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Urgente Medico Chirurgicale Digestiv

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    URGENE MEDICO-CHIRURGICALE

    URGENE ALE APARATULUIDIGESTIV

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    GREAA

    Cea mai frecvent manifetare !i"etiv #nt$%nit #n ca&inet'%t(mat(%("ic ) "enerat !e manevre%e efect'ate #n cavitatea (ra%*

    Mecanim'% a+ari iei ete c(m+%e, ) r(%'% ma(r #% are an,ietatea

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    Atit'!inea !e 'r"en #n ca&inet'% t(mat(%("ic

    .ntrer'+erea tratament'%'i Se va %ini/ti +acient'% Se a!minitrea0 'n e!ativ-an,i(%itic c' a&(r& ie ra+i! -

    mi!a0(%am1 D(rmic'm23 (%' ie 4 m"5m%3 '&%in"'a% Se va re%'a tratament'% !'+a a+ari ia e! rii* Dac fen(men'% e re+et +acient'% va fi re+r("ramat /i e!at

    #naintea #nce+erii tratament'%'i t(mat(%("ic1 mi!a0(%am c+* 634 m"+er ( c' ( (ra #nainte a' (%* 4m"5m% im* a' '&%in"'a%

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    DUREREA A7DOMINAL8A7DOMENUL ACUT

    Abdomen acut9 Sin!r(m c%inic +%'rieti(%("ic ce are ca e%ement+rinci+a% !'rerea a&!(mina% c' !e&'t ac't 1ma, !e 6: !e (re2

    ;n +ete !in ca0'ri a&!(men'% ac't ete c?ir'r"ica%* ;n %i+atratament'%'i me!ica% ev(%'@ia ete ra+i! c' a+ari@ia !ec(m+%ica@ii 1+erit(nita ac't %(ca%i0at 5 "enera%i0at3 (c%'0ieintetina%2 (+era@ie !e 'r"en@*

    4=> neceit internare B=> neceit tratament c?ir'r"ica% => !ia"n(tic "re/it => m(rta%itate

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    Mecanim'% !e +r(!'cere9 D'rerea a&!(mina% +arieta%1(matic29

    A+are %a nive%'% +erete%'i a&!(mina%3 +erit(ne' +arieta%3r!cina me0enter'%'i3 !iafra"m'%'i* Arc ref%e, c' ca%ea en0itiv T ) L D'rere &ine %(ca%i0at3 inten3 e,acer&at !e re+ira@ie3 t'e3

    mi/care

    D'rerea vicera%9 A+are %a nive%'% 'n'i (r"an a&!(mina% !eterminat !e 'n

    +r(ce inf%amat(r3 ic?emie3 ne(+%a0ii3 !itenie &r'c3+ame a%e m'c'%at'rii nete!e

    D'rere c' t(+("rafie im+reci i c' emne !e irita@ie

    +erit(nea%

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    S'nt ca'0e ma(re !e a&!(men ac't c?ir'r"ica%9

    A+en!icita ac't Pancreatita ac't 7(a%a '%cer(a c' +erf(ra@ie C(%ecitita ac't

    Oc%'0ia intetina% Diec ia !e a(rt

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    ;n =>!in ca0'ri a&!(men'% ac't ete !at(rat ca'0e%(rme!ica%e9

    !i"etive9 c(%(n irita&i% rect(c(%ita '%cer(?em(ra"ic - +'e' ac't !ivertic'%ita Mece% !itenia ?e+atic !e ca'0 ?em(!inamic 1in'ficien@a car!iac2

    rena%e9 c(%ici ren('retera%e +ie%(nefrita ac't

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    ne'r(%("ice9 ta&e ?er+e 0(ter

    vac'%are9 infarcte me0enterice em&(%ii rena%e em&(%ii +%enice anevrim !e A( a&!(mina%

    meta&(%ice9 cet(aci!(0a !ia&etic 'remia +(rfiria ac't intermitent

    in'ficin@a c(rtic('+rarena%ian ac't

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    afec@i'ni e,traa&!(mina%e ce !etermin !'reri a&!(mina%e9

    infarct'% mi(car!ic +ne'm(nia +%e're0ia +ericar!ita

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    C%inic9 Anamne0a9

    M(ment'% a+ari@iei !'rerii ) !'rata M(!'% !e inta%are Ev(%'@ia !'rerii 1 +r("reiv #n (c%'0ia intetina%3 c(%icativ3

    c(ntin' #n +ancreatite2 Ce a"ravea0 !'rerea C'm e aten'ea0 !'rerea P'nct'%3 0(na !e !e&'t Ira!ierea !'rerii Fen(mene !e #n(@ire9 "rea@3 vrt'ri3 tran0it'% intetina%3

    !i'rie3 +(%ai'rie

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    Semne "enera%e9 7(%nav a"itat #n c(%ic 7(%nav im(&i% /i ta?i+neic #n +erit(nite Fe&r #n infec@ii Stare !e /(c /i +a%(are #n r'+t'ri !e (r"an 1+%in3 A(3 arcin

    ect(+ic2 R'+t'ra !e A( a&!(mina% mete(rim a&!(mina%3 maa

    +ara(m&i%ica% t$n" +'%ati% 'f%'3 /(c3 n' e,it emne

    !e irita@ie +erit(nea%

    E,amen'% a&!(mn'%'i9 In+ec@ie !itenie a&!(mina% 1(c%'0ie23 cicatrici

    +(t(+erat(rii3 ec?im(0e 1+ancreatita ac't23 (rificii !e ?erniere Pa%+are 0(ne eni&i%e3 f(rma@i'ni a&!(mina%e +a%+a&i%e3

    emne !e irita@ie +erit(nea% 17%'m&er"3 c(ntract'ra&!(mina%2

    A'c'%ta@ie 'f%'ri

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    APENDICITA ACUT8

    Definiie9 infectarea c(n@in't'%'i a+en!ic'%ar !at(rit &%(crii%'men'%'i c' 'n feca%(m 1a' #n ca0'ri mai rare +rina!en(+atie3 %imfan"it2 'rmat !e +erf(ra@ie a+en!ic'%ar /iinf%am@ie +erit(nea%

