1
Ziekteleer
Inhoud
Gastro-intestinale ziekteleer ......................................................................................................... 9
Slokdarm (oesophagus) .............................................................................................................. 9
Maag.................................................................................................................................................. 12
Ulcus ............................................................................................................................................. 12
Functionele darmstoornissen ...................................................................................................13
IBS .................................................................................................................................................13
Functionele dyspepsie = non-ulcer dyspepsie ............................................................... 14
Coeliakie ..........................................................................................................................................15
Inflammatoire darmziekte .........................................................................................................15
IBD .................................................................................................................................................15
Hemorroïden (aambeien) examen ........................................................................................... 17
Hepatische ziekteleer ..................................................................................................................... 18
Inleiding algemeen ...................................................................................................................... 18
Hepatitis.......................................................................................................................................... 18
Hepatitis B .................................................................................................................................. 18
Hepatitis C .................................................................................................................................. 20
Hepatitis D................................................................................................................................... 21
Alcoholische hepatitis ................................................................................................................. 21
Klinisch spectrum .................................................................................................................... 22
Symptomen (!!) ......................................................................................................................... 22
Prognose & therapie ............................................................................................................... 22
Toxische hepatitis ........................................................................................................................ 22
Medicamenteuze hepatitis = DILI ........................................................................................ 23
NAFLD en NASH........................................................................................................................... 23
NAFLD ......................................................................................................................................... 23
Metabool syndroom ................................................................................................................ 23
Ziekteprogressie in fatty liver disease..............................................................................24
Diagnose NAFLD ......................................................................................................................24
Pancreatitis ...................................................................................................................................24
Acute pancreatitis........................................................................................................................24
Medisch diagnostisch proces ....................................................................................................... 26
Anamnese + lichamelijk onderzoek ....................................................................................... 26
Aanvullende testen ..................................................................................................................... 26
,2
Medische besliskunde ................................................................................................................ 27
Scoresystemen............................................................................................................................. 27
Acromegalie ...................................................................................................................................... 27
Groeihormoon: productie .......................................................................................................... 27
Groeihormoon: acties ................................................................................................................. 27
Acromegalie: bepaling, oorzaak, tekenen ............................................................................ 27
Diagnose & behandeling ............................................................................................................ 28
Gynaecologie ..................................................................................................................................... 28
Polycysteus ovariumsyndroom (PCOS) ................................................................................ 28
Endometriose ................................................................................................................................ 29
Bepaling, symptomen, mechanisme .................................................................................. 29
Ectopische zwangerschap .................................................................................................... 29
Schildklier ...........................................................................................................................................31
Aandoeningen schildklier ...........................................................................................................31
Struma- goiter ...............................................................................................................................31
Schildklierfunctie ..........................................................................................................................31
Hyperthyreoïdie – thyreotoxicose ...........................................................................................31
Mola gravidarum ...................................................................................................................... 32
Schildklier scintigrafie ........................................................................................................... 32
Ziekte van Graves .................................................................................................................... 32
Hypothyreoïdie .............................................................................................................................. 32
Primaire hypothyreoïdie: oorzaken .................................................................................... 33
Behandeling ............................................................................................................................... 33
Atherosclerose – aorta aneurysma ........................................................................................... 33
Atherosclerose ............................................................................................................................. 33
Plotse hartdood ............................................................................................................................34
Acute ischemie .............................................................................................................................34
CVA = cerebrovasculair accident (beroerte ....................................................................34
Acuut myocard infarct ............................................................................................................ 35
Abdominale atherosclerose ................................................................................................. 35
Perifeer vaatlijden – occlusie .............................................................................................. 35
Perifeer vaatlijden – claudicatio ......................................................................................... 35
Lange-termijn behandeling ...................................................................................................... 35
Aorta-aneurysma ........................................................................................................................ 36
Aneurysma ................................................................................................................................. 36
Aorta-aneurysma .................................................................................................................... 36
,3
Cerebraal aneurysma ............................................................................................................. 36
Thoracaal aorta aneurysma ................................................................................................. 36
Abdominaal aorta aneurysma.............................................................................................. 36
Thoraco- Abdominaal aorta aneurysma ........................................................................... 37
Aorta aneurysma – risicofactoren ..................................................................................... 37
Aorta aneurysma – diagnose ............................................................................................... 37
