ESOFAGITE.ppt

7/25/2019 ESOFAGITE.ppt

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ESOFAGITEESOFAGITE


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Defni\ie:Defni\ie:

Infama\ia uneia sau tuturor tunicilorInfama\ia uneia sau tuturor tunicilorproprii esoagului.proprii esoagului.

Clasifcare clinic`Clasifcare clinic` (`r` delimitare de(`r` delimitare detimp):timp):

- acute- acute

- cronice- cronice


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Clasicare etiologic`Clasicare etiologic`

MicrobieneMicrobiene iraleirale MicoticeMicotice

C!imiceC!imice "i#ice"i#ice MedicamentoaseMedicamentoase

$ecundare tulbur`rilor de motilitate$ecundare tulbur`rilor de motilitate- %&'- %&'

- ac!ala#ie- ac!ala#ie


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atogene#aatogene#a

- ContinuitateContinuitate

- ContiguitateContiguitate

- *ematologie*ematologie

- ImunodepresieImunodepresie


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ClinicaClinica

+simptomatic`+simptomatic`

isagieisagie

&dinoagie&dinoagie


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DiagnosticDiagnostic

EndoscopieEndoscopie

, e. bacteriologic, e. bacteriologic

, e. micologic, e. micologic, e. !istologic, e. !istologic

EchoendoscopieEchoendoscopie


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/0I012I/0I012I


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I. C+/I+ +34IC+/$I. C+/I+ +34IC+/$

Component normal al forei bucale.Component normal al forei bucale. +ntibiotice+ntibiotice Corticosteroi#iCorticosteroi#i

0ratament antiacid0ratament antiacidiabetiabet +lcolism+lcolism

'adioterapie'adioterapie0ulbur`ri de motilitate0ulbur`ri de motilitate*I C5 6 7889mmc*I C5 6 7889mmc


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ndoscopiendoscopie

l`ci mici albe9g`lbuil`ci mici albe9g`lbui

l`ci groase acoperind esoagull`ci groase acoperind esoagul

;lcera\ii;lcera\ii

Mase conopidiormeMase conopidiorme


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Diagnostic dieren\ial Diagnostic dieren\ial

coloniare!inec\ie princoloniare!inec\ie princitologie!histologiecitologie!histologie


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0ratament0ratament


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II. *'$ $IM3>II. *'$ $IM3>

Trata"ent:Trata"ent:

+ciclo?ir @88 mg+ciclo?ir @88 mg


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Urbano F and Nguyen M. N Engl J Med 1999;340:1254

A 47-year-old o!an "#$ a $"%#ory o& $y'er#en%"on and al(o$ol abu%e $ad $ad &a#"gue) nau%ea)*o!"#"ng) and abdo!"nal 'a"n &or #o day%


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+$an + and +$"u ,. N Engl J Med 2007;357:e13

A 75-year-old o!an "#$ !ore #$an a 10-year $"%#ory o& $y'er#en%"on and d"abe#e% !ell"#u%re'or#ed a 3-day $"%#ory o& #$roa# d"%(o!&or# and $"#e eru'#"on% on #$e #ongue


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III. CMIII. CM

Trata"entTrata"ent::

%anciclo?ir%anciclo?ir


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"lby J and "ng$ . N Engl J Med 2000;342:475

A 4/-year-old !an "n&e(#ed "#$ #$e $u!an "!!unode&"("en(y *"ru% $ad $ad re(urren# 'a"n&ulul(er% "n $"% !ou#$ and e%o'$agu% &or %e*eral year%


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I. $&"+%I0+ I. $&"+%I0+ '"3;>'"3;>

atogene#a esoagitei:atogene#a esoagitei:de#ec!ilibrude#ec!ilibru

agresiune9ap`rareagresiune9ap`rare


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#$ Agresi%ne#$ Agresi%ne

clorhidropeptic`clorhidropeptic`a) 0impul de epunerea) 0impul de epunereb) Momentul epunerii:b) Momentul epunerii:

- diurn- diurn- nocturn- nocturn

- postprandial- postprandial

c) +c\iune acilitat` -c) +c\iune acilitat` -!iperosmolalitatea alimentelor!iperosmolalitatea alimentelor


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&$ 'eisten\a "%coasei&$ 'eisten\a "%coasei

a(a( Strat%l para)eratiniantStrat%l para)eratiniant

*(*( Strat%l "edi%Strat%l "edi% - #ona ocludens- #ona ocludens

- +0-a#a /a9*- +0-a#a /a9*

c( Strat%l *aalc( Strat%l *aal


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A+ATO,IE -ATO.OGIC/A+ATO,IE -ATO.OGIC/

+lungirea papilelor+lungirea papilelor

;lcera\ii;lcera\ii

asodilata\ieasodilata\ie Inltrat infamator mononuclearInltrat infamator mononuclear

3e#area glandelor3e#area glandelor

Metapla#ie columnar` 4+''00Metapla#ie columnar` 4+''00Maligni#are =8AMaligni#are =8A


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Diagnostic%l endoscopic:Diagnostic%l endoscopic:

