DIAREE DIAREE CRONIC~CRONIC~

DEFINI|IE: DEFINI|IE:

> 3 scaune/zi, peste 4 s`pt.> 3 scaune/zi, peste 4 s`pt.

> 300 g/zi> 300 g/zi

> 10 ml/kcorp/zi, > 3 s`pt> 10 ml/kcorp/zi, > 3 s`pt

CONSISTEN|A:CONSISTEN|A:

hidric`hidric`

gr`sosgr`sos

alimente nedigeratealimente nedigerate

NOCTURNNOCTURN

PATOLOGIC: PATOLOGIC: - mucus- mucus

- puroi- puroi

- s@nge - s@nge

DIFEREN|IAT~ DE:DIFEREN|IAT~ DE:

I. INCONTINEN|~:I. INCONTINEN|~:• • SCAUN LICHIDSCAUN LICHID

• • SCAUN SOLID = ANOMALIE SCAUN SOLID = ANOMALIE

SFINCTERIAN~:SFINCTERIAN~:

LEZIUNE PROPRIELEZIUNE PROPRIE

NEURO MUSCULAR~NEURO MUSCULAR~

II. DISKEZIEII. DISKEZIE

DIAREE FUNC|IONAL~DIAREE FUNC|IONAL~

1. ISTORIE LUNG~1. ISTORIE LUNG~

2. ABSEN|A LEUCOCITELOR, S^NGELUI2. ABSEN|A LEUCOCITELOR, S^NGELUI

3. ABSEN|A PIERDERII PONDERALE3. ABSEN|A PIERDERII PONDERALE

4. APARI|IA EXCLUSIV DIURN~4. APARI|IA EXCLUSIV DIURN~

FALSE DIAREIFALSE DIAREI

LA CONSTIPA| IE SCAUN DUR + AP~ TU}EU RECTAL

INCONTINEN| ~ ANAMNEZ~, TU}EU MANOMETRIE

TUMORI RECTALE MUCUS, HEMATOCHEZIE RECTOSCOPIE

VALOARE SEMIOLOGIC~VALOARE SEMIOLOGIC~

ALTERAREA ST~RII ALTERAREA ST~RII GENERALEGENERALE

TUMORI, ADENOPATIITUMORI, ADENOPATIIARTRITEARTRITEULCER G-DULCER G-DEDEMEEDEMEFLUSHFLUSHHIPERPIGMENTAREHIPERPIGMENTAREERITEM NODOSERITEM NODOSGU}EGU}ENEUROPATIENEUROPATIE

CANCER, IBD CANCER, IBD

CANCER, LIMFOMCANCER, LIMFOMIBD, WHIPPLEIBD, WHIPPLES. ZOLLINGERS. ZOLLINGERS. MALABSORB|IES. MALABSORB|IES. CARCINOIDS. CARCINOIDADDISONADDISONIBDIBDHIPERTIROIDIE, HIPERTIROIDIE,

CANCERCANCERDIABET, AMILOIDDIABET, AMILOID

DIAREE + DUREREDIAREE + DURERE

TIP ULCERTIP ULCER

S. KOENIGS. KOENIG

PERIOMBILICAL~PERIOMBILICAL~

LOCALIZAT~ LOCALIZAT~

INFRAOMBILICALINFRAOMBILICAL

S. ZOLLINGERS. ZOLLINGER

STENOZ~:STENOZ~:

- INFLAMATORIE- INFLAMATORIE

- TUMORAL~- TUMORAL~

ANGORANGOR

S.I.I.S.I.I.

FIZIOPATOLOGIEFIZIOPATOLOGIE

• DIAREE MOTORIEDIAREE MOTORIE

CAUZ~ SAU EFECTCAUZ~ SAU EFECT

• TRANSPORT ANORMAL DE FLUIDETRANSPORT ANORMAL DE FLUIDE

SC~DEREA ABSORB|IEI - OSMOTIC~SC~DEREA ABSORB|IEI - OSMOTIC~

CRE}TEREA SECRE|IEI - SECRETORIECRE}TEREA SECRE|IEI - SECRETORIE

DIAREI MOTORIIDIAREI MOTORIIRELA|IE INVERS~ T.T. - VOLUM SCAUN RELA|IE INVERS~ T.T. - VOLUM SCAUN

([n absen\a leziunilor organice)([n absen\a leziunilor organice)

