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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
[email protected]
TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
VIEÂM THÖÏC QUAÛN DO NAÁM
BS NGUYEÃN THUÙY NGAPHOØNG KHAÙM MEDIC
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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CASE REPORT _ Beänh Aùn
Beänh nhaân:Leâ thò N. 45 t nöõ Ñòa chæ: Haøm Taân, Bình thuaän, Ngheà nghieäp: Noäi trôï Nhaäp vieän ngaøy 29/09/99 vôùi lyù do Nuoát ngheïn Beänh söû:Caùch ngaøy nhaäp vieän 3 tuaàn xuaát hieän nuoát
ngheïn khi aên uoáng , gia taêng nhieàu trong 1 tuaàn nay Tieàn söû:Baûn thaân:Lao phoåi ñaõ ñieàu trò caùch nay 1 naêm Gia ñình: Choàng ù chích xì ke ñaõ cai 3 naêm Thaêm khaùm:Toång traïng gaày yeáu, suy kieät, M 118 l/p, HA: 100/60 mmHg. Nghe tim bình thöôøng. Nghe phoåi aâm pheá
baøo thoâ raùp. Khaùm buïng:buïng meàm aán khoâng ñau, gan laùch khoâng sôø thaáy.
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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Xeùt Nghieäm Caän Laâm Saøng
Noäi soi Daï Daøy taù traøng:Vieâm haàu hoïng, vieâm thöïc quaûn vôùi nhieàu giaû maïc maøu traéng bao phuû daøy
Soi Töôi:Naám Candida Albicans(+) H. I. V Test 1 & 2 (+) S/C =108 (BL<1) X Quang Tim Phoåi Thaúng: Toån thöông thaâm nhieåm caû 2
phoåi. Sieâu aâm buïng: Bình thöôøng
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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ESOPHAGEAL DISEASES
1. Reflux esophagitis 2. Infectious esophagitis 3. Chemical esophagitis 4. Esophageal motility disorders 5. Tumours
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Reflux Esophagitis
Sypmtoms:Heartburn, dysphagia, chest pain Causes :abnormalities in lower esophageal sphinter function,
esophageal acide clearance Treatment: a/Lifestyl modification:Elevation of the patient’s ead,
dietary restriction (alcohol, mints chocolate caffein, moking, medications(theophylline, Calcium blocker , nitrates, , anticholinergics, adr antagonist
b/Medical Therapy:H2 antagonist, the proton pump inhibitors, cisapride , metopropamide , Antacides
c/ Surgery: Laparoscopy Technique
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
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X QUANGX QUANG
MRIMRI
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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Infectious Esophagitis
Symptoms: Odynophagia, dysphagia, most common in patients with AIDS, diabetes, or others causes of impaired immunity
Causes:ª Candida Albiansª Herpes Simplex virus(HSV)ª Cytomegalo virus(CMV)ª Tuberculosis( very rare)
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Infectious Esophagitis . . .
Treatment: Candida Albicans:
ª Mild:Nystatine 400. 000-600. 000 UI qid , Clotrimazole 10mg q 6h X 2 W
ª More severe:Ketoconazole 200mg bid, Fluconazole 100mg qd X 7 days Unresponsive: Amphotericin B 0. 3-0. 5mg/kg/d
HSV Esophagitis: ª Acyclovir(Zovirax) 5mg/kg IV q 8h X 7 days or 800mg PO X
5 times /d X 14 days CMV esophagitis:
ª Ganciclovir
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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PHOØNG KHAÙM
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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Esophageal Motility Disorders(Spasm &Achalasia).
Symptoms: Noncardiac chest pain(Atypical), Intermittent dysphagia to liqids & solids . No abnormalities on Endoscopy or Barium swallow Diagnosis: Esophageal manometry Treatment:
ª Long acting Nitratesª Calcium channel blockersª Psychoactive(antidepressants & anxiolytics) Trazodone
50mg po bid-tid
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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Others Esophageal Diseases --
1/Chemical Esophagitis: Result from the use of medications(as doxycycline, oral potassium, quinidine, , NSAIDs, VitaminC, Fluorouracil ,
2/ Tumours:Polype, Cancer. . .
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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PHOØNG KHAÙM
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
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NOÄI SOINOÄI SOI
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PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
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MEDIC 254 Hoøa Haûo Q. 10 TP. Hoà Chí Minh ÑT: 8357284 - 8355 136 fax: 84-8-8352543 email:
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TRUNG TAÂM Y KHOA MEDIC
SIEÂU AÂMSIEÂU AÂM
CT SCANCT SCAN
NOÄI SOINOÄI SOI
PHOØNG KHAÙM
PHOØNG KHAÙM
XEÙT NGHIEÄMXEÙT NGHIEÄM
DSADSA
X QUANGX QUANG
MRIMRI
References
ª The Washington Manual of Medical Therapeutices 29th edition - 1998
ª Theory and Practice in the Education of Gastroenterology - 1995
ª Internal Medicine - Diagnosis and Therapy - 1988 - 1989