E>AI HOC Y DllOC THANH PHO HO CHi MINH

KHOA y. BO MON NBI

I I I

Chu biin: PGS. TS, VO MINH PHUC

CHUYEN KHOA NHI

A

TAI ueu HllONG DAN

DANH CHO SINH VIEN Y4 - Y&

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 I - -�"""""' I ' .._, V -....... ' - -- - .. ' '111'1 -- , u
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Ml.JC LI.JC

LOI NOi E)AU

1. Lich th Ve t$p - nQi quy - lu�ng gia sinh vlAn y4 ...................... 1

2. Lich thlJc t$p - nQI quy - lu�ng gla slnh viAn y� ...................... 5

3. s•nh an nhi kho a ...................................................................... g

Chlldng 1: Kham tre em lanh monh........................ � ................... 13

4. Kham tre em lanh mtnh ........................................ ,................ 15

5. Tham vf n chung ngua ............................................................ 31

Ch lldng 2: Cfp cuu ...................................................................... 47

6. PhAn lo,i VB Xll tr[· cfp CLIU tre btnh t(li phong kham ............. 49
7. Chiln doan va XLI trr suy hO hfp ............................................. 59

a. Chlin dean va dit1u trj s6c ....................................................... 74

9. Tiep c$n ·VS. XLI trr bfnh nhi hOn m6 ..................................... :.. 97

Ch lldng 3: Nhli-m -- Than -klnh ........................................ ........... 107

10. Tiep c$n s6t a tre em ....................................'..................,... 109

11. Tiep c$n tre s6t c6 kem thee co gl$t .................................. 122 ·

12. Bi�n luJn ket qua dich nao tuy cua tre trong b$nh ly nhilm trung131

Chlldng 4: H6 hilp ................ 7••••••••••••••••••••••••••••••••••••••••••••••••••••• 139

.i I
l
:
/ 13. Kham hO hip .... t................. �... , ...........................................
'
.
141

14. Elanh gia phAn lo(li ho - kh6 /thcJ 1va cac vfn dt1 v� t�i a �re
tll 2 thang d�n 3 tudl ................., ..............I.......................... 153
!

15. Tiep cA
'i'n tre ho
................ ./.···········�···································· 157 .
·, ' I
I I
I I
16. Tiep c$n tre kh6 thcJ ················································�·········· 160

17. Tiep c$n tre thCJ rrt ............····· ····················· · ··················..... 1 64

18. Tiep c�n kho khe tre em......... ·······························.··.......... 1 70

Chlldng 5: Tim m,ch .. � ............................................................... 1 n

19. Kham tim m�ch Cl tre em .................................................. .. 179

20. Thtp c$n ch�n doan va phAn lo�.i tim bAm sinh lJ tre em ... 201

21. Tiep ctn suy tim cJ tre em .......-............................................ 210

22. Can trm thieu oxy ............................................................... 218 ·

22a. E>h)n tAm do blnh thLl�ng cJ tre em ....... �·...................... � ..... 226

22b. Echocard iogram ................................................................ 227

22c. BMI - Weight - Height ...................................................... ·228

22d. Phi.I Ive - Be nam - Kham tre em lanh m�nh .................. 231

22e. Phv Ive - Be gai - Kham tre em lanh m�nh .......·..·........... 233
23. Kham khdp tre · em ............................................................... 235

24. Tiep ca)n chi dau ............................... : ................................. 246

Chlldng 6: Thtn Nlou

................................................................. 253
25. M1.1c tiAu. khoa th n ............................................................. 255
$
26. Th$n hQc tre em ........
.......•................................................. 259
27· B nh c u th
4) 4 tn .................................................................... 260
28· Tifp ctn b*)nh nhl
b*)nh th$n va dLl�ng tiet ni4)U ................ 262
29· Ti p ctn b nh
' t) nhAn ti.Su m4u ............ : ................................ 271

Chudng 7: Huyet h9c ................................................................. 27_7

3
o. E>anh gia - phAn 10$1 thieu mau - nhe cAn theo IMCI ········ 279
 CHUONG
TIEU H6A
 KHAM CO QUAN TIEU H6A TRE EM
ThS. Nguyln Hall Phong

;·· MUC Tl�Uk� dt1<1c trlnh ti/ cac thao tac khi kham bvng.
;.-' 1. Lilt
2. Trinh bAy nhilng n�i dung cin khi thl,lc hifn kham bt,mg.
3. Thf/c hifn thuln th11c cac thao tac kham bvng.
,. .
\;· NOi DUNG

1. D�I ClldNG
Cung nhll nhOng bGnh ly ca quan khac a tre em, benh ly vd tieu h6a
bi!u hien ra'.t da dang. Benh c6 the di�n tle'n tl,I glOi h�n cho dfn nJng.
phllc �p. keo dai. Eld ch�n doan chrnh xac mOt bOnh khOng chJ dVa vao
mot hai da'.u hieu cin 1am sang. ma c�n phal c6 mot b$nh SLI ro rang, d4y
du Va quan trQng hOn la de thu dllQC cac triOU ch(lng chrnh xac qua qua
· trlnh th!m kham k9 llfflng, dung k9 thu4t la viec lam rat quan trQng tnIOc
khi th!y thu6c dd nghj bat ky c�n 1am sang nao hO trQ cho chin doan. Do
dlc diim tre em khac vOi ngUeJi IOn. vln d� kham b1,mg, he ti!u h6a b!n
�nh nhilng ph!n gi6ng nhll a ngl/Oi ICJn con c6 nhOng di�m khac c4n hAl ll.

