NHM 5

BI NGUYN NG KHOA 115314013

TRN TN TN 115314031
NGUYN PHC THIT 115314026
L TH M 115314016
TRN BCH TRM 115314026
TRN NGC 115314021
HUNH TH YN NHI 115314026
HUNH TH TH M CHI 115314004
VIEM AC
HIEU
 VIEM AC HIEU
1. Ton thng ai the hoan toan ro
ret.
2. Ton thng vi the: ac hieu cho tac
nhan gay benh.
 VIEM LAO
Muc tieu:
1. Hieu ro ac iem vi khuan lao.

2. Mo ta 4 hnh thai ton thng ai the

3. Phan tch s hnh thanh nang lao.

4. Phan tch 3 dang viem lao

 AC IEM CUA VI KHUAN
LAO
Mycobacterium tuberculosis

Dai 1 - 4m, ng knh 0,3m, xep hnh

day.
Vi khuan ai kh. Khong di ong.
Phan chia nhanh trong vong 20 gi
Nhuom Ziehl-Nelsen
Mycobacterium tuberculosis
 AC IEM CUA VI
KHUAN LAO (tt)

Gay benh nh:

Cac chat lipid nh acid mycolic, acid phtioic.

Chat protein (cau tao nen tuberculo-protein)

Chat carbohydrate: polysaccharid.

 NG LAY TRUYEN

ng ho hap: nguy hiem, pho

bien
ng tieu hoa
ng niem mac va da
ng mau
 PHAT HIEN BENH LAO
Dung tuberculin phat hien lao

PCR

Choc hut te bao bang kim nho

Sinh thiet

PHONG NGA LAO

BCG (bacille Calmette-Guerin)

 HNH THAI AI THE
Dang lan toa
Dang khu tru:
Hat lao (hat ke): 1-5 mm, tron, trang
Cu ke (ton thng c ban): nhieu hat
ke hp thanh am quanh 1 phe quan
nho, ranh gii ro, <3 cm, trung tam
mau vang
Cu song
Cu hoa boc: nhieu cu ke hoac cu
LAO KE PHOI
LAO KE PHOI
 HNH THAI VI THE
Xuat dch (sm nhat): sung huyet,
phu, bach cau thoat mach.
Nang lao
 2
1

3
 2
1
Mycobacterium bovis (Nhuom AFB)
CAC HNH THAI VIEM LAO
Lao nhiem (lao nguyen phat):

phc hp nguyen thuy

Lao benh (lao th phat)

U lao: phoi, ruot

 CAC TON THNG DANG
LAO
Benh Brucellosis

Benh Sarcoidosis

Benh Crohn
VIEM PHONG
 MUC TIEU
Ke ro nhng ac iem cua vi khuan
phong.

Mo ta va phan tch 4 hnh thai ton

thng ai the cua viem phong: phong u,
phong cu, phong bat nh va phong giap
bien.
 AC IEM CUA VI KHUAN PHONG
Vi khuan Hansen (Mycobacterium leprae), hnh que
thang, hai au tron, dai 5 - 8 m,

Khang con, acid, mau o. K sinh trong te bao.

Co the song ngoai c the 1-2 tuan

Nhay cam vi anh sang
Sinh san cham, 12 ngay (co the 25 ngay)
Thi ky u benh dai, trung bnh la 3 - 5 nam
 NG LAY TRUYEN
Trc tiep: da, niem mac

Ho hap: niem dch mui co nhieu

trc khuan va khi ho, khac, noi
chuyen se ban ra nhng giot nc
cha trc khuan, nhng kho lay.
 PHAN NG MITSUDA

Phan biet cac the benh phong.

Sau 3-4 tuan: da noi cuc quang o, 5 - 10
mm, ton tai lau. co mien nhiem cao:
Mitsuda (+)
 CAC HNH THAI TON
THNG
Phong bat nh (I)

Phong cu (TT)

Phong giap bien (BB)

Phong u (LL)
 PHONG BAT NH (I)
Khong co ac iem ro ret

Viem b khong ac hieu

Lam sang thoang qua va khi au cua the phong

cu, u.

Nhng dat, thieu sac, tang sac, vo sac mau

hong ban hoac mau ong, vo cam hoac thieu

cam.
 VI THE

Viem b khong ac hieu: lan toa hoac

quanh cac phan phu da.

Trc khuan thng(-) hoac t, ri rac.

Mitsuda thng khong ro, (-): phong u, giap

bien, (+) phong cu).

