ClickCease
+ 1-915-850-0900 spinedoctors@gmail.com
Select Page

Kujambula & Kuzindikira

Back Clinic Imaging & Diagnostics Team. Dr. Alex Jimenez amagwira ntchito ndi akatswiri odziwa zachipatala komanso akatswiri ojambula zithunzi. M'mayanjano athu, akatswiri ojambula zithunzi amapereka zotsatira zachangu, zaulemu, komanso zapamwamba kwambiri. Mothandizana ndi maofesi athu, timapereka chithandizo chabwino chomwe odwala athu ali nacho komanso zoyenera. Diagnostic Outpatient Imaging (DOI) ndi malo apamwamba kwambiri a Radiology ku El Paso, TX. Ndilo likulu lokhalo lamtundu wake ku El Paso, lomwe lili ndi ntchito ndi Radiologist.

Izi zikutanthauza kuti mukabwera ku DOI kuti mufufuze mayeso a radiologic, tsatanetsatane uliwonse, kuchokera ku mapangidwe a zipinda, kusankha zipangizo, akatswiri osankhidwa ndi manja, ndi mapulogalamu omwe amayendetsa ofesi, amasankhidwa mosamala kapena opangidwa ndi Radiologist. osati ndi akauntanti. Msika wathu wagawo ndi malo abwino kwambiri. Makhalidwe athu okhudzana ndi chisamaliro cha odwala ndi awa: Timakhulupirira kuchitira odwala momwe tingachitire ndi banja lathu ndipo tidzayesetsa kuonetsetsa kuti muli ndi zochitika zabwino kuchipatala chathu.

Kuonetsetsa Chitetezo cha Odwala: Njira Yachipatala mu Chipatala cha Chiropractic

Kuonetsetsa Chitetezo cha Odwala: Njira Yachipatala mu Chipatala cha Chiropractic

by | Chiropractic, Kuchiza Mankhwala, Chiropractic News, aakulu Chisoni, Kujambula & Kuzindikira, Kuchiza

Kodi akatswiri azachipatala ku chipatala cha chiropractic amapereka bwanji njira yachipatala kuti apewe zolakwika zachipatala kwa anthu omwe ali ndi ululu?

Introduction

Zolakwa zachipatala zinachititsa kuti 44,000-98,000 amwalira m'chipatala ku America chaka chilichonse, ndipo zina zambiri zinayambitsa kuvulala koopsa. (Kohn et al., 2000) Chiwerengerochi chinali choposa chiwerengero cha anthu amene amamwalira chaka chilichonse ndi AIDS, khansa ya m’mawere, ndi ngozi za galimoto panthawiyo. Malinga ndi kafukufuku wamtsogolo, chiwerengero chenicheni cha imfa chikhoza kukhala pafupi ndi 400,000, ndikuyika zolakwika zachipatala monga chifukwa chachitatu cha imfa ku US. Kaŵirikaŵiri, zolakwa zimenezi sizichokera kwa akatswiri azachipatala amene ali oipa mwachibadwa; m'malo mwake, ndizo zotsatira za zochitika zadongosolo ndi kayendetsedwe ka zaumoyo, monga machitidwe osagwirizana ndi opereka chithandizo, ma network a inshuwaransi osagwirizana, kusagwiritsidwa ntchito bwino kapena kusowa kwa ndondomeko za chitetezo, ndi chisamaliro chosagwirizana. Nkhani ya lero ikuyang'ana njira yachipatala yopewera cholakwika chachipatala muzochitika zachipatala. Timakambirana zachipatala chogwirizana ndi chithandizo chamankhwala chothandizira anthu omwe akudwala matenda aakulu. Timawatsogoleranso odwala athu powalola kuti afunse mafunso ofunika kwambiri komanso ovuta kwa omwe amawathandiza. Dr. Alex Jimenez, DC, amangogwiritsa ntchito chidziwitsochi ngati ntchito yophunzitsa. chandalama

Kufotokozera Zolakwa Zachipatala

Kuzindikira cholakwika chachipatala chomwe chili gawo lofunikira kwambiri pazokambirana zilizonse zokhudzana ndi kupewa zolakwika zachipatala. Mutha kuganiza kuti iyi ndi ntchito yosavuta, koma izi ndizotheka mpaka mutayang'ana pamitundu yambiri ya mawu omwe amagwiritsidwa ntchito. Mawu ambiri amagwiritsidwa ntchito mofanana (nthawi zina molakwika) popeza mawu ena amatha kusinthasintha, ndipo nthawi zina, tanthauzo la liwu limadalira zapadera zomwe zikukambidwa.

 

 

Ngakhale kuti bungwe la zaumoyo linanena kuti chitetezo cha odwala ndi kuthetsa kapena kuchepetsa zolakwika zachipatala zinali zofunika kwambiri, Grober ndi Bohnen adanena posachedwa monga 2005 kuti adalephera m'dera limodzi lofunika kwambiri: kudziwa tanthauzo la "mwinamwake funso lofunika kwambiri ... vuto lachipatala? Kulakwa kwachipatala ndiko kulephera kukwaniritsa zomwe munakonza pachipatala. (Grober & Bohnen, 2005) Komabe, palibe mawu alionse amene munthu angawatchule kuti ali ndi vuto lachipatala—odwala, chithandizo chamankhwala, kapena china chilichonse—amene akufotokozedwa m’nkhaniyi. Ngakhale zili choncho, tanthauzoli limapereka chikhazikitso cholimba cha chitukuko china. Monga mukuwonera, tanthauzo lenilenili lili ndi magawo awiri:

  • Kulakwitsa: Kulephera kukwaniritsa zomwe unakonzeratu monga momwe unafunira.
  • Vuto lokonzekera: ndi njira yomwe, ngakhale ndi kuphedwa mwangwiro, sikutulutsa zotsatira zomwe mukufuna.

Lingaliro la zolakwika za kuphedwa ndi kukonza zolakwika sizokwanira ngati tikufuna kufotokozera zolakwika zachipatala mokwanira. Izi zikhoza kuchitika kulikonse, osati kuchipatala kokha. Chigawo cha kayendetsedwe kachipatala chiyenera kuwonjezeredwa. Izi zimabweretsa lingaliro la zochitika zosasangalatsa, zotchedwa zochitika zoyipa. Tanthauzo lodziwika bwino la chochitika choyipa ndi kuvulaza mwadzidzidzi odwala omwe amabwera ndi chithandizo chamankhwala m'malo mwa matenda awo. Tanthauzoli lapeza kuvomerezedwa padziko lonse lapansi mwanjira ina. Mwachitsanzo, ku Australia, mawu akuti zochitika amatanthauzidwa ngati kuvulaza komwe kunapangitsa munthu kulandira chithandizo chamankhwala. Izi zikuphatikizapo matenda, kugwa koyambitsa kuvulala, ndi nkhani za mankhwala operekedwa ndi dokotala ndi zipangizo zachipatala. Zochitika zina zosavomerezeka zitha kupewedwa.

 

Mitundu Yodziwika ya Zolakwa Zachipatala

Nkhani yokhayo ndi lingaliro ili ndikuti sizinthu zonse zoipa zomwe zimachitika mwangozi kapena mwadala. Chifukwa wodwalayo amatha kupindula, zomwe zimayembekezeredwa koma zolekerera zimatha kuchitika. Pa mankhwala a chemotherapy, nseru ndi kutayika tsitsi ndi zitsanzo ziwiri. Pamenepa, kukana chithandizo chomwe akulangizidwacho chingakhale njira yokhayo yanzeru yopewera zotsatirapo zosasangalatsazo. Timafika pamalingaliro azovuta zomwe zingapewedwe komanso zosalephereka pamene tikukonzanso tanthauzo lathu. Sikophweka kuyika chisankho chololera kukhudzika kumodzi zikadziwika kuti zotsatira zabwino zidzachitika nthawi imodzi. Koma cholinga chokha sichinthu chowiringula. (Patient Safety Network, 2016, para.3) Chitsanzo china cha cholakwika chokonzekera chingakhale kudulidwa kwa phazi lamanja chifukwa cha chotupa ku dzanja lamanzere, chomwe chikanakhala kuvomereza chochitika chodziwika bwino ndi chonenedweratu poyembekezera zotsatira zopindulitsa pamene palibe chomwe chinayamba. Palibe umboni wotsimikizira kuyembekezera zotsatira zabwino.

 

Zolakwa zachipatala zomwe zimavulaza wodwala ndizo zomwe timayang'ana kwambiri pa kafukufuku wathu. Komabe, zolakwa zachipatala zimatha ndipo zimachitika ngati wodwala sanavulazidwe. Kupezeka kwa zophonya pafupi kungapereke chidziwitso chamtengo wapatali pokonzekera momwe mungachepetsere zolakwika zachipatala m'chipatala. Komabe, kuchuluka kwa zochitikazi poyerekeza ndi zomwe madokotala amawauza pafupipafupi kuyenera kufufuzidwa. Kuphonya kwapafupi ndi zolakwika zachipatala zomwe zikanavulaza koma sizinachitike kwa wodwalayo, ngakhale wodwalayo akuchita bwino. (Martinez et al., 2017) N’chifukwa chiyani mungavomereze chinachake chimene chingakubweretsereni mlandu? Taganizirani zimene zinachitika pamene namwino, pazifukwa zilizonse, anali atangoyang'ana zithunzi za mankhwala osiyanasiyana ndipo anali pafupi kupereka mankhwala. Mwinamwake chinachake sichim'kumbukira, ndipo amasankha kuti si momwe mankhwala enieni amawonekera. Atayang'ana, adapeza kuti mankhwala olakwika adaperekedwa. Akaona mapepala onse, amakonza zolakwikazo n’kupatsa wodwalayo malangizo oyenerera. Kodi zingatheke kupeŵa cholakwika m'tsogolomu ngati zolemba zoyang'anira zikuphatikizapo zithunzi za mankhwala oyenera? N'zosavuta kuiwala kuti panali kulakwitsa ndi mwayi wovulaza. Mfundo imeneyi imakhalabe yoona mosasamala kanthu kuti tinali ndi mwayi woipeza m’nthawi yake kapena kuvutika ndi zotsatirapo zilizonse zoipa.

 

Zolakwika za Zotsatira & Njira

Timafunikira deta yathunthu kuti tipeze njira zothetsera chitetezo cha odwala komanso kuchepetsa zolakwika zachipatala. Pang'ono ndi pang'ono, pamene wodwalayo ali m'chipatala, zonse zomwe zingatheke kuti zisawonongeke ndikuziika pangozi ziyenera kufotokozedwa. Madokotala ambiri atsimikiza kuti kugwiritsa ntchito mawu olakwika ndi zochitika zowawa kunali kokwanira komanso koyenera pambuyo poyang'ana zolakwika ndi zochitika zovuta pazachipatala ndikukambirana za mphamvu zawo ndi zofooka zawo mu 2003. akuphonya, ndi zolakwika zokhazikika komanso zobisika. Kuphatikiza apo, mawu akuti "zoyipa" amaphatikizanso mawu omwe nthawi zambiri amatanthauza kuvulaza odwala, monga kuvulala kwachipatala ndi kuvulala kwa iatrogenic. Chokhacho chomwe chatsalira ndikusankha ngati bungwe lowunikira ndilo bungwe loyenera kuthana ndi kulekanitsa kwa zochitika zolephereka komanso zosalephereka.

 

Chochitika cha alonda ndizochitika pomwe kulengeza ku Joint Commission kumafunika. The Joint Commission ikunena kuti chochitika cha alonda ndi chochitika chosayembekezereka chomwe chimaphatikizapo kuvulala kwakukulu m'thupi kapena m'maganizo. ("Sentinel Events," 2004, p.35) Palibe chosankha, chifukwa chiyenera kulembedwa. Zipatala zambiri, komabe, zimasunga zolemba zawo zofotokoza zochitika za alonda ndi zomwe angachite ngati wina atatsimikizira kuti mfundo za Joint Commission zikukwaniritsidwa. Izi ndi zina mwazochitika pamene kuli bwino kukhala otetezeka kusiyana ndi chisoni. Popeza kuti “zowopsa” ndi lingaliro lachibale, pangakhale mpata wokangana potetezera wantchito mnzathu kapena bwana. Kumbali ina, kunena molakwika chochitika cha alonda ndikwabwino kuposa kulephera kupereka lipoti la alonda. Kulephera kuulula kumatha kukhala ndi zotsatirapo zoyipa, kuphatikiza kuchotsedwa ntchito.

 

Poganizira zolakwika zachipatala, anthu nthawi zambiri amalakwitsa pongoyang'ana zolakwika zomwe amapatsidwa ndi dokotala. Zolakwika zamankhwala mosakayikira zimachitika pafupipafupi ndipo zimaphatikizapo zolakwika zambiri zamachitidwe monga zolakwika zina zamankhwala. Kusokonekera kwa kulumikizana, zolakwika zomwe zimachitika panthawi yamankhwala kapena kupereka, ndi zina zambiri ndizotheka. Koma tingakhale tikulingalira molakwa kwambiri nkhaniyi ngati tingaganize kuti kulakwa kwa mankhwala ndi kumene kumavulaza wodwala. Vuto limodzi lalikulu pakuyika zolakwika zosiyanasiyana zachipatala ndikusankha kuyika zolakwikazo potengera njira yomwe ikukhudzidwa kapena zotsatira zake. Ndizovomerezeka kuyang'ana maguluwa pano, poyesa kuyesa kangapo kuti akhazikitse matanthauzidwe ogwirira ntchito omwe amaphatikiza zonse zomwe zikuchitika komanso zotsatira zake, zambiri zomwe zidachokera ku ntchito ya Lucian Leape kuyambira m'ma 1990. 

 

Limbikitsani Moyo Wanu Masiku Ano- Kanema

Kusanthula & Kupewa Zolakwa Zachipatala

Ogwira ntchito ndi osagwira ntchito anali magulu awiri akuluakulu a zochitika zovuta zomwe Leape ndi anzake adazisiyanitsa mu phunziroli. (Leape et al., 1991) Mavuto okhudza opaleshoni anali monga matenda a zilonda, kulephera kwa maopaleshoni, mavuto omwe si aukadaulo, zovuta mochedwa, ndi zovuta zaukadaulo. Osagwira ntchito: mitu monga yokhudzana ndi mankhwala, osadziwika bwino, ozunzidwa, okhudzana ndi ndondomeko, kugwa, fracture, postpartum, anesthesia-related, neonatal, and catch-all head of the system anaphatikizidwa pansi pa gulu ili la zochitika zovuta. Leape adayikanso zolakwika powonetsa zomwe zidawonongeka. Adazigawanso izi m'mitu isanu, yomwe ili: 

  • System
  • Magwiridwe
  • Mankhwala Osokoneza Bongo
  • matenda
  • Zoteteza

Zolakwika zambiri zamachitidwe zimagwera pamitu yopitilira imodzi, komabe zonse zimathandiza kudziwa chomwe chimayambitsa vuto. Ngati madokotala oposa mmodzi akugwira ntchito kuti adziwe malo enieni omwe akufunika kuwongolera, ndiye kuti mafunso owonjezera angafunikire.

