Bolest respiratornih organa

8/18/2019 Bolest respiratornih organa

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Gimnazija

Maturski rad iz biologije

BOLESTI RESPIRATORNI ORGANA

Mentor: Učenik:


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Bolesti respiratornih organa

SA!R"A#:1.UVOD.....................................................................................................................................3

2. BOLESTI GORNJIH DIŠNIH UTOV!.............................................................................."

1.1 2.1. re#$%&%................................................................................................................"2.1.1. 'n%ko(i i )i*+to*i.................................................................................................."

2.1.2. U,ročni-i..................................................................................................................

2.1.3. %to/i,io$o0i%..........................................................................................................

2.1.. Di%0no,%.................................................................................................................

2.1.". Liečene...................................................................................................................4

2.1.. re(en-i%.................................................................................................................4

1.2 2.2. 5%rin0iti).............................................................................................................16

2.2.1. U,ročni-i................................................................................................................16

2.2.2. Si*+to*i................................................................................................................16

2.2.3. Liečene.................................................................................................................11

1.3 2.3. L%rin0iti)............................................................................................................12

2.3.1. !k7tni $%rin0iti)i....................................................................................................12

2.3.1.1. !k7tni e&e*%to,ni $%rin0iti)...............................................................................13

3. BOLESTI DONJIH DIŠNIH UTOV!...............................................................................1

1. 3.1. !k7tni 8ron#iti)..................................................................................................1

3.1.1. U,ročni-i................................................................................................................1

3.1.2. Si*+to*i................................................................................................................14

3.1.3. Di%0no,%...............................................................................................................14

3.1.. Liečene.................................................................................................................14

1." 3.1.2. Hronični 8ron#iti)............................................................................................19

3.1.3. E*/i,e*.................................................................................................................26

1..........................................................................................................................................21

1. 3.2. !)t*%..................................................................................................................21

3.2.1. U,ročni-i................................................................................................................22

3.2.2. %to/i,io$o0i%........................................................................................................23

3.2.. re(en-i%...............................................................................................................2

3.2.". Liečene.................................................................................................................2

1.4 3.3.ne7*oni% 7+%$% +$7;%


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3.3.2. Si*+to*i................................................................................................................2

3.3.3. Liečene.................................................................................................................24

3.3.. re(en-i%...............................................................................................................24

3..1. U,ročnik.................................................................................................................293..2. Si*+to*i................................................................................................................36

3..3. %to/i,io$o0i%........................................................................................................31

3... Di%0no,%...............................................................................................................31

3..". Liečene.................................................................................................................32

3... re(en-i%...............................................................................................................32

1.9 3.". R!= LU>!.....................................................................................................33

3.".1. U,ročni-i................................................................................................................33

3.".2. Ti+o(i r%k% +$7;%....................................................................................................3

3.".3. Si*+to*i................................................................................................................3

3.".. Di%0no,%...............................................................................................................3"

3.".". Liečene.................................................................................................................3

. '!=LJU?!=......................................................................................................................34

".LITER!TUR!......................................................................................................................6

3


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$%&'O!

Re)+ir%torni )i)te* or0%n% )%)toi )e o& 0orni# &i@ni# +7to(%: no)%A &rie$% i 0rk$%n%

,%0ri%(%neA ($%eneA či@;ene i &e,in/ek-i% ,r%k%


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(% BOLESTI GORN#I !I)NI P&TO'A

2.1. Prehlada

re#$%&% e +o,n%t% i k%o n%,o/%rin0iti)A rino/%rin0iti) i$i %k7tn% (iro,%. R%&i )e o,%r%,no 8o$e)ti 0orne0 &i@no0 )i)te*% ko% )e $%ko @iri i ko% +o0%% 70$%(no* no).Si*+to*i 7k$7č77 k%@%$A 0r$o8o$7A i)-e&%k i, no)% rinore7< i 0ro,ni-7. Si*+to*i o8ičnone)t%7 7 rok7 o& )e&%* &o &e)et &%n%. Neki )i*+to*iA *e7ti*A *o07 tr%%ti i &o tri)e&*i-e. Rino(ir7)i )7 n%če@;i 7,ročni-i +re#$%&eA %$i i)t7 *oe 7,roko(%ti (i@e o& &(ie)totine r%,$ičiti# (ir7)%.In/ek-ie 0orni# &i@ni# +7te(% k%te0ori,ir%ne )7 +o &ie$o(i*% tie$%koi )7 +reteno +o0oFeni. re#$%&% +r(en)t(eno n%+%&% no)A 0r$o /%rin0iti)< i )in7)e)in7)iti)


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2.1.2. Uzročnici

O8ičn% +re#$%&% (ir7)n% e in/ek-i% 0orni# &i@ni# +7te(%. N%če@;i e 7,ročnik rino(ir7)S$ik% 1.< koi )+%&% 7 0r7+7 +i-orn%(ir7)%A *%$i# RN= (ir7)%A % o&0o(or%n e ,% 36

&o 46 )$7č%e(%. S$e&e;% )k7+in% če)ti# 7,ročnik% +re#$%&e )7 koron%(ir7)iS$ik% 2.< i

7,rok77 16 &o 1" )$7č%e(% +re#$%&eA % i)to to$iko )$7č%e(% 7,rok7e i in/$7en,%(ir7)(ir7) 0ri+e


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2.1.3. Patofiziologija

ret+o)t%($% )e &% )7 )i*+to*i +re#$%&e 70$%(no* i*7no$o@ki o&0o(or n% (ir7).Me#%ni,%* i*7no$o@ko0 o&0o(or% )+e-i/ič%n e ,% )(%ki (ir7). N% +ri*erA rino(ir7) )e

o8ično )teče 7 i,r%(no* kont%kt7 on )e (ee )e n% $7&)ke I!MC1 re-e+tore n% ne+o,n%tn%čin i %kti(ir% o)$o8%%ne /%ktor% 7+%$e. O)$o8oeni 7+%$ni /%ktori 7,rok77 )i*+to*e

+re#$%&e. Me#%ni,%* $ok%$i,ir%ne 7+%$e koi )e r%,(ie ko& ,%r%,e rino(ir7)o* 7 +r%(i$7 ne7,rok7e o@te;ene no)no0 e+ite$%.

