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

Kufungidzira & Diagnostics

Back Clinic Imaging & Diagnostics Team. Dr. Alex Jimenez anoshanda nepamusoro-rated diagnosticians uye imaging nyanzvi. Mukubatana kwedu, nyanzvi dzekufungidzira dzinopa nekukurumidza, zvine ruremekedzo, uye zvemhando yepamusoro mhedzisiro. Mukubatana nemahofisi edu, tinopa kunaka kwesevhisi zvakatemerwa nevarwere vedu uye zvakakodzera. Diagnostic Outpatient Imaging (DOI) inzvimbo-ye-the-art Radiology centre muEl Paso, TX. Ndiyo chete nzvimbo yerudzi rwayo muEl Paso, ine uye inoshandiswa neRadiologist.

Izvi zvinoreva kana iwe uchiuya kuDOI yekuongororwa radiologic, zvese zvese, kubva mukugadzirwa kwemakamuri, sarudzo yemidziyo, inotorwa nemaoko tekinoroji, uye software inomhanyisa hofisi, inosarudzwa kana kugadzirwa neRadiologist. uye kwete neakaunzi. Yedu yemusika niche ndiyo imwe nzvimbo yekunaka. Tsika dzedu dzine chekuita nekutarisirwa kwevarwere ndeidzi: Tinotenda mukurapa varwere nenzira yataizobata nayo mhuri yedu uye tichaita zvese zvatinogona kuti tive nechokwadi chekuti une chiitiko chakanaka kukiriniki yedu.

Kuongorora uye Kurapa Herniated Bulging Discs

Kuongorora uye Kurapa Herniated Bulging Discs

by | Chiropractic Examination, Kufungidzira & Diagnostics

MaMRIs anoshandiswa sei kubatsira kuongorora bulging uye herniated discs uye kubatsira vatapi vehutano kugadzira zvirongwa zvekurapa zvinobudirira kune vanhu vane zviratidzo zvekurwadziwa shure?

Kuongorora uye Kurapa Herniated Bulging Discs

Herniated Bulging Disc MRI

A herniated bulging disc inowanzozivikanwa panguva yemagnetic resonance imaging (MRI); zvisinei, kazhinji kacho chiitiko chekutsvaga chakaitwa kune zvimwe zvikonzero uko matambudziko emusana uye / kana kukuvara kunowanikwa. A bulging disc yakajairika, kunyangwe kune vanhu vasina zviratidzo. A herniated kana bulging disc kumusana inogona kuonekwa neMRI bvunzo, inowanzokurudzirwa kana mumwe munhu achinzwa zviratidzo zvekudzokera shure kwemavhiki matanhatu. (American Academy yeNeurological Surgeons, 2024) Kupfeka kwakajairwa uye kubvarura uye zera kunokonzera shanduko muspinal disc/s cushion kuti ipunduke uye ive isina kurongeka nemuzongoza. (Brinjikji W. et al., 2015) Uye ne disc herniated, inogona kudzvanya pamutsipa wepelinha uye tsinga. Kudzokorora kusimudza zvinorema, kudzidzira maitiro asina kunaka, nhoroondo yekukuvara kwemusana, kana mamiriro ehutano ari pasi pezvikonzero zvinowanzoitika.

Bulging Disc

Bulging discs inowanzoitika kunyange muvanhu vane hutano asi inogona kuva yakaoma kududzira yakazvimiririra paMRI, saka zvimwe zviratidzo uye zvakawanikwa zvakakosha pakuongorora.

Zvinokonzera

A bulging disc inowanzoonekwa sezera-ane hukama nekuchinja kwekuchinja kunokonzera kuti dhisiki iende pasi negiravhiti. (Penn Mushonga, 2018)

zviratidzo

Vazhinji vane dhisiki rinoputika havazove nezviratidzo pakutanga. (Wu PH, Kim HS, & Jang IT 2020) Zvakawanikwa zveMRI zvinobatsira asi zvinoda kuongororwa pamwe chete nezvimwe zviratidzo (American Academy yeNeurological Surgeons, 2024) (Penn Mushonga, 2018)

  • Kutambudzika shure
  • Marwadzo mumakumbo uye/kana matako
  • Kuchinja kwekufamba uye / kana kuoma kufamba
  • Zviratidzo zvinobata divi rimwe chete

Kuputika kwakakosha kunotarisirwa kukonzera kurwadziwa kwegumbo nekuda kwekushatirwa kune tsinga dzinodzika nemakumbo. (Amin RM, Andrade NS, & Neuman BJ 2017) Sezvo mamiriro acho achifambira mberi, zvinopfuura disc imwe inogona kuchinjwa, zvichiita kuti kune mamwe mamiriro emusana, kusanganisira spinal stenosis.

A Bulging Disc PaMRI

A disc bulge ichayera pamusoro pe25% yehuwandu hwe disc circumference. Kuchinja kwayo kunowanzoita 3 millimeters kana zvishoma kubva kune yakajairika chimiro uye chinzvimbo che disc. (Radiopaedia, 2024)

Herniated Disc

A herniated disc inosimuka kubva panzvimbo yayo chaiyo uye inomanikidza tsinga dzemusana dziri pedyo, zvichikonzera marwadzo uye nyaya dzekufamba.

Zvinokonzera

Herniated disc zvikonzero zvinosanganisira:American Academy yeOrthopedic Surgeons, 2022)

  • Kukuvara kwetsaona dzemotokari
  • Basa kana mitambo inodzokorora kukuvara kwekufamba
  • Kusimudza kunorema uye/kana Maitiro ekusimudza asina kunaka
  • Kuva kunyanyisa
  • Basa rekugara uye / kana mararamiro anoisa kumanikidza pamuzongoza kana wakagara.
  • Kusvuta kunogona kukurumidzisa kukuvadzwa kwemusana.

zviratidzo

Zviratidzo zvinosanganisira musana nemakumbo kurwadziwa pamwe ne: (American Academy yeOrthopedic Surgeons, 2022)

  • Tingling nezvekufadza
  • Numbness
  • Kupisa kwekunzwa
  • Tsvina dzemuviri
  • Utsi husina simba

Herniated Disc paMRI

Herniated discs ichayera isingasviki 25% yehuwandu hwe disc circumference. Nekudaro, herniation yakavakirwa pamhando uye inogona kusanganisira: (Wei B., & Wu H. 2023)

  • Disc Protrusion - kutama kwacho kunogumira, uye ligaments iri intact.
  • Disc Extrusion - chikamu che disc chinoramba chakabatana asi chakatsvedza kuburikidza ne annulus kana kunze kwekuvhara kwe disc.
  • Disc Sequestration - chidimbu chemahara chakaparadzana uye chakatsemuka kubva kune huru disc.

Vanokwikwidza Kune Spinal MRI

Iyo MRI inowanzochengeteka kune vakawanda, kusanganisira avo vane midziyo yemoyo yakasimwa senge nyowani-modhi pacemaker. (Bhuva AN et al., 2020) Zvakadaro, zvakakosha kuve nechokwadi chekuti timu yezvehutano inoziva nezve cochlear implants kana zvimwe zvigadziriso kuitira kuti patorwe matanho anodiwa. Zvinokurudzirwa kune vanhu vese kuti zviratidzo zvivepo kwemavhiki matanhatu pamberi peMRI. Nyanzvi inogona kuda kuona MRI mhinduro nekukurumidza, kunyanya kana zviratidzo zvinosanganisira: (American Academy yeNeurological Surgeons, 2024)

  • Kukuvara chaiko, sekudonha kwakakonzera marwadzo
  • Chirwere chemazuva ano kana chemazuva ano kana fivha ine zviratidzo zvemusana
  • Kushaya simba kwakanyanya mumaoko kana makumbo
  • Kurasika kwekunzwa pelvic.
  • Nhoroondo yekenza yemetastatic.
  • Kurasikirwa kwechibvunda kana kutora mahara

MRI inogona kudiwa kana zviratidzo zviri kukurumidza kuwedzera. Nekudaro, vazhinji vane disc bulge havana zviratidzo zvachose. Muzviitiko zvakawanda, MRI inzira yekunze inogona kupedzwa muawa kana pasi asi inogona kutora nguva yakareba kana dhayi yekusiyanisa ikashandiswa. Mutariri wehutano achapa mirairo chaiyo pamusoro pekugadzirira MRI.

mabatiro

Kurapa kwe disc herniated kana bulging kunoenderana nechikonzero uye kuoma kwezviratidzo.

Bulging Disc

Mazhinji disc bulges haadi kurapwa; zvisinei, bulging disc kurwadziwa kurapwa kunogona kusanganisira: (American Academy yeOrthopedic Surgeons, 2022) (American Academy yeNeurological Surgeons, 2024)

  • Zorora
  • Hapana kusimudza zvinorema
  • Kufamba zvishoma
  • Pamusoro-the-counter marwadzo ekuzorodza, kusanganisira nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Physical therapy
  • Muzviitiko zvisingawanzoitiki izvo zvisina kugadziriswa nekurapa kwekuchengetedza, kuvhiyiwa kunogona kukurudzirwa.

Yeuka kuti zvakawanikwa zveMRI zvingasaziva kana kubvisa kunze kwemamiriro ose ezvinhu, kusanganisira kushungurudzika kwemisungo kana kukuvara kwemakumbo, izvo zvingada kurapwa kwakasiyana-siyana, zvakadai sekutambanudza kutambanudza uye maitiro. (Brinjikji W. et al., 2015) (Fujii K. et al., 2019)

Herniated Disc

Kurapa kunoenderana nechinokonzera uye kuoma kwezviratidzo, kana zviripo. Inogona kusanganisira kumira-yega kana musanganiswa wekurapa kwepanyama, mishonga, uye steroid jekiseni. Nyaya dzinowanzogadziriswa mumavhiki matanhatu kusvika gumi nemaviri (Penn Mushonga, 2018). Kukurudzira tsinga dzemagetsi kunogona kuitwa kuburikidza nemidziyo yakasarudzika uye/kana acupuncture kubatsira nekutsikirira tsinga. (National Institute of Neurological Disorders uye Stroke, 2020) Kuvhiya kunogona kukurudzirwa kana marapirwo anochengetedza akakundikana kuwana marwadzo makuru uye kuporesa. (Wang S. et al., 2023)

Kukuvadza Chiremba Chiropractic uye Inoshanda Mushonga Kliniki

Mutariri wehutano anogona kukurukura nzira dzokurapa zvakadai semishonga yemarwadzo, kurapwa kwemuviri, uye kuvhiyiwa. Injury Medical Chiropractic uye Functional Medicine Clinic inoshanda nevarapi vehutano hwekutanga uye nyanzvi kugadzira hutano hwakakwana uye hutano mhinduro. Isu tinotarisa pane izvo zvinoshanda kwauri kuti ubvise marwadzo, kudzoreredza basa, uye kudzivirira kukuvara. Nezve marwadzo emusculoskeletal, nyanzvi dzakaita sechiropractors, acupuncturists, uye masaja therapists vanogona kubatsira kudzikisira marwadzo kuburikidza nekuchinja kwemusana kunobatsira muviri kuzvigadzirisa. Vanogonawo kushanda nevamwe vashandi vezvokurapa kuti vabatanidze chirongwa chekurapa kugadzirisa nyaya dzemusculoskeletal.

Midzi Zvikonzero zveSpinal Stenosis

References

American Academy yeNeurological Surgeons. (2024). Herniated disc. www.aans.org/patients/conditions-treatments/herniated-disc/

Brinjikji, W., Diehn, FE, Jarvik, JG, Carr, CM, Kallmes, DF, Murad, MH, & Luetmer, PH (2015). MRI Zvakawanikwa zveDisc Degeneration Zvakanyanya Kuwanda kune Vakuru vane Low Back Pain kupfuura muAsymptomatic Controls: A Systematic Review uye Meta-Analysis. AJNR. American Journal yeNeuroradiology, 36 (12), 2394-2399. doi.org/10.3174/ajnr.A4498

Penn Mushonga. (2018). Bulging Disc vs. Herniated Disc: Chii Chinosiyana? Penn Musculoskeletal uye Rheumatology Blog. www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2018/november/bulging-disc-vs-herniated-disc

Wu, PH, Kim, HS, & Jang, IT (2020). Intervertebral Disc Diseases CHIKAMU 2: Ongororo Yezvino Yekuongorora uye Kurapa Matanho eIntervertebral Disc Disease. International Journal of Molecular Sciences, 21(6), 2135. doi.org/10.3390/ijms21062135

Amin, RM, Andrade, NS, & Neuman, BJ (2017). Lumbar Disc Herniation. Ikozvino wongororo musculoskeletal mushonga, 10 (4), 507-516. doi.org/10.1007/s12178-017-9441-4

Radiopaedia. (2024). Disc herniation. radiopaedia.org/articles/disc-herniation

American Academy yeOrthopedic Surgeons. (2022). Herniated disk muzasi kumashure. orthoinfo.aaos.org/en/diseases-conditions/herniated-disk-in-the-lower-back/

Wei, B., & Wu, H. (2023). Kudzidza kweKugoverwa kweLumbar Modic Shanduko muVarwere vane Low Back Pain uye Correlation neLumbar Degeneration Diseases. Nyaya yekutsvakurudza kurwadziwa, 16, 3725-3733. doi.org/10.2147/JPR.S430792

Bhuva, AN, Moralee, R., Mwedzi, JC, & Manisty, CH (2020). Kuita kuti MRI iwanikwe kune varwere vane cardiac implantable electronic devices: kukura kudiwa uye zvipingamupinyi zvekuchinja. European radiology, 30 (3), 1378-1384. doi.org/10.1007/s00330-019-06449-5

Brinjikji, W., Luetmer, PH, Comstock, B., Bresnahan, BW, Chen, LE, Deyo, RA, Halabi, S., Turner, JA, Avins, AL, James, K., Wald, JT, Kallmes, DF, & Jarvik, JG (2015). Yakarongeka mabhuku ekuongororwa kwekufungidzira maficha ekuderera kwemusana muasymptomatic populations. AJNR. American Journal yeNeuroradiology, 36 (4), 811-816. doi.org/10.3174/ajnr.A4173

Fujii, K., Yamazaki, M., Kang, JD, Risbud, MV, Cho, SK, Qureshi, SA, Hecht, AC, & Iatridis, JC (2019). Discogenic Back Pain: Zvinyorwa Kudzokorora Tsanangudzo, Kuongororwa, uye Kurapa. JBMR plus, 3(5), e10180. doi.org/10.1002/jbm4.10180

