Summary

Samenvatting spijsvertering deel 1

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Course
Spijsvertering (BKULE0C09A)

Institution
Katholieke Universiteit Leuven (KU Leuven)

Samenvatting van het vak spijsvertering van de eerste master geneeskunde aan de KU Leuven. Dit is enkel deel 1, omdat het volledige bestand te groot is om in 1 keer te uploaden. Deel 2 is ook beschikbaar. Beide delen kunnen ook aangekocht worden in een voordeelbundel. Voorbeeldpagina's kunnen gezie...

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Uploaded on September 5, 2023
Number of pages 130
Written in 2022/2023
Type Summary

spijsvertering
gastro enterologie
geneeskunde
master geneeskunde
master
ku leuven

Institution
Katholieke Universiteit Leuven (KU Leuven)
Education
Geneeskunde
Course
Spijsvertering (BKULE0C09A)

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1. Summary - Samenvatting spijsvertering deel 1
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SPIJSVERTERING

INHOUDSOPGAVE

Inleiding (geen leerstof) ................................................................................................................................ 12

H1: Goedaardige aandoeningen slokdarm, maag en duodenum.................................................................... 14
1. Aandoeningen van de slokdarm .................................................................................................................... 14
1.1 Symptomen en diagnostiek van slokdarmaandoeningen ....................................................................... 14
Dysfagie .................................................................................................................................................... 14
Odynofagie ............................................................................................................................................... 15
Pyrosis en regurgitatie ............................................................................................................................. 15
Thoracale pijn ........................................................................................................................................... 15
Globusgevoel ............................................................................................................................................ 15
Secundair.................................................................................................................................................. 15
1.2 Technische onderzoeken bij slokdarmziekten ........................................................................................ 15
Endoscopie en biopsie.............................................................................................................................. 15
Manometrisch onderzoek ........................................................................................................................ 16
pH meting ................................................................................................................................................. 16
Radiologische onderzoeken ..................................................................................................................... 16
1.3 Gastro-oesofagale refluxziekte ............................................................................................................... 16
Presentatie ............................................................................................................................................... 17
Etiopathogenese ...................................................................................................................................... 17
Graden van reflux en refluxziekte ............................................................................................................ 17
Betekenis van de aanwezigheid van metaplastisch cilindercellig epitheel .............................................. 18
Diagnostische evaluatie bij een patiënt met refluxziekte ........................................................................ 18
Behandelingsmogelijkheden .................................................................................................................... 19
Praktisch therapieschema ........................................................................................................................ 20
1.4 Motorische stoornissen van de slokdarm (zz, geen details kennen) ...................................................... 21
Primaire motiliteitsstoornissen van de slokdarm..................................................................................... 21
Secundaire motoriekstoornissen van de slokdarm .................................................................................. 22
Eosinofiele esofagitis ................................................................................................................................ 22
Oesofagale ring of diafragma ................................................................................................................... 23
1.5 Candidiase van de slokdarm ................................................................................................................... 23
Virale oesofagitis ...................................................................................................................................... 24
1.6 Caustische esofagitis (niet in hb) ............................................................................................................ 24
1.7 Tumoren van de slokdarm (niet in hb) ................................................................................................... 24
Take home .................................................................................................................................................... 24
2. Aandoeningen van maag en duodenum ....................................................................................................... 24
2.1 Diagnose van een Helicobacter Pylori infectie ....................................................................................... 25
2.2 Behandeling van een HP infectie ............................................................................................................ 25
2.3 Maag- en duodenumulcus ...................................................................................................................... 25
Presentatie ............................................................................................................................................... 25
Definitie en lokalisatie .............................................................................................................................. 25
Pathogenese ............................................................................................................................................. 26
Diagnose ................................................................................................................................................... 27
Behandeling.............................................................................................................................................. 27
Verwikkelingen ......................................................................................................................................... 27

