Seminarski - Kolike Konja.docx

7/25/2019 Seminarski - Kolike Konja.docx

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VISOKA POLJOPRIVREDNA KOLA STRUKOVNIH STUDIJAABAC

Seminarski radpredmet: Interne bolesti

tema: KOLIKE KONJA

Professor:

Dr. Vladimir Mlaan

Student:

Dragan Rajin

1!"#$ %&

Sadraj:


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Anatomija digeti!nog tra"ta "onja'''''''''''''''''''''''''' 1

Koli"e "onja'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' #

O()te o *o+,*-.-''''''''''''''''''''''''''''''''''''''''''''''''''''' # Pode+- *o+,*-''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' # Et,o(-to/ene0-''''''''''''''''''''''''''''''''''''''''''''''''''''''' #

Vrte "olini# $olo!a''''''''''''''''''''''''''''''''''''''''''''''''''' S(-st,*, *o+,n, 2o+o3,'''''''''''''''''''''''''''''''''''''''''''' D,sten0,4s*, *o+,n, 2o+o3,''''''''''''''''''''''''''''''''''''''''' 5e0enter,4-+n, *o+,n, 2o+o3,'''''''''''''''''''''''''''''''''''' Per,tone-+n, *o+,n, 2o+o3,''''''''''''''''''''''''''''''''''''''''

Klini"a o$rada "onja a "oli"om'''''''''''''''''''''''''''''' 6 An-.ne0-''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 6 K+,n,*- s+,*-'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' !

Metode %retrage'''''''''''''''''''''''''''''''''''''''''''''''''''''''''' & Sond,r-n4e''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' & Aus*u+t-7,4- , (er*us,4- -2do.en-'''''''''''''''''''''''''' & Re*t-+n- (retr-/-'''''''''''''''''''''''''''''''''''''''''''''''''''' 1% Pun*7,4- -2do.en-''''''''''''''''''''''''''''''''''''''''''''''''' 11 L-2or-tor,4s*e (retr-/e *r3, , seru.-'''''''''''''''''''''' 11 Dod-tne d,4-/nost,*e .etode'''''''''''''''''''''''''''''''' 18

Koline $oleti'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1# 9-stroduoden-+n, u+*us,''''''''''''''''''''''''''''''''''''''''' 1# Enter-+/,- 7-t-rr;-+,s'''''''''''''''''''''''''''''''''''''''''''''' 11$8."#%+?'


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8

Se.,n-rs*, r-d Interne $oleti: Koli"e"onja

Prote,n,$ u/+4en, ;,dr-t,$ .-st,$ 3,t-.,n, , .,ner-+,$ se 3-re u

t-n*,. 7re3,.-' Vod- se -2sor2u4e u de2e+o. 7re3u'O*o & unete ;r-ne se$ u 3,du fe7es-$ ,02-7, ,0 d,/' tr-*t- 0- 6do ! -so3- od uno)en4-'

S+'1 D,/est,3n, tr-*t *on4-


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#


Koli"e "onja O%)te o "oli"ama

Bro4ne 2o+est, d,/est,3no/ tr-*t- ,0-0,3-4u 2o+o3e *o4, seo,t-3-4u s+,n,. s,.(to.,.- *o4, se (o3e0u4u u 7e+o3,t, *+,n,*,s,ndro. F s,ndro. *o+,*- >do+ores 7o+,$ 7o+,7-?' Ko+,*- se deGne)e*-o s,ndro. 2o+- u -2do.enu$ ne0-3,sno od s-.o/ u0ro*- *o4, 4e,0-03-o 2o+' Ko+,*e se 4-3+4-4u n-4e)e *od *on4-' A*utn--2do.,n-+n- 2o+ (redst-3+4- n-4e)- ;,tn- st-n4- *od *on4-' N-/od,)n4e. n,3ou 1% do #6 s3ets*e (o(u+-7,4e *on4- ,.-odreen, o2+,* *o+,*e' U 3eter,n-rs*o4 +,ter-tur, o(,s-no 4e o*o 1%%2o+est, *o4e se (redst-3+4-4u *o+,*o.$ no n-43e, deo 4e 2+-/o/,nten0,tet- , n-4e)e se +e, .ed,*-.entno. ter-(,4o.'

&odela "oli"a

S o20,ro. n- (ore*+o 2o+o3- u -2do.enu *o+,*e de+,.o n-:

1' (r-3e *o+,ne 2o+o3e >(ot,u od or/-n- d,/est,3no/ tr-*t-?8' +-=ne ,+, (r,3,dne *o+,ne 2o+o3e >dru/, or/-n, u -2do.enu

odnosno e*str-,ntest,n-+n, u0ro7,?'

Etio%atogene*a

Posto4e r-0+,,t, s(e7,Gn, , nes(e7,Gn, f-*tor, *o4, .o/udo3est, do r-0n,; 2o+est, d,/est,3no/ s,ste.- *o4e se (o*-0u4u*o+,*o.'

Jed-n od n-42,tn,4,; u0ron,*- su specifnosti probavnog trakta*on4-:

4-*, sGn*ter, =e+u7- .-+, =e+ud-7 du/, 7re3n, tr-*t


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nefros(+en,n, (rostor$ ,n/3,n-+n, *-n-+?$ -n-to.s*, re+-t,3no us*, (re+-0, ,0.eu (o4ed,n,; de+o3-

7re3-'

Parazitske invazije>n(r' P-r--s7-r,s euoru.$ 9-stro(;,+us s(('$.-+, , 3e+,*, stron/,+,d,? t-*oe .o/u 2,t, est, u0ro* *o+,n,;2o+o3-'

Meteroloki aktori, n-/+e (ro.ene (r,t,s*- te.(er-ture , 3+-/ede+u4u n- 3e/et-t,3n, =,3-n, s,ste.$ te ,0-0,3-4u s(-st,*e *o+,*e'

Stres (redst-3+4- 4ed-n od 0n--4n,4,; f-*tor- 0- (o4-3u2o+est, d,/est,3no/ tr-*t- *od *on4- , u0ro*u4e (o4--n, tonus(-r-s,.(-t,*us- u 7e+o. ,+, de+o3,.- 7re3no/ tr-*t-$ te n-ru)-3-0-)t,tnu fun*7,4u s+u0n,7e =e+u7- , 7re3-'

Greke is!rani " ;r-n- s*+on- sn-=no4 fer.ent-7,4,$ .-n4-*

3ode'

Greke dr#anj i iskoritavanj konja " neredo3n- ,neu4edn-en- ;r-n,d2-$ 2o+est, ust- , 0u2-$ du/otr-4n, )t-+s*, t,(dr=-n4- , s.-n4eno *ret-n4e (o/odu4u e)o4 (o4-3, *o+,*- *od*on4-'

Kon4, ,.-4u 3r+o .-+u to+er-n7,4u n- -2do.,n-+nu 2o+ , sto/-esto ,.-4u s,.(to.e *o+,*e' H+-dno*r3ne (-s.,ne *on4- ,.-/-r7, ,.-4u 3,), (r-/ to+er-n7,4e n- -2do.,n-+nu 2o+ do*to(+o*r3ne (-s.,ne *on4- ,s*-0u4u e)e *o+,ne 2o+o3e 02o/ 3r+on,s*o/ (r-/- to+er-n7,4e n- -2do.,n-+nu 2o+'


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est, (r-t,+-7 2o+est, (ro2-3no/ s,ste.- 4e endoto*s,n, )o*' Kon4,s- *o+,*o. 02o/ o)teene 7re3ne s+u0o*o=e ,.-4u 3e, r,0,* 0--(sor(7,4u endoto*s,n- u 7,r*u+-7,4u'

Endoto*s,n 4e +,(o(o+,s-;-r,d *o4, u ,nter-*7,4, s ,.un,.s,ste.o. ,0-0,3- )o*' 9+-3n, u,n7, -*utne endoto*se.,4e suredu*7,4- (er,ferne (erfu0,4e 02o/ ;,(o*s,4e t*,3- , (u+.on-+n-;,(erten0,4- *-o re0u+t-t o)teen4- e(,te+n,; st-n,7- (+u-' U,re3er0,2,+no. st-d,4u.u endoto*s,no/ )o*- r-03,4- se d,fu0n-,ntr-3-s*u+-rn- *o-/u+-7,4-'

Vrte "olini# $olo!a

S o20,ro. n- .e;-n,0-. n-st-n*- -2do.,n-+ne 2o+,$ *o+,ne2o+o3e de+,.o u et,r, /ru(e:

1' S%ati"i "olini $olo!i su (os+ed,7- /n4een4- ner3n,;

0-3r)et-*- u s+u0o*o=, or/-n- d,/est,3no/ tr-*t- 02o//re3,t,; s(-st,*,; *ontr-*7,4-' Tr-4u o2,no do 1 .,nut-$0-t,. (o(uste$ te se (ono3no (o4-3+4u4u' U s(-st,*,*ontr-;,r-no. de+u 7re3- 4e 02o/ (r,t,s*- n- *r3ne =,+es.-n4en- 7,r*u+-7,4-' Nedo3o+4no st-2de3-n4e s+u0o*o=e7re3- *r3+4u t-*oer ,0-0,3- 2o+'

8' Diten*ij"i "olini $olo!i n-st-4u 02o/ r-ste0-n4-7re3ne s+u0o*o=e , 3,7ser-+no/ +,st- (otr2u)n,7e , tr-4no/ su*-r-*ter-'

