Bệnh nội khoa - Hướng dẫn chẩn đoán và điều trị: Phần 1

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Tài liệu Hướng dẫn chẩn đoán và điều trị bệnh nội khoa được biên soạn nhằm cung cấp, chia sẻ kiến thức cơ bản và kinh nghiệm về chẩn đoán và điều trị các bệnh nội khoa cho các thầy thuốc thực hành. Mời các bạn cùng tham khảo nội dung chi tiết phần 1 tài liệu.

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Nội dung Text: Bệnh nội khoa - Hướng dẫn chẩn đoán và điều trị: Phần 1

| 3 §gk B O Y T E ^PpP? B E N H V IE N B A C H M A I HlTtiNG DAN CHAN DOAN VA DIED TRI %, r * V (Cam nang nghiep vu cua bac si lam sang) Chu bien: TS. Nguyen Quoc Anh PGS.TS. Ngo Quy Chau • Cap ciru • Hoi sire tich curc • Chong doc • Tim mach • Ho hap • Noi tiet - Dai thao dirong • Tieu hoa r • Than - Tiet nieu • C o - Xirong - Khdp • Truyen nhiem • Dj irng - Mien djch lam sang ^ NHA XUAT BAN Y HOC - 2011
HU0NG DANCHANDOANVADIEDTRI BENH HOI KHOA
B Q Y T E X w 7, B E N H V IE N B A C H M A I HUONG DAN CHAN DOAN VA DIED TRI B EN H NOl K H M ■ ■ (C a m nang nghiep vu cua bac si lam sang) Chu bien: T S. Nguyen Quoc Anh PG S.T S. N go Quy Chau NHA X U A T B A N Y HOC - 2011
HOI BONG BIENSOAN C h u tjch TS. N g u y in Q u o c A n h P h o c h u tjch P G S .T S . N go Q uy C hau U y vien P G S .T S . 0 6 D oan L g i P G S .T S . T ran V a n C h a t P G S .T S . Tran T h u y H anh P G S .T S . D in h T hj Kim D ung TS . N g uyen Q u o c Tuan P G S .T S . N g uyen V a n D o a n G S TS . T ran N g o c A n P G S .T S . N g uyen T hi N g o c Lan G S .T S . N g uy§n T h i Du P G S .T S . D o T hi Lieu G S. V u V a n D in h P G S .T S . D a o V a n Long G S .T S . P ham G ia Khai P G S .T S Trinh T hj N g oc G S .TS . Tran Di>c Tho P G S .T S . D o T rung Q uan G S .T S . N g uy§n K h anh T rach TS. P h am D ue G S .T S . N g uyen Lan V iet TS . C hu T hi H anh P G S .T S . N g uyen D a t A n h TS . D a n g Q u o c Tuan P G S .T S . N g uy§n G ia B inh TS. N g u y§ n K h oa D ieu V a n BAN THLT Kl T rird n g ban TS N g uy§n Q u o c Tuan T hanh vien T hS N g uy§n T h a n h Hoi T hS N go Q uang H uy T hS N g uyen T hi H ong V an T hS N g uyen Thi M y C hau
d a n h s a c h t Ac g i a s tt H o va te n C h ip c vu, dcrn v j 1. TS. N g uyen Q u o c A n h G iam doc B enh vien 2. P G S .T S . Tran T hu y H anh H ieu tru a n g T ru o n g T H Y T B ach M ai N guyen G iam doc B enh vien 3. P G S .T S . N g o Q uy C hau Pho G iam doc B enh vien 4. P G S .T S . D o D oan L a i Pho G iam doc B enh vie n 5. GS.VQ V a n D in h N guyen T ru o n g khoa A 9 6. G S .T S . Tran N goc An N guyen T ru o n g khoa C o x u o n g kh a p 7. G S .T S . N g uyen T hi Du N guyen G iam doc T rung tarn C h ong doc 8. G S .T S . P ham G ia Khai N guyen V ien T ru o n g V ie n Tim m ach 9. G S .T S . Tran D u e Tho N guyen T ru o n g khoa N oi tie t - D a i th a o d u o n g 10. G S .T S . N g uyen K hanh Trach N guyen T ru o n g khoa Tieu hoa 11. G S .T S . N g uyen Lan V iet Vien T ru o n g V ien Tim m ach 12. P G S .T S . N g uyen O at A nh T ru o n g khoa C ap c u u 13. P G S .T S . N g uyen G ia B inh T ru a n g khoa Hoi s u e tich c u c 14. P G S .T S . Tran V a n C h at N guyen T ru o n g khoa T ha n - Tiet nieu 15. P G S .T S . D in h T hi Kim D ung T ru o n g khoa T ha n - Tiet nieu 16. P G S .T S . N g uyen V a n D oan G iam doc T rung tarn Dj u n g - M ien dich lam sang 17. P G S .T S . T ru o n g T ha nh H u a n g V ien Tim M ach 18. P G S .T S . D in h T hj T hu H u a n g P ho vien tru a n g V ien Tim m ach 19. P G S .T S . N g uyen Thj N g oc Lan T ru o n g khoa C o x u o n g kh a p 20. P G S .T S . D o T hj Lieu K hoa T ha n - Tiet nieu 21. P G S .T S . D a o V a n Long T ru a n g khoa Tieu hoa 22. P G S .T S . Trjnh T hj N g oc N guyen T ru a n g khoa T ruyen nhiem 23. P G S .T S . N g uyen VTnh N goc K hoa C o x u o n g k h a p 24. P G S .T S . D o T rung Q uan T ru a n g khoa K ham c h u a benh th e o yeu cau 25. P G S .T S . H o ang H ong Thai K hoa Ho hap 26. P G S .T S . Tran H oang T hanh Khoa Ho hap 27. P G S .T S . Be H o ng T hu P ho G iam doc T rung ta m C h ong doc 28. P G S .T S . V u T hj T h a n h T huy N guyen T ru o n g khoa C o x u o n g k h a p 29. P G S .T S . N g uyen Q uang Tuan V ien Tim m ach 30. P G S .T S . D a n g Q uoc Tuan Pho T ru a n g khoa Hoi s u e tic h c u e 31. P G S .T S . N g uyen K h oa D ieu V an T ru a n g khoa Noi tie t - D a i th a o d u o n g 32 P G S .T S . N g u ye n T hj V a n T rung tam Di u n g - M ien dich lam sang 33 TS . N g uyen Hai A n h P ho T ru a n g khoa Ho hap 34 TS . T a M anh C u’a n g V ien Tim m ach
