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Samenvatting 'gastcolleges' - Longen 1

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Samenvatting van de gastcolleges als onderdeel van het vak 'Longen 1' gegeven in de 2e Bachelor Geneeskunde aan de UA. Volledige samenvatting gebaseerd op college slides, eigen lesnotities én handboek. Inhoud - gastcolleges - leerstof tijdens Carrousel en practica

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  • August 23, 2024
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  • 2023/2024
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Inhoudstafel
De tol van roken & principes van rookstop................................................................................................. 7
De grootteorde van tabakroken..................................................................................................................7
Prevalentie......................................................................................................................................7
Determinanten van preventie..............................................................................................8
Tabaksgebruik - naar een gezond België....................................................................................... 8
Toxicologie van roken.................................................................................................................................9
7000 chemicaliën in een sigaret..................................................................................................... 9
De menselijke tol van tabak roken........................................................................................................... 10
Bradford-Hill criteria voor causaliteit van een associatie tussen blootstelling en ziekte............... 10
Pathofysiologie van roken in het ademhalingsstelsel................................................................... 10
Risico van tabak in vergelijking met andere doodsoorzaken....................................................... 10
Organisatie van rookpreventie..................................................................................................................11
Economische kosten van roken....................................................................................................11
Preventie WHO.............................................................................................................................12

Gedragstherapie bij rookstop..................................................................................................................... 13
Inleiding.................................................................................................................................................... 13
Verslaving.................................................................................................................................................13
Lichamelijk....................................................................................................................................14
Meetapparaten..................................................................................................................14
Stoppen met roken................................................................................................................................... 15
Nicotinevervangers (NRT)............................................................................................................ 15
Gedragsmatige aanpak............................................................................................................................ 15
Fasen van gedrasverandering......................................................................................................15
Gedachten controleren................................................................................................................. 16
5 G’s schema....................................................................................................................16
Belang van gedragsmatige aanpak.............................................................................................. 17
Wat werkt er?........................................................................................................................................... 17
Minimale interventie................................................................................................................................. 18
ASK.............................................................................................................................................. 18
ADVISE........................................................................................................................................ 18
ASSESS (beoordelen)..................................................................................................................18
ASSIST.........................................................................................................................................19
ARRANGE....................................................................................................................................19
REFER......................................................................................................................................... 19
Practicum rookstopconsultatie................................................................................................................. 19
Monotherapie................................................................................................................................19
Patch.................................................................................................................................19
Kauwgom..........................................................................................................................20
Zuigtabletten..................................................................................................................... 20
Inhaler...............................................................................................................................20
Spray................................................................................................................................ 20
Combinatietherapie...................................................................................................................... 20
E-sigaret....................................................................................................................................... 21
Heat not Burn............................................................................................................................... 21
Nicopops.......................................................................................................................................21

,De pathologische long (non-neoplastisch)............................................................................................... 21
Pathologie................................................................................................................................................ 21
Non-neoplastische longziektes.....................................................................................................21
Histologie..................................................................................................................................................22
Wandstructuur.............................................................................................................................. 22
Trachea en grotere bronchi.............................................................................................. 23
Bronchus...........................................................................................................................23
Bronchiolus....................................................................................................................... 23
Longparenchym............................................................................................................................23
Patronen van inflammatie.........................................................................................................................24
Acute inflammatie......................................................................................................................... 24
Resolutie van acute inflammatie.......................................................................................24
Vorming van granulatieweefsel.........................................................................................25
Chronische inflammatie................................................................................................................ 25
Granulomateuze inflammatie........................................................................................................26
Aspiratie pneumonie......................................................................................................... 26
Sarcoïdose = duivenmelkerslong..................................................................................... 26
Respiratoire infecties................................................................................................................................27
Pneumonie................................................................................................................................... 27
Lobaire pneumonie........................................................................................................... 27
Pulmonale tuberculose................................................................................................................. 28
Fungale infecties.......................................................................................................................... 28
Aspergillose...................................................................................................................... 28
Obstructieve luchtweginfecties.................................................................................................................29
Ziekte van de bronchiolus.............................................................................................................29
Ziekte van de bronchus................................................................................................................ 30
Chronische bronchitis....................................................................................................... 30
Bronchiëctasie.................................................................................................................. 30
COPD........................................................................................................................................... 30
Emfyseem.........................................................................................................................31
Asthma......................................................................................................................................... 31
Histopathologie................................................................................................................. 31
Interstitiele longziektes (IDL).................................................................................................................... 32
Acute longbeschadiging............................................................................................................... 32
Diffuse alveolar damage (DAD)........................................................................................ 32
Chronisch diffuse longbeschadiging.............................................................................................33
2 soorten fibrose............................................................................................................... 33
Organising pneumonie................................................................................................................. 34
Pneumoconiosis........................................................................................................................... 34
Asbestose......................................................................................................................... 34
Gecombineerde patronen van longziekten...................................................................................35
Hypersensitieve pneumonitis (HP)................................................................................... 35
Beeldvormings modaliteiten..................................................................................................................... 35
RX vs. CT..................................................................................................................................... 36
RX.................................................................................................................................................36
Standaard thorax-opname................................................................................................ 36
Bedside thorax-opname....................................................................................................36
1

