{"id":999,"date":"2021-09-19T00:12:16","date_gmt":"2021-09-18T17:12:16","guid":{"rendered":"http:\/\/phauthuatnhi.vn\/vi\/?p=999"},"modified":"2021-09-19T00:12:19","modified_gmt":"2021-09-18T17:12:19","slug":"vang-da-u-mat","status":"publish","type":"post","link":"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/vang-da-u-mat\/","title":{"rendered":"V\u00e0ng da \u1ee9 m\u1eadt"},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>\u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/p>\n\n\n\n<ul><li>M\u1eadt l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t ra \u1edf gan, d\u1ef1 tr\u1eef \u1edf t\u00fai m\u1eadt v\u00e0 b\u00e0i xu\u1ea5t v\u00e0o \u0111\u01b0\u1eddng ti\u00eau h\u00f3a qua h\u1ec7 th\u1ed1ng \u0111\u01b0\u1eddng m\u1eadt. Th\u00e0nh ph\u1ea7n c\u1ee7a d\u1ecbch m\u1eadt bao g\u1ed3m n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i, mu\u1ed1i m\u1eadt, bilirubin, cholesterol\u2026 c\u00f3 vai tr\u00f2 trong vi\u1ec7c h\u1ea5p thu c\u00e1c ch\u1ea5t b\u00e9o v\u00e0 m\u1ed9t s\u1ed1 vitamin c\u1ea7n thi\u1ebft\u2026<\/li><li>\u1ee8 m\u1eadt l\u00e0 t\u00ecnh tr\u1ea1ng d\u00f2ng m\u1eadt \u0111\u01b0\u1ee3c ti\u1ebft ra \u1edf gan v\u00e0 b\u00e0i xu\u1ea5t xu\u1ed1ng \u0111\u01b0\u1eddng m\u1eadt b\u1ecb gi\u1ea3m, g\u00e2y ra s\u1ef1 t\u00edch t\u1ee5 m\u1eadt trong t\u1ebf b\u00e0o gan v\u00e0 \u0111\u01b0\u1eddng m\u1eadt, l\u00e2u d\u1ea7n c\u00f3 th\u1ec3 g\u00e2y v\u00e0ng da, g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn gan, vi\u1ec7c h\u1ea5p thu m\u1ed9t s\u1ed1 ch\u1ea5t c\u1ea7n thi\u1ebft cho c\u01a1 th\u1ec3, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng gan, suy gan\u2026<\/li><li>V\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, v\u00e0ng da \u1ee9 m\u1eadt \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi t\u00ecnh tr\u1ea1ng t\u0103ng Bilirubine tr\u1ef1c ti\u1ebfp trong m\u00e1u >1,0mg\/dL (> 17mmol\/L), b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 Bilirubine to\u00e0n ph\u1ea7n.<\/li><li>V\u00e0ng da \u1ee9 m\u1eadt c\u00f3 th\u1ec3 g\u1eb7p \u1edf c\u1ea3 tr\u1ebb nam v\u00e0 n\u1eef, c\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i. Trong \u0111\u00f3, l\u1ee9a tu\u1ed5i s\u01a1 sinh l\u00e0 m\u1ed9t trong nh\u1eefng l\u1ee9a tu\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1eb7c bi\u1ec7t quan t\u00e2m do c\u00f3 \u0111\u1ebfn 60-80% tr\u1ebb s\u01a1 sinh c\u00f3 t\u00ecnh tr\u1ea1ng v\u00e0ng da. V\u00e0ng da t\u1eafc m\u1eadt g\u1eb7p \u1edf 1\/5.000 \u2013 1\/2.500 tr\u1ebb sinh ra s\u1ed1ng.