Benh Ly Than

Question 1

Trieu chung lam sang AKI

Answer 1

Luong nuoc tieu
Hc ure huyet
Tr/chung nn

Question 2

Tc ure huyet/ stc

Answer 2

Tieu hoa: oi, buon non, chan an, liet ruot
Tk: (tr uong) tk khu tru, lo mo, ngu ga ; (ngoái bien) hc chan khong yen, rung vay
Tim mach: viem mnt, suy tim chen ep tim

Question 3

Trieu chung phu thuoc nn trong stc: truoc than

Nn

Answer 3

Khat nuoc, chong mat
Mat dich co the : oi, tieu chay; tieu, x huyet/ gan , tim, nhiem trung/ NSaids, acei, arbs
Dau thieu nuoc: veo da, niem mac, tm co xep
Mach nhan, ha giam, rl tri giac
Nn:
- gian the tĩch noi mach : giam nhap/ tang xuat(tieu/ tieu hoa/ xuat huyet/ khoang thu 3)
- giam tuoi mau than do rl huyet dong: giam co, gian mach toan than, co mach/ mat dieu hoa than!

Question 4

Stc tai than: tr chung

Nguyen nhan:

Answer 4

Cau than: 
- tien can viem hong, nhiem trung da
- phu, tieu mau, THA
Ong than:
- ong than mo ke: 
@ sot, dau khop, phat ban kem ngua
@ dau hong lung: tac mach than/ cang chuog bao do viem dai be than cap 2 ben
- hoai tu otc: 
@thieu mau va 
@doc chat( thuoc: khang sinh, hoa tri lieu ung thu..., can quang, ly giai co, truyen mau)
Mm than: tang ha
Nguyen nhan: 
- tac mm than 2 ben/ 1 ben than doc nhat hay than giam chuc nang
@ cau than
@ tac mach
@ tha ac tinh
- ong than
@atn: thieu mau, nhiem trung, doc chat
@viem on than mo ke cap
@tac nghen

Question 5

Nguyen nhan trog aki gay:

• vo nieu
• ko thieu nieu

Answer 5

Vo nieu (500ml/d)

• viem ong than mo ke cap
• ATN ( thieu mau, doc than: can quang, hoai tu co van)
• tac nghen duong tieu ko hoan toan

Question 6

Trc stc sau than

Nguyen nhan:

Answer 6

Tien can phau thuat phu khoa, u ac tinh: bly tac nghen, xam lan
Dau hong lung lan vung ben dui, tieu mau;’ hoai tu nhu than, soi than
Tieu nhieu, tieu dem, tieu kho: bly tlt
Nguyen nhan:
- co bang quang : tlt( phi dai, ung thu, n trung) , bang quang than kinh (dtd, ton thuong tuy)
- nieu quan 2 ben/ 1 ben trong than doc nhat hay than con lai giam chuc nang: ngoai chen vao/ trong long
- nieu dao

Question 7

Sieu am he nieu: truong hop khong gay gian nieu quan

Answer 7

Nieu quan bi chen ep ( xo hoa sau phuc mac), ung thu xam lan, hay thieu the tich dich tram tròn

Question 8

Chi dịnh sinh thiet than/ stc

Answer 8

Stc tai than, nn chua ro ràng: viem cau than, viem mm, viem than mo ke DO dap ung dieu tri chuyen biet

Question 9

Tom tat chan doan nn stc

Phan biet stc truoc than va hoai tu ong than cap

Answer 9

Hinh!

Question 10

Tieu chuan KDIGO 2012

Answer 10

Tang Cre >= 0,3mg% (26,5 micromol/l) trong 48h
Tang gap 1,5 lan cre nen trong 7 ngay
V nuoc tieu

Question 11

Chia giai doan

Answer 11

Gd 1: 
- tang >\= 0,3 mg/dl / 
-tang 1,5-1,9 / 
-v nuoc tieu 12h
Gd 3:
- tang >/= 4 mg/dl ( >|= 353 micromol/l)
- 3 lan cre nen
- dieu tri thay the than
- |=24h
- vo nieu >\= 12 gio

Question 12

Chan doan AkI va CKD

Answer 12

Hinh

Question 13

Bien chung roi loan nuoc dien giai/stc

Answer 13

Roi loan nuoc dien giai:

• tang V ngoai bao
• giam Na mau
• tang Kali mau
• ha Kali mau: stc khong thieu nieu do AG, amphortericin B, ciplastin
• tang phosphat nhe/ nang ( 10-20 mg/dl) : di hoa nang, ly giai co van, tan huyet, thieu mau mo, hc ly giai buou
• ha canxi ( giam vit d, lang dong can): nang ( ly giai co, bicarbonate, vtc hay suy than man)
• -) ly giai co, hc ly giai buou, VTC: ha can, tang phos

Question 14

Bc chuyen hoa trong stc

Answer 14

Toan ch tang AG

Kiem : dieu tri bu bicar, mat dich da day ( oi, hut dich dd)

Question 15

Bc tim mach/stc

Answer 15

Loan nhip
nMCt
Thuyen tac phoi
Suy tim, phu phoi cap
Viem man ngoai tim, tran dĩch, chen ep tim

