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TÀI LIỆU ÔN THI TUYỂN SINH CAO ĐẲNG, ĐẠI HỌC MÔN GIẢI PHẪU SINH LÝÔN THI TUYỂN SINH ĐẠI HỌC CÁC NGÀNH : ĐIỀU DƯỠNG, XÉT NGHIỆM Y HỌC, RĂNG HÀM MẶT, Y ĐA KHOA, Y TẾ CÔNG CỘNGLIÊN THÔNG TỪ TRUNG CẤP LÊN CAO ĐẲNG, TRUNG CẤP LÊN ĐẠI HỌC
TRIfONG DI HOC TRA VINH 1CHOA Y — DOC TAI LIEU ON THI TUYEN SINH MON GIAI PHAU - SINH GV bien sogn: Doan Dwang Chi Thie:n Tra Vinh, 2016 Urn hanh nOi KHOA Y - DINC BO MON GIAI PHAU TiNH TRANG PHE DUYET TAI LIEU Giai pat — Sinh VT Ten tai Ngay hoan chinh: 28/01/2016 Tac gia Nen soan: Bs Doan among Chi Thin Don vi cong tac: Khoa Y — Duct, BO mon Giai pi& Tra Vinh, 28 thang 01 nam 2016 Tac gia & ghi lz9 ten) PRii,ch 7- goa,74 PHE DUYET CUA BO MON D6ng 5/ sir ching tai lieu On thi tuyen sinh mon: Giai phAu — Sinh VT GV Doan Dircmg Chi Thin Nen soan d On thi tuyen sinh nganh : Dieu dung, xet nghiem y h9c, rang ham mat, y da khoa, y t cong cOng (lien thong tir trun cdp len cao ding \TA trung cdp len dai h9c) Tra Vinh, nga than nam 2016 TRIJ'ÔGBI ON PHE DUYET CtIA ICHOA Tra Vinh, 1.K thcing STRIMING ICHOA A nam 2016 r-h;e,24" Tai lieu on thi tuyen sinh mon: Giai ph au.7 Sinh lj A P Ert MIJC LUC Ni dung Trang CHU'ONG 1: GIAI PHAU HE XVONG CHVONG 2: Gal PHAU Ht CO CHICON G 3: GIAI PHAU Ht TIM MACH CHVON G 4: GIAI PHAU Ht HO HAP CHVONG 5: GIAI PHAU HE TIEU HOA CHVONG 6: GIAI PHAU HE TIET NItU CHIYONG 7: GIAI PHAU H SINH DIJC CHU'ONG 8: GIAI PHAU lit THAN KINH CHVONG 9: GIAI PHAU CAC GIAC QUAN CHVONG 10: SINH LI"( MAU CHVONG 11: SINH LI"( TUAN HOAN CHVONG 12:SINHLYHOHkP CHU'ONG 13: SINH LY HE TIEU HOA CHU'ON G 14: SINH 1STH TIET NItU CHVONG 15: SINH 1ST SINH SAN CHVONG 16: SINH LI"( Ht THAN KINH CHU'ONG 17: SINH LI"( Ht NO! TIET 17 39 56 65 81 86 93 111 118 128 140 149 159 164 176 191 TAI LIEU THAM KHAO 200 CHIYONG GIAI PHAU HE XVONG 1‘11,1C TIEU 1.Trinh bay clwac nhiing kiln thac chung nhdt ve he xwang: sw phan chia, clac diem cdu tao caa ni logi xwang, str hinh va phcit trien caa cac xtrang 2.Mei tá dtrac nhang dc diem hinh the chinh caa cac xtrang: cac melt khop, ark ch a barn cita ca, cac mac be mat 3.Goi clang dtrac ten cita cac chi tilt chinh tren cac phwang tin thwc hanh giai phial xtrang D#i arang Xozmg la nhang ca quan dugc cu tao cha y6u bang m6 xuang, m6t loai mo lien k& ran BO xuang.dam nhiem cac chirc nang: nang di" ca the, bao ve va lam ch6 dira cho cac ca quan, va v'an dOng (ding h ca - khap); b0 xuang ming la nth san sinh cac te' bao mau va la kho du trill chit khoang va chit beo 1.1 Hinh th'j ngodi Dtra vao hinh the' ngoai va cAu tao c6 the' chia xuang cac loai nhu xtrang dai (long bone),:xwang ngan (short bone), =mg det (flat bone), xtrang khong du (irregular bone), xtrang có hoc (pneumatized bone) va xwang yang (sesamoid bone) Cac loai xuang v6i nhang hinh the' khac k teen thich fing v6i cac chirc nang rieng bit, vi du nhu xuang dai cO kha nang van d6ng vai d6ng tac rOng rai, xuang det thien v chirc nang bao ve v.v Cac xuang dai c6 m6t than xuang va hai du xuang, vo xuang chua truing thanh, than va m61 du xuang dai dugc ngan each bang mOt sun du xuang 1.2 Cau tgo 1.2.1 Cdu tgo chung caa cric logi xtrang BAt kS, m6t xuang nao cfmg dugc cAu tao bang cac phAn sau day, ke' tir ngoai vao trong: mang ngoai xuang, mo xucmg dc, mo xucmg x6p va tuSi M6 xuang thu6c loai m6 lien k6t, bao g6m cac te' bao bi vay quanh bai chAt can ban ran dc ChAt can ban dm xuang bao g6m 25% milk, 25% sgi protein va 50% mu6i khoang Cac loai t bao cUa mo xuang la tao cat bao, hug/ cot bao va te bao xuang Mang ngoai xtrang (periosteum) la mOt mang mo lien k& dai giau mach mau boc quanh b'e mat xuang (trir nai cO sun khOp) Mang g6m hai l6p: lop ngoai la m6 sgi, lop chira cac te' bao sinh xucmg (osteogenic cells) Mang ngoai xucmg giüp xucmg ph& trien v chieu rOsng No cling -co tac dixng bao ye ya nuoi chrOng xtrong, gitlp lien xucmg gay va 1a nth barn cho cac day chang va gan Siin khOp la mOt lOp sun bao phil mat khop c4a cac xuang N6 lam giam ma sat va lam giam sir Va cham tai nhcmg khop hoat dich Xwang dac (compact bone) la phAn dong vai tre chinh chirc nang bao ve, nang cleY va khang lai luc nen op cüa luc hay sir van d6ng M6 xucmg dac dugc t6 chirc nhang don vi dugc ggi la cac h thang Havers Me)ill th6ng Havers bao Tai lieu on thi tuye'n sinh mon:Giai pheiu — Sinh lj gm mOt dng Havers trung tam chira cac mach mau, mach bach huyet va than kinh Bao quanh ang la cac xtrang d6ng tam Gifra cac la xucmg la nhang khoang nho (g9i la cac ho) chira the te bao xuang va dich ngoai bao :Ong Havers va cac 116 dugc n6i lien bang nhang kenh nho ggi la the tiu quan xtrang Vang nam Oita the he th6ng Havers chira cac xuang ice Cac la xucmg bao quanh xuang a dtrai mang xtrcmg la cac• la chu vi ngoai )(Jiang xdp (spongy bone) nhieu be xuang bat cheo chang chit tao nen m6t mang 1u6i vay quanh cac khoang nho, tong nhtr bgt bin Khoang nam gifta cac be xucmg chira tuf, (red bone marrow), nth san xuat cac t bao mau Mi be „dm xuang x6p cling dugc cu tao bang cac la xtrang, cac 116 chira the th bao xtrang va cac lieu quan nhung khong c6 cac h th6ng Havers thge O tuf) (medullary cavity) la khoang rang ben than xuang dai chira tuj) yang (yellow bone marrow) Thanh tuY dugc lot bang nai cdt mac (endosteum) Tug' yang chira nhieu t bao ma 1.2.2 Dc diem c du tgo rieng cia mdi logi xtrang Xucmg dai O than xtrang (diaphysis), lap xuang ac day gift va m6ng clan ye phia hai dau; lap xuang x6p thi ngtrgc lai & hai dau xtrang (epiphysis), lap xu(Yg dc chi cOn la mOt 16p mong, ben la kh6i xucmg x6p chira tug' Xuang ngan Co cu tao gi6ng nhu dau xtrang dai Xuang det gm hai ban xtrang dc kep & gala la m6t lap xuang x6p 1.3 Ctic mitch mdu caa xwo'ng Xucmg dugc cap mau t6t nha hai loai dOng mach: cac d6ng mach nuoi xtrang va cac d6ng mach mang xucmg Vai mOt xtrang dai, cac 'Ong mach nuoi xtrang thuemg gm mOt d6ng mach Ian chay ehech qua xucmg dc qua mOt nuoi xurmg (nutrient foramen) gan gitra than xucmg den xtumg va mOt s6 dOng mach nh6 di vao dau xuang Trong tug' xuang dOng mach Ian chia cac nhanh gan va xa chay dgc theo chieu dai cüa tug' va phan chia cac nhanh nha dan di vao mo wiz:mg dm than xuang, cac d6ng mach cOn lai nuoi duang cho mo xucmg va tuY d6 cUa dau xtrcmg Cac clang mach mang xtrang cap mau cho mang ngodi xtrang Ott cac mat khap); mOt sd nhanh mach rat nho chui qua mang ngoai xuang tai phan ngoai xuang dc va n6i Wei) vai cac nhanh cUa d6ng mach nuoi xucmg tft phia tug' di 1.4 Sr hinh