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Nguy\u00ean nh\u00e2n<\/strong><\/p>\n\n\n\n<p><strong>T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng m\u1eadt<\/strong><\/p>\n\n\n\n<ul><li>Teo \u0111\u01b0\u1eddng m\u1eadt<\/li><li>Nang \u1ed1ng m\u1eadt ch\u1ee7<\/li><li>S\u1ecfi m\u1eadt hay b\u00f9n \u1ed1ng m\u1eadt<\/li><li>U (intrinsic and extrinsic)<\/li><li>Vi\u00eam x\u01a1 \u0111\u01b0\u1eddng m\u1eadt nguy\u00ean ph\u00e1t (PSC)<\/li><li>Th\u1ee7ng \u1ed1ng m\u1eadt<\/li><\/ul>\n\n\n\n<p><strong>Nhi\u1ec5m tr\u00f9ng<\/strong><\/p>\n\n\n\n<ul><li>Virus (HIV, CMV, Herpes, Rubella, Echovirus, Adenovirus&#8230;)<\/li><li>Toxoplasma<\/li><li>Vi khu\u1ea9n (nhi\u1ec5m tr\u00f9ng ti\u1ec3u, nhi\u1ec5m tr\u00f9ng huy\u1ebft, giang mai)<\/li><\/ul>\n\n\n\n<p><strong>B\u1ea5t th\u01b0\u1eddng b\u1ea9m sinh<\/strong><\/p>\n\n\n\n<ul><li>H\u1ed9i ch\u1ee9ng Alagille<\/li><li>Gi\u1ea3m s\u1ea3n \u1ed1ng m\u1eadt gian th\u00f9y kh\u00f4ng ph\u1ea3i h\u1ed9i ch\u1ee9ng<\/li><li>B\u1ec7nh Byler, PFIC<\/li><li>X\u01a1 gan b\u1ea9m sinh<\/li><li>B\u1ec7nh Caroli<\/li><\/ul>\n\n\n\n<p><strong>R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a<\/strong><\/p>\n\n\n\n<ul><li>Galactosemia, Fructosemia, Glycogenesis<\/li><li>R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a amino acid<\/li><li>Tyrosinemia<\/li><li>R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a lipid<\/li><li>R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a t\u1ed5ng h\u1ee3p acid m\u1eadt<\/li><li>H\u1ed9i ch\u1ee9ng Zellweger<\/li><li>Thi\u1ebfu \u03b11 &#8211; Antitrypsin<\/li><\/ul>\n\n\n\n<p><strong>Kh\u00e1c<\/strong><\/p>\n\n\n\n<ul><li>B\u1ec7nh n\u1ed9i ti\u1ebft (suy gi\u00e1p, suy tuy\u1ebfn y\u00ean)<\/li><li>\u0110\u1ed9c ch\u1ea5t<\/li><li>Thu\u1ed1c<\/li><li>Nu\u00f4i \u0103n t\u0129nh m\u1ea1ch<\/li><li>Vi\u00eam gan s\u01a1 sinh v\u00f4 c\u0103n<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Nh\u1eefng d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd c\u1ea7n \u0111\u01b0a tr\u1ebb \u0111i kh\u00e1m khi c\u00f3 v\u00e0ng da (\u0111\u1eb7c bi\u1ec7t \u1edf s\u01a1 sinh)<\/strong><\/p>\n\n\n\n<ul><li>Ti\u1ec1n c\u0103n gia \u0111\u00ecnh (cha m\u1eb9, anh ch\u1ecb em m\u1eafc b\u1ec7nh t\u01b0\u01a1ng t\u1ef1), g\u1ee3i \u00fd c\u00e1c b\u1ec7nh l\u00fd di truy\u1ec1n (x\u01a1 nang, thi\u1ebfu \u03b11 &#8211; antitrypsin, \u1ee9 m\u1eadt trong gan ti\u1ebfn tri\u1ec3n c\u00f3 t\u00ednh gia \u0111\u00ecnh, h\u1ed9i ch\u1ee9ng Alagille)<\/li><li>Tr\u01b0\u1edbc sinh: nhi\u1ec5m tr\u00f9ng b\u00e0o thai, k\u1ebft qu\u1ea3 si\u00eau \u00e2m ti\u1ec1n s\u1ea3n (nang \u1ed1ng m\u1eadt ch\u1ee7 hay c\u00e1c b\u1ea5t th\u01b0\u1eddng \u1edf ru\u1ed9t)<\/li><li>Nhi\u1ec5m tr\u00f9ng s\u01a1 sinh, \u0111\u1eb7c bi\u1ec7t nhi\u1ec5m tr\u00f9ng ti\u1ec3u<\/li><li>Ch\u1ebf \u0111\u1ed9 \u0103n: kh\u00f4ng u\u1ed1ng s\u1eefa m\u1eb9 ho\u1eb7c s\u1eefa c\u00f4ng th\u1ee9c c\u00f3 galactose.