Khi co the co hach lon

Thứ hai, 25 Tháng bảy 2005, 20:14 GMT+7

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Khi co the co hach lon
Hach la mot to chuc lympho, nam o nhieu noi nhu vung co, tren xuong don, nach va ben, binh thuong khong so thay. Khi phai hoat dong manh de bao ve co the chong lai benh tat, hach sung to.

Hach la mot to chuc lien vong noi mo, co chuc nang san sinh ra dong bach cau lympho va san xuat khang the de chong lai tac nhan gay benh. Khi hach hoat dong manh thi sung to, hay gap trong cac benh lien quan den he lien vong noi mac, benh tao huyet, cac benh nhiem khuan va benh ung thu.

Hach co the bang hat ngo, hat lac, co khi to bang qua trung, qua xoai, dau hoac khong dau, rat de phat hien. Co 4 yeu to quan trong de giup chan doan hach to la: Tuoi benh nhan, dac diem cua hach bach tuyet, vi tri hach, cac bieu hien lam sang va toan than phoi hop voi hach to.

Hach to o vung co, vung thuong don

Lao hach: Hach nho, nhieu, xuat hien dan dan, khong dau, xep thanh chuoi doc theo hai ben co uc don chum, duoi xuong ham. Hach to nho khong deu, cai mem, cai chac, luc dau di dong de, lau dan hach dinh vao nhau, co khi ro ra chat ba dau, bo vet ro nham nho, mau tim, de lau thanh seo xau, dan gian goi la “trang nhac”. Kem theo co khi sot ve chieu, nguoi gay, sut can, xanh xao. Co nhung ton thuong lao o noi khac nhu phoi, mang phoi, mang bung.

Hach Hodgkin: Do Hodgkin tim ra nam 1832, gap o nam gioi nhieu hon nu, hach to o ho thuong don trai, roi lan len co, it lau co the co hach o hai ben, nhung ben trai van to hon. Dan dan co hach o nach (65%), trung that (70%). Dac diem cua hach la ran, khong dau, khong dinh vao da, khong dinh vao nhau, khong hoa mu. Thuong kem theo lach to, cung nhu da (65%), ngua (70%). Benh nhan sot tung dot, moi lan sot thi hach to them hoac xuat hien mot hach khac.

Hach to xuat hien o ben

Benh Nicolas Favre: Do nhiem Chlamydia, xuat hien thanh chum hach to nhieu hoac it, phat trien sau vao ho chau. Hach dau va mem, co the ro ra thanh nhieu lo nhu kieu guong sen.

Benh ha cam: Do nhiem khuan duong sinh duc. Hach ben nhieu khi o mot ben, mot hach to, nong, dau, mom, tien trien thanh mu. Tim thay truc khuan Ducrey trong mu cua hach.

Benh giang mai: Giai doan dau, hach noi to o ben, la cho xam nhap cua xoan khuan Treponema pallidum. Thuong ben co 4-5 hach nho, hoi ran, di dong de. Sang giai doan hai, hach co the moc moi noi trong co the.

Hach to vi tri khong xac dinh

Viem hach: Hach nho don doc hoac tung chum, o bat ky vi tri nao: co, nach, ben. Dau am i, dau tang khi so nan, nong, di dong duoi da va to chuc sau, co sot. Hach viem nang co the vo mu dac, xanh hoac vang. Xet nghiem mau: Bach cau da nhan trung tinh tang.

Viem nhiem gay sung hach o vung lan can: Thuong thay hach to o nhung vung co hach bach huyet chi phoi. Khi bi viem nhiem, cac hach nay se sung len nhu viem hong, viem amidan, viem o vung rang, ham, mat, gay sung hach o duoi ham, nhot o vung dui co hach o ben. Zona nguc co hach o nach. Hach o day co dac tinh cua mot viem nhiem: sung, nong, do, dau, mat do chac, di dong duoc. Co khi hach tien trien thanh mu, vo ra ngoai.

Ung thu hach (Lymphosarcome): Con goi la benh Kundrat (1893), gap o nguoi tren 45 tuoi. Nhieu hach to o co, thuong don, nach va hach mac treo. Hach thuong dinh voi nhau thanh khoi lon, xuat hien va phat trien nhanh. An dau, mat do ran, dinh vao to chuc duoi da va to chuc sau, nen khong di dong duoc. Benh nhan suy sup toan than, tien trien nhanh 1-2 nam. Lach to trung binh, lam xet nghiem sinh thiet thay te bao ung thu.