thank va phát triin can xtrang Xuang dugc hinh thai ki phoi thai (vao cu6i thang thir nhat ciXa phoi) va tip Atc phat trien cho tai tu6i tnrang Co hai giai doan hinh xtrang: d giai doan thir nhat, i mo lien ket long leo eita phoi (thuOc trung mo, ma trung mo bat nguon tir trung bi) bin th-J dc dux% clang mOt mang dai xuang dugc hinh tren mang dai Giai doan thir hai din cac th bao dm the dc (mang dai) bin xtrang, theo hai each: a Teri lieu on thi tuyen sinh mon:Giai phau — Sinh MOt so it xuvng (gm cac xuang vOm SQ, xtrcmg ham dual va xuang don) dirge hinh bang each chuyen tn,rc tip mang xtiong Vi dii, yam SQ cüa phoi tnrac hai thang chi la mOt mang; tir thOng tha hai ten mang xuAt hien nhang diem cOt hod lan rOng &An tap nen nhang xuang det cUa yam SQ Qua trinh bin mang xucmg dugc goi mang cat hoa va xuang dugc hinh theo each la xuang mang Cac xtrang lgi (chi6m.hAu het cdc xuang) dugc hinh tir sin Truac het the dac trung ma too ma hinh xuang bang still du thang thir hai) Tài cu6i thang thir hai, svn phat trien, nO bi mach mOu xam ln Cdc t bao mach mdu mang tai phd hUy sim va ch6 sip bi pha hAy dugc thay the' bang ma xuong Qua trinh dugc g9i la sun c& hoa va xucmg dugc hinh theo each dugc g9i xtrong syn Vai xuang dai, thuang thi m6 hinh siin bi mach xam ldn a trung tam (img voi gala than xuong) Cdc tao c6t bao mach mdu mang tai tao xuang bang each: te bao tao xuang tit chit cOt giao; chat ngAm mad calci bin xuang; diem tao xuang ban &Au trung tam cot hoa nguyen phat (primary ossification centre) Khi trung tam cOt hoa phat trien rOng tai duai mang ngoai xuang, xucmg dugc fief, ttic dugc sinh bâi mang ngodi xucmg Sir to v &rang kinh cüa xuang sip la mang ngoai xuang xay dap them cdc xtrang ding tam ice tier, (ve ccv ban gi6ng xuang mang) Val xtrcmg stm ngan va nho (xuang c6 tay, c6 chan), sim dugc thay the dAn chi bang mOt trung tam c6t hoa nguyen phat Xucmg cOt sOng \fa xuang dai dm chi dugc hinh tir nhieu trung tam c6t hoO gm: trung tam cot hod nguyen phat (chinh) tao than xucmg va cac trung tam c& hoa thi' phat (secondary ossification centre) hay cac trung tam cat ho(1 clau xwang tao cac dAu (epiphyses) hay mom xuang Cdc trung tam c6t hod dAu xucmg phAn lan xuAt hien sau sinh Trong qua trinh phat trien, cac trung tam c6t hod Mu xuang ngan each vai trung tam c6t hod chinh bang mOt tAm sun clau xwang (epiphysial cartilage) Sin giup xuang Oat trien v chieu dai TAm siin Mu xtrang tang sinh ve phia than xucmg va phAn tang sinh dugc chuyen xuong Khi tOc dO c6t hod still lan tOc dO tang sinh siin thi stm dAn dugc thay the het bang xucmg xuang ngimg tang tnrang v chieu dai Sir tang truang cUa xtrcmg mang ve ca ban la bang mOt qua trinh b6i dap them xtrang teen be mat va cdc b xtrang Vi dii nhu sr dOng dAn cUa cdc thOp (\rang nam gala cdc b g6c xucmg vom s9): xuang tin dAn vao mang thop bang each b6i dap them xucmg vao cac b xuang; d6ng then, mang xuang b6i dap them xuang len be mat xuang Thgc qud trinh c6t hod bao gm hai c6ng viec din dong thai: qua trinh kien thiet nha the tao cOt bao va qua trinh phd hug/ nha cac hug/ cOt bac) Sir phd hug/ xuang giup too nen cdc h6c tug/ a xtrcmg x6p, tug/ a xuang dai va cdc ong Haver caa mO xuong 1.5 SI) luTing va phan chia 206 xuang cüa bO xuang nguai dugc sap xep phan: 80 mil:mg eUa bO xuang trvc va 126 xuang cUa b'9 xuang treo BO xtrang tryc (axial skeleton) gm 22 xuang SQ, 'an:mg mong, xuang nhO cüa tai va 51 xuang than (g6m 26 xuang ct song, 24 xucmg Tai lieu on thi tuyen sinh mon:Giai phou — Sinh l3 suan va xtrong irc) Bó xtrang treo hay xtrang chi (appendicular skeleton) g6m 64 xtrcmg chi tren va 62 xtrcmg chi clued Xuang so (bones of cranium) Xucmg SQ la mOt kh6i gam 22 xuang nam du tren cüa cOt sting Phan chia SQ hai nhom xuong hop thanh: cdc xuang hOp SQ va cac xtrong mat Hp SQ la hOp xucmg bao v cho nao tam xucmg tao nen: hai xtrang dinh, mOt xtrang tran, mOt xtrang chdm, mOt xuarzg &dm, mOt xtrang sang hai xtrang thai during Cac xtrang mat tao nen khung xuong dm mat, Om muai ba xuang dinh mOt kh6i va dinh vai hOp SQ, va mOt xuang lien ket vai kh6i xucmg SQ bang khOp hoat dich Muai b6n xuong mat la: hai xtrang le, hai xtrang xoan mW dithi, hai xtrang miii, hai xtrang ham tren , hai xtrang khdu cai, hai xurmg go ma, mOt xtrang ham cltrai va mOt xtrang la mia Nhang dac diem chung Ngoai vi'ec tao nen hOp SQ, cdc xtrong SQ ding tao nen mOt s6 khoang nho khdc, bao g6m mrii va cdc hac mat ma phia truck MOt s6 xuang SQ chimg dugc goi la nhling chira nhfing khoang dugc lot bang niem mac va th6ng vai xoang canh miii Trong xmmg thai throng di nhang khoang nh6 chira cdc cau tile lien quan tai thinh gidc va thang bang Trong cdc xucmg Sc), chi co xtrang ham duai cO the chuyen dOng &roc, cac xtrang c6n lai dinh chat ved mOt kh6i bang cdc dung khop bat dOng nao nam ten va mOt yam bao quanh va day tren nao Cdc Hp SQ co mOt nn xuong cña yam SQ duac tao nen tir hai ban xtrong dac (ban ngoai va ban trong) ngan each bang mOt lap xucmg x6p goi la 151 xap Mat hp SQ dinh vai mang nao cimg, mat ngoai tao nen ch"6" barn cho cdc cci dau mat Ngoai viec tao nen khung xuong dm mat, cac xuong mat bao v cho duang vao cüa the he ho hap va tieu hod Ca kh6i xuong Sc) bao ve va nang dt cho cdc gide quan chuyen bit v thin, nem, ngiri, nghe va thang bangXtrang tran (frontal bone) Xizang tan g6m hai phan chinh: mOt phan tao nen trdn (phan fru& cila hOp Sc)) la trai tran, mOt phan nam ngang tao nen tan mat vã hau ht phan tnracc dm nn SQ (hOp SQ tnr6c) O mat ngoai, hai phan cua xucmg trdn gap tai bo• tren a mat Ngay tren bo nay, ben trai tran cO hai xoang tran Cac xtrang dinh (parietal bone) Hai xucmg dinh tao nen phan lan cüa cdc mat ben va dinh SQ Ching tip khop vai tai &Tang khOp doe, vai xucmg tan tai duong kh6p vanh, ved xuang cham tai duang khop lambda va vai cac xucmg thai dung tai cdc throng khOp trai Mat cüa 'cm:mg dinh lOm va co nhang ranh d cac mach mdu di qua Cac xuang thai &rang (temporal bone) 1\ni xuong thai dung to nen mOt mat duai-ben cña hp Sc va mOt phan dm nn SQ NO tip khOp voi cdc xucmg dinh, cham, buam va g6 ma bang cdc khop bat d6ng Xucmg thai dung ba phan tao nen: phan dá, phan trai va phan nh'i Phan del c6 hinh thap tam gidc nam ngang qua nn SQ, glib xucmg buom va xuong cham Phan chira tai giira va tai trong, va nhting 6ng cho dOng mach canh va thin kinh mat di qua a ng clOng mach canh co mOt 16 ngobi ma a mat dtrai phan dá va mOt 16 ma a dinh phan dd Mom nhon tir mat duai phan da nho