pmye DANA VELIMIROVICI MARIA RADA coorponaror: SILVIA MANCAS MEDICINA, INTERNA PENTRU ASISTENTI MEDICALL gps? = BIBLIOTECA,Editura VICTOR BABES Plata Bhimie Margu2, cam. 516, 30001 Timigoare Tel/Fax 0256495210 eal: obs, calasb@umftro seorweavb.imttro Director general Prof nv. i. lefan Tosi Driguescu Conse editorial: Claudia Christian (Covet: oan Lapa Colectas MANUALE (Coordonatorcolecie Prof unto, d, Andre Motoe Referees Prof wt. Sete Meese (©2010 Teste drephneasupra acess ei sant exerts [Repeoucerea paral stu inepeal texas magi, pe erce suport, Sek acordul sre latory, ote nari tee va saeona confor legion vigor, a ‘altur areal de Minister Bducin Cerca prin Const [National sl Cece Sinifie inInvimntl Superior, od 32, Deseriovea CEP a BibiltecllNajonale@ Romfalel VELIMIROVSCr, DANA, “Medicing interns pentru asisent meieall Dana Velimizovct, Maris Rady soon: Sivia Manoap.-Timioar: aur Vitor Babe, 2010 ‘ibliow. ISBN 978-606-8054.30.8, Rada, Mars T Mancey as ia (coord) ‘Tpart a UTOUMET, PREEATA Ioitiméntul medical se af tuto continu transformare, bec e principal fied st ereee specialist de ina enlifcare de care ocean are nevoe Informa nadia, ose tmbogaegte i difera cu 0 vitexd uluitore, aduce cu sine date nol sau le modifi pe cele dein comoscut. Informatio, permanent actuliat este wna inte, comdiile __ rors ect 9d cen, prezental atu are alec pind a disponfastuenfilor de a Spit de sur dura, poco el eadrelor md asisteni medical) 1m material istenatiza care cuprinde lat date clase, oft pe cle mai oi, stabiite de alte ghiduri si ‘conser fs mica tera “Intruc tkie o advoirat-revcljie telco inf, meicina tegen supust umor transform grew de preoiat 2emulf ani wr ‘Apar not domenit ale madiin noi metode de diagnostic gi tratamen,. fnformapile medical ind lat de abundente fc utitzoren lr impune 0 ‘muct enorma gio sistematizare riguaae, doar veckiul setascop mai + tnsojgte madd modern coo elie awe lumi tect ‘Matic moder inp o a mare riguroitate fo Tbinare cu role matde de inestigare gi tatament, acest imbinare dine clinic Investgeit poralnice repéxinll succesul munell tn echt medic practic -asstnt mada ste cunoscutfaptul of examen matical - acl medial pest de metic ~ nu epnizanat inns vom de racist atv’ care onsite ingrire bolnaoulul. Madu trece,astent rimne. Medicul presi, istnta exec” ~ ll de ce ndplinien obligor ear revi, ta am ive superior de Snelegere gi intepretae ca urmare a preg sale de a gi tehwic-profsional, constitu eportul remarcabil a esistnti ati codPrezntul volum, ce se adressi i speci studenilor de ta fifimdntal de scurtt dura pecializaren Aietenfi Meticalt General, Radiologie sf Imagistict Medical), dar gi astenfilor medical, prexnut ltr de datele cles, dja vert gadis o ceri de nl ahi, cere 5 confor mera tristura de actalitale ce dustread progres ty ‘madicina intern, El poate pen reais “prea comple, dav cred ct student tebuie st dspund de un material biblografc coespenater ct nivlul cunogtinflor pe ple interafonat din domentu gt cw nigetal regis ur student cn eale mai prestigiase institu de teint ‘medical. Sperim acest volun sf fie il tuturor color clrora Ui se adres Autors i | | | | | | PREFATA Inotiimbntal mates! se of ino. continu transformer biectoulsprincipl find stereos pei de nl elie es sect arene Inforatia medial ring cfc © ited duit, aie cu sine date nots le madifck pe ee tg curate Informafio, permanent ectaizt, ete vom dine eonfile Progr fxm i de ace, pret tlm ove on eben und le dpa tudenfr dee old de sue darth, pres eater ma sitnf madi materi stomata copie sud tl clase, of ip ele ma a, tite de uli ghar 9h ‘onsensaritn mena intr, Inirutt tit 0 atotratt revolute tence ging, medina ese sup anor trams gre de prot eu malar ur Apa vot dome ele mein, not tate de dagrstc 9 trance, informatie medical ieee abundente tnt niizre or impneo ‘nunc enrmé go sistematare igure doar vc sscyy a insole medic mader x relic ne tani Wet. Moticina modern impuneo ma mar igure so tbinme cu toile mete de incestigar pt aarti nbinare dre tne investiga reprezint® enced munci tn ecip mate racic stent media. Ete cast pul examen io ~ ctl madi pet de smeic = nu epuzae mesul volun de pacts ere cnc Ingres bleu, Medical tec, aston imine. Mail psc stn execu itd de ce indepen obligor ee rein at vel superior de felegeresinerprtare ex armarea pret ale de at $f tenicopafesionle,costitie aportul remastered * ediePrezentul volum, ce se adveseml in special studenilor de la Iida de scurtd durata(epeciaiarea Asistensé Medical General, Radiologie sf Imagistiot Media), dar $i esstnfilr meen, prexnta tur de dtl csc deja vera gi mise, o seri de not ach, cena 2 conferd material trsdtura de actual ce dase progres fn ‘madicna Intend. El poate ples relatio “pren comple, dar eredem cu {Bult trae of diggs de wn material bbliografic corespuster eel exwoptinflor pe pln torational dix domenia ex ocd reptiri nal student din cle mai prstiginse institu de indnt ‘matical. Sperer of ecest volun sf fie wil tuturor cel ero W ae dreaas, Point CUFRINS, tll ‘AFECTTUNILE APARATULUI RESPIRATOR LL. Explorares fictional respreorie 12, Tahoobroaga act. . 15, Breepaciopet oni ani 13.1 Brongn coat. 2, Efe pulmonar 1.4: Ast bron = FE Broasictie =. 16, Presmoril 162, Preamoail ebaceion (pis) so 163, Poeumooile i cong de imuntatescuta as 1.1 Sopra le paenehienl pulmonar an 1 Cater tepanaet 19. Pearse 10, Paeamotoracal spoon 1 Inufcenaresprorie 1512, Tubeealoa palmonart LIZ Tubereloea pia 1122. Tuberetora Secunda tl TT AFECTIUNILE APARATULUI CARDIOVASCULAR 2. Elecuocardiogrms eta, nertare "2-4. Tabu det (te) ven 211.2. Telbriile do conduoar .. 22, Hipetensiones tera 23, Hipotnsiunea arterial 2, Cardiopaiaishomied cnn 253, Reumatieml arula cut 25, Valvlopaile "2.61, Stenora mia 2.62, Inaficieta mili agora mia).263. Stenoza 208 ee a 2.66 Imei or (Rau a) wn 2.65, Protease valvular ~ 28, Cariomioptile 28.1. Cardiomiopatadilatatva 2.82. Cardiomiopasa biped ——— 2.33. Cardiomiopatiaresictva 2.84 Dipl timogent a etic de 29, Percale : 29.1 Pevicerice acute 2 ~ 2.92, Pevcurdialeeronice ct 2.10. Insufcien earaed cnn : 2. Coral pulmonar. an 210 God lon tn pone 2.112. Cord pulmonar eon 212. Aterosle028 on 2.13. Boileaonet nnn = =e 2.3.1, Anes ore 2.132. Dsexille aol 2:13. Obstruciaeronich aot icd(Sindromal Lerche) 2.14 Boilearerelor perferce 214.1. Arteriopats obliterans roicd a moneloraftonre 2.142. Ischemia aril st. aan 2.143, Turan vasulare fncjions om 2.15. Bolle venelor Tse 215. Tmbon ci fin oot poi) 16 2.152. Trombotebit sper... 138 ta TIE ‘AFECTIUNILE APARATULUIDIGESTIV 159 3.1. Reda gasto-sofugian 19 32 Tulburt motor exofgine — ist 33. Caner esofaiah -orennsmvnnonnrnrnnrorennennnns 12 34. Gast. acai a 3.5, Ueealgasto-duodenal ns smsenoenncnnonnes 164 3.6 Dispepsa fanconala on caer 3.7. Cancer gate snnonssonns oes her 3.4, Boal inflamatrie intestinal 381. Rectocolia uleer-hemeragi = 169 5.82. Bosla Cron et 39, Caner colores am 3.10. Coloma tabi. a= = im 3.11 Panerntineronicd wn v5 3.12. Liea bie 7 3.13, Hepatiele eroize = 17 3 1B.E Hepatia croc cu vise B moa 53152. Hepasia cronies B soci avin 181 5.133 Hepasita cronies virisC. = 3.134 Hepat sutimunt 3.44 Crean hepatica 5: Blihepatce prio meconse mun S151, Cioza baa primi 3.152 Colangta sere. 3.16. Bot metabotice cedars. 3161. Hemosromatozs primar 3.162. Bosla Wison ape ‘BOLI DE NUTRITIE $1 METABOLISM 41, Dishetl etka z 42 Dislipidemil Hiporipoprotinemie) 210 43. Hiperricenia 44 Oberiaten m 2 cas tll V - AFECTTUNILE APARATULUI RENAL -. 5.1 Glomerulonefit aut ifs... 11, Glomertonetita eu psttepiocorct 228 5. loneneti eae i perpen 8 52. Glomerlonettita rapid proresivt 226 53. Glomeruloncfite craic primitive Caan $54 Sineomal nef wns nnnncneonnnn oat 535, Anomali urine esinptwatce 230 56 Infoilewacrli urnar aa ‘36.1 Pilonfite eat a "25.62, Piloneita ere ern os 233 5.63. Batra asimptoatcd ncn 388 5.64. Cit wn a 5: Netroptile tbl nese ee OT ‘57.1 Nefiopaile abstr acu as 5.72. Neoptil abu intertfalecronice cae 58. Neiopataeademicx balan 2a 539. Nefopai ubulere . aa S10 Netooeincan ei med Tas 5.1. Iufcona real at a ae 2a 512, insufciens renal cronies a 233 apd VE 259 259, AFECTIUNILE HEMATOLOGICE wi 61, Anemiile G11 Anemia fei at 61.2. Avemillomepaobinatice mer a6 a6 268 6.22, Loveemia set fobs 369 63 Sindomal misloprolifatiyeronic . mae) (63.1. Leuoemia misllds ernie. 270 632, Poleteria Ye es 2m 633. Tromboctenia sca (ial) aa Sam 6.4. Boss Hodehia = 6.5. Limfoame maligne nonkodghinicae nc 6 655, Leaemillimfbid 088 enennesvocooes Tan 6.6.1. Lencemia lifes eronied 20 46.62. Leacemiacu celal pirate aw 69, Patologia bemoans 279 6:71. Bol bemorapice prin lexiuni ale posicil vascular 230 (622. Bolihemeragice de origin ombocitart 2m 673.Sindroame heweragice prin burazea coil sanguag 282 6.73.1. Si{ prin deft reir de tri de coagulate u- 282 6.73.2. SH pra inlien exces 286 Cite VIE AFECTIUNILE APARATULU! ENDOCRIN - PATOLOGIA GLANDEITIROIDE, “14, Hipetoidia Tieotoxicoa) ~ Fd. Boal BAW semenrfovv 72. lasuicienfa irons = "721. Mixedeal edu 1713. Dist enderi reaped é 4. Title — "TAL. Tio soll apart 742, Toit sb 7.43, Tioiitel ronioe elon 175, Cancel tedian : * opi VET AFECTIUNILE REUMATICE 1 CDLAGENOZLE fl, Boal artozica ‘LL. Spondllcs su sponds 812, Artors mit 313. Artem genuachilul (omeons) 8114, Arora oldu (eoxt028) on BLS. Ancoma eu ae fealion 82, Rowmatinmal barnes | 821, Umirl durers (pera papel -numcal) 522 Bpicoodiia : Pons 523. Sindroml decal sean 1.24 Sindroml decal tarsan| £25, Tenosgovity 83. Colagenoale z 2 334 Poiana reametoida 832 Spondiitaanchlozmtl | 533. Hou ction ss 834, Scleroderma. I [Bibliogratie selectivs Abserlecarro AFECTIUNILE APARATULUI RESPIRATOR 4. EXPLORAREA FUNCTIONALA RESPIRATORIE ‘valore fiscinst steal rexpirator se realize pi: 1 te vetlometize(Gentr deermoaeavoisclor plone static a dette venori damice), 2. tse de evauare aschimbull gros, 3: tte de precise czoulaelstnguin plana. ! Spirometria fortatl- determiners capaci vile foreie (CVE), ee tse ~ digoosticul spa do disfncic venir: obstuctina (DVO), ‘eatitvi (DVR), mics DVM + Umsres crocs naturale smu sub cement & afi Puimensce; + eyes pcicafilor eu ile pest afefntcrnicepulmoaare (Guntoret expe factor rise ccupainaly vile prepertre, ex indicator al tie! muniorprosdut Chiru pa tape postopera » Tehls de deerminare diminsa,dopt nerupere teapetbroshomotorit (-12 ox) gi a anata (oe! putin fe); ~ ville obit so rporezs la vals deste (aula Reo 4 tie, gout, vr, sexs, + mbieci, ca mal pensat bustle scnse tn jor pies bul, festa un inspite, urna en expt nlf oh ‘npr mana epett detail or) mater de expr a CVF exe compet fn 2.4 accands, dar 12 ‘ecomandsprefungies sla 6 arcade, > Volume sl eapact pulmenare Fi. + sumtin sie dependents de ie, vst, se; tin splrmeta lent oe detent esl 3 volume care compun CV (Cv capaci al fora n+ VIR vol inpirator de recervit 2 C= volun etre + VER=volumul expirator de ecervd + Helumal real UR) termi on mtode indie; epnde viet + Cipactaten puimonari até (CPT) = CVF + VR. Fig Sogn sot vans plone > Evincpstt paramet ventiometiel sunts CVF, VEMS (F2V,), VEMSICV76 (PD), FEP x31, FBP ©) CVF feapactaen td fog) = voll de er expzat rnt-an expir maximal frat dps un ner mila (CVE ~ CVS (eisrat pinto manor ei, nef). 8) VEMS san FEVI (rolumul espirator maxi pe sesunda) = Yotumuler expat rine sera expr aia oat cl normal VEMS: 70-85% dia CY Debit espiratnt mel 1 debitle exprtoi? maxine ‘ratte TT gon LF y= debi medi expt ae 25-79% ‘eapeat 138-859 in volun OVE, tbs (gg Bs FED) ~ dei exprator main instamanaa sins un volum palmons dat mpl sane (CVE! ein npn 25% 3089 75% dia CVE 2 eflecn me pare hl ce espa medi gmk 1 alone le FEF ay 656 din eal ne inn VEMS os, permiloddagnstul & sndrm trac del Debit exirator maxne de wirf (PEF peak eran flow) = chit xpi taxin sat Se tingal mere CVE, se Sergent la nepal neve expr fra! CV. ens n sufi oor rete + Sine etre cenale { nobrrcile bronpce Stale PEF-t seduce ou ia fermcle modem sev sovere * ly vr ame de 1 «PEP ot agit pty ‘uae cbs itemfente a fa de ‘at = Sr ral peel dette BPC a ‘he variables PEP ene sec fn abou! I min rezntats totle do soverate ale dint ia ‘uf epriaspt parent veatlonech. Tabelul! = VEMS |: DVO, DVR ~stabieteseveritatendiatinefc, eee ©) Raportal VEMSICV (3) seu indicle de permeabiliate bronsicd ene (PB) = reportatTifeneau Poste = scabs progresiv cb vest, dort micgortel elastic a plant at = Rommals> 70% ieee + VMS ji1PB — aprecieres obstufi roogice, 2Moda prnctor qn in dni vn sete oraponivae ome nape ear atc DP) ‘i ta ania a ey roe ae (CV, VEMS, PEF: | (< 80% din ideal), ~ probit cu B 2-simpeticomimetice: } VEMS > 12% sau ex > 200m! bee emenaeele eo teeter samme ipa ee et Ot ee > BREST OST gaat tr a _ Sete SE Civ 9 : ~ ees am aipcaes ran = i SD ay sic ereie tet ete Sarre iia scar pp rerepgitemr + LEFAOG gi FEP oy 5 trig do astm + VEMS st PEF limite normale ra 2. Tastee de bronoprovocare ~ VEMSICV (4) Ia timita do jos a onal = evideniszahiperreacvitaea brogid FIRB) + india 3. Disjunciewetlatorie mit (DPM) ~[ftrorparmetrorvertiometrl Principalelecanze de disfnctcvenlatorie sunt recente ta abel I ‘a sop dagnosi (atm bagi); pen evalurenefiienfeleapeutc, Tete = Rssmafce (utlizaeS metacalin, histami’, ecetleoind tn ‘dminisrar ichalatorie i dove pogrsi este) {Test poaiv: | VEMS= 20% + dozs de agent bronhoconstcr care proguce sderen VEN cu 20% senotanea PC ane ovate & PC +8 pf ini dingnoatil de astm; + = B'mg/m tm context clinic sugestv contin diugnstcal de a tm + seiice (AB.- diferto alergene fa edna juhaltri, doze progres crescinde), tinct cimenrvae1.2, TRAHEOBRONSITA ACUTA (rea) Patines ian cut a asi ga bogie mei, prt ati int fi Droge mari parti, 1 Virsuie (60-40% sdenvii, virul_gipat A Paragripale, rhinovirus, v. sincifial respirator; i ae Mycontam pooumonis (1-136) ace: aemophyius infucazas, patos, epoca eau chiar Age cin ncke i time «ictal su prfeonal amons, clo, in sce, formal, fam te. tee oni eal # econ res preht ‘tecret de it le eine ‘spa sien cod su eu tnonge . Tatameeatt #Inceput, devine foarte frecvents,chinutoda, ‘ebell le fi de rarer 2-4 le) ws wet, eed '* faza de coctiune - tuse productivi. * “ + Speco = inj sou sp eau, opti say snot cesar ete +r aes non (alo * durata botii 8-10 zile, “ me 1 Tau scot san foomenle bronaspasice pot pasta pin dpa Ta mene eat Exam obit = ra die cr onto ates = shri nln one! sant a bon Exploniri pamnelinice ccs acbciae pe ban boule 9 a ‘explorisilor paractinice; nd + poem ie "TBA secompliat "evoale spre vindecare in 1-2 sips = prognoati ivorabl Compo poste: *ascten morbid: moar ronal, oti, sina, encealit = mnetmonieinterstia + Sipainfejiebacerian, ‘Teatement L-Preventiv: 1 Mist igieno ~dietotice ~ opis Suman © evtree ambaafl umede rec : = Iminomedulaie eicienscontovesats: Bronbovaion, ‘iii (Aspiring, Paracetamol) Vitesina nitive (Codsin) I Inepat xpectorantefi mucoliice Macosolven, Aceleseint) + hidetere 13. BRONHOPNEUMOPATIA CRONICA OBSTRUCTIVA rco) Definite tare patlogics crate pin obra fla de act to lil asrene, datoit asciet In proporie indvializnts broil tronic eu emzeml pulmonsr ‘Obst erator Sonics ‘revesibilt progresivi paiva ‘Davartara de iin BY Ferma Sen BIBLIOTECA,in 200 fc pare: 1 eit nrc ‘tle pleas + Sinton ie 10 an deve, 134. BRONSITA CRONICA (20) Definite: boat» bron, earacterizaté prin hipersecrie de mvs, care {emia te popstar orn alles cl pe 3 ls pe en, minim 2 ai consecutiv = : 1 fama ~ cel mai imporant agent cauzal, 70-90% diate peceni cu BC sunt ft 2. suscepibiiates genetca 3: poluaren amestarie (pat fam, 503, NOs) 4: Infetite taclui respirator infor (Gn specie ete dezvotte {nsinea vist de 2 an. Tablout clinic aren matin a osput + delangat i exacerbate aor rece, fut poluey stmostecst ~ devine permanent, mai nteass romps, eel, chino © expeetoratia gh debut + devine progres mal abundent ispaea: trv, propresivs In efor ince a ce mai 2B Examen obiectio ~ hlue-loters™= Dui albastri belay pene, ober, ew cinoed Facial poi genraiat inteas, albert, dagete hipocrace ‘aire + inspirzgomotos, xpi preungt (whee) sali bronsice rotate gi sitiante faze avansste— sernele CPC decompensht Explontté paractince 9) Bsplorarea raologicd + “ormali th3 dia cara de BC ~ esenbronhovasclar acest nei lob interior. | | ) Eiploraree factional +) FEF som | te azele incipient le obstructed 2 REV VES) | © FEVIICVF% (PB) <70%, ©) Alte explore + ECG: P pulmonar micovets orzantaizre QRS examen hematologi:polictemie, HO>SS%, leuoeitor, ozinofili 4 Exomenalehorbactertalogts al spue. Ean clnice BC sinpla nenpurai: expectoric miniat; tse in enotimpaile ‘unede ec, matalss © BC obstructva: tse produetiva eronik; dlspnee progresias pir reingi! ca wheesing, . © BC infoctord (eupurstt, portend): use + cipoctnge ‘ucopurulentl ta pevoadele de exaerbare spol permanent pot ‘pres sir sangutnlente; BC axtmanforma: debuted ca o'BC obsrtive + aceese dspnice de tp astmatic;ipereactvitatebongck, ‘+ Boal eiioraeriene ict tse isin, spn la efortur moderate. ‘ssumari; VEMS - nema; obtuse ial, = BC hemoragied: hemp pure 2 fevomene separative. Diagnostic poztiv clini sndrom obtusa Diagnostic diferent + enfizemul pulonsr + astmul bronfic cu dspace contnus insta veils sags + brongcctacs = mmucovseiden ada. ou + BC sinpld~ evolu Cevorabilt si prognostic bun dace sup fanatical fet etiologic, BC obsiroctivd— evolueel see agravare cu pevioude de remisiei, rognstcu! nd ezera. 1 Factor de prognostic nefavorabl dhitori ammputate” a 2 Teaedin piace” Sree dame antarepotrir lraea 1) Probe freon rexprtori: 7 pera’ repere vouneor pulmonar: (VR, CPT) Suc all aan sodres VEMS- 1 preteen goer sanguine: Pade GMs jr = PoC (sau ace: * plmeusy,nirovoly omega Dep ctrl care de alts retin plsoonh Eoonecnice BPCO > BPCO predominan bongo (Sp B us BE = be blstrs alia: 1» BRCO predominat enfemates > (6p A sau PP pin putes = pei colons. e ‘cusine noni de serra a BPCO tt press In Te Fabel It buns Cusincarea i funefie de severtate# BPCO coor Seeereee eet oe Sareea ste Tom os Sass _ Siem eee Tae oom oa stadia: BPCO mode ‘Deatement 1 Tratament profactie Combatersn tabaslzmulué (activ, pasiy; Unites expunedi le potase a dohime pees ete oni wma soc ~_oflaia infer vile yi beterine > veccnt 2. Tratiment euraty i LObiectie "iene: vindarareaexscebirlorinfectoase suis = de duet: * Imbunititren tooranjei te fort gi emeliorren status pologic ~_prevenrea complictilor, 1. AMjlocete tropa sat pezenat fa Tebele 1. 4 Tabetut IY Mijtocetorapentce ta BPCO nen 2st Hest [Conese duet Perm simiea estas” ‘Tratamentalrecomandat pena flcare trea de everiiate a BPCO * Stall I~ BPCO wjor:bronhotltatvare eu dat de ate so In evoie. * Stout 1 BPCO moder: + ttament regula eu wou ari mte broshodiatatoar eu durat lungs de sofia +rebiliare, * Stal 1 -BPCO sever T+ gacocatceinbletort dacs exacerbate, * Stal 17 -BPCO foarte sever: It oxigenoteapie de nga rats oo fosufctena repirataeeronict, de conserttatureaal hires 1.4, ASTMUL BRONSIC (An) efit: talk epi pada ds areca trot ‘Primer desl lh ete terial Cuore sean Siem Hoops, an eps Sas poet any toe de dayne: expire tn Hoong cess pone come * Ftosteni alt bereogt Jr AB arg (erin) ge do onic anion (loge) 9 tina a) ~ eset do fut AB materi (nines) mane nae; Ata og) ite cor poss, per maces ea Rakai ite (aceite) Aten de pero vaca nett a reba ten oped ep eh tes de dps prise ed surat de te ‘compl stpnas fae sane Siem Pasa at a, seein ings epi 1 ite: pee pte hea + so 1 soe nae << Exonen be ~ dese nich waa, emp ee, bipwomerit susie mtrarsi er peta! ‘inal Boe brane gum! de fsa) 2) Esza um: eipectorfe mucous das. catatv + pat pera * urna cz 1-2 oe repesane sponta uu aaron PAB monelergic + "aeoes ape, darth mat mare = peritnfsusldlpne!uoare sau moderate fire vie ~ ‘apectoraic mai shundent, event mocopurulenta, | 2.AB ex dspnee continu eronic) + freveat dap vista de 50 en * disaee persistent pe fondu era pot api saulsazeh deri astmate coe pice de ABposte + primar (lade) sesundae (AB imbiténit) ‘+ tticareterapeusca pala ‘evolu spre insuring ospiatoro ever i CPC {Forme particaare ‘AB indus de cxerciin AB indus de apiint 1 AB profesional et. 43. Steren de nw astmatic (SRA) sce de AB sove,drsis> 24 ore ‘etc la moda bonhodiatsoare factor precipitant: 1 fei espisaori severe “> expuneres ttt nto I lrg = 4 Inerupoon true a cortcotapi! © folesite sbuciv dB 2-simpaticominatice. bat progesiy sau bus enomene repro drpoeeintns, popes expiratorc tse hiuitonre, neproducta lanes ‘maniferacardio-varclare:taicurdo, (TA, some da CP act ‘ulus neuro-piice Potosi: 1 ipoie, percep i acidozdrespiatorie 1,20 apes plialese, cosoile made, VST volte * tentaent coret + favorable Explore! pancinice ‘@) Bxplorare fnclonalt replratorie: rar eects in acose ‘VEMS, IPB, PEF:-|proparjonal cu soverlten acer ‘volume pulmonar 3 CVs nermals eb + vRacrr. test de bromo: - cofimmareadiagostcui teste de bromhoconsrie:- evideniren HIE primare ) Examen radilogt: pom AB ujor sau moder 2 Gisenietorcit in AB sever 2 evidetirea complies. 