Re)+ir%torni )in-i-i)ki (ir7) RSV< +reno)i )eA k%ko i,r%(ni* &o&iro* )% )ekreti*%A t%ko i +7te* $e8&e;i# k%+$i-%. U8r,o )e r%,*noi 7 e+ite$7 no)% i 0r$% +oto* ko$oni,ir% &one &i@ne +7te(e. RSV o@te;7e e+ite$ koi ko$oni,ir%. Vir7) +%r%in/$7en,e o8ično 7,rok7e 7+%$7 no)%A0r$% i &i@ni# +7te(%. U )$7č%7 ,%r%,e &e-e če)to ko$oni,ir% &7@nik te *oe 7,roko(%ti

)i*+to*e +ro*7k$o0 k%@$% i ote%no0 &i)%n% i )tri&or%. T%k%( )k7+ )i*+to*% n%,i(%*okr7+. O(i )e )i*+to*i +r(en)t(eno %($%7 ko& &e-e 87&7;i &% )7 &eči &i@ni +7te(i 7e0

+ro*er%.

2.1.4. Dijagnoza

R%,$ike *e7 in/ek-i%*% 0orne0 &i@no0 )i)te*% 70$%(no* )e te*e$e n% %n%to*)ko$ok%-ii )i*+to*%. re#$%&% +r(en)t(eno +o0%% no)A /%rin0iti) 0r$oA % 8ron#iti) +$7;%A *e7ti**o07)e %(iti i 8itn% +rek$%+%n% ko& )i*+to*%. re#$%&% )e če)to &e/inir% k%o %k7tn% 7+%$% no)%A %*oe 7k$7či(%ti i r%,$ičit )t7+%n 7+%$e 0r$%. S%*oC&i%0no)ti-ir%ne e 7o8ič%eno. I,o$%-i%(ir7)% 7,ročnik% +re#$%&e rietko )e +ro(o&i. U (e;ini )$7č%e(% nie *o07;e i&enti/i-ir%ti(r)t7 (ir7)% i)k$7či(o +7te* )i*+to*%.

2.1.5. Liječenje

Ne +o)toi $iek i$i 8i$ni +ri+r%(%k koi 8i &ok%,%no *o0%o )kr%titi tr%%ne

+re#$%&eA %$i +o)toe $ieko(i koi *o07 ,n%tno 78$%iti )i*+to*e. Neke )7 )e (r)ten%ro&no0 $iečen% +ok%,%$e 8$%0ot(orni*A k%o n+r. *iro(%neA 7no@ene o8i$% tek7;in%i 0r0$%ne to+$o* )$%no* (o&o*A %$i 8$%0ot(orno)t o(i# *eto&% 70$%(no* )e +ri+i)7e

+$%-e8o 7čink7.

Ter%+i)ki +o)t7+-i koi )e kori)te ,% 78$%%(%ne )i*+to*% 7k$7č77 k$%)ične $ieko(e ,%78$%%(%ne 8o$i %n%$0etike< i )ni%(%ne te*+er%t7re %nti+iretike


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ne&ok%,%ne 7činko(ito)ti =%n%&% e 2669. o0r%niči$% 7+otre87 8e,re-e+tni# $ieko(% +roti(k%@$% i +re#$%&e ,% &e-7 &o @e)t 0o&in%. '$o7+otre8% &ek)tro*etor/%n% 8e,re-e+tno0 $iek%

+roti( k%@$%< &o(e$% e &o ,%8r%ne ne0o(% kori@ten% 7 *no0i* ,e*$%*%.

=o& o&r%)$i# )e )i*+to*i -7ren% i, no)% *o07 )*%niti 7+otre8o* %nti#i)t%*inik% +r(e0ener%-ie. Oni )e *eF7ti* +o(e,77 ) nee$eni* n7)+o%(%*% +o+7t +o)+%no)ti. O)t%$i&ekon0e)ti(i +o+7t +)e7&oe/e&rin% t%koFer )7 )e +ok%,%$i &e$ot(orni*% ko& o&r%)$i#.

!ero)o$ni +ri+r%(-i ,% no) n% 8%,i i+r%tro+i% *o07 78$%iti -7rene i, no)%A %$i ne*%7(e;i# 7čin%k% n% ,%če+$eno)tA &ok )e %nti#i)t%*ini-i &r70e 0ener%-ie ni)7 +ok%,%$i&e$ot(orni*% 7 )$7č%7 +re#$%&e.

2.1.. Prevencija

Je&ini 7činko(it n%čin )+reč%(%n% +re#$%&e e /i,ičko )+reč%(%ne @iren% (ir7)%. To +r(en)t(eno 7k$7č7e +r%ne r7k7 i no@ene *%)ke ,% $i-eA &ok )e 7 ,&r%()t(eni* 7)t%no(%*%kori)te i +$%@te(i i r7k%(i-e ,% e&nokr%tn7 7+otre87. I,o$ir%ne ,%r%ene o)o8e nie *o07;e

er e 8o$e)t (eo*% r%@iren%A % )i*+to*i ni)7 )+e-i/ični. ie+$ene )e nie +ok%,%$o7)+e@ni* ,8o0 (e$iko0 8ro% *o07;i# (ir7)% 7,ročnik% 8o$e)ti i ni#o(e )+o)o8no)ti 8r,e*7t%-ie. roi,(o&n% -e+i(% @iroko0 )+ektr% &e$o(%n% )to0% e *%$o (ero%tn%. Re&o(ito

+r%ne r7k7 +ok%,%$o )e 7činko(iti* 7 )*%nen7 +reno@en% (ir7)% +re#$%&eA +o0oto(o ko&

&e-e. Nie &ok%,%no +o(e;%(% $i 7+otre8% &e,in/ek-i)ki# )re&)t%(% tieko* nor*%$no0 +r%n% r7k7 7činko(ito)t )+rieč%(%n% ,%r%,e +ri$iko* +r%n% r7k7. Inte0r%-i% -inko* +ok%,%$% )e 7činko(ito* 7 )*%nen7 8ro% 0o&i@ni# e+i,o&% +re#$%&eA &ok r7tin)ko&o&%(%ne (it%*in% ne )*%n7e ri,ik ni o,8i$no)t )i*+to*% +re#$%&e. Vit%*in *oe)kr%titi tr%%ne +re#$%&e.

