thuc nhm khng thit yu.

1.4. Ging ha protid

Cc acid amin ca qu trnh ging ha protid: - 90% c ti s dng tng hp protid ca c th.

- 10% cn li c oxy ha cho nng lng hoc tham gia tng hp lipid, glucid.

Khu phn n hng ngy phi b p c s hao ht ny.

Qu trnh ging ha protid qua nhiu khu trung gian phc tp:

- Cc enzyme ca cc m nh catepsin, protease phn hy protid ca cc t bo b

thoi ha cung cp acid amin c th ti s dng.

- Phn ng chuyn amin (do enzyme Transaminase m nhim) gip c th t tng

hp hoc phc hi mt s acid amin.

- Phn ng kh carboxyl (do enzyme Decarboxylase m nhim) lm mt nhm

carboxyl to CO2, cn li l mt s amin c hot tnh nh: histamine, serotonin,

2. Ri lon chuyn ha protid

2.1. Ri lon tng hp v lng

2.1.1. Tng tng hp chung

Khi qu trnh ng ha acid amin mnh hn d ha, cn bng nit dng tnh, gp

trong:

Sinh l: thi k trng thnh, ang tp luyn, thi k ang bnh phc bnh.

Bnh l: cng tuyn yn.

2.1.2. Gim tng hp chung

Cn bng nit m tnh gp trong i trng din, suy dinh dng, i ng, ung th,

bng, st ko di,

2.1.3. Tng tng hp ti ch

Gp trong phi c quan, ung th, ang lin vt thng, phc hi thiu mu,

2.1.4. Gim tng hp ti chGp trong tc mch c quan, teo hoc hoi t c quan.


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2.2. Ri lon protid huyt tng

Protid huyt tng c hm lng khong 75 80g/lt, c ngun gc ch yu t gan (95%

albumin, 85% globulin).

2.2.1. Vai tr ca protid huyt tng

- Cung cp acid amin cho c th.

- To p lc keo gi nc trong lng mch, iu ha chuyn ha nc v in gii.

- Tham gia chuyn ha, vn chuyn cc cht nh hormone, st, chng nhim khun, nhim

c.

2.2.2. Gim lng protid huyt tng

2.2.2.1. Nguyn nhn

- Do cung cp khng : i

- Do gim tng hp: trong x gan, suy gan.

- Do gim hp thu: vim rut, x ty- Do tng s dng: gp trong mt s trng hp nh ang lin vt thng, ung th, ri lon

chuyn ha glucid.

- Do mt ra ngoi: bng, hi chng thn h, l d,

2.2.2.2. Hu qu

Lm sng: st cn, teo c, thiu mu, c th b ph. Tr em chm ln.

Xt nghim:

- Protid huyt tng gim trong albumin thng gim nhanh v nhiu hn globulin. Do , t

l A/G thng b o ngc (bnh thng t l A/G >1, tr thnh


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Albumin: m bo 80% p lc keo ca mu, gim trong tt c cc trng hp gim

protid huyt tng. Albumin huyt tng thng gim nhiu trong trng hp suy

dinh dng, hi chng thn h.

-globulin: tng trong cc trng hp vim cp, vim mn, hoi t t chc, ri lon

chuyn ha (hi chng thn h, thn nhim bt). -globulin tng lm tng qunhca mu, tc lng mu tng.

-globulin: c vai tr quan trng trong vn chuyn lipid. Do , cc trng hp tng

lipid mu nh trong i ng, tc mt, hi chng thn h, x va ng mch u c

tng -globulin.

-globulin: l khng th, do vy tng trong mu khi nhim khun, qu mn, u tng

bo,

2.3. Ri lon tng hp protein v cht

C nhiu gen tham gia iu ha, chi phi sinh tng hp protid nhng gen cu trc vgen iu ha l 2 gen quan trng nht. Chnh v vy, ri lon 2 gen ny gy ra

nhiu bnh l phc tp.

2.3.1. Ri lon gen cu trc

- Gen cu trc mang thng tin quy nh trnh t cht ch cc acid amin trong mch

polypeptide. Mi mt acid amin tng ng vi mt b ba nucleotide nht nh, v d

b ba GAA m ha cho glutamin.

- Bnh l do ri lon gen cu trc thng gp l:

2.3.1.1. Bnh ri lon cu trc Hemoglobin:

- Bnh thiu mu hng cu hnh lim: do thay th acid amin th 6 trong chui ca

HbA ngi bnh thng l Glutamin bng Valin nn HbA s chuyn thnh HbS lm

hng cu b bin dng hnh lim, sc cng b mt gim nn d v gy thiu mu do

tan mu.

- Bnh thiu mu hng cu hnh bia: tng t nh trn nhng Glutamin b thay bng

Lysin nn HbA s chuyn thnh HbC, hng cu d v khi thiu oxy gy thiu mu tan

mu.

2.3.1.2. Bnh do thiu men trong chui chuyn ha

- Bnh bch tng: do thiu men tyrosinase nn khng to c sc t melanin.

- Bnh ng glycogen gan

2.3.2. Ri lon gen iu ha

Nu hot ng ca gen iu ha b ri lon th cc protid c tng hp ra mt cn

i v t l (qu tha hoc qu thiu) hoc vn tng hp mt protid m c th khng

cn n na. Bnh thng gp l bnh huyt sc t F (Thalassemia). C ch sinh bnh

nh sau:


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- bo thai, c 2 gen cu trc tng hp 2 chui peptid v to nn huyt sc t bo

thai l HbF (22). HbF rt nhy cm vi bt gi oxy lm cho thai d ly oxy t mu

m nhng hng cu cha HbF d v.

- Khi tr ra i,gen iu ha km hm vnh vin gen cu trc ca chui peptid , gii

phng gen tng hp peptid . Do vy, huyt sc t ca ngi trng thnh bnhthng s l HbA (22). Nu HbF vn tn ti vi lng ln ngi trng thnh s

gy bnh l Thalassemia.

2.4. Ri lon chuyn ha acid nucleic

in hnh l bnh Goute. Trong bnh Goute, nng acid uric tng cao trong mu v

trong nc tiu, lng ng tinh th urat sn, khp, thn, da, c,biu hin triu

chng lm sng rt sm cc khp ngn tay, ngn chn gy au, bin dng khp.

C ch sinh bnh: do thiu men hypoxanthin-guanin phosphoribosyl transferase

nn hypoxanthin v guanine khng tham gia tng hp nucleotide tng ng m bthoi ha thnh acid uric vi s lng ln m thn khng c kh nng o thi ht.


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RI LON CHUYN HA LIPID(1 tit)

MC TIU HC TP

1. Trnh by c chuyn ha bnh thng ca lipid trong c th.

2. Trnh by c cc ri lon chuyn ha lipid thng gp.

NI DUNG

1. i cng

Lipid trong c th ngi gm 3 nhm chnh:

- Triglycerid

- Phospholipid

- Cholesterol

Ngun cung cp chnh lipid cho c th l t thc n, ng thi n l mi trng ha

tan cc vitamin tan trong du m c th c th hp thu.Lipid thc n c tiu ha ngay t t trng nh men lipase ca ty, rut v c bit

l nh mui mt c tc dng bin lipid thnh dng nh tng gi l Chylomicron c

ng knh ht khong 0,4 micron. Sau , lipid c chuyn ha ny hp thu theo

2 ng: tnh mch ca qua gan hoc hp thu theo ng bch mch rut vo tun

hon chung. Ba n nhiu lipid c th lm huyt tng tr thnh c v lng

Chylomicron rt cao.

2. Ri lon chuyn ha lipid

2.1. Tng lipid mu

Bnh thng, lipid ton phn trong mu n nh trong khong 600 -800mg% l nh s

cn bng gia cung cp (hp thu, tng hp) v tiu th.


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2.1.1. Tng lipid mu sinh l

Gp sau ba n. Triglycerid tng sm v cao nht, sau l phospholipid v cui

cng l cholesterol. Sau khi n 2 gi th lipid bt u tng, cao nht sau 4-5 gi v tr

v bnh thng sau 7-8 gi. Du thc vt lm lipid mu tng nhanh nhng cng gim

nhanh v d hp thu. Ngc li, m ng vt lm lipid mu tng chm nhng ko di.

Lipid mu tng sau khi n thng dng ht nh (chylomicron) lm cho huyt tng

c. Do , ly mu xt nghim thng tin hnh vo bui sng khi cha n g

khi sai lch kt qu.

2.1.2. Tng lipid mu do huy ng

- Khi tc huy ng cao hn bnh thng, hu ht trng hp u c vai tr ca

hormone.

- Trong trng hp u nng mt s tuyn (tuyn yn, tuyn gip, tuyn thng thn;

hoc tim adrenalin, corticoids) u c tng lipid mu v chng hot ha men lipase m m. Thnh phn tng ch yu l acid bo

- Tng huy ng cn gp khi ngun nng lng t glucose t ra khng m bo nhu

cu: gp trong i, st, bnh tiu ng

- Do gim s dng v chuyn ha lipid lm tng lipid mu gp trong vim gan cp,

vng da tc mt, ng c rulipid t m m ch huy ng mc bnh thng

nhng khng c gan tip nhn v do gan gim sn xut cht vn chuyn m l

apoprotein.

