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Samenvatting gastro-enterologie Prof. De Looze
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Samenvatting gastro-enterologie Prof. De Looze AJ 23-24
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Prof. De Looze AJ 23-24Samenvatting Problemen van digestief stelsel, endocrien stelsel en voeding
1. Aandoeningen van de slokdarm............................................................................................. 4
1.1. Gastro-oesofageale refluxziekte (GERD) ............................................................................... 4
1.1.1. Symptomen GERD ............................................................................................................ 4
1.1.2. Pathogenese GERD ........................................................................................................... 5
1.1.3. Diagnose GERD ................................................................................................................ 5
1.1.4. Behandeling GERD ............................................................................................................ 6
1.1.5. Verwikkelingen van GERD ................................................................................................... 7
1.2. Dysfagie ............................................................................................................................. 8
1.2.1. Achalasie ......................................................................................................................... 9
1.2.2. Eosinofiele oesophagitis (EoE) .......................................................................................... 10
2. Aandoeningen van maag en duodenum ................................................................................ 11
2.1. Gastritis en gastropathie ....................................................................................................11
2.1.1. Acute gastritis ................................................................................................................. 11
2.1.2. Chronische gastritis ......................................................................................................... 11
2.2. Ulcus ventriculi en ulcus duodeni .......................................................................................12
2.2.1. Etiopathogenese ulcera.................................................................................................... 12
2.2.2. Symptomen ulcera .......................................................................................................... 12
2.2.3. Diagnose ulcera .............................................................................................................. 12
2.2.4. Behandeling ulcera .......................................................................................................... 13
2.2.5. Verwikkelingen ulcera ...................................................................................................... 13
3. Aandoeningen van de dunne darm........................................................................................ 14
3.1. Malabsorptie .....................................................................................................................15
3.1.1. Coeliakie........................................................................................................................ 15
3.1.2. Lactose-intolerantie ........................................................................................................ 17
3.1.3. Bacteriële overgroei in de dunne darm ................................................................................ 18
3.1.4. Andere oorzaken van chronische diarree............................................................................. 19
4. Chronische inflammatoire darmziekten ............................................................................... 20
4.1. DiIerentiatie tussen Crohn en colitis ulcerosa .....................................................................21
4.2. Ziekte van Crohn ................................................................................................................21
4.3. Colitis ulcerosa ..................................................................................................................22
4.4. Diagnose Crohn en colitis ulcerosa .....................................................................................22
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,Prof. De Looze AJ 23-24
4.5. Behandeling Crohn en colitis ulcerosa ................................................................................23
4.6. Microscopische colitis .......................................................................................................24
5. Disorders of gut-brain interaction (DGBI) .............................................................................. 25
5.1. Functionele dyspepsie .......................................................................................................25
5.2. Prikkelbare darmsyndroom.................................................................................................26
5.3. Functionele constipatie ......................................................................................................27
5.3.1. Anismus ........................................................................................................................ 29
5.3.2. Rectocoele..................................................................................................................... 29
5.4. Faecale incontinentie.........................................................................................................29
6. Proctologie (aandoeningen van anus en anaal kanaal) ........................................................... 31
6.1. Anamnese .........................................................................................................................31
6.2. Proctologisch onderzoek ....................................................................................................31
6.3. Proctologische aandoeningen ............................................................................................31
6.3.1. Hemorrhoïden ................................................................................................................ 31
6.3.2. Anale fissuur .................................................................................................................. 32
6.3.3. Pruritis ani ...................................................................................................................... 33
6.3.4. Anaal abces en anale fistel ............................................................................................... 33
6.3.5. Anorectale SOA .............................................................................................................. 34
6.3.5.1. Condylomata accuminata ............................................................................................ 34
6.3.5.2. Herpes simplex........................................................................................................... 35
6.3.5.3. Syfilis (lues of harde sjanker) ........................................................................................ 35
6.3.5.4. Gonorroe ................................................................................................................... 36