2) Examen spate fe imaeroncopc: viscose, albus sau glbuie 2 Imicrocapie: eozinofile,cisiale™ Charcot-Leydea, spirale Cust, PMN bast _ o) Hemograma:~oyceitezs crac eu eozinfile sau PMN ©) Donan gasslorsorguine ia fonmele sever hipene, hipercapnic, Soca resprtri) Teste eutanate:- wile in diagnostic! etiologic 1B Dosore deg Di reclnie + pace (explorii fsnctionale respirator, nborter) + Dilan settee Diagnostic diferentia ‘Giza de astm bronsic Tasufclena ventricular stg aut PCO eurotoralspentan “mbolia pulmoaars ‘dgposeaangand Alspoden edo. ‘ABexdismee cominns = brongia eronca 2 enim plmonar 2 eles Sem pulmonic 2 Sebolis pulonars masive preunotararul masv ‘Euolutie prognostic complicatt ‘Bwoiie eM worebill spre Vindecare in AB cx debut in copie (S05), AB profesional, ABalrgic + Sajonars + agvareComet ste 7 saad su emae riterzarea sub intact prempune modifiers. atu ize paar obs teapeace tn fn de evel i sens inl ta iene tment Orcedeteonre conte are se meine dup nt cauztorinpune ease etme Prograsti: vzervat 2. Hipovensibilizaren: admiostare id. sau sc. doze progetve de 1 cod pulmonar acut sa eric [ © pooumotorae + Insite rsprstorie conic ~ complica corticorerpie I aetatic corticodependeap. Teatament s 4 Tabelu! ¥ este prezentata sutegisterapeutcS 4 AB in tepe Ja Obiectve: fete de evertaton acest prevenizes apart! simptomelor i croscini bolt = meotneen aprospenommalaa fei pulmonere = mertisres use leranfewormale In efert, = prevenires exacerbarlrastnatie Pes «lates efetelor adverse ale medical aninstmatics. - A lacurareafatortior cows Tabet ¥ Stratgie terapentct tn AB ‘unter Int Indepirarea alegeifor,poluanor din medial profsionst, a ma ‘eta bronkocontistare ‘esmite_| or onile 8. Bévcata bonallor# filet seseate |Nuwse eRe —Pearaea —f St act fs iMytowee rape. fcr forces Jott [tue ami [on 4. Medicatlaantastmaties Shou re 7 Siew fat paar seurth > Selbutamol (Ventolia), Fonotral (Bete), Sta ae ‘exbutlinn (Bricans) 5 piunel > SelmeterolSereven), Formotercl (Oxi), $s metitxantine opine) —» Mahi, Teoflin *® omtcolinergce (ogee) + Brmaura de Ipratropium (Atrovent) +) antinflmatoare (medica preventv): Snamine —*sosoRe daods Ga, saloon soe (ila) © antleucotene + Singular, Ziteuton * conicteepie ~ ialtore | —s beclomatzont (Becotde), buesonid (Pulnicor, Auissons ixotde) = cali Prednison ~ nfravenoasi—+ HEC. ‘ERs dt hg tine = 2 i 7 i j i on ee | | I i 415. BRONSIECTAZIILE Definite: diataii croice ieversbie ale brngilor taste de storsivnes lamenuli leone determinate do e mulitine deft = slteeazasructura mucoolariesa pert bog Etigpatogenle = defect congenital 2 it el mai roves). Princ mene ino ye ome Co = obstrcia bony ~ lamina (oe sen, tumor, dop de mucus) * xtalumiala iportora ganghonar ils din cancer sau ro) + alerares cial boogie psionic. . Tabtout tine debut a vce vst: cu octal infati repintr acute = estos dup inf eerets tenant 4 tse: herent put abundant (100 S000) + sput: ~ muopuruent sau purus, fds 1 sdimentea in 3-4 sat Shunde imines sau chimera poi = hemopii ai rr mas). " + Ba sem dereenti aexpectorac 1 Guta complication. + durjeateracies extn a plo. Examen obectio: discrepant ne ineasiaten smptoratolgi! i sca senaelr Baie Explore parsclinice @) Radiografatorcle -aspoet ait cee normal ‘pwc trabeculae dear ar nod coir ts *opsctnossemntzate reacties neretractle pect de plans in ague™ Snediperini compensators ) Bronhografa: precizez til, lcaliarea i extensa broniectailr 6) Temogrefia computeriat -meoda sensibl speciies (9 Bamana de labora: Tewcocitezd, nem VSEC ore clinice # Sindrom Broneecatepotuberclos (50% sun de rigine TBC) 7 Tcalzate eu prediletiein lbi superior # Frozachisca (3% in eazunle aula. val NaCl wangpese> 80m «2 Aspergioza alergica brontepulmonard~considert co fort ompiict de astm inst de speci de aspergi, i i ostic ‘Bolu: oni, ondulnt, cu repeat episode de supraintecic Comptia ‘ hemoptii + empiem pearl 5 plopneumotorax 1 BC ti obrrctiva = localiza splice stan (abeesecerebrale, hepatic) Progrosies erent 1 Proflctic = "yest antnjeolce,anipersis Ie copt © Broabovaxon It adult precspus! peat infctii cspiesort recidvante tratamental prompt al infefilor tractus respirator shanareafocarelor ce intestic Aopistarea gi tatares precoce a TBC tenageren (endoscopic) precoe oui corp sin bromsc 2.Curatiy "antbiotopis: betalctamine, cilins, covimoxszol amino: wleozide ‘rover dup 23 tpt «woul agent antimicti (Diflaesn) ‘eotrpie (rea) postural + tpot traci) ‘ronhoaspratc prio bronboscop ‘tervenl chiuricla(xerezelobare sau segmentare)1.6, PNEUMONIILE (r) Defi: bolt inftamstori acute do etiologic infos i neinfecioash attetrizae prin inflame newopartivtapareachimolu ce realize om sinrom de condensarepulmonad(evideniail clini isa adolgi). Bacteil: preumocos, sueplococ, stflocs, Klebsiella, pci, proes, Eel et = jeaprasme: myeopltma pesumnine (egent Esto) > Pirasurs rpale i pararpale,vrusul varcele, rele, sina respirator, adenovirus + Rickedstcoxiella Bore = Chlamit ries, tcc ing: actnomicos,sanidon, espera te + Protozoare: peumocystis cai + Netnaciose: de aspirate, tice, de rade ~ Alergie: femmes, cultivates de elope, mine, leitor ea deren (Cat dncontaminare = aerand = heatogent sau lift Inbotnivien ste denna de ~" dminaarea sau prabuses mecansmelor de aptate + virlenacresctt a apeniorellopst combiarea ela dou con Factor! favorizamis. tat, lmona,obtrcia bone, boi Clasificare patogenict 1 prinive- Is personne sinstoase 2 Secundare~*" conplicsie’ a unor_boli_bronko-pulnosare rexistente sau x unr infec vile repeat 4 metasttce ~ cae hematogend eu itech dia focare primar (a ‘Spleen. sum de alcool, figul, sea cronies, SIDA, 1.64. PNEUMONIILE BACTERIENE. MOCOCICA {. rane ~ 90% din P,bacterens, mal feevent a bbe slumede + Ines se produce pe cae seria exudatslveotar lecalizare mn epione infeoare sou posteroae ale ptménuti afeteci un sing lob sa ete segments rr mullobrs, Tablo etinie : Debutul- rua, monte pri ~ fison violent, uni 30 al. eae, vrei 2 fibra-> 39°C, umenca sonal ~ Gumghil toracie = i sort inp dup son, diver violent, adesea ‘ubmamarg acceorust de epic, + tizea = x doun ai duph son, rack 9 ial useall, ulterior se intensifies" progesiv” deveniad productvd et” cepecorae ‘caraceriste,ruginie, dereath de fndul recipient + ipreea = tn Po masive sau clod exist 0 aletere pulmonart reali trea general — ser, > Exasnenl obiectio 4) Inspectia genera - congeste ficial (mai accentuate pe parca seca), hespesnazolaba, limb usat cu dapoite + clnord a ‘bic, Bcamerat gporatulus respirator = ond almonar cu: ‘otinporle ei ~ reducers amplailor respitor de paren afectatt + acoentuarea vibrator vsale + submtiate sau matte respira fnapi sau sultant suf bar uo zon elated rls crepitante jr bong obsirat tite + abolie vibrator vocae gt « murmmunsll vezi. a6) Examen gpartult cardiovacalr ‘ahlcsdle mode jour ipotnsiane arterial in fomale severe arto nsuiienl cadies, ATA sever, colaps, raclinice Expres radoloic) de Sik i prof sent condewara Pulmonect ‘pace ce cup un segment sou un lo, bine dently omogent e intosiate subcostal, ford timghivard ca viru ape taza a peifere 2) Bxamenale biologics: - = feueoetoz (10.00030.000L Jane), neurotic <_VSH si rinogen t ©) Bxamanal Bacteriological spt =" pncumocoe: sub foi de coi gram +, zla sus diplocoet ) Hemocuture = poalve in 20-30% di era Forme clnice ° aie forma comnts abard = “Irontopeimonta i cop, biti; but i putin bral, isoane repente, spud abunden purulent, radologie aspect ncomogen, volute grav 7 PP abortive cs vindscre a 23 ile 1 PP forme frase (Congest pulmoose) - seme clnice moderate, tadllopeapotae reo sitesi; vindeate 7-10 le enceretingte= ipso nine de le copi: rr sbdominae irs, consi, mening > tabard voi ai cu inate cardiac respatai Diagnostic pozti: clini + practi. Diagnostic diferentiat = pacunnifacaiene nepreumosocie te bot pultonare ~~ paumoniatberefoas nfl pulmonsr zncerulbroahopomoas,aboesl pulmonar, plerei, atlas pulmenst poamonit alersce ‘Epolutic complica prognostic Elisa patra (Gr testament) ~ 10-18 zie, urmati de vindecar eet mh ‘reeves: = sub raiamont onibiotie: 2 ere | 248 de oe 7 Semncl lini de sondensare puimonars + regreseat In 35, zie = opiate dipare dup 10-14 ile {acim obtint vindecare clined 3 resortiaradologia dpa 3 Stpiiming este ntosrarsestindereaexplorarlor”incksiy lvonhoscop), pantnt a exclude Pseewdareobstruclorneoplasice Complicate PP "Pi learezin serofbiooat parspoeumonict please purulent 2 Bees pulmonse recor intra ‘Toatament 1: Tratamentanthnleroblan: ‘Psi G: 1,6 24miLUU24ore divisat la 6 oe, 710 ile 2-4 ile ‘daft: Arsplcling Amoxctind; Augmentin; Bist = Ucar de lorie Bizomicin’ 292400, . {Ga allemative tempestice, in ez do pncumocoe_rezitent pening, eo pot utliza celosprine, chinolone, Clindamicin, Veocomiins, 2. Tratament general #simptomati: Pepnae apa in prion fbr Te 6-10 zie {1 regim hdro-aturat,bogat a viamine, suc, cet, ape (ide ‘mls parental) ‘rigenoteapie tiipireto: Asp, Algocelmin, Paracetamol stialgice: Amin, Codcina ombetrea foul septic: Dopaini, HHC. 3. Preveniren, PP" in petwoenle cu vise tralt “> voecinae ‘anipacamoooce.B. PNEUMONIA STARILOCOCICA (ps) Agent tiologic satloccal au 2H de contaminant = bonbepe 2 pematopen : ‘rontopneumosie ca fcare multiple eu enna erte Ge cmc amen rr > cre Ico bt! a ta ~ cebu promt cu dur de tev ile cu asta, ed moder, SUBS feria ascesune toil de fisoane rpc, dapee inienst expects purlenl cn str angola ears ocr ata : Examen object: «tis, 2oe de submatiats, ra cepente i suberepitat seat peut m i 2) Examen rode opsciifrtinde, sab dle de intesitte obcosat tna ob 20 dicot malate zoe pulmonar imei pot dros te dhlgetrnmparni cu carci cite paar -ac tne rologie de enpiem pleural st iogeemmetoee 2 Beamer pu ~ solos Gram ~ vextofle gi coci Gram post fava 9 cal stutocoe aur 2) Bxomene ilogie isco, seni, ombclopenie d) Hemoculturi: pozitive pentru staflocoe. Sep Sent de apra In Sta, copii eeu tah, fn condi de ‘plate = Shs carinii sont de insgiea alo de evident stalocoa Sous sau boost compl os revere; oral 3 Compliant posibils; empiem pleursl, abeese pulmonn -eumotorx, isle peuropulmoaare, meningitastaflecocies ke Teatement;precoc,intens, prelangt ‘Terapia antimerobiana "in fnte de antbiograma, darts 2 stptimani (4-6 spt) dacs sparen cada septceilx) * peniciine semisinetice reinsente ts actunea _pesiiinazes (Nafeiins, Onan) # aminoglicozde (Centzmicln Renamiis), ‘efilosporine, iscomicng, chiolone Pheu cm Agentetiologi:srepocoel hematite de gp A. Beste primed na secundard abot: sox ipa tl, isonne repos, terra mareat geet, tse cu expecoraie acorn seme. Bees dire Goenka de stmt, soe expo) we eadiologeropcii scan, duno, de ies mii, treor caveat pera ‘Teataniat: Peacia G mini 6 2, sau amoxil PNEUMONIA CU GRAM NEGATIV = 20-50% dia P. coneaetate sit + Al eovene i nou ssa, bony tai, polispitalizay ~ eBid cotaminare: bronkogens (rar hetogend). ‘Sant rapecemiate de 1“ Peuklbsiela paeumoniae 2. Preubuemopfusiflaensne 3. PLeupseudomons aruginge (ioe) 4: Plex lepionels poeumophile 5. Pea gemen anaeroti 16.2, PNEUMONIILE NEBACTERIENE (ATIPICE) + 30359% din P, aut evioada de ineubatie varihils. Debut: progresiv (ar brutal) cx vnore,rinifvngitt, curbatr, fia, ‘soa met ropette, tse ssc scat 8Tabloul clinic: dsconens te imporuate semnelor subective 5 seria tmaelor oblectve Cipere sau rare rahnh crpitanle ‘sberepitnt) Explor paraclinice ‘@) Bromenul radiologic: - ume iofabilare forte un su bilateral —+ SSpect dessin na", pach stemaiate loare sau segment, tinectei"” lamelare " paraiafagratie, opscitfinfaive nesitematiet, imag sleume, Dy Beomencte de aborator: -lcapenie rnuloctopeie: 8) Tee serologic: nt elv, BEC in tot fnfefie vile Rnolutie: de obs tenign8. ‘Complientite rare: sopsinfeett beste, supra, emfizem bul, Temoptr, este len, poeumotore, misc, prcadtecte ‘A PHEUNONIA GU MYCOPLASMA PNEUMONIAE [agetul stom). i coven paeumonie nebacoriant (50-8076) —» pneumonia Suraa de infect: om. Merfapstologie: prouronit intersils 9 alveolar asociat eu brogit sl brnsioli. ‘Tablout clinic idem + miss volute: fvorbil, reitora febra in 37 zl a usin 14-21 zl Complicate Tratament: * antibiotce (Estomiclan 2g/More, Teta Doxiscint 100mp40%0) = nist siplomatice B. PNEUMONIVIRALE erent gripe, pragriale, viwsl variceli,rajoole, sical respirator, enrovitsule, adeoovirusuril ee = ml freevent ia cop glee imunoeprima 1 Ghten de patrandere arash determin’ fenomene iaflametoit Snr, votre, bron. 2yHore, PREUMOMA GRIPALA 15-40% din paeumoilenebacteiene “Tablowl ent: variate nent ‘Debut - bras, eu fscane repeats, celle, deri retroorbitats, isi, use rebels taspirai, Perioada de stare: ~ dspace progresiv,tahipmeic, cianan, teicadi, ‘xpecorfe spumoast "B Examenul oblectio: ira. Diaguostic comext epidemiologic + tblou cline + radiologic + teste eralogie i viutlogie Explondvi paraclnice @ amen rile ope iit extesv, cae ia ea In sre psiteie 1) Examens de laborator: - Teocepenis, VS = teste regi, virwsologce, cat ‘Boolile svers cu ortalise cect datos inauviatl respirators ‘sca, goca Compleat: uprenfct bacteine, Tontement = fnprimele2¢ oe antigrpale Amantadin, Rimuntadins) 2 inP supesnfetate + antbiosr CHAM (Chlamydia prittact—»omitoes su pstacoes Receroaral de infec: stile D.ENEUMONILE RICKETTSIENE Produse de Ricketsla Burnett (Cexila Barnett). Rezeroral de infece: tubs! digesv al nor speit de cipuye eae azz vasioare pi rumepioare domestic su sbi,1.63, PNEUMONIT IN CONDITI DE IMUNITATE SCAZUTA > Pneumonia eu Pneunmoeystis carinit * protooar ce se see Tn tract respirator inferior som, de obici epatopen, » Pneumonia cu virus cltomegalic ‘pare dup transplant gf bola eu SIDA 2 moritte 80.99% > Prewmoniile nsocomiale (obtndite in spitl) incident ma rein wife ATI vole severs 1.7, SUPURATI ALE PARENCHIMULUI PULMONAR * Abeesul pulmonar 2008 aerolicparcchimull pln, compusd in una sau ai mute caviar, confined material pualea. Pneumonia necrozanta - proces infetos sypurstiv, comps diat-an ‘num mai mare de excavai ie (dime <2em), © Gangrena -supurte dies a paenshimuluipuonr. ‘Sipurti pulmonare ‘primitive 2 Remears (Ca de pttradere a permenitor ‘Spirafa connate! nazo- seu orfiringian * isemiarenbematogent = contiguias (de a supurati subintagmatice sa meciastigl) = plug traces deseise Ta ‘Stadlul de constr (debut) + insdios sau aut, rapid propresiv darts 5-10 zl, tabloul enc este estat une preumoni in care staren general septs ae agravenshpropesv ‘axa de deschidere: ceqere feavenel secular Ge tse cei de ‘put (vomics) ¢ sputs mucopurleats, purulent sau piosangunolets, fetid 1 ¢inemsipcencubelor febrile oo eaitii de spall. ‘Dranajalbrongiee breshoree purletsbundentt(100-400m); seme de infec gtoxemio. ‘Faza de croncizare: anemia, cana, bpacrtisl digital, ailoidrt, insufcien espirtori. Explore paractinice 2) Examen ratilogie ~ fova de consiure—+opsctate ron ca contr esto rnogead + aoa de supuri cofetad:» dans vomick > imagine hironeich ¢ revrsatplearal, idropneumotors 1) Bxamene de labrator + "VSH ,leueocitozacu neutrfie cxamehul spats Nor polimor be cnetice ‘bemecultura poate fi pvitva © Flroscopla: lin dagnosti 9 trataent ~~ examen clinic (Talon predipozan, sare ifetins,"broshore sa ‘vomiet puulet, Zeid) + examen radiologe (imagine hesoteri, ied 1 Info de spuraiecrcumsercd eu inflata tutereuls Assmano ‘beret ‘neoplasm tronic = chil cai {espe nteroba monte pulmonar benigne indent puimonar nfs deride ~ exncerlbroshopuleons primi infetat ‘ubercaloza pulmonar evils chistl ida suprintctat pseudocaveria bonged bul de emfizany tumor benign. rool tie ‘volujalafue|ate de: virentaagenluiinfbeios, reistnfa ‘cgaismulu,precocitatea dagnostouu,catameatul covet, operate, Complicati ~ Toca hemeptisie, empiemul,plopacamatran,bronsicuai) © Tata esasze spt) Prognatie: ese . . »Tratament 1. Antbioterapie = "in fineye de antibiograms de aurata 2-4 unk de rogaldascire de anbiotice Pencil G, Clindamicina, Menonidzol, Ceforitin, Vancomicns, aminoglicoide 2. Drenajul postural: absolut neces 3 Medicale MuldianG # expectorant 4 Miser gleo-tee: rep pt, inet compe, bie 5. Intervenfie chirurgicati indicat cau efecla espe medial, ‘spares de hemoplizi repent sau masiv, conten une piosleroce, ‘L8, CANCERUL BRONHOPULMONAR (car) Definite: xopas ca pc de pls nivel epitelil boi 1 footer de med par plone tnasteret urun se profeionals = Ison de een” (ete planar din TRC, zoned 2. 2 fecal genie. Mexfopatologie 1 Catarina Peon nes tem = adenocarcinomul, cea 2 arin cu ete mai 1c saan tata ‘Diseniorea > enalopnh + mettze nodular nice se tile > linet > iingt crore ia ‘risonaced miler ‘ablouLctinte- 4 sndoane 1 Sindroml epiratar “tues tative eae, pest = homopiin sm sua hemopses pst de cost") ‘expetoraa mio pues spaces - maniertare tdi a CBP ure torcioe end tama interes Hletele nervoase sau plu 2. Sindroml sistem: asteio faied mart, Inapeteyl, stdere tara In cntans(extatoracice) " Melacovele regional: + disfnie 2 istgie pacers laiapntich ‘inom de compresion pe vena cavl superior (,eem fs pelring”) <> Tamponsds prisardict 2 pleuresie neoplascs evra breil 4 lstestavele la dstona:cexebae hepatice,oscase. 4. Sindroamele parancoplaic: sunt uburir funcjionale i metabolic forerale 4 euro evole ete legth de cox tamer (9b easpund a fetement ponte, en cal al tumor prise). Explore paracinice ‘Beamer radiologic aspect pstlogce variate ‘marten umber eu pretongt a pari Stoltz localiza aun lob su lama Teainoe inGltratva in parencial pulmonar ods soir pacit multindatare ‘sess pend {iingt cartons 1) Tomogr comp ido adopt ie xen Coat se mesa bonorcopt ® ‘metoda de electie pentru dg, neoplasmului brongic central pin ches api 6) Bebnonl cote ap sol pirat bagi sas T- forecast. <Date este vosogate 1 puncope onsen bigpsis gimlionitn perfec, mediasnescopi (pena apeeierea presen denopatio) + mefode peur evidenirea metastazlor racotomin explora. Forme clinies CBP ‘© Cancer enzo“ + Cancer perfec © Cancer paramedian {+ Canceral sical (sindomul Pancoast Tobias), ___Siadiaizarea ~ TN (Camara ~ ganglion ~ metastaze): pernite pracleareaprognosticuli boi a renee tumor Dinguasticpocitio ‘Sad inal ~ ett {Diagnose precoc, screening: mar fumétrl, varsté > 50 an. BPCO, TBC, flbrce presmnoconacs. ‘tode de screening: MEF, examen ctloge a spt ‘Stadiavanaie~ simptomatologi lined explora parectnze Diagnostic diferentint = TAC = lmfoame hodgkinien g naahodgkinine = tumort mediatinate *peoumonie south (cents) Dahipeoris apical sbces pulmonar hie dati, ‘Deatament CBP Princip genera: Tatas ecips complet + rents nesatsfestoare ~ pentru subilires strategic 2elemente sunt eseaile ~ forma histoogics + stadiaizarea TNM. Miosce terapetice LTratamentalehirurgleal: indeat n special i stad incpiote e 2, Radioterapa: > indicat a cazurile operable, da eu se operator erescut © ein pacenal fut inerventia chines postopeatar ul ale fn metastazele de CBP altel clince sunt descratoue 19, PLEUREZIILE (PL) ita: sndroame plretilogcecarctrizate prin prezens unui lcd in cantate putoloies in avis pleural Exiopntogania PL. exe fos eivrst (Tel V1), Tobetal VI ‘teil tone ca hsp Sieve gnc san geet tenn atm ‘pS aspect chide: seroctn, peruent, hemoragc chiles up eantatea de eh: *plenrte(leweal rete) - chi a canis mek pleat ichidn canine me sat mare + tanec de focateares ‘FL alo marl cavisti 4 PL incisiate 1h Tabet Vi est edit freer tre transudaToboll Vat Diterenfiereaintretransedatsiexudat ns reine Soe ‘Tablow! lini: simprome ‘apidiates instal ‘Dararea pleural 7 evantuat de respi dase poate sur sau ineash 1 Gimim oda ce ecules lcd, ‘Tusa ust» rode pin ilar pleueor, pacietit adopting la Incepoto poz analget, pe pares sintoasé gi apo, pe misura Scumultnde lil, pe paren bolnav penis 2 pemite amplinit omisle hentosceai siattos + Dispncza poate debua brie saul, inion _B Beane obicetto —~ sindrom lehiian pleural: = Lamplsiforracce gia vbr vocale Submatiate sou matte lz perce (inia fui Damoisem - acendentd. spre axl) ~ fcined pis (fen preeoavt su tx pine do sorb + Sue pletreti fe PL ex cantata madi de ichid (absent PL ‘oluninose ana mie) sunt dependents de cansitatea delish g de Explonid paraclinice Examen radioge ‘pacifiers (Volare ini a sinsuli cose *opecifiressinusuui costodiaagmatc gi azn femitoracelu sau ‘hae hemtorsele +n PL nchistate led muse deplasean in pal pleural ott cu schimbarea poi! pacietuli 1) Bxamencle de laborator pci pleural cu examinarn macroscopicd si microseopies Feat pleural = ditresiah un exodat do un waniudat gi aduce clement de dlagnonteeologic «) Biosiaplowatsrsorandat fod eologi ee incerta 4 Tovecoseopta (leurosopi) ~inseap diagnostic au teraputc 2 ale tnesigapcltretexamenul clogs al spt, emocut, {emograta computes, bronbascopi, oacotomia explore ~ Foameslnie tole raconte PL tuber tall sot 30% ca, rest act © Stomane parle vexsaenal radiologic + scumlarelihidian® plewala, de um vaio preactin event ein dep tubercles * + Heh plewal > exaat eect © pantie iopie + og ciferentaletologe: previ neoplaccs 1 pleireri din nao nespeiice - erorbtia rp ihidulai—+ chimioterapie antinberculoas (umpicin + eon + Prazinamis) = Ssigurares une nei pulmooare orale» eveuare St mal complet a lichidula pleual + terpie aotinlamstone + - inestorpe. 2. PL neoplaziea est de pai 3) metastatic +) soiree umortr primitive ale plourel -mezotsliom. 6) PLmatiatca' spat In carcinosmele brossice, des, prostat, real, ‘igs, Linfoame, luce aut abou! cline: sindrom lekiian abundent recistet 1a tatamente “unale; ich serobemoragle,sroibrinos sta hemoragic = agnostic de certtdins"eidenires fa Hahid colllor ca Caracer peoplasie * biopic pleuals bonhoseopic gi tomograie ompateriats = eval: netivorbiment: evaciisi repetate + tratament local intapeurl cu iatosttice + ealiarea soar pleural pin infroduceren de le Inplearal 1) Mexotlizmal plewal: apredyps expnere ndelungat Ie azbest lini drei torscice, uneor foarte intense, sindrom lihiian rebel Shipoeratism digital fexamene paraclinee: chi seros sux hemoragic ex um contin tseseut de sci hialuonic sf ov eitlogie pleural posi: pleuoscopia~ peur sete, coast, ck mugurl proeinea = Gage decorttudne:Bopsie < tratamant decoricare + taioterpie + chimioerapic, 3. PL parapneamoniet + “antiaten de ei varia de i evn elit pin a liv tins lappa la opalescent, bactrian = poate vita spre plerene pure, 4. PL purulent (emplemtl polmmanae) ~ agent incrimiaf stalooeal au, pretmacceul, seposocul, iv, annerobi yi une abercloes oar rides G9-40°C),tisoane, sanspirate, Seis cenaiy, stare de prostate, sbi a cre se tdnigh ter tomcice, fe sna si ureaas,dipnoeinenss sempelecbiestve locale evidenjazdexsens uno! evn perl = examene pradlniee "examen radiologic + reveat Hoe im mare cavitt;In fxn de Tochistre limita supaioa devine convent 3 bine ‘elite unc plewals «alte exumene — VSH acslem,bipsrevcocited ou neutoliie = volte: favorably tatament rece si coect > otamentantbioteapie —PecetingG, Onaclins, Ampiciig, CGenttient, efalooporine ~ Putcigeett . Dleurotomierinimi cu drengj gpratv fa plopneumoronx pleuotomia lrg epee shite eineaiteapin suitur generale ~ combaterea dente secundare prin dete iperpotce, hidratare cored, wtaminaterpie, corectret éezchilbnisi mato,” etamental ubursor hidewelecolie. (Bo 6 PLede cauzlsubdhatragmat So = unilateral, teevent pe saga in pasreaiascutl9Abooi in +" apare th tomboembolisml pulmonar de dimensiuni medi nftet prlmons) Teva ichidian te catitat mie au medic olin, ex regres a perineal pleural Ts 7-14 ‘ratament ell tromboemtolismuti pulmont. Ld rigine panereates sl pancreatic + tablol eve sogttiv pentru pancteatit scat, aoc pleural tulbue sau emoragie + diagnostic: decelzea ts ebiulplewal a vnor nivel exescute le singel 7. Transuatele pleural in = insufiienf cardiac congextivs ciroze hepatic decompenete vascular * siadromal Meigs tamora ovaand benign asociatd cu asi hidtotorm) + sindomal neo, 3. Chuatoravat ~ seumularea de imi tm caviten pleural secundsr unor tmumatisme toric, pligi penetrance, lnervetit chirurgie toncie, obstructs metistnule ~ clini: revirsat afer, cu aspect cls, ev rfecere rapid, obigtad ‘a panei tepetate ce dat la eagene i Linfopenie = linjegranas prectsnzh sedi eltatea fete * dggostcaferega:~ ca pleura cliforma —+ coajnutcrescu decoleterol 9. Hemotorasal - prozania de singe cosgulabil ~ cove: trumatsme toracice, sndroame hemoragipar,trtanent suticongulant exeesiv, pers un anes de oor in pleur ~ agnostic post wscieea unui sindrom anemic In un revst pleural hemoragic + diagnostic ferent: PL hemoragie - nu congules2t1110. PNEUMOTORAXUL SPONTAN (1s) Definite sfetine camctrizat prin prezona unel coli gazoase tn ‘evi plea relizas In uma uel perfoati patologice netsumatie 2 teroare! pearl le = PIS primi (diopi) co mai vent = Prssecundar (ntestiog,emizenlpalxooe) Tablout clinic ~ jung frac vielen, dspuee tens, use seek inten, nxt aor, clanozi, ubicarde, hipotensune BEsamen obiectio > imobiliarea gibombars hewitoracehi timpanis, abies vbr s murmur vicar ©) Examen radologie: bipercansprena hemiterachi plimén roéus de ‘olus i olabar fi 2) Temografia compulertzalds evidenia8 veicule asrene tn concala pelmoasr ©) Toracoscopia(peuroscopia): indict a Scop dlaznosti i erepetic Diagnostic posit: lnc + radiologic. Diagnostic diferentiat nfaetl mioerdi, infarc pulmonar, edema plmonar set, atl brongi nevi. sti. complicait Bwoluyjie:favorbis,exitind cazuri de recdiv i eronicizare dori bse eexpasioni pmsl dp 3 un Conmplcet sedaren duredi gi a sel, pleural, revenirea pint perete sl normallzarea conditilor' venlstoris exlag Seconpresiva, plewotomie eu dren} agpctor contigs; tertamant fantnfeios sat uaasuai de singe; kinenterapierespraarie 43. Tratament chirurgie: sure fst, exerzateitriorsegmentare a lobar, indicat negcaldengjulul aspirator ont, 4, Preventrearecdlvelor:simfizs