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DIAREEDIAREECRONIC~CRONIC~
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DEFINI|IE:DEFINI|IE:
> 3 scaune/zi, peste 4 s`pt.> 3 scaune/zi, peste 4 s`pt.
> 300 /zi> 300 /zi
> !0 "#/$c%&p/zi, > 3 s`pt> !0 "#/$c%&p/zi, > 3 s`pt
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CONSISTEN|A:CONSISTEN|A:
'i(&ic`'i(&ic`
&`s%s&`s%s
a#i"ente ne(ie&atea#i"ente ne(ie&ateNOCTURNNOCTURN
PATOLOGIC:PATOLOGIC: ) "ucus) "ucus
) pu&%i) pu&%i
) s*ne) s*ne
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DIFEREN|IA+~ DE:DIFEREN|IA+~ DE:
I. INCON+INEN|~:I. INCON+INEN|~:
-CAN ICID-CAN ICID
-CAN -OID 1 ANO2AIE -FINC+ERIAN~:-CAN -OID 1 ANO2AIE -FINC+ERIAN~:
EINE RORIEEINE RORIE
NERO 2-CAR~NERO 2-CAR~
II. DI-5EIEII. DI-5EIE
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DIAREE FNC|IONA~DIAREE FNC|IONA~
!. I-+ORIE N6~!. I-+ORIE N6~
7. A8-EN|A ECOCI+EOR, -9N6EI7. A8-EN|A ECOCI+EOR, -9N6EI
3. A8-EN|A IERDERII ONDERAE3. A8-EN|A IERDERII ONDERAE
4. AARI|IA EC-I; DIRN~4. AARI|IA EC-I; DIRN~
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FA-E DIAREIFA-E DIAREI
A CON-+IA| IE -CAN DR < A~+=E REC+A
INCON+INEN| ~ ANA2NE~, +=E2ANO2E+RIE
+2ORI REC+AE 2C-, E2A+OCEIEREC+O-COIE
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;AOARE -E2IOO6IC~;AOARE -E2IOO6IC~
ALTERAREA ST~RIIALTERAREA ST~RIIGENERALEGENERALE
TUMORI, ADENOPATIITUMORI, ADENOPATII
ARTRITEARTRITE
ULCER G-DULCER G-D
EDEMEEDEME
FLUSHFLUSH
HIPERPIGMENTAREHIPERPIGMENTARE
ERITEM NODOSERITEM NODOS
GU}EGU}E
NEUROPATIENEUROPATIE
CANCER, IBDCANCER, IBD
CANCER, LIMFOMCANCER, LIMFOM
IBD, WHIPPLEIBD, WHIPPLE
S. ZOLLINGERS. ZOLLINGERS. MALABSORB|IES. MALABSORB|IE
S. CARCINOIDS. CARCINOID
ADDISONADDISON
IBDIBDHIPERTIROIDIE,HIPERTIROIDIE,
CANCERCANCER
DIABET, AMILOIDDIABET, AMILOID
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DIAREE < DREREDIAREE < DRERE
+I CER+I CER
-. 5OENI6-. 5OENI6
ERIO28IICA~ERIO28IICA~
OCAIA+~OCAIA+~
INFRAO28IICAINFRAO28IICA
-. OIN6ER-. OIN6ER
-+ENO~:-+ENO~:
) INFA2A+ORIE) INFA2A+ORIE) +2ORA~) +2ORA~
AN6ORAN6OR
-.I.I.-.I.I.