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2.2. Faringitis

5%rin0iti) e ,%+%$ene )$7,ni-e &re$% i kr%nik%A i,%,(%no r%,$ičiti* *ikro8ni*

7,ročni-i*%. O(o o8o$ene e *eF7 n%če@;i* in/ekti(ni* o8o$eni*%A 7 če*7 e i ne0o(e+i&e*io$o@ki ,n%č%.

2.2.1. Uzročnici

N%če@;i 7,ročni-i /%rin0iti)% )7 (ir7)iA %$i n%(e;i ,n%č% i*% 8%kteri)ki /%rin0iti)i,%,(%n Streptococcus pyogenesomA ,8o0 +otre8e ,% %nti8iot)ko* ter%+io* i ko*+$ik%-i%*%koe *o07 n%)t%ti 7ko$iko )e ne $ieči re7*%t)k% 0ro,ni-%A %k7tni 0$o*er7$one/riti)

878re0%


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Lok%$ni n%$%, 7 (r%t7 e n%če@;e nek%r%kteri)tič%n: +o)toe #i+ere*i% i e&e* )$7,okoe. =o&

%&eno(ir7)ne i EBV in/ek-ie *o07 +o)to%ti ek)7&%ti(ne +ro*ene n% ton,i$%*%. =oer+etično0 /%rin0iti)% HSV< +o)toe (e,ik7$e i +$itke 7$-er%-ie n% $%8i%$no 7)ne< i 87k%$no *7ko,i o8r%,


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2.2.3. Liječenje

U+%$% kr%nik% ko% e 7,roko(%n% )tre+tokokno* in/ek-io* o8ično )e $ieči%nti8ioti-i*% k%o @to e +eni-i$in. onek%&A +o)e8no ko& *%$e &e-e ko% i*%7 +ote@ko;e ko&

07t%n%A +eni-i$in )e &%e inek-io*. !nti8iotike o8ično tre8% 7,i*%ti 8%re* 16 &%n%. I%ko ;e)e &iete (ero%tno o)e;%ti 8o$e n%kon e&no0 i$i &(% &%n%A (%no e &o(r@iti 7 -ie$o)ti$iečene %nti8ioti-i*%. reki&%ne $iečen% +ot+o*%e )t(%r%ne )oe(% 8%kteri% koe )7ot+orne n% %nti8iotike. ore& to0%A in/ek-i% )e *oe (r%titiA 7,rok77;i +oten-i%$no o,8i$neko*+$ik%-ie. N%%$o)tA ,% )%&% ne +o)toi nik%k(o $iečene (ir7)% koi 7,rok77 7+%$7kr%nik%. Moe +ro;i o& &o 1 &%n% &ok )e &iete 7 +ot+7no)ti ne o+or%(i. onek%&A $iečnik *oe +re+or7čiti &% )e &eteto(i kr%ni-iA % *o&% i %&enoi&ne (e0et%-ie tre;i kr%nik<7k$one. O(o re@ene )e o8ično kori)ti )%*o k%& 7+%$e kr%nik% 7teč7 n% &eteto(o o+;e,&r%($e i$i o*et%7 &i)%ne i$i )$7#. Ton,i$ekto*i% )e o8ično +ro(o&i k%o kr%tkotr%n%

o+er%-i%. To ,n%či &% ;e &iete *o;i i;i k7;i &r70i &%n n%kon @to e i,(r@en% o+er%-i%.MeF7ti*A &o +ot+7no0 o+or%(k% *oe +ro;i i &o 2 )e&*i-e.

N%kon o+er%-ieA &iete *oe i*%ti +ri$ičn7 0r$o8o$7. T%koe *oe i*%ti i 8o$o(e 7 7@i*%.Tieko* +r(o0 te&n% n%kon o+er%-ieA n%)toite &r%ti &iete +o&%$e o& (e;i# )k7+in% $7&i io)o8% koe 8i *o0$e 8iti 8o$e)ne. Diete e 7 to (rie*e o)et$i(ie n% in/ek-ie. T%koeAi*%te n% 7*7 &% 7k$%n%ne kr%nik% i %&enoi&ni# (e0et%-i% *oe )*%niti in/ek-ie 0r$%A %$ii# ne *or% 7 +ot+7no)ti )+reč%(%ti.

2.3. Laringitis

'%+%$ene )$7,ni-e 0rk$%n%. o)toe %k7tni i #ronični $%rin0iti)i.

2.3.1. "k#tni laringitisi

U,ro-i )7 r%,$ičiti i *o07 8iti ko*8ino(%ni: re)+ir%torni +r%@in%A &i*A &7#%nA #$%&%n,r%kA it&.


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S$ik% . L%rin0iti)

Lije*enje e r%,$ičitoA ,%(i)no o& )te+en% o8o$en%. otre8no e: (ok%$no *iro(%neA ,%8r%n% +7@en%A o&*or 7 ($%no i to+$o )re&ini.

ri*en77 )e in#%$%-ie 8$%0i# $eko(iti# +%r% $i+%A *%k


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t7*or)kiA +o)tr%&i%-ioniA tok)ičniA ren%$niA it&. O&$ik7e )e $%rin0e%$no* &i)+neo* ko%(%rir% +re*% )e&i@t7 i (o$7*en7 otok%. G$%) e +ri07@enA +ro*7k%o. =%@%$ e r%,$ičitA k%o io+@ti ,n%-i koi ,%(i)e o& etio$o0ie otok%. In&irektn% i$i &irektn% $%rin0o)ko+i% ko& &etet%A&o(o&i &o +o)t%($%n% &i%0no,eA +rik%,77;i )e&i@te e&e*% i ne0o( i,0$e&A k%o i )te+en

)7en% +ro)tor% ,% &i)%ne.

Slika ). *ematozni laringitis. +ii se gotovo potpuno za'epl(en(e grkl(ana

Lije*enje. S%)toi )e o& o&*or%A +ri*%n% %nti8iotik%A kortikoi&%A %nti#i)t%*inik%A%nti)+%,*o&ik%. o0or@%ne )i*+to*% ,%#tie(% tr%#eoto*i7A +re*% )e&i@t7 e&e*%.

