Y HC C S

Y HC C SCHNG I: H TIU HA

Bi 1: i Cng Gii Phu H Tiu Ha

H tiu ha gm:

Ming, hu, thc qun, d dy, rut non, rut gi, trc trng, hu mn.

Cc tuyn ph ( tuyn nc bt, gan v ty).

Thc qun dn thc n t thc qun n d dy.

D dy:

2 l:L tm v trn, l ni thc qun xung d dy.

L mn v di, l ni di dy xung rut.

2 b cong: B cong nh ( bn phi). B cong ln ( bn tri).Rut non: di 6.5m, gm t trng( l ni ng mt ch v ng ty chnh vo), hng trng, hi trng.

Bi 2: Sinh L Tiu Ha.

Bng tm tt cc loi men tiu ha:

DchMen phn gii GlucidMen phn gii ProtitMen phn gii

Lipit

Ming: nc btPtyalinKhng c menKhng c men

D dy: dch v (c HCl) tc nhn gy lot d dyKhng c menPepsinLipase

Rut t: dch ty, dch mtAmylase

AmylaseTrysin

TrysinLipase( phi hp vi dch mt).

Rut non: dch rutAmylaseLactase

Saccarose

MaltoseErepsinLipase

Bi 3: Gan & Tuyn TyGan c 8 chc nng chnh:

1. Chc nng to glycogen.

2. Chc nng to ure.3. Chc nng to m v tiu m.4. Chc nng bi tit mt.

5. Chc nng chng c.

6. Chc nng d tr st.

7. Tham gia c ch ng mu.

8. Chc nng d tr Vitamin.

ng ty: gm nang ty v o ty.

Nang ty: l nhng ti tit ra dch ty do cc t bo ngoi tit hp thnh.

o ty: l nhng m t bo nm ri rc gia cc nang ty.

Tuyn ty c 2 chc nng:

1. Chc nng ngoi tit: tit ra dch ty.

2. Chc nng ni tit: tit ra 2 loi hormon

Insulin: c tc dng chuyn ha protit, lipit v c bit l vn chuyn glucose t mu vo gan d tr di dng glycogen.

Glucagon: c tc dng phn gii glycogen thnh glucose vo mu.

Bi 4: Mt S Bnh Ca H Tiu Ha

LOT D DY-T TRNG.

Nguyn nhn

Nhim Helicobacter Polori 70% Thuc khng vim non- steroid (NSAID): 25%

Yu t nguy c:

S tng tit acid d dy v s trng d dy sm sau n.

Thuc l, ru, caf, stress.

Chun on lot:

(Triu chng c nng:

au vng thng v:

Cn au do lot d dy: xut hin mt thi gian ngn sau khi n ( khi no).

Cn au do lot t trng: xut hin khi d dy trng ( khi i).

Cc triu chng khc: y bng, chua, hi

(Triu chng thc th:

Trong cn au: n au vng thng v.

Ngoi cn au: khng c du hiu lm sng.

(Cn lm sng: Ni soi d dy, t trng km sinh thit (Clotest).

Bin chng:

1. Xut huyt tiu ha.

2. Thng d dy t trng.

3. Hp mn v.4. Ung th.

( iu Tr Ni Khoa:

Nguyn tc iu tr:

S dng cc loi thuc lm gim tnh acid ca dch v, hay tng cng bo v nim mc d dy.

Nu H.pylori dng tnh, phi c phc iu tr.

Ngng s dng NSAID, hn ch thuc l v ru.

( iu Tr Ngoi Khoa:

lot khng p ng vi iu tr ni khoa ( trn 2 nm).

lot c bin chng nng.

VIM RUT THA CP:Lm sng:

1. Triu chng c nng:

au bng m vng bng quanh rn hay thng v, sau cn au s di tr xung h chu.

C th st nh.

Nn i.

Chn n, b trung & i tin.

2. Triu chng thc th:

n au bng h chu phi, im Mc Bumey (+), 1/3 xng chu n rn.