- C th ngi gi thng c tng lipid mu do h lipase m b gim hot tnh.

2.1.3. Tng lipid mu gia nh

Do mt gen tri quy nh.

2.1.4. Hu qu

Tng lipid mu nu ngn hn khng gy hu qu g nghim trng nhng nu tng ko

di s gy bnh. V d: ch n qu nhiu m, tha nng lng c th gy bo ph,

suy chc nng gan, tng cholesterol mu gy x va ng mch

2.2. Ri lon lipo-protein (LP)

Thng gp bnh l tng LP mu. Gim LP him gp v thng l bnh di truyn.

- Tng chung gp trong suy gip, thn h nhim m, suy thng thn hoc do ch

n

- Tng tng loi:

+ Tng do thiu men lipo-protein lipase thng gp ngi gi, c a x va,

tiu ng

+ Tng ring l cc thnh phn lipo-protein: nh tng lipo-protein, tin

lipo-protein hoc lipo-protein thng gp trong bnh tiu ng, x va ngmch, u vng (xanthoma)


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2.3. Ri lon chuyn ha cholesterol

-Trong c th, cholesterol c xut pht t 2 ngun: t thc n v t tng hp.

- Khong 50% lng cholesterol c o thi theo ng mt xung phn sau khi c chuyn

thnh acid mt, 50% cn li c o thi di dng sterol trung tnh.

2.3.1. Tng cholesterol mu

- Nguyn nhn

-Do n nhiu cc thc n giu cholesterol, m ng vt, gan, no,

-Do km o thi: tc mt

-Tng huy ng: tng cng vi lipid mu trong i ng ty, hi chng thn h

- Hu qu

Cholesterol mu tng cao v ko di s xm nhp t bo gy ri lon chc phn t bo

2.3.2. Gim cholesterol mu

Do tng o thi hoc gimhp thu gp trong vim rut, Basedow. C trng hp gim cholesterolbm sinh do mt gen ln gy ra.

2.4. Bnh x va ng mch

- Thnh ng mch c nhiu lp, lp chun gip ng mch c tnh n hi iu ha p lc v lu

lng mu. Lp c gip ng mch thu hp ng knh khi cn nng huyt p, lp v x tng sc

bn thnh mch v lp ni mc trn nhn c vai tr bo v v chng ng mu t pht.

- X va ng mch l s tch ng cholesterol di lp o trong ca ng mch lm thnh mch

dy ln, thu hp lng mch. Tip , s lng ng canxi a n thoi ha, lot si do thiu nui

dng (va) v lm m x pht trin ti ch;

- S lot si khin ni mc ca lng mch mt trn nhn, to iu kin cho tiu cu bm vo v khi

ng qu trnh ng mu (gy tc mch).

- X va l bnh ca cc mch mu tng i ln khc vi tng huyt p l bnh ca h thng ng

mch tn, hai bnh ny c th to thun li cho nhau pht trin

- LDL c vai tr bnh sinh quan trng nht trong x va ng mch: l dng gan a

cholesterol ti cc t bo s dng; trong khi HDL c vai tr mang cholesterol t cc m tr v gan.

Khi tng LDL th tng kh nng b x va ng mch do lng ng cholesterol thnh mch. Khi

tng HDL th gim kh nng b x va ng mch doHDL c tc dng bo v thnh mch v

chuyn cholesterol tha v gan.

- iu kin thun li gip cholesterol tng lng ng:

+ Thiu vitamin C

+ Gim st h men heparin-lipase ngi gi.

+ Lipid mu tng cao ko di.

+ Tng huyt p.

+ Nghin thucl, ru, t vn ng


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SINH L BNH H H HP

(2 tit)

MC TIU HC TP

1. Trnh by c cc hnh thi ca thiu oxy trong bnh l h hp.

2. Trnh by c cc kiu ri lon thng kh.

3. Trnh by c cc biu hin ca suy h hp v s thch nghi ca c th trong suy

h hp.

NI DUNG

1. Thiu oxy:

1.1. Khi nim:

Thiu oxy t bo l tnh trng cc t bo c th khng thu nhn lng oxy theo nhucu. a s trng hp l do ri lon b my h hp haytun hon nhng cn c th

gp trong cc trng hp:

- Thiu oxy khi bn giai on h hp hon ton bnh thng: l do thnh

phn v p lc khng kh b thay i.

- Thiu oxy khi pO2 mu vn bnh thng: l do ri lon chc nng ca

cc enzym h hp trong t bo.

1.2. Phn loi thiu oxy:

- Thiu oxy do thay i thnh phn v p sut kh th. - Thiu oxy do ri lon qu trnh thng kh.

- Thiu oxy do ri lon qu trnh khuch tn.

- Thiu oxy do ri lon giai on vn chuyn.

- Thiu oxy dori lon giai on h hp t bo.

1.2.1. Thiuoxy do kh th

Nu phn p oxy trong kh th khng cao hn phn p oxy trong mu tiu tun

hon do ng mch phi a n, th khng th c s trao i ca vch ph nang.

Trng hp trong khng kh th c ln cc cht kh c i lc cao vi hemoglobin (Hb)

s xy ra tranh chp Hb, cng c th a n thiu oxy.

Trong trng hp ny c nhng nguyn nhn sau y:

- Thiu oxy do cao.

- Thiu oxy do khng kh b t hmhoc b ngt.

- Thiu oxy do kh CO (c i lc cao i vi Hb)

1.2.2. Thiu oxydo ri lon thng kh

- C ch:do gim khi lng nhu m phi, gim lu lng kh trao i giaphi vi mi trng bn ngoi.


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- Hu qu:tt c cc giai on sau(khuch tn, vn chuyn v h hp t bo)

u thiu oxy v tng pCO2.

1.2.3. Thiu oxy do ri lon khuch tn

- C ch:gim din tch khuch tn; c th tht s (v mt gii phu) hoc ch

gim v chc nng din tch ny(do din tch khng tip xc vi mao mch thc

hin s trao i kh)...Trn thc t rt hay gp gim v chc nng. Dy mng khuch

tn v gim hiu s p lc khuch tn cng l c ch hay gp.

- Hu qu: gim lng kh trao i gia mu v ph nang, do vy cc giai

on sau khuch tn u thiu oxy v ng CO2.

1.2.4. Thiu oxydo ri lon vn chuyn

- C ch:ri lon vlng hoc cht ca hemoglobin c trong mu, khin n

khng bt giv mang ti c y lng oxy do phi cung cp.

- Hu qu:gim lu lng v p lc tun hon, d l i tun hon hay tiutun hon u a n thiu oxy cho t bo.

1.2.5. Thiu oxy do ri lon h hp t bo

- nh ngha: H hp t bo l giai on cui ca qu trnh h hp. u vo ca n

gm oxy v cc cht dinh dng cha nng lng, c hai u do tun hon a n.

u ra ca n gm nng lng, kh CO2, v nc.

Ri lon h hp t bo do thiu mt s yu t sau y:

- Khi thiu c cht:c th l khu cung cp thiu cht dinh dng cho c th.

- Gim hot tnh ca mt s enzymh hp:c th do:+ Gim sn xut enzym h hp c th xy ra nu c th thiu protein cung cp tng

hp phn apoenzym; nhng hay gp nht l cc trng hp gim sn xut cc

coenzym m thnh phn quan trng nht ca chng l cc vitamin. Do vy, mt trong

nhng c ch ca bnh thiu vitamin l gim sn xut cc enzym t bo m quan

trng nht l cc coenzymh hp. Cc vitamin bao gm vitamin nhm B (B1, B2,

B6, PP).

+ Thiu st

+ Ng c t bo: nhiu cht c tc dng ln h enzym h hp trong t bo khin t

bo b ngt, mc d mu rt nhiu oxy, chng hn thuc ng, thuc m,lm c

ch hoc t lit cc enzym tch hydro.

2. Ri lon chc nng h hp ngoi:

2.1. Theo c ch bnh sinh

V sinh l bnh v lm sng: c hai ri lon thng kh, t cng c hai loi suy h

hp:

2.2.1. Rilon thng kh do hn ch:Do gim khi lng nhu m phi tham gia trao i kh vi mi trng bn ngoi.


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- S lng ph nang b gim tht s v d b ct b thy phi, teo phi do tc

nhnh ph qun, xp phi...

- Cc ph nang b xp khin mt vng phi b xp, hon ton khng cha kh b

loi tr ra khi qu trnh thng kh v khuch tn.

- C th gim v chc nng ca ph nang: do tn thng khuyt tt ca lng

ngc hoc do bnh l tn thng ca nhu m phi.

2.2.2. Ri lon thng kh do tcnghn:

Khi c s cht hp ca ng dn kh nh hng n s trao i kh ca s ln ph

nang, c th chia ri lon tcnghn ra cc dng sau:

- Do ng dn kh cao: ph thanh qun, bch hu, tht c, d vt ln,

- ng h hp sn b d vt nh, u gy chn p...

- Do ng h hp mng, do thnh ph nang ph i hoc tit dch..

