Phan tich dich bang

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<ul><li> 1. PHN TCH DCH BNG ThS GVC TRAN TH KHANH TNGBM NOI HYK PHAM NGOC THACH1</li></ul> <p> 2. Mau sacVang trong, trang trong (BC 10.000/mm3Nh mau ( bloody ascites) : HC &gt; 50.000/mm3 XH noi : v gan ( u gan hay chan thng ), lach Gap 5% trong x gan ( t phat hay cham mach : comau cuc ) Chiem 20% case K di can mang bung Chiem 10% K mang bung nguyen phat (peritonealcarcinomatosis) 2 3. Mau sac uc co the do BC, hay do Triglyceride ( &gt; 50mg/dl hay 0,56mmol/l uc) nh lng Triglyceride (TG) uc nh sa : Bang bung dng chap (Chylous ascites) khi TG &gt; 200mg/dl (2,26mmol/l) va &gt;TG mau : K, x gan ( 0.5-1 %), nhiem trung ( lao, giun ch ) Nau o nh lng Bilirubin (Bilirubin dch bang &gt; mau VPM mat : v tui mat hay thung ta trang) 3 4. P H ANT C H D C H BANGTra li 2 cau hoi chnh ( XN thng qui ) Dch bang co nhiem trung ? Co tang ap TMC ?Cau hoi phu Protein cao hay thap ? Gi y nguyen nhan ( ket hp LS) XN chon loc. 4 5. XT NGHIM THNG QUI(ROUTINE TESTS) em te bao Albumin Protein Tra li cau hoi 1va 2 5 6. XT NGHIM CHN LC(OPTIONAL TESTS) GlucoseX E T N G H IE M LDH T L A M Nhum gram Bilirubin Cy trong chai cy mu Triglycerit ADA Nhuom va cay VK Amylaselao Cytology 6 7. E M TE B A O ( c a u h o i 1)Cham mach : Tr 1 BC/750 HC; 1Neu/250 HCDch thm thng BC &lt; 500 / mm3 , Neutrophil &lt; 250/mm3 Neu Neutrophil 250/mm3 va 50% tong soBC Dch bang nhiem trung (VPM)7 8. VPM th phat nghi ng khi co 2 trong 3 tieu chuan sau: 1- Protein &gt;1.0g/dl 2- Glucose &lt; 50mg/dl (2.8 mmol/L) 3- LDH DB LDH mau ( gii han tren bnh thng ) Khi cay DB thng moc 2 loai vi trung. 2 tieu chuan cay nhieu loai VT 96% VPM th phat * CEA &gt;5 ng/mL hay ALP &gt;240 UI/L dch bang : onhay 92 % va chuyen 88 % e phat hien thung tang rongvao dch bang **. Soriano G, Castellote J, Alvarez C, et al. Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosisand management. J Hepatol 2010; 52:39.** Wu SS, Lin OS, Chen YY, et al. Ascitic fluid carcinoembryonic antigen and alkaline phosphatase levels for the differentiation of primary from secondarybacterial peritonitis with intestinal perforation. J Hepatol 2001; 34:215.8 9. VPM th phat : thung hay khong thung(abscess quanh than ) TV 100% neu khongPT *Nghi ng VPM th phat : tm thung tang rong( liem hi di hoanh) hay nhiem trung khutru( CT scan )Neu khong tm thay ieu tr nh VPM t phat * Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98:127. 9 10. VPM t phat : khong hay ch co 1 tieuchuanCay ch moc 1 loai vi trung.PT khong can thiet /v VPM t phat : 80% TV** Pinzello G, Simonetti RG, Crax A, et al. Spontaneous bacterial peritonitis: a prospective investigationin predominantly nonalcoholic cirrhotic patients. Hepatology 1983; 3:545 10 11. O CHENH ALBUMIN (cau hoi 2)SAAG : (Serum-ascities albumin gradient )Chnh xac 97% trong phan loai dch bangSAAG = Albumin mau Albumin dch bang 1.1g/dl : co tang ap TMC(SAAG cao)&lt; 1.1g/dl : khong tang