2.3.1.2. %r#p

=r7+ e %k7tn% 7+%$% 0orne0 i &one0 &i@no0 )7)t%(% ko7 n%če@;e 7,rok7e (ir7) +%r%in/$7en-e ti+% 1. o8$ik %k7tno0 $%rin0iti)% ko& no(oroFenč%&i i &e-e &o tri 0o&ine<M%ni/e)tir% )e k%@$e* +o+7t $%(e% i in)+ir%torni* )tri&oro*. Di%0no,% e o8ično k$iničkiočit% %$i )e *oe +o)t%(iti %ntero+o)teriorno* RTG )$iko* (r%t%. Lieči )e %nti+ireti-i*%A#i&r%-io*A r%-e*ični* %&ren%$ino* +ri*ieneni* +o*o;7 r%)+r@i(%č% i kortiko)teroi&i*%.ro0no,% e i,(r)n%.

Sim+tomi% =r7+7 o8ično +ret#o&e )i*+to*i in/ek-ie 0orne0 &i@no0 )7)t%(%. oto* )eAo8ično no;7A +o%(e n%+%&i k%@$% n%$ik n% $%(eA i +ro*7k$o)t i)to t%koA *oe +o)to%ti i

in)+ir%torni )tri&or. Diete )e no;7 *oe +ro87&iti ) re)+ir%torni* &i)tre)o*A t%#i+neo* i

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7($%čene* no)ni-% i &i@ni# *i@i;%. U te@ki* )$7č%e(i*% )eA k%& )e &iete ,%*oriA *oe +o%(iti -i%no,% +r%;en% )(e +$i;i* &i)%ne*.Očiti re)+ir%torni &i)tre) i 0r78i in)+ir%torni)tri&or )7 n%&r%*%tičnii /i,ik%$ni n%$%,i.

=r7+ *oe 8iti +ri*%r%n rei< %ko )e o&*%# +o%(e &i/terične )kr%*e 7 0r$7A i$i)ek7n&%r%nA k%& n%)t%e @irene* &i/terični# )kr%*% i, &rie$% i$i no)% ne$iečeno0 i$i k%)no$iečeno0 8o$e)nik%. St(%r%ne* &i/terični# )kr%*% n% )$7,ni-i $%rink)% n%)t%e *e#%ničko)7%(%ne ot(or% i,*e7 0$%)ni# i-% 7 in%če 7,%no* 0rk$%n7 *%$e &e-e. o)$e&i-eo(%k(i# +ro*en% )7: ote%noA #r%+%(o i č7no &i)%neA +ro*7k$o)tA k%@%$A % k%)nie i )$%8%ok)i0en%-i% kr(i. S$ik% .<

Slika ,. Su-en(e larinksa ko krupa

!7)k7$t%-io* )e č7e +ro&7$eni in)+iri i )tri&orA če)to 7, ne@to ek)+ir%torni# #ro+%-% i,(i&7k%. Vr7;i-% )e n%$%,i 7 oko 12 )$7č%e(%. U7tro )e )t%ne &etet% *oe činiti 8o$i*A no

+ono(no )e +o0or@%(% no;7.on%($%ni n%+%&i )e če)to n%,i(%7 )+%)tični* kr7+o*. U r%,(o7)+%)tično0 kr7+% 7$o07 *o07 i*%ti %$er0i% i$i re%kti(no)t &i@ni# +7to(%A no k$iničke )e*%ni/e)t%-ie ne *o07 r%,$iko(%ti o& (ir7)no0 kr7+% % )+%)tični kr7+ e n%če@;e +ot%kn7t(ir7)no* in/ek-io*.

=r7+ +očine +o)te+eno i i*% tri )t%&i7*%:

!is,oni*ni stadijum: +o)te+eno n%)t%%ne +ro*7k$o)ti ko% i&e &o %/onie 078itk% 0$%)%< i0r78 k%@%$ koi +o&)e;% n% $%(eA neo8ič%n ko& *%$e &e-e. D%$ni* )7%(%ne* ot(or%i,*e7 0$%)ni# i-% n%)t%e

!is+noi*ni stadijum:in)+ir%torn% &i)+ne% )tri&or #r%+%(oA )tr70%(o č7no &i)%ne


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As,iksi*ni stadijum:&i)%ne e to$iko ote%no &% )eA 7)$e& $o@e ok)i0en%-ie kr(iA %($%-i%no,% *o&ri$o koe i )$7,ni-e


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)$7,%(oC0noni )%&r%. =%@%$ e o)no(ni *e#%ni,%* i,8%-i(%n% 8ron#%$no0 )ekret%. ?e@;e)e +o%($7e 7 ,i*)ki* *e)e-i*%A % n%(i@e o8o$ie(%7 *%$% &e-%.

Slika . Bronhitis

3.1.1. Uzročnici

Re)+ir%torni )7 (ir7)i 7,ročni-i %k7tno0 8ron#iti)%A % +o&e&n%ko 0% če)to 7,rok77(ir7)i o8ične +re#$%&eA k%o @to )7 rino(ir7)i i koron%(ir7)iA i oni in(%,i(niiA k%o @to )7 (ir7)iin/$7en-e i %&eno(ir7)iA % 7 &e-e i re)+ir%torni )in-i-i)ki (ir7) i (ir7)i +%r%in/$7en-e. !k7tni

e 8ron#iti) +o)e8no če)t ,% (rie*e e+i&e*ie in/$7en-e. !&eno(ir7)i )7 n%(%nii 7,ročni-i7 (oni* ko$ekti(i*%. I%ko rino(ir7)i ni)7 to$iko +%to0eniA oni )7 ,8o0 )(oe 8rono)ti i

7če)t%$o)ti (r$o (%ni 7,ročni-i %k7tno0 8ron#iti)% i 7 &e-e i 7 o&r%)$i#. S%*o e *%$i +o)tot%k %k7tni# 8ron#iti)% 7,roko(%n ne(ir7)ni* 7,ročni-i*%. /ycoplasma pneumoniae en%,%)t7+$eni% 7 *%$e i 7 )t%rie &e-e. B%kterie 70$%(no* )%*o )ek7n&%rno in/i-ir%7)$7,ni-7 8ron#% o@te;en7 (ir7)i*% i$i 7,rok77 %k7tn7 e0,%-er8%-i7 +o0or@%ne )t%n%< 7

8o$e)nik% ) #ronični* 8ron#iti)o*.