pleural instilaresitraplerall unor get a» exacting ale, singe prop. 1.11. INSUFICIENTA RESPIRATORIE (7 nites sindrom fungionsl plurieologc deterninat de. skerarsa ehimbull gazslor repiatort (On, CO,) fae alveollé capac Fone, manifests prin hipoxenie (PaOp < GOmng) co si fd Fiperapnic (PaCO3> 45mg. Valorifisioogice ‘PaO (pesiines patil a Oi angele rei: 95 - 100m S20 (satura do Ove stagsulartarl: 96% £) paCOs (preter aval a CO) 40 # Sm Etiowatogenie ' ® Inseficen respiratri prin tulburarea vented eM obatuctive 2 restive nat. «+ Tnsufcenta repiratorie prin tulburarea distribute eerl insist 1, BC, easizem pulmonnr, AB, neplasmnepulmonare J Incaficlenta respiratorie prin tuburarea alfwtuntl recor prin {nembrana slveoioeapliars “emfsem pulmonar, flxoze TEC, posumon interstitial, EPA mas, insuicenti respirator prin amerecal sngelu arterial cw cl venos. Be 2 eroniodapae lent 2 eromid acta = agrevare ruse pe un plies cs IR execs In funcie de severitat: 1 font = cu asian clinice sugestve abgente to reps, dar prezante la efert, 2. manifest (patent) ~cu serine clincepreznt a repaus;evoleazt In “dou fies compensa decompensas.1. ups mecanismul de producers 1 partial (ip 1) hipoxersie, fi ipercpaie 218 lobold fp I) boxers hipereapte ie ‘) Bvideerca put sia sever -_detemingree PaO, si PaCS pH-u,bicarbont sri (Astrp) ‘about by sintrar niger ines ‘manifestaile clinice ale IR sunt produse de hipoxemie (Tabelul VIII) ~~ informagii asupra tipulut si sevesitatii disfuncjiei ventilacorit Shes abel (Coin Tabet an 2 one ree tame et rekon Mant cle ee poset FF nan nice eames a carne Paine soe ben ci = wree amearepemn SSO | dan omas ai erp era ypc extn de CPA eames | (armas. is fen aoe a ier se . Seen” [antennal I onisines Sa = Evens " = — a eines ie + Fa ope scnuntats ono Sf = ogee tl srr cut genio nt diy Tate | Te ccetpate tp ee Mantes tne de rpereapi Scope Tia a alana? —— Ohecie sone as ty i a tipeentieeeda ‘eure “beens (nm) © FO ex eer papiar 1. Combaterenhipoxemiel perenne acid eset oman ie enn eames is ence a : Sgedtee ee twrdirscte | “hpeeeintnzenans Yl mi FACOG lung durati—» domiciliy ae + coe peeps ee ain cabo 7 — (hematin ia = SOS ed (872) NalCOy Lt PEV as po. 300m! si THAM, 2. Reducerea ravallulal esprator supleeren ventilate! deficitare = adrininistarea de Ope sonds taza, ase * intbayeeadowabealt i vensage mecaiettnaleptice esprit = zalxone,nlorfind, dopa 4. Asigurarea unet bune mots acute! toralee(evacareacaviti pleurale uprimareadistense sbdominale) 5: Mlsurl specifica raparte eaza IR, 1.12, TUBERCULOZA PULMONAR (rac) efit: vost, prezenia de manifests clnice glean. rdiologie eteminate de spunsul organisulul gazd fj de miplicren bcitt toberculze (SK: bal Koch) nfecia THC ~ infec latent cu BK, fe manifest clinica, adiclgice sau bscerilogiee > Gar de TBC - posousa eu tuberclonh Inca medical specialist ‘ecide dexe necesartIncopert talent smudge = "car nov = bolna eu TAC eae neces tetament ere mu a ‘rit iciodstd tatamentantuberealos + faz reais (reidere,retmboindvirs)~ bol ta pseu de ‘TBC ce acces tatment care fn enecadensofetuat alent Agentul patogen Mycobacterium ubercuose(. Koch) =" baci acio-lecolo-ressteat + colorajaZihl-Neesen ~ bastonag roi pe fond abastes clo horses — besontye gulben poral pe ond = calturt ps medi Loowonsein-Jensn + primele cola apa dup To-1Smin, sumed Ia ature dp 3-4 span, nme se face pint In 3 Iuni + cloni) prosmivente verscoaee,nigose, scat, gba > Sursedo necie ‘pci ex TBC palmonact * pesien ca TBC extaplmonart * animale bolave de TBC. > Ci de contaminare ales seria 1 cals digests i * ispartim ae pent ‘eal Eats sou mucoass~excapional > Infect st imbotnavirea “)InfotaImoats-» TBC primar 1) Infectia tard» TBC secandars Populaia sempre: nenfcta » IDK negativ ‘nc IDR pot: - satis “purtior “Eola > Rolul caracterelor infectil(suprainfectel) “Important epldemiologic mse ‘) antiatea de boc elimina de bolnav "elaa a etoe spt sut pap fn evideng a examsnat Imitoscope bac rs de nfecie de 10-20 on ms mare Wola elvrsput use pun Ta evident bac det prin utr sede nfoetre a eds. bj eataiea grmemsst vesera, paloyeaiate) 9) continitatea darts elimina lr > Rola fuctrilor de aren foto gens =item HLA ‘Onl rocoptv fat de infcie “rela ease fa de Imbotnvire — 3 deral- baat 4 factor immelogit specif: 5: bot ate str morbice: evolu conic, malnurijiaprteno- lore, DZ, seoplanee, IRC, HIV SIDA. Tocuija, standardul iginicosnitar gi ‘altura, ota si naveismal popula, migratile de popu, ‘ctor psihesocal, misurle anuiuberculease — veosinarea ‘himiotenpia 1112.41, TUBERCULOZA PRIMARK Ansan de manifrtisi apéute consecutiv primi contac cu BK ‘ umci orgiism pli atuneindemnis apt intala obligate « boi lubereloae proprlu~zise. ‘A Tubereloas primar nemonifets (cath latent) Devons fra aneaorics all un fel de manifesta resco poi la barat= cvoute inion 3 B. Tuberculozaprimard manifest + subfebelii sau febed — hiperirenie, febet osilen remiens, intemitent = erteme, keato-conjunetvit tna * sindrom de impregnare baci: subfbrit +astenie + anoreie + sSetdere ponder = micropoliadenoptie clincon 1. Complexal primar simply represent de +> ganer de inoculere fet pina) -tsbercul velar 2 Senopatiaseteli Cine: sino de mre gone baci. 1 Adenopati trabeo-brongies 3 form spa = = forma complica 1, Forme extensivinflamatort:simptomstologfe mini’, dar devine _zgomotoat cand eeonstiueostelectasie mare, Pos adil te ga T. Forme exensv-eareonse ‘pumeate eazzouss = _bronto-mneumonie eens 1, Formelediserinate hematopen + THC mile * mesiago-encfsitabercubas 2 pleuresia THC. fe iat 4: Informeteincare predomi adenopail Mare hipercofite gangionare hile ein afécinile broshopulmonsre ncepesifce boala Hodgkin, adeacpatite din hemopati maligne seoidona SIDA {nformele tn care predomind medifcrile parenchimatoase condeasti pacumonice inet vittoe In formate de tuberelosS. primar cu dsemindri nodslore ulnonare ‘romhopaeunona bese ‘urcinomstoen miars tlveolite alergice Plearecia berculoasé tebue diereand de urmitoarele tpi de ‘spontamentepleurale plesrei inte, parapreumonice . Pleurei neoplaie, mezneiom pleural Pleureis pancreatic ten, 1.122, TUBERCULOZA SECUNDARA (FTIZIA) ‘Cwprnde toate formele de TBC polmcta cae. apsipe unten slecgc, cu predominans imuntit avprahipesensiblisin de, chi lary, dupe Vndsearea complex primer, Foneclinice de TBC secundari "TBC nodular ‘TBC infiltrative ‘TBC fibrocnzeoest evita TBC Aros ‘TBC tabeo-bronyict, TBC ese fecrent soci eae afeclunt 2 pmoumoceninee = Supra bronhopuimenere I ope papi once 2 sia + boli psiice = eaucerl pulmonar, Dinguosti dferentiat 4Al seb hemoptoitor ~"subibriti ernice dn ol infeons Ienopti plmonae, sno de hipertersiun pulmonar, sinom hemareipar ~ peumoaii sau inflate vroe teat, neopaai, hemopat ia brongieciazit, cancer bronho pulmonar, hemaeiderors s2B. Al tbercolomu pulmonar cu BK negatiy cance rotindpenifeie ‘tumori Benigne: condom, angio, Ielomiom, chist hidatie select rtinde * faleeplewrenhinbirnte * rmatun! ovate. CAlformelor cavtare ‘ancerl ear © dhees pense iste seiene soitare sa cise boagioe hist hide perfor * micoze pulmonareeavitaze - Slicea pseudotumoral evita, Al tberetoslr dtp flores diz ‘pneumopai interstate diizeuespeciie(ercoidess, ‘pneumoconiozs, eolageeoz) E Alfibvoteraeuat ~"plewreat masive 2 Retest maive Dhiploute masiv. n 1. Tratament medleamentos ‘Principle conduit! citoterape antibucnr: Splcaeasistematfet ascljillr de madieamente(RMP-HIN) tn vedere prevnini selec g stl! chimioreiten!secundare Sle neanlinibolnavals on sshd infec = Rminisreres st fie de dura el putin 6 lan) + asigrareareplariti comunity Fespeciaren dzelor + sit supraveghere. 2 Tuberculosttice sential 2) major: zoniazida(AD), talc RMP) ib) de asociee: pirazinamida(PZ¥),stopromicin(STR) gi etambutol EB). ' Tuberculostatice de rezervi -eficactte modest, foleren reds, cunpe: eons, ciclovens, opredioxaing,viomisina, 2 Alte metode de watament: = medica patogeiek:sntibponce, ntonidant,heptmpotectoae, Jimunomoduaie specie gi nespcitia colspsoterapie metiels Uatament chiaepcn! (exree, torcoplti) * Iineiterapiarespiratorie tratamentl plete secoibrinoase. 5 na infeotat Suprindees vill tybecuine. sou a slfulul_mberulinie eontactaes resent infest + IDR pe fj ancerioart a anebapl sg in 1/3 medic Ol (20 PPD) 1 In cae do supicine cf persoana este infecttd, dor real ete egats se poate repeta ( pupul 56 msm uj de portals (Cops ier pnt i 2026 ant = sea lcalt- prime ore (24-48 or) ~hafoueriteratos ‘com poctive la 72 ore - papal du, proeminena ving uleare ried ca dam. max. > 9 ma + reef fs patie: tere hperergce (AB, rn sepa de ehnies - sypredoza| PPD persone infctate anor co myecbsctenatipce + seactie general = fbr, curbatr, asteaie 12 ile 'B.Invastigata Dacteralogicl erent dingo Fclare repost 3 probe fechueazinsinte tnceperi atameatu (C.Buamenulradifotogratie Gepstarea Integral ~teitoc co morta foarte ceecut& TBC © depistt sleetive vil preity = indivi’ peieitay + depistt oczzinale ‘eps elect Is persoane evo simplomatologe respirator de Ings dra . Anchetaepidemiologlet de fists. jes) 2controll vaesindilor BCG: cofet cestrce ca dlemtna > 3mm st gaia alerpieh postvarciaare tn decus de 4-6-sEpma dua Madoc 2 Chimioproflaa ‘sb adreseazunor catego de populate stoned, dar caste reset de imbolnivre: contac oy olay eliminetori de. bail opi af ert cu vis) tuberculin eee; persoane cu lesa inarea BCG fe efecttect cu o singh de ms inzodue tn 13 supror cerrou TE ‘wap {Om vacein BCG" papul de 56 mm cu poet de Suseaees AFECTIUNILE APARATULUI oats CARDIOVASCULAR + fag cate tn jr vet de 6 tu ou presi ccaice ‘accini sauauo eabce ev ametn =} man : User aise eae a 21, ELECTROCARDIOGRAMA: contrandea INREGISTRARE, INTERPRETARE +" nownic dsroet =_efsnue fn convalescent dup bol infeto-cntasionse te 1G) - mend de inegittere gait, esr lossocardograuli, a vaiailor de potenjal ce aper ca umtars & sev eleemge a celullor eariace > Blalonarea gormals a BCG. + vitea de oegitre: Som ;_smplitudne (oil): IeV=tem (0 mVImn). | > Insererea ECG - Int sist grafic bdineosioaal pocrzontls ty plmonare fibrotce; ft bolnvi de TDC; pleurezie de eilogls Deverteals | — sete (poctv yi nega») fncen ampliines, determin setderea mobi de 3-4 oF Site de mere line vertzale”marcheazt impel (in finetie de viteza_ de ‘srogatrare) 1 25mavs—» Immo0,0s, Sm, 205 Tinie orizontae marchean eae amplitdines + lmV= Jem O,imV=1mm 0smV=Sni0) 1 Viteze de registred: Smal; 100mm 12am’, 625m Amplitudes dei V2; V=0, Sem + frexistarea ECG - plasarea electri, 2. STenivell membre > Top antebre rep galben-antebra sng; = verde - gembl sag negra - gum drape + regime precodial: “V1 (ofu - spailTV io, parastema dept + V2 galbea) “spatial IV ie peasernal sting ®~ V3 (verde) - mio init dite V2 cu V4 = WA (nar) - spatial Vie. stig pe iia mado-clavieulrt = 5 (aug) »SpatolV ie. sting pe Enis aar nterioars = V6 (mov) spat Vi tng pe lin axils edie, 6 derive ale memetor: Dl, DIL, DI, aV, aVL,aVE » G dervati precordiate: Vi, V2, V3, V8, V5, Ve yt ee 9 In timp una itu cardiae BCG se iaregsreec 3 ‘and P= cpolaiare stilt Intervatel PR (PQ) tpl Ge conducere AV + complexul ORS - deplariareaveuticulars + sepment ST timpol tn care venticuli sunt complet epolaza una T= rpolarizare vented tnda U- repolrizare let a item Purine. laloare: ~amplindine 1mm = IV; + te 25man/ Imm = 0,085, @ ig ones engin ECG lt snusal (RS) doc ‘undele Pawo Greeven normal ne 60-100b/nin «isto und P ce precede fcoae complex QRS — "nde dures <0, 1s, roplitadne = 2.5mm fatal PR nora 120.208 pe linia oslctics ‘)sitmurt anormate ait Calculareafecvenplcardace- eto: ~" curigla de cael fecventl * raporare dntre sum de bas cardiace Ia ntervale de 0.20 Fi. + peinterva de 6 seunde *Hrecvanteuloes~ GOOO/RR sou (PP in si 2 Morfotoge $i dmenstunea ORS dutta touts 0105 + devote membrelor:R dominant fs DI, DU, negative AVR, Dill vriabla,aVF asemdadior DIU i aVLatemsnitor D1. =~ dative precordie: V1 compler; V6 qk — vols tundei crete progesiv de V1 La V6 Suma dise'S coast profund ct uns Rea mai tat < 35am ‘unda Q 1/4 din unde Rn DIM AVF, < 1/3 dia unda RY VS-V6 ras 0,048. 5 de ecund), aFig Clee cen cntice 4 Byauarensegmantli ST, unde T,intervatold OT ganda U ‘ST normal ete odecre cy vrai =e nda T poate DL, Dik ave tend T negative inaVR, Vi una Tasimeiss, poli, neat bifzied sx path Vs Vie contin oma 5 fn omer ont) unde T poziva V2V6 2 empl unde T 13 din ampliin fi QRS fntevalal Te: <4 5 nde t $2596 dina T ‘4 Stables ex elctrle i ORS cu stra desivaitr DI gt aVF 2° QRS pos Dl aVF x tered nema 2 QRS postin Dts nepatvinaVF ac cove stag (0-50) {QRS sega Di porn VE ~ x dev a deat (1909180) Rs seat Dp aVE = devi Gewph extent 39, i808) 5. Hipertrofite -nojune enatomich gi corespunde Tagrogsit gi slang Setar mioeadice @ 1 Tipur de bipetoie ip SF, 8) hipertofe abil sdagtdreptarials * hipertofe ventricular stingldreapalbiventiulrs > miperfirild atves (HAS) ‘rats undetP 2 0,12 (7p mitra) fn D, DU, Dl, VS-V6 Tntmea undei P: normal (2.5mm) snd P predominant segue V1 (orines ein > 0,48 9 sdincime > Imm). ‘da Persia fn DU, V5-V6. > Hipornofe ventricular sting (75) wax QRS orzontlizt, devia a tings © drata QRS normals (£0,115) 2 SVIFRVS sau V5> 35mm GndiceSokolow-Lion) ‘modifies secundare ale repolareiivensicolre:subeniveire Segment ST cu und8T napa tn Dl aVE; V3rV6. > Mipertafe aval dreopts (HAD) + arplitodines unde P 2 25mm ('p pulmonae) tn DU (Il, s¥6), 215mm fa Vi, V2 mero nde Pl DU, DU: pt aca nts unde P nom > Hips voter cep 7D) evijio neal reap 5 SmVI GSA) aspect gR in Vi, unda Sadcs ia VS, V6 rodifcad secundae ale repolaraai venticulare: sudenivelar fegment ST ev unds T negativin VI, V2. meta Te © Wiperate saves ng& Tif Fipsiote wa vena Gey 6 Ale modifica BOG Tulburirl de lon $conducere © eemia miocardc 7: ~ ‘ischemie =" wT fat simetrict— echemiesubendocarics und simetried negative — ischemic subepeardics Fi athe inemic niet iced 6 + xiune supredenvelie| > 2mm a segmentulul ST—+ ezine wansmurslt su subepiarties = subdenivelir> 0.5mm ‘+ necrozt ude Q, 2.1.1. TULBURARILE DE RITM (arrmntey Deft brn oma cnt impute sve cares woe = bradicandi FC < bln + taheandls FC> 100b/ Etiopatogeie: cause aritmilor sux de natort cara i extosrdocs (abel ‘ST —leziune subendocaict Pabel Tatil pots 2 dspace urea nginoet secandsr. 1 Nu exlednctdeauna ws paraleliom ture Inportana sinploelor ublectve gt sevartiata arn, TL Ksamenal obicctv ‘Snmomentl arin 2 nara episod aim[IL Masajatsinocarotiian manevra Valsalva “afioneas prin tonne vagal —> | Trecvenja nodal simsl gi 4 langest eoaduceren AV, Exploniri paracinice = BCG proba e fort Toregistarea Holter explora electofiziologcteadocavitark Saregstarea ECG esofaiea8 Tnreistrarenpotenillor ade Clasifiearea estos font de edi este ret Tabu Tabet (Casiticares aritmilor- fu fie de sd ip sia tara Exon ae jena es Relea Ble AV gma.) Sls recta (ois et) ‘Tratament > Tratamentul ohtaritatitor 8) Tratamental farmacologe el ‘Chien “A: Chiniding, Procsinemigs,Dscpzamit C: Feasinid, Propateon ‘Clas 1 (btabtacante) ~cardioseectiv: Atenolol, Metoprolol tc, : <_srsletve: Propranolol, Timolol, te (Chass IIT blocante ale canaelor de potasu) = Armiodaroat, Sool (Casa TV (Boeante ale canaleor lente de calla) = Verspamil, Diliszem Alte antnrtmice wo ~ Digits, Adenozins (Fsfobon), * Attopind, Sra de magnesie 1) Testament electric “1 Hletraconversia (Soe electra) “Indo: ati gt Nutra atl tbicari din sindrowut WPW, ‘shir venta, teal bitin vatiula ‘ Socelecric extern: 1004001 | Socelecrc inter: 15-301; sondtéadocsvitat 2. Terapia de blast prin curent de radiafrcevenft | Andiof tabicardia. tril, Hateral ati, abicerdl jontionals, tahicrdi in WPW, heard venous 4. Stinultorlancaticerdes in compen defibriltoelor ‘adie ga atrlstonrclor Terapia chirurgleals * rgchzuai aera > a or ') Tratameatalfarmacoogie -rareiesoe + dminstrarea de simpaticomimatie ia blocuile abioventiculre gi ‘vapoliiee fs bradiarl sa ble sonata. Simultoral (pacemaker-u) cardiac impli spoil subelavicar stag su dept pia item ‘nei snde de stimula, trod encovenos "»stimul cevitiledrepte dura de fantionre: 7-12 ant stimulaea poate: venules bicameals + temporars seu razor,I. Asitmile sinusale 1 Tabieardia snusal (TS) (ip Bh oven it siusl > 1006ia [ECG: undele Psimusele armate de complexe QRS normale eu © fiveven> 1008 nin 3. Arima sinuses aun eapirstore tne. 4. Boala de nd sisal - ek i =" sindrom cu talburt ale etl somal ale fom impusull st gi ma depart se pout manifesta ca: Tradicadie snus pon ‘yenoular lent ual sisal su bie i Sndrom bradcardie ashlee, 4 Probacudiropind: advair = peatrs forme simptonatios Framer IL Aritmiileatriate 1 Extassolle tral Fg.) =" biti arial precoce, precede eu col snus, unde extra finsele + ECG: unde Pexrasitlicg, PR ‘de pauat porterrseoic, © datrste pe prim pan unor dul sinus gi ale transite la feud sau Stra, ats opin fuss 72mg hv» FC < 90 bin practic. implant, de stimulator tumate de complexe QRS jdeatice police cu morfologie cfr de xa ral Seu seurtat, QRS subj urmat Fy Tlnatse Fu Steen swat [| }}--1--- i mam EM ‘Frecvence Ia al pain |S Modal de aparitie a extasitlelor alrite i ‘eolte- 925A le moa ite sista sausale fo 10 stole simusale= SA bigeminoe-llereazto sso sisal ex una extrasistolicd| = ESA migenince -lpupuri de 3 sstole(primele 2 sinassle, a teia ESA) 3 + ES interpolate - ~ ESA cuplate sau abble- dupa 0 sists sinuslt apar 2 BSA (pot ‘monomort sat dime) + Tohicarda ara jovristicd-succesiune de 3 ESA monormore Jtrclat tn interval dintre 2 sistlesinwale ~ BSA cx aborana penrieulord ~ modifcaes sspeculti QRS — fovomen Ashonon ~ “ESA blocare ~undelP cu carcter scopic $i precoc, dae neue de Rst + watsmnent ord inden) sdare afecar crdhot - antavitnice din clasa Ts betablocane, 2. Piri arate ~ seta letic tall enrhie, ovo foevent de 350 - 600 bn conte oe complet neeglns fev inte 100 ‘Soran ig Faia ~ poate fi: poroxistca| recent, permanent gi cu debut nerecizat ~ ECG: absen undelor gi flocires lor eu unde ,f” mie! sau ample, a fecvenaarala i veneeulsrs menial entaior ~ eatument ‘converse leis 200) ana femscolgic (cla 16, 1) reveazeardivlor revenireacomplicailorwomboembulic -snicoegulant, laagroprate + contol ecvente! venture, $3. Muteral teat ig) ~ Iabiarmie generat de fear etopce alii, cu feevens de 250- 3sbbimin, conducerea AV fesse eu blee 2/1, 3/4 a cing in - BCG: sheenfa unde P, prezeae uadeior (DI, Dill, VE), cu fieeventsundelo F (int de feet) ds 250 ~3¢0b/m. cu rorfologi sl smplitadine sonstantt + linia oetecues sheen + Mecvenj venicuarh regu a occ de gre bloull sas nerepulst a fone de gral Blalal ~ QRS morflosie normal ea ii ‘converse elected de eles tau medicementocs ‘reveniteaaccselor cu antirtmie din casa IC gi 117 ‘lfc prin exreat de radiofecven | wl ig Far wr 4-Tunlearia atria ~sitie produstprinto activare cu focvenl de 150-2006, + ECGr und Pdifer de cea normal, event 150 200'mia. conduesren + AVeste 1], 10r2/1,3/, complex QRS normals aberant, ‘ie cronotogit cu uada >+ Ta caz de toxictate digtalics ttreruperon digitale uplimentare 2 potas Digoxin penta seer rita ventricular alarimie clase 1A, 16, 1, 1V {oc elouie eau abla prin rdioieevens, TM. Aritmil jonctionale 1. Tableardla paroxistcs supraventricular + tale debt final Ure, declanga de BSSV ~ frecvenis 150 -2506/nin

0,0: dates prezonat unde ta vd dele ‘Segment ST subdenivelt in ens opus complecului QRS, uma. ae Tifa seu T nega. 4 Priori cestaspect ECO fac frecvent occese de tahicere pororiica “nartlee~ lass IC, It ‘chgurgieal~nerapeeaZsccutlut bla pia adofieven~de lesion WPW simptomat. pine ee Dag hiype ark 4 TOR —tH: |. 7 ty Fig Hesintom Weturznce White WW) _ IV. Anitmile ventriculare 1. Extrasitolele ventricular G6) “eomplexe de ‘dopolaire Yeuticale precoce, survis_ iol, ‘Snemationt gemini butalesgusals urmats de ESV rien ‘low bs normale ummate de ESV), sau grup (uplte sau perech ss) > potapizes pe cord iatioe bony: cardipatieitchemie, IMA, velvuopati, erdiomiopat * BOG: complex QRS lect umat deo unds 7, ores inves fj de {QRS si apol deo pauek compensa Astana inte cele dou unde celnglobersk ESV est opal ex 2RR),neprocadat de unda P n~ losatzare ~ ESV depte aspect de BRS, ESV sng -aspeetde BRD ~ totament 1 SY fimeyionle- excludes Sctellordecangang, sedative mu beabloeate + £5V organice- staan boli de baz, sntinimice casa 1A, 1B I prevenzea TV prin satritmice din clsa I, I, aeeen ore HOP pe Es ae ann oem 6 ee Fig B:cxemiotevenicle 2. Tahicarda ventrfeulars ~ Beg ~ succesine de> 3 complexe veaticulare lt (>0,ds) eo 0 fecvenf de 140-200/min Hecveut de 140-200'nin intervale RR ropulst soa ajornecegulate ‘complerul ST-T opus vectorial ai QRS bat tii bse, ” = clsifcare > dunk citer dra Susu rah > 30 i resist ~ dra < 30 9.) ‘monomor~ aspect dene al QRS, polimorf- QRS biforme aerate stu polimorie ‘wetameit bec prineipal conver laritm sinus TY sustimad, bine tleratd hemodinans ‘Amniodsrond, converse elect in st de cpee > dup 1 T7 usa eu volerana hemodtanies provid ~ coaverieslecsa + prevenitea socureajelor de TV ~» betblocente Qetoprolt, Sola), “Amiodron, dailtor implant wh Ie III I Pe] stay PAA AY] Tig Tile earn iit ip. eta velt se % “ling, Prosinmid,‘Torso varfuitor (8 forms de aicade veneers 7 BCG ‘arian semaiistivt a morologielcomplexslar QRS socials (ot sFsucitea vifilr eampleelo tn jut lintel ioelctice + Becher veioulrt150-250fmia intewal QT Becvetprlungit_ ‘degeneare Hecveatl spre tbicadie ventricular sonst eau Sbriaje ventecular. ec clectrc exter 200 40 aso cardiac extem sresyrai gu In gurk pt cod exits posibiitateaadministan phuli elec extra bentbonat de otis end FY drat >30 60s prevenfisacurnjlo cu sehisice cate IA, 1B, Iv. ‘ardioverer impantabl i Hema ior Fa Par ine ‘3. Flutter venriolar 8) +" taleardie venticulaa cu leevenl de 150 - 300bnin, de abies! 200/min, care procde sia verculars “BOG: delexun ou accegi morfologie i amplinine ce ialoulse lundelo Ki S(esocesine imssoidals), segmental ST guna Ta Sopot ditinge 4. Fibllafia ventreularé (FY) ~ piederon aot eletice veniulare, trad clini prin esp hemodioumic gi decestn 3-5 min. dela debutal ati fo abeaa trsament ~ FOG: absenja under P, QRS giTditncte eflcin bootie, neeguate cu morflogie si amplitudine ‘asa, feevenl de 150: 300b/nia. ig. 20) Paaainn\rermnnniymcuvy| Fi 0 ie nits2:12. TULBURARILEDE CONDUCERE, ‘Represinté tulbwif ta condueerea mmpulsului lec, want au _| pemansnteditorate mor anomalistusirsle su fnetionale. 1. Blocurileatrioventriculare 1. Bloeu! atroventicala gradu Ii. 2) 28S: interval PR 4020s (unt coast), ecae mpl al ete condus spre ventric, = QRS morfologe normal = watsmentetilog + tament ‘tologie, Atoping,antcolisrice,simpatcomimtice Implant de stimulator (pacer) Fite woven pea 2% Blocal AV gradu Miobite I (cu perioade Wenckebact fig. 22 ~ ECG: lngireaprogesivaaintevalull PR pln cd ound P este loca interval PP ose rgult, iar RR eo sourtese od slungiren intel PR ‘QRS morfologie normals = tatamest~tiologle. 