Du phn ng di.

Bin chng:

1. Vim phc mc.

2. p-xe rut tha.

3. m qunh rut tha.

iu tr: Phu thut.

CHNG II: H TIT NIUBi 1: i Cng Gii Phu Sinh L H Tit Niu.THN:

(V thn: Trong v thn cha n v thn, gi l nephron, khong 80% nephron v thn. Mi thn cha khong 1,2 triu nephron

Cu trc ca nephron: tiu cu thn, ng lng gn, ng ln xa( c mt im tip gip vi nang bowman bng nhm t bo c bit gi l Vt c), ng gp.(Ty thn: cha 20% nephron.

(B thn: l ni dn nc tiu vo niu qun.

Chc Nng Sinh L Ca Thn:

1. Chc nng iu ha ni m thn.

2. Chc nng ni tit.: iu ha huyt p qua h rennin- angiotensin, n nh s lng hng cu trong mu, tit mt s hormon, mt s men v duy tr s n nh chc nng ca nephron.( vitamin D3)Chc nng sinh l ca nephron: lc, ti hp thu & bi tit.

Nhng yu t nh hng mc lc ca cu thn:

1. Mng bao thn b vim s.

2. Huyt p ng mch.

3. p sut keo trong huyt tng.

4. Lu lng mu n thn.

Bi 2: Mt S Bnh ng Tit Niu.

NHIM TRNG TIU:

1. Nguyn nhn:

Escherichia coli, Staphylococcus saprophyticus, Chlamydia trachomatis.

N thng gp hn nam.2. Yu t nguy c:

Khuyt tt ng tit niu, t ng thng tiu, tiu ng, c thai, mn kinh, khuyt tt bm sinh.

3. C ch bnh:

Nhim trng tiu di: niu o, bng quang.

Nhim trng tiu trn: b thn.

Triu Chng Lm Sng:

1. Nhim trng tiu di: tiu gt but, nc tiu thng trng c hoc ln cn, c th hi .( dng khng sinh 1 tun).

2. Nhim trng tiu trn: st, lnh run, au hai bn hng lng. ( kh tr hn, dng khng sinh khong 2 tun).

SI THN:

Si thn l bnh do cc vin si, c to thnh trong thn gy nn vi nhng biu hin au d di, cn au qun thn ( khi si b kt).

1. Nguyn nhn: di truyn, cc d tt bm sinh, ni tit, thuc, ch n ung.

2. Triu chng lm sng: u tin ch au m vng tht lng, au tng ln khi vn ng, i ng di, p xe, biu hin cn au qun thn.

( Cn au qun thn: (khi si kt). au:

( Tnh cht: au d di, mnh lit.

( Hng lan: t h tht lng lan xung di hoc ra ph trc n h chu rooid b phn sinh dc ngoi v mt trong i.

( Tiu mu.

( St.

Cn Lm Sng: chp X-quang (KUB), chp niu tnh mch(UIV), siu m, xt nghim nc tiu.

Bin chng: Vim thn- b thn cp.

Thn nc.

Suy thn cp.

Suy thn mn.

iu tr:1. Ni khoa: ung nhiu nc, vn ng, thuc gin c, m ly si.

2. Ngoi khoa:

Tn si ngoi c th

Tn si qua da

Phu thut ni soi, hay phu thut h.

SUY THN MNSuy thn mn l hu qu ca cc bnh thn mn tnh ca thn, gy gim st t t s lng nephron chc nng lm gim mc lc cu thn ( < 60 ml/ pht)

Nguyn nhn:1. Ph mm, n lm khng au, ph ton thn.

2. Thiu mu.

3. Tng huyt p.

4. Xut huyt, st huyt.5. Nga. do lng ng Canxi di da

6. Chut rt.

7. Hn m do tng Ure mu mn.

Cn lm sng: Tng ure mu, creatinine mu.

Gim h s thanh thi creatinine.

