semio digestiv 2009 partea a iiia

8/8/2019 Semio Digestiv 2009 Partea a IIIa

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HEPATOMEGALIA

consistenta, forma, sensibilitate- cu margine inferioara rotunjita, inflamatie/infectie

suprafata neteda, sensibil la palpare congestie venoasa ICD

- ferma, suprafata regulata + icter icter obstructiv

- ferma/dura, cu margine/ suprafata neregulata ciroza

+ durere neplasm

- pulsatilitate insuficienta tricuspidiana

- auscultatie


2/29

HEPATOMEGALIA

aparenta lob Riedel

inflamatorie/infectioasa

afectiuni tropicale

chistica

afectiuni metaboliceafectiuni hepatice cronice

obstructie biliara

congestie venoasa: ICD, pericardita constrictiva, boala venoocluziva

tumori

primare

secundare: sin, plamin, ovar, tract gastrointestinal

boli hematologice


3/29

SCHISTOSOMIAZA

Schistosoma Mansoni

Schistosoma Japonicum

Hepatosplenomegalie +

HP presinusoidala

KALA AZAR

forma viscerala a leishmaniozei

febra,

adenopatie,

hepatosplenomegalie

MALARIE

Plasmodium falciparum

anemie, trombocitopenie

hepatosplenomegalie

tulburari neurologice

cefalee, delir, hemoragii retiniene


4/29

abces hepatic piogen

- stare de rau, febra, greata

- soc toxico septic cu

germeni gram

- Escherichia colli,

Streptococus faecalis,

Staphylococus aureus,

Proteus vulgaris

abces amoebian

- stare de rau precedata de diaree

hepatomegalie dureroasa

sindrom lichidian pleural


5/29

boala fibrochistica

- asimptomatic sau

jena in hipocondrul

drept

- asociata cu chiste

pancreatice, renale

hemocromatoza

- peste 50 ani

- pigmentare

tegumentara

- hepatomegalie

-insuficienta viscerala:

DZ, IC,

insuf.gonadala,

artropatie

- cancer hepatic

chist hidatic

- mai frecvent in

hipocondrul drept

- se poate palpa

- la auscultatie -

freamatul veziculelor

amiloidoza

- material amorf, hialin

- hepatosplenomegalie

- IC

- sindrom nefrotic

boala Caroli

= dilatatie saculara

a ductelor biliare

intra / extrahepatice

febra,

dureri abdominale,

colangita, septicemie

primara

secundara

infectii

inflamatii cronicemielom multiplu

boala Hodgkin


6/29

Hadziyannis. J Eur Acad Dermatol Venereol. 1998.

Infectia VHC

Manifestari extrahepatice

HematologiceCrioglobulinemia mixta

Anemia aplastica

Trombocitopenie

Limfom cu celule B non-Hodgkin

DermatologicePorphyria cutanea tardaLichen planus

Vasculita cutanata necrozanta

RenaleGlomerulonefrita

Sindrom nefrotic

EndocrineAnticorpi anti-tiroidieni

Diabet zaharat

SalivareSialadenita

OculareUlcer cornean

Uveita

VasculareVasculita necrozanta

Poliarterita nodoasa

Fibroza pulmonara

NeuromusculareMialgii

Neuropatie periferica

Artrita/artralgii

Fenomene autoimuneSindrom CREST

Granuloame

Autoanticorpi


7/29

obezitate adipocitokine VHC

SOCS3

(semnal citokinic

supresor)

scaderea

raspunsului rezistenta la insulina fibrozala terapie hepatica

activare celule stelate

hipercoagulabilitate Mota M Medica- a Journal of Clinical Medicine 2008;3(2):100-108Persico M Gut 2008;57:507-517

Fumio M Liver International 2008: 28(1): 355-362


8/29

Alcool

ficat gras +

greata, varsaturi, diareehepatomegalie

hepatita alcoolica

simptome putine

icter moderat

ciroza alcoolica

dureri abdominale

febra prin necroza hepatica

Deficit 1 antitripsina

la nastere icter colestatic

tinar hepatita cronica +

emfizem pulmonar

Boala Wilsondegenerescenta hepatolenticulara

copii boala hepatica

tineri suferinta neurologica


9/29

Adipocyte-macrophage interaction

leading to dysfunction

Gideon R.Hajer, Timon W. van Haeften, and Frank L.J.VisserenAdipose tissue dysfunction in obesity, diabetes, and vascular diseases

European Heart Journal(2008) 29,2959-2971


10/29

Seung Hwan,MD, PhD, Michael J.Quon,MD,PhD,Jeong-a Kim, PhD, Kwang kon, MD, PhD,FACCAdiponectin and Cardiovascular Disease

JACC vol.49, No.5, 2007


11/29

Antiatherogenic Effects of Adiponectin

Seung Hwan,MD, PhD, Michael J.Quon,MD,PhD,Jeong-a Kim, PhD, Kwang kon, MD, PhD,FACC

