Ok Bolile Stomacului Curs

7/23/2019 Ok Bolile Stomacului Curs

1/11

Cuprins Bolile stomaculuGASTRITELE................................................................................................................................................ ......

Clasificare:............................................................................................................................................... ......1) Dup tipul inflamaiei:.........................................................................................................................

2) Dup lcali!are:...................................................................................................................................") Dup etil#ie......................................................................................................................................GASTRITA AC$T%...................................................................................................................................................GASTRITA CR&'IC%...............................................................................................................................................In(esti#aii paraclinice:..................................................................................................................................

a) Enscpia i#esti( superiar:........................................................................................................*) +ilanul san#uin...................................................................................................................................c) E,amenul scaunului.............................................................................................................................

-ELIC&+ACTER /L&RI........................................................................................................................ ...... 0anifestri #astrice iferite bacterie/gazd....................................................................... ...... Infecia cu -.plri are 2 caracteristici ma3re:..................................................................................

Structura mrfl#ic:....................................................................................................................................Infecia cu -.plri........................................................................................................................................Dia#nsticul infecie cu -elic*acter plri:.................................................................................................

a) 0etele inirecte...............................................................................................................................*) 0etele irecte in(a!i(e....................................................................................................................c) 0ete irecte nein(a!i(e...................................................................................................................

$LCER$L ETIC........................................................................................................................................ ......Etipat#enie............................................................................................................................................ ......

1. 4actrii e a#resiune ai mucasei #astr5uenale:..........................................................................2. 4actrii e aprare ai mucasei #astrice:.............................................................................................

Simptmatl#ie:..................................................................................................................................... ......

a) Caracterele urerii in ulcerul peptic:.................................................................................................*) 2. ir!isul...........................................................................................................................................c) ". Durere cu iraiere............................................................................................................................

E,amenul *iecti(:.........................................................................................................................................In(esti#aii paraclinice:..................................................................................................................................

1) Enscpia i#esti( superiar.........................................................................................................Dia#nsticul iferenial..................................................................................................................................

Clinic:............................................................................................................................................ ...... Enscpic:................................................................................................................................... ......

E(luie. Cmplicaii.....................................................................................................................................CA'CER$L GASTRIC.................................................................................................................................. ......

Etipat#enie............................................................................................................................................ ......Clasificare:............................................................................................................................................... ......1) Cancerul #astric precce localizat doar n mucoas i eventual nsubmucoas..................................................................................................................................... ......2) Cancerul #astric a(ansat procesul tumoral depete submucoasa..............................

Simptmatl#ie...................................................................................................................................... ......

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6) D$REREA EIGASTRIC%............................................................................................................. ......7) Simptme ate e cmplicaiile lcale: -DS8.....................................................................................9) Simptme ate e metasta!ele lcre#inale i la istan: icter8 ascit etc.......................................;) Sinramele paranepla!ice: ac


3/11

etil#ia #astritei lcali!area inflamaiei e,emple: #astrit acut meicamentas antral8 #astrit crnic cuH.pyloriantral etc

GAS!"A AC#$ ini#estia8 ispepsia acut frec(ent infecias8 aler#ic8 alclic8 meicamentas anamne!

De*ut acut8 uneri fe*r8 cefalee8 ameeli urere epi#astric cntinu8 e,acer*at e alimente8 #reuri8 (rsturi alimentare ?intleran i#esti()


4/11

escperireaH.pyloria sc


5/11

sr. ispeptic tate EDSPPP cu #astrit la cerere

cum testmO pe cine tratmO

0iagnosticul in-ecie cu 'elicobacter plori:

a) mete irecte i inirecte*) mete in(a!i(e i nnin(a!i(ea) etodele indirecte

serl#ice in(a!i(PO ?puncie (enas) Ac anti-p @n sHn#e

o re!ultate fals ne#ati(eBfereastra imunl#ic8 tarai8 imunsupresaio re!ultate fals p!iti(e Ac ispar @n ani up eraicare ?titru)

met ieftin nu se indic pentru controlul eradicrii

Indicaie: diagnosticul infeciei

Foarte util n prezena unei gastrite atrofice !istologic" cnd numrul de colonii scade

#i nu poate fi identificatb) etodele directe invazive e,amenul micrscpic irect e,amenul


6/11

cmpara*il ca i cst cu


7/11

1% (actorii de agresiune ai mucoasei gastroduodenale: Aciul clr


8/11

urerea este ritmat e in#estia e alimente apare pstpranial i este calmat ein#estia e alimente

urerea pate apare la 156 re up mas mai precce @n ulcerele #astrice urerea este a*sent imineaa la sculare8 pe peria e 152 re urerea este calmat e alcaline ?lapte) i e meicaia antiaci ?I) test terapeutic urerea sur(ine @n fiecare an @n periae urerase e 256 sptmHni are caracter periic

periicitatea pate a(ea caracter se!nier prim(ara i tamnab) 2% +irozisul

pir!isul inic pre!ena reflu,ului #astr5esfa#ian (rsturile sunt rare @n ulcerul necmplicat pstpraniale (rsturile e(in a*unente8 cu alimente semii#erate @n ulcerul uenal cmplicat cu

sten! calmea! urereac) 3% Durere cu iradiere

urere epi#astric intens8 cu iraiere psteriar $D penetrant @n pancreas urere epi#astric cu iraiere @n tt a*menul8 intens ulcer perfrat -DS e *icei uce la ispariia urerii

(1amenul obiectiv: 'rmal ulcerul necmplicat Sensi*ilitate la palpare @n epi#astru

n ulcerul cmplicat: es


9/11

permite ia#nsticul infeciei cu H.pylori *ipsie #astric testul rapi al urea!ei ie,amenul


10/11

Clasifcare:1) *ancerul gastric precoce localizat doar ,n mucoas -i eventual

,n submucoas2) *ancerul gastric avansat procesul tumoral dep-e-te

submucoasa n cancerul #astric precce supra(ieuirea la 7 ani este e J n cancerul #astric a(ansat supra(ieuirea este su* 1J la 7 ani Cancerul #astric precce este asimptmatic pr#rame e screenin# cei care au factri e

riscSimptomatologie

asimptmatic cancerul #astric precce.) D/0E0E E+#40#*56) imptome date de complicaiile locale: $D7 vrsturi care nu calmeaz

durerea7 saietate precoce 8stenoza antropiloric)7 dis!agie 8localizaretuberozitar)

9) imptome date de metastazele locoregionale -i la distan: icter7 ascit etc

) indroamele paraneoplazice: ac;antosis nigricans7 !ebr


11/11

marQerii tumrali CA ;256 mnitri!area tratamentului i e(luiei ?@n asciere cuACE i CA15)

c) +entru stadializarea 4> Ec

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