Ung thu di can: Tinh chat cua hach giong nhu tren. Ung thu tu mot co quan khac di can vao he thong hach bach huyet. Thuong ung thu vu di can vao hach nach, ung thu xuong, da day, phe quan, vom hong di can hach thuong don, ung thu tu cung, tinh hoan di can hach ben.

Hach to do co dia: Thay o mot so nguoi gay yeu, suc khoe toan than kem. Thuong hach o ben, co. Hach nho de di dong, khong dau, mat do chac. Khong dieu tri, sau mot thoi gian hach se het khi suc khoe co the hoi phuc binh thuong.

Hach to do cac benh ve mau

Benh bach cau cap: Hach to, mem, di dong, xuat hien hau het o cac vung co hach (co, nach, ho thuong don, ben), hach chi la trieu chung phu. Dau hieu noi bat la hoi chung thieu mau phat trien nhanh, hoi chung chay mau duoi da, sot rat cao, lach to nhanh. Co ton thuong loet niem mac mieng va hong. Lam huyet do thay giam dong hong cau, tieu cau, bach cau tang rat nhieu...

Benh bach cau man the lympho: Hach nhieu, da so hach be, phat trien nhanh. Chi trong vong vai ba thang la cac hach o co, nach, ben to, mem, di dong duoc. Lach chi hoi to, lam huyet do va tuy do, hong cau va tieu cau giam, dong lympho tang nhieu.

Hach to do cac benh toan than

Benh dich hach (the noi hach): Truoc day co nhung dai dich ma nam 1894 Yersin da tim thay vi khuan Pasteurella pestis. Ngay nay rat it gap loai dich nay. Nguon benh tu loai chuot dong. Bo chuot la dong vat trung gian truyen benh.

Truoc khi noi hach, benh nhan thuong co kho chiu nhu nhuc dau, chong mat, dau tu chi, buon non va gai sot. Hach noi o bat ky noi nao, phan nhieu hach o ben, nach, co, co uc don chum. Hach hinh tron hay hinh qua xoai, hach dinh vao da xung quanh, nan rat dau. Sau do mot tuan thi do dau, mem va vo mu. Trong mu co the thay vi khuan Pasteurella pestis, tinh trang toan the rat nang. Co the suy nhuoc, u ru, bo pho. Sot cao 39-40oC. Khi hach vo mu thi ha sot.

Benh phat ban: Nhu Rubella, sot xuat huyet, sau khi sot thi noi ban hay xuat huyet. Sau ba ngay thi het ban. Hach to bang dot ngon tay, hay nho hon, mem, khong hoa mu, dau khi so nan.

Benh tang bach cau don nhan do nhiem virus: Nhieu hach, to bang hat lac den qua tao, xuat hien o toan than. Hach chac, nhan, so dau, di dong de dang, khong hoa mu. Toan than co sot cao, mach nhanh, mat do. Co viem hoac loet hong, lach to.

Benh BBS (Besnier-Boeck-Schaumann, hay benh Sarcoidose): La benh cua cac to chuc lien ket. Hach toan than rat ran, khong dau, tien trien cham, hau nhu khong khoi. Sinh thiet hach thay te bao dac hieu. Ton thuong cac phu tang nhu: phoi xo, dua den tam phe man tinh; tam viem man, ure tang, protein nieu, dai ra mau; co tim bi xo, loan nhip.

Benh meo cao: Do mong meo, do gai cac cay co mu (xuong rong), do chan thuong nho dua virus vao. Sau 15 ngay bi cao, benh nhan sot thi xuat hien hach toan than, nhung nhieu nhat la o khu vuc bi cao. Hach nho khong dau, xet nghiem bach cau ha, dong te bao Monocyte va Lympho tang. Hai, ba tuan sau se khoi.

Hach do phan ung thuoc: Nhu Hydralazin, Allopurinol…

Khi thay nghi ngo hoac chac chan minh co hach to, nen den bac si se co nhung loi khuyen cu the va cach xu tri thich hop.

Theo Suc Khoe & Doi Song

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