3.1.2. !imptomi

!k7tno* 8ron#iti)7 če)to +ret#o&i #7n%(i-%A ,i*i-%A )$%8o)tA *%$o +o(i@en% te$e)n%te*+er%t7r%A 8o$ 7 $ei*%A *i@i;i*% i 0r$o8o$%. =%@%$ e 7 +očetk7 )7#A %$i )e (e; n%konneko$iko )%ti i$i &%n% *o07 +o%(iti *%$e ko$ičine 07)to0%A i$%(o0A 7;k%)toC)i(o0 i)k%@$%%)+7t7*%


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i*%7 %re;7 8o$ i,% +r)ne ko)ti. Bo$ )e toko* k%@$%n% +o%č%(%. Si*+to*i o8ično ne)t%7n%kon 3 &o " &%n%. Bo$e)nik *oe i &%$e k%@$%tiA č%k i neko$iko te&%n%. Bo$e)ni-i k%tk%&*o07 o)t%ti 8e, ,r%k% %ko )e ,%če+e &i@ni +7to(i. =%tk%&%A #ronični )in7)iti) *oe o+on%@%ti)i*+to*e 8ron#iti)%A t,(. )ino8ron#%$ni )in&ro*.

3.1.3. Dijagnoza

U )(%ko&ne(no )e +r%k)i &i%0no,% %k7tno0 8ron#iti)% ,%)ni(% n% te*e$ito %n%*ne,ii ko*+$etno*e +re0$e&7. Liečnik %7)k7$t%-io* +$7;% otkri(% +o)(7&% +o%č%n @7* &i)%n% )r%,$ičiti* #ro+-i*%. Ren&0en)k% e )$ik% +$7;% 7re&n% i n%(%nii e r%,$iko(ni ,n%k +re*%7+%$i +$7;%. L%8or%tori)ki n%$%,i ne*%7 (e;7 (rie&no)t 7 &i%0no)ti-i. Se&i*ent%-i% *oe

8iti 78r,%n%A no n%če@;e e nor*%$n%. To *%ne ,%(i)i o (r)ti 7,ročnik%A % (i@e o %k7tno)ti

+ro-e)%A +ret#o&ni* #ronični* 8o$e)ti*% i e(ent7%$ni* ko*+$ik%-i%*%. I 8ro e $e7ko-it%70$%(no* nor*%$%n. L%8or%tori)ki *ikro8io$o@ki< +re0$e& i)k%@$%% i 8ri) no)% o& *%$e )7

+o*o;i.

3.1.4. Liječenje

Liečene e %k7tno0 8ron#iti)%A 7 +r%(i$7A )%*o )i*+to*%t)koA 7)*ereno n%78$%%(%ne k%@$%. O,&r%($ene +o)+e@7e o+ti*%$n% *ikrok$i*% ) ($%ni* ,r%ko* 7 )o8iA

,%8r%n% +7@en%A @te&n% 0$%)%A 7,i*%ne (e;e ko$ičine n%+it%k% te kon%čno $ieko(i ,%)*iri(%ne k%@$% %ntit7)i-i


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8o$e)ti i ne ,n%7 &% e i*%7. '8o0 7če)t%$i# in/ek-i% 8ron#% i 8ron#io$% &o$%,i &o o&e8$%n%i i)kri($en% )$7,ni-e ti# -ie(i koe )7 )7ene i ,%če+$ene o& +reko*erno0 i,$7či(%n% )$7,i i

+reter%no0 )te,%n% *i@i;% 7 )tienk%*% . U Ve$iko Brit%nii o& #ronično0 8ron#iti)% 7*ire0o&i@ne 36 666 $7&i t. e&n% o)o8% n% 2666


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3.1.3. &mfizem

E*/i,e* +$7;% e +$7;no o8o$ene ko& ko0% &o$%,i &o +reter%no0 +o(e;%n% +$7;ni#%$(eo$% i )*%ni(%n% +$7;no0 tki(%A koe )e n%$%,i i,*eF7 ni# S$ik% 11


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1.3 3.2. Astma

!)t*% o& 0rčko0 )t#*%A ,%&7#%< e 7če)t%$% #roničn% 7+%$n% 8o$e)t &i@ni# +7te(%o8i$een% r%,no$iki* i re-i&i(ir%7;i* )i*+to*i*%A re(er,i8i$no* o+)tr7k-io* &i@ni# +7to(% i 8ron#o)+%,*o* S$ik% 4.


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e &% %)t*7 *o07 i,%,(%ti i ($%0% i +$ie)ni 7 )t%*8eno* +ro)tor7.

O)i* to0%A +o)toi teori% ko% n%(o&i &% 8i 7,rok +o(e;%no0 8ro% %$er0i% i o8o$e$i# o&%)t*e *o0$o 8iti i )(e če@;e -ie+$ene +roti( r%,$ičiti# 8o$e)ti. '8o0 )*%nene 7če)t%$o)tiin/ek-i% i*7no$o@ki )7)t%( e +ron%@%o no(e ne+ri%te$e +roti( koi# ;e )e 8oriti. N%%$o)tAto )7 +o)t%$e t(%ri koe n%) o&7(iek okr777 i n% koe +o)t%e*o o)et$i(i i %$er0ični +e$7&Ak7;n% +r%@in% i )$.


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!)t*% e o8i$een% re-i&i(ir%7;i* n%+%&i*% ,(i&%n%A kr%tko;e &%#%A +riti)k% 7 +r)i*% i k%@$%. Moe &o;i &o )t(%r%n% i)k%@$%%A no n%če@;e i)k%@$%(%ne* ne &o$%,i &oi,8%-i(%n% nik%k(o0 )%&r%%. I)k%@$% )e *oe +o%(iti tieko* r%,&o8$% o+or%(k% o&n%+%&%A i t%&% e )$ič%n 0no7 er )%&ri *no@t(o $e7ko-it% eo,ino/i$%. Si*+to*i )e o8ično

+o0or@%(%7 +o no;i i 7 r%ni* 7t%rni* )%ti*%A i$i n%kon (e8e i$i i,$%0%n% #$%&no* ,r%k7.U neki# 8o$e)nik% ) %)t*o* )i*+to*i )7 rietko)t i o8ično )e %($%7 n%kon i,$%0%n%oki&%či*%A &ok &r70i 8o$e)ni-i *o07 i*%ti i,r%ene i tr%ne )i*+to*e.