<\/li><li>Ch\u1eadm t\u0103ng c\u00e2n: vi\u00eam gan s\u01a1 sinh v\u00e0 c\u00e1c b\u1ec7nh chuy\u1ec3n h\u00f3a c\u00f3 th\u1ec3 g\u00e2y ch\u1eadm l\u1edbn<\/li><li>N\u00f4n \u00f3i: c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh chuy\u1ec3n h\u00f3a, t\u1eafc ru\u1ed9t v\u00e0 h\u1eb9p m\u00f4n v\u1ecb<\/li><li>\u0110i ti\u00eau: ch\u1eadm \u0111i ti\u00eau c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh x\u01a1 nang, suy gi\u00e1p; ti\u00eau ch\u1ea3y c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh l\u00fd nhi\u1ec5m tr\u00f9ng, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a, \u1ee9 m\u1eadt trong gan ti\u1ebfn tri\u1ec3n c\u00f3 t\u00ednh gia \u0111\u00ecnh<\/li><li>M\u00e0u ph\u00e2n: ph\u00e2n b\u1ea1c m\u00e0u k\u00e9o d\u00e0i.<\/li><li>M\u00e0u n\u01b0\u1edbc ti\u1ec3u: ti\u1ec3u s\u1eadm m\u00e0u g\u1ee3i \u00fd v\u00e0ng da t\u0103ng bilirubin tr\u1ef1c ti\u1ebfp<\/li><li>Ch\u1ea3y m\u00e1u b\u1ea5t th\u01b0\u1eddng: g\u1ee3i \u00fd r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, thi\u1ebfu vitamin K<\/li><li>Tri gi\u00e1c: tr\u1ebb k\u00edch th\u00edch trong b\u1ec7nh l\u00fd chuy\u1ec3n h\u00f3a ho\u1eb7c nhi\u1ec5m tr\u00f9ng huy\u1ebft; li b\u00ec kh\u00f3 \u0111\u00e1nh th\u1ee9c c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh l\u00fd chuy\u1ec3n h\u00f3a, nhi\u1ec5m tr\u00f9ng huy\u1ebft, suy gi\u00e1p, suy tuy\u1ebfn y\u00ean.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Kh\u00e1m l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n<ul><li>D\u1ea5u hi\u1ec7u sinh t\u1ed3n v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u00e1nh gi\u00e1 t\u0103ng tr\u01b0\u1edfng (c\u00e2n n\u1eb7ng, chi\u1ec1u cao, v\u00f2ng \u0111\u1ea7u)<\/li><li>T\u1ed5ng tr\u1ea1ng: tr\u1ebb m\u1ec7t m\u1ecfi g\u1ee3i \u00fd b\u1ec7nh nhi\u1ec5m tr\u00f9ng ho\u1eb7c chuy\u1ec3n h\u00f3a, trong khi tr\u1ebb teo \u0111\u01b0\u1eddng m\u1eadt c\u00f3 t\u1ed5ng tr\u1ea1ng t\u1ed1t<\/li><li>\u0110\u1eb7c \u0111i\u1ec3m chung: tr\u1ebb h\u1ed9i ch\u1ee9ng Alagille c\u00f3 khu\u00f4n m\u1eb7t \u0111\u1eb7c tr\u01b0ng v\u1edbi m\u1eaft c\u00e1ch xa nhau, khu\u00f4n m\u1eb7t h\u00ecnh tam gi\u00e1c, m\u1eaft l\u00f5m s\u00e2u)<\/li><li>Soi \u0111\u00e1y m\u1eaft: nhi\u1ec5m tr\u00f9ng b\u00e0o thai, b\u1ec7nh t\u00edch t\u1ee5<\/li><li>\u00c2m th\u1ed5i \u1edf tim: c\u00f3 th\u1ec3 g\u1eb7p trong teo \u0111\u01b0\u1eddng m\u1eadt ho\u1eb7c h\u1ed9i ch\u1ee9ng Alagille<\/li><li>Kh\u00e1m b\u1ee5ng: b\u00e1ng b\u1ee5ng; tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7; k\u00edch