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Samenvatting Long 1

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Samenvatting van de lessen long 1, pneumologie

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  • December 17, 2023
  • 107
  • 2019/2020
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Inhoudsopgave
HOOFDSTUK 1: SEMIOLOGIE VAN HET ADEMSTELSEL.....................................................................................4
RESPIRATOIRE ANAMNESE.........................................................................................................................................4
RESPIRATOIRE KLACHTEN..........................................................................................................................................4
DYSPNEU...............................................................................................................................................................4
Speciale vormen...............................................................................................................................................5
Oorzaken:.........................................................................................................................................................5
hyperventilatiesyndroom.................................................................................................................................5
DYSPNEU METEN: SUBJECTIEF....................................................................................................................................5
borgschaal........................................................................................................................................................6
Medical research council (MRC).......................................................................................................................6
NYHA................................................................................................................................................................6
Saint George respiratory questionnaire: SGRQ................................................................................................7
BEHANDELING........................................................................................................................................................ 7
WHEEZE/STRIDOR...................................................................................................................................................7
HOEST...................................................................................................................................................................7
(sub) acute hoest..............................................................................................................................................7
chronische hoest...............................................................................................................................................8
SUPTUM/PHLEGM...................................................................................................................................................8
HEMOPTOË............................................................................................................................................................8
oorzaken van hemoptoë...................................................................................................................................9
BORSTPIJN............................................................................................................................................................. 9
borstwand pijn.................................................................................................................................................9
pleuritische pijn................................................................................................................................................9
retrosternale pijn..............................................................................................................................................9
SNURKEN...............................................................................................................................................................9
LICHAMELIJK ONDERZOEK........................................................................................................................................10
inspectie.........................................................................................................................................................10
HOOFDSTUK 2: STRUCTUUR EN FUNCTIE VAN ADEMHALINGSSYSTEEM........................................................12
HOOFDSTUK 3: VENTILATIE.......................................................................................................................... 15
HELIUM-VERDUNNING...........................................................................................................................................17
BODYBOX............................................................................................................................................................17
ADEMHALINGSPIEREN............................................................................................................................................17
TOTALE VENTILATIE V’E VS ALVEOLAIRE VENTILATIE V’A...............................................................................................18
HOOFDSTUK 4: SPIROMETRIE....................................................................................................................... 20
LONGFUNCTIETEST................................................................................................................................................ 20
GLOBAL LUNG FUNCTION INITIATIVE (GLI).................................................................................................................23
Conclusie GLI..................................................................................................................................................23
ASTMA EN COPD.................................................................................................................................................24
HOOFDSTUK 5: DIFFUSIE.............................................................................................................................. 26
CAPACITEIT VAN DE LONG ALS GASWISSELAAR.............................................................................................................26
WET VAN FICK.....................................................................................................................................................26
SINGLE BREATH DIFFUSIE-METING.............................................................................................................................27
HOOFDSTUK 6: GASTRANSPORT................................................................................................................... 29
Gastransport oiv diffusie................................................................................................................................29
Zuur-base evenwicht......................................................................................................................................29
HOOFDSTUK 7: CIRCULATIE.......................................................................................................................... 32
HOOFDSTUK 8: ADEMMECHANICA............................................................................................................... 35
ELASTICITEIT........................................................................................................................................................37
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,HOOFDSTUK 9: ADEMREGULATIE................................................................................................................. 38
ADEMHALINGSFEEDBACK........................................................................................................................................40
CONCLUSIES.........................................................................................................................................................43
HOOFDSTUK 10: VENTILATIE-PERFUSIE VERHOUDINGEN..............................................................................44
HYPOVENTILATIE...................................................................................................................................................44
HOOFDSTUK 11: BLOEDGASSEN................................................................................................................... 48
HOOFDSTUK 12: LONGFUNCTIE.................................................................................................................... 54
statische longvolumes....................................................................................................................................54
HOOFDSTUK 13: ERGOMETRIE..................................................................................................................... 55
CARDIO PULMONAIRE OEFENING TEST.......................................................................................................................55

