Professional Documents
Culture Documents
REFERAT
2006 -
CUPRINS
I.
II.
III.
IV.
TRATAMENT
CHIRURGICAL ..........................................................
1. Cnd se impune abordul
chirurgical? ...............................................
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2
4
2
6
6
1
2
1
8
2
2
2
3
2
3
2
4
2
4
3
9
V.
VI
.
2. Metode de tratament
chirurgical .......................................................
4
4
5
1
5
7
Cascada mecanismelor
Msuri
etiopatogenice
terapeutice
FACTORI INIIATORI
Infecii, toxine
Profilaxie?!
AINS
FACTORI DE PERPETUARE
Bacterii din lumen
Superantigeni
Antigeni alimentari
- Spltura intestinal
- Fixarea sau degradarea Pg-PS, fMPL, LPS
- Transplant fecal
ANOMALII DE IMUNOREGLARE
INFLAMAIE
Polimorfonucleare
Macrofage, Tx, LT
SIMPTOMATOLOGIE
Diaree, sngerare, durere
- Terapie nutritional
Scdere ponderal
- Antidiareice
Efectul
Eicosanoidele
- Scderea prostaglandinelor
Blocheaz:
Ciclooxigenaza
- Creterea prostaglandinelor
Degradarea prostaglandinelor
- Scderea LT B4
Lipooxigenaza
- Scderea tromboxanului A2
Sinteza tromboxanilor
- Scderea FAP
Neutrofile
Blocheaz:
- Scderea activitii
macrofagelor
Receptorii f-MLP
Citokine
Scade:
Eliberarea IL-1
Legarea TNF-
Legarea IFN
Imunoglobuline
Scade:
- Scade reaciile citotoxice
anticorp-mediate
Radicali liberi
- Reducerea inflamaiei
10
11
Chimie
Nume
comercia
l
Forma
Mecanis
farma
mul
ceutic
eliberr
ul
ii
Doza
el
ib
e
r
ri
i
3.Olsala
zine
(Dipentu
m)
5-AS
=
sulfap
iridin
a
Tablet
e
Il
e
o
nc
ol
o
n
Diazoreducta
za
5-AS
=
Capsu
le
C
ol
o
n
Diazoreducta
za
4
amin
obenzil
-alanin
a
5-AS
=5
AS
Capsu
le
12
C
ol
o
n
Diazoreducta
za
4-6
g/24
ore
1-2 g
intra
veno
s
1,5
g=
3g
Sala
zopir
ina
5-AS
= 4amin
obenzo
ilglicin
a
Capsu
le
C
ol
o
n
Diazoreducta
za
5. PolyASA
5-AS
=
sulfon
ilamid
o-etilpolim
er
Capsu
le
C
ol
o
n
Diazoreducta
za
5-AS
2.
Claversa
l
(Salofalk
,
Mesalal)
5-AS
3.
Rowasa
5-AS
Cps
inveli
s
Eudra
git S*
Eudra
git L*
Eudra
git L
100*
13
Il
e
o
n
di
st
al
Il
e
o
nc
ol
o
n
Il
e
o
nc
ol
pH >7
1,53g/2
4ore
pH >7
1,52g/2
4ore
pH > 6
2-4
g/24
ore
5-AS
Micro
ganul
e
etilcel
uloz
Duo
den,
jeju
n,
ileo
n,
colo
n
14
2. CORTICOSTEROIZII (CS)
Folosirea corticosteroizilor n tratamentul BC are la baz aciunile
imunosupresive i antiinflamatorii multiple precum i promovarea absorbiei
apei i sodiului (Tabel 3.). Efectele adverse ale corticosteroizilor sunt
acceptabile ntruct rezultatele obinute sunt de regul bune i foarte bune
[50]. Se folosesc corticosteroizi cu aciune sistemic i corticosteroizi cu
aciune nonsistemic, local (Fig. 3.).
