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Samenvatting Pathologische fysiologie (Carmeliet)
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Dit document bevat alle hoofdstukken van het deel 'pathologische fysiologie' van ziektemechanismen. Dit vak werd gegeven door prof. Carmeliet.
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INHOUDInleiding................................................................................................................................................................... 5
Situering van de discipline pathologische fysiologie ........................................................................................... 5
Definities ............................................................................................................................................................. 5
Activiteit .......................................................................................................................................................... 5
Pathologisch .................................................................................................................................................... 6
Huidige doodsoorzaken ...................................................................................................................................... 6
Levensexpectantie .............................................................................................................................................. 6
Veroudering ........................................................................................................................................................ 6
Meten van ‘veroudering’................................................................................................................................. 6
Veroudering vs leeftijdsgebonden ziekten...................................................................................................... 6
Cellulaire en moleculaire oorzaken van veroudering...................................................................................... 7
Schade aan macromoleculen ...................................................................................................................... 7
Inadequaat herstel van schade ................................................................................................................... 7
Ontregeling van de homeostase van celaantal ........................................................................................... 8
Kenmerken van veroudering ........................................................................................................................... 8
Veroudering vertragen .................................................................................................................................... 9
Deel I: capita selecta uit de algemene fysiopathologie....................................................................................... 10
Hoofdstuk 1: het ‘local adaptation syndrome’: de acute ontstekingsreactie ....................................................... 10
Inleiding............................................................................................................................................................. 10
Pathofysiologie van de acute ontstekingsreactie.............................................................................................. 10
Fase 1: vasculaire elementen van de ontstekingsreactie.................................................................................. 11
Pathofysiologie .............................................................................................................................................. 11
Biochemische mediatoren ............................................................................................................................ 12
Fase 2: cellulaire elementen van de ontstekingsreactie ................................................................................... 15
Pathofysiologie .............................................................................................................................................. 15
Biochemische aspecten ................................................................................................................................. 16
Stoornissen in de cellulaire fase .................................................................................................................... 17
Verdere evolutie ............................................................................................................................................... 17
Algemene weerslag van de acute ontstekingsreactie ....................................................................................... 18
Hoofdstuk 2: koorts en andere stoornissen van thermoregulatie ........................................................................ 19
Inleiding............................................................................................................................................................. 19
Fysiologie van thermoregulatie......................................................................................................................... 19
Effector-apparaat .......................................................................................................................................... 19
Warmte-productie en aanpassingsmechanismen..................................................................................... 19
Warmte-afgave en aanpassingsmechanismen ......................................................................................... 20
1
, Sensor-apparaat ............................................................................................................................................ 21
Set-point........................................................................................................................................................ 22
Pathofysiologie van de thermoregulatie ........................................................................................................... 22
Koorts ............................................................................................................................................................ 22
Pathofysiologie .......................................................................................................................................... 22
Klinisch voorkomen en begeleidende verschijnselen ............................................................................... 23
Behandeling .............................................................................................................................................. 24
Hyperthermie ................................................................................................................................................ 24
Oorzaken ................................................................................................................................................... 24
Verwikkelingen van hyperthermie ............................................................................................................ 25
Hypothermie ................................................................................................................................................. 25
Hoofdstuk 3: voeding en metabolisme ................................................................................................................. 27
Normale voedingsbehoeften mens ................................................................................................................... 27
Essentiële nutritionele behoeften................................................................................................................. 27
Energie ...................................................................................................................................................... 27
Eiwit........................................................................................................................................................... 27
Lipiden en koolhydraten ........................................................................................................................... 28
Vitaalstoffen .............................................................................................................................................. 28
Water en elektrolyten ............................................................................................................................... 28
Aanbevolen hoeveelheden ........................................................................................................................... 28
Factoren die behoefte aan nutriënten beïnvloeden ..................................................................................... 29
Malnutritie ........................................................................................................................................................ 29
Eiwit – energie............................................................................................................................................... 29
Marasmus-like ........................................................................................................................................... 29
Kwashiorkor-like........................................................................................................................................ 29
Hypometabole en hypermetabole toestanden ............................................................................................. 30
Hormonen ................................................................................................................................................. 30
Hypermetabool: metabolisme – eiwit – glucose....................................................................................... 31
Hypometabool: metabolisme – eiwit – glucose ........................................................................................ 31