1

, 2.4 Syndroom van Zollinger-Ellison .............................................................................................................. 30
2.5 Acute diarreee ........................................................................................................................................ 31
2.6 Congenitale aandoeningen van maag en duodenum ............................................................................. 31
3. Inleiding tot de abdominale heelkunde ......................................................................................................... 31
Inleiding ........................................................................................................................................................ 31
3.1 Laparotomie ........................................................................................................................................... 32
3.2 Laparoscopie ........................................................................................................................................... 32
3.3 Minimaal invasieve technieken .............................................................................................................. 32
3.4 Viscerale anatomie ................................................................................................................................. 32
3.5 Basis voor de oncologische resectie van GI-tumoren ............................................................................ 33
3.6 Darmanastomose ................................................................................................................................... 33
Anastomoselek ......................................................................................................................................... 33
3.7 Stoma ...................................................................................................................................................... 33
3.8 Postoperatieve morbiditeit en mortaliteit ............................................................................................. 34
4. Morbide obesitas – metabole chirurgie ........................................................................................................ 34
Inleiding ........................................................................................................................................................ 34
4.1 Techniek van meest voorkomende procedures ..................................................................................... 35
Mason gastroplastie ................................................................................................................................. 35
Laparoscopische gastric banding.............................................................................................................. 35
Laparoscopische Roux-en-Y gastric bypass (RYGB) .................................................................................. 35
Sleeve gastrectomie ................................................................................................................................. 36
Nieuwe procedures .................................................................................................................................. 36
4.2 Indicaties................................................................................................................................................. 37
4.3 Complicaties ........................................................................................................................................... 38
Korte termijn complicaties ....................................................................................................................... 38
Lange termijn complicaties ...................................................................................................................... 39
4.4 Follow-up na bariatrische chirurgie ........................................................................................................ 40
4.5 Conclusies en toekomstperspectieven ................................................................................................... 40

H2: Goedaardige aandoeningen dunne darm, colon en rectum ..................................................................... 41
Studiedoelstellingen .......................................................................................................................................... 41
1. Ziekten gekenmerkt door malabsorptie ........................................................................................................ 41
1.1 Wat is malabsorptie? .............................................................................................................................. 41
1.2 Klinisch relevante malabsorptie ............................................................................................................. 41
Presentatie ............................................................................................................................................... 41
Malabsorptie van vetten .......................................................................................................................... 41
Malabsorptie van koolhydraten ............................................................................................................... 43
Malabsorptie van proteïnen..................................................................................................................... 43
Bijzondere klinische symptomen van malabsorptie................................................................................. 43
2. Coeliakie ........................................................................................................................................................ 44
Presentatie ................................................................................................................................................... 44
2.1 Definitie .................................................................................................................................................. 44
2.2 Etiologie en pathogenese ....................................................................................................................... 44
Diagnose (histopathologie) ...................................................................................................................... 44
Verwikkelingen ......................................................................................................................................... 45
Behandeling.............................................................................................................................................. 45
3. Bacteriële overgroei in de dunne darm ......................................................................................................... 45
Presentatie ................................................................................................................................................... 45
3.1 Oorzaken................................................................................................................................................. 45
3.2 Mechanismen ......................................................................................................................................... 46
3.3 Diagnose ................................................................................................................................................. 46

2

, 3.4 Behandeling ............................................................................................................................................ 46
4. Congenitale aandoeningen van de dunne darm ........................................................................................... 46
5. Pathologie van de appendix .......................................................................................................................... 46
5.1 Anatomie ................................................................................................................................................ 46
5.2 Acute appendicitis .................................................................................................................................. 46
Diagnose ................................................................................................................................................... 47
Behandeling.............................................................................................................................................. 47
Valkuilen en moeilijkheden ...................................................................................................................... 48
Pathologie ................................................................................................................................................ 48
6. Inflammatoire darmaandoeningen ............................................................................................................... 48
Presentatie ................................................................................................................................................... 49
6.1 Samenvatting .......................................................................................................................................... 49
6.2 Wat zijn inflammatoire darmziekten? .................................................................................................... 49
6.3 Incidentie ................................................................................................................................................ 49
6.4 Geografische verspreiding ...................................................................................................................... 49
6.5 Erfelijkheid .............................................................................................................................................. 50
6.6 Risicofactoren ......................................................................................................................................... 50
6.7 Immunologie ........................................................................................................................................... 50
6.8 Bacteriën................................................................................................................................................. 50
6.9 Pathologie ............................................................................................................................................... 50
6.10 Extra-intestinale manifestaties ............................................................................................................. 51
6.11 Classificaties van IBD ............................................................................................................................ 51
De Montreal-classificatie van de ziekte van Crohn .................................................................................. 51
De Montreal-classificatie van colitis ulcerosa .......................................................................................... 52
Diagnose ....................................................................................................................................................... 52
Labo .......................................................................................................................................................... 52
Differentiaaldiagnose ............................................................................................................................... 52
Behandeling .................................................................................................................................................. 53
Medische behandeling en doelstellingen van de behandeling ................................................................ 53
Complicaties ............................................................................................................................................. 56
7. Chirurgische aspecten van inflammatoire darmziekten ................................................................................ 57
7.1 De ziekte van Crohn ................................................................................................................................ 57
7.2 Stenoserende ziekte ............................................................................................................................... 57
Presentatie ............................................................................................................................................... 57
Inleiding .................................................................................................................................................... 57
Diagnose ................................................................................................................................................... 57
Chirurgische behandeling ......................................................................................................................... 58
7.3 Fistulerende ziekte ................................................................................................................................. 58
Presentatie ............................................................................................................................................... 58
Inleiding .................................................................................................................................................... 59
Preoperatieve beeldvorming.................................................................................................................... 59
Chirurgische behandeling ......................................................................................................................... 59
Postoperatieve therapie........................................................................................................................... 59
7.4 Anale Crohn ............................................................................................................................................ 60
7.5 Colitis ulcerosa ........................................................................................................................................ 60
Presentatie ............................................................................................................................................... 60
Indicaties voor heelkunde ........................................................................................................................ 60
Type heelkunde ........................................................................................................................................ 61
Ileostoma.................................................................................................................................................. 62
8. Verwikkelingen van radio-enteritis en radiorectitis ...................................................................................... 62
Presentatie ................................................................................................................................................... 62
8.1 Oorzaken en voorkomen ........................................................................................................................ 62

