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Samenvatting - longen 1
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Samenvatting van het vak 'longen 1' gegeven door prof. Oostveen. Gemaakt aan de hand van de slides en eigen notities.
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Longen 1Inhoudsopgave
Structuur en functie van de longen ................................................................................................................ 14
Ademhalingssysteem ........................................................................................................................................ 14
Veel gebruikte afkortingen ............................................................................................................................... 14
Normale (ideale) long ‼ .................................................................................................................................... 15
Partiële druk ‼ .................................................................................................................................................. 15
Samenstelling van “lucht” (zeeniveau) ‼ .......................................................................................................... 15
Ademhalingsproces ........................................................................................................................................... 16
Trachea en bovenste luchtwegen ..................................................................................................................... 16
De longkwabben ............................................................................................................................................... 17
Anatomie volgens Weibel ................................................................................................................................. 17
Doorgankelijkheid per luchtweggeneratie ............................................................................................... 18
Verdeling weerstand over luchtwegen ............................................................................................................. 18
Anatomie: doorsnede door een long ................................................................................................................ 18
Anatomie: alveolo-capillaire membraan .......................................................................................................... 19
Anatomie: alveoli ‼ ........................................................................................................................................... 19
Structuur – functie ............................................................................................................................................ 19
Verdedigingsmechanismen ............................................................................................................................... 20
Ventilatie 1..................................................................................................................................................... 21
Ideale long ........................................................................................................................................................ 21
Ventilatie........................................................................................................................................................... 21
Meting longvolume verandering ...................................................................................................................... 22
Onderverdeling longvolumes ‼ ......................................................................................................................... 22
Elastische eigenschappen van long en borstkas ............................................................................................... 22
Elasticiteit van het respiratoir systeem ............................................................................................................. 23
Ademhalingsspieren ......................................................................................................................................... 23
Adembeweging ........................................................................................................................................ 23
Totale ventilatie (V’E) vs. alveolaire ventilatie (V’A) .......................................................................................... 24
Relatie tussen ventilatie en PCO2 ‼ .................................................................................................................... 24
Ventilatie-verdeling over de normale long ....................................................................................................... 24
Perfusieverdeling over de normale long ........................................................................................................... 24
1
, Ventilatie/perfusie (V’/Q’) verdeling‼ .............................................................................................................. 25
Ventilatie 2..................................................................................................................................................... 26
Statische longvolumes ...................................................................................................................................... 26
Helium-verdunning ........................................................................................................................................... 26
ATP-BTPS condities ........................................................................................................................................... 27
Bodyplethysmograaf ......................................................................................................................................... 27
Het meetprincipe ..................................................................................................................................... 27
Wet van Boyle: PxV = constant ................................................................................................................ 28
FRCpleth bepaling .................................................................................................................................... 28
Rookstop ........................................................................................................................................................ 29
De grootteorde van tabakroken ....................................................................................................................... 29
Tabaksgebruik – naar een gezond België ................................................................................................. 29
Toxicologie van roken ....................................................................................................................................... 29
7000 chemicaliën in een sigaret .............................................................................................................. 30
Bradford-Hill criteria voor causaliteit van een associatie tussen een blootstelling en een ziekte ........... 30
Pathofysiologie van roken in het ademhalingsstelsel .............................................................................. 31
De menselijke tol van tabak roken .................................................................................................................... 31
De economische kosten van roken .......................................................................................................... 31
3 grote boodschappen voor de individuele roker .................................................................................... 31
Organisatie van primaire (voorkomen) en secundaire (doen stoppen) rookpreventie ..................................... 32
Hoe de epidemie stoppen? WHO Mpower initiatief ............................................................................... 32
Tabakswetten ........................................................................................................................................... 32
Anti-rookplan Vandenbroucke (2023) ..................................................................................................... 32
Kosteneffectiviteit van rookstop .............................................................................................................. 33
Conclusies ......................................................................................................................................................... 33
Gedragstherapie bij rookstop ......................................................................................................................... 34
Inleiding ............................................................................................................................................................ 34
Rookstopbegeleiding ........................................................................................................................................ 34
Verslaving ................................................................................................................................................. 34
Afkickverschijnselen ............................................................................................................................ 35
Gewoonte ............................................................................................................................................ 35
Psychologisch....................................................................................................................................... 35
Hoe stoppen met roken? ......................................................................................................................... 36
Gedragsmatige aanpak ............................................................................................................................ 37
Wat werkt er? ................................................................................................................................................... 39
Minimale interventie......................................................................................................................................... 40
ASK ........................................................................................................................................................... 41
ADVISE...................................................................................................................................................... 41
ASSESS ...................................................................................................................................................... 41
ASSIST ....................................................................................................................................................... 41
2
, ARRANGE ................................................................................................................................................. 42
ASK ........................................................................................................................................................... 42
ADVISE...................................................................................................................................................... 42