CARACTERECARACTERE

1. SCAUN LICHID <1l/24 ore1. SCAUN LICHID <1l/24 ore

2. SCAUN IMPERIOS, POSTPRANDIAL2. SCAUN IMPERIOS, POSTPRANDIAL

3. RESTURI ALIMENTARE3. RESTURI ALIMENTARE

4. TEST INDIGOCARMIN TT< 8H4. TEST INDIGOCARMIN TT< 8H

5. INFLUEN|A ALITARII5. INFLUEN|A ALITARII

ETIOLOGIEETIOLOGIE

• CAUZE ORGANICECAUZE ORGANICE

- GASTRECTOMII- GASTRECTOMII

- COLECISTECTOMII- COLECISTECTOMII

- REZEC|II, BOLI - REZEC|II, BOLI

ILEALEILEALE

- FISTULE- FISTULE

• CAUZE ENDOCRINECAUZE ENDOCRINE

- HIPERTIROIDIE- HIPERTIROIDIE

- CANCER MEDULAR- CANCER MEDULAR

- S. CARCINOID- S. CARCINOID

• DISAUTONOMIE - DISAUTONOMIE -

NERVOASENERVOASE

• IDIOPATICEIDIOPATICE

FIZIOPATOLOGIA OSMOTIC~FIZIOPATOLOGIA OSMOTIC~

SARCIN~ OSMOTIC~ SARCIN~ OSMOTIC~ DILU|IE DILU|IE APA APA

IZOTONIE IZOTONIE RETRORESORB|IA Na RETRORESORB|IA Na

VOLUM VOLUM CRE}TEREA "GAP" CRE}TEREA "GAP"

OSMOLARITATEAOSMOLARITATEASCSC - OSMOLARITATEA - OSMOLARITATEASS < 20 < 20

(Na + K)X 2 (N = 220 mEg/l)(Na + K)X 2 (N = 220 mEg/l)

ETIOLOGIEETIOLOGIE

1. EXOGENE:1. EXOGENE:

LAXATIVE: PEG, Mg, NaLAXATIVE: PEG, Mg, Na22POPO44, , NaNa22SOSO33

ANTIACIDEANTIACIDE

VARIA: - COLCHICIN~VARIA: - COLCHICIN~

- COLESTIRAMIN~- COLESTIRAMIN~

- NEOMICIN~- NEOMICIN~

Ahmed S and Gunaratnam N. N Engl J Med 2003;349:1349

A 60-year-old woman with a family history of colon cancer and a history of adenomatous colorectal polyps underwent surveillance colonoscopy

ETIOLOGIEETIOLOGIE

2. ENDOGENE:2. ENDOGENE:

A) CONGENITALE:A) CONGENITALE:

- DEFICIT DE LACTAZ~- DEFICIT DE LACTAZ~

- ABSORB|IE - ABSORB|IE GLU., FRUCT.GLU., FRUCT.

- A- ALIPOLIPO

- LIMFANGIECTAZIE- LIMFANGIECTAZIE

- FIBROZ~ CHISTIC~- FIBROZ~ CHISTIC~

B) DOB^NDITEB) DOB^NDITE - - S. MALABSORB|IES. MALABSORB|IE

Lubinski S and Hendrix T. N Engl J Med 2004;351:808

A 50-year-old woman presented with a five-month history of fatigue, weakness, and diarrhea

DIAREE SECRETORIEDIAREE SECRETORIE PATOGENIE: PATOGENIE: INCAPACITATEA DE INCAPACITATEA DE

ABSORB|IE SAU/}I SECRE|IA ACTIV~ DE ABSORB|IE SAU/}I SECRE|IA ACTIV~ DE Na, K, ClNa, K, Cl

= SCAUN IZOTONIC CU PLASMA= SCAUN IZOTONIC CU PLASMA

INFEC|IOASE:INFEC|IOASE:

HOLERAHOLERA

COLICOLI

PERFRINGENSPERFRINGENS

CEREUSCEREUS

AURIUAURIU

NONINFEC|IOASENONINFEC|IOASE

HORMONALEHORMONALE

LAXATIVELAXATIVE

A. VILOASEA. VILOASE

MALABS. AC. MALABS. AC. BILIARI, GR~SIMIBILIARI, GR~SIMI

Pierdere acizi gra]i

Pierdere a.a. glucide,

minerale, vitamine

Vit. A Vit. K

Acizi gra]i

Ca2+

Vit. D

osteomalacie

Modific`ri piele

Protrombin` ↓

hemoragie

Electroli\i

Fe

anemie

Diaree

1

Dezhidratare

Ac. folic

Vit. B12

Vit. B6

Vit. B2

Vit. B1

anemie

Pierdere calorii

anemie anemie Glosit`

Polinevrit`

Denutri\ie

Deficit proteic

Insuficien\`

pancreatic`

Hipo-pituitaris

m

Amenoree

Atrofie vilozitar

`

Osteoporoz`

Fracturi

Hipo-serinemi

e

1

1

edem

DIAREI INFLAMATORIIDIAREI INFLAMATORII

I. LEZ. MINIME:I. LEZ. MINIME:- BACTERII (EAEC)- BACTERII (EAEC)- VIRUSURI (ROTA, NORWALK)- VIRUSURI (ROTA, NORWALK)- PARAZI|I (GIARDIA, ASCARIS)- PARAZI|I (GIARDIA, ASCARIS)- MIXT (SPRUE TROPICAL)- MIXT (SPRUE TROPICAL)- CITOSTATICE- CITOSTATICE- Rx TERAPIE- Rx TERAPIE- COLIT~ COLAGEN- COLIT~ COLAGEN- GVHD- GVHD

Esser-Kochling B and Hirsch F. N Engl J Med 2005;352:e4

A 63-year-old woman was admitted to the hospital with vomiting and abdominal pain

II. LEZIUNI MACROSCOPICEII. LEZIUNI MACROSCOPICE

- COLITA ULCEROAS~- COLITA ULCEROAS~

- BOALA CROHN- BOALA CROHN

- DIVERTICULITA- DIVERTICULITA

- COLITA ISCHEMIC~- COLITA ISCHEMIC~

S. MALABSORBTIVES. MALABSORBTIVE

DEF: DEF: INCAPACITATEA T. DIGESTIV DE INCAPACITATEA T. DIGESTIV DE

A TRANSPORTA CU V. NORMAL~ A TRANSPORTA CU V. NORMAL~

HRANA {N COMPLEXITATEA EI SAU A HRANA {N COMPLEXITATEA EI SAU A

ORIC~RUI COMPONENT LUMEN-ORIC~RUI COMPONENT LUMEN-

S^NGE, LIMFA.S^NGE, LIMFA.

DIFERIT~ DE MALDIGESTIEDIFERIT~ DE MALDIGESTIE

TIPURITIPURI

ABSORB|IE DEFECTOAS~ABSORB|IE DEFECTOAS~

-HIPER-HIPER

-HIPO-HIPO

- GLOBAL~- GLOBAL~

- SELECTIV~- SELECTIV~

MECANISMEMECANISME

1. ACTIV~:1. ACTIV~:

- NECESIT~ ENERGIE- NECESIT~ ENERGIE

- NECESIT~ TRANSPORTOR- NECESIT~ TRANSPORTOR

- POATE FI INHIB. COMPETITIV- POATE FI INHIB. COMPETITIV

2. FACILITAT~:2. FACILITAT~:

- NECESIT~ TRANSPORTOR- NECESIT~ TRANSPORTOR

- POATE FI INHIBAT~ COMP.- POATE FI INHIBAT~ COMP.

3. PASIV~:3. PASIV~: - - CONFORM GRADIENTELORCONFORM GRADIENTELOR

ABSORB|IEABSORB|IE

PE PRINCIPII:PE PRINCIPII:

• Fe, Ca, VIT. HIDROSOLUBILE, GR~SIMI Fe, Ca, VIT. HIDROSOLUBILE, GR~SIMI

JEJUNJEJUN

• ZAHARURI ZAHARURI INTESTIN PROXIMAL }I MEDIUINTESTIN PROXIMAL }I MEDIU

• A. ACIZI A. ACIZI INTESTIN MEDIU INTESTIN MEDIU

• VIT BVIT B1212, S~RURI BILIARE , S~RURI BILIARE ILEON DISTAL ILEON DISTAL

PATOGENEZA STEATOREEIPATOGENEZA STEATOREEI

1. DIGESTIE DEFICITAR~1. DIGESTIE DEFICITAR~

2. ALTERAREA FORM~RII MICELIILOR2. ALTERAREA FORM~RII MICELIILOR

3. TRANSPORT ANORMAL:3. TRANSPORT ANORMAL:

a) RED. S. ABSORBTIVE: rezec\ii, fistulea) RED. S. ABSORBTIVE: rezec\ii, fistule

b) ALTERAREA MUCOASEI: sprue, parazi\Ib) ALTERAREA MUCOASEI: sprue, parazi\I

c) DEFICIT DE c) DEFICIT DE LIPOPROTEINELIPOPROTEINE

d) BLOCAJ LIMFATIC:- limfoamed) BLOCAJ LIMFATIC:- limfoame

- meta- meta

- TBC- TBC

STEATOREE

6-14 g > 14g < 6g

ABUNDENT~

DA NU

BILAN| DIAREE

SECRETORIEOSMOTIC~

ECHOABD

ENDOSCOPIE,BIO JEJUN

BILAN| D-XYLOZ~ENTEROSCOPIE

PANCREASBILAN|

NU

PATOLOGIEN

PANCREAS

FIZIOLOGIC

Pierdere acizi gra]i

Pierdere a.a. glucide,

minerale, vitamine

Vit. A Vit. K

Acizi gra]i

Ca2+

Vit. D

osteomalacie

Modific`ri piele

Protrombin` ↓

hemoragie

Electroli\i

Fe

anemie

Diaree

1

Dezhidratare

Ac. folic

Vit. B12

Vit. B6

Vit. B2

Vit. B1

anemie

Pierdere calorii

anemie anemie Glosit`

Polinevrit`

Denutri\ie

Deficit proteic

Insuficien\`

pancreatic`

Hipo-pituitaris

m

Amenoree

Atrofie vilozitar

`

Osteoporoz`

Fracturi

Hipo-serinemi

e

1

1

edem

CLINICACLINICA

1. SIMPTOME SPECIFICE DEFICITELOR 1. SIMPTOME SPECIFICE DEFICITELOR SAU MALABSORB|IEI GENERALESAU MALABSORB|IEI GENERALE

2. SCAUN2. SCAUN

3. DISTENSIE ABDOMINAL~3. DISTENSIE ABDOMINAL~

4. CRAMPE4. CRAMPE

5. GREA|~5. GREA|~

6. ANOREXIE 6. ANOREXIE

DIAGNOSTICDIAGNOSTIC

I. STABILIREA MALABSORB|IEII. STABILIREA MALABSORB|IEI

A) DOZAREA LIPIDELORA) DOZAREA LIPIDELOR

B) CB) CAA = (G = (GDD-G-GFF)/G)/GDD X 100 N>94% X 100 N>94%

C) IZOTOPI IC) IZOTOPI IBIBI

D) PROTEINE MARCATE N<5%D) PROTEINE MARCATE N<5%

E) D XYLOZ~E) D XYLOZ~

DIAGNOSTICDIAGNOSTIC

II. DEFINIREA DEFICITELOR NUTRI|II. DEFINIREA DEFICITELOR NUTRI|IONALEIONALE

III. DG. ETIOLOGIC:III. DG. ETIOLOGIC:1. ANAMNEZA1. ANAMNEZA2. EX. FIZIC2. EX. FIZIC3. TESTE: 3. TESTE:

- Rx: - nespecific- Rx: - nespecific- specific: - fistule- specific: - fistule

- obstruc\ii- obstruc\ii - diverticuli - diverticuli

4. BIOPSIE4. BIOPSIE

ANATOMIE PATOLOGIC~ANATOMIE PATOLOGIC~

1. ENTERIT~ RADIC~: - ACUT1. ENTERIT~ RADIC~: - ACUT

- CRONIC- CRONIC

2. LIMFANGIECTAZIA2. LIMFANGIECTAZIA