 

 

Mwaukadaulo, cholakwika chachipatala chingapangidwe ndi wogwira ntchito aliyense pachipatala. Sizimangoperekedwa kwa akatswiri azachipatala monga madokotala ndi anamwino. Woyang'anira akhoza kumasula chitseko, kapena wogwira ntchito yoyeretsa akhoza kusiya mankhwala m'manja mwa mwana. Chofunika kwambiri kuposa kudziwitsidwa kwa wolakwayo ndi chifukwa chake. Nanga zisanachitike? Ndipo tingatsimikize bwanji kuti zimenezo sizichitikanso? Pambuyo kusonkhanitsa deta onse pamwamba ndi zina zambiri, ndi nthawi kudziwa mmene kupewa zolakwa zofanana. Ponena za zochitika za alonda, Joint Commission yalamula kuyambira 1997 kuti zonsezi zichitike ndondomeko yotchedwa Root Cause Analysis (RCA). Komabe, kugwiritsa ntchito njirayi pazochitika zomwe ziyenera kufotokozedwa kwa anthu akunja ziyenera kukonzedwa.

 

Kodi Choyambitsa Choyambitsa Ndi Chiyani?

Ma RCA "anajambula tsatanetsatane komanso momwe amawonera." Amapangitsa machitidwe owunikira kukhala osavuta, kuwunika ngati kuwongolera kuli kofunikira, ndikutsata zomwe zikuchitika. (Williams, 2001) Kodi RCA ndi chiyani kwenikweni? Poyang'ana zochitika zomwe zidayambitsa cholakwikacho, RCA imatha kuyang'ana kwambiri zochitika ndi njira m'malo mowunikiranso kapena kuimba mlandu anthu ena. (AHRQ, 2017) Ichi ndichifukwa chake ndikofunikira kwambiri. RCA nthawi zambiri imagwiritsa ntchito chida chotchedwa Five Whys. Iyi ndi njira yodzifunsa mosalekeza kuti "chifukwa chiyani" mutakhulupirira kuti mwazindikira chomwe chayambitsa vuto.

 

Chifukwa chomwe chimatchedwa "zifukwa zisanu" ndichifukwa, ngakhale zisanu ndizoyambira zabwino kwambiri, muyenera kumafunsa nthawi zonse mpaka mutazindikira chomwe chayambitsa vutoli. Kufunsa chifukwa chake mobwerezabwereza kumatha kuwulula zolakwika zambiri pamagawo osiyanasiyana, koma muyenera kupitiliza kufunsa chifukwa chake pagawo lililonse la nkhaniyo mpaka mutatha zinthu zina zomwe zingasinthidwe kuti mupereke zotsatira zabwino. Komabe, zida zosiyanasiyana kupatula izi zitha kugwiritsidwa ntchito pakufufuza zomwe zimayambitsa. Ambiri alipo. Ma RCA akuyenera kukhala amitundu yambiri komanso osasinthasintha ndikuphatikiza onse omwe akhudzidwa ndi vutolo kuti apewe kusamvetsetsana kapena kupereka lipoti lolakwika la zomwe zachitika.

 

Kutsiliza

Zolakwika zachipatala m'mabungwe azachipatala ndizochitika pafupipafupi komanso zosafotokozeredwa zomwe zimawopseza kwambiri thanzi la odwala. Anthu pafupifupi kotala la miliyoni amaganiziridwa kuti amamwalira chaka chilichonse chifukwa cha zovuta zachipatala. Ziwerengerozi ndizosavomerezeka panthawi yomwe chitetezo cha odwala chikuyenera kukhala chofunikira kwambiri, koma palibe zambiri zomwe zikuchitika kuti asinthe machitidwe. Ngati zolakwa zachipatala zafotokozedwa molondola ndipo gwero la vutolo likupezeka popanda kupereka mlandu kwa ogwira ntchito enieni, izi sizofunikira. Zosintha zofunikira zitha kupangidwa ngati zoyambitsa zolakwika za dongosolo kapena ndondomeko zizindikirika bwino. Njira yosasinthika, yosiyana siyana yowunikira zifukwa zomwe zimagwiritsa ntchito zikhazikiko monga zifukwa zisanu kuti zifufuze mpaka zovuta zonse ndi zolakwika zitawululidwa ndi chida chothandiza. Ngakhale kuli kofunikira kuti pakhale zochitika za alonda, Root Cause Analysis ikhoza kugwiritsidwa ntchito pazolakwitsa zonse, kuphatikizapo kuphonya pafupi.

 

Zothandizira

Agency for Healthcare Research and Quality. (2016). Kusanthula Zoyambitsa Mizu. Zabwezedwa pa Marichi 20, 2017, kuchokera psnet.ahrq.gov/primer/root-cause-analysis

Grober, ED, & Bohnen, JM (2005). Kufotokozera zolakwika zachipatala. Kodi J Surg, 48(1), 39-44. www.ncbi.nlm.nih.gov/pubmed/15757035

Kohn, LT, Corrigan, J., Donaldson, MS, & Institute of Medicine (US). Komiti ya Quality of Health Care ku America. (2000). Kulakwitsa ndi munthu : kupanga njira yotetezeka yaumoyo. National Academy Press. books.nap.edu/books/0309068371/html/index.html

Leape, LL, Brennan, TA, Laird, N., Lawthers, AG, Localio, AR, Barnes, BA, Hebert, L., Newhouse, JP, Weiler, PC, & Hiatt, H. (1991). The chikhalidwe cha chokhwima zochitika m'chipatala odwala. Zotsatira za Harvard Medical Practice Study II. N Engl J Med, 324(6), 377-384. doi.org/10.1056/NEJM199102073240605

Lippincott ® NursingCenter®. NursingCenter. (2004). www.nursingcenter.com/pdfjournal?AID=531210&an=00152193-200411000-00038&Journal_ID=54016&Issue_ID=531132

Martinez, W., Lehmann, LS, Hu, YY, Desai, SP, & Shapiro, J. (2017). Njira Zozindikiritsira ndi Kuwunikanso Zochitika Zoyipa ndi Zosowa Zapafupi Pachipatala Chachipatala. Jt Comm J Qual Patient Saf, 43(1), 5-15. doi.org/10.1016/j.jcjq.2016.11.001

Patient Safety Network. (2016). Zochitika zoyipa, zophonya pafupi, ndi zolakwika. Zabwezedwa pa Marichi 20, 2017, kuchokera psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors

Williams, PM (2001). Njira zowunikira zomwe zimayambitsa. Proc (Bayl Univ Med Cent), 14(2), 154-157. doi.org/10.1080/08998280.2001.11927753

chandalama

Spinal Stenosis MRI: Back Clinic Chiropractor

Spinal Stenosis MRI: Back Clinic Chiropractor

by | Kujambula & Kuzindikira, Care Care

Spinal stenosis ndi pamene danga kwinakwake kapena mkati mwa msana umayamba kuchepa, kutseka mphamvu ya kuyenda bwino / bwino komanso kuyendayenda kwa mitsempha. Zingakhudze madera osiyanasiyana, kuphatikizapo pachibelekero/khosi, lumbar / low back, ndipo, kawirikawiri, zigawo za thoracic / pamwamba kapena zapakati kuchititsa dzanzi, dzanzi, kukokana, kupweteka, kufooka kwa minofu, kapena kuphatikiza kumbuyo, mwendo / s, ntchafu, ndi matako. Pakhoza kukhala zifukwa zosiyanasiyana zomwe zimayambitsa stenosis; Kuyeza kolondola ndi sitepe yoyamba, ndi kumene msana stenosis MRI amabwera mkati.

Spinal Stenosis MRI: Chiropractor Wachipatala Wovulaza

Spinal Stenosis MRI

Stenosis ikhoza kukhala yovuta kuti izindikire chifukwa ndi chizindikiro / zovuta zambiri kuposa chikhalidwe, chomwe nthawi zambiri chimayamba chifukwa cha herniated discs, fupa la mafupa, matenda obadwa nawo, opaleshoni pambuyo pa opaleshoni, kapena pambuyo pa matenda. Magnetic resonance imaging/MRI ndi mayeso omwe amagwiritsidwa ntchito pozindikira.

Matendawa

  • Katswiri wa zachipatala, monga chiropractor, katswiri wamankhwala, katswiri wa msana, kapena dokotala, ayamba ndikumvetsetsa zizindikiro ndi mbiri yachipatala.
  • Kuyezetsa thupi kudzachitidwa kuti mudziwe zambiri za malo, nthawi, maudindo, kapena zochitika zomwe zimachepetsa kapena kukulitsa zizindikiro.
  • Mayeso owonjezera akuphatikizapo mphamvu ya minofu, kusanthula kupindula, ndi kuyesa kuyesa kuti athandize kumvetsetsa kumene ululu ukuchokera.
  • Kuti mutsimikizire matenda, kujambula kumafunika kuti muwone zomwe zikuchitika.
  • MRI imagwiritsa ntchito kujambula kopangidwa ndi makompyuta kuti apange zithunzi zomwe zimasonyeza mafupa ndi minyewa yofewa, monga minofu, mitsempha, ndi tendon, ndipo ngati akakamizidwa kapena kukwiya.
  • Katswiri wazachipatala ndi Katswiri wa MRI adzadutsa zofunikira zachitetezo pamaso pa kujambula.
  • Chifukwa makinawa amagwiritsa ntchito maginito amphamvu, sipangakhale chitsulo m'thupi kapena m'thupi, monga ma prostheses oikidwa kapena zida zomwe zimaphatikizapo:
  • Mapulogalamu
  • Chochlear implants
  • Pampu kulowetsedwa mankhwala
  • Njira zolerera za intrauterine
  • Neurostimulators
  • Zithunzi za Intracranial aneurysm
  • Zolimbikitsa kukula kwa fupa
  • Mayesero osiyana a kujambula angagwiritsidwe ntchito ngati munthu sangathe kukhala ndi MRI ngati CT scan.

MRI imatha kuyambira mphindi zingapo mpaka ola limodzi kapena kupitilira apo, malingana ndi malo angati omwe ali ofunikira kuti adzilekanitse malo ovulala ndikupeza chithunzi chomveka. Mayesowa sakhala opweteka, koma nthawi zina anthu amafunsidwa kuti asunge malo omwe sangakhale omasuka. Katswiri/makatswiri adzafunsa ngati pali kusapeza bwino ndikupereka thandizo lililonse kuti izi zikhale zosavuta momwe zingathere.

chithandizo

Sikuti matenda onse a stenosis amayambitsa zizindikiro, koma pali njira zochizira zomwe akatswiri azachipatala angalimbikitse.

  • Chisamaliro chodziletsa ndiupangiri woyamba womwe umaphatikizapo chiropractic, decompression, traction, and physiotherapy.
  • Kuchiza kumawonjezera mphamvu ya minofu, kumapangitsa kuyenda bwino, kumapangitsa kuti thupi likhale bwino, kumachepetsa zizindikiro zosasangalatsa, komanso kumaphatikizapo njira zopewera ndi kusamalira zizindikiro.
  • Mankhwala olembedwa ndi dokotala angakhale mbali ya dongosolo lalikulu la chithandizo.
  • Opaleshoni ikhoza kukhala njira yosankha nthawi zovuta kwambiri pomwe chisamaliro chokhazikika sichikugwira ntchito.

Mimba Yam'mimba

Zothandizira

Nawonsotha ya Ndemanga Zazotsatira (DARE): Ndemanga Zowunika [Intaneti]. York (UK): Center for Reviews and Dissemination (UK); 1995-. Kuzindikira kwa lumbar spinal stenosis: kusinthidwa mwadongosolo kulondola kwa mayeso ozindikira. 2013. Akupezeka ku: www.ncbi.nlm.nih.gov/books/NBK142906/

Ghadimi M, Sapra A. Magnetic Resonance Imaging Contraindications. [Kusinthidwa 2022 May 8]. Mu: StatPearls [Intaneti]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Zikupezeka kuchokera: www.ncbi.nlm.nih.gov/books/NBK551669/

Gofur EM, Singh P. Anatomy, Back, Vertebral Canal Blood Supply. [Yosinthidwa 2021 Jul 26]. Mu: StatPearls [Intaneti]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Zikupezeka kuchokera: www.ncbi.nlm.nih.gov/books/NBK541083/

Lurie, Jon, ndi Christy Tomkins-Lane. "Kusamalira lumbar spinal stenosis." BMJ (Clinical Research ed.) vol. 352 ndi 6234. 4 Jan. 2016, doi:10.1136/bmj.h6234

Stuber, Kent, et al. "Chiropractic chithandizo cha lumbar spinal stenosis: kubwereza kwa mabuku." Journal of chiropractic Medicine vol. 8,2 (2009): 77-85. doi:10.1016/j.jcm.2009.02.001

Kuganizira Za msana Kuzipatala Zowawa Zoyembekezera

Kuganizira Za msana Kuzipatala Zowawa Zoyembekezera

by | Kujambula & Kuzindikira

Madokotala ndi akatswiri a msana amagwiritsa ntchito kujambula kwa msana kudzera mu X-ray, MRIs, kapena CT scans kuti adziwe chomwe chikuyambitsa mavuto ndi ululu. Kujambula ndizofala. Kaya chiropractic kapena opaleshoni ya msana, amathandizira kwambiri kuzindikira zovuta zam'mbuyo ndikulola munthu kuti awone zomwe zikuchitika. Mitundu ya milandu imaphatikizapo kupweteka kwa msana kuti:

  • Amachokera kusokonezeka
  • Wakhala kwa masabata anayi mpaka asanu ndi limodzi
  • Zimatsagana ndi mbiri ya:
  • Cancer
  • malungo
  • Kutuluka kwa usiku

Madokotala amagwiritsa ntchito zithunzizi pamene kuzindikira matenda a msana. Pano pali chidziwitso chazithunzi za msana.

 

Kuganizira Za msana Kuzipatala Zowawa Zoyembekezera

X-ray

Ma X-ray a ululu wammbuyo amatha kukhala othandiza. An X-ray ndi yochokera ku radiation ndipo imagwiritsidwa ntchito powunika momwe mafupa amagwirira ntchito. X-ray ndi yabwino kwa minyewa ya fupa kapena minyewa yomwe ili ndi ossified kapena calcified. Amagwira ntchito bwino kwambiri ndi minofu yolimba, makamaka mafupa. Minofu yofewa ngati minofu, ligaments, kapena intravertebral discs sizipezekanso.

Anthu omwe akujambulidwa kumbuyo kwa X-ray amawunikiridwa ndi makina omwe amapanga mtengo. Wolandira amasankha mtengowo ukadutsa m'thupi ndikupanga chithunzi. Zimatenga pafupifupi mphindi zisanu kuti amalize koma zitha kukhala zazitali kutengera kuchuluka kwa zithunzi za dokotala. Ma X-ray ndi othandiza pazifukwa za inshuwaransi ndipo amachotsa mafupa ngati kupanikizana fractures ndi/kapena mafupa spurs. Ma X-ray amalamulidwa pazifukwa zenizeni ndipo nthawi zambiri amakhala gawo la kafukufuku wowunika thupi lonse. Izi zikuphatikizapo MRI ndi / kapena CT scan.

CT Scan

CT imayimira zopangidwa tomography. Ndi mndandanda wa ma X-ray omwe amasinthidwa kukhala zithunzi pogwiritsa ntchito kompyuta. Ubwino wa CT scan mpaka ma X-ray wamba ndikuti imapereka malingaliro / ngodya zosiyanasiyana za thupi ndipo imatha kukhala mu 3D. Ma CT scans amagwiritsidwa ntchito nthawi zambiri pakavulala kapena anthu omwe achitidwa opaleshoni. Amatenga pafupifupi mphindi zisanu. Pa X-ray, anthu amaimirira kapena kugona pansi pa makina a X-ray pamene akuyesa thupi. CT scan imapangitsa munthuyo kugona pansi pamakina owoneka ngati donati omwe amasanthula uku akuzungulira pojambula. Anthu akulimbikitsidwa kuvala zovala zotayirira komanso zomasuka. Nthawi zina utoto, kapena kusiyanitsa kwa mtsempha, kumagwiritsidwa ntchito kuti minyewa yamitsempha iwonekere, kutulutsa zithunzi zomveka bwino.

