Curs 7.Aparatul Digestiv

7/24/2019 Curs 7.Aparatul Digestiv

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CURS DE MEDICINA INTERNA

CONF DR BABES KATALIN


2/28

Hepatitele croniceInfamatia catli c per!i!tenta proce!li

infamator cel ptin " lni#

Etiolo$ie% & 'epatita c (ir! C !i B )mai rar D* & alcooll

& me+icamente )i,onia,i+a-metil+opa- anticonceptionale-etc*

& .actori to/ici )c'imici- ciperci*

& .actori meta0olici )'ipertiroi+i!m-+ia0et*


3/28

Ta0lol clinicFoarte (ariat % a!imptomatic 1 .orme !e(ereSimptome neuro-psihice% a!tenie- o0o!eala la

e.ortri mici- in!ta0ilitate (e$etati(a )tran!piratie-

ta'icar+ie- lipotimie- tl0rare +e +inamica !e/ala*Simptome digestive% 2ena !a +i!com.ort in eta2l

a0+ominal !perior !i 'ipocon+rl +rept- anore/ie-+iaree- intoleranta la alcool !i $ra!imiSemne generale% !0icter !a icter- !tari

!0.e0rile- artral$ii- acnee- erptii (a!clare-anemie#Ex. obiectiv% 'epatome$alie- !plenome$alie- icter-

!telte (a!clare


4/28

E/aminarile paraclinice)3*Teste functionale hepatice:

a*In!cienta 'epatica%

& in!cienta !inte,elor proteice% proteinetotale- al0mina- 0rino$enl !ca,te#

& !ca+erea (al4 Cole!terolli

& +eciente in !tocarea $lco,ei !0 .orma +e$lico$en in cat#

0* Te!te care e/prima pre,enta ni !in+rominfamator%

& 5SH accelerat

& cre!terea $amma$lo0linelor


5/28

E/aminarile paraclinice)6*c* Te!te care e/prima pre,enta +e 'epatocitoli,a% & cre!terea 78T- 7OT- LDH#

+* Te!te care e/plorea,a !in+roml 0ilioe/cretor

)cole!tatic*% & cre!te 0ilir0ina +irecta

& .o!.ata,a alcalina & $amma 7T

e*Te!te care e/plorea,a !in+roml 'ematolo$ic%

)e/pre!ia 'iper!pleni!mli 1 cre!te +i!trctiaelementelor $rate ale !an$eli*

& lecopenie & trom0ocitopenie

& anemie


6/28

E/aminarile paraclinice)9*.* Te!te imnolo$ice% & imnelectro.ore,a

& +eterminarea in !an$e a nor anti$ene (irale

& +eterminarea in !an$e a nor anticorpi .ata +ecomponentele (irale

Punctie biopsie hepatica

& permite +i.erentierea +e 'apatitele acte c

reca+eri- +e ciro,a 0iliara primiti(a- +e 'epatopatiaalcoolica

& necro,a 'epatocellara- inltrat cellar infamator

& 0ro,a a0!enta !a re+!a


7/28

TratamentlPrognostic.oarte (aria0il% re$re!ie- e(oltie

lenta !a !pre ciro,a 'epatica

Tratamentul%

& intrerperea con!mli +e alcool !a ame+icamentli in ca,a#

& +ieta ) n .oarte re!tricti(a:*

& a$enti anti(irali% lami(+ina- $anciclo(ir-

ri0a(irina# & mo+icatori ai ra!pn!li imnolo$ic%

inter.eronl- interle;inele

& imno!timlatoarele


8/28

Ciro,a 'epaticaDenitie% 0oala 'epatica +i.,a% a!ocierea

0ro,ei c no+ri +e re$enerare !i necro,e 1alterarea ar'itectrii 'epatice#

Mo+icarile !nt la ni(ell intre$li cat !i !ntire(er!i0ile

Etiologie% in.ectii )(ir!rile 'epatice B-C !i D*-to/ine )alcooll*- ra!pn! imn alterat- o0!trctie

0iliara- tl0rari (a!clarePatogenie% !ta+il nal al nmeroa!elor tipri +ele,ini 'epatice 1 n atat +e mlt +e a$entlca,al- cat +e natra le,inilor !i +e ra!pn!lcatli


9/28

Ta0lol clinic )3*Ciroa hepatica compensata%

& a!imptomatici !a

& !la0icine $enerali,ata- anore/ie- !ca+ere +in$retate- !in+rom +i!peptic ne!pecic#fatlenta- +reri a0+ominale +i.,e- meteori!m#

