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Samenvatting pneumologie Problemen van longen, bloedvormende organen en nieren
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Samenvatting pneumologie Problemen van longen, bloedvormende organen en nieren AJ 23-24 H1-9 (niet H10 en H11)
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Prof. Brusselle AJ 23-24Samenvatting pneumologie: longziekten
Inhoudsopgave
1. Symptomen en klinische tekenen............................................................................................................... 4
1.1. Symptomen............................................................................................................................................. 4
1.1.1. Hoest................................................................................................................................................... 4
1.1.2. Hemoptoe............................................................................................................................................ 5
1.1.3. Thoraxpijn............................................................................................................................................ 6
1.1.4. Piepende ademhaling (= wheezing) en stridor.......................................................................................7
1.1.5. Dyspnoe............................................................................................................................................... 7
1.2. Klinisch onderzoek.................................................................................................................................. 9
1.2.1. Algemene inspectie.............................................................................................................................. 9
1.2.2. Palpatie.............................................................................................................................................. 10
1.2.3. Percussie............................................................................................................................................ 10
1.2.4. Auscultatie......................................................................................................................................... 11
2. Technische onderzoeken........................................................................................................................... 12
2.1. Longfunctie........................................................................................................................................... 12
2.2. Beeldvorming........................................................................................................................................ 15
2.3. Huidtesten............................................................................................................................................ 15
2.4. Labo onderzoek: bloed en sputum......................................................................................................... 15
2.5. Pleurapunctie, pleurabiopsie, pleuroscopie............................................................................................16
2.6. Bronchoscopie....................................................................................................................................... 16
2.7. Mediastinaal onderzoek........................................................................................................................ 17
3. Astma...................................................................................................................................................... 18
3.1. Prevalentie astma.................................................................................................................................. 18
3.2. Pathologie en pathofysiologie astma..................................................................................................... 18
3.3. Oorzaken astma.................................................................................................................................... 20
3.4. Diagnose astma..................................................................................................................................... 21
1
,Prof. Brusselle AJ 23-24
3.5. Behandeling astma................................................................................................................................ 22
4. COPD....................................................................................................................................................... 26
4.1. Definitie COPD...................................................................................................................................... 26
4.2. Pathogenese en pathofysiologie COPD................................................................................................... 26
4.3. Risicofactoren COPD.............................................................................................................................. 27
4.4. Kliniek COPD......................................................................................................................................... 28
4.5. Diagnose COPD..................................................................................................................................... 28
4.6. Verwikkelingen COPD............................................................................................................................ 30
4.7. Prognose COPD..................................................................................................................................... 30
4.8. Behandeling COPD................................................................................................................................ 31
5. Interstitiële longaandoeningen (ILD)......................................................................................................... 34
5.1. Definitie ILD.......................................................................................................................................... 34
5.2. Kliniek ILD............................................................................................................................................. 34
5.3. Pathogenese ILD.................................................................................................................................... 35
5.4. Classificatie ILD..................................................................................................................................... 35
5.4.1. Idiopatische longfibrose (IPF).............................................................................................................. 36
5.4.2. Bindweefselziekten geassocieerde ILD................................................................................................ 37
5.4.3. Overgevoeligheidspneumonitis........................................................................................................... 37
5.4.4. Pneumoconiose.................................................................................................................................. 38
5.4.5. Sarcoïdose.......................................................................................................................................... 39
6. Pulmonary Vascular Diseases (PVD).......................................................................................................... 41
6.1. Longembolen........................................................................................................................................ 41
6.1.1. Veneuze trombo-embolie (VTE).......................................................................................................... 41
6.1.2. Preventie VTE (DVT en LE)................................................................................................................... 41
6.1.3. Klinische presentatie van longembolie................................................................................................ 42
6.1.4. Diagnose LE........................................................................................................................................ 44
6.1.5. Behandeling....................................................................................................................................... 45
6.2. Pulmonale hypertensie.......................................................................................................................... 46
6.2.1. Types PHT........................................................................................................................................... 46
2
,Prof. Brusselle AJ 23-24
6.2.2. Kliniek PHT......................................................................................................................................... 47
6.2.3. Diagnose PHT..................................................................................................................................... 47
7. Slaapapneu.............................................................................................................................................. 48
7.1. Ademstoornissen tijdens de slaap.......................................................................................................... 48
7.2. Obstructief slaapapneu syndroom (OSAS).............................................................................................. 48
7.2.1. Kliniek OSAS....................................................................................................................................... 49
7.2.2. Diagnose OSAS................................................................................................................................... 50
7.2.3. Behandeling OSAS.............................................................................................................................. 50
8. Respiratoir falen....................................................................................................................................... 52
9. Longkanker.............................................................................................................................................. 53
10. Respiratoire infecties.............................................................................................................................. 54
3
, Prof. Brusselle AJ 23-24
1. Symptomen en klinische tekenen
Longziekten: 8 majeure ziektedomeinen
1.1. Symptomen
Anamnese:
Aanmeldklacht? Snurken, (slaap)apneu
Koorts, nachtzweten Beroepsanamnese
Eetlust, gewicht Familiale anamnese
Moe(heid) Blootstelling: huisdieren, asbest, …
Hoest, sputum, hemoptoe Rookgewoonten (wat en hoeveel)
Dyspneu, thoracale pijn Duur
Piepende ademhaling en stridor
1.1.1.Hoest
Duur: acuut of chronisch
Productief: sputum, bloed, …
Uitlokkende factoren en tijdstip: houdingsgebonden hoest, nachtelijke hoest, bronchiale
hyperreactiviteit (BHR)
4
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