Samenvatting Thema 4 Tractus Digestivus geneeskunde jaar 2 deel I
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Course
GNK 2.1 Thema 4 Tractus Digestivus
Institution
Rijksuniversiteit Groningen (RuG)
Deze samenvatting bevat alle leerstof van thema 4 Tractus digestivus jaar 2 semester 1! Het is een complete samenvatting van de leerstof, uitgebreid en duidelijk weergegeven, inclusief illustraties. Nota bene: week 14 is niet geheel meegenomen in deze samenvatting (wel de fysiologie, histologie en ...
Thema 4 – Tractus Digestivus deel I
Geneeskunde jaar 2 semester 2.1
Week 12 – Slikklachten ................................................................................................................................... 3
Anatomie ............................................................................................................................................................ 3
De pharynx = keelholte ............................................................................................................................. 3
De mondholte = orale cavitis .................................................................................................................... 5
De larynx ( = het strottenhoofd) ............................................................................................................... 8
De hals en nek ......................................................................................................................................... 13
De lymfedrainage van het hoofd-hals gebied ......................................................................................... 19
De schildklier ........................................................................................................................................... 20
De hersenzenuwen ................................................................................................................................. 21
Embryologie van de oesophagus ............................................................................................................ 23
Bovenste luchtwegen: volwassenen versus kinderen............................................................................. 24
De lippen en orale holte .................................................................................................................................... 25
Anatomie................................................................................................................................................. 25
Fysiologie ................................................................................................................................................ 29
Examinatie van de lippen en orale holte................................................................................................. 29
De pharynx en oesophagus ............................................................................................................................... 30
Anatomie van de farynx .......................................................................................................................... 30
De anatomie van de parapharyngeale ruimte ........................................................................................ 31
De anatomie van de oesophagus ............................................................................................................ 31
De fysiologie van slikken ......................................................................................................................... 32
De structuur en functie van de tonsillar ring (Waldeyer’s ring) .............................................................. 33
Examinatie van de pharynx ..................................................................................................................... 33
De larynx ........................................................................................................................................................... 34
Anatomie................................................................................................................................................. 34
Symptomen van laryngeale aandoeningen ............................................................................................. 34
Examinatie methoden ............................................................................................................................. 35
Aandoeningen van de hypofarynx en oesophagus ........................................................................................... 36
Schade en corpora aliena ........................................................................................................................ 36
Divertikel ................................................................................................................................................. 37
Tumoren van de hypopharynx ................................................................................................................ 38
Aandoeningen van slikken en de oesophagus (fysiologie) ................................................................................ 39
Paralyse van het slikmechanisme ........................................................................................................... 39
Achalasie en megaoesophagus ............................................................................................................... 39
Aandoeningen van de oesophagus ................................................................................................................... 40
Gastro-oesophageale reflux disease (GORD) .......................................................................................... 40
Complicaties van gastro-oesophageale reflux disease (GORD) .............................................................. 42
Motiliteitsaandoeningen ......................................................................................................................... 42
Andere oesophageale aandoeningen ..................................................................................................... 44
Oesophageale tumoren .......................................................................................................................... 45
Malformaties van de larynx .............................................................................................................................. 46
Laryngomalacie ....................................................................................................................................... 46
Congenitale laryngeale cystes (sacculaire cysts) ..................................................................................... 46
Laryngoceles ........................................................................................................................................... 46
Congenitale laryngeale web en glottic atresie ........................................................................................ 46
Congenitale subglottic stenose ............................................................................................................... 47
Neurogene aandoeningen: congenitale stembandverlamming.............................................................. 47
, Laryngeale subglottis hemangioom ........................................................................................................ 47
Infecties van de larynx in kinderen ................................................................................................................... 48
Difterie à true croup.............................................................................................................................. 48