& catl mai .erm- c mar$inea a!ctita

& !plenome$alie

& pro0ele 0iolo$ice% normale !a mici cre!t


10/28

Ta0lol clinic )6*Ciroa hepatica decompensata1.Parenchimatos:

& capacitatea +e e.ort ,ic !i intelectal e!te re+!a

& +entritia & catl mic- neori nepalpa0il

& .e0ra ) citoli,a 'epatica- in.ectie !praa+a$ata-carcinom 'epatic*

& icter

& 'ipere!tro$eni!m% !telte (a!clare- eritem palmar-plantar- .emini,are ) re+cerea parli p0ian- a/ilar- apilo,itatii .aciale la 0ar0ati- $inecoma!tie

& .actorii +e coa$lare +ecitari% $in$i(ora$ii- epi!ta/i!-'emora$ie +i$e!ti(a- 'ematoame- ec'imo,e- pete!ii#


11/28

Ta0lol clinic )9*

& e/aminarile paraclinice% !an$ine 1

tran!amina,e cre!cte- .o!.ata,a alcalina-$amma$lo0lone- cole!terol- pancitopenie-etc

& eco$raa a0+ominala% +imen!inile !i

!trctra catli !i a !plinei & pnctie 0iop!ie 'epatica


12/28

Ta0lol clinic )=*2. CH decompensata vascular

& 'iperten!ine portala

& !plenome$alie & circlatia colaterala a0+ominala

& 'emoroi,i

& (aricele e!o.a$iene !i $a!trice 1 rptra 1

'emora$ii +i$e!ti(e !perioare% 'emateme,a !imelena

& a!cita

& ence.alopatia portala


13/28

TratamentlPrognostic1 +icil +e e!timat- +i.erite

etiolo$ii

Tratamentul de sustinere% & eliminarea a$entilor to/ici

& +ieta normala- !plimente (itaminice-'epatoprotectoare !a troce 'epatice

& me+icamente anti0ro,ante )colc'icina*

& tratamentl complicatiilor

Transplantul hepatic


14/28

Litia,a 0iliara

Denitie% pre,enta calclilor la ni(ell

(e,iclei 0iliare !i>!a cailor 0iliare6?@ pe!te " +e ani pre,inta litia,a 0iliara

6&9 / mai .rec(enta la .emei

Alti .actori .a(ori,anti% o0e,itatea- +iate-antece+ente .amiliare- +ia0etl ,a'arat


15/28

Ta0lol clinicA!imptomaticiSimptome +e +i!pep!ie necaracteri!tica% 0alonari-

$retri-etc

O0!trctia tran,itorie a canalli ci!tic 1 +rere colicati(aO0!trctia per!i!tenta% infamatie !i coleci!tita acta

Colica biliara

- +pa in$e!tia +e alimente coleci!to;inetice

& locali,ata in 'ipocon+rl +rept !a epi$a!tr

& inten!itatea cre!te pro$re!i( !i rapi+- +pa care !ementine con!tant pe toata +rata colicii

& apare mai ale! noaptea

& !e pot in!oti +e $retri- (ar!atri 0ilioa!e- .e0ra-tran!piratii- !0icter pa!a$er


16/28

Dia$no!ticl

Eco$raa a0+ominala 1 (i,ali,ea,a in mo+

+irect calcliiE/4 Ra+iolo$ic 1 til pentr calclii ra+iopaci

E/4 Biolo$ice 1 normale in litia,a necomplicata

& 5SH accel4 78T- 7OT- amila,e-te!te +e

cole!ta,a- etc


17/28

TratamentlCalclii a!imptomatici% 6@ complicatii>pe an

Calclii !imptomatici%

& colica 0iliara 1 +ieta- anti!patice- antial$ice-AB

& ri!c cre!ct +e complicatii% coleci!tita acta-pancreatita acta- per.oratie c peritonita

acta- mali$ni,are- etc & coleci!tectomie la rece

& coleci!tectomie laparo!copica


18/28

Coleci!tita acta )3*Denitie% infamatia acta a pereteli coleci!tli-

pro(ocata +e o0icei +e o0!trctia litia,ica a canalli ci!tic)@*

Simptome si semne%

& +rere colicati(a locali,ata in 'ipocon+rl +rept cira+iere !0!caplar +r4

& $reata- (ar!atri

& aparare m!clara in partea +r4

& coleci!t palpa0il )?@* & 2n$'i +rero! la in!pir pro.n+

& !emnl li Mp'