Complicaties – dissectie ........................................................................................................ 37
Complicaties – ruptuur .......................................................................................................... 37
Aorta aneurysma – behandeling ......................................................................................... 37
Infectieziekten: pathofysiologie & algemene aspecten – sepsis & septische shock ..38
Definitie infectieziekte ................................................................................................................38
Routes van besmetting ..............................................................................................................38
(Micro)-organismen ....................................................................................................................38
Microbiële virulentie ...................................................................................................................38
Primair pathogene MO ........................................................................................................... 39
Potentieel pathogeen MO ...................................................................................................... 39
Opportunistisch pathogeen MO ........................................................................................... 39
Afweermechanismen van gastheer ....................................................................................... 39
Humorale afweer .................................................................................................................... 40
Cellulaire afweer: fagocyten ............................................................................................... 40
Cellulaire afweer: T-cellen .................................................................................................. 40
Epidemiologie van (infectie)ziekten ...................................................................................... 40
Endemisch vs epidemisch ..................................................................................................... 41
Epidemiologie............................................................................................................................ 41
Aanvullende diagnostiek ....................................................................................................... 41
Microbiologische diagnostiek............................................................................................... 41
Sepsis .............................................................................................................................................. 41
Oude definitie sepsis............................................................................................................... 41
Nieuwe definities .....................................................................................................................42
Epidemiologie sepsis ..............................................................................................................42
Etiologie ......................................................................................................................................42
Pathogenese..............................................................................................................................42
Sepsis: prognose .....................................................................................................................43
Sepsis: behandeling ................................................................................................................43
Sepsis zonder duidelijke orgaanlokalisatie .....................................................................43
Bijnierpathologie ............................................................................................................................. 44
,4
Anatomie ....................................................................................................................................... 44
Hypothalamus – hypofyse – bijnier ....................................................................................... 44
Renine-angiotensine-aldosteron .......................................................................................... 44
Bijnieraandoeningen: bijnierschors ...................................................................................... 44
Overproductie glucocorticoïden: syndroom van Cushing........................................... 44
Onderproductie gluco-en mineralocorticoïden: ziekte van Addison .......................45
Overproductie mineralocorticoïden: syndroom van Conn ..........................................45
Effecten glucocorticoïden.......................................................................................................... 46
Bijnieraandoeningen: bijniermerg .......................................................................................... 46
Overproductie catecholamines: feochromocytoom ...................................................... 46
Bacteriële infectieziekten.............................................................................................................. 46
Lyme borreliose ........................................................................................................................... 46
Verloop ziekte ........................................................................................................................... 46
Diagnose ..................................................................................................................................... 47
Preventie .................................................................................................................................... 47
Behandeling ............................................................................................................................... 47
Oorzaken therapie falen ....................................................................................................... 48
Syfilis .............................................................................................................................................. 48
Primaire syfilis ........................................................................................................................ 48
Secundaire syfilis ................................................................................................................... 48
Latente syfilis........................................................................................................................... 48
Tertiaire syfilis ......................................................................................................................... 48
Diagnose syfilis ....................................................................................................................... 48
Behandeling syfilis .................................................................................................................. 49
Kattenkrabziekte .......................................................................................................................... 49
Kattenkrabziekte: kliniek ....................................................................................................... 49
Kattenkrabziekte: lymfadenopathie ................................................................................... 49
Kattenkrabziekte: zeldzame gevallen ...............................................................................50
Kattenkrabziekte: diagnose ..................................................................................................50
Kattenkrabziekte: behandeling ............................................................................................50
Brucellose ......................................................................................................................................50
Brucellose: kliniek ...................................................................................................................50
Brucellose: diagnose ..............................................................................................................50
Brucellose: behandeling ........................................................................................................50
Infectieuze endocarditis ............................................................................................................50
Oorzakelijke kiemen ................................................................................................................51
,5
Vegetatie ......................................................................................................................................51
Gevolgen ......................................................................................................................................51
Kliniek: aspecifieke klachten .................................................................................................51
Verwikkelingen ..........................................................................................................................51
Diagnose ......................................................................................................................................51
Behandeling ............................................................................................................................... 52
Acute bacteriële meningitis ...................................................................................................... 52
Risicofactoren ........................................................................................................................... 52
Symptomen & tekens.............................................................................................................. 52
Verwikkelingen ......................................................................................................................... 53
Diagnose ..................................................................................................................................... 53
Profylaxe bij meningokokken meningitis ......................................................................... 53
