Tima Setotegia Pasretia Su Cesk Cauctinss ongan oH fenetie nike (eucloessn si &koezin) CFnrotorwion tore 1 aut he eloana '» erkroferitoniad, Li-La Es pas ioe bag © et - ont. de Lt b eooola-Ceborol eortaL tang (x/- xi) ‘+ Aeopersl oe aulo. fBro- con WMeHiVE eu lh pra Boone bs aan oe ts eee ee ty Krone si oer - Poseini rere dubti2i derport rraseanaoayh. Yu Lobubl tsk ee odived, whe eurba, duc diu olwefta $i Vareke wn rem ULE Su fRnion b post = Voww eowe iw beomouh Si fior be ter0- sup, a cuod beset - de Vashi wmrrnteiale vb. b> Subo. amt Qeaberit ww purctonen - aolioemt re dhomoe 3. to tn ldona. AL von metemnterine Sup. > fue aoa 3ros. sb - tn eovlast eu OAD, Aim buf. 1 QE. Yu Quote PGE. Crvvelain VIER ,varels conale amt. de cwnieliul tine ox odthan fo, ¢.st., mitul a si Storuno, CLE st, ryorful - Gok ox direetie sup.cle yAlin’d ofafuka Vasten- t bo tw nouns, * froieoiuntay cousedl fe fuk Conp.c mucoar aupatenubui be = COME, citindlried gf tiformad ~ 3-18 mm ‘pote {i halhas® frin uae jus WeEth@- bor bauetenr nine eter meta nad a din caaolo- = “= = infer. ji ae Ca 4 Yousk Pawetuntic Princixad * Cobra Bitiata) primed = Se unt, “> auibule, bitiopaueteatiea) (Vater) "= te aleacliol tn york, duremndinde @ ducdonubus (En papite duedle nal oa) Dun Wiraung oor ta, dust? Gifior tomun Co niv. au. Valen bea-ymm Cianmebus , Ap oligestio alimente »fattiewls eote m £i abrwrbite ce iutatirn (15 frmud) Se Robo cs (Ser. ferme gi auunca.) a F Se NEE ert ie Oh, xe.)4 Voluwwd Seretot tn oluodir 45-2 tfiuh - pH &4-F& Firment protee cities : 1. Enolo, iclarcke » Lriprina, hunt ina , Lorbora, colagenn- a. bx dared: conboxiptplicta ta AgB, onwinobeptidaca 3. Whekeazee : Ceonuekeate , ob 2oxi2we6. * Dames Ripe tities 1. dipara 2. Forfots ae 3. Colestuclyiteta za 4. di inkipata 5. Udttta2za hmede giicotitice = 4. A- auulazq Teiprine = frofeing — auuincasiz Scenanind Arikate ,mathaza > pluciole > plucoza) dipazo > eatin Pliedina gi aei2i p2oY5 3 mspomitont = ivfroell , nudopen OO ee do mae. necv. gi. 3 fare = nef lictoue , : 5 etd tes en Rien pow ’ eye yeenba Wb found Twoeives , obo frO- erations (ibeivegme, chane- Hiipiwopa , frecoutoon - befotialata , okt:) by ory. we dupa balwmnotuue tr duootr karan dracon > Cle taibpinagin, D> tibrind axtiv® wb ad. wiodiinazer > careoold, one CAVE Qutoradalitie ust ri Arnvudur gi AY [oteotitior ee, a - eee Ain ol griircott ty Heese SATE Un wal de auwiclow Lp ott Yicoridied) >olkxtina, wralidovk , Xt. Ly Ayal. A- aritore = 2 +ioui de Cot fe Wyobili2ona eudimei rashivibadte d-awnitord higheaiolie. > bio li2o 42 oegtieiolt > QrwramogUierrio eu Livros. acter 0204) Pemudeara Tice > piitir: wied » ivf oerbi Oeiot» Rénea- TH ovtiv. enrimed. Cotigere. > pple fru Gifotios bask. dear + cipota ~ ustabiGsie activ. fipadre pun tporly HAD gi ddan Gidton > Tivksact. nae be ; P gemale RVR Ripore ouive jut ploy! fa $6 => cohen dwelt Grape + twot coipors, + mieeRe Feloipore. Ar -t% sae fous weaetevd Z pod P fleuteS bse askv: Oe pibyind tm Huccnr > L2rotetina >Aeikind Conroe xicsterlidse Cota ¢ Onk.nanbprri tices Lrgeimmolsod= ConBorrgeseasela Moltorole bie L ex-Cohsleriner by anit Gian, iwastiveard getOwlas anpime We Mrolectine Srmtile clowrgecouer = frecan ore when eapilarS cane dentin te Romuw jwrotigulanr. (LE fhe seer, (Ylicogmotiza ,) Hueanue genera) 7 ttaats eect Seti ef é) CU 4 2 deertes (Tptcopnotite gi gtusonvopenssa) (MU 6 (A) + dente, (inhi S.gerdia dot f. 65) (ML PP = Sexrekd (‘whut ecockinds $i ser intra) CCE = feet: (iWin ®. 2 Beroren, af. ingudines L» hwativae singe > Witueore vieiupelu & Ami fara cthnpelea! ee urine --PiGirubina tooled, diwetd gi inoliDeto bALT, AST % Co®* Mitra ,eteo¥imina.Rx abolomem & Ry dros “USG abd. &CT +ALEDS me COO BIO, , ColeOK CELMIeTO. Casric’ Aremoti Caregen hake A Pormer carter hrorgaxe Ca 9 4-bddbi. uubrionora = abun db osbatie @ rugu- Ub embriionax vevtzod pomersatrc fn juan ducdunuki Miwwh, ch teeut pameunde meouiaox®: couplet slau portion pory. cleatenotente a cucolumului be Coxe © poore dknete. ious frbire etimice = Gemre OY trast cronite daw gente TiotowmiX NM 2 luoclue- cucolime” youu , luacine- bd SOU COneomitenrt ev Leludoatio {yume -amarslamors. ng tUbusar h-e. Ledshimmit. pt 2 pordjusns sfieeote Bnd olucturs b- autonome corte de UNOS Tn duck Ly Pvedrod de umyie eu duoolen in cued Wie. > ewoart.oluooln , AN en Corse Sure PA en uti tur abolonum & Himeka inaolteia- 4B O covkrutulus pameror> dorxod Dieegnosric + ERCR (collaugiofauerosopradio vetsopraold (nalalep) be peeutea de tyut paueteone elistop'e e2 de peore foe.ta Uhomor ,owovtim , Veticn Gitiand Sou Averill Were. Chic < humocagie it, prrforatia sau tuff. puree iiteatinal LPN humor agice Comrtowoste pe prouercos aberout atoms erectia. Sepmeatului sau Cobei stammie 7 OoARE. yreditend. cocotxitale mnuepvisercloed Fseeutic gCiudetinals, OMULOKTe 3 Browhwen) ay be olilarodi istier, dbstuerii &» fin OY 0 voeuwaseut tutdrjerea quaeudtui yrttontulen , [cher tou obstwetia Brombit Cor yer A prabayioe Zespirator'e Lrinmficiate. pouencaies Y Agr Lowes scanned vols mivoode , 92640044 ,mivod fertiC/ & feet ww f mtote b “yon diabet jmnulinode, bb j- eoze , Gitar GiiDAD , Viccoroliapati bb g?- dtuititate , ¥ hipofuticitare Diaguogshe +» Sinkud hamspivadier - wel 102 auctooligta tie. actragale Tati calor aupios ref tex, tro w6080, infaset rae fate ofau G24 ofebta feta, focore fe inf. ew Orie foe. Tu organs ern. Apuat ptepen pir — fae: alta tinfogmnsd, Lumatoyy a, comaliolard Sou obit fuin con tinuitatea /focar epee aldtuart) Dauafitacticd- vatool: fatatie eabitslote vaseulants Peete => aekiv. Caut eurimarie pacieteas. Atimectt ta. cate frvieatile vate seu bod > oe auafitartte > flixe huo- vost. © cebetateg enzirme peotectitice { paveasa = xeitati enderoeepsive cachougea 2 th etehyrreolid Siskomud wiles Uadrad , Briumi, dikuminate de varodi€aroitje ,soluim, huuotogrr, ae pomeeaticn,. Shi throtja faraverleSala ex navoraind sau ify, Becca) cpictutal putungit moots UA. askvirtotea ckapeara 0. impact eubui abd. ofiyte noliitia boli 3 ununre Ao. ustabitiua rvopidd® a botuavubul. oT tosieis + ath, cbs toriee. Cay wivetul asineb. Ex. aleootel » mse uc ett, sect Wa >. fined Odi. Nereza: rrwuchivraton si” eausecice odiuui famenfiter Moleobiiethiptina, laste) $i uh. astive (Kokieuin, Kinine, Wistaina,serofonina, plarmina) hasta. * aekivnta a fi fosfotipasi of AcUTE Pan =,T PA Colematoos6 , TPA swccrotiew Xiep ete alae Guatia LA be OW (il iia +abus encatopin te (tout fepmon vtolsioneat! elie ff (inf, /reinf) te fitude TES eee. eozive TPA tdioatoary BTA nerokew BTA infibtrativ - werotied WIA purobeut - wecnotied 1QDuwne bin oe a are (itadlitke tn temifotace fi eaputo-hasesce) - Plobion. (icoliese ¥ cotto-vertebeal w.) Duwe oe euturd any in Inipogastrn (wased) Spend >Ntw fern (Goes +S. te fs ddr wats taia) *D.tn 1g. O 5 Canc ot fase! Guchuri gs vaudturs esther 2 Talbuudti ttayzit digesh Theachanc ffune-iteach 4. Acroianct +s, Waudor - Lau beatae (rrp.fete’ vi ght) bs. Gray -Tumar (park fat. abcloutn) vg, Callen (rap. oubi-tie) Exauimeatia abdommuled A semnuk Poude Losi natdaia. abdontn -mikdtivm elon tiansves) to Sonn ckopeotelu& S. Sobief (doworitote hauvesalis suimivare) 4S. Kotnw [watitok ole, ia) Zone ceebive) 4 5, Korte (arrishnta nusenlota) proieedia. frauucten eli) es, VosKnMineRi ( diShore [obsatia cota’ eb dow pol) » fu settozia = Luis abol be Jilh. veto - pri hi ee & Maui fes tori anole Onwestigeti ok Laberator L> Leueoeido2@ ( f0-20,000) eu dwite tu vfdupa, a Liss fofumse fi moot ie Sauunie 31 TVSH 7 Rokinal wartiva > Twivelul sie al queimelor eater armiCara, tiprina ipaza, dpsinopun + TWVE (tuuser rievosis forte) $i Polgmerthenuleas Lottose) = noua o,3ng]mt ; 202 pauctionunoea OA. vrivsi = albumin » Lucoeitunt be binotune om punoatue tama sautinela” duatiusd cle pare te fiporonolta afdug. “Semmul Soibet = dishume giroasd coloupauevers a. Ry toroet be Aeute fapcatory distress sy notome + didniol tm ba20 vibugay 3. Rx eu toubost % real vadrimse In volun pe , Colonel fi femub oliu Cxjar fraucteaties) bs che stormae fi duo Iman auth sowar aut hofecava auootnald) =" crasuinar chor se olifetenpiard st: Copldtmm), torp (22mm) ,i8tm, Coola (AS rm) Semvr &Pteilice = Tolimeudiure, holats. neomdikatorra of. Witaung , feeuta tielia Pale Ceuta poled Yiedidl BO Ouantoeua ei¥D PA + cotietiis GHaed Cotutl tab orion 5. Roloumografio = various omotlouie oh fourtiunl totoloce- witsunp ,jdeeeuza dusk cow , obstanedtii 6. jo vicsunpratia twoloseagiee> teleplada) - taldieore + subs. eauttau En anipula Voter VOT + ah putin tow 210 ch Ca clebuduh Pil (extiuoltea aried alt weeto edd) Snoleotfi peu OT verificoces Lafmai efivier ful alk date mu-s sufieitute cs Laspiwoliee Fi cokorwul oferDcii Qep. $i cedcoperitones * apavoue feed fociet ton + Sumne ole renege iuff, sisteunied (SIAZ ) cathe punhir |drnwav. coletii Ciel hiene cetroperitouiade Eyoduore deveritott = Sea ratinzor - [a iS Severiionta PR oapeed OF 2a tree jes rr ican din B + infitvarea ‘| Arse! | Modiicaai din C+ o colectie ihe oaca) Creer erty Crete erect uelehuy chek | eBilor Gieiopauetendrer GFGSS + Coubone fuck posi ; pasteodiuccteuit® aeuti freatolob , t°nxmadtif, X eoubrae tua .ADA Ad + onnolpprien gi dpasmotives nepfo, papoveti, Mott fbn A Toxin entiation = Supuiveadia sercyie’ fouckeaties - steer Erarborat, odxogGimo, eifestaticr- 5-Pluoron€ 3 Arigutarce Waar netmale wbimatiec 4 Uimimare udine diy dtuit sougiin © Nuactivaua tusime wv aubtudime(cwuttieal) 6 Rcchilibrare ye (0b. glucore , got. inten, ploxma, potiplucina) 1. Auti bjobite - cowfe. juff, 5. Jost atimentar, alimentotie wuttat [pati Kral tparetirnt - jheus, Mahal - uluate traustst rratcesatul dfbitenesstor” feu A pitied (oho cafe boticn) | a op Lecce ( aépt. B-h oe Ca, elebeot) Dnroticatii sSeowistenfr soewkui faucreatopin cefeoetor a Somme oe immuficienta poliorgomed d.lomblicati purudente aistwetive eoufiumartt tab. We Snefiitotea 12. eoumrvory timp ae 42h Mitoolde pp» PM wcrohica distruetive Dewehuise : eeetie tn Neer eedustzeetouue + olitnads ew dueburr ty Neer sedustzeetonvit + faves poste tn Neer srdustovedonut + cekabaxotomie La nurvitare Lo Neer selustreetonue + lnnare tetefaxatomie fecpramated o> Neer erusteeetomil + tretidete fuuporard 0 frrek be Grmcor) > Nerwlustoconie + 204 bole | | iCathe clicucgrcate a aces In SA bowmmhil mic Rip. qastros ilunie + wweocalau Luaudyerr >waroraton Rausvers tip partreealie Moleeolate intr coboomentate Sune obesotior 4A Deenosea shatin poueccatic 54 sp. ectropecitonia® econ Sees cre Dudicatin p-u Prurrsoernen toscopte He dhiSeoneorcautea olinte JC oruntat ab FA gi cote Laporoacopiee ,, searbGole “ + hepistosen ocr o demrlor inotireete a PA olisfuetive reritoka efecbudrit mami puke titer diegrasiin sj cucarive > tWlatutorne cudletidui din cau. [30 * Nertrebomioa primaxe & fEolo miviizoxen porpiots a frruetsos HDunour exits a AD Dupe £ ere (6 @tuzimat'e ei OHO - i) ios wile! aes eenta substrat fatomerfotsgic bo fuuegional + otpanier ate dituarne pogta fies! efi fracas ivhe -/exha- abel. Dupe timbul aporitics tapbteeoee a furan decade » digotive b+ ohers », list be ie » HDS 3. AOR (inforet , We » umotor, in dau Sere friu cocerprenie -iut, eebtji2e holonMOummak ~ axtrarocliqestive bid. uafiratocie. biurf.emnald gor enerfabofate iG »perora Pa Keri (noctuki dubeatanoti) »wapulo br xeti no hatic tn ful-hove. bepwriamtar astiunr Piprivui, Gporel, Chinivelor, Bicbouninei , Servo tovivsi i jWOk