35 TS. P ham D ue G iam doc Trung ta m C h o n g doc 36 TS. V u A n h D ung V ien Tim m ach 37 TS. Tran V a n D o ng V ien Tim m ach 38 TS . C hu T hi H anh Pho T ru o n g khoa H o hap 39 TS . N g uyen Lan Hieu V ien tim m ach 40 TS . P ham Thi H ong Hoa N g uyen T ru o n g khoa N oi tie t - D a i th a o d u o n g 41 TS. Tran Thi M inh Hoa Pho T ru o n g khoa C o x u o n g k h o p 42 TS . N g uyen T hi Thu Hoai V ien Tim m ach 43 TS. N g uyen T h a n h Hoi K h oa Ho hap 44 TS. N g uyen T hj V a n H ong Pho T ru o n g khoa Tieu hoa 45 TS. P h am M anh H ung V ien Tim m ach 46 TS . D o Q uoc H ung V ien Tim m ach 47 TS . N g uyen V a n H ung K hoa C o x u o n g k h o p 48 TS . P h am Q uoc K hanh P ho V ien T ru o n g V ie n Tim m ach 49 TS . T o T h a n h Lich V ien Tim m ach 50 TS. D a n g H ung M inh K h oa Ho hap 51 TS. V u B ich N ga K hoa N oi tiet - D a i th a o d u o n g 52 TS. T a Tien P h u o c V ien Tim m ach 53 TS . P han T hu P h u o n g K hoa H o hap 54 TS . N g uyen Kim S o n Pho G iam d o c T rung ta m C h o n g doc 55 TS. D 6 Ngoc Son K h oa C a p c u u 56 TS . P h am H ong T hi V ien Tim m ach 57 T S . P h am T h a n h T hu y P ho T ru o n g kh o a T ru ye n nhiem 58 TS . P h am H oan Tien V ien Tim m ach 59 TS . N g u ye n Q uoc Tuan T ru o n g phong K H T H 60 TS . D o G ia T uyen K hoa T ha n - Tiet nieu 61 TS . Le T hi D iem T uye t K hoa Hoi s u e tic h c u e 62 TS. N g u ye n T h i B ach Yen Pho V ien T ru o n g V ie n T im m ach 63 B S C K II. Le T hi V a n A nh K hoa H o hap 64 B S C K II. Tran K h ac D ien K h oa T ruyen nhiem 65 B S C K II. N g uyen M ai H ong P ho T ru o n g khoa C o x u o n g k h o p 66 B S C K II. N g uyen P h u o n g M ai K hoa Noi tie t - D a i th a o d u o n g 67 B S C K II. N g uyen Q u a n g Tuan T ru o n g kh o a T ruyen nhiem 68 B S C K II. D a n g T hj X u an Trung tam C h o n g doc 69 T hS . G ia n g T h u c A n h K hoa Hoi s u e tic h c u e 70 ThS . N g uyen Q uang Bay K hoa Noi tie t - D a i th a o d u o n g 71 ThS . B ui H ai B inh K hoa C o x u o n g k h o p T hS . N g u ye n T ha i B inh K hoa Tieu hoa T hS . D a o X u a n C o K hoa Hoi s u e tic h c u c ThS . D o D uy C u o n g K hoa T ruyen nhiem T hS . T ran T hi T o C hau K hoa C o x u o n g k h o p T hS . N g u ye n V a n Chi K hoa C a p c u u T hS . Lu'u T hi M inh D iep K hoa Tieu hoa
78 ThS. N guyen Tien D ung T rung tam C hong doc 79 ThS . H oang Van D ung K hoa C o x u o n g k h o p 80 ThS . N guyen Van DOng K hoa Truyen nhiem 81 ThS . Tran V an D u o n g V ien Tim m ach 82 ThS . Bui M inh D u e Pho T ru o n g khoa Noi tie t - D a i th a o d u o n g 83 T hS . Bui Thi H u o n g G iang K hoa Hoi su e tic h c u e 84 T hS . Tran S ong G iang Vien Tim m ach 85 T hS . V u V a n G iap K hoa Ho hap 86 T hS . D a ng T hi V iet Ha K hoa T han - Tiet nieu 87 T hS . H oang Bui Hai K hoa C ap c u u 88 ThS . N g uyen Tuan Hai V ien Tim m ach 89 ThS . P ham T hj T hu H ien K hoa Tieu hoa 90 ThS . N g uyen T hi T h u c Hien K hoa Noi tie t - D a i th a o d u o n g 91 T hS . N guyen D ieu H ong K hoa Ho hap 92 ThS . N guyen M inh H ung V ien Tim m ach 93 ThS . P ham N h u H ung V ien Tim m ach 94 ThS . H oang Tien H u n g K hoa Noi tiet - D a i th a o d u o n g 95 T h S .K h o n g N am H u o n g V ien Tim m ach 96 ThS . Trjnh T hi H u o n g K hoa Ho hap 97 ThS . N g uyen Thj H u o n g K hoa Than - Tiet nieu 98 ThS . N g uyen Thj T ha nh H uyen K hoa Ho hap 99 ThS . V u T ru o n g Khanh K hoa Tieu hoa 100 ThS . D o an T hi P h u o n g Lan K hoa Ho hap 101 ThS . P hung N am Lam K hoa C ap c u u 102 ThS . N g uyen T hi Q uynh Loan K hoa H o hap 103 ThS . N g uy§n C ong Long K hoa Tieu hoa 104 T hS . Le T h i Lieu K hoa C o x u o n g k h o p 105 T hS . P ham Tran Linh V ien Tim m ach 106 T hS . N g uyen T hj T ha nh Mai K h oa C o x u o n g k h o p 107 T hS . N g uyen H oai N am K hoa Tieu hoa 108 T hS . N g uyen T hi N ga K hoa C o x u o n g kh o p 109 T hS . Le Ba N goc K hoa Noi tie t - D ai th a o d u o n g 110 T hS . N g uy§n T hi B ich N goc K hoa Than - Tiet nieu 111 T hS . N go D u e N goc K hoa Hoi su e tic h c u e 112 ThS . Bui D u e N g uyen K hoa Truyen nhiem 113 T hS . N g uyen T rung N guyen T rung tam C h ong doc 114 T hS . P han D in h Phong V ien Tim m ach 115 T hS . D a o D u e P hong K hoa Noi tie t - D a i th a o d u o n g 116 T hS . H o ang T hj Lien P h u o n g K hoa Noi tie t - D a i th a o d u o n g 117 ThS . N g uyen H u u Q uan K h oa C ap c u u 118 ThS . P h am T hj Le Q uyen K hoa Ho hap 119 ThS . N g uyen T ru o n g S o n K hoa Tieu hoa T hS . P h am T hj M inh-Tam K h oa Noi tie t - D a i th a o d u o n g