#' Me*enterijalni "olini $olo!i su (os+ed,7- /n4een4- ,+,r-ste0-n4- .e0enter,4u.-' On, su ,0r-0,to 4-*o/ ,nten0,tet- ,tr-4no/ *-r-*ter-' U0 .e0enter,4-+ne 2o+o3e esto se(o4-3+4u4u , 2o+o3, 02o/ (ore.e-4- u 7,r*u+-7,4,'


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(od-7, o -(et,tu , u0,.-n4u 3ode 3rst- ;r-ne , re=,. ;r-n,d2e >(ro.en- ;r-ne? n-,n dr=-n4- , r-d-

d- +, 4e =,3ot,n4- ,.-+- r-n,4e *o+,*u$ -*o 4este *o+,*o (ut-$*-d- , n- *o4, n-,n 4e +een- tret.-n endo(-r-0,t,7,.- >*o4, , *-d-? *od *o2,+- o2r-t,t, (-=n4u n- /r-3,d,tet

Posto4e odreene (o+ne , do2ne s(e7,Gnost, 0- (o4-3u*o+,*e' Kod (-stu3- 4e est, u0ro* *o+,*e ,n/3,n-+n- ;ern,4-$ - *od*o2,+- 4e (o3e-n, r,0,* od 3o+3u+us- 3e+,*o/ *o+on- (re , (os+e(-rtus-' Kod no3oroene =dre2-d, (osto4, r,0,* od 0-e(+4en4-

.e*on,4- *o4, .o=e do3est, do *o+,n,; 2o+o3-'

Klini"a li"a

K+,n,*- (retr-/- *on4- s- *o+,*o. o2-3+4- se *-o s*r-en,*+,n,*, (re/+ed 02o/ ;,tnost, st-n4- , )to r-n,4e/ (oet*-od/o3-r-4ue/ +een4-' Be0 o20,r- n- u0ro* *o+,*e o2-3e0no 4eur-d,t, sond,r-n4e , re*t-+nu (retr-/u *od s3,; *on4-' S*r-en,*+,n,*, (re/+ed (odr-0u.e3- s+edee r-dn4e:

.eren4e te+esne te.(er-ture ut3r,3-n4e fre*3en7,4e , *3-+,tet- 2,+- ut3r,3-n4e fre*3en7,4e d,s-n4- (retr-/u 3,d+4,3,; s+u0n,7- , 3re.e (ono3no/ (un4en4-

*-(,+-r- >en/' CRT? (ro7enu ;,dr-t-7,4s*o/ , *-rd,o3-s*u+-rno/ st-tus- (retr-/u -2do.en-


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@


N-4e), *+,n,*, s,.(to., *o+,ne 2o+, su:

ud-r-n4e *o(,to. (re.e)t-n4e s- no/e n- no/u ,ste0-n4e ud-r-n4e , o/+ed-n4e (re.- -2do.enu 2-7-n4e , 3-+4-n4e uest-+o +e/-n4e , ust-4-n4e od2,4-n4e ;r-ne (ore.een- 7re3n- (er,st-+t,*- u2r0-no d,s-n4e

s-(et ;od seden4e (o(ut (s- ;+-dnoM , (rofu0no 0no4en4e

(elesna temperatra 4e o2,no unut-r G0,o+o)*,; 3rednost,$no *od 4-*o/ enter,t,s- , (er,ton,t,s- 4e (o3,)en-'

)rekvencija i kvalitet bilasu 3r+o (ou0d-n, (o*-0-te+4, te=,ne*o+,*e , stu(n4- d,sfun*7,4e *-rd,o3-s*u+-rno/ s,ste.-' B,+o 4e uG0,o+o)*,. /r-n,7-.- *od 2+-/e *o+,*e , u (oetno4 f-0, *o+,*e'S+-2 *3-+,tet 2,+- , fre*3en7,4- ,0n-d @%".,n u*-0u4u n- 4-*ude;,dr-7,4u$ r-03o4 endoto*s,no/ )o*- , ,0r-0,tu -2do.,n-+nu 2o+'

*isanje 4e n-4e)e *ost-+no/ t,(-$ - fre*3en7,4- ,0n-d#%".,n 4e (os+ed,7- u.erene do 4-*e -2do.,n-+ne 2o+, ,(u+.on-+no/ o)teen4- 02o/ endoto*se.,4e ,+, ;,(o3o+e.,4e'


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Pretraga vidljivi! slznica u*-0u4e n- trenutn, ;,dr-t-7,4s*, ,*-rd,o3-s*u+-rn, st-tus *on4-' Kod de;,dr-7,4e s+u0n,7e suu.ereno 2+ede'

+reme ponovnog pnjenja kapilara(redst-3+4- trenutn, odr-0t*,3ne (erfu0,4e , *-rd,o3-s*u+-rne fun*7,4e >G0,o+o)*, 1 do 8 se*$*od u.erene de;,dr-7,4e # do < se*unde$ *od te)*e de;,dr-7,4e do 6 se*unde?'

Metode %retrage

Sondiranje


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U s3,. s+u-4e3,.- *o+,*-,nd,7,r-no 4e sond,r-n4e'Sond,r-n4e ,.- d,4-/nost,*, ,ter-(,4s*, 0n--4' Sond,r-n4e.

do2,4-.o =e+u-n, s-dr=-4 0--n-+,0u odreen,; (-r-.et-r->.,r,s$ 2o4-$ *on0,sten7,4-$ (H$ste(en s3-renost,?' Ve- *o+,,n-*,se+o/ =e+u-no/ s-dr=-4- >(H #6? do2,4en- sond,r-n4e. u*-0u4en- /-str,n, reu*s 02o/ (r,.-rne(re(un4enost, =e+u7-'

A+*-+n, =e+u-n, s-dr=-4 =uto s.ee 2o4e >(H 6@? u*-0u4e n-

/-str,n, reu*s *o4, 4e (os+ed,7-o(stru*7,4e t-n*,; 7re3-'Sond,r-n4e. t-*oe (ost,=e.o -n-+/ets*, u,n-*

,s(u)t-n4e. /-so3- , teno/ s-dr=-4- , s.-n4u4e.o 2,tno r,0,* odru(ture =e+u7-' A*o s-dr=-4 ne ,0+-0, s(ont-no n- sondu (otre2no

4e ,0 =e+u7- s,ste.o. s(o4en,; (osud- ,+, (o.ou 3e+,*e 2r,0/-+,7e,03+-,t, s-dr=-4' N-*on to/- .or-.o ,s(r-0n,t, , ,s(r-t, =e+ud-7t-*o d- *ro0 sondu u+,4e.o 8 +,tre 3ode' S+o2odn, *r-4 sondes(ust,.o ,s(od 3,s,ne =e+u7- do* ne ,s7ur, ten, s-dr=-4 ,0 =e+u7-'-;3-t se (on-3+4- do* se ne do2,4e /oto3o ,st- tenost odnosnodo* ne ,s(ere.o =e+ud-7'

Auskultacija i perkusija abdomena

Aus*u+t-7,4- -2do.en- se o2-3+4- s- o2e str-ne -2do.en-s- 7,+4e. ut3r,3-n4- fre*3en7,4e , *3-+,tete (er,st-+t,*,; )u.o3-*o4, (ot,u 3e,no. ,0 3e+,*o/ *o+on- , 7e*u.-' Posto4e d3- t,(-(er,st-+t,*,; )u.o3- de2e+o/ 7re3- u G0,o+o)*,. (r,+,*-.-: *r-t*,

, .e)o3,t, >8< ".,n? odnosno du/, , (ro(u+0,3n, >1 u 8< .,n?*o4, su e), , /+-sn,4, (os+e ;r-n4en4-' U s+u-4e3,.- -2do.,n-+ne2o+, (ro(u+0,3n, )u.o3, (ost-4u s+-2,4, , re,'

Per*us,4o. -2do.en- .o/ue 4e ut3rd,t, n-de. 7e*u.- ,3e+,*o/ *o+on-' U s+u-4u n-de.- 7e*u.- u desno.

Sl$: Sondiranje


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(-r-+u.2-+no. (odru4u -us*u+t-7,4o. u0 ,sto3re.enu (er*us,4u7e*u.- u4-n 4e (,n/M efe*t'

Rektalna pretraga

Re*t-+n- (retr-/- 4o) u3e* (redst-3+4- n-4*or,sn,4ud,4-/nost,*u .etodu *od *o+,*e *on4-' Kod 3e,ne *on4- .o/ue

4e re*t-+no (-+(,r-t, 8#% >*od .-n4,; *on4-


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Punkcija abdomena

Pun*7,4- -2do.en- se o2-3e0no ,03od, -*o us(r*oso2-3+4en,. (retr-/-.- ne donese od+u*- o n-,nu +een4- ,+, -*one.- (o0,t,3ne re-*7,4e n- .ed,*-.entnu ter-(,4u odnosno -*o(osto4, su.n4- n- (ro.enu s-st-3- (er,tone-+ne tenost,'5-*ros*o(s*, do2,4en- tenost tre2- 2,t, =ut- , (ro0,rn-$ - s3e.-*ros*o(s*e (ro.ene ,0/+ed- tenost, u*-0u4u n- (-to+o/,4u ud,/est,3no. s,ste.u' Q,0,o+o)*, (un*t-t -2do.en- s-dr=, do #%%%+eu*o7,t-"+ , !18 /"+ u*u(n,; 2e+-ne3,n-'