2.2. Phn loi theo v tr tn thng:2.2.1. Bnh l v thn kinh- c:

- Do trung tm h hp b c ch hoc t lit, thm ch b hy hoi . Vddo chn

thng s no vng hnh- cu, mt s th vim no, ng c.

- Do dn truyn t trung tm n c h hp: chn thng t sng c, vim thn kinh

lin sn, bnh bi lit th cao.

- Do bn thn c h hp: chn thng lng ngc, vim c h hp.

2.2.2. Bnh l v khung xng:

- Tt ca khung xng: qu nh so vi chiu cao.

- Khp cng lm gim n lng ngc khi th.

2.2.3. Bnh l phi - mng phi:

- Phi:c th a n ri lon thng kh khi mc cc bnh nh sau: km sn xut

surfactant, bnh phi thm nhim lan ta.

- Mng phi:dy v dnh gy co ko lm phi km dn n

2.2.4. Bnh l v ng dn kh:

- Tc nghn do hp ng dn kh nh.

- Tc nghn kh qun v cc ph qun ln.

2.2.5. Bnh l ngoi ng h hp:

C trng, ganto, chng d dy..

3. Suy h hp

3.1. nh ngha

L trnh trng chc nng h hp ngoi khng m bo c yu cu cung cp oxy v

o thi kh CO2cho c th.

3.2. Cc biu hin ca suy h hp:3.2.1. H hp chu k


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L kiu th bt thng, lp i lp li c chu k, c th gp trong mt s bnh.

Bnh nhnth su mt s nhp lin tip ri chuyn sang th nng hoc tm ngng, ri

lp li.

Hay gp nht l kiu th ca Cheyne v Stokes m t, c trng bng nhng

t kodi t 40- 60 giy th su xen k nhng t th nng.

3.2.2. Tm ti

L tnh trng hemoglobin kh mu mao mch t 10- 20% tng ln mc

hemoglobin kh tnh mch 30%, khin da nim mc v nhng vng giu mao mch

ng da c mu tm nh mu tnh mch.

3.2.3. Kh th

C th kh th tht s do tc nghn ng h hp khin bnh nhn phi huy

ng cc c h hp gng sc v thy r cm gic vt nng trn ngc.

3.3. Thch nghi ca c th trong suy h hp:Di y l cc bin php thch nghi thng thng m c th bnh thng c

th p dng, nhng mt c th suy h hp ch thc hin c mt phn no.

Thch nghi ca phi:Tng cng thng kh c ch do tr CO2, kt hp vi thiu

oxy kch thch trung tm h hp.

Thch nghi ca tun hon:do tng cng h hp to p lc m tnh trong lng

ngc c tc dng ht mu v tim. Mt khc cc th quan ca tim v thnh mch cng

nhy cm vi thiu oxy lm tng hot ng ca tim mch.

Thch nghi ca mu:thiu oxy thn lm tng sn xut erythropoietin, qua kch

thch ty xng sn xut ra hng cu. Trc mt khi thiu oxy, c th huy ng mu

cn tn ng trong cc xoang gan, lch v cc mao mch ngh vo vng tun hon.

Thch nghi ca t bo v c:tng cng khi thiuoxy, tn dng ti a lng oxy

sn c mu ng mch. Tng ion H+cng nh CO2 gip phn ly nhanh HbO2 cc

m.


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SINH L BNH H TUN HON(2 tit)

MC TIU HC TP

1. Trnh by c kh nng thch nghi ca h tun hon.

2. Trnh by c cc ri lon bnh l trong suy tim.

3. Trnh by c cc ri lon hot ng ca h mch mu

H thng tun hon ca cth gm c tim v cc mch, c chc nng ti mu cho t

bo, m ... em n cho t chc cc cht dinh dng nh oxy, glucose, hormone ...

v nhn cc cht cn o thi nh ur, CO2 ..

1. KH NNG THCH NGHI CA H TUN HON

Nhu cu trao i cht ca c th lun lun thay i nn chc nng ca h tun hon

phi lun lun thch nghi: tng hay gim cho ph hp yu cu c th; kh nng thchnghi ca h tun hon rt ln.

1.1. Kh nng thch nghi ca tim:

Hiu sut ca tim rt cao v tim c kh nng tng nng sut ln rt nhiu ln khi

cn p ng nhu cu c bit. Nng sut ca tim c th tng ln 5 - 10 ln lc cth

lao ng cc nng hoc lc st, so vi lc ngh ngi hon ton: bnh thng lu lng

mu/pht ca tim l 4,0 - 4,2 lt c th tng ln 20 - 24 lt trong lao ng nng; thi

gian mu i 1 vng t 1 pht c th rt ngn cn 0,2 pht (12 giy).

1.2. Kh nng thch nghi ca mch:Xung huyt ng mch lm tng lng mu ti cho cquan:

- S mao mch c chc nng tng ln cung cp mu cho m.

- Tc mu tng gp 3 - 5 ln.

- Mu qua tim tng ln, mu qua ni tng gim.

- Co mchgan lch, tng mu d tr vo vng tun hon.

1.3. Kh nng thch nghi ca h h hp:

Tng cng trao i kh phi v mao mch. Lc ngh c 30% lng oxy mung mch (6ml), trong lao ng nng, s lng ny c th t ng ln 60 - 70% (12 -

14ml).

1.4. Cc bin php thch nghi ca tim:

Khi nhu cu oxy bt cht tng ln th tim p nhanh ln. Dn tim v ph i ctim l

cc bin php thch nghi chm hn khi nhu cu oxy tng ko di.

1.4.1. Tim p nhanh:

L mt bin php xy ra rt nhanh, nhy khi nhu cu tng ln i hi phi tng lu

lng tim. Nhp tim c th t 60 - 80 ln/pht ln 140 - 160 ln/pht.


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Tim p nhanh ch c tc dng tm thi gip hi phc huyt p, tng mu ti ctim.

Nu ko di s c hi cho ctim, lm suy yu dn ctim do:

- Thi gian tm trng ngn li, ctim khng c ngh ngi y .

- Tun hon vnh b km(mu chy vo ng mch vnh trong th tm trng).

Khng th tng nhp qu cao m khng c nguy csuy tim cp.

- Thi gian tm trng qu ngn, lng mu ht v tht cha , khin cung

lng tim gim d c tng nhp.

1.4.2. Dn tim:

L tnh trng t bo ctim dn di ra lm tng dung tch bung tim, cha c nhiu

mu hn.

Dn tim c th xy ra th ng sau suy tim, do c tim mm nho trc,sc co bp

gim nn khng tng c mu ra khi bung tim, mu li lm dn tim.

1.4.3. Ph i tim:L tnh trng cc si ctim to ra, ctim s dy ln song s lng si ckhng tng

ln. Kh nng lm vic ca si ctim lc ny tng ln, sc bp khe hn, tng c

nhiu mu hn lm cung lng tim tng, lu lng tim tng.

Ph i c th l:

- Sinh l: gp ngi luyn tp, lao ng nng nhc ko di. Ph i sinh l l c gii

hn.

- Bnh l: gp trong cc bnh tim mch nhhp van ng mch ch, cao huyt p...

Do tim lm vic tng trong mt thi gian di nn ph i qu mc. Ph i bnh l nmt gii han nht nh c th phc hi c..

Ph i qu mc gii hn s gy suy tim.

2. SUY TIM

2.1.nh ngha:

L tnh trng tim mt mt phn hay ton b kh nng co bp bo m lu lng

mu cho nhu cu cth.

2.2. C ch suy tim:

Suy tim xy ra khi c ri lon cc yu t trn lm gimsc co bp ca si ctim hay

do c ri lon chuyn ha trong t bo ctim. Quan trng nht trong suy tim l s ri

lon chuyn ha t bo ctim.

2.3. Nguyn nhn gy suy tim:

2.3.1. Tn thng ctim khng phi do bnh mch vnh: Gp trong

- Ri lon van tim; ctim b qu ti lu ngy.

- Thiu oxy mn tnh (trong bnh l phi mn tnh, thiu mu nng).


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- Do ng c: ng c in gii nh K+, Ca++ (nng vo t bo ctim qu cao c

th thy do tai bin iu tr, ng c gip, ng c thuc gy m nh clorofoc,

xyclopropan.

- Do nhim c, nhim khun (thng hn, cm,)

- Do suy mch, h huyt p, gim khi lng mu lu thng.

2.3.2. Tn thng ctim do mch vnh:

- Co tht mch vnh

- Tc mch vnh sau qu trnh x va hay do huyt khi gy hoi t vng c tim

tng ng gi l nhi mu ctim (NMCT).

- Cao huyt p, hp ng mch ch ... lng mu tng vo ng mch ch gim lm

tr mu tiu tun hon vi cc triu chng kh th,ph phi mn hoc cp,

2.4. Ri lon hot ng khi tim suy:

2.4.1. Gim lu lng:Khi tim suy, tc l kh nng co bp ca c tim gim, tim khng y ht

lng mu vo ng mch (60ml) do cung lng tim (lu lng tm thu) gim.