3. Blocul AV gradul I Mobite I fi.) ~ BOG: tm tial oat bocares perifdicd coum, a ofle unui stimal aril, fick rlungies pr resiva enteral PR forme: sstenatizat 2/1 com osstoratiat (972,49) oe ged tal(3/1 4, 1) % "i ls aioe gal Up obi Blocel AV gradul 1 comple, ot fis) ECG: sclsieaiovestcunr (sctiviats atril indepeadeatt de cen ‘Yeaniculr), manifest prin existn|s under P ou o smith eve smcomplexcor QRS exo fresvent joa 30 = AObinn), inte cle dout Unde neexistind mci reais empoal + sumul aval ponte sina, ecopic arial (Srila, ft tal) + complexele QRS pot subj sau lle foe Us sia tau ‘de atepre” ‘ventricular: - QRS cu morslogi bizar gi rats mare> 0,124 Reeventt 30-4 ~~ Jooctonal: - QRS eu merfologie i drat normal + fieoveata45-cmi ~ teatumental sincopl Adam Stokes: Tovitut ex pumnul in torace, stoping, izoprotrenol,stimuare exter rnatorie . implant de stimulator ventricular pemnanent. —”~ 3Sra iy 2 Bleaiovensir gn HL Blocusile intraventriulaxe : cal de ramuri sting BRS fy 2) ‘major ‘orn QRS> 0,123 fepet RR’ tn V5, V6 sbdenivelie de tesment ST und T ngatv ‘nda S lrg adn in VI- V3 ou eopradenivelae do sopment ST ‘morfbogie de bloc de amar stag furin ORS «0,125. 2. loc de ramurd dreapt.~BRD (5,258) ‘BCG: ‘major ‘Guat QRS> 0,125 fepect aR, RSI in Vi, V2 ‘tbdenivelae de seomiat ST cu un T negatva tds § lrg aint ia DI, VE, V5-VS rata QRS normal Sepect at sue? fa VIVE ‘odie secundare ale faa eminale tn VI-V2 ‘ude Slt in V5-V6,. Bloc jor dram dept ip BBcode ng) # ap) 2.2. HIPERTENSIUNEA ARTERIALA, Depinitie: crestere, de regula permanent,» vloilor’ tenn arterial Sisilice (TAS) pest 14Ommntfg aa lstolce(TAd) peste Somat TSM e yt TA xe ret Tate 2 > HITA malign’ © = TA > 13ommbig + reinopatic bipeteasiva staal TV (edom apis) = insulin cardiac, eacealopatie, insulin renal ‘evolu rapid progres, > WTA aceleraat ~ vali mac ale TA +0. stadl TM, evolu spre forma aligns a+ simptomatologia ce ar putea sgera cad scundard de HTA, ~ ctor ders eardiovscaar, conde de vias munce > sllipertensinnen ioltd de eabinet "sv 4 hipertenstanen de haat | ae ~ mntument anthpertensiv ummateatrior gi adaparenpacieaut = 17 numa la contoalle medieale > HTA sistole-diasoich ‘erp. + ITA sstolie infin aoete,Sstlesteriovenose, vssteh Pesescaleee + ITA disoliss- esniit n general ~ fhimea i greater pacientui, caleulares indicelui do mast corporis Stamens pt: a pulmonar, espn pacienul Ulan than 1 si V (spar) « agomolelor Koro penta identficarea TA stoic especty, diastolic. ‘Marui TA biter IL In raport en ettopatogenta “A-HTA esenfinl (ria, dlopatic) - 95% BATA secundard 5% ceeitesies te ene Oo alas “~~ examentl partull cardiovascular sui preci fcaroiiens TS See pL mene = examen abdomenuli:rsihi (netemegalie, sufi ebdomisel) — a or Masurarea corectt.a TA Ness rm Permit pacientilor st se egeze pent cllova mime ato camera esate _-was lini osinte de facepe misuaren TA, ager : Y Eftcrust minimum 2 determin a iterval do 1-2 minute, preeam Age x ron i doterinkr suplimentare daca pile dou sue fords raped sa ¥, Uiliza o manger standard (12-13 er ime 133 ca ng) TA et a = a ° Ponitionai mangeia Ta nivel cords, indifisent de poviia 1a prima conta enti «detcta posite ‘cooprcshinatoes Airs dtr ana ate vere poe ‘seoracalns % Misra TA i915 mint dpa ecto onstationI sabiei dort icin, In acini ibe in ovce al itais Ie ere Src ipoteminee postural (VTA ost) pout fr Hoeven oot ra repet Bal newotogice 2. Raplordpasctince Sessa pote ator unalone wit Katte eat = agent EE ghocy, Upidogun, fnogana eit, sid ure err Evaluaneapacientulu uO, sleanoe-ul cresting, examen "de ssi (mirulbumiase, 4. Aamnezn seu urna prota) *"AHG, APP -seaniatve frregeeere BOG ~ momoal dpi valores ale TA radiorateoraics ~ scurele subcctive: cefilee occipital’ mation, ver, fosfene, ‘cufne, presen, burs de hb de meray nxielte,nihae ~ simpiomologin actual sau tocuth ce ar pten suger ecar ‘rptnclor ints sau complica als BTA ori konmonale fn supicane de BTA endocrnd ECO cardiac: HVS, fief sstolia pi castolied ECO abdominal: evaluarea riichilor, suprerenaelor sau ‘complica renaledate do BTA, a ®~ . BOO vaca bo vatelare (crt, etd a peri) = nde genta ckamenal find de och (.0.): pnt sprecitea modifica a Sve stn vasclr cree 3 ~ montrsreambulateies TA pe ore (Hote TA). Evoluti, complicti_prosnsstic "BTA cael ete o oa oni evindscbil, care i ooo Stee re inn, vu c,h, we omplicastor la sent ake ~ adul de vscerizae ai HTA i presse factrloe de see EXdorsadar come cite" iporatte le sada ‘veri cout a ali progaontea (20). esata ames — | remus | rages | songs | yrgate | vniale aaa fae a. Sealer sal pn cmt progres > Factorll de ise eardiovascalar feos in satificeren sul = nivlal TA stale distolice lvl preston palslu a vsti) ~ ‘arts (sb > 55a emel > 65a) > fama + iipdenia (colesteol total > 190mg seu LDL-e > 11Sma/ sa HDL: B <40mgl, F< 46g sa wigleeide> 150m) ~ Da, licemia joun stores ites de tolerant la glucozt anormal Ps ~ obezimtes abdominals (ckeumferota abdominald B > 102m: F > teen) Ssaie fila de boalscardiovasculat premsinrd (B < SSan, F< san), > Afectare subline de organ OHVs: ECG: indicele Skelow-Ly00 > 38mm corariografc: index de mack venrculartstagi ~ IMVS peatuB 2 I25gin"\F > 110p'n ~ dover! ulasonografce de Ingrogare 2 pestelai arterial: grosimes Intime-medie (IMT itima-medi thickness) > 09 sm space Merocertica ~ seleitte cerotido-etutl a unde pulslai > Pave * Indio tension glemibrat<09 * sojeen poor retinielserce (8 12-1 Smal F 1.2 ‘a enimal lic plomeaiare init 60 nin, ‘lewrpeo-l create eit < SOmlnin ~ ‘miroabminure 30300mp24 re) » Arcane ardovasulra sa renal constaitt Mectine cerebrovascular) AVC ihe, Hamorgi cel sag + Heian caeaet: int moar, angi, oes foronaran, icant cardiac ~ afesjune venali: neffopatie dabei, shinee renal (ceaining {esi ln B> Lgl, FI ama) proeinarie > 300mg/240r) = arteriopatieperterici ‘eilnopateuvansati: hemor sau exudate, em pail Ttamental HA > Obiocve generale ~ {TAC 40 90mmtig 1 depataresfetorior ders i liminare su amelirarea lor 2. modifcarea sla de ving 3. terpiafarmacologit 1 Depistarea factorllor de rse + auumnecH minviost examen clinic parse stent ‘iminuee sau ameliorsres lr 8s2. Modifcares stata do vist ops fame rena te tex ‘ipsa Se Nacradore ‘educaes consul dslenel B < 309 F-<209 4 Iodieten dite apor de gsi satiate 9 tole 9 © Inhibitor enim de converses auglatensinel (15) 7 Captopsl, Enalapril, Ramipil, Perndopa), Beuaeepel, Lisinoptl, ‘a blocant ale canateor dean Diltiazem, " Verapamil, Nifipint, Amiodipas, Feodiina, Nicaea ‘© antagonist receptoror angotensine It “Losarian, Valsartan, Candssern, best, Telisetan ‘modemt 30-45 minutes i Hala Tblocante ‘limites street pli. 2" Prazasa, Doxazosin, 4. Tratament farmacologie Alte anthipertensive Princip generates E 1 alfa? agonist central: Cloiting, Moxondina, Metyidops conto i permaneniore 2 2 ‘vasodllatstonre directe: Hidralazint, Minoxidil, Diazoig, [Niweprasiat de soaty ~ 3. inhibitor adrenergic Guoneiins, Recep. > Aaocier posible de medicaments antihipetensive Fg 29 ‘rans poss teae ctr spin propor mae de pce wa ses re eid epi ‘ott et ange ate Ta : ~ ln ep fcc sng pes eek ‘il ancntomsige ot eipatatets v Ge TA me canoe pec aod pot sib Stent achat mye dye ad 4 v0 ast joe Gr ui nt eigiepeu ‘Sipe enna tg ; ¥ towel pet rpnilr es ace pani gre oglu pct oir patter {it etn eemene + Ste ce So ements lore 7 te: Ficosrta Cots 2 np 2 Dlr det Free, Tsenl Bune 2 Biwi sonmibone do poms ‘Spomoctns, Amor Tose bette "Meodoceetne: Metro, Atco, Biopll, Beal ‘ot «cane: Ppl Sl, int, ada 86 fig Z:Poe ces ce mmes athipntensne 2.3, HIPOTENSIUNEA ARTERIALA (nt) sindrom clinic caaceriat pin scSderes TAs = 100matlg gi x TAd ATA orto seldereaexcsiv a TA la tecerea tn etotti, (2 20/ldmnits) w+ BTA pote 5 asimpromatct * Simptomatcs (asene, cxflee occipital, insomai lpotim, rae sncop). 24, CARDIOPATIA ISCHEMICA, GOATA CARDIACK ISCHEMICA Definite: clburae miccudics gators unui devez sare taxa, ‘umguin coronarian gh neceiiile mioeatdce, pods prin tod ins ‘lai coronaria, tigpatogenie ~ sterosclaczn ext caus ces msi feoventh a cardioptte iscemice > Tnguteas sau oblitresailumenul rtelorcoronare in porfines lot cpleardca; facto de rise el procesulalaterogen sunt! T LDE®, | ‘indroamele coronariene acute (SCA) - componente angina installa IMA asocat ou sopradenivelure de segment ST (infarct Q) IMA ce subdenivear de segment ST infirt non Q) ‘motes sbi corona SCTORALA STABILA (CRONIC anit _Tabioutcinic evens nai 5060 ani in special la bir {= Dureresanginoass sei etrosteral sau precordial arcter consti, aru, ent Intestate vit, sre > atzece drat: seu numa lt do 10 min a t indere __ HDG, out D2, TA ams = rp ag mrginen cob 9 mtbr pd la spasm coronarian eee 2 seme + bam goat ols corartae cones fags re tee Seem = coronas 2 mop = fomalilecongesiale 1 repose tog Clasiicarea formslr de eariopatie chemi (abel X21). abel XT “pigase excuse de epic -> eft fie sau tes emtione condi de dispar > 5-10 min. dup fcetrea eforuli sou mei pid dupt adminstarea de nitogicern. © Atte manifestirt fines alia paar, tnspiai neta Tipoini eau sncope. > ramen fle dose noma bia fcr Inderal de mast corporalé (IMC), circumfeing alii {antlasne, pete de ncotio pe degete ‘emne de artriopate pets = i. Ctoscaren formar de crdipatis checkcardiomegaie ‘fur eardace psa glopveateeule FO, det hiperteasi su diabetic, Tesi de laboretor profil lipid lcemia,bemoleucoprame complet, creating 8) BOG de repr Ie ‘geese: N (Gar mu exclude diggostcl), sa tuburti de ‘polarize permanente ain 3 In rizi:subdenivelae sau supadenivelare de seg. ST. 6) Montirsare BCG de tp Holter += even prezeaa scheme’ sua aritmilor (24-48 oe) =” prezeni denivlaior pment ST" nc eescu de SCA. b Redlografe traced, 4 sspicune de insufclentcarind sau asculsi‘crdacanormal stspciune de bald pulmonarssemaifcatva, 9) Beocardografia + penile evaluare global regional venrcuuli sng ‘videntieS ulburiile de cinedei paricala. generate de boa I Test de fort BCG ice: ubenivtict >t ne pin dou drawn, cofizontle su descendents + modifictrile und 7, tulburtle de conducere gi aritmie nu sunt 2 “pects pene econ rere sau sobdenivelici ST severe la oft redus, persisteate > 5 min. lecun avansata scheme seers se sfetucaat presen unit medic gi a cchipsmeati de 2) Test de efort n combinatic cu metode imogitice (eocerdiografia, Selulgraia de peace) 3 «paca cuted efor neconcdent. ‘Testa farmacologe de stress (ou dabutamind,dipridanal)asocot cu ‘ehnicile magitice ici incepabli sk peste efor fic Pasient cutest de efor necoacladentdsort pons tolecane ek Stor value vehi iocadin, %0 iat chau de boat corosrans 9 test de tess poctv sau neconcluden. J Tein imvrive ‘arteriografia coronarend (coroarografa): evalusci stenozle ‘vaselar produse de eteescleron,defnete opine rape traronagraiainravasculara IVUS): permite objet de agi i interorl vaselorcronaiene. cara ILANGWAINSTABILA ‘ee produ de instabitiotea lesan aterotclerticn Clasificaren gine insabile dup Braunwald (Fabel X17) : Jabelat XIV Clasiticarea Braunwald a snginet nati Sa TT eT ace aE etme = Sigh Retr ia Enre ey ce rt at, enim See eam menace fates nor iets at are feces meee See ae Sonat * repreintlo vartl de AP ce survine mises tn reps i hs cuss opti, in aceasi ont (wangina cu orar fx"), generat Ge spasmel > lines rere intent, proresiva pitaEB nets anxitate i dspoee ~ ECG: supmedrivelar eaitore marcati a supmontil ST fafa erator pacieatltolereut bine eforal; ECG normal, CORA AIA MEROMSELARA) feevent in emo nur de 0 de a drere traced asemandtoare angie! tpice san atipic, pelungits, cu ‘spun inconstat la nitoglceing + ECG - modifies nespecifice = text doef pozitiv ~ coronarorafe-coroare spect normal ostiul “clinic +ECG= teste de efor cornarografie. = = Diaguosticdferentia al AP § infarct miocedic act: durere mai intend, ma prea, ma cadens Te nitoglicennt gi se tnsofeste de regal de apecte ECG $f modifi + drei de porte tracie anterior: sindvom Tietze, nevralglimercostle, Deva seapulo-humerala sting, masaze costae, drei cumat (Gone zoster) 5 + Boll respimtois pleuritt sting, penumotorax sponta, preumni, boli pulmonare Dericrdite: feb resi, mopradenivelire segment ST + lure sbdonsone indie ta tore: coicebliar, drere pancreatic, ‘er gastroduodenal nei bernie hatala = nevrzacardint(sindrom Ds Cos). Enolutie si proguostical AP > AP cronied vba - safionas ol tip (ai) SAP instabls Sima = 1C progesiva > APintabld voli favrabls Ma, “Blemonte de prognostic nefevorail ie event, intense wpa modified ECG severe; atcteres fete dese nesoarela. 2 obietve | 1 Prevenirea gi tratarea durerit Strategic terapeutica SAP stabil =" tatameatul ebuleindvia 1 Provenrea ratarea caret 1 Combatereafotorilar ders 1. Terapia farmacologict a) Nitapt = Murglicerina: op ~s1 Say ja; plastur; ungueat ~ hterupe foarte api (1-2 in) ascsul de anging poate fepeas In interval|deS mis, oes de 2 oo cuz de 10-40 mg do23 oni2 )Betablocantle ‘smetioretz sindromul angizos {ical rsidivelor do inte! Preparaeuillzate: Metoprolol, feos, Cavell, Bisoprotal, te Feevefacadict de epuus: $5160 min, ©) Inhibitor enzimel de converse ring, tenopiidinele (l ,elopidins), inhibitor sSpian denopiinel (epioprea, seopline), inion: de 2) Agent metabolic andischeme ‘Trinectaidion.> AP insta “ itoriare ECG i cnsatics * ‘betablocanteblpeante de clei 2 ECA > uatament entagrdgmnt anticoagulant © oreetia factofior precipitant, TA, Da crops par ce 11 Lp font tel Sgn omer slr BCS Geis afire ee > Antine Prinmt py rf cant ey i > imu acs bag pT, dss Sato ange 1 Eeara scr pole "Fennel dorsal, pein 1 [spe Gs enn a a tect tice rio mane 2 fete kes + aca Individuliet, "Na ‘ angiplasie rn transluminal perewans (PTCA) j TF co geek ee ee et cane a promresivl ivelllzonlor de stenora 3 PECA se poate asia on pasts de stent ‘wstenoze: 20-30%, mai eevee fn prime 3 uni 2) bppast india ‘imptome, chem srr lec letzte ert insbordabil penta PTCA €) combitereaobeitai: IMC -<25 kgin? 4 reucerea consumull de sleol: 203091 «) educre higercolesteremel (CT < 175mg%; LDLe < 00mg; (optional CT-<155 mg/l si LDL 80 mp ‘ios Stine: Rosuvastain, Atorvastatin, Simvastatin, Flvasati, te, ‘rai: Fenoibeat, Banzaforst ‘2 normalzaea TA (TA14000mmiHg; TA<130/8Oeunlf pacieni cu DZ) 9 consol gcc: <110mg%" 7 4) mediate enagregantt fi sntiombotcs: septins, vepopiidiale (Glopdogrel,tilopdin), \WMFARCTULMDeARDIC ACUT Definite din pct de ve enwome-ptlogie neta mica seit se \dehit pin more celullor locate’ secunda uceal ‘ocala. 5 Ellnatogerie plas de atau - tare co wombs supdugels, homer | teil pli, ambele ar spasm eornaian eu tomboa secur, emboli cxoaree, Cero, colgeces,enomai engi hide! din 2007 privind defnitin universld a TM, propune 0 asifcareclinct care include Stipa de IM, especie 1. IM spontan ascit eu ischemia datoris unui eveninent coronaisa primar, cum arf erodarea gas rita, fista on dscin pis Stemecerotice, 2 IM secundar ischemic fe datos unui nevesar de oxigen cesut, fe sportlu foadevat, cum ar f spasm! coronaria, enbotsms ‘oronaran, anemic alta, per atu hipotcasane, 3. Moore subité carded iaclweid stop ean, desod esi de simptome sugesive peniraischemie, inspite de supadenivelre ‘econ de segment ST, BRS nou apiru, sau dovads existent! nu ‘womb proaspitangiografic ea a autopsi, dar deceslproducdadu, ‘fine de age preva probe sanguine, sau recolarn aceon 9 fost ut nin de part biomarker cade! in sage,4.2. IM asoiat cu interven cornarand pereutané (PCD 3 IM msocint cx trombozd inrastent documents sngiogafc smu necroptic 5. IDM asocit bypass ul aortacoronaran (CABG), ‘Tablont clinic > semne procromate or, aie, siti tate de debut + dire anginonst cu dif aspect de anglat pectoral instil = ewe nespecifc ase, anxitate, ver). Lsbuat Tnorice ort mai event matinal ~ tn repaus au fa cars ual efrt fii, ates emotional, AVC, | intervenor rurgicale pe cont + dominat de dee, tbe emodinamle, ait. > ~ Durer intent xo srvr, aoe, lncnant i afgotoace hts > 20min. > or» a, dou ze Tocaizarererotermal, epaasra ‘nia nba rar abdomen, spat, mia ini, » Examen one ~ "micas, aginte,plooe, eanpiasi, exten rei, fbr 38°C, bTA sa TA, ‘bradzadie (MA infin), thicardie+ BTA (IMA anterior) ~ examenul fii: agoros cardiac arte, ari, aul stole fxpresie a insufeeoel mitale prin aisonegic de. muschi epi: eestor priui. 7 ft - CG: 15% din cam normal but f IM poste fir » eu und Q ~»nectzd antral 3 > fr undi Q ynon-Q"—> wosrorsnetsasial Subendocadid 1 Infrceal miocard und Oi 29) = Sind acut2 23 spt dap debut 3 ~ supradenivlae convex de segment ST (lez) in derivaile | ste gi subdeivelare ta ele opase + unde Q'ecroat) spare I etava ore + unde T negative settee (scher) + Stadia subacute 23 spt 2-3 ji * sepuent ST isoeecine Tip 7 seal sivesices wit > Infarceul mivear fir unde © (IM nen-0) 28) : ~ subdenivelare marealt a segmental ST si und T negra ta record. a[Localizreainfarctlul(bazat pe trtoruleoronaran aft) = Di antaxior = Df anroseptl = IM anerletarl 1M Ino perce interior DM intron IM ste posterior IM subendocardic. 4 11 Crtertu important decd ating dub normal. ~ “restinfnfokineza (CPI) ~ izosnimn MB: {tn primele 3-4 or ‘Ming maximal fn 12-24 oe se nermalzeat hs 2-ile ~ toponins cadet san Tn prize 2-4 ore; singe maximal fa 12 Woe ge normalizoat 5-10 zl; cel ma eens masher ~ + aminouansfraele sevice (GOT=AST): tin primele #12 or; ating ‘waximal tn 1836 ore gi se nomnalianas in 3-9 riley specie reds 3 = neticodehidrogeanza (LDED: 7 dup 248 or; tinge msn! la 3 6 ile gi ce normalize tq 7-14 ile — ule in dingnostical retospeatv al boli, 3 Tite aarti ~ hipsrglicamis (150mg%), lewcoctos, 1 VSH, 1 Sbrinogea, 1 = tein Creativ, modifier se ipidlor sree” = Radiorafi rciog ~ evidenjazt miimea coulis staza pulmonar. > tlburit de cineticd paritls (hipokincie,skineie,diskineie, evra) valued fincia sistoics (FE) 4 ities a VS ‘oeci pericardice trom ceviter regurgitare mitral ischemiot complica = sentigata miocrdes cu Techni 9-pirofett + zona de neerad imagine cal") ; 98 ~scitgafa miocndes cu Thalia 201: 2001 de necoss (rmgine ec) i dferenias necro ai de oa cronies ~ anglografn radioizoopict: evelues funcia de pompt st funn segmentark veaticalarh > Somograia cu emise de pocivoni (PET) ste metoda de retest causes viebilisi mioewrdoe, )Resoanga apneic muna (RMD, 7 ‘i Aneiacaranararaia:evaloeeai pemmesiiitescoroaisoe. le posi «© Criter de diagnostic pentru IMA & Crtert volaile pentru spurile I si 2 de IMA: extra bomaskeior cardiac (referbil tropeniaa) ex el pin © title ee limita supeioara de refering a percentile! 99 aspciat care! pin tue a ‘umtosele evidenedeschemie ~ simptome de ischemic ~ Modif ischemice EKG nou sprue: de segment Sunda Tsau BRS. = spars undi @ palo + evidene imagisice do. pierdeve a visbiitiii miocantat sau ‘ulburai de cinetica parietal now apie, > Crier valaile peor pul 3 de dd: moar subitt de cased caincd (aclusiv sopul cardiac) ca simptome de ischemic miocardich nso de: upradeivelare ST nou wml, BRS nou sau tomb coronaria evident angografc sau a neeropse; ces mpdrt iain de obfiaesa sau ‘modicares biomarker exriac > Crtert valabile enor pure day b de IMA 4a Infect miccardeaspetat PCL a = ereserea biomarker cardiac corelai-PCE (pola de fa © froponig baal normals) > 3x limita superiors de refer patent 9. ‘th. nfrct mioeardtcasoctstrombose btext ~ wombozaintasteat demonstrat analografic/autopsie =, ssocint cu rezenf eer pena info miosrespontan > Criteri alae pens tpl Sd hdd ~ IM acter C40 ~ rejeren biomarkevlorcardinei coteati = CABG > $ x tinata ‘super de ern percentile 99 asocia cs nd Q san BRS »f i i i b sy ocune coroariant nativalegrftul su pirdorn vsblitii ‘local (evident mugs) nou eparute '* Critert de diagnose pentru IM veeht-preexbtent *aparia dens Q patoologck~ cu suf simptome + dovea\ imagstice ale wel zone de mocard nevi subs, cleat Y olear psec, sindrom Dreaslet, angi pectrala reid, reciivt de infet, povrtstsoqpulo humeral, nowruct 7 ezl edt de dese it sie sve, oct cage, ‘insuficienjs cardiaca gi rupturile de miocard eal io 7 Mamata "pene fa dpe de: tine ms somes Deena, spa complain, nape — -Coronaragratic, prezenfa DZ, aHTA ele, se angina petra - dat mai seu are fn tnumite ica EGG mu prea seme de ners, cozimee Sercesnt nora a mori bite + prevenies fi combeteres compicafilor majors «initia zane de necroes boi respirator: poeumotoraul aut, pocumoait j afegfunt abdominale acute uloer gastric sau duodenal pera nero acu colette acts “i U.Petioade de sare hirer 3-5 efpimin + formarea sia saves georall se amelioreei brn sea i asteni spare = TAsestabiioes = complica event pole = diseofa de aor trans NTO i my pectin cs ain peng 2 Mie pemeea ed vais = Seta aon = 7 tmp Sunmesadl Gombole (orepin oka ‘tenecteplazi, reteplazi) sh 4. rove sao: Salo ei pl pee 1 Sdn -cmpltte suum 1 Peon esatatare oso HOTA FR, Sect conten de EE mye spate he popes cist 2 That arcapeh crdinsclas (paar fr st) - iret 25 ipa aw espe capes ana ep psa real vente mae mi ps 1 ebtipordtinei cart + dureezt plats eproximatiy 3 hai line abies simptomelr * complizeie fiz! I tblow nevotioe anos deprsive, eat ie Campizeis pot presoce eu trv arte: vesicle, supravenvculre, jencionle,tulbrii de ‘entiela sing, edem pulmooar acu oe cardiogea Imeconce:raptchpestlit ventric, sept, « mage poplar, enevesm ventricular Enbolize: somber ntcardiac, emboli sitemice i punenare 00 a0+ speimarea Ramat 4 sedarea:dlzepam,pthoerapie 5. mijloace ce vzszt limitaresexpaniuni zoel de necrozk 5) niu de ing © NTO sini > atbigeane + antangregante + axigenoarnie * ees anagregant plachotre ‘© Faza I Gpltalizarea sau fara gets): dares ped Ia 3 spate’ se a scop preveireacompliailarprovocste de rpausul prelingi am ~ regermesbilizare cornarant prin metodeinverive (PTCA si by. Faza-3 etape 4) etapa 1: 14 sil, Taospe_ Ia 24 ore de a debutul SCA dict cient eate sail hemedinamic scons Tn mii active pave fe membrelor, exerci de respi; fo tu a 2-t paca se imeniaz8 sngur Tn pat iat In alle 2-3 s0 ayeaca a mangoes atl (-2ocefa ise ic oleta pat in pat, 4) etapa 2: ttre aia 5-8 9 cont tn deplasere liber fa salon ilo ole foaletd arial la bale, mes progres tnsoft pe cordon 50, 200m, 22-3 eres © etapa 3: ine lle 9-12, ate penn esa ep codor 200m de Ie, coborien sf wreseaa 1-2 eaje de Pel too, ian pres extermi se fice un test do fort Hitt de eparia orca npn Su pl a 83% ain EMT, feat Intrmediad: cu dah 12 spp, efectuts ln domi, ‘re ca stop menfinetea rnuttelor sbi ‘n lara T cons jelins de sntrcament propre: dist 30-€0min, rovenre {min pus jcur de agrement 10-30min; 3 zl. tosis permis efor et pin a 85% din eevena ais lates de efor. aay 1 Faza In (de mentinere sau de fnejncre) ae loc ambulatory su in compastinente Se recaprare acai sil de eeuperare de fra a3 labrt + Se ca scop mertneres capaci fice resizate in faea a Ws © trees abatia + darenzt tat via ~ uilizenat metodoogis fei H+ joc! eereative 18fect porcadiea/ versa peveardie enna de ufcien canine cog 4. Nodal subenienay’ spar la = 9% in poe = dimensiuni reuse, nedureroy adore 25, REUMATISMUL ARTICULAR ACUT efitie “afectnne infamatorie sult resepraiv osu conunctiv “onscigt tiv ffs faringene cu streptocoe beta hemolite de {esl clue rabeutant [seo nevos eet Epldemialogie-superpanbilt cu a fring sreptococice 1, ict economic sau de medi 2. factor bacteologse 3. fitoal gr ‘ablowl cline = varia Debutel RAA ls 1-5 sipiindai (ln medic 19 zle) de Ia o infec ssrepncacc fragt. ‘Manifest linle spediee 1. polareita 2) cardia oumatismals 3 oul beta 4 etl margnat 5 soreea minor Fs : ace a 75% dn posit poliacits acut mieratorie = Mtaeprodominacts siculilor mari i oczionl color mich cel pin dou areal tzu sunt umefinte xtemstoase,clde, dreroase gow ‘mascet impotcol funcional. 