Summary
Samenvatting Klinische vraagstukken cluster C, excl. C5 (MED-BKVS1-4)
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Samenvatting van KVS cluster C. C5 helaas niet aanwezig.
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pietergrinwis
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InhoudC1 – Gastro-enterologie A ....................................................................................................................... 3
Inhoud ..................................................................................................................................................... 3
Bovenbuiksklachten ................................................................................................................................ 4
Gastro-intestinale bloedingen ................................................................................................................. 6
Chronische diarree .................................................................................................................................. 8
Congenitale gastro-intestinale afwijkingen ........................................................................................... 12
Intra/extraperitoneaal anatomie .......................................................................................................... 14
Breuken ................................................................................................................................................. 15
C2 – Gastro-enterologie ........................................................................................................................ 16
Inhoud ................................................................................................................................................... 16
Inflammatory Bowel Disease ................................................................................................................. 17
Infectieuze diarree ................................................................................................................................ 23
Passageklachten – motiliteit tractus digestivus .................................................................................... 25
Pancreatitis ............................................................................................................................................ 31
Icterus .................................................................................................................................................... 36
Galsteenlijden........................................................................................................................................ 39
Pijnbestrijding........................................................................................................................................ 41
C3 – Urogenitale problemen in de fertiele levensfase .......................................................................... 42
Inhoud ................................................................................................................................................... 42
Urineweginfecties.................................................................................................................................. 43
SOA’s en vaginale klachten.................................................................................................................... 47
Anticonceptie en ongewenste zwangerschap ....................................................................................... 49
Mictieklachten bij mannen .................................................................................................................... 53
Seksualiteit ............................................................................................................................................ 56
C4 – voortplantingsgeneeskunde .......................................................................................................... 58
Inhoud ................................................................................................................................................... 58
Fysiologie zwangerschap ....................................................................................................................... 59
Infertiliteit.............................................................................................................................................. 61
Normale baring...................................................................................................................................... 65
Pathologie zwangerschap en baring...................................................................................................... 67
Placenta ................................................................................................................................................. 71
Kraamperiode ........................................................................................................................................ 73
Pasgeborene .......................................................................................................................................... 75
1
,C5, incompleet....................................................................................................................................... 78
C6 – Speciële oncologie ......................................................................................................................... 79
Inhoud ................................................................................................................................................... 79
Ovariumcarcinoom ................................................................................................................................ 80
Cervixcarcinoom .................................................................................................................................... 82
Endometriumcarcinoom ....................................................................................................................... 84
Vulvacarcinoom ..................................................................................................................................... 86
Colorectaal carcinoom........................................................................................................................... 88
Colorectale operaties ............................................................................................................................ 90
Poliepen in tractus digestivus................................................................................................................ 92
Pancreascarcinoom ............................................................................................................................... 94
Hematurie.............................................................................................................................................. 95
Blaaskanker ........................................................................................................................................... 96
Nierkanker ............................................................................................................................................. 97
Testiscarcinoom..................................................................................................................................... 98
Prostaatkanker .................................................................................................................................... 100
C7 – Buikpijn/Acute buik ..................................................................................................................... 102
Inhoud ................................................................................................................................................. 102
Inleiding ............................................................................................................................................... 103
Peritonitis ............................................................................................................................................ 105
Ileus/Darmobstructie .......................................................................................................................... 107
Acute buikpijn...................................................................................................................................... 109
Somatisch onvoldoende begrepen buikpijn ........................................................................................ 111
Acuut scrotum ..................................................................................................................................... 113
Urolithiasis ........................................................................................................................................... 115
Centraal vaatlijden, angine abdominale.............................................................................................. 118
Vaatchirurgie ....................................................................................................................................... 119
Shock ................................................................................................................................................... 122
2
,C1 – Gastro-enterologie A
Inhoud
Bovenbuiksklachten ................................................................................................................................ 4
Gastro-intestinale bloedingen ................................................................................................................. 6
Chronische diarree .................................................................................................................................. 8
Congenitale gastro-intestinale afwijkingen ........................................................................................... 12
Intra/extraperitoneaal anatomie .......................................................................................................... 14
Breuken ................................................................................................................................................. 15
3
, Bovenbuiksklachten
Vroeger: maagzweer gevolg van stress, dieet (koffie, alcohol, kauwgum, gebrek aan fruit)
Behandeling met rust, pap/melkdiëten, operatie (vagotomie is een goede behandeling).
75% is SOLK
Rest: reflux, gastritis, ulcus, maagcarcinoom, overig
Diagnostiek: gastroscopie, pH-meting, manometrie
Functionele dyspepsie: 25% van de bevolking, laatste 3 maanden klachten, geen somatische
verklaring
Gastric Esophageal Reflux Desease
Pathofysiologie: Gevolg van overmatige blootstelling van de mucosa van de oesofagus aan maagsap.
sap. De oorzaak is multifactorieel en deels nog onbegrepen. De belangrijkste defensiemechanismen
tegen reflux zijn: (a) een sufficiënte hogedrukzone ter plaatse van de gastrooesofageale overgang
door de werking van de onderste slokdarmsfincter, de hoek van His (hoek tussen slokdarm en
fundus; bij overgewicht minder scherp en dus minder bijdragend aan refluxpreventie) en de crura
van het diafragma; (b) effectieve klaring van het refluxaat door slokdarmperistaltiek en
zwaartekracht; (c) neutralisatie van zuur door bicarbonaat als gevolg van speekselvloed en secretie
uit submucosale klieren in de slokdarm; en (d) een intacte mucosale barrière. Negatief beïnvloed
door o.a. type voedsel, overgewicht, motiliteit van de slokdarm, medicatie.
Symptomen: zuurbranden (bukken/liggen), pijn op de borst, regurgitatie, opgeblazen gevoel,
opboeren, heesheid, hoesten (chronisch)
Risicofactoren: roken, leeftijd, alcohol, vertraagde maagontlediging, zwangerschap
Complicaties: barret oesofagus, carcinoom, peptische stenose, astma
Diagnostiek: gastroscopie
Behandeling: De refluxklachten kunnen worden verminderd door de zuurgraad van het refluxaat te
verminderen, door vermindering van de uitscheiding zuur, door het tegengaan van de
pathofysiologische mechanismen die reflux veroorzaken etc. In het kader hiervan: leefstijladviezen
(afvallen, roken, alcohol, dieet, hoofeinde omhoog) en maagzuurremming.
Medicamenteuze behandeling: protonpompremmer, H2-antagonisten, antacida
Gastritis
Komt veel voor, vaak asymptomatisch. Veroorzaakt door: Helicobacter Pylori, NSAID’s, alcohol.
Behandelen met triple therapie: omeprazol, clarythromycine, amoxicilline.
Diagnostiek: gastroscopie, biopten, HP diagnostiek d.m.v. ureum ademtest, PA, serologie, antigeen
test in ontlasting.
Ulcus ventriculi/duodeni
Pathofysiologie: H. Pylori, NSAID’s, stress, Zollingen Ellison syndroom, SSRI’s
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