2.4.2. Tng th tch mu:

Trong suy tim, th tch mu tng. Tim suy co bp yu, khng y ht mu ra

khi tim cho nn mu v tim khng y s li h tnh mch. Mu tr nn qua

thn t, chc nng lc ca cu thn gim dn ti gi nc v in gii do th tch

mu tng. Mc khc trong suy tim c th lun lun b thiu oxy, ty xng b kch

thch nn tng sinh hng cu cng lm tng th tch mu.

2.4.3. Gim tc mu chy:

Trong suy tim, kh nng co bp ca c tim gim nn mu chy chm, c bit h

tnh mch do mu phi trong suy tim tri v mu h tnh mch ngoi vi

trong suy tim phi.

2.4.4. Thay i huyt p:

Huyt p ph thuc vo lu lng tim v sc cn ngoi vi. Trong suy tim, lu lng

tim gim, sc co bp ctim gim, ng thi sccn ngoi vi cng gim do c dn

mch (do thiu oxy v tun hon chm) cho nn trong suy tim thng thy huyt p

ng mch gim. Huyt p tnh mch th tng do tim co bp yu, mu chy chm.

3. RI LON HOT NG H MCH MU

Bnh l mch mu c th gp nh :

- Xva ng mch.

- Tng huyt p.

- Gim huyt p gy cc trng thi bnh l try mch sc, ngt.


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3.1. Xva ng mch: (XVM)

(XVM) l tnh trng vch mch dy ln do lng ng cholesterol vo cc lp o

trong ca mch mu gy tn thng thoi ha, lon dng, trn s lng ng canxi,

vim, lot, si, huyt khi, hp lng mch v ng mch khng co dn c nh bnh

thng trc cc bin i sinh l v bnh l.

3.1.1. Cch bnh sinh :

XVM l do ri lon chuyn ha lipoprotein. Lipid cvn chuyn trong mu di

dng kt hp vi cc protein c hiu (apoprotein) gi l lipoprotein (LP).

Cc LP gm 2 phn :

- Lipid gm cc cht nh cholesterol ton phn (CT), cholesterol este ha (CE) cc

phospholipid (PL) v triglyxrit (TG).

- Apoprotein.

Theo t trng t thp n cao cc LP c chia thnh cc loi sau: + Chylomicron

+ VLDL (Very Low Density LP) : LP c t trng rt thp.

+ IDL (Intermediate Density LP) : LP c t trng trung bnh.

+ LDL (Low Density LP) : LP c t trng thp.

+ HDL (High Density LP) : LP c t trng cao.

LDL - C (Cholesterol ca LDL) c tc dng chnh trong vic gy VXM.

HDL - C (Cholesterol trong HDL) khng gy VXM, l loi cholesterol tt, c tc

dng chng li s lng ng LDL - C thnh mch.3.1.2. Nguyn nhn VXM: Ch yu do :

- Di truyn:khng tng hp c cc receptor c hiu vi LDL-C; hoc do di truyn

tng enzym HMG CoA reductaza

- Do n nhiu m nht l m ng vt nh lng trng, gan, tm, cua lm tng

cholesterol, s lng ng thnh mch.

3.1.3. Cc iu kin thun li cho s lng ng cholesterol thnh mch.

- Thiu vitamin C, tyroxin lm gim ging ha cholesterol.

- Cc stress lm huy ng m, ko di tnh trng lm tng m trong mu. Cc stress

cn lm tng tit adrenalin, gim ng huyt ko di cng gy tng m trong mu.

- Tng huyt p cng d VXM, c th hnh thnh vng xon bnh l.

- Tn thng vch mch do ha cht (nicotin, tng cholesterol trong mu...) hay do

chc (thng cung ng mch ch, ch ng mch phn nhnh hay cc ni ng

mch t di ng nh thnh sau ng mch ch

- Tng ng huyt v i ng.

- Bo ph bnh l.- t hot ng th lc.


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3.1.4. Hu qu VXM :

- Tnh n hi ca thnh mch gim do tnh chu lc ca mch gim, d v mch

chy mu, d gy tng huyt p.

- Kh nng co gin cng gim : Khng thch nghi c vi cc tc nhn sinh l hoc

bnh l, d chy mu khng cm c (ch trong m ngi gi, chy mu ln

ng tiu ha ca ngi gi) d gy tng huyt p.

- Hp lng ng mch (suy tun hon no, tim), tc mch do huyt khi (nu tim c

th gy bin chng nguy him l NMCT) hay bong ra tri i gy tc mch ni khc.

3.2. Tng huyt p:

Tng huyt p khi huyt p ti a cao hn hay bng 160mmHg v/hocti thiu cao

hn hay bng 90mmHg.

3.2.1. Huyt p c hai cch iu ha :

iu ha huyt p thng qua cc yu t sau: th tch mu - Renin - Angiotensin -Aldosterone. Khi trng lc h giao cm tng lm co mch v thn, renin c tit

ra lm angiotensinogen chuyn thnh angiotensin I ri thnh angiotensin II gy co

mch nn tng huyt p. Renin cn lm tng tit aldosterone gy tng ti hp ... thu

Na+, lm thay i tnh thm mng t bo, lm tng tnh kch thch ca ctrn v tng

huyt p.

Prostaglandin iu chnh th tch mu ng ln gn, c tc dng gy li tiu. Khi

Renin - Aldosterone tng tit lm huyt p tng ln, lu lng mu n ty thn s

tng ln lm tng tit prostaglandin (PG) c bit PGA v PGE, gy dn mch vthn li tiu, huyt p do s tr li bnh thng.

3.2.2.Nguyn nhn

Tng huyt p c th l mt triu chng ca nhiu bnh hay l mt bnh ring bit -

bnh tng huyt p (khng tm c cc nguyn nhn)

3.2.2.1. Tng huyt p triu chng:Gp trong cc bnh sau:

- Tng huyt p do thn:

Dobnh nhu m thn hay do mch thn. Bnh nhu m thn lm tng huyt p

nhvim cu thn mn (sau nhim lin cu hay do cc nguyn nhn min dch khc),

vim i b thn mn.

- Tng huyt p do ni tit :

Thng gp trong u ty thng thn hay u hch giao cm

Hi chng Conn: tng aldosterone mu nguyn pht do tng tit cc hormone v

thng thn.

Tng huyt p trong hi chng Cushing: do tng cc glucocorticoit v cc

mineralocorticoit, c tc dng gi Na+.- Tng huyt p do VXM:


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Trong lm sng thy huyt p tng cao nhiu ngi c tui b VXM,

cholesterol ng trong lp di ni m ng mch ch, cc ng ln, ng mch

vnh tim, ng mch no.

3.2.2.2. Bnh tng huyt p:

Khng tm c nguyn nhn gy tng huyt p. Do ri lon hot ng ca thn kinh

trung ng, ri lon hot ng ca cc h thng iu ha huyt p (ngoi vi v trung

ng: h giao cm, thn, ni tit, mch v ri lon mi lin quan gia cc h thng

iu ha ni trn). Cc thuc an thn dn mch c tc dng tt vi nhng bnh nhn

ny.

Yu t di truyn c vai tr quan trng trong bnh sinh ca bnh cao huyt p ny.

3.2.3. Hu qu v bin chng ca tng huyt p:

3.2.3.1. Suy tim:

Tng huyt p gy dn tim v ph i tht tri; p lc nh tri v p lc mao mchphi u tng ln; ph phi (c bit ph phi cp) xy ra khi p lc mao mch phi

ln hn tng s p lc keo mu; dn dn suy tim tri. V sau, tng p lc ng mch

phi, suy tht phi gy ph i tht phi, tng p lc nh phi v p lc tnh mch, i

n suy tim ton b.

3.2.3.2. Suy mch vnh:

- Tng huyt p to iu kin cho VXM vnh pht trin .

- Tng huyt p gy co tht hay tc mch vnh a n tai bin mch vnh.

3.2.3.3. Bin chng no:- Mch mu xnn d v, nguy him nht l v, chy mu no, lt no.

3.2.3.4. Gim th lcdo ri lon nhxut huyt, ph n ng mch vng mc do

tng huyt p.

3.3. Gim huyt p:

Gp trong sc, tru mch.

3.3.1. Try mch:

3.3.1.1. nh ngha:

Trymch l tnh trng dn t ngt h tiu ng mch v c bit l h tnh

mch, huyt p tt t ngt, c th xung s khng. Tim bp rng, cng vi cc du

hiu thiu oxy no nghim trng (xy xm mt my, ti mt )

3.3.1.2. Nguyn nhn :

- Trung tm vn mch b c ch trong nhim khun, nhim c. Ngoi c t vi khun

cn b nhim c do sn phm chuyn ha trong tnh trng thiu oxy.

- Thay i tth t ngt (t nm sang ng)c th xy ramt s ngic bit

cc bnh nhn nng, c th yu nm lu, khi ng ln, mu theo trng lng dnxung phn di cth, tnh mch ni tng, mu khng ln c no.


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- Chc tho bng qu nhanh v nhiu gy dn qu mc cc mch mu ni tng lm

gim khi lng mu lu thng, gy thiu mu ln no.