Wang, S., Zhao, T., Han, D., Zhou, X., Wang, Y., Zhao, F., Shi, J., & Shi, G. (2023). Kurongeka kwecervical disc herniation myelopathy kana radiculopathy: magnetic resonance imaging-based analysis. Quantitative imaging mukurapa uye kuvhiyiwa, 13 (8), 4984-4994. doi.org/10.21037/qims-22-1387

National Institute of Neurological Disorders uye Stroke. (2020). Low back pain fact sheet. Zvakatorwa kubva www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

Kuvimbisa Kuchengetedzeka Kwemurwere: A Clinical Approach muChiropractic Clinic

Kuvimbisa Kuchengetedzeka Kwemurwere: A Clinical Approach muChiropractic Clinic

by | Chiropractic, Chiropractic Examination, Chiropractic News, chisingaperi Pain, Kufungidzira & Diagnostics, Mishonga

Ko vashandi vehutano mukiriniki yechiropractic vanopa sei nzira yekiriniki yekudzivirira zvikanganiso zvekurapa kune vanhu vari kurwadziwa?

ziviso

Zvikanganiso zvekurapa zvakakonzera kufa kwe44,000-98,000 muchipatara kufa kweAmerica gore negore, uye zvimwe zvakawanda zvakakonzera kukuvara kwakaipisisa. (Kohn et al., 2000) Iyi yaipfuura nhamba yevanhu vaifa gore negore neAIDS, kenza yemazamu, uye tsaona dzemotokari panguva iyoyo. Zvinoenderana netsvakiridzo yakazotevera, nhamba chaiyo yevakafa inogona kunge iri pedyo ne400,000, ichiisa zvikanganiso zvekurapa seyechitatu inonyanya kukonzera rufu muUS. Kazhinji, zvikanganiso izvi hazvisi chibereko chenyanzvi dzekurapa dzakaipa panyama; Asi, iwo mhedzisiro yehurongwa hwehurongwa hwehutano hwehutano, hwakadai sekusagadzikana muridzi wekudzidzira maitiro, zvakavanzika inishuwarenzi network, kusavapo kana kusavapo kwekuchengetedza protocol, uye kutarisirwa kusarongeka. Chinyorwa chemazuva ano chinotarisa nzira yekiriniki yekudzivirira kukanganisa kwehutano muhutano hwehutano. Isu tinokurukura vanobatana nevarapi vekurapa vanonyanya kurapa kwakasiyana siyana kubatsira vanhu vari kurwara nenyaya dzisingaperi. Isu tinotungamirawo varwere vedu nekuvabvumira kubvunza avo vanobatana navo vekurapa mibvunzo yakakosha uye yakaoma kunzwisisa. Dr. Alex Jimenez, DC, anongoshandisa ruzivo urwu sebasa rekudzidzisa. Disclaimer

Kutsanangura Zvikanganiso Zvekurapa

Kuona kuti ndechipi chikanganiso chekurapa inhanho yakakosha mune chero hurukuro yekudzivirira kukanganisa kwekurapa. Iwe unogona kufunga kuti iri ibasa rakareruka kwazvo, asi izvi zvinongoitika chete kusvikira wapinda muhuwandu hwakawanda hwemazwi anoshandiswa. Mazwi mazhinji anoshandiswa zvakafanana (dzimwe nguva zvisiri izvo) sezvo mamwe mazwi achichinjika, uye dzimwe nguva, zvinoreva izwi zvinoenderana nehunyanzvi huri kukurukurwa.

 

 

Kunyange zvazvo chikamu chehutano chakataura kuti kuchengetedzwa kwevarwere uye kubvisa kana kuderedza zvikanganiso zvekurapa zvaive zvakakosha, Grober naBohnen vakacherechedza munguva ichangopfuura se2005 kuti vakanga vakundikana mune imwe nzvimbo inokosha: kusarudza tsanangudzo ye "zvichida mubvunzo wakanyanya kukosha ... kukanganisa kwekurapa? Chikanganiso chekurapa ndiko kutadza kupedzisa chiito chakarongwa munzvimbo yekurapa. (Grober & Bohnen, 2005) Zvisinei, hapana kana rimwe remashoko anowanzozivikanwa nemunhu ane dambudziko rezvokurapa—varwere, utano, kana chimwe chinhu—rinodudzwa murondedzero iyi. Zvisinei neizvi, tsananguro yacho inopa hwaro hwakasimba hwekumwe budiriro. Sezvauri kuona, iyo tsanangudzo chaiyo ine zvikamu zviviri:

  • Kukanganisa kuita: Kutadza kuzadzisa chiito chakarongwa sezvakarongwa.
  • Kutadza kuronga: inzira iyo, kunyangwe nekuita kwakakwana, haiburitse mhedzisiro inodiwa.

Pfungwa dzekukanganisa kwekuita uye kuronga kukanganisa hakuna kukwana kana tichizotsanangura kukanganisa kwekurapa zvakakwana. Izvi zvinogona kuitika chero kupi, kwete chete kunzvimbo yekurapa. Chikamu chekurapa kwekurapa chinofanira kuwedzerwa. Izvi zvinounza pfungwa yezviitiko zvisingafadzi, zvinonzi zviitiko zvakashata. Tsanangudzo yakajairika yechiitiko chakashata kukuvadza kusingatarisirwi kune varwere vanounzwa nekurapa kwekurapa kwete chirwere chavo chiri pasi. Tsanangudzo iyi yakawana kugamuchirwa pasi rose neimwe nzira. Semuenzaniso, kuAustralia, izwi rekuti zviitiko rinotsanangurwa sekuti kukuvadza kwakakonzera munhu kuwana hutano. Izvi zvinosanganisira kutapukira, kudonha kunokonzera kukuvara, uye nyaya nemishonga yekurapa nemidziyo yekurapa. Zvimwe zviitiko zvisina kunaka zvinogona kudzivirirwa.

 

Mhando Dzakajairika dzeKukanganisa Kwekurapa

Nyaya chete ine pfungwa iyi ndeyekuti hazvisi zvese zvakaipa zvinoitika netsaona kana nemaune. Nekuti murwere anogona kupedzisira abatsirwa, chiitiko chinotarisirwa asi chinoshivirira chinogona kuitika. Munguva yechemotherapy, kusvotwa uye kurasikirwa kwebvudzi mienzaniso miviri. Muchiitiko ichi, kuramba kurapwa kunokurudzirwa ndiyo chete nzira ine musoro yekudzivirira mhedzisiro isingafadzi. Isu nokudaro tinosvika pane pfungwa yekudzivirirwa uye isingadzivirirwe yakaipa zviitiko apo isu tinoenderera mberi nekunatsa tsananguro yedu. Hazvisi nyore kuronga sarudzo yekushivirira imwe mhedzisiro kana yaonekwa kuti yakanaka mhedzisiro ichaitika panguva imwe chete. Asi chinangwa chega hachisi chikonzero chekuzvipembedza. (Patient Safety Network, 2016, ndima.3) Mumwe muenzaniso wekukanganisa kwakarongwa kungave kugurwa kwetsoka yekurudyi nekuda kwebundu kuruoko rworuboshwe, iyo inenge ichibvuma chiitiko chisingafadzi chinozivikanwa uye chakafanotaurwa mune tarisiro yemigumisiro inobatsira apo pasina imwe yakambomuka kare. Hapana humbowo hunotsigira tarisiro yemugumisiro wakanaka.

 

Zvikanganiso zvekurapa zvinokonzeresa kukuvadza kumurwere ndizvo zvinonyanya kutariswa patsvakiridzo yedu. Zvakangodaro, zvikanganiso zvekurapa zvinogona uye zvinoitika kana murwere asina kukuvadzwa. Kuitika kwekupotsa kwepedyo kunogona kupa data rakakosha pakuronga nzira yekudzikisa zvikanganiso zvekurapa munzvimbo yehutano. Zvakadaro, kuwanda kwezviitiko izvi zvichienzaniswa neakawanda makiriniki anovaudza zvinofanirwa kuongororwa. Pedyo nekupotsa zvikanganiso zvekurapa zvinogona kunge zvakakonzera kukuvadza asi hazvina kumurwere, kunyangwe murwere ari kuita zvakanaka. (Martinez et al., 2017) Sei uchibvuma chimwe chinhu chinogona kuguma nedanho repamutemo? Funga nezvechiitiko apo mukoti, chero chikonzero chipi, anga achangobva kutarisa mifananidzo yemishonga yakasiyana uye akanga ava kuda kupa mushonga. Zvichida chimwe chinhu chinoramba chiri mundangariro dzake, uye anosarudza kuti handiwo maratidzirwo emushonga chaiwo. Paakatarisa, akaona kuti akanga apiwa mishonga isiri iyo. Mushure mekutarisa mapepa ose, anogadzirisa chikanganiso uye anopa murwere tsamba yakakodzera. Zvingaite here kudzivirira kukanganisa mune ramangwana kana rekodhi rekodhi raisanganisira mafoto emushonga wakakodzera? Zviri nyore kukanganwa kuti pane kukanganisa uye mukana wekukuvadza. Chokwadi ichocho chinoramba chiri chechokwadi pasinei nokuti takaita rombo rakanaka here kuiwana munguva kana kuti kutambura chero migumisiro yakaipa.

 

Kukanganisa kweZvabuda & Maitiro

Tinoda data rakazara kugadzira mhinduro dzinovandudza kuchengetedza kwevarwere uye kuderedza zvikanganiso zvekurapa. Zvirinani, kana murwere ari munzvimbo yekurapa, zvese zvinogona kuitwa kudzivirira kukuvadzwa uye kuvaisa munjodzi zvinofanirwa kutaurwa. Vanachiremba vakawanda vakasarudza kuti kushandisa mitsara zvikanganiso uye zviitiko zvakashata zvaive zvakanyanya uye zvakakodzera mushure mekuongorora zvikanganiso uye zviitiko zvakashata muhutano hwehutano uye kukurukura simba ravo uye kushaya simba kwavo muna 2003. Iyi tsanangudzo yakabatanidzwa yaizowedzera kuunganidza deta, kusanganisira kukanganisa, kufona kwepedyo, pedyo. misuva, uye zvikanganiso zvinoshanda uye zvakavandika. Pamusoro pezvo, izwi rakashata zviitiko rinosanganisira mazwi anowanzoreva kukuvadzwa kwemurwere, sekukuvara kwekurapa uye iatrogenic kukuvara. Chinhu chimwe chete chakasara ndechekuona kana bhodhi rekuongorora inhengo yakakodzera yekubata kupatsanurwa kwezviitiko zvinodzivirirwa uye zvisingadzivirirwe zvakashata.

 

Chiitiko chevarindi chiitiko chinodiwa kuzivisa kune Joint Commission. The Joint Commission inotaura kuti chiitiko chevarindi chiitiko chisingatarisirwi chinosanganisira kukuvara kwakanyanya mumuviri kana mupfungwa. ("Sentinel Zviitiko," 2004, p.35) Hapana sarudzo, sezvo inoda kunyorwa. Zvizhinji zvivakwa zvehutano, zvisinei, zvinochengeta zvinyorwa zvadzo zvichitsanangura zviitiko zvevatumwa uye zvekuita kana mumwe achivimbisa kuti zviyero zveJoint Commission zvinosangana. Iyi ndiyo imwe yemamiriro ezvinhu apo zviri nani kuva akachengeteka pane urombo. Sezvo “serious” iri pfungwa ine mwero, pangava neimwe nzira yokusagadzikana pakudzivirira waunoshanda naye kana kuti mushandirwi. Ukuwo, kushuma chiitiko chemurindi zvisiri izvo zviri nani pane kutadza kushuma chiitiko chevarindi. Kutadza kuburitsa pachena kunogona kuve nemhedzisiro yakakomba, kusanganisira kumisa basa.

 

Paunenge uchifunga nezvekukanganisa kwekurapa, vanhu vanowanzoita chikanganiso chekungotarisa zvikanganiso zvechiremba. Kukanganisa kwemishonga pasina mubvunzo kunowanzoitika uye kunosanganisira akawanda ekukanganisa kwemaitiro semamwe zvikanganiso zvekurapa. Kuputsika mukutaurirana, kukanganisa kwakaitwa panguva yekunyorerwa kana kugovera, uye zvimwe zvinhu zvakawanda zvinogoneka. Asi isu tinenge tichifungira zvisizvo nyaya iyi kana tikafunga kuti kukanganisa kwezvinodhaka ndiko chete honzeri yekukuvadza kumurwere. Rimwe dambudziko guru mukuisa mhosho dzekurapa dzakasiyana ndere kuona kuti chikanganiso chiri mumapoka zvichienderana nemaitirwo anoitwa kana mhedzisiro. Zvinotenderwa kuongorora aya maclass pano, kupihwa kuedza kwakawanda kwakaitwa kugadzira tsananguro dzekushanda dzinosanganisira zvese maitiro uye mhedzisiro, mazhinji acho akavakirwa pabasa raLucian Leape kubva kuma1990s. 

 

Natsiridza Mararamiro Ako Nhasi- Vhidhiyo

Kuongorora & Kudzivirira Kukanganisa Kwezvokurapa

Kushanda uye kusashanda ndiwo mapoka maviri makuru ezviitiko zvakashata izvo Leape nevamwe vake vakasiyanisa muchidzidzo ichi. (Leape et al., 1991) Matambudziko ekuvhiya aisanganisira utachiona hwemaronda, kutadza kuvhiyiwa, nyaya dzisiri dzehunyanzvi, kunonoka kunetsa, uye matambudziko ehunyanzvi. Nonoperative: misoro yakadai semishonga ine chokuita nemishonga, isina kuongororwa, kubatwa zvisina kunaka, nzira-yakabatana, kudonha, kuputsika, postpartum, anesthesia-yakabatana, neonatal, uye kubata-zvose musoro wegadziriro yakabatanidzwa pasi pechikamu ichi chezviitiko zvakashata. Leape akarongawo zvikanganiso nekunongedza poindi yekuparara kwemaitiro. Akaisawo izvi mumisoro mishanu, inosanganisira: 

  • maitiro
  • mutambo
  • Mishonga Inorapwa
  • chirwere
  • Kudzivirira

Mazhinji maitiro ekukanganisa anowira pasi peinopfuura musoro wenyaya, asi iwo ese anobatsira kuratidza chaicho chikonzero chenyaya. Kana kupfuura chiremba mumwe akabatanidzwa mukugadzirisa nzvimbo chaidzo dzinoda kuvandudzwa, ipapo mimwe mibvunzo inogona kudiwa.