121 ThS . Le T hi T a m K hoa Noi tiet - D a i th a o d u o n g 122 ThS . N g uyen C o ng Tan K hoa Hoi s u e tic h c u c 123 ThS . Bui Q u a n g T hach K hoa Tieu hoa 124 ThS . N g uyen Q u o c Thai V ien Tim m ach 125 ThS . P ham H uy T ho ng T rung tam Di u n g - M ien dich lam sang 126 ThS . Tran H u u T h o n g K hoa C a p c u u 127 ThS . Le Q uang T huan Trung ta m C h ong doc 128 T hS . N g u ye n P h u o n g T huy K hoa C o x u o n g kh o p 129 T hS . M ai D uy Ton K hoa C a p c u u 130 ThS . D o a n T hu Tra Khoa T ruyen nhiem 131 ThS . Le T h i Tram Khoa Ho hap 132 ThS . N g u ye n H u u T ru o n g T rung ta m Dj u n g - M ien dich lam sang 133 ThS . N g uyen D a n g Tuan K hoa Hoi s u e tic h c u e 134 T hS . Le D anh V inh K hoa T ha n - Tiet nieu 135 T hS . H a L u o n g Yen Khoa Noi tie t - D a i th a o d u o n g 136 BS. Bui V a n C u o n g Khoa Hoi s u e tic h c u e 137 BS. P h am T h u Ha Khoa Noi tie t - D a i th a o d u o n g 138 BS. C hu C h i H ieu T rung ta m di u n g - M ien dich lam sang 139 BS. N g uyen D u e V inh K hoa C a p c u u
LGflGldl THIEU Chan doan va dieu tri benh la viec quan trong va phUc tap. Muon co ket qua dieu tri tot, ngay tCr dau, benh nhan phai duqc tham kham lam sang ti mi, chi dinh cac xet nghiem , tham do can lam sang phu hop, phoi hop hieu qua cac th on g tin lam sang va can lam sang de dua ra chan doan benh day du va chinh xac, tu" do co hudng dieu tri kip thdi, an toan va hieu qua. Tren the gidi, nhieu nude da ban hanh cac hudng dan chan doan va dieu tri. d nude ta, Bo Y te tU nhieu nam nay da lUu tam tdi cong tac ban hanh cac hudng dan chan doan va dieu tri. Nam 2004, Bo Y te da ban hanh 3 tap dau tien cua bo sach Hudng dan dieu tri. B o Y te hoan nghenh Benh vien Bach Mai da sdd un g hieu qua nguon lac cuaO e an Xay dung m ot so benh vien ve tinh cua Benh vien Bach Mai, huy dong tri tue cua cac nha khoa hoc de bien soan cuon sach quy nay. Cuon sach bao gom 203 hudng dan chan doan va dieu tri cac benh thud ng gap tren nhieu linh vuc noi khoa. Cuon sach co nhieu kien thUc mdi, vdi kinh nghiem quy bau cua cacThay thuoc dau nganh cong tac tai Benh vien Bach Mai, hUu (ch cho cac thay thuoc lam sang dung de tham khao tro n g thUc hanh hang ngay. Vdi viec xuat ban cuon sach HUdng dan chan doan va dieu tri benh noi khoa, Benh vien Bach Mai m ot lan nUa the hien vai tro dau nganh, m ot trung tam y te chuyen sau cua ca nude, dac biet trong chan doan va dieu tri cac benh noi khoa. Nhan ky niem 100 nam thanh lap Benh vien Bach Mai, thay mat Bo Y te, toi chuc Benh vien Bach Mai tie p tu c phat trien trd thanh m ot tru ng tam y te chuyen sau ngang tam cac nude tro n g khu vUc va tren the gidi, xUng dang la la cd dau cua nganh y te. B 0TR tfdN G BOYTE TS. NGUYEN QUOC TRIEU
LCfl NOI DAU Tl/ m ot co sd kham chCfa benh truyen nhiem nho be mang ten "Nha thuong Cong Vong" dupe thanh lap nam 1911 - Benh vien Bach Mai trai qua nhUng budc thang tram trong nhieu giai doan phat trien, da Idn manh va trd thanh Benh vien da khoa hoan chinh hang dac biet dau tien cua Viet Nam. La c o s d th u c hanh chinh cua Truong Dai hoc Y Ha Noi, Benh vien bao gom 2 vien, 7 trung tam , 22 khoa lam sang, 6 khoa can lam sang, 9 phong, ban chUc nang, 1 trUdng Trung hoc Y te. Benh vien la m ot Trung tam y te chuyen sau, co trang th ie t bi hien dai va dong bo. Dpi ngu Giao sU, Pho Giao sU, Tien si, Bac si, Dupe si, Ki su, Dieu duong, Ho If va can bo nhan vien dong dao, co tr'inh do gidi, tan tam vdi ngudi benh. Suot chang dudng lich sU 100 nam xay dUng va phat trien, Benh vien da thu dupe nhieu thanh tuu to Idn trong cong tac kham chUa benh, dao tao, nghien cUu khoa hoc va ho trp y te tuyen trudc. Nhieu trudng hop m k benh hiem ngheo, hiem gap da dupe cUu song, Benh vien la dia chi tin cay cua ngudi benh va nhan dan cung nhu cua ban be, dong nghiep quoc te. Ghi nhan nhUng dong gop to Idn cua Benh vien trong su nghiep cham soc va bao ve sUc khoe nhan dan, Dang va Nha nude da tang thu dn g nhieu danh hieu cao quy: Huan chuong Ho Chi M inh, Huan chuong Khang chien hang Nhat, Huan chuong Ooc lap hang Nhat, Huan chuong Lao dong hang Nhat, Danh hieu Anh hung LUc lupng Vu trang nhan dan, Danh hieu Anh hung Lao dong th d i ky doi m di... De th ie t th i/c chao mUng le ki niem 100 nam thanh lap, vdi trach nhiem dinh hudng chuyen nganh tro n g ca nUdc, Benh vien Bach Mai da tap trung tri tue cua cac nha khoa hoc de bien soan cuon sach "Hudng dan chan doan va dieu tri cac benh noi khoa" nham cung cap, chia se kien thUc co ban va nhUng kinh nghiem quy bau ve chan doan va dieu tri cac benh noi khoa cho cac thay thuoc thUc hanh. Mac du da dupe tap the cac Giao su, Pho Giao sU, Tien si, Bac si chuyen khoa cap II, Thac si bien soan va chinh sUa cong phu nhUng chac chan khong the tranh khoi nhUng thieu sot, rat m ong ban doc xa gan dong gop y kien de lan xuat ban sau sach se dupe hoan thien hon. Xin tran trong cam on! GlAM OOC BENH VIEN BACH MAI TS. NGUYEN QUOC ANH