xu6ng clued la a Tai lieu on thi tuyen sinh mon:Giai phau — Sinh lj mom tram Nan phan dá huang ngoai va sau Mom lot ten nn phan cid, sau 18 tai ngoai, duvc goi la m6m cam Trong m6m chum c6 nhiau xoang nho O gith mom tram va mom chi:1m c6 16 tram-chicm, nth khoi s9 cUa than kinh mat Tren mat sau phan dá c6 l va ong tai trong, nai cac than kinh s9 VII va VIII di qua B6 sau phan cid cang vui wow chAm gith han nen a tinh mach canh, nai di qua dm filth mach canh Phdn trai la manh xtrcmg mong hinh quat Phan duai cUa trai thai duang tach mom go ma chay tnrac tip khOp vai m6m thai ducmg cUa xucmg g6 ma; m6m cUa hai xuang ding tax) nen cung gO ma HO lOm nam & mat sau-duai mom g6 ma la ho' ham du& va ch8 16i tr6n tnrac 116 la cic kh6p H6 va cü tip khap vai chom xtrang ham duth tao nen khOp thai dung-ham dtrai Phdn nhr la manh xucmg mong vay quanh va ong tai ngoai Xmang chdm (occipital bone) Xuang cham tao nen phan sau cUa vOm va nan s9 Xizang chAm gm ba phan vay quanh 18 lan xuong cham Le low la nai hanh nao lien tip vai tuY seing Tnr6c l8 10n la phdn nen, hai ben la cac phiin ben va sau la trai chdm Mat trail phan nn dc dirng va du0c g9i la cloc Tren mi phAn ben c6 mOt /67 cdu chdm tip khop vai mat tren cüa kh6i ben d6t dOi va mOt ang thdn kinh thiet, nai di qua dm than kinh s9 XII Mat sau trai chdm c6 u chdm ngoai gifra va cac du6ng gay a mi ben Gitra mat truck (hay mat trong) trai &Am c6 chdm G6 xtrcmg tir i di tai 18 ch'Am la mao chdm trong, cOn hai ranh k tip tir i chay sang hai ben la ranh xoang ngang va rc7nh xoang sigma Ranh xoang ngang ngan each hai 116a mat trai cham: clai nc7o a tren va ho' tieu nc7o a duai Xicang bu6m (sphenoid / sphenoidal bone) Xuang buam nam gicra nn s9 va tip khOp vâi tat ca cac xuang khac cUa hp s9 Ngoai hp so, nO can gOp phan tao nen tran mai va cac mat Cac phan cUa xucmg btram la than, canh nh6, canh lan va cac mom chan Imam Than nam gifra xuang Imam, tip giap vai xuang sang ey truck va xuang cham a sau Mat tren dm than xuang buOin cO ranh tru6c giao thoa va ho' tuyen yen M8i canh nho dinh vao phan tnrac than Imam bang hai r va ding than Warn giai Ilan nen dng thi giác, nai di qua dm than kinh s9 II phia sau, mi canh kin cling tir mOt ben than buam chay sang ben, tao nen phan gitra cüa nan s9 Hai canh ding vai than Imam giai hart nen khe d mat tren, nai di qua dm cac than kinh VI, III, IV va VI Tren earth 10n co a tran va 16 bdu clyc, Ian luat la nai di qua dm than kinh V2 va V3 Cac mom chan btram tir than chay xu6ng cac ben mUi Trong than xuang imam c6 cac xoang &thin thong vai Xtrang sang (ethmoid/ethmoidal bone) Xtrcmg sang nam tren threw gitra, a phan truac nn so NO cOn gOp phan tao nen vach mUi, tan mili, ngoai mUi va mat Cac phan cita xucmg sang gam manh sang, math thang dirng va cac me dao sang Manh sang lap vao ch8 khuyet cUa phan mat xtrang tan, ngan cach ho s9 truck voi mai; gift mat ten dm math sang nho len mOt mom hinh tam giac g9i la mao ga, hai ben mao c6 cac le sang Manh thang dthig chay vao vach mUi M8i me ciao sang la Tai lieu on thi tuyen sinh phou — Sinh l m6t kh6i xuang x6p narn gifra mat va müi Kh6i chfra cac xoang sang thong voi ma Hai math xtrang tir mat tn.& me dao sang nho vao miii dugc goi la cac xoan mW tr.'en va chi& Xwang ham tren (maxilla) Hai xtrang ham tren (dã dinh tao nen ham tren va tip khop v6i tat ca cac xuang mat khac, trir xuang ham dui N6 tao nen mOt phan dm • san mat, mOt phan cüa ben va san miii, va hau ht khAu cai cimg Xuang ham ten g6m than va cac mom Than ca cac mat huang ve mat, müi, h6- dui thai ducmg (dugc goi ran hrgt la mat ô mat, mat mid va mat &ten thai &rang) va v'e phia tnrac (mat trwac) Nhting chi tit quan trgng teen cac mat la: ranh &col d m'at a m4t mat, cite& a mat va khuyit mW i mat truac, ci ham mat duai thai dung, ranh le va xoang ham tren i m'Ot miii Than xucmg chira mOt xoang lan ma vao müi, xoang ham tren Co b6n mOm tir than xuang nho ra: mom tran chay len tip khop vgi xuang tan; mom go ma tip khop vai xucmg go ma; mom huyet rang la m6t cung mang cac huyet rang cila cac rang ham tren; va mom khau cal tao nen 3/4 trtrac khau cai cimg Xtrong ham teen cimg canh lan xtrcmg btram giOi han nen khe mat dtrai Xwang ham du.61 (mandibula) Xuang ham duoi g6m mOt than va hai nganh ham day duai va phan huyet Than xtrang ham &col cong hinh mOng ngra, g6m mOt ifen rang a tren Gitra mat truac nn ham dtrai loi a Mi cam va m8i ben c6 mOt ló cam Phan huy't rang cong cung huyet rang va mang cac 16 huy't chan rang ham duai M8i nganh ham du-61 lien tip vai than ham dtroi tai goc ham dulai Tir day, nganh ham chay len ten gan nhu vuong goc vai than ham Du tren ciia nganh ham tach mom vet a truck va mom /di cu a sau; gliiia hai m6m la khuyit ham the& M6m 16i cau c6 mOt chom tip khap v6i h6 ham &raj va cii khop ciia xtrang thai duang Tren mat ciia nganh ham c6 mOt 16 cho than kinh hu)* rang duai di vao xucmg ham, a ham chrol L8 la cii.a vao ciia ang ham dithi Ming 16 &rye chin bang mOt math xuang ggi la lwãi ham chroi Xwang mid (nasal bone) Cac xtrang miii gap ten dui:mg gitra va tao nen mOt phan ciia cu Xurfng le (lacrimal bone) Hai xucmg lO la nhang xuang nh6 nam a sau va ngoai cac xuang miii va tao nen mOt phan mat Xucmg lO ding vgi mom tran xuang ham teen gigi han nen h6 l, nai ma titi l nam Xicang go ma (zygomatic bone) Xuang g6 ma lam cho g6 ma 16i len g6 va tao nen mOt phan ciia ngoai va san mit No tip khap vai cac xtrung tan, ham tren, buom va thai dung Xmang khau cal (palatine bone) Xuang g6m Math nam ngang math thing ding hop hinh chir L Math nam ngang cimg voi math nam ngang ciia xuang ben d6i din tao phan sau ciia khau cai cling Math thing dimg nho len ten d'ez' tao nen mOt phan ciia ngoai miii va mOt phan san mat Xicang xoan mill du& (inferior nasal concha) M8i xuang la mOt xtrang mong cuOn lai va nho vao miii a dtrai xucmg xoan miii gifra a Tai lieu on thi tuyen sinh mon:Giai phju.— Sinh Xuang la mia (vomer) Day la mOt ,xucmg ming hinh tam giac W.