th\u01b0\u1edbc, v\u1ecb tr\u00ed, m\u1eadt \u0111\u1ed9 c\u1ee7a gan; k\u00edch th\u01b0\u1edbc v\u00e0 m\u1eadt \u0111\u1ed9 c\u1ee7a l\u00e1ch; kh\u1ed1i u \u1edf b\u1ee5ng; tho\u00e1t v\u1ecb r\u1ed1n<\/li><li>Quan s\u00e1t tr\u1ef1c ti\u1ebfp n\u01b0\u1edbc ti\u1ec3u v\u00e0 ph\u00e2n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u00e0u s\u1eafc: n\u01b0\u1edbc ti\u1ec3u s\u1eadm m\u00e0u g\u1ee3i \u00fd t\u0103ng bilirubin tr\u1ef1c ti\u1ebfp; ph\u00e2n b\u1ea1c m\u00e0u g\u1ee3i \u00fd \u1ee9 m\u1eadt<\/li><li>Da: b\u1ea7m m\u00e1u ho\u1eb7c xu\u1ea5t huy\u1ebft \u0111i\u1ec3m (r\u1ed1i lo\u1ea1i \u0111\u00f4ng m\u00e1u)<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" width=\"621\" height=\"377\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum1.jpg\" alt=\"\" class=\"wp-image-1001\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum1.jpg 621w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum1-300x182.jpg 300w\" sizes=\"(max-width: 621px) 100vw, 621px\" \/><figcaption><strong>H\u00ecnh 1: M\u1ed9t s\u1ed1 m\u00e0u ph\u00e2n b\u1ea5t th\u01b0\u1eddng<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"has-medium-font-size\"><strong>C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n<ul><li><strong>\u0110\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n m\u1eadt<\/strong><ul><li>Bilirubin to\u00e0n ph\u1ea7n v\u00e0 tr\u1ef1c ti\u1ebfp<\/li><li>ALT v\u00e0 AST, ALP v\u00e0 GGT.<\/li><\/ul><\/li><li><strong>\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan<\/strong><ul><li>Prothrombin time v\u00e0 Partial thromboplastin times (PT, aPTT)<\/li><li>C\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u<\/li><li>Albumin\/huy\u1ebft thanh, NH3\/m\u00e1u, cholesterol\/m\u00e1u, glucose\/m\u00e1u<\/li><\/ul><\/li><li><strong>T\u00ecm nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng<\/strong><ul><li>C\u00f4ng th\u1ee9c m\u00e1u v\u1edbi ti\u1ec3u c\u1ea7u \u0111\u1ebfm<\/li><li>C\u1ea5y m\u00e1u, n\u01b0\u1edbc ti\u1ec3u, v\u1ecb tr\u00ed kh\u00e1c n\u1ebfu nghi ng\u1edd<\/li><li>T\u00ecm si\u00eau vi: HBsAg, TORCH, VDRL, EBV<\/li><\/ul><\/li><li><strong>Ch\u1ecdc d\u00f2 d\u1ecbch \u1ed5 b\u1ee5ng n\u1ebfu c\u00f3<\/strong><\/li><li><strong>T\u00ecm nguy\u00ean nh\u00e2n chuy\u1ec3n h\u00f3a<\/strong><ul><li>T\u00ecm c\u00e1c ch\u1ea5t kh\u1eed trong n\u01b0\u1edbc ti\u1ec3u (reducing substances)<\/li><li>\u0110\u1ecbnh l\u01b0\u1ee3ng \u03b11 &#8211; Antitrypsin v\u00e0 phenotype<\/li><li>Test m\u1ed3 h\u00f4i (sweat chloride analysis)<\/li><li>T\u1ea7m so\u00e1t c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a (amino acid n\u01b0\u1edbc ti\u1ec3u v\u00e0 huy\u1ebft