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samenvatting longen 1
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Dit is een samenvatting van Longen 1. Dit is een zeer goede uitschrijving van wat je moet kennen op het examen.
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2020-2021 Samenvattinghart, longen, nier
en bloed
Partim longen
Kjell Van Rompa
2 BA GENEESKUNDE
,1
,Inhoudsopgave
1. SEMIOLOGIE VAN HET ADEMHALINGSSTELSEL .................................................................................... 10
1.1. ALGEMENE TERMINOLOGIE ....................................................................................................................... 10
1.2. AH-ANAMNESE ...................................................................................................................................... 10
1.3. AH-KLACHTEN ....................................................................................................................................... 10
1.3.1. Algemeen overzicht ....................................................................................................................... 10
1.3.2. Dyspnoe......................................................................................................................................... 10
1.3.3. Wheeze/stridor ............................................................................................................................. 12
1.3.4. Hoest ............................................................................................................................................. 12
1.3.5. Sputum/slijmen/phlegm ............................................................................................................... 14
1.3.6. Hemoptoë ..................................................................................................................................... 14
1.3.7. Pijn op de borst ............................................................................................................................. 15
1.3.8. Snurken ......................................................................................................................................... 15
1.4. LICHAMELIJK ONDERZOEK ......................................................................................................................... 16
1.4.1. Verloop onderzoek ........................................................................................................................ 16
1.4.2. Verschillende thoraxvormen ......................................................................................................... 16
1.4.3. Clubbing ........................................................................................................................................ 17
1.4.4. Erytthema nodosum ...................................................................................................................... 17
1.4.5. Gewicht ......................................................................................................................................... 17
1.4.6. 2 fenotypen van COPD .................................................................................................................. 17
2. STRUCTUUR EN FUNCTIE ..................................................................................................................... 18
2.1. ADEMHALINGSSYSTEEM ........................................................................................................................... 18
2.1.1. Functie........................................................................................................................................... 18
2.1.2. Structuur ....................................................................................................................................... 18
2.2. AFKORTINGEN ........................................................................................................................................ 18
2.3. NORMALE (IDEALE) LONG ......................................................................................................................... 18
2.3.1. Belangrijke waarden ..................................................................................................................... 18
2.3.2. Partiële druk .................................................................................................................................. 18
2.3.3. Ademhalingsproces ....................................................................................................................... 19
2.4. ANATOMIE ............................................................................................................................................ 19
2.4.1. Trachea en bovenste luchtwegen.................................................................................................. 19
2.4.2. Longkwabben ................................................................................................................................ 19
2.4.3. Anatomie volgens het model van Weibel ...................................................................................... 19
2.4.4. Longen: doorsnede ........................................................................................................................ 20
2.4.5. Alveolo-capillaire membraan ........................................................................................................ 20
2.4.6. Alveoli............................................................................................................................................ 20
2.5. VERDEDIGINGSMECHANISMEN ................................................................................................................... 20
3. VENTILATIE (1&2) ................................................................................................................................ 21
3.1. VENTILATIE ............................................................................................................................................ 21
3.2. METING LONGVOLUME VERANDERING ........................................................................................................ 21
3.2.1. Natte spirometer ........................................................................................................................... 21
3.2.2. Longvolumes ................................................................................................................................. 21
3.3. ELASTISCHE EIGENSCHAPPEN VAN LONG EN BORSTKAS .................................................................................... 22
3.3.1. Algemeen ...................................................................................................................................... 22
3.3.2. Theoretisch model ......................................................................................................................... 22
3.3.3. Diagram ........................................................................................................................................ 22
3.4. ADEMHALINGSSPIEREN ............................................................................................................................ 23
3.5. TOTALE VENTILATIE (V’E) VS ALVEOLAIRE VENTILATIE (V’A) .............................................................................. 23
3.5.1. Algemeen ...................................................................................................................................... 23
3.5.2. Hoe V’A en V’D meten? (Fowler methode) ..................................................................................... 24
3.5.3. Fysiologische dode ruimte ............................................................................................................. 24
3.6. VENTILATIE-/PERFUSIEVERDELING NORMALE LONG ........................................................................................ 24
3.7. HELIUM INWAS ...................................................................................................................................... 25