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16
17
18
19
20
Supresia suprarenal. Budesonide poate reduce rspunsul axului hipotalamohipofizo-corticosuprarenalian la stress, dar ntr-o mai mic msur dect
corticosteroizii convenionali [115, 54]. Drept urmare, substituia cu
glucocorticoizi cu efecte sistemice marcate la budesonide trebuie realizat cu
precauie. n plus, suplimentarea cu glucocorticoizi sistemici poate fi necesar
la pacienii ce vor fi supui interveniei chirurgicale sau alte situaii de stress.
3. ANTIBIOTICELE
Antibioticele au un rol bine stabilit n tratamentul complicaiilor septice ale
bolilor inflamatorii intestinale (IBD), cum sunt abcesele i infeciile plgilor.
Spre deosebire de aceasta, beneficiul lor n ceea ce privete tratamentul
procesului patologic primar propriu-zis, nu a fost dovedit nc n trialurile
clinice, dei sunt folosite n mod curent [124]. Raionamentul se bazeaz pe o
larg eviden ce demonstreaz faptul c bacteriile luminale au un rol
important n patogenia IBD.
Tratamentul cu antibiotice are puterea de a influena evoluia IBD prin diferite
mecanisme:
descreterea concentraiei bacteriene n lumenul intestinal;
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22
23
24
4. IMUNOSUPRESIVELE
25
5.
INHIBITORI AI EICOSANOIDELOR
26
7. MEDICAIA ANTIMICOBACTERIAN
Pornind de la posibilul rol al M. paratuberculosis n BC s-au fcut unele
ncercri de tratare a BC cu medicamente antituberculoase.
Medicamentele antituberculoase folosite au fost etambutolul (20mg/kg corp)
si rifabutin (5 mg/kg corp) pe perioade ntre 6 i 12 luni. Rezultatele au fost
neconcludente [50].
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28
29
30
31
32
33
34
35
36
37
38
39
40
41
9. TRATAMENTUL MEDICAL
AL FORMELOR CLINICO-EVOLUTIVE
Tabelul 5. Criterii de severitate ale BC.
Uoar
Medie
Sever (toxic)
scaunelor
<4
zile
> 6/zi
> 1 g/zi
Sngerare
+/-
++
Continuu
Febr
Norma
l
> 37,5o C
>37,5oC
Puls
Norma
l
>90/min
>90/min
Norma
l
<75%
Necesit
transfuzie
< 30
mm/h
>30 mm/h
> 30 mm/h
Edem colonic
thumb
printing
nivele de aer
Frecvena
Hemoglobin
a
VSH
Radiografi
e
abdominal
42
Semne
Moliciune
abdominal
clinice
Distensie,
diminuarea
zgomotelor
intestinale
Forme severe
Forme moderate
Corticosteroizi
parenteral
Prednisolon
oral
Remisiune
Nutriie
-
6 luni
parenteral
+ cs parenteral
Prednisolon
10 mg/zi
Profilaxia
recidivei
ntreruperea
medicaiei
5-AS
43
-------------
Recidiv
Prednisolon oral
+
Azatioprine
Reacii adverse
Recdere dup
ntrerupere
Chirurgie
Tratament continuu
Prednisolon+Azatioprin
Asimptomatic
44
45
46
47
48
Traiecte
fistuloase
Abces perianal
Drenaj extern n
apropierea sfincetrului
anal
49
Ileon
Strictur
destins
Ileocecectomie
anterioar
Segment de rect
obstrucionat
50
51
Colectomi
e
Rect pstrat
Ileum
conectat cu
rectul
Colon
nlturat
Anastomoz
ileorectal
Proctocolectomi
e
Colon
i
rect
nlturate
Ileostomie
Brooke
Sac de
ileostom
52
53
Scop
Ameliorarea simptomelor
Tratamentul complicaiilor
Principii
Tip intervenie
Rezecii segmentare
Tratamentul specific al complicaiilor
(abcese, fistule)
Indicaii de urgen
Ocluzie intestinal
Complicaii septice (abcese, fistule)
Megacolon toxic
Perforaia
Hemoragia digestiv sever
Indicaii elective
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http://www.nlm.nih.gov/medlineplus
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