REFER ....................................................................................................................................................... 42
Casus ................................................................................................................................................................. 43
Spirometrie .................................................................................................................................................... 44
Longfunctietests................................................................................................................................................ 44
Indicaties voor longfunctie-onderzoek .............................................................................................................. 44
Spirometrie ....................................................................................................................................................... 44
Spirogram: volume-tijd curve............................................................................................................................ 44
Spirometrie: kerngetallen ................................................................................................................................. 45
Spirometrie ....................................................................................................................................................... 45
MEFV ........................................................................................................................................................ 45
MEFV-MIFV .............................................................................................................................................. 46
Andere getallen ........................................................................................................................................ 46
FV ............................................................................................................................................................. 46
FV-curve vs. absoluut longvolume .................................................................................................................... 47
Gestoorde longfunctie: oorzaken ...................................................................................................................... 47
Uitvoering spirometrie: inleiding ...................................................................................................................... 47
Spirometrie: standaardisatie ‼ ......................................................................................................................... 48
Goede FVC test .................................................................................................................................................. 48
FVC-manoeuvre: accepteerbaarheid ................................................................................................................ 48
Kenmerk “goede” spirometrie .......................................................................................................................... 48
(F)VC-manoeuvre: on-accepteerbaarheid ......................................................................................................... 48
Interpretatie spirometrie .................................................................................................................................. 49
Interpretatie kerngetallen: referentiewaarden ................................................................................................. 49
Global Lung Function Initiative (GLI) ................................................................................................................. 50
Wanneer is longfunctie afwijkend? .................................................................................................................. 50
Interpretatie spirometrie .................................................................................................................................. 50
Obstructieve aandoeningen .............................................................................................................................. 51
Reversibiliteit: beoordeling ...................................................................................................................... 51
Pathologie van de long ................................................................................................................................... 52
Niet-neoplastische longziekte ........................................................................................................................... 52
Oorzaak vs. patroon van de ziekte ........................................................................................................... 52
Type van pathologische samples ............................................................................................................. 52
Introductie: histologie .............................................................................................................................. 52
3
, Patronen van inflammatie ................................................................................................................................ 53
Definitie en signalen ................................................................................................................................ 53
Acute inflammatie .................................................................................................................................... 53
Formatie van granulatie weefsel.............................................................................................................. 54
Chronische inflammatie ........................................................................................................................... 54
Granulomateuze inflammatie .................................................................................................................. 55
Respiratoire infecties ........................................................................................................................................ 55
Pneumonie ............................................................................................................................................... 55
Lobaire pneumonie.............................................................................................................................. 56
Granulomateuze inflammatie: pulmonaire tuberculose ......................................................................... 56
Fungale infecties: aspergillose ................................................................................................................. 56
Obstructieve luchtwegziekte ............................................................................................................................. 57
Gelokaliseerde obstructieve luchtwegziekte ........................................................................................... 57
Diffuse obstructieve luchtwegziekte ........................................................................................................ 57
Ziektes van de bronchiolus ...................................................................................................................... 57
De bronchus ............................................................................................................................................. 57
Chronische bronchitis .......................................................................................................................... 58
Bronchiëctasie ..................................................................................................................................... 58
Chronic obstructive pulmonary disease (COPD) ...................................................................................... 58
Emfyseem ............................................................................................................................................ 59
Astma ....................................................................................................................................................... 59
Histopathologische vindingen ............................................................................................................. 59
Interstitiële longziekte (ILD) .............................................................................................................................. 60
Histopathologische patronen vs. ziekte entiteiten .................................................................................. 60
Histologische reactiepatronen van de long ............................................................................................. 60
Acute long schade: diffuse alveolar damage (DAD) ................................................................................. 60
Oorzaken.............................................................................................................................................. 60
Pathofysiologie en fases ...................................................................................................................... 61
Chronische diffuse interstitiële longziekte: patronen van fibrose ........................................................... 61
Organising pneumonie: alveolaire filling ................................................................................................. 62
Pneumoconiosis ....................................................................................................................................... 62
Asbestosis ............................................................................................................................................ 62
Gecombineerde patronen van longziekte: hypersensitiviteits pneumonitis ........................................... 62
Granulomateuze inflammatie .................................................................................................................. 63
Aspiratie pneumonie ........................................................................................................................... 63
Sarcoidose ........................................................................................................................................... 63
Diffusie ........................................................................................................................................................... 64
Gastransport oiv diffusie ................................................................................................................................... 64
Gaswisseling dmv diffusie ................................................................................................................................. 64
Single breath diffusie-meting (DL,CO-SB) ............................................................................................................ 65
RGA: rapid gas analyser .................................................................................................................................... 66
Definitie diffusiecapaciteit ................................................................................................................................ 66
Single breath diffusie-meting (DL,CO-SB) ............................................................................................................ 66
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