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By: mirtheverplaetse • 4 months ago
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PROPEDEUTICAINHOUDSOPGAVE
Algemene inleiding .......................................................................................................................................... 6
Methoden ........................................................................................................................................................... 6
Inspectie ........................................................................................................................................................ 7
Palpatie .......................................................................................................................................................... 7
Percussie ........................................................................................................................................................ 8
Auscultatie ..................................................................................................................................................... 9
Instrumenten .................................................................................................................................................... 10
Percussiehamer en plessimeter................................................................................................................... 10
Reflexhamer ................................................................................................................................................ 10
Stethoscoop ................................................................................................................................................. 10
Thermometer .............................................................................................................................................. 11
Bloeddrukmeters ......................................................................................................................................... 11
Klinisch onderzoek (KOZ) .................................................................................................................................. 14
Signalement ................................................................................................................................................. 14
Anamnese .................................................................................................................................................... 16
Algemene indruk ......................................................................................................................................... 18
Algemeen KOZ ............................................................................................................................................. 20
Specifiek KOZ ............................................................................................................................................... 21
Bloed .............................................................................................................................................................. 21
Bloedstaalname ................................................................................................................................................ 21
Indicatie, voorbereiding en dierfixatie ........................................................................................................ 22
Bloednametechniek ..................................................................................................................................... 22
Recipiënten .................................................................................................................................................. 23
Bewaring ...................................................................................................................................................... 24
Pre-analytische fouten ................................................................................................................................ 24
Macroscopische beoordeling ............................................................................................................................ 25
Analyse van staal .............................................................................................................................................. 25
Bewaring en transport ................................................................................................................................. 25
Wie doet analyse? ....................................................................................................................................... 25
Wat is normaal? Wat is afwijkend? ............................................................................................................. 26
Analytische fouten ....................................................................................................................................... 26
Hematologie ..................................................................................................................................................... 27
Rode bloedcellen ......................................................................................................................................... 29
Witte bloedcellen ........................................................................................................................................ 33
Neutrofielen ............................................................................................................................................ 33
Lymfocyten ............................................................................................................................................. 34
Monocyten .............................................................................................................................................. 35
Eosinofielen ............................................................................................................................................ 35
Basofielen ............................................................................................................................................... 35
Leukogram .............................................................................................................................................. 35
1
, Bloedplaatjes/thrombocyten ...................................................................................................................... 36
Biochemie ......................................................................................................................................................... 37
Totaal serum eiwit ....................................................................................................................................... 37
Albumine ..................................................................................................................................................... 38
-globulines ................................................................................................................................................. 39
-globulines ................................................................................................................................................. 39
-globulines .................................................................................................................................................. 39
Bilirubine (lever) .......................................................................................................................................... 40
Galzuren (lever) ........................................................................................................................................... 40
Ammoniak (lever) ........................................................................................................................................ 40
Leverenzymen ............................................................................................................................................. 41
Ureum & creatinine (nier) ........................................................................................................................... 41
Glucose (energiemerker) ............................................................................................................................. 41
Triglyceriden ................................................................................................................................................ 42
NEFA, vrije vetzuren .................................................................................................................................... 42
Ketonen ....................................................................................................................................................... 42