Preventie meningitis ............................................................................................................... 53
Hyperlipidemie.................................................................................................................................. 53
Vetzuren .........................................................................................................................................54
Lipoproteïne ..................................................................................................................................54
Functies ..........................................................................................................................................54
Classificatie plasma lipoproteïnen .........................................................................................55
Klinisch belang hyperlipidemie ...............................................................................................55
Classificatie hyperlipidemie volgens pathogenese ...........................................................55
Polygenetische hypercholesterolemie: 1/6 ......................................................................55
Familiale hypercholesterolemie heterozygoot 1/500 ................................................... 56
Familiale gecombineerde hyperlipidemie ........................................................................ 56
Familiale dysbetalipoproteinemie ...................................................................................... 56
Familiale LPL of apo CII deficiëntie .................................................................................... 56
Classificatie hyperlipidemie volgens primaire vs secundaire ....................................... 56
Behandeling hyperlipidemie ..................................................................................................... 56
Voeding ....................................................................................................................................... 57
Fysieke activiteit & rookstop ................................................................................................ 57
Medicatie .................................................................................................................................... 57
Parasitaire infecties........................................................................................................................58
Malaria ............................................................................................................................................58
Immuniteit ..................................................................................................................................58
Incubatie ..................................................................................................................................... 59
Symptomen ................................................................................................................................ 59
Verwikkelingen ......................................................................................................................... 59
,6
Diagnose ..................................................................................................................................... 59
Behandeling ............................................................................................................................... 59
Preventie naar lokale bevolking ......................................................................................... 59
Preventie bij reizigers ............................................................................................................ 60
Toxoplasmose ............................................................................................................................... 60
Diagnose – behandeling – preventie .................................................................................. 61
Schistosomiasis ............................................................................................................................ 61
Katayama .................................................................................................................................... 62
Diagnose ..................................................................................................................................... 62
Behandeling ............................................................................................................................... 62
Preventie .................................................................................................................................... 62
Echinococcose .............................................................................................................................. 62
Symptomen ................................................................................................................................ 63
Diagnose – behandeling ........................................................................................................ 63
Strongyloidiasis............................................................................................................................ 63
Diagnose ..................................................................................................................................... 64
Behandeling ............................................................................................................................... 64
Filariase .......................................................................................................................................... 64
Wuchereria bancrofti .............................................................................................................. 64
Loa Loa ....................................................................................................................................... 64
Onchocerca volvulus .............................................................................................................. 64
Longziekten ....................................................................................................................................... 65
Sarcoïdose ..................................................................................................................................... 65
Sarcoïdose: epidemiologie .................................................................................................... 65
Sarcoïdose: etiologie .............................................................................................................. 65
Sarcoïdose: pathogenese ...................................................................................................... 65
Sarcoïdose: kliniek .................................................................................................................. 66
Sarcoïdose: orgaanaantasting ............................................................................................. 66
Sarcoïdose: diagnose.............................................................................................................. 67
Sarcoïdose: behandeling ....................................................................................................... 67
Tuberculose ................................................................................................................................... 68
Epidemiologie tuberculose ................................................................................................... 68
Tuberculose in België ............................................................................................................. 68
Geslacht, leeftijd, nationaliteit ............................................................................................. 68
Tuberculose pathofysiologie ................................................................................................ 68
Tuberculose klinische manifestaties ................................................................................. 69
,7
Tuberculose: long .................................................................................................................... 69
Tuberculose: pleura ................................................................................................................ 69
Tuberculose: miliair ................................................................................................................ 69
Tuberculose: klier .................................................................................................................... 70
Tuberculose: skelet ................................................................................................................. 70
Tuberculose: CZS ..................................................................................................................... 70
Tuberculose: abdominaal ...................................................................................................... 70
Tuberculose: genito-urinair .................................................................................................. 70
Tuberculose: pericard............................................................................................................. 70
Tuberculose: diagnose ........................................................................................................... 70
Tuberculose: behandeling ...................................................................................................... 71
Resistente tuberculose ........................................................................................................... 71
Tuberculose: preventie............................................................................................................ 71
Pneumonie ...................................................................................................................................... 71
Pneumonie: pathofysiologie ................................................................................................. 72
CAP: Streptococcus pneumoniae........................................................................................ 72