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FIIOA+OO6IEFIIOA+OO6IE
DIAREE 2O+ORIEDIAREE 2O+ORIE
CA~ -A EFEC+CA~ -A EFEC+
+RAN-OR+ ANOR2A DE FIDE+RAN-OR+ ANOR2A DE FIDE
-C~DEREA A8-OR8|IEI ) O-2O+IC~-C~DEREA A8-OR8|IEI ) O-2O+IC~
CRE=+EREA -ECRE|IEI ) -ECRE+ORIECRE=+EREA -ECRE|IEI ) -ECRE+ORIE
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DIAREI 2O+ORIIDIAREI 2O+ORIIRELA|IE INVERS~ T.T. - VOLUM SCAUNRELA|IE INVERS~ T.T. - VOLUM SCAUN
([ !"#$%! &$')&*+ *+!$([ !"#$%! &$')&*+ *+!$
CARACTERECARACTERE
!. -CAN ICID !#/74 %&e!. -CAN ICID !#/74 %&e7. -CAN I2ERIO-, O-+RANDIA7. -CAN I2ERIO-, O-+RANDIA
3. RE-+RI AI2EN+ARE3. RE-+RI AI2EN+ARE
4. +E-+ INDI6OCAR2IN ++ ?4. +E-+ INDI6OCAR2IN ++ ?@. INFEN|A AI+ARII@. INFEN|A AI+ARII
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E+IOO6IEE+IOO6IE
CAUZE ORGANICECAUZE ORGANICE
) 6A-+REC+O2II) 6A-+REC+O2II
) COECI-+EC+O2II) COECI-+EC+O2II
) REEC|II, 8OI) REEC|II, 8OI
IEAEIEAE
) FI-+E) FI-+E
CAUZE ENDOCRINECAUZE ENDOCRINE
) IER+IROIDIE) IER+IROIDIE
) CANCER 2EDAR) CANCER 2EDAR
) -. CARCINOID) -. CARCINOID
DISAUTONOMIE -DISAUTONOMIE -
NERVOASENERVOASE
IDIOPATICEIDIOPATICE
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FIIOA+OO6IA O-2O+IC~FIIOA+OO6IA O-2O+IC~
-ARCIN~ O-2O+IC~-ARCIN~ O-2O+IC~
DI|IEDI|IE
AAAA
IO+ONIEIO+ONIE
RE+RORE-OR8|IA NaRE+RORE-OR8|IA Na
;O2;O2
CRE=+EREA 6ACRE=+EREA 6A
O-2OARI+A+EAO-2OARI+A+EA-C-C
) O-2OARI+A+EA) O-2OARI+A+EA--
70 70
BNa < 5 7 BN 1 770 "E/#BNa < 5 7 BN 1 770 "E/#
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E+IOO6IEE+IOO6IE
/. E0OGENE:/. E0OGENE:
AA+I;E: E6, 2, NaAA+I;E: E6, 2, Na77OO44,,
NaNa77-O-O33AN+IACIDEAN+IACIDE
;ARIA: ) COCICIN~;ARIA: ) COCICIN~
) COE-+IRA2IN~) COE-+IRA2IN~
) NEO2ICIN~) NEO2ICIN~
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E+IOO6IEE+IOO6IE
1. ENDOGENE:1. ENDOGENE:
A) CONGENITALE:A) CONGENITALE:
) DEFICI+ DE AC+A~) DEFICI+ DE AC+A~) A8-OR8|IE) A8-OR8|IE
6., FRC+.6., FRC+.
) A) AIOIO
) I2FAN6IEC+AIE) I2FAN6IEC+AIE) FI8RO~ CI-+IC~) FI8RO~ CI-+IC~
B) DOB^NDITEB) DOB^NDITE)) -. 2AA8-OR8|IE-. 2AA8-OR8|IE
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DIAREE -ECRE+ORIEDIAREE -ECRE+ORIE
A+O6ENIE:A+O6ENIE:
INCAPACITATEA DE ABSORB|INCAPACITATEA DE ABSORB|
IE SAU2}I SECRE|IA ACTIV~ DE N!, 3, C&IE SAU2}I SECRE|IA ACTIV~ DE N!, 3, C&4 SCAUN IZOTONIC CU PLASMA4 SCAUN IZOTONIC CU PLASMA