 PHONG CU
50 - 60%, nhe, t lay, t
vi khuan.
Mang viem phong,
dat ln hoac nho,
khong oi xng,
thieu sac hoac mau
hong, thieu cam hoac
vo cam.
V tr: mat, chi, than.
 VI THE
Thng b teo et nhe hoac khong teo et.
Mo lien ket co nhieu nang phong gan
phan phu da, nang phong khong co chat
ba au.
Ton thng day than kinh rat ro.
Phan ng Mitsuda dng tnh ro.
 PHONG GIAP BIEN (BB):
La the phong ang chuyen dang va trung
gian gia the phong u va the phong cu.
Gom nhng dat, san, kch thc kha
ln kem nhng ton thng ve tinh, nho
vung ke can.
Phong giap bien gan Phong gap bien gan u
cu
 VI THE
Co ton thng nh dang
Tuy ket qua ieu tr, sc e khang,
phong giap bien thanh phong u (phong
can u BL) hoac thanh phong cu (phong
can cu BT)
Mitsuda thay oi tuy vao tien trien.
Trc khuan hop thanh am nho.
 PHONG U (LL)
Cac dat co the
dnh nhau, mang, u
phong, ro nhat
mat: mat sng phu,
hong o, rung long
may.
 VI THE
Thng b teo et.

Ngay di thng b co vien sang Unna.

Mo lien ket tham nhap nhieu te bao

viem man va te bao phong lan toa (t

mo bao, co nhieu dang: Virchow, bot

bao, thoai bao)

 PHONG U (LL)
Viem day than kinh ngoai vi (day tru, quay,
hong to): sng to, roi loan cam giac, van
ong va dinh dng mo (teo c, loet da )
Vi khuan: vao mau, dch limpho va gay
ton thng nhieu tang
Phan ng Mitsuda am tnh
Mycobacterium leprae (Nhuom AFB)
Viem quanh day than kinh
Viem quanh day than kinh
 NHNG TON THNG
KHAC
Viem day than kinh
Ton thng xng
Ton thng hach limpho
Ton thng nhan cau
Ton thng niem mac ng ho hap tren
Ton thng tang
Ton thng lo ao
Ton thng than kinh
Ton thng than kinh tru
Ton thng than kinh tren o
mat
 TON THNG LO AO
15% benh nhan phong (90% phong cu). Hiem khi

di 20 tuoi.

Gii nam > n. V tr: 1/3 trc long ban chan, kho

lanh, co the huy hoai cut t mot phan ban

chan.Do:

Viem day than kinh

Roi loan van mach va than kinh giao cam

Nhiem khuan.
VIEM GIANG
MAI
 MUC TIEU
Ke ro nhng ac iem cua xoan khuan

giang mai.

Mo ta va phan tch cac thng ton cua 3

thi ky viem giang mai.

Mo ta va phan tch cac ton thng cua viem

giang mai bam sinh.

AC IEM XOAN KHUAN GIANG MAI
Treponema pallidum: hnh xoan, di chuyen xoan oc.

Kch thc 8 - 15 m, vo bao cha nhieu thanh

phan cau tao mang tnh ac hieu mien nhiem.

Phan chia trong vong 30 gi

De b huy hoai moi trng nong, kho, hoa

chat

Song c trong moi trng lanh, am t.

 NG LAY TRUYEN

Trc tiep: qua quan he tnh duc

Me sang con
 CAC GIAI OAN
Giang mai I
Giang mai II
Giang mai III
 GIANG MAI I
Vai gi: xoan khuan vao mau, lan rong

nhanh trong 24 gi theo mach limpho en

hach.

Vai ngay: viem ban cap hach vung,

khong au, co the cha xoan khuan.

Ngay th 7 - ngay 14 sau nhiem, co the

thay xoan khuan trong mau, ni ton thng.

 GIANG MAI I (tt)

Thi ky u benh: 3 - 4 tuan

Hnh thanh mun nhiem giang mai

(Hunter) cha xoan khuan, t khoi
sau 3 - 4 tuan.
 AI THE

Vet l tron, 0,5 - 2cm mau o sam, ay ran cng,

khong au
90% cac mun nhiem ng sinh duc n.
 VI THE
Lp b: mo hat viem, limpho bao,
mo bao, tng bao.

Vi mach: tang san, viem TB noi mo,

lap kn long mach, huyet khoi nho, o
viem thoai hoa, hoai t
 GIANG MAI II
9 14 tuan sau nhiem (45 ngay sau mun

nhiem)

Da: hong ao.

Co the co hong ban san, o sam, khong

nga, long ban tay, ban chan, t bien mat

sau vai thang hoac e lai nhng dat sac

 GIANG MAI II (tt)
Xoan khuan lan rong trong mau: ton
thng nhieu c quan.

ieu tr: khoi hoan toan.