CAP: Mycoplasma pneumoniae ........................................................................................... 72
CAP: klinische manifestaties ................................................................................................ 72
CAP: diagnose ........................................................................................................................... 72
CAP: behandeling ..................................................................................................................... 73
CAP: preventie .......................................................................................................................... 73
Nosocomiale pneumonie: definities ................................................................................... 73
HAP/VAP kliniek ....................................................................................................................... 74
HAP/VAP diagnose .................................................................................................................. 74
HAP/VAP behandeling ............................................................................................................ 74
Hartritmestoornissen ..................................................................................................................... 75
Pathofysiologie ............................................................................................................................. 75
Elektrische geleiding hart ..................................................................................................... 75
AP hart ........................................................................................................................................ 75
ECG ............................................................................................................................................... 75
Diagnose – symptoom ritmecorrelatie ............................................................................. 76
Aritmogenese............................................................................................................................ 76
Bradycardie ................................................................................................................................... 77
Sinus bradycardie .................................................................................................................... 77
Sick sinus syndroom (SSS) .................................................................................................. 77
Atrioventriculair blok (AV-blok).......................................................................................... 77
,8
Tachycardie .................................................................................................................................... 78
Geïsoleerde ectopie ................................................................................................................ 78
Bigeminie – trigeminie ........................................................................................................... 79
Runs van ectopie...................................................................................................................... 79
Ectopie......................................................................................................................................... 79
Tachycardie ................................................................................................................................ 79
Supraventriculaire tachycardie ........................................................................................... 79
Ventriculaire ritmestoornissen ............................................................................................... 81
Ventrikel tachycardie .............................................................................................................. 81
Bloedings-en stollingsstoornissen ............................................................................................ 82
Hemostase ..................................................................................................................................... 82
Verhoogde tromboseneiging ....................................................................................................85
Veneuze trombo-embolie (VTE) ..........................................................................................85
Verhoogde bloedingsneiging .................................................................................................... 89
Infectieziekten veroorzaakt door virussen .............................................................................. 90
Influenza ......................................................................................................................................... 90
Pandemische griep................................................................................................................... 91
Vogelgriep .................................................................................................................................. 92
Seizoensgriep ........................................................................................................................... 92
Overdracht Influenza .............................................................................................................. 92
Symptomen influenza bij volwassenen ............................................................................ 92
Influenza complicaties ........................................................................................................... 92
Influenza diagnose .................................................................................................................. 92
Influenza preventie.................................................................................................................. 93
Antivirale therapie ................................................................................................................... 93
Herpes virus infecties ................................................................................................................ 93
Epstein-Barr virus................................................................................................................... 93
CMV .............................................................................................................................................. 93
Herpes simplex ........................................................................................................................ 94
Varicella zoster ........................................................................................................................ 94
Hantavirus...................................................................................................................................... 95
HIV en AIDS: aanvullingen ..................................................................................................... 95
HIV teststrategie: doel ............................................................................................................ 95
HIV infectie gevolgen .............................................................................................................. 95
Combinatietherapie ................................................................................................................. 95
,9
Gastro-intestinale ziekteleer
- Slokdarm: achalasie, slokdarmspasmen, GERD & maligne tumoren
- Maag: ulcuslijden, gastritis, maligne tumoren
- Functionele darmstoornissen: IBS, functionele dyspepsie
- Coeliakie
- Inflammatoire darmziekten: ziekte van Crohn, colitis ulcerosa
- Diverticulitis = ontsteking van kleine uitstulpingen in dikke darm (divertikels)
- Hemorroïden
Slokdarm (oesophagus)
- Functie: aboraal transport van voedselbolus & speeksel + voorkomen van
reflux van maaginhoud
- Via: peristaltiek (primaire, secundaire), sfinctermechanismen (cricopharyngeus,
GES) & neuronale controle (inhibitie & excitatie)
- Peristaltiek: spieren contraheren waardoor de passageweg smaller wordt & de
voedselbolus naar beneden wordt getrokken => bij voedselbolus relaxeren
spieren waardoor passageweg breder wordt zodat voedselbolus kan passeren
- Symptomen bij slokdarmpathologie: dysfagie (moeilijk slikken), odynofagie (pijn
bij slikken), regurgitatie (terug naar boven komen van onverteerd voedsel),
pyrosis (reflux), aspiratie(maaginhoud komt via mond terug naar binnen =>
longen), gewichtsverlies, bloedverlies, globusgevoel, halitose (slechte
ademgeur) examen
- Onderzoek bij slokdarmpathologie: examen
o Oesophagoscopie: met endoscoop kijken of mucosa ontstoken is van
slokdarm
, 10
o Röntgenonderzoek: met contrastvloeistof => kijken of contrastvloeistof bijft
hangen (tumoren)
o Manometrisch onderzoek: verschillende kanalen in slokdarm om peristal te
meten, volgt normaal een bepaald patroon => indien afwijkingen wijst dit op
een pathologie (als contracties allemaal tegelijk gebeuren)
o Ambulante pH meting: buisje met meetpunten voor pH te meten gedurende
24u, indien reflux = lagere pH in slokdarm (want maagzuur komt in slokdarm)
▪ Gouden standaard voor diagnose GERD
▪ Kwantificatie tijd dat mucosa blootgesteld wordt aan maagzuur
▪ Meet vermogen van slokdarm om refluxzuur te clearen
o Impedantie meting: meting elektrische weerstand, indien er een voedselbolus
aanwezig is, zijn er veel ionen aanwezig dus lage impedantie
- Slokdarmpathologie:
o Motorische stoornissen:
▪ Achalasie (examen): een motiliteitsstoornis van de slokdarm,
progressieve ziekte gekenmerkt door dysfagie voor vast & vloeibaar
voedsel
• Prevalentie: 7-32/100 000
• Meestal tussen 40 & 60 jaar
• Geen peristaltiek in slokdarm = simultane contracties =>
slokdarm is heel breed
• Lage gastro-oesofageale sfincter (GES) dilateert niet, hoge GES
tonus
• Progressieve obstructie slokdarm => geen passage naar darm
• Oorzaak: denervatie van inhibitorische neuronen tgv
progressieve degeneratie ganglioncellen thv. myenterische
plexus in slokdarmwand => inhibitie valt weg
• Primair: idiopathisch => vermoedelijk auto-immuunziekte +
genetische predispositie