Do2,4en- tenost se -n-+,0,r- n- u*u(n, 2ro4 2e+-ne3,n-$

2ro4 , t,( e+,4- odnosno 2-*ter,4e'

Sl$0: Pnkcija abdomena

Laboratorijske pretrage krvi i seruma

Odre,3-n4e 3rednost, ;e.-to*r,t- , u*u(n,; 2e+-ne3,n- 4e0n--4no 0- o24e*t,3nu (ro7enu ste(en- de;,dr-7,4e ,;,(o3o+e.,4e' An-+,0- *o.(+etne *r3ne s+,*e 4e 2,tn- *-*o 2,s.out3rd,+, d- +, 4e *on4 s- *o+,*o. u se(s, odnosno endoto*se.,4,'L-2or-tor,4s*, (o*-0-te+4, endoto*s,no/ )o*- su (o3,)en,;e.-to*r,t$ neutro(en,4-$ -7,do0-$ tro.2o7,to(en,4-$ (rodu=eno(rotro.2,ns*o , -*t,3,r-no (-r7,4-+no tro.2o(+-st,ns*o 3re.e >PV ,


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1#


APTV?' E+e*tro+,t, , -7,do2-0n, st-tusu *on4- su (o3e0-n, s-nor.-+n,. 7re3n,. .ot,+,teto.' N-tr,4u.$ *-+,4u.$ ;+or,d, ,*-+7,4u. .o/u 2,t, (o3,)en, ,+, sn,=en,$ - n4,;o3e 3rednost, su0-3,sne od *-r-*ter- *o+,*e' 5et-2o+,*, st-tus *on4- s- *o+,*o.

3-r,r- od te)*e -+*-+o0e do te)*e -7,do0e' Bo+est, d,/est,3no/tr-*t- *od *on4- esto u0ro*u4u ;,(o3o+e.,4u$ s.-n4enu t*,3nu(erfu0,4u , u2r0-n, .et-2o+,0-.$ - s3e to (ore.et, -7,do2-0n,st-tus *on4- , re0u+t,r- .et-2o+,*o. -7,do0o.'

Dodatne dijagnostike metode

Rent/ens*- (retr-/- *od *on4- s- *o+,*o. 4e 3r+o +,.,t,r-4ue(r,.ene *od odr-s+o/ *on4- 02o/ 3e+,,ne , 3o+u.en-s-dr=-4- u de2e+o. 7re3u'

U+tr-03un- (retr-/- (o.-=e u d,4-/nost,7,r-n4ud,4-fr-/.-ts*e ;ern,4e$ +e3e dor0-+ne d,s+o*-7,4e *o+on-$(er,tone-+n,; ,0+,3- , -2do.,n-+n,; -2s7es-'

9-stros*o(,4- 4e 2,tn- s(e7,Gn- d,4-/nost,*- .etod- *o4-

o.o/uu4e (retr-/u s+u0n,7e (ro2-3no/- tr-*t- odnosnoot*r,3-n4e r-0+,,t,; +e0,4-'

Pretr-/- fe7es- u*+4uu4e ut3r,3-n4e *on0,sten7,4e , 2o4efe7es-$ (r,sutnost str-n,; te+-$ 2-*ter,o+o)*u (retr-/u ,(ose2no dete*7,4u (-r-0,t- *-o .o/u,; u0ro*- *o+,*e *od*on4-'

L-(-ros*o(s*- (retr-/- 4e ,nd,7,r-n- u s+u-4e3,.- re*t-+ne

(-+(-7,4e'


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1enteros(-0-.$ -*utno , ;ron,no (ro),ren4e =e+u7-$ .eteor,0-.$tro.2oe.2o+,ne *o+,*e$ (e)-ne *o+,*e$ o(st,(-7,4-?$ *o4e seu/+-3no. +ee *on0er3-t,3no$ , .e;-n,*e ,+, ;,rur)*e >,+eus? *o4ese +ee ;,rur)*,'

Gastro-duodenalni ulkusi

U et,o+o/,4, (e(t,*,; u+*us-$ (ored =e+ud-n,; se*ret-$ (res3e/- ;+oro3odon,ne *,se+,ne$ 0n--4nu u+o/u ,/r-4u f-*tor, *o4,do3ode do o)teen4- (rote*t,3no/ .u*o0no/ 2+o*-' Kod odr-s+,;*on4- =e+ud-n, u+*us 4e re+-t,3no est- (os+ed,7- (rodu=ene

u(otre2e nestero,dn,; -nt,,n-.-torn,; sredst-3-$ u (r3o. redufen,+2ut-0on-' Ne .-n4e 0n--4-n f-*tor 4e stres' K+,n,*- s+,*-.o=e 2,t, , d,s*retn-' Ter-(,4- *od =e+ud-noduoden-+n,; u+*us-$(ored neod+o=no/ ,s*+4u,3-n4- nestero,dn,; -nt,,n-.-torn,;sredst-3- >n-4e), u0ro*?$ o2u;3-t- (r,.enu 2+o*-tor- H8re7e(tor-$ *-o )to su 7,.et,d,n , r-n,t,d,n$ (r, e.u se u*-0u4e ,n- .o/unost *or,)en4- no3,4,; -nt-7,d- (o(ut o.e(r-0o+-'


18/38

1


Enteralgia catarrhalis

4e n-ro,t, o2+,* *o+,no/ o2o+4en4-$ *o4, se .-n,festu4e

*r-t*otr-4n,. /re3,.- (o4ed,n,; (-rt,4- 7re3- (r-en-(ore.e-4,.- .otor,*e 7re3- , 2o+o3,.- s(-st,no/ *-r-*ter-'

1tiologija F n-4e), u0ro* 4e ;+-en4e te+- us+ed n-(-4-n4-;+-dno. 3odo.$ u0,.-n4e (ro.r0+e ;r-ne$ *u(-n4e u ;+-dno43od,$ 0-dr=-3-n4e 0no4-3o/ *on4- n- ;+-dno. 3etru *-o ,neredo3no ;r-n4en4e , n-(-4-n4e$ (+esn,3- ;r-n-$ ne*ontro+,s-nou0,.-n4e 0rn-ste ;r-ne'

PatogenezaF us+ed (ore.e-4- r-3note=e 3e/et-t,3no/ s,ste.-do+-0, do (ore.e-4- r,t.- (er,st-+t,*e' U ne*,. de+o3,.- 7re3-se 4-3+4- 4-*- , 2urn- (er,st-+t,*-$ - u dru/o. de+u 7re3- se 4-3+4-sn-=-n , tr-4-n /r' A*o$ *-o (os+ed,7- o3o/ /r-$ se 4-3,0-t3-r-n4e +u.en- 7re3- do+-0, do 0-e(+4en4- t-n*o/ 7re3-'

'linika slikaF 2o+est (o,n4e ,0nen-d-$ =esto*,. n-(-d,.- *o4,tr-4u 1% F 8%.,n'$ d- 2, se (os+e *r-e (-u0e (ono3o 4-3,+,' O()test-n4e n,4e 2,tno (ore.eeno' Us+ed /re3- 4-3+4- seu0ne.,renost$ (o4--no 0no4en4e$ sten4-n4e$ ne*-d 2e0o20,rno3-+4-n4e , 2-7-n4e' U *r-t*otr-4no4 (-u0, =,3ot,n4- se (ot(uno s.,r,do (o4-3e no3o/ /r-' Aus*u+t-7,4o. -2do.en- n- ne*,..est,.- se u4u 03u7, 4-*e (er,st-+t,*e$ - n- dru/,. ne.- 03u*-'

J-3+4- se *-)-sto3oden-st (ro+,3 s- nes3-ren,. de+o3,.- ;r-ne$


19/38

16


-+, 2e0 s+u0,$ *r3, , 0n-*- tru+4en4- )to se 4-3+4- *od dru/,;0-(-+4en4- 7re3-'

(ok enteros(-0-. tr-4e 1 F 8;'

(erapija F u2+-=-3-n4e ,+, u*+-n4-n4e /r- (r-eno/ 2o+o.d-3-n4e. -n-+/et,*- , s(-0.o+,t,*-' Isto3re.eno$ d-4e se (o.ounosne sonde 8 F #+ -4- od *-.,+,7e'

Akutna dilatacija eluca

1tiologija F n-st-4e us+ed (re*o.erno/ u0,.-n4- ;r-ne$(re=der-3-n4- te)*o s3-r+4,3o. ;r-no. > s+-.-$ *u*uru0o3,n- ?$3+-=no. , (+esn,3o. ;r-no.$ ;r-no. *o4- +-*o 2u2r, > 2unde3-$*ro.(,r$ ;+e2$ /r-)-*$ (-su+4 ?' Ko.2,n-7,4- ne-de*3-tne ,s;r-ne ,

te)*o/ G0,*o/ r-d- ,+, +o)e/ tr-ns(ort- t-*oe .o=e do3est, do(o4-3e o2o+4en4-' T-*oe$ (-r-0,t, u d,/est,3no. tr-*tu (o/odu4ur-03o4u 2o+est,' Se*und-rno$ .o=e se 4-3,t, *-o (os+ed,7-o(st,(-7,4e ,+, ne*e dru/e .e;-n,*e ne(ro;odnost, 7re3-'

Patogeneza F (od ut,7-4e. et,o+o)*,; f-*tor-$ .o=e do, dos(-0.- (,+orus- u0 ,sto3re.eno 0-t3-r-n4e *-rd,4e' U =e+u7u;r-n- 2u2r,$ r-03,4-4u se /-so3, )to do3od, do r-ste0-n4- 0,d- ,(o3e-n4- o2,.- o3o/ or/-n-' e+ud-7 3r), (r,t,s-* n-

d,4-fr-/.u$ (o3e-3- se ,ntr-tor-*-+n, (r,t,s-* )to do3od, doote=-no/ d,s-n4-$ (ore.e-4- u r-du sr7-$ (ore.e-4- *r3no/(r,t,s*-' U d-+4e. to*u (o(u)t- tonus =e+ud-no/ 0,d- 02o/ e/-se n-st-3+4- ),ren4e , .o=e do, do ru(ture =e+u7-'


20/38

1!