Clasifcarea .os AngelesClasifcarea .os Angeles+ B =-n ulcera\ii 6 mm+ B =-n ulcera\ii 6 mm4 B =-n ulcera\ii D mm 6 7A din4 B =-n ulcera\ii D mm 6 7A din

circumerin\`circumerin\`

C B EAC B EA

B circumeren\ial` B circumeren\ial`

Conceptul M;$Conceptul M;$


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DiagnosticDiagnostic

emonstrarea refuuluiemonstrarea refuului

0estul peru#iei acide0estul peru#iei acide

ManometrieManometrie

p*-metriep*-metrie

'adioi#otopic`'adioi#otopic`

?iden\ierea esoagitei?iden\ierea esoagitei


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Trata"entTrata"ent

#$ SC0I,1A'EA STI.2.2I DE 3IA4/#$ SC0I,1A'EA STI.2.2I DE 3IA4/&$ ,EDICA4IE:&$ ,EDICA4IE:

a) +ntisecretoriia) +ntisecretorii

b) roFineticeb) roFinetice c) +ntirefuatc) +ntirefuat

5$ E+DOSCO-IE:5$ E+DOSCO-IE:

a) 0ermoabla\iaa) 0ermoabla\ia

b) "otoabla\iab) "otoabla\ia

c) InGectarea sncteruluic) InGectarea sncterului

6$ C0I'2'GIE6$ C0I'2'GIE


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. $&"+%I0. $&"+%I0

MIC+M/0&+$MIC+M/0&+$$e eclud:$e eclud:

$cleroterapia$cleroterapia

'adioterapia'adioterapia

CausticeleCausticele

rogurile ce aectea#` $Irogurile ce aectea#` $I


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.OCA.I7A'E.OCA.I7A'EB de elec\ie =9H medieB de elec\ie =9H medie

soagita suspendat`soagita suspendat` BB 78A =9H inerioar`78A =9H inerioar` FI7IO-ATO.OGIE!TI,- DE T'A+7IT:FI7IO-ATO.OGIE!TI,- DE T'A+7IT:

- M`rimeM`rime- "orm`"orm`- "orma galenic`"orma galenic`- o#i\iao#i\ia

- +p`+p`- 0ulbur`rii motorii0ulbur`rii motorii- Compresii etrinseciCompresii etrinseci


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To8icitatea direct`To8icitatea direct`

p*-ul de disolu\iep*-ul de disolu\ie

ite#a de solubili#areite#a de solubili#are

+cumularea n celule+cumularea n celule

asoconstric\ie (


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E9ol%\ieE9ol%\ieB cicatri#are H-JB cicatri#are H-J

s`pt`mKnis`pt`mKni

Co"plica\iiCo"plica\iiB steno#eB steno#e

Trata"ent:Trata"ent:- oprirea drogului- oprirea drogului

- sucralat antiacide- sucralat antiacide

- dilatare- dilatare

- c!irurgie- c!irurgie


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I. $&"+%I0 C+;$0ICI. $&"+%I0 C+;$0IC

S%*stan\e ce s%nt capa*ile s` distr%g`S%*stan\e ce s%nt capa*ile s` distr%g`\es%t%rile la ni9el%l loc%l%i de aplicare\es%t%rile la ni9el%l loc%l%i de aplicare

3rste:3rste:7-E ani958-57-E ani958-5

Istoria nat%ral`:Istoria nat%ral`:- natura produsului- natura produsului

- concentra\ie- concentra\ie

- cantitate- cantitate- durata contactului- durata contactului


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Anato"ie patologic`Anato"ie patologic`

A$A$ Ini\ialIni\ialB ragilitate !iperemieB ragilitate !iperemieulcera\iiulcera\ii

1$1$ Faa de deter;are:Faa de deter;are:B 0rombo#e ?asculare0rombo#e ?asculare

B demdem

B ;lcera\ii cu alse membrane;lcera\ii cu alse membrane


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C$ Faa de reparare:C$ Faa de reparare:- apare sclero#a- apare sclero#a

- posibil perora\ii stule- posibil perora\ii stule

D$ Faa de cicatriare:D$ Faa de cicatriare:

- sclero#a B steno#`9aderen\`- sclero#a B steno#`9aderen\`


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Si"pto"eSi"pto"e

ureri oroaringieneureri oroaringiene

urerei retrosternaleurerei retrosternale

ureri epigastriceureri epigastrice *ipersali?a\ie*ipersali?a\ie

`rs`turi`rs`turi

*..$*..$ $emne de perora\ie$emne de perora\ie


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;rgen\` medical`;rgen\` medical`

o#i\ia se#Knd`o#i\ia se#Knd`

+bstinen\a alimentar`+bstinen\a alimentar`

+ntiemetice+ntiemetice Cur`\area ca?it`\ii bucaleCur`\area ca?it`\ii bucale

3inie ?enoas`3inie ?enoas`

&igen&igen


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iagnosticiagnostic Endoscopie Endoscopie

GradGrad EndoscopicEndoscopic ExtindereExtindereleziunileziuni

00 Fara leziuniFara leziuni

II EritemEritem

IIaIIa PseudomembranaPseudomembrana

IIbIIb Ulceratie &/Ulceratie &/

necrozanecrozaIIIaIIIa PseudomembranaPseudomembrana CircumferentialCircumferential

IIIbIIIb Ulceratie &/Ulceratie &/

necrozanecroza

CircumferentialCircumferential


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Trata"ent :Trata"ent :

'epaus digesti?'epaus digesti?

+spirarea substan\ei+spirarea substan\ei

+ntibioterapie+ntibioterapie

/utri\ie parenteral`/utri\ie parenteral`

C!irurgie-perora\iiC!irurgie-perora\ii


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