MUCLUC • • C h u o n g 1. C A p c u u ................................................21 27. Hon m e tang ap lu c tham thau 1. C ap c u u n g u n g tu a n hoan c o b a n .............23 o n g u d i dai thao d u o n g ...............................116 2. C ap c u u n g u n g tu a n hoan nang c a o ........ 27 28. Hon m e nhiem toan ceton do 3. C ap c u u hon m e ................................................32 dai th a o d u o n g ................................................ 119 4. C ap c u u ha d u o n g h u y e t.............................. 36 29. Hoi c h u n g H e llp ............................................... 121 30. Hoi c h u n g tieu c o van c a p ..........................124 5. C ap c u u dot quy den s o m 31. T ang ap lu c noi s o ..........................................127 (trong vo n g 3 g io ) ............................................. 39 32. Hoi c h u n g G uillain - B a rre ...........................130 6. C ap c u u dau n g u c c a p ................................... 42 33. V iem tuy cap n a n g ..........................................133 7. C ap c u u dau b un g c a p ................................... 46 34. Suy gan c a p ......................................................137 8. C ap c u u c o n dau q ua n th a n c a p ................49 35. T ang natri m a u ................................................ 140 9. T i c dong m ach p ho i c a p ................................51 36. Ha natri m a u ......................................................142 10. C ap c u u xu a t h u ye t tieu hoa c a o ................ 55 37. T ang kali m a u .................................................. 145 11. C ap c u u soc g ia m the t ic h ............................60 38. Ha kali m a u ........................................................ 147 12. C ap c u u ban dau soc nhiem k h u a n ...........63 39. T an g calci m a u ................................................ 150 13. C ap c u u kh o th o c a p .......................................67 14. T i c d u o n g ho hap t r e n .................................. 71 C h u o n g 3. C h O n g d o c ................................................ 1 5 3 15. C a p c u u ban dau suy ho hap c a p ..............73 40. N go doc c a p ......................................................155 16. C a p c u u d o t ca p benh phoi ta c nghen 41. Ngo doc cap E th a n o l......................................160 m an t in h ................................................................ 78 42. N go doc khi carbon m onoxide ( C O )....... 163 C h u o n g 2. HOi s ire tich c u c ...............................81 43. NgO doc cap o p io id .........................................166 44. N go doc cap n e re is to x in .............................. 168 17. Hoi c h u n g suy ho hap cap tien trie n ..........83 45. N go doc cap hoa chat tru sau 18. Suy ho hap nan g do d o t cap cua P h o sp h o h u u c o ............................................. 170 benh phoi t i c n gh en m an tin h ..................... 86 46. N go d o c ca p hoa chat diet chuo t natri 19. V iem p ho i nang do vi khuan flo u ro a c e ta t va flo u ro a c e ta m id .................. 173 tai co n g d o n g ...................................................... 89 47. N go d o c cap hoa chat diet chuot 20. V iem phoi nang do virus cum A ................... 93 loai m uoi p h o sp h u a (p h o sp h u a kern, 21. V iem p ho i lien q u a n den th o m ay (VAP)... 96 p h o sp h u a n h o m )............................................. 176 22. Tran khi m a n g phoi 6 benh nhan 48. N go doc ca p hoa ch a t diet chuot th o m a y ............................................................... 100 loai w a fa rin ......................................................... 180 23. S oc p ha n v e ...................................................... 102 49. R ln ho m ang c l n ........................................... 182 24. S oc n hiem k h u a n ............................................ 105 50. R ln ca p ma c l n ...............................................185 25. Suy than ca p tron g hoi s u e .........................108 51. R an luc c l n .........................................................188 26. C o n n h u o c c o n a n g ......................................113 52. O ng d o t................................................................ 190