MRI

MRI ndi yaufupi kujambula kwa magnetic resonance. MRIs amagwiritsa ntchito maginito kupanga zithunzi. Kujambula kwa MRI nthawi zambiri kumagwiritsidwa ntchito mwa anthu omwe achitidwa opaleshoni. Amatenga nthawi yayitali, nthawi zambiri amakhala pafupifupi mphindi 30 mpaka 45. Palibe zinthu zachitsulo zomwe zimaloledwa mu MRI. Odwala amafunsidwa kuchotsa zinthu monga malamba, zodzikongoletsera, ndi zina zotero. Utoto wosiyanitsa ukhoza kukhala gawo la MRI. Makinawa ali ngati ngalande. Izi zitha kukhala zovuta kwa anthu omwe ali ndi claustrophobia. Lankhulani ndi dokotala kuti mudziwe momwe mungakhalire omasuka panthawi ya ndondomekoyi.

Mitundu ina ya Kujambula kwa Msana

Mitundu ina yojambula ndi:

CT navigation

  • CT navigation imasonyeza zenizeni zenizeni zenizeni panthawi ya ndondomekoyi.

Mafilimu

  • Fluoroscopy imaphatikizapo mtanda wa X-ray womwe umadutsa mwachindunji m'thupi lomwe limasonyeza zithunzi zoyenda.

Mitundu iwiriyi ya kujambula kwa msana imagwiritsidwa ntchito panthawi ya maopaleshoni. Nthawi zina, kujambula kwa intraoperative amagwiritsidwa ntchito. Kujambula kwamtunduwu kumagwiritsa ntchito makina apamwamba kwambiri othandizira opaleshoni kuti azitha kudutsa m'malo olimba panthawi ya opaleshoniyo. Izi zimawonjezera kulondola kwa dokotalayo ndikuchepetsa kukula kwa chochekacho.

ultrasound

Ultrasound ingagwiritsidwe ntchito pazikhalidwe za msana. Uku ndi kuyesa kujambula komwe kumagwiritsa ntchito mafunde amawu kuti apange zithunzi. Komabe, mayeso oyerekeza omwe amagwiritsidwa ntchito pojambula msana ndi ma X-ray ndi MRIs.

Kusankhidwa kwa Kujambula

Lankhulani ndi dokotala wanu kapena chiropractor pasadakhale kuti mumvetsetse zomwe mungayembekezere panthawi yojambula. Adzakudziwitsani momwe mungakonzekere komanso malangizo aliwonse apadera nthawi isanakwane. Pamodzi ndi mbiri yachipatala ndi kuunika kwa thupi, kujambula kwa msana ndi gawo lofunika kwambiri lachidziwitso kuti apeze zomwe zimayambitsa ululu ndikupanga ndondomeko yabwino yothandizira.

Kupanga Thupi

Zotsatira Zanthawi Yaifupi za Khofi ndi Kuthamanga kwa Magazi

Kafeini mu khofi ndi stimulant kapena chinthu chomwe chimasangalatsa machitidwe a thupi. Pamene caffeine ilowetsedwa, anthu amakhala ndi chisangalalo chochuluka, makamaka mu dongosolo la mtima. Chisangalalo ichi chimapangitsa kugunda kwa mtima ndi kuthamanga kwa magazi kukwera kenako kutsika mpaka pamlingo woyambira kwa anthu athanzi. Coffee imawonjezera kuthamanga kwa magazi kwakanthawi kochepa. Kumwa khofi pang'ono ndikwabwino kwa anthu omwe alibe matenda amtima omwe analipo kale.

Zothandizira

United States Nuclear Regulatory Commission. (Meyi 2021) "Mlingo M'miyoyo Yathu Yatsiku ndi Tsiku" www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html

X-Ray ya Kupweteka Kwamsana: Ndemanga Zaposachedwa mu Musculoskeletal Medicine. (April 2009) “Kodi kujambula zithunzi mukamamva kupweteka kwambiri kwa msana ndi kotani?” www.ncbi.nlm.nih.gov/pmc/articles/PMC2697333/

Njira Zowonetsera Madandaulo a Ana | El Paso, TX.

Njira Zowonetsera Madandaulo a Ana | El Paso, TX.

by | Kujambula & Kuzindikira

  • Uku ndikuwunika mwachidule zina mwazodandaulo za ana zofunika zomwe zimachitika muzachipatala.
  • Acute Trauma kuphatikizapo kupwetekedwa mtima kwakukulu kwa mutu
  • Kuvulala Kopanda Ngozi mwa Ana (mwana womenyedwa)
  • Madandaulo a Musculoskeletal (Ana a Idiopathic Arthritis, scoliosis,
  • Ma neoplasms wamba (CNS & ena)
  • Kutenga
  • Matenda a metabolism

Acute Pediatric Trauma:

Kujambula kwa matenda a ana el paso, tx.
  • Kuvulala kwa FOOSH (mwachitsanzo, kugwa pa nyani-bar)
  • Supracondylar Fx, chigongono. Nthawi zonse d/t kuvulala mwangozi. <10-yo
  • Zowonjezera Fx
  • Gulu la Gartland limakhala ndi zovulala zosadziwika bwino zomwe zidachitidwa ndi kusasunthika pang'ono poyerekeza ndi kusuntha kwa chigongono cham'mbuyo kuthandizidwa mothandizidwa
  • Chiwopsezo chokhala ndi vuto la ischemic ngati chisamaliro chikuchedwa (mgwirizano wa Volkmann)
  • Mayeso a Radiological ndi ofunikira: chikwangwani chapanyanja & chikwangwani chapambuyo chamafuta chokhala ndi mzere wammbuyo wa humeral sichinadutse pakati/2/3 ya Capitellum.

Fx ya ana osakwanira:

Kujambula kwa matenda a ana el paso, tx.
  • Ambiri mu <10 yo Greenstick, Torus, Pulasitiki aka Bowing deformity
  • Chiritsani bwino, kuthandizidwa mosamala ndi immobilization
  • Kupunduka kwa pulasitiki ngati> 20-degrees kumafuna kuchepetsedwa kotsekedwa
  • Kuthyoka kwa chigaza cha ping pong kumatha kuchitika pambuyo povulala, kutulutsa mphamvu ndi zovuta za kuvulala kobadwa. Zingafunike kuyesedwa ndi ana neurosurgeo.n
Kujambula kwa matenda a ana el paso, tx.
  • Mitundu ya Salter-Harris ya kuvulala kwa mbale ya physeal kukula
  • Type 1-slip. mwachitsanzo, Slipped Capital Femoral Epiphysis. Nthawi zambiri palibe kuthyoka kwa fupa komwe kumadziwika
  • Type 2-M/C ndi kuneneratu kwabwino
  • Type 3- intra-articular, motero amakhala ndi chiopsezo cha msanga nyamakazi ndipo angafunike chisamaliro cha opaleshoni d/t kukhala wosakhazikika
  • Lembani 4- Fx kudutsa zigawo zonse za physis. Kuneneratu kosasangalatsa komanso kufupikitsa miyendo
  • Type 5 - nthawi zambiri palibe umboni wa kusweka kwa fupa. Kusazindikira bwino d/t kuphwanya kuvulala ndi kuwonongeka kwa mitsempha ndikufupikitsa miyendo
  • Kuwunika kwazithunzi ndikofunikira

Kuvulala Mopanda Ngozi (NAI) mwa Ana

Kujambula kwa matenda a ana el paso, tx.
  • Pali mitundu yosiyanasiyana ya nkhanza za ana. Kuchitiridwa nkhanza kwakuthupi kumatha kuyambira kuvulala kwapakhungu kupita ku zovulala zosiyanasiyana za MSK / systemic zomwe zimakhudza mafupa ndi minofu yofewa. Kujambula ndikofunikira ndipo kutha kuzindikira zizindikiro zodziwitsa azachipatala ndikudziwitsa zachitetezo cha ana ndi mabungwe okhazikitsa malamulo okhudza kuzunzidwa.
  • Mu mwana: �Shaken baby syndrome� imatha kuwoneka ndi zizindikiro za CNS d/t kung’ambika kwa mtsempha wosakhwima womanga mtsempha ndi subdural hematoma zomwe zimatha kupha. Kutaya magazi kwa retinal nthawi zambiri kumakhala chizindikiro. Mutu wa CT ndi wofunikira.
  • MSK Radiological Red Flags:
  • 1) fupa lalikulu Fx mwa mwana wamng'ono kwambiri (0-12 mo)
  • 2) Nthiti zam'mbuyo Fx: mwachibadwa sizichitika ngozi za d / t. Nthawi zambiri njira: kugwira ndi kufinya mwana kapena kugunda mwachindunji.
  • 3) Mitsempha Yambiri yokhala ndi machiritso osiyanasiyana motsatana, mwachitsanzo, ma calluses a fupa omwe akuwonetsa kuvulala kobwerezabwereza
  • 4) Metaphyseal kona Fx aka Chidebe chogwirizira Fx, nthawi zambiri pathognomonic kwa NAI mwa ana. Zimachitika pamene malekezero okhudzidwawo agwiridwa ndi kupindika mwamphamvu.
  • 5) Kuthyoka kwa mafupa aatali mwa mwana wamng'ono ndi chitsanzo china cha NAI.
  • Zizindikiro zina zofunika za NAI. Mbiri yosagwirizana yoperekedwa ndi oyang'anira / osamalira. Palibe umboni wa kubadwa kwapafupa / kagayidwe kazinthu zolakwika za mafupa monga Osteogenesis Imperfecta kapena Rickets/osteomalacia etc.
  • NB Pamene olera ana anena za mbiri yomwe malipoti akugwa ndi ngozi zapakhomo, Ndikofunika kudziwa kuti mwachiwonekere ngozi zambiri / kugwa m'nyumba sizichitika kawirikawiri kapena sizingatheke chifukwa cha kuthyoka kwakukulu kwa fupa.
  • Kufotokozera nkhanza za ana ku Illinois:
  • www2.illinois.gov/dcfs/safekids/reporting/pages/index.aspx

Njira Yoyerekeza ya MSK mu Pediatrics

Kujambula kwa matenda a ana el paso, tx.
  • Juvenile Idiopathic Arthritis (JIA)-anawona M/C matenda aakulu aubwana. Clinical Dx: kupweteka pamodzi / kutupa kwa masabata a 6 kapena kuposerapo mwa mwana <16-yo Mitundu yosiyanasiyana ilipo: Dx yoyambirira ndiyofunikira kuti tipewe zovuta zochedwa
  • Mitundu yodziwika bwino ya JIA:
  • 1) Matenda a Pauciarticular (40%) - m / c mawonekedwe a JIA. Atsikana ali pachiwopsezo chachikulu. Amapezeka ngati nyamakazi mu <4 mfundo: mawondo, akakolo, dzanja. Mwala. Mtundu uwu umasonyeza kuyanjana kwakukulu ndi kukhudzidwa kwa maso monga iridocyclitis (25%) yomwe ingayambitse khungu. Labs: RF-ve, ANA zabwino.
  • 2) Matenda a Polyarticular (25%): RF-ve. Atsikana ali pachiwopsezo chachikulu. Zimakhudza ziwalo zazing'ono ndi zazikulu nthawi zambiri zimakhudza msana wa Cervical
  • 3) Mawonekedwe amtundu wa JIA (20%): nthawi zambiri amakhala ndi mawonekedwe owopsa monga kutentha thupi, arthralgias, myalgias, lymphadeno[pathy, hepatosplenomegaly, polyserositis (pericardial/pleural effusion). Zofunikira za Dx zimakhala ndi zotupa zamtundu wa evanescent pinki pa malekezero ndi thunthu. Mawonekedwe a Systemic ali ndi kusowa kosiyana kwa kukhudzidwa kwa mawonekedwe. Zolumikizana zambiri nsapato palibe kukokoloka poyerekeza ndi mitundu ina. Chifukwa chake kuwonongeka kwamagulu sikumawonedwa

Kujambula mu JIA

Kujambula kwa matenda a ana el paso, tx.
  • Kukokoloka kwa mafupa a mafupa a patella cartilage / kukokoloka kwa mafupa kunachititsa kuti DJD
  • Zala ndi mafupa aatali kutsekedwa koyambirira kwa physeal / kufupikitsa miyendo
  • Rad DDx bondo/bondo: Hemophilic arthropathy Rx: DMARD.
  • Zovuta zimatha kuchitika kuwonongeka kwa mafupa, kuchepa kwa kukula / kufupikitsa miyendo, khungu, zovuta zadongosolo, kulumala.

Ma Neoplasms Odziwika Kwambiri a Ana Owopsa Pafupa

Kujambula kwa matenda a ana el paso, tx.
  • Osteosarcoma (OSA) & Ewing's sarcoma (ES) ndi 1 st ndi 2 M / C primary malignant bone bone neoplasms ya ubwana (pamwamba pa 10-20 yo) Zachipatala: kupweteka kwa mafupa, kusintha kwa ntchito, metastasis oyambirira makamaka pulmonary mets akhoza kuchitika. Kusazindikira bwino
  • Ma Ewing amatha kuwoneka ndi ululu wamfupa, kutentha thupi komanso kuchuluka kwa ESR/CRP motengera matenda. Dx yoyambirira yokhala ndi zithunzi ndi masitepe ndizofunikira.
  • Kujambula kwa OSA & ES: x-ray, yotsatiridwa ndi MRI, chifuwa CT, PET / CT. Pa x-ray: OSA ingakhudze fupa lililonse koma ambiri amapezeka ngati fupa laukali lomwe limapanga ma neoplasms pa bondo (50% milandu) makamaka ngati osteoid kupanga zilonda zaukali mu metaphysis ndi kulingalira / sunburst periostitis & Codman triangle. Kuwukiridwa kwa minofu yofewa.
  • ES ikhoza kupezeka mu shaft ndikuwonetsa kufalikira kwa minofu yofewa koyambirira. MRI ndiyofunikira kuti iwonetse kukula kwa mafupa ndi ST, MRI yofunikira pokonzekera opaleshoni
  • OSA & ES Rx: Kuphatikiza kwa opaleshoni, ma radiation, chemo. Njira zopulumutsira miyendo nthawi zina zimachitika. Kudziwikiratu kolakwika ngati kuzindikirika mochedwa.
Kujambula kwa matenda a ana el paso, tx.
  • Kujambula kwa Ewing's sarcoma
  • Kusokoneza mafupa
  • Kuwukira koyambirira komanso kozama kwa minofu yofewa
  • Aggressive periosteal reaction ndi laminated (anyezi khungu) kuyankha
  • Saucerisation of cortical bone (muvi wa lalanje)
  • Chotupa nthawi zambiri chimakhala diaphyseal chokhala ndi kukulitsa kwa metaphyseal
  • Amadziwika kuti Round cell chotupa limodzi ndi Multiple Myeloma ndi Lymphoma