thanh, c\u00e1c acid v\u00f4 c\u01a1 trong n\u01b0\u1edbc ti\u1ec3u)<\/li><li>Thyroxine, TSH, s\u1eaft, ferritine, acid m\u1eadt trong n\u01b0\u1edbc ti\u1ec3u v\u00e0 m\u00e1u<\/li><li>\u0110o ho\u1ea1t t\u00ednh galactose-1-uridyl transferase trong h\u1ed3ng c\u1ea7u<\/li><\/ul><\/li><li><strong>C\u00e1c x\u00e9t nghi\u1ec7m marker ung th\u01b0<\/strong>: CA 19.9, AFP\u2026<\/li><li><strong>X\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh<\/strong><ul><li>Si\u00eau \u00e2m b\u1ee5ng gan m\u1eadt: \u0111\u01b0\u1ee3c d\u00f9ng nh\u01b0 m\u1ed9t x\u00e9t nghi\u1ec7m ban \u0111\u1ea7u gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00ec kh\u00f4ng x\u00e2m l\u1ea5n, d\u1ec5 th\u1ef1c hi\u1ec7n, c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac c\u1ee7a h\u1ec7 gan m\u1eadt. H\u1eefu \u00edch trong ch\u1ea9n \u0111o\u00e1n nang \u1ed1ng m\u1eadt ch\u1ee7 v\u00e0 gi\u00fap g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n teo \u0111\u01b0\u1eddng m\u1eadt.<ul><li>Nang \u1ed1ng m\u1eadt ch\u1ee7: \u0111\u1ed9 ch\u00ednh x\u00e1c 71-97%, c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh \u1ed1ng m\u1eadt ch\u1ee7 d\u00e3n th\u00e0nh nang \u00b1 d\u00e3n \u0111\u01b0\u1eddng m\u1eadt trong gan. Ngo\u00e0i ra si\u00eau \u00e2m tr\u01b0\u1edbc sinh c\u0169ng c\u00f3 th\u1ec3 gi\u00fap ph\u00e1t hi\u1ec7n s\u1edbm nang \u1ed1ng m\u1eadt ch\u1ee7 t\u1eeb kho\u1ea3ng 3 th\u00e1ng gi\u1eefa \u0111\u1ebfn 3 th\u00e1ng cu\u1ed1i thai k\u1ef3.<\/li><li>Teo \u0111\u01b0\u1eddng m\u1eadt: gi\u00fap kh\u1ea3o s\u00e1t b\u1ea5t th\u01b0\u1eddng t\u00fai m\u1eadt (h\u00ecnh d\u1ea1ng, k\u00edch th\u01b0\u1edbc nh\u1ecf), d\u1ea5u hi\u1ec7u th\u1eebng x\u01a1 tam gi\u00e1c (TC sign) (h\u00ecnh 2A), t\u00ecnh tr\u1ea1ng x\u01a1 h\u00f3a gan, gan l\u00e1ch to, \u0111a l\u00e1ch,\u2026<\/li><\/ul><\/li><li>X\u1ea1 h\u00ecnh gan m\u1eadt: hi\u1ec7n \u00edt s\u1eed d\u1ee5ng<\/li><li>X-quang c\u00e1c x\u01b0\u01a1ng d\u00e0i v\u00e0 x\u01b0\u01a1ng s\u1ecd trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng b\u00e0o thai, X-quang ng\u1ef1c th\u1eb3ng t\u00ecm b\u1ec7nh ph\u1ed5i v\u00e0 tim.<\/li><li>MRCP: c\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n s\u1ecfi, nang \u1ed1ng m\u1eadt ch\u1ee7 (h\u00ecnh 2B), u v\u00f9ng m\u1eadt t\u1ee5y.<\/li><li>Ch\u1ee5p h\u00ecnh \u0111\u01b0\u1eddng m\u1eadt qua da ho\u1eb7c qua n\u1ed9i soi: \u00edt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh.<\/li><\/ul><\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum2-1024x598.jpg\" alt=\"\" class=\"wp-image-1003\" width=\"768\" height=\"449\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum2-1024x598.jpg 1024w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum2-300x175.jpg 300w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum2-768x449.jpg 768w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/09\/vdum2.jpg 1078w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/><figcaption><strong>H\u00ecnh 2: A. D\u1ea5u hi\u1ec7u TC d\u01b0\u01a1ng t\u00ednh tr\u00ean si\u00eau \u00e2m g\u1ee3i \u00fd teo \u0111\u01b0\u1eddng m\u1eadt (m\u0169i t\u00ean tr\u1eafng). B. Nang \u1ed1ng m\u1eadt ch\u1ee7 tr\u00ean MRI (m\u0169i t\u00ean v\u00e0ng).<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<ul><li><strong>C\u00e1c th\u1ee7 thu\u1eadt<\/strong><ul><li>H\u00fat d\u1ecbch t\u00e1 tr\u00e0ng \u0111\u00e1nh gi\u00e1 s\u1ef1 ti\u1ebft m\u1eadt v\u00e0o ru\u1ed9t: hi\u1ebfm khi s\u1eed d\u1ee5ng<\/li><li>Sinh thi\u1ebft gan qua da (kh\u1ea3o s\u00e1t m\u1eabu m\u00f4 d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi quang h\u1ecdc v\u00e0 \u0111i\u1ec7n t\u1eed, \u0111\u00e1nh gi\u00e1 enzym h\u1ecdc) trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p<\/li><li>T\u1ee7y \u0111\u1ed3 v\u00e0 c\u1ea5y nguy\u00ean b\u00e0o s\u1ee3i \u1edf da n\u1ebfu nghi ng\u1edd b\u1ec7nh \u1ee9 \u0111\u1ecdng<\/li><li>M\u1ed5 b\u1ee5ng th\u00e1m s\u00e1t v\u00e0 ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt trong l\u00fac m\u1ed5 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ho\u1eb7c lo\u1ea1i tr\u1eeb teo \u0111\u01b0\u1eddng m\u1eadt.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n\n\n\n<p>K\u1ebft h\u1ee3p gi\u1eefa l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 c\u00f3 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p t\u00f9y theo nguy\u00ean nh\u00e2n v\u00e0ng da.<\/p>\n\n\n\n<p class=\"has-medium-font-size\"><strong>\u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n\n\n\n<p><strong>N\u1ed9i khoa<\/strong><\/p>\n\n\n\n<ul><li>\u0110i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c<\/li><li>\u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng c\u1ee7a \u1ee9 m\u1eadt m\u1ea1n t\u00ednh<ul><li>K\u00e9m h\u1ea5p thu &#8211; suy dinh d\u01b0\u1ee1ng<ul><li>Cung c\u1ea5p n\u0103ng l\u01b0\u1ee3ng t\u1ed1i \u01b0u (125-150% nhu c\u1ea7u b\u00ecnh th\u01b0\u1eddng)<\/li><li>D\u00f9ng MCT (medium chain triglycerides), gi\u1ea3m t\u1ec9 l\u1ec7 LCT (long chain triglycerides)<\/li><li>B\u1ea3o \u0111\u1ea3m cung c\u1ea5p \u0111\u1ee7 l\u01b0\u1ee3ng acid b\u00e9o c\u1ea7n thi\u1ebft v\u00e0 \u0111\u1ea1m<\/li><li>B\u1ed5 sung amino acids chu\u1ed7i nh\u00e1nh<\/li><li>Tr\u1ebb bi\u1ebfng \u0103n c\u00f3 th\u1ec3 \u0111\u1eb7t sonde d\u1ea1 d\u00e0y<\/li><\/ul><\/li><li>Vitamin v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 