3.3.2. Sc:

3.3.2.1. nh ngha:

Sc l mt hi chng suy tim mch cp tnh. Duhiu xc nhnsc l c ri

lon vi tun hon, do cc cquan trng yu ca cth (no, tim) khng c ti

mu y .

Khc vi try mch, sc din bin khng t ngt, c mt qu trnh chia nhiu

giai on trong cth c th huy ng cc phn ng b.

3.3.2.2. Phn loi sc:

- C th chia theo nguyn nhn: sc chn thng, sc chy mu, sc bng, phn v,

nhim khun ...

- Thng phn loi sc theo cch bnh sinh: sc c gim hay tng huyt ng: nhlu lng tim, sc khng ngoi vi, paCO2, pH, paO2....

3.3.2.3. Cch bnh sinh ca sc:

- Hin tng u tin ca sc (nhim trng, chn thng, mt mu ln, phn v, bng

...) l gim khi lng mu lu thng (KLMLT). Trong sc, nhiu li mao mch lc

bnh thng khng c ti mu, nay dn rng v mt lng mu ln tp trung vo

. Do gim KLMLT l do ri lon phn b mu trong cth.

Trong sc nhim khun, cc c tc vai tr trong vic khi pht s gim KLMLT.

Cc c t ca vi khun to ra c t phn v hay tc ng trc tip gy co cc tiung mch ni tng, da v co tht h tiu tnh mch lm ng mu mao mch, ri

lon mu v tnh mch gy nn gim KLMLT, v lm gim huyt p. V li gim

huyt p cn do suy mch cp tnh do lit trung tm vn mch.

- Thiu oxy trong t chc: Do KLMLT gim nn lng mu n cc cquan trng

yu cng t i. Lu lng tim gim kt hp vi s tng sc khng ngoi vi cng

lm gim mu ti cho t chc.


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SINH L BNH TIU HA(4 tit)

MC TIU HC TP

1. Trnh by c c ch bnh sinh ca lot d dy-t trng.

2. Trnh by c cc ri lon tit dch, co bp v hp thu ti rut.

NI DUNG

Bnh l ca tiu ha c th xy ra bt c on no biu hin thay i cu trc

v ri lon chc nng: thng gp v quan trng nht l nhng ri lon ti d dy v

ti rut.

1. Ri lon tit dch trong bnh sinh ca lot d dy - t trng:

1.1. i cng:Theo Schwartz 1910 ngoi tc dng tiu ha thc n, bn thn dch v cn c

tc dng ph hy nim mc d dy- t trng nhng tc dng ny b cc yu t bo v

chng li lm mt hiu lc do vy bnh d dy t trng khng xut hin ngi bnh

thng.

Schwartz xut quan nim cho n nay vn cha c chng minh l ng:

lot DD- TT l hu qu ca s mt cn bng gia cc yu t tn cng v cc yu t

bo v trong cc yu t tn cng chim u th.

Cho n nay ngi ta xc nh c:

Cc yu t tn cng Cc yu t bo v

Cc acid Cht nhy

Men pepsinogen HCO3-

S ti to nim mc

Chnh v vy khi bnh lot d dy t trng l do yu t tn cng tri hn hay yu tbo v gim i.

Gn y ngi ta pht hinra vi khun Helicobacter pylori l mt tc nhn mch

m h tryu t tn cng v lm suy yuyu t bo v a n lot.

1.2. Cc yu t bo v:

* Lp nhy:ph trn b mc nim mc, n tn ti di dng gel v mang tnh cht

kim, n khng thch hp vi s phn hy ca pepsine, ng thi khng cho php

acid t dch v khuch tn su vo trong.

* T bo biu m nim mc: ti sinh rt nhanh mi khi tn thng, ng thi snxut c mt s ion bicarbonat trung ha vi acid.


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* S ti mu phong ph:mang i cc ion H+v hn gn cctn thng.

* Prostaglandine:c sn xut ti ch. Prostaglandine c tc dng khuch i v

iu phi cc yu t bo v ni trn, gip qu trnh ti to xy ra lp tc.

* S ti to v hn gn:

Nhng tn thng do yu t tn cng gy ra cho nim mc d dy c hn

gn tc khc, k c khi nng ca acid H+tng ln gp nm ln.

Khi cc yu t bo v ni trn t ra bt cp, khin tn thng vt qu lp

mng y ca biu m ti lp di nim mc th s ti to tc thi ca biu m khng

c thc hin. Qa trnh sa cha din bin chm li, v phi c cc t bo t bn

ngoi xm nhp v tng sinh vng tn thng lp ch. Vai tr phi hp ca

Prostaglandine lc ny cng t ra quan trng. y, cn c vai tr ca yu t tng

trng EGF. N c bi tit trong nc bt v t trng, c tc dng gim tit acid,

kch thch s xm nhp v tng sinh t bo vng tn thng.1.3. Cc yu t tn cng:

* Pepsinogen:Trong lot pepsine to iu kin cho ion H+ca acid khuch tn su

vo lp gel tip cn lp biu m nim mc d dy. Mt khi lp nhy b ph v v

nim mc b H+lm tn thng th pepsin c iu kin phi hp lm nng thm cc

tn thng ti lot.

* Acid HCl:ngi ta chng minh c s khuch tn ngc ca ion H +t lng d

dy thm qua lp gel vo tn cu trc di nimmc. Ion H+c gy tn thng hay

khng cn ty thuc vo nng ca ion H+thm vo v kh nng bo v. Cc cutrc tn thng do ion H+gy ra gm: biu m nim mc, cc nron mch mu, kt

hp vi s xm nhim ca cc t bo vim gy mt chui hu qu nh sau:

+ Gii phng cc cht dn truyn thn kinh (cng gy tng acid).

+ Xm nhp cc thnh phn mu cng gy nn tn thng, to nn hn hp peptit v

acid amine gy kch thch tit thm acid HCl.

+ Hot ha cc t bo vim trc tip kch thch t bo thnh tit thm acid HCl.

1.4. Nhng tc nhn gy tng acid v lm gim kh nng bo v bao

gm:

- Yu t di truyn.

- Thuc khng vim khng steroid.

- Thuc l

- Ru

- Cafe.

- Acid mt

- Vi khun Helicobacter pylori (H.P)- Stress


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1.5. Ri lon chc nng co bp:

- Co bp d dy c tc dng nho trn v chuyn thc n xung t trng trong .

- Trng lc: gip cho thnh d dy p st vo nhau, gip cho sc cha ca d dy

thch ng vi th tch thay i vi lng thc n a vo.

-Nhu ng: l cc cn co chu k tc dng trn v chuyn thc n

- Hai yu t lm co bp d dy l: thn kinh ph v v histamine.

+ Gim co bp:c th xut hin tm l lo lng, cn tr c hc ko di, mt thng

bng thn kinh thc vt, hu qu l triu chng y hi, tc bng, kh tiu nng nht

l sa d dy khi khi c d dy b lit.

+ Tng co bp:c th gp; vim d dy, tc mn v giai on sm, mt thng bng

thn kinh thc vt, thc n c cht kch thch nh ru, cafe, thuc l, cc gia

v...hoc dng cc loi thuc kch thch d dy nh histamine. Hu qu vch d dy p

cht vo nhau gy tng p ti hi v thc n b y nhanh xung t trng.2. Sinh l bnh chcnng rut:

2.1. Ri lon tit dch v co bp ti rut:

Chc nng quan trng nht ca rut l tit dch, co bp v hp thu.

2.1.1. Ri lon dch mt:

Mi ngy gan tit ra khong 500ml mt, trong tc nhn tiu ha lipit l mui mt

vi cc tnh cht nh ha m hn hp enzym lipase ca dch rut. Gim tit dch mt

c th lp li khi thiu nng gan, tcng mt ch, bnh hi trng lm km hp thu

mui mt.

Hu qu c th 60% m khng c hp thu.

2.1.2. Ri lon v dch ty:

Tuyn ty tit ra enzym ch lc tiu ha protid, glucid v ngoi ra cn tit

lipase tiu ha lipid. Suy chc nng ty bao gi cng gy ra ri lon tiu ha nng.

* Thiu nng ty:thng gp trong vim ty mn, gy ri lon tiu ha v gy kch

thch rut, nu ko di c th gy ra suy dinh dng. C th c nhng ri lon do

thiu cc insuline. Ngoi ra cn gp si v giun gy tc bng Vater hay ng Wirsung.

* Vim ty cp: y l bnh l vim hoi t cp din, gy au n

d di, dn n sc nng, t l t vong cao. Vim ty cp thng xy

ra ngi bo sau mt ba n qa nhiu m v protein. Cc nh

nghin cu cho rng tnh trng trn khin lng dch ty tit ra nhiu

lm tng p lc trong ng dn ty gy tc , dch ty c iu kin

trn ln vi mt v do vy cc tin enzym b hot ha lm tiu hy

m ty . Enzym ty do s hoi t cn thot khi ty ra bng gy t nh

trng hy hoi quanh ty, gii ph ng cc cht gy ri lon huyt nghc ti ch v ton th n dn n sc.


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2.1.3. Hi chng tiu chy:

- Tiu chycp: nu i tin nhiu ln lin tip trong mt thi gian ngn, khin c th

mt nhiu nc theo phn.