 

 

Nehunyanzvi, kukanganisa kwekurapa kunogona kuitwa nechero mushandi pachipatara. Izvo hazvina kuganhurirwa kune nyanzvi dzekurapa sevanachiremba uye vanamukoti. Mutungamiriri anogona kusunungura gonhi, kana kuti mushandi wokuchenesa anogona kusiya kemikari mukati memwana. Chinonyanya kukosha kupfuura kuzivikanwa kweakakanganisa ndicho chikonzero chiri shure kwayo. Ko pamberi pazvo? Uye tingava sei nechokwadi chokuti izvozvo hazviitiki zvakare? Mushure mekuunganidza data rese riri pamusoro uye nezvimwe zvakawanda, inguva yekuona kuti ungadzivirira sei zvikanganiso zvakafanana. Kana dziri zviitiko zvevarindi, Joint Commission yakaraira kubvira 1997 kuti zviitiko zvese izvi zviitwe nzira inonzi Root Cause Analysis (RCA). Nekudaro, kushandisa nzira iyi kune zviitiko zvinoda kuziviswa kune vekunze zvingada kugadziriswa.

 

Chii chinonzi Root Cause Analysis?

MaRCA "akatora ruzivo pamwe nemaonero makuru." Ivo vanoita kuti masystem ekuongorora ave nyore, kuongorora kana kugadzirisa kwakakosha, uye maitiro ekutevera. (Williams, 2001) Chii chaizvo chinonzi RCA, zvakadaro? Nekuongorora zviitiko zvakakonzera kukanganisa, RCA inogona kutarisa pane zviitiko uye maitiro pane kuongorora kana kupa mhosva kune chaivo vanhu. (AHRQ,2017) Ndicho chikonzero nei zvakakosha. Iyo RCA inowanzo shandisa chishandiso chinonzi Five Whys. Iyi ndiyo nzira yekuramba uchizvibvunza iwe "nei" mushure mekunge watenda kuti waona chikonzero chenyaya.

 

Chikonzero icho ichinzi "zvishanu nei" imhaka yekuti, nepo shanu iri nzvimbo yakanaka yekutanga, iwe unofanirwa kugara uchibvunza kuti sei kusvika waona chiri kukonzera dambudziko. Kubvunza kuti sei uchidzokorodza uchigona kuratidza kukanganisa kwakawanda pamatanho akasiyana, asi iwe unofanirwa kuramba uchibvunza kuti sei nezvese chikamu chenyaya kusvika wapererwa nezvimwe zvinhu zvinogona kugadziriswa kuti zvipe mhedzisiro inodiwa. Nekudaro, zvishandiso zvakasiyana kunze kweiyi zvinogona kushandiswa mukutsvagisa chikonzero. Vamwe vakawanda variko. MaRCA anofanirwa kunge ari emhando dzakasiyana siyana uye anoenderana uye achibatanidza mapato ese ane chekuita nekukanganisa kudzivirira kusanzwisisana kana kutaura zvisirizvo zvezviitiko.

 

mhedziso

Zvikanganiso zvekurapa muzvipatara zvinowanzoitika uye kazhinji zvisingataurwi zviitiko zvinokanganisa hutano hwevarwere zvakanyanya. Vanhu vanosvika chikamu chimwe muzvina chemiriyoni vanofungidzirwa kuti vanofa gore rega rega nekuda kwekukanganisa kwekurapa. Huwandu uhu hahugamuchirwe munguva iyo kuchengetedzwa kwevarwere kunofungidzirwa kuti ndiko kwekutanga, asi hapana zvakawanda zviri kuitwa kushandura maitiro. Kana zvikanganiso zvehutano zvakanyatsotsanangurwa uye chikonzero chechinetso chinowanikwa pasina kupa mhosva kune vamwe vashandi, izvi hazvidiwi. Shanduko dzakakosha dzinogona kuitwa kana zvikonzero zvakakosha zvehurongwa kana kukanganisa kwemaitiro zvakaonekwa nemazvo. Nzira inopindirana, yakasiyana-siyana yekuongorora chikonzero chemudzi iyo inoshandisa masisitimu akafanana neaya mashanu ekuti sei kuongorora pasi kudzamara matambudziko ese uye hurema hwaratidzwa chinhu chinobatsira. Kunyange zvazvo iko zvino kwave kuri madikanwa pakumuka kwezviitiko zvevarindi, iyo Root Cause Analysis inogona uye inofanira kushandiswa kune zvese zvinokonzeresa kukanganisa, kusanganisira pedyo nekupotsa.

 

References

Agency for Healthcare Research uye Hunhu. (2016). Root Cause Analysis. Yakadzorerwa Kurume 20, 2017, kubva psnet.ahrq.gov/primer/root-cause-analysis

Grober, ED, & Bohnen, JM (2005). Kutsanangura kukanganisa kwekurapa. Anogona J Surg, 48(1), 39-44. www.ncbi.nlm.nih.gov/pubmed/15757035

Kohn, LT, Corrigan, J., Donaldson, MS, & Institute of Medicine (US). Komiti yeKunaka Kwehutano Hwehutano muAmerica. (2000). Kukanganisa munhu : kuvaka hutano hwakachengeteka. 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). Chimiro chezviitiko zvakashata muvarwere vari muchipatara. Mibairo yeHarvard Medical Practice Chidzidzo 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). Matanho Ekuona uye Kuongorora Zviitiko Zvakaipa uye Nekupotsa Pedyo paAcademic Medical Center. Jt Comm J Qual Patient Saf, 43(1), 5-15. doi.org/10.1016/j.jcjq.2016.11.001

Patient Safety Network. (2016). Zviitiko zvakashata, pedyo nekupotsa, uye kukanganisa. Yakadzorerwa Kurume 20, 2017, kubva psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors

Williams, PM (2001). Matekiniki ekuongorora chikonzero chemudzi. Proc (Bayl Univ Med Cent), 14(2), 154-157. doi.org/10.1080/08998280.2001.11927753

Disclaimer

Spinal Stenosis MRI: Back Clinic Chiropractor

Spinal Stenosis MRI: Back Clinic Chiropractor

by | Kufungidzira & Diagnostics, Spine Care

Spinal stenosis inguva apo nzvimbo pane imwe nzvimbo pamwe chete kana mukati memuzongoza inotanga kutetepa, kuvhara kukwanisa kwemaitiro / kugadzikana kufamba uye kutenderera kwetsinga. Inogona kukanganisa nzvimbo dzakasiyana, kusanganisira iyo remuromo wechibereko / remutsipa, lumbar / pasi kumashure, uye, zvishoma, iyo thoracic / yepamusoro kana yepakati-kumashure matunhu kukonzera kurira, kusanzwa, kuputika, kurwadziwa, kupera simba kwetsandanyama, kana kusanganiswa kumusana, gumbo / s, zvidya, uye matako. Panogona kuva nezvikonzero zvakasiyana-siyana zvinokonzera stenosis; Kuongororwa kwakarurama ndiro danho rokutanga, uye apo spinal stenosis MRI inouya.

Spinal Stenosis MRI: Kukuvadza Medical Chiropractor

Spinal Stenosis MRI

Stenosis inogona kuva yakaoma kuti iongorore sezvo yakawanda yechiratidzo / chinetso pane mamiriro ezvinhu, anowanzokonzerwa ne-herniated discs, bone spurs, chirwere chekuberekwa, mushure mekuvhiyiwa, kana mushure mehutachiona. Magnetic resonance imaging/MRI ndiyo bvunzo yakajairika inoshandiswa pakuongorora.

kuongorora chirwere

  • Nyanzvi yehutano, sechiropractor, murapi wepanyama, nyanzvi yemuzongoza, kana chiremba, anotanga nekunzwisisa zviratidzo uye nhoroondo yekurapa.
  • Kuongororwa kwemuviri kuchaitwa kuti udzidze zvakawanda nezve nzvimbo, nguva, zvinzvimbo, kana zviitiko zvinodzikisira kana kuwedzera zviratidzo.
  • Mimwe miedzo inosanganisira simba remhasuru, kuwana ongororo, uye kuenzanisa kuyedzwa kubatsira kunzwisisa zviri nani kuti kurwadziwa kunobva kupi.
  • Kuti usimbise kuongororwa, kufungidzira kunodiwa kuti uone zviri kuitika.
  • MRI inoshandisa imaging yakagadzirwa nekombuta kugadzira mifananidzo inoratidza mapfupa uye matishu akapfava, semhasuru, tsinga, uye tendon, uye kana akamanikidzwa kana kushatirwa.
  • Nyanzvi yezvehutano uye MRI tekinoroji ichaenda pamusoro pezvinodiwa zvekuchengetedza pamberi pekufungidzira.
  • Nekuti muchina uyu unoshandisa magineti ane simba, hapagone kuve nesimbi pairi kana mumuviri, senge akaisirwa prostheses kana zvishandiso zvinosanganisira:
  • Pacemakers
  • Cochlear implants
  • Mishonga infusion pombi
  • Intrauterine contraceptives
  • Neurostimulators
  • Intracranial aneurysm clips
  • Bone-kukura stimulators
  • Muedzo wakasiyana wekufungidzira unogona kushandiswa kana munhu asingakwanisi kuva neMRI senge CT scan.

MRI inogona kubva pamaminitsi akawanda kusvika paawa kana kupfuura, zvichienderana nekuti zvingani zvinzvimbo zvakakosha kuti zviparadzanise nzvimbo yakakuvadzwa uye kuwana mufananidzo wakajeka. Muedzo wacho haurwadzi, asi dzimwe nguva vanhu vanokumbirwa kuchengetedza nzvimbo chaiyo inogona kusagadzikana. Iyo technician/s inobvunza kana paine kusagadzikana uye kupa chero rubatsiro kuita kuti chiitiko chive nyore sezvinobvira.

mabatiro

Haasi ese zviitiko zve stenosis zvinokonzeresa zviratidzo, asi kune nzira dzekurapa dzinogona kukurudzirwa nenyanzvi yezvehutano.

  • Conservative care ndiyo kurudziro yekutanga inosanganisira chiropractic, decompression, traction, uye kurapa kwemuviri.
  • Kurapa kunowedzera simba remhasuru, kunonatsiridza mafambiro, kunonatsiridza chimiro uye kuenzanisa, kunoderedza zviratidzo zvekusagadzikana, uye kunosanganisira nzira dzekudzivirira nekugadzirisa zviratidzo.
  • Mishonga yemishonga inogona kuva chikamu chechirongwa chikuru chekurapa.
  • Kuvhiya kunogona kuve sarudzo mune zvakanyanya kuomarara chengetedzo isiri kushanda.

Spinal Stenosis

References

Database yeAbstracts yeOngororo yeMamiriro (DARE): Huwandu-yakaongororwa Ongororo [Internet]. York (UK): Center for Ongororo uye Kuparadzira (UK); 1995-. Kuongororwa kwe lumbar spinal stenosis: yakagadziridzwa yakarongeka yekuongorora kwechokwadi chekuongorora kuongororwa. 2013. Inowanikwa kubva: www.yori.nlm.nih.gov/books/NBK142906/

Ghadimi M, Sapra A. Magnetic Resonance Imaging Contraindications. [Yakagadziridzwa 2022 Chivabvu 8]. Mu: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Inowanikwa kubva: www.yori.nlm.nih.gov/books/NBK551669/

Gofur EM, Singh P. Anatomy, Back, Vertebral Canal Ropa Supply. [Yakagadziridzwa 2021 Jul 26]. Mu: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Inowanikwa kubva: www.yori.nlm.nih.gov/books/NBK541083/

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

Stuber, Kent, nevamwe. "Chiropractic kurapwa kwe lumbar spinal stenosis: kuongororwa kwemabhuku." Nyaya yechiropractic mishonga vol. 8,2 (2009): 77-85. doi:10.1016/j.jcm.2009.02.001

Spinal Kufungidzira Kudzoka Kliniki Inotarisira

Spinal Kufungidzira Kudzoka Kliniki Inotarisira

by | Kufungidzira & Diagnostics

Chiropractors uye nyanzvi dzemuzongoza dzinoshandisa kufungidzira kwemusana kuburikidza neX-rays, MRIs, kana CT scans kuti vaone kuti chii chiri kukonzera matambudziko kumashure nemarwadzo. Kufananidzira kwakajairika. Ingave chiropractic kana kuvhiyiwa kwemusana, ivo vanobatsira zvakanyanya kuwana kumashure nyaya uye vanobvumira munhu kuti aone zviri kuitika. Mhando dzemakesi dzinosanganisira kurwadza kwemusana kuti:

  • Kubva ku dambudziko
  • Akagara kwemavhiki mana kusvika matanhatu
  • Inoperekedzwa nenhoroondo ye:
  • kenza
  • chimhepo
  • Night sweats

Vanachiremba vanoshandisa mifananidzo iyi kana kuongorora chirwere chemusana. Heano mamwe manzwisisiro eiyo spinal imaging.

 

Spinal Kufungidzira Kudzoka Kliniki Inotarisira

X-rays

X-ray yemarwadzo ekumusana inogona kubatsira chaizvo. An X-ray inonzi radiation-based uye inoshandiswa kuongorora mamiriro emapfupa emapfupa. X-rays ndiyo yakakwana yemapfupa emapfupa kana matishu ane ossified kana calcified. Vanoshanda zvakanyanya nenyama yakaoma, kunyanya mapfupa. Zvinyoro zvinyoro semhasuru, ligaments, kana intravertebral discs hazvipo zvakare.

Vanhu vari kuvhenekwa X-ray yekumashure vanozoongororwa nemuchina unogadzira danda. Anogamuchira anotora kunyoresa danda mushure mekunge rapfuura nemuviri uye rinogadzira mufananidzo. Zvinotora anenge maminetsi mashanu kuti apedze asi anogona kureba zvichienderana nenhamba yemifananidzo yachiremba. X-rays inobatsira kune zvinangwa zveinishuwarenzi uye inobvisa mamiriro emapfupa senge compression fractures uye / kana bone spurs. X-rays inorongerwa zvikonzero chaizvo uye inowanzova chikamu chekuongorora-muviri wese. Izvi zvinosanganisira MRI uye/kana CT scan.