Ziekteleer
Inhoud
Gastro-intestinale ziekteleer ......................................................................................................... 9
Slokdarm (oesophagus) .............................................................................................................. 9
Maag.................................................................................................................................................. 12
Ulcus ............................................................................................................................................. 12
Functionele darmstoornissen ...................................................................................................13
IBS .................................................................................................................................................13
Functionele dyspepsie = non-ulcer dyspepsie ............................................................... 14
Coeliakie ..........................................................................................................................................15
Inflammatoire darmziekte .........................................................................................................15
IBD .................................................................................................................................................15
Hemorroïden (aambeien) examen ........................................................................................... 17
Hepatische ziekteleer ..................................................................................................................... 18
Inleiding algemeen ...................................................................................................................... 18
Hepatitis.......................................................................................................................................... 18
Hepatitis B .................................................................................................................................. 18
Hepatitis C .................................................................................................................................. 20
Hepatitis D................................................................................................................................... 21
Alcoholische hepatitis ................................................................................................................. 21
Klinisch spectrum .................................................................................................................... 22
Symptomen (!!) ......................................................................................................................... 22
Prognose & therapie ............................................................................................................... 22
Toxische hepatitis ........................................................................................................................ 22
Medicamenteuze hepatitis = DILI ........................................................................................ 23
NAFLD en NASH........................................................................................................................... 23
NAFLD ......................................................................................................................................... 23
Metabool syndroom ................................................................................................................ 23
Ziekteprogressie in fatty liver disease..............................................................................24
Diagnose NAFLD ......................................................................................................................24
Pancreatitis ...................................................................................................................................24
Acute pancreatitis........................................................................................................................24
Medisch diagnostisch proces ....................................................................................................... 26
Anamnese + lichamelijk onderzoek ....................................................................................... 26
Aanvullende testen ..................................................................................................................... 26
,2
Medische besliskunde ................................................................................................................ 27
Scoresystemen............................................................................................................................. 27
Acromegalie ...................................................................................................................................... 27
Groeihormoon: productie .......................................................................................................... 27
Groeihormoon: acties ................................................................................................................. 27
Acromegalie: bepaling, oorzaak, tekenen ............................................................................ 27
Diagnose & behandeling ............................................................................................................ 28
Gynaecologie ..................................................................................................................................... 28
Polycysteus ovariumsyndroom (PCOS) ................................................................................ 28
Endometriose ................................................................................................................................ 29
Bepaling, symptomen, mechanisme .................................................................................. 29
Ectopische zwangerschap .................................................................................................... 29
Schildklier ...........................................................................................................................................31
Aandoeningen schildklier ...........................................................................................................31
Struma- goiter ...............................................................................................................................31
Schildklierfunctie ..........................................................................................................................31
Hyperthyreoïdie – thyreotoxicose ...........................................................................................31
Mola gravidarum ...................................................................................................................... 32
Schildklier scintigrafie ........................................................................................................... 32
Ziekte van Graves .................................................................................................................... 32
Hypothyreoïdie .............................................................................................................................. 32
Primaire hypothyreoïdie: oorzaken .................................................................................... 33
Behandeling ............................................................................................................................... 33
Atherosclerose – aorta aneurysma ........................................................................................... 33
Atherosclerose ............................................................................................................................. 33
Plotse hartdood ............................................................................................................................34
Acute ischemie .............................................................................................................................34
CVA = cerebrovasculair accident (beroerte ....................................................................34
Acuut myocard infarct ............................................................................................................ 35
Abdominale atherosclerose ................................................................................................. 35
Perifeer vaatlijden – occlusie .............................................................................................. 35
Perifeer vaatlijden – claudicatio ......................................................................................... 35
Lange-termijn behandeling ...................................................................................................... 35
Aorta-aneurysma ........................................................................................................................ 36
Aneurysma ................................................................................................................................. 36
Aorta-aneurysma .................................................................................................................... 36
,3
Cerebraal aneurysma ............................................................................................................. 36
Thoracaal aorta aneurysma ................................................................................................. 36
Abdominaal aorta aneurysma.............................................................................................. 36
Thoraco- Abdominaal aorta aneurysma ........................................................................... 37
Aorta aneurysma – risicofactoren ..................................................................................... 37
Aorta aneurysma – diagnose ............................................................................................... 37