- Tiu chy mn: phn nho ko di trong nhiu tun, nhiu thng; khng mt nc

m hu qu ch yu l km dinh dng do gim hp thu.

* Nguyn nhn:

- Tn thng thc th t bo nim mc, vim (do vi khun, k sinh vt, c t ca

chng), do c cht gy d ng rut.

- Thiu dch v enzym tiu ha.

- U rut

- Bnh l rut vim phc mc, vim rut tha.

* C ch bnh sinh gy tiuchy:

- C ch tng tit dch:c ch ny hay gp trong vim rut, nc t nim mc ruttit ra c th gp hng chc ln bnh thng, nht l do vim cp trong ng c( c

t vi khun, t, thc n i thiu..) gy mt nc cp .

- C ch gy tng co bp:lm thc n qua rut nhanh khi cha kp tiu ha v hp thu

y . Du hiu c trng l y bng, phn sng. C ch ny cng gp trong vim

rut, ri lon vi khun ch rut.

- C ch gim hp thu:khin lng nc thi theo phn tng ln. Gp trong vim rut

khc nhau trong ct on rut, hoc ri lon vi khun trong nhng on rut khc

nhau.

* Hu qu:

- Tiu chycp: biu hin bng hai hi chng: ri lon huyt ng (mu c c v

gim khi lng tun hon v gy tt huyt p v to nn gnh nng cho tim); nhim

c v nhim acid (do mt d tr kim theo phn, t bo chuyn ha ym kh, ng

thi ngng o thi nc tiu)

2.1.4. Hi chng rut d kch thch:

L ri lon chcnng mn tnh rut m khng c tn thng thc th. cc

nc n chim gn na s trng hp ti khm chuyn khoa tiu ha v a s l n

vi cc triu chng:

+ Cm gic kh chu vng bng(ti pht t nht sau 3 thng), tm gim sau khi i

tin.

+ C t nht 2 trong 5 du hiu sau: thay i s ln i tin trong ngy, phn khng

thnh khun, thay i khi tng phn, phn c nhy nht, chng bng.

Bnh nguyn v bnh sinh cha hon ton sng t, k c gi thuyt trc y cho rng

ch n khng cht x.


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2.1.5. Hi chng tc rut:

l mt on rut mt lu thng, khin phn trn dn to do tr thc n v

cht dch.

* Nguyn nhn: tc rut c hc v tc rut chc nng( lit rut do cng ph giao

cm).

* Hu qu:ty theo v tr cao hay thp:

- Tc rut cao: biu hin ni bt l mt nc do nn.

- Tc rut t trng, nn ra dch rut, dn n mt nc km nhim acid.

- Tc thp: biu hin nhim c sm hn v nng hn so vi nhim c mt nc

thy nhim c nng hn.

2.1.6. To bn:

l tnh trng kh hoc khng i tin c do khi phn tr nn rn chc, nm lu

trong i trng lu hn bnh thng. Thnh phn ch yu l phn, cht x, nc vxc ca vi khun.

* C ch v nguyn nhn:

- Tc nghn c hc i trng, rut xichma, trc trng, khin phn nm lu trong trc

trng. Gp trong trng hp u, so, co tht ko di i trng v di .

- Gim trng lc rut gi, do vy gim co bp y phn i. Gp nhng ngi

bo, ngi gi sng tnh lng, nhng ngi do ngh nghip ngi lu ti ch.

- Thi quen nhn i tin .

* Hu qu:bnh nhn khc phc to bn bng c rn i tin s dn n phng tnhmch hu mn v trc trng(gi l tr). C th thiu mu do mt mu, cn c th

nhim khun ti ch hay ton thn tiu im t cc bi tr b v.

2.2. Ri lon hp thu:

2.2.1. i cng:

Hp thu l chc nng quan trng nht ca rut v cng l ton b h tiu ha. l

mc ch cui cng ca tiu ha ni chung. tiu ha tt, cn c s hon thnh cc

chc nng khc nh co bp, titdch. Cc iu kin hp thu:

- Thc n c th c bin ha thnh dng c th hp thu c; iu ny ph thuc

vo cht lng tiu ha v thi gian tn ti ca thc n trong rut non.

-Nim mc hp thu phi ton vn, rng v cp mu y .

- Tnh trng ton thn lin quan n tiu ha phi c m bo.

2.2.2. Bnh nguyn v bnh sinh ca ri lon hp thu tiu ha:

Km hp thu ch a n hu qu r rng nu xy ra trong mt thi gian di

lin tc hoc lp i lp li nhiu ln: c th chia thnh hai nhm ln sau y:

* Nguyn nhn ti ng tiu ha:gm nguyn nhn ti rut, nguyn nhn ngoi rutnh(d dy, gan, ty..)


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* Nguyn nhn ngoi ng tiu ha.

- Ri lon ti rut a n km hp thu gm: nhim khun, nhim c tiu ha, gim

tit enzym tiu ha, gim din tch hp thu.

- Ri lon ngoi rut a n gim hp thu gm: bnh d dy (vim lot d dy, ung

th, ct on d dy..), suy gan (gy thiu mui mt gim hp thu lipid), suy ty

lm gim hp thu v thiu enzym tiu ha quan trng.

2.2.3. Hu qu ca gim hp thu:

- C th a n thiu dinh dng nu thiu calo v protein.

- C th thiu mt vi hay nhiu vitamine v yu t vi lng, kt hp suy dinh

dng hay c lp. Ty theo thiu cht g m biu hin bnh l c trng.


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SINH L BNH CHC NNG GAN

(2 tit)

MC TIU HC TP

1. Gii thch c ch ri lon chc phn gan v chuyn ha protid, glucid, lipid, mui

v nc.

2. Gii thch c ch chc phn chng c ca gan.

3. Trnh by ri lon chc phn cu to v bi tit mt ca gan.

4. Trnh by c cc mc ri lon chc nng gan trong suy gan.

NI DUNG

1. i cng:Gan l mt c quan ln nht trong c th, m nhim nhiu chc nng quan

trng vphc tp. Gan ng v tr cang, ni lin ng tiu ha vi ton b c th,

gan tch ly v chuyn ha hu ht cc cht c hp thu rut vo v cung cp cc

cht cn thit cho c th.

Cc chc nng ca gan c thc hin nh hai loi t bo (t bo nhu m gan

v t bo Kuffer thuc h thng lin vng ni mc) v nh c mt lng mu qua gan

rt ln (mi pht gan nhn khong 1500ml mu).

2. Nguyn nhn ri lon chc nng gan2.1. Cc yu t gy bnh

2.1.1. Cc yu t bn ngoi

-Nhim khun ( vi rt, vi khun, k sinh trng), c t tc ng trc tip trn nhu m

gan v gin tip khi tnh trng nhim khun gy suy sp ton thn trong c gan.

-Nhim k sinh trng: cc loi KST c th gy x gan bao gm: k sinh trng st rt,

sn l gan.

-Nhim c cp tnh: nhim ch, ng, phospho, cacbon...

-Nhim c mn tnh nh ru.

2.1.2. Yu t bn trong:

- mt:tn thng gan do mt c th nguyn pht hay th pht din bin lu ngy

dn n x gan.

- tr tun hon:tc tnh mch trn gan do chn p t bn ngoi ca cc khi u c

tnh, p xe gan do amip, t mu...

- Ri lon chuyn ha:gan l kho d tr ca nhiu cht ng thi l ni chuyn ha

ca cc cht din ra rt mnh. Cc phn ng chuyn ha gan nh h thng enzym


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ni bo. Ri lon chc phn chuyn ha gan c th do thiu hoc tha enzym hoc

cc cht chuyn ha.

2.2. ng xm nhp ca cc yu t gy bnh

2.2.1. ng tnh mch ca

Yu t gy bnh t ng tiu ha (vi khun, cht c t thc n). y l ng chnh

v quan trng nht, v d vim gan do trc khun coli, thoi ha m gan do ng c

phospho, ru...

2.2.2. ng ng dn mt

Vim ng dn mt do vi khun dn n ri lon chc nng gan v x gan.

2.2.3. ng tun hon mu

Cc vi khun v virut theo ng tun hon mu tii gan nh lao, nhim khun huyt,

vim gan do virut, ng c thuc m.

2.2.4. Theo ng bch huytCc yu t gy bnh t ng tiu ha theo ng bch huyt ti gan nh amp gy ti

m gan.

3. Ri lon chc nng ca gan

3.1. Ri lon chuyn ha do bnh gan

Mi chc nng chuyn ha u c thc hin bi t bo nhu m, nh mt h thng

enzym phong ph c trong t bo ny.

3.1.1. Ri lon chuyn ha protid

- Gim kh nng tng hp protid, mi s bnh gan gy gim kh nng tng hpprotid, trc nht l albumine, globuline.

- Gim tng hp cc protid tham gia phn ng gy ng mu, nh cc yu t II, VII,

IX, X... cc yu t gy chng chy mu A, B, C, phc hp prothrombine, fibrinogen.

Do vy bnh nhn suy gan, d b xut huyt di da v gy chy mu.