Calci mu: calci mu gim phospho mu tng giai on u, giai on sau c 2 cng tng.

iu tr suy thn mn trc giai on cui:

Nguyn tc chung:

Theo di liu trnh iu tr bnh thn.

Ngn chn s tin trin ca suy thn mn.

Trnh cc loi thuc c cho thn.

iu tr cc bin chng ca suy thn mn, cao huyt p

Chun b cho vic iu tr thay th thn suy giai on cui, lc thn, thay thn.Lm chm s tin trin ca suy thn mn:

Duy tr tt huyt p v lm gim Protein niu.

Cung cp Protein trong ch n thch hp.

CHNG III: H SINH DC

Bi 1: I CNG GII PHU-SINH L H SINH DC

I H sinh dc nam:

Cu to:

1. Dng vt: 2 vt hang, 1 vt xp nm di 2 vt hang, gia c niu o.

2. Tuyn tin lit: nm di c bng quang, bao quanh niu o tin lit sau xng mu v trc rut thng. Dch tin lit tit ra cng vi dch do ti tinh tit ra to nn tinh dch.

3. Tinh hon: Gm c nhiu tiu thy => ng sinh tinh => mo tinh => ng dn tinh => ti tinh => ng phng tinh.

4. Sinh l:

- Chc nng ngoi tit sn sinh ra tinh trng t 16 tui => sut i, mi trng thch hp mi trng kim, nhit 35=>36oC. - Chc nng ni tit: tit testosteron lm pht trin c quan sinh dc v gii tnh ph.

II. H sinh dc n:

Cu to: gm 5 b phn: m h, m o, t cung, 2 vi trng & 2 bung trng

T cung:

T cung l ni sinh ra kinh nguyt, ni trng lm t v thai nhi pht trin.

T cung gm 3 phn: thn, eo v c, c gi bi cc tng v cc dy chng.

T cung gm 3 lp: lp thanh mc, lp c ri v lp nim mc.Vi trng:

Gm 4 on: on thnh, on eo, on bng vi v on loa vi.

C 2 l thng vi t cung v vi bng.

Bung trng:

Va ngoi tit: to trng.

Va ni tit to: estrogen & progesteron

Hin tng th tinh thng 1/3 ngoi ca vi trng.

Bi 3: MT S BNH THNG GP H SINH DC.

I. Hi chng tit dch m o:

1. Yu t nguy c:

S dng thuc khng sinh lu di.

Tiu ng khng kim sot c.

Suy gim min dch, ri lon min dch.

Tht ra m o, hay thuc t m o lu di.

S dng ni tit(thuc nga thai, bnh l huyt gip, corticoids). Thai k.

Dng c trnh thai.

II. Vim m o do vi khun.

Nguyn nhn: do vi khun Gardnerella vaginalis v c th phi hp vi mt s vi khun ym kh khc.

L vim m o khng c hiu do cc vi khun k kh ni sinh tng sinh ti m o

Bnh khng phi ly do quan h tnh dc nn khng cn iu tr cho bn tnh.

Triu chng lm sng:

Triu chng c nng: kh h va hoc t, mi hi, khng c biu hin au.

Khm: kh h mi hi, mu trng xm, ng nht nh kem pht u vo thnh m o mt lp mng, khng c vim m o.

VIM PHN PH:

i cng:

Vim phn ph l tnh trng vim nhim kh ph bin xy ra vi trng.

Nguyn nhn rt da dng, c th l bin chng ca vim m h m o, c t cung, hoc l do cc th thut ph khoa khng an ton, quan h tnh dc khng an ton.

Mm bnh thng gp: l t cu, lin cu, lu cu, Chlamydia..

iu tr vim phn ph cp phi trit trnh chuyn sang tnh trng vim phn ph mn, thng gy hu qu v sinh th pht v gim kh nng lm vic.

CHNG IV: H NI TIT

BI 1: I CNG H NI TIT V CC TUYN NI TIT

H ni tit gm: Vng di i, tuyn yn, tuyn gip, tuyn cn gip, tuyn thng thn, tuyn ty, bung trng, tinh hon.

