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Samenvatting prof. Wilmer (alle leerstof inhoudstabel)
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INHOUDSlokdarmfunctie ...................................................................................................................................................... 4
slokdarmpathologie ................................................................................................................................................ 4
Pathologie ........................................................................................................................................................... 4
Motorische stoornissen .................................................................................................................................. 4
Hernia hiatus Esophagei (hiatushernia) .......................................................................................................... 5
GERD (peptische oesofagitis) en GORZ (gastro oesofageale refluxziekte) ...................................................... 6
Fysiologie ................................................................................................................................................................ 7
Peptische letsels ...................................................................................................................................................... 7
peptische Ulcera.................................................................................................................................................. 8
Ulcusziekte ........................................................................................................................................................ 11
Symptomen en verwikkelingen ..................................................................................................................... 11
Diagnose ........................................................................................................................................................ 12
Behandeling .................................................................................................................................................. 12
Functionele darmstoornissen ............................................................................................................................... 12
Irritable bowel syndrome (IBS) = spastische colon ........................................................................................... 12
Symptomen ................................................................................................................................................... 12
klinische fenotypes:....................................................................................................................................... 12
Pathofysiologie (LEZEN) ................................................................................................................................ 12
Functionele dyspepsie ....................................................................................................................................... 13
Symptomen ................................................................................................................................................... 13
Potentiële mechanismen voor pathofysiologie (Lezen) ................................................................................ 13
Coeliakie ................................................................................................................................................................ 13
Structurele veranderingen ............................................................................................................................ 14
Pathofysiologie .............................................................................................................................................. 14
Symptomen ................................................................................................................................................... 15
Diagnose ........................................................................................................................................................ 16
Inflammatoire darmziekten (IBD) ......................................................................................................................... 16
Ziektebeeld .................................................................................................................................................... 16
Ziekte van Crohn ............................................................................................................................................... 17
Distributie...................................................................................................................................................... 17
klinisch en pathologisch gedrag .................................................................................................................... 17
Etiologie EN pathogenese ............................................................................................................................. 18
Diagnose ........................................................................................................................................................ 19
Behandeling .................................................................................................................................................. 19
Colitis ulcerosa .................................................................................................................................................. 19
,Anatomie en functies lever ................................................................................................................................... 19
Leverfalen.............................................................................................................................................................. 20
Symptomen en comlicaties ........................................................................................................................... 20
Diagnose ........................................................................................................................................................ 20