    Inciden9a+are %a (rice v$rt3 mai a%e %a tineri

    Debut9 &r'c3 !e J?3 mai ini!i( %a &tr$niEx. clinic9 !'rere e+i"atric /i +eri(m&i%ica% care mi"rea0 #nf(a i%iac !rea+t3 fe&r3 "rea@3 vrt'ri3 m(!ificri !e tran0it1!iaree a' c(nti+a@ie23 irita@ie +erit(nea% %(ca%i0at #n f%anc'%!re+t

    Investigaii9 %e'c(cit(03 VSH 3 Ec("rafie a&!(mina%3 CTTratament9 c?ir'r"ica%Evoluie:m(rta%itate mare %a &trni

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    PERFORA IA DE ORGANE

    Perf(ra@ii%e (r"ane%(r cavitare a&!(mina%e a' a%e (r"ane%(r a&!(mina%e

    !evenite cavitare +rin tranf(rmare +at(%("ic 'nt 'rmate !e irita@ie+erit(nea% 1%a ince+'t c?imic2 /i a+(i e+tic3 care "enerea0 'n in!r(m!e +erit(nit ac't 1!e a&!(men ac't2*

    Fact(rii eti(%("iciFact(rii eti(%("ici** U%cer'% "atric /i !'(!ena% 1+erf(ra@ie "atr(!'(!ena%2U%cer'% "atric /i !'(!ena% 1+erf(ra@ie "atr(!'(!ena%2:* A+en!icita "an"ren(a 1+erf(ra@ia a+en!ic'%ar2:* A+en!icita "an"ren(a 1+erf(ra@ia a+en!ic'%ar2B*B* Perf(ra@ii intetina%ePerf(ra@ii intetina%e - &(a%a Cr(?n- &(a%a Cr(?n - ne(+%ame !e +erete intetina%- ne(+%ame !e +erete intetina% - infarct me0enteric avanat- infarct me0enteric avanat - (c%'0ii intetina%e- (c%'0ii intetina%e - in"etia !e c(r+i trini 1ace3 (ae etc*2 +(ate !'c %a- in"etia !e c(r+i trini 1ace3 (ae etc*2 +(ate !'c %a

    +erf(ra@ia intetin'%'i '&@ire /i a c(%(n'%'i+erf(ra@ia intetin'%'i '&@ire /i a c(%(n'%'i - ne(+%ame !e c(%(n- ne(+%ame !e c(%(n - rect(c(%it '%cer(necr(tic- rect(c(%it '%cer(necr(tic

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    * C(%ecitit ac't %itia0ic /i ne%itia0ic 4* Sarcina ect(+ic - +i(a%+in, r'+t

    - c?it (varian r'+t3 - +erf(ra@ia tr(m+ei 'terineTa&%(' c%inic

    Durere abdominal - vi(%ent3 &r'ta%3 c' e!i'% /i ira!ierea #n f'nc@ie!e (r"an'% +erf(rat*

    a2 '%cer'% "atric /i !'(!ena% +erf(rat 9

    e!i'% !'rerii ini@ia% e+i"atric3 ira!iere !(ra%3 intenitate!e(e&it3 +$n %a tarea !e /(c !'rerea3 Kca ( %(vit'r !e +'mna%3 'rmat !e Ka&!(men !e

    %emn1ri"i!itatea a&!(mina% n' a+are #n nici ( a%t afec@i'ne at$t!e &r'c /i at$t !e inten2*

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    &2 a+en!icita ac't +erf(rat 9 !'rerea ete im@it !e &(%nav ini@ia% #n f(a i%iac !rea+t 1e

    "enera%i0ea0 mai t$r0i'2

    c2 +erf(ra@ia intetin'%'i '&@ire /i a c(%(n'%'i 9

    e!i'% !'rerii ete ',ta+'&ian 1#n a+r(+ierea re"i'nii +'&iene2

    !2 +erf(ra@ia ve0ic'%ei &i%iare 9 !'rerea ete ini@ia% #n ?i+(c(n!r'% !re+t c$n! +r(ce'% inf%amat(r !etermin +erf(ra@iave0ic'%ei &i%iare3 intenitatea !'rerii !in ?i+(c(n!r'%

    e2arcin ect(+ic3 +i(a%+in, r'+t3 c?it (varian r'+t9 !'rereaa&!(mina%3 %(ca%i0at #n a&!(men'% inferi(r 1+e f%anc'ri23 e"enera%i0ea0 +e m'r ce +erit(ne'% ete inva!at !e $n"e1?em(+erit(ne' #n arcina ect(+ic r'+t3 c(r+ "a%&en r'+t3 c?it

    (varian r'+t2 a' !e +'r(i #n ca0 !e +i(a%+in, r'+t*

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    Contractur abdominal

    Ia in+ec@ie9 a&!(men retractat /i im(&i% a' c' m(&i%itate re!' %ami/cri%e re+irat(rii

    %a +a%+are9 ri"i!itate m'c'%ar "enera%i0at Ka&!(men !e %emnVrsturi

    !rirea tran"itului intetina% +entr' feca%e /i "a0e 1'ne(ri e,it!iaree2 #n r'+t'ra !e ane,e3 n' ete '+rimat tran0it'%