Khong ieu tr: keo dai vai thang hoac

2 - 3 nam (di dang giang mai tiem an).
 LAM SANG
Thang th 4 - 12 sau mun nhiem:
Mang viem giang mai:

Than, chi, long ban tay, ban chan,

mui, mieng, chan toc, hau mon -
sinh duc,
Viem loet niem mac mieng, li,
amidan, thanh quan (nuot kho, khan
giong).
 AI THE

Hong ao: Vet

tron, dat hnh bau

duc, mau hong

nhat, khong nga,

oi khi nho cao, rai

rac ngc, tren

ngi, hiem mat.

 AI THE (tt)
Mang viem giang
mai: 3-6mm, o
sam, bong, co
khi co vay, co
the ph ai
(Condilom lata)
 VI THE
Thng b: tang gai, viem b lan toa.

Mach mau: viem noi mac, vach

mach day, te bao viem man bao

quanh, tao lp ao vo mach mau.

 GIANG MAI TIEM AN
Khong co lam sang ro ret

Chan oan qua huyet thanh (+)

Keo dai suot i hoac chuyen thanh giang

mai III.

Giang mai tiem an n co the gay giang mai

bam sinh.
 GIANG MAI III
Ton thng c ban: gom giang mai,
nhieu gom, tao thanh u giang mai.
Viem noi mac vi mach: hoai t mo ke
can kem tham nhap u loai te bao
viem, oi khi xep ong tam giong nang
giang mai.
Khong co viem hach sng to.
 GIANG MAI III (tt)
Niem mac, da:
Cu: ri hoac dnh nhau, mau ong o,
lp b sau, be mat da nhan hoac co
the loet.
Gom giang mai: 0,5 - 1cm, n oc, loet,
b ro, mu (-), au (-).
Bach san niem mac ma, moi, co the
sau day, loet va hoa ac.
 GIANG MAI III (tt)
Viem ong mach: 10%, khong kha hoi, Nam/ n = 2/1.

Viem ong mach chu: viem toan bo ong mach, bat

au lp ngoai mach, en ao gia, ao trong lam
lp noi mo day. Mo si thay the, mat tnh chun gian,
x cng, phong mach, de v.

Viem ong mach nho: te bao noi mo, chu bao tang
san, vach mach day, hep long mach. Co nhieu te
bao viem man quanh ong mach
V PHNH ONG MACH CHU DO
GIANG MAI
 TON THNG MC
DO GIANG MAI

MC BNH THNG
 GIANG MAI III (tt)
Viem than kinh trung ng: 7-10%.

X hoa vung sau tuy song.

Day than kinh so, teo than kinh th

giac.

Viem mang nao - nao lan rong, nhoi

mau nao, bien oi tam than.

 GIANG MAI III (tt)
Gan: gom giang mai, x gan giang mai.

Bao khp: co cac cuc viem, khong au, x

cng.

ng ho hap tren: thung vom khau cai.

Xng: gay huy hoai vach ngan xng mui.

Bien dang xng chi di thanh vong cung.

 GIANG MAI THAI KY
Xoan khuan qua hang rao nhau thai t thang th

5.

Trc co thai, trong thai ky: khong ieu tr, sau

thang th 5, giang mai bam sinh

Neu khong ieu tr: say thai, thai chet lu, e non,

giang mai bam sinh

 GIANG MAI BAM SINH
Giang mai bam sinh sm:
Nhau ph ai,cu non, bong nc long
ban tay, chan, khe nt mieng, hau
mon, loet cac xng sun mui, hong
(tieng khoc khan tram).
80% viem xng sun vao thang th 2 - 3
Gan to cng va x, lach to, viem than,
viem tinh hoan, viem mang nao, viem
day than kinh th giac, thieu mau.
GIANG MAI BAM SINH SM
 GIANG MAI BAM SINH (tt)
Giang mai bam sinh muon:
Thng tre 2 tuoi, 5 - 10 tuoi, luc
trng thanh.
Hiem co ton thng da - niem mac.
Thng ton thng xng khp (xng
chay bien dang, hnh li kiem cong,
viem xng giang mai...).
Ton thng mat, tai, rang.
RANG HUTCHINSON
BIEN DANG XNG
CHAY
 GIANG MAI BAM SINH (tt)
Giang mai bam sinh tiem tang:

Ch da tren ket qua chan oan huyet

thanh (+) ngi me v be sinh t me
co benh (du a c ieu tr) van co
the co khang the ton d t me trong
vai ba thang, tre phai c theo doi va
ieu tr.