INFEC|IOASE:INFEC|IOASE:OERAOERA
COICOI
ERFRIN6EN-ERFRIN6EN-CERE-CERE-
ARIARI
NONINFEC|IOASENONINFEC|IOASEOR2ONAEOR2ONAE
AA+I;EAA+I;E
A. ;IOA-EA. ;IOA-E2AA8-. AC.2AA8-. AC.
8IIARI, 6R~-I2I8IIARI, 6R~-I2I
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ie&(e&e
acizi &ai
ie&(e&e a.a.#uci(e,
"ine&a#e,ita"ine
;it. A ;it. 5
Acizi &ai
Ca74P !00 N>4P
C IO+OI IC IO+OI I8I8I
D RO+EINE 2ARCA+E N@PD RO+EINE 2ARCA+E N@P
E D QO~E D QO~
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DIA6NO-+ICDIA6NO-+IC
II. DEFINIREA DEFICITELOR NUTRI|IONALEII. DEFINIREA DEFICITELOR NUTRI|IONALEIII. DG. ETIOLOGIC:III. DG. ETIOLOGIC:
!. ANA2NEA!. ANA2NEA
7. E. FIIC7. E. FIIC3. +E-+E:3. +E-+E:) RL: ) nespecic) RL: ) nespecic) specic: ) stu#e) specic: ) stu#e
) %Gst&ucHii) %Gst&ucHii ) (ie&ticu#i) (ie&ticu#i4. 8IO-IE4. 8IO-IE
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ANA+O2IE A+OO6IC~ANA+O2IE A+OO6IC~
!. EN+ERI+~ RADIC~: ) AC+!. EN+ERI+~ RADIC~: ) AC+
) CRONIC) CRONIC
7. I2FAN6IEC+AIA7. I2FAN6IEC+AIA
3. -CERODER2IA3. -CERODER2IA
4. IO4. IO 6O8INE2IA6O8INE2IA
@. ARAI|I@. ARAI|I
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CA-IFICARECA-IFICARE
I. LEZIUNI MUCOASE:I. LEZIUNI MUCOASE:
) -RE) -RE
) -RE +ROICA) -RE +ROICA
) DER2A+I+A ERE+IFOR2~) DER2A+I+A ERE+IFOR2~
) COA6ENOE) COA6ENOE
) IO) IO 6O8INE2IA6O8INE2IA
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II. LEZIUNI PARIETALE:II. LEZIUNI PARIETALE:
1. CONGENITALE:1. CONGENITALE:) I. -CR+) I. -CR+
) I2FAN6IEC+AIA) I2FAN6IEC+AIA
2. DOB^NDITE:2. DOB^NDITE:
) 8. CRON) 8. CRON
) I2FOA2E) I2FOA2E
) A2IOID) A2IOID
) IN-F. AR+ERIA~) IN-F. AR+ERIA~) RL+) RL+
) O8-+RC|IE I2FA+IC~) O8-+RC|IE I2FA+IC~
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III. INFEC|II:III. INFEC|II:
!. EN+ERI+E AC+E!. EN+ERI+E AC+E7. ARAI|I7. ARAI|I
3. +8C3. +8C
4. KIE4. KIE
@. -+AA:@. -+AA:
a ANA+O2ICa ANA+O2ICG FNC|IONAG FNC|IONA
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IV. L. BIOCHIMICE:IV. L. BIOCHIMICE:
!. AAC+AIE!. AAC+AIE
7. A7. A IORO+EINE2IEIORO+EINE2IE
3. AN3. AN IORO+EINE2IEIORO+EINE2IE
4. -. OIN6ER4. -. OIN6ER@. 2ACROA2IAE2IA@. 2ACROA2IAE2IA
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V. BOLI E0TRADIGESTIVEV. BOLI E0TRADIGESTIVE
A ENDOCRINOA+II:A ENDOCRINOA+II:) ti&%i(`) ti&%i(`
) pa&ati&%i(`) pa&ati&%i(`
) (iaGet) (iaGet) A((is%n) A((is%n
8 +2ORI:8 +2ORI:
) &ena#e) &ena#e
) s. ca&cin%i() s. ca&cin%i(
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-RE CEIAC-RE CEIACBEN+EROA+IA 6+E2IC~BEN+EROA+IA 6+E2IC~
BAZ~ GENETIC~:BAZ~ GENETIC~:
!:300 Ian(a!:300 Ian(a !:7000 a#te z%ne!:7000 a#te z%ne
&up sanuin O&up sanuin O e"ei L 7 8e"ei L 7 8
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FACTORI E0OGENI :FACTORI E0OGENI :
)) 6IADINA ) &acHiune s%#uGi#` n a#c%%#.6IADINA ) &acHiune s%#uGi#` n a#c%%#.