53. N go (Joe m at ca tra m ..................................... 193 92. D o t cap benh phoi t ic nghen man tinh 54. N go doc cap b a rb itu ric .................................. 195 tai khoa n o i................................................. 362 55. N go (Joe cap a ce ta m in n o p h e n 93. G ian phe quan 364 (p a ra c e ta m o l)....................................................198 94 Hen phe q u a n ............................................ 370 56. N go doc cap R o tu n d in .................................. 202 95. Tran dich m ang p h o i............................ 57. N go doc nam d o c ............................................204 96 Tran khi m ang p h o i........................................ 379 58. Ngo doc cap P araquat qua d u o n g 97. Tran mu m ang p h o i....................................... 383 tieu h o a .................................................................207 98. Ung th u phe quan nguyen phat 99 T am phe m a n ................................................ 391 C h u o n g 4. T im m a c h .............................................211 100. Ho ra m a u ....................................................... 395 59. Tang huyet a p ...................................................213 101. Ho keo d a i....................................................... 399 60. Tang huyet ap 6 phu n u m ang th a i......... 217 102 Tang ap dong m ach p h o i..................... 402 61. Roi loan lipid m a u ...........................................220 103. Benh s a rc o id ................................................. 405 62. Thap t im ............................................................. 226 C h u o n g 6 . N o i t i £ t - D ai t h Ao d u o n g ......... 4 0 9 63. Phu phoi cap huye t d o n g .............................230 64. D au that n g u c khong on dinh va nhoi m au 104. D ai th a o d u o n g ........................................ 411 c o tim khong co ST chen h le n ................... 233 105. C ac bien c h u n g cap tin h do 65 N hoi m au c o tim c a p ......................................237 dai th a o d u o n g giai doan dau 417 66. H ep van hai la ...................................................244 106. Bien c h u n g m ach m au Ion do 67. H o van hai la .....................................................249 dai th a o d u o n g ............................................ 423 68. H ep van dong m ach c h u .............................. 253 107. Bien c h u n g m ach m au nho do 69. H o van dong m ach c h u ................................ 258 dai th a o d u o n g ............................................. 427 70. T ho ng lien n h l...................................................263 108. Benh B a s e d o w ............................................ 433 71. T ho ng lien th a t..................................................267 109. Suy g ia p ......................................................... 437 72. C on ong dong m a c h .......................................271 110. B u o u nhan tu ye n g ia p ............................... 442 73. H ep van dong m ach p h o i.............................274 111. U ng th u tu ye n g ia p .................................... 445 74. N hip nhanh th a t............................................... 279 112. V iem tu ye n g ia p .......................................... 448 75. N hip nhanh tre n th a t.......................................283 113. Benh to ca c vien c u e ................................ 452 76. Roi loan nhip tim c h a m ................................. 289 114. S uy tu ye n y e n .................................................456 77. N goai ta m th u ....................................................295 115 D ai th a o n h a t..................................................460 78. B loc n h l th a t ..................................................... 299 116. C u o n g can gia p tie n p h a t.........................453 79 Hoi c h u n g suy nut x o a n g .............................306 117. S uy can g ia p ..................................................4 6 6 80. R ung n h l..............................................................310 118. Hoi c h u n g C u s h in g ......................................4 6 9 81. V iem noi tam m ac nhiem k h u a n ................314 119. S uy th u o n g th a n .......................................... 