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8/8/2019 Semio Digestiv 2009 Partea a IIIa
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HEPATOMEGALIA
consistenta, forma, sensibilitate- cu margine inferioara rotunjita, inflamatie/infectie
suprafata neteda, sensibil la palpare congestie venoasa ICD
- ferma, suprafata regulata + icter icter obstructiv
- ferma/dura, cu margine/ suprafata neregulata ciroza
+ durere neplasm
- pulsatilitate insuficienta tricuspidiana
- auscultatie
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HEPATOMEGALIA
aparenta lob Riedel
inflamatorie/infectioasa
afectiuni tropicale
chistica
afectiuni metaboliceafectiuni hepatice cronice
obstructie biliara
congestie venoasa: ICD, pericardita constrictiva, boala venoocluziva
tumori
primare
secundare: sin, plamin, ovar, tract gastrointestinal
boli hematologice
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SCHISTOSOMIAZA
Schistosoma Mansoni
Schistosoma Japonicum
Hepatosplenomegalie +
HP presinusoidala
KALA AZAR
forma viscerala a leishmaniozei
febra,
adenopatie,
hepatosplenomegalie
MALARIE
Plasmodium falciparum
anemie, trombocitopenie
hepatosplenomegalie
tulburari neurologice
cefalee, delir, hemoragii retiniene
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abces hepatic piogen
- stare de rau, febra, greata
- soc toxico septic cu
germeni gram
- Escherichia colli,
Streptococus faecalis,
Staphylococus aureus,
Proteus vulgaris
abces amoebian
- stare de rau precedata de diaree
hepatomegalie dureroasa
sindrom lichidian pleural
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boala fibrochistica
- asimptomatic sau
jena in hipocondrul
drept
- asociata cu chiste
pancreatice, renale
hemocromatoza
- peste 50 ani
- pigmentare
tegumentara
- hepatomegalie
-insuficienta viscerala:
DZ, IC,
insuf.gonadala,
artropatie
- cancer hepatic
chist hidatic
- mai frecvent in
hipocondrul drept
- se poate palpa
- la auscultatie -
freamatul veziculelor
amiloidoza
- material amorf, hialin
- hepatosplenomegalie
- IC
- sindrom nefrotic
boala Caroli
= dilatatie saculara
a ductelor biliare
intra / extrahepatice
febra,
dureri abdominale,
colangita, septicemie
primara
secundara
infectii
inflamatii cronicemielom multiplu
boala Hodgkin
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Hadziyannis. J Eur Acad Dermatol Venereol. 1998.
Infectia VHC
Manifestari extrahepatice
HematologiceCrioglobulinemia mixta
Anemia aplastica
Trombocitopenie
Limfom cu celule B non-Hodgkin
DermatologicePorphyria cutanea tardaLichen planus
Vasculita cutanata necrozanta
RenaleGlomerulonefrita
Sindrom nefrotic
EndocrineAnticorpi anti-tiroidieni
Diabet zaharat
SalivareSialadenita
OculareUlcer cornean
Uveita
VasculareVasculita necrozanta
Poliarterita nodoasa
Fibroza pulmonara
NeuromusculareMialgii
Neuropatie periferica
Artrita/artralgii
Fenomene autoimuneSindrom CREST
Granuloame
Autoanticorpi
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obezitate adipocitokine VHC
SOCS3
(semnal citokinic
supresor)
scaderea
raspunsului rezistenta la insulina fibrozala terapie hepatica
activare celule stelate
hipercoagulabilitate Mota M Medica- a Journal of Clinical Medicine 2008;3(2):100-108Persico M Gut 2008;57:507-517
Fumio M Liver International 2008: 28(1): 355-362
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Alcool
ficat gras +
greata, varsaturi, diareehepatomegalie
hepatita alcoolica
simptome putine
icter moderat
ciroza alcoolica
dureri abdominale
febra prin necroza hepatica
Deficit 1 antitripsina
la nastere icter colestatic
tinar hepatita cronica +
emfizem pulmonar
Boala Wilsondegenerescenta hepatolenticulara
copii boala hepatica
tineri suferinta neurologica
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Adipocyte-macrophage interaction
leading to dysfunction
Gideon R.Hajer, Timon W. van Haeften, and Frank L.J.VisserenAdipose tissue dysfunction in obesity, diabetes, and vascular diseases
European Heart Journal(2008) 29,2959-2971
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Seung Hwan,MD, PhD, Michael J.Quon,MD,PhD,Jeong-a Kim, PhD, Kwang kon, MD, PhD,FACCAdiponectin and Cardiovascular Disease
JACC vol.49, No.5, 2007
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Antiatherogenic Effects of Adiponectin
Seung Hwan,MD, PhD, Michael J.Quon,MD,PhD,Jeong-a Kim, PhD, Kwang kon, MD, PhD,FACC
Adiponectin and Cardiovascular DiseaseJACC vol.49, No.5, 2007