3. SCLERODERMIA 3. SCLERODERMIA

4. HIPO 4. HIPO γγGLOBULINEMIAGLOBULINEMIA

5. PARAZI|I5. PARAZI|I

CLASIFICARECLASIFICARE

I. LEZIUNI MUCOASE:I. LEZIUNI MUCOASE:

- SPRUE- SPRUE

- SPRUE TROPICAL- SPRUE TROPICAL

- DERMATITA HERPETIFORM~- DERMATITA HERPETIFORM~

- COLAGENOZE- COLAGENOZE

- HIPO - HIPO γγGLOBULINEMIAGLOBULINEMIA

II. LEZIUNI PARIETALE:II. LEZIUNI PARIETALE:1. CONGENITALE:1. CONGENITALE:

- I. SCURT- I. SCURT- LIMFANGIECTAZIA- LIMFANGIECTAZIA

2. DOB^NDITE:2. DOB^NDITE:- B. CROHN- B. CROHN- LIMFOAME- LIMFOAME- AMILOID- AMILOID- INSUF. ARTERIAL~- INSUF. ARTERIAL~- RxT- RxT

- OBSTRUC|IE LIMFATIC~- OBSTRUC|IE LIMFATIC~

III. INFEC|II:III. INFEC|II:

1. ENTERITE ACUTE1. ENTERITE ACUTE

2. PARAZI|I2. PARAZI|I

3. TBC3. TBC

4. WIPPLE4. WIPPLE

5. STAZA: 5. STAZA:

a) ANATOMICa) ANATOMIC

b) FUNC|IONALb) FUNC|IONAL

IV. L. BIOCHIMICE:IV. L. BIOCHIMICE:

1. ALACTAZIE1. ALACTAZIE

2. A 2. A LIPOPROTEINEMIELIPOPROTEINEMIE

3. AN 3. AN LIPOPROTEINEMIELIPOPROTEINEMIE

4. S. ZOLLINGER4. S. ZOLLINGER

5. MACROAMILAZEMIA5. MACROAMILAZEMIA

V. BOLI EXTRADIGESTIVEV. BOLI EXTRADIGESTIVE

A) ENDOCRINOPATII:A) ENDOCRINOPATII:

- tiroid`- tiroid`

- paratiroid`- paratiroid`

- diabet- diabet

- Addison- Addison

B) TUMORI:B) TUMORI:

- renale- renale

- s. carcinoid- s. carcinoid

SPRUE CELIACSPRUE CELIAC(ENTEROPATIA GLUTEMIC~)(ENTEROPATIA GLUTEMIC~)

BAZ~ GENETIC~:BAZ~ GENETIC~:

1:300 Irlanda1:300 Irlanda

1:2000 alte zone1:2000 alte zone

grup sanguin "O"grup sanguin "O"

femei x 2 Bfemei x 2 B

• FACTORI EXOGENI :FACTORI EXOGENI :

- - GLIADINA - frac\iune solubil` [n GLIADINA - frac\iune solubil` [n

alcool.alcool.

• FACTORI IMUNI:FACTORI IMUNI:

- Ag HLA cl II DQ3- Ag HLA cl II DQ3

- Ac antigliadin`- Ac antigliadin`

- Ac antiendomisium- Ac antiendomisium

- Ac antireticulin` - Ac antireticulin`

ANATOMIE PATOLOGIC~ANATOMIE PATOLOGIC~

1. 1. Alterarea microcitelorAlterarea microcitelor

2. 2. Pierderea vililorPierderea vililor

3. 3. Infiltrat limfocitar [n laminaInfiltrat limfocitar [n lamina

4. 4. Cre]terea nr. mitozeCre]terea nr. mitoze

FIZIOPATOLOGIEFIZIOPATOLOGIE

1. REDUCEREA SUPRAFE|EI ABSORPTIVE1. REDUCEREA SUPRAFE|EI ABSORPTIVE

2. SC~DEREA ENZIMELOR2. SC~DEREA ENZIMELOR

CLINICACLINICA

1. V^RSTA DE DEBUT1. V^RSTA DE DEBUT2. SCAUN2. SCAUN3. MANIFEST~RI GENERALE:3. MANIFEST~RI GENERALE:

- ASTENIE- ASTENIE- INAPETEN|~- INAPETEN|~- SL~BIRE- SL~BIRE

4. G-I: - DIAREE 90%4. G-I: - DIAREE 90% - ABDOMEN DESTINS 75%- ABDOMEN DESTINS 75% - ABDOMEN DUREROS 50%- ABDOMEN DUREROS 50%