CT Scan

CT inomirira computed tomography. Iri nhevedzano yeX-rays inoiswa mumifananidzo ichishandisa komputa. Chakanakira cheCT scan kune yakajairwa X-rays ndechekuti inopa maonero / makona akasiyana emuviri uye inogona kunge iri mu3D. CT scans inowanzoshandiswa muzviitiko zvekushungurudzika kana vanhu vakambovhiyiwa. Vanotora anenge maminitsi mashanu. PamaX-ray, vanhu vanosimuka kana kurara pasi pemuchina weX-ray apo unovheneka muviri. A CT scan inoita kuti munhu arare pasi mumuchina wedenderedzwa unotarisisa uchitenderera panguva yekufungidzira. Vanhu vamwe navamwe vanokurudzirwa kupfeka zvipfeko zvakasununguka, zvakasununguka. Dzimwe nguva dhayi, kana kuti intravenous musiyano, inoshandiswa kuita kuti tsinga dzevascular dzimire, ichigadzira mifananidzo yakajeka.

MRI

MRI ipfupi ye magnetic resonance imaging. MRIs inoshandisa magineti kugadzira mifananidzo. MRI imaging inowanzoshandiswa kune vanhu vakavhiyiwa. Vanotora nguva yakareba, kazhinji kutenderera 30 kusvika 45 maminetsi. Hapana zvinhu zvesimbi zvinotenderwa muMRI. Varwere vanokumbirwa kubvisa zvinhu zvakaita semabhandi, zvishongo, nezvimwe. Kusiyanisa dhayi kunogona kuva chikamu cheMRI. Muchina wacho wakafanana nemugero. Izvi zvinogona kuve zvakaoma kune vanhu vane claustrophobia. Bvunza nachiremba uye uwane nzira yekugadzikana panguva yekuita.

Mamwe Mafomu eSpinal Imaging

Mamwe mafomu emifananidzo anosanganisira:

CT navigation

  • CT navigation inoratidza chaiyo-nguva CT scans panguva yekuita.

Fluoroscopy

  • Fluoroscopy inosanganisira X-ray danda rinopfuura zvakananga nemuviri rinoratidza mhenyu, mifananidzo inofamba.

Ose ari maviri emhando idzi dzespinal imaging anoshandiswa panguva yekuvhiya. Kune zvimwe zviitiko, intraoperative imaging inoshandiswa. Iyi mhando yekufungidzira inoshandisa yepamusoro-tech marobhoti kubatsira vanachiremba vanovhiya kufamba munzvimbo dzakasimba panguva yekuitwa. Izvi zvinowedzera kurongeka kwechiremba uye zvinoderedza ukuru hwekuchekwa.

Ultrassom

Ultrasound inogona kushandiswa kumusana mamiriro. Uyu muedzo wekufungidzira unoshandisa masaisai enzwi kugadzira mifananidzo. Nekudaro, iwo maedzo ekufungidzira ayo anoshandiswa muspinal imaging anonyanya X-rays uye MRIs.

Imaging Appointment

Taura nachiremba wako kana chiropractor nguva isati yasvika kuti unzwisise zvaunotarisira panguva yekufungidzira. Ivo vanokuzivisa iwe kugadzirira uye chero yakakosha mirairo pamberi pekugadzwa. Pamwe chete nenhoroondo yezvokurapa uye kuongorora kwepanyama, kufungidzira kwepelinha chikamu chinokosha chekutsvaga kwekutsvaga kuti chii chinokonzera marwadzo uye kukudziridza chirongwa chakanakisisa chekurapa.

Mutumbi Muumbi

Yenguva pfupi Migumisiro Yekofi uye Kuwedzerwa Ropa

Iyo caffeine iri mukofi inosimudzira kana chinhu chinofadza masisitimu emuviri. Kana caffeine inopinzwa, vanhu vanoona kuwedzera kwekunakidzwa, kunyanya muhurongwa hwemoyo. Kunakidzwa uku kunoita kuti kurova kwemwoyo uye BP ikwire uye yozodzikira kumashure kusvika padanho rekutanga revanhu vane hutano. Kofi inowedzera zvishoma-nguva pfupi yeropa. Kunwiwa kwekofi zvine mwero kwakachengeteka kune vanhu vasina pre-epo yemoyo yemoyo mamiriro.

References

United States Nuclear Regulatory Commission. (Chivabvu 2021) "Doses muhupenyu hwedu hwezuva nezuva" www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html

X-Ray yeKurwadza Kwekumashure: Ongororo Yazvino muMusculoskeletal Medicine. (April 2009) "Ndeipi basa rekufungidzira mukurwadziwa kwakanyanya kwemusana?" www.ncbi.nlm.nih.gov/pmc/articles/PMC2697333/

Zvirwere Zvepabonde Kuona Mafungiro Kusvika | | El Paso, TX.

Zvirwere Zvepabonde Kuona Mafungiro Kusvika | | El Paso, TX.

by | Kufungidzira & Diagnostics

  • Uku ndiko kuongororwa kwenguva pfupi kwezvimwe zviyeuchidzo zvemishonga zvinowanikwa mumakiriniki.
  • Acute Trauma kusanganisira acute head trauma
  • Kwete-chiitiko chinotambudza muvana (akarwa mwana)
  • Musculoskeletal Complaints (Juvenile Idiopathic Arthritis, scoliosis,
  • Kazhinji vana mapundu (CNS & vamwe)
  • Kurwara
  • Chirwere chemagetsi

Zvakanyanya Kurapa kwevana:

chirwere chekuongorora chimiro e paso, tx.
  • Makuvadzwa eFOOSH (semuenzaniso, akawira pambongoro-bar)
  • Supracondylar Fx, murwi. Nguva dzose d / t tsaona inoshungurudza. <10-yo
  • Extra-articular Fx
  • Gartland maitiro emakoroti minimally evlaced mavanga akavanzika akabatwa nechinhu chisina kumira zvakanaka vs. posterior elbow dislocation treated nenzira
  • Izvo zvinogona kuisa njodzi yekunyengedzera kwekwenyengeri kana kucherechedza kunonoka (Volkmann chibvumirano)
  • Iyo Radiological bvunzo yakakosha: chikepe chiratidzo & yekumashure mafuta pad chiratidzo pamwe neamberi humeral mutsara yakakundikana kuyambuka pakati / 2/3 yeCapitellum.

Chirwere chisina kukwana Fx:

chirwere chekuongorora chimiro e paso, tx.
  • Mazhinji mu <10 yo Greenstick, Torus, Plastic aka Kukotama hurema
  • Kazhinji kuporesa zvakanaka, kurapwa nekuchengetedza
  • Kukanganisa kwepurasitiki kana> makumi maviri-madigiri inoda kudzikiswa kwakapfigwa
  • Ping pong skull fracture inogona kukura inotevera kushungurudzika, forceps kubhadhara uye zvinetso zvekurwadziwa kwekuzvarwa. Ingadi inofanira kuongororwa nevana vevana neurosurgeo.n
chirwere chekuongorora chimiro e paso, tx.
  • Salter-Harris rudzi rwekukuvara kwepasseal kukura
  • Tora 1-slip. Somuenzaniso, Slipped Capital Femoral Epiphysis. Kazhinji hapana pfupa rakaputika rakataurwa
  • Tora 2-M / C nekutaura zvakanaka
  • Ita 3- intra-articular, saka inotakura dambudziko risati rasvika chemajoini uye inogona kutarisirwa kushanda d / t kusagadzikana
  • Tora 4- Fx kuburikidza nemativi ose nezve physis. Kusagamuchirwa kusagadzikana uye chidimbu chinopfupisa
  • Tora 5- kazhinji hapana uchapupu hwepfupa pfupa rakaputsika. Kutadza kukurumidza kufara d / t kupwanya kukuvadza uye kukuvara kwevascular pamwe nekuderera kwechiso
  • Kufungidzira kuongorora kunokosha

Kwete-Kungoerekana Yakuvara (NAI) muvana

chirwere chekuongorora chimiro e paso, tx.
  • Ikoko maitiro akasiyana-siyana ekudzvinyirirwa kwevana. Kushungurudzwa kwepanyama kunogona kubva pakakuvara kweganda kune zvakasiyana zvakakuvara zve MSK / systemic zvinokanganisa mapfupa uye zvinyoro zvishoma. Kufananidza kwakakosha uye kunogona kuziva zviratidzo zvakajeka zvichiruramisa vatapi vezvechiremba uye kuzivisa mabasa ekudzivirirwa kwevana uye mitemo yekudzivirira mitemo pamusoro pekushandisa zvisina kunaka.
  • Mucheche: shaken baby syndrome inogona kuuya neCNS zviratidzo d / t kubvarura kwekukura kusingaiti mutsinga uye subdural hematoma iyo inogona kuuraya. Retinal hemorrhaging kazhinji chiratidzo. Musoro CT wakakosha.
  • MSK Radiological Red Flags:
  • 1) gurufu pfupa Fx mu mwana asina mwana anovhiringidza (0-12 mo)
  • 2) Nhamba dzomumatare Fx: kazhinji hazviitike d / t zviitiko. Zvingangodaro nzira dzekushandisa: kubata uye kufambisa mwana kana kutsvaga zvakananga.
  • 3) Fractures dzakawanda dzine maitiro akasiyana-siyana ekuporesa zviyero, kureva, mapfupa emapfupa anoratidza kudzokorora mumuviri
  • 4) Kona yemapapanse Fx aka Bucket kubata Fx, kazhinji pathognomonic ye NAI muvana. Inoitika apo migumo yakagadziriswa inobatwa uye ichishungurudzika.
  • 5) Kuputsika kwemafupa emapfupa marefu mumwana muduku ndiyo imwe muenzaniso weNaI.
  • Zvimwe zvinokosha zvinokosha zve NAI. Kusabvumirana nhoroondo yakapiwa nevarindi / vatarisi. Hapana uchapupu hwehutano hwemapfupa / metabolic husina kunaka sezvakaita Osteogenesis Imperfecta kana Rickets / osteomalacia nezvimwewo.
  • NB Kana vachengeti vemwana vakataura nhoroondo inoratidza kuti kudonha uye tsaona mumba, Zvakakosha kuziva kuti zvinoita tsaona / kuwira mumba kazhinji kacho kana zvisingaite zvinoguma nekutyoka kwemapfupa.
  • Kuzivisa kushungurudzwa kwevana mu Illinois:
  • www2.illinois.gov/dcfs/safekids/reporting/pages/index.aspx

MSK Kufanirwa Kusvika Patiatrics

chirwere chekuongorora chimiro e paso, tx.
  • Juvenile Idiopathic Arthritis (JIA)-kutarisirwa M / C chirwere chisingaperi chehudiki. Clinical Dx: kurwadziwa pamwe chete / kuzvimba kwemavhiki matanhatu-kana kupfuura mumwana <6-yo Mafomu akasiyana aripo: Pakutanga Dx yakakosha kudzivirira kunonoka kunetseka
  • Nzira dzakawanda dzinozivikanwa dzeJIA:
  • 1) Pauciarticular chirwere (40%) - m / c chimiro cheJIA. Vasikana vari pangozi huru. Inopa seArthritis mu <4 majoini: mabvi, makumbo, ruoko. Gokora. Rudzi urwu rwunoratidza hukama hwakawanda neunobata uchiita se iridocyclitis (25%) iyo inogona kutungamirira kuhupofu. Labs: RF-ve, ANA yakanaka.
  • 2) Polyarticular chirwere (25%): RF-ve. Vasikana vari pangozi huru. Inobata zviduku zviduku uye zvikuru zvinowanzobata Kervical spine
  • 3) Chimiro cheJIA (20%): kazhinji chinopa nehukuru systemic kuratidzwa semafuta anopikisa, arthralgias, myalgias, lymphadeno [pathy, hepatosplenomegaly, polyserositis (pericardial / pleural effusion). Zvinonyanya kukosha Dx zvinoratidzika zvinoratidza sevanescent salmon rinopisa pink pamagumo uye mutumbi. Nzira yakarongeka ine kusiyaniswa kwakasiyana kwekuona kusanganisa. Mazamu kazhinji kacho shangu haasi kupesana kunoenzaniswa nemamwe marudzi. Nokudaro kupatsanidza pamwe chete hakusi kuonekwa

Kufungidzira muJIA

chirwere chekuongorora chimiro e paso, tx.
  • Joint effusion bone inokonzera squaring ye patella cartilage / kuputika kwepasipo DJD yakawanda
  • Zvigunwe nemapfupa marefu mapepa ekuvhara muviri wep physeal / mutsva kupfupika
  • Rad DDx knee / ankle: Hemophilic arthropathy Rx: DMARD.
  • Zvinetso zvinogona kuitika kuparadzana pamwe chete, kukurumidza kukura / kupfupisa kwechimbaridzo, kupofumadza, kunetseka kwemaitiro, kuremara.

