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VOLLEDIGE LESNOTITIES - Lessen Prof. Pattyn
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Een volledig uitgewerkt bestand met lesnotities bij Prof. Pattyn. Bevat alle informatie die in de les behandeld is.
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Problemen van Digestief Stelsel, Endocrien Stelsel en VoedingProf. P. Pattyn
Table of Contents
1. Algemeen ................................................................................................................................. 4
2. Dysfagie ................................................................................................................................... 4
2.1. Divertikel van Zenker ..................................................................................................................... 4
2.1.1. Casus ................................................................................................................................................................. 4
2.1.2. Algemeen .......................................................................................................................................................... 4
2.1.3. Symptomen ....................................................................................................................................................... 5
2.1.4. Behandeling ...................................................................................................................................................... 5
2.2. Achalasie ........................................................................................................................................ 5
2.2.1. Casus ................................................................................................................................................................. 5
2.2.2. Algemeen .......................................................................................................................................................... 6
2.2.3. Behandeling ...................................................................................................................................................... 6
2.2.4. Postop Care ....................................................................................................................................................... 7
2.3. GERD .............................................................................................................................................. 7
2.3.1. Casus ................................................................................................................................................................. 7
2.3.2. Algemeen .......................................................................................................................................................... 7
2.3.3. Investigaties ...................................................................................................................................................... 7
2.3.4. Behandeling ...................................................................................................................................................... 8
2.3.5. Barrett oesophagus ........................................................................................................................................... 8
2.4. Maaghernia .................................................................................................................................... 9
2.4.1. Casus ................................................................................................................................................................. 9
2.4.2. Algemeen .......................................................................................................................................................... 9
2.4.3. Andere diafragmabreuken........................................................................................................ 10
2.5. Drinken van caustische stoffen (destop) ....................................................................................... 10
2.6. Ingeslikte batterijen ..................................................................................................................... 11
2.6.1. Casus ............................................................................................................................................................... 11
2.6.2. Algemeen ........................................................................................................................................................ 11
2.7. Mediastinitis (abces) ten gevolge van slokdarmperforatie ............................................................ 11
2.8. Vreemd voorwerp in de oesofagus ............................................................................................... 11
2.9. Iatrogene slokdarmperforatie....................................................................................................... 11
2.10. Boerhave syndroom ..................................................................................................................... 11
2.11. Slokdarmcarcinoma ...................................................................................................................... 12
2.11.1. Casus .......................................................................................................................................................... 12
2.11.2. Algemeen ................................................................................................................................................... 12
2.11.3. Mechanisme ............................................................................................................................................... 12
2.11.4. Investigaties................................................................................................................................................ 12
2.11.5. Behandeling ................................................................................................................................................ 12
3. Colorectale Carcinomen .......................................................................................................... 14
1
, 3.1. Epidemiologie .............................................................................................................................. 14
3.2. Diagnose ...................................................................................................................................... 14
3.1. Colonoscopie ................................................................................................................................................... 14
3.3. Staging ......................................................................................................................................... 15
3.4. Gemetastaseerde colorectale tumoren......................................................................................... 15
3.5. Niet-gemetastaseerde colontumoren ........................................................................................... 15
3.5.1. Adjuvante behandeling ................................................................................................................................... 15
3.6. Niet-gemetastaseerde rectumtumor ............................................................................................ 16
3.7. Prof. Pattyn en Prof. Boterberg: inleiding ..................................................................................... 16
3.8. Radiotherapie .............................................................................................................................. 17
3.8.1. Timing van radiotherapie ................................................................................................................................ 17
3.8.2. Radiotherapie – Technisch .............................................................................................................................. 17
3.8.3. Nevenwerkingen ............................................................................................................................................. 18
3.9. Chirurgie ...................................................................................................................................... 18
4. Maagproblemen ..................................................................................................................... 20
4.1. Bloedend ulcus ............................................................................................................................. 20
4.2. Perforatie ..................................................................................................................................... 20
4.2.1. Aanpak ................................................................................................................................................................. 20
4.3. Tumoren ...................................................................................................................................... 21
4.3.1. GIST ................................................................................................................................................................. 21
4.3.2. Gastro-Intestinale lymfomen .......................................................................................................................... 21
4.3.3. Carcinoom ....................................................................................................................................................... 22
5. Bariatrische heelkunde ........................................................................................................... 24