, Anatomie...........................................................................................................................36
CT.................................................................................................................................................37
Verschillende vensters......................................................................................................37
Pulmonaire embolie protocol............................................................................................ 37
Anatomie...........................................................................................................................37
Interpretatie van radiologisch onderzoek................................................................................................. 38
Moeilijkheden bij RX-beelden....................................................................................................... 38
Pathologie – mediastinum........................................................................................................................ 39
Verwijd mediastinum.....................................................................................................................39
Pneumomediastinum....................................................................................................................40
Pneumomediastinum vs. azygos fissure.......................................................................... 41
Pneumoperitoneum...................................................................................................................... 41
Pulmonaire embolie......................................................................................................................41
Pathologie – hilum....................................................................................................................................42
Sarcoïdose................................................................................................................................... 42
Pathologie – bronchiale boom..................................................................................................................43
Pathologie – longparenchym....................................................................................................................43
Atelectase vs. pneumonie............................................................................................................ 44
Pulmonair oedeem....................................................................................................................... 45
Emfyseem.....................................................................................................................................45
Pneumothorax.............................................................................................................................. 46
Tension pneumothorax..................................................................................................... 46
Specifieke infecties.......................................................................................................................46
Tuberculose...................................................................................................................... 47
Aspergillose...................................................................................................................... 47
Pneumocystis jiroveci pneumonie.................................................................................... 47
Pathologie – pleura.................................................................................................................................. 47
Pathologie – bot en weke delen............................................................................................................... 49
Respiratoire insufficiëntie......................................................................................................................... 50
Acute op chronische respiratoire insufficiëntie............................................................................. 50
Bloedgassen.................................................................................................................................50
2 vormen van respiratoire insufficiëntie........................................................................................ 51
Bloedgaswaarden............................................................................................................. 52
Behandeling..................................................................................................................................53
Type I respiratoire insufficiëntie (longinsufficiëntie) → hypoxemie...........................................................53
Diffusiestoornis............................................................................................................................. 53
R-L shunt...................................................................................................................................... 53
V’/Q’ mismatch............................................................................................................................. 54
Klinische verschijnselen van hypoxemie...................................................................................... 54
Type II respiratoire insufficiëntie (ventilatoire insufficiëntie) → hypercapnie............................................ 54
Oorzaken van chronisch adempompfalen.................................................................................... 55
Ademspierzwakte en hypoventilatie................................................................................. 55
Oorzaken van hypercapnie...........................................................................................................55
Klinische verschijnselen van hypercapnie.................................................................................... 56
Zuurstoftherapie....................................................................................................................................... 56
Acute zuurstoftherapie..................................................................................................................56
Bleomycine en zuurstof.................................................................................................... 56
Acuut myocardinfarct en zuurstof..................................................................................... 57
2

, Zuurstoftoediening............................................................................................................ 57
FI, O2 en zuurstoftoediening............................................................................................ 57
Chronische zuurstoftherapie.........................................................................................................58
Zuurstofbesparing: DODS................................................................................................ 59
High flow nasal oxygen therapy (HFNOT/HFNC)............................................................. 59
Beademing............................................................................................................................................... 60
Niet-invasieve ventilatie (NIV)...................................................................................................... 60
Chronische thuisbeademing............................................................................................. 60
Invasieve ventilatie (IV)................................................................................................................ 61
Tracheostomale beademing (TPPV)................................................................................ 61
Traject: duur en wijze van beademing..........................................................................................61
Conclusie..................................................................................................................................................61

Klinische voorbeelden van longlijden (+ zie ppt.).....................................................................................62
Obstructieve longziekten.......................................................................................................................... 62
COPD........................................................................................................................................... 62
Asthma bronchiale........................................................................................................................63
Medicatie.......................................................................................................................... 63
Mucoviscidose.............................................................................................................................. 63
Compressie van buitenaf..............................................................................................................64
Restrictieve longziekten........................................................................................................................... 64
Idiopathische longfibrose..............................................................................................................64
Kyfoscoliose................................................................................................................................. 65
Maligne pleuraal mesothelioom....................................................................................................65
Hypersensitiviteitspneumonitis..................................................................................................... 66
Het respiratoire controlesysteem..............................................................................................................67
Centrale chemoreceptoren........................................................................................................... 67
Perifere chemoreceptoren............................................................................................................ 67
Relatie tussen ventilatie en Pa, CO2............................................................................................68
CO2 ventilatoire controlesysteem.....................................................................................68
Respiratoir ritme genererend centrum..........................................................................................68
Effect van opioïden (bv. morfine)...................................................................................... 69
Pontiene respiratoire groep (PRG, pons)..................................................................................... 69
Hypoglossus motor nucleus......................................................................................................... 69
Overzicht...................................................................................................................................... 69
Vrijwillige ademhaling (motorische cortex)................................................................................... 69
Controle-feedback systeem..........................................................................................................69
Loop gain.......................................................................................................................... 70
Receptoren in de luchtwegen....................................................................................................... 70
Overige receptoren.......................................................................................................................71
Overzicht...................................................................................................................................... 71
Evaluatie ademhalingscontrole................................................................................................................ 71
Directe methoden......................................................................................................................... 71
Indirecte methoden.......................................................................................................................72
Bloedgassen (ABG).......................................................................................................... 72
Slaaponderzoek................................................................................................................73
Pathologische adempatronen........................................................................................... 74
Nachtelijke ademregulatie bij centrale slaapapneu (CSA)....................................................................... 74
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