HOOFDSTUK 14: PATHOLOGIE VAN LONGZIEKTEN (NIET-NEOPLASTISCH).....................................................58
HISTOPATHOLOGISCHE PATRONEN............................................................................................................................58
Acute longschade  diffuse alveoliare schade DAD.........................................................................................58
Neonatal respiratory distress syndroom.......................................................................................................59
Acute (lobaire) pneumonie............................................................................................................................59
Acute lobaire pneumonie...............................................................................................................................59
Chronische diffuse interstitiele longziekten..................................................................................................59
Acute bronchiolitis.........................................................................................................................................59
Bronchiolitis Obliterans syndroom................................................................................................................60
Chronische bronchitis....................................................................................................................................60
Emfyseem.......................................................................................................................................................60
Astma.............................................................................................................................................................61
Granulomateuze ontsteking..........................................................................................................................61
Granulomateuze ziekten van de long:...........................................................................................................61
Sarcoidose en de patholoog...........................................................................................................................63
Pneumoconiosis.............................................................................................................................................63
Hypersensiviteits pneumonitis (extrinsieke allergische alveolitis)................................................................65
Neuromusculaire ziekten en longziekten......................................................................................................65
Fetal akinesia sequence.................................................................................................................................65
Specifieke oorzaken acute longschade...........................................................................................................65
HOOFDSTUK 15: OBSTRUCTIEVE SLAAPAPNEU.............................................................................................67
DEFINITIE “SLAAPAPNEUSYNDROOM” SAS.................................................................................................................67
DIAGNOSE............................................................................................................................................................69
Polysomnografie............................................................................................................................................69
Cardiovasculaire effecten...............................................................................................................................71
behandeling....................................................................................................................................................72
HOOFDSTUK 16: CENTRAAL SLAAPAPNEUSYNDROOM CSAS.........................................................................73
HOOFDSTUK 17: NACHTELIJKE HYPOVENTILATIE.......................................................................................... 77
OBESITAS HYPOVENTILATIE SYNDROOM OHS.............................................................................................................78
CONCLUSIES.........................................................................................................................................................79

HOOFDSTUK 18: BEELDVORMING VAN DE THORAX......................................................................................80
HOOFDSTUK 19: DIEPTE EN HOOGTE FYSIOLOGIE......................................................................................... 81
HOOGTE............................................................................................................................................................. 81
hypoxie...........................................................................................................................................................82
Lichamelijke probelemen en toepassingen....................................................................................................84
besluiten op hoogte........................................................................................................................................85
DIEPTE................................................................................................................................................................86
Barotraumata bij duikers...............................................................................................................................88

2

, Decompressie aandoeningen bij Scuba..........................................................................................................90
besluiten op diepte.........................................................................................................................................90
HOOFDSTUK 20: MAATSCHAPPELIJKE ASPECTEN VAN ROKEN.......................................................................91
EMANCIPATIE.......................................................................................................................................................91
TECHNOLOGIE EN DESIGN........................................................................................................................................91
VERANDERE MINDSET: ROOKVRIJE STRATEN................................................................................................................92
CONCLUSIE..........................................................................................................................................................92
HOOFDSTUK 21: ROOKSTOPINTERVENTIE.................................................................................................... 93
HOOFDSTUK 22: BREATHOMICS................................................................................................................... 94
HOOFDSTUK 23: RESPIRATOIRE INSUFFICIËNTIE........................................................................................... 95
ZUURSTOFTHERAPIE.............................................................................................................................................101
CONCLUSIES.......................................................................................................................................................103

HOOFDSTUK 24: RESPIRATOIRE KINESITHERAPIE........................................................................................104
ADEMHALINGSFYSIOLOGIE.....................................................................................................................................104
RESPIRATOIRE INSUFFICIENTIE................................................................................................................................104
INTRAPULMONAIRE PRECUSSIVE VENTILATIE..............................................................................................................104
HOEST ASSISTENTIE..............................................................................................................................................105

HOOFDSTUK 25: KLINISCHE VOORBEELDEN: RESTRICTIEF EN OBSTRUCTIEF.................................................106
HOOFDSTUK 26: ROOKSTOP....................................................................................................................... 107




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, HOOFDSTUK 1: SEMIOLOGIE VAN HET ADEMSTELSEL
Leer der ziekteklachten en tekenen
- Symptoom/klacht: subjectieve beschrijving door pt van een wijziging in
het lichaam of functie die op aandoening wijst
- Teken: afwijking bij lichamelijk onderzoek
- Syndroom: specifiek complex van symptomen en/of tekenen die naar
oorzaken verwijst
- Test: objectieve meting verricht aan bed of in lab/afdeling


RESPIRATOIRE ANAMNESE
1) Medische antecedentenk
2) Familiale anamnese
a. Astma, cystische fibrose (muco)
b. Kanker  komt met clusters van symptomen
3) Roken?
a. 1 pakje sigaretten/dag gedurende 1 jaar = 1 pakjaar
b. 20 jaar ½ pakje roken/dag = 10 pakjaar
c. Hoeveel, hoelang, wat, gestopt?
4) Professioneel – hobbies
a. Blootstelling aan mineralen, dampen, asbest
b. Dieren en vogels
c. Duur blootstelling


RESPIRATOIRE KLACHTEN
Kortademigheid = dyspneu
Hoest
Sputum = expectoratie
Bloed ophoesten = hemoptoë
Pijn op de borst = precordialgie
Piepen
Snurken


DYSPNEU
= ontregelde adem
 Subjectieve ervaring van verhoogde ademarbeid (kwalitatief
onderscheiden sensaties die in intensiteit variëren
 Fysiologisch bij inspanning
 Pathologisch in rust of bij beperkte inspanning
 Complexe en multifactoriële mechanismen  centraal en perifeer een bron
hebben
 Onevenwicht tussen neurogene stimulatie van ademspieren en ventilatie
die bereikt wordt door deze spieren




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