3.1.2. Ri lon chuyn ha lipid

Gan khng nhng gip cho c th tng hp m qua ng tiu ha m nh mt

ca n bi tit ra m cn c nhim v chuyn ha nhng m hp thu a n gan

qua ng mu. V vy khi chc phn chuyn ha lipid ca gan b ri lon th c

nhng biu hin sau y.

- Lng m d tr trong gan gim nhanh do gim hp thu v gim tn to m t

protid v glucid.

- M lu hnh trong cc thnh phn ca lipoproteine huyt tng cng vi cc cht

vn chuyn m do t bo gan tng hp v cc cholesterol t do v cc este ha cng

gim.


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- Gim hp thu cc vitamine tan trong m nh: Vitamine A, D, E, K v gim hp thu

m ni chung. Hu qu ca thiu cc vitamine ny nh bnh kh mt do thiu

vitamine A, chy mu do thiu vitamine K, ci xng do thiu vitamine D.

3.1.3. Ri lon chuyn ha glucid

Gim kh nng chuyn ng mi hp thu t ng tiu ha v ng glycogen

d tr. Gim kh nng d tr glycogen, ngi bnh d b h ng huyt sau ba n.

3.1.4. Ri lon chuyn ha nc mui

Th hin ri lon chuyn ha mui nc trong suy gan l ph. Ph do gim p

lc keo, do tng p lc thy tnh (trong trng hp c tng p lc tnh mch ca)

nc b y ra ngoi lng mch v gim kh nng phn hy mt s hormon nh ADH

c tc dng gi nc, Aldosterongi mui v ko theo gi nc.

3.2. Ri lonchc nng chng c

Ri lon chc nng chng c ca th hin:+ Gim phn hy mt s hormone: kch t sinh dc, kch t v thng thn, bnh

nhn suy gan c hin tng mui v nc.

+ Gim kh nng chuyn cht c thnh cht khng c hoc km c bng phng

php ha hc.

3.3. Ri lon chc phn cu to v bi tit mt

Vng da do tnh trng bnh l xy ra khi sc t mt trong mu cao hn bnh

thng v ngm vo da v nim mc.

* Vng da do nguyn nhn trc gan:- L vng da do tng tan mu nn hemoglobine c chuyn thnh bilirubine t do

qu nhiu.

- Nguyn nhn c th l: nhim khun, k sinh trng, nhim c, do truyn nhm

nhm mu.

* Vng da do tn thng gan:nguyn nhn gy vng da ny do nhim c, nhim vi

khun(nhim khun huyt, giang mai)

* Vng da do nguyn nhn sau gan:mt khng xung c rut, vo mu gy vng

da, phn trng, nc tiu vng.

Nguyn nhn:c hc do si, giun chui ng mt, u u ty, hch to chnp ng

dn mt....

3.4. Ri lontun hon v chc phn to mu

3.4.1. Ri lon tun hon

3.4.1.1. mu ti gan

Tt c cc nguyn nhn mu tun hon v tim phi, u lm cho mu

gan, nh suy tim phi, vim ngoi tm mc co tht, bnh phi mn tnh, tc tnh mchch di, tnh mch gan do vim hoc do chnp u lm ri lon chc nng gan.


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* Hu qu:ty theo thi gian mt. u tin gan c th to, tnh trng gan lc ny gi

l gan n xp. Khi mu gan lu ngy, gan s b thiu oxy ko di dn ti hoi t

t bo nhu m gan quanh tnh mch trung tm tiu thy, t chc x pht trin dn ti

hnh thi bnh l gan ht cau.

3.4.1.2.Tng p lc tnh mch ca

Nguyn nhn gy tng p lc tnh mch ca do huyt p tnh mch ton thn

tng, do h thng tnh mch ca b tc mt on no trc hoc sau xoang, do x

gan, do u chn p.

- Hu qu ca tng p lc tnh mch ca: T chc x ca gan d pht trin do

trung tm tiu thy thiu dinh dng, tunhon bn ngoi gan pht trin gy nn:

+ Nn ra mu do tng p lc vng ni thc qun gia tnh mch vnh v ca h

thng ca vi tnh mch n ca h thng ch, v tnh mch ch trn.

+ Tr do tng p lc vng ni trc trng gia tnh mch tr trn ca h thng ca vitnh mch tr gia v di ca h thng ch v tnh mch ch di.

+ Tun hon bng h do tng p lc vng ni quanh rn ca h thng ca vi tnh

mch thng v, h v ca tnh mch ch di, biu hin lm sng l nhng chm tnh

mch ngon ngoo ni di da bng.

Bng nc l kt qu phi hp ca nhiu ri lon:

- Do tng p lc thy tnh ca h thng tnh mch ca.

- Do tng tnh thm ca thnh mch v tnh trng thiu oxy v nhim c mn tnh

bnh nhn suy gan.

- Do gim p lc keo huyt tng (gan gim chc nng tng hp protid).

- Do gan khng phn hy mt s hormone gi mui nh aldosteron v gi nc nh

ADH.

Bng nc trong x gan l bng nc nhiu nc, mu vng chanh v hi snh. Bng

nc c th gy chn p cc tng trong bng, nh hng n hot ng c honh

gy kh th.

3.4.2. Ri lon chc phn trong cu to mu

Trong mt s bnh l ca gan thng c nhng biu hin thiu mu do thiu

protein, st, vitamine. Chy mu do thiu cc yu t ng mu v chng ng mu.

Hi chng chy mu trong suy gan cn do tng p lc tnh mch ca, dn tnh mch

lm tng tnh thm thnh mch v lch x.

4. Suy gan

Suy gan l tnh trng bnh l trong gan khng lm trn cc chc nng ca

n v nh hng cc hot ng ca cc c quan khc. Biu hin lm sng v mc

ri lon cc chc nng ty thuc vo suy gan cp hoc suy gan mn tnh.


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4.1. Suy gan cp

Ty theo thi gian xut hin ca du hiu suy gan sm hay mun, gan teo nh

k t khi c vng da m chia ra ba loi:

- Suy gan ti cp nu bnh nhn din bin trong thi gian mt tun.

- Suy gan cp nu bnh din bin trong thi gian ba tun.

- Suy gan bn cp nu bnh din bin trong vng 2- 3 thng.

4.1.1. Nguyn nhn

Tt c cc nguyn nhn lm gan b nhim c nng nh phospho, thuc m

hoc nhim khun nng nh vim gan do virut.

4.1.2. Biu hin lm sng

Bnh nhn c nhng du hiu nng ngay t u, hnh thnh rt y v

nhanh ty theo mc ca x gan: du hiu nn v du hiu thn kinh xut hin sm,

xut huyt di da hoc d dy..- Xt nghimmu: glucose huyt gim, cholesterol este ha gim nhiu, amoniac tng

cao.

- Gii phu bnh: nhu m gan b hoit ton b hoc kiu mi gm, hoc hoi t c

cu ni nht l hoi t vng trung tm tiu thy.

4.2. Suy gan mn tnh

4.2.1. Nguyn nhn

Suy gan mn tnh thng gp nhng ngi b bnh gan ko di, nhu m gan

b tn thng lm nh hng n chc nng gan.

4.2.2. Biu hin lm sng

Thng qua cc ri lon chc nng sau y:

- Ri lon chc nng tiu ha: chn n, bun nn, chng hi, y bng, a lng..

- Ri lon chc nng tun han: thiu nng tim mch do tng lu lng tun hon do

ng c c tim v cc cht c chung cho ton c th.

- Ri lon chc nng thn: gy ra hi chng gan thn c thiu niu, c ur mu cao..

- Ri lon chc nng thn kinh: run tay, ri lon tr nh hoc nng hn l hn m..

4.3. Hn m gan

Hn m l do suy gan bt u t nhng ri lon thn kinh nh run tay, phn x

tng, thc gim st, m mng, ni lp bp, co git v cui cng l hn m.

C ch c th l do: tng amoniac trong mu, hoc tng cc dn truyn thn

kinh gi.


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SINH L BNH CHC NNG THN(2 tit)

MC TIUHC TP

Sau khi hc xong bi ny sinh vin c kh nng:

1. Trnh by nguyn nhn, c ch, ca ri lon chc nng cu thn.

2. Trnh by c ch suy thn cp v suy thn mn.

3. Trnh by nguyn nhn, c ch, ca ri lon chc nng ng thn.

NI DUNG

1. i cng v chc nng thn:

Thn c chc nng o thi ra khi c th nhiu cht nng ca chng

khi tng ln trong huyt tng (chc nng ngoi tit). ng thi cn sn xut ra mt

s hot cht a vo mu (chc nng ni tit) duy tr s lng hng cu v huyt p.- Chc nng ni tit bao gm:

+ Tit ra renin: c vai tr duy tr n nh huyt p.

+ Tit ra erythropoietin: c vai tr duy tr s lng hng cu do kch thch s pht

trin v trng thnh ca hng cu trong ty xng.

- Chc nng ngoi tit:

+ Lc cu thn o thi ra khi huyt tng.

+ Cc sn phm cui cng ca qu trnh chuyn ha cht trong c th.