Matenda Odziwika Paubwana

Kujambula kwa matenda a ana el paso, tx.
  • Neuroblastoma (NBL) Matenda a M/C a ukhanda. Amachokera ku neural crest cell aka PNET zotupa (mwachitsanzo, chifundo ganglia). Nthawi zambiri zimachitika mwa ana <24-miyezi. Ena amawonetsa zam'tsogolo zabwino koma> 50% ya milandu imakhala ndi matenda apamwamba. 70-80% ali ndi miyezi 18 kapena kuposerapo ali ndi metastasis yapamwamba. NBL ikhoza kukhala mu adrenal medulla, chifundo ganglia ndi malo ena. Amawoneka ngati misa m'mimba, kusanza. > 50% amawonetsa kupweteka kwa mafupa d/t metastasis. Zachipatala: kuyezetsa thupi, ma lab, kujambula: chifuwa ndi abd x-rays, mimba ya CT ndi chifuwa ndizofunikira kwa Dx. MRI ingathandize. NBL ikhoza kusauka ku chigaza ndi kulowa m'mitsempha yokhala ndi mawonekedwe ngati pathological sutural diastasis.
  • Matenda a m'magazi a khansa ya m'magazi ndi matenda a m/c aubwana. Pathology: kulowetsedwa kwa maselo a m'magazi a m'mafupa kumabweretsa kupweteka kwa mafupa ndikusintha maselo ena abwinobwino a m'mafupa ndi kuchepa kwa magazi, thrombocytopenia, neutropenia ndi zovuta zina. Maselo a leukemic amatha kulowa m'malo ena kuphatikiza CNS, ndulu, mafupa ndi zigawo zina. Dx: CBC, serum lactate dehydrogenase levels, Bone marrow aspiration biopsy ndiye chinsinsi. Kujambula kungathandize koma osafunikira kuti muzindikire. Pa radiography, kulowetsedwa kwa leukemic m'mafupa kumatha kuwoneka ngati ma radiolucent m'mbali mwa mbale ya kukula kwa physeal. Rx: chemotherapy ndi kuchiza zovuta
Kujambula kwa matenda a ana el paso, tx.
  • Medulloblastoma: M/C zoipa CNS neoplasm ana
  • Ambiri amakula asanakwanitse zaka 10
  • Malo a M / C: cerebellum ndi posterior fossa
  • Histologically imayimira chotupa chamtundu wa PNET osati glioma monga momwe amaganizira poyamba
  • MBL, komanso Ependymoma ndi CNS lymphoma, zingayambitse kugwa kwa metastasis kudzera mu CSF komanso kuimira zosiyana kwambiri ndi zotupa zina za CNS zimasonyeza kufalikira kwa metastatic kunja kwa CNS, m / c mpaka fupa.
  • 50% ya MBL ikhoza kukhala yokhazikika
  • Ngati Dx ndi chithandizo zimayamba metastasis isanayambe, kupulumuka kwa zaka 5 ndi 80%
  • Kujambula n'kofunika kwambiri: CT scanning ingagwiritsidwe ntchito koma njira yojambula ndi MRI yomwe idzaperekanso kuwunika kwapamwamba kwa neuraxis yonse ya metastasis.
  • MBL imawoneka ngati zilonda zamtundu wa heterogenous hypo, iso ndi hyperintense pa T1, T2 ndi FLAIR scans (zithunzi zapamwamba) poyerekeza ndi minofu yaubongo yozungulira. Nthawi zambiri kupondereza 4 ventricle ndi obstructive hydrocephalus. Chotupacho nthawi zambiri chimawonetsa kukwezeka kwa T1+C gad (chithunzi chakumanzere chakumanzere). Donthotsani metastasis kuchokera ku MBL yokhala ndi T1+C yokulitsa zotupa mu chingwe

Matenda Ofunika Kwa Ana

Kujambula kwa matenda a ana el paso, tx.
  • Mwana wakhanda/khanda <1month: kutentha thupi> 100.4 (38C) kungasonyeze matenda a bakiteriya komanso ma virus. Strep B, Listeria, E. Coli angayambitse sepsis, meningitis. Njira: chifuwa X-ray, lumbar puncture ndi chikhalidwe, magazi chikhalidwe, CBC, urinalysis.
  • Mwa ana ang'onoang'ono, Hemophilus influenza type B (HIB) imatha kuyambitsa Epiglottitis kukhala vuto losowa koma lalikulu. Katemera wamakono amathandizira kuchepetsa kuchuluka kwa matenda a Epiglottitis ndi matenda ena okhudzana ndi HIB.
  • Parainfluenza kapena RSV Kachilomboka kangayambitse Croup kapena pachimake Laryngotracheobronchitis.
  • Epiglottitis ndi Croup ndi Dx kuchipatala koma AP ndi khosi lofewa la minofu x-rays zothandiza kwambiri
  • Epiglottitis imakhala ndi "chizindikiro cha chala chachikulu" chomwe chimagwirizana ndi epiglottis d/t epiglottic edema. Izi zitha kukhala ngozi yoyika moyo pachiwopsezo chosokoneza ma airways (pamwamba kumanzere)
  • Mphungu ikhoza kuwonetsa "chizindikiro chopindika" kapena "chizindikiro cha botolo la vinyo" chokhala ndi hypopharynx yodziwikiratu ngati njira yochepetsetsa ya subglottic airway pa AP ndi khosi lofewa la x-ray (pamwamba kumanja)
  • Matenda a Syncytia Virus (RSV) ndi fuluwenza zimatha kuyambitsa chibayo cha virus chomwe chingakhale ndi zovuta zowopsa kwa omwe alibe chitetezo chamthupi, achichepere kwambiri komanso ana omwe ali ndi comorbidities. CXR ndiyofunikira (pakati kumanzere)
  • Streptococcal pharyngitis ndi matenda a GABHS angayambitse zovuta zina zowopsa kapena zochedwa (mwachitsanzo, Rheumatic fever)
  • Peritonsillar abscess (pamwamba pakati kumanja) Nthawi zina zimatha kukhala zovuta komanso zovuta chifukwa cha kufalikira kwa minofu yofewa m'khosi zomwe zimatha kufalikira m'malo a sublingual/submandibular (Ludwig Angina) pomwe njira zapamlengalenga ziyenera kuwongoleredwa d/t m'munsi mwa lilime edema.
  • Kukula kwa abscess retropharyngeal kungayambitse kufalikira kwa matendawa kudzera mukulankhulana momasuka kwa neck fascia zomwe zimapangitsa necrotizing mediastinitis, Lemmier syndrome ndi kuwukira kwa malo a carotid (zonse zomwe zitha kupha moyo)
  • Griesel syndrome- (pamwambapa pansi kumanzere) zovuta zachilendo zamtundu wa tonsillar / pharyngeal oral matenda omwe amatha kufalikira ku prevertebral space yomwe imatsogolera ku C1-2 ligaments laxity ndi kusakhazikika.
  • Matenda ena ofunika kwambiri kwa ana ndi chibayo cha bakiteriya (Pneumococcal), matenda a mkodzo ndi Acute Pyelonephritis (makamaka kwa atsikana) ndi Meningococcal Meningitis.
Kujambula kwa matenda a ana el paso, tx.
  • Matenda a Metabolic a Ana
  • Ma Rickets: amaonedwa kuti ndi osteomalacia mu chigoba chosakhwima. Zone of provisional calcification ya epiphyseal growth plate imakhudzidwa makamaka
  • Kuchipatala kumawonetsa kuchepa kwa kukula, kugwada kumalekezero, rosary ya rachitic, chifuwa cha nkhunda, nthiti zachisoni, mikono yokulirapo komanso yotupa, ndi akakolo, chigaza chamutu.
  • Pathology: Vit D ndi kuchepa kwa calcium ndiye chifukwa cha m/c. Kusowa padzuwa esp. wakhungu lakuda, zovala zoletsa kuti ziwonekere pakuwala, kuyamwitsa kwanthawi yayitali, veganism, malabsorption syndromes m'matumbo, kuwonongeka kwa aimpso ndi zina.
  • Kujambula: metaphysis yosweka aka utoto burashi metaphysis ndi kuyaka, kukulitsa mbale ya kukula, bulbous costochondral mphambano ngati rachitic rozari, kugwada kumalekezero.
  • Rx: thandizirani zomwe zimayambitsa, kuperewera kwa zakudya m'thupi, ndi zina.

Zothandizira

Mimba: Njira Yoyerekeza Kuzindikira | El Paso, TX.

Mimba: Njira Yoyerekeza Kuzindikira | El Paso, TX.

by | Kujambula & Kuzindikira

 

  • Kuzindikira matenda am'mimba kumatha kugawidwa m'magulu awiri:
  • Zolakwika za m'mimba thirakiti (m'mero, m'mimba, matumbo ang'onoang'ono & aakulu, ndi appendix)
  • Zowonongeka za ziwalo za m'mimba (Hepatobiliary & pancreatic disorders)
  • Matenda a genitourinary ndi ziwalo zoberekera
  • Zowonongeka za khoma la m'mimba ndi ziwiya zazikulu
  • Cholinga cha phunziroli ndi kupereka chidziwitso chofunikira kwambiri pazambiri kujambula zithunzi njira ndi kasamalidwe koyenera kachipatala kwa odwala omwe ali ndi matenda ambiri a m'mimba
  • Njira zowonetsera zomwe zimagwiritsidwa ntchito pofufuza madandaulo a m'mimba:
  • AP pamimba (KUB) ndi CXR yowongoka
  • Kujambula kwa CT m'mimba (ndi pakamwa ndi IV kusiyana ndi w/o kusiyana)
  • Maphunziro apamwamba ndi apansi a GI Barium
  • Ultrasonography
  • MRI (yomwe imagwiritsidwa ntchito kwambiri ngati MRI ya Chiwindi)
  • MRI enterography & enteroclysis
  • MRI rectum
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) - makamaka hepatobiliary ndi pancreatic ductal pathology.
  • Kujambula kwa nyukiliya

N'chifukwa Chiyani Mukufuna X-ray Yam'mimba?

chithunzi cha matenda a m'mimba el paso tx.

 

  • Phatikizani kuwunika koyambirira kwa mpweya wa m'matumbo pakachitika mwadzidzidzi. Mwachitsanzo, kafukufuku wolakwika mwa wodwala wochepa kwambiri angapewe kufunikira kwa CT kapena njira zina zowononga.
  • Kuwunika kwa machubu a radiopaque, mizere, ndi ma radiopaque akunja
  • Post-procedural evaluation intraperitoneal/retroperitoneal free gasi
  • Kuyang'anira kuchuluka kwa mpweya wa m'matumbo ndi kusintha kwa postoperative (adynamic) ileus
  • Kuyang'anira kanjira kakusiyana kudzera m'matumbo
  • Maphunziro opita ku colonic
  • Kuyang'anira aimpso calculi

 

chithunzi cha matenda a m'mimba el paso tx.

 

Zomwe Muyenera Kudziwa pa AP Pamimba: Supine vs. Upright vs. Decubitus

  • Mpweya Waulere (pneumoperitoneum)
  • Kutsekeka kwa m'mimba: Ziphuphu zowonongeka: SBO vs LBO (lamulo la 3-6-9) SB-pamwamba malire-3-cm, LB-pamwamba malire-6-cm, Caecum-pamwamba malire-9-cm. Zindikirani kutayika kwa haustra, kukulitsa chidziwitso (kukhalapo) kwa valvule conivente (plica semilunaris) mu SBO
  • SBO: zindikirani kutalika kosiyanasiyana kwamadzi amadzimadzi pamakwerero afilimu owongoka� mawonekedwe, ofanana ndi SBO
  • Zindikirani kuchepa kwa gasi wa rectal/colonic (ochotsedwa) mu SBO

 

chithunzi cha matenda a m'mimba el paso tx.

 

  • CT scanning m'mimba -modality kusankha pa kafukufuku pachimake ndi aakulu madandaulo m`mimba makamaka akuluakulu. Mwachitsanzo, zilonda zam'mimba zimatha kuzindikirika bwino ndikuyika zidziwitso zachipatala pokonzekera chisamaliro
  • Ultrasound ya m'mimba, aimpso ndi pelvic akhoza kuchitidwa kuti athandize matenda a appendicitis (makamaka ana), pachimake & aakulu mtima matenda matenda, hepatobiliary abnormalities, obstetric ndi gynecological pathology.
  • Kugwiritsa ntchito ma ionizing radiation (x-ray & CT) kuyenera kuchepetsedwa mwa ana ndi magulu ena omwe ali pachiwopsezo.

 

chithunzi cha matenda a m'mimba el paso tx.

 

Kuyerekeza Kuzindikira Matenda Akuluakulu a M'mimba

  • 1) Matenda am'mimba
  • 2) Gastric carcinoma
  • 3) Gluten Sensitive Enteropathy
  • 4) Matenda Otupa
  • 5) Pancreatic ductal adenocarcinoma
  • 6) Colorectal carcinoma
  • 7) Acute appendicitis
  • 8) Kutsekeka kwamatumbo ang'onoang'ono
  • 9) Zovuta

Matenda a Esophageal

  • Achalasia (primary achalasia): Kulephera kwa dongosolo la esophageal peristalsis d/t kulephera kupumula kwa m'munsi esophageal sphincter (LOS) ndi kufalikira kwapakhosi komanso kukhazikika kwa chakudya. Kutsekeka kwa distal esophagus (nthawi zambiri chifukwa cha chotupa) kumatchedwa "secondary achalasia" kapena "pseudoachalasia." Peristalsis mu gawo la minofu yosalala ya m'mero ​​imatha kutayika chifukwa cha kusakhazikika kwa Auerbach plexus (yomwe imayambitsa kupumula kwa minofu). . Ma vagus neurons amathanso kukhudzidwa
  • Pulayimale: 30 -70s, M: F ofanana
  • Matenda a Chagas (Trypanosoma Cruzi matenda) ndi kuwonongedwa kwa minyewa ya Myenteric plexus ya GI system (megacolon & esophagus)
  • Komabe, mtima ndi chiwalo chokhudzidwa ndi M / C
  • Zachipatala: Dysphagia kwa zolimba zonse ndi zamadzimadzi, poyerekeza ndi dysphagia ya zolimba pokhapokha milandu ya esophageal carcinoma. Kupweteka pachifuwa ndi regurgitation. M / C pakati esophageal squamous cell carcinoma pafupifupi 5% chifukwa cha kukwiya kosalekeza kwa mucosa ndi stasis ya chakudya ndi secretions. Chibayo cha aspiration chikhoza kukula. Candida esophagitis
  • Kujambula: �Mlomo wambalame� kumtunda kwa GI barium kumeza, kufutukuka kummero, kutayika kwa peristalsis. Kuyesedwa kwa endoscopic ndikofunikira.
  • Rx: zovuta. Calcium channel blockers (kanthawi kochepa) . Jekeseni wa poizoni wa botulinum amatha pafupifupi. 85 miyezi mankhwala. Ikhoza kuwononga submucosa yomwe imatsogolera ku chiwopsezo chowonjezereka cha kuwonongeka kwa myotomy wotsatira. Opaleshoni ya myotomy (Heller myotomy)
  • 10 -30% ya odwala amakhala ndi gastroesophageal reflux (GERD)

 

chithunzi cha matenda a m'mimba el paso tx.

 

  • Presbyesophagus: Amagwiritsidwa ntchito pofotokozera mawonetseredwe a kuwonongeka kwa kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe kake
  • Odwala akhoza kudandaula za dysphagia kapena kupweteka pachifuwa, koma ambiri ndi asymptomatic
  • Diffuse/distal esophageal spasm (DES) Ndi vuto la kusayenda kwam'mero ​​lomwe limatha kuwoneka ngati kumeza kwa mkanda kapena mkanda wa rozari pamamezedwe a barium.
  • 2% ya ululu pachifuwa chosakhala ndi mtima
  • Manometry ndiyeso yoyezera golide.
chithunzi cha matenda a m'mimba el paso tx.