ap lc TMC (SAAG thap)11 12. P R O T E INProtein dch bang dch tham hay tietProtein 2.5g/dl dch tiet, &lt; 2.5g/dl dchthamNhng chnh xac ch 56% !!!.Da LDH DB/ mau va protein DB/mau( giongtieu chuan Light ) o chnh xac cungkhongcao hn. o Suy tim P dch tham, nhng Pro 2,5g/dl o Dung thuoc li tieu nhieu Pro cao / x gan.12 13. Ket hp ca SAAG va Protein DB gi y NN gay bang bung.VD : SAAG cao + Pro cao thng la ST P SAAG thap + Pro cao thng benh lyac tnh hay lao mang bung. 13 14. C A C XE TN G H IE M K H A CN huo m G ra m va C a y10ml trong moi trng cay mau onhay cao hn.C y t o l o g y : tm TB d dango nhay gan 100% K mang bungnguyen phato nhay 60%vi K di can mangbung. 14 15. C A C XE TN G H IE M K H A C A m y la s e DB x gan khong bien chng : 40IU/L va Amylase DB/ mau # 0.4 Amylase DB/ mau &gt; 0.4 : Bang trong Viemtuy hay thung tang rong vao DB. ADA 39IU/L : o nhay 100% va o chuyen97.2% trong lao mang bung * * Riquelme, A, Calvo, M, Salech, F, et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 2006; 40:705.15 16. C IM DCH BNGTRONG MT S BNH L 16 17. LAO MNG BNGVng chanhBC : 150 - 4000 /mm3, Lympho chim u th *Protein &gt;3.0 g/dL *Trn BN khng x gan : SAAG 1000 pg/ml: nhy loi tr xgan gy bng bng n thun khng suy tim l100%X gan v suy tim ( x gan tim ) : tr spro-BNP nh suy timSheer TA, Joo E, Runyon BA. Usefulness of serum N-terminal-ProBNP in distinguishing ascitesdue to cirrhosis from ascites due to heart failure. J Clin Gastroenterol 2010; 44:e2318 19. N G U YE N N H A NSAAG cao :S A A G tha p :Protein DB caoProtein DB cao- Suy tim phai, viem - Ung th nguyen phat hay dimang ngoai tim co that .can- Hoi chng Budd - Chiary- Lao mang bunghay benh tac mach giai- Viem tuy hay do tuyen tuy,oan sm do nang gia tuy...Protein DB thap - Viem thanh mac (serotitis )- X gan , viem gan do Protein DB thapru, suy gan toi cap.- Hoi chng than h- Hoi chng Budd - Chiary- Suy dinh dnghay benh tac mach giai oan tre) 19 20. TRNG HP 1Mu : Protein 6.5g/dl, Albumin 2.8g/dl,LDH ( 180 - 350 IU/l )DB : vng trong Protein : 1.3g/dl, Albumin 0.8g/dl BC : 650 / mm3 , Neu 452/ mm3 HC : 150/ mm3 LDH : 220 IU/l Glucose : 77 mg/dl20 21. TRNG HP 2Mu : Protein 5.5g/dl, Albumin 2.0g/dl LDH ( 180 - 350 IU/l )DB : trng trong Protein : 1.8g/dl, Albumin 1.1g/dl BC : 150 mm3 / , Neu 52/ mm3, Mono 148/ mm3 LDH : 190 IU/l Glucose : 87 mg/dl21 22. TRNG HP 3Mu : Protein 7.5g/dl, Albumin 3.9g/dlLDH ( 180 - 350 IU/l )DB : vng trong Protein : 4.3g/dl, Albumin 3.1g/dl BC : 1450 / mm3 , Neu 20%, Lym 80% HC : 150 / mm3 LDH : 250 IU/l Glucose : 85 mg/dl 22 23. TRNG HP 4Mu : Protein 6.8 g/dl, Albumin 3.2 g/dlLDH ( 180 - 350 IU/l )DB : vng trong Protein : 2.9 g/dl, Albumin 1.6 g/dl BC : 120 / mm3 , Neu 25%, Mono 70% LDH : 260 IU/l Glucose : 95 mg/dl 23 24. TRNG HP 5Mu : Protein 7.8 g/dl, Albumin 3.9 g/dlLDH ( 180 - 350 IU/l )DB : hng nht Protein : 4.9 g/dl, Albumin 3.2 g/dl BC : 220 / mm3 , Neu 25%, Mono 70% HC : 1250 / mm3 LDH : 260 IU/l Glucose : 95 mg/dl 24</p>