vi l\u01b0\u1ee3ng<ul><li>Theo d\u00f5i \u0111\u1ecbnh k\u1ef3 n\u1ed3ng \u0111\u1ed9 c\u00e1c vitamin trong huy\u1ebft thanh<\/li><li>Cung c\u1ea5p c\u00e1c vitamin tan trong m\u1ee1 (A, D, E v\u00e0 K)<\/li><li>Cung c\u1ea5p c\u00e1c vitamin tan trong n\u01b0\u1edbc g\u1ea5p 2 l\u1ea7n nhu c\u1ea7u b\u00ecnh th\u01b0\u1eddng<\/li><li>\u0110i\u1ec1u ch\u1ec9nh v\u00e0 ph\u00f2ng ng\u1eeba thi\u1ebfu c\u00e1c ch\u1ea5t kho\u00e1ng v\u00e0 y\u1ebfu t\u1ed1 vi l\u01b0\u1ee3ng<\/li><\/ul><\/li><li>Ng\u1ee9a v\u00e0 xanthomata<ul><li>Ursodeoxycholic acid 15-30 mg\/kg\/ng\u00e0y<\/li><li>Rifampicin<\/li><li>Cholestyramine<\/li><li>Phenobarbital<\/li><\/ul><\/li><\/ul><\/li><li>Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh gan ti\u1ebfn tri\u1ec3n<ul><li>C\u1ed5 ch\u01b0\u1edbng<ul><li>Ki\u00eang mu\u1ed1i Na 1-2 mEq\/kg\/ng\u00e0y<\/li><li>L\u1ee3i ti\u1ec3u: spironolactone 3-5 mg\/kg\/ng\u00e0y, t\u0103ng li\u1ec1u khi c\u1ea7n<\/li><li>Ch\u1ecdc th\u00e1o v\u00e0 truy\u1ec1n albumin (1-2 g\/kg trong 6 gi\u1edd) n\u1ebfu c\u1ed5 ch\u01b0\u1edbng kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb nh\u01b0 tr\u00ean ho\u1eb7c c\u00f3 \u1ea3nh h\u01b0\u1edfng ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/li><\/ul><\/li><li>T\u0103ng \u00e1p t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n<ul><li>Ph\u00f2ng ng\u1eeba: propranolol 0,5-3 mg\/kg\/24 gi\u1edd, chia 2-3 l\u1ea7n\/ng\u00e0y<\/li><li>N\u1ed9i soi (ch\u00edch x\u01a1, th\u1eaft t\u0129nh m\u1ea1ch)<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Ngo\u1ea1i khoa<\/strong><\/p>\n\n\n\n<ul><li>Ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p v\u00e0ng da t\u1eafc m\u1eadt do nguy\u00ean nh\u00e2n ngo\u1ea1i khoa nh\u01b0 nang \u1ed1ng m\u1eadt ch\u1ee7, teo \u0111\u01b0\u1eddng m\u1eadt, u b\u01b0\u1edbu v\u00f9ng t\u1ee5y m\u1eadt\u2026 Vi\u1ec7c ph\u1eabu thu\u1eadt th\u1ef1c hi\u1ec7n c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t s\u1ebd mang l\u1ea1i hi\u1ec7u qu\u1ea3 t\u1ed1t h\u01a1n v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh (\u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh teo \u0111\u01b0\u1eddng m\u1eadt). <em>(Xem th\u00eam b\u00e0i nang \u1ed1ng m\u1eadt ch\u1ee7, teo \u0111\u01b0\u1eddng m\u1eadt)<\/em><\/li><li>Ph\u1eabu thu\u1eadt t\u1ea1o shunt trong tr\u01b0\u1eddng h\u1ee3p x\u01a1 gan c\u00f3 t\u0103ng \u00e1p c\u1eeda g\u00e2y xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li><li>Gh\u00e9p gan n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Bi\u1ebfn ch\u1ee9ng &#8211; ti\u00ean l\u01b0\u1ee3ng<\/strong><\/p>\n\n\n\n<p>Ngo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p vi\u00eam gan s\u01a1 sinh v\u00f4 c\u0103n, h\u1ea7u nh\u01b0 c\u00e1c nguy\u00ean nh\u00e2n c\u00f2n l\u1ea1i \u0111\u1ec1u \u0111\u01b0a \u0111\u1ebfn b\u1ec7nh gan m\u1ea1n t\u00ednh.