 

  • Zenker diverticulum (ZD) thumba la pharyngeal
  • Kutuluka pamlingo wa hypopharynx, kuyandikira kumtunda kwa esophageal sphincter, komwe kumadziwika kuti Killian dehiscence kapena Killian triangle.
  • Odwala ali ndi zaka 60-80 ndipo alipo ndi dysphagia, regurgitation, halitosis, globus sensation.
  • Zitha kukhala zovuta pakulakalaka komanso zovuta zam'mapapo
  • Odwala amatha kudziunjikira mankhwala
  • ZD- ndi pseudodiverticulum kapena pulsion diverticulum yochokera ku herniation ya submucosa kudzera mu Killian dehiscence, kupanga sac komwe chakudya ndi zina zimatha kudziunjikira.
chithunzi cha matenda a m'mimba el paso tx.

 

  • Matenda a Mallory-Weiss Amatanthawuza misozi ya mucosal ndi submucosal ya distal esophageal venous plexus yomwe imagwirizanitsidwa ndi chiwawa / kusanza ndi kuwonetsa zam'mimba za m'munsi. Zidakwa ndizomwe zili pachiwopsezo chachikulu. Matendawa amapezeka ndi hematemesis yopanda ululu. Chithandizo chimakhala chothandizira.
  • Dx: kujambula kumagwira ntchito pang'ono, koma kusiyanitsa kwa esophagram kumatha kuwonetsa misozi ya mucosal yodzazidwa mosiyanitsa (chithunzi chakumanja chakumanja). Kusanthula kwa CT kungathandize kuchotsa zomwe zimayambitsa magazi a GI apamwamba
chithunzi cha matenda a m'mimba el paso tx.

 

  • Boerhaave syndrome: kuphulika kwam'mero ​​kwachiwiri mpaka kusanza mwamphamvu
  • Kufotokozera: M>F, kusanza, kupweteka pachifuwa, mediastinitis, septic mediastinum, pneumomediastinum, pneumothorax pleural effusion
  • M'mbuyomu, zinali zakupha nthawi zonse
  • Njira zimaphatikizapo kutulutsa m'mimba mwamphamvu makamaka ndi zakudya zazikulu zosagawika pamene esophagus imagwira mwamphamvu motsutsana ndi glottis yotsekedwa ndipo 90% imachitika kumanzere kwa khoma la posterolateral.
chithunzi cha matenda a m'mimba el paso tx.

 

  • Hiatus hernias (HH): kutulutsa zamkati m'mimba kudzera mum'mero ​​kutha kwa diaphragm kupita ku thoracic cavity.
  • Odwala ambiri omwe ali ndi HH amakhala opanda zizindikiro, ndipo ndikupeza mwangozi. Komabe, zizindikiro zingaphatikizepo kupweteka kwa epigastric / chifuwa, postprandial fullness, nseru ndi kusanza.
  • Nthawi zina HH imatengedwa kuti ndi yofanana ndi matenda a reflux a gastro-oesophageal (GORD), koma pali kugwirizana koyipa pakati pa mikhalidwe iwiriyi!
  • Mitundu iwiri: chophukacho chotsetsereka 2% & chophukacho (paraoesophageal) chophukacho 90%. Chotsatiracho chikhoza kufooketsa zomwe zimabweretsa ischemia ndi zovuta.
chithunzi cha matenda a m'mimba el paso tx.

 

  • Esophageal Leiomyoma ndi M/C benign esophageal neoplasm. Nthawi zambiri imakhala yayikulu koma yosasokoneza. Zotupa zam'mimba za m'mimba (GIST) ndizochepa kwambiri pakhosi. Ayenera kusiyanitsidwa ndi Esophageal carcinomas.
  • Kujambula: kusiyanitsa esophagram, kumtunda kwa GI barium kumeza, CT scanning. Gastroesophagoscopy ndi njira ya Dx yosankha.

chithunzi cha matenda a m'mimba el paso tx.

  • Esophageal carcinoma: kuwonjezereka kwa dysphagia, koyambirira kwa zolimba ndikupita ku zakumwa ndi kutsekeka muzochitika zapamwamba kwambiri
  • <1% ya khansa zonse ndi 4-10% ya matenda onse a GI. Pali kuzindikirika kwa amuna omwe ali ndi squamous cell subtype chifukwa cha kusuta ndi mowa. Barrett esophagus ndi adenocarcinoma
  • M: F 4:1. Anthu akuda ndi omwe ali pachiwopsezo kwambiri kuposa azungu 2:1. Kuneneratu koyipa!
  • Kumeza kwa barium kumatha kuzindikira misa ya esophageal. Gastroesophagoscopy (endoscopy) amatsimikizira matenda ndi minofu biopsy
  • Pazonse, zilonda zofala kwambiri ndi 2ndary gastric fundal carcinoma invading distal esophagus.
  • Squamous cell imapezeka pakatikati pa esophagus, Adenocarcinoma kudera la distal
chithunzi cha matenda a m'mimba el paso tx.
  • Gastric carcinoma: chotupa chachikulu cha m'mimba epithelium. Osowa kwambiri asanakwanitse zaka 40. Zaka zapakati pa matenda ku United States ndi zaka 70 kwa amuna ndi zaka 74 kwa akazi. Mayiko a Japan, South Korea, Chile, ndi Eastern Europe ali ndi chiwerengero chachikulu kwambiri cha khansa ya m'mimba padziko lapansi. Chiwopsezo cha khansa ya m'mimba chikutsika padziko lonse lapansi. Khansara ya m'mimba ndi 5th yomwe imayambitsa imfa yokhudzana ndi khansa. Kuyanjana ndi matenda a Helicobacter pylori 60- 80%, koma 2% yokha ya anthu omwe ali ndi H. Pyloris amakhala ndi khansa ya m'mimba. 8-10% ali ndi gawo lobadwa nalo m'mabanja.
  • Gastric Lymphoma imagwirizananso ndi matenda a H. Pyloris. Gastrointestinal Stromal Cell Tumor kapena GIST ndi neoplasm ina yomwe imakhudza m'mimba
  • Zachipatala: Palibe zizindikiro pamene ili pamwamba komanso yokhoza kuchiritsidwa. Mpaka 50% ya odwala akhoza kukhala ndi madandaulo osakhala enieni a GI. Odwala atha kukhala ndi anorexia ndi kuchepa thupi (95%) komanso ululu wosadziwika bwino wa m'mimba. Mseru, kusanza, ndi kukhuta koyambirira kumatha kuchitika ndi zotupa zazikulu kapena zotupa zolowa zomwe zimasokoneza kutukuka kwa m'mimba.
  • Zoneneratu: Makhansa ambiri am'mimba amapezeka mochedwa ndipo amatha kuwonetsa kuukira kwanuko ndi adenopathy, chiwindi, ndi kufalikira kwa mesenteric. Kupulumuka kwazaka 5 kwa 20% kapena kuchepera. Ku Japan ndi S. Korea, mapulogalamu owunika koyambirira adawonjezera kupulumuka mpaka 60%
  • kulingalira: Barium upper GI kuphunzira, CT scanning. Kuyeza kwa endoscopic ndiyo njira yodziwira matenda. Pakuyerekeza, khansa ya m'mimba imatha kuwoneka ngati kuchuluka kwa exophytic (polypoid) kapena mtundu wa Fungative, Ulcerative kapena Infiltrative/diffuse type (Linitis Plastica). Kuwunika kwa CT ndikofunikira kuti muwunikire kuukira kwanuko (node, mesentery, chiwindi, ndi zina).
chithunzi cha matenda a m'mimba el paso tx.
  • Matenda a Celiac aka non-tropical sprue aka Gluten-sensitive enteropathy: T-cell mediated autoimmune chronic gluten-induced mucosal kuwonongeka komwe kumabweretsa kutaya kwa villi m'matumbo ang'onoang'ono komanso m'mimba malabsorption (ie, sprue). Amaganiziridwa zina za chitsulo akusowa magazi m`thupi cha undetermined chifukwa. Odziwika ku Caucasus (1 mu 200) koma osowa ku Asia ndi anthu akuda. Pamwamba pawiri: kagulu kakang'ono muubwana woyambirira. Nthawi zambiri muzaka za 3 ndi 4 za moyo.
  • Zachipatala: Kupweteka kwa m'mimba ndi chizindikiro cha m / c, kutayika kwa zakudya / mavitamini: IDA ndi guaiac-positive chimbudzi, kutsegula m'mimba, kudzimbidwa, steatorrhea, kuchepa thupi, kufooka kwa mafupa / osteomalacia, dermatitis herpetiformis. Kuchulukitsa kuyanjana ndi T-cell lymphoma, Kuchulukitsa kuyanjana ndi esophageal squamous cell carcinoma, SBO
  • Dx: Upper GI endoscopy yokhala ndi ma duodenal biopsies angapo amawonedwa ngati a matenda muyezo kwa matenda a celiac. Histology imasonyeza kulowetsedwa kwa T-cell ndi lymphoplasmacytosis, Villi atrophy, Crypts hyperplasia, Submucosa, ndi Serosa ndizopulumuka. Rx: kuchotsa zinthu zomwe zili ndi gluten
  • Kujambula: Sikofunikira kwa Dx koma pa Barium kumeza fluoroscopy: mucosal atrophy ndi kuwonongedwa kwa mucosal folds (zochitika zapamwamba zokha). Kuchulukitsa kwa SB ndiko kupeza kodziwika kwambiri. Nodularity of the duodenum (bubbly duodenum). Kusintha kwa makwinya a jejunal ndi ileal mucosal:
  • �Jejunamu amaoneka ngati leamu, leamu amaoneka ngati jejunum, ndipo duodenum amaoneka ngati gehena.
chithunzi cha matenda a m'mimba el paso tx.

Matenda Otupa: Matenda a Crohn (CD) & Ulcerative Colitis (UC)

  • CD: Kutupa kwapang'onopang'ono-kuchotsa autoimmune kutupa komwe kumakhudza gawo lililonse la thirakiti la GI kuchokera pakamwa kupita ku anus koma poyambira nthawi zambiri kumakhudza kutha kwa ileamu. Kuwonetsera kwa M / C: kupweteka m'mimba / kupweteka ndi kutsekula m'mimba. Njira: mapangidwe a granulomata omwe mosiyana ndi UC ndi transmural, omwe angayambitse kukhwima. Madera omwe amakhudzidwa ndi kutupa nthawi zambiri amakhala ochepa
  • Zovuta ndizochuluka: kuperewera kwa zakudya / mavitamini (kusowa kwa magazi m'thupi, kufooka kwa mafupa, kuchedwa kwa kukula kwa ana, kutenga matenda a GI, kutsekeka kwamatumbo, kupanga fistula, mawonetseredwe owonjezera a m'mimba: uveitis, nyamakazi, AS, erythema nodosum ndi ena. angafunike opaleshoni m'mimba pambuyo 10-zaka za CD kawirikawiri kwa strictures, fistiluzation, BO.
  • Dx: zachipatala, CBC, CMP, CRP, ESR, mayesero a serological: DDx ya IBD: anti-Saccharomyces cerevisiae antibodies (ASCA), perinuclear antineutrophil cytoplasmic antibody (p-ANCA) histologically kapena mu seramu. Kuyesa kwa Fecal Calprotectin kumathandizira DDx IBS ndikuwunika kuyankha kwamankhwala, zochitika za matenda / kubwereranso.
  • Dx yosankha: endoscopy, ileoscopy, ndi ma biopsies angapo amatha kuwonetsa kusintha kwa endoscopic ndi histological. Video capsule endoscopy (VCE), Imaging ingathandize ndi Dx ya zovuta. Rx: mankhwala osokoneza bongo, mankhwala owonjezera, zakudya, ma probiotics, opaleshoni. Palibe mankhwala koma cholinga chake ndikuyambitsa chikhululukiro, kuwongolera zizindikiro ndi kupewa/kuchiza zovuta
  • Kujambula Dx: KUB kupita ku DDx SBO, Barium enema (kusiyana kumodzi ndi kawiri), matumbo aang'ono amatsatira. Zomwe anapeza: kudumpha zilonda, zilonda zam'mimba / zakuya, mabala a fistula / sinus, chizindikiro cha chingwe, zokwawa zoweta zimakankhira malupu a LB, maonekedwe a cobblestone d / t fissures / zilonda zomwe zimakankhira mucosa, CT scanning ndi oral ndi IV kusiyana.
chithunzi cha matenda a m'mimba el paso tx.
  • Kujambula kuchokera kwa wodwala wa Crohn yemwe anali ndi matumbo ang'onoang'ono kuti atseke.
  • (A) CT scan ikuwonetsa kutupa komwe sikodziwika
  • (B) MRE wa dera lomwelo limasonyeza fibrostenotic stricture
chithunzi cha matenda a m'mimba el paso tx.
  • UC: Makhalidwe amakhudza m'matumbo okha, koma msana wa ileitis ukhoza kukula. Kuyamba kumakhala pa 15-40s ndipo kumakhala kofala kwambiri mwa amuna, koma kuyambika pambuyo pa zaka 50 kumakhala kofala. Zambiri ku North America ndi Europe (hygiene hypothesis). Etiology: Kusintha kwa chilengedwe, majini ndi matumbo a microbiome kumakhudzidwa. Kusuta fodya ndi appendectomy oyambirira amakonda kusonyeza kuyanjana koipa ndi UC, mosiyana ndi CD amaganizira zina mwa zinthu zoopsa.
  • Zachipatala: Kutuluka magazi m'matumbo (wamba), kutsekula m'mimba, kutuluka kwa mucous m'matumbo, tenesmus (nthawi zina), kupweteka kwa m'mimba ndi kutaya madzi ambiri kuchokera ku purulent rectal discharge (zazovuta kwambiri, makamaka okalamba), fulminant colitis ndi megacolon yapoizoni imatha kukhala ya fetal koma ndizovuta zomwe sizichitikachitika. . Pathology: Palibe granulomata. Zilonda zimakhudza mucosa ndi submucosa. Ma pseudopolyps amawoneka ngati mucosa otetezedwa.
  • Njira yoyamba nthawi zonse imakhudza rectum ndikukhalabe matenda am'deralo (proctitis) mu (25%). 30% Proximal matenda owonjezera amatha kuchitika. UC imatha kuwoneka ngati yakumanzere (55%) ndi pancolitis (10%). Nthawi zambiri zimakhala zochepera mpaka zocheperako
  • Dx: colonoscopy yokhala ndi ileoscopy yokhala ndi ma biopsies angapo imatsimikizira Dx. Labs: CBC, CRP, ESR, Fecal calprotectin, Zovuta: kuchepa magazi, megacolon yapoizoni, khansa ya m'matumbo, matenda owonjezera amatumbo: nyamakazi, uveitis, AS, Pyoderma gangrenosum, Primary sclerosing cholangitis. Rx: 5-aminosalicylic acid oral or rectal topical therapy, corticosteroids, immunomodulatory drugs, colectomy ndi machiritso.
  • Kujambula: sikofunikira kwa Dx koma barium enema ikhoza kuwonetsa zilonda, kusindikiza thumbprint, m'mikhalidwe yapamwamba kutaya kwa haustra ndi kuchepetsedwa kwa colon yomwe imapanga � lead-pipe colon. milandu. CT ikhoza kuthandizira ndi Dx ya zovuta. Chithunzi chopanda filimu chimavumbulutsa "matumbo a lead-pipe" ndi sacroiliitis ngati Enteropathic arthritis (AS)
chithunzi cha matenda a m'mimba el paso tx.
  • Colorectal carcinoma (CRC) m/c khansa ya thirakiti la GI ndi 2nd yowopsa kwambiri mwa akulu. Dx: endoscopy ndi biopsy. CT ndiyo njira yomwe imagwiritsidwa ntchito kwambiri popanga masitepe. Kuchotsa opaleshoni kungakhale kochiritsira ngakhale kuti zaka zisanu zopulumuka ndi 40- 50% kutengera siteji. Zowopsa: kutsika kwa ulusi ndi mafuta ambiri komanso zakudya zama protein, kunenepa kwambiri (makamaka mwa amuna), matenda am'matumbo osatha. Colonic adenomas (polyps). Familial adenomatous polyposis syndromes (Gardener syndrome) ndi matenda a Lynch monga polyposis omwe si abanja.
  • Zachipatala: kuyambika mochenjera ndi zizolowezi zosinthika zamatumbo, magazi atsopano kapena melena, kusowa kwachitsulo kuperewera kwa magazi kuchokera ku kutaya magazi kwamatsenga kwanthawi yayitali makamaka mu zotupa zakumanja. Kutsekeka kwa matumbo, kutengeka, kutulutsa magazi kwambiri komanso matenda a metastatic makamaka ku Chiwindi kungakhale kuwonetsa koyamba. Njira: 98% ndi adenocarcinomas, amachokera ku ma colonic adenomas omwe analipo kale (neoplastic polyps) okhala ndi kusintha koyipa. Kupulumuka kwazaka zisanu ndi 40-50%, ndi sitepe yogwira ntchito chinthu chimodzi chofunika kwambiri chomwe chimakhudza kudwala. M / C zotupa za rectosigmoid (55%),
  • NB Ena adenocarcinomas esp. mitundu ya mucinous nthawi zambiri imawonetsedwa mochedwa ndipo nthawi zambiri imakhala ndi matenda osadziwika bwino chifukwa cha kuwonetsa mochedwa komanso katulutsidwe ka mucin komanso kufalikira kwanuko/kutali
  • Kujambula: Barium enema ndizovuta za polyps> 1 masentimita, kusiyana kumodzi: 77-94%, kusiyanitsa kawiri: 82-98%. Colonoscopy ndi njira yosankha yopewera, kuzindikira, ndi kuzindikira colorectal carcinoma. Kuwunika kowonjezera kofananira kumagwiritsidwa ntchito powunikira ndikuwunika kwa mets.
  • Kuwunika: colonoscopy: amuna 50 yo-10-zaka ngati zabwinobwino, zaka 5 ngati polypectomy, FOB, 1st digiri wachibale ndi CA amayamba kuyang'aniridwa ali 40 yo
chithunzi cha matenda a m'mimba el paso tx.