=o& 8o$e)nik% ) %)t*o* )eA 7 7)+ore&8i ) $7&i*% koi o& ne ne 8o$77A če@;e +o%($7e ni,&r70i# +ore*e;%% k%o @to e: 0%)troe,o/%0e%$n% re/$7k)n% 8o$e)t GERB


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N%7činko(itie +ri $iečn7 %)t*e e +ron%$%ene oki&%č%A k%o @to )7 &i* -i0%ret%A k7;ni$78i*-i i$i %)+irinA te i# i,8e0%(%ti. Uko$iko e i,8e0%(%ne oki&%č% ne&o(o$noA +re+or7č7e)e +ri*en% $ieko(%. O&%8ir $iek% )eA i,*e7 o)t%$o0%A ,%)ni(% n% i,r%eno)ti 8o$e)ti i7če)t%$o)ti )i*+to*%. S+e-i/ični $ieko(i ,% %)t*7 )e @iroko &ie$e 7 )k7+in7 $ieko(% 8r,o0

&e$o(%n% i )k7+in7 $ieko(% )+oro0 &e$o(%n%.

=o& 8o$e)nik% )% )(%ko&ne(ni* n%+%&i*%A +ri*en7e )e (e;% &o,% in#%$%-i)ki#kortiko)teroi&%. ri 7*ereno i$i %ko e0,%-er8%-iiA o(i* )e $ieko(i*% &o&%e i or%$n%

+ri*en% kortiko)teroi&%. Lieko(i )e ti+ično +roi,(o&e 7 o8$ik7 in#%$%tor% 7 ko*8in%-ii )&o&%tni* )+re*niko*A i$i k%o in#%$%tori +r%@k%. S+re*nik e +$%)tični -i$in&%r 7 koe* )e$iek *ie@% )% ,r%ko*A o*o07;77;i 7)+e@ni7 +ri*en7 -e$ok7+ne &o,e $iek% S$ik% 9.


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S$ik% 16. ne7*oni%

I,r%, +ne7*oni% )e +onek%&% kori)ti ,% @ire o,n%č%(%ne 8i$o koe0 )t%n% koe 7,rok7e7+%$7 +$7;% 7,roko(%n7A n% +ri*erA %7toi*7no* 8o$e@;7A #e*i)ki* o+ek$in%*% i$ire%k-i%*% n% $ieko(e


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7,ročnik *%ni# )re&ni# 7 &eči* ko$ekti(i*% i 7 @ko$%*%< i (r$o (e$iki# 0r%&)ki# ire0ion%$ni#< e+i&e*i% %ti+ični# +ne7*oni%. Ve$ike )e e+i&e*ie +o%($77 7 &o)t% +r%(i$ni*(re*en)ki* r%,*%-i*%A )(%ki# &o 0o&in%. E+i&e*i% o8ično +očine 7 e)enA r%,(i% )e

+o)t7+no i tr%e (i@e *e)e-iA )(e &o +ro$e;%. T%&% o8ično o8o$ie(%7 @ko$)k% &e-% i *$%e

o&r%)$e o)o8e. ne7*oni% e o8ično 7če)t%$i%A % k%tk%& i te% 7 &eč%k% ne0o 7 &e(oči-%.Re)+ir%torni )7 (ir7)i (r$o če)ti 7,ročni-i +ne7*oni% 7 &e-e o)o8ito &e-e *$%e o& +et0o&in%


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0$%(o8o$%A 8o$ 7 *i@i;i*% i ,0$o8o(i*%A o+;% )$%8o)t i 7*orA % k%tk%& *7čnin%A +o(r%;%ne i +ro$e(. =%@%$ )e o8ično ,%+%% n%kon 3 &o &%n%A % re&o(ito e )7# i n%&r%%%nA 8e,*o07;no)ti i)k%@$%(%n%. '8o0 nek%r%kteri)tični# )i*+to*% &i%0no,% )e +o)t%($% k%)niene0o 7 8%kteri)ki* +ne7*oni%*%A če)to tek n%kon ren&0en)ko0 )ni*%n% +$7;%. Vir7)ne

+ne7*onie )e o8ično ne *o07 i r%,$iko(%ti o& o)t%$i#A %$i )7 +o )i*+to*i*% i ,n%ko(i*% 8o$e)ti te +o o)t%$i* n%$%,i*% )$ičnie %ti+ični* +ne7*oni%*%.

3.3.3. Liječenje

U $7&i ) (i)oki* ri,iko*A k%o @to )7 oni ) kir7r@ki* ,%#(%to* n% +r)no* ko@7 i$io)$%8$ene o)o8eA 7 )+reč%(%n7 +ne7*onie +o*%7 (e8e &78oko0 &i)%n% i $iečene )-i$e* &% )e 7k$one $7če(ine. I o)o8%*% ) +ne7*onio* +otre8no e 7k$oniti $7če(ine.

S(e (e;i 8ro 8%kteri% koe 7,rok77 7+%$7 +$7;% +ne7*oni7< r%,(i$e )7 re,i)ten-i7ot+orno)t< n% %nti8iotike. N% +ri*erA *no0i )t%/i$okoki )t(%r%7 en,i*e +eni-i$in%,e< koi)+reč%(%7 &% i# +eni-i$in 78ie. ne7*okoki )7 t%koe +o)t%$i re,i)tentnii n% +eni-i$in,%#(%$77;i r%,$ičiti* *e#%ni,*i*%. Ot+orno)t n% %nti8iotike +re&)t%($% o,8i$%n +ro8$e*Ao)o8ito 7 )$7č%7 in/ek-i% )tečeni# 7 8o$ni-i. In/ek-ie re,i)tentni* )t%/i$okoki*% *o07 )e$iečiti %nti8ioti-i*% koi )7 7činko(iti i 7 +ri)7)t(7 +eni-i$in%,eA %$i neki )7 )t%/i$okoki +o)t%$iot+orni i n% te $ieko(e. '% te )t%/i$okokeA če)to )e &%e $iek (%nko*i-in. St%/i$okokn%

+ne7*oni% )+oro re%0ir% n% %nti8iotikeA +% e 8o$e)nik7 +otre8%n &70otr%%n o+or%(%k. ?e)too)o8e koe ni)7 %ko 8o$e)ne *o07 7,i*%ti %nti8iotike n% 7)t% i o)t%ti ko& k7;e. St%rie i one)% ,%&7#o* i$i one koi i*%7 o& +rie 8o$e)t )r-% i$i +$7;% )*e@t% )e 7 8o$ni-7 i &%e

%nti8iotike intr%(en)ki* +7to*. Mo07 i* 8iti +otre8iti i &o&%tni ki)ikA in/7,ie i *e#%ničk% +ot+or% &i)%n7.