FACTORI IMUNI:FACTORI IMUNI:
) A A c# II DS3) A A c# II DS3) Ac anti#ia(in`) Ac anti#ia(in`
) Ac antien(%"isiu") Ac antien(%"isiu"
) Ac anti&eticu#in`) Ac anti&eticu#in`
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ANA+O2IE A+OO6IC~ANA+O2IE A+OO6IC~
!.!. A#te&a&ea "ic&%cite#%&A#te&a&ea "ic&%cite#%&
7.7. ie&(e&ea i#i#%&ie&(e&ea i#i#%&
3.3. In#t&at #i"%cita& n #a"inaIn#t&at #i"%cita& n #a"ina
4.4. C&ete&ea n&. "it%zeC&ete&ea n&. "it%ze
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FIIOA+OO6IEFIIOA+OO6IE
!. REDCEREA -RAFE|EI A8-OR+I;E!. REDCEREA -RAFE|EI A8-OR+I;E
7. -C~DEREA ENI2EOR7. -C~DEREA ENI2EOR
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CINICACINICA
/. V?
) A8DO2EN DE-+IN- T@P) A8DO2EN DE-+IN- T@P ) A8DO2EN DRERO- @0P) A8DO2EN DRERO- @0P
@. SECUNDARE MALABSORB|IEI@. SECUNDARE MALABSORB|IEI
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2ANIFE-+~RI -ECIAE2ANIFE-+~RI -ECIAE
!.!. 2ODIFICAREA A2REN+EOR2ODIFICAREA A2REN+EOR
7.7. FE8R~FE8R~
3.3. -ENO2E6AIE-ENO2E6AIE
4.4. +RO28OCI+OENIE+RO28OCI+OENIE
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DIA6NO-+IC DIFEREN|IADIA6NO-+IC DIFEREN|IA
!.!. 8OI FNC|IONAE8OI FNC|IONAE
7.7. -. 2ADI6E-+IE-. 2ADI6E-+IE
3.3. -. 2AA8-OR8|IE-. 2AA8-OR8|IE
D & & &D & & &
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D!*#)& $+$!& !&D!*#)& $+$!& !&!+*$ &*!#$!+*$ &*!#$
6ia&(ia6ia&(ia -p&ue c%#aenic-p&ue c%#aenic Ente&ita &a(icaEnte&ita &a(ica 8.K'ipp#e8.K'ipp#e+uGe&cu#%z+uGe&cu#%z 6ast&%ente&ita e%zin%#ica6ast&%ente&ita e%zin%#ica i"%a"ei"%a"e -.%##ine& E##is%n-.%##ine& E##is%n
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DIA6NO-+IC OI+I;DIA6NO-+IC OI+I;
/./. AMELIORARE:AMELIORARE:
) CINIC~: !)!4 zi#e) CINIC~: !)!4 zi#e
) ANA+)A+: !4)!?0 zi#e) ANA+)A+: !4)!?0 zi#e
1.1. RECIDIV~RECIDIV~
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COMPLICA|IICOMPLICA|II
/. LIMFOAME/. LIMFOAME
1. CANCERE:1. CANCERE:
E-OFA6E-OFA6
OROFARIN6EOROFARIN6E
-9N-9N
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TRATMENTTRATMENT
-unt inte&zise &au#,%&zu#,seca&a-unt inte&zise &au#,%&zu#,seca&a
-unt pe&"ise %&ezu# p%&u"Gu# s%&u#-unt pe&"ise %&ezu# p%&u"Gu# s%&u#%azu#%azu#
-u&se (e a"i(%n ca&e p%t %#%site-u&se (e a"i(%n ca&e p%t %#%site'&isca,"ei,a&%&ut,ca&t%,tapi%ca'&isca,"ei,a&%&ut,ca&t%,tapi%ca
Nuci,a#une,U%a&ea s%a&e#uiNuci,a#une,U%a&ea s%a&e#ui