    #i!ersensibilitatea abdominal e +'ne #n evi!en@ +rin !'rere %a

    !ec(m+rei'nea &r'c a +erete%'i a&!(mina%3 !'+ ( a+are +r("reiv a acet'ia 1emn'% 7%'m&er"2*Dis!ariia reflexelor c'tanate a&!(mina%e

    Dis!ariia matitii $e!atice 1n'mai c$n! e,it +ne'm(+erit(ne'2 e+'ne #n evi!en@ +rin +erc'@ie 1mai i"'r /i mai evi!en@ia&i% +rine,amen ra!i(%("ic2 #n +erf(ra@ia ve0ic'%ei &i%iare n' a+are+ne'm(+erit(ne'

    #i!ereste"ia cutanat 1!'rerea +ie%ii %a cea mai mic atin"ere2

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    %emne generale 1#n +erit(nita avanat2 9 facie caracteritic 1'ferin!23 facie +erit(nea%9 +a%(are3 cearcne3

    (c?i #nf'n!a@i #n (r&ite3 c' '&@ierea ari+i%(r na'%'i3 #n+im$ntat3

    tran+irat re+ira@ii c'rte3 ra+i!e /i '+erficia%e ta?icar!ie ?i+(teni'ne arteria%*

    C(n!'ita !e 'r"en@ Perf(ra@ii%e !e (r"ane c(ntit'ie ( 'r"en@ c?ir'r"ica% a&(%'t*

    Orice &(%nav care manifet emne%e 'nei irita@ii +erit(nea%etre&'ie tran+(rtat ime!iatctre 'n ervici' !e c?ir'r"ie*

    P$n #n m(ment'% in care e +(ate face tran+(rt'% &(%nav'% va fi9 - a/e0at #n re+a' a&(%'t3 %a +at3 - !ac ete +(i&i% e va +'ne ( +'n" c' "?ea@ +e

    a&!(men

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    Atenie &&&&

    e inter0ice (rice a%imenta@ie3 inc%'iv a+a e inter0ice a!minitrarea !e +'r"ative a' a!minitrarea !e

    c%ime

    n' e a!minitrea0 ana%"etice ma(re3 !e(arece +rin efect'%acet(ra e mac?ea0 emne%e !e +erit(nit3 #n"re'n$n!!ia"n(tic'% /i in!ica@ia tera+e'tic

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    PANCREATITA ACUT8

    Definiie9 +ancreatita ac't ete ( afec@i'ne caracteri0at anat(m(-

    +at(%("ic3 +rin inf%ama@ie e!emat(a 1+ancreatita ac't e!emat(a23?em(ra"ic 1+ancreatita ?em(ra"ic23 necr(tic a'necr(tic(?em(ra"ic*

    Inciden9 a+are %a a%c((%ici /i %a cei c' %itia0 &i%iar De&'t9re%ativ &r'c ) 0i%e

    Tablou clinic:a' D'rerea a&!(mina%

    - %(ca%i0are #n eta'% a&!(mina% '+eri(r K#n &ar - ira!iere #n +ate /i mai rar #n 'meri3 im'%$n! '%cer'% +erf(rat - ete c(ntin'3 !e intenitate mare

    - 'ne(ri &(%nav'% ia +(0i@ii anta%"ice 1f%e,i'nea tr'nc?i'%'i3ante&ra@e%e +e a&!(men a+$n! re"i'nea !'rer(a2

    b' Vrsturi - a%imentare3 &i%i(ae a' ?em(ra"ice -

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    (eteorism

    Tulburri de tran"it 1c(nti+a@ie a' i%e' !inamic2

    %tare de )oc#n f(rme%e "rave 1+a%(are3 +'% mic /i ra+i!3 teni'nearteria% c0't3 tran+ira@ii3 e,tremit@i reci3 an,ietate3 ta?i+nee2*

    Ex. clinic9- emne%e %(ca%e 'nt race

    - 'ne(ri ( '/(ar a+rare e+i"atric - +e a&!(men a+ar #n 'ne%e ca0'ri +ete cian(tice 1#n f(rme%e

    necr(tice2*E,* +arac%inic9 ami%a0e erice /i 'rinare 1!e trei (ri n(rma%'%23 %i+a0a

    1ete cea mai +ecific23 %e'c(cit(0a3 ?em(c(ncentra@ie3

    ?i+er"%icemie3 ?i+er%i+emie3 ec?("rafia a&!(mina%3 CTTratament9 c(nervat(r #n f(rma e!emat(a3 c?ir'r"ica% #n f(rmanecr(tic /i #n ce%e c(m+%icateEvoluie9 fav(ra&i% #n f(rma e!emat(a :=> m(rta%itate #n f(rma

    necr(tic

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    OCLUIA INTESTINAL8

    Defini@ie9 Prin (c%'0ie intetina% e #n@e%e"e (+rirea c(m+%et /i

    +eritent a tran0it'%'i intetina% /i #n c(necin@3 im+(i&i%itateaevac'rii !e materii feca%e /i "a0e*

    O+rirea tran0it'%'i +(ate fi +r(v(cat !e 'n (&tac(% mecanic a'!e 'n (&tac(% !inamic*

