Gout (MOI)

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  1. 1. B S . N G U Y N M I N H P H N G B M N Y H C G I A N H T R N G H Y K H O A P H M N G C T H C H Gout (Thng phong)
  2. 2. Mc tiu : Sau khi hon tt bi hc, hc vin c th : Trnh by cc yu t nguy c ca bnh Gout M t triu chng c nng, thc th ca bnh Gout. Trnh by phng php iu tr mt cn gout cp Trnh by bin php qun l bnh nhn Gout, gio dc v d phng ti pht
  3. 3. I.i cng Bnh Gout l hu qu ca s chuyn ha acid uric bt thng, tng nng axit uric mu v lng ng tinh th urate cc khp, m mm v ng tit niu. Chng thng gy nn nhng cn au khp cp tnh hoc mn tnh. Khi pht ca nhng cn au cp tnh thng ngn chn ci hoc vim khp n c. Biu hin lm sng c trng l nhng cn au d di, sng , v nng .
  4. 4. II.Dch t Gout thng xy ra bnh nhn nam nhiu hn bnh nhn n. Thng thng, nam tui trung nin v n tui sau mn kinh c t l mc bnh cao. Gout him khi xy ra cho nhng ngi tr tui, nhng nhng bnh nhn trc 30 tui m b bnh gout th kh nng bnh nng hn Nhng bnh nhn c tin s bnh huyt p cao, m trong mu cao, v bo ph c nguy c bc pht bnh Gout cao. Yu t di truyn cng gp phn vo bnh Gout
  5. 5. III.Sinh l bnh hc S bi tit qua thn b hn ch l nguyn nhn thng nht gy nn Hyperuricemia Thng thng, bnh nhn cy ghp m nu s dng thuc mnh c th gy hi cho thn, dn n tnh trng ng tinh th mui Urat. Vic d tha Urate c th do lng Nucleoprotein tng trong trng hp b Lymphoma , Ung th mu , bo ph hoc trong trng hp ang c iu tr bng ha cht bnh ung th . Vic hp thu qu nhiu thc phm giu Purine (chng hn gan, ct, mng ty, nm, hi sn) c th gp phn vo vic tng acid uric trong mu. Yu t di truyn hoc ang c iu tr bng thuc li tiu cng l nguyn nhn gy nn Gout
  6. 6. III.Sinh l bnh hc S tch t Urate trong c th dn dn s to thnh nhng tinh th sc nhn nm trong sn , gn, v vng da xung quanh cc khp ti hot dch. Trong trng hp nghim trng hn, MSU s ng li trong cc khp xng chnh v thn.
  7. 7. V.Lm sng Cc nhn t khi pht/ yu t nguy c : Vim khp Gout cp tnh c th khi pht bi va chm/chn thng, phu thut, thuc li tiu, hoc tiu th thc phm giu cht purine v cn nh ru bia S gia tng hoc st gim t ngt nng acid uric trong c th s gy ra nhng cn au d di. Tophi xut hin xung quanh v ngay cc khp c th s hn ch kh nng chuyn ng khp, v bin dng cc khp. Bnh Gout mn tnh lm tng t l nhim trng c xng khp th cp (secondary osteoarthritis/thoi ha khp th pht).
  8. 8. V.Lm sng 1.Gout cp: Biu hin khi pht ca Gout cp tnh thng bt u bng nhng cn au d di (nht l vo bui ti), c bit l khp bn-ngn chn ci, tuy nhin u gi, mt c chn, c tay v ci ch cng c th b au( au khp n c) Nhng cn au ngy cng tng v nng hn, thng ko di trong vi ting ng h, v c khi khin bnh nhn khng th chu ni. c im nhn dng l tnh trng sung ty, nng , v cng phng cc khp b au. Lp da ngay trn ch au tr nn cng, nng, bng .
  9. 9. V.Lm sng Tng nhp tim, st, v ton thn n lnh Nhng cn au u tin thng xut hin mt khp no , v ko di vi ngy. Nhng cn au sau thng xut hin nhiu khp cng mt lc hoc ri rc, v ko di n 3 tun nu khng c iu tr. Bnh nhn sau khi c iu tr dt cn au lc u thng ngh rng ht bnh v ngng vic iu tr, nhng c khi cn au v sau s ti pht (c khi c nm sau), v s gy au ngy cng nhiu v cng nng hn
  10. 10. Vim khp bn-ngn chn ci
  11. 11. V.Lm sng 2.Gout mn Nt tophy Cc u cc sn vnh tai, phn mm cnh khp, quanh khp,ct sng, tim Thng c to thnh bnh nhn gout khng iu tr sau 10 nm Vim nhiu khp c th i xng, bin dng khp, teo c, cng khp. Si niu do acid uric lng ng ng thn
  12. 12. VI.Cn lm sng Phn tch dch khp: Trong trng hp nghi ng vim Gout cp tnh, cn phi tin hnh ly v phn tch dch khp ngay. Nng axt uric/mu: S gia tng nng axt uric l du hiu ca Gout, nhng c t nht 30% bnh nhn c lng acid uric/mu trong mc bnh thng vn khi pht cn au cp tnh. X-Quang: Nhng khi u tophi c th thy c bng hnh chp x-quang, tuy nhin iu ny khng cn thit v chn on c th chnh xc hn bng vic phn tch dch khp.