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Interaction among the mechanisms involved
on blood pressure elevation,in the presence
of the metabolic syndrome
Journal of Hypertension 2009, Vol 27 No3Journal of Hypertension 2009, Vol 27 No3
Mecanisms of hypertensions in the cardiometabolic syndromeMecanisms of hypertensions in the cardiometabolic syndrome
Josep Redon, Ranata Cifkova, Stephane Laurent, Peter Nilsson, Krzysztof Narkiewicz,Josep Redon, Ranata Cifkova, Stephane Laurent, Peter Nilsson, Krzysztof Narkiewicz,
Serap Erdine and Giuseppe ManciaSerap Erdine and Giuseppe Mancia
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HIPERCOAGULABILITATEAHIPERCOAGULABILITATEA
IN STEATOHEPATITA SI SMIN STEATOHEPATITA SI SM
disfunctie endotelialadisfunctie endoteliala
hipercoagularehipercoagulare
rezistenta la insulinarezistenta la insulina + CD36+ CD36PAIPAI11
factor von Willebrandfactor von Willebrand
factor tisularfactor tisular
factor VIIfactor VII
Northup GP Thromb.Haemost 2008;6: 2Northup GP Thromb.Haemost 2008;6: 2--99
Progresia bolii hepatice
Risc crescut arterial
- coronarian- cerebrovascular
Risc tromboembolic venos
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CIROZA HEPATICA
idiopatica
alcoolica
post hepatita
altele
ciroza biliara
hemocromatoza
boala Wilson
boala polichistica
medicamentoasa
congestie venoasa hepatica
fibroza si regenerare
modificari functionale
Ciroza biliara
prurit
icter colestatic pigmentare
xantelasme, xantoame
hepatomegalie
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celule hepatice
celule endoteliale
celule Kupffer
celule Ito
perisinusoidal
stocheaza lipide
depoziteaza vitamina A
rol in fibroza hepatica
celule fenestrate LK
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icter insuficientahepatica
hipertensiuneportala
ciroza
hepatica
CLASIFICARE CHILD -TURCOTTE PUGH
bilirubinemie
albuminemie
TP
ascita
starea de nutritie
encefalopatie port sistemica
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SPLENOMEGALIA
moale infectie, septicemie
ferma congestie, infiltrat
dura fibroza, scleroza
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infectii
- virale
- parazitare
- bacteriene
- fungice
inflamatie
- P.R.
- sarcoidoza
- LES
- Dializa
neoplasm
- leucemii
- limfoame
- slndrom mieloproliferare cronica- metastaze
hemoliza
- sferocitoza
- talasemie majora
- HPN
Splenomegalii
afectiuni infiltrative
- boala Gaucher- boala Niemann-Pick
- amiloidoza
- hematopoieza extramedulara
hipertensiune portala
boli endocrine
- tiroidita Hashimoto
altele
- limfadenopatia angioimunoblastica
PTI
anemie hemolitica
boala Hodgkin
hipertensiune portala
posttraumatic
SPLENECTOMIE
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HEPATOMEGALIE
SPLENOMEGALIE
inflamatie/infectie
afectiuni metabolice
afectiuni hematologice
boli hepatice
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TUMORI MASIVE ABDOMINALE
ficat tumoral primitiv/metastatic
splenomegalie
rinichi polichistic
adenopatie + splenomegalie
pseudochist pancreatic
cancer gastric
adenopatie+ splenomegalie
chist mezenteric
anevrism aortachist ovar
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Apendicita acuta- febra, greata, varsaturi,
- dureri initial in epigastru si periombilical, apoi in fosa iliaca dreapta
- iritatie peritoneala
- durere la compresia pe psoas
Diagnostic diferential in apendicita acuta
Boala Crohn
Adenita mezenterica
Diverticuli colon drept
Diverticul Meckel
Adenocarcinom colon drept peforat
Colica renala dreapta
Chist ovarian torsionat
Sarcina extrauterina rupta
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icter insuficientahepatica
hipertensiuneportala
ciroza
hepatica
CLASIFICARE CHILD -TURCOTTE PUGH
bilirubinemie
albuminemie
TP
ascita
starea de nutritie
encefalopatie port sistemica
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ecografie abdominala
CT
aprecierea functiei hepatice
SaO2
ecocardiografie
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SINDROM BUDD CHIARIobstructie a venelor suprahepatice
cresterea presiunii sinusoidale
staza si congestia hepatica duc la lezare
necroza hepatica centrolobular
tabloul clinic depinde de brutalitatea instalarii obstacolului
hepatica
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ASPECT ECOGRAFIC IN HP
VS >
VP >
prezenta sunturilor porto cave
tromboza vena porta,
transformare cavernoasa a venei porte