An Assessmen Plan !"r a Paien #i$ P""rl% &es'"nsi(e Celia) *isease
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Green P and Cellier C. N Engl J Med 2007;357:1731-1743
An Assessmen Plan !"r a Paien #i$ P""rl% &es'"nsi(e Celia) *isease
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DEFICI+ DEDEFICI+ DE
DIAARIDAEDIAARIDAE
A2IDON ) a"i#%pectineA2IDON ) a"i#%pectine 6ICO6EN ) a"i#aza6ICO6EN ) a"i#aza
A2IAA !,4:A2IAA !,4:
2A+O~2A+O~
2A+O+RIO~2A+O+RIO~
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DIAARIDAEDIAARIDAE
2A+A~2A+A~
-CRA~-CRA~
AC+A~AC+A~
DE+RINA~DE+RINA~
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DI-+RI8|IADI-+RI8|IA
MN +I2 B IIIMN +I2 B III
ANA+O2IC~ANA+O2IC~
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DEFICI+DEFICI+
/. PRIMAR/. PRIMAR
1. SECUNDAR:1. SECUNDAR:
a ap%&t eLcesia ap%&t eLcesi
G &ezecHiiG &ezecHii
c G. intestina#`c G. intestina#`
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FIIOA+OO6IEFIIOA+OO6IE
DEFICI+ AC+A~DEFICI+ AC+A~
IDROI~ DEFICI+AR~IDROI~ DEFICI+AR~
CRE=+E O
)c&a"pe)(ia&ee)&eaH`
FER2EN+A|IE
AC. OR6ANICI
DIAREE
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DIA6NO-+ICDIA6NO-+IC
!.!. CINICCINIC
7.7. 8IOO6IC8IOO6IC
3.3. I-+OCI2ICI-+OCI2IC
4.4. COROO6ICCOROO6IC
@.@. RLRLJ.J. RE-IRA+ORRE-IRA+OR
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BOALA WHIPPLEBOALA WHIPPLE
8%a#a &a&a , p&%tei%&"a ca&acte&izata8%a#a &a&a , p&%tei%&"a ca&acte&izatap&in (ia&ee, s#aGi&e a&t&a#ii.p&in (ia&ee, s#aGi&e a&t&a#ii.
+&%p'i 1'&ana+&%p'i 1'&ana
e&V"a 1 Ga&ie&ae&V"a 1 Ga&ie&a
W'ipp#eiW'ipp#ei
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GERMENELEGERMENELE
-e t&ans"ite eca#) %&a#-e t&ans"ite eca#) %&a#
-e cu#tia pe ce#u#e sau "e(iu cu-e cu#tia pe ce#u#e sau "e(iu cua"in%)acizia"in%)acizi
A&e An( (e ! "eaGazaA&e An( (e ! "eaGaza
-e &ecun%sc 7 specii-e &ecun%sc 7 specii
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ANATOMIE PATOLOGICAANATOMIE PATOLOGICA
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P!*$$P!*$$
A)8 7T / i"un%sup&esieA)8 7T / i"un%sup&esie
Ina(eaza "ac&%ae#e ca&e sue&aIna(eaza "ac&%ae#e ca&e sue&aap%pt%za , pe&"itan( (ise"ina&eaap%pt%za , pe&"itan( (ise"ina&ea
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EVOLUTIE STADIALAEVOLUTIE STADIALA
RODRO2A ) AR+RI+ERODRO2A ) AR+RI+E
) a&t&a#ii) a&t&a#ii
-+ARE DA J ANI ) 8AR8A+I 0P-+ARE DA J ANI ) 8AR8A+I 0P