° nen mOt phan vach mill N6 tip khop a duai vâi cac xuang cüa khau cai cirng tai &rang gifra va tren vai manh thang dirng cüa xucmg sang va xuang buam Xizang ming (hyoid bone) Xuang khong thuOc xuang SQ nhung duqc m6 tã cang xuang SQ cho tin NO la mOt xucmg thi hinh mong ngga nam cac m6 m'ena dm \rang ca, c teen quan va duai xuang ham duai Xucmg mOng gm mOt than nam ngang va hai sirng a m'6i ben: sung ion va sling nho Xtrang thin Xuang dm than bao gm cc:it song va cac xuang noc 3.1 CP sling (vertebral column) COt sang la mOt eau triic vita mm deo vita yang chic NO vita c6 th"8 van Ong linh hoat vita bao boc va bao ve dry song, nang da" cho du, va tao ch8 barn cho cac xuang sithn, dai chau va cac co lung COt sang tao nen khoang 2/5 chie‘u cao ca the' va 26 xuang tao n8n, bao gm xuang ding, xuang cirt \fa 24 dat sang raj Cac dat sang red Om dat s6ng ca, 12 dat sang floc va dat sang that lung Xuang ciing dat sang ding dinh lin ma thanh; xucmg cvt thuang dat sang cvt dinh lai COt sang san c6 hai duang cong li sau tit lüc sinh va kh6ng mAt di: cong nguc va cong cimg Khi tre lon len va c6 th'e dirng thang, cOt s6ng xuat hi8n th8m hai &rang cong mai (dwang cong tide That): cong cd va cong that lung (au 18i truac) 3.1.1 Cac phan cita mOt dot song dien hinh M8i clot sang (vertebra) Om CO than cidt sang va cung (rat sang vay quanh 18 dat sang Than clot sang (vertebral body) c6 hinh det, mat tren va mat duai la cac mat gian cl'Ot sang tip khOp Arai dat sang ke' can qua dia gian dat sang Cung dOt sOng - (vertebral arch) a phia sau than dat sang, cang vai than dat sang gioi han nen 18 slat sing Cung gm manh cung clot sang (lamina of vertebral arch) rOng va dct, nam a sau; cac cung Cung dot sang (pedicle of vertebral arch) a tnrac manh, dinh vai than; va cac m6m tir cung MQC Cac•ba teen va duai ctia cung du lOm va duqc g9i la cac khuyb sang ( tren va dual) Khuy& s6ng duai cüa d6t s6ng tren ding khuy& sang ten cüa dat sang duai lin k giai Ilan nen l gian clot sang (intervertebral foramen), nai ma cac day than kinh sang va cac mach mau di qua Cung dat sang tach cac mom; Mdt mom gai (spinous process) tit Oita mat sau cüa math cung dot song chay sau va xuang duài, sa thay chtqc a duai da lung; Hai mom ngang (transverse process) tir ch8 nai gift cuang va math chay ngang hai ben; va mom khop, Om mom khop tren va mom khop dwai (superior and inferior articular process) mang the mat khOp, cling tach tir khoang ch8nOi giita cu6ng va manh; cac dat sang tip khop vai thi mom khop duai cira dat sang tren tip khOp vai mom khop ten cUa dat sang duai Teti lieu On thi tuyen sinh phau — Sinh lj nao dieu hod tnrang luc ca, tham gia gift thang bang cho cci the, dieu hod dOng tac, dieu hod phan )(a tu the, chinh the Cfic duiYng lien he ciia tieu nao TAt cd cac duang cam gide di len vo nao du cho thong tin den tiL nao, cac th6ng tin dm v6 nao cam gide yà van dOng du CO &rang dua den ti6u nao Tr tiCAu nao CO duang lien N vai nhan do, nhan tin dinh, v6 nao va tieu.nao Mi ben Chth 'fang dinh khu Tieu nao gm: nguyen tieu nao ld phAn phat tri6ri so'm nhat theo bac thang tin hod dm dOng Vat, tieu nao c6, lieu nao mai chi c6 a nhimg dOng vat cao cap Cac phAn khac c6 chirc nang khac nhau: _ Nguyen tieu ntio: Cac thOng tin cam gide tir cat yang cci the, cam giac ye vi tri khong cita du dugc dua v nguyen tieu nao, cho phdp nhan bit vi tri khong gian cüa tfmg phAn ca the dac bit la vi tri cüa du khong gian, tir tieu nao dieu hod truang lire ca gift thang bang cho co the Tieu nao c Cac thong tin cam giac dc b* la cac thong tin ve throng luc ca cua cat phAn cci the den tieu nab c6 Tieu nao c6 c6 tac dung chU yeu lam giam tnrang lc ca, la trung tam cila phan xa gift thang bang yà phan xa chinh th& Cac thong tin tir vo nao va cat thong tin cam giac va giac quan Tieu nao den lieu nao mai Tieu nao mai co tat dung chü yeu la tang truong luc ca, dieu hod ph6i hop d6ng tac phirc tap, lam cho cac d6ng tac chinh xdc Chi phiii van clang ciia tieu nao Tieu nao chi phi van d6ng cfmg ben Tac dOng len neuron van dOng cüa tily -.• Tac dOng len nao vimg cam giac yang van dOng Cfic ri lo#n lam sang ton thtrang tieu nao Khi t6n thuang tieu nao thuang thay r6i loan, thang bang, thehin bang di ldo ddo, dAu lac hi, lay tong mat Cac ri loan dieu hod 'twang luc cot ld d6ng tac sai tam, sai huong, va run T6n thucmg tieu nao gay cac r6i loan nira cci the cang ben vai ben t6n thuang a CHtfC NANG VAN BONG CiTA VO NAO V6 nao van dOng nam tnrac ranh trung tam, chi phi cac van d6ng ca thirc ya dieu hod phi hop cac dOng tac Vimg van deng so• cAp (yang theo Brodman) Chi phi van d0ng CO thirc, chi phi nira nguai d61 ben Ban d6 chi phi van dOng lOn ngugc PhAn cci the dr dOng phirc tap vimg dai din lan Vang filen van Ong (yang theo Brodman) Chi phi d6ng nh6m ca, hinh chiau ca the gi6ng vfmg Cimg vimg van d6ng sa cdp chi phi nhieu nhOm co Vfmg lien van d6ng cfmg vai the nhan nen, di thi NIA \Tang van dOng sa cap chi 186 Tai lieu on thi tuyen sinh mon:Giai pluiu — Sinh ph6i phan lan cac cr dOng phirc tap Vimg v'an d(ing IA sung (vUng theo Brodman) Ph& hop vai vimg tin van &Ong tao tu the khac cüa cac phan ca the WY sti viing v4n dOng dac bit Viing Broca nam tnrac \Tang van &Ong sa cap ph& hop Wing gay &Ong tac ho hap, dr Ong day am, dr Ong cüa mieng va 1u6i inc mai Nam ben ban call trai voi ngu6i thuan tay phai T6n thing gay khong noi dugc (yang van dOng dm 16i n6i) -Wing Wernick la viing nhan thirc dm 16i n6i, tOn thucmg kh6ng hieu 16i noi, kitting noi dirge nam & hi nep cong thuS, thai throng Cac &drug van d',6ng xuat ph& tir vo nao 5.1 B6 vo ttly (b6 thap) Tir vo nao di xu6ng den hanh nao 9/10 bat cheo sang ben di din (b6 thap cheo) den tip n6i voi neuron van Ong & sirng tru6c s6ng 1/10 s6 sai lai di thang xu6ng tit)/ (b6 thap thang) bat cheo den ben d6i din tip n& v6i neuron van &Ong & sing tnr6c TOn.thucmg ve nao van dOng gay liet nira ngtr6i ben di din • SINH LY HE THAN KINH THVC VAT 1-1 than kinh thuc vat c6 chirc Wang: chi phi va dieu hoa hoat dOng cüa cac tang Cac tang d6 la da day - rut, du6ng can phi, tim, than, Dc diem du tao chtic Jiang than kinh thuc vat bao gm: he than kinh giao cam va he than kinh giao cam Hoat &Ong dm he than kinh thuc vat ten co s6 cung phan xa Cung phan xa thuc vat gm naron, naron cam giac di tir tang v trung tam, tir trung tam di den tang gm naron: neuron dilr nit& di -Ur trung tam den hach thuc vat dtrac g9i la sai trtrac hach, neuron thir hai di tir hach thuc vatden tang goi sau hach Trung tam h giao cam sung ben chat xam tit)/ Li - TL3 va tit)/ ding - He ph6 giao cam trung tam & hanh nao cho cac day ph6 giao cam di theo day than kinh s6 Ix, X Hach thgc vat dm h giao cam gan trung tam, xa tang; hach thuc vat he pito giao cam gan tang xa trung tam Tic dung dm h thin kinh thuc Vat ten cac tang Caquan Tim Duong clan D4 day - ruOt £06ng tir' Bang quang 14' giao cam Tang hog dOng Gian Gian Gian Gian Tai lieu on thi tuyen sinh rnon:Giai phelu — Sinh