19/28

Coleci!tita acta )6*Evolutia:& ameliorare in 6&9 ,ile- !e re,ol(a

in ,ile

Complicatii% empiem- $an$rena- per.oratie% & !tare $enerala alterata- .e0ra-

lecocito,a- !emne +e peritonita- ile!- icter

& amila,ele cre!te 1 pancreatita

Diagnostic%

& eco$rae a0+ominala

& colan$iocoleci!to$rae i,otopica


20/28

Coleci!tita acta )9*

Taratamentul% & re'i+ratare parenterala

& !on+a +e a!piratie na!o$a!trica

& coleci!tecomie +e r$enta )in ca, +e

complicatii*

& coleci!tectomie tar+i(a 1 la " !apt4


21/28

Coleci!tita cronicaDenitie%

& in$ro!area !i 0ro,a parietala c retractia(e,icii 0iliare#

Clinic%& colici recrente

Patogenie%

& calcli !a noroi care pot o0!tra canall

ci!tic & mcoa!a lcerata !i 0ro,ataTratament!

& c'irr$ical


22/28

8ancreatita actaDenitie% infamatie acta care !e (in+eca clinic

!i 'i!tolo$icEtiologie:

& afectiunile biliare - alcoolul

& me+icamente & 'iperlipemie- 'ipertri$liceri+emie

& in.ectii- & inter(entii c'irr$icale

& anomalii !trctrale ale cailorpancreatice- 0iliare-

& tramati!me#


23/28

8ato$enieE+em 1 necro,a 1 'emora$ie

Acti(area en,imelor pancreatice )trip!ina-.o!.olipa,a*

8ancreatita e+ematoa!a 1 infamatia limitata la

pancrea! 1 mortalitatea @

8ancreatita 'emora$ica 1 necro,a !i 'emora$ie 1mortalitatea G3?&?@

Hipo(olemie 1 !oc

En,imele intra in circlatie 1 le,ini or$anice +i.,e

In.ectie


24/28

Ta0lol clinicDreri a0+ominale !e(ere c ira+iere in !pate-

tenace- per!i!ta ore !a ,ile

7reata- (ar!atriTran!piratii- ta'icar+ie

Re!piratia !perciala

Fe0ra

Alterarea con!tientei 1 precoma

Di!tenia a0+ominala- iritatie peritoneala a0+omen +e lemn


25/28

E(oltie- complicatiiDece! prin !oc !i in!cienta renala !a prin

in!cienta re!piratorieIn.ectia pancreatica a te!trilor

retroperitoneale c $ram ne$ati(i

8!e+oc'i!t pancreatic 1 colectie +e lic'i+

pancreatic 0o$at in en,ime !i retri ti!lareinantrl ,onei +e necro,a 1 in.ectie-'emora$ie !a rptra


26/28

Dia$no!ticCre!terea amilaei si lipaei serice"adiograa abdominala pe gol% calcli- ile!

+inamic#

Ecograa% calcli 0iliari- +ilatatia cailor 0iliaree+empancreaticTC% (i,ali,area pancrea!li- e+em- e/tra(a,are +e

lic'i+e- necro,a pancreatica## criterii prognostice ale lui "$%S&%% (ar!ta

G +e ani- $licemia G 6?? m$>+l- LDH G 9? UI-78T G 6? U- lecocito,a G 3"???>mlLa = +e ore !ca+erea Ht c G3?@- cre!terea reeei

G m$>+l- Ca !eric m$>+l- 8aO6 "? mmH$-+ecit +e 0a,e G =mE>l- !ec'e!trare lic'i+iana G "l


27/28

TratamentSon+a na!o&$a!trica- per.,ii i(- a!piratia

lic'i+li $a!tric !i a $a,elor

Internare intr&o !ectie +e ATICompen!area pier+erilor 'i+rice

Tratamentl +rerii

Tratamentl in!cientei car+iace- renale

Anti0iotice

Alimentatia i(- re(ine pe!te 6&9 !aptamani-

Inter(entie c'irr$icala


28/28

8ancreatita cronicaEtiopatogenie% alcooli!m !i i+iopatice-

microlitia,a- ocl,ia canalli pancreatic principalprin !teno,a- litia,a !a cancer

Simptome si semne% +rere epi$a!trica- !tetoreec !cane $ra!e- intoleranta la $lco,a

Diagnostic% & e/4 Ra+iolo$ic- e/4 Eco$rac !i TC

)normale in primii ani +e 0oala*

Tratament% & alcooll inter,i!- tratarea ni p!eact- ma!ri +ietetice- tratament c'irr$ical

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Curs 7.Aparatul Digestiv

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