5. SECUNDARE MALABSORB|IEI5. SECUNDARE MALABSORB|IEI

MANIFEST~RI SPECIALEMANIFEST~RI SPECIALE

1. 1. MODIFICAREA AMPRENTELORMODIFICAREA AMPRENTELOR

2. 2. FEBR~FEBR~

3. 3. SPLENOMEGALIESPLENOMEGALIE

4. 4. TROMBOCITOPENIETROMBOCITOPENIE

DIAGNOSTIC DIFEREN|IALDIAGNOSTIC DIFEREN|IAL

1. 1. BOLI FUNC|IONALEBOLI FUNC|IONALE

2. 2. S. MALDIGESTIES. MALDIGESTIE

3. 3. S. MALABSORB|IES. MALABSORB|IE

Diagnosticul diferential al Diagnosticul diferential al atrofiei viloaseatrofiei viloase

• GiardiaGiardia• Sprue colagenicSprue colagenic• Enterita radicaEnterita radica• B.WhippleB.Whipple• TuberculozTuberculoz• Gastroenterita eozinofilicaGastroenterita eozinofilica• Limfoame Limfoame • S.Zollinger Ellison S.Zollinger Ellison

DIAGNOSTIC POZITIVDIAGNOSTIC POZITIV

1. 1. AMELIORARE:AMELIORARE:

- CLINIC~: 1-14 zile- CLINIC~: 1-14 zile

- ANAT-PAT: 14-180 zile- ANAT-PAT: 14-180 zile

2. 2. RECIDIV~RECIDIV~

COMPLICA|IICOMPLICA|II

1. LIMFOAME1. LIMFOAME

2. CANCERE:2. CANCERE:

ESOFAGESOFAG

OROFARINGEOROFARINGE

S^NS^N

TRATMENTTRATMENT

• Sunt interzise graul,orzul,secaraSunt interzise graul,orzul,secara

• Sunt permise orezul porumbul sorgul Sunt permise orezul porumbul sorgul ovazulovazul

• Surse de amidon care pot fi folosite Surse de amidon care pot fi folosite hrisca,mei,arorut,cartof,tapiocahrisca,mei,arorut,cartof,tapioca

• Nuci,alune,floarea soareluiNuci,alune,floarea soarelui

Green P and Cellier C. N Engl J Med 2007;357:1731-1743

An Assessment Plan for a Patient with Poorly Responsive Celiac Disease

DEFICITUL DE DEFICITUL DE DIZAHARIDAZEDIZAHARIDAZE

• AMIDON - amilopectineAMIDON - amilopectine• GLICOGEN - amilazaGLICOGEN - amilaza

AMILAZA 1,4: AMILAZA 1,4: MALTOZ~ MALTOZ~ MALTOTRIOZ~ MALTOTRIOZ~

DIZAHARIDAZEDIZAHARIDAZE

• MALTAZ~MALTAZ~

• SUCRAZ~SUCRAZ~

• LACTAZ~LACTAZ~

DEXTRINAZ~DEXTRINAZ~

DISTRIBU|IADISTRIBU|IA

• {N TIMP (L III){N TIMP (L III)

• ANATOMIC~ANATOMIC~

DEFICITDEFICIT

1. PRIMAR1. PRIMAR

2. SECUNDAR:2. SECUNDAR:

a) aport excesiva) aport excesiv

b) rezec\iib) rezec\ii

c) b. intestinal`c) b. intestinal`

FIZIOPATOLOGIEFIZIOPATOLOGIE

DEFICIT LACTAZ~DEFICIT LACTAZ~

HIDROLIZ~ DEFICITAR~HIDROLIZ~ DEFICITAR~

CRE}TE PO-crampe-diaree-grea\`

FERMENTA|IE

AC. ORGANICI

DIAREE

DIAGNOSTICDIAGNOSTIC

1. 1. CLINICCLINIC

2. 2. BIOLOGICBIOLOGIC

3. 3. HISTOCHIMICHISTOCHIMIC

4. 4. COPROLOGICCOPROLOGIC

5. 5. RxRx

6. 6. RESPIRATORRESPIRATOR

BOALA WHIPPLEBOALA WHIPPLE

• Boala rara , proteiforma caracterizata Boala rara , proteiforma caracterizata prin diaree, slabire artralgii.prin diaree, slabire artralgii.