II? 06 giao cam Giam hoat Ong Co Co Co Co 187 Chit truyen dal than kinh cüa sgi sau hach giao cam la noradrenalin; sgisau hach giao cam la acetylcholin Di&I hoi hog Ong he thAn kinh thtyc vOt \Tung duai di dugc xem la trung tam cao cap cua N than kinh thgc vat, \Tung truck la trung tam cao cap cau h giao cam, viing sau la trung tam dm h giao cam Nhieu hoat deng nao anh huang den he than kinh thge vat; ô trang thai Vic cam lam thay di nhip tim, nhip the", co gian mach,v.v Hormon tuyen giap lam tang hoat deng h giao cam CHtfC NANG CAP CAO CfJA HtTHAN KINH Nhang chirc nang cao cap dm he than kinh thuang de cap den qua trinh: nhan thirc, tu duy, ng6n ngfr, tri nhO, XÜC cam,v.v nhimg qua trinh din cher yeu vo nao Can true chtit nang cüa vo nao Phan hog dOng chirc nang cua vo nao chU yeu la met lap noTon day tir den mm, phü toan bô v6 nao Toan be vo nao CO khoang 100 tS7 noTon, chia lam lop Mgi \rang cUa vo nao du cO lien he mat thiet vai cac call true duai vo, dac biet voi cfoi M61 \Tung cUa vo nao CO lien h hai chieu voi met phan tucmg Ung cüa di thi Mgi diKmg dAn truyen cam giac tnrac den vo nao du di qua di thj Tren vo nao cO nhitng \Tung chuyen biet: \ding cam gide than the la vUng tip nhan va phan tich th6ng tin cam giac - giac quan (c6n ggi la cac Wing so cap; Wing cap I), cac \ding van dOng Ngoai ra, tren vo nao CO CAC yang lien hop thir cap cap II, cap III va cao hon nita Nguyen 157 hog Ong ciia nAo Cac thong tin tir mei twang hay mei tnrang ccr the, dugc Wei) nhan bai co quan tiep nhan cam giac oh he than kinh He than kinh phan tich, tich hop cac thong tin dO ri dua guy& dinh clan den mgt dap img thich•hop dam bao sir eon tai va Oat tritn dm co the M6i quan h giira cam gide va van deng lam cho co the la met kh6i:th6ng that va m61 ca the có tinh each rieng nha the, tri nha; ban nang va tri th6ng minh Phan x# có diu kien (diet' kien hofi) Duai tac Ong cua kich thich cüa mei twang, h than kinh hinh met mOi quan N mai gifra hoan canh cüa mei tnrang va hanh vi cira co the DO la sir hinh phan xa ca dieu kien hay dieu kien hoa Khac vai cac phan xa khong dieu kien, dieu kien hod (phan xa cO dieu kien) dugc hinh d6i sting, mang tinh ca the va khong ben yang, khong phu thuOc vao tac than kich thich va be phan nhan cam Nha co:5 loai phan xa ma cci the thich nghi vai dieu kien song luon thay di Hien nguad ta chia dieu kien hod dieu kien hoa typ I va dieu kien hoa typ II a 188 Tai lieu on thi tuy'sjn sinh mon:Giai ph7du — Sinh lj 3.1 Dieu ki?n hofi typ I (phfin xa kieu Pavlov) Phan )(a c6 dieu kien cila Pavlov da dugc de cap den nhieu tai lieu, phan xa c6 dieu kin: bat den gay bai tit ntrac bgt Nhu \Tay kich thich cita moi truang, d6i tugng dap img lai kich thich Co the thAy dieu kin hod ducyc hinh den seing, nhung di tugng khong kiem soat kich thich, hanh dOng la kich thich tao ra, dap frng cUa di tugng la thv dOng theo hoan canh chit khong phai la ST d6 caa d6i tugng 3.2 Dieu kin hofi typ II (phfin xa kieu Skinner) Thi nghiem dm Skinner, cho mOt chim b6 cau vao mOt hp (hop Skinner) Trong hp c6 mOt cAn gat, nu chim m6 vao cAn gat thi lam ma lay va Co hat tit& rai Luc dAu, chim m6 ngau nhien, dAn dAn chim h9c dugc la phai m6 vao mOt ch8' nhAt dinh thi se c6 thoc va xac dinh dugc ch6 phai m6 vao ca tit& an Trong thi nghiem nay, kich thich duong tinh (dugc thoc rai) la he qua oh hanh vi (m6 &mg dich) Sir khac cor ban a day vai phan xa kieu Pavlov la chim b6 cau chit dOng, hanh dOng lam tit& roi Bâi vay phan xa kieu Skinner cOn duỗie g9i la dieu kien hod hanh dOng Phan xa kieu Skinner dugc Ung diving nhieu nghien dm tam 1S7, tam sinh 1S/, dugc 1)", h9c lam sang Co thecüa dieu kin hoa dang dtrgc nghien ciru tr mire d'O neuron cho den mire dO phan dr, tir mirc dO b0 phan den mirc dO t6 chirc - chirc nang cüa ca 114 theing Tri nh& Tri nha la kha na'ng luu giü va tai hien lai th8ng tin da tip nhan trtrac dO Ve phucmg din Sinh l h9c, tri nha la du vet lai dm qua trinh thA'n kinh tren inOt mach naron sau kich thich va dap frng xay va c6 kha nang tai hien lai (trong rigid hoc la lap lai hanh dOng tnr6c da c6) nhang dieu kin nhAt dinh Phan loai tri nha, c6 nhieu each phan loai nhu: tri n1-16 duang tinh va am tinh Cach hay dugc dung nhAt la phan loai tri nhà theo thai gian fon tai tri nha, bao gm: tri nha tire thati, vi dtj nha mOt s6 din thoai vai phitt; tri nha ngan han, loai ltru gift nha dtrac vai phut den hang tuAn sau mAt di hoc tra tri nha dai hp; tri nha dai han, loai km gift nh6 c6 densulot dai Gicra cac loai tri nha CO sir chuyen hod Ian Chinh vi vay tri nha la co sOn cüa tri thirc, kinh nghiem Den co citecüa tri nha chua dugc bit Co tac gia cho rang la mach neuron dOi lai (tri nha tic tiled); c6 tac gia cho rang nhitng Wen d6i l — hod On \ding synap (tri nha ngan han); c6 tac gia cho la bin d6i cAu tritc synap (tri nha dai hart) M9i phAn dm he thAn kinh du c6 tham gia vao qua trinh nha, nhtmg dc bit la cac cau tr.& sau: hi hai ma, thuST thai duang (hi Wernicke, hanh than): luu gift cac thong tin mai Di thi: Km giir cac thong tin cit CHUYEN HOA CtJA NAO Chire 'tang cUa noron la phat va dan truyen din the hog dOng, sir phat sinh din the boat dOng la dong mOn cac kenh ion, de lap lai n'ong d'O ion gift va ngoai a a Tai lieu on thi tuyen sinh mon:Giai ph au — Sinh l3 189 naron la nha vao hoat dOng cüa cac born ion, vay nang luang tieu hao la rat lan ChuyeAn hoi ciia neuron va chuyen hoi ciia nao Trong dieu kin nghi ngai, chuyen hoa cüa nao chiem khoang 15% chuyen hod toan than mac dü nao chi nang bang 2% luang ca the Nhu vay, chuyen hoa cüa tido rigay ca luc nghi ngai ding han chuyen hod chung cüa ca the tai 7,5 lam Chuyen hod dm nao xay chü yeti a cat neuron, nang luong chuyen hod chi' yeu dugc neuron dung vao viec barn natri va canxi ngoai t bao va born kali va vao ben Cix nZi lan neuron truyen di m6t din the hog d6ng thi c6 sr van chuyen cac ion qua mang va lai dôi hoi phai co na'ng lugng d tai lap n6ng d6 ion ve mirc binh thuemg Khi nao hoat dOng rat mph thi chuyen hoa dm neuron c6 the tang len nhieu ran Nhu cau oxy cüa IA() Nhieu mo dia ca the c6 the chili dung tinh trang thieu oxy nhieu phut, tham chi tai nira gia, khoang tiled gian Ay, m6 lay nang luang tir cac qua trinh chuyen hod yem (phan giai khong hoan toan mOt luang lan glucose va glycogen, khong can ket hop vai oxy) M6 nao 'thong c6 kha nang du tit oxy, lai khong c6 kha nang.chuyen hod him DO la mix chuyen hod rat cao cüa cat neuron, dOi hOi cung cap rat nhieu