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Samenvatting - Gastro intestinaal en endocrien stelsel stofwisseling
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Samenvatting - Gastro intestinaal en endocrien stelsel stofwisseling
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SYMPTOMEN DIAGNOSE BEHANDELINGHepatische -Gestoord bewustzijn: 4 types -Causaal: infecties, bloeding,
encefalopathi -Verandering in dehydratatie, sederende
e persoonlijkheidsstructuur medicatie
-Intellectuele deterioratie -Lactulose/lactilol
-Spraak is traag en monotoon -Antibiotica: metronidazole,
-Flapping tremor (asterixis) rifaximine
-Dieet: eiwitinname max 1-1,5 g per
kg (enkel bij onbehandelbare
encefalopathie)
-Algemeen: geen sedativa en
diuretica, elektrolyten corrigeren,
zinkdeficiëntie opsporen
, SYMPTOMEN DIAGNOSE BEHANDELING
Varices -Geen specifieke symptomen -Endoscopie (varices, volume, red -Intensieve zorgen
-Collaterale circulatie buikwand spots, geassocieerde letsel) -Transfusies
(onderste deel thorax, bovenste -Echografie: lever, -IV vasoactieve stoffen
deel abdomen) splenomegalie, diameter V (somatostatine, terlipressine)
-Syndroom van Cruveilhier- portae -Endoscopische ligaturen
Baumgarten: caput medusae -Dopplerechografie: richting -Slokdarmtamponade met
-Splenomegalie bloedstroom, anatomie balloncatheter of slokdarmstent
hypersplenisme portaal stelsel -TIPSS
(pancytopenie) -Angiografie met veneuze -AB: quinolones –
tijd: doorgankelijkheid V amoxyclavulaanzuur (5 dagen)
portae en collaterale -Primaire en secundaire preventie
circulatie
-HVPG
Ascites -Plots of insidieus -SAAG: oorzaken ascites -Natriumrestrictie tot 2g per dag
-Abdomen gedistendeerd door -Vochtrestrictie tot 1L per dag (bij
vocht dilutie hyponatriëmie)
-Matiteit bij percussie die -Diuretica:
zich verplaatst bij o Distale diuretica:
positieverandering spironolactone (aldosteron
-Knipproef positief antagonist) 100 mg tot 400
-Pleuratranssudaat bij 1 op 15 mg OF amiloride of triamterene
(defect diafragma) o Loopdiureticum: furosemide 40
tot 160 mg
-Therapeutische paracentese: 20g
albumine IV per 2,5 L vocht
-TIPS (MELD ≤ 20)
-Transplantatie
Spontan -Pt met gedecompenseerde cirrose -Verhoging -AB: amoxy-clavulaanzuur of
e gaat plots achteruit polymorfonucleairen (>250 quinolones
bacteriël -Onverklaarde encefalopathie pmn/mm3) ascitesvocht -Albumine
e -(Koorts, buikpijn, loslaatpijn) -Positieve cultuur ascitesvocht -Preventie met quinolones (recidief
peritoniti hoog)
s
, Hepato-renaal Uitlokkende factoren: -Oplopende uremie -Preventie (uitlokkende factoren)
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