 

chithunzi cha matenda a m'mimba el paso tx.
  • Khansa ya Pancreatic: ductal epithelial adenocarcinoma (90%), kulosera koyipa kwambiri komwe kumafa kwambiri. 3rd M / C khansa ya m'mimba. Mphuno ndi #1, mimba #2. Khansara ya kapamba imachititsa 22 peresenti ya imfa zonse chifukwa cha matenda a m'mimba, ndi 5 peresenti ya imfa zonse za khansa. 80% ya milandu mu 60+. Kusuta fodya ndiye chinthu champhamvu kwambiri pachiwopsezo cha chilengedwe, chakudya chokhala ndi mafuta anyama ndi mapuloteni. Kunenepa kwambiri. Mbiri ya banja. M / C wapezeka mutu ndi uncinate ndondomeko.
  • Dx: Kusanthula kwa CT ndikofunikira. Kuwukira kwa Superior Mesenteric Artery (SMA) kumawonetsa matenda osachiritsika. 90% ya pancreatic adenocarcinomas ndi yosachotsedwa ku Dx. Odwala ambiri amamwalira mkati mwa 1-chaka cha Dx. Zachipatala: jaundice yopanda ululu, abd. Ululu, ndulu ya Courvoisier: jaundice yosapweteka ndi ndulu yokulirapo, Trousseau's syndrome: migratory thrombophlebitis, new start diabetes mellitus, dera komanso metastasis yakutali.
  • CT Dx: pancreatic misa yokhala ndi mphamvu ya desmoplastic reaction, kukulitsa kosakwanira, komanso kutsika pang'ono poyerekeza ndi chithokomiro choyandikana nacho, kuwukira kwa SMA.
chithunzi cha matenda a m'mimba el paso tx.
  • Appendicitis: chikhalidwe chofala kwambiri mchitidwe wa radiology ndipo ndichomwe chimayambitsa opaleshoni ya m'mimba mwa odwala achichepere
  • CT ndiyo njira yovuta kwambiri yodziwira appendicitis
  • Ultrasound iyenera kugwiritsidwa ntchito mwa odwala achichepere ndi ana
  • KUB Radiographs sayenera kutenga nawo gawo pakuzindikira matenda a appendicitis
  • Pakujambula, appendicitis imawonetsa chowonjezera chotupa chokhala ndi khoma lokhuthala, kukulitsa, ndi kutsekeka kwamafuta a periappendiceal. Zotsatira zofananira zakukula kwa khoma ndi kukulitsa zimadziwika ku US. �chizindikiro chodziwikiratu) chimadziwika pamalo afupipafupi a US axis.
  • Ngati appendix ndi retro-caecal kuposa US angalephere kupereka molondola Dx ndi CT scanning ingafunike.
  • Rx: opareshoni kuti mupewe zovuta
chithunzi cha matenda a m'mimba el paso tx.
  • Zing'onozing'ono zochepa (SBO) -80% ya kutsekeka kwa matumbo am'makina; 20% yotsalayo imabwera chifukwa cha kutsekeka kwamatumbo akulu. Ili ndi chiwopsezo cha kufa kwa 5.5%
  • M / C chifukwa: Hx iliyonse ya opaleshoni yam'mimba yam'mbuyomu ndi zomatira
  • Kuwonetsedwa kwachikale ndi kudzimbidwa, kuwonjezereka kwa m'mimba ndi mseru ndi kusanza
  • Ma Radiographs ndi 50% yokha yomwe imakhudzidwa ndi SBO
  • CT idzawonetsa chifukwa cha SBO mu 80% ya milandu
  • Pali njira zingapo zochepetsera matumbo ang'onoang'ono, koma 3.5 cm ndikuyerekeza kwamatumbo ang'onoang'ono.
  • Pa Abd x-ray: supine vs woongoka. Matumbo otuluka, ma valvulae conivente otambasulidwa (mapindikidwe a mucosal), milingo yamadzi ena a mpweya "masitepe".
  • Rx: opareshoni ngati �mimba yowawa.�
chithunzi cha matenda a m'mimba el paso tx.
  • Volvulus-m/c mu Sigmoid colon esp. mu okalamba. Chifukwa chachikulu: kudzimbidwa kosatha ndikupindika kwa sigmoid pa sigmoid mesocolon. Zimayambitsa kutsekeka kwamatumbo akulu (LBO). Zomwe zimayambitsa: chotupa cha m'matumbo. Sigmoid vs. Caecum volvulus
  • Zachipatala: zizindikiro za LBO ndi kudzimbidwa, kutupa m'mimba, kupweteka, nseru, ndi kusanza. Kuyamba kungakhale koopsa kapena kosatha
  • Ma radiographically: kutayika kwa Haustra mu LB, LB distension (> 6-cm), �chizindikiro cha nyemba za khofi� chotsatira chotsatira, kumapeto kwa volvulus kumaloza ku pelvis.
  • NB: Lamulo la chala chachikulu pamatumbo otuluka ayenera kukhala 3-6-9 pomwe 3-cm SB, 6-cm LB & 9-cm Coecum
  • Rx: opareshoni ngati �mimba yowawa.�
chithunzi cha matenda a m'mimba el paso tx.

Zothandizira

 

Matenda a Chifuwa Njira Yowunikira Kujambula

Matenda a Chifuwa Njira Yowunikira Kujambula

by | Kujambula & Kuzindikira

Core Anatomy

  • Onani mibadwo ya mtengo wa tracheal-bronchial, lobes, magawo, ndi ming'alu. Onani pulmonary lobule yachiwiri (1.5-2-cm) -gawo loyambira la mapapu lomwe limawonedwa pa HRCT. Zindikirani zofunika structural bungwe la alveolar mipata ndi kulankhulana pakati (pores wa Kohn & ngalande za Lambert) kuti amalola mpweya kutengeka ndi njira yomweyo kulola exudative kapena transudative madzimadzi kufalikira m'mapapo ndipo anaima pa kupasuka. Zindikirani mawonekedwe a pleura: parietal yomwe ili gawo la endothoracic fascia ndi visceral yomwe imapanga m'mphepete mwa mapapo � pleural space pakati.

 

Kujambula kwa chifuwa cha paso tx.

 

  • Mediastinum: wozunguliridwa ndi pleura ndi mapapo. Imakhala ndi zigawo zazikuluzikulu zimakhala ndi ma lymph nodes ambiri (onani chithunzi chosonyeza ma mediastinal node ndi kutenga nawo gawo mu Lymphoma

 

Kujambula kwa chifuwa cha paso tx.

 

Njira Yonse Yofufuza Madandaulo a Chifuwa

  • Kuyeza kwa Radiographic (Chifuwa X-ray CXR); zabwino kwambiri 1 sitepe. Kutsika mtengo, kutsika kwa radiation, kuwunika madandaulo angapo azachipatala
  • CT scanning: chifuwa CT, High-Resolution CT (HRCT)
  • Njira zapathology m'chifuwa:
  • Zovuta
  • Kutenga
  • Neoplasms
  • Edema yamaphunziro
  • Pulmonary emphysema
  • Atelectasis
  • Pleural pathology
  • Mediastinum

PA & Lateral CXR

Kujambula kwa chifuwa cha paso tx.

 

  • Mawonedwe owonjezera angagwiritsidwe ntchito:
  • Maonedwe a Lordotic: amathandizira kuwunika madera a apical
  • Decubitus amayang'ana kumanja ndi kumanzere: kuthandizira kuyesa kutulutsa kobisika kwa pleural, pneumothorax ndi matenda ena.

 

Kujambula kwa chifuwa cha paso tx.

 

Kujambula kwa chifuwa cha paso tx.

 

  • Normal CXR PA & Lateral view. Onetsetsani kuti zikuwonekera bwino: ma T-spine discs ndi zotengera zodutsa pamtima zimawonetsedwa pakuwona kwa PA. Werengani 9-10 nthiti zakumbuyo zakumanja kuti mutsimikizire kulimbikira kokwanira. Yambani kufufuza mokwanira pogwiritsa ntchito njira iyi: Kodi Pali Zotupa Zambiri Zam'mapapo A-mimba/diaphragm, khoma la T-thorax, M-mediastinum, L-mapapu payokha, Mapapo-onse. Pangani njira yabwino yofufuzira

 

Kujambula kwa chifuwa cha paso tx.

 

  • 1) Airspace matenda aka alveolar m'mapapo matenda? Kudzaza m'mapapo alveoli, acini ndipo kenako lobe lonse ndi madzimadzi kapena chinthu chilichonse zikuchokera (mwazi, mafinya, madzi, mapuloteni kapena maselo maselo) Radiographically: lobar kapena segmental kugawa, airspace tinatake tozungulira tingadziŵike, chizolowezi coalesce, mpweya. bronchograms ndi silhouette chizindikiro. Kugawa kwa batwing (gulugufe) komwe kumadziwika kuti mu (CHF). Kusintha kwachangu pakapita nthawi, mwachitsanzo, kuchuluka kapena kuchepa (masiku)
  • 2) Interstitial matenda: kulowa m`mapapo mwanga interstitium (alveoli septum, mapapo parenchyma, chotengera makoma, etc.) mwachitsanzo ndi mavairasi, mabakiteriya ang'onoang'ono, protozoans. Komanso kulowetsedwa ndi maselo monga maselo otupa / owopsa (mwachitsanzo, ma lymphocytes) Amawonetsedwa ngati kutsindika kwa mapapo interstitium ndi reticular, nodular, mix reticulonodular pattern. Ma etiologies osiyanasiyana: kutupa matenda oponderezedwa, matenda a m'mapapo, matenda a m'mapapo a ntchito, matenda a viral/mycoplasma, TB, sarcoidosis lymphoma/leukemia ndi zina zambiri.

 

Kujambula kwa chifuwa cha paso tx.

 

  • Kuzindikira mitundu yosiyanasiyana ya matenda a m'mapapo kungathandize ndi DDx. Misa vs. Consolidation (kumanzere). Zindikirani njira zosiyanasiyana zamatenda a m'mapapo: matenda a airspace monga kuphatikiza kwa lobar kuwonetsa chibayo, kuphatikiza kophatikizana komwe kumawonetsa pulmonary edema. Atelectasis (kugwa ndi kutayika kwa voliyumu). Mitundu yapakati ya matenda a m'mapapo: reticular, nodular kapena mix. SPN vs. Magulu angapo ophatikizika (nodule) omwe mwina akuyimira ma mets olowera motsutsana ndi kulowerera kwa septic

 

Kujambula kwa chifuwa cha paso tx.

 

  • A = intraparenchymal
  • B = pleural
  • C = extrapleura
  • Zindikirani malo ofunikira a zotupa pachifuwa

 

Kujambula kwa chifuwa cha paso tx.

 

  • Zizindikiro zofunika: Chizindikiro cha Silhouette: Thandizo pakukhazikitsa ndi DDx. Chitsanzo: Chithunzi chakumanzere chakumanzere: Kuchuluka kwa radiopacity m’mapapo kumanja, kuli kuti? Kumanja MM chifukwa malire amtima wakumanja omwe ali moyandikana ndi lobe yapakati kumanja sakuwoneka (yopangidwa ndi silhouetted) Ma bronchogram: mpweya wokhala ndi bronchi/bronchioles wozunguliridwa ndi madzi.

 

Kujambula kwa chifuwa cha paso tx.

 

Chifuwa cha Chifuwa

  • Pneumothorax (PTX): mpweya (gasi) mu pleural space. Zifukwa zambiri. Zovuta:
  • Kuthamanga kwa PTX: Kuwonjezeka kosalekeza kwa mpweya mu pleural space yomwe imakanikiza mediastinum ndi mapapo mwachangu kumachepetsa kubwerera kwa venous kumtima. Zitha kupha ngati sizikuthandizidwa mwachangu
  • PTX yodziwikiratu: yoyambirira (achinyamata achikulire (30 -40) makamaka amuna aatali, owonda. Zina zowonjezera: Marfan's syndrome, EDS, Homocystinuria, a -1 -antitrypsin akusowa. , lung fibrosis ndi zisa, catamenial PTX d/t endometriosis ndi ena.
  • Traumatic pneumothorax: kuphulika kwa mapapo, kuvulala koopsa, iatrogenic (machubu pachifuwa, ndi zina zotero) kutema mphini, ndi zina zotero.
  • CXR: onani visceral pleural line aka mapapo m'mphepete. Kusowa kwa minyewa ya m'mapapo / zotengera kupitilira mzere wa visceral pleural. Wobisika pneumothorax akhoza kuphonya. Pamalo olunjika, mpweya umakwera ndipo PTX iyenera kufunidwa pamwamba.
  • Kuthyoka nthiti: v.common. Zowopsa kapena zoyambitsa matenda (mwachitsanzo, mets, MM) Mndandanda wa nthiti x - kunyezimira sizothandiza chifukwa CXR ndi / kapena CT scanning ndizofunikira kwambiri kuyesa kuvulala kwapambuyo kwa PTX (kumanzere kumanzere) ndi njira ina yayikulu.

 

Kujambula kwa chifuwa cha paso tx.