) -A8IRE 3P) -A8IRE 3P ) DIAREE ?0P) DIAREE ?0P
) AR+RI+E T0P ) AR+RI+E T0P
) ADENOA+II 40P) ADENOA+II 40P
) 2EANODER2IE @0P) 2EANODER2IE @0P
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D!*#D!*#
Ane"ie,#euc%cit%zaXe%zin%#ie,t&%"G%penieAne"ie,#euc%cit%zaXe%zin%#ie,t&%"G%penie
Reactanti (e aza acutaReactanti (e aza acuta
2uc%asa (u%(ena#a2uc%asa (u%(ena#aa#Gena,"it%asa/e&ite"at%asa,e&%ziuni,&ia#Gena,"it%asa/e&ite"at%asa,e&%ziuni,&i
aGi#aaGi#a
C%#%&atia A-C%#%&atia A-
Aspect t&i#a"e#a& a# pe&ete#ui "ic&%GianAspect t&i#a"e#a& a# pe&ete#ui "ic&%Gian
C%#%&a&e i"un%c'i"icaC%#%&a&e i"un%c'i"ica
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TRATAMENTTRATAMENT
+et&acic#ina+et&acic#ina
-u#a"et'%Laz%#)t&i"et%p&i"-u#a"et'%Laz%#)t&i"et%p&i"?00/!J0?00/!J077
-t&ept%"icina !/zi< penici#ina !,J-t&ept%"icina !/zi< penici#ina !,J"i#/zi"i#/zi
< cet&iaL%n< cet&iaL%n7/zi7/zi
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+en"llar + e al. N Engl J Med 2007;35,:55-,,
niial reamen and /seen &ela'se in $i''les *isease
6A-+ROEN+EROA+IA6A-+ROEN+EROA+IA
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6A-+ROEN+EROA+IA6A-+ROEN+EROA+IAEDA+I;~EDA+I;~
DEFINI|IE:DEFINI|IE:-in(&%" ca&acte&izat p&in-in(&%" ca&acte&izat p&in
pie&(e&i an%&"a#e (e p&%teine.pie&(e&i an%&"a#e (e p&%teine.
CLINIC:CLINIC:DIAREE < EDE2E < DRERIDIAREE < EDE2E < DRERI
BIOLOGIC:BIOLOGIC:
) c#ea&ance) c#ea&ance //A+ > !7"/74 %&eA+ > !7"/74 %&e
) a#Gu"in` "a&cat` B+c, C&) a#Gu"in` "a&cat` B+c, C&
E+IOO6IE
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E+IOO6IEE+IOO6IE
I. CAUZE CE CRESC PRESIUNEA INTERSTI|IAL~I. CAUZE CE CRESC PRESIUNEA INTERSTI|IAL~/. L!$!'! *$!&/. L!$!'! *$!&
1. O"#+)%! $'$$+:1. O"#+)%! $'$$+:
a +8Ca +8C
G sa&c%i(%z`G sa&c%i(%z`c #i"%a"ec #i"%a"e
( G&%z` &et&%pe&it%nea#`( G&%z` &et&%pe&it%nea#`
5. C+$$+$! PVC:5. C+$$+$! PVC:
a pe&ica&(it` c%nst&icti`a pe&ica&(it` c%nst&icti`
G insucienH` ca&(iac`G insucienH` ca&(iac`
II BOLI CU ULCERA|IIII BOLI CU ULCERA|II:
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II. BOLI CU ULCERA|II:II. BOLI CU ULCERA|II:
aa ast&ite sau ente&ite e&%zieast&ite sau ente&ite e&%zie
GG ne%p#aziine%p#aziicc G. C&%'nG. C&%'n
II. BOLI F~R~ ULCERA|II:II. BOLI F~R~ ULCERA|II:
aa 2enet&ie&2enet&ie&GG K'ipp#eK'ipp#e
cc a#e&icea#e&ice
(( ast&%ente&ite e%zin%#east&%ente&ite e%zin%#eee sp&uesp&ue
-E-E