Yakawanda Inowanzobatwa Nevana VanaMarignant Bone Neoplasms

chirwere chekuongorora chimiro e paso, tx.
  • Osteosarcoma (OSA) & Ewing's sarcoma (ES) 1 st uye 2nd M / C primary malignant bone neoplasms youcheche (nheyo pa 10-20 yo) Clinically: kurwadziwa kwepfupa, kuchinja mumabasa, masitasita epakutanga kunyanya mishonga yemapammoni inogona kuitika. Varombo vasina kunaka
  • Ewing s inogona kuuya nekurwadziwa kwepfupa, kupisa uye kukwirisa ESR / CRP kuteedzera hutachiona. Pakutanga Dx ine imaging uye staging yakakosha.
  • Kufananidza kweOSA & ES: x-ray, inoteverwa neMRI, chifuva CT, PET / CT. Pane x-rays: OSA inogona kukanganisa chero pfupa asi mazhinji aripo seane hasha mapfupa anogadzira mamota pamusoro pemabvi (50% kesi) kunyanya seosteoid inogadzira chironda chine hukasha mune metaphysis ine fungidziro / sunburst periostitis & Codman triangle. Yakaratidzirwa yakapfava tishu inopinda.
  • E ES inogona kuisa mumumvuri uye kuratidza mavara ekutanga. MRI inokosha kuti iratidze huwandu hwemapfupa uye ST inopinda, MRI inodikanwa pakugadzira chirongwa
  • OSA & ES Rx: Kubatanidzwa kwekuvhiya, radiation, chemo. Limb salvage maitiro anoitwa mune dzimwe nguva. Kufungidzira kwakashata kana kukaonekwa kunonoka.
chirwere chekuongorora chimiro e paso, tx.
  • Kufungidzira kweEwing's sarcoma
  • Kukonzera kuputika kwepfupa
  • Pakutanga uye kwakakura kwemavara emhando yepamusoro
  • Aggressive periosteal react with laminated (onion skin) response
  • Saucerisation ye cortical bone (machungwa museve)
  • Chirwere chinowanzoita diaphyseal ine mamwe maitiro ekuwedzera
  • Inozivikanwa seRondle sechirwere pamwe chete ne Multiple Myeloma uye Lymphoma

Kazhinji Vechiduku Malignancies

chirwere chekuongorora chimiro e paso, tx.
  • Neuroblastoma (NBL) M / C yakaipa yehucheche. Inotorwa kubva kune neural crest maseru aka PNET mamota (semuenzaniso, anonzwira tsitsi ganglia). Zvizhinji zvinoitika muvana <24-mwedzi. Vamwe vanoratidzira kufungidzira kwakanaka asi> 50% makesi aripo nechirwere chemberi. 70-80% pazera 18-mwedzi kana mukuru aripo ane advanced metastasis. NBL inogona kukura mune adrenal medulla, inonzwira tsitsi ganglia uye imwe nzvimbo. Inopa seyedumbu dumbu, kurutsa. > 50% inopa nemarwadzo epfupa d / t metastasis. Kiriniki: bvunzo dzemumuviri, marabhu, kufungidzira: chipfuva uye abd x-rays, CT dumbu uye chipfuva kwakakosha kuna Dx. MRI inogona kubatsira. NBL inogona metastasize kune dehenya uye kupinza masuture nehunhu hunoratidzwa sehutachiona sutural diastasis.
  • Acute Lymphoblastic Leukemia ndiyo m / c kuipa kwehuduku. Pathology: leukemic cell infiltration marrow bone rinokonzera kurwadziwa kwepfupa uye kushandiswa kwemamwe masero emurairo ane anemia, thrombocytopenia, neutropenia uye zvinetso zvinosanganiswa. Leukemic masero angapinda mune dzimwe nzvimbo kusanganisira CNS, spleen, bone uye dzimwe nzvimbo. Dx: CBC, serum lactate dehydrogenase levels, Bone marrow aspiration biopsy ndicho chinhu chinokosha. Kufungidzira kunogona kubatsira asi kusingakoshi pakuongororwa. Pachando chemafirimusi, marapu ekuputika kwepfupa angangowanzoonekwa sezvikwata zvinokonzera kupisa pamwe nepaseal growth plate. Rx: chemotherapy uye kurapa zvinetso
chirwere chekuongorora chimiro e paso, tx.
  • Medulloblastoma: M / C yakaipa CNS neoplasm muvana
  • Nhamba zhinji dzinokura zvisati zvaitika 10-yo
  • M / C nzvimbo: cerebellum uye posterior fossa
  • Histologically inomiririra chirwere chePNET kwete glioma sezvaimbofungidzirwa pakutanga
  • MBL, pamwe neEpendymoma uye CNS lymphoma, inogona kukonzera kuderedza metastasis kuburikidza neCSF uye kuwedzera kuve yakasiyana yakasiyana nedzimwe zvirume zveCNS zvinoratidza kupararira kwemasasita kunze kweCSS, m / c kusvika pfupa
  • 50% ye MBL inogona kunge yakagadziridzwa zvizere
  • Kana Dx nemishonga inotanga kusati yasvika metastasis, 5-gore rinopona ndi80%
  • Kufananidza kwakakosha: CT scanning inogona kushandiswa asi mafungiro ekufungidzira aunosarudza ndeyeMRI iyo inowedzera kupa tsvakurudzo yepamusoro yeeuraxis yose ye metastasis.
  • MBL inowanzoonekwa se hypoterinic hypo, iso uye hyperintense lesion ku T1, T2 uye FLAIR kuongorora (mifananidzo yakakwirira) kana ichienzanisa nehupi hwepfungwa dzehupi. Kakawanda kunokonzera 4th ventricle nevanopisa hydrocephalus. Dumbu racho rinoratidzira kuratidzira kusiyanisa pa T1 + C gad (pasi kuruboshwe mufananidzo). Drop metastasis kubva ku MBL ne T1 + C kukusimudzira chironda mumudonzvo

Chirwere Chetachiona Chinotakurwa

chirwere chekuongorora chimiro e paso, tx.
  • Mune neonate / mucheche <1month: fever> 100.4 (38C) inogona kuratidza hutachiona uye humwe hutachiona hutachiona. Strep B, Listeria, E. Coli inogona kutungamira kune sepsis, meningitis. Inzira: chest x-ray, lumbar puncture netsika, ropa tsika, CBC, urinalysis.
  • Muvana vaduku, Hemophilus influenza type B (HIB) inogona kutungamirira kuEpiglottitis chisingaiti asi chinetso chakakomba. Ikozvino chirwere chinobatsira kuderedza nhamba yemhosva dzeEpiglottitis nedzimwe zvirwere zveHIB zvine chokuita.
  • Parainfluenza kana RSV Utachiona hunogona kutungamirira kuCroup kana kuti kuRaryaryototchechebronchitis.
  • Epiglottitis neCroup zvinonzi Dx kliniki asi AP uye lateral soft tissue neck x-rays zvinobatsira zvikuru
  • Epiglottitis inopa nehunhu thumb sign inoenderana neakakora epiglottis d / t epiglottic edema. Izvi zvinogona kuve zvinotyisidzira hupenyu zvinokanganisa mweya (kumusoro kuruboshwe)
  • Croup inogona kuratidza steeple sign kana wine bottle sign ine distended hypopharynx sekukomba kuderera kwe subglottic airway paAP uye yekupedzisira mutsipa nyoro nyama x-ray (kumusoro kurudyi)
  • Kuporesa Syncytia Virus (RSV) uye furuwenza inogona kutungamirira kuhutachiona hwepirumoni inogona kuve nehutano hwehupenyu huri muhutachiona husina kunaka, huduku zvikuru uye vana vane comorbidities. CXR inokosha (pakati kuruboshwe)
  • Streptococcal pharyngitis nehutachiona hweGABHS inogona kutungamirira kune zvimwe zvakaoma kana kuti kunonoka kunetseka (semuenzaniso, Rheumatic fever)
  • Peritonsillar abscess (kumusoro nepakati kurudyi) inogona kukura mune dzimwe mamiriro ezvinhu uye kuomeswa nekupararira pamwe chete nemapuraneti ari nyore mumutsipa zvinogona kutungamirira kupararira mune zvinyorwa zvinyorwa / submandibular (Ludwig Angina) apo mhepo inofanirwa kudzora d / t dhemi rwemirimi edema
  • Kubudirira kwekubviswa kwetropharyngeal kunogona kutungamirira pakupararira kwehutachiona kuburikidza nekukurukurirana pachena musungo fascia zvichiita kuti necrotizing mediastinitis, Lemmier syndrome nekupinda kwemahara carotid (zvose zvinogona kutyisa upenyu)
  • Griesel syndrome- (kumusoro kumusoro kuruboshwe) kusanzwisisika kusingaitiki kwemasango emunharaunda / pharyngeal mishonga inogona kupararira kune prevertebral nzvimbo inotungamirira kuC1-2 ligaments kusagadzikana uye kusagadzikana
  • Zvimwe zvirwere zvinokosha muvana zvinowanzoita mabhakitiriya (Pneumococcal) pneumonia, Urinary tract infection uye Acute Pyelonephritis (zvikurukuru kuvasikana) uye Meningococcal Meningitis
chirwere chekuongorora chimiro e paso, tx.
  • Chirwere cheMatabolic Disease
  • Rickets: inofungidzirwa osteomalacia mumarara asina kuchena. Chikamu chekugadziriswa kwenguva yakareba ye epiphyseal kukura ndiro inonyanya kukanganiswa
  • Chipatara chinopa kukura kwekukurumidza, kupera kunamatira, rachitic rosary, pigeon chest, kushushikana nenyundo, kubhururuka uye kubhururuka maziso, uye maziso emakumbo, tsvina
  • Pathology: Vit D uye calcium zvisina kufanana ndeyo m / c chikonzero. Kusava kwezuva kusununguka esp. munhu ane ruvara rwemajenya, zvipfeko zvinodzivirira kuti awane chiedza, kuwedzera kwenguva refu kunwisa, veganism, malabsorption syndromes mudumbu, kukuvara kwechimbichimbi nevamwe
  • Kufananidza: frayed metaphysis waka aka purasitiki mabheti emasiphysis ane flaring, kuwedzerwa kwepulumu yokukura, bundu rinodhura sorosi yepamusoro se rosary rachitic, kupfugama kunopfugama
  • Rx: shandisa zvinokonzera zvikonzero, kukwana kwakakwana kwezvokudya, uye zvimwe.

References

Mhumbu: Kuongorora Kufananidza Kuenda | | El Paso, TX.

Mhumbu: Kuongorora Kufananidza Kuenda | | El Paso, TX.

by | Kufungidzira & Diagnostics

 

  • Kuongororwa kwezvirwere zvemuviri kunogona kuiswa mu:
  • Kuipa kweiyo utumbo turakiti (esophagus, mudumbu, diki & hombe ura, uye mupiro
  • Kusagadzikana kwenhengo dzekugaya dzinowanikwa (Hepatobiliary & pancreatic kusagadzikana)
  • Kusagadzikana kweiyo genitourinary & nhengo dzekubereka
  • Kukanganiswa kwemuviri mudumbu nemidziyo mikuru
  • Iyi mharidzo ine chinangwa chekupa ruzivo rwakanyanya rwevanhu vose kufungidzira imaging kuswedera pedyo uye kukodzera kukiriniki yekuchengetedza varwere vane zvirwere zvakanyanya zvemuviri
  • Kufungidzira nzira dzakashandiswa panguva yekutsvakurudza kwezvipomha zvemuviri:
  • AP mudumbu (Kub) uye CXR yakarurama
  • Abdominal CT scanning (nemuromo uye IV kusiyana uye w / o kusiyana)
  • Dzidzo yepamusoro nechezasi yeGI Barium
  • Ultrasonography
  • MRI (inoshandiswa seLiver MRI)
  • MRI kuiswa uye enteroclysis
  • MRI rectum
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) - kunyanya hepatobiliary uye pancreatic ductal pathology
  • Nhoroondo ye nyukireya

Sei Kurayira Madzimai X-ray?

mimba kuongororwa imaging e paso tx.

 

  • Ivai nemuongorori wekutanga wegesi remuviri mumamiriro ekupedzisira. Semuenzaniso, kudzidza kwakashata mumurwere anononoka kunogona kukanganisa kudiwa kweTCT kana zvimwe zvinoparadzirwa
  • Kuongororwa kwemashupu, marita, uye radiopaque kunze kwenyika
  • Post-procedural evaluation intraperitoneal / retroperitoneal gas gasi
  • Kuongorora kuwanda kwemagetsi emagu uye kusarudzwa kwe-postoperative (adynamic) ileus
  • Kuongorora kutarisa kwepakati pemuviri
  • Colonic transit zvidzidzo
  • Kuchengeta renal calculi

 

mimba kuongororwa imaging e paso tx.

 

Zvinofanira Kuziva pa AP Madzimai: Supine vs. Yakarurama vs. vs. Decubitus

  • Mhepo Yerusununguko (pneumoperitoneum)
  • Nhengo yekudzivirira: Kuvhara zvishongo: SBO vs LBO (3-6-9 mutemo) SB-kumusoro chikamu-3-cm, LB-kumusoro chikamu-6-cm, Caecum-upper-limit-9-cm. Cherechedza kurasikirwa kwehaustra, kunyora kuchera (kuvapo) kwevhirivule conivente (plica semilunaris) muSBO
  • SBO: cherekedza makomo akasiyanasiyana emhepo-mvura pamatanho akatwasuka firimu nhanho manera - kutaridzika, kwakajairika kweSBO
  • Cherechedza paucity ye rectal / colonic gas (yakabviswa) muSBO

 

mimba kuongororwa imaging e paso tx.

 

  • Abdominal CT scanning -hupenyu hunosarudzwa panguva yekutsvaga mheremhere yakaoma uye isingaperi yepamu kunyanya kune vanhu vakuru. Semuenzaniso, kumarara kwemuviri kunogona kuongororwa zvakajeka uye kugoverwa kupa ruzivo rwekliniki rwekugadzirira kuchengetedza
  • Dumbu, renal uye pelvic ultrasound inogona kuitwa kubatsira kuongororwa kweappendicitis (esp. muvana), acute & chronic vascular pathology, hepatobiliary zvisizvo, obstetric uye gynecological pathology
  • Kushandiswa kweionizing radiation (x-rays & CT) inofanirwa kudzikiswa muvana uye mamwe mapoka anotambura.

 

mimba kuongororwa imaging e paso tx.

 

Kuongororwa Kufananidzirwa Kwemajeri Makuru Evanhukadzi

  • 1) Matambudziko eEophageal
  • 2) Gastric carcinoma
  • 3) Gluten Sensitive Enteropathy
  • 4) Chirwere Chirwere Chirwere
  • 5) Pancreatic ductal adenocarcinoma
  • 6) Colorectal carcinoma
  • 7) Zvakakwana Appendicitis
  • 8) Chidziro chechidiki
  • 9) Volvulus

Esophageal disorders

  • Achalasia (primary achalasia): kutadza kweakarongeka esophageal peristalsis d / t kukanganisika kwekuzorora kwepasi esophageal sphincter (LOS) ine yakamisikidzwa kuwedzerwa kwesophagus uye chikafu stasis. Kuvhiringidzwa kweiyo distal esophagus (kazhinji nekuda kwethumba) kwave kunzi "yechipiri achalasia" kana "pseudoachalasia." . Vagus neurons inogona zvakare kukanganiswa
  • Primary: 30 -70s, M: F yakaenzana
  • Chagas chirwere (Trypanosoma Cruzi hutachiona) nekuparadzwa kweMyenteric plexus neurons yeGI system (megacolon & esophagus)
  • Zvisinei, mwoyo ndeye M / C nhengo yakakanganiswa
  • Clinically: Dysphagia kune zvese zvakanyanyisa uye zvinodhaka, mukuenzanisa nedysphagia yezvinyorwa chete mumatambudziko e esophageal carcinoma. Kuora kwepfupa uye kudzokerazve. M / C mid esophageal squamous cell carcinoma munenge 5% pamusana pekutsamwa kusingaperi kwemucosa ne stasis yezvokudya uye zvinyorwa. Kupisa pneumonia kunogona kukura. Candida esophagitis
  • Kufungidzira: Bird -beak pamusoro wepamusoro GI barium kumedza, yakasimudzwa esophagus, kurasikirwa kweperistalsis. Kuongorora kwekupedzisira kunokosha.
  • Rx: zvakaoma. Calcium channel blockers (pfupi -term) Kuwedzera kwepneumatic, inoshanda mu85% yevarwere vane 3 -5% dambudziko rekubuda ropa / kupera. Botulinum jekisi yexikisi inongogumira chete. Mwedzi 12 pakurapa. Inogona kuvhara iyo submucosa inotungamirira kuwandu hwekukanganisa kwehupenyu panguva inotevera myotomy. Kuvhima myotomy (Heller myotomy)
  • 10 -30% yevarwere vanoita gastroesophageal reflux (GERD)

 

mimba kuongororwa imaging e paso tx.