2. KHAM TOAN THAN

Mic du cac ca quan khac c6 the khOng lien quan tn.tc tiA'p dA'n vin dd
v6 tiau hoa, tuy nhi!n cfn kham toan than mot each ht th6ng.
Kham da ni!m mac: phat hien tal nhQt, vang da, thiA'u mau, s6t phat
ban, hich ngo,i vi, phu.
Kham xac djnh tlnh tr�ng s6c: m�ch, huye't ap, nghe tim, t1nh tr,ng
suy hO hfp (nhjp tho, nghe phdi), kham tim, phdi, kham khdp tlm xuft
huy!t khOp, khOng quen kham tai mui hQng.
Kham to�n thin kA't hQp vdi benh SU, kham b1,mg.

3· KHAM BUN
G
, dJp th80 nhiP
�1. Nhln: Ouan sat hlnh d9ng btmg: 16i lorn, do'i xang m da
i�h. thfy s6ng n
hu dOng, bit thlliin o mich mau ngo�I bl� , vl kh�
Ph�t dl.tJc th nlm
t.rc hien t6t nha't khl anh sang d4y du vOi tll th& b�nh nhi
ngua ng·""'·
• uui kham dung ben phai bGnh nhan.
n cang chllO · ltS gJp sau khi an no, tlJY nhien co thI gJp khi
Qua1 ruogt
_Bi.i ng th ng
t1!y hcJI, thun� �ng r6ng, a phan, kh61 u O bvng, hoJc bang bvng.
 Bung IOm long thuy�n c6 the gap benh O benh nhi t�c ng hen tie
tren hay sau thbi gian khOng an u6ng. u h6a
S6ng nhu dOng rUOt c6 th' nhln thay trong mOt s6 tnlbng hc,p, nh
ling
theo m�ch dJp thuong kh6 quan sat.
sv hien dien cua vung da tang ho�c giam sAc t6 c6 th & la blnh thua
no.
C6 th� do u m�ch mau. nhi�u hon cac d�ng u mau khac.
Thanh bung 16i thllang do thoat vj rO'n hay g'p O nhO nhi va tre nh6
d�c biet IA tre da den. Da phin cac tn.lOng h(fp nay khOng biln Chung'
khOng c!n phii can thiGP phiu thuit va se tv phvc h6i. NguyAn nhao kM�
c6 th� do tach dOi co thing bvng va thoat vj thl.lQng vi nho, nA'u khOng
xua't hien tv nhien khi kham, c6 th� gay ra bhng each cho bGnh nhi nlm
ngtta. nhfc d!u 1an khoi mat phAna ban kham hay yeu c�u benh nhl cang
ca thanh bung; nhOng thoat VI nay khOng c!n can thiep phau thuat.
3.2. Nghe bung
Nghe thl1C1ng dUOC thVc hien trl/oc khi SC1 go. Vl sc, go tn/dc c6 thi lam
thay ddi trnh cha:t cua nhu dOng ruOt. Theo sinh ly blnh thttang, c,ac trnh
nhu dOng ru()t ra:t thay ddi, luc d6i nhu dOng ruOt tang, sau An no nhu dOng
ruOt giim.
Thao tac nghe b1,1ng thvcing kh6 va khOng dem l�I ka't qua b nhilng tre
hie'u dOng, khOng hc,p tac. nhung 1,i ra:t co gia tri cJ nhOng tre dang bi kh6
chju vung bvng.
a
Tang nhu dOng ruOt thllCJng gap benh nhi vlem d� day ruOt va th�ng
a
giim hay khOng c6 benh nhi viem ruOt thua giai do�n sau hoJc t�c ruOt
Hep dOng m�ch chu, dOng m�ch chiu. dui hay dOng m�ch th;n c6 the
nghe dl.lQc 4m thOi.
C6 th� sll d1,mg ky thu�t nghe d� djnh be, dlt11 cua gan hay lach bAng
each ciit 6ng nghe tren thanh b1,mg benh nhi va krch thfch nhe blng mot
v3t tu. KhlJi d4u b gee ph:ln tll dllOi cung phra vai co quan dang kham �
tiln d4n 1en tren. ng�i kham se phat hien ra be, cua gan ho,c lach naY
khi nghe sv thay t16i am thanh tu trong thanh due.
3�3. Go bvna . thl
Ga bvng giup phat hiGn khO'i u va kfch thlltJc cac t�ng va thl/0�� co n h�
ng
xac dinh vimg bvno bi dau. Ca"u true d�c hay chl1a d4y d!ch, g,o g khi
ron
bAng quang ctng d!y mlOc ttiu thutJng gO nghe am thanh dvc; t
qual ruOt chCta khr thlltJng gO vang. . bvno
Thao tac g o dung di chin doan bang bvng trong tntano h<'P. oiu
cang chltJng. eenh nhi nlm ng(Ja, ngUOI khim bAt d4u go tit_ ng�: �;· dlch
h
ti&n s! nghe dvc, cang tifn vd trung tam, cac quai ruOt chaa k
301