Dit document omvat aantekingen en slides van het vak Ziekteleer (). Beide onderdelen (colleges prof. Dierickx en colleges prof. Verslype) komen aan bod. Elk hoofdstuk is op dezelfde manier systematisch onderverdeeld, wat tevens zichtbaar is in de inhoudstafel.
Fully! Sometimes too many spaces that ruin large number of pages+layout far
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ZIEKTELEER
Prof. Chris Verslype
Prof. Daan Dierckx
Academiejaar 2020-2021
Phaedra Vanhove
, Ziekteleer
Inhoud
CV-1: inleidende les ziekteleer ............................................................................................................... 9
Aandoeningen (~ ziekten) ................................................................................................................... 9
Symptomen en klinische tekenen ....................................................................................................... 9
Concept: “symptoom – ziektebeeld – aandoening” ........................................................................... 9
LEERDOELEN ...................................................................................................................................... 10
CV-2: algemeen deel inflammatie ........................................................................................................ 10
Deel 1: inzicht in de normale werking van het immuunsysteem .......................................................... 10
Wat is het immuunsysteem? ............................................................................................................. 10
Aangeboren (innate) versus adaptieve immuniteit ...................................................................... 11
Tijdslijn van een normaal immuunantwoord tegen een virus ...................................................... 12
Interacties tussen aangeboren en adaptieve immuniteit ............................................................. 13
Communicatie tussen immuuncellen onderling en andere cellen.................................................... 13
Cytokines ........................................................................................................................................... 13
Sensoren in de aangeboren immuniteit: “pattern recognition receptors” of PRRs ......................... 15
De aangeboren immuniteit: inflammatie (of ontsteking) ................................................................. 16
Kenmerken van het adaptief immuun systeem ................................................................................ 16
Het adaptief immuun system: antigenen? ........................................................................................ 16
Belangrijke T cel-acties tegen ziekteverwekkers ........................................................................... 17
Conclusies: het normale immuun systeem (!)................................................................................... 18
Deel 2: enkele voorbeelden van problemen door een overactief immuunsysteem ............................ 18
CV-3A: slokdarm/maag/darm .............................................................................................................. 20
Anatomie ............................................................................................................................................... 20
De (9) zones van het abdomen.......................................................................................................... 20
Terminologie van ingrepen – procedures ......................................................................................... 20
Toepassing van het concept “symptoom – ziektebeeld – aandoening” op het domein
slokdarm/maag/darm ................................................................................................................... 21
CV-3B: oefeningen ................................................................................................................................ 29
CV-4: slokdarm ...................................................................................................................................... 32
DEEL 1: onderzoekstechnieken slokdarm ............................................................................................. 32
Endoscopie en echoendoscopie ........................................................................................................ 32
Rx-slokdarm ....................................................................................................................................... 32
24u- ambulante pH metrie ................................................................................................................ 33
Phaedra Vanhove (2020-2021)
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, Meten van mucosale integriteit door impedantiemeting ................................................................. 34
Manometrie van de slokdarm ........................................................................................................... 34
CT-thorax (met drinken van contrast) ............................................................................................... 34
FDG-PET-CT........................................................................................................................................ 35
DEEL 2: Systematische bespreking aandoeningen ................................................................................ 35
1. Aangeboren: (atresie), divertikel van Zenker ............................................................................ 35
2. Ontstekingen ............................................................................................................................. 36
GERD .............................................................................................................................................. 36
Reflux oesofagitis .......................................................................................................................... 36
Candida – schimmelinfecties van de slokdarm ............................................................................. 40
Eosinofiele oesofagitis ................................................................................................................... 40
3. Tumoren: slokdarmkanker ........................................................................................................ 40
4. Vasculair: slokdarmverices (zie lever en portale hypertensie).................................................. 41
5. Functioneel: reflux, achalasie, spasmen.................................................................................... 41
6. Traumatisch: slokdarmscheur, vreemde voorwerpen .............................................................. 42
CV-5: maag ............................................................................................................................................ 43
Onderzoekstechnieken.......................................................................................................................... 43
Systematische bespreking aandoeningen ............................................................................................. 43
2. Ontstekingen ................................................................................................................................. 44
Gastritis (maagontsteking) ............................................................................................................ 44
Maagzweer (ulcus) ........................................................................................................................ 44
3. Tumoren (adenocarcinoom).......................................................................................................... 46
CV-6: dunne darm ................................................................................................................................. 46
Bespreking begrippen digestie + absorptie en maldigestie + malabsorptie ......................................... 46
Anatomie en functie van de dunne darm ......................................................................................... 46
Systematische bespreking aandoeningen ............................................................................................. 48
1. Aangeboren: Divertikel van Meckel .......................................................................................... 48
2. Ontstekingen ............................................................................................................................. 49
Ziekte van Crohn (= IBD, inflammatoire darmziekte) .................................................................... 49
Coeliakie (of gluten-enteropathie) ................................................................................................ 52
CV-7: dikke darm en aars...................................................................................................................... 53
Normale functie en onderzoeken.......................................................................................................... 53
Anatomie en normale functie van de dikke darm ............................................................................. 53
Onderzoeken van de dikke darm ...................................................................................................... 54
Systematische bespreking aandoeningen ............................................................................................. 54
Overzicht aandoeningen dikke darm ................................................................................................ 54
Phaedra Vanhove (2020-2021)
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, 1. Aangeboren: Ziekte van Hirschsprung .................................................................................. 55
2. Ontstekingen ......................................................................................................................... 55
3. Tumoren ................................................................................................................................ 57
4. Vasculair: ischemische colitis ................................................................................................ 58
5. Functioneel ............................................................................................................................ 58
Overzicht: aandoeningen van de aars ............................................................................................... 60
2. Ontstekingen: Anaal abces en fistel .......................................................................................... 60
3. Tumoren: Anale wratten/condylomen.................................................................................. 60
4. Vasculair: Hemorrhoiden of aambeien ................................................................................. 61
6. Traumatisch : Anale kloof (of fissuur) ....................................................................................... 61
CV-8a: lever en galwegen ..................................................................................................................... 62
Anatomie ............................................................................................................................................... 62
Anatomie en functie van de lever: de verschillende cellen .............................................................. 62
Samenstelling gal(vocht) en uitscheiding .......................................................................................... 63
................................................................. 64
Hoe kunnen we de lever en de galwegen onderzoeken? ................................................................. 64
Interpretatie van bloedwaarden ................................................................................................... 65
Aandacht voor de bovenbuik ........................................................................................................ 66
Symptomen en klinische tekenen ......................................................................................................... 66
Toepassing van het concept “symptoom – ziektebeeld – aandoening” op het domein lever en
galwegen ........................................................................................................................................... 66
Phaedra Vanhove (2020-2021)
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