S+' 6 F Ru(tur- =e+u7-

'linika slika F 2o+est n-st-4e 3eo.- 2r0o > u (r3,. -so3,.-n-*on u0,.-n4- ;r-ne ?' ,3ot,n4- 4e u02uen-$ ne.,rn-$ 0no4, se$0-u0,.- neG0,o+o)*e st-3o3e F PSEI STAV' Ko+,n, n-(-d, se

4-3+4-4u 4ed-n 0- dru/,. u *r-t*,. r-0.-7,.-' J-3+4- se

(odr,/,3-n4e - ,0 ust- se ose- *,seo 0-d-; *o4, do(,re ,0 =e+u7-'D,s-n4e 4e ote=-no$ (u+s 4e do @%".,n' Per,st-+t,*- 4e s3e re- ,n-*r-4u (rest-4e'

(ok i prognozaF2o+est tr-4e od 1 do 3,)e -so3-' 5o=e d- (roes(ont-no$ ,. s(-0-. (,+orus- (o(ust,$ s-dr=-4 n-/+o (re+-0, uduodenu.' e)e$ -*o se ;,tno ne (r,stu(, ter-(,4, s.rt n-st-4eus+ed /u)en4-$ sr-no4 s+-2ost,$ ree us+ed ru(ture d,4-fr-/.e ,+,=e+u7-' A*o 4e do)+o do ru(ture$ o()te st-n4e se ,0nen-dno .en4-

F (odr;t-3-n4e .us*u+-ture$ ;+-dno 0no4en4e$ (u+s se (en4e (re*o1%%".,n$ te.(er-tur- (-d- ,s(od G0,o+o)*e'

*ijagnozaFn- osno3u *+,n,*e s+,*e$ -n-.ne0e , t-no. 3re.enu,02,4-n4- 2o+est, .o=e se (osu.n4-t, n- -*utno (ro),ren4e =e+u7-'Pot3rd- su.n4e 4e d,4-/nost,*o sond,r-n4e > s-dr=-4 =e+u7- s-


21/38

1@


(uno /-so3-$ *,se+o/ 0-d-;- ?' A*o 4e do)+o do ru(ture$ *ro0u3uenu sondu se 0-(-=- stru4-n4e 3-0du;- u o2e d,s-4ne f-0e$-2do.,n-+n, (un*t-t , de+o3, ;r-ne u n4e.u su deGn,t,3n- (ot3rd-

ru(ture =e+u7-'(erapijaFsond,r-n4e > (re*o ust- ?' A*o od.-; ne *rene =e+ud-n,s-dr=-4 u+,4e se 8 #+ .+-*e 3ode (- se n-/+o s(u)t- sond- d- 2,se s-dr=-4 e3-*u,s-o ,0 =e+u7-' N-*on to/-$ =e+ud-7 se ,s(ere s-deset-* +,t-r- ;+-dne 3ode' Isto3re.eno d-4u s(-0.o+,t,7, ,-n-+/et,7, d- 2, se u*+on,o 2o+ , do)+o do ot3-r-n4- (,+orus-',3ot,n4u ne tre2- )et-t, 4er te+esn, (o*ret, s(re-3-4u (r-=n4en4e=e+u7-'

!ronina dilatacija eluca

se ree 0-(-=- , to *od *on4- *o4, su (o (r-3,+u u +o)o4*ond,7,4,' K-r-*ter,)e se uest-+,. *o+,n,. n-(-d,.-$ u/+-3no.n-*on ;r-n4en4-$ *o4, se 4-3+4-4u 02o/ ote=-no/ (r-=n4en4- =e+u7-'e+ud-7 4e (ro),ren$ -ton,-n ,+, ;,(oton,-n$ neret*o 3,)estru*o3ee/ 3o+u.en-' Do /u2,t*- .otorne fun*7,4e o2,no do+-0, n-*ondu/otr-4no/ ;r-n4en4- /ru2o. *-2-sto. ;r-no.$ neredo3no/;r-n4en4- , est,; (re=der-3-n4- s- (os+ed,n,. d,+-t-7,4-.-=e+u7-' D,4-/no0- n- osno3u -n-.ne0e , *+,n,*o/ n-+-0-$ -ter-(,4- se s3od, n- (r-=n4en4e =e+u7-$ u0 u3oen4e (ose2no/re=,.- ,s;r-ne$ .-+,.$ est,. o2ro7,.- *3-+,tetne$ +-*o s3-r+4,3e;r-ne'


22/38

1&


"eteori#am $nadutost% - "eteorismus intestini

S(-d- u n-4e)e , te=e o2+,*e *o+,n,; o2o+4en4- *on4-'

1tiologijaF1' Pr,.-rn, n-dun n-st-4e u0,.-n4e. ;r-ne *o4- 4e (od+o=n-

4-*o. 3ren4u >dete+,n-$ +e/u.,no0e$ *u*uru0$ s3enu+- 0e+en-;r-n-?$ us+ed (ore.eeno/ 3-ren4- ,+, us+ed /ut-n4- 3-0du;-

8' Se*und-rn, n-dun r-03,4- se *-o (os+ed,7- 0-t3or- 7re3- ,3e,no. se o/r-n,-3- n- (ot(uno odreene de+o3e >+o*-+n,.eteor,0-.?

'linika slika F u +-*),. s+u-4e3,.- su *o+,n, n-(-d, sredn4e/

ste(en-$ ,s(re*,d-n, *r-t*,. (-u0-.-' O()te st-n4e n,4e(ore.eeno$ (er,st-+t,*- 4e =,3-;n-$ ,0+-0e 7re3n, /-so3,' Re*t-+nose *onst-tu4u de+o3, 7re3- *o4, su n-du3en,' I0.et 4e s3et-o$*-)-st$ *,se+o/ .,r,s- - .o=e d- s-dr=, .e;ur,e /-so3-'

U te=,. s+u-4e3,.-$ *o+,n, n-(-d, su 4-,$ =,3ot,n4- 0-u0,.-nenor.-+ne st-3o3e' A2do.en 4e 3,d+4,3o r-),ren$ d,s-n4e 4eote=-no' R-d sr7- 4e u2r0-n *-o , (u+s' Re*t-+no se ust-no3+4-3-

7eo -2do.en ,s(un4en n-du3en,. 0-3o4,.- 7re3-(ok F n-dun tr-4e ne*o+,*o -so3-$ ne*-d , du=e' S.rt .o=en-stu(,t, us+ed /u)en4-$ sr-ne s+-2ost, ,+, ru(ture 7re3-'

(erapijaF u +-*),. s+u-4e3,.- (er,st-+t,*- se re/u+,)e +e*o3,.- ,+,se ,03r), ,s(,r-n4e =e+u7- ;+-dno. 3odo.$ .o/ue 4e (r,.en,t,;+-dne *+,0.e , *ret-n4e' U te)*,. s+u-4e3,.- se (r,.en4u4e(un*7,4- 7re3-' R-d, se re*t-+no$ 2e0 (red;odne de0,nfe*7,4e' Pre

(un*7,4e$ ,s(r-0n, se -.(u+- re*tu.- , ,s(ere .+-*o. 3odo.'


23/38

8%


Proksimalni enteritis

O3- s+-2o (o0n-t- 2o+est 0-;3t- (ro*s,.-+n, deo t-n*o/7re3- , ,.- r-0+,,te n-0,3e: (ro*s,.-+n, enter,t,s F 4e4un,t,s$enter,t,s -nter,or$ duoden,t,s F 4e4un,t,s' Po 0-;3-eno. 7re3u(ron-+-0e se +e0,4e *o4e 3-r,r-4u od ;,(ere.,4e do ne*ro0e s+u0n,7e, ,nf,+tr-7,4e su2.u*o0e u(-+n,. Ce+,4-.-' U3e* su (r,sutn,ede. , *r3-ren4- u r-0+,,t,. s+o4e3,.- 7re3ne s+u0o*o=e'

K-r-*ter,st,-n 4e r-0+,,t ste(en -2do.,n-+ne 2o+, >od

2+-/e do 3r+o 4-*e 2o+,?$ ,0r-0,to o2,+-n =e+u-n, ref+u*s' Ko+,*-(re+-0, u de(res,4u' Re*t-+no se .o=e (-+(,r-t, u.ereno do 4-*ooteeno t-n*o 7re3o' Oteen, duodenu. .o=e se (-+(,r-t, ur-0+,,t,. s+u-4e3,.-'S-dr=-4 (rote,n- u (er,tone-+no4 tenost, 4e (o3,)en > # /"d+?$ -2ro4 +eu*o7,t- 4e f,0,o+o)*,$ (- n- te.e+4u o3- d3- (o*-0-te+4- ne.o=e.o r-0+,*o3-t, o3u 2o+est od dru/,; 2o+est, t-n*o/ 7re3-'