<\/p>\n\n\n\n<p class=\"has-medium-font-size\"><strong>T\u00e1i kh\u00e1m theo d\u00f5i<\/strong><\/p>\n\n\n\n<p>T\u1ea5t c\u1ea3 tr\u1ebb c\u00f3 b\u1ec7nh l\u00fd v\u00e0ng da \u1ee9 m\u1eadt c\u1ea7n \u0111\u01b0\u1ee3c t\u00e1i kh\u00e1m v\u00e0 theo d\u00f5i k\u1ef9 v\u1ec1 n\u1ed9i khoa v\u00e0 ngo\u1ea1i khoa (trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh l\u00fd c\u00f3 ph\u1eabu thu\u1eadt).<\/p>\n\n\n\n<p><strong><em>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/em><\/strong><\/p>\n\n\n\n<ul><li>Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb B\u1ec7nh vi\u1ec7n Nhi \u0111\u1ed3ng 2.<\/li><li>https:\/\/www.emjreviews.com\/hepatology\/article\/cholestasis-in-the-baby-and-infant\/<\/li><li>https:\/\/www.childrenshospital.org\/conditions-and-treatments\/conditions\/c\/cholestasis<\/li><li>D&#8217;Amato-Guti\u00e9rrez Monica, Aguirre Karen, Ruiz Navas Patricia, et al. (2016), &#8220;Colestasis en pediatr\u00eda&#8221;, Revista Colombiana de Gastroenterologia, 31, pp.409-417.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>\u0110\u1ea1i c\u01b0\u01a1ng M\u1eadt l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t ra \u1edf gan, d\u1ef1 tr\u1eef \u1edf t\u00fai m\u1eadt v\u00e0 b\u00e0i xu\u1ea5t v\u00e0o \u0111\u01b0\u1eddng ti\u00eau h\u00f3a qua h\u1ec7 th\u1ed1ng \u0111\u01b0\u1eddng m\u1eadt. Th\u00e0nh ph\u1ea7n c\u1ee7a d\u1ecbch m\u1eadt bao <a class=\"mh-excerpt-more\" href=\"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/vang-da-u-mat\/\" title=\"V\u00e0ng da \u1ee9 m\u1eadt\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":4,"featured_media":1008,"comment_status":"open","ping_status":"open","sticky":false,"template":"template-full.php","format":"standard","meta":[],"categories":[4,16],"tags":[],"_links":{"self":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/999"}],"collection":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/comments?post=999"}],"version-history":[{"count":7,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/999\/revisions"}],"predecessor-version":[{"id":1010,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/999\/revisions\/1010"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media\/1008"}],"wp:attachment":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media?parent=999"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/categories?post=999"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/tags?post=999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}