nang luang Mt VT nira la ltrang glycogen va luang oxy du fru m6 nao rat it, vi vay hoat tinh dm neuron phi thu6c hoan toan vao sir cung cap oxy tit mdu vao Mc Do vay, chi can mau khong len nao hay thieu oxy mdu tit den 10 giay cling CO the gay bat tinh Vai tro ctia glucose ell vori cung cAp 'tang hrtyng cho nao Trong dieu kin binh thuang, hall het nang luang can cho hoat d6ng cilaneuron la tit glucose man cung cap Gi6ng nhu doi vai oxy, glucose dung mau mang tai va rat it dirge chuyen glycogen du trita nao Su van chuyen glucose qua mang d vao neuron kh6ng phi thuOc vao insulin O benh nhan bi dai thdo duang nang, luang insulin hau nhu bang khong thi glucose van vao dugc neuron mOt each d dang nen hog d6ng tam than dm benh nhan van khong bi r6i loan Trong tntang hop glucose huyet bi thap; ca & nhung benh- nhan mAc dai thdo duang bi tiem qua lieu insulin khien glucose huyet bi giam xu6ng rat thap thi insulin lam cho glucose ducic chuyen nhanh vao cad loai te bao khat khong phai la neuron Luc nay, luang glucose cung cap cho neuron khong du dAn den r6i loan hoat Ong tri óc, r6i loan tam than - tam VT va c6 gay hon a 190 Tai lieu on thi tuyen sinh mon:Giai ph au — Sinh CHU'ONG 17 SINH LY NO PEET MAJC TIEU Trinh bay Ayr tac clung va diu hOa bai tMt cac hormon, Tuyen nOi tiat ld cac tuyen khong CO iSng bai fiat, cac chit tuyen san xuat dugc bai tit vao mau den cac m6 gay tac dung tai dO Cac chat dugc tuyen nOi tit bdi tit g9i hormon Hormon la nhcmg chat He h9c mOt nhOm t bao hoc tuyen nOi tiat tit ra, dugc van chuyan theo mau tài nhang noi ma n6 tac dung Noi chiu tac dung cüa hormon dugc goi ld m6 dich hay cc/ quan dich Ha thOng nOi tiat chit yeu diau hoa cac chuyan hoa dm cor the', sr phat trien ca the', tac dung cham nhung Ice° dal, ding vai than kinh ddm bao sr hang tinh cUa nOi moi thOng nOi tit bao gth nhiau tuyen nOi fiat, m8i tuyen ca chirc nang rieng, car the' cac tuyen hog Ong ph& hgp nhau, duâi sir chi huy cüa vimg duoi dOi (hypothalamus) Diu hem bdi tit hormon: nang dO hormon mau dugc diau hoa bang car che diau hOa ngugc, chit yeti la diau hea ngugc am tinh Diu hoa ngugc mi nang dO hormon tuyen dich thay di CO tac dung ngugc tra lai tuyen chi huy lam thay di nang dO hormon tuyen dich Diu hod ngugc am tinh la m8i namg dO hormon tuyen dich thay di CO tac dung ngugc tra lai \rang duoi di va tuyen yen lam cho nang dO hormon mau tra v binh thuong SINH IA? ViJNG DUI% DOI Nhic lui giai phAu viing (WM di VUng duai di la mOt eau true than kinh thuOc nao trung gian, nam quanh nao that III VUng duai di c6 lien than kinh vori cac \ding cüa nao va vai thuy truck tuyen yen qua he mach cira Popa va Fielding VUng duoi di bai tit cac hormon den thity tuft tuyen yen qua mach cira Popa yd Fielding da diau h6a bai tit cac hormon thily truck tuyen yen Ngodi viing duai di c6n tit hai hormon: oxytocin, ADH (vasopressin) du till a thity sau tuyen yen, dugc bai tit vao mau theo nhu cau cüa co the Tfic dung dm cfic hormon yang duti di Cac hormon cüa \rang duai di tac dung Tfic.dung len tuyen yen , ' Ten hormon STT , Kich thich bai tiet GH GHRH (Growth Hormone Releasing GHIH (Growth Hormone Inhibiting Hormon) l'ic cher' bai tit GH Ted lieu on thi tuyen sinh mon:Giai pluiu — Sinh lj 191 TRH (Thyrotropin Releasing Hormone) Kich thich bai tie't TSH CRH (Corticotropin Releasing Hormone) Kich thich bai tit ACTH GnRH (Gonadotropin Releasing Hormone) Kich thich bai tit FSH va LH PIH (Prolactin Inhibiting Hormone) tic the bai tiet prolactin Di'&1 hem bai titt Cac hormon \rang dm% di dugc dieu hoa theo ca cite dieu hod ngugc (feedback) da dugc m6 tã a bai ma (tau, chit yeti la theo dieu hoa ngtrgc dm tinh.Si ding d6 hormon tuyen yen tang c6 tac Ong irc the sir bai tit hormon Wang frng dm \Tang &raj di va nguvc lai (feed back vOng ngan) Dieu hoa ngtrgc duang firth xuat hi8n m6t vai tnrang hap due bit nhung khong keo dai SINH LY TUYEN YEN Tuyen yen gem c6 hai thity, thity tnrac lien h8 mdt thiet vâi \rang duai d6i bang h8 mach cira Popa va Fielding, thity sau li8n 118 vai viing duai di bang &rang than kinh Cac hormon tuyen yen gem c6: GH (Growth Hormone) - hormon fang truirng 1.1 Tfic dung Lam Oat trien co the bang tang s6 luvng va kich thtrac t bao, phat trien six lien hap du xucrng dai lam cho ca the 16n len Lam tang t6ng hap protein deng thai giam thoai hoa protein Lam tang &rang huyet ire ch vdn chuyen glucose vao te bao Tang thoai h6a lipid cho 'fang luang 1.2 Diu him bai tit Neng dO GH la GHRH ya GHIH cUa viing cluai di, n6ng dO glucose matt giam lam tang bai tit, stress lam tang bai tiet 1.3 Ittli loan bai tit Thieu GH tnrac tu6i tnrang gay lün tuy6n yen Thira GH truac tu6i tnrang gay b'enh kh6ng 16 Thira GH sau tu6i twang gay b8nh to dau ngon TSH (Thyroid stimulating Hormone) - hormon kich thich tuyen gifip 2.1 Tfic dung Tac dijng 18n tuyen giap lam tang s6 lung va kich thuac t6 bao nang tuyen giap, lam tuyen giap to Tang mao mach tuyen giap Tang tiing hop va giai phong hormon tuyen giap vao mau 2.2 Diu him bai tit • TRH dia \ding duai di kich thich bai tit TSH Hormon T3, T4 dm tuyen giap dieu hoa bai tit TSH theo ca cite' dieu hOa ngugc ACTH (Adreno Cortico stimulating Hormone) - hormon kich thich tuyen vo thulyng thin 3.1 Tfic dung 192 Tai lieu on thi tuyen sinh mon:Giai phau — Sinh if) Tac dicing len tuyen vo thugng than lam tang sinh lap 1)6 va lop luai lam tuyen nâ to, tang t6ng hop va bai tit& hormon tuyen vo thugng than (di din cortisol) Tang qua trinh hoc tap va tri nha Kich thich to sac t6 (melanin) va phan tan sac t6 lam cho da c6 mau 3.2 Dieu Ilea bai tit CRH cua yang duai di lam tang bai tit ACTH, cortisol tuyen vo thugng than dieu haa theo cor the dieu h6a ngugc ACTH dggc dieu haa theo nhip dem, tang len vao Mc sang sam, thap nhat vao dem FSH (Follicle stimulating Hormone) - hormon kich thich nang trumg phat trien 4.1 Tac dung Tren nam, kich thich 6ng sinh tinh phat trien, kich thich te bao Sectoli phat trien.Tren nfl, kich thich nang trimg phat tri6n 4.2 Dieu hea bai tit GnRH cüa \rang &PM di lam tang bai tit, inbihin bai tit tfl t6 bao Sectoli va hoang the bai tit ire ch bai tiet FSH LH (Luteinising Hormone) 5.1 Tic dung Tren nam, kich thich te bao Leydig phat trien va bai tit testosteron Tren nit, ph6i hop vai FSH lam nang trang phat trien den chin, phong noan, kich thich hinh hoang the LH lam nang trUng va hoang the bai tiet estrogen va progesteron 5.2 Dieu hea bai tit GnRH cüa \ding duai di lam tang bai tit LH Testosteron