473 82. H uyet khoi tin h m ach sau chi d u o i..........318 120. U tu y th u o n g th a n ...................................... 4 7 7 83. B enh dong m ach chi d u o i m an tin h ........ 323 84. Tai bien m ach m au n a o ................................ 329 C huong 7. T ieu h 6 a ............................................ ...481 85 P h in h ta ch dong m ach c h u ..........................333 121. Loet da day - hanh ta tr a n g ..................... 483 86. V iem m ang ngoai t im .....................................339 122. V iem tu y c l p ................................................. 487 87. V iem c o t im ....................................................... 342 123. V ie m tu y m an t in h ........................................492 124 X o g a n .............................................................494 C h u o n g 5. HO h A p ................................................. 3 4 5 125. X u a t huye t tieu hoa c a o ............................. 498 88. V iem phe quan c a p ......................................... 347 126. X u a t huye t tieu hoa do loet da day - 89. V iem phoi m lc phai o cong dong 350 ta tra n g .............................................................. 502 90 A p xe p h o i...........................................................354 127. X uat huyet tieu hoa cao do 91. Benh phoi t i c nghen m an t in h .................. 358 tang ap lu c tin h m ach c u a ........................506
128. B?nh co t h it ta m v j ..................................... 509 165. D au cot song t h it lu n g ..............................647 129. A p xe gan do a m ip ...................................... 511 166. D a u than kinh t o a .........................................650 130. N hiem trun g d u o n g m a t............................514 167. B enh g u t .......................................................... 653 131. V iem gan viru s B m an tin h ....................... 517 168. B enh li viem diem bam gan, 132. V iem gan viru s C m an tin h ....................... 522 phan m em q ua nh k h d p ..............................658 133. Tieu chay cap d n g u d i Idn 526 169. Hoai tu vo khua n chom x u o n g d u i....... 663 134. V ie m loet dai - tru e tran g chay m a u ..... 530 170. V ie m k h d p vay n e n ..................................... 666 135. P o lyp th u c quan, da day va ruot non 534 171. B enh Still d n g u d i Id n ................................668 136. P o lyp dai tra n g va m ot so 172. Lao cot song ................................................. 671 hoi c h u n g p o lyp hay g a p ...........................538 173. Lao k h d p g o i.................................................. 675 137. Ung th u th u c q u a n .......................................542 174. N h u o c c o ........................................................678 138. Ung th u dai - tru e tra n g .............................545 175. V iem x u o n g tuy nhiem k h u a n .................682 139. Ung th u p h u c m ac n gu yen p h a t.............550 176. V iem k h d p nhiem k h u a n ............................686 140. Ung th u bieu m o te bao g a n .................... 553 177. V iem c o nhiem khuan - ap xe c o ......... 690 141. B enh tr i..............................................................558 178. Ung th u di can x u o n g ................................693 142. T a o b o n .............................................................560 179. Loan d u d n g c o ............................................. 696 143. Lao m ang b u n g ............................................. 563 180. V iem da c o va viem da c o ....................... 699 144. Hoi c h u n g gan th a n .................................... 567 C h u o n g 1 0 . T r uyen n h i Gm .............................. 7 0 3 C h u o n g 8. T h an - T i £ t n ie u ............................. 571 181. B enh th u y d a u ............................................... 705 182. B enh do nam C a n d id a ...............................708 145. D ai m a u .............................................................573 183. V iem gan viru s c a p ..................................... 711 146. V iem bang q u a n g c a p ................................ 