2. Candita revmatiomald pare a 45-50% in paso Tadametcingparent clini ~»mlocard sever = agnosia de crit reumatilt: “paris /modifcerea un suf cardiac organic _rotre dimensunlor eordulul (rdlogi sau copra) 104 ors ~ localizae: pe supa esate proeminente; pe tendosnele ‘eu loelizate a nivel cvtensorlor dee mii pete oe uli : 5 — == semnifcte: ari reumatsmalasovers sas medi, 2 card 4 Ertan margin 2 fegumenttor ~apare la 10% din pacer = erupietanzterie = lecallzae: in ona proximal extomithir, rash ete neprriinos, migator pote fi accentuate evident pia Splice cal ocale enifcatie cardiareumatiomla, Coreen minor (eoreca Sydenham) ~ pare a 15% da pacin, redominant afer = perond delta: ctova luni de a infefaseoptocecies = dfectueasstutl nervos een = bloal tnie ee instaleae rept: nial apare nervozitate, dlifculate da efecta mune mamuae, mes geo, pied; poi ‘ijeil spesmodic,inolunare,necordonat, bane ale tembroor, devin daosbit de volent,hipotonis muscular ‘tliat Sevindoes fir ocho fo 1-3 ta. Explored parecinice ‘Teil de aboraior = reactnfide fir acuta eescufi: VSH, prose Creativ, finogen plat, ELFO, complement sei, complex ime, Dbenegrans izolara sreptococuli hemi de grup A dia cultwafcingiens exer ateopilorantsreptococic: ASLO 9) Bleracangrane ‘albu de concer Bloc sroventrcular de grads I(T interval PR) ~ tufbure de itm odie ale fez! trminale 105©) Beocardiografia = pancarareumatimas Examen radiologic ~ start polmone = odie le sues cariace modes pulmonae(infitati parnchinatoas, pleat. Diagnostic positin- po bara etlor Janes reds fa abel AY. ertince z Teer Ge fa ai: poi =F otra FR pe ECO 2 2 ster majore © su | eriteiu major 2 minore 1 +evidenteren obligatrie Infect streptococice: cultura fringian:steptoos bet-bemliti de grup A + titu antic sntistepococe nostic di Bolt eo manifest artculace = boli infections ~ boli imunolosie eu marist atieas = boli decolagen ~ = endocadita infections ct gi subacute = ocr i preaite = valvulopai congeniale = valvloptironie eumatimale 4 = prolapul de valva iva 106 Enolutic,wrognostic = vindocare a 6-12 sitar = 65% din exzuri Boal persist peste 6 luni, ani coma ‘reumeiamala cried = tblon eine nsec cardack ‘sonic prognosis ezervat ~ recurenee reumalamale oni event npr a Datament © Obiective majore [. eradiarea infect steptocsbice 2. ameliorarea manifeetiorinfanor 3. tstsmentl complicailor 1. Terapia anibiotedantistreptocociet ~ Peoiclnaantiboticl delacfe = + Peniilinn eistalind 12-16 mL Ue i,t 69 ox 10 aie san ‘Beszatin-penicli G12 mil Ulin ova unica ~ Eritromicint 1 g/t 10 ale paca efarie!f penkin > pol paciantul int tn programa de profiate a recurenelor ‘reumamale 2. Terapia aniafiarmatoare 2 Aina dul: 68 efi (LOOmphk com, adiainsirate aor, Posprindial ~ mclocrea simptometor +4 fbi -> | doe la 29 din doza de ‘tse pnt Ia normalizrea dtelor de laborer ~>+ doe i 2 din or de ate, 8 sprit, 1 Concours = picini cu cardi sever, inate candieetcongetiva ~ Frodnison: 1,5 mghkgcomial > | VSH 4 wept x doze peo Peviond de 2 siptimdn (Smg a 3-4 ile), aod so ere ses 2 spt: + asprin, crew continul 23 sip pd nneruperen covtcoeapiel penn prevenzea rebound 3.Tratamental eompicailor taameatlinufcieneleardinc:repeus la pet + diuretics ‘riamentul core: epaasl total ig pais + sedare Proflaxia primar a RAA P > Vireztjrovenires span RAA > Const n depstarea $i waar coret a frngtei suaptocoice 107Scheme de profilasie 1 Beneatinspensiind G, ds wie, im.>27 kg: 1,2 miioaze U 2 Benin V oral, 10; edu: SOOmg Ia & ore 5: Exton (lee ls pein), orl 10 ile 250 mg a 6 oe, maxim Ia [Asiromicin’SOOmg in prima 2 spo 250m umnttoatle 4 ie Profilin secundani.a RA >" revere renter I ob ce. aaa un prim ue de A durta fe func de ora de eur ide vse patient, k ‘Scheme de proflaxie : 1 Beszatin-pnilling G lunar 1,2 wilioane U, i. (Gea mai fost bligstorie in cardia roumatsnalt) : 2. PeiciogV, oral 2S0me/2\ E 4, Sufcieaing, oral Ifa acu, — f 4. Eivomicinl, or! 2250mgia li Durata profacel secundar - In fncje de vir gi de forma de but a AAA (Taba X72. _ Fabel 211 Dorats proflaieyecandaria RAA Fea osc TORTS Wan de cal opdel pa la @ rena sl orn a) 2.6. VALVULOPATHLE Definite: afi ce a ca substat ulbarareafunctide supap8 x uns ‘i mai multo valve cardiac, fet seasul eaczeor fe al rgurgirlor (asuiienlon. 2.63. STENOZA MITRALA 3 x obersia flat distole tsmsmital lois anor proces paologive ear redue aia orci valvalar mitral 3 ~ "ra oficial mia ‘poral 6 em" ‘enora mal <2 om? 108 m ~ valvlita eumtismalt (interval de latent 10-20 de ai) = congenital (rr) = funcional fa enixomul atl sag. “ 0,125 ta derivaile DIS! Vs devia axa reaps sarne de hiperroie venti deep a ‘senozs arta = bombara arcu mili stag in parte infvioar,dubls contr pe ‘margacadreapi gi esotag barat doplsatpostror —> AS mit ~ bombarea arch moc sting in parte speroar3 (lates ‘rere pulmonar) fa cela inferior rept (mtrea ini eps) HIP 6e tp venos seu atrial. 1090) Beacardiograie ~ remanires valve mitral, = dimeasiunea AS, VS gi VD ~ prezcoa au abstaja tomoz’ striae denon mitral (plaimatee) = Skamenl Doppler ‘radiotl maxim si medio trnsvalular sia stenoze ITT, presiune sistent anor pulmonar, 4) Catetri crdiae = gradient presional diastolic date AS si VS = ia ovata nite = presumes in aera pulmonar = rezistenfs pulmonars 5 India el peje dures precordial de ip enginoe ozs ital soca nel enun orice, vrs > 40 an = discodsn ne dateleclinie cole oft de expr. clini + pact, Diagnostic diferential tnlxonl aa ting tonoss Wewpidiond eter septal arial ‘suflul Aust Flot dia refines aorich hipertensivne pulmonars primar au consecutiv efector seipratortcromce part sbvalvalar _Bvolute:promsie In goneal lent peo priosdtde 10-20 ani, ptoud 1m eae uni bolnsyi pot rime pact aslnpomad, a ait pot ava ‘vale ap, eatit ‘= rita ail (beta ails) demu pulmonar cut inmufcons ceded congestivs = hemoptzia wombors AS no ~ tembomnboi siti ener et splen, ie membrelor 7 onesie aoa ~ moana pinoner epee een = secant = cums diuretics : F< ~ digoxin seubetablocine sau blocant de calif biti tala = aiccopulantoniagrepaneplachetre = ,alaimice su oe elec pena estas ritmulu inset <2. Valvulopasia percutand eu batons J} 4-Proftais endocaritelinteetiose, tn soto ue pn! dn volamal sanguin 8 AS detract inept emo abe ose eae corse ugh papa). oom fe seth cra, = ncn eet ee | = mpm de corte rel ed al, edocrd in © infarct miocardic). bn a aaa~ cron higewofes oben = "Srsopail congelne = olageozete Tabloullinie = siploallogi boli de bck Sipe ip ndtngst ‘el ion ape ef, ape, dpe proxsich — 7 Ruut piel stele pos sa ~ abi cran ck ste earn, aii, sini de uit ed, etd powder char expla ~ lp (ae ara. 5 Examen obiectio or oexin deplete taj? ‘iil apex 1 Seamatalie ‘asa Set din ot preset ‘Mu foloiae spor cu nha xi (om median pe. Sonn, Exploit paraclnice DECC. itn sins fii tai = dora! ns HAS, HVS = remne de ners nines ichamie 1 Radon tora sr eget cu cord nana + em plone eat = Innere mal rice pine porn AS, VS » Songenievenart © Booed chimes AS, VS = ae pivind olga Gagropare velco, leit ineaa titel diltres fea, vgesp vallar,rptra Se ears ‘lpr wai pots) — spevces contaci’ prelor VS gia FE = Kamen! Dppier = tants reargisre inal m2. 9 Su raiztopce = Fancia VS. ©) Coteterism eatin: = presiunes AS, artes pulmonar i VD crest = froin de ject vetrcului ting 1 aeveriiatenregrgitii 4 grade = volumol regurgitant = insta wicuspidiand = stenges sorted = ‘cxidiomiopatshiperones __ = defectprt de sept ventricle b= Complicatit ‘iperteosune pulmonar, insulin cardiac deep = inguin cardiac globalt = fii aa = omboza sal stings, rombembolism sistenic = endocardit infsioasa ‘pacieofasimplomatici: roilaxiaendocarditelinfefioase + Aispensaricare * vasdiatstoare areal iakbitori cnzimei de convesi, ‘lslezion sq alf-Blocantadreergis) = extant ineficienti erase ‘elemental lai eal 2.Tratament chirurgical: "tod valvaloplarta mrad sa protearea valvular malt 4 Profiatia endocaritlinfetioase 32.63. STENOZA AORTICA et int wo at pis venti ing scl ce | me Boon - = Sova = sone ns 253 cn Etiologie - eg = ee > Ett tile Set at > Time scape Steplcar oe ean ste Fra gut a" een 2 Rares ema sie Rr eh, rg eta fc ‘Shc nda va ota ECG: oral in sail nite = HVS de tp bara) eu unde Tnepativ ip — ulburiideconducere (BRS, BAV) 8) Radlograietoracie: YS dimensuni normale sau mast (ae inferior sting alungt rotunj) = cabeifiare insu sort valvele aortioe = distaye postitenotit a ore ascendente = cicuajie pulmonar de tp venos na 0) Beceardogrofis Snore i caleiicarea vavelo,malformai congenial ale valve escbderea valvutart Iperf pereflor ventricular ‘latacasortelagcendente fica venviulae ‘xamenul Doppler aprecierea sever vatvulce (rant tranvaalar maxim § medi aia valvular) 4) Cateterts carci ‘sprecirenseveriti insufieja mi | ‘xrdomiopitia hiperofies obstructive insufcens tricuspid efectl sptl venscuar sou sitlie fama, omplicatit moarea sist ‘ngin pstorals sinops hipertensianenpulmonsrs ‘nsufcona sardines bliss tromboza aril ting ‘rombembolisml sitemic ndocardit infectioash reuretareunatisral |. Tralament medicamentos se areseazScomplicsilor: agin, Sbrilie eal, insult ude “ usary Sey is3 Palpare:goc sperian amp, a 2 Ascultafie: sua diastole !vuloplastia sortie percutand eu balonas: — copit tine eu SAO congenital necalcifeta 3. Tratament chirurpeal: -— “ndiat a paces simptomatct mete: comisurotmie sores, protezare valvular artis. 4 Profilaxiaendocardtelinfetiase 264, INSUFICIENTA AORTICA (Regugitre sori) Se mai bine mpi g ‘Explore parnclinice ECG: ~ hiperwsieventsiulars stings © amplitude mare, indice Sokol fas trina hipersofiaacestia est a stngs gta jos sot eu ieadiere pe marpnes nga Sterul,tp focaral Eb, cu euacter dulce aspraty, se ica torscele epost ip diastolic: comploxe QRS oa ‘Tyon> 38mm, discrete moi Pac ret lane ening aor oben = Gniet <= Slur aati talaga lie soc relat Tbe Beer a waa sire ‘vizualizeaza valvele gi aorta ascandent dinenstnes VS (OTS-VS> sop ceca) = iam i votuml ventcaar fifi sito wesc examen! Dopplr apresian eae 2 Catron care: eat abr > 40 alga der angio Diagnostic posto cle + peace Diagnostic diferential ~ isles pulmonar = stnem wiowpidins len bine tolerat = sinptomatoogie: petrstenfe de canal aerial ee st = rapira de snes Vale > amen Enola, complica . ‘vole: - bie toleat o lng ~ spariasmpiomatlogit + sem de alam, 2 Examen objectio Pals: ecler eats ‘TA: dfseojala mpl, divergent, |S Complicpi:~ talus de nit seed teen ree 6 aw ng eit puri aortice in 4” fn posimenopaucl saan cae de de tim. ara, sues cates27, ENDOCARDITA INFECTIOASA en Definite: sfecime infections sever cu specs etiologic gi clini fan larg, cae tn absent unui dagoosieposocs gia ure! terapi nls ramos seve pone ie deve Gree epee eal lull valve ‘© Clasifcare tradiionals ~ El wcll = ELsubcut ‘© Clsflearea EX dups lcalizarea infetici yi dupa prezenfa/abseala eral stn intracardiac gl pe val ana Sxag pe pte vals EP): “TERY pcos 1a dee nan valet EDV trav > fan despa yalv = Hisinimi pte 7 EL” soci” dipotivelor incadice (pacemaker: “tbat tinnatovene asic cae nee tratanet anticoagulant acini ou ister! renal conch “Avni: bemoan apo deca normal, a atcoagulr ‘Desavantaje: degenerscens (dust shtie 67 an). Inco 1. lei preeistene ale exdocardit dete 2 agen ine : 13. fcor ders: manevrle care permit interes agnplornfefog * continica 1, Lennie preexistente ale endocardulut rscinlt: = protee valvlarecodiae Digfunetide protera = malformai carise congenital ianogene 1 Disfineti bemodinai i = antecedents de EI . {unm sitenieplnoasre chu > risc moderat: - valvulopatii dobindite . polps de vale i cu epugtae su gropare ‘severd a valvelor a = bol congenial uae neiaugene ex excee DSA tp ont eed csv asia sere + etiomiopatinhipetofed us2 Agentiinfetoxh I Septocec (van, eterocoe) 1 Stalococi aureus, epidenmiis) Bacil gram negate *_Fungl (candida, aspects). ‘3 Factor deri” manevrle ear permit ptrunderea agnor inte: = “bronhoscope (eu bronhostop rigid) = ehetoseopie feats preven ine wrinare—— biopsied tact ura! posta ~ pte maps ees fungal sa moms ~ topsletomie, adenvidectomie = istareerofaglandicoorrep > exploraren instrumental a retrilrbiliae obstasie eosin wansretral de prosatt * meneveinsirumentae urealoélaire 1 Hotipsiaexracorprala 5 procera ster sineologe in prez infil + bemoultr pesitve mnt cotinate (nodal Osler, lesan Janewey) ex ofaimice (pete Rot) + Sai mite ae erp inim drepte) + abeese peers (eae, pene de eoloand vertebra) interven diagnostic sau traputice, ecete nuzatour.do brcteriemie important. | Suspicion clnicd este setent tn exz de febra, dr fra ate ‘manifest Explor paractinice © @) Probe biolopce: «Teed nora nexpecife (ini, esos, sembociopni trombofie, Vsti poems C. nce semi iets boc, Smarr) 2. emociresnt sane pens apie! wtament Ee Sind ponte ta 90-95% dn coe 5. Metisie sesopce co idenifiae « agclor cxuzah ait ‘comantin no spend Hommel ent eee ‘Tablont cline =) me blo 1 Air bral - dminat de semne infections fn El act, = mae t inside co complica sistemice in E subecrs. Duce lsice qt puaciice oe sugereea 0. stpllune clini freseutd de EL 9 roprern inicae de wrgenis peat scecung ‘Socudiogeic Gnvertonte_ ce tebuie efecuntlimediet cos ‘pote igor sunt erect de Tenn valvlae noi ula de egueptare pow spt) renale = Fieerbrate) = frp de etotogio noprecizath hematuria, glomensoneti su supicine de niet renal Seba plas existen nel protezecadiae ate precispozii sist entra EL 1 rit vetsculte saa flburr de conducere zou pte prime menfetare de nro erdiacs m0 = examen eocardiogrei (ranstori & trnssotsgan. ‘ret modfici ecocadiogafie sunt comsdarete af exter majne de dagnosic al ene, obi ap a, nod pe pte 2, demons existe uses ole Scien wuts yes vine speci ed vin spate + emocltir patie penta Et video feet eadcearic -ecoerdiografe pontvs pens Elcondi predipozdnt cardiace stu sur de drogrtintravenos indrom feb enomene vascua fenomeneimnologice hemocaltur pocitive, dar aa eter major. Conform eniteciloy Duke Ye pone afirma cE cert (fn) clad ree? 2 eter more, sma % Totteru msjor*3 minor, say a % Sextet minore aL 2 EY pote decojon vate comico, at arias ct. i extaeardine, ml dnt sestea find mal doprab expresa manifestly ‘mulisitemice ale bol dat complica — ‘Cardiace 4 = insuficient carding 2 reidveale sr Z abcese repr mioerdice = ulburi de condocere = jntctmiocarie = mioeardt, price Exeraearalace = emboli i rmetastze septic | tubule SNC, museulare gi cuanate tuber rete | enomene imunoogie. Tea Diagnostica recat hinugealt au o important tieace, TL Terspie ntibotict 1, Tratament chiseled IL Tratamenalcompliatir Profaxia endocarttnfocoane ats ceric mae pi tenia ‘minevrelorsingerinde care permit prunderenegenor infection } om ~ simurilesntbitice profilacicesut fn fncie de til intervee upotential de bacteiemic tale de sdministrare: =" eal (6 Lor tnsnteaprocedri) *pareneata (eu 12 oF nantes proceduri, 2.8. CARDIOMIOPATIILE ‘fectunl sle miocenduli asoiate cwalteratcn prformani caine, s lasificares fictional ‘A. cardicmopatia ilatatva Bi cariomopatahiperuick Ceniomiopaia reetitva . oe .cxtdiomlopati aritmogens a venteululu ope 1 cadioniopati neclsfieabile 281. CARDIOMIOPATIA DILATATIVA ‘Defiise:dtare ventricular, cu grosime paretals normals sau seta, ‘Socith cu altsrarea prformanfe! mlosadieesstoliceo ventical sng, ‘vestrcuul dee sa ambilorventricul reduces debit eae, < Htionatogenie ~ idepatiot = fame = cazdiopateechemiot CMD hiperegopatic (valylopati,bipetensane artist) = biarien = toxce (tan), chimioterapce oes) matboice (arene nutfonale, slbure endocrine) ~ infect (vine, bactsiene, gies rcktiene, paella ete) = bolisisemice = disfneti peripartom ~ diswofi newomesculare. 4 Definite: boalt iocsrtica primsrt de cauek necunosels, carcerieth inte venta ang So biventiard inte 8 usabut insdis > simptome de debit cardi setast fen ventricular eu bur det i ‘> Esamenlobietio ae cardimegaie predominating coe epeian slab 2 pals pene mie 2 hide sna, art aril son ventselare 2 alo venir 2 Sin de epugtare Sernne de saz pullnooar semi. Explor pavactinice 2) ECG: - HVS, BRS, Qpatoogic, ritnit 1) Examen radioogi: suet cardia mats sca pulmonura + BPA 6) Beocardiografe =| iemetaor cavity, albu de cinch Davie, | FE, cuatfcarearegurpilar, rmbt intoeaiar 2) Ventrcuogrofia oop» lsae ventscaar i selderee ‘conuaciiti 1 Samigrefia de periaie miacardict: - Seguosticditrenial cu CMB {ashame Coronarografa: -exchde batt cornarantsemaificalvs {2 Diop endomiocardcd ‘ enibolisitemice sa pulmonsre, rtm, oss subith ‘Testament 1: Misa genes Ameen ctv ii ep apt peroada de Secompensare = ditt posed _sprimaren loool Samatui 12. Teraple medteamentoass = Gareice ma = vaodiatatoare ECA = digitata = betablocante ~ anicongulante ore 3. Tratament clrurgles! OS piste valor © tenspant cardiac vas 30-55 anh ~ cons crnic substantia de alcool (100 mil24 or) mai malt de 10 anh debut ~insidins —ftigaiitate —brust asin vetiularl stings eu, recvent debut ete prin fle arial. “ suprmatee compet moda consumul cook = ‘atameatlinsofcenei cardiac i tir. elev, de stooge pate sinensis ‘Tabla clinic = snp, beige yi alia + nen cardia Pergiane ~ nro ei in ae dino vi ae ronal, ns, lp snp ~ ‘ion denna ceric en | — nico oniangene nocaioe 1 - marker serologici f= = ei codomioewaet examen htloi. — diac antinfanatore neste = teen suse carcos (ie, IECA, tice) = epi poses inet = cortotmape seat slots = easplet cardi. us4. Hlestrostimulare cardiac bicameral ip DDD 5 Ablafie septal prin embolizareslcoles aerl septal (6 Proflaxa endocardte infections ie COI obstructs, 2.83. CARDIOMIOPATIA RESTRICTIVA (CMR) Definti: boalk 2 miocarduli avind drept camctrsties dimiauase complanei venrcuare, a funefel dasoice, ou prezeevarea Za hipersoieveniiculaa marett mai ales a cota ‘Componente fziepatologice in CMH: TE obstucia tatu de eject al vntricublu sting 2. disfincfia diastolic veotseull sting 3. ischemia miocardict ilosatogside ee Sinners wou neeiloe : orem toto doit a dopa ffs ancionale 7 = snark Mani fencon ~via (moos trodes) ioc ~ rezauismozs(onoromsleh, cogent) © Grr nginosst Sey ablowt clinic te semae:- palpi, mone sbi, sere de IC. ges de fot de eps saplome de debit carn set Pome exiopomation 2 Evamenlobicto sz vetest plo 9 ssteeh Examen obiectio Faipare:goe speranputernic, eplse tral a 13-5; regurgtare mia, distincic dastles 1d) Seintgrafia de prfie: deface a parzie de tip iechemis in absent Texioiorcoronariene 4) Casterisrul cardiac: penta excluderea boli coronsrene. Teatament 1. Bvilarenefortalu fale 2. Tratament medleament 2 etablocante 6i : £ | L ‘Tratamentul - actor: 1 Medieamentors Amiodirons [3 Chirargical:vansplant aria. 2.9, PERICARDITELE, Definite lise peicedullproduse prni-n proces inftamator de Clasificare 1 Cera evotaty 1 Percardita scat - vindscare fn 68 epi 2. Perieardita ernie - evoluie> 6 tn ase rezol iciodat {Uni cutrtdosr pereardiasubacutl, core are 0 dural bre blunt MCrtoriatetitogic Talopaes Vatu coxseckieB, eco, adeno, wononucleozs, SIDA et * Bact: poeumocoe ailocne, steptocoe, meningocoe, ee, 2 Tubercle [Agent extern ii chimle: ain, raumatsne toric, ec. 2 Bo tuloimune "sau prin hipereasbilaare (3 Infarct mosaic: precoce inom Dresler ‘Minedem (ipotoids) Uremio (+ hemodializa) idrotorex(ipoalbumineme, nsf cardiac. Mh. Criteria morfologie i Percudite Svoase 2 Perea exudative Gichidiens) 5, Peis consuictve = cali 4 Pecan ronics fs consti. 1 Prinele dowd sunt act, ultimele ronice sau subacute. us 294. PERICARDITELE ACUTE © pefinitie sindcom produs de inflamata pericardull prin varite cae, eactriat prin duter foncice, fect pericardics, trevent rviest piace mfca elecrocardiogafice a sri caracteratie, Fb coh cat Mbrinasi) = debut insdios cu palpitep jena precordial insogt de feb, reo debut apie (Ge brutal, fc inapares) > durererelrostemal ~»iredire tn umeri il bazagituli gi cu aezetsare in inspir gla modifcareapociici,uneoi tse iritativs, suai, dispnee |= exameaulobiectiv: ectarapercendied — patonomonis, iL. Povicardtaaculchidandlexudatval PSI wosat cele uscate areri avind un debut bra, cu acumulare rapids SEE delchia durere send i intensitat, dar dispaeen se acentuaz progresiy, in anetie de cantitstea de lich ide viteza de acumulare abies gi fincjional -semne de compresiune pe: = sof disagie = nervrecurent sting ~ disfonie = ‘bronsii— ruse spastic > nervi simpaticicervcali—> midiiet sfogt. BExamenul obiectio ‘nspectie: Bmbarea regiuni presordiale palpar: diminuares jocalui apexian pnt la anuare = percufie"mirree mati eardisce + asculiae: oidereaintenstii zgomotelorcardiace Ia ‘apex, eventual frecitud in zona superioargieritait + consteinge temodinamice: TA, puls paradoxal, raluri de stazi,semuele de stzi sistem, sindrom feb i sernele boli de baz ~ supeadenivolare cocav,concrdans segment’ STi toate au rajoriates drvailor m9- mur onarrt ete rnin = microvoltajul complexelor QRS 3 olf: 2 Se eee Ss Sire eee re = itm snus ebicardc neo bite atrial say Nite rl 1) Examen ecocardografe canis de eka et (< 300m) > moderaté(300-500m!) = mare (500-1500m) ©) Examen roo: . = "noma act vom! de cid < 200m ries umbrei cardiac, siete n “cara = + pleurese stag lei’ pulmonar (TBC, neoplasm). 1 Panctapetcardis =" confir prezen hid perc = permite recotres de ihid post soit de biopiepxcari. Teod crepes in xz d tamponade’, ©) Tomogrfia computerizat ronan magretomiceard ~"Iscazuile eu diagostie ie. 2 Coteterismal cardiac cardoanpagrafi cu substan de contrat = inion numal near pile. 2) Exanene de latortor: = "pent diagostical etologs. Diagnostic posite dss clinic * modiictle BCG, radiologic ecocrdoyaice. 