Lactaat ......................................................................................................................................................... 42
Enzymen ...................................................................................................................................................... 43
Ionen ............................................................................................................................................................ 45
Sporenelementen ........................................................................................................................................ 47
Bloedgasanalyse ............................................................................................................................................... 48
Bijkomend onderzoek ....................................................................................................................................... 48
Post-analytische fouten .................................................................................................................................... 48
Casus ................................................................................................................................................................ 48
Circulatiestelsel .............................................................................................................................................. 49
Anamnese & algemene indruk ......................................................................................................................... 49
Dyspnee & vermoeidheid ............................................................................................................................ 50
Hoesten ....................................................................................................................................................... 51
Oedeem ....................................................................................................................................................... 51
(Pre)syncope ................................................................................................................................................ 51
Overige verschijnselen + bijkomende vragen .............................................................................................. 51
Specifiek klinisch onderzoek ............................................................................................................................. 52
Arterieel systeem: pols ................................................................................................................................ 52
Capillair systeem: slijmvliezen/mucosae ..................................................................................................... 56
Veneus systeem ........................................................................................................................................... 56
Hart .............................................................................................................................................................. 58
Harttonen ............................................................................................................................................... 59
Hartruis of bijgeruis ................................................................................................................................ 60
Hartfrequentie ........................................................................................................................................ 63
Hartritme ................................................................................................................................................ 64
Auscultatie: praktische uitvoering & adviezen ....................................................................................... 65
Bijkomend onderzoek ....................................................................................................................................... 65
Medische beeldvorming .............................................................................................................................. 65
Hartcathetirisatie ......................................................................................................................................... 65
Bloedonderzoek ........................................................................................................................................... 65
2
, ECG .............................................................................................................................................................. 66
Indicaties ................................................................................................................................................. 66
Plaatsing elektrodes ................................................................................................................................ 66
Interpretatie ........................................................................................................................................... 67
Bloeddruk .................................................................................................................................................... 69
Nier ................................................................................................................................................................ 69
Fysiologie nier & urinelozing: basisconcepten .................................................................................................. 69
Werking nier ................................................................................................................................................ 69
Urineopslag.................................................................................................................................................. 70
Mictio/urinelozing ....................................................................................................................................... 71
Signalement nierpatiënt ................................................................................................................................... 71
Anamnese & algemene indruk ......................................................................................................................... 71
Waar het probleem: pre-renaal, renaal, postrenaal ................................................................................... 71
Wat heeft de eigenaar gezien? .................................................................................................................... 72
Kleur/geur van de urine .......................................................................................................................... 72
Manier/frequentie van urineren............................................................................................................. 72
PU/PD...................................................................................................................................................... 73
Gastro-intestinale symptomen ............................................................................................................... 73
Niet-specifieke symptomen .................................................................................................................... 73
Is het primair probleem, of secundair aan andere aandoening? ................................................................ 73
Klinisch onderzoek ............................................................................................................................................ 74
Algemene symptomen die wijzen op nierprobleem ................................................................................... 74
Onderzoek nieren ........................................................................................................................................ 74
Onderzoek ureters ....................................................................................................................................... 75
Onderzoek blaas & urethra ......................................................................................................................... 75
Onderzoek penis & vulva ............................................................................................................................. 76
Verzamelen urine ........................................................................................................................................ 76
Belang van urineonderzoek in stellen van diagnose ............................................................................... 76
Uitvoeren van een urinestaalname ........................................................................................................ 77