Adiponectin and Cardiovascular DiseaseJACC vol.49, No.5, 2007


12/29

Interaction among the mechanisms involved

on blood pressure elevation,in the presence

of the metabolic syndrome

Journal of Hypertension 2009, Vol 27 No3Journal of Hypertension 2009, Vol 27 No3

Mecanisms of hypertensions in the cardiometabolic syndromeMecanisms of hypertensions in the cardiometabolic syndrome

Josep Redon, Ranata Cifkova, Stephane Laurent, Peter Nilsson, Krzysztof Narkiewicz,Josep Redon, Ranata Cifkova, Stephane Laurent, Peter Nilsson, Krzysztof Narkiewicz,

Serap Erdine and Giuseppe ManciaSerap Erdine and Giuseppe Mancia


13/29

HIPERCOAGULABILITATEAHIPERCOAGULABILITATEA

IN STEATOHEPATITA SI SMIN STEATOHEPATITA SI SM

disfunctie endotelialadisfunctie endoteliala

hipercoagularehipercoagulare

rezistenta la insulinarezistenta la insulina + CD36+ CD36PAIPAI11

factor von Willebrandfactor von Willebrand

factor tisularfactor tisular

factor VIIfactor VII

Northup GP Thromb.Haemost 2008;6: 2Northup GP Thromb.Haemost 2008;6: 2--99

Progresia bolii hepatice

Risc crescut arterial

- coronarian- cerebrovascular

Risc tromboembolic venos


14/29

CIROZA HEPATICA

idiopatica

alcoolica

post hepatita

altele

ciroza biliara

hemocromatoza

boala Wilson

boala polichistica

medicamentoasa

congestie venoasa hepatica

fibroza si regenerare

modificari functionale

Ciroza biliara

prurit

icter colestatic pigmentare

xantelasme, xantoame

hepatomegalie


15/29

celule hepatice

celule endoteliale

celule Kupffer

celule Ito

perisinusoidal

stocheaza lipide

depoziteaza vitamina A

rol in fibroza hepatica

celule fenestrate LK


16/29

icter insuficientahepatica

hipertensiuneportala

ciroza

hepatica

CLASIFICARE CHILD -TURCOTTE PUGH

bilirubinemie

albuminemie

TP

ascita

starea de nutritie

encefalopatie port sistemica


17/29

SPLENOMEGALIA

moale infectie, septicemie

ferma congestie, infiltrat

dura fibroza, scleroza


18/29

infectii

- virale

- parazitare

- bacteriene

- fungice

inflamatie

- P.R.

- sarcoidoza

- LES

- Dializa

neoplasm

- leucemii

- limfoame

- slndrom mieloproliferare cronica- metastaze

hemoliza

- sferocitoza

- talasemie majora

- HPN

Splenomegalii

afectiuni infiltrative

- boala Gaucher- boala Niemann-Pick

- amiloidoza

- hematopoieza extramedulara

hipertensiune portala

boli endocrine

- tiroidita Hashimoto

altele

- limfadenopatia angioimunoblastica

PTI

anemie hemolitica

boala Hodgkin

hipertensiune portala

posttraumatic

SPLENECTOMIE


19/29

HEPATOMEGALIE

SPLENOMEGALIE

inflamatie/infectie

afectiuni metabolice

afectiuni hematologice

boli hepatice


20/29

TUMORI MASIVE ABDOMINALE

ficat tumoral primitiv/metastatic

splenomegalie

rinichi polichistic

adenopatie + splenomegalie

pseudochist pancreatic

cancer gastric

adenopatie+ splenomegalie

chist mezenteric

anevrism aortachist ovar


21/29

Apendicita acuta- febra, greata, varsaturi,

- dureri initial in epigastru si periombilical, apoi in fosa iliaca dreapta

- iritatie peritoneala

- durere la compresia pe psoas

Diagnostic diferential in apendicita acuta

Boala Crohn

Adenita mezenterica

Diverticuli colon drept

Diverticul Meckel

Adenocarcinom colon drept peforat

Colica renala dreapta

Chist ovarian torsionat

Sarcina extrauterina rupta


22/29

icter insuficientahepatica

hipertensiuneportala

ciroza

hepatica

CLASIFICARE CHILD -TURCOTTE PUGH

bilirubinemie

albuminemie

TP

ascita

starea de nutritie

encefalopatie port sistemica


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25/29

ecografie abdominala

CT

aprecierea functiei hepatice

SaO2

ecocardiografie


26/29


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28/29

SINDROM BUDD CHIARIobstructie a venelor suprahepatice

cresterea presiunii sinusoidale

staza si congestia hepatica duc la lezare

necroza hepatica centrolobular

tabloul clinic depinde de brutalitatea instalarii obstacolului

hepatica


29/29

ASPECT ECOGRAFIC IN HP

VS >

VP >

prezenta sunturilor porto cave

tromboza vena porta,

transformare cavernoasa a venei porte

semio digestiv 2009 partea a iiia

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