Acute subglottis layngitis (= acute laryngotracheobronchitis) ................................................................ 48
Bacteriële (laryngo)tracheïtis .................................................................................................................. 48
Acute spasmodische laryngitis ................................................................................................................ 49
Acute epiglottitis ..................................................................................................................................... 49
Laryngeale betrokkenheid in infectieuze ziektes .................................................................................... 49
Inflammatie van de larynx in volwassenen ....................................................................................................... 50
Acute laryngitis ....................................................................................................................................... 50
Acute epiglottitis (=adult supraglottitis) ................................................................................................. 50
Angioneurotisch laryngeal oedeem, acuut laryngeaal oedeem.............................................................. 50
Chronische nonspecifiek laryngitis .......................................................................................................... 50
Reinke’s oedeem (=chronische hyperplastische laryngitis) .................................................................... 51
Posterieure laryngitis (=gastro-oesophageale reflux laryngitis (GERL) ................................................... 51
Laryngitis in chronische infectieziekten .................................................................................................. 51
Intubatie granuloom ............................................................................................................................... 51
Contact-ulcus .......................................................................................................................................... 51
Andere problemen in de larynx ......................................................................................................................... 52
Corpora-aliena aspiratie.......................................................................................................................... 52
Externe schade aan de larynx ................................................................................................................. 52
Internae schade aan de larynx ................................................................................................................ 52
Tumoren van de larynx ..................................................................................................................................... 53
Goedaardige neoplasiën ......................................................................................................................... 53
Maligne laryngeale tumoren – laryngeal carcinoom .............................................................................. 54
Neurogene aandoeningen van de larynx .......................................................................................................... 56
Recurrent laryngeale zenuwverlammingen ............................................................................................ 56
Superieure laryngeale zenuwverlamming............................................................................................... 57
Nervus Vagus verlamming ...................................................................................................................... 57
De stem ............................................................................................................................................................. 58
Spraak-productie..................................................................................................................................... 58
Diagnostiek ............................................................................................................................................. 59
Klinische aspecten van stemaandoeningen ............................................................................................ 60
Radiotherapie ................................................................................................................................................... 61
De rol van radiotherapie in oncologie ..................................................................................................... 61
Werkingsmechanisme ............................................................................................................................. 61
Typen bestraling...................................................................................................................................... 61
Indicaties ................................................................................................................................................. 62
Technieken om risico-organen (OARs) te sparen .................................................................................... 62
Toxiciteit.................................................................................................................................................. 62
Protonentherapie.................................................................................................................................... 63
Bestralingstherapie voor hoofd- en nekkanker....................................................................................... 63
Voeding ............................................................................................................................................................. 66
Eiwit-energie ondervoeding (PEM) in ontwikkelde landen..................................................................... 66
Malnutritie .............................................................................................................................................. 72
Het schatten van de lichaamssamenstelling ........................................................................................... 76
,Week 12 – Slikklachten
Anatomie
De pharynx = keelholte
- Nasopharynx
o Posterieur van de nasale
holte
o Boven het zachte palatum
o Innervatie:
§ Sensorisch: CN V2
§ Motorisch: CN X
- Oropharynx
o Posterieur van de orale
holte
o Vanaf het zachte palatum
tot het superieure puntje
van de epiglottis
o Innervatie:
§ Sensorisch: CN IX
§ Motorisch: CN X
- Laryngopharynx
o Vanaf het superieure puntje van de epiglottis tot het inferieure deel van het
cricoid kraakbeen (=hypopharynx).
o Innervatie:
§ Sensorisch: CN X
§ Motorisch: CN X (Behalve de m. Stylopharyngeus: CN IX)
Bloedaanvoer van de pharynx
- Aftakkingen van de thyrocervicale trunk (=a. subclavia)
o Met name de ascending cervicale arterie + externe arteria carotis.
Waldeyer’s tonsillar ring: ring van lymfe-
weefsel in de mucosa die de superieure
openingen in de pharynx (naar de nasale en
orale holten) bewaakt.
- Tubal tonsillen: naast de gehoorgang;
- Pharyngeale tonsillen: in de
posterieure wand + dak van de
nasopharynx;
o “Adenoïden” wanneer ze
vergroot zijn
- Palatine tonsillen: tussen de palatus-
glossal en palatus pharyngeale vouwen
- Linguale tonsillen: lymfoïde nodules
op het posterieure 1/3e deel van tong
, Pharyngeale spieren
- Doen mee aan het slikken: contraheren superieur naar inferieur om de bolus naar
beneden te drukken vanuit de oropharynx en de laryngopharynx in de oesophagus.
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