1 Pants fecare car th pte ese cer se stableased a grate port dar cel etloge crea penta atm Diagnostic siferential infart mocaie, disci de sort plearezie cu seu fr poeumonie, ‘eumotorx, pemomediastn lecsti, pancreas eval intercosa. eo lag.vol ete a. 10 compli oT amponaia pinta ‘sprint toidiene (prednison) ‘epinde de diagnostic, detrarmeniapiat etiologic = recurent pecicnriel seat: 20-30% dn ecu revit pesardc ernie conse percardie, ‘epi igieno-latete spas a pat ‘Tratament medlcamentes:aninftrstri nestroidiene (orate, 29.2. PERICARDITELE CRONICE, pescadit cx evoujie eros, to ear clomeatul dominant este Tino postinamatorc a perieardol, ov su fr elec ce datrains = Sredcere expansion diestolice a unpier venture, volta spre percadt cronil conitivs este ia fecvett fn azul ‘umnitoeelorpercaite acute tabercloast, purulent, neoplaie,e _Tabloul clinic Senne funclonale “ispuce moderth tse. 2 Menifestr de tcl venous periferct "Ypsendociroce™ ~ ugeseensjuplars = hepstomegalie moue spo fermi/splenomegaic = cits 1 Cirozshepaied decomponsatd vascular ave acsleastsemne, dar fers ‘rgescend jugular 114. Some cardiace pale: oe spexian sib fic = scutes asus agometelor, dedublreszgomotu I 4: Selderentensiunil arterial cu diferent mich “ ovoliis et lent progreriv, ca accentares lementalr de stash. ‘Testament chug! 3 Pais poral constant pene pra mull, nsec etindare pe vel & Some generate daar idrareseuraponderl earectoni paral ss Wd aloe nerectnice 2. medi Benen aon - et ipsoda 7” ach coal not ci, spct iil eae Sonat - = = iti cade) = Sian price 1 consis wsce 4 se pin contac ovina prcesic =p bit ee cx emia Ven ai (Mite inh ve =" seiptens heeled fell elie 50% din x = Racor} = devia axa dea = ST ecbdenveiat au normal, wad Tapio en negative ©) Beocardiografe (4 2, Doppler): =" ingropse gi imobilzarea peicardul uneot Heid = aplatizars migtsi diastolic pereteui posterior al VS; AS, AD dinate = igre pardoxalt a septllintevencalae 1) Cateterisn cana drep: ingot de catia. Diagnostic poxitio itric de pericarits acu + digpee aso ox sere de IC At ‘ariomegall stat pulmoaara sau sere de ice hepaties cx trgesceag jugular. CConfmsren diggostulu este adusa de cxameace sadiolgice, ecocatdograte ide snetersml card. boli cardiac fit hipodastoli: SM, mlxom arial rept afesiunicardiace cu hipodiastie prin reducerea compliant ardiace’ erdomiopnt esitive ~ bolt ndocardice: endocardiomiofibnezs fui’ exraardiace: crn hepatic decompenssth snail Budd-Chi, stele epatomegalile de rie nat, ~ skid pericrdid neconsrctiv cu aderete de rgance vecine (oedasio, lear), 2:10, INSUFICIENTA CARDIACA ac) Definite “elas: sndrom cine (au stare patologcs) datoratincspacii nimi ‘Sraasigua dbl cieulstornoeese seit metaboice Sar st ‘over scope nevotlr de Oy ale esumr. ¥ detsie ‘sndrom clinie earaceret prin semne de stat (pulmonar sau sistomid) i debit eardae okt ara n ele ma ‘ols cazur In evoluja unl bol eardiace. Diatunein cardiact vs sitolads FEVS <45-50% © Glasto: series utorndie de unplzea VS. Clasficareesiterminologia utiliza tn insufiientacardiact 1. Dip debut evolu IC ocd el pulmonar out (EPA) qi ooulcerdiogen ‘biCeronias 2. Jn aport cu eaitaten predominant insufitent: "2 1C tingd-» congetepuonars: dispoee, ise capac 12 12. Warsts~revent inte $5.5 sexu > Bxamenul fizie seme georale: tonne, puloare evental canoe tanspei, tn bs dreaptd — congetiesistemic:cinocd, hepa de efoto = Iepatomegalie duress, turgecentd jugular, deme, ligase ‘ior ast revttsedeme, sublter Sa eee © IC globald IC sting +1 despa = semnul Haze: puisaié vil ubnitoian 3. Dap neti predominant afecttls ‘ariomegalie cu depasrea foul spexin spre stings jos 3: IC itll produ de dafinctissistlick VS 1. C dasoied * indsa prin dsineie cscs document pin ‘cografis Doppler sau ventculogratie izotopss ot FEVS socal HTC refactad tau ieductila = imposiblliateeTeawce Simptomatlogiet sb ratoent ° Etiolagies ato solic implica i paris IC sunt 1. Cariiopatia de fond: ~" eardiopatie schemes ITA gasocieres for valvlppatilereumasinale generative x (CMD neiehemice boi cardiovasularecongeitate ‘ubiartmi supeaventculre cu dort prelungit (Rive stil Eater aia = tbicardie = zgomotul It (gop vetiule sou potoiasaic) sulla sso de insysiiet ital (hctional, = senne de congestie pulmonar li tronho-aveotare {Geberepitnt) Te Bas laminas seme de congeste ssi + distensia jugularlorexteme + hepatomezalie splenomegatic ‘deme ale merbreorinfroare + revirsat pleural, percudle, peritoneal — forme avansate de IC nase deme masive fn repunes genital + seer» pete sheorinal + evar pleural asi or ini 8) Radiografa tract postero-anterioard ~ catiomogaies ICT> 0,3 5 _ seme de iperteasune venosepulinonart ~ stars £00: ~ complex QRS > 120 ms sugeena pezenfa une ausineroni?™eardiace modi nts eis 1C determinate RTA = irate —1¢ generat de erdopain itchemics fami > bitbap dupa 75a, "Tat pa ede lps - prota tact orga pear at - iat ermine de eee pti is ip 2 et ~ Githctia = Belcec tra, ©) B00 Doppler onsoract: 7 simmsines xvii, volunel, gross perfor Gia parts, FEVS © 45-50% = distinct casos, mest de laboratore "emograma (Hts! #4): anemia > poate induce sau arava IC + plileblie- seeusént waar boi plore iturin eligi to mpl ile go crestere duces eu michiant repeiate In curl nop (cur) indus de modfele de pefure renal ~ durerteabdominale localize in hipacondral dept i epigastr; produse de hepatomegali mat ales cfd aceasta einstaleacd ruse (FAcu AV apda, emboli pulmonnd = IC deep acts). 1 1i ~ concentra plastid de pet nairetc (BNF; NT-proBNP) - uss in diagnsueal Ic ele | su a pcieat ttt —~ pn probabil IC = oie plaice de BNP pogease = cretinin geri: eetere modes 132 04% ~ 5 poate nomalaa (Cass D: VOsnu < 10 mili {Chast E: Vien < 6 milling Incadvareapacienlor in func de distantaparcursd ta test de mers fb trataren carat 3 = valores fire epatice -varsriaze bums libs iS tip de poronbint 5 ‘SNiprsieren prada ler eptc n1C 2 aS ere ee “© ICest un siadrom clinic tn care pacieni au urmitorele carats = ionogram series ~ simptome ipice de IC (spe de rspaus sa fet, ftgablats, = ee : obese; net tir ~ Sere pie de 1 (ublcarde tcipacs, ral pulmonare,ceviat eg ces towns — Pere ea teat een een a 1 en aessco cee +tcodewes” af = pe ite ind Sn ise 2 cept penchreciccanemne Sint ecto Speen = Dita jenteranss Pe gsr mpen ono chin eases i Taba! esc ee ae ee ee eee cae eee eens ane eect ard Se ene en Be SeaTac bcos pent aioe! ee ee a Sttenaiciae fone ‘etricloraia orp = probe vention = proba de eft enum maxim de oxigen 5 stem miearas Incadrareapaclelor te clascle NYHA -Tabelal XVI ca Te iT [ bgmecs var ecexoese TH [Dapee tra sbr Tit | Dares ra Evolufie ‘4 Jncadrarea pacenfior in fine de consumal maxim de oxigen VOvwis Yi \- ~ progresiva, pute evoln spre deces, moraitte nS ani ind de 50% (clasifiarea Weder) = ites volte épinde de: acto caval, moment diagnostclu gi ‘Chase A? VOsns > 20 ints q trtamenna pion (Chase B: VOnen = 1620 ml/kg VO pms = 10-15 mnie+ luetice: + doanss Fursemid) + tnitie Net) = nama de poesia eneldostronie-Spitonolstons. 4. Betablocantole sabia eu ECA, dartcele digital ~ determina remodel VS (lop IM, Cl ile cariopati) ‘amelonre subi lnc eer éshinin, - 1Cou FA rape nocetolet c digital «Carvedilol, Bisoraol, Metopretelsucinnt, Retlvotol ‘Terapia digitalics . + detemini amelionrea simptomelor i reduces sptaticti “indicap IC ea FA jit situa a ox ev 1C persistent sub tatament cu IECA gi diese © -Digoxin, Distorina Comptia ~ lichemie cerebral coronarians/ renal womnboze cu nesrozt ~ twomboce ntmcvitare sau venosse —» emboli sistemic ~ 5 nls “FAP mai 20 mig op nls nil CF pot react (era) 2 Greener 21, CORDUL PULMONAR ACUT (Pa) Etopatgene Shes is enola pulmonar (SP) ee obtcact > 50% dap rst pisonr poe ern el = PAP ‘embol = om moblizat din Venele profunde ale membrelrinferiare “pid venel Bazin sa inimn dept, ‘:BOUA PULONARA (EP) ‘Definite; open situate patologc8 reall pein migrarea asst fcaril pulmonar uns embol, cel tai adesea sanguin, responsbil de ‘bltrarebrsel, ttl su partial aces terior, Etiopatogenic 1 limbol 1 1 proapeintadeoune (20%) provia dino trombook venous profiad ‘rembrelriferioe, ml bez, nai ar din yeaa ev inferior 2. Contertal nperteh 2 Gmabieae prelungt ou sta venous uo Factor de rise internti ciruricale abdominal, povin,prosttce Intervent ortopedie, fact, parte ipsa fasonobstctal giecologie:avor septic, aviv pelungi, t fer) medical: 1C'de onee origin, neoplasm (stomac, pence), sindrom nelle, boli hematologice, boli infectoase, imebilizare prekings i fistor ste de bporcoagulsiliat, vista > 40 an, entocedente de fromboat venoast, consum de aniconcepfionale ccroprogestaive, ‘bene > Tet tor joach un rl important in trombogeners (triads Viechow)- zs wenossh |. Bmbolia masiva(eupraaeuts) PM dere traci bata, tat eepzator, de tp pleura + hemoptize ‘Fdispace ca hice rtapase= iada eocatcare ‘imptomatologia act se intleza rss (anor sincopS, $e) Seazafe de mosrte mina, eit inexpiabls seat detomboct venostprofinds citnczaextremitigior ‘urgecent jugular, ¢jgulre pulse, hepatomegale de sas taipoce 20 espnin} febra > 38°C [BTA sa gc; tabicarie 100 bmin), + FA sbi (ns) flop VD, sul rosa parte de insufceny wcuspicina boli medi (acu) cee sub forma de jung (sa dee plea) ispnespoliposied + hemopiizie eu singe roqu > run ngs sunita, sub abit {shir ait aia paises (extasisoe, bai, Auten), 3. boll miei eronice) 7 sores de dispose ne eu repeat homoge 1 smxicate axon 1 jent trates se abit supraventricular nexpicabile + tn Gals iastaleart cord! pulmonar craic su subaot, “1 La bola cardiac EP se poats manifesta nha prnt-o acentuars @ ‘apne fbr ou wn pusen de IC, apart sub un ratamen Bg concs,Explored paractinice 1 Deorientare diagnosed Examen radloogi of date supestive, nu patognomenice x epangament plea, iftat palmonar 1 mcensionrea cupola diagmatce de pres lca i iminuaen excuse slo (Gemnul Flesch) + Seatetectzie lacie diminuarea sa dispar dese vasculge a i “oral a peste 1 in pacer modicsile eind exis sunt nespeciee gi rnzitons tables. Gloviale axils “esp, Ghriafie sau fuer arial, VD, BRD, ogatvarea unde T Iipenentiags) ~ PaOs< 50% serie obstotin> 50% a pata aerial pulmonar, Investig visand rombocavenoae ~ Teogrfia eu substan de contrast defects de umpleré vero ‘urasonografia Doppler tembofibita oprapoplite. ©) Invetigot bilogice (vloare orienta): ~ tanaitoc aerate iliabina, PA, LDH, ASAT, ALAT) = TVSH, leocscttoza. 2) Dazarce D-dimerilor(snalitte 965%) TL Decerttadine )Ecoprafa cards are valosre muna deo este poctvl (enor: ~ distuncie VD, HTP, + tombi in eavtiledrepte eters pulmonori 1 dbsenfasemnelor BCO mi permite eliminarea dlagnasticl de BP. 19 dniogrfn conpnterizt de a rl "onion opeccae pero egoprel pulmonrede bd prefat de doo de exclude EP bs dtd el nt din vale dna. oj ctmatietecer MDCT. ‘rina int de oveigei a pci ou prosbin line re Ete ine deinestgt pce cell Dimelor ema rr 1 Ansiografia pulmonar “indicat end angiografa CT de inl rezaute mest disponbit ~ stematiavaivi ar pune dignosiul de cettudie al obstruct ales foxuipultrona (standard de aur) 9) Scnirapia ~ indict in suspiciunea de emboli pulnonsr cd nu exist att altemativa dingnostis i penta apecere releteloterpic, laguostic pozitio af «vest dtgnostic line pu, linio-bo 1! otean context vocat es adesta dS urgent r observate In ecogaliatantoazicl & emnclr JF. deCCPA a un bolnay feta pstlogic pane practic diagnostcul de EP, peck: Pt ~ eumonis, paeumotoratul levee, cancer! bronhopulwonst Infra migcaaie 5 * acurcostte, zona zoster ae bot: peccadit, teeta, ise de om abdomen acut ~ ignowiclditeroaial al gol (higovolemis septic 2) = iagnosticu eiterentil al bemoptzs(neoplasn, FBC, ec). tu = Bvohiie spre vindeare- prompe rogult a EP mic medi covet tate + revive de EP, CPC postembolic-canplieaie arava +, decesl in emboli masive, prin sincop,ieuicon VD reinctars Progrostie:amaliorat prin valent pete, ‘Obiective: &) Prventearesiivei care ete de cele mst mle or fatale 5) Repermenbilzaree weel pulmonate prevents HTP LoTratamentul antcoagelant © Heperina obignittnefactionas (HNP) 5,000-10.000U doze ints Sf s70i— 1.000UTH a perfuzie, cu contol aP TT (tmp do romboplating sf Poi ecivati care rebuie st ede 15-25 ors men de nortan, [<> Heparint cu greutate moleculae mica (GMM) in fete de greattce coord (a patieni cu probable mcd de EP), anata deasocterca tS Bile cu antccagulante orale (rombostp) gi a= continud numa eu terpia | oral penn operoeds decal pun 3-6 at sub contol TQ NR CA © Terapia trombolltick 2] 7 sioptoinaza,urokinsza gi tPA grau dovedieicienta + protpalaiadicatiefn EP maive Pry+ ups absnta sou presenta sonelr de hipertensone venoar sstemicd ots) oj emboli ea punct de plecae i 1/2 afsoar a copull SCPC compensat IV. Embolectomia pulmonar® india E> Cec decompensat. =" EP masive oi loalizareangiograies at-oanteraarcesibilt © tabloul clinic 5 cin train tromboites ete oefieace sau contalndiat ere compenset ‘manfetril boli plmonare + semnleinsufcene respirator {_HVD suspect tn caz de puts crest al VD paresternal sting interior ‘HIP: lini pring I intrt un zgomot de ein focal pulmonar. reveniren BP se refers Is proflaie rombeflebitel prod pi 2) combaterea saz = itiaren prbelor cu 15° mai sus de planul compl ‘taal tombe iriure mpd scare CPC tecompena: 1 ober postpeatoig postin presse = Stead rts ‘ompesine vena precede bea lace. “1 fase de hiperenstne venost sstmict (agua urgscens, © epatomegale on efx heptougala, deme deliv, mala ei). paploni paracinie: visas astra VD TP” ss ‘BCG: devin nila dreapta QRS, aspect de P pulnonus,aspec: QS i Vi-Vs, 2.41.2, CORD FULMONAR CRONIC(C#C) ‘unde T nopative tn drial precordial depo, wasouhipvola, BRD Bualoie CPC parenchinaies “Tol te prenehimai pulmonar se eilor acre inatoracie oli pulmonsreobstuetve(SPOC),asanul cover, rearee) Sronrsctaniineluivibroza chs bolt pulmonar restrictive. + Afectr ale cute oracie: 7 cies sa eifscoliogs froze peur ints + Bell etronmecnar, * Alterres coatoluui cen esprit: ‘space de soma _indrom de hipoveatiatiaopatics-obecitate (indrom Pickwick) scoeotunat disuachs ventlalorie obsietvs i agravessh ipo, a {nsufcona rxpzalori gt HTP ayind oa rerltat 1C dread {n aftciunile plswonarecbstnctive prognostic ee Tapa de gral rogresa insite! raptor Mesiunile pulmonar restesve qi CPC vascular eveluess spre IC freapt reiactar. * Bol care prada ochzi dif pat vatcaler “ twomboambolizmal plmonar ernie (EP recent) * hpertensiunes pulmonar pimitiva (optics). Clasificare in fimcie de fetoreaprimaréasruturller nevasclar sau vsculare Tintament “CPC parenchimates LOxigenoterapia lepe vaveular = “reduce hiporia alveolar, | PAP i ameliceaa fincfia VD a us2. Rrontoatatore =" coflos, beasiultoarle sdreneaice 9 deriva de ipatopam rede spas! hese bonis 2. cConicterapiatvs ~"hemisuccnat de idocotiaon si al x predason + sad infamsi i hpesecria rong 4 antbteee a et pce 4. Diartoe ~ + “Turosemid—+ pent este ren hide ia dest 4 igosinas Dole de digtld rebue radhon rss do txiclate 1 lguaten i dient fe: CPC ox tain’ supravetcua, ct distinc solos pew dane 1 Yao pcm Nie ace fT? prin 4. reamed anterngelnt nie HCPC tonboenbolic 3 5 Singrares "200" 40001 TIBI 5S dup ri tog, ingecil pot rept 10.transpan de pln. 2.2. ATEROSCLEROZA Definitie: modinearea paologic8 ees msi importants care s0dezvoltt in| ‘organism, determinindleiuni caractersice ce evoluesal in arterle- ‘muscularé mar, dr g tn artrle laste i care prin progrsia lor afeteast =| perfiriaunoe eter xem de imporaate (nina, rer rnc, membre). — > Factrll de rise al ateroscerozel, x 2 itipidemite fama 2 ata iaberal zara cute respirator edetarsmt, > All factor de ise clasie™ 2 vars * istrie faiial de cardioptiischemich sou alte bol eardiovascuae sterselraice (bir sub 55 ani a fomel sub 68 sn) ra factor prihoscil (ip do personal, depresle,snxitate, sce) > Ne face de rise petra ateronerena mul de insuinorensten (cinder metabolic) poprenina ©) L909) sgregareaplachetarcreveus ‘brinogeal = proeina Creaetiva, ~ © Tipurteronal asc se desera 3 tpuri de ez stersclttce:= * stile pie (ty ten) aca boast sau placa de sero fboasd fezimna complica: esocne lear - sree rapid ‘ *hemoragi a paca rombees + dais aevromat + fibrozue™eseicare, 213, BOLILE AORTEL 243.1, ANEVRISMELE AORTEL Dette as ements, sath > 50% den rm {Tani ewe eet tat cave as a a ~ lage sesceor, ogee marae nna), ave, inflamatorii, infectioase. > Taft ite 9 urd ere! race:- imgtomatice so enon see tnt pte crane omar e ea *" Course ons dapan econ. ee ‘ean ploone ces ‘Sepains ve pct li cl on See so ni ug oe (ae +t ee de tr se 0 + Sapte pls digs sou edem a ro‘+ compresunes canals torscio— edemie membre infroar upeior ting 1 dnesrigmeteaortet abdominals 1 Manifsieelinice + aeimplomaice dere intense radiant intereapulovertebral, in sbdomen, lms 4 dure constants medio-bominalt ombud sau polio, ais inghinal enn fo; tere» imineno ptr Exploniei parncinice 8) Eramonal racolope: diagnostic i comresiynil indase de angi © ortprafia et substan de conrat: Gane, Iungimes, forms ‘opograliaanesismulut ©) Computer tonegrfia: ifeeaiazs anevrismele do Exdotonice . {RUN permite un dlagnostic de aut. clini (elnd anewiamul ete simmptonistis) i paracinic atic diferent = formafun! mediastinal Prognostic: depinde fi de exstenja ator determin seroscertice. ‘Teniament:ehiriel 2432, DISECTULE AORTEL finite; civajllongltdinl al pert aot la nivelal tune med, rods pia apuria bused a use lesion ntime acetic > topoprafie: sor ascondens ye dosendents, ~ Moroes @ TAL poten grotto cope, + foctort favorizant - comcaia sort, bis Tipopleia novel, al iflarardy emematinne valve ort, ECG: excuderea unl init loca act Sichiar In membrele infericare Irnspirai profize posi me ICC, AVC, sincop, schon cut unc extent BBcamen oblects ipertasiune su ipotnsunesrterilt ingufcieot aortic renting noma al plsfu limiauare sow aboie) * semne nesroogie:hemiplei, peralzi, monoplegt + cope su gor hemorasc ‘ofnetl mocardic act fastens sorted acuta percents acts fumors mediastinal. pur (peicard lear, madistis) tote sbi roniizare (soa cronies) lnsulictt sore covers AVC, leziunl neutlogce inde direct de sect. usTratament: cop -oprives sete} 1 Tratament mei ~ "ina Ia tf pacient ptt ta stabilren diagnortioui poaitiv si tlteriordepreferat In dst dsl eu evolje cronies = elmare ser = Lestat sreratesstoice— vacedittoare = dimizusts dete! VS~ beablocante 2.Tratament ehirargical: “ae lovie a dsetia seus proximal 213.3, OBSTRUCTIA CRONICK AORTO-ILIACA, (SINDROMUL LERICHE) Definitie: seromatozs bifurctisinortice cu trimboes supraatngs, Etilogie steroscleroz; mai event la birbati peste SO desi. Ser a moe be cores vars’ diatom sed (Glandicaieymolet, impotent sex alsa pull femural ister Aiminuarea emperatui cleat a pilosa ofl eutaat i muscular 4 membrelor infra, Deatament: by-pass sro. 2.14. BOLILE ARTERELOR PERIFERICE 2.14, ARTERIOPATIA OBLITERANTA CRONICK A -MEMBRELOR INFERIOARE Definitisefctune arterials obstructive determi reduces progres ‘lumepuli vascular ga axl sanguin spre membre. lili: teosetoza. ablou line > Mansi ent dude lermitens lacie, mas + aero fe fepas Ta sda" evens, stnusts de meoines ‘mombroloe infra atteate fa marpnea pat + paresteai gi semzatie de real. 190 1 Exam general Steel epimers ofc cuanat, ules schemice seen a6: imine su dpe ual ~ stadia absent oa siptom de chemi; igus de bsts at bstucin aout agnor cinta pon ee ae Shion + Std Tisch defor cu anti iter © ls>200m de men test + i me ee Pee 1 Bane Doppler: deteriora vail vitzi de serge singel inset slan-ray AB: deans ici sclera ef rpral inte eusunenatals asus ih aead eee ets nivel rere! brains, ABICO9 = eesionne ore ‘Seog hireentors ©) Antografia cu evetage de conrat 5 Computrtomograia thdvad B Iinerigare ctor dtc of terocerecl DZ, dstpdemi TA. zi line +prsctnc al claudiaped ~ selon: durer in ropunes fir ga coupes co persist fn repaus sss nonpes, mu se Taofesc de ulbure tfc: + esiciena veoasd eronil » membrlorinferioere: - duit apar ts mars i sunt tenuate de ecubit ex mabye ateronre cen, dome perifice, cianozi, vee sperfcaeineasune polimionita:»durerimuselae + dfct mincla, dure de reps: bl arculare = boli musculire: toi masouare, dit motor * boli peuoogie,¥ - tis complicatit Sin 75% in cana claudicatis itermitont so stabilizes’ say = Etiologie embolic entries: valvlopat, belie aval, infer miocardie 2x smiorsz8| ‘womboss VS, endocardtifefiousa = ischemie seus prin rombous > gangread i ampuai. > _. wombogsanvate: ateotramboad,anevesme atria Tentament 1. Tratament medical ‘suri generale tenet aie: mers pe jos 30mia/ Usp - 6 ask 1 contol faciorir de se: tneruperesfumiub, control HTA A1DZ,corectarea dsipidemil ») ertament farmacologle 7 esndilatatonre’Papaverin,Pestoxiing = aniagregante: Asping, Thienopiidnele edict anticoaglana fn episode chemi aut proiactc 1 mtlece sralgzie orl la neve opiacos = 2, Terapia de revaseularzare snstoplasi transluminal porate {bypass oclirea zoel obetuat ex un gefon vemos, 3. Terapia chirargicala Tablowl clinic { senme de scheme arterial aut PNahecfa pall stera veal tere obstrate rere tent progesivdurmels de seazaia do cite gFhpoesidi. plore cero, temperate seieu a tegumentalor- 1 elbursenive motor, ‘examen ine genoa tal nimi permite idntiicarea suse de emboli Diaguostc diferent = obstnfia tombote ee tnisicafieinlrmitents, lesival_obsthictive sé membrul ‘ontolatrl fr scbemie acu.” = Sredografia” eu substan de contmst_evidenfia_ sedi, fbstuiast mecanismal saa ~ ice acu de or = feted nearologice:-> dure pin intens,paresteci gi deficit motor ti cu DCI: ~> hipovolemia, se de go la bolnait cu artriopatic ‘bliterintheronics& membvelor infioare pot mma ischemia ei south neadeovate: ‘entmentl corect lt IeeunlorInedliale, unghill Tncamate, ah ‘micorsle i chiral icin ca tba rofice sa neil dioze Gena prin inci al lexi infetate,oxeezs local a leiuior necrotiee ea empult iat 2.34.2, ISCHEMIA ARTERIALA ACUTA Definiie tateruperes bratals 2 fects sanguin doris unei emboli tromboae, traumas, spasm ara nts sau de exgie iatrogend,avénd 2 conic apr mein hen aero vel smembreloraferte 1 Tratament medleamentor atioagulate: Heparin * romboitce# anglplaste transluminal: wokinaz (intraarea) 1 analgzice: opiacee © terapevasodiaatoae ‘menfneren mambrelar fa poxle ujor dociva gi evitaea porijit Fides 2. Tratamentchirurgleat * emboletomia de urn cu sond cu balonas Fogarty in prime 6 oe {bypass sau endaterectomie 5. Mituri rapeutie postoperatort rttmentaticoagulan. 12 192.143, TULBURARI VASCULARE FUNCTIONALE. FENOMENUL RAYHAUD 61 BOALA RAYNAUD ‘Definiis: sindrom care se manifests prin sccose de palace gi ciaoad a \depetelrincondifi de fi su emofi. tullurare primari — Boala Reynaud; ai event a fee = fonomenal (indromul) Raynaud Tablas! dlinie-3 face — = fia sincopaflengele distal devia forte palide,ceosse, resi se pai tind fa toatl mia, pcicrs, nes, able preter, abolvea sensi tactile; = faca asfiicd: cianoxA cx accensi topograic, dgete rec, ‘Staie de esr sau chisedorere impotent fnejonai Diagnostic poxtin =» aparanez sau provocateasccesuli prin imeria msinlor Ta apse, Diagnostic diferentiat = seule mboti sau tombose: ar dispel nivel oxremitiilr Comaticatit. a sangre wets 2 Spur > est = seleroductlie progesva Testament evitrea expunei a fg extemitiilor = Blocantle de clon de cleetie 1 simpaectomia prepenglionit HL.AGROCIANOZA ‘Definite: cianoza simotes mnilor i mai rac picosrelo, soit de temperatura local sez vail Tablout + elanez localiza lamin, picioae, wes, as, coat, se, 154 4 asoctren une ale afe(iunt sau eanredecelabile (bolt utoimune) pares, = fazn de vasodilatatie reactvd: Sidor’ local, larogirea weguimenteice ‘uma de estsbilien culos norma a tegumentclor; dats eStva minis Diagnostic dUerentiak * cimozele €6 cauel general, fenomens! Raynaud, antiga obsiactive s var expuneri aig lun alevolizante snub cade extrem IMLLIVEDO RETICULARIS 7 1 Definibie eimnoos neomegens eu aspect marnarst sau pitt lola lx ici, gumbe. Tabloul clinic + pete doreri + uleoraifurtedureroase, tensa yzeidivante spintensfet a fgg minut I alr, Definitie: vesoilstatieparoistc a sivellpicioarctr, a mn, nsf dure: intense, nrositea pel i cretere temper locale Tabloal clinic fazsese paronistice de erm fnsoie. de cestores tempera ‘utnste loal si due intense (lath, degete ge poste exe) = spire dup efor cid lea, smote cu tempera crescu ” ‘manifest sschemice a blternt = polineet: empeatrt nommall su sez Tratament => evisesexpuneri la tempest ridests Compras ret 2 spi. lwombangete obliterans si aerontieE tte © existnj ator predispozani+tablou clini +explorti practice Diagnostic diferentiad ‘eaumatls, pte, hemstom muscu, mio Aebita superieals, varicele primitive 2.15. BOLILE VENELOR 2:54. TROMBOZA VENOASA PROFUNDA (TVP) ase ‘TROMBOFLEBITA PROFUND, efits ateyine datos produceit uni tombus, de obs! pun darn, int vet profunds, Eindromul postombatie ; Scene dpimobzar ou pon 1 St trp eos, hacia gui pated. . ') Factori de vise: vit, chiruria generals, neopazle, AVC, sarin, pablo ‘contraceptive rae antecedente de TVP ee. Tablou! clinic i *dureren = edie sa ujoars, tn lau gid dint ~ dae fn et a drsofscia pci emul Homes). 