Complicaties – dissectie ........................................................................................................ 37
Complicaties – ruptuur .......................................................................................................... 37
Aorta aneurysma – behandeling ......................................................................................... 37
Infectieziekten: pathofysiologie & algemene aspecten – sepsis & septische shock ..38
Definitie infectieziekte ................................................................................................................38
Routes van besmetting ..............................................................................................................38
(Micro)-organismen ....................................................................................................................38
Microbiële virulentie ...................................................................................................................38
Primair pathogene MO ........................................................................................................... 39
Potentieel pathogeen MO ...................................................................................................... 39
Opportunistisch pathogeen MO ........................................................................................... 39
Afweermechanismen van gastheer ....................................................................................... 39
Humorale afweer .................................................................................................................... 40
Cellulaire afweer: fagocyten ............................................................................................... 40
Cellulaire afweer: T-cellen .................................................................................................. 40
Epidemiologie van (infectie)ziekten ...................................................................................... 40
Endemisch vs epidemisch ..................................................................................................... 41
Epidemiologie............................................................................................................................ 41
Aanvullende diagnostiek ....................................................................................................... 41
Microbiologische diagnostiek............................................................................................... 41
Sepsis .............................................................................................................................................. 41
Oude definitie sepsis............................................................................................................... 41
Nieuwe definities .....................................................................................................................42
Epidemiologie sepsis ..............................................................................................................42
Etiologie ......................................................................................................................................42
Pathogenese..............................................................................................................................42
Sepsis: prognose .....................................................................................................................43
Sepsis: behandeling ................................................................................................................43
Sepsis zonder duidelijke orgaanlokalisatie .....................................................................43
Bijnierpathologie ............................................................................................................................. 44
,4
Anatomie ....................................................................................................................................... 44
Hypothalamus – hypofyse – bijnier ....................................................................................... 44
Renine-angiotensine-aldosteron .......................................................................................... 44
Bijnieraandoeningen: bijnierschors ...................................................................................... 44
Overproductie glucocorticoïden: syndroom van Cushing........................................... 44
Onderproductie gluco-en mineralocorticoïden: ziekte van Addison .......................45
Overproductie mineralocorticoïden: syndroom van Conn ..........................................45
Effecten glucocorticoïden.......................................................................................................... 46
Bijnieraandoeningen: bijniermerg .......................................................................................... 46
Overproductie catecholamines: feochromocytoom ...................................................... 46
Bacteriële infectieziekten.............................................................................................................. 46
Lyme borreliose ........................................................................................................................... 46
Verloop ziekte ........................................................................................................................... 46
Diagnose ..................................................................................................................................... 47
Preventie .................................................................................................................................... 47
Behandeling ............................................................................................................................... 47
Oorzaken therapie falen ....................................................................................................... 48
Syfilis .............................................................................................................................................. 48
Primaire syfilis ........................................................................................................................ 48
Secundaire syfilis ................................................................................................................... 48
Latente syfilis........................................................................................................................... 48
Tertiaire syfilis ......................................................................................................................... 48
Diagnose syfilis ....................................................................................................................... 48
Behandeling syfilis .................................................................................................................. 49
Kattenkrabziekte .......................................................................................................................... 49
Kattenkrabziekte: kliniek ....................................................................................................... 49
Kattenkrabziekte: lymfadenopathie ................................................................................... 49
Kattenkrabziekte: zeldzame gevallen ...............................................................................50
Kattenkrabziekte: diagnose ..................................................................................................50
Kattenkrabziekte: behandeling ............................................................................................50
Brucellose ......................................................................................................................................50
Brucellose: kliniek ...................................................................................................................50
Brucellose: diagnose ..............................................................................................................50
Brucellose: behandeling ........................................................................................................50
Infectieuze endocarditis ............................................................................................................50
Oorzakelijke kiemen ................................................................................................................51
,5
Vegetatie ......................................................................................................................................51
Gevolgen ......................................................................................................................................51
Kliniek: aspecifieke klachten .................................................................................................51
Verwikkelingen ..........................................................................................................................51
Diagnose ......................................................................................................................................51
Behandeling ............................................................................................................................... 52
Acute bacteriële meningitis ...................................................................................................... 52
Risicofactoren ........................................................................................................................... 52
Symptomen & tekens.............................................................................................................. 52
Verwikkelingen ......................................................................................................................... 53
Diagnose ..................................................................................................................................... 53
Profylaxe bij meningokokken meningitis ......................................................................... 53