  13. 13. Ht tophi bn tay
  14. 14. Ht tophi bn chn
  15. 15. Ht tophi ti khp gi
  16. 16. VII.Chn on Tiu chun chn on cn goup cp: Tin s vim cp 1 khp, tip theo c nhng giai on khi hon ton khng triu chng. Hin tng vim p ng tt vi colchicine (trong vng 48h) Tng a.uric mu > 420 mmol /L ( >7 mg/dL)
  17. 17. Tiu chun chn on gout theo American College of Rheumatology 1977: Tm thy tinh th a.uric trong dch khp hoc Tophy c chng minh c cha tinh th urat hoc C>= 6 trong cc tlu chun sau: 1. Vim khp tin trin ti a trong vng 1 ngy 2. C hn 1 t vim khp cp 3. Vim 1 khp 4. vng khp 5. Sng, au khp bn ngn chn 1 6. Vim khp bn ngn chn 1 mt bn 7. Vim khp c chn 1 mt bn 8. Nt tophy 9. Tng acid uric 10. Sng khp khng i xng (Xquang) 11. Nang di v, khng khuyt xng (Xquang) 12. Cy vi trng m tnh
  18. 18. Chn on phn bit 1.Cn vim khp gout cp Vim khp nhim trng Gi Gout (Pseudogout) Chn thng khp v quanh khp Lao khp Thoi ha khp 2.Vim khp gout mn Vim khp dng thp Thoi ha khp
  19. 19. VIII.iu tr Nguyn tc iu tr : Chm dt t Gout cp tnh bng NSAIDs hoc corticosteroids. Ngn nga nhng cn au cp tnh ti pht bng colchicine. Ngn nga s lng ng ca tinh th urate, v hn ch nhng tc ng bc pht bng vic s dng allopurinol nhm h thp mc axit uric trong c th. y mnh s bi tit urate bng probenecid, hoc sulfinpyrazone. iu tr song song vi cc bnh cao huyt p, cao m trong mu, v bo ph.
  20. 20. VIII.iu tr 1. Cn gout cp : La chn hng u : 1. NSAIDs, Indomethacine 50mg x 3 ln/ngy,nu dung np tt (trong 3-5 ngy) sau 25mg x 3 ln/ngy n khi ht au. C th nhm NSAIDs khc . 2. Colchicine 0.5 mg liu u, sau 0.5 mg mi 6-8 gi sau cho n khi ht au (thng 1- 2 ngy sau) hoc xut hin du hiu qu liu : tiu chy Tng liu ti a ca colchicine l 6-8mg/24h.
  21. 21. VIII.iu tr Lu : Phi c dng sm Khng dng khi suy thn Trnh phi hp vi clarithromycin c bit trong trng hp suy thn mn Ngoi NSAIDs, Colchicine ,c th ung thm thuc gim au ( Paracetamol ...), ngh ngi, chm nc cng c khuyn co.
  22. 22. VIII.iu tr 2.Ngn nga ti pht Allopurinol Tc dng : va gim sn xut va tng o thi acid uric => gim acid uric huyt v acid uric niu Vic iu tr c bt u vi 100mg 1 ln/ngy v c th c tng ln n 800mg 1 ln/1 ngy. Liu lng thng thng nht l 300mg/ngy Lu : vic iu tr h acid uric mu ch nn khi u sau thoi lui cn gout cp it nht 3-6 tun .
  23. 23. VIII.iu tr(2) Probenecid. Sulfinpyrazon : tng thi a.uric qua ng niu. iu tr gout gia cc cn cp, hoc mc a.uric huyt cao. Liu dng : Probenecid 500mg x2/ngy Sulfinpyrazon: 100-200mgx2/ngy Ch : ung nhiu nc v phng lot d dy.
  24. 24. VIII.iu tr(3) 3. iu tr tng acid uric huyt : Ch tng a.uric huyt n thun: khng iu tr Tng a.uric huyt lu di km bnh thn hay vim khp do gout ti pht hoc nt tophi di da: Allopurinol hoc thuc gy acid uric niu ( ch nn dng 1 trong hai nhm trn khng nn phi hp)
  25. 25. Ch nh ct b ht tophi Phu thut ct b ht tophi c ch nh trong nhng trng hp : Ht tophi km theo bin chng lot, hoc Bi nhim Ht tophi, hoc Kch thc ht tophi qu ln nh hng n vn ng hoc v l do thm m
  26. 26. IX. Gio dc phng nga: Khi cn gout cp lui ,cn phi c bin php phng nga ti pht. C th : Gim cn Ch dinh dng cn bng v cht Trnh nhng thc phm giu purin nh ni tng, tht ,c mi, tm cua and game Gim bia ru, thc ung c ga ung nc ( >2 lt/ngy) trnh s dng thuc li tiu (thiazides, furosemide) v aspirin. Mang giy thoi mi, khng qu cht.
  27. 27. Ti liu tham kho Rheumatoid arthritis gout. (n.d.). Arthritis Foundation, from http://www.arthritistoday.org/tools-and-resources/expert-q-and-a/gout- questions/arthritis-or-gout.php. Rheumatoid arthritis (RA): Treatment programs for rheumatoid arthritis pain. (n.d.). Arthritis Foundation,from http://www.arthritis.org/conditions- treatments/disease-center/rheumatoid-arthritis/. Gout. (2012, September). American College of Rheumatology, from http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions /gout.asp. Bin chng bnh gt, from http://gout.com.vn/436/dau-hieu-va-trieu-chung/Bien- chung-benh-gout-%E2%80%93-Hat-Tophi.aspx Harrisons Principle of Internal medicine 17th Edition. 2008. H Phm Thc Lan. Gout.Bnh hc ni khoa. H Y khoa Phm Ngc Thch. L Hong Ninh (2012).Tng axit uric v thng phong. Y hc gia nh,i hc Y Dc TPHCM,tp 2. Trn Th Thu Hng.(2011)Thuc tr Gout. Dc lc hc .NXB Phng ng, ti bn ln th 12.