+ Cc cht c ni sinh (bilirubine, kt hp vi acid, gy nhim toan) v mt s chtc ngoi sinh (i vo bng ng tiu ha hoc ng mu).

- Bi tit v ti hp thu:

+ Bi tit mt s cht, ngoi s lng c o thi bng lc, cn c bi tit gp

nm ln ng thn.

+ Ti hp thu: thu hi v tr li huyt tng nhiu cht cn thit cho c th trc

b thotra t cu thn do ln vo cc cht o thi.

2. Cc biu hin bnh l nc tiu v mu2.1. Nc tiu

Trong bnh l nc tiu c th thay i v lng hoc v thnh phn. Nhng

thay i ny c th do nguyn nhn ti hoc ngoi h tit niu.

2.1.1. Thay i v s lng nc tiu:

S lng nc tiu trong 24 gica ngi bnh thng rt thay i, c th dao

ng trong khong 500ml - 2000ml, trung bnh khong 1000ml - 1500ml. iu ny

ph thuc vo lng nc o thi theo hi th hay theo m hi tng hoc gim,

lng nc tiu chu nh hng r rt ca:- Ch n ung: nhiu hay t nc.


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- Thi tit nng hay lnh.

- Lao ng c bp cng cao hay thp.

* a niu:

l lng nc tiu trn 2000ml/ ngy m khng do ung nhiu.

C th do nguyn nhn ti thn nh:

+ X thn:a s gp ngi gi hoc bnh nhn vim k thn mn tnh, vim b

thn mn...

+ Bnh tiu nht:t bo ng thn km nhy cm vi vi ADH.

C th do nguyn nhn ngoi thn nh:

+ Bnh tiu nht:lng ADH gim st do vng di i v tuyn yn km sn xut.

C th bi tit 25 lt nc tiu/ ngy do ng ln xa hu nh khng ti hp thu nc.

+ a niu thm thu:do tng p sut thm thu trong lng ng thn gy cn tr s

hp thu nc. C th gp trong bnh tiu ng, khi truyn dch manitol hoc khi sdng cc thuc li tiu thm thu.

* Thiu niu:

Khi lng nc tiu di 400ml/ngy, nu khng phi gim lu lng mu ti

thn a n gim lc (nguyn nhn trc thn) th thng do nguyn nhn ti thn

hoc do nguyn nhn tc ng dn niu (sau thn).

- Trc thn: do mt mu, x va ng mch thn... dn ti gim p lc lc v

lu lng mu n thn.

- Ti thn: trong bnh vim cu thn, c ch thiu niu do cc cu thn ng

mu, cn huyt tng ti ch hnh thnh dch lc. Trong khi kh nng hp thu trong

ng thn hon ton bnh thng; trong vim ng thn, t bo ng sng ph n hoc

bong ra gy hp hoc tc ng thn khi lu lng qua thn rt km.

- Sau thn: c th do si, u c th gy tc ng tit niu.

* V niu:l lng nc tiu di 100ml/ngy.

V niu c th do nguyn nhn:

+ Trc thn (mt nc nng).

+ Ti thn (vim cu thn cp din, vim ng thn nng n).

+ Nguyn nhn sau thn: tc t i b thn tr xung.

2.1.2. Thay i thnh phn ca nc tiu

* Protein niu:

Bnh thng: lng protein mt theo nc tiu khng ng k (150mg), khng

pht hin c bng cc xt nghim n gin.

Nguyn nhn:

- Trc thn:gp trong bnh a u ty xng, mt s bnh c ri lon sn xut khngth.


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- Ti thn:ch yu gp trong cc bnh vim cu thn, hoc ng lu..

- Sau thn:l do tn thng hoc vim ng dn niu khin protein t tn thng,

hoc t mu trong vim lc vo. Tuy nhin trong trng hp ny triu chng protein

niu t quan trng m ni bt l cc thnh phn bt thng khc trong nc tiu nh:

hng cu, bch cu, t bo vim v t bo m..

* Hng cu niu:

Bnh thng s lng hng cu trong nc tiu 24 gi khng ng k.

Nguyn nhn gy ra hng cu niu:

- Trc thn: rt him, c th gp trong bi cnh ri lon ng mu nng n, xut

huyt ton thn hoc ni tng, gm c thn.

- Ti thn:khi c tn thng on bt k no ca nephron u c th lm mu chy

vo trong lng ng thn, Trong vim cu thn, vim k thn. vim ng thn... hng

cu niu l mt triu chng ca b phc hp gm tr niu, protein niu v bch cuniu. Trong trng hp c vim m thn th hng cu niu triu chng i km vi

triu chng chnh l c bch cu, bch cu thoi ha v t bo m nc tiu.

- Sau thn: do v mch mu vo ng dn niu hay gp khi c si, vim nhim ( b

i thn, niu qun, bng quang v niu o) hoc do chn thng.

* Tr niu:

L cu trc vi th trong nc tiu c hnh tr, do protein b ng vn li theo

khung ca lng ng thn. iu kin xut hin tr:

-Nng protein trong nc tiu cao.

- Lng nc tiu tng i thp chy theo trong ng thn c thi gian hnh thnh

tr.

- C th thay i l ha trong nc tiu gip cho protein d ng li.

Hay gp tr niu trong cc bnh vim cu thn, thn h nhim m.

3. Thay i mu trong bnh thn:

- Tng ur huyt: (hi chng tng ur huyt).

-Nhim acid mu

- Thiu mu.

- Tng huyt p

4. Sinh l bnh cu thn v ng thn

4.1. Vim cu thn cp

4.1.1. Nguyn nhn:

L hu qu ca ri lon min dch, hay gp tr em do mt nhim khun ko

di, do lin cu tan huyt A gy nn. Sau vi ba tun b nhim khun, lng khng th

xut hin hnh thnh phc hp min dch lu hnh lu trong mu th d b bin


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chng vim cu thn cp. C ch l do phc hp min dch b o thi v lng ng

cc lp ca mng lc cu thn.

4.1.2. C ch bnh sinh:

S lng ng ca phc hp min dch gy ra mt s hu qu:

- Xc trong phc hp min dch hp dn mt s ln bch cu tp trung to cu thn

lm nhimv thc bo v phng thch cc enzym gy tiu hy.

- Phi hp vi bch cu l s hot ha b th ti ch. l hai tc dng gy vim ch

yu, m i tng ph hy l cc lp t bo ca mng lc.

4.1.3. Biu hin lm sng:Bnh nhn thng c v niu, tiu mu, ph..

4.2. Vim cu thn mn

4.2.1. Nguyn nhn:

- Vim cu thn cp dn n vim cu thn mn.

- Bnh v mch thn.- Bnh t min.

- Bnh h thng.

4.2.2. Bnh sinh:

Din bin chung sau khi pht trin, cu thn b x ha, mt dn cu trc, do

vy ton b nephron thoi ha theo gm ng thn v mao mch quanh n. Ban u ch

c mt s nephron thoi ha khng phc hi.

4.3. Vim ng thn cp

Rt nhiu nguyn nhn c th gy vim ng thn v ch vim cp m khng c vim

mn. Chung quy, cc nguyn nhn u thng qua mt s c ch gy tn thng v

hoi t cho ng thn, trong c hai c ch quan trng nht:

- Thiu mu, thiu nui dng.

- Mt s c cht c i tnh vi enzym ht sc phong ph t bo ng thn, mui kim

loi nng, c tnh trong gan cc, nhim khun gram m, mt s thuc...

5. Suy thn

Suy thn mn l hu qu ca nhiu bnh khc nhau, trong thn khng thc hin

y cc chc nng ca n, trc ht l chc nng o thi, biu hin bngs

ng trong c th cc cht cn b v cc cht tha khc. Suy thn nu ko di, cn

biu hin bngtnghuyt p v thiu mu.

5.1. Suy thn cp

5.1.1. Nguyn nhn trc thn:

- Gim th tch mu.

- Gim cung lng tim.

- Do tt huyt p nng v ko di.- Do cc bnh h thng a n.


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5.1.2. Nguyn nhn ti thn:

- Do mch ln cu thn: huyt khi ng mch thn, huyt khi tnh mch thn, vim

mch thn x va..

- Do cu thn: vim cu thn cp

- Vim thn k thn cp din, d ng, thuc (khng sinh, li tiu..).

5.1.3. Nguyn nhn sau thn:rt him gp.

5.1.4. C ch bnh sinh:

T bo ng thn tn thng, thoi ha v hoi t a li cc hu qu:

- T bo phng to lm cht hp hoc tc ng thn

- T bo hoi t, bong ra lm tcng thn v quan trng nht lm nc tiu chy trc

tip vo mu em theo cht o thi.

- S tr cp din nhiu sn phm c nh hp cht ca nit..

- Cc cht c hot tnh ca vim gii phng vo trong mu.5.2. Suy thn mn

Chc nng thn gim dn, din bin ko di, do s cu thn gim i, tuy nhin

khi triu chng suy thn biu l trn lm sng v trn xt nghim th thi im

c ti 70% s cu thn b x ha v hon ton khng cn hot ng chc nng.


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SINH L BNH QU TRNH VIM(2 tit)

sinh li benh

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