BNH PHIThs.Bs.Hoang c Trinh

MUC TIU M t v phn tch c im ca cc bnh phi tc nghnM t v phn tch c im ca bnh phi hn chM t v phn tch c im cc dng vim phiM t v phn tch c im i th v vi th carcinm phi

CU TRC NG H HP

Hnh nh nim mc ng h hp: gm cc t bo tr gi tng c lng chuyn v cc t bo i

Cu trc ph nang vi cc ph bo type I v II

1. BNH PHI TC NGHN nh ngha: l s suy yu kh nng thng kh, khng kh thot khi ph nang trong th th ra kh khn hnLm sng c xc nh bi FEV1/FVC gimVim ph qun man tnhHen ph qunDan ph qun

1.1 VIM PH QUN MN TNH Cc tuyn nhy to ra Mng y dy Thm nhp t bo vim mn Chuyn sn gai Tng sinh t bo i

1.1 VIM PH QUN MN TNH

1.1 VIM PH QUN MN TNHCh s Reid (A/B > 0,4)AB

1.2 HEN PH QUNnh ngha: c trng bi nhiu phn ng co tht kh ph qun, p ng vi cc kch thch ni sinh v ngoi sinh. Bnh hen ph qun thng km vi vim nhim mn tnhPhn loi bnh hen ph qun: bnh hen ph qun do d ng v khng do d ng

1.2 HEN PH QUNBnh hen ph qun do d ngDch t hc: Thng gp tr em Nguyn nhn: phn hoa, bi, thucTriu chng i km: Bnh nhn c th c st hay chmC ch: phn ng qu mn cm type I

1.2 HEN PH QUN Hen ph qun khng do d ng Dch t hc: thng ngi ln Nguyn nhn: Lnh, thuc, d dy tro ngc, nhim siu vi C ch: Khng do phn ng qu mn cm type I, mc IgE bnh thng. Nhn chung, bnh hen ph qun l c trng ca s tng co tht kh ph qun, phn ng li kch thch

1.2 HEN PH QUNi th: phi tng kch thc, nt nhy bt kn kh ph qunVi th: c trn phi ai, tng collagen mng y, tuyn nhy tng sinh, v xm nhp bch cu i toan, hin din tinh th Charcot-Leyden (gm cc protein) v xon Curschmann

1.2 HEN PH QUN

1.2 HEN PH QUNNut nhy, vim

1.2 HEN PH QUN Thnh ph qun ph Thm nhp lymph bo, tng bo, bch cu i toanMng y dy Ch s Reid tng Trc biu m Tng sinh t bo i

1.2 HEN PH QUNTinh th Charcot-LeydenXon Crushmann

1.3 DN PH QUN nh ngha: s gin n bt thng ca ph qun Nguyn nhn: Nm Aspergillosis, si bc, v hi chng Kartagener, Nhim: Staphylococcus, KlebsiellaCc nguyn nhn khc: khi u, di vt, v cht nhy trong ng h hpSinh bnh hc: hai qu trnh chnh l nhim trng v tc nghn. Cui cng l hy hoi si c trn v si n hi ca kh ph qun

1.3 GIN PH QUNi th: dn ph qun thng xy ra thy thp, phi bn phi nhiu hn phi bn triVi th: vim v s ph hy m, c bit l c trn

1.3 GIN PH QUN Thnh ph qun b ph hy

1.3 GIN PH QUN Biu m: Lot, chuyn sn gai Thm nhp t bo vim mn tnh, x ha Tng sinh lymph Ph hy sn, c, mch mu

2. BNH PHI TC NGHEN MAN TNH (COPD) Bnh phi tc nghn mn tnh l thut ng dng ch tnh trng ng thng kh h h hp b tc nghn, gy kh th

Nhu m phiVim pq mn tnhKh ph thng2 BNH PHI TC NGHEN MAN TNH

2. BNH PHI TC NGHEN MAN TNH Phi binh thng Khi ph thung

YU T NGUY C CUA COPDDinh dngVim nhim Tnh trng kinh t x hiNgi ln tui

3. BNH PHI HAN CHNguyn nhn:Nguyn nhn ngoi phi: bo ph v g vo ct sngNguyn nhn trong phi: vim cp tnh v mn tnh phiBnh phi hn ch cp tnh cn gi l hi chng suy h hp cp v bnh phi hn ch mn tnh l mt nhm bnh bao gm nhiu thc th ring bit

3.1 BNH PHI HAN CH CP TINH nh ngha: Bnh pht trin trong mt thi gian ngn, thng th pht theo sau mt bnh cnh ton thn, suy h hp, h oxy huyt (pO2 > 60 mm Hg) Thut ng lm sng cho bnh phi hn ch cp tnh l hi chng suy h hp cp tnh, v thut ng gii phu bnh, tn thng ph nang lan ta.