    ;n f'nc@ie !e acete +(i&i%it@i !e +r(!'cere3 (c%'0ia a f(tc%aificat #n !(' ti+'ri9

    clu"ie mecanicclu"ie mecanic (+rirea tran0it'%'i +(ate fi +r(v(cat !e 'n(&tac(% mecanic3 it'at (ri'n!e #n %'n"'% intetin'%'i '&@ire a'a% intetin'%'i "r(*

    clu"ie dinamicclu"ie dinamic 1f'nc@i(na%2 (+rirea tran0it'%'i ete !at(rat'nei t'%&'rri f'nc@i(na%e a m(ti%it@ii intetina%e fie +rine,a"erarea c(ntrac@iei m'c'%at'rii +erete%'i intetina%3 fie +rin+are0a a' +ara%i0ia aceteia*

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    Ca'0e%e (c%'0iei intetina%e9Oc%'0ia intetina% mecanic +(ate 'rvin fie +rin (&tr'c@ie3 fie

    +rin tran"'%are

    Tumori ma%i"ne a' &eni"ne 1+re0ente #n interi(r'% intetin'%'i a'#n afara tract'%'i intetina%3 care c(m+rim ane%e2

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    Invaginaie intestinal3 ca'0 frecvent !e (c%'0ie intetina% %ac(+ii f(arte mici3 'rvine +rin int'&area 1te%ec(+area2 'nei+(r@i'ni !e intetin #n a%t'%3 ca 'n !e"et !e mn'/

    Cor! strin - "?em !e acari0i3 feca%(ame3 ca%c'%i &i%iari* %teno"e - inf%amat(rii #n +r(cee t'&erc'%(ae3 care #n ta!i'% !e

    cicatri0are retractea0 +ere@ii3 ten(0$n! %'men'% intetina% a'ten(0e cicatricea%e +(ttra'matice a' +(t(+erat(rii

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    V(%v'%' 1t(ri'ne23 r'cirea anei intetina%e #n 'r'% a,'%'i 'V(%v'%' 1t(ri'ne23 r'cirea anei intetina%e #n 'r'% a,'%'i 'me0enteric a' #n 'r'% 'nei &ri!eme0enteric a' #n 'r'% 'nei &ri!e

    *rid*rid-- &ri!&ri!!e ne(f(rma@ie3 'rmare a 'n'i +r(ce inf%amat(r!e ne(f(rma@ie3 'rmare a 'n'i +r(ce inf%amat(r

    a+r't !'+ interven@ii c?ir'r"ica%e a' !'+ +erit(nite /i carea+r't !'+ interven@ii c?ir'r"ica%e a' !'+ +erit(nite /i carec(m+rim intetin'%c(m+rim intetin'%

    ;n (c%'0ii%e +rin tran"'%are 1v(%v'%'3 &ri!e3 ?ernii3 inva"ina@ii2 eteintereat /i circ'%a@ia me0enteric3 atfe% c3 #n afar !e (&tr'c@ie3

    e !e0v(%t /i 'n +r(ce !e ic?emie a +erete%'i intetina%3 care!'ce Ia !evita%i0area anei intetina%e3 Ia necr(0a /i +erf(ra@iaaceteia*

    De aceea3 (c%'0ii%e +rin tran"'%are 'nt mai "rave ca ce%e +rin(&tr'c@ie*

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    Cau"ele oclu"iei intestinale dinamice9

    Oc%'0ia intetina% dinamic 'rvine fie +rin +ara%i0ia m'c'%at'rii

    intetin'%'i3 fie +rin +am'% aceteia* Stim'%ii nerv(/i care!etermin (c%'0ia f'nc@i(na% +(t fi !ec%an/a@i !e 9

    Afec@i'ni a&!(mina%e9 - inf%ama@ii a%e m'c(aei3 m'c'%(aei a' er(aei intetin'%'i

    - +erit(nite "enera%i0ate a' %(ca%i0ate - ?em(+erit(ne' - +ancreatit ac't - ?em(ra"ii !i"etive3 - infarct me0enteric

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    Afec@i'ni a%e item'%'i nerv(9 - tra'matime craniene - tra'matime me!'%are - &(%i ne'r(+i?ice Int(,ica@ii9 - 'remie3

    - int(,ica@ii +r(fei(na%e - t(,ic(manii* A%te &(%i9 - t(racice 1tra'matime3 em&(%ii +'%m(nare3 infarct mi(car!ic2 - &(%i a%e (r"ane%(r retr(+erit(nea%e 1c(%ica nefretic3 t'm(ri

    retr(+erit(nea%e3 ?emat(m retr(+erit(nea%23 - &(%i a%e a+arat'%'i "enita%*

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    Ta&%(' c%inic9

    a2 D'rerea a&!(mina%- a+are &r'c - ete %(ca%i0at ini@ia% %a %(c'% %e0i'nii3 #n e "enera%i0ea0

    re+e!e - ete e,trem !e +'ternic at'nci c$n! (c%'0ia e inta%ea0 &r'c

    1&ri!e3 v(%v'%'3 #ncarcerri 2 - #n t(ate ti+'ri%e !e (c%'0ii mecanice !'reri%e a' ce% mai !e

    caracter c(%icativ3 intermitent3 +am(!ic 'rvenin! %a =:= !emin'te&2 Vrt'ri%e

    - 'rvin !e (&icei !'+ ( cri0 !'rer(a- a+ar !'+ ( +eri(a! #n care -a ac'm'%at c(n@in't'% #n ana !e

    !ea'+ra (&tac(%'%'i3 c' at$t mai c'r$n!3 c' c$t (&tac(%'% ete it'atmai '*

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    - %a #nce+'t 'nt f(rmate !in c(n@in't a%imentar3 a+(i !evin &i%i(ae/i '%teri(r feca%(i!e*

    c2 ;ntrer'+erea tran0it'%'i intetina%- (+rirea evac'rii !e materii feca%e

    /i "a0e- ete 'n im+t(m car!ina% #n (c%'0ia intetina% - !ac e!i'% (c%'0iei ete #na%t3 &(%nav'% +(ate avea emiie !e