 

  • Presbyesophagus: yaishandiswa kurondedzera kuratidzwa kwekudzikira kwemota basa mune yekukwegura esophagus> 80-yo Nekuda kwekukanganisa kweiyo Reflex arc ine yakadzikira senzwi kune distension uye shanduko mune peristalsis.
  • Varwere vangave vachinyunyuta dysphagia kana kurwadziwa kwepfuva, asi vazhinji vanoratidzika
  • Diffuse / distal esophageal spasm (DES) iyo inonzi motility disorder yeeophagus iyo inogona kuonekwa semucheka wekona kana rosary bead yeopu pa swallowum swallow.
  • 2% yemarwadzo asina cheputi chepfupa
  • Manometry ndiyo yegoridhe-yakaenzana kuongororwa test.
mimba kuongororwa imaging e paso tx.

 

  • Zenker diverticulum (ZD) aka pharyngeal pouch
  • Kubuda kwepamusoro kwehutano hwe hypopharynx, kunongowedzera kune wepamusoro esophageal sphincter, inozivikanwa seKillian dehiscence kana Killian triangle
  • Varwere vane 60-80 yo uye vanopa ne dysphagia, regurgitation, halitosis, globus sensation
  • Itai kunetseka nechishuvo nemapurmaria zvisiri izvo
  • Varwere vanogona kuunganidza mishonga
  • ZD- inonzi pseudodiverticulum kana kukwezva diverticulum inokonzerwa nekucheneswa kwe submucosa kuburikidza neKillian dehiscence, kugadzira ganda apo zvokudya nezvimwe zvirimo zvingawedzera.
mimba kuongororwa imaging e paso tx.

 

  • Mallory-Weiss syndrome inoreva mucosal uye submucosal misodzi yepalus oesophageal venous plexus inosangana nechisimba kugadzirisa / kurutsa uye kurongeka kwezvokudya zvechingwa zvinopikisana nechepasi. Zvinodhaka zvine ngozi chaiyo. Mhosva dziripo nemarwadzo asingatauri hematemesis. Mishonga inowanzosigira.
  • Dx: Kufananidza kunobatsira zvishoma, asi kusiyana kweesophagram kunogona kuratidza mamwe mucosal misodzi yakazadzwa nemusiyano (pasi wekodzero chaiyo). CT kuongorora kunogona kubatsira kubvisa zvimwe zvikonzero zvekumusoro kweGI kubuda ropa
mimba kuongororwa imaging e paso tx.

 

  • Boerhaave syndrome: sophageal rupture yechipiri kune kurutsa kusimba
  • Mharidzo: M> F, kurutsa, kurwadziwa kwepfupa, mediastinitis, septic mediastinum, pneumomediastinum, pneumothorax pleural effusion
  • Munguva yakapfuura, yaigara ichiuraya
  • Nzira dzinosanganisira kubviswa zvakasimba kwezvokudya zvine gastric zvikuru kunyanya nezvokudya zvakakura zvisingaverengeki apo sophagus inobvumirana zvakasimba kurwisana glottis yakavharwa ne 90% inowanikwa pamwe nechekumashure kwemashure enderolateral
mimba kuongororwa imaging e paso tx.

 

  • Hiatus hernias (HH): kunyoreswa kwemuviri zviri mukati kuburikidza ne-esophageal hiatus yechipfupa mumumvuri we thoracic.
  • Varwere vakawanda vane HH havakwanisi kuverenga, uye ndeyekutsvaga kunowanzoitika. Zvisinei, zviratidzo zvinogona kusanganisira epigastric / chest pain, postpandial fullness, kushungurudza uye kurutsa
  • Dzimwe nguva HH inonzi inofanana ne gastro-oesophageal reflux chirwere (GORD), asi pane kuwirirana kwakashata pakati pemamiriro maviri aya!
  • 2-mhando: inotsvedza hiatus hernia 90% & rolling (paraoesophageal) hernia 10%. Iyo yekupedzisira inogona kudzipa inotungamira kune ischemia uye matambudziko.
mimba kuongororwa imaging e paso tx.

 

  • Esophageal Leiomyoma ndiye M / C benign esophageal neoplasm. Inowanzove yakakura asi isiri isina kudzivirira. Maviri emakumbo emakumbo (GIST) ndiwo anonyanya kuonekwa mumutumbi. Inofanira kusiyaniswa kubva kuEsophageal carcinomas.
  • Kufananidza: Kusiyana esophagram, GI yepamusoro yeBARUM swallow, CT kuongorora. Gastroesophagoscopy ndiyo Dx nzira yekusarudza.

mimba kuongororwa imaging e paso tx.

  • Esophageal carcinoma: iyo inowedzera nekuwedzera dysphagia, pakutanga kuoma uye kuenderera mberi kune zvinodhaka nekudzivirira mune mamwe matambudziko akakwirira
  • <1% yekenza dzese uye 4-10% yeese maGI malignancies. Iko kunozivikanwa kwevanhurume kupererwa neiyo squamous cell subtype nekuda kwekusvuta uye doro. Barrett esophagus uye adenocarcinoma
  • M: F 4: 1. Vanhu vemavara ndivo vanonyanya kunetseka kupfuura vanhu vema White 2: 1. Kutaura kusina kunaka!
  • Chirwere cheBangium chinogona kuva nehanya pakuziva masimba evanhu. Gastroesophagoscopy (endoscopy) inopupurira kuongororwa ne biopsy yemaviri
  • Pasi pose maronda anonyanya kufanana ndeye 2ndary gastric fundal carcinoma inopinda sopal
  • Serofu inoshandiswa inowanzoonekwa pakati pepakati, Adenocarcinoma munzvimbo inonzi distal
mimba kuongororwa imaging e paso tx.
  • Gastric carcinoma: primary malignancy ye gastric epithelium. Kazhinji vasati vava nemakore 40. Nguva yepakati pekuongororwa muUnited States ndeye 70 makore kwevarume uye 74 kwemakore nekuda kwevakadzi. Japan, South Korea, Chile, uye Eastern Europe dzine imwe yepamusoro yepamusoro yekenza yepamu munyika. Kenza yemukondombera inoderera pasi rose. Chirwere chepabonde chirwere che 5th chinokonzera kufa nekenza. Kushamwaridzana neHelicobacter pylori chirwere 60- 80%, asi chete 2% vanhu vane H. Pyloris vanoita kenza yemudumbu. 8-10% ine nhengo yemhuri yakagara nhaka.
  • Gastric Lymphoma inobatanidzawo neHylorlor infection. Gestrointestinal Stromal Cell Tumorori kana GIST ndeimwe chirwere chinokonzera mudumbu
  • Clinically: Hapana zviratidzo kana zvisingatauri uye zvinogona kuporesa. Kusvikira ku 50% yevarwere vangave vasina zvikwangwani zveGI zvisiri izvo. Varwere vanogona kupa neoreoreia uye kuora kurasikirwa (95%) pamwe nekurwadziwa kwepamuviri kusina kujeka. Nausea, kurutsira, uye kusanganisa satiety d / t kudzivirira kunogona kuitika nemavhumu anokonzera kana zvipembenene zvinopisa zvinokonzera kusuruvara kwemudumbu.
  • Prognosis: Kazhinji kemukari inoratidzirwa inoratidzwa munguva pfupi uye inogona kuratidza kupindira kwekune imwe nzvimbo nechekudzivirira zvirwere, chiropa, uye mesenteric kupararira. A 5-gore rinoponesa muzana we20% kana pasi. MuJapan uye S. Korea, mapurogiramu ekuongorora mavambo akawedzera kupona kusvika ku60%
  • kuri: Barium kumusoro GI kudzidza, CT scanning. Endoscopic kuongororwa ndiyo nzira yekusarudzwa. Pamusoro pekufungidzira, Mukenza weGastric ungaratidzika semafungiro emhando yepamusoro (polypoid) mashoma kana kuti Fungative type, Ulcerative kana Infiltrative / disperse type (Linitis Plastica). CT kuongorora kunokosha kuti uongorore kupinda kwenharaunda (node, mesentery, chiropa, nezvimwewo)
mimba kuongororwa imaging e paso tx.
  • Chirwere cheCeliac non-tropical sprue Aka Gluten-sensitive enteropathy: A T-cell mediated autoimmune chronic gluten-induced mucosal kukuvara kwakaguma nekurasikirwa kwevilli mumutambo muduku wechipfuva uye muviri malabsorption (kureva, sprue). Inofungidzirwa mune dzimwe mamiriro ehurumende kushaya simba anemia yechikonzero chisina kugadziriswa. Inowanikwa muCaucasians (1 mu200) asi inowanikwa muAsia uye vanhu vatsvuku. Tsamba mbiri: girasi duku muduku. Kazhinji mu 3rd uye 4th makumi emakore ehupenyu.
  • Clinically: Hurwa nemimba ndeyem / c chiratidzo, malabsorption yemuviri / mavitamini: IDA nemagaiac-positive, diarrhea, kudzivirira, steatorrhea, kuora muviri, osteoporosis / osteomalacia, dermatitis herpetiformis. Kuwedzera kushamwaridzana neT-cell lymphoma, Kuwedzera kushamwaridzana ne esophageal squamous cell carcinoma, SBO
  • Dx: Kumusoro kweGI kunopedzisira kune dzimwe nhengo dzakasiyana-siyana dzinonzi biodenal biopsies inofungidzirwa se chirwere chekuongorora nokuda kwechirwere ichi. Histology inoratidza T-cell kupinda uye lymphoplasmacytosis, Villi atrophy, Crypts hyperplasia, Submucosa, uye Serosa hazviperi. Rx: kubviswa kwezvinhu zvinokonzera gluten
  • Kufananidza: Hazvidiwi kuDx asi paBurum swallow swallowororcopy: mucosal atrophy uye kuparadzwa kwemucosal folds (advanced cases chete). SB kuwedzerwa ndiyo yakanyanya kuwanikwa yekuwana. Nodularity ye duodenum (bubbly duodenum). Kuchinja kwe jejunal uye ileal mucosal folds:
  • JeJejunum inoita kunge ileum, iyo ileum inoita kunge jejunum, uye duodenum inoita kunge gehena.
mimba kuongororwa imaging e paso tx.

Chirwere cheHosha Chirwere: Chirwere cheCrohn (CD) & Ulcerative Colitis (UC)

