Tiu chy & To bn

TS BS Quch Trng c

B Mn Ni i Hc Y Dc TP HCM

Tiu chy

nh ngha
Tnh trang i tieu phan long
> 2 lan / ngay Lng phan > 200g/ngay.

Phan loai tuy thi gian din tien

< 2 tuan: cap

2 4 tuan:
> 4 tuan:

dai dang
man

Phan biet
Gia tieu chay (pseudodiarrhea): i cau nhieu lan, nhng moi lan i ch c chut t phan,

i kem vi trieu chng buot mot.

Tieu khong t chu: benh nhan khong t kiem soat c tnh trang thoat phan.

C che benh sinh

4 c che chnh:

Tieu chay tham thau

Tieu chay dch tiet Tieu chay do viem (dch r) Tieu chay do roi loan van ong ruot

Phoi hp cac c che tren

C che benh sinh

Tieu chay tham thau:

Niem mac ruot hoat ong nh mot mang ban tham

Khi trong long ruot co mot lng ln cac chat co tnh
tham thau cao nhng khong c hap thu
(thuoc tay xo, cac thuoc cha Magne sulfate ).

Nong o tham thau cao trong long ruot se gay ra

s di chuyen Na+ va nc vao trong long ruot.

Ngng dien tien neu benh nhan nhn oi.

C che benh sinh

Tieu chay dch tiet:

Hien dien chat co tac dung kch thch s bai tiet nc

va Cl- vao trong long ruot.

oc to cua vi khuan
(Vibrio cholerae, E. coli, S. aureus, Baccillus cereus)

Mot so thuoc nhuan trng.

C che benh sinh

Tieu chay do viem (dch r):

Thng do nhiem cac tac nhan xam lan niem mac

Tai vung niem mac b ton thng:

Bai tiet nhay, mau, mu, protein vao long ruot.

Roi loan kha nang hap thu nc, ion va cac chat hoa tan. Prostaglandine do hien tng viem nhiem tao ra con lam tang tiet va tang nhu ong ruot
gop phan vao c che gay tieu chay.

C che benh sinh

Tieu chay do viem (dch r):

Tac nhan
Vi trung: Shigella
Salmonella Campylobacter Yersinia

Clostridium difficile

KST:
Entamoeba histolitica

C che benh sinh

Tieu chay do roi loan van ong ruot:

Chu yeu gay ra tieu chay man tnh

Gap trong cac benh:
ai thao ng Cng giap Suy thng than (benh Addison)

Nguyen nhan: Tieu chay cap

Nhiem trung Nhiem oc chat Che o an uong, dung thuoc Khac

Tieu chay cap co the la khi au cua mot tnh trang tieu chay
man tnh

Nguyen nhan: Tieu chay cap

Nhiem trung: Vi trung: Salmonella Shigella Campylobacter Vibrio cholerae E. coli Clostridium difficile Yersinia Virus: Rota virus, enterovirus, Norwalk virus

KST: Amibe, giun ua, giun moc, giun ln, G. lamblia

Nguyen nhan: Tieu chay cap

Nhiem oc chat: oc chat t vi trung (ngo oc thc an):

Staphylococcus
C. perfrigens E. coli

Clostridium bolilinum
Pseudomonas
Hoa chat oc: ch thuy ngan arsenic

Nguyen nhan: Tieu chay cap

Che o an uong dung thuoc

Ru
Tnh trang khong dung nap thc an khong ac hieu D ng thc an

Tac dung phu cua mot so thuoc

Benh ly khac viem ruot tha

viem tui tha xuat huyet tieu hoa chng nghet phan (fecal impaction)

Tiep can BN tieu chay cap

1.Tieu chay? 2.Cap tnh? 3.Nguyen nhan

4.He qua
Mat nc Roi loan ien giai Nhiem trung nhiem oc

e ngh cac can lam sang ho tr

Cac trng hp ac biet

Can theo doi ky va lam them XN:

> 70 tuoi Suy giam mien dch Sot > 38,5oC Co dau hieu mat nc au bung nhieu Co trieu chng toan than Tieu ra mau Trieu chng keo dai hn 24 gi ma khong cai thien.