Ter-(,4- .o=e 2,t, .ed,*-.ento0n- ,+, ;,rur)*-'5ed,*-.ento0n- ter-(,4- tre2- (ost,, de*o.(res,4u >do* seref+u*s ne s.-n4,?$ - u*+4uu4e 4o) , ,'3' -(+,*-7,4u tenost, ,

-n-+/et,*e' 5no/, *+,n,-r, (ro(,su4u (en,7,+,n$ f+un,*s,nF.e/+u.,n u n,s*,. do0-.-$ - ne*, 4o)(ro(,su4u neost,/.,n ,+,.et-*+o(r-.,d 0- st,.u+-7,4u (er,st-+t,*e' Potre2no 4e (re/+ed-t,, no/e 02o/ -*utno/ +-.,n,t,s- *-o este *o.(+,*-7,4e >4-3+4-se *od 8E *on4- s (ro*s,.-+n,. enter,t,so.?' Pro*s,.-+n,enter,t,s(re2o+,


24/38

81


Salmonelo#a

(redst-3+4- ,n-.-torno o2o+4en4e 7re3- *od *on4- (r-eno

*o+,n,. 2o+o3,.-' Do3od, se u 3e0u s- r-0+,,t,. serot,(o3,.-Salmonella sp' >S$ t2p!imrim, S,$ agona, S$anatm, S$ ne3port?$(r, e.u n-43-=n,4u u+o/u ,/r- (o s3e.u sude, Salmonellat2p!imrim' J-3+4- se u su2*+,n,*o. >*+,7ono)e? , *+,n,*o.o2+,*u' N-*on u+-s*- u or/-n,0-.$ s-+.one+e n-4(re (-s,r-4ud,st-+ne (-rt,4e 7re3- , *o+on- u*o+,*o ne (osto4, *o.(+etn-.,*roor- 7re3- *o4- o.et- n4,;o3u *o+on,0-7,4u' 2o/ to/- seo2o+4en4- e)e 4-3+4-4u *od .+-d,; =,3ot,n4- *o4e ne.-4u*o.(+etnu .,*rooru 7re3-' Kod st-r,4,; =,3ot,n4- se ,nfe*7,4-.o=e 4-3,t, us+ed (ore.e-4- nor.-+ne .,*roore 7re3- >ter-(,4--nt,2,ot,7,.-$ =e$ n-/+- (ro.en- ,s;r-ne ,td'?' 2o/r-0.no=-3-n4- s-+.one+- u 7re3,.- n-st-4e 0-(-+4en4s*- re-*7,4-$- us+ed to/- n-st-4e /u2,t-* tenost,$ 2,*-r2on-t- , ;+or,d- ,0or/-n,0.- )to se .-n,festu4e (o4-3o. (ro+,3-' I0 7re3- s-+.one+edos(e3-4u u *r3oto* , 4etru'Us+ed r-0-r-n4- s-+.one+- os+o2--4u se endoto*s,n, s-+.one+-)to u0ro*u4e s,ste.s*e (ore.e-4e >(o3,)en4e te+esnete.(er-ture$ (-d (r,t,s*-$ *r3-ren4e$ )o*?' Kod /r-3,dn,; =,3ot,n4-$s-+.one+e (rod,ru do fetus- , do3ode do se(t,*e.,4e , u/,nu-' U

se(t,*e.,no. o2+,*u 2o+est,$ s-+.one+e se ),re u r-0n- t*,3- ,*od ne*,; =,3ot,n4- ,0-0,3-4u fo*-+n, .en,n/oen7ef-+,t,s$ /no4n,2-*ter,4s*, -rtr,t,s ,+, ,nf-r*t 2u2re/-'

Ter-(,4- se s3od, n- ,nfu0,4u 3e+,*,; *o+,,n- tenost, ,e+e*tro+,t-$ (r,.enu -nt,2,ot,*-$ (o .o/ust3u n-*o/ (ro3ereneoset+4,3ost,$ e3entu-+no o(re0nu (r,.enu -.,no/+,*o0,d-$(eror-+nu (r,.enu 7re3n,; -dsor2en-t- , -dstr,n/en-t->.ed,7,ns*, u/-+4$ 2,0.ut su2s-+,7,+-t?$ 0-t,. (r,.enu un,*s,n.e/+u.,n-$ u (r3o. redu 02o/ o(-snost, od endoto*se.,4e , )o*-

&lostridio#a

se$ (o(ut (ro*s,.-+no/ enter,t,s-$ *-r-*ter,)u (ro/res,3n,.(o/or)-n4e. , )o*o.'

A*o se 0-ne.-re (er-*utn, o2+,7, *+ostr,d,o0e *o4, 2r0odo3ode do u/,nu- =,3ot,n4-$ u -*utno. o2+,*u se .o=e uo,t,


25/38

88


(o3e-n4e te+esne te.(er-ture$ u2r0-n (u+s$ u2r0-no d,s-n4e$+et-r/,4-$ 0-t,. d,4-re4- s- ,+, 2e0 (r,.es- *r3, , s- *o+,n,.2o+o3,.-$ u0 2r0, r-03o4 de;,dr-7,4e , )o*-'

Pro/no0- 4e ne(o3o+4n-$ (r, e.u se ter-(,4- s3od, n--/res,3nu ,nfu0,4u 3e+,*,; *o+,,n- tenost, >4l$ perringens? (er-*tutno. s-+.one+o0o. , s+' K-r-*ter,)e se-*utno. d,4-re4o. (r-eno. *o+,n,. 2o+o3,.- , 2r0,. r-03o4e.)o*-' S.rt .o=e d- n-stu(, 0- .-n4e od # -s- od (o4-3e (r3,;s,.(to.-$ u (rose*u 0- 188< -s-' S-.- d,4-/no0- se$ (r, to.e$

(ost-3+4- (ost.orte.'I-*o se u/+-3no. 0-3r)-3- u/,nue.$ e3entu-+n- ter-(,4- 2,

se s3e+- n- -/res,3nu ,nfu0,4u 3e+,*,; *o+,,n- tenost, , e+e*tro+,t-$(r,.enu -nt,2,ot,*- >(en,7,+,n$ .etron,d-0o+?$ un,*s,n- , 3,so*,;do0- *ort,*ostero,d-'

(romboemboline kolike>7o+,7- tro.2oe.2o+,7-? ,0-0,3-4u +-r3e Stron/,+us- 3u+/-r,s-

*o4e .,/r,r-4u u s+u0o*o=, *r-n,4-+ne , .e0enter,4-+ne -rter,4e (r,e.u u0ro*u4u -rter,t,s , tro.2o0u )to do3od, do s.-n4en4-7,r*u+-7,4e$ ,s;e.,4e , ;e.or-/,no/ ,nf-r*t- 7re3-'

N-4e)e se d,4-/nost,*u4e u u0/o4,.- *on4- s- +o)o.(-r-0,t-rno. *ontro+o. >neredo3,t- de;e+.,nt,0-7,4-?'


26/38

8#


D,4-/no0- se (ost-3+4- te)*o$ n-4s,/urn,4e n- se*7,4,$ (o)to 4e0- =,3ot- te)*o do*-0-t, o)teen4- n- endode+u *r3n,; sudo3- ,+,7re3no. 0,du$ 02o/ e/- su (od-7, o uest-+ost, o3-*3,; *o+,*-(r,+,no *ontr-d,*torn,' Re*t-+n,. (re/+edo. se (one*-d .o=e

ust-no3,t, (o+ute-n s-dr=-4 s- (r,.es-.- *r3,$ - u-2do.,n-+no. (un*t-tu dost- +eu*o7,t-$ er,tro7,t- , (rote,n-'

Ter-(,4- 4e s,.(to.-ts*- , (odr-0u.e3- ,nfu0,4u 3e+,*,; *o+,,n-tenost, >0- (re3en,r-n4e )o*-?$ -nt,2,ot,*-$ -n-+/et,*- >n-42o+4eun,*s,n?$ 0-t,.$ +-r3,7,dn,; -nt;e+.,nt,*- *o4, (redst-3+4-4u 4ed,no(r-3o sredst3o 0- (re3en,r-n4e no3,; o)teen4-'

)pstipacija(redst-3+4- n-*u(+4-n4e 3ee *o+,,ne (o+usu3o/ 7re3no/

s-dr=-4- u (o4ed,n,. de+o3,.- 7re3-$ *o4, se 02o/ du=e/0-dr=-3-n4- , -(sor(7,4e 3ode s3e te=e .o=e e3-*u,s-t,' Doo(st,(-7,4e n-4e)e do+-0, u de2e+,. 7re3,.-$ (re s3e/- u3e+,*o. *o+onu$ 0-t,. 7e*u.u$ .-+o. *o+onu , re*tu.u$ (r, e.usu o(,s-n, , s+u-4e3, o(st,(-7,4e t-n*o/ 7re3-$ u (r3o. reduduodenu.- ,+, ,+eu.-'

Pe*ane kolikese 0-(-=- *od *on4- du/otr-4no ;r-n4en,; ;,/,4ens*,

ne,s(r-3no. ;r-no. *ont-.,n,r-no. 0e.+4o. , (es*o. >seno s-(+-3n,; teren-? ,+, n-(-4-n,; n- (+,t*,. ,03or,.- s- s,tn,. (es*o.'Pe)-n- *o+,*- 4e ;ron,n- *o+,*- *o4- se (o3re.eno .-n,festu4e*o+,n,. n-(-d,.-$ *o.2,no3-no s- s,.(to.,.- d,s(e(s,4e'O2o+e+, *on4, su o2,no u +o)o4 *ond,7,4,$ .r)-3, ,+, *-;e*t,n,$ d+-*-

4e 2e0 s4-4-$ +o)e/ *3-+,tet-$ -(et,t 4e s.-n4en$ (one*-d(er3er0-n

D,4-/no0- se (ost-3+4- n- osno3u -n-.ne0e , *+,n,*o/n-+-0-$ u (r3o. redu n-+-0o. 0rn-7- (es*- u 7re3no. s-dr=-4u'

Ter-(,4- se s3od, n- s,.(to.-ts*o +een4e *o+,no/ n-(-d-$(ro.enu ;r-ne$ (o*u)-4 ,02-7,3-n4- 0-ost-+o/ (es*- u 7re3,.-$n-+,3-n4e. 3ode u =e+ud-7$ +-*s-ntn,. sredst3,.- ,+,


27/38

8(ro2,ot,7,$ s+u0 +-neno/ se.en- , s+'?