    "a0e /i mai a%e !e materii feca%e !in +(r@i'nea inferi(ar aintetin'%'i

    !2 Ditenia a&!(mina% 1mete(rim'% a&!(mina%2 - ete !e(e&it !emarcat c$n! (&tr'c@ia ete it'at %a nive%'% c(%(n'%'i /i #n!e(e&i%a nive%'% c(%(n'%'i i"m(i!*

    e2 7(r&(rime%e 1c%a+(ta'% intetina%2

    - +rin +erc'tarea +erete%'i a&!(mina% c' t(at m$na e+'ne #n evi!en@ 'n 0"(m(t caracteritic ce%'i +e care-% face %ic?i!'%ametecat c' aer3 0"(m(t ?i!r(aeric*

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    Parac%inic9 E,amen'% ra!i(%("ic a% a&!(men'%'i fc't K+e "(%Q3 arat c

    intetin'% ete +%in !e "a0e /i !e %ic?i! intetina%

    - e creea0 ima"inea ra!i(%("ic !e nive%e ?i!r(aerice #nc'i&'ri !e r$n!'nic - "a0e care +%'tec !ea'+ra %ic?i!'%'i

    C(n!'ita !e 'r"ent9C(n!'ita !e 'r"ent9 - (rice &(%nav c' (c%'0ie intetina% a' c' '+ici'ne !e

    (c%'0ie tre&'ie internat !e 'r"en@ #ntr-'n ervici' !e c?ir'r"ie3+entr' !efinitivarea !ia"n(tic'%'i

    - e inta%ea0 ( (n! !e a+ira@ie na0("atric +entr'c(m&aterea ta0ei

    - e intit'ie +rime%e m'ri !e c(m&atere a trii !e /(c

    - c(rectarea t'%&'rri%(r ?i!r(e%ectr(%itice /i a ec?i%i&r'%'iaci!(&a0ic

    - e fac e,aminri !e 'r"en@ 9 i(n("ram3 re0erv a%ca%in3a0(temie3 %e'c(cite

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    - #n (c%'0ia mecanic3 at'nci c$n! e,it fen(mene !e

    tran"'%a@ie a' !e +erit(nit3 e in!ic interven@ia c?ir'r"ica% !ema,im 'r"en@* - #n ca0'% (c%'0iei +ara%itice e a!minitrea0 e,citante a%e

    +erita%tim'%'i intetina%9 mi(tin fi(% i*m3 c%im evac'at(are* - #n (c%'0ia !inamic +rin +am e a!minitrea0 anti+atice

    '& f(rm inecta&i%9 +a+averin3 c(&'ti%

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    COLICA 7ILIAR8

    Definiie9( !'rere ac't vi(%ent3 %(ca%i0at #n ?i+(c(n!r'% !re+t3c' ira!iere +$n #n c(%(ana verte&ra%3 'mr'% /i (m(+%at'% !re+t3

    'rvenit #n c'r'% c(%ecit(+atii%(r %itia0ice /i ne%itia0ice Ca'0e9

    - %itia0a &i%iar ete +re0en@a !e ca%c'%i #n ve0ic'%a &i%iar a' #nci%e &i%iare intra /i e,tra?e+atice

    - c(%ecitita ac't ete ( inf%ama@ie c' caracter ac't a +erete%'ic(%ecitic !e ce%e mai m'%te (ri 'rvine !in ca'0a (&tr'c@ieicana%'%'i citic 1%itia0 citic2 /i infec@iei +ere@i%(r ve0ic'%ei &i%iare*

    - an"i(c(%ite%e 1c(%an"ite2 'nt afec@i'ni inf%amat(rii a%e ci%(r&i%iare e,tra /i intra?e+atice 1c$n! ete intereat /i c(%ecit'% ete

    v(r&a !e an"i(c(%ecitite2* - c(%ecitita cr(nic /i !iine0ii%e &i%iare1!iine0ii%e &i%iare

    'nt t'%&'rari a%e m(tricit@ii ve0ic'%ei &i%iare2* - +ara0it(0e%e intrave0ic'%are 1"iar!ia2*

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    Ta&%(' c%inic9

    a2 D'rerea

    - e !at(re/te 'n(r c(ntrac@ii +atice ref%e,e a%e ve0ic'%eia' a%e ci%(r &i%iare3 'rmate !e cre/teri a%e +rei'nii !in ar&(re%e&i%iar

    - !e&'tea0 #n ?i+(c(n!r'% !re+t a' #n e+i"atr'3 eaccent'ea0 +r("reiv3 atin"$n! intenitatea ma,im #n c$teva (re/i ce!ea0 &r'c a' %ent

    - ira!ia0 '& re&(r!'% c(ta% !re+t #n re"i'nea !(r(-%(m&ar3 ca+'%ar3 #n 'mr'% !re+t

    &2 +reuri3 vrsturic' c(ntin't a%imentar a' &i%i(*

    c2Icter - c(%(ra@ia e !at(re/te 'n'i e!em3 +am ref%e, a%fincter'%'i O!!i /i e +(ate inta%a fr e,ite 'n (&tac(% +rinca%c'% +e c(%e!(c*

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    !2 ,risonul a+are c$n! +re!(min infec@ia ci%(r &i%iare ete 'rmat!e tran+ira@ii a&'n!ente

    e2 ,ebra a+are mai a%e #n c(%ecitite%e ac'te /i an"i(c(%ite

    ec'n!are infec@iei c' "ermeni micr(&ieni*E,amen (&iectiv9 - ve0ic'%a &i%iar +(ate fi +a%+a&i% /i f(arte eni&i%3 ceea ce e