vide ,nst te - /cotaaferifoniae = Soud houehabogin. =VEWrd TAPI, 1 prea breitatea voseulose darvattone DIC (deminatecl intravasular coagutation) he Socutur + Vetighucina, (64000 me /ach) , Proxmasel ,Plarme? , Ploiema., Mba mi- we, 40l, Luto2d- (30- 40x) Fentoritisinc + jor umoragic, furitowitn BaetercanD , b rehesrotia [oehstara, poteronard. $i tapotics , Teebimé PO80S th tudlotorieudse ly je iwittne sau humatoerit<30/% * fromnfurie sénge PSL. existakoide = fi IT dle ap@ $i siiruris fin véractuni/)otisdie ele Lr Pou a Jeaclea coutitatea cndimilor , calieteints, chinine , Mi stouninss Sok substoxicn Je va utitita: @) diurre. forkote. - IV tl. birartboned oe soobir sf -soome Sot. Ringer (vou oti x0li) 1500 me 7 Tu jet manibol 45% + sone BU - HRA, (10 ower put +tosfe.xsit\ 5) Hoe Aeehroliti ee fSbome Coma, bumina, Us te de amina - 1500 WL Qioshj, pritoviod Laporoscopie c) Ru bows bums - ipobrorbyie » Mos wo fortress d) trom furis out ole ddvge © pomenouterors. Wanve owhimeard ter actipor Cetxobetito- wer ex oe hoceb. (exkuhibas clropritonioles gherdont®) exe loot fist sro Qamocogicd 1 ivfitakiv nitotied) WUwrdki bo - Prtulen thdbo amnerantita seo- hum UL, = Le WOAAMAAY Cupeescens, nee wut de ere + Foret, infickrokiv - peeropite + Cox acter auptic, _ foot nee hn 3-6 Ga by wartotico - + = Ql fierra yerrolicn + Perret eet er meer toh edogen® (cai Gaon , 163) sau eraginn (Obeh. eo taysstpomaola, vost) 0 Cid = WUE reefomie tn mat mulhe Qu aromas gbatiu robo (Loial ge forrranzd Burtovimnbogiomer §) lhemurs : faurbar, BO, eft - Dark 3 PUR Bolnowuel se rwopseaze pw tule tualea declustre Ciderr 4) focore vuerolier 4 cline. 4 Trodtowmunt ivory + yuo pans fuori + auch biotier + lezindwicny btn wWeathotul Kiclai era und facar nutote mare ce autienca- za ‘on Maocer fi Leetuk Witsumg . Fistele poate even sectin te oriea cag. Tretormeet beon sowotiv = damon fitule rigaue tx fAeiol Lactic ,coolcofrapia. dictoterabio. * chiuapieal » mEdte ti fisteebee wu apticatea, firtele jeunc-anaitan contain aistades 0 famedeabitid’ Jaw flew Eatea, fists bor. fe Wlomae oluooler , jfure Pekinak OL mod rucBle yihere taper tu far aij o pometronmozes +00} frokotitie @ sudinwtor i O Cindri dubai. ferent thoutera yortler jutogau'er Mem Neruthatue didumei ergamutai tu qpusotic farerotuctd Dinguostie = fialutopragie , FEGDS Tistornent Conserwanty 4s abhiratic goitrediodnala , AHei?. troieet fritelos gi /igatea wx sof TRirnotions (arid Cortie 4sg4 $0. Vall 4000 mk 14 Siealbonart |20fonit) + Qhiamuntodie ay yi fuer be de Oe tod eee eel ae frtelahuretia sepmut fatelos aban eee ee ee Ge colic datpd = iktoriaunia. de divatie | 02 color foumanua. isttui fats tu tar ole tibifier sielureoree focotelee — com deunge te posal e foocunt, Uaetiv ys ofekears, Jet, aotiaciut. aYuhafeueuae ncaa Geo b)ecrapomeratic luett. difatot wunifowm jes dofuri- protice