Kanker cachexie ............................................................................................................................................ 31
Regeling energiebalans en obesitas .................................................................................................................. 32
Energiebalans ................................................................................................................................................ 32
Energie-inname (appetijt) ......................................................................................................................... 32
Energieverbruik ......................................................................................................................................... 32
Obesitas......................................................................................................................................................... 32
Etiologie .................................................................................................................................................... 33
Pathogenese.............................................................................................................................................. 33
2
,Deel II: stoornissen van homeostasemechanismen ............................................................................................ 34
Hoofdstuk 1: calcium ............................................................................................................................................ 34
Fysiologische aspecten ...................................................................................................................................... 34
Homeostase serum calcium .......................................................................................................................... 34
Voeding en turn-over van bot ....................................................................................................................... 34
Hormonale controle van calciumhomeostase .............................................................................................. 35
Parathyroïdhormoon (parathormoon) ...................................................................................................... 35
Vitamine D................................................................................................................................................. 35
Calcitonine ................................................................................................................................................ 36
Pathofisiologie van calciumhomeostase ........................................................................................................... 36
Hypocalcemie ................................................................................................................................................ 36
Oorzaken ................................................................................................................................................... 36
Symptomen ............................................................................................................................................... 37
Beandeling................................................................................................................................................. 37
hypercalcemie ............................................................................................................................................... 38
Oorzaken ................................................................................................................................................... 38
Symptomen ............................................................................................................................................... 38
Behandeling .............................................................................................................................................. 39
DEEL III: capita selecta uit orgaan- en systeem fysiopathologie ......................................................................... 40
Hoofdstuk 1: Pathofysiologie van ademhalingsstelsel .......................................................................................... 40
Pathofysiologie van hypoxie en hypercapnie.................................................................................................... 40
Hypoxie ......................................................................................................................................................... 41
Oorzaken ................................................................................................................................................... 41
Symptomen en begeleidende verschijnselen ........................................................................................... 41
Hypercapnie .................................................................................................................................................. 42
Oorzaken ................................................................................................................................................... 42
Symptomen en begeleidende verschijnselen ........................................................................................... 42
Belangrijkste vormen van longpathologie ........................................................................................................ 42
Obstructieve aandoeningen .......................................................................................................................... 42
Astma ........................................................................................................................................................ 43
Chronisch obstructief longlijden (COPD) ................................................................................................... 44
Restrictieve aandoeningen............................................................................................................................ 45
Interstitieel longlijden (longparenchym)................................................................................................... 45
Pneumonie (longparenchym) .................................................................................................................... 46
Atelectase (longparenchym) ..................................................................................................................... 46
Pleura ........................................................................................................................................................ 46
Thorax ....................................................................................................................................................... 46
3
, Vasculaire aandoeningen .............................................................................................................................. 46
Pulmonale hypertensie ............................................................................................................................. 46
Longstuwing en longoedeem .................................................................................................................... 47
Longembool .............................................................................................................................................. 47
Hoofdstuk 2: fysiopathologie van cardiovasculair stelsel ..................................................................................... 49
Syncope ............................................................................................................................................................. 49
Circulatoire oorzaken .................................................................................................................................... 49
Syncope door arteriolaire vasodilatatie .................................................................................................... 49
Cardiale vormen van syncope ................................................................................................................... 50
Niet-circulatoire oorzaken ............................................................................................................................ 50
Hartfalen ........................................................................................................................................................... 51
Syptomen ...................................................................................................................................................... 51
Pathofysiologie .............................................................................................................................................. 51
Hartfalen met gedaalde ejectiefractie ...................................................................................................... 51
Hartfalen met bewaarde ejectiefractie ..................................................................................................... 51
Shock ................................................................................................................................................................. 52
Indeling obv pathogenese ............................................................................................................................. 52
Hypovolemische shock .............................................................................................................................. 52
Cardiogene shock ...................................................................................................................................... 52
Algemene pathofysiologie van shock ............................................................................................................ 52
Symptomen ................................................................................................................................................... 53
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