    +'ne #n evi!en@ cer$n! &(%nav'%'i in+ire +r(f'n! #n tim+ cem$na +a%+ea0 ?i+(c(n!r'% !re+t* Dac ve0ic'%a ete inf%amat3 #n

    in+ir +r(f'n!3 &(%nav'% imte ( !'rere accent'at 1emn'%M'r+? +re0ent2*C(n!'ita !e 'r"en@ C(%ici%e &i%iare !e intenitate /i !'rat mic3 fr c(m+%ica@ii3 +(t

    fi tratate %a !(mici%i' +rin 9

    - re+a' %a +at - re"im a%imentar - ana%"etice

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    - anti+atice ) c(&'ti%

    C(%ici%e &i%iare #n(@ite !e vrt'ri 1c' t'%&'rri

    ?i!r(e%ectr(%itice23 %a ce% mai mic emn !e ev(%'@ie nefav(ra&i%neceit internarea !e 'r"en@ +entr' inveti"a@ii /i tratamentme!ic(c?ir'r"ica%

    Calmarea durerii:

    - c(&'ti% c(m+' :-B fi(%e - '%fat !e atr(+in =34m" *c* !e :-B (ri +e 0i3 - +a+averin 1:- fi(%e #n : !e (re2* - nitr("%icerin a!minitrat '&%in"'a% a' inecta&i%

    re!'ce +am'% fincter'%'i O!!i /i c(ntrac@ii%e ?i+ert(ne a%e

    ve0ic'%ei &i%iare- a%"(ca%min3 f(rtra%

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    Dac n' ce!ea0 c(%ica3 e rec'r"e %a mia%"in ==-4= m" %a interva%!e -J (re3 me!icament care are avanta'% !e a n' +r(v(ca +am'%m'c'%at'rii nete!e*

    Atenie: u se administrea" morfin deoarece accentuea"s!asmul cilor biliare

    Ca%marea vrt'ri%(r 1&(%nav'% var3 !eci n' e +(ate a!minitranimic +er(2

    - met(c%(+rami! f* - +%e"(ma0in f*

    C(m&aterea infec@iei9 - anti&i(tice9 am+ici%ina : B "50i +er( a' i*m* 1e

    e%imin &i%iar23 +enici%in 1e e%imin +'@in +rin ci%e &i%iare2 =mi%i(ane U50i3 tetracic%in 1n' e e%imin +rin ci%e &i%iare2 :B "50i*

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    C(rectarea t'%&'rri%(r ?i!r(e%ectr(%itice /i aci!(-&a0ice#n f'nc@ie!e re0'%tate%e !e %a&(rat(r*

    A!minitrarea !e e!ative +entr' ca%marea trii !e a"ita@ie1?i!r(,i0in3 !ia0e+am3 &ar&it'rice2

    P'n"a c' "?ea@ +e ?i+(c(n!r'% !re+t re!'ce in f%ama@ia*

    ;n ca0 !e ev(%'@ie nefav(ra&i% e rec'r"e %a tratament c$irurgical.

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    ISCHEMIA MEENTERIC8

    Definiie:!eterminat !e afectarea arterei me0entarice '+5inf ce

    vac'%ari0ea0 intetin'% '&@ire /i c(%(n'% !re+t C'+rin!e9 ic?emia3 infarct'%3 tr(m&(0a ven(a me0enteric3

    arterita Inciden9 %a +acien@i c' mai m'%t !e = ani i c' emne !e

    &(a% ATS

    De&'t9 varia&i%3 #n f'nc@ie !e f(rma !e ic?emie E,* c%inic9 !'rere mare3 +eri(m&i%ica%3!ar 'ne(ri +(ate fi im@it

    #n ?i+(c(n!r'% !re+t a' f(a i%iac !rea+t3 fr irita@ie+erit(nea%3 e,amen a&!(mina% rac3 /(c3 !iaree3 fe&r3rect(ra"ii

    Investigaii: %e'c(cit(03 ?em(c(ncentra@ie3 ?i+erami%a0emie3cre teri a%e TGP3TGO3 FAS3 EG3 R, a&!(mina% im+%3an"i("rafie3 iri"("rafie

    Evoluie9 m(rta%itate

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    ANEVRISMUL DE AORT8 A7DOMINAL8

    Definiie9 Anevrim'% a(rtei a&!(mina%e re+re0inta !i%atarea

    e,ceiv 1#n "enera% +ete cm2 a !iametr'%'ii a(rtei %a nive%a&!(mina%* Peric(% !iec@ia !e a(rt1&re #n intima a(rtei c'+tr'n!erea !e .n"e #ntre intim i a!ventice2

    Cau"e: AT% ?i+erteni'nea arteria%3 ?i+erc(%eter(%emia3(&e0itatea 3 f'mat'% 3 tra'matime%e a&!(mina%e3 fact(rii "enetici

    1+acientii c' m(!ificari "enetice a%e te't'%'i c(n'nctiv - !e ti+in!r(m Marfan) Inciden9 %a +acien@i 4 ani c' emne !e ATS Debut9 %ent a' &r'c c' !iec@ie /i /(c Ex. clinic9 !'reri intene #n f%anc3 %(m&3 mem&re inferi(are3

    a&!(mina%e neitemati0ate3 /(c3 f(rma@i'ne +'%ati% Investigaii9 R, a&(mina%3 ECHO3 CT3 RMN3 an"i("rafia a(rtei Tratament9 !e 'r"en@ c?ir'r"ica% Evoluie9 nefav(ra&i% c' m(rta%itate mare