1. Vng di i: sx hormon khng bi niu(ADH)& oxytocin. C ADH & oxytocin u c d tr thy sau tuyn yn.

2. Tuyn yn: thy trc tuyn yn sx v ch tit ra 6 loi hormon:

GH Hormon tng trng: kch thch s tng trng.

TSH Hormon kch thch tuyn gip: nh hng n s pht trin & hot ng ca tuyn gip.

ACTH: chc nng kch thch v thng thn. FSH: prolactin, hoocmon kch thch nang trng.

LH: hormon hong th ha.

ADH: hormon khng bi niu c vng di i sx v d tr thy sau tuyn yn. ADH lm cho thn ti hp thu li nc t nc tiu. Oxytocin: c sx vng di i & c d tr thy sau tuyn yn.

3. Tuyn thng thn: v thng thn tit ra khong 30 loi hormon corticoid, quan trng nht l cortisol ( iu ha hot ng chuyn ha carbohydrate, protein v cht bo ca c th) v aldosterone (iu ha s cn bng mui v nc ca c th.

Ty thng thn c mu nu ch yu l do n cha nhiu mch mu bn trong. N ch tit ra 2 loi hormon l adrenaline (tng nhp tim) v norepinephrine ( co mch tng huyt p). 2 loi hormon ny c ch tit ra khi c th i u vi nhng nguy him hoc cng thng. N chun b cho c th i u vi nhng tnh hung khn cp bng cch tng nhp tim, tng huyt p, tng mu n cc c v nhng qu trnh tng t nh vy.

4. Tuyn gip v tuyn cn gip: cc nang gip ch tit ra 2 loi hormon chnh l thyroxine ( iu ha tc chuyn ha v tr em n tc ng n qu trnh pht trin) & calcitonin ( lm gim nng calci trong mu).

BI 2: CC BNH NI TIT THNG GP

BNH I THO NG:

Nguyn nhn: do ty khng th sx insulin hoc do cc t bo khng p ng c vi tc dng ca insulin.

Triu chng: tiu nhiu, kht nc nhiu, mt mi, st cn, i, v chm lnh vt thng, t tay chn. Nhng tc dng lu di ca i tho ng bao gm: gim th lc, gim mu n cung cp cho tay v chn, v au. Nu khng c iu tr bnh s dn n suy thn, bnh tim, t qu, hn m & t vong.

C 2 loi i tho ng: type I do thiu insulin, type II t bo khng insulin.

Type I: ty tit t hoc hon ton khng tit insulin. Type II: ty c th sx insulin, nhng cc t bo ca c th tr nn khng vi tc dng ca insulin.

BNH CNG GIP.

Cng gip: l tuyn gip tng sx qu nhiu thyroxine.

Triu chng: st cn, tng cm gic thm n kh th, cng thng v lo u, nhp tim nhanh, yu c, khng chu c nng v kh khn trong vic th gin v ng., mt c th b li ra.

BNH NHC GIP

Nhc gip: l thiu thyroxine.

Triu chng: mt mi, gim nhp tim, tng cn, trm cm, au c hoc yu t, da kh, tng nhy cm qu mc vi cm gic au, ph mt. nu xy ra sm tr em s dn n tr n.CHNG V: H THN KINHI. T bo thn kinh gm 2 loi:

1. Neuron: l n v chc nng chnh ca HTK.

2. T bo thn kinh m: khng trc tip x l thng tin, c nhim v nui dng, bo v h thng neuron.

II.Thn kinh trung ng.

1. Trm no: gm hnh no, cu no, tiu no.

2. i no: gm gian no & oan no.

3. Ty gai:

- Bt u t b trn t sng i (C1), ni lin tc vi hnh no v tn cng b di t sng tht lng I (L1), hay b trn t sng tht lng II ( L2).

- Cht xm: xp thnh hnh ch H.

- Cht trng: nm bao quanh cht xm.