2
, 3.7.1. Werking ......................................................................................................................................... 25
3.7.2. ATP-/BTPS-condities ...................................................................................................................... 25
3.8. BODYPLETHYSMOGRAAF/BODYBOX ............................................................................................................ 25
4. SPIROMETRIE ...................................................................................................................................... 27
4.1. LONGFUNCTIETESTS................................................................................................................................. 27
4.2. INDICATIES VOOR LONGFUNCTIE-ONDERZOEK ............................................................................................... 27
4.3. SPIROGRAM ........................................................................................................................................... 27
4.3.1. Kerntermen ................................................................................................................................... 27
4.3.2. Spirogram...................................................................................................................................... 27
4.3.3. De drie diagrammen ..................................................................................................................... 28
4.3.4. MEFV ............................................................................................................................................. 28
4.3.5. MEFV-MIFV ................................................................................................................................... 28
4.4. RESTRICTIEVE VS OBSTRUCTIEVE GESTOORDE LONGFUNCTIES ........................................................................... 28
4.5. UITVOERING SPIROMETRIE ........................................................................................................................ 29
4.5.1. Inleiding......................................................................................................................................... 29
4.5.2. Standaardisatie ............................................................................................................................. 29
4.5.3. Goede FVC-test.............................................................................................................................. 29
4.5.4. Goede spirometrie: kenmerken ..................................................................................................... 29
4.5.5. FVC-manoeuvre: accepteerbaarheid ............................................................................................. 29
4.6. INTERPRETATIE M.B.V. REFERENTIEWAARDEN ............................................................................................... 30
4.6.1. Algemeen ...................................................................................................................................... 30
4.6.2. Global Lung Function Initiative (GLI) ............................................................................................. 30
4.6.3. Wat is normaal/abnormaal?......................................................................................................... 30
4.6.4. Interpretatie flowchard ................................................................................................................. 30
4.6.5. Ernst van longfunctiestoornis........................................................................................................ 31
4.6.6. Interpretatie spirometrie: voorbeeld ............................................................................................. 31
4.7. ASTMA VS COPD ................................................................................................................................... 31
5. DIFFUSIE.............................................................................................................................................. 32
5.1. ALGEMEEN ............................................................................................................................................ 32
5.2. GASTRANSPORT O.I.V. DIFFUSIE ................................................................................................................. 32
5.2.1. Algemeen ...................................................................................................................................... 32
5.2.2. Wet van Fick .................................................................................................................................. 32
5.2.3. Grafiek........................................................................................................................................... 32
5.3. SINGLE BREATH DIFFUSIEMETING (DL,CO-SB) ............................................................................................... 33
5.3.1. Algemeen ...................................................................................................................................... 33
5.3.2. Verloop .......................................................................................................................................... 33
5.3.3. Standaardisatie ............................................................................................................................. 33
5.3.4. Voorwaarden ................................................................................................................................ 34
5.3.5. Diffusiecapaciteit .......................................................................................................................... 34
5.3.6. Pathologie i.v.m. DL,CO ................................................................................................................... 34
5.3.7. Interpretatie diffusiemetingen ...................................................................................................... 35
6. GASTRANSPORT .................................................................................................................................. 36
6.1. SAMENSTELLING LUCHT MET BIJHORENDE P ................................................................................................. 36
6.2. GASTRANSPORT O2 EN CO2 ...................................................................................................................... 36
6.3. BLOEDGASSEN ........................................................................................................................................ 36
6.3.1. Saturatie........................................................................................................................................ 36
6.3.2. OHDC (OxyHemoglobine DissociatieCurve) ................................................................................... 37
6.3.3. Hypoxie ......................................................................................................................................... 37
6.4. CO2-TRANSPORT .................................................................................................................................... 37
6.4.1. Drie vormen................................................................................................................................... 37
6.4.2. CO2-uitwisseling naar bloed .......................................................................................................... 38
6.5. ZUURTEGRAAD ....................................................................................................................................... 38
6.5.1. Grafiek van Davenport .................................................................................................................. 38
6.5.2. Verstoringen in de grafiek van Davenport .................................................................................... 38
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