Hepatitis ............................................................................................................................................................ 20
Virale hepatitis .............................................................................................................................................. 20
Alcoholische hepatitis ................................................................................................................................... 25
NASH en NAFLD ................................................................................................................................................. 28
Pancreatitis ........................................................................................................................................................... 31
Exocriene functie pancreas ........................................................................................................................... 31
Acute pancreatitis ............................................................................................................................................. 31
Classificatie .................................................................................................................................................... 31
Factoren die AP veroorzaken en pathogenese ............................................................................................. 32
Symptomen en complicaties acute ernstige pancreatitis ............................................................................. 32
Chronische pancreatitis..................................................................................................................................... 33
Oorzaken ....................................................................................................................................................... 33
Symptomen en gevolgen............................................................................................................................... 34
Galstenen .............................................................................................................................................................. 35
Ontstaansmechanisme ...................................................................................................................................... 35
cholesterolgalstenen ..................................................................................................................................... 35
,
,GIT ZIEKTELEER
SLOKDARMFUNCTIE
▪ Transport van voedselbolus en speeksel
▪ Voorkomen reflux maaginhoud
Dit gebeurd via:
→ peristaltiek
→ sfinctermechanismen
→ neuronale controle
SLOKDARMPATHOLOGIE
Symptomen
Dysfagie, Odynophagie (pijn) , Regurgitatie, Pyrosis, Aspiratie, Gewichtsverlies, Bloedverlies, Globusgevoel,
Halitosis
Onderzoek
▪ Manometrisch onderzoek
▪ Oesofagoscopie
▪ Ambulante pH-meting
▪ Röntgenonderzoek
PATHOLOGIE
MOTORISCHE STOORNISS EN
ACHALASIE
Achalasie van de slokdarm is een zeldzame chronische ziekte waarbij de zenuwvoorziening van de slokdarm
beschadigd is. Hierdoor blijft het gladde spierweefsel in de slokdarm constant aangespannen. Dit leidt ertoe
dat de sluitspier tussen slokdarm en maag moeilijk voedsel door kan laten en er geen normale peristaltiek meer
plaatsvindt bij het slikken
,Motorische stoornis tussen 30-60 jaar met
▪ GES dilateert niet, tonus
▪ Slokdarmperistaltiek
▪ Progressieve obstructie ▪ Progressieve obstructie
Oorzaak: denervatie inhibitorische neuronen tgv degeneratie van ganglion cellen thv myenterische plexus
→Primair: idiopathisch
→Secundair: Ziekte van chagas (Trypanosoma cruzi), slokdarmkanker
Symptomen: Diagnose:
▪ Dysfagie (98%) ▪ Röntgen
▪ Retrosternale pijn dmv contracties (42%) ▪ Gastroscopie
▪ Regurgitate (78%) ▪ Manometrie
▪ Pneumonie
Therapie
▪ Dilataties
▪ Chirurgische esophagomyotomie
▪ Endoscopische myotomie
▪ Botulinustoxine
HERNIA HIATUS ESOPHA GEI (HIATUSHERNIA)
‘middenrifhernia/ maagbruek’: Deel maag komt omhoog in thoraxholte → glijbreuk
▪ Frequent op oudere leeftijd
▪ Para-oesofageale hernia
▪ Meestal asymptomatisch
▪ Soms refluxziekte
▪ Zelden therapie
,GERD (PEPTISCHE OESOFAGITIS) EN GORZ (GASTRO OESOFAGEALE REF LUXZIEKTE)
Ontsteking van de slokdarm door reflux maaginhoud (+- Gal) die voorkomt bij 14-20% van volwassenen met als
definitie: een aandoening waarbij reflux verontrustende symptomen veroorzaakt (tenminste 2 x /week)
Zuur, pepsine, galzouten veroorzaken ontsteking epitheel van slokdarm
→Erosies en Ulcera
→Vooral distale deel
TYPISCHE SYMPTOMEN EN VERWIKKELINGEN VAN GERD
▪ Pyrosis ▪ Bloeding
▪ Retrosternale pijn ▪ Barret oesofagus
▪ Ontsteking van ▪ Kanker
mucosa ulceraties
▪ Strictuur
PATHOGENESE
▪ Transiënte relaxaties
→Plotxe onset/ offset complete
relaxatie (niet veroorzaakt door
slikken)
→Reflux tijdens relaxatie
▪ Insufficiënte sfincterdruk
▪ Hiatale hernia
▪ Onvoldoende volume clearance (
peristaltiek)
▪ Onvoldoende pH clearance (
speeksel, buffer)
▪ Vertraagde maaglediging
,Diagnose:
▪ Endoscopie
▪ 24h pH-metrie
Bij refluxevent
zal de oesophagale Ph stijgen, de hoeveelheid reflux kan dan
gemeten worden door het %tijd te meten dat de Ph kleiner dan 4
is.
Behandeling GERD
▪ Algemene maatregelen: vermijden van irriterend/zurig voedsel (tomaten, pikant,…),
sigaretten, alcohol,..
▪ PPI
▪ H2 blokkers
▪ Chirurgie: fundoplicatio van
▪ Nissen
▪ Endoscopische procedures
MAAG
FYSIOLOGIE
Parietale cellen → Maagzuur en IF
▪ H+ = protonenpomp = H+/K+ ATPase = H+ - productie
▪ IF = Vit B12 - resorptie
Chief cellen → pepsine
▪ Vertering van eiwitten
G-cellen → Gastrine
PEPTISCHE LETSELS
, = ulcuslijden
▪ Erosieve gastritis
▪ Ulcus (prevalentie 5-10%)
▪ Peptische oesofagitis
▪ Zollinger Ellison Syndroom = gastrinoma
PEPTISCHE ULCERA
= onevenwicht tussen agressieve en protectieve factoren met spontane genezing in 30-70% (75% recidiven).
Agressie: zuur productie, infectie H. Pylori
Protectie: mucusfilm, HCO3-, PGE2, bloedflow in maagwand en lokale groeifactoren
→ Ulcus ventriculi en duodeni + stressulcera
Ulcus ventriculi: meestal in kleine curvatuur (meestal >40j)
Ulcus duodeni: meestal in bulbus (bijna 100 is HP positief)
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