MUC TIEU

1.Mo ta 2 d tat bam sinh cua ai trang.

2.Mo ta va phan tch benh tr.

3.Mo ta va phan tch 3 loai viem ai trang. 4.Mo ta va phan tch 2 loai polp ai trang.

5. Mo ta va phan tch 3 loai u tuyen ai trang.

6.Phan tch moi lien he gia u tuyen va ung th ai trang. 7.Mo ta va phan tch ton thng cua carcinom ai trang.

8.Phan loai carcinom ai trang (theo DUKES).

9.Mo ta va phan tch viem ruot tha cap tnh.

ai trang khong co nhung mao. Be mat hap thu phang vi nhieu hoc dang ong thang, lot bi cac te bao ai che nhay.

Mat niem mac c phu bi cac te bao hap thu. Cac te bao
nay co cac vi nhung mao tren be mat hng vao long ruot. Mang than kinh gom mang Auerbach, mang Meissner.

NIEM MAC AI TRANG BNH THNG

1. D TAT BAM SINH 1.1 Benh Hirschsprung

Ni b hep do khong co te bao hach than kinh Auerbach va Meissner,

phan ai trang pha tren cho hep b phnh to. 1.2 Chng khong co hau mon Do lp mang ngan gia phan ruot vi lo hau mon khong thung trong qua trnh phat trien cua bao thai.

BENH HIRSCHSPRUNG

BENH HIRSCHSPRUNG

2. CAC TON THNG KHAC 2.1 Benh tui tha ai trang

95% tui tha co ai trang sigma.

Tui tha co vach mong vi lp niem mac teo et, di lp niem b ep, lp c trn b mat hoac mong.

X QUANG: TUI THA AI TRANG

TUI THA AI TRANG

TUI THA AI TRANG

TUI THA

AI TRANG

2.2 Benh tr
La benh dan cac tnh mach cua mang tnh mach tr hau mon va quanh hau mon. Do s tang ap lc tnh mach lau dai mang tnh mach tr. Tr co 2 loai tr noi va tr ngoai phan cach nhau bi ng lc.

CAU TRUC BNH THNG CUA ONG HAU MON

3. VIEM AI TRANG
3.1 Viem loet ai trang do amp

ai the: Thng gap manh trang vi cac vet loet hnh co chai
co b vang nau nham nh, co ay la lp di niem mac hoac lp c.

Vi the: Cac ton thng ban au ch co t te bao viem n nhan,

vi nhieu mo hoai t va tham nhap bach cau nhan mui, mo hat viem ay loet va amp.

CAC VET LOET TRONG BENH AMP AI TRANG

AMP VIEM AI TRANG DO AMP

3.2 Viem loet ai trang vo can

Benh thng trc trang, ai trang sigma. Niem mac sung huyet o am hoac o tm va mn nh nhung. Khi au la vet cht nho, cac vet cht nay sau hn roi thanh nhng vet loet doc theo chieu dai ai trang. Lp c day cng, mat mot phan hay mat hoan toan tnh co dan.

G AU: LOET NONG

G SAU: THANH RUOT CNG

AI TRANG

VIEM LOET AI TRANG VO CAN

VIEM LOET AI TRANG VO CAN

VIEM LOET AI TRANG VO CAN

VIEM LOET AI TRANG VO CAN: CHO HNH ANH GIA POLYP

VIEM LOET
AI TRANG VO CAN

GIAI OAN CAP

GIAI OAN SAU

3.3 Viem ai trang co mang gia

La viem cap tnh cua ai trang, vi mang gia phu len tren lp

niem mac, gay ra bi oc to cua Clostridium difficile.

Gom nhng mang dnh nhau, mau vang xanh, go cao, cach nhau bi

nhng vung niem mac bnh thng.