• Trophi =hranaTrophi =hrana• eryma = barieraeryma = bariera• whippleiwhipplei

GERMENELEGERMENELE

• Se transmite fecal- oralSe transmite fecal- oral• Se cultiva pe celule sau mediu cu Se cultiva pe celule sau mediu cu

amino-aciziamino-acizi• Are And de< 1 megabazaAre And de< 1 megabaza• Se recunosc 2 speciiSe recunosc 2 specii

ANATOMIE PATOLOGICAANATOMIE PATOLOGICA

PatogeniePatogenie

• HLA-B 27 / imunosupresieHLA-B 27 / imunosupresie• Invadeaza macrofagele care sufera Invadeaza macrofagele care sufera

apoptoza , permitand diseminareaapoptoza , permitand diseminarea

EVOLUTIE STADIALAEVOLUTIE STADIALA

• PRODROMAL - ARTRITEPRODROMAL - ARTRITE

- artralgii- artralgii• STARE DUPA 6 ANI - BARBATI 90%STARE DUPA 6 ANI - BARBATI 90%

- SLABIRE 93%- SLABIRE 93%

- DIAREE 80% - DIAREE 80% - ARTRITE 70% - ARTRITE 70%

- ADENOPATII 40%- ADENOPATII 40%

- MELANODERMIE 50% - MELANODERMIE 50%

DiagnosticDiagnostic

Anemie,leucocitoza±eozinofilie,trombopenieAnemie,leucocitoza±eozinofilie,trombopenieReactanti de faza acutaReactanti de faza acutaMucoasa duodenala Mucoasa duodenala

galbena,mitoasa/eritematoasa,eroziuni,frigalbena,mitoasa/eritematoasa,eroziuni,fri abilaabilaColoratia PASColoratia PASAspect trilamelar al peretelui microbianAspect trilamelar al peretelui microbianColorare imunochimicaColorare imunochimica

TRATAMENTTRATAMENT

• TetraciclinaTetraciclina• Sulfamethoxazol-trimetoprim Sulfamethoxazol-trimetoprim

800/160800/16022• Streptomicina 1g/zi+ penicilina 1,6 Streptomicina 1g/zi+ penicilina 1,6

milU/zimilU/zi

+ ceftriaxon + ceftriaxon 2g/zi2g/zi

Fenollar F et al. N Engl J Med 2007;356:55-66

Initial Treatment and Subsequent Relapse in Whipple's Disease

GASTROENTEROPATIA GASTROENTEROPATIA EXUDATIV~EXUDATIV~

• DEFINI|IE:DEFINI|IE: Sindrom caracterizat prin Sindrom caracterizat prin

pierderi anormale de proteine.pierderi anormale de proteine.

• CLINIC:CLINIC: DIAREE + EDEME + DURERI DIAREE + EDEME + DURERI

• BIOLOGIC:BIOLOGIC:

- clearance - clearance 11AT > 12mg/24 oreAT > 12mg/24 ore

- albumin` marcat` (Tc, Cr)- albumin` marcat` (Tc, Cr)

ETIOLOGIEETIOLOGIEI. CAUZE CE CRESC PRESIUNEA INTERSTI|I. CAUZE CE CRESC PRESIUNEA INTERSTI|

IAL~IAL~

1. Limfangiectazia congenital`1. Limfangiectazia congenital`2. Obstruc\ia mezenteric`:2. Obstruc\ia mezenteric`:

a) TBCa) TBCb) sarcoidoz`b) sarcoidoz`c) limfoamec) limfoamed) fibroz` retroperitoneal`d) fibroz` retroperitoneal`

3. Cre]terea PVC:3. Cre]terea PVC:a) pericardit` constrictiv`a) pericardit` constrictiv`b) insuficien\` cardiac`b) insuficien\` cardiac`

II. BOLI CU ULCERA|II:II. BOLI CU ULCERA|II:

a) a) gastrite sau enterite erozivegastrite sau enterite erozive

b) b) neoplaziineoplazii

c) c) b. Crohnb. Crohn

II. BOLI F~R~ ULCERA|II:II. BOLI F~R~ ULCERA|II:

a) a) MenetrierMenetrier

b) b) WhippleWhipple

c) c) alergicealergice

d) d) gastroenterite eozinofilegastroenterite eozinofile

e) e) spruesprue

f) f) SLESLE