Preventie meningitis ............................................................................................................... 53
Hyperlipidemie.................................................................................................................................. 53
Vetzuren .........................................................................................................................................54
Lipoproteïne ..................................................................................................................................54
Functies ..........................................................................................................................................54
Classificatie plasma lipoproteïnen .........................................................................................55
Klinisch belang hyperlipidemie ...............................................................................................55
Classificatie hyperlipidemie volgens pathogenese ...........................................................55
Polygenetische hypercholesterolemie: 1/6 ......................................................................55
Familiale hypercholesterolemie heterozygoot 1/500 ................................................... 56
Familiale gecombineerde hyperlipidemie ........................................................................ 56
Familiale dysbetalipoproteinemie ...................................................................................... 56
Familiale LPL of apo CII deficiëntie .................................................................................... 56
Classificatie hyperlipidemie volgens primaire vs secundaire ....................................... 56
Behandeling hyperlipidemie ..................................................................................................... 56
Voeding ....................................................................................................................................... 57
Fysieke activiteit & rookstop ................................................................................................ 57
Medicatie .................................................................................................................................... 57
Parasitaire infecties........................................................................................................................58
Malaria ............................................................................................................................................58
Immuniteit ..................................................................................................................................58
Incubatie ..................................................................................................................................... 59
Symptomen ................................................................................................................................ 59
Verwikkelingen ......................................................................................................................... 59
,6
Diagnose ..................................................................................................................................... 59
Behandeling ............................................................................................................................... 59
Preventie naar lokale bevolking ......................................................................................... 59
Preventie bij reizigers ............................................................................................................ 60
Toxoplasmose ............................................................................................................................... 60
Diagnose – behandeling – preventie .................................................................................. 61
Schistosomiasis ............................................................................................................................ 61
Katayama .................................................................................................................................... 62
Diagnose ..................................................................................................................................... 62
Behandeling ............................................................................................................................... 62
Preventie .................................................................................................................................... 62
Echinococcose .............................................................................................................................. 62
Symptomen ................................................................................................................................ 63
Diagnose – behandeling ........................................................................................................ 63
Strongyloidiasis............................................................................................................................ 63
Diagnose ..................................................................................................................................... 64
Behandeling ............................................................................................................................... 64
Filariase .......................................................................................................................................... 64
Wuchereria bancrofti .............................................................................................................. 64
Loa Loa ....................................................................................................................................... 64
Onchocerca volvulus .............................................................................................................. 64
Longziekten ....................................................................................................................................... 65
Sarcoïdose ..................................................................................................................................... 65
Sarcoïdose: epidemiologie .................................................................................................... 65
Sarcoïdose: etiologie .............................................................................................................. 65
Sarcoïdose: pathogenese ...................................................................................................... 65
Sarcoïdose: kliniek .................................................................................................................. 66
Sarcoïdose: orgaanaantasting ............................................................................................. 66
Sarcoïdose: diagnose.............................................................................................................. 67
Sarcoïdose: behandeling ....................................................................................................... 67
Tuberculose ................................................................................................................................... 68
Epidemiologie tuberculose ................................................................................................... 68
Tuberculose in België ............................................................................................................. 68
Geslacht, leeftijd, nationaliteit ............................................................................................. 68
Tuberculose pathofysiologie ................................................................................................ 68
Tuberculose klinische manifestaties ................................................................................. 69
,7
Tuberculose: long .................................................................................................................... 69
Tuberculose: pleura ................................................................................................................ 69
Tuberculose: miliair ................................................................................................................ 69
Tuberculose: klier .................................................................................................................... 70
Tuberculose: skelet ................................................................................................................. 70
Tuberculose: CZS ..................................................................................................................... 70
Tuberculose: abdominaal ...................................................................................................... 70
Tuberculose: genito-urinair .................................................................................................. 70
Tuberculose: pericard............................................................................................................. 70
Tuberculose: diagnose ........................................................................................................... 70
Tuberculose: behandeling ...................................................................................................... 71
Resistente tuberculose ........................................................................................................... 71
Tuberculose: preventie............................................................................................................ 71
Pneumonie ...................................................................................................................................... 71
Pneumonie: pathofysiologie ................................................................................................. 72
CAP: Streptococcus pneumoniae........................................................................................ 72