b> eoleuti- WitsugionribDure ehdouinata, = thigastaied , furcoubitic, tori, eeutases* bo obsbuekiv Team REAA top of CBP be QMalobsorbtie cu dkotore D2 KbT Prolunena ta fakparr tr eetucl fatparea fsrucoctilit bo wa vat fbror sou frritoniod 1. Suleptrgatie rastioummelicd. en t2olat -plieuinds-3 = func. exoesincd ADE = Plucora ji urba gliemied 3.4 adore , amita 2uriec, Upara dnine WSkotors 5. Creator 6. Kipurgtcceusee 4. Teste sendetorii pawereaticn mnagisie oP bo gor - ender fer MUSG = cattifirs , lukropenitase ,olitar. duet Wicseae [eoerts ; purvalthitt Terapia conservativa se reduce la o dieta bogata in produse vegetale cu diminuarea grasimilor si proteinelor; se administreaza deasemenea substante spasmolitice (papaverina, no-spa, platifilina, baralgina; substante pancreatostimulatoare (apa minerala, plante medicinale); preparate enzimatice, care substituie functia exocrina dereglata (pancreatina, panzinorm, festal), vitamine din grupul B; tratament sanatorial (Slanic-Moldova, Truscavet, Esentuki). Tratamentul chirurgical este indicat in colecistocolangiopancreatita cronica si se reduce lacolecistectomie, coledocotomie cu evacuarea calculilor, asociata sau nu cu papilosfincterotomie odiana, dar cu drenaj coledocian extern temporar. in pancreatita cronica indurativa cu dereglarea pasajului sucului pancreatic sunt posibile mai multe variante : papilosfincterotomia cu Wirsungotomie - cand stenoza (sau calculii) este situata in portiunea terminala a canalului pancreatic principal. Daca stenoza este situata in portiunea corporala a canalului este indicata pancreatojejunostomia longitudinala (Puestow), care realizeaza o derivatie pancreato-digestiva larga, de tip latero-lateral, intre canalul Wirsung deschis longitudinal si o ansa jejunala. Atunci cand staza si hipertensiunea canalara intrapancreatica este determinata de stenoza canalului Wirsung in segmentul terminal este indicata pancreato-jejunostomia caudala (Duval) dupa pancreatectomia caudala simpla sau asociata cu splenectomie. Daca induratia predomina in regiunea capului si corpului pancreasului cu comprimarea cailor biliare extrahepatice este indicata duodeno-pancreatectomia cefalicad. Aceasta interventie este o operatie majora cu o mortalitate foarte crescuta si rezultate la distanta deloc imbucuratoare, ceea ce face sa nu aiba aplicabilitate. Actualmente aceasta operatie se efectueaza numai in cazurile cand forma pseudotumorala a pancreatitei cronice nu poate fi diferentiata de tumoarea maligna a capului pancreasului. in pancreatita scleroasa difuza in care tabloul clinic este dominat de durere, iar permeabilitatea canalului Wirsungeste pastrata se pot incerca si unele operatii pe sistemul nervos vegetativ, dintre care cea mai utilizata a fost splanhnico-solarectomia stanga (sectiunea splanhnicului mare, splanhnicului mic si ganglionului solar stang). Se mai