5 +e aeruenz Sa dispare la rdicaea membralu aft ‘destupa zonal san dp tev ile + teenth de pote deotv, tse, stant ~edemult “dante, inolor + dispar dick Segmental afetat est ict “ neentat de poate dee “Tocalizat pe ia dorsal a pcioruu,perimaleoler. © Boolyo Bye Sgeevebls F5 Complicot ‘mbolepulmonart Sindrom postuembeie © peofilarin TVP “ozs mide heparinsnectionats dainstare de hoprine raciont: Deluparns, Enoxspsrina = ttconglante ole: Aceaocumaroh, Warfarina Seducerea sszelveuoase:moblizare precoge,, compreiane cordon et roma ka “ie tons sapere Fossa incites inj ten age é “mic gamer a cons, ok emp oat yor =f, seam: Apa i sca con pi ecommerce E ina gente i node bia, mlette Range nee | TAM Seca ldo Sovainege : otal aime 2 tote ape 2 Test anaolgce (enol poe) 1 see vasa mtd (AVO) ‘avec parce 1 jam mop nce cael ea chee. Deatument Objective ‘roveivs exten rombuca sav redcrea mass eae 2) mestigt de laborator: - Ht 1, polglobulie, wombocitzs ttombopenie, teste de congue lobule teste functional hepatce gi renale 7 1) Flebografia econdnt de conrat = dteclaten chart 1 § ©) Examen ulresonografc 2 pvonitea emboli palmenare 1 Venogrfi eorptcd 3. preveniea rcurspe! tombozs i ©) RAV" evidence rombilrnonocluzivi 4. preveniescomplicaior ave b 1) Computer tomes E = Ndetectares tombozsor venoase aomine peli = ferent wombusal recent dec vec,4. Tratament medica! = imobiliaren membrulu aforat > diinu rise emboli = taticosgulare => tetament de elec: heparina neiatonait say hepaine ca greatate molecular mies (GMM. 2. Tratament ehirurglea: wonbectomi (de excep) 2.152. TROMBOFLEBITELE SUPERFICIALE Definiie fetiuni iftamatri de regu ciceunserge gi nbsteriene, ale ere vneler subcatanat, iso de frmar de bug aden = Euiologie Saree + boli cu tropism vascular: tombangelts obliternt, vascul tome sau bol de eolagen enerrovut LE AFECTIUNILE APARATULUI DIGESTIV 3.1. REFLUXUL GASTRO-ESOFAGIAN Definite 4 Boala de reflex gastrosofiglan: totaiste simmptomelor produse de * refx cofinut gastric soe 4+ Esofagea de reflex: vizezi leziunileexoagiene induse de rfl = tumor mal > masvo-esongan, 1 info te stags -- Etlopatogenie 2 > fark cas deel “A: Cac fiotogee “Tablout inte Sedeen presinilefinctetsi exofagien inferior (SED, indusd de | ‘ctor medicaments alimeatat eles, umn, coal 2, solders moti gastric eu ntaierea pli gases 3, afeetaren clearence esofagian de confined refs, ~ B. Cauze mecantce 1. Bela isa 2 crstre presunilineasbdominale 3 lige unghinfu His angil dace esta stoma) 4 selcaren pense diaagmatice 3 selerodermin roa aol s mucus utede “estas desi “abloul elni:smptome scaonale sau cvasipecaen = piozis-acentuat de manevre ce cet prevuneaiatesbooals ‘equi dede sau alimentare ‘Seat rtortowald caine degli dreroas) sau dsfgie (degli difcit) simptome respratorli—sufocare,dspaoe noua, rized asta, simptome ORL — living, paresteifrngien, defo ~ Neuron em, dares la preson su sponta stom oct evel process peifebie = epumentesoprincnt etemaoes cade alutisigmaguostic ~"enometle lamar per spntan nto ile sv stints, «arcu pessoa uo cordon adr ndlor _veneeecnaiats sunt seep lero de bite Tomtom Shnflamator etre pe cle generat [coger nes) {ncn notin fbi ops Explonivi paracinice 9) Endorcopia digestvs superioané & bioptatslei: lexi esofapene (Grofit, stenoo} ecuni gstodvodenale; era hitala 158 159F i * soacide: Maalox, Novlox, Rennie, Dicarbcalm { proscioue al mucoael: Sacra. s-ndoscople ~"senozecsofagiene: clare cu sonde sav baloane de presine DS: hemostz eadoscopis prin. injotres do adenalin, by Bari po uli mot: aes, spasm dif exofgien “ tenoes exatgiand “ei hats (Us poate Trenelenburg) ¢) Phmetriaexofegiand: 1 in dteinarea durte!refuxult 1 Monamapia esofgtana: deelazt tubule moter esfapiene 1) Sebarataenfogiand: tr flit 3 Forocoagulae,aplicarea de hemoetipur D Tat Bertin = prfuiaesfaguui eu HCINIIO ~+ reproduce sinptomele, © = ssofigul Berets foweoaguisres ca ple cu Argon sau ‘ucosstomie endoscopice Diagnostic pact: clic + pee. a lagna difeential = Botaigestve wie pstrduoenl reise + felon gots) ga om in a 4. Chirurgeal: ra, Ta esofagit co ne cSspundsa-ttamenial medics 3.2. TULBURARI MOTORII ESOFAGIENE ‘yaspermanent = ‘Sunt acu desl de ae diel de diagsostet uneort din cre spcteti ein ei er ign cancer eta ‘nc pre aeslaci, spesmul ifr esoigln 9 eofaglhiperperatsic. AGALAZIA Definite: Uiperonie SBI, abs reanirit SEL Ia degluiie i aksejn dolor parities in 2/3 exfagane infest, ngofisieatcunosut. ecto inerlminai = factor genatic (prsisprii) rere cadincs + BOG-+ TE + coronarografe 5 ian de atm brie e poate ecangata do renal eld Evolutie.complicatit ‘Bole indelangst. CCompicai:- esata de ref, uleresfagan tect exofagianh + eit Bart - condi premalign pentru cancer esfigaa| ‘ctr de medi (viru neuotop) “hemorigedigesva sapenonr ra “emo rs leno gi gh die agi (elute dre Teen ett 7 sagl (dephtiie cl) dino gi egliieduexoas) ‘este aimentare: evitaes masclor volaminoae, cafe, clocolats = ‘utr cardogazoes, rim aloo, evtare fat requritai portaliectare ~ eviureadocobitulal posprandal {uses dspace induse de opus scSdorea in greta * pozifa Vana retees presiui ntorcice ce wpurecd treserea * eviures medieamentslor ce | presumes, SEI: nifedipint, nit, ‘ol atimentr i stone alin parsinpatcalitice. 2. Medicamentas: "lean Hy histmincl: rating, famosa zai (Axi) 5) Bxamon barat: sofa lata carts portinea inferior ce ingustesas ©) Monomer: - absenj undeorprisalie in esol inferior { Gloantpompel de proton oepnaol (Lose, ‘Uap, Ome ah Sse mant nae epee Comey mpl Cas, eon gia then i Diggnosticpasitin + pena: mote, depen stun) capt SS nelte+ paint 7 (cordina z TEProgroste:e2ernt CComplico: pmeumonit de aspen, fstle eso-bronyce, perfoac, bemorgi, i nepal esofagian + stenoza esofagiant organics spasm exofagian df i esofagulhiperperistalic Teatament 1. Chirurgieal 1. Medicaments: medicaments ce cad pesunes SE (ota, basa Getafe iralelorde ali, fin eosin anaes) E = coltectomia 5 co deazipes poli superior leo 2. Bndoseopes dite SEI a taloo jer de anstoxna bound a naditerapie: net cadet 5 ‘nae (BoTex) ~» pre mast Seton Epo 3. Chimioterapla:Beonicn, Copan 5-Floowai 5. Chirugial -cardlomiotria SE (a). A Bndoscopte ~ Tezofe eadoscopct In cancels ncipiente Drotezre endoscopich- metoss palatine in canece avanste, co Aiatae endoscopic nant de aplcaea prota, 34, GASTRITELE Definite tection gasice sate sn conic, caracterzate pri lec de [© tp inflamstor, provocte de dive fico eticlonc sa patent puriod | S flasimptomatie sau cu expresie cline nespeifct | © Clasfcar -enterit 3.3. CANCERUL ESOFAGIAN 15% din cancel digg; roovent a bi > 60 ai actor fanorizanti fama consul de cot {ctor aliments deficit pros, aport eds de vitemina A gC, exe enizezamie, caren deine, te condi: eansum de ihc excesty de fern, enpanere la ada ‘onizans, gen ntbetoi(rploma vin), itor! genic. is 7. Clnioreotuve oN sneer din sere ORL ‘A. Act: evlueszt spo viadacare su spre croniclzare fsofagul Barret . Groce: iflmajit de mgt durat,putindy-ee vindace Sul testament 2 mmegnesofagut ‘su evolu, indiferent de tatament divert exofgieni + senozepostaustie pepe ra ‘Macull ui. Te ge pain + cde pote aul su papel xia rettencie > Ato ea hpetotek + ttn stptome preset fe de obcl dpi din pnt de 2 Bemongil ‘ede chinegeal. Casitas dap nines, > Animal: tp B produst de Heicabacter Pylori Diagnasticnacitiv ~ exdoseopie + bionic Fund: tp A‘eutoimens = examentl radiologic mettre = ecoendoscopia fi tomogratia computrizatl sunt ule pent t Historie eee eed 1B Gast cronies Peers . Gastrit atofick 1a nel+ factor geno - agrogarea fail narkert geactiel (grup sanguin OD. baci - Helicobacter Fyor saloene vir citomepso-vrs orp ius “fungi - Candida = paras Toxoplasma ~gastli aofid ou meme Bieomer . (C. Medicamentoasi: -AINS (anlinflamatoare nestles) k . Species: boule Cro gar ezine, gat limita. ‘SASTRITACRONICA , PYLOLPozTIWA Defixitierialenapin muccasi gasvce, predominant eal indus d i «Helicobacter Pylori scare oelzats sat de mucus). 3 (Clinic epigastai, rej, vrstu. ‘tio; eodoscopic + biopsie + evidefifca bac lout ‘ darsres- simptral cardinal sedi pe linia wifo-omblicalé 23cm deasupes ombilicui siti apa cliic nlgatré cu meses) trav postalieniar in UD * = -230mia=I aria US : corecterul srr, senajie de aptsare seu roadore uraia: 30min ort cedlad prompt eu gradual Ia ingest de ‘lente sau lcatine pride privacy oom. rac 2) Endasopiadigestiv- prozeata nie cross & heporagi : Holiobactar Pyle. 1 brelevaea de bop in UG = ssl crteidor i Evolitia: gutid cronies avofict —> cancer gas sen imfom dc bengnte seu maligne p Bodgknin ~ vars inch i “Tealement cratcere fei ca HP (em ox uta osto- dec)" * Siti vu etd sUG to ta: 35, ULCERUL GASTRO-DUODENAL Defies vicersl gascle (UG) sf wleeral duodenal (UD) repre fotreruper circomecrte, nice aot multiple, ale coasauitsi pee src su duodenal, oie deo rece Mlroast need dels mucoas utd penetra pind in ress. 4 1) Examen radiologic: ~ metodh complementarh de diagnestic, rakes © clad x banuiejtoo tlburce do ovscuns gas (stenoen pier), 9 Determinarea Helicobacter Pylon ein tad FOI Gracie necesita eadoscopie: dsterminares HP tistlogie din biopsi gasie, etl ureazs sx pin cua indtete mu netesitendosopie: determiarea anscopilor ant HP din ter sau chiar dia singe tepral, saliva; determinaren AGHP fecal Etigpatogenia ‘8 Feotri de agresine -eretuft- infec cu Helicobacter Pylori secrfaaidh 1 eit bili 1. Factrii de aprare scSzais Preeti rerezeot de mucus de supra “ect de ont bierbonic (COs) ~neoplselgs, infomul patio ~eadassopie x bipsc, 1 tas bit > ogra rae » Epo preset de: interne membre! apcle puerta conic & Bop opel mi Gp el ont i ison Go prcareaonior de E- + Buoluie commlicati si progstie CHa de medial invidoa bergen: Biola: versie, invodusres tepist anti-H « us la iminuarca +a es, conse rome ot _eilvelor sles 1 inediamenteAspron i AINS,corcoteroit E b 16 16Compican: hemoregie dgesva supvioar, perforate uleroash plore, mlignizarea leer ‘Prognostcul: amelie pint trapie de eradicare cores a HP 3.6, DISPEPSIA FUNCTIONALA Definite suerinfs fncionala (ou are subsea organic), earacaiata ‘riatro simpromatblogc localizat in abdomen supetior $f avied ot 1. Regia alimenta ‘manifest Greil epigastric, plenitoines,bulonarea seu dicenfrt ‘equnated ls fmat, evra alimentclor acide, isa pperte (Clasfleare: dup smptomalSomiaast = inverzieten consul de aspiring, AINS gi corticola, " e ‘ae ates elomenia, decbonce 2 Terapia medicamentons: alserfa vier, anise * ~"blocant de recepori Hs histminic:cimetiding, renting, siting, fmotidins ‘locanp. a pompel protonis omeprzc, pant esomopeozl » on sera E )autiacid: = Mason, Almagel, Alfoge. > Scheme de tratament in Infertia ca HP bl trap: ‘ omepaz6l + emoxicink ~ tip eciere= coal frecvent ‘ omeprazal *amoxiiing + cletromiing * omeprzol + amoxielling + metroniazal + Sacha asoctere . * omepazol + bismuteubire + metonidazol + tet cind + dara 10 ile (14 ale fn evedrupa een) umes hemostaca endoscopic uleerelor homoragice prin: injects de sbutane selrozante sau adtenaling, compare ot Pas spon ‘su ls, plasare de hemoclpurt “ + diate endoscopic a stenozlorpilorice * imucoseetomiaTesinllor ueerate gustice cu diplaie sna chia ance asc nin" 4. Teatament elrurgial~ indica (ler gastrle:- forme refractr Ia tratament, oottante su pefoat * hemoragi eu ris il foam dureroas,eadoscopa elev ta ‘ae olin; plenitudine psi, ‘bslonre,erutai;explorfendgestivarelevé absent lezin or it sential; simptome ce aparn celor dot ‘ipuripreaentateanerir Diagnostic: de excludere leziunlorganie ale etjuli abdominal superior olen et. ep slecroe —> ocanti Hy histminc amici, fraliares HP end et rena, Aispepsie de tip dismotitiate — prochintic, ferment digesv sxe sbsorbang a gazelor intestine ‘motiaiesimpromstch. ln tatsormele sedative au chiar pierre. 3.7. CANCERUL GASTRIC biel ainentre conto crest de nitrozamine ia ‘conservate prin sr i fun [ctr genetic - predispelte familias sandal economico socal etait infefa cu Helicobacter Pyion, Afetunt gastric predispoante Dolpisdenomatogi gases rezecie gated sia cu pli gigante Minetriee. ra= ulcer gute 3.8. BOALA INFLAMATORIE A INTESTINULUI Tablou! clinic ‘simpiomati nu polimort 3.81. RECTOCOLITA ULCERO-HEMORAGICA Lee ‘Definite: bots inftamatore testinal, caracteiat pein lacs ecurente Feet apts pete ial Free pond grav eel neoplai arhonorge (eomatemecs gan ‘ar honorgie gene superiors hematerea ‘adc pranoplsion bite migratr, acatnis pice snc mes gy, sd pete = Peat nev: eal de dace sng, ia p (10 _sstnun/a) in perioadle severe po pies doar emis de singe “duet ebdominl, tenssme, erampe + manifists exrdigetve ~anemie seeundarkpledert de singe, (bes > sua suet n pusea,plewdere pondral, aston. denopati supacaviulre, nee a en ceise creme . Sa, rr nina gf Bert 8 Geer ee alr ‘ SO es we £2) Barly poe: toda depot, adresot In general noplasmelo avai D Keografa transabdominelé: poue evidejia metustze hepalice si ‘Menopati pesigastrice 1) Beo-andoscopia permite sadaizareaT (armors) gi aprecere exten. areal gastie. = sdcom inflamaior: VSH t leuocitoz, protsna Creat 2 coprocultur pent excioderea une eauzeinfejioass 1) Date endoscopic pseu > mucous ibis, eu ulcerai superficial, cw eer diz, Cupiederen desenull vascular Hpi, acoperi de macs sto), = romisiune + desea vascular ses, poeudopoipi, singers cpio extase TM, de il isooge, de vist pace cay 1 ppevchien ee ome ba caozereteiperine > “dia = itien tamanr co PMO Wve cues, tcptabcas, clea @ Beonent atop > alert fel conice Cane cin nt itpeate: 1 cancetele dept cirrgeal 5 Chloloerapla forme evasat (cure cu sramicin, ea $Moroursi Semis sspscol ganar al micosc,_peeopoi revs bree ooo sepa blr «Frio inaaders ell cmt cole 0 Benes toma ec gents perl clonic a evahre i han set (> Siam stele ool. Diagnsti postin eins (Gineec sings, mus pu + endoxopc * etosgmoidoeopi eu olonoecopie) + bopaiForme clince = forma fulminant = forma erie ietermitents form ernie continua Di iat ‘neoplasm de colon + endoscopic Aizentria basilar ena ale cauze nfectonse + coproculrs ‘alia schemict ~ endoscopies i binptie Colita de adie + itor de aire abdominal, ‘ena! decolageneubmnucotse ~ Sola Crota = leiut deontoue endoscopic user aoc tend neg pits lc’ renulomatos, loans eve Heogu! terminal eolonsis soit colgeodsnu colts imfectart + endaseope normal, bipsig - forme cronie discontinve~pusel seu se trteu cu daze mai erste, latin moment remisini endoscope ji hstologice e ire lk doa de 1 nejioerecusalazopsag sew meslain (Selfa), : {fiienatratamentutl va moritorisat clinic endoscope 3. Chrurgiels. ~ far, fas megacolon toric, peefoasie sau stngerare necontoa ergot - 3.82. BOALA CRON, : afnitie: afectinneinftamstore conic, ex afectaea leon terminal > (30% dia esau), leo-clit (30%), uneod doar colonl, dar poate feta erie segmental abu dgesy Etiopatoganie tu ete car cunosest ind evocate implicates sno boii Efe,” Spt ciate etn se mea Gata tt aa et Euolufies complicatit ‘role: eplsoads de aetizare cu dura de siptimtni sa hui, urate senate 9 in, rei ‘ablout clinic Compleat -mepscolon toxic ‘sone digestive: icee “tenors intestate ‘rei ebdominle ~sSngerae masivieuanemi sever malabsoibj “cancer de colon *Tezuniperanale— file. “ munifetrextadigetive sever ‘+ semneexradigesive fb sau bei TDintament “asteal, sede ponders 1 gieno-dette:evitarea late ga lnctatlor, a lepumelor i ftlr, 5 ait eritem nodos slenoee, sue inteme sau exes perforai, deose, stare sepia, | © Reciomia:- recvent ia neoplsmele cu loalizare sting “in fingie de Tocslzar, sfogele poate Hops, viginis smesteet ex sem sau al tpetezs; poate doar emis de reaun —auseaun eu glee 2 Tulburdre de ance consipalie ebll gl exacerbatt—» neoplasm de colon sting “ iaees ~ nooplass de colon erept 2 moriane pont dagnatic cd nt carbonate cu alt senne © Sindvomu suboclutopivinerntet i iasomplei rant 1 Sindromul anemie: anes de ip frp (tipocom, roca), ‘Exploviri paractinice & fa) Rectoscopia rig: evaluesa repiona distal a tubulu digestv 1 Maticnmentos set 1) Recosigmoldascopa fleet: vnaalizare cloauh sag (90-90% din eat | neoplasne sunt localiza la acest nivel) = 9 Coloarcopa violas ein slew gi ein acl ~ permis preter do ep Zep terest plpstis, enc endo 19 tsar: wears lr pe opciin nomad | = keoraiesbdonina ntsoronograia exenocople gD re hens -axeramre feesgior oe dsc, + corticoterapie -simiar cu RUE 1 Tectia enteral =e arocneh meselzina 1 imenzde innoecessdkugare de satiprins a metronidarol 1 femme leat sn ileo-colonie coral eu arian locals 2 Gudesoni) 1 Glare Imodium sou Codi ‘Chirarpieals| complica sun forme nerespasive a tatumeat Feaooi)sogmestare cu enastomozi, ume do temple prolngits ex! “vert sais "cai icbemis colt ai (potas) : avid alone lent op sagan at anomie acs igri. Beasonsin Elites compliatt Bolla = dapinde de momeatldscopcisi rapt oper “fneoplie eo meus pains ee are ri 5 Comps dra “oc neta 39. CANCERUL COLORECTAL Etignatogeni 4) Factor allmentaris excesul de ris animale, prtenc,cames roi Alcootl yi apart eatore exces 2 2) Rola atellorbitart dicta ©) Strte predispocante:~olipi colorectal deoomatoyt = pedipnita ae “odo Lyaeh ance elorectal edi) rata fT cir + pl erent deine diene= este prcedat de evalurea exeniei ganglion gi 8 metastazt pulmonar, hepsi osu perionsle, 2. Chitnioterapia postehirurgicl ~" efnd tumor invadeszt fete peetlecaloului yi cd sust pig ‘Bnglioatloco-egionale + 5 turo-uraclasoeiat evemizal. 3. Radioterapis + _sancer esta (se pia ports oa tn meu bain mu poate exe, a Profilaia cancer cole primar =P isu de educa aimentars ( secuntard = “Tnlitraes eazelor: pop -plipstomie endoscopic efeetnres de test hemceul; cid est pov se inc colonia = colonoscopia de supravegher: tn ball infamatort ale colonia ig ‘lescendenfiv pesoanelor cu cancer de colon, istorie de. po ‘ole + serecingul molecular: declare mutator genetice.predispozaa penta neoplasm = Wozaren d= ACE (antigen carcino-embrions): evideniazh ap tventalelor recive leale + ecogafe computer tomograe:depstarea mtastesor hepa 3.10, COLONUL IRITABIL ‘Defintie: reprint o boat futeionsl crecterianté prin tulburere ‘wana, durert abdominale difwz, uneeremisie de mucus; fi lei loaptnive dvelabile pei enc paral, {Nevrora anlasdepresta este ferent la aces pactenf Tabloul clinic + durerlebdominale:difsze sa oealizate pe tsceal coli, ure sa a ‘acter cliati,campe es dua de secunde sa mime: ~ falburdrt de rence aleranf constipajesiares, descor sean fom de schbale acoperite de mucus trmat de sean lich de int calc + mie do mucus: ce Hecvent, spend sehibalele: = balonare: events, dif su localiza, pent excladereabolilororanice abdominal. i pin exchdevesleriunilor orgaice. ste fal neoplasm anorectal noplasmal de colon, + boll inflamator colonize (als Cron, RUI) iverialoza colonit si dveriealita > etc de eta 1 ispepss fenefonas = ndelengats, vob, legate ses, irk complicti ‘Teatament = ificiun rol important ae exhlbar psiics, L Dietetic + dict predomindconstipaja fore alinentare Ixatve (Fry) = _ se evitalimeatee ce prods simpome “= 2 Medieamentos = anldiareice: Sect nu Imad + _antspastis:Spasmamen, Debra, NoSpa 2 sedative ptboterpie 3.11, PANCREATITA CRONICA eo) H Deftite: atone infamatovie conct cx evolu propeiva cite Bf src paneetc xo enor pate insuicient pnt. 8) leolsm conc ~ > 90% PC dp cons 1020 en stool tet, _ opts, cont hatch eck Pies bis ltr ert postr panrestia conic Ef tigeeacmia in nipepenttion fot dace pin: taunt pce, mor pancreatic, enone | dilene,caleal ta Wiig enol congeisie~-panern dvi” “Smarties= PC cacian- cu calefics fa parenchirml panereatic about ein = PC fond mints -cu eae dilatr ductale = Sbut inion, dp 40 ni, 3-4 or ma cnet ebb det Info rere 3 oct epigass, promi sun bac rea, soplaons aon teud crapermaned, nai rina posterior delegate abondet, ‘iter sata i 1 stestoree cu mlabsorbge abet sahaatsecund "B Examen objeto: ou adie at rlevans rs post paps ws uous paris mare st exist sepinen oni ev volute si complicats ‘Brolite:-eronil cu pute de exacerbare lincepat poste fasimpromatics, daria timp devine ureroash fet benef prin opie consul de leno} spiuiele sete: rege lineata alia prea, sons 2. Madicnsenton > atlgeie (Ages, if, Tama Foxtel) tient eens pancrasie’ (Coon, Pansy, Fev) 2) dears grasimilorin scan -statree © darares perder de protsine pinto ranioree(>2,Sesi) pliownia = dlabeesecundar eat TTGO poste evident tolerant a glucozs oral : 2) Bvalvarea imaged: pose. dignosica 0 PC asimplomatics ie Aescoperi caus ue! dures abdomisale elpce. ‘Radiogrofiepe gl eakicks pancreatic In 30% din PC clefts “gi atte nad co vena oo ist pocrais den “ 2 aterm chdoscopi su chia 1 Sergei peri - dtl 3.12, LITIAZA BILIARA iatare duct! Wirsung > Sum ena pesana de call le acest ive: 7 paeudctitepanerenes Computer tomografas metas lsc de dg de unica voli PC ‘Pancrectografa endoscopies retrogads (ERCP): evideniaas tmorfologcal duu pancreatic (lati steaoz). *Ecoendoscopta 6) Tere sesso pancreatic: evalueeck rezrva fenton pcre ~ Entel crete, apes 10% in popu wa. © = Dacor nt et pone f ini mat "© Blepstogini: ody genet, veal feminine: ba = _- EDs besten pelo, bel Steet Pec ape a lnc gare coli bia sn ur sino 1) paractinie: —— “Temple: inayat peretecogne, mobile ca pot ‘bolnavului, cu con de umbri posterior ioe ~ somptr omogre Casficare 4) Forme clince de PC: - PC ox dure (neriten sun cantina) “PC esinpiomatis. 18) Forme anctomapatoogice 2" obit cdr important de duct Wirsang %> tn momenta suepciua HC; = ananmers etiologies Ef examen clinic: hestomcgati, splenomezlie ~ evahsre biologics — 4" sindrome: hepatcitoitc, hepato, > itaza bars ™ Simptomatic:-dureeintens sau violent localiza Ta epigast stu hipocoadral dept adie sbseapor, es urs =17208 so mal =: : ee . ie : eS a Daan er, mete el B-___ Sieier per a