3.1 BNH PHI HAN CH CP TINH Sinh bnh hc: tn thng t bo thng m hoc ni m mch mu, lm cho ph nang c k h, protein i vo ph nang. Cc t bo thng m tip tc hoi t v bong ra

3.1 BNH PHI HAN CH CP TINHC ba giai on ca s tn thng ph nang lan ta: Giai on xut tit dch: protein v lp t bo hoi t vo lng ph nang, to thnh mng hyalin Giai on tng sinh: p ng vi tnh trng hoi t t bo. Loi ph bo II tng sinh Giai on si ho

3.2 BNH PHI HAN CH MAN TINH nh ngha: bnh phi hn ch mn tnh, cn c gi l bnh phi k, thng tn lan ta phi, gm hai qu trnh vim v si ha Khi u kh th nh v ho khan, th nhanh- Cc du hiu: ting rt cui th ht vo, ngn tay di trng, suy tim phi- X quang ngc: hnh nh li v nt dng li.Chn on: sinh thit

Nguyn nhn chungNguyn nhn c th1. Bnh t minLupus U ht Wegener Vim khp dng thp2. Ngh nghipBnh phi abestosisBnh phi bi silicBnh phi bi than3. Do thucBleomycin, Busulfan,Amiodarone, Methotrexate4. V cnVim phi v cn Bnh Sarcoidosis

4. BNH M K PHI LAN TA Tn thng ph nang lan ta Vim phi m k mn tnh Vim phi do tia x Sarcoidosis Vim phi ha m

4.1 TN THNG PH NANG LAN TA Chn thng ngc Vim phi do virus Ht acid Thuyn tc Sc nhim trng Sc gim th tch

4.1 TN THNG PH NANG LAN TA Pha xut tit khong 1 tun Thot dch v mu vo m k v lng ph nang Hyalin ha vch ph nang

4.1 TN THNG PH NANG LAN TAPha tng sinh: T ngy th 4 Ph bo II Nguyn bo si T bo vim

4.2 VIM PHI M K MN TNH Thm nhp limph bo, tng bo Nguyn nhn cha bit r t min Din tin ko di nhiu thng n nhiu nm

4.2 VIM PHI M K MN TNH Vim phi m k thng thng (Usual interstitial pneumonitis) - UIP Vim phi m k trc vy (Desquamative interstitial pneumonitis) - DIP Vim phi m k lymph bo (Lymphoid interstitial pneumonitis) - LIP

4.2 VIM PHI M K MN TNHVim phi m k thng thng Ph m kTng sinh ph bo II X ha Tn thng nhiu nhiu giai on khc nhau.

4.2 VIM PHI M K MN TNHVim phi m k trc vy Nhiu i thc bo sc t trong lng ph nangThm nhp t bo vim trong m k va phi

4.2 VIM PHI M K MN TNHVim phi m k lymph bo

Nhiu lymph bo v tng boKh phn bit vi Lymphm phiL tn thng tin lymphm

4.3 VIM PHI DO TIA X

Khi pht sau 2-3 thng x tr vng ngc Sm: ging nh tn thng ph nang lan ta (ph hyalin ha, tng sinh biu m) Mun: t bo d dng, lon sn

4.3 VIM PHI DO TIA XGiai on cp: ph, hyalin ha, tng sinh t bo biu m

4.3 VIM PHI DO TIA XGiai on mn: T bo d dng, nhiu nhn

5. BNH BI PHI Bnh bi than Bnh Silico Bnh Asbestos

5.1 BNH BI THAN

Do ht vo v lng ng cht carbon t bi than Hin din i thc bo n bi than

5.1 BNH BI THAN

5.1 BNH BI THAN

i thc bo n bi than Dn tiu ph qun h hpV ti kh thng

5.2 BNH SILICO Do ht tinh th silica SiO2 Cc i thc bo ph nang n tinh th ri cht, x ha to nt

5.2 BNH SILICOi th: dng khi kt hp

5.2 BNH SILICO Silicotic node Collagen dy c, xp vng, rt t t bo

5.3 BNH ASBESTOS Do ht si asbestos Cc si asbestos b thc bo, c ph bi mucopolysacharide gn vi ion st hnh thnh th st C th gy u trung biu m c tnh, carcinm phi