+leus4e *+,n,*, (o4-. *o4, o0n--3- (re*,d (ro;odnost, 7re3- s-

(os+ed,no. -*utno. -2do.,n-+no. *r,0o. , )o*o.' 5o=e 2,t,d,n-.,*, , .e;-n,*,'

Dinami"i ile(4e fun*7,on-+no/ (ore*+-$ (r, e.u se 4-3+4-*-o s(-st,n, ,+eus >tr-4n, /r s- (ot(un,. 0-t3-r-n4e. +u.en-7re3-? , (-r-+,t,n, ,+eus$ *-o (os+ed,7- (er0,stentne -ton,4e 7re3-'

Spastini " trajni gr>iles spastics? 4-3+4- se ,0u0etno ret*o$ *odo)teen4- /-n/+,4- , ner-3- u (odru4u s(+-n;n,*us-$ tro.2o0e.e0enter,4-+n,; -rter,4- +-r3-.- stron/,+,d- , s+'

Paralitini iles >iles paralitics? 4e t-*oe red-*$ o(,s-n 4e *od

(redo0,r-n4- -nt,;o+,ner/,*,; +e*o3-$ (er,ton,t,s-$ t-*oe *odtro.2o0e .e0enter,4-+n,; -rter,4- ,td' >U s3-*odne3no4 *+,n,*o4(r-*s, (ose2-n 0n--4 ,.- ne*r,t,n- (r,.en- ,+, (redo0,r-n4eBus*o(-n- >Bus7o(-n 7o.(os,tu. F Hoe7;st?$ *o4, 4e u 4edno.(er,odu 2,o ,0u0etno (o(u+-r-n +e* 0- *o+,*e *on4-?'


28/38

8


Me#ani"i ile( 4e .no/o e),$ s- *+,n,*o/ -s(e*t- 4eneu(ored,3o 0n--4n,4, , (ro/nost,*, n-4ne(o3o+4n,4,'' Pro/no0- (r,to.e 0-3,s, od ste(en- (ro;odnost, *r3n,; sudo3-' I+eus *o4, se*-r-*ter,)e ne(ro(;odno)u 7re3- , ou3-no. 7,r*u+-7,4o. n-0,3-

se o%tr("+ioni ile(.O(stru*7,on, ,+eus 4e (r, to.e (ro/nost,*,(o3o+4n,4, od ,+eus- *o4, se u0 ne(ro;odnost 7re3- *-r-*ter,)e ,ne(ro;odno)u *r3n,; sudo3-' On se n-0,3- trang(la+ioniile('

Pre.- .e;-n,0.u n-st-n*-$ ,n-e$ ,+eus .o=e d- 2ude*o.(res,on,$ str-n/u+-7,on,$ o(tur-7,on, , ;e.od,n-.s*, ,+,,s;e.,n,'

'ompresioni ilesse 4-3+4- *-o (os+ed,7- (r,t,s*- n- 7re3n, 0,d

s(o+4-' Vr+o 4e red-*$ s o20,ro. d- (-to+o)*e t3ore3,ne u-2do.enu$ (o(ut tu.or-$ ;e.-to.-$ -(s7es- , s+' ret*o *-d-.o/u u to4 .er, d- (o.ere ,+, (r,t,snu 7re3o$ s- (ot(un,.(re*,do. (-s-=e s-dr=-4-'

Stranglacioni iles 4e 3ero3-tno n-43-=n,4, o2+,* ,+eus-$ *o4, se4-3+4- *-o (os+ed,7- (ro.ene (o+o=-4- 7re3-' 5o=e d- se 4-3, u3,)e o2+,*- - n-4e)e *-o:Str-n/u+-t,o ,ntest,n, ,+, 0-(et+4-4 7re3- 0-4edno s-

.e0entr,4u.o.In7-r7er-t,o ,ntest,n, ,+, u*+4e)ten4e 7re3- s- (r,(-d-4u,.

.e0enter,4u.o.Tors,o ,ntest,n, ,+, u3rt-n4e 7re3- s- (r,(-d-4u,.

.e0enter,4u.o.Vo+3u+us ,ntest,n,$ 3e0,3-n4e ,+, u3rt-n4e 7re3- o*o so(st3eno/

.e0enter,4u.-In3-/,n-t,o ,+, u3+-en4e 7re3- u 7re3oQ+e,o ,+, (res-3,4-n4e 7re3- , s+'

5ptracioni iles.o=e d- n-st-ne us+ed 0-e(+4en4-$ o*+u0,4e ,+,su=en4- 7re3-:

O2tur-t,o s' o2stru7t,o F 0-e(+4en4e *-o (os+ed,7- (r,t,s*- n-7re3n, 0,d ,0 +u.en- 7re3-


29/38

86


O77+us,o F *-o re0u+t-t (r,t,s*- n- 7re3n, 0,d , +u.en 7re3- ,0s-.o/ 0,d- 7re3- F n-st-4e *-d- se u 7re3no. 0,du r-03,4u;e.-to.,$ -(s7es,$ /r-nu+o.,$ tu.or, , s+'$ 0-t,.

Stenos,s str,*ture$ steno0e F uroen- ,+, steen- su=en4-7re3-$ (r,r-s+,7e , s+'

Is!emini ili !emodinamski iles(redst-3+4- ne(ro;odnost 7re3-*o4- n-st-4e *-o (os+ed,7- (r,.-rn,; (ore.e-4- 7,r*u+-7,4e7re3no/ 0,d-$ u (r3o. redu e.2o+,4e' U0ro* e.2o+,4e -rter,o+- ,*-(,+-r- u 0,du 7re3- su$ (r, to.e$ o2,no tro.2, ,+, de+o3, tro.2-$(re s3e/- (-r-0,ts*e et,o+o/,4e >S' 3u+/-r,s?$ *o4, (ot,u ,0o/r-n-*- -' .esenter,-+,s 7r-n,+-,s$ .-d- u0ro* e.2o+,4e .o/u2,t, , .et-st-ts*, tro.2, *o4, .o/u dos(et, u 0,d 7re3- ,0 2,+o *od

de+- or/-n,0.-'

Sl$66 " +olvls intestini

Promena polo#aja creva:

1' Rota+ija F o2rt-n4e 3e+,*o/ *o+on- o*o n4e/o3e u0du=neoso3,ne8' ,or*ijaF o2rt-n4e t-n*o/ 7re3- o*o .e0enter,4u.-#' Vol!(l( F 0-(+et-n4e$ 0-3e0,3-n4e t-n*o/ 7re3-


30/38

8!


!' In!agina+ijaF u3+-en4e u so(st3ene de+o3e 7re3-@' O$t(ra+ija F 0-e(+4en4e 7re3-

Peritonitis

-(-+4en4e tr2u)ne .-r-.,7e ,+, (er,ton,t,s *od *on4- sen-4e)e 4-3+4- u -*utno. o2+,*u$ ret*o u ;ron,no. o2+,*u'O2,no se 4-3+4- u d,fu0no.$ ree 7,r*u.s*r,(tno. ,+, +o*-+no.o2+,*u$ , to *-o e*sud-t,3n, (er,ton,t,s >(er,ton,t,s seros-$seroG2r,nos-$ (uru+ent-$ ,7;oros-$ ;-e.orr;-/,7-? , su3, (er,ton,t,s >(er,ton,t,s s,77- s' G2ros-?'u0ro* (er,ton,t,s- su u/+-3no. 2-*ter,4e *o4e u (er,tone-+nu)u(+4,nu dos(e3-4u n- r-0+,,te n-,ne: u (r3o. redu *-o (os+ed,7-ru(ture -2do.,n-+n,; or/-n- >*od -*utno/ (ro),ren4- =e+u7-$o(stru*7,4e , .eteor,0.- 7re3-?$ ne t-*o ret*o 02o/ (rodor-2-*ter,4- *ro0 0-(-+4en4e. ,+, ne*ro0o. 0-;3-enu s+u0o*o=u=e+u7-$ 7re3-$ .-ter,7e$ .o*r-ne 2e),*e ,td'

D,4-/no0- (er,ton,t,s- se (ost-3+4- 4ednost-3no$ u/+-3no.n- osno3u *+,n,*e s+,*e , G0,*o/ n-+-0-$ re*t-+n,. (re/+edo..o=e se oset,t, ;r-(-3 , 2o+-n (er,toneu.$ -2do.,n-+n, (un*t-t