di vâi nam, estrogen va progesteron d6i vai nil dieu hea bai tit LH theo cc( cha dieu haa ngugc Prolactin- hormon kich thich bai tit sfra 6.1 Tac dung Kich thich tuyen vu bai tit sfla, sau tuyen vu dã chiu tac Ong cua estrogen va progesteron 6.2 Dieu him bai tit PIH cüa \rang duai di irc che bai tiet prolactin, kich thich num vU lam tang tit prolactin ADH (Anti Diuretic Hormone)- hormon chting bai niu La hormon cUa viing duai di, dir tilt a thily sau tuyen yen 7.1 Tic dung Tang tai hap thu nu& a 6ng lugn xa va 6ng gap, a n'ong dO cao CO tac (twig co mach tang huyet ap dOng mach, vi vay cOn c6 ten la vasopressin 7.2 Dieu hoa bai tit mau tang lam tang bai tiet ADH va ngugc 10, the tich Ap sat tham thau mau giam lam tang bai tit ADH 7.3 ROi loin bai tit Tai lieu on thi tuyn sinh mon:Giai phau — Sinh l5 193 T6n thucmg vimg duai di hoc thity sau tuyen yen lam giam nong dO ADH gay benh dai nhat Benh dai nhat the hien bang lugng nuac tieu nhieu, nuac lieu cac chat din giai thap nhieu so vai binh thuang Oxytocin La hormon dugc bai tiet a \ding duai di va du tr(t a thity sau tuyen yen 8.1 Tic dung Lam co ca tir cung mang thai va vao nhang thang cu6i cüa thai IcS7 c6 thai, dc bit chuyen da Tac dung len tuyen vu oxytocin gay bai xuat sea 8.2 Dieu boa bai tit _ Kich thich num vu lam bai tiet oxytocin, kich thich giao cam, tam VT thoai mai lam tang tie't oxytocin SINH LI'L7 TUYEN GIAP Tuyen giap nam truac sun giap, co hai thity trai va phai, bai tit cac -hormon thamgia dieu hOa sr phat trien ca the va chuyen Ma Cac hormon tuyen giap gm c6: thyroxin (T4), triiodothyronin (T3) bai tit tir nang tuyen; ngoai bai tit calcitonin Hormon T3, T4 NguYen lifrho hormon T3, T4 Hai nguyen lieu chinh clang t6ng hop hormon giap tang la acid amin va iod c6 ngu'on g6c tir thien nhien vao ci the bang &rang tieu hoa, qua mau dua tuyen giap t6ng hop hormon 1.2 Tic dung ciia hormon T3, T4 Tac dung len sr phat trien ca the: c6t hOa sun xucmg, phi hop vai GH lam pita trien ca the Trong thai kS7bao thai c6 tac dung lam phat trgn v cAu truc va chirc nang cUa nao Sau sinh hormon tuyen giap cAn cho sir pilaf trien va hoat dOng binh thuang cUa nao Tre nhugc nang tuyen giap thi cham phat trien gay lUn va dan dOn tru nang giap tre em lam phat tri6'n sam nhtmg kh6ng gay kh6ng 16 Tac dung len chuyen h6a: tang thodi hOa glucose a te bao, tang phan giai glycogen glucose Tang thodi He lipid, giam cholesterol mau Tang thoai h6a protein va tang t6ng hop protein, tiled IcS7 phat trien ding hop lan han thodi h6a Lam tang nhu cau vitamin Liu nang tuyen giap lam giam lugng va c6 cam giac n6ng Tac dung len tim mach, lam tang tan s6 tim, lam gian mach mau cac m6, dc bit & da Tac dung len he than kinh ca: tang tinh phan dm than kinh - ca nue day su pilaf trien dm nab v kich thuac va v chirc nang, can cho sir hoat d6ng binh thuang cUa nao Khi uxu nang lam tang thodi hoa protein co gay yeti ca Len ca quan sinh duc: hormon tuyen giap can cho su phat trien va hoat dOng 194 • Tai lieu on thi tuy'en sinh mon:Giai phju — Sinh lj binh thu6ng ciia ci quan sinh dttc Nhugc nang giap gay mAt tinh chic a nam, gay bang kinh va da kinh tru nang giap gay bAt ltrc & nam, gay thieu kinh hoc vo kinh nir 1.3 Dieu hoa bai tit Do TSH cüa tuyen yen lam tang bai tiet Hormon T3,T4 tang bi stress, bi lanh Wong dO iod vo cor mau cao irc che bai tit T3,T4; n6ng dO iod him cor mau cao irc che t6ng hop hormon giap Calcitonin 2.1 Nguen gOc Calcitonin &roc bai tit tir te' bao canh nang (te bao C) cUa tuyen giap bai tit 2.2 Tfic dung Lam giam calci huyet tucmg Lam giam s luong va giam hog dOng cüa cac t bao hug/ xtrang, gay Fang dong calci & xtrong Mc citing quan tong tre em Calcitonin CO vai tr6 quan tivng di v6i sr chuyen hod calci va tao xucmg a tre nho 2.3 Dieu hoh bai tit N6ng dO ion calci huyet tuang tang lam tang bai tiet calcitonin va ngugc 14i 2.4 Cfic rei loan thuirng gp cüa tuyen giap Buou ct) don than (binh giap): co the thieu iod, tuy'en giap phi dai nhtmg chirc nang birth thuemg hoc horn giam Cu nang tuyin giap (benh Graves - Basedow):tuytn giap bai tit qua nhieu hormon thuemg khong phai TSH tang ma mOt globulin mau kich thich trtrc tip len tuyengiap Berth nhan co buau c6, mat 16i va sang, nhip tim nhanh, tay run, silt can, thin kinh (16 kich thich, chuyen hoa co sâ tang, n6ng dO T3,T4 mau tang, dO tap trung iod cao Nhuqc Wing giap: nu nhtroc nang bAm sinh hay bi tr lüc cOn nho thi gay lim tuyen giap (lim khong can d6i, dAn dOn); nett phat hien va dieu tri sau de muOn thi kha nang phat trien vai tan thi tre có the phat trien binh thu6ng; cang binh thu6ng cang khO, nhAt la ve mat tri tue Nhugc nang tuyen giap a tu6i truemg gay benh phU niem Cac trieu chirng hoan toan nguoc v6i the trieu chimg cüa cuemg giap a SINH LI"( TUYEN CAN GIAP Nhic Ii gifii,phau CO tuyen can giap nam sau cac ctrc cUa tuyen giap Cac tuyen rat nho nen bi cat nhAm cat bo tuyen giap Tuyen can giap có tinh sinh mpg Neu mAt tAt ca tuyen can giap thi se bi chet nu khong duvc dieu tri Te bao chinh cüa tuyen can giap la te bao san xat hormon la Parathormon a Tai lieu on thi tuyen sinh mon:Giai ph au — Sinh lj 195 Parahormon 2.1 Tic dung Lam tang calci huyet Parathormon kich thich qua trinh huS, xuang, giai phong calci-vao mdu lam tang calci mdu 2.2 Dieu hoa bai tit Ming dO calci mau giam nhe thi da lam cho parathormon dugc bai tit tang len va ngugc lai 2.3 Mt se reyoun bout ding tuyen cin giap Duy tri nong dO ion calci binh thuang man la dieu kin can thiet d cho he than.kinh - ca hoat dOng binh thueng Khi n6ng dO ion calci huyat giam thi ngtfang kich thich cüa he than kinh - co giam, clan den bi kich thich Nhuvc Wing: a the nhe c6 du hieu co mOt s6 ca mOt each tkr Oat hay bi kich thich nhe (du hieu ban tay nguai d'a de, co co mat); the nang xat hien cdc co cimg kieu tetanie; benh than c6 the bi tir vong co that ca quan gay tac tha Trong mdu calci giam, phosphat tang Uu nang: thuong kh6i u tuyen can giap; he xuang bi phd huS, math, clan den bi gay, gay tkr phat, lang dong söi a nhieu nai, dc bit la & than Calci huyet rat cao a • SINH LI"( TUYEN THONG THAN Tuyen thugng than gm hai phan co nguiin g6c phoi thai hoc khac Phan tüy CO ding ngu6n g6c vai he than kinh va •dugc coi nhu hach giao cam; can phan vo la tuyen nOi ti6t CO tinh sinh mang Tuyen vô thircrng thin • V6 thugng than gm CO lap, tir ngoai vao la cac lap cau, 16p 1)6 va lop luai Lap cAu bai tit cac hormon chuyen hod mu6i nuac (mineralocorticoid), lap b6 va lap