5.3 BNH ASBESTOSX ha phi lan ta: vng x ha xen k trong nhu m phi

5.3 BNH ASBESTOSTh Asbestos trong long ph nang

6. BNH NHIM TRNG PHI Vim phi thy Vim ph qun phi Vim phi do Staphylococcus Aureus Vim phi do Pseudomonas aeruginosa Vim phi do Klebsiella Pneumoniae Lao phi

6.1 VIM PHI THY Tn thng lan rng 1 thy phi Thng do nhim ph cu Din tin qua 4 giai on: Sung huyt, gan ha , gan ha xm, hi phc Do ht vi trng, thc n

6.1 VIM PHI THY

6.1 VIM PHI THYNhiu BC trung tnh v i thc bo trong lng ph nang

6.1 VIM PHI THYNhiu BC trung tnh, dch tit

6.2 VIM PH QUN PHI Tn thng khu tr, ri rc tng Ph cu, lin cu, t cu trng Cc tn thng khng cng tui Do ht vi trng, thc n

6.2 VIM PH QUN PHI

6.3 VIM PHI DO Staphylococcus Aureus Tn thng gm 1 hay nhiu vng p xe ha Nhiu p xe nh c khuynh hng lin kt vi nhau C th dn n trn m mng phi

6.3 VIM PHI DO Staphylococcus AureusNhiu p xe phi

6.3 VIM PHI DO Staphylococcus Aureusp xe phi

Cc m vi trng tp trung quanh mch mu6.4 VIM PHI DOPseudomonas aeruginosa

6.5 VIM PHI DO Klebsiella Pneumoniae BN nghin ru, tiu ng, nhim trng rng ming Tn thng thy trn phi phi, nt cng sm hoc p xe lan rng

6.5 VIM PHI DO Klebsiella Pneumoniae Cc m vi trng trong lng ph nang b ph

7. LAO PHI VT Mycobacterium tuberculosis Tn thng khu tr thy nh hoc lan trn 2 phi Ht lao 1 3 mm C k vi mm n 3cm C sng: gm nhiu c k hp li C ha bc: gm nhiu c k hoc c sng c bao si

7. LAO PHIC k

7. LAO PHIC sng

7. LAO PHISinh thit: T bo dng biu m

7. LAO PHIChi ph qun: T bo dng biu m

7. LAO PHIHoi t b u

7. LAO PHINhum Ziehl-Neelsen: Trc khun lao 92

8. U PHI L bnh ca nn vn minh S pht trin ca cng nghip S nhim mi trng ng th 2 ti M 80-90% bnh nhn cht v ung th phi c ht thuc l

8. U PHI Hu ht l u c: . 90-95% l carcinm ph qun . 5% l carcinoid v 2-5% l sarcmCarcinm ph qun . Gpp Nam > N. Tui mc bnh t 50 70. Nhng ngi ht thuc ung th xut cao gp 10 20 ln.

Cc thay i c th gp biu m ph qun ca ngi ht thuc l

8.1 UNG TH PH QUNCarcinm t bo gai: 30 - 40%Carcinm tuyn: 40 - 45%Carcinm t bo ln: 10 - 20%Carcinm t bo nh: 15 - 20%

8.2 CARCINM T BO GAI Chim 30-40% Thng gp, nam nhiu hn n Lin quan n ht thuc l trung tm C khuynh hng hoi t to hang Xm ln hch rn phi Di cn xa tr

8.2 CARCINM T BO GAI U mu trng xm, cng chc (do to x) U to c th b hoi t

Bit ha rBit ha vaBit ha km

BIT HA Bit ha r (grade 1)Nhiu cht sng, cu sngCu lin bo r Bit ha trung bnh (grade 2)Bit ha km (grade 3)T bo d dng, nhiu phn bo Hoi t u, vim