 

Kutenga

  • Chibayo: bakiteriya motsutsana ndi mavairasi kapena mafangasi kapena omwe alibe chitetezo chokwanira (monga Cryptococcus mu HIV/AIDS) Pulmonary TB

 

Kujambula kwa chifuwa cha paso tx.

 

  • Chibayo: chopezeka ndi anthu ammudzi vs. chopezeka kuchipatala. Chibayo chodziwika bwino cha bakiteriya kapena chibayo cha Lobar (chosakhala chagawo) chokhala ndi zinthu zotsekemera zodzaza alveoli ndikufalikira ku nsonga yonse. Matenda a M/C Streptococcus Pneumonia kapena Pneumococcus
  • Zina: (Staph, Pseudomonas, Klebsiella esp. mu zida zoledzeretsa zomwe zingathe kutsogolera ku necroSIS / gangrene ya m'mapapo) Mycoplasma (20-30s) akamayenda chibayo, ndi zina zotero.
  • Zachipatala: chifuwa chogwira mtima, kutentha thupi, kupweteka pachifuwa cha pleuritic nthawi zina hemoptysis.
  • CXR: Kuwonekera kwa airspace komwe kumangoyang'ana mbali zonse. Air bronchograms. Thandizo la silhouette ndi malo.
  • Viral: Influenza, VZV, HSV, EBV, RSV, ndi zina zotero zimasonyeza ngati matenda a m'mapapo omwe amatha kukhala awiri. Zitha kuyambitsa kusagwirizana kwa kupuma
  • Chibayo chosawoneka bwino ndi chibayo cha fungal: Mycoplasma, matenda a Legionnaire, ndi chibayo cha fungal/Cryptococcus chikhoza kukhala ndi matenda am'mapapo.
  • Chiphuphu cha m'mapapo: Kutoleredwa kwa zinthu zotulutsa purulent m'mapapo zomwe nthawi zambiri zimakhala ndi necrotize. Zitha kubweretsa zovuta zazikulu zam'mapapo ndi machitidwe / kuyika moyo pachiwopsezo.
  • Pa CXR kapena CT: zosonkhanitsira zozungulira zokhala ndi malire okhuthala ndi necrosis yapakati yokhala ndi mulingo wamadzi amadzi. DDx yochokera ku empyema yomwe imasokoneza mapapu ndi pleural-based
  • Rx: maantibayotiki, antifungal, antiviral agents.
  • Chibayo chiyenera kutsatiridwa ndi CXR yobwerezabwereza kuti muwonetsetse kuthetsa kwathunthu
  • Kuperewera kwa radiographic kwa chibayo kumatha kuwonetsa kuchepa kwa chitetezo chamthupi, kukana kwa maantibayotiki, carcinoma ya m'mapapo kapena zinthu zina zovuta.

TB ya m'mapapo

Kujambula kwa chifuwa cha paso tx.

 

  • Matenda ofala padziko lonse lapansi (maiko a 3rd world). Munthu mmodzi pa anthu atatu alionse padziko lonse amadwala TB. TB imayambitsidwa ndi Mycobacterium TB kapena Mycobacterium Bovis. Bacillus ya intracellular. Macrophage imagwira ntchito yofunika kwambiri.
  • Primary Pulmonary TB & Post-primary TB. Pamafunika kuwonetsedwa mobwereza bwereza pokoka mpweya. Ambiri immunocompetent makamu, yogwira matenda si kukula
  • TB ikuwoneka ngati 1) yoyeretsedwa ndi wolandirayo, 2) yoponderezedwa mu Latent Tuberculosis Infection (LTBI) 3) imayambitsa matenda a TB. Odwala omwe ali ndi LTBI sakufalitsa TB.
  • Kujambula: CXR, HRCT. TB yoyamba: kuphatikiza kwa pulmonary airspace consolidation (60%) kutsika kwa lobes, lymphadenopathy (95% - hilar & paratracheal), pleural effusion (10%). Kufalikira kwa TB yayikulu kwambiri mwa omwe alibe chitetezo chamthupi komanso ana.
  • Milliary TB: kufalikira kwa pulmonary ndi system complication komwe kumatha kupha
  • Matenda a post-primary (wachiwiri) kapena kubwezeretsanso: Nthawi zambiri mu Apices ndi zigawo zam'mbuyo za lobes zapamwamba )pamwamba PO2), 40% -zotupa za cavitating, patchy kapena confluent airspace disease, fibrocalcific. Zobisika: ma nodal calcifications.
  • Dx: Acid-fast bacilli (AFB) smear ndi chikhalidwe (sputum). HIV serology mwa odwala onse omwe ali ndi TB komanso kachirombo ka HIV kosadziwika
  • Rx: 4-mankhwala regimen: isoniazid, rifampin, pyrazinamide, mwina ethambutol kapena streptomycin.

Pulmonary Neoplasms (khansa yoyambirira ya m'mapapo vs. pulmonary metastasis)

  • Khansara ya m'mapapo: khansa ya m / c mwa amuna ndi khansa yachisanu ndi chimodzi mwa amayi. Kulumikizana kwakukulu ndi kutsekemera kwa carcinogens. Zachipatala: kupezeka mochedwa, malingana ndi malo a chotupacho. Matenda (mitundu): Maselo ang'onoang'ono (SCC) vs. Non-small cell carcinoma
  • Selo yaying'ono: (20%) imachokera ku neuroendocrine aka Kultchitsky cell, motero imatha kutulutsa zinthu zomwe zimagwira ntchito ndi paraneoplastic syndrome. Nthawi zambiri amakhala chapakati (95%) pafupi ndi mainstem/lobar bronchus. Ambiri amawonetsa kusazindikira bwino komanso kusasinthika.
  • Selo yosakhala yaing'ono: Lung adenocarcinoma (40%) (M/C khansa ya m'mapapo), M/C mwa amayi ndi osasuta. Zina: Squamous cell (ikhoza kukhala ndi cavitating lesion), Large cell ndi ena
  • Filimu yowoneka bwino (CXR): chotupa chatsopano kapena chokulirapo, chokulitsa mediastinum chosonyeza kukhudzidwa kwa ma lymph node, pleural effusion, atelectasis, ndi kuphatikiza. SPN-itha kuyimira khansa ya m'mapapo yomwe ingakhalepo makamaka ngati ili ndi malire osakhazikika, zotengera zodyetsera, khoma lakuda, m'mapapo apamwamba. Manodule angapo am'mapapo amatha kuyimira metastasis.
  • Njira Yabwino Kwambiri: HRCT yosiyana.
  • Mitsempha ina ya pachifuwa: Lymphoma ndi v. yofala pachifuwa makamaka m'manotsi am'mimba ndi mkati mwa mabere.
  • Pafupifupi M / C pulmonary neoplasms ndi metastasis. Zotupa zina zimawonetsa kupendekera kwakukulu kwa mapapu, mwachitsanzo, Melanoma, koma khansa iliyonse imatha kufalikira m'mapapo. Meta ena amatchedwa "Cannonball" metastasis
  • Rx: radiation, chemotherapy, resection

 

Kujambula kwa chifuwa cha paso tx.

 

  • Pulmonary edema: liwu lodziwika bwino limatanthawuza kuchuluka kwamadzimadzi kwachilendo kunja kwa mitsempha. Amagawidwa kwambiri mu Cardiogenic (mwachitsanzo, CHF, mitral regurgitation) ndi Non-cardiogenic ndi zifukwa zambiri (mwachitsanzo, kuchuluka kwa madzimadzi, pambuyo poika magazi, zimayambitsa mitsempha, ARDS, pafupi ndi kumira / kupuma, heroin overdose, ndi zina)
  • Zoyambitsa: kuchuluka kwa Hydrostatic pressure vs. kutsika kwa oncotic pressure.
  • Kujambula: CXR ndi CT: 2-mitundu ya Interstitial ndi Alveolar kusefukira. Kuwonetseratu kumatengera magawo
  • Mu CHF: Gawo 1: Kugawanso kwa mitsempha (10- 18-mm Hg) yodziwika ngati �cephalization� ya pulmonary vasculature. Gawo 2: Interstitial edema (18-25-mm Hg) Interstitial edema: peribronchial cuffing, Kerley mizere (mitsempha yodzaza madzi) A, B, C mizere. Gawo 3: Alveolar edema: matenda am'mlengalenga: kuphatikizika kwa zigamba kukukula kukhala matenda am'mlengalenga: Batwing edema, ma bronchogram.
  • Rx: Zolinga zazikulu 3: O2 Yoyamba kusunga O2 pa 90% machulukitsidwe
  • Kenako: (1) kuchepetsa pulmonary venous return (preload reduction), (2) kuchepetsa kwadongosolo kwa mitsempha ya mitsempha (kuchepetsa kuchepa kwapambuyo), ndi (3) chithandizo cha inotropic. Chitani zomwe zimayambitsa (mwachitsanzo, CHF)

 

Kujambula kwa chifuwa cha paso tx.

 

  • Lung atelectasis: Kukula kosakwanira kwa pulmonary parenchyma. Mawu akuti "mapapo ogwa" nthawi zambiri amasungidwa pamene mapapo onse agwa
  • 1) Resorptive (obstructive) atelectasis imachitika chifukwa cha kutsekeka kwathunthu kwa njira ya mpweya (mwachitsanzo, chotupa, zinthu zopumira, etc.)
  • 2) Passive (kupumula) atelectasis kumachitika pamene kulumikizana pakati pa parietal ndi visceral pleura kumasokonekera (pleural effusion & pneumothorax)
  • 3) Compressive atelectasis imachitika chifukwa cha chotupa chilichonse cha thoracic chomwe chimakhala ndi mapapo komanso kutulutsa mpweya mu alveoli.
  • 4) Cicatricial atelectasis: zimachitika chifukwa cha zilonda kapena fibrosis zomwe zimachepetsa kukula kwa mapapu monga matenda a granulomatous, chibayo cha necrotizing, ndi radiation fibrosis.
  • 5) Zomatira m'mapapo atelectasis zimachitika chifukwa chosowa surfactant ndi kugwa kwa alveolar.
  • 6) Zofanana ndi mbale kapena discoid nthawi zambiri zimayamba pambuyo potsatira anesthesia wamba
  • 7) Kujambula mawonekedwe: kugwa kwa mapapu, kusamuka kwa ming'alu ya mapapu, kupatuka kwa mediastinum, kukwera kwa diaphragm, hyperinflation ya mapapu oyandikana nawo osakhudzidwa.

 

Kujambula kwa chifuwa cha paso tx.

 

  • Mediastinum: Matenda amatha kugawidwa m'magulu omwe amachititsa kuti thupi likhale lokhazikika kapena lomwe limayambitsa matenda opatsirana okhudza mediastinum. Kuphatikiza apo, mpweya ukhoza kulowa mu mediastinum mu pneumomediastinum. Kudziwa za anatomy mediastinal kumathandiza Dx.
  • Anterior mediastinal mass: chithokomiro, thymus, teratoma/germ cell zotupa, lymphoma, lymphadenopathy, kukwera kwa aortic aneurysms.
  • Middle mediastinal misa: lymphadenopathy, mtima, zotupa za bronchial etc.
  • Mitsempha yam'mbuyo yam'mbuyo: zotupa za neurogenic, aortic aneurysms, misa yam'mimeo, unyinji wa msana, aortic chain adenopathy.

 

Kujambula kwa chifuwa cha paso tx.

 

  • Pulmonary emphysema: kutayika kwa minyewa yotanuka bwino / kufooka kwa mapapu ndikuwonongeka kwa ma capillaries ndi alveolar septum/interstitium.
  • Kuwonongeka kwa mapapo parenchyma chifukwa cha kutupa kosatha. Protease-mediated kuwonongeka kwa elastin. Kutsekera kwa mpweya / kukulitsidwa kwamlengalenga, hyperinflation, pulmonary hypertension, ndi kusintha kwina. Zachipatala: kusokonezeka kwapang'onopang'ono, kosasinthika. Panthawi yomwe mphamvu yopuma mokakamizidwa mu 1 sekondi (FEV1) yatsikira ku 50% wodwala akupuma pang'onopang'ono komanso amazolowera moyo.
  • COPD ndiye chifukwa chachitatu chakufa padziko lonse lapansi. Zimakhudza 1.4% ya akuluakulu ku US. M:F = 1 : 0.9. Pts zaka 45 ndi kupitirira
  • Zomwe zimayambitsa: Kusuta ndi kusowa kwa-1-Antitrypsin (kugawidwa kukhala centrilobular (kusuta) ndi panacinar.
  • Kujambula; zizindikiro za hyperinflation, kukoka mpweya, bullae, pulmonary hypertension.

 

Kujambula kwa chifuwa cha paso tx.

 

Kuvulala kwa Mutu Ndi Njira Zina Zofananira za Intra-Cranial Pathology

Kuvulala kwa Mutu Ndi Njira Zina Zofananira za Intra-Cranial Pathology

by | Kujambula & Kuzindikira

Kuvulala kwamutu: Kuthyoka Chigaza

mutu trauma imaging el paso tx.
  • SKULL FX: ZOWAMBIRITSA M'KONKHA ZOKHUDZA MTIMA. SKULL FX NTHAWI ZONSE ZINTHU ZINA ZOVUTA ZINTHU: INTRA-CRANIALHEMORRHAGING, KUCHEDWA KUBWERA WOPHUNZITSA UBONGO NDI MAVUTO ENA AKULU
  • MA X-RAY A CHIBADWE AMAKHALA CHOSATHA PAKUYENZA KUBULALA KWA MUTU. CT SCANNING W/O CONTRAST NDI CHOCHITA CHOFUNIKA KWAMBIRI CHOYAMBA CHOYANIKITSA MTIMA WACHIWIRI. TRAUMA. MRI HASA KUTHA WOSAVUNDUTSA ZIWALO ZA CHIBADWE, NDIPO OSATI AMAGWIRITSA NTCHITO POYAMBA DX WA MUTU WOTSATIRA. TRAUMA.
  • SKULL FX AMADZIWA KUTI FXS OF SKULL VAULT, SKULL BASE NDI MIGOGO YA NKHOSI ILIYONSE CHOGWIRIZANA NDI NKHANI ZOYENERA NDI ZOTHANDIZA KULOSERA ZOVUTA.
  • LINEAR SKULL FX: SKULL VAULT. M/C FX. CT SCANNING NDI MFUNDO YOUCHULIKIRA KUKHALA KWA ARTERIALEXTRADURAL HEMORRHAGING
  • X-RAY DDX: SUTURES VS. LINEAR SKULL FX. FX NDI THINNER, �BLACKER� IE ZABWINO KWAMBIRI, ZOPHUNZITSA, & ZOPHUNZITSA ZOPHUNZITSA, ZOSAVUTA
  • RX: NGATI PALIBE MALOZI OGWIRITSA NTCHITO KUTI KULIBE MANKHWALA. CHISAMALIRO CHA NUROSURGICAL NGATI KUCHITSA MWAZI KUONEKERA NDI CT SKANNING
mutu trauma imaging el paso tx.
  • CHIGAWO FX CHOGWIRITSA NTCHITO: 75% MU VAULT. ZITHA KUKHALA ZAMFA. AMAGANIDWA NDI OPEN FX. ZOCHITIKA ZAMBIRI AMAFUNA NEUROSURGICALEXPLORATION MAKA MAKA IFFRAGMENTS OPANDA > 1-CM.ZOGWIRITSA NTCHITO: MIFUPA YOPHUNZITSA / HEMATOMAS, PNEUMOCEPHALUS, MENINGITIS, TBI, CSF LEAK, BRAIN HERNIATION ETC.
  • KUSINTHA: CT KUSINTHA W/O KUSINTHA
mutu trauma imaging el paso tx.
  • BASILAR SKULL FX: ZITHA KUKHALA ZAMFA. NTHAWI ZONSE PAMODZI ZINTHU ZINTHU ZINTHU ZIKULUKULU ZA VAULT NDI FACIALSKELETON, NTHAWI ZONSE NDI TBI NDI KUKHALA KUKHALA KUKHALA KWACHIKULU. NTHAWI ZONSE ZIMACHITIKA NGATI �KUTUKO� KUCHITIKA KWA NTCHITO NDI KUPIRITSIDWA KWA MANKHWALA KUPITIRIRA MAFUPA OTSATIRAPO NDIPONSE KUPYOLERA SPHENOID NDI MAFUPA ENA A MAFUPA ACHIBADE. ZINTHU: MASO A RACCOON, CHIZINDIKIRO CHA BATTEL, CSFRHINO/OTORRHEA.