VIEM AI TRANG GIA MAC

VIEM AI TRANG GIA MAC

Ton thng niem mac vi xac te bao va te bao viem cap

Chat hoai t t huyet va xac te bao

VIEM T GIA MAC: GIAI OAN CAP

VIEM T GIA MAC: GIAI OAN SAU

4. BENH CUA RUOT THA

4.1 Viem ruot tha cap tnh

Luc au, dch xuat, bach cau a nhan trung tnh niem mac, di
niem mac.

Tre hn, bach cau a nhan trung tnh tham nhap en lp c. Thanh
mac phu lp mu fibrin.

Xau hn, loet xuat huyet niem mac, hoai t va hoai th ra en thanh
mac, gay v ruot tha.

VRT cap mu

RT bnh thng

VRT cap hoai t

VIEM RUOT THA CAP

VIEM RUOT THA CAP

VIEM RUOT THA CAP

5. U CUA AI TRANG 5.1 Polp

5.1.1 Polp tang san

V tr: trc trang va ai trang sigma 60-80% Thng khong co cuong, tron hoac dai, thng di 5mm, thng co nhieu polp. Polp tang san gom nhng ong va nhng hoc tuyen lot bi te bao thng mo nh bnh thng.

POLP TANG SAN

POLP TANG SAN

5.1.2 U tuyen ong

Thng co cuong, nho Vi the: Gom nhng tuyen xep day ac. Te bao thng mo co hnh thai t biet hoa. Te bao t biet hoa la tieu chuan e phan biet gia u tuyen vi polp tang san. Cac te bao cao, gia tang, tang sac vi t le nhan/bao tng tang.

Nghch san, khong ien hnh, phan bao.

5.1.3 U tuyen nhanh

Bat ky u tuyen ai trang nao co tren 50% cau truc nhanh th c goi la u tuyen nhanh. U tuyen nhanh la ton thng tien ung th co xuat o cao.

5.1.4 U tuyen ong-nhanh

Khi thanh phan nhanh chiem 20% - 50%.

U TUYEN ONG

U TUYEN ONG-NHANH

U TUYEN ONG-NHANH

U TUYEN ONG-NHANH

U TUYEN NHANH

U TUYEN NHANH

U TUYEN NHANH

U TUYEN

U TUYEN HOA UNG TH

U TUYEN HOA UNG TH

5.1.5. Cac hoi chng a polp

* Benh a polp gia nh:
Ban chat la cac u tuyen, thng la u tuyen ong.

* Hoi chng Peutz-Jeghers:

Ban chat la hamartom, te bao thng mo tiet nhay giong bnh thng. om sac to niem mac.

Khong tr thanh ung th.

* Hoi chng Gardner:

Gom a polp kem theo cac u bo si. Cac polp nay cung de tr thanh ung th .

* Hoi chng Turcot

Gom a polp ai trang va u nao.
Cac polp co the hoa ac.

A POLP GIA NH

A POLP GIA NH

HOA AC

A POLP GIA NH

HOI CHNG

PEUTZ-JEGHERS

5.2 Carcinom tuyen Tai TP. Ho Ch Minh, nam 1997, ung th ai trang ng hang th 4 gii nam, th 3 gii n. Yeu to moi trng gi vai tro rat quan trong.

5.2.2 Hnh thai giai phau benh

Trc trang: 50%

ai trang sigma: 20%

ai trang phai: 15%

ai trang ngang: 6 - 8%
ai trang xuong: 6 - 7%

Hau mon: 1%

Thng co 2 hnh thai:

Carcinom cua ai trang trai

Ton thng co dang vong siet an cng vach ruot, lam hep long ruot
kem loet rong gia, gay nghet ruot. Carcinom cua ai trang phai Ton thng co dang sui len dang bong cai hoac mang rong co nhu, choi vao long ruot.

Dang vong quanh T

Dang sui
AI THE CUA
CARCINOM AI TRANG

Dang sui loet

AI THE CUA CARCINOM AI TRANG

AI THE CUA CARCINOM TRC TRANG

Carcinom tuyen cua T

Bieu hien lam sang:

Hau het eu dien tien am tham. Benh nhan co xuat huyet tieu hoa va/hoac thay oi thoi quen cua ruot.