luai bai tit cac hormon chuyen hod &rang (glucocorticoid) va cdc hormon sinh dvc (androgen) 1.1 Nhom glucocorticoid: dai din la cortisol 1.1.1 Tic dung Tdc dung len chuydn hod glucid: tang tao duong mai a gan, lam giam tieu thp glucose a moi t bao ca the Kt qua la cortisol lam tang dung huyet, c6 the dan den dai thao duang Tdc dung ten chuydn hod protein: lam tang thodi hod protein, lam giam t6ng hop protein Tdc dung len chuydn hod lipid: lam tang thodi hod lipid a cdc mo m'a, tang oxy hod acid beo Ar cac th bao d tao nang lucmg Chong stress: bi stress (do char' thuong, nhi8m khan cap, ruing hoc lath qud, xiic cam qud mire) thi lugng ACTH tang, lam luong cortisol dugc- bai tit tang len nhanh ch6ng, nha ca the huy dOng dirgc nhieu nang luong, tang cuang krong 196 Tai lieu on thi tuyen sinh mon:Giai phau — Sinh dich vao mach mau d chOng lai tinh tang stress Taz dvng diacortisol c6 tinh sinh mpg Chong viem: cortisol Co tac dvng ire ch phan üng viem no lam cho mang lysosom ben virng, khong giai phong dugc ceic chat gay viem; lam giam sir tao prostaglandin va leukotrien la hai chat gay cac phan irtig viem math Tac dicing dugc fing dvng nhieu lam sang ChOng dj l'rng: cortisol irc che giai phong histamin la chat gay cac phan frng di irng nhu gian mach, tang tinh tham mao mach, c6 tac dvng chOng di img Tac dung len mem va he thong milli dich: lam 0am bach cu Ai toan va bach cu lympho; giam kich thuac cac mo lympho; giam san xuat lympho T; lam tang sinh hOng cu , Ngoai ra, cortisol lam tang bai tit acid a da day, ire the quA trinh tao xuong 1.1.2 Dieu hea bai Het Su bai tit cortisol cüa tuyen thugng than phi,' thuOc vao lugng ACTH cilia tuyen yen va ding theo nhip dem Sr bai tit cortisol tang len rat math stress 1.2 Nhom mineralocorticoid: dal din la aldosteron 1.2.1 Tic dung Lam tang tai hap thu ion natri va tang bai xuat ion kali a 6ng then, dan den gift natri ice° theo gift nu& vey dam bao dugc lugng dich ngoai bao 1.2.2 Dieu hoi bil tiet Cac yeti t6 chinh dieu hoa bai tit aldosteron la: nOng dO ion kali mau tang lam tang bai tiet aldosteron He thOng Renin - Angiotensin tang hoat dOng lam tang bai tit aldosteron NOng dO ion natri dich ngoai bao tang lam giam bai tit aldosteron 1.3 Rei loan hot ding vo thuvng thin Nhuvc nang vó thuvng than (benh Addison): thieu cac glucocorticoid va mineralocorticoid dan den nOng dO natri mau giam, nOng dO ion kali tang, giam the tich dich ngoai bao, luu lugng tim giam clan den tCr vong nu khong dugc dieu tri sam bang aldosteron, bU nuac va can bang din giai; giam glucose huyet, chuyen hod giam; kha nang chOng stress, ellen-1g viem giam Benh nhan c6 the bi rOi loan sac t6 da ACTH tang, kich thich san xuat va phan tan melanin a te bao da va niem mac Cu Wing vó thugng than (hai chimg Cushing): u vo thugng then, u te bao bai tiet ACTH dm tuyen yen Benh nhan Co huyet áp cao, glucose mail cao (c6 the dai thao dung); roi loan phan btim (ix king 6., bung, nguc), met bi phü, da c6 nhftng ve't flirt ran benh than bi giam Hai chieng tang aldosteron Wen phat: u t6 bao kali huyet, tang natri huyat, tang the tich ngoai bao, tang huyet áp Hormon ctia tuyen tity thtroyng thin Cac hormon cUa thugng then dugc g9i la cac catecholamin: adrenalin va Rd lieu on thi tuyen sinh azon:Giai philu — Sinh l 197 noradrenalin 2.1 Tic dung cila adrenalin Tac dung len tim: lam tim - dap nhanh, dap manh Mc dung len mgch mau: lam co mach &raj da; gian mach trung tam (mach yank' mach nao, mach co van, mach than); lam tang huy'et ap ti da Lam gian co tran ruOt non, pile quan, bang quang; lam gian co d'ong tir va co tir cung LAM tang chuyen hod, tang tieu thu oxy, tang sinh nhiet Lam tang phan giai glycogen a gan, giai ph6ng glucose vao - 2.2 'Tic dung ctia noradrenalin Noradrenalin co tac dung tucmg tu nhu adrenalin nhung tdc dung lam co mach cüa noradrenalin math hon Noradrenalin lam co ca math ngoai vi va mach tiling tam nen lam tang ca huyet ap ti da va huyet ap tOi thieu 2.3 Dieu hoi bai tit hormon tüy thircrng than Trong tinh trang binh thuang, cdc catecholamin &roc bai tit it Trong tinh trang stress, giam duang huyet, giam huyet ap hoc kich thich than kinh giao cam thi tUy thuong than tang cuang bai tit cdc catecholamin • 2.4 ItOi loon hoot Ong ttly thtrumg than • U cdc t bao ua crom cUa lily thuong than lam tang san xuAt va bai tiet cdc catecholamin va gay tang huyet ap, an den suy tim, c6 the gay tir vong SINH 1,)"( TUYEN Tin( NOI TIET Ngoai chirc nang tieu hod, tuyen can c6 chirc nang nOi tit Cdc t baocila tieu -dao Langerhans san xudt cdc hormon cüa Cdc te bao beta dm tieudao Langerhans san xuAt insulin; te bao alpha san xudt glucagon Insulin Insulin te bao beta cila san xudt Insulin dtroc bai tiet va duqc van chuyen mdu duai dang tkr den mo gay tdc dung 1.1 Tac dung •Tac dung len chuyen hoti glucid: lam tang van chuyen glucose vao te bao va tang thodi hod glucose a te bao co, tang tOng hop glycogen Ket qua la insulin lam glucose huyet Day la hormon nhAt CO tdc dung lam giam &rang huyet nen duqc irng dung dieu trj dái thdo &rang typ I Tac dung len chuyen hoa lipid: tang ding hop acid beo va van chuyen acid beo tai cdc mo m'O Tac dung len chuyen hog protein: lam tang ttmg hop protein, ire chesi,r thodi hod protein 1.2 Dieu hoa bai tit Dieu hoa bang co che the dich: nng ctO glucose mdu tang lam tang bai tit insulin de dua &rang huyet v mirc binh thuang 198 Tai lieu on thi tuyen sinh mon:Giai phau — Sinh lj Dieu hoa bang co che' than kinh: kich thich thin kinh giao cam giao cam lam tang bai tit insulin 1.3 ROI( loan hal tit Tang tit gay throng huyet, giam tiet gay tang throng huyet clan de'n dái dia.° &rang Glucagon Glucagon te bao alpha cila san xuat 2.1 Tic dung Tac dvng len chuyen hod glucid: lam tang phan gidi glycogen ó gan, tang tao &rang mai a gan, ke't qua ld lam tang throng huyet Cdc tdc dung khdc (khi nOng dO glucagon mdu cao): tang phan giai lipid a mo cllr tit; irc che tOng hop triglycerid a gan, irc ch6 van chuyen acid beo tir mdu vao gan; lam tang bail ti& acid a dich vi 2.2 Dieu hoa bai tit Yong dO glucose huyet giam kich thich bai tit nhieu glucagon NOng dO glucose huy& tang irc ch'e bai tit glucagon Van &Ong, luy'en tap Ong kich thich bai tit nhi&I glucagon Tai lieu on thi tuyen sinh tnon:Giai ph — Sinh if; 199 TAI LIEU THAM KHAO Giai phau h9c — & , Dti h9c Y Dugc Tp.HCM Giai phau — Sinh V/, Dai h9c Y Dugc Tp.HCM Giai phau h9c h tho'ng, GS Le Van Cuing 200 TN lieu on thi tuyen sinh mon:Geri Sinh lj