Mictio........................................................................................................................................................... 78
Specifiek onderzoek .......................................................................................................................................... 78
Aanwijzingen uit het bloedonderzoek ......................................................................................................... 78
Hematologie ........................................................................................................................................... 78
Biochemie ............................................................................................................................................... 79
Urineonderzoek ........................................................................................................................................... 81
Indicaties ................................................................................................................................................. 81
Macroscopisch onderzoek ...................................................................................................................... 81
pH............................................................................................................................................................ 82
Densiteit .................................................................................................................................................. 82
Glucose, ketonen, eiwit, bilirubine, nitrieten ......................................................................................... 83
Sediment ................................................................................................................................................. 84
Testen om nierfunctie in te schatten .......................................................................................................... 85
Beeldvorming, endoscopie, cytologie & histopathologie ............................................................................ 85
Stomatologie .................................................................................................................................................. 86
Onderzoek mondholte hond & kat ................................................................................................................... 86
3
, De tand ........................................................................................................................................................ 86
Gebit van de hond ....................................................................................................................................... 88
Tandnummering: Triadan systeem .............................................................................................................. 89
Occlusie of beetrelatie bij de hond .............................................................................................................. 90
Schedeltypes ................................................................................................................................................ 90
Gebit van de kat........................................................................................................................................... 90
Occlusie of beetrelatie bij de kat ................................................................................................................. 91
Anamnese .................................................................................................................................................... 92
Wakker onderzoek....................................................................................................................................... 93
Inspectie mondholte.................................................................................................................................... 93
Onderzoek bij verdoofde patiënt ................................................................................................................ 96
Onderzoek paardengebit .................................................................................................................................. 97
Mondonderzoek ........................................................................................................................................ 101
Gastro-intestinaal stelsel.............................................................................................................................. 103
Signalement.................................................................................................................................................... 103
Anamnese & algemene indruk ....................................................................................................................... 103
Wat heeft eigenaar gezien? ....................................................................................................................... 103
Bijkomende vragen .................................................................................................................................... 105
Klinisch onderzoek .......................................................................................................................................... 106
Uitwendig onderzoek kop.......................................................................................................................... 106
Mondholte ................................................................................................................................................. 107
Slokdarm .................................................................................................................................................... 108
Abdomen: maag-darmstelsel .................................................................................................................... 109
Uitzicht abdomen ................................................................................................................................. 109
Palpatie ................................................................................................................................................. 110
Succutie................................................................................................................................................. 111
Percussie: rund ..................................................................................................................................... 112
Pijnproeven ........................................................................................................................................... 112
Auscultatie ............................................................................................................................................ 113
Rectaal onderzoek ................................................................................................................................ 113
Lever .......................................................................................................................................................... 115
Milt ............................................................................................................................................................ 115
Rectum, anus & omgeving ......................................................................................................................... 116
Specifiek onderzoek ........................................................................................................................................ 116
Ademhalingsstelsel ...................................................................................................................................... 119
Anamnese & algemene indruk ....................................................................................................................... 119
Neusvloei ................................................................................................................................................... 119
Stridor ........................................................................................................................................................ 120
Niezen & ‘reverse sneezing’ ...................................................................................................................... 121
Hoesten ..................................................................................................................................................... 121
Dyspnee ..................................................................................................................................................... 122