4e 0-.uen$ 2o/-t o*u+-.- G2r,n-$ u (oet*u se .o=e ust-no3,t,+eu*o7,to0-$ - u )o*u +eu*o(en,4-'

Ter-(,4- se s3od, n- ot*+-n4-n4e (r,.-rno/ u0ro*- , (r,.enu3,so*,; do0- -nt,2,ot,*- ),ro*o/ s(e*tr-$ nestero,dn,;-nt,,n-.-torn,; sredst-3- >un,*s,n .e/+u.,n?$ ,nfu0,4u 3e+,*,;*o+,,n- tenost, , e+e*tro+,t- , e3entu-+no +-3-=u (er,tone-+ne)u(+4,ne'

Leenje


31/38

8@


9+-3n, 7,+4e3, +een4- *o+,*- su s.-n4en4e , (re*,d-2do.,n-+ne 2o+,$ re;,dr-7,4- *on4-$ su02,4-n4e endoto*s,no/)o*- , us(ost-3+4-n4e 7re3ne (-s-=e , .ot,+,tet- 7re3-' N-43e,2ro4 *o+,*- 4e 2+-/o/ ,nten0,tet-$ te se n-*on od/o3-r-4ue

-n-+/ets*e ter-(,4e , us(ost-3+4-n4- (-s-=e 7re3no/ s-dr=-4- ,G0,o+o)*o/ .ot,+,tet- 7re3- (ost,=e (o2o+4)-n4e *+,n,*e s+,*eodnosno (ot(uno ,0+een4e'

Analge*ija

Potre2no 4e )to (re s.-n4,t, odnosno su02,t, 2o+ *od *on4- s-*o+,*o.' Pre*,do. -2do.,n-+ne 2o+, (re*,d- se ree*sn- ,n;,2,7,4-.ot,+,tet- 7e+o/ (ro2-3no/- tr-*t-' I02or n-,n- -n-+/e0,4e 0-3,s,

od u0ro*- , ,nten0,tetu -2do.,n-+ne 2o+,'Posto4e d3- n-,n- -n-+/ets*e ter-(,4e *on4- s- *o+,*o.: de*o.(res,4- >sond,r-n4e$ (un*7,4- 7e*u.-? , .ed,*-.entno'

Sondiranje odnosno n-0o/-str,n- ,ntu2-7,4- 4e ,nd,7,r-n-*od s3,; *o+,*- 2e0 o20,r- n- ,nten0,tet 2o+,' Os,. d,4-/nost,*o/0n--4- ,.- 3e+,*, ter-(,4s*, 0n--4 4er sond,r-n4e. (ost,=e.o-n-+/ets*, u,n-* ,s(u)t-n4e. /-so3- , te*ue/ s-dr=-4- ,0

(ro2-3no/- tr-*t-' N- t-4 n-,n s.-n4u4e.o 2,tno r,0,* od ru(ture=e+u7-' An-+/ets*, u,n-* (ost,=e.o , de*o.(res,4o. 7e*u.-*o4o. .o=e.o re),t, (r,.-rn, n-dun 7e*u.- odnosno ,s(ust,t,/-s *o4, 4e n-st-o *-o re0u+t-t o(stru*7,4e .-+o/ ,+, 3e+,*o/ *o+on-'Os,. -n-+/ets*o/ u,n*- de*o.(re7,4- 7e*u.- (o.-=e uus(ost-3+4-n4u nor.-+ne /-stro,ntest,n-+ne fun*7,4e' De*o.(res,4-7e*u.- se ,03od, u desno. (-r-+u.2-+no. (odru4u u sred,n,,0.eu 0-dn4e/ re2r- , 3entr-+ne ,02o,ne tu2er 7o-e'

Sl$ 7 . *ekompresija cekma


32/38

8&


S,ste.s*, -n-+/et,7, (redst-3+4-4u n-4e), (ut *ontro+e-2do.,n-+ne 2o+,' N-4u,n*o3,t,4- s*u(,n- -n-+/et,*- 0-ne;,rur)*e$ -+, , ;,rur)*e *o+,*e su nestero,dn, (rot,3 u(-+n, +e*o3,>NSPUL?' O3, +e*o3, 2+o*,r-4u en0,. 7,*+oo*s,/en-0u$ 02o/ e/-

se s.-n4u4e (rodu*7,4- (rost-/+-nd,n-'

Prostaglandini sen0,2,+,0,r-4u ner3ne 0-3r)et*e n- 2o+ ,n-4od/o3orn,4, su 0- (o3e-n4e 2o+, to*o. n-d,.-n4- 7re3-$,s;e.,4e ,+, u(-+e' Q+un,*s,n .e/+u.,n 4e n-4u,n*o3,t,4, NSPUL *o4,se *or,st, *od -*utne -2do.,n-+ne 2o+, u *on4-' N4e/o3- (rednost

4e (odr=-3-n4e nor.-+ne 7re3ne 7,r*u+-7,4e to*o. o(stru*7,4e7re3- , do2-r u,n-* n- 7re3n, .ot,+,tet' A*o un,*s,n.e/+u.,n>%$81$1 ./"*/ ,3' ,+, ,.'? ne su02,4e 2o+ ,+, se on- u *r-t*o.

3re.enu o(et (o4-3, t-d- 4e 3ero3-tno d- 4e *o+,*- 0- ;,rur)*o+een4e' )lniksin meglmin t-*oer su02,4- u,n*eendoto*se.,4e' Nedost-7, NSPUL su (oten7,4-+n- to*s,nost ,u+7er-7,4e n- s+u0n,7, (ro2-3no/- tr-*t- ,+, o)teen4e 2u2re/-' Dot-*3,; ne=e+4en,; (o4-3- NSPUL do+-0, -*o se d-4u (eror-+no(ose2no to*o. de;,dr-7,4e *on4- ,+, u *o.2,n-7,4, s--.,no/+,*o0,dn,. -nt,2,ot,7,.-' Ne*, -+f-8 -/on,st, su t-*oe(oten7,4-+n, -n-+/et,7, *o4, u0ro*u4u re+-*s-7,4u .,),- , sed-7,4u'N-4e)e se *or,ste *s,+-0,n , deto.,d,n *o4, us(e)no *ontro+,)u 2o+*od -*utno/ -2do.en-' 'silazin >%$81$1 ./"*/ ,3' ,+, ,.'? 4esed-t,3 , -n-+/et,* *r-t*o/ de+o3-n4-$ (ose2no u,n*o3,t *odn-dutost, *o+on-' Tre2- 2,t, o(re0-n u *or,)en4u *s,+-0,n- 02o/n4e/o3o/ ne/-t,3no/ u,n*- n- 7re3nu 7,r*u+-7,4u'

*etomidin>1%


33/38

#%


./"*/ .o/u u0ro*o3-t, t-;,*-rd,4u$ (o3e-n4e s,sto+,*o/ (r,t,s*- ,e*s,t-7,4u *on4-' Butorf-no+ redu*u4e .ot,+,tet t-n*,; 7r,4e3-'Spazmolitici .o/u ,nd,re*tno os,/ur-t, -n-+/e0,4u redu7,r-4u,s(-0-. 7re3-' Ind,7,r-n, su *od 2+-/,; *o+,*- , *o+,*- n-st-+,;

02o/ 0-t3or-' N-4e)e se *or,st, 2utW+s7o(-+-.,n >%$1%$8 ./"*/,3? , .et-.,0o+'

*iazepam 4e sed-t,3 >%$%%$1 ./"*/? *o4, n,4e *+-s,G*o3-n*-o -n-+/et,*$ -+, se *or,st, *-o (o.o u *ontro+, -2do.,n-+ne 2o+,u0ro*o3-ne =e+u-n,. u+*uso. *od =dre2-d,'

,era%ija tenotima

Re;,dr-7,4- -*utno/ -2do.,n-+no/ (-7,4ent- .o=e

(redst-3+4-t, n-42,tn,4, deo ter-(,4e , esto odreu4e use; ,+,,0ost-n-* (o0,t,3no/ ter-(,4s*o/ u,n*- u *on4- s- )o*o.' To*o.*o+,*e (otre2no 4e n-do*n-d,t, ,0/u2+4enu te+esnu tenost ,odr=-3-t, G0,o+o)*, ;,dr-t-7,4s*, st-tus *on4-' H,dr-t-7,4s*, st-tusodreu4e.o n- te.e+4u tur/or- *o=e$3rednost, ;e.-to*r,t-$ CRT-, u*u(n,; 2e+-ne3,n- (+-0.e' -3,sno od 3e+,,ne *on4- tre2- 1do 8 +,t-r- tenost, 0- (od.,ren4e u0dr=n,; (otre2-' O2,nos3-*o. *on4u s- *o+,*o. u (r3,; 8 s-t- (oetne ter-(,4e (otre2no

4e -(+,7,r-t, u ,ntr-3ens*o4 ,nfu0,4, 1% +,t-r- G0,o+o)*o/ r-st3or-

n-tr,4u. ;+or,d-' To*o. ter-(,4e tenost,.-$ u s*+-du s-+-2or-tor,4s*,. n-+-0,.-$ (otre2no 4e t-*oe n-do*n-d,t,e+e*tro+,te , *or,/o3-t, -7,do2-0n, st-tus *on4-' Ko+,,nu (otre2netenost, 0- re;,dr-7,4u >G0,o+o)*, r-st3or n-tr,4u. ;+or,d- , R,n/er?(rosuu4e.o (o ste(enu de;,dr-7,4e' T-*oe 4e (otre2no ut3rd,t,te*ue /u2,t*e te+esne tenost, >/-str,n, reu*s$ (r(+,3$ 0no4en4e?'Pre.- to.e$ u*u(ne dne3ne (otre2e *on4- 0- teno)u,0r-un-3-.o n- te.e+4u: osno3ne (otre2e ste(en de;,dr-7,4ete*u, /u2,7,' N-do*n-d- ,0/u2+4ene tenost, (o (r-3,+u(odr-0u.e3- d- se (o+o3,n- ,0/u2+4ene tenost, n-do*n-d, to*o.