Xam nhap va di can:

Trc tiep en cac cau truc lan can, ng limpho va ng mau: hach vung, gan, phoi, xng, phuc mac, nao.

Tien lng:
Tuy thuoc vao o lan rong cua ton thng, o lan rong en hach va cac ni khac, o biet hoa mo hoc cua ton thng.

anh gia giai oan: Bang Dukes bien oi .

Bang anh gia giai oan theo Dukes

5.3 Carcinom te bao gai Thng ch co vung hau mon.

5.4 Sarcom
Hiem gap, gom sarcom c trn, sarcom mach mau, sarcom m, sarcom si. 5.5 Limphom

Hiem gap hn so vi da day, ruot non.

6. U VA TON THNG GIA U CUA RUOT THA 6.1 Boc nhay cua ruot tha va u nhay gia phuc mac Long ruot tha b dan rong do ong chat nhay, tao thanh boc nhay.

Co 2 loai boc nhay: loai do nghet va loai do u.

BOC NHAY
RUOT THA

6.2 U boc tuyen nhay

6.3 Carcinom tuyen boc dch nhay Kho phan biet vi u lanh. Te bao u xam nhap qua vach ruot, gieo rac xa, di dang cac

not phuc mac.

6.4 U carcinoid cua ruot tha Xuat o cao nhat la u te bao noi tiet t gay hoi chng carcinoid.

U BOC TUYEN NHAY

CUA RUOT THA

CARCINOM TUYEN CUA RUOT THA

4. BENH CUA RUOT THA 4.2 Ung th ruot tha: Carcinom tuyen tiet nhay

U CARCINOID RUOT THA

Chieu dai: 3,6 6m Ta trang, hong trang va hoi trang. Nhung mao rat nhieu. Benh chnh la viem va cac roi loan a en kem hap thu.

RUOT NON BNH THNG

1. Tui tha

1.1. Tui tha ta trang, hong trang, hoi trang

Do iem yeu lp c
Tui tha chu yeu lalp niem mac va di niem.

1.2. Tui tha Meckel

Xay ra trong s quay cua ruot

ay u 4 lp nh ruot bnh thng.

TUI THA MECKEL

TUI THA MECKEL

2. Viem ruot do vi khuan

Thng nhat la E. coli Ton thng thay oi theo tac nhan gay benh 3. Viem ruot khong do vi khuan Virus:

Tre em: Retrovirus, Rotavirus.

Ngi ln: Pavovirus

Nam: Benh nhan co sc e khang giam

Protozoa: Amp, Gardia lamblia

4. Benh Crohn
1932: Crohn phat hien ra benh nay ruot non. nh tuoi: 20-40 t va 60-70t 50% xay ra oan cuoi hoi trang. AI THE - Nhieu o loet dang aphthe - Kht hep.

- Hnh anh a cuoi.

BENH CROHN: Cac o loet dang aphthe

BENH CROHN

KHT HEP RUOT

HNH ANH A CUOI

BENH CROHN: KHT HEP RUOT

BENH CROHN: A CUOI

VI THE - Viem hat - Tao khe nt - Viem xuyen thanh

BENH CROHN

VIEM HAT KHE NT VIEM XUYEN THANH

TON THNG NHAY COC

BENH CROHN

VIEM LOET T VO CAN

5. Ton thng gay nghet ruot Thoat v: Thng nhat la thoat v ben

Long ruot:
Tre em: nguyen nhan cha ro Ngi ln: Khoi u Day dnh ruot: Viem phuc mac, sau phau thuat bung. Xoan ruot

THOAT V BEN

LONG RUOT

XOAN RUOT

LONG RUOT

6. U lanh

5 loai u lanh thng gap theo th t:

- U c trn - U m - U tuyen - U mach mau - U si

U M LANH

7. U ac 3 loai u ac thng gap theo th t: - U carcinoid: U te bao a bac - Carcinom

- Sarcom

U CARCINOID

U CARCINOID

SARCOM C TRN RUOT NON