vee | oc {EE catenin Pate inti ; SRE Gets ~ finutl sub observafic: deficit de alfa-t antitripsin’ ee : ss a Se osm a Mtn medicamentoas pet ell de eoTesieol de imenst imici > “acid urodeoxicolie (Ursofell) + acié chenodcoxcal (Citosily 3-12 ln! (er utizt nut ani) 3434, HEPATITA CRONICA CU VIRUS B pec ts 2 Git ene elt te te st oni ‘vaginal, lapte de sin) ae . cnet + sssetlvlate general, eu exceptiacelor crea tecut prin bossa 9.13. HEPATITELE CRONICE (Ho) finite proves necro-infuatot i Sri heptice coo evolu de peas pate 6 Ii ‘ctor vacina. Pai )transmterea virus ao * otizonal eect ~ paentoral sau pereutan: singe, derivate din singe, contact cu ‘histologic 12 din acini nor stale periodic st ecogati de rains lestumentar infect, incl it ~ sont fre non-sexal: insulin coleivtti de cop ” 51 Purtétoru! non-eplicatv de virus B (purtoril sdndton: Agts = contact on * emanate cp 5 precnt AND VHD Ag lipo lar ransaninacle sunt norma. > Priucipalii marker! serologic: © “1. Misuri generale: 9 4g H0Bs “marker de infects es pare atk faa sou a boi, at $i Im pacieni cu hepatta crnieg)persistea sa peste 6 Tusk fermaifichcroniczaca ‘cant HBS sete ranizare prin infec au prin vacenare © Ae ant Hite ~ sernitih treceren pia boal apr ner Is ea {nfs cronies su sunt markar infect! sete or reper ile fg Hite secs fra velcaliva' inerie, preven sh ilk 9 vole apresiva a boli epaice (de andl Hie - denod 0 replica’ viral redast fa eel eu inecie {= DNA HBV reprziitmarkeral cl mai censbil af rit via poritivitsea sso corelees cu viremia “srren sa cali prin PCR permite apreciere propre hepa cronice By rlspunll a tatamental vil 1 Primal element pe care fchutin lao HC ete dghtBs, doc el eat post seve educa conta replicarea val (4g HBe 1 DNA HB). ‘regia de Vat: activites fick ujoars gf cominuzen sci profesional ta formele woare sau moderate >> Anturjl bolnevilrcu heats B ! portonsel carte va fi vocenat “imptrva hep! Bs Engen B (01, 6 un), 2.Diew: Pete containdiet consul de alcool ‘Spor seient de protene, vegeta i ret 3; Medicale shepattrepa Ezonfale foto Liv 52, Endona es, ‘& Medicatla’andvirala iterferon sav stag’ ulaorii india in nme replicative de hepa B cu wansuminaze cence. © Interferon - interferon fs recombioat (itton Asa Roferon A) fet antvical ft imunomodultr, 5, 4-6 fa = rewmaeys lana amar de ombocits leu, valoile ‘wxoseminazlor la 12 in paceniaparereroconversia + interferon pegylat (PEGIFN). + auuloaitaucloszdic: lamivudine (Zeb), adefovira gl eatscavel, =~ Sigur ees asi a ntertoron, 3132, HEPATITA CRONICK B ASOCIATA CU VIRUS D Sa xt capt ie a na aio on Seine ae eng ema ee pepe orn isa ~ sorta olonvilr sunt ssmptomat au pot acten sstesld} —Tagitere similar cu cea VHB; adic parcatcalsanguind sau seal an lla een = SnD a ae, aed at fe conten an + Seon oor pte dace mt oe cal ioe ME VED, pm Sie eed eo. Sod eal cacictoneyl keel aap aie Sage erent ren Oa ee esa oat tnomep ocxa ctead “waco eee Pupmingegia Vb: “Mager apt unl epod aac ee pe onl neti ~ la punto! conic do AgHBs, fia boald hopati — episod de pats seus = clinic mu sre semne particular ‘Tablou!biotogic snirom bepstcitoli:#tansaminazelr (160, TOP) de 2-3 oi 1 sindrom infsmstor: 7 gamaglbulineior + sindrom hepatopiv 110, TQ ipoafbuminemi; pun modieat = sindrom bitloexereto:iliabine este desl de rad ee ee + marker epatct AgHBs, DNA HBV, AgHBs 9) © ecnuatetia prez ase a Aghe, AgHD, anHD + cereetaea visu D (det). Af cnieca-prezata nso Aptis, tt HDT.2) teste fetionatehepaice > modifiara lo select gradu afetr bepatce, ‘Teatament: iteceron alfa reombinat anu interferon peeyat wn an ca Tenuate sabe 3433, HEPATITA CRONICA CU VIRUS € ransmitees VEC. , 9) paventeali > Gansti de tgs sal dogen injectable, renepa ‘de organ, beds, infect nasosonsle 1) nom parenterala ~ sexual i tenses vertical (momt-Pt), intafoaiislt oe ¢ sur e infec mal botany ¢ receptvintes populate - genera * istoria tural: pizodal sew feeventevblinle forma acuti severt:grefarea pe fondul unei hepatopati ross clnd se produce ocoafeeie VHB-VEC + roniizare i decvoiare de cra sau hepatecrcizom, > Apart circ ete fore de arin ent > onsum zn dealeool de minimm 50g 2 Seal mascain Inet acts nsf = cointeoia VED sau HV. abl - = cel mai adesea ses sau absent > caracteriti: astenie persistent ftigabiiat,iaspetent, ial ‘area hipocondal dept, sindrom dspepicnesitematinnt = stadia avanset de bald ier, hepato-splenomegalic + manifest extabeptie inde de burs imsnologce. ~ nticorpt anti HCV: — stable etologii + seria trecere prin hepa Cf informa. © ‘supre vindeet > ssosrea cu gansaminaze modifete sonics Jnfete cctv nex de dubie se ecomands eterminara Vom (prin PCR ARN HCV) + evalunea leiilr exteepice prin dteminsre: eosobtalr, proteinure,sedimentului Addis, clearencs-uui cu ereatinin’, Eoaluaren mi jet -prin BPH * stailizarea boi dere terapeutic, Diagnostic tiie (snd exist) biologie + eolgie + sadializare histologic ~* Bvoue: de Iungk data» ncor spre cir (15-20 ani) : Comic ciro2s hepatica “hepctocarenom Spars + gomerstonefit— isuien onal croc fle bot esoimane. ‘Tontament 1. Misuri generale: -asemiitoare ct cele din hepatita 2. Terapia medleamentonsa Intern | an t > actor pret pent rps topes bun ‘radiarea VHC | ' monoteapie cu Itereron ‘ ‘ terapie combina Interferon + Ribavirin, ‘lest tart 0 a shen cirzsi un ser histologic mica froze Ieteeare vial joss secu ein, 8.134, HEPATITA AUTOIMUNA (HA) Definite boats qutoimand, ee apa ai fecvent le sexol femivin, ‘aroterzat prin afectare hepatcs one males tune sistem, 5 Eilopatogenie preispoitie getics fictor exogent: visu hepaitetC, alfa metildopa ‘ablout elinie ~zgomotos, dar simptomele ptf i evsibsente Teel tne saa 40 a tei, ftigabltats, fr, arta= -manifestiri mune: troidt, amenoree, anemic hemolie = sioz bilan piitv (colestan intrabeptics) aulimun, glomerulocetit coset polars eumatid, ec. Panda seers} = circa bla Secundar (coletaaextaepatice) 4 cauah metabo: boala Wilson (doit de cesoplsmind + éepanee de eps) 2 1QQbiliubing,lbumins serch vari aerate = hemocromatoen(éepunere de et) 2 crestees gxmagibulinelor = defiitde lf anttripsina 2 tuoandcort: ANA (aticonpsniucear), SMA (smooth mui = glcogenoza(depunere de gicogen) caus vascular + chtra cariacs (IC overs iprelangie) - — ciozs di sndroml Buad Chis (romboza vector spre hepatis, bola venooeuziva) 6, caus medicamentosi:melotreat,emiodarons, izniardl et 1. caus stein: socuars HA 4 cauzt mutionl: deni, by-pass 9 eauzlnedetorminaa cra eripopenctil. Clasifewrea macroscopied acres e face dupa: 2) lmenstunes feat -hipenoha “rotice fanbod)), anti LRM T (ver kidney microsomal), ant LSP (Gv Specie prota). - Diagnostic positiv seme clinics (manifests sitemice de tip imun) + biologie! (Gioia, ipergmaglobulinenie) + autoerticory SHC vile mater via posivt epatapatia cronies aleoolck~consim de alepol + 1407. HC metionmentoas -anamnatic — ons lf metiops boata Wilson = nel comean KeiserFleshor + smane neurologic jnare ceruloplsmie| sxc, cupremil gl eupriel fn anfepsind- slat son aboot 1 kozs bili primiva ~ pra rons, GT, t FAL gi bilirubin spate de esicorpantnstoconda (AAM). morals pat + micronodular (cooict) + nodal de regenerare <2-3mm = macronodulara (postvirsald,toxi, autmund) —> aoduli de regenerare > Sm init ~macronodsar Jo: simpomele po lips! sau poate exists astenie Biz gi + ai tru: singer gogiale, male, subicter sau icer felerotogumentar ~ fae tardive: fete, abdomen mist de volum pra asi, ginecomasi, stro musculae sl entre > about clint x func de fee necezar rtuaea teaptel. 3.14. CIROZA HEPATICA cw isaennonen ee fi in it steric mein ee, pr te fees me pecs one se veel E> since ca ‘8: raducerenparenchinulalhepatie: snore, faible, see ta rulte,hepatalgi de efor, ra, pr, pls, gingiva | > bs hipertnsianen portal: dsconort gi bloat: poses sadam ——: [Vcnize vine: B,C gD (CH postnecrotics) 2 cuz anole (ctoza Lanes) 5 ened colesttict> Examen obicctio ~ matali: nib de ceaguare,tomboctpene, nee micociars ‘inspeetie ipocoms ~ fale secre pe tece atropine pet ive G7] - MGM coef peual,snron heptopiimont, penne hepates) =e pulmonar primis «nal sindrom hepato-rena + ele sau subictr sclorotagmentar primitvd gi tn facele finale seu de acuzare in CH vinwale ay it parmein Sevolize; rl eblrste, put, 4) Tabu! blog = beoe pal i 1 moderat sau marco ay globulnelor yi = + prezena cituliielelaterale pe sbdomen, fiepriombiial spect de cap de meduat sv pe lancust = Sscitl-“marrea de volom a abdomenuluiedsmne * tore muscular Ta nivelat membrelor, ste caracteistie rezena ascii + axpect de pinjen” + modi endoctinologies: parti hpertofat, tesouls ato pilocitate eu dspocie ginotd I Bisbal, elburrt de ely pn i nore a Ten. ‘+ Palpate a = Tspefomogalie lat mars, cu margine ssa, consistenis esa, sau acpalpabil in eozle sroice = lmunopiobalinelr(gG t ciroza bila primtivs ph is roe tool eay 2 ie: terewerea transuninazeor eat ni reds deste it 3 sedrom_hepatpriv: T urobiliogeouli, IQ, « albuninemiel gt a ‘oitestemaei 4 sino billoexeretor:fbilrubinl totale a fossa alcalnesiy OT ~ tent, letcopenie trombocitopenie ~ipersplenim, » Pentru“ tneadrarea etiologies « CH ae vor cfuta urtitort ramet biologiel: {Soli vimlt: ABH, Ac andHICY sau anid * stologia cies: mamnest consume de 60-70 rl aloot = plenomezalie. stolut imp de 10 an le bib Om sooo! absolut la anes + Pertti . + bonla Wilson: dozarea ‘ceroplastine! eleva valor coke, ~ ‘matte de ip chiion — suspicion derevaratpsitoneal ctpremia i eapeurieantenacte $8 CH poae fs omaenaatd (ene end lipses sei ter) + emosromozicsderemie i feria crecutt precum # ereseen + decompansat: vaseulr (ct 9 em) oeficenull de sameatie a tanseine purechimats (te). > Afectareaaltor organe sl ssteme (0 digestive: variceesoagien #fudice + sive blias primitive: 7 GT, FAL, blibina, Ac antimfocondial (aang) * Gioza cardiac sindromul Budd-Chisr elomentl diagostic ete “Sota deren ; Bonide bert = stn eastopta por iets hpeesuns lors enti de alt 1 angi: doce sea lev ral ‘hr ent abe ce gsr a desl ~ shoslndet de hepatia moines: gamagoutoety, et « “iad ers = + pusticulor AN, SNth oat LEM 14st Cat 2 exratigetes = 9 Dianova “rata © eect beptic pie ae cnt cia ~ taupe pene 2 incase ne “elton sewoloie sm Babinski igi 1 trope ep ‘noch ageme CT + Spee obec + sao mopar pont 1 lapse detabires pero vee “acinar clr pot, tense miceropte net _—g | RBDEA debts pot 186 = od6) logos endasope coos a pei Npeesunh pole ps ‘vides: varceloresofiiene = gasropati port hipertensive 3 @) Diagnostica morfologie exe necesar in adil incipient end exo” Sspiclanes clinic au biologi de iors hepatic = oscar = et ninety de deterinare ioe epatice = npurseopia diagnosis -spreciarea ndullr de egenerat cope = _bopsia hepatic remanierenhepatid fbrocs Evolutie detuned ‘fica compensatd fara ascia sy iter © facndecomponsaid "vecular—>aceit cdeme evisat pleural “ paenchimator ee, > Rezerva funeionld bepatcd poste 6 epreciatt pe buza uno param ‘are, grip formencletasflearen Child Pugh, ce ulizeuza urnaioerele ‘clement slbunicemia, ase, bilirabine, insle Quick 9 acsilop Gomplicatt HEMORAGHA ti ') Ruptura de varie erofaglene mari indusk de creeren brs © Ripereosual porate prin efor de iar, eran, se, eper api e ~ ecilbraren pacictuui pris uatres goeulat hemorgie ou singe sat last expander ~ Imeizai vasoeonstrctone arterial pear seSderea presi i vrcele ‘sofgiee -vvopreina su toiprein, stomatstatina sa deriva si Slate preprtsanihomoragio congulate + attiseretori injectable fhibitor a pompel de proton! sau blocani Hs ~ manevreendoscopce« Hgntra clastic sau seerterapia *"hemosizs prin compresiane eu sondl cu belonay Sengtaken — Blackmore. + Proflaslarupturl de varie esoagiene profilaca primar ae eae su a singer! nsiodatt * profilaxa secundard la clea a ava dje un episod emoragi prin ruprd de vaice + se fice cu: bea-blocante (propranola), nial, asociere propranolol + iva teil speciate: {TIPS (gut porto-sistemictansugula) ‘ aastomozechirugicale (jut porto-ev sau spleno renal. by Ulcorl gastro-duodenal hemoragle = hemontat endoscopic Majette in bazatleruui de lool absolut au de salute ade > hemostazhtrmichcurondetemice a * pista de hemoclip pe srs de sngsrare - 1 ocsogulare cu plas cu argon sa ase ‘o mediate ansseretorie de ip locas pomp de protoni © chirurpcl end eeealtemijoace au au rezotvat hemostaza ©) Gastropatn portal hipertensiva 2 emostate argon mn { etacbocante pots sede hipetensiunil portale ‘.ENCEFALOPATIA HEPATICA (i) -snérom nzuropsitic ee apa n CEL ‘Gini: asi, lenioare,semolens, tulburs telecon ial ce eat instal coma superficial sau profiad. Exnmen obiectiv: «tapping tremor” (astern) ~ migcti tmembrelor suparoare cu amplindine me, cu fecvana mic, ‘Simeuice,spoutane su provocie. ‘Cauze dectanyatoare ale EEL “rag alimentar hiperpretec, HDS * dminstare de sedative sau hipnotice inte hepaite acute suprasdugae(lcolice eau vise) * ezacbiibe hide leovaliice postdocs constipatia Incerveaichirurgicale Staizaren Ei fice nd ‘staal Fbolna apatic confi, perderea capaci de conceatare, ‘modiiars rieulat somn-voghe ~ Stdil I: bolny somolent,conz rispunde df a ntrebis © stadia IE: somo marca drzorienare tempore-spai, ‘spns doer la stil potent +a TV: com, tps de espns la stcni‘Teatemental EH ~ evita euzalr dectangatoare roginl aimeata:-normoprotei a citi rk EX = hipoptec ae ox encelopatic + normaleare antl ist - toes + inhibares atv frei ameniofermatare: Metronidazol sau Neonat + aginin - sorbitl PEV. ~ atagonit benzodinaxpnil ~ Fumazeai 3. ASGITA (decompensares vascular) datraihiposlursinersi,hipertnsini portale staeltimftie, Diagnostic: clinie + ccografl (aprocirea somicantaivs = volumut site) + peacentzaexplraorc(Pansodat su exuéat, hema, info levcocit) ‘Tratament 3) igionodietee: ropa apa, dit hiposedatt 5) medicamenas:dturctice (Spionolatont, Farosemi) sl se ve url ivreza, reutaten corporal i dozarea Ki Ne “ ©) paracenens Pere ede mci mre aac react I teapie © yacuae sie ta nile 3 * albumict umces desodet last am Dexzan- pent ‘vitae hipovolemie,hpotnstni ga iscbemie renal purr re peritoneo-venonse (pain lite) © TIPS tenn jogole potest unt). 4 MFECTAREA ASCITE SI PERTONITA BACTERIANA SPONTANK ‘Agen tlologlel: E.coli, Klbsal obramising 7-4 ale ‘S.HEPATOCARGIOMUL (HC! - complicate teeveats ‘Tablowl elite: seidere ponds, seith cas cepte rapid sau devise reffactrt a diuretics, obra san subfebilitat, duet ia ipocondrl rept. ‘Examen obleci: fst dur, tumoral Diagnostic face prin do metode: ¢ serlogict:dozaea alfa eoprtene > <00ng/t + imagisie "ecole mash Npoccogen,hpetopent, In acocudt” say nom nt wonbore malign, dla tumor cu dmc arden + Samper toga N= stadloes HCC Fiat hii de exci —~ ri optane + shemeenbolzare ex adroit panicle de gelatin prin wea fepatia > uo a = slelzare tumoral peruse exophidt sa bli rin tcved © = Tmo nor mar <= amepliat haptic LHP - Inset eal oon area car cu sic avast {ean eben real redcere ste glomerare = Gilg eepues ree! ava hponato = dois testa plomeropsicononitnts ok hipovolnia dnt pracetee ms ce + fatimetcovrta hlbwisior Moslctolies, admire de pit epi, mene vara Sip pe sn ee cena ‘Tontumentul Ct ihn chs, consum de protein redus a finetie de forma clinich + sonsum de lichide 1,52 Ul, eonsam rds d sre tei cu asi preveirea consipatie 2. Tratament etofogie + craze compensits de etclogi visit» tratmneat antiviral (Camivudina i eticlogiaB gt Intererog + Ribavii in etilogieC) sits bli primiiva~» tapi es ci ursedeoxlclie sitezasutaimins ~ eoriotrie, 43. Tratament patogeae concoteapte Predsson + coon autoimun compensa, croze aleootiee + cin bila’ — crore bitin compensa, cirzealcolice su virwale ‘abrosant - Colic» itz a fe inepente 4 gf, mal ales wa<= _hepstoprotectoare sau woice hepatic; suplient vitaminice: BS, Bi ‘4. Tratamentl compliatitr. ‘5 Tranplantal hepade. 3.15. BOLI HEPATICE PRIN MECANISM IMUN ‘3154. CIROZA BILIARA PRIMITIVA Definite: etiologic neunogeus, evlueai cu colestark eric, dist Drogrsivs s dictelorbilareinieahopatce, iaflamafie portal gi 0 ‘Boal spe ciroz i insuiien hepa, roti: progreiva. 'O posts snnliznre clini «craze! ive piitive ete ~ asimptomatcs ‘Simplomatid anicteicd Smplomatiaiteriea 1. Tratamental manifestirlo colestaice + pustu:~colestraming, fenobari ~ anistaminice, orcosteot “fotterape ou levitate = plasmatereca a : sears! seaderen spor de gsi + vitamine liposolubile ested: - Ca, Vitamins D. Tr dst neroperatve a dactalorbilare 2 lesion hepmontare indus do aca iat pimari gi preven in eoncetrai rescue > Anomalies moral = IgM series mult rest “Ae antmtocondil (AAD) prez a 95-100% cazur - elulra:granuloame infiltrate fet. ‘3Teatamental trove 3152, COLANGITA SCLEROZANTA (Csi) * Forme asinptzmatice + soma de cles: TAL Defi: clang sleocan pint (CSP) 1 her foram, prints calor "lar, at ite + romedinptonatie 6 deb sitios: condicod i coo bic insulin hats enn 2 Begins ‘eens 1 piomentae mela togumentlr 1 tcl eu ft! austonne ns perf enologce 2 tc Social cael ete 2. Secdarl -cnza et coach 5 epatanpleomegatc ~ iene biliare pois, colegioecinom, chile bil in 1 laa vaminor A.D. secede anceaia ci aaa Diagnostic: Tabloul clinie seminom cole: - 1 fosfvtza slink, yOT, tlabins = Cee ete md dningupata de rine ‘ei liar seit piel ice = fmologie:- 7 sncorpllanimitocontiai aun tra > 1/40 1 ftmgitie = ecoprfa computer tmograia au dau date specificor ce @) Biologics [FAL 2 sansaminaze = gamaglobuine eo), + Hemocromatozi primar etiologic necunoscuts _ Hemocromateraseeundard - supraueseares oransiolui cert bol ect, ingest ols defer, oll patie cronee, hemodializs ema = prezeja Ac anes “£4 Tablout clini: smptomstologis spare dps 10:0 sok 2 Imagite:colagiogratia endoscopic rerognds ERCP)» wera de ag. pauline Drimf intenjie ce evdentin modifica ale arbors ili. lati "i ‘vole: if de prevent, ove i forele simpomatce, Complicait ‘MT coz 1 tote complica Z ~ _sadom cols seatoes, malsbsorbyi vitamineler posoluil, 1, hapatomeetie—» cco eu splenomepalic, iter, ssciea 42 DZ-213 din pasion sant inslinodependea “““S Pipmenderea tegumenteor- tg tuete avensate ele boli, dstoreseh ‘excenu de mlaning (au depciti fell tn tegument > Ale manifestiri: caciacs (IC congesiva) aeons. simetics, endocrine (insulin gonaic,setdere libido), : ‘ntesporort) x2 Diagnostic. = Mien tart + SeHeres coetcentll de siturje a tansérne! > 459% = colansicarinomul, Sefer tn serce > 20 gral ln bral > 250 nl a fone Teaternent Sdoremie> 7s 6 1. Tratamentl eolestazet (a ioe bir primitvs) * ences de Fe in esuturi:coloratia Pesce pe ftagmente biopic, computer tomograte; RMN. uti i pro voll: lava; moat se produce prin IH, 1, complicit DZ, cancer, Prognonte: ezrvat in stad de CH. 2 Tratamena competion ~ angiocllaentbioues eu spect lng stenoze sever: iltarea lor endoscopic cu tondecu balan proteze + caleal: chiragical 5 linger chiral eee 5. rate clnglororant Ts Diet src er aloo! 2 maa - 2. Madleamentos scott medzamestele et "pe note - Mette ~ "Seber nal 23 yatnepani 350. 500a singed 2 Sol nitro Otic 23 eotomiln peat neice " 2 bli -sofunodencenc Ge — seu chord er Desteoina Det) 2 cubicop: a nee xo ven pte f= tt ©) chirargical: ioterventit de dra) bilar Ia CSP sniplomatic $1 Colungiocarinom. Definite: eaursmorcaracteriants prin depuneren de cuora in fsa 3.16, BOLILE METABOLICE EREDITARE ‘parte de mani epatee, neulogin, cculae Gal Kecee i F Feats) stn alte rgane (nich, cae, epuneat) Se ao AT Oza FRIMARA, G] > Boalt genetics cutanamitere sutosomal ress finite tecarismora aie sistish ce se cracterznat pin ocaed HF EHiopatagenies 2s e for in ongane pureochimctoase (Gcat in specil) si apeiia do: croot 1. sere sntze de ervloplasid Sepatet, dabet srt (rosea,plgmenare exes atopas, eee 2._soideeselimiase bln de expr, cardiac i hipogonaiem, (Tabloul clini: primelesimptome apr la edolesca. 15 3.462. BOALA WILSONTrade de manifest clinice 1 Hepatice oa Reson te sue ac ii sot fulminant cu ance eroltes, insulin hepa ‘oll progodiesver, dees Ineo so < ‘epatl coi a vrata 10-30 an evolu spre coxa. 2. Neuropsihice ges coreiorme,sindro Parkinson, wemuritr, tutor deel saree + modifies police, neadaptre"in eolectviae, dterirarea capac Inlet 3, Ocular: i! Patognorsnic ine! Kater-Flelscher- a petits nel eenuiu- ran sau ver . capitate LV BOLI DE NUTRITIE $I METABOLISM. 44. DIABETUL ZAHARAT 07) e este un sindrom caractereat prin thipergiizemie™ cron determina de seideres excell de insulind (Gece absolu) sna portbars acflnil acessin (efit relat), induetnd peri In Ellas metbolime * Trsportent rma multe motive ats feovent G ay, afetdadnegatv spray de vi alten sa “Toate cosiior ar eoluieindolngats doe le complica conie:~ vusculare Diagnostic pociiz a inrre islogteetdeea cenlpltmlel see; eer excel LED'S teh coerce cura beeen exrBaf de cops fit atcare epee potelor bape aco eck net ae o coli rapt, doe ede ap 15 i Mb ttament frre pt muologia se amelonsat FChaare logic. 1 lemoate ever nf neelopc, i hepatte foinan + DZipt DE tnmnodepedent ‘Br hepatic 1DZtp2 Dz ndusalocdoendent ec eoeia “fat cent + Ate tp spenifice (onload tp A, tll we ‘acrenul exon cabins de drogu aula chee ‘hcocorict tes tiene) Dz geaafone 4 Altre lane a gooet Ateneo dom > chase cnr sai ssonall pelbib flan fa gozost (TTGO - text de ‘ott la glue ns palo tn anecdente) + tonal poplar! le gooek eee dete cot Tae! “feel eu lout i mal ms de 4 etme ee) 2. Medicamentos D-penielanint agent celsor (reduce cup ier tx fin singe gi eee sliminares sa wart, vtamina 6; neal reduc sorb copra 3. Transplant hepatic abel ac fulminant sroia cu bemoliza; CH decompensata 4 Profactic. 1% 7loa (Orgenizapia Mondita ‘Sinatapi) yi ADA (American Diabetes sociation) ircumstante de dagnastcpociv 1 Normoghcemie 1) fe peamnfssemnelorelnice ~ lice jeun 126mg 2 determin ~ 0) glicemis a erce momenta zi >700 6) TTGO ~ indica» plicemia 4 jeun 100-13emu% + ices potpranda 150-200 mg%s “persoane eu rise dabetogen crest pen disgnosial DZ gestational soulizeans 75g giucc’ dialvatln 250-300 100m¢% (ADA) 9 <26me% ~ 122 ore dap incareae (TTGO) saOmg%e 3 23. Alterarea toleranfel a ghucozs- csgnoste ps doar pin FTGO ~ lcemie jun Dito ‘Acautolman « feoveat in opie adateoens ~ predisporita genetic “rea pti i Meconome de asfime i tan ci into Tinie: tp pees Pe > HecamtDzfp = ois obese oper produed hope glcoa. aaa 7 inguast > Bunerse complalie ~~ poliuria > 2.000 ml/24 hi - prin mecanism osmotic ce de Dé di a ok in 4 Tabla 1 exe isa dagoorscu difweaal tare Dz | ilinodependent (DZ tp 1! Dz aeinslsdependst Opp + polis, etdere tn greta “stone, cides fof! Sieg infelectsle seme compli infefoese Qlanopost,vulvovagtita, gngrene): weabel Diagnose difrenia ate DZ tp 1 g6DZ tp 2 omplicaie grav al cre stad avanst este repezenat de coma hiperlicemicecocacidorich > moarte ‘os recvents in DZ ip 1 i ne 5 pei np fa pe rr \ a es fo oe + ncenpes at i Se = + hfe Lf a pecaicoas - ‘ Sega [eens feo 3 Fee room ' ae _—_ fase —fosmoie veecn: "PES ebn eerie of Ei EAD epi Sa te — 2S EAD event coma ditties sa ean oe come da a =a cabin =a “TI ini tat rnp, ania, dca FST | ATT ae Hapa ar oe ph -ul> 7,35, Somat 2 A sale colds bt Piette pies conte “eat “sen “lode sponta cna abet 2. inj: pnts te te amon = Sink san pa ee ma aca, z [SHES Seon ups nites fon sek Ml jcte-repror TBO) wna curoomneous ORL gE Bolen “hpi mt meet 2 dogenerative: a) mieroangiopat ® plaal i COs ta setdere = pico, ctonure. a linker pect general > fies paid su rts seme de dethidratare > limba uscat, pis, tegument seats i persent, lb cel poot abewdi, te 1 TA, espioia Kussmaul— sema de aidora serve digestive —~ gf, viet, der abdominal ee “Gem neurologic" pect no, eu pt hte»= post 7a0-721 ~hiposcone = ur eet. “hipopoacemic 0 sever a oma ae linc: delat axing, spe Kasmaat impesinan pi hamomg dgetve feeve ampli some dgesive agi. glecmie> 70-800 mgr > (at 1000-2000 CouA BABE HPEROSUOLARA eee amma ee stare ere par dtp os, Tome tess 2) grace > 600 ne 6 E —~bompelariates seriui>350 mosevt ©) bienonat sere (RA)> 20 mEq @ ph-al arerial> 73 “fuburt idro-alectrlitioe severe “Teuceitees (10000-20000) con ue segs hs coe cides ti cbt MpogioaeeE £) tive sere de com etonici normal Bineostc al com hia hipoat 1 deprimaroa moderat sau severdcongtine. . Apare In paca vas, soa e DE tp 2 necunoseay, cx | itor preigpoeafinferi dvee fafa mocards Sat Diagnostic diferent inte coma hipersiemict wl hlponlcenich |” Clini tablou de nutans innerea fick acideat (lps repaia Kesa) aie ce erp eons wr. | ae aoe 7 ropes Gna ‘Toatament: a te CAD, dar fit alealine, | oe ae ‘cols anTA foxtench cv Aavock crc’) sone Paseo sa eeneeaa Acieca ate exw crt xe de sto mete pacient seca eet ‘pitta stat de hiponie sul (a cove) ws mnt, ents samara aa — Sales ‘Ubud ce boli patie cance et eon en fi geomet iaguosticul;- concentra ssngind a laetattu> § rol * phel aaa < 735, "os Jn Tables pec cae de cde lee 1. tratament insline mumai sab forma insolnelor en aciune rp - doa init 10-200 Lv. mat de 0, whoa iy. 2 retacereadefetual det ‘spl = NaCI 9% ghucozt 5-10-20% cin glcemin <250m8% * slocwot—» KCN 7.5% 3. combaterea seidozsi ~» shite bicabonst de sou la pH < 7,1 Iinetie de ozerve alana ‘ratamental factorior predisparanti 2 abel 21 Cauzelencdoze atice ipa awaits Nessa in trae ees oe ies rte eaberar sng, "ale siom tts or we sD, xcuoue, ssh fete eo im es es + BET tint de maemo tml et Sciam ceria one ifs dete ogee a fideo do detest resitois zs promi ne Se Hsrmererd ma