5.1. Probleem van overgewicht ........................................................................................................... 24
5.2. Behandeling overgewicht ............................................................................................................. 24
5.3. Type heelkunde ............................................................................................................................ 24
6. IBD ......................................................................................................................................... 27
6.1. Algemeen ..................................................................................................................................... 27
6.2. Colitis Ulcerosa ............................................................................................................................. 28
6.2.1. Kliniek .............................................................................................................................................................. 28
6.2.2. Behandeling .................................................................................................................................................... 29
6.2.3. Toxisch megacolon .......................................................................................................................................... 30
6.2.4. Carcinoma ....................................................................................................................................................... 30
6.2.5. Electieve chirurgie ........................................................................................................................................... 30
6.3. Crohn ........................................................................................................................................... 33
6.3.1. Kliniek .............................................................................................................................................................. 33
6.3.2. Indicatie voor heelkunde ................................................................................................................................ 34
7. Darmpathologie ..................................................................................................................... 35
7.1. Intestinale obstructie ................................................................................................................... 35
7.1.1. Kliniek & investigaties ..................................................................................................................................... 36
7.1.2. Management ................................................................................................................................................... 36
2
, 7.2. Acute Appendicitis ....................................................................................................................... 36
7.2.1. Kliniek .............................................................................................................................................................. 37
7.2.2. Management ................................................................................................................................................... 37
7.3. Divertikel van Meckel ................................................................................................................... 37
7.4. Angiodysplasie ............................................................................................................................. 38
7.4.1 Rood bloedverlies per anum ........................................................................................................................... 38
7.5. Ischemie ....................................................................................................................................... 39
7.5.1 Bloedvoorziening colon ................................................................................................................................... 39
7.5.2 Kliniek .............................................................................................................................................................. 39
7.5.3 Oorzaken ......................................................................................................................................................... 39
7.5.4 Therapie .......................................................................................................................................................... 39
7.6.1 Poliepen ....................................................................................................................................... 39
8. Klinische Les ........................................................................................................................... 40
8.1. Anale incontinentie ...................................................................................................................... 40
8.1.1. Een dame van 75 jaar kan haar huis niet uit wegens schrik voor stoelgangsverlies ....................................... 40
8.1.2. Continentie...................................................................................................................................................... 40
8.1.3. Pseudo-incontinentie ...................................................................................................................................... 40
8.1.4. Overflow incontinentie ................................................................................................................................... 40
8.1.5. Incontinentie met normale bekkenbodemfunctie .......................................................................................... 40
8.1.6. Incontinentie met abnormale pelvische vloer ................................................................................................ 41
8.1.7. Denervatie van de pelvische vloer .................................................................................................................. 41
8.1.8. Uitwerking faecale incontinentie .................................................................................................................... 41
8.1.9. Aanpak ............................................................................................................................................................ 41
8.2. Diverticular Disease ...................................................................................................................... 42
8.2.1. Aanpak ............................................................................................................................................................ 42
9. Casussen ................................................................................................................................. 44
EXTRA ............................................................................................................................................ 47
EXAMEN
MCQ uit grote letters tekstboek
Open vraag of 2: casus oncologisch hoe is het zorgtraject, of uitleggen aan ptt die
overgewichtsprobleem heeft met tekening van bypass (uitleggen met tekening)
3
, 1. Algemeen
Cursus Pattyn: ook kleine letters zijn wel belangrijk om betere punten te scoren. Blokboek is wat je
nodig hebt voor het examen, lessen zijn bedoeld om een geanimeerd verhaal te vertellen.
EXAMEN
MCQ uit grote letters tekstboek
Open vraag of 2: casus oncologisch hoe is het zorgtraject, of uitleggen aan patiënt die
overgewichtsprobleem heeft met tekening van bypass (uitleggen met tekening)
2. Dysfagie
2.1. Divertikel van Zenker
2.1.1. Casus
Man komt consulteren wegens blokkeren van voedsel in de keel (74j)
Anamnese
- Drinken: verslikt zich soms, maar wel gebruikt om toch voedsel te kunnen inslikken.
- Vezelig eten lukt niet (vooral vlees bijvoorbeeld), bij ander voedsel moet gewacht worden tot
het passeert. Duurt soms lang alvorens voedsel zakt.
- Soms is dit benauwend, vrouw is soms ongerust.
- Niet vermagerd.
- Probleem sinds jaren.
- Niet gerookt, geen speciaal alcoholgebruik.
- Recente opname met slikpneumonie
Aanpak
- Endoscopie zou eerste aanpak zijn, maar kan hier gevaarlijk zijn. (Je kan in het divertikel
terechtkomen. Er wordt de eerste 6 cm niet gekeken waar men zit. Men ziet een lumen en
duwt aan.) Alleszins zeker ook denken aan een carcinoom op deze leeftijd!
- RX aangevraagd (omdat bij vermoeden van Zenker endoscopie gevaarlijk kan zijn).
o Zakje te zien hoog aan de oesofagus: divertikel van Zenker
2.1.2. Algemeen
Incidentie: 2/100 000 per jaar. Toch toename de voorbije jaren, omdat het eigen is aan de oudere
bevolking.
Divertikel ontstaat op overgang van pharynx naar slokdarm. De m cricopharyngeus gaat in spasme en
kan zorgen voor een overdruk meer proximaal. In de ruimte van Killians (locus minoris resistentiae,
tussen m cricopharyngeus en constrictor faryngis inferior) kan dan een divertikel ontstaan. De ziekte
heeft dus stappen met divertikel dat steeds groter gaat worden. Zo kan het divertikel dus zelf ook
druk geven op de slokdarm.
Niet enkel de dysfagie door de cricofaryngeus is belangrijk, maar ook die door de druk van het
divertikel op de slokdarm. Dit divertikel is de voorkeursweg voor voedsel.
Voedsel kan beginnen gisten in het divertikel en kan zo ook een slechte adem geven.
= “krop” als het ware zoals bij een duif.
Meestal is het divertikel gevuld met iets en moet de patiënt dit als het ware uitspoelen.
Tijdens endoscopie is anterieur de slokdarm te zien, posterieur een ander “lumen” dat eigenlijk het
divertikel is.
4
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