Dng t bo hnh thoiDng t bo dng y

Carcinm t bo gai bin th dng nh

8.3 CARCINM T BO NH Chim 20%, tin trin nhanh, di cn sm Lin quan n thuc l, m uranium T l ph n mc bnh tng U trung tm, gn rn phi Ho, ho ra mu, au ngc Xm ln trung tht

8.3 CARCINM T BO NHU to, trng nh tht c, mm

Nhn: mn, tng sc,dng mui tiu, ht nhn khng r nhiu phn boBo tng: t8.3 CARCINM T BO NH

8.3 CARCINM T BO NHT bo nh nh lymph bo (lympho Like)

8.3 CARCINM T BO NHGEN:Thng mt on NST 3 t bin p53 >90%Bt hot gen Rb >90%

8.4 CARCINM TUYN Chim 40 - 45%, di cn sm C c nhng ngi khng ht thuc l ngoi vi phi, tiu ph qun

8.4 CARCINM TUYNU gii hn r, b chia thy, nm st di mng phiMu xm hay vng nht, cng hoc mm, tit nhy

Dng signet ring cellDng tuyn bit ha r

Dng nhyDng nh

8.4 CARCINM TUYNDng c

8.4 CARCINM TUYNCarcinm tuyn bit ha km

8.4 CARCINM TUYNCarcinm tiu ph qun-ph nang, loi ch nhy

8.5 CARCINM T BO LN Chim khong 10-20% Lin quan thuc l U thng trung tm hoc ngoi vi

8.5 CARCINM T BO LN

8.5 CARCINM T BO LNT bo u to, d dng trong nn hoi t rng

8.5 CARCINM T BO LN

8.6 CARCINM GAI-TUYNThnh phn tuyn ung th v gai ung th chim t nht 10%

8.7 U CARCINOID Chim 5% cc u phi, di 40 tui, nam = n U ngoi bin, khng Triu chng, pht hin tnh c Xut ngun t t bo ni tit thn kinh a bc

8.7 U CARCINOID

Dng (nest)Dng b nh (trabecular)-T bo xp cu trc dng b, dy, dng , dng c lan ta, hay dng nh dng tuyn, dng hoa hngDng tuynDng hoa hng

-T bo nh ng dng, nhn trung tm-Bo tng va, c ht, i khi c bo tng sng-t phn bo-T bo c th hnh thoi nh ( dng ngoi bin)

-M m giu mch mu-C th hyalin ha-M m c th chuyn sn xng

-Phn bo (2-10/ 10 QTL)-Hoi t

U PHI CHA R NGUN GC TO M

9. HAMARTOMA-Gii hn r- Mt ct trng

9. HAMARTOMANgoi bin: o sn bnh thng , thng canxi ha, him khi ha xng, m, c trn, vch lt biu m h hpNi ph qun: t sn, m m nhiu hn, t biu m

10. U MCH MU X HASang thng lnh tnh, him gpGp ngi ln, nL 1 nt nh (< 5cm), n c, khng triu chng Ln chm

10. U MCH MU X HAGii hn rKhng v baocNht muC th ha nang xut huyt

10. U MCH MU X HA-Dng nh, c, x ha, dng mch mu-M m collagen, hyalin ha-TB trn hay a din, ng nht, , khng ht nhnBo tng nhiu mu hng1 hng t bo

11. U T BO SNGTn khc sugar tumorTng sn t bo sng lnh tnh, u gii hn r, bo tng c nhiu glycogen.Xut pht t t bo c trn dng biu m quanh mch mu do dng tnh HMB45. Gp ngi ln

-T bo ln dng nhn-Bo tng sng hoc hng, cha glycogen-khng phn bo-m m k tNhiu mch mu thnh mng

12. M LC CH PHIU MNG NO:Kch thc c th n 10 cmCh yu dng si, dng chuyn tipPhn bo himT bo khng in hnh him

U TUYN C -Kch thc c th n 10 cm- Chn on nh hai dn s: t bo biu m v lymh bo

13. U C NGUN GC LYPHLymphm t bo toLymphm MALTLymphm HodgkinU tng bo

13. LYMPHMT bo lymph xm nhp nhu m phi cng vi i thc bo trong nn m m si

14. UNG TH DI CNV, i trng, d dy, ty Thn, melanoma, tuyn nc bt, ganTuyn gip, cholangiocarcinoma.Metastatic renal cell carcinoma

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