Abnormale stem & kreunen ...................................................................................................................... 122
Hik .............................................................................................................................................................. 123
Andere cruciale info .................................................................................................................................. 123
Specifiek klinisch onderzoek ........................................................................................................................... 123
4
, Ademhalingsbewegingen .......................................................................................................................... 124
Diepte ................................................................................................................................................... 124
Type ...................................................................................................................................................... 124
Dyspnee ................................................................................................................................................ 125
Ritme ..................................................................................................................................................... 125
Frequentie............................................................................................................................................. 125
Ademhalingspatroon ................................................................................................................................. 126
Neus ........................................................................................................................................................... 127
Sinussen ..................................................................................................................................................... 130
Mond & keelstreek .................................................................................................................................... 131
Uitwendig onderzoek ............................................................................................................................ 131
Inwendig onderzoek ............................................................................................................................. 132
Trachea ...................................................................................................................................................... 133
Thorax ........................................................................................................................................................ 134
Bijkomende onderzoeken .......................................................................................................................... 137
Orthopedie................................................................................................................................................... 139
Iatrope probleem ............................................................................................................................................ 139
Signalement.................................................................................................................................................... 140
Anamnese ....................................................................................................................................................... 142
Lichamelijk onderzoek .................................................................................................................................... 143
Inspectie .................................................................................................................................................... 143
Stilstaand .............................................................................................................................................. 143
Beweging .............................................................................................................................................. 144
Palpatie ...................................................................................................................................................... 150
Aanvullende klinische diagnosemiddelen (bevestiging/verder zoeken) ................................................... 154
Bijkomend onderzoek ..................................................................................................................................... 155
Oefeningen bloedonderzoek ........................................................................................................................ 157
Oefening 1 ...................................................................................................................................................... 157
Oefening 2 ...................................................................................................................................................... 158
Oefening 3 ...................................................................................................................................................... 160
Oefening 4 ...................................................................................................................................................... 161
Oefening 5 ...................................................................................................................................................... 162
Oefening 6 ...................................................................................................................................................... 163
Voorbeeld examenvraag 1 ............................................................................................................................. 163
Voorbeeld examenvraag 2 ............................................................................................................................. 164
Voorbeeld examenvraag 3 ............................................................................................................................. 164
5
,ALGEMENE INLEIDING
• Examen
o 50 MC vragen met 4 opties
o Verhoogde cesuur: 31/50 = 10/20
o Theoretische vragen: kennis
o Toepassingen/inzichtsvragen: bvb bloedanalyses en interpretatie urine
o Klinische casus
o Herkennen van symptomen op beeldmateriaal en geluidsopnames (bvb hart-
of longgeluiden)
• Propaedeutica = voorbereidend onderzoek (KOZ) om finaal tot een actie
(behandelen, genezen) te kunnen overgaan
• Hoe meer tijd je besteed aan KOZ, hoe efficiënter het therapeutisch handelen
• Waarom?
o Probleem van het dier en de eigenaar aanpakken/oplossen door een diagnose
te stellen en daaruitvloeiende behandeling in te stellen
o Het effect van een behandeling te leren evalueren (hercontrole)
o Diagnostische therapie
o Gerichte verzoeken van de eigenaar uitvoeren
▪ Bvb
gezondheidscontrole,
vaccinatie, controle
op rasgebonden
afwijkingen,
aankooponderzoek,
import, certificering,
...
• Hoe? (zie schema)
o Als het een spoedgeval is
andere procedures
o Niet stoppen met onderzoek
als je iets vindt, ook de rest
onderzoeken
METHODEN
• Zintuiglijke waarnemingen
o Gezichtsvermogen → inspectie
▪ Vorm, kleur, beweging
o Tastzin → palpatie
▪ Vorm, consistentie, T°
6
, o Reukzin
▪ Huid, oren, mond
▪ Bij subklinische mastitis smaakt melk zouter door beschadigde bloed-
melkbarrière
• Hulp van instrumenten bvb stethoscoop, thermometer
INSPECTIE
• Algemene inspectie
o Visuele waarneming van gehele dier
o Goed verlichte ruimte (zie hoofdstuk algemene indruk)
• Lokale inspectie
o Bepaalde handelingen
o Soms focale lichtbron
o Specifieke instrumenten (zie afzonderlijke orgaanstelsels)
PALPATIE
• Voorzichtig tasten; bij te hard drukken:
o Verlies van sensorisch gevoel in vingertoppen
o Wegdrukken van te onderzoeken structuren, vnl in buikholte
o Pijnreacties bij dier
• Extra handelingen om waarneming uit te breiden: undulatieproef
o Voor de vaststelling van vrij vocht in buikholte (ascites)
o Uitvoering:
▪ Je gaat achter dier staan
▪ Aan ene zijde leg je je vlakke hand als een detector
tegen de buik
▪ Met vingers van andere hand geef je een korte tik
tegen buikwand
▪ Door opgewekte drukgolf verplaatst de vloeistof zich
wat je met je andere hand kan waarnemen
▪ Let op voor vals pos: obese hond, volle blaas, cyste, …
• Beschrijving van een verdikking/massa door inspectie en palpatie
o Plaats: nauwkeurige lokalisatie kan soms anatomische herkomst vaststellen
▪ Juiste termen voor locatie: dorsaal, lateraal, craniaal, … → ook op
stationsproef correcte termen gebruiken, niet zeggen “daar onderaan”
bvb
o Grootte:
▪ Omvang van verdikking meten in 3 dimensies
▪ Lineaal, schuifmaat, genummerde kralenstreng
▪ Bedekkende structuren worden niet meegerekend!
7
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