3.3.4. Prevencija

re(en-i% o87#(%t% -ie+$eneA %(no,&r%()t(ene *ere i o&0o(%r%7;e $iečene&r70i# +o)toe;i# 8o$e)ti. =%& 8i )e o&0o(%r%7;e +re(enti(ne *ere +ro(e$e n% 0$o8%$nor%,iniA )*%tr% )e &% 8i )e )*rtno)t 7 &e-e )*%ni$% ,% 66 666 )$7č%e(%A % k%& 8io&0o(%r%7;e $iečene 8i$o )(7&% &o)t7+no t% 8ro 8i )e )*%nio ,% 66 666 )$7č%e(%.

re+or7č7e )e +re)t%n%k +7@en% i )*%nene 7n7t%rne0 ,%0%en% ,r%k%. Učinko(iti

+re(enti(ni +o)t7+-i )7 i +r%ne r7k7 i k%@$%ne 7 r7k%( ne ,%k$%nene 7)t% r7ko*


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-%.% TB/ 0 tuberkoloza1

T78erk7$o,% TB< e o& &%(nin% ,n%n% 8o$e)t ko% e i &%n%) e&n% o& n%o,8i$nii# in%r%@irenii# ,%r%,ni# 8o$e)ti. Go&ine 1996. S(et)k% ,&r%()t(en% or0%ni,%-i% +ro-ieni$% ek%ko e 1A *i$i%r&i $7&i +rok7eno 8%kterio* /ycobacterium tuberculosis t78erk7$inC

+o,iti(niA )$ik% 14.


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neko$iko te&%n%A 8%-i$i t78erk7$o,e *o07 +7te* kr(i i $i*/e 8iti +rene)eniA &o)$o(-e 7 8i$okoi or0%n tie$%.

3.4.2. !imptomi

Si*+to*i *o07 8iti 8o$ 7 +r)i@t7 i &70otr%ni k%@%$ +r%;en i)k%@$%e*. Oko 2" 8o$e)nik% ne*% nik%k(e )i*+to*e o&no)noA 8o$e)t e %)i*+to*%t)k%P


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In/ek-i% ) TB ,%+očine k%& *iko8%kterie &o)+i7 &o +$7;ni# %$(eo$%A 0&e 7$%,e 7%$(eo$%rne *%kro/%0e i &ie$e )e 7 ni#o(i* en&o)o*i*%. ri*%rno *e)to in/ek-ie 7 +$7;i*%n%,i(% )e G#ono(o %ri@te i )*e@teno e 7 0orne* &ie$7 &one0 ren%A i$i 7 &one* &ie$70orne0 ren%. Do t78erk7$o,e +$7;% *oe &o;i i ,%r%,o* +7te* kr(iA @to )e n%,i(%

Si*ono(o %ri@te. Si*ono(o )e %ri@te ti+ično n%$%,i 7 (r@k7 +$7;%.

S$ik% 13. Ren&0en)ki )ni*%k t78erk7$o,e

T78erk7$o,% e 0r%n7$o*%to,n% 7+%$%. Gr%n7$o*i )7 n%k7+ine 7+%$ni# )t%ni-%: *%kro/%0%A T$i*/o-it% i B $i*/o-it%A 0&e $i*/o-iti okr777 ,%r%ene *%kro/%0e. St(%r%ne* 0r%n7$o*%tie$o n%)toi )+riečiti @irene *iko8%kteri% i )t(%r% $ok%$no okr7ene ,% $%k@e*e7&e$o(%ne )t%ni-% i*7no)no0 )7)t%(% S$ik% 13.


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3.4.5. Liječenje

Bo$e)t )e *oe r%,(iti 7n7t%r neko$iko te&%n% o& +ri*%rne in/ek-ieA % *o07 +ro;i i0o&ine +rie ne0o $i )e r%,(ie. De-%A )t%rie i i*7noko*+ro*itir%ne o)o8e +ri*eri-eA o)o8e) !IDSCo*A 8o$e)ni-i n% ke*oter%+ii i$i 8o$e)ni-i n%kon tr%n)+$%nt%-ie koi 7,i*%7i*7no)7+re)i(ne $ieko(e< i*%7 (e;i ri,ik o& 8r,o0 r%,(o% 8o$e)ti. =o& +$7;no0 TBC%A

+ro@ireno)t 8o$e)ti *oe (%rir%tiA no 8e, 7činko(ite ter%+ie 8o$e)t (r$o 8r,o n%+re&7e.Re%kti(%-i% t78erk7$o,e +o)$e&i-% e %kti(%-ie *ir77;i# 8%-i$% 7 7&%$eni* *e)ti*%.O(%k%( tiek 8o$e)ti (i% )e 7 96 o&r%)$i#. =%&% )e re%kti(%-i% o&i0r%(% 7 +$7;i*%An%če@;e ,%#(%;% (r@ne i )tr%ne &ie$o(e 0orni# rene(%. Ti+ični ren&0en)ki n%$%,i )e o@7(iek če)to (i%7.