Ziphuphu Pamaso

mutu trauma imaging el paso tx.
  • NASAL MAFUPA FX: 45% YA ALLFACEFXM/C IMPACT NDIPONSO (FIST BLOW ETC.) NGATI MANKHWALA A UNDISPLACEDNO, NGATI KUSINTHA KUNGAWONONGE KUYAMBIRA KWA MPINGO NDI KUPUMA PASSAGE, KUYANG'ANANI KULUMIKIZANA NDI KUCHITSA ZINTHU MAKHOPO/CHIFUWA. X-RAYS 80% ZOKHUDZA, ZOTSATIRA ZOvulaza CT INCOMPLEX.
  • ZOPHUNZITSA ZOPHUNZITSA FX: KUBWERA KWAMBIRI KWAMBIRI D/T ZOKHUDZA PA GLOBU NDI/OR MAFUPA OWAWA. FX YA ORBITAL FLOOR INTOMAXILLARY SINUS VS. MPUNGA WAPANSI MU ETHMOID SINUS. ZOVUTA: ENTRAPPEDINFERIOR RECTUS M, PROLAPSEORBITAL FAT, & SOFT TISSUES, HEMORRHAGING AND OPTIC NERVE DAMAED. RX: ZOKHUDZA ZOKHUDZA KWA DZIKO LA GLOBE NDIZOFUNIKA, ZONSE ZIMACHITIKA NDIPONSO NGATI PALIBE MAVUTO ALIPO
mutu trauma imaging el paso tx.
  • TRIPOD FX: 2ND M/C FACIAL FX#PATER NASAL (40% OF MIDFACEFX) 3-POINT FX-ZYGOMATICARCH, ORBITAL PROCESS YA ZYGOMATIC BONE & SIDE OF MAXILLARY SINUS WALL, MAXILLARY PROCESS OF ZYGOMATIC BONE.COMPLICATED INTCRY METAMA, TEMGERATED BY NERPOMATIC. KUSINTHA KWA CT NDIKUDZIWANITSA KWAMBIRI KUTI X-RAYS (MAONEdwe A MADZI).
  • LEFORT FX: SERIOUS FX NTHAWI ZONSE IMAKHALA NDI MALALE ZA PTERYGOID, ZIMENE ZINGATHE KULEKANITSA MIDFACE NDI KANJIRA YA ALVEOLAR NDI MANO KUCHOKERA KUCHIBAWA. ZOKHUDZA: AIRWAYS, HEMOSTASIS, KULIMA KWA minyewa. CT SCANNING NDI YOFUNIKA. ZOYENERA KUCHITA ZA BASILAR SKULL FX
mutu trauma imaging el paso tx.
  • PING-PONG FX:�KUKHALA M'MATANDA. ZOSAVUTA FX D/T FOCALDEPRESSION: FORCEPS KUTUMIKIRA, NTCHITO YOVUTA NTCHITO ENA. FOCALTRABECULAR MICROFRACTURIINGLEAVING KUSINTHA MTIMA OFANANA NDI APING-PONG. DX M'MAKAKULU AMAONEKANA NGATI FOCAL DEFECT �DEPRESSION� MU CHIGAWO. TYPICALLYNEUROLOGICALLY INTACT. CT Ikhoza KUTHANDIZA NGATI AKUGANIZIWA KUTI AKULUDILIDWA MU UONGO. RX: OBSERVATIONAL VS. OPANDA OPANDA KUBWERA KWAMBIRI. SPONTANEOUSREMODELING WALALIDWA
mutu trauma imaging el paso tx.
  • LEPTOMENINGEAL CYST (GROWING SKULL FX)- NDIKUKULIKULIRA CHIBAWA CHOMWE CHIMAKHALA PAFUPI NDI POSTTRAUMATIC ENCEPHALOMALACIA
  • SI CYST, KOMA KUWONJEZERA KWA THEENCEPHALOMALACIA KUONA MIYEZI YOCHEPA POST-TRAUMA NDI YAM'MBUYO YOTSATIRA NTCHITO YA MENINGES NDI ADJACENTBRAIN NDI PULSATIONS YA CSF. CT NDI YABWINO KWAMBIRI ATDX IYI PATHOLOGY. ZIKUSONYEZA: KUKULA FX NDIPO ADJACENT ENCEPHALOMALACIA AS FOCALHYPOATTENUATING LESION.
  • ZOCHITIKA: KUKULITSIDWA KWA KALVARIAL, ZOWAWA, ZINTHU ZIZINDIKIRO/KUKHUDZANA. RX: NEUROSURGICAL CONSULT NDIKOFUNIKA
  • DDX: MALO OGWIRITSA NTCHITO/METS/ZINTHU NEOPLASMSINTO SUTURES, EG, INFECTION ETC.
mutu trauma imaging el paso tx.
  • MANDIBULAR FXS: WABWINO. MWINA KUGANIZA OPEN FX D/T INTRA-ORALEXTENSION. 40% FOCAL BREAK POKHALA KUKHALA mphete. DIRECT IMPACT(ASSAULT) M/C MECHANISM
  • PATHOLOGICAL FX D/T BONE NEOPLASMS, INFECTION ETC. IATROGENIC PAKATI PA Opaleshoni Mkamwa (KUCHOTSA MANO)
  • KULINGALIRA: MANDIBLE X-RAYS, PANOREX, CT SCANNING ESP. PAMENE WOYANKHULA NKHOPI/MUTU WOVUTIKA
  • ZOVUTIKA: KUPIGWIRA KWA AIRWAY, HEMOSTASIS NDIKUGANIZIRA KWAMBIRI, KUKHALA KWA MANDIBULAR N, OSTEOMYELITIS / CELLULITIS NDIPONSO KUYENERA KUFANIKIRA PANSI PA MWA (LUDWIGANGINA) NDI KHOSI FASCISUES SOFTIMED TINOFT. SINGAKOSE KUNYAMULIRA D/T ZOKHUDZA ZOMWE ZIKUFA.
  • RX: CONSERVATIVE VS. KUGWIRITSA NTCHITO

Acute Intracranial Hemorrhage

mutu trauma imaging el paso tx.
  • EPI AKA EXTRADURAL: (EDH) KUKWATUlidwa KWAMBIRI KWA MISHIPA YA MENINGEAL (MMA CLASSIC) POPANGA MWANGWIYO WA HEMATOMA PAKATI PA CHIGAWA CHAMKATI NDI KUNJA KWA DURA. CT SCANNING NDI Mfungulo KU DX: AMAPEREKA MONGA �LENTIFORM� IE BICONVEX COLLECTION OF ACUTE (HYPERDENSE) MWAZI OSATI WOWONJEZERA NDIPO AMATHANDIZA NDI DDX YA SUBDURAL HEMATOMA. ZOCHITIKA: HA, LUCID EPISODE POYAMBA NDIPO IKUCHULUKITSA MWA MAola OCHEPA.ZOGWIRITSA NTCHITO: BRAIN HERNIATION, CN PALSY. O/KUGWIRITSA NTCHITO KWABWINO NGATI WASAMUTSIDWA MWANGU.
  • SUBDURAL HEMATOMA (SDH): KUKWATUlidwa KWA MKWATULO WA MKWATULO PAKATI PA DURA YA MKATI NDI ARACHNOID.KUCHOKERA KOMA KUCHOTSA MWAZI WOPEMBEDZA. MAKAMAKA ANGAKHUDZA ANA ACHINYAMATA NDI ACHIKULU NDI MU MIKAKA YONSE (MVA, FALLS ETC.) ANGAKHALE MWA �SHAKEN BABY SYNDROME�. DX INGACHEWEKWE NDIKUCHULUKITSA CHIFUKWA CHAKE NDI ZIMENE ZIMENE AMAPHA. Okalamba CHIKWANGWANI CHAMUTU chitha kukhala chaching'ono kapena chosakumbukika. KUYAMBIRA KWAMBIRI NDI CT NDIKOFUNIKA. IKUKHALA NGATI CRESCENTSHAPEDKOLEKANI ZIMENE ZIMENE ZIMENE ZIMENE ZIMENE ZIMUkhoza kuwoloka SUTURES KOMA ZIMAYIMITSA PA DURAL REFLECTIONS. KUSIYANA KUSINTHA PA CT D/T MALO OSIYANA WOYANUKA MWAZI: ACUTE, SUBACUTE,�AND CHRONIC.MAY KUPANGA KUSONKHANA KWAKHALIDWE-CYSTICHYGROMA. ZOCHITIKA: KUKHALA KWAMBIRI, 45-60% KUKHALA NDI MTIMA WOPANDA NTCHITO KWAMBIRI, KUSALINGANA KWAMBIRI. Nthawi zambiri NDIKUPIRITSIDWA KWA Ubongo, KENAKO NDI LUCID EPISODE ASANAKUVUTIKA KWAMBIRI. MU 30% MIWA ZOKHUDZA KWAMBIRI MU Ubongo Odwala ANALI NDI SDH. RX: URGENT NEUROSURGICAL.
mutu trauma imaging el paso tx.
  • SUBARACHNOID HEMORRHAGE (SAH): MAGAZI MU SUB-ARACHNOID SPACE MONGA ZOTSATIRA ZA TRAUMATIC OR NON-TRAUMATIC ETIOLOGY: BERRY ANEURYSMS AROUND CIRCLE OF WILLIS.SAH 3% YA STROKES, 5% YA FETAL STROKES: FETAL STROKES: KUMUWUWA KWA MUTU � AKUFOTOKOZEDWA NGATI � HA NDI MOYO WABWINO KWAMBIRI�. PT IKUGWIRITSA NTCHITO KAPENA KAPENA SAYANSO CHIKUMBUTSO. PATHOGY: DIFFUSE BLOOD INSA SPACE 1)SUPRASELLAR CISTERN WITH DIFFUSE PERIPHERAL EXTENSION, 2)�PERIMESENEPHALIC, 3) BASAL CISTERNS. MWAZI WONAYITSITSA MU SA SPACE UNDERARTERIAL PRESSURE IMENE AKUYAMBIRA PADZIKO LONSE LA MPHAMVU YA NTCHITO, ACUTE GLOBAL ISCHEMIA IKUCHITIKA NDI VASOSPASM NDI KUSINTHA ENA.
  • DX: KUKHALA: KUSINTHA KWAMBIRI KWA CT W/O CONTRAST, CT ANGIOGRAPHY ITHANDIZA KUTI 99% YA SAH. LUMBAR PUNCTUREKUTHANDIZA KULAMBIRA KWAKUCHEDWA. PAMBUYO POYAMBA DX: MR ANGIOGRAPHY AMATHANDIZA KUPEZA CHIFUKWA NDI ZINTHU ZINA ZOFUNIKA
  • ZINTHU ZOYENERA: MWAZI WOWIRITSA NTCHITO NDI WHIPERDENSE PA CT. ZOPEZEKA MU DIFFERENTCYSTERNS: PERIMESENEPHALIC, SUPRASELLA, BASAL, VENTRICLES,
  • RX: Intravenous ANTIHYPERTENSIVE MEDS, OSMOTIC AGENTS (MANNITOL) KUTI DECREASEICP. NEUROSURGICAL CLIPPING NDI NJIRA ZINA.

CNS Neoplasms: Benign vs. Malignant

mutu trauma imaging el paso tx.
  • ZOPHUNZITSA ZA MUUNGO TIYIKIRANI 2% YA ZINTHU ZONSE ZA KANSA. CHIMODZI PACHITATU NDI CHACHIWIRI, CHOMWE ZOPHUNZITSA ZA METASTATIC BRAIN NDI ZONSE ZONSE.
  • ZIMENE ZIKUKHALA NDI ZOSAVUTA ZA CNS ZA M'MALO, KUCHULUKA KWA ICP, KUCHOKERA MWAZI KWA INTRACEREBRAL ETC. MAFAMILIALSYNDROMES: VON-HIPPEL-LANDAU, TUBEROUS SCLEROSIS, TURCOT SYNDROME, NF1 & NF2 AKUWUTSANI ZOCHITA. KWA ANA: M/C ASTROCYTOMAS, EPENDYMOMAS, PNETNEOPLASMS (mwachitsanzo MEDULLOBLASTOMA) ETC. DX: MALINGALIRO NDI NDANI CLASSIFICATION.
  • AKULUAKULU: M/C BENIGN NEOPLASM: MENINGIOMA. M/C PRIMARY: GLIOBLASTOMA MULTIFORME (GBM)METSEMAKAMAKA KUCHOKERA KWA LUNG, MELANOMA,�NDI MABWERE. ENA: CNS LYMPHOMA
  • KULINGALIRA NDIKOFUNIKA: ZIZINDIKIRO ZOYAMBIRIRA ZITHA KUKHALA NGATI KUKHUDZA, ICP SIGNS HA. KUYESA NDI CT NDI MRI NDI IV GADOLINIUM.
  • KULINGALIRA KUDZIWA: INTRA-AXIAL VS. EXTRA-AXIALNEOPLASMS. ANAKUMANA KUCHOKERA KU PRIMARY BRAIN NEOPLASMS MAYO CCUR KUPITIRIRA CSF NDI ZOWONJEZERA ZOWERA ZA M'MALO
  • DZIWANI IZI AXIAL CT SLICE YA MENINGIOMA NDI AVIDCONTRAST ENHANCEMENT.
  • AXIAL MRI PA FLAIR PULSE SEQUENCE INAWULULA NEOPLASM YOKHALITSA NDIPO KUDZIWA CYTOTOXIC EDEMA YA BRAIN PARENCHYMA CHARACTERISTIC OF GRADE IV GLIOMA (GBM) NDI ZOSAVUTA KWAMBIRI. PAM'MBUYO YOTSATIRA TUMIZANI LINKI SINDIKIZANI KOPERANI MAPODIKASITI MITU YA NKHANI YAM'MBUYO YOTSATIRA TUMIZANI LINKI SINDIKIZANI KOPERANI MAPODIKASITI MITU YA NKHANI YAM'MBUYO YOTSATIRA TUMIZANI LINKI SINDIKIZANI KOPERANI MITU YA NKHANI MELANOMA AMAKHALA WOTSATIRA KUMUONGO (ONANI NTCHITO YOPHUNZITSIRA) MRI Ingakhale DIAGNOSTIC D/T SIGNAL YAMKULU PA T1 NDI KULIMBIKITSA ZOSIYANA.
  • RX: NEUROSURGICAL, RADIATION, CHEMOTHERAPY, NJIRA ZA IMMUNOTHERAPY ZIKUPHUNZITSA

Kutupa kwa CNS Pathology

mutu trauma imaging el paso tx.

CNS Matenda

  • BACTERIA
  • MYCOBACTERIAL
  • FUNGAL
  • VIRAL
  • PARASITIC