CAP: Mycoplasma pneumoniae ........................................................................................... 72
CAP: klinische manifestaties ................................................................................................ 72
CAP: diagnose ........................................................................................................................... 72
CAP: behandeling ..................................................................................................................... 73
CAP: preventie .......................................................................................................................... 73
Nosocomiale pneumonie: definities ................................................................................... 73
HAP/VAP kliniek ....................................................................................................................... 74
HAP/VAP diagnose .................................................................................................................. 74
HAP/VAP behandeling ............................................................................................................ 74
Hartritmestoornissen ..................................................................................................................... 75
Pathofysiologie ............................................................................................................................. 75
Elektrische geleiding hart ..................................................................................................... 75
AP hart ........................................................................................................................................ 75
ECG ............................................................................................................................................... 75
Diagnose – symptoom ritmecorrelatie ............................................................................. 76
Aritmogenese............................................................................................................................ 76
Bradycardie ................................................................................................................................... 77
Sinus bradycardie .................................................................................................................... 77
Sick sinus syndroom (SSS) .................................................................................................. 77
Atrioventriculair blok (AV-blok).......................................................................................... 77
,8
Tachycardie .................................................................................................................................... 78
Geïsoleerde ectopie ................................................................................................................ 78
Bigeminie – trigeminie ........................................................................................................... 79
Runs van ectopie...................................................................................................................... 79
Ectopie......................................................................................................................................... 79
Tachycardie ................................................................................................................................ 79
Supraventriculaire tachycardie ........................................................................................... 79
Ventriculaire ritmestoornissen ............................................................................................... 81
Ventrikel tachycardie .............................................................................................................. 81
Bloedings-en stollingsstoornissen ............................................................................................ 82
Hemostase ..................................................................................................................................... 82
Verhoogde tromboseneiging ....................................................................................................85
Veneuze trombo-embolie (VTE) ..........................................................................................85
Verhoogde bloedingsneiging .................................................................................................... 89
Infectieziekten veroorzaakt door virussen .............................................................................. 90
Influenza ......................................................................................................................................... 90
Pandemische griep................................................................................................................... 91
Vogelgriep .................................................................................................................................. 92
Seizoensgriep ........................................................................................................................... 92
Overdracht Influenza .............................................................................................................. 92
Symptomen influenza bij volwassenen ............................................................................ 92
Influenza complicaties ........................................................................................................... 92
Influenza diagnose .................................................................................................................. 92
Influenza preventie.................................................................................................................. 93
Antivirale therapie ................................................................................................................... 93
Herpes virus infecties ................................................................................................................ 93
Epstein-Barr virus................................................................................................................... 93
CMV .............................................................................................................................................. 93
Herpes simplex ........................................................................................................................ 94
Varicella zoster ........................................................................................................................ 94
Hantavirus...................................................................................................................................... 95
HIV en AIDS: aanvullingen ..................................................................................................... 95
HIV teststrategie: doel ............................................................................................................ 95
HIV infectie gevolgen .............................................................................................................. 95
Combinatietherapie ................................................................................................................. 95
,9
Gastro-intestinale ziekteleer
- Slokdarm: achalasie, slokdarmspasmen, GERD & maligne tumoren
- Maag: ulcuslijden, gastritis, maligne tumoren
- Functionele darmstoornissen: IBS, functionele dyspepsie
- Coeliakie
- Inflammatoire darmziekten: ziekte van Crohn, colitis ulcerosa
- Diverticulitis = ontsteking van kleine uitstulpingen in dikke darm (divertikels)
- Hemorroïden
Slokdarm (oesophagus)
- Functie: aboraal transport van voedselbolus & speeksel + voorkomen van
reflux van maaginhoud
- Via: peristaltiek (primaire, secundaire), sfinctermechanismen (cricopharyngeus,
GES) & neuronale controle (inhibitie & excitatie)
- Peristaltiek: spieren contraheren waardoor de passageweg smaller wordt & de
voedselbolus naar beneden wordt getrokken => bij voedselbolus relaxeren
spieren waardoor passageweg breder wordt zodat voedselbolus kan passeren
- Symptomen bij slokdarmpathologie: dysfagie (moeilijk slikken), odynofagie (pijn
bij slikken), regurgitatie (terug naar boven komen van onverteerd voedsel),
pyrosis (reflux), aspiratie(maaginhoud komt via mond terug naar binnen =>
longen), gewichtsverlies, bloedverlies, globusgevoel, halitose (slechte
ademgeur) examen
- Onderzoek bij slokdarmpathologie: examen
o Oesophagoscopie: met endoscoop kijken of mucosa ontstoken is van
slokdarm
, 10
o Röntgenonderzoek: met contrastvloeistof => kijken of contrastvloeistof bijft
hangen (tumoren)
o Manometrisch onderzoek: verschillende kanalen in slokdarm om peristal te
meten, volgt normaal een bepaald patroon => indien afwijkingen wijst dit op
een pathologie (als contracties allemaal tegelijk gebeuren)
o Ambulante pH meting: buisje met meetpunten voor pH te meten gedurende
24u, indien reflux = lagere pH in slokdarm (want maagzuur komt in slokdarm)
▪ Gouden standaard voor diagnose GERD
▪ Kwantificatie tijd dat mucosa blootgesteld wordt aan maagzuur
▪ Meet vermogen van slokdarm om refluxzuur te clearen
o Impedantie meting: meting elektrische weerstand, indien er een voedselbolus
aanwezig is, zijn er veel ionen aanwezig dus lage impedantie
- Slokdarmpathologie:
o Motorische stoornissen:
▪ Achalasie (examen): een motiliteitsstoornis van de slokdarm,
progressieve ziekte gekenmerkt door dysfagie voor vast & vloeibaar
voedsel
• Prevalentie: 7-32/100 000
• Meestal tussen 40 & 60 jaar
• Geen peristaltiek in slokdarm = simultane contracties =>
slokdarm is heel breed
• Lage gastro-oesofageale sfincter (GES) dilateert niet, hoge GES
tonus
• Progressieve obstructie slokdarm => geen passage naar darm
• Oorzaak: denervatie van inhibitorische neuronen tgv
progressieve degeneratie ganglioncellen thv. myenterische
plexus in slokdarmwand => inhibitie valt weg
• Primair: idiopathisch => vermoedelijk auto-immuunziekte +
genetische predispositie