6.3.5.5. Chlamydia trachomatis ................................................................................................ 36
6.3.5.6. Molluscum contagiosum .............................................................................................. 37
6.3.5.7. Apenpokken ............................................................................................................... 37
6.4. Anorectitis .........................................................................................................................37
6.5. Anaal carcinoom................................................................................................................38
7. Colorectaal carcinoom (CRC) ............................................................................................... 39
7.1. Colonpoliepen ...................................................................................................................39
7.1.1. Adenoma-carcinoma-sequentie........................................................................................ 40
7.1.2. Familiale polyposis syndromen ......................................................................................... 40
7.1.2.1. Familiale adenomateuze polypose (FAP) ........................................................................ 40
7.1.2.2. HNPCC of Lynch-syndroom ......................................................................................... 41
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,Prof. De Looze AJ 23-24
7.1.2.3. Peutz-Jeghers syndroom (PJS)....................................................................................... 41
7.1.3. Secundaire preventie CRC ................................................................................................ 41
8. Gastro-intestinale bloeding ................................................................................................. 42
8.1. Evaluatie bij GI bloeding .....................................................................................................42
8.2. Hoge GI bloeding ...............................................................................................................43
8.2.1. Peptisch ulcus duodeni of ulcus ventriculi .......................................................................... 43
8.2.2. Mallory-Weiss syndroom.................................................................................................. 43
8.2.3. Portale hypertensie ......................................................................................................... 43
8.2.4. Ulceratieve oesofagitis ..................................................................................................... 43
8.2.5. Erosieve gastritis – stressgastritis ...................................................................................... 44
8.2.6. Dieulafoy letsel ............................................................................................................... 44
8.2.7. Vasculaire ectasieën........................................................................................................ 44
8.2.8. Aorta-duodenale fistel ..................................................................................................... 44
8.2.9. Hemobilie ...................................................................................................................... 44
8.3. Middelste en lage GI bloeding .............................................................................................44
8.3.1. Colondiverticulose – diverticulaire bloeding ........................................................................ 45
8.3.2. Inflammatoir/infectieus darmlijden .................................................................................... 45
8.3.3. Ischemische colitis.......................................................................................................... 45
8.3.4. Neoplasmata.................................................................................................................. 45
8.3.5. Angiodysplasie ............................................................................................................... 45
8.3.6. Dunne darm bloeding....................................................................................................... 45
9. Pathologie van de pancreas ................................................................................................. 46
9.1. Evaluatie van pancreaspathologie en exocriene pancreasfunctie..........................................46
9.2. Acute pancreatitis ..............................................................................................................47
9.2.1. Oorzaken en pathogenese ................................................................................................ 48
9.2.2. Symptomen.................................................................................................................... 48
9.2.3. Diagnose........................................................................................................................ 48
9.2.4. Behandeling ................................................................................................................... 48
9.2.5. Verwikkelingen................................................................................................................ 49
9.3. Chronische pancreatitis .....................................................................................................49
9.3.1. Oorzaken en pathogenese ................................................................................................ 49
9.3.2. Symptomen.................................................................................................................... 50
9.3.3. Diagnose........................................................................................................................ 50
9.3.4. Behandeling ................................................................................................................... 50
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, Prof. De Looze AJ 23-24
1. Aandoeningen van de slokdarm
Parate kennis:
Binnenste laag slokdarm: epitheel (niet-verhoornd meerlagig plaveiselcel epitheel)
Daarrond lamina propria, daarrond muscularis mucosa
è Die 3 lagen vormen de mucosa
Onder de mucosa zit de submucosa (hierin zi?en bloedvaten en lymfevaten)
Daarrond zit de muscularis (inwendige circulaire en uitwendige longitudinale spierlaag)
è peristalCek!! (autonoom)
Daarrond afsluiCng door serosa of advenCCa
1.1.Gastro-oesofageale refluxziekte (GERD) In België: 28% zure reflux
= reflux van maag (zuur) of duodenum (basisch)
è symptomen en/of beschadiging van de slokdarm, orofarynx of luchtwegen
Fysiologische reflux = tot 20x/dag, max 4% van 24u, geklaard door secundaire peristalCek
Pathologische reflux = langdurige zuurblootstelling met symptomen
1.1.1. Symptomen GERD
1. Pyrosis: branderig gevoel van maagstreek tot achter sternum
o Vooral na maalCjden, vooroverbuigen, ’s nachts, zwangerschap
2. Zure regurgitaCe: zure maaginhoud tot in keelholte
3. Dysfagie: voedsel zakt moeilijk Bij oesofagi+s of
vernauwing door li3eken
4. Odynofagie: pijn achter sternum bij passage voedselbolus
5. Extra-oesofageale symptomen
o Onverklaarbare heesheid
o Keelschrapen An#-reflux barrière:
o FaryngiCs 1. Zwaartekracht
2. NaHCO3
o Globusgevoel 3. Primaire en secundaire peristal+ek
4. Lagere oesofageale sfincter
o Hoesten 5. Goede maaglediging
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