  • CD: chisingarambizve kudzoka-kuregera kunokonzera kuputika kunobata chero chikamu chegwaro reGI kubva pamuromo kusvika kune anus asi pakutanga kutanga kunowanzobatanidza nechokuguma neum. M / C mharidzo: kurwadziwa kwepamuviri / kugumburwa nekurwara. Nzira: granulomata kuumbwa kwakasiyana neUC inoshandura-shanduka, izvo zvingangotungamirira kumagetsi. Nharaunda dzinokonzerwa nekuputika zvinowanzoita patchy
  • Zvinetso zvakawanda: malabsorption yezvimiti / mavhithamini (anemia, osteoporosis, kukurumidza kunonoka kwevana, kunokonzerwa neGI kuuraya, kuvhara muviri, fistula maitiro, kuwedzera-mumimba zviratidzo: uveitis, arthritis, AS, erythema nodosum nevamwe.10- 20% inogona kuvhiyiwa mucheche mushure me10-makore eCD kazhinji kune zvigadziriswa, fistiluzation, BO.
  • Dx: kliniki, CBC, CMP, CRP, ESR, maitiro ekudzivirira: DDx yeBD: anti-Saccharomyces cerevisiae antibodies (ASCA), pineinuclear antineutrophil cytoplasmic antibody (p-ANCA) zvisiri izvo kana mu serum. Fecal Calprotectin test inobatsira DDx IBS uye kuongorora mhinduro kumushonga, chirwere chekuita / kudzokazve.
  • Dx yekusarudza: endoscopy, ileoscopy, uye mikana yakawanda inogona kuratidza endoscopic uye histological change. Vhidhiyo capsule endoscopy (VCE), kufungidzira kunogona kubatsira neDx yezvinetso. Rx: immunomodulatory drugs, mishonga inobatanidza, kudya, probiotics, operative. Hapana mushonga asi chinangwa ndechokukurudzira kuregererwa, kudzora zviratidzo uye kudzivirira / kubata zvinetso
  • Kufananidza Dx: Kub kuDBO DDx, Barium enema (kusarura uye kuwirirana kwechipiri), zvishoma zvishoma zvinotevera. Zvitsva: kuregerera zvipembenene, aphthous / zvakakomba zvipembenene, fistula / mapepa e sinus, Chiratidzo chechidimbu, chinokambaira mafuta chinokonzera mashizha eLB, cobblestone kuonekwa d / t kupisa / ulcers kusunga mucosa, CT kupenya nemuromo uye IV kusiyana.
mimba kuongororwa imaging e paso tx.
  • Kufungidzira kubva kumurwere waCrohn uyo aive aine diki matumbo resection yekuvhiringidzwa.
  • (A) CT scan inoratidza kusina kuvhiringidza kwakadaro asi
  • (B) MRE yemunzvimbo imwechete inoratidza kugadzirwa kwefrostenotic
mimba kuongororwa imaging e paso tx.
  • UC: unhu hunosanganisira chete hutoni asi bhukwash ileitis inogona kukura. Kutaridzika kunowanzo pa 15-40s uye kunowanikwa kune varume, asi kutanga kwezera re 50 kwave kuchijairikawo. Zvinowanzoitika muNorth America neEurope (hygiene hypothesis). Etiology: Kubatanidzwa kwezvakatipoteredza, maitiro uye maitiro ehupenyu hunochinja zvinosanganiswa. Kusvuta uye kutanga appendectomy zvinoratidzira kuratidza kusashamwaridzana neUC, zvakasiyana neCD zvakarangarira zvimwe zvezvipingamupinyi.
  • Clinical Features: Routal bleeding (inowanzo), chirwere, chirwere chinonzi rectal mucous discharge, tenesmus (pane dzimwe nguva), kurwadziwa kwepamuviri kwepamusoro uye kuora mvura kwakanyanya kubva ku purulent rectal discharge (muzviitiko zvakakomba, kunyanya kune vakwegura), fulminant colitis uye mexicacon inotyisa inogona kuva fetal asi haisi nyore . Pathology: Hapana granulomata. Kuora mwoyo kunobatsira mucosa uye submucosa. Pseudopolyps inouya sepamusoro yakachengetwa mucosa.
  • Nzira yekutanga inobata nguva dzose rectum uye inoramba iri yeropa (proctitis) mu (25%). 30% Kuwedzera kwechirwere chirwere chinogona kuitika. UC inogona kuisa sechitseri-sided (55%) uye pancolitis (10%). Kuwanda kwematambudziko kune unyoro kuenzanisa
  • Dx: colonoscopy neeoscopy ine maitiro akawanda anosimbisa Dx. MaRabs: CBC, CRP, ESR, Fecal calprotectin, Matambudziko: anemia, megacolon inotyisa, megacolon, kenza yemukoroni, yakawedzera-colonic zvirwere: arthritis, uveitis, AS, Pyoderma gangrenosum, Primary sclerosing cholangitis. Rx: 5-aminosalicylic acid muromo kana rectal topical therapy, corticosteroids, immunomodulatory drugs, colectomy inorapa.
  • Kufananidza: hazvidiwe kune Dx asi barium enema inogona kuburitsa maronda, kupurinda zvigunwe, mumatambudziko epamberi kurasikirwa kwehaustra uye kuderera kwekoloni inoburitsa lead-pipe colon. kesi. CT inogona kubatsira neiyo Dx yezvinetso. Plain firimu mufananidzo unoratidza adlead-pipe colon uye sacroiliitis se Enteropathic arthritis (AS)
mimba kuongororwa imaging e paso tx.
  • Colorectal carcinoma (CRC) m / c kenza yepeji yeGI uye 2nd inowanzovhiringidza vanhu vakuru. Dx: endoscopy uye biopsy. CT ndiyo miitiro inowanzoshandiswa pakutsvaga. Kutsvakurudza resection kunogona kunge kuchirapa kunyange zvazvo makore mashanu ekupona kwemazana ari 40- 50% zvichienderana nekugadzira. Zvinokonzera njodzi: pasi fibhi uye mapuroteni ane mafuta akawanda uye emhuka, kuora muviri (zvikurukuru mumarume), kusingaperi kwechirwere chirwere. Colonic adenomas (polyps). Familial adenomatous polyposis syndromes (Gardener syndrome) uye Lynch syndrome sevasiri polyposis.
  • Clinically: kunyengedza kutanga nemararamiro akashandurwa, ropa idzva kana melena, kuperevedza kwesimbi kusagadzikana kubva kuhutachiona hwekuwedzerwa kwemazuva mashoma mumakumbo akanaka. Kuvhara muviri, kubata, kubuda kunorema uye chirwere chemasastatic kunyanya kuChiropa chingangova kutanga kutaura. Nzira: 98% ndiyo adenocarcinomas, inomuka kubva kare-yakagara iripo colonic adenomas (neoplastic polyps) ine shanduko yakaipa. Iko makore mashanu ekupukunyuka muzana ndeye 40-50%, nechitambo chekushanda chimwe chinhu chinonyanya kukosha chinokonzera kufungidzira. M / C rectosigmoid tumors (55%),
  • NB Zvimwe adenocarcinomas esp. Mucinous types dzinowanzotaurwa nenguva uye dzinowanzotadza kusagadzikana nekuda kwekuguma kwehurukuro uye mucin secretion uye kupararira kwekuno / kure
  • Kufungidzira: Barium enema inonzwarisa polyps> 1 cm, imwechete musiyano: 77-94%, yakapetwa kaviri: 82-98%. Colonoscopy ndiyo nzira yesarudzo yekudzivirira, kuona, uye kuzivikanwa kwecolorectal carcinoma. Kusiyanisa-kunatsiridzwa CT kuongorora kunoshandiswa pakuratidzira uye kufungidzira kuongororwa kwemamets.
  • Kuchengetedza: colonoscopy: varume 50 yo-10-makore kana yakajairika, 5-makore kana polypectomy, FOB, 1st degree neA CA inotarisa ku 40 yo
mimba kuongororwa imaging e paso tx.

 

mimba kuongororwa imaging e paso tx.
  • Pancreatic Cancer: ductal epithelial adenocarcinoma (90%), kunyanya kufungidzira nekufa kwepamusoro. 3rd M / C kenza yemukamu. Colon iri #1, mudumbu #2. Mukenza wepancreatic anoverengera 22% yevose vanofa nekuda kwekudya kwepamuviri, uye 5% yevose vanofa nekenza. 80% yematambudziko mu60 +. Sodya fodya ndiyo yakasimba yezvakatipoteredza njodzi chinokonzera, kudya kunopfuma mumafuta emhuka uye mapuroteni. Kuwedzera muviri. Nhoroondo yemhuri. M / C inoonekwa mumusoro uye inogadzirisa nzira.
  • Dx: CT kuongorora kunokosha. Kurwiswa kweSuperior Mesenteric Artery (SMA) inoratidza chirwere chisingadzoreke. 90% yepancreatic adenocarcinomas haigadzirisike paDx. Vazhinji varwere vanofa mukati megore rimwe reDx. Kiriniki: isingarwadzi jaundice, abd. Pain, Courvoisier's gallbladder: painless jaundice uye yakawedzera nduru, Trousseau s syndrome: inofamba thrombophlebitis, nyowani yekutanga chirwere cheshuga mellitus, matunhu uye ari kure metastasis.
  • CT Dx: pancreatic masimba ane simba remasoplastic reaction, mashoma ekusimudzira, uye zvishoma nezvishoma kutetwa kwechienzanidzo nechepakati chemaitiro akafanana, SMA inopinda.
mimba kuongororwa imaging e paso tx.
  • Appendicitis: chinowanzoitika mumharaunda yakawanda yehurology uye inoita chikonzero chikuru chekuvhiyiwa mumimba kune vechidiki vaduku
  • CT ndiyo inonyanya kunzwisisika kuti ione appendicitis
  • Ultrasound inofanira kushandiswa kuvarwere vaduku nevana
  • KUB Radiographs haafaniri kutamba nharo mukuongororwa kwe appendicitis
  • Pakufungidzira, appendicitis inoburitsa yakatsva appendix ine madziro kuomesa, kuwedzera, uye periappendiceal mafuta stranding. Zvakafanana zvakawanikwa zvekusimba kwemadziro uye kuwedzera zvinoratidzwa paUS. Chaizvoizvo target sign inozivikanwa pane pfupi pfupi axis yekumisikidza nzvimbo.
  • Kana iyo appendix iri retro-caecal kupfuura US inogona kukundikana kupa Dx uye CT kuongorora kwakakodzera kunogona kudiwa
  • Rx: inoshanda kuti isabatwa nezvinetso
mimba kuongororwa imaging e paso tx.
  • Chidiki chekudzivirira (SBO) -80% yezvose mechanical matumbo ekudzivirira; iyo 20% yakasara inokonzerwa nekudzivirira kukuru kwemuviri. Iine chiyero chekufa kwe5.5%
  • M / C dzinokonzera: chero hupi Hx yekuvhiyiwa kwepamuviri uye kubatisisa
  • Chikoro chekutaura kuvhara, kuwedzera kumimba kwemashure nekunyunyuta uye kurutsa
  • Radiographs chete 50% inonzwisisika yeSBO
  • CT icharatidza chikonzero cheSBO mu80% yematambudziko
  • Ikoko kune zvinowanzoenderana nehuwandu hudiki hwekudzivirira hutachiona, asi 3.5 cm ndeyekufungidzira kusingatarisirwi kwechikwata chinoputika
  • PaAbd x-ray: supine vs. yakamira. Dilated bowel, yakatambanudzwa valvulae conivente (mucosal folds), imwe nzira yemhepo-yemvura mazinga step manera.
  • Rx: inoshanda se acute dumbu.
mimba kuongororwa imaging e paso tx.
  • Volvulus-m / c muSigmoid colon esp. muvakwegura. Chikonzero chikuru: kusagadzikana kusingaperi nekugadzirisa sigmoid kushandura pa sigmoid mesocolon. Inotungamirira Kukudzivirira Kwemakumbo Makuru (LBO). Zvimwe zvinokonzera zvinokonzera: tumorumbu yekoloni. Sigmoid vs. Caecum volvulus
  • Muchipatara: zviratidzo zveLBO nekudzivirira, kubvisa pamuviri, kurwadziwa, kushungurudza, uye kurutsa. Kutarisana kungave kwakaoma kana kusingaperi
  • Radiographical: kurasikirwa kwehaustra muLB, LB distension (> 6-cm), coffee bean sign inotevera slide, iyo yekupedzisira magumo evolvulus anonongedzera muchiuno.
  • NB: Mutemo wechigunwe chemuviri wakadzvanywa unofanira kunge uri 3-6-9 uko 3-cm SB, 6-cm LB & 9-cm Coecum
  • Rx: inoshanda se acute dumbu.
mimba kuongororwa imaging e paso tx.

References

 

Zvirwere zve Chest Inopinda Kuongorora Kufananidza

Zvirwere zve Chest Inopinda Kuongorora Kufananidza

by | Kufungidzira & Diagnostics

Core Anatomy

  • Cherekedza zvizvarwa zveiyo tracheal-bronchial muti, lobes, zvikamu, uye zvipuka. Cherekedza yechipiri pulmonary lobule (1.5-2-cm) -iyo yakakosha inoshanda unit yemapapu anoonekwa paHRCT. Cherekedza kurongeka kwakarongeka kwenzvimbo dzealveolar nekutaurirana pakati (pores yeKohn & migero yeLambert) iyo inobvumidza kufambiswa kwemhepo uye neiyo imwecheteyo nzira inobvumidza exudative kana transudative fluid kuti ipararire kuburikidza nemapapu uye yakamira pane iyo fissure. Cherekedza chimiro cheiyo pleura: parietal iyo iri chikamu che endothoracic fascia uye iyo visceral iyo inogadzira mapapu - nzvimbo yekumeso iri pakati.

 

chifu chekuongorora imaging el paso tx.

 

  • Mediastinum: yakakombwa ne pleura uye mapapu. Inogadzirisa zvivako zvakakura zvine lymph nodes dzakawanda (ona diagram inoratidza nhengo dzepasi-kati uye nhengo dzavo muLymphoma

 

chifu chekuongorora imaging el paso tx.

 

Nzira Yese Yakagadzirirwa Kuongorora Mhosva Yechipfuva

  • Radiographic examination (Chest X-ray CXR); yakanakisisa 1st danho. Kudhura kwakaderera, kuderera kwemazuva ano kuonekwa, kuongororwa kwakawanda kwekunyunyuta kwekliniki
  • CT kuongorora: chifuva CT, High-Resolution CT (HRCT)
  • Chep pathology approach:
  • Trauma
  • Kurwara
  • Neoplasms
  • Pulmonary edema
  • Pulmonary emphysema
  • Atelectasis
  • Pleural pathology
  • Mediastinum

PA & Yakazotevera CXR

chifu chekuongorora imaging el paso tx.

 

  • Mamwe maonero anogona kushandiswa:
  • Isheotic maonero: anobatsira kuongorora apical nzvimbo
  • Decubitus anoona kurudyi uye kuruboshwe: rubatsiro rwekuongorora tsvina yakawanda inonzi effusion, pneumothorax nezvimwe zvirwere

 

chifu chekuongorora imaging el paso tx.

 

chifu chekuongorora imaging el paso tx.

 

  • Yakajairwa CXR PA & Ekupedzisira maonero. Ita shuwa kuratidzwa kwakanaka: T-musana disc uye midziyo kuburikidza nemoyo inoonekwa pane PA kuona. Verenga 9-10 kurudyi positi mbabvu kuti usimbise zvakakwana kukurudzira simba. Tanga ongororo yakakwana uchishandisa nzira inotevera: Pane Zvirwere Zvakawanda Zvemapapu A-dumbu / diaphragm, T-thorax madziro, M-mediastinum, L-mapapu zvakasiyana, Mapapu-ese ari maviri. Gadzira yakanaka yekutsvaga pateni

 

chifu chekuongorora imaging el paso tx.

 

  • 1) Chirwere chema Air aka alveolar lung chirwere? Kuzadza evhaveoli yemapapu, acini uye inotevera lobe yose ine mvura inenge yakasvibiswa kana yechinhu chero chipi zvacho (ropa, pus, mvura, proteinaceous material kana kunyange masero) Radiographically: lobar kana segmental distribution, airspace nodules inogona kuonekwa, chido chekubatana, mweya bronchograms uye chiratidzo chechi silhouette chiripo. Batwing (butterfly) kugoverwa kunoonekwa se (CHF). Kuchinja nokukurumidza kwenguva, kureva, kuwedzera kana kuderera (mazuva)
  • 2) Kurwara kwepakati: chirwere chepermonary interstitium (alveoli septum, lung parenchyma, masvingo emadziro, nezvimwewo) nemuenzaniso nemavirusi, mabhakitiriya maduku, protozoan. Uyewo kupindira nemasero akadai semasero ekuvhiringidza / anouraya (semuenzaniso, lymphocytes) Anowanikwa sechirevo chepapu interstitium ne reticular, nodular, reticulonodular pattern. Kusiyanisa kwakasiyana-siyana: kupisa autoimmune zvirwere, fibrosing mapapu chirwere, chirwere chemapapu chebasa, chirwere chetachiona / mycoplasma, TB, sarcoidosis lymphoma / leukemia nezvimwe zvizhinji.

 

chifu chekuongorora imaging el paso tx.

 

  • Kuziva zviratidzo zvakasiyana zvezvirwere zvepermonary zvinogona kubatsira neDDx. Misa vs. Kurambidzwa (kuruboshwe). Cherechedza mararamiro akasiyana ezvirwere zveplummoni: chirwere chemhepo chinokonzerwa nekuputika kwechirwere chinoratidza chirwere chepineumia, kuparadzaniswa kwechirwere chekuona kwepermonary edema. Atelectasis (kuwa uye kurasikirwa kwevhu). Zvinyorwa zvinokonzera chirwere chepemmonary: reticular, nodular kana yakavhenganiswa. SPN vs. Multiple focal consolidations (nodules) zvichida inomiririra muto infiltrates vs. septic inopinda

 

chifu chekuongorora imaging el paso tx.