Question 16

Bc khac/ stv

Answer 16

Thieu mau
Tang acid urix mau: nhieu nghi stc do benh than so urat
Nhiem trùng: thuong phoi/ duog tỉu
Xhth
Suy dd:

Question 17

Stc do:

• thuoc can quang
• aG
• ly giai co van
• phau thuat tim mach, ung thu

Answer 17

• 24-48h sau dung thuoc, cao nhat 3-5ds hoi phuc trong 5-7ds + thuog xay ra o nguoi co yeu to ton thuong than trũo do
• 5-7 ds sau su dung thuoc
• chan thuong/bat dong/phau thuat/ gang sũc/statin + dau co, nuoc tieu sam mau + tang Kali, giam can, tang phos+ que nhung duong tinh voi mau nhun khong co hc, FEna

Question 18

Tieu chuan hoi chung gan tha

Answer 18

• xo gan co truong

- cre > 1,5 mg/dl. Can lang sach, FEna

Question 19

Muc tieu dieu tri stc

Answer 19

Can thiep som/ gd khoi dau
Dieu tri va ngua bc urre huyet gd thieu noeu/ vo noeu
Dieu chinh kip thoi thay doi dien tien benh /gd da nieu den khi khoi benh hoan toan

Question 20

Dieu tri stc truoc than

Answer 20

Dieu tri ngay trong luc chan doan
Ngung cac thuoc doc than
Boi hoan the tich dich/co the
- giam the tĩh mau: mat gi bu do
- suy tim: chap nhan tinh trang tang azote mau nhe-vua phai
- xo gan: pb hc gan than
- hc than hu: benh nguyen phat, cổticpod, cyclos

Question 21

Stc tai than

Answer 21

Dieu tri nhu stc truoc than

Cac dieu can tranh/ stc truoc than

Question 22

Cac dieu can tranh/stc tai than

Answer 22

Loi tieu lieu cao
Dopamin lieu than
Thuoc doc than va dieu chinh lieu cac thuoc duoc bai tiet qua than tuy theo muc do suy than

Question 23

Loi tieu lieu cao/stc tai than

Answer 23

Muc tieu: thieu nieu--) ko thieu nieu de bu dich don gian hon.
Yeu cau:
- danh gia the tih noi mach
- dung som trong giaidoan khoi dau cua stc sau khi bu du dich ( ngay sau khi truyen nham nhom mau va ly giai co van)
Lieu:
- furo 20mg/h ttm 
Dap ung: luong nuoc tieu tang dan--) giam dan loi tieu 
Muc tieu: v nuoc tieu 1l/ngay
Ngung ngay khi bn ko dap ung
Tien luong dap ung: kem khi
- stc >36h
- v  5-6 mg/dl

Question 24

Dopamin lieu than

Answer 24

Ho tro tuan hoan chong shcok /suy tim nang

Question 25

Bu dich/stc

Answer 25

Luong nhap moi ngay= nuoc mat ko nhan biet (400-600 ml/ngay) + luong nuoc mat do duoc ( nuoc tieu, dich dan luu, oi, tieu chay)
Giam muoi

Question 26

Dieu tri tang Kali mau

Answer 26

Nhe (5,5) han che kali qua an uong, thuoc men
Tr binh (5,5- 6,5 + ecg bt) : an uong, thuoc men, resin trao doi ion
Nang ( >6,5 | thay doi ecg ) : phoi hop
@ ngung nhap + loai bo mo hoai tu + tri nhiem trung + cung cap du calo tranh thoai bien dam
@ canxi glucuronate 10% 5 ml 2 ong
@ insuline + glucose mau
@ kiem hoa mau: khi tang kali kem toan ch
@ kich thĩh beta 2
@ loai bo thuc su: loi tieu (furo, thia), resin trao doi ion, than nhan tao

Question 27

Dieu tri toan ch

Answer 27

Chindinh

- nahco3

Question 28

Thieu mau

Answer 28

Nang: truyen mau

- du phong xhth bang ppi

Question 29

Bc tim mạch/stc

Answer 29

Ko nen dieu tri tich cũc tha neu ko phai tha khan cap (tonthuong co quan dich₫

Question 30

Bc tieu hoa:

Answer 30

Phong ngua xhth /

• tho may
• bly dong mau di kem

Question 31

Nhiem trung

Answer 31

Khang sinh khi sot va bang xhung nt

Question 32

Gd tieu nhieu, tinh tràn

Answer 32

• tieu ra chat co tinh than thay(uere)
• luong nuoc du thua
• ong than phuc hoi cham hon cau than
• -) theo doi sat tt dĩch va dien giai

Question 33

Dinh duong/stc

Answer 33

Ngan+ ko di hoa nang:

Question 34

Suy than cap sau than,

Answer 34

Tac duong tieu duoi: thong tieu

Tac tren: mo than ra da/sten nieu quan

Question 35

Phog ngua stc

Answer 35

Bu du tuan hoan
( nuoc mat ko nhan biet: tang 100ml /do)
Cac thuoc dõ than chinh lieu, han che phoi hop