Liečene t78erk7$o,e +ro(o&i )e $ieko(i*% koe n%,i(%*o %ntit78erk7$oti-iA % -i$ e)7,8i%ne i i,$ečene in/ek-ie i)koreni(%ne i(i# *iko8%kteri%


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1." 3.". #A$ PL%&A

o)toe &(ie (r)te r%k% +$7;% koe )e ,%)ni(%7 n% to*e k%ko )t%ni-e i,0$e&%7 +o&*ikro)ko+o*: r%k *%$i# )t%ni-% i r%k (e$iki# )t%ni-%. St%ni-e r%k% )(%ko0 ti+% r%)t7 i @ire )en% r%,$ičite n%čineA te )e )to0% i r%,$ičito $ieče. R%k (e$iki# )t%ni-% +$7;% o8ično e +o(e,%n )

+ret#o&ni* +7@ene*A +%)i(ni* +7@ene* i$i nen%*erni* i,$%0%ne*. Uo+@tenoA r%k *%$i#)t%ni-% o8ično )e (e; +ro@irio &o +o)t%($%n% &i%0no,e i $ieči )e #e*oter%+io* ii$ir%&ioter%+io*. R%k (e$iki# )t%ni-% +$7;% )e ne *or% +ro@iriti &o +o)t%($%n% &i%0no,eA te e*o07;% kir7r@k% re)ek-i% o(o0 ti+%. Met%)t%,ir%ni r%k +$7;% +ro@ireni r%k +$7;%< *oe )er%,(iti 7 )koro )(%ko* &ie$7 tie$%A % 7o8ič%eni or0%ni )7 *o,%kA ko)tiA kr%$eničk% *o&in%i etr%. Liečene )e ,%)ni(% n% o&rei(%n7 (r)te )t%ni-% r%k%A te (e$ičini +ri*%rno0 t7*or% io+)e07 7 koe* )e +ro@irio n% $i*/ne č(oro(e i$i *e)t% *et%)t%,ir%n%. ro0no,% *o07;no)ti,$ečen%< i i,8or ter%+ie o(i)i o )t%&i7 r%k% e $i ,%#(%tio )%*o +$7;% i$i )e i +ro@irio


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%$(eo$%rni# )t%ni-% n%)t%e i, ,r%čni# *e#7ri;% %$(eo$e< +$7;%. re*&% )e t% r%k *oe +o%(iti )%*o n% e&no* *e)t7 +oe&in%čni i,r%@t%


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)*eteno)tA 0rče(i i 8o$ 7 ko)ti*% *o07 )e r%,(iti i +rie ne0o )7 +o)t%$i očiti +$7;ni +ro8$e*iA@to ote%(% r%no +o)t%($%ne &i%0no,e.

Neki o8$i-i r%k% +$7;% $7če #or*one i$i t(%ri n%$ik #or*oni*% @to i*% ,% +o)$e&i-7 nenor*%$no(i)oke r%,ine #or*on%. N% +ri*erA k%r-ino*i *%$i# )t%ni-% *o07 $7čiti kortikotro+inA te

7,roko(%ti 7)#in0o( )in&ro*A i$i %nti&i7ret)ki #or*on koi &o(o&i &o ,%&r%(%n% (o&e i ni)ker%,ine n%tri% 7 kr(i. I,(%nre&no (e$iko )t(%r%ne #or*on% *oe +ro7,ročiti k%r-inoi&ni)in&ro*-r(eni$o $i-%A #ri+%neA +ro$e( i +ro8$e*i )% )rč%ni* ,%$i)-i*%. =%r-ino* +$oč%)ti#)t%ni-% *oe $7čiti t(%r )$ičn7 #or*on7 ko% &o(o&i &o (r$o (i)oki# r%,in% k%$-i% 7 kr(i. Dr70i#or*on)ki )in&ro*i (e,%ni 7, r%k +$7;% 7k$7č77 +o(e;%ne 0r7&i 7 *7@k%r%-% 0ineko*%)ti%< i

+or%)t #or*on% @titn%če #i+ertireo,%


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i)k%@$%% *oe o)i07r%ti &o(o$no *%teri%$% ,% t%k(7 +retr%07 ,o(e )e -ito$o0i% i)k%@$%%


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oko 2" 8o$e)nik% ke*oter%+i% 8itno +ro&7$7e +rei($ene. L7&i ) k%r-ino*o* +$7;%*%$i# )t%ni-% koi )7 &o8ro re%0ir%$i n% ke*oter%+i7 *o07 i*%ti kori)ti o& ,r%čen% 0$%(e 7)$7č%e(i*% k%& )e r%k +ro@irio n% *o,%k.

Mno0i $7&i ) r%ko* +$7;% +ok%,77 8itno )niene +$7;ne /7nk-ie 8i$i $iečeni i$i ne. Ter%+i%ki)iko* i $ieko(i*% koi +ro@ir77 &i@ne +7to(e *oe o$%k@%ti +ote@ko;e +ri &i)%n7. Mno0i$7&i ) 7,n%+re&o(%$i* r%ko* +$7;% i*%7 t%k(e 8o$o(e i +ote@ko;e &i)%n% &% i* )e te&ni*%i *e)e-i*% +rie )*rti *or%7 &%(%ti (e$ike &o,e n%rkotik%. Sre;o*A n%rkoti-i *o07 8itno

+o*o;i %ko )e &%7 7 +ri*ereni* &o,%*%.

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N%kon )(e0% n%(e&eno0 *o0%o 8i# ,%k$7čiti &% )e 96 o(i# 8o$e)ti %($% 7)$e&ne&o(o$ne +%ne o ($%)tito* i(ot7 i *i)$i* &% e 0$%(ni ,%k$7č%k o(o0 r%&% t% &% *or%*o

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+o*%nk%ne te$e)ne %kti(no)ti. $7;ne 8o$e)ti ire(er,i8i$no ne+o(r%tno< o@te;77 +$7;% ten%)t%e te@k% /7nk-i)k% ne)+o)o8no)t i +o0or@%(% )e k(%$itet% i(ot%. o)$e&ni# 0o&in%)*%n7e )e r%,no(r)no)t +ri)t7+% 7 $iečen7 ti# 8o$e)ti te )e o8%($7e )(e (i@e*e7n%ro&ni# )*erni-% i +rie&$o0% r%&i +re(en-ieA r%no0 otkri(%n% i $iečen% #ronični#

+$7;ni# 8o$e)ti.

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o8o$ie(%n% )t%no(nik%. '%e&ničke )7 i* ,n%č%ke: *no0o)tr7ki 7,ro-iA ne+ri*et%n

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+očet%kA #ronič%n tiekA k%o i ,% )%&% o@ )kro*ne *o07;no)ti )+reč%(%n% te ne*o07;no)t +ot+7no0 i,$ečen%.

N%če@;e (rie*e k%&% )e in/ek-ie %($%7 )7 e)en i ,i*%. Vr$o )7 če)te i čine 23 )(i#in/ek-i%. re*% e+i&e*io$o@ki* )t%ti)tik%*%A o&r%)$i čo(ek 0o&i@ne o8o$i 2C +7t%A % &e-%o& C4 +7t%.

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