3

, 8.2 Pathologie ............................................................................................................................................... 62
8.3 Lokalisatie ............................................................................................................................................... 63
8.4 Differentieeldiagnose ............................................................................................................................. 63
8.5 Behandeling ............................................................................................................................................ 63
9. Invaginatie .................................................................................................................................................... 63
Presentatie ................................................................................................................................................... 63
9.1 Pathologie ............................................................................................................................................... 63
9.2 Klinische tekens ...................................................................................................................................... 63
9.3 Diagnose ................................................................................................................................................. 63
9.4 Verwikkelingen ....................................................................................................................................... 64
9.5 Behandeling ............................................................................................................................................ 64
9.6 Prognose ................................................................................................................................................. 64
10. Volvulus ....................................................................................................................................................... 64
Presentatie ................................................................................................................................................... 64
10.1 Pathologie ............................................................................................................................................. 64
10.2 Diagnose ............................................................................................................................................... 65
10.3 Evolutie ................................................................................................................................................. 65
10.4 Behandeling .......................................................................................................................................... 65
11. Diverticulose en diverticulitis ...................................................................................................................... 65
Definitie ........................................................................................................................................................ 65
11.1 Epidemiologie ....................................................................................................................................... 65
11.2 Pathogenese ......................................................................................................................................... 65
11.3 Acute diverticulitis ................................................................................................................................ 66
Presentatie ............................................................................................................................................... 66
Diagnose ................................................................................................................................................... 66
Behandeling.............................................................................................................................................. 66
11.4 recidiverende diverticulitis ................................................................................................................... 66
11.5 Sigmoidfistels ........................................................................................................................................ 67
11.6 Diverticumaire bloeding ....................................................................................................................... 67
11.7 Heelkunde voor diverticulitis en verwikkelingen .................................................................................. 67
Electieve sigmoidresectie ......................................................................................................................... 67
Heelkunde voor Hinchey 3 (purulente peritonitis)................................................................................... 67
Heelkunde voor Hinchey 4 (fecale peritonitis) ......................................................................................... 68
11.8 Speciale gevallen .................................................................................................................................. 68
12. Endometriose .............................................................................................................................................. 68
Presentatie ................................................................................................................................................... 68
Definitie ........................................................................................................................................................ 68
12.1 Epidemiologie ....................................................................................................................................... 69
12.2 Pathogenese ......................................................................................................................................... 69
12.3 Pathologie ............................................................................................................................................. 69
12.4 Diagnose ............................................................................................................................................... 69
12.5 Transvaginale echografie ................................................................................................................. 70
12.6 RX colon (bariumenema) .................................................................................................................. 70
12.7 MR .................................................................................................................................................... 70
Exploratieve laparoscopie ........................................................................................................................ 70
12.8 Behandeling .......................................................................................................................................... 70
Algemene principes .................................................................................................................................. 70
Dunne darm en appendix ......................................................................................................................... 71
Prognose .................................................................................................................................................. 71
13. Vasculaire insufficiëntie van de darm ......................................................................................................... 71
13.1 Bemerkingen vooraf ............................................................................................................................. 71
13.2 Angor abdominalis ................................................................................................................................ 71

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