III. H thn kinh ngoi bin.

Gm 31 i dy thn kinh gai sng & 12 i dy thn kinh s. Ngoi ra cng thuc HTK ngoi bin c cc m ri tk thc vt nm trc v gn cc ni tng. Thn kinh thc vt gm c tk giao cm & ph giao cm, ch huy c trn cc thnh ni tng ( tun hon, tiu ha, h hp, tit niu, sinh dc, cc tuyn) v cc c trn ca da. Thn kinh thc vt ch yu thc hin chc nng dinh dng v bi tit, hot ng khng theo mun, v chc nng chng c lin quan cht ch vi nhau v u do v no ch huy iu ha.BI 2: TAI BIN MCH MU NO.

I Nguyn Nhn.

1. Tc mch ( nhi mu no).

- Do x va v co cng ng mch l nguyn nhn quan trng nht thng gp ng mch no gia, ng mch cnh trong, mng x va bi p ln thnh ng mch lm ng mch hp li gy lin kt tiu cu v hng cu to cc mu ng, dn n tc mch hoc do mng x va di chuyn n ng mch lm cho ng mch hp v gy tc.

- Do cc huyt khi hoc do bng hi xut hin khi tim truyn, cc cc huyt khi gp trong cc bnh v van tim nh hp van 2 l.

2. V mch mu ( xut huyt no).

- Mch mu v => mu trn ra ngoi.

- Do cao huyt p.

- Do x va ng mch.

- Bnh a chy mu cng c th gy xut huyt no nh bnh bch cu cp, bnh Hemoglobin, xut huyt gim bch cu bnh Scholein Henock.II. iu tr.

1. Nguyn tc iu tr. Hi sc ton din.

m bo lu thng, ng h hp, tun hon.

Theo di tin trin ca bnh.

Phng bin chng.

Phc hi chc nng vn ng, h hp, tun hon.

CHNG VI: H TH GIC.

BI 1: I CNG GII PHU SINH L MT.

1. V bc nhn cu:

- Gic mc: l mt mng trong sut, rt dai, khng c mch mu, c hnh chm cu chim 1/5 pha trc ca v nhn cu.

- Cng mc:(trng trng): l mt m x rt dai, mu trng chim 4/5 sau nhn cu.2. Mng mch: gm 3 phn l mng mt ( lng en), th mi & hc mc.

3. Vng mc: cn gi l mng thn kinh, nm trong lng ca mng b o. l ni tip nhn cc kch thch nh sng t ngoi cnh ri truyn v trung khu phn tch th gic v no.

4. Tin phng v hu phng.

Tin phng:l mt khoang nm gia gic mc pha trc, mng mt v th thy tinh pha sau, trong cha y thy dch.

Hu phng: (trc mng mt), cso gii hn trc l mt sau mng mt v gii hn sau l mt trc ca mng dch knh.

5. Cc mi trng trong sut. Nhn p trung bnh 16=>22mm HgThy dch: l mt cht lng trong sut do th mi tit ra cha y trong tin phng v hu phng.

Th thy tinh: l mt thu knh trong sut hai mt li c treo c nh vo vng th mi nh cc dy Zinn.

Dch knh: l mt cht lng nh lng trng trng nm sau thy tinh th, chim ton b phn sau nhn cu.T bo que hot ng khi nh sng yu, ti

T bo nn hot ng khi nh sng mnh, => cho hnh nh c mu sc.

BI 2: VIM KT MC

Bnh mc ht cng l mt trong nhng vim kt mc (/s).

1. Triu chng thc th.

Mi sng n, c th mng nu l vim cp, kt mc cng t , mt sc bng, dy ln nh ming thch.

Kt mc: ph n v c th phi qua khe mi ( vim do lu rt hay gp du hiu ny). Trn kt mc cn thy cc hnh nh tn thng c bn khc nh:

+ Ht: r nht cng di v hai gc trong, ngoi ca kt mc mi trn nhng ht ny c c im l to, trong, kp khng v.

2, iu tr: khng sing, st trng, chng vim.