Thăm Dò Cận Lâm Sàng Hệ Thận Tiết Niệu

KHM LM SNG H THNG THN TIT NIU B mn Ni tng hp-i Hc Y H Ni 1 Nhc li gii phu ca h thng thn tit niu Bnh thng hai thn nm hai bn ct sng, trong h thn, cc trn ngang mm ngang t sng lng 11, cc di ngang mm ngang t sng lng 3, thn phi thp hn thn tri.

Bt thng: (d dng) c ngi ch c mt thn, hoc 3 thn, hoc khng nm trong h thn m nm ngoi h thn, bt c ni no trong bng 2 Nhc li gii phu ca h thng thn tit niu i chiu thn ln thnh bng, pha trc l vng mn sn, pha sau l vng h tht lng. H thn l mt m lin kt rt lng lo.

c tnh gii phu hc ca thn l rt di ng v bnh thng ta khng s thy c thn. Nhng khi thn to ln ta c th s c. 3 Nhc li gii phu ca h thng thn tit niu T thn i xung c hai niu qun chy dc hai bn ct sng. Si khi nm niu qun hoc i qua c th gy cn au.

Hai niu qun vo bng quang. Nc tiu t bng quang i ra ngoi qua niu o. Ring nam gii c tin lit tuyn, tuy nm ngoi ng tit niu v thuc v b my sinh dc nhng c lin quan mt thit vi b my tit niu v nm ngang vng bng quang bao quanh niu o pha sau. Khi tin lit tuyn b vim hoc c u s c nhng biu hin v ri lon tiu tin 4 THM KHM TON THN MT NGI C BNH THN TIT NIU

Tnh trng ton thn: gy yu, mt mi, n, ung, ng, tnh trng mch, nhit . RI LON TIU TIN Ph Huyt p Thiu mu Soi y mt

5 CCH KHM THN T th ngi bnh nm nga Nhn: vng h tht lng xem c sng khng, nhn bng c thy khi u ni ln khng. S: L phng php quan trng nht khm thn to Trong khi s, ch cm gic au ca ngi

bnh v phn ng bng 6 CCH KHM THN Tm du hiu chm tht lng (contact lombaire): dng mt bn tay t pha sau vng h tht lng, cn bn tay kia s v n ln khi u. Nu thn to, s thy c cm gic chc. Du hiu ny rt quan trng chn on thn to. Tm du hiu bp bnh thn: ngi bnh nm nga, mt tay t pha h tht lng, mt tay trn bng, vng mn sn. Tay trn yn, tay di

dng ngn tay n v ht mnh ln, ri lm ngc li, tay di yn, dng u ngn tay trn y xung, lm khi ngi bnh bt u th ra. Cn y nhanh v hi mnh nu y chm s khng c kt qu. 7 CCH KHM THN T th ngi bnh nm nghing Ngi bnh nm nghing, mt chn dui. Mun khm thn bn no th nm nghing bn i din, thy thuc ngi pha sau lng. V d mun khm thn bn phi, ngi bnh nm nghing v bn tri, thy thuc ngi sau lng, dng tay tri t h tht lng, tay phi t pha bng. Ngn tr cch xng sn th 10 khong 2 khot ngn tay. Khi ngi bnh ht vo su, thn c y xung, ta s thy thn.

Trong cc phng php s nn trn, phng php bp bnh thn l phng php tt nht khm thn to v n gin v chnh xc, khi c du hiu bp bnh, thng khi u l thn to. Tuy nhin c trng hp bp bnh thn khng c hoc khng chc chn, phng php nm nghing s b sung thm. 8 KHM IM AU CA NIU QUN im niu qun trn hay im cnh rn: k mt ng ngang qua rn gp b ngoi c thng to, hoc 3 khot ngn

tay cch ngang rn. Tng ng vi L2 (1) im niu qun gia: K ng ngang qua hai gai chu trc trn. Chia lm 3 phn: hai u ca on 1/3 gia l im niu qun gia tng ng vi khp L4 L5. im niu qun di: phi 9 KHM IM AU CA NIU QUN 10 KHM IM AU CA THN

(PHA BN V SAU) im sn lng: im gp nhau ca b di xng sn 12 v b ngoi khi c lng to. im sn ct sng: gc xng sn 12 v ct sng. 11 KHM IM AU CA THN (PHA BN V SAU) V hng lng: Phng php v thn tm du hiu rung

thn (Patenpxki) ging nh du hiu rung gan; mt bn tay ln vng thn ri dng mp bn tay kia v ln trn. Bnh thng, khi lm nghim php ny, ngi bnh khng au, nhng nu c bnh l thn, nht l nc v m thn lm nghim php ny rt au. 12 Khm bng quang Nhn: nu c cu bng quang, vng h v ni ln mt khi u trn nh bng qu cam hay to ln tn rn.

S: khi u rt trn nhn, c cm gic cng cng, khng di ng. G: c, vng c hnh trn nh li ln pha trn. Thng i: ly c nhiu nc tiu, khi u xp ngay. l phng php chc chn nht phn bit vi cc khi u khc. 13 Khm tin lit tuyn Thm trc trng: Nu ngi bnh nm nga, ta

quay u ngn tay ln pha trn, khong 12 gi nu ngi bnh nm sp, chng mng quay mt trc ngn tay pha xung di, khong 6 gi, th u ngn tay s c cm gic chm vo mt khi u nh hi li ln trn mt ca trc trng. l tin lit tuyn. Bnh thng TLT l mt khi nh, khng s thy hoc ch hi ni ln, c hai thu, gia c mt rnh. V tr nm vng c bng quang m ly niu o mng, ngang di khp v. ngi gi tuyn ny b x nn c th hi cng v to 14 Khm tin lit tuyn Tin lit tuyn c th to ln trong trng hp:

Ung th tin lit tuyn: thm trc trng thy tin lit tuyn to, rt cng c khi s thy nhn ung th rt cng, li hn ln. n c th au. C th to mt thu hoc c hai thu. V tin lit tuyn nm ngang c bng quang nn khi to s i c bng quang ln v niu o, gy ri lon v i tiu. Vim tin lit tuyn: tin lit tuyn to, mm hn v rt au. Khi thm trc trng c th nn m chy ra. Ly m em cy v em soi vi khun. Vim tin lit tuyn c th lan vo bng quang. 15

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