To bn

NH NGHA
i tieu kho, phai ran nhieu Giam so lan i tieu hn bnh thng ( < 3 lan / tuan) Phan cng

Cam giac i tieu khong het phan - Khi tiep can BN than phien tao bon, can hoi benh ky
- Tren thc te co khong t trng hp benh nhan t cho la mnh b tao bon nhng lai khong thuoc cac trieu chng nao trong cac nh ngha neu

tren.

C CH BNH SINH (1)

A- Cham van chuyen ai trang:
-Trieu chng thng khi phat t t va xay ra quanh tuoi day th. oi tng thng gap nhat la phu n tre, - ac trng bi bieu hien giam so lan i cau ( <1 lan / tuan). - Cac trieu chng i kem la au bung, chng hi, met moi. - - Trieu chng khong

cai thien mac du a s dung che o an

nhieu chat x, cac thuoc nhuan trang tham thau.

C CH BNH SINH (2)

B- Roi loan thoat phan
- Qua trnh lam trong trc trang khong hieu qua do s khong co s phoi hp nhp nhang cua c bung, c hau mon trc trang va c san chau. - Benh nhan thng co tnh trang co c vong hau mon khong thch hp khi ran. - Nhieu benh nhan b roi loan thoat phan cung co kem tnh trang cham van

chuyen ai trang.

C CH BNH SINH (2)

B- Roi loan thoat phan (tiep)
- Roi loan thoat phan thng la do mac phai va xay ra t tuoi nho. ay co the la hau qua cua thoi quen nn ai tien nham tranh au khi i tieu phan ln, cng hoac khi ang b nt hau mon, tr viem

-Roi loan thoat phan cung ac biet pho bien nhng ngi gia b tao bon
man tnh, phai ran nhieu va khong ap ng vi ieu tr bang thuoc.

C CH BNH SINH (2)

C- Cam nhan sai ve thoi quen i cau
- Thng co kem cac roi loan ve tam ly xa hoi. - - Toc o van

chuyen doc khung T bnh thng.

- Mot so benh nhan co kem bat thng chc nang cam giac va

van ong vung hau mon trc trang do o rat kho phan biet
vi nhom benh nhan tao bon do cham van ong ai trang.

NGUYEN NHAN
Thuoc hai nhom:
A- Roi loan lam ay trc trang va

B- Roi loan tong xuat trc trang

NGUYEN NHAN
A- Roi loan lam ay trc trang
1- Benh ly thc the ng tieu hoa gay hep long ruot
U lanh hoac ac tnh

Viem: L man tnh, viem ai trang trc trang

Crohns, viem tui tha Roi loan chc nang: Hoi chng ruot kch thch Bat thng bam sinh: Benh Hirschsprungs

viem xuat huyet,

NGUYEN NHAN
A- Roi loan lam ay trc trang
2- Th phat do roi loan noi tiet ien giai
Thai ky
Suy giap Cng pho giap Tieu ng Ha kali mau

Ngo oc ch

NGUYEN NHAN
A- Roi loan lam ay trc trang
3- Tac dung phu cua thuoc
Nhom a phien

Khang cholinergic
Antacid Chong tram cam Li tieu

NGUYEN NHAN
B- Roi loan lam trong trc trang
1- Roi loan phan xa i tieu do benh tai cho
Benh ly hau mon trc trang (loet hau mon, nt

hau mon, do hau mon, viem trc trang, tr, tang

ap lc c that hau mon) Benh ly than kinh Thieu ong, c bung yeu, tuoi gia

NGUYEN NHAN
B- Roi loan lam trong trc trang
2- Roi loan phan xa i tieu do nguyen nhan khac
Khong tap thoi quen i tieu tot Lam dung thuoc nhuan trng

Nguyen nhan tam ly

Tiep can BN tao bon

1. Thc s ung nh ngha tao bon?
2. C che g?
3. Trieu chng gi y benh ly thc the / c nang 4. Trieu chng gi y benh ly lanh tnh / ac tnh 5. anh gia tong the
ac iem tam ly than kinh

Benh ly noi ngoai khoa phoi hp

Cac thuoc ang s dung

e ngh cac can lam sang ho tr