 

  • A = intraparenchymal
  • B = kuderera
  • C = extrapleura
  • Ziva nzvimbo inokosha yepfupa remakumbo

 

chifu chekuongorora imaging el paso tx.

 

  • Zviratidzo zvinokosha: Silhouette chiratidzo: rubatsiro nekunzvimbo uye DDx. Muenzaniso: Mufananidzo wezasi uri kuruboshwe: radiopacity mumapapu akanaka, ari kupi? Kurudyi MM nokuti mwoyo wekodzero wakarurama uri pedyo nepakati yakarurama yepamusoro hauonekwi (silhouetted) Air bronchograms: mhepo ine bronchi / bronchioles yakakomberedzwa nemvura

 

chifu chekuongorora imaging el paso tx.

 

Chest Trauma

  • Pneumothorax (PTX): mhepo (gasi) mune nzvimbo yakazara. Zvikonzero zvakawanda. Matambudziko:
  • Kutsigira PTX: kuenderera mberi kwekuwedzera kwemhepo munzvimbo inoshandiswa mhepo inokurumidza kusimbisa mediastinum uye mapapu zvinotadzisa kuderedza kudzoka kwemoyo kune mwoyo. Inogona kuuraya kana isingarapwa nokukurumidza
  • PTX inongoerekana yaitika: vechidiki (vechidiki (30 -40) kunyanya vakareba, vatete varume. Zvimwe zvinokonzeresa: Marfan s syndrome, EDS, Homocystinuria, a - 1 -antitrypsin kushomeka. , lung fibrosis uye honeycombing, catamenial PTX d / t endometriosis nevamwe.
  • Kutambudza pneumothorax: maperembudzi ekudzivirira, kushungurudzika kwakashata, iatrogenic (mafupa emapfupa, nezvimwewo) kugadzika, nezvimwewo.
  • CXR: chinyorwa chinyorwa chinonzi pleural line aka aka lung edge. Kusabatwa kwezviputi zvemapurmoni / midziyo kunze kwekutenderera kwechirwere chekuona. Subtle pneumothorax inogona kushaikwa. Panzvimbo yakamira, mhepo inobuda uye PTX inofanira kutsvaga kumusoro.
  • Rib fractures: v.common. Kushungurudzika kana kurwara (eg, mets, MM) Rib Rib series x - mazai haabatsiri nokuti CXR uye / kana CT kuongorora kunokosha zvikuru kuongorora PTX (pasi nechokuruboshwe) kugadzirisa mapapu uye imwe nzira huru

 

chifu chekuongorora imaging el paso tx.

 

Kurwara

  • Pneumonia: bhakitiriya inorwisana nevirwere kana fungal kana musingazivikanwi nemusikana (eg, Cryptococcus muHIV / AIDS) Pulmonary TB

 

chifu chekuongorora imaging el paso tx.

 

  • Pneumonia: inharaunda-inowanikwa nechepatara-inowanikwa. Izvozvo zvinokonzerwa nebhakitiriya pneumonia kana kuti Lobar (kwete-segmental) pneumonia ne purulent nyuchi ichizadza alveoli uye ichipararira kune rose lobe. M / C mhukaStreptococcus Pneumonia kana Pneumococcus
  • Vamwe: (Staph, Pseudomonas, Klebsiella vari mune zvinodhakwa zvinogona kutungamirira kune necroSIS / mapapu emakumbo) Mycoplasma (20-30s) aka kufamba pneumonia, nezvimwewo.
  • Muchiratidzo: kuora kunobudirira, fivha, kurwadziwa kwepfupa muchipfuva dzimwe nguva hemoptysis.
  • CXR: mhepo yakasununguka inopindirana yakavharidzirwa kune lobe yose. Air bronchograms. Silhouette chiratidzo anobatsira nenzvimbo.
  • Viral: Influenza, VZV, HSV, EBV, RSV, nezvimwewo zvinopa sepakati pemapapu chirwere chinogona kuwirirana. Inogona kutungamirira kune kuporesa kunokanganisa
  • Atypical pneumonia uye Fungal Pneumonia: Mycoplasma, Legionnaire's disease, uye mamwe fungal / Cryptococcus pneumonia inogona kuve ne-interstitial lung disease.
  • Kupamba kwepulmonary: chikwata chinotapukira che purulent nyamuviri mumapapu anowanzotapisa. Inogona kutungamirira kune zvakakosha mapemonary uye zvinetso zvehupenyu / hupenyu hunotyisidzira.
  • Pamusoro peCXR kana CT: kuunganidza zvakapoteredza nemiganhu yakaoma uye necrosis inenge ine air-fluid level. DDx kubva empyema iyo inoparadzanisa mapapu uye kunyunyuta-kubva
  • Rx: ma antibiotics, antifungal, antiviral agents.
  • Pineumonia inofanira kuteverwa pamwe nekudzokorora CXR kuchengetedza kusarudzwa kwakakwana
  • Kushayikwa kwehuwandu hwemhepo yepineumonia kunogona kureva kudzivirira mishonga, antibiotic resistance, pasi pepakenza carcinoma kana zvimwe zvinonetsa

Pulmonary TB

chifu chekuongorora imaging el paso tx.

 

  • Utachiona hunowanikwa munyika yose (nyika ye3rd nyika). 1 muvanhu vane 3 munyika yose inobatwa neTB. TB inokonzerwa naMycobacterium TB kana Mycobacterium Bovis. Intracellular bacillus. Macrophage ine basa rinokosha.
  • Chekutanga Pulmonary TB & Post-primary TB. Inoda kudzokororwa kuratidzwa kuburikidza nekufema. Mune mazhinji masisitimu anokwanisa kuzvidzivirira, hutachiona hunoshingaira hahupo kukura
  • TB inopa sa 1) yakabviswa nemuiti, 2) yakadzingwa muLatent Tuberculosis Infection (LTBI) 3) inokonzera chirwere chinoshanda cheTB. Varwere vane LTBI havaparadzi TB.
  • Kufungidzira: CXR, HRCT. Primary TB: pulmonary airspace consolidation (60%) yakadzika lobes, lymphadenopathy (95% - hilar & paratracheal), pleural effusion (10%). Kupararira kwekutanga TB kunowanzoitika mune kusazvidzivirira uye vana.
  • Milliary TB: pulmonary uye system complication kuparadzirwa kunogona kuuraya
  • Post-primary (secondary) kana kuti reactivation infection: Kazhinji muApices nepamashure mapoka e-upper lobes) high PO2), 40% -kuvhiringidza zvipembenene, zvinokonzera kana zvinoputika airspace chirwere, fibrocalcific. Latent features: nodal calcifications.
  • Dx: Acid-fast bacilli (AFB) smear uye tsika (sputum). Utachiona hweHIV mune varwere vose vane TB uye husingazivikanwi hweHIV
  • Rx: 4-drug regimen: isoniazid, rifampin, pyrazinamide, uye ega ethambutol kana streptomycin.

Zvinyorwa zvePulmonary Neoplasms (kanhi yemukenza yemapapu vs. mastasia metastasis)

  • Kanza yemaperembudzi: m / c kenza mumarume uye 6th kanama inowanzoitika kune vakadzi. Kushamwaridzana kwakasimba nejacinogens inhalation. Kliniki: kuwanikwa kwekupedzisira, zvichienderana nenzvimbo yechipfuva. Pathology (mhando): Small cell (SCC) vs. Non-small cell carcinoma
  • Sero duku: (20%) rinobva paurouroendocrine Aka Kultchitsky cell, saka inogona kubudisa zvinhu zvinoshandiswa zvipenyu zvinopa neparaneoplastic syndrome. Inowanikwa nzvimbo yepakati (95%) pane kana pedyo ne-mainstem / lobar bronchus. Vazhinji vanoratidzira kusagadzikana uye kusakanganisika.
  • Kwete-duku kero: Lung adenocarcinoma (40%) (Murefu wemapapu M / C), M / C kuvakadzi nevasiri vasvuta. Zvimwe: Squamous cell (inogona kuve neine cavitating lesion), Ikamu huru uye vamwe
  • Firimu yeArain (CXR): chirwere chetsva kana chakawedzerwa, chinowedzera mediastinum zvinonzwisisika zvekushandiswa kwemuviri wecymph node, kuderera kwechisimba, atelectasis, nekubatanidzwa. SPN-inogona kureva kanzura yemapapu emapapu kunyanya kana ine mitsara isina kukwana, kupa zvikepe, masvingo akareba, mumapapu ekumusoro. Multiple lung lung nodules zvinogona kumira mastasisis.
  • Nzira Yakanakisisa: HRCT ine kusiyana.
  • Mimwe chipfupa neoplasms: Lymphoma ndeyev. Inowanikwa mubhokisi kunyanya mukati memasikati uye mukati mammary manotsi.
  • Pakazara M / C pulmonary neoplasms ndeye metastasis. Mamwe mamota anoratidzira kufungidzira kwepamusoro kwemamapu emapapu, semuenzaniso, Melanoma, asi chero gomarara rinogona kusangana nemapapu. Mamwe mamets anonzi Cannonball metastasis
  • Rx: radiation, chemotherapy, resection

 

chifu chekuongorora imaging el paso tx.

 

  • Pulmonary edema: izwi guru rinotsanangura kusachena kwemvura kunowedzera kunze kwezvivako zvevascular. Zvinowanzoparadzaniswa muCardiogenic (kureva, CHF, mitral regurgitation) uye Kwete-cardiogenic nehuwandu hwezvikonzero (semuenzaniso, kuwedzera kwemvura, mushure mekuisa ropa, zvinokonzerwa neurological, ARDS, pedyo nekudonhera / asphyxiation, heroin overdose, nezvimwe)
  • Zvinokonzera: kuwedzerwa muHystrostatic pressure vs. kupera mu oncotic pressure.
  • Kufungidzira: CXR uye CT: 2-types Interstitial uye Alveolar mafashamo. Kufananidza mharidzo kunobva pane zvikamu
  • MuCHF: Stage 1: kuiswazve kwevascular kuyerera (10- 18-mm Hg) inozivikanwa se cephalization yeiyo pulmonary vasculature. Stage 2: Interstitial edema (18-25-mm Hg) Yepakati edema: peribronchial cuffing, Kerley mitsetse (lymphatics yakazadzwa nemvura) A, B, C mitsara. Stage 3: Alveolar edema: airspace chirwere: zvakasangana zvakasangana zvichikura kuita chirwere chemuchadenga chinopararira: Batwing edema, air bronchograms
  • Rx: 3 zvinangwa zvikuru: Chekutanga O2 kuchengetedza O2 pa 90% kuwanisa
  • Zvichizoitika: (1) kuderedzwa kwekudzoka kwepummonary venous (kuperevedza kunoderedza), (2) kuderedzwa kwe systemic vascular resistance (afterload reduction), uye (3) inotropic tsigiro. Tora zvinokonzera zvikonzero (semuenzaniso, CHF)

 

chifu chekuongorora imaging el paso tx.

 

  • Lung atelectasis: kusakwana kwekuwedzera kwepermonary parenchyma. Izwi rokuti "kupera mapapu" rinowanzochengeterwa apo mapapu ose aputsika
  • 1) Kugadzirisa (kuvhiringidzika) atelectasis kunoitika semugumisiro wekudziviswa kwakakwana kwenzira inoenda kumhepo (semuviri, zvinoputika zvinhu, nezvimwewo)
  • 2) Passive (zororo) atelectasis inoitika kana kusangana pakati parietal uye visceral pleura kukanganiswa (pleural effusion & pneumothorax)
  • 3) Compressive atelectasis inoitika semugumisiro weiipi chero ipi zvayo inonzi thoracic-occupying lesion iri kukonzera mapapu uye ichimanikidza mweya kunze kweiyo
  • 4) Chirwere chekudya atelectasis: chinoitika semugumisiro wekucheka kana fibrosis inoderedza kukura kwemapapu sezvinoita zvirwere zvakakura, necrotizing pneumonia, uye radiation fibrosis
  • 5) Adhesive lung atelectasis inowanikwa kubva pakushaya simba uye kuparara kwemagetsi
  • 6) Chipata-kana kana chinowanikwa kazhinji chinowanikwa mushure mekutevera anesthesia
  • 7) Kufananidza zviitiko: kupera kwemapapu, kubuda kwemapapu emapapu, kupotsa kwemukatikati, kukwira kwechidimbu, kuwedzera kwemafupa emapapu asina kukodzera

 

chifu chekuongorora imaging el paso tx.

 

  • Mediastinum: hutachiona hunogona kugoverwa mune izvo zvinoguma nehukuru hwepamusoro kana izvo zvinokonzera zvirwere zvakasiyana zvinosanganisira mediastinum. Uyezve, mweya inogona kutarisa mukati me mediastinum mu pneumomediastinum. Zivo yehutachiona hwemuviri inobatsira Dx.
  • Anterior masikati makuru: thyroid, thymus, teratoma / germ cell tumor, lymphoma, lymphadenopathy, achikwira anortic aneurysms
  • Pakati pemasikati makuru: lymphadenopathy, vascular, bronchial lesions etc.
  • Posterior mediastinal masses: neurogenic tumor, aneorysms aortic, esophageal masses, spinal masses, aortic chain adenopathy

 

chifu chekuongorora imaging el paso tx.

 

  • Pulmonary emphysema: kurasikirwa kwemazuva ose elastic tissue / kutengesa kwepapu nekuparadzwa kwemapapuriri uye sarumenolar septum / interstitium.
  • Kuparadzwa kwemapapu parenchyma nekuda kwekusingaperi kukira. Protease-mediated destruction of elastin. Kushungurudza air / space space, kuwedzera, hyperinflation, pulmonary hypertension, uye zvimwe zvinoshanduka. Kliniki: progressive dyspnea, isingabvumirwi. Nenguva iyo iyo yakamanikidzirwa kuporesa mukati ye 1 yechipiri (FEV1) yakawira ku 50% murwere ari kufema paanenge achiita zvishoma uye anogadzirisa mararamiro.
  • COPD ndiyo yechitatu inokonzera rufu rwepasi rose. Inobata 1.4% yevanhu vakuru muUnited States. M: F = 1: 0.9. Pts 45 makore uye kupfuura
  • Zvinokonzera: Kusvuta uye-1-Antitrypsin kukwana (yakakamurwa kuva centrilobular (kusvuta) uye panacinar.
  • Imaging; zviratidzo zve hyperinflation, air trapping, bullae, pulmonary hypertension.

 

chifu chekuongorora imaging el paso tx.