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    HEMORAGIA DIGESTIV8 SUPERIOAR8

    HDSre+re0int e,teri(ri0area 1+ier!erea2 !e $n"e %a nive%'% t'&'%'i!i"etiv3 av$n! (ri"ine #n %e0i'nea acet'ia !e %a nive%'% '+eri(r +$n

    %a 'n"?i'% %'i Treit0*Se e,teri(ri0ea0 '& f(rm !e me%en /i5a'?emateme0*

    HD mi%(cie !e %a nive%'% t'&'% !i"etiv inferi(r 1'n"?i'% %'i Treit0

    va%va i%e(ceca%2 'nt c'n(c'te /i '& !en'mirea !e enter(ra"ii*See,teri(ri0ea0 ce% mai frecvent '& f(rm !e ?emat(c?i0ie* HD inferi(ar $n"erare !e %a nive%'% c(%(n'%'i 1va%va i%e(ceca%an'2*Se e,teri(ri0ea0 '& f(rm !e emiii !e $n"e ne!i"erat*

    Hem(ra"ii (c'%te ?em(ra"ii #n cantit@i mici care n' e

    evi!en@ia0 macr(c(+ic3 'nt !(ar micr(c(+ice*E%e +(t +r(veni!in t(t t'&'% !i"etiv*

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    Eti(+at("enia HDS A* HDS !e ca'0 !i"etiv

    T'&'% !i"etiv

    E(fa"'% 9 varice e(fa"iene r'+te e(fa"it +e+tic !e ref%',

    ?ernie "atric tran?iata% '%cer e(fa"ian cancer'% e(fa"ian t'm(ri &eni"ne e(fa"iene

    in!r* Ma%%(r ) Wei

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    St(mac'% U%cer Gatrite er(0ive

    Cancer "atric A%te t'm(ri ma%i"ne "atrice 1%imf(m "atric2 P(%i+i /i +(%i+(0e "atice St(mac (+erat

    An"i(!i+%a0ie ) rar

    D'(!en'% U%cer !'(!ena% D'(!enite ac'te T'm(ri !'(!ena%e

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    G%an!e ane,e9G%an!e ane,e9

    Ficat'%Ficat'% Hi+erteni'nea +(rta%Hi+erteni'nea +(rta% Hem(Hem(&&i%ia 1!e ca'0 ?e+atic a' ve0ic'%ar2i%ia 1!e ca'0 ?e+atic a' ve0ic'%ar2

    Pancre'%Pancre'% Cancer'% !e +ancreaCancer'% !e +ancrea Pancreatite ac'te /i cr(nicePancreatite ac'te /i cr(nice

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    7* HDS !e ca'0 e,tra!i"etiv9 Sin!r(ame ?em(ra"i+are9 C(a"'%(+atii c(n"enita%e C(a"'%(+atii !(&$n!ite ) antic(a"'%ante3 tr(m&(%itice3 AINS3

    in?i&it(rii "%ic(+r(teici IIa III&

    Tr(m&(cit(+enii Hem(fi%ia Hem(+atii ma%i"ne P'r+'re vac'%are

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    Ta&%(' c%inic

    De+in!e !e "ra!'% ?em(ra"iei 1cantitatea !e $n"e +ier!'t23 !era+i!itatea ?em(ra"iei 14== m% +ier!'@i ra+i! ) +(ate fi fata%23 !e

    va%(area H& #nainte !e ?em(ra"ie* M(!a%itatea !e e,teri(ri0are !e+in!e !e %(ca%i0area 'rei !e

    $n"erare3 cantitatea !e $n"e +ier!'t*Hemateme0

    e,teri(ri0area HDS care e +r(!'ce +rin vrt'r c' $n"e 1!ac e( cantitate !e $n"e :== m% #n t(mac irita@ie !ec%an/arearef%e,'%'i !e vrt'r2

    a+ect'% ti+ic ete !e 0a@ !e cafea 1!ac n' ete ( cantitate mare !e$n"e2

    Me%ena ca'n ne"r' %'ci( ca +c'ra3mai m(a%e c' mir( #n@e+t(r +entr' a+ari@ia 'n'i ca'n me%enic 'nt neceari 4=-= m% n"e

    Hemat(c?i0ia re+re0int +ier!erea !e n"e +e ca%e recta% a+are #n HDS3 c$n! tran0it'% ete f(arte acce%erat a' ete ( cantitate

    mare !e $n"e 1===m%2

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    Examen fi"ic general

    +a%(are c'tane(-m'c(a tran+ira@ii reci

    verti ta?icar!ie ?TA ?TA (rt(tatic

    Anamne"a !entru boala de ba"

    c(n'm cr(nic !e me!icamente ce +(t !etermina HDS9

    c(rtic(ter(i!iene3 AINS3 antic(a"'%ante it(ric !e '%cer !'(!ena%3 '%cer "atric3 cir(0 ?e+atic Examen fi"ic

    '&icter3 te%'@e vac'%are +'r+'r 1tr(m&(+atii2

    ec?im(0e 1!*?em(ra"i+are2 ?e+at(+%en(me"a%ie 1cir(03 ?em(+atii ma%i"ne2 +a%+area t'm(rii "atrice e+i"atr' eni&i%

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    Sta&i%irea "ravit@ii $n"errii +rin in!ice%e !e /(c

    Criterii%e Smit?-Wei%%9

    Hem(ra"ii '/(are9 - X:4= m% !e $n"e ) :4> !in v(%'m'% circ'%ant

    - ta?icar!ie == &5min - TA

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    Hem(ra"ii me!ii* - XB4=m% !e $n"e ) B4>!i v(%'m'% circ'%ant - ta?icar!ie !e re+a' ) :=&5min

    - TA 6=mmH" - in!ice !e /(c -34 - +rei'nea ven(a centra% #nce+e ca! - !i're0a #nce+e ca!