576 184. B enh quai b j....................................................716 147. V iem th a n - be th a n c a p ............................579 185. V iem nao he rp e s s im p le x ..........................720 148. S uy th a n c a p ...................................................583 186. V ie m m ang nao do nam 149. V iem cau th a n lu p u s ....................................586 c ry p to c o c c u s n e o fo rm a n s .........................723 150. Hoi c h u n g th a n h u .......................................589 187. B enh do nam Penicilliurm m a rn e ffe i...... 726 151. Soi tie t n ie u .....................................................592 188. V iem m ang nao tang bach cau ai to a n . 728 152. Ha hu ye t ap tro n g than nhan ta o ............596 189. N h iem khua n h u y e t......................................731 153. V iem p h u c m ac d benh nhan Iqc 190. V iem m ang nao m u ..................................... 736 m ang bung lien tu c ngoai tr u ................... 599 191. B enh uon v a n ................................................ 742 154. T h ie u m au va d ieu trj th ie u m au 192. N h iem tru n g do tu cau vang b ln g E rythro poie tin d benh nhan (S ta p h y lo c o c c u s a u re u s )...........................748 suy than m a n ..................................................601 193. B enh sot m o ....................................................753 155. N ang d o n th a n ...............................................604 194. B enh th u o n g h a n .........................................756 195. B enh ly tru e k h u a n .......................................760 C h u o n g 9. C o X u o n g K h 6 p .............................6 0 7 156. V ie m k h d p d an g th a p ................................. 609 C h u o n g 11. D j ung - M i £ n d |ch l A m s A n g ...763 157. V iem co t song d in h k h d p ..........................614 196. X o c u n g bi he th o n g tien tr ie n ................ 765 158. V iem k h d p phan u n g .................................. 617 197 Dj u n g th u o c ...................................................769 159. V ie m k h d p th ie u nien tu p h a t.................. 620 198. L u p u s ban do he th o n g .............................775 160. V iem q u a n h k h d p v a i................................. 625 199 M ay d a y ............................................................779 161. V ie m m a n g h o a t dich k h d p goi 200. P hu Q u in c ke dj u n g .....................................783 m gn tin h kh o n g dac h ie u ...........................629 201. V ie m m ach di u n g ........................................ 787 162. Loang x u o n g ..................................................633 202. V iem gan tu m ie n .........................................791 163. T h o ^ i h o a co t s o n g ......................................637 203. V iem da dj u n g ...............................................796 164. T h c a i hoa k h d p g o i......................................642
CACTir VIET TAT C h u o n g 1: C a p c u u TCV: Tieu c o van BN: B enh nhan NTH: N g u n g tuan hoan A LN S : Ap lu c noi so NKQ: Noi khi quan ALTM N : Ap lu c tu d i m au nao TM: T in h m ach HATB: H u ye t ap tru n g binh H S TP: Hoi sinh tim phoi HA: H u ye t ap HA: H u yet ap HATT: H u ye t ap ta m thu NMCT: N hoi m au c o tim HATTr: H u yet ap ta m tru o n g BM C: D o ng m ach chu V TC : V ie m tu y cap TH A: Tang huye t ap A LO B : A p lu c o bung TD M P : T a c d on g m ach phoi CT: C h u p cat lo p vi tin h D TD : D ai th a o d u o n g TK M P : Tran khi m ang phoi C h u o n g 3: C h o n g d o c XH TH : X u a t huyet tieu hoa BN: Benh nhan TM TQ : T in h m ach th u c quan HA: H u ye t ap CVP: A p lu c tin h m ach trun g tam TM : TTnh m ach SNK: S oc nhiem khuan ALTM TT: Ap lu c tin h m ach tru n g tam ARDS: Hoi c h u n g suy ho hap tien trien CW H Loc m au lien tu c C O PD : B enh phoi ta c nghen m an tin h ALTT: Ap lu c th a m thau CO: C a rb o n m o n o xid C h u o n g 2: H 6 i s u e tic h c u c PP H C : P h o sp h o h u u c o ARDS: Hoi c h u n g suy ho hap tien trien TKTU: T h a n kinh tru n g u o n g ALI: Ton th u o n g phoi cap PAM: P ra lid o xim e EC M O : Tim phoi nhan tao TM C : TTnh m ach cham BP TN M T: B enh phoi t i c ngh§n m an tinh INR: P ro th ro m b in TKNT: T h o n g khi nhan tao H TKN : H u ye t th a n h khan g noc CW H: L qc m au lien tuc NKQ : Noi kh i quan BC: B ach cau ALTM TT: A p lu c tin h m ach trun g tam C h u o n g 4: T im m a c h STC: S uy th a n cap TH A: T an g h u ye t ap H TO TC : H oai tu ong than cap HA: H u ye t ap TM TTnh m ach HATT: H u ye t ap ta m thu HM TALTT: H on m e tang ap lu c tham thau HATTr: H u ye t ap ta m tru o n g DTD: D a i th a o d u o n g