6 do @ s-t,$ - ost-t-* (otre2- u ,du,; 16 do1@s-t,' U s+u-4e3,.-te)*e de;,dr-7,4e u*+4uu4u, endoto*s,n, )o* ,nd,7,r-ne su;,(ertons*, r-st3or, N-C+ ,+, ;,dro*s,et,+ s*ro2 >HAES? 02o/(o2o+4)-n4- (erfu0,4e , nor.-+,0-7,4e sr-ne fre*3en7,4e' Redo3n-*ontro+- re;,dr-7,4e se s(ro3od, .eren4e. 3rednost, ;e.-to*r,t- ,u*u(n,; 2ee+-ne3,n- u (+-0., s3-*,; 6 s-t,' Ter-(,4- tenost,.-


34/38

#1


(ro3od, se ne*o+,*o d-n- odnosno do* se ne us(ost-3, G0,o+o)*-fun*7,4- (ro2-3no/ tr-*t- *on4-'

,era%ija endoto"inog )o"a

Endoto*se.,4- 4e est- (o4-3- r-0+,,t,; 2o+est, (ro2-3no/s,ste.- *o4- do3od, do *-rd,o3-s*u+-rno/ *o+-(s- , .u+t,(+o/0-t-4en4- or/-n-' K+,n,*, s,.(to., endoto*s,no/ )o*- su7,4-no0-$ 2,+o s+-2,; *3-+,tet-$ t-;,*-rd,4-$ t-;,(ne4-$ 0no4en4e ,;+-dn, e*stre.,tet,' L-2or-tor,4s*, (o*-0-te+4, endoto*s,no/ )o*-u*+4uu4u (o3,)en, ;e.-to*r,t$ neutro(en,4u u (r3,; # do < s-t-*o4- s+ed, u s*ret-n4e u +e3o$ -7,do0u$ tro.2o7,to(en,4u$(rodu=eno (rotro.2,ns*o , -*t,3,r-4ue (-r7,4-+no

tro.2o(+-st,ns*o 3re.e' Osno3no n-e+o +een4- endoto*s,no/)o*- 4e o2no3- 7,r*u+-torno/ 3o+u.en-' H,(ertons*,. r-st3or,.-N-C+ , HAES n-sto4,.o n-do*n-d,t, 7,r*u+-torn, 3o+u.en , su02,t,*-rd,o3-s*u+-rn, *o+-(s'

)lniksin meglmin (redst-3+4- +e* ,02or- 0- su02,4-n4eo)teen4- or/-n- , s(re-3-n4e d-+4e resor(7,4e endoto*s,n- ,0o)teen,; 7re3-' U do0, %$8 do %$ ./"*/ s3-*,; @ s-t, un,*s,n.e/+u.,n u*+-n4- 3e,nu *+,n,*,; 0n-*o3- endoto*se.,4e ,

0n--4no (o3e-3- (ro7en-t (re=,3+4-3-n4-'Stim(la+ija +re!nog motiliteta

Kod 3e,ne *o+,*- do+-0, do (ore.ee4- .ot,+,tet- 7re3-'St,.u+-7,4- 7re3no/ .ot,+,tet- (redst-3+4- 3r+o 2,tn, se/.ent uter-(,4s*o. (roto*o+u' Ind,re*tn- st,.u+-7,4- se (ost,=e odreen,..ed,*-.ent,.- *o4, .en4-4u *3-+,tet 7re3no/ s-dr=-4-(o3e-3-4u, udeo 3ode u 7re3no. s-dr=-4u' L-*s-t,3ne so+, *o4ede+u4u n- 2-0, os.ots*e reten7,4e tenost, u 7re3no. s-dr=-4u(o3e-3-4u udeo 3ode u 7re3no. s-dr=-4u , s.-n4u4u 3re.e(-s-=e' N-4e)e se *or,ste 1psonova 9gorka so ili magnezijmslat i Glaberova so ili natrijm slat$ A(+,7,r-4u se sondo.(ret;odno oto(+4ene u do0, 1/"*/ t4e+esne .-se u < +,tre 3ode'

Tre2- n-(o.enut, d- 4e n-tr,4u. su+f-t *ontr-,nd,7,r-n *od0-t3or- 3e+,*o/ *o+on-'


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Parafnsko lje >1% do 1 .+"*/? 4e +u2r,*-ntn, +-*s-t,3 *o4,2,tno o+-*)-3- 7re3nu (-s-=u$ -+, ne.- ut,7-4 n- 3re.e (-s-=e' Us+u-4u /-str,no/ reu*s- ne s.e se d-3-t, n,t, 4edno +-*s-t,3no

sredst3oX Pro*,net,7, >n(r'neost,/.,n$ 7,s-(r,d$ .eto*+o(r-.,d?,.-4u s-.o de+,.,n, u,n-* n- .ot,+,tet 7re3- u *on4-'

Anti$ioti+i

U(otre2- -nt,2,ot,*- u +een4u *o+,*- 0-3,s, od s-.o/*-r-*teru 2o+est, , .o/u,; *o.(+,*-7,4-.-' Kod ne*,; 2o+est,(ro2-3no/ tr-*t- su ne(otre2n,$ - *od dru/,; 4e ,nd,7,r-n- n4,;o3-du/otr-4n- (r,.en-'

Indi"a+ije *a #ir(r)"o leenje "oli"e

Od+u*- o +een4u *o+,*e s-.o .ed,*-.entno ,+, ;,rur)*, n,4eu3e* +-/-n-$ s o20,ro. d- n,4e .o/ue u3e* (ost-3,t, o24e*t,3nud,4-/no0u' 2o/ to/- se od+u*- o ;,rur)*o. +een4u odreene*o+,*e donos, n- te.e+4u 2ro4n,; *+,n,*,; , +-2or-tor,4s*,;(o*-0-te+4-:

tr-4n- *o+,n- 2o+ refr-*torn- ,+, de+,.,no re-/u4e n--n-+/et,*e

*-rd,o3-s*u+-rn, , ;,dr-t-7,4s*, st-tus *on4-: 0n--4ne(ro.ene n- s+u0n,7-.-$ fre*3en7,4, , *3-+,tetu 2,+-$ 3rednost,;e.-to*r,t- , u*u(n,; 2e+-ne3,n- >n-(o.en-: (ro.enes-.o o3,; (o*-0-te+4- n,su ,nd,*-7,4- 0- ;,rur)*, 0-;3-t?

/-str,n, reu*s >(H 6@? u *o+,,n, 3eo4 od # +,tre ,0ost-n-* (er,st-+t,*,; )u.o3- n-*on .ed,*-.entne

ter-(,4e


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##


re*t-+n, n-+-0: (ro),ren4e t-n*o/ 7re3-$ (ro),ren , d,s+o7,r-n3e+,*, *o+on$ (-+(-7,4- str-no/ te+-

(ro.ene u s-st-3u (er,tone-+ne tenost,

Inten*i!na nega i "ontrola "onja a "oli"om

Potre2-n 4e st-+n, n-d0or *on4- s- *o+,*o. , 2r0o(re(o0n-3-n4e (ro2+e.- ,+, *o.(+,*-7,4-$ tetrenutn-.ed,*-.entn- ter-(,4-' Kontro+ne *+,n,*e (re/+edeto*o. -*utne f-0e te)*e *o+,*e (otre2no 4e o2-3+4-t, s3-*,; s-t

3re.en-$ - *od (o2o+4)-n4- *+,n,*e s+,*e s3-*,; 6 s-t,' Kontro+n,*+,n,*, (re/+ed, (odr-0u.,4e3-4u *ontro+u te.(er-ture$ 2,+-$d,s-n4-$ 2o4e s+u0n,7-$ 3re.e (ono3no/ (un4en4- *-(,+-r-$ (ro3eru;,dr-t-7,4s*o/ st-tus-$ -us*u+-t-7,4u (er,st-+t,*e$ (ro7enu,nten0,tet- -2do.,n-+ne 2o+,$ *ontro+u defe*-7,4e$ /-str,n, reu*s, (-+(-7,4u d,/,t-+n,; -rter,4- 02o/ .o/ue/ +-.,n,t,s-'

I#rana "onja "oli"om

Osno3no (r-3,+o 4e ne ;r-n,t, *on4- do* su (r,sutn, 0n-*o3,*o+,*e' Pr3, o2ro* tre2- d-t, *on4u n-*on 18 do 8< s-t- od(rest-n*- s,.(to.-' O2ro7, *3-+,tetno/ sen- tre2-4u 2,t,*o+,,ns*, .-+,$ -+, uest-+,' N-*on < do ! d-n- u0 o2ro* sen-(ostu(no se u3ode =,t-r,7e ,+, (e+et,r-n- ;r-n-' To*o. ,du,; !d-n- (ostu(no se (o3e-3- o2ro* do uo2,-4ne *o+,,ne'


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