    Hem(ra"ii evere 1/(c'% ?em(ra"ic2 - +ier!ere v(%emic im+(rtant 14=>2 ) :4==m% - TA X = mmH" - +'% ra+i!3 acce%erat :=&5min - (%i"'rie - +rei'nea ven(a centra% m'%t c0't - in!ice !e /(c 34

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    Dia"n(tic'% +(0itiv !e HDS

    Evi!en@ierea m(!'%'i #n care -a e,teri(ri0at $n"erarea +acient'% var3 TR care arat ca'n'% me%anic*

    Dia"n(tic'% !iferen@ia% E+ita,i maiv #n"?i@it Hem(+ti0ii #n"?i@ite 5 e,teri(ri0ate +rin t'e Sca'n m(!ificat %a c'%(are 1+re+arate c' Fe3 &im't3 +anac2

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    Tratament'%

    Mi%(ace%e +rin care e rea%i0ea0 ?em(ta0a 'nt9

    * Met(!e me!ica%e9 %ava'% "atric c' (%'@ii ?i+(terme Y a!rena%in +e (n!

    refacerea v(%'m'%'i an"'in c' er fi0i(%("ic3 (%'@ie Rin"er3tranf'0ii !e .n"e inte"ra%

    in?i&area ecre@iei aci!e "atrice a!minitrarea iv* !e in?i&it(ri!e H: 1Raniti!in3 Fam(ti!in23 in?i&it(ri !e +(m+ !e +r(t(ni1e(me+ra0(%3 +ant(+ra0(% 3 (me+ra0(%2

    a!minitrarea iv* !e S(mat(tatin3 ?(rm(n nat'ra% c' efecte?em(!inamice i !e in?i&are a ecre@iei c%(r?i!r(+e+tice

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    9

    :* Met(!e en!(c(+ice

    e%ectr(c(a"'%area &i+(%ar f(%(it #n '%cer'% ?em(ra"ic

    f(t(c(a"'%area %aer 9 '%cer'% ?em(ra"ic3 t'm(ri "atrice

    tera+ie %(ca% ?em(tatic9 a"en@i c%er(0an@i 1+(%i!(can(% -:>3

    "%'c(0 ?i+ert(n2

    %i"at'ra en!(c(+ic a varice%(r e(fa"iene

    B* Met(!e c?ir'r"ica%e9

    e a+%ic #n HDS mari care +'n #n +eric(% via@a &(%nav'%'i e +ractic %i"at'ri vac'%are3 re0ec@ii

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    ENCEFALOPATIA HEPATIC8

    Sin!r(m ne'r(+i?iatric caracteri0at +rin9

    m(!ificri !e c(m+(rtament 1+er(na%itate2

    emne ne'r(%("ice - f%a++in" trem(r m(!ificri EEG

    P(ate fi ac't /i reveri&i% a' cr(nic /i +r("reiv*

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    Fact(rii +reci+itan@i9

    S$n"erri

    "atr(intetina%e E,ce !e +r(teine #n

    a%imente C(nti+a@ie

    Diaree A0(temia A%ca%(0a Hi+(ca%cemia Di'retice%e

    Paracente0e%e maive Hi+(v(%emia Me!icamente !e ti+ 7D3

    &ar&it'rice Cancer'% ?e+at(ce%'%ar

    Infec@ii%e Interven@ii%e c?ir'r"ica%e Anete0ia

    St !i %i

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    Sta!ia%i0area9 Sta!i'% I

    A%terarea ritm'%'i

    (mn-ve"?e T'%&'rri !e

    c(m+(rtament F%a++in" trem(r EEG n(rma%

    Sta!i'% II S(mn(%en@ Ata,ie

    Diartrie F%a++in" trem(r M(!ificri EEG

    Sta!i'% III St'+(r

    Hi+erref%e,ie 7a&ini +(0itiv F%a++in" trem(r EEG m(!ificat

    Sta!i'% IV C(m ce r+'n!e %a

    tim'%i !'rer(/i C(m ce n' r+'n!e %a

    tim'%i !'rer(/i Fr f%a++in" trem(r M(!ificri EEG

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    Tratament

    Tratarea /i #n%t'rareafact(ri%(r +reci+itan@i

    C%ime evac'at(rii c'%act'%(0) !i0a?ari!intetic care tim'%ea0inte0a &acterii%(r ce %ea"am(niac'% +rin f(rmarear'ri%(r !e am(ni' /ie%iminarea %'i +rin ca'n

    Rifa,imin 1N(rmi, ) t&*:==m"2 ==m" ,B50i %act'%(0

    Am(ni(fi,at(are%e9 aci!'%a+artic 1A+at(f(rt23 ar"inin-"%'tamat3 (rnitin-a+artat3acetat'% !e 0inc

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    Se e,c%'! +r(teine%e!in a%imenta@ie

    A!minitrarea !e

    %act'%(0 B=-:= m%50i+$n are : ca'ne m(i

    A!minitrarea !eanti&i(tice ce n' e

    a&(r& 1Metr(ni!a0(%"50i3 Ne(micin :"50i3Vanc(micin "50i3

    Anta"(ni ti&en0(!ia0e+inici1F%'ma0eni%2 careac@ii(nea0 ca 'n a"ent!e tre0ire3 c' ac@i'ne

    ra+i!3 #n c.teva min'te!ar !e !'rat c'rt 1:-(re2

    Tran+%ant ?e+atic


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