DM V: D o ng m gch vanh NT: N h iem trun g Y TN C : Y eu to nguy c o ODM: O ng d on g m ach BMV: B ^n h m ach vanh CODM: C on ong dong m ach HDL L o p oprote in phan ti> Im yng cao XQ : X q uang LDL: L o p oprote in phan tu- lu’o n g thap C A TTTD : C h enh ap ta m thu toi da H D L-C : H D L -ch o le ste ro l T P -D M P : T h a t phai va d on g m ach phoi LD L-C : L D L -ch o le ste ro l NN VLN T: N hip n ha nh vao lai n h l that LP(a): Lip o p ro te in a NNTT: N hip nhanh tren th a t ADR: T ac d un g khon g m ong m uon BLN: B loc nhanh TG: T rig lycerid RLNT: Roi loan nhip tim W HO: To chi>c Y te The g id i TB M N : Tai bien m ach m au nao TTT: T h o i tam thu RN: R ung n h l HoHL: H o van hai la NX: N ut xoan g HoC: H o van dong m ach chu Q R S: T an so tim C TM : C o ng th u c m au NP: NhT phai A S LO : A n tis tre p to h y a lu ro n id a s e TNT: T ao nhip tim HHL: H ep van hai la NTT: N g oai ta m thu NMCT: N hoi m au c o tim HCSNX: H oi c h u n g suy nut xoang N KQ : Noi kh i quan tP H N X : T h d i gian phu c hoi nut xoang HFQ . H ep p h e quan rD TX N : T h d i gian dan tru ye n xoang n h l CPAP: T h d m ay khon g xam nhap H KTM : H u ye t khoi tin h m ach TM: TTnh m ach H K T M S C D : H u ye t khoi tin h m ach sau chi C O PD : B e nh phoi ta c nghen m an tin h dudi DTNKOD: D a u th a t n g u c khon g on dinh TBM M N: Tai bien m ach m au nao D TD : D ie n tim do BN: B enh nhan LM W H : H e p a rin co tron g lu’o n g phan tu DM: D o n g m ach th a p CT: Ccit lo p vi tin h HCMVC: H oi c h u n g m ach vanh cap M RI: C h u p cong h u d n g ti> TLT: T h o n g lien th a t SA TQ . S ieu am th u c quan VLT: V a ch lien that CK: C re a tin in kin ase C h u o n g 5: H o h a p AL: A p ly e ALDM P: A p lu'c dong m ach phoi B K (B a cille de K och): T ru e khua n Lao GS: G in g sire TH A: T a n g hu ye t ap : T tfH d .V - TB: T rung b inh B P T N M T (C O P D ): B enh phoi ta c nghen m an C t f Q - 2 A M *. tin h DM P: D o n g m ach phoi v i i ' ; f*H U T H O T K N T K X N : T h o n g kh i nhan ta o khong xam PPC: Phu phoi cap nhap KLSL: K h oang lien s u d n I’f ' W V S E N G PQ : G ian phe quan TLN : T h o n g lien n h l w , , , . y { o iA H PQ : H en phe quan * DTD D ie n tam do
LLD: L u u lim n g dinh ke C h u ’O’ng 7: T ieu hoa ICS: C o rtico id d un g th e o duO ng hit, xit hoac khi dung PUD Loet da day hocic ta tran g hoSc ca hai ICS + LABA: D ang ket h o p g iu a corticoid dang phun hit v d i th u o c gian PPI: N h om th u o c u c che b o m proton phe quan ta c dung keo dai V TC : V ie m tu y cap dung th e o du’d n g phun hit (biet CT: C i t Id p vi tin h d u o c tren thi truO ng: S ym bicort, M RI: C o ng h u d n g tu- S e retid e) ERCP: C h up m gt tu y n g u o c dong TDMP: Tran dich m ang phoi EU S: S ieu am noi soi LD H: L actic d e h yd ro g e n a se ICU: D o n vi dieu tri tic h e y e TKM P: Tran khi m ang phoi XHTH: X u a t hu ye t tieu hoa CLVT: C at Id p vi tin h BN: B enh nhan HC: Hoi c h u n g C TM : X e t n g h ie m co n g th u c m au M SCT: CSt Idp vi tin h n g u c da dau do N S A ID s: T h u o c g ia m dau chon g viem TA D M P: T an g ap dong m ach phoi khon g stero id ALTM C: Ap lu c tin h m ach c u a C h u ’O’ng 6: N o i tie t - D a i th a o du’d n g TM T Q : TTnh m ach th u c quan D TD : D a i th a o d u o n g V G V R B M T : V ie m gan viru s B m an tin h GM: G lu co se m au HBV: V iru s vie m gan B HA: H u ye t ap HCV: V iru s vie m gan C TH A: Tcing h u ye t &p G FR : M u c lo c cau than TZD : T h ia z o lo d in e d io n V L D T T C M : V ie m loet dai - tru e tra n g chay D P P IV: D ip e p tid yl p e p tid a se IV m au ALTT: Ap lu c th a m thau UTOTT: U ng th u dai tru e tran g AC E : T h u o c u c ch e m en chuye n PEI: Tiem con tu y e t doi A R B s: C hen thu the A n g io te n sin RFA: D o t n h ie t khoi u gan b ln g song ca o tan M RI: C ong h u d n g tu H C C: U ng th u bieu m o te bao gan V TG : V ie m tu ye n giap HCGT: Hoi c h u n g gan than TR A b: R e ce p to r tu ye n giap AF P : A lp h a fe to p ro te in G H: H o rm o n ta n g tru d n g GHRH: G iai p ho ng ho rm o n tang tru d n g ADH: H o rm o n cho n g bai tiet C h u ’o n g 8: T h a n - T ie t nieu BT: B in h th u o n g UPR : C h u p be th a n n g u o c dong PTH: H o rm o n can g iap trang AG : C h u p m a ch than M EN: H oi c h u n g da u cac tuyen noi V T B T cap V ie m th a n - be than cap tie t UIV: C h u p th a n nieu quan co th u o c SCG: S uy can giap can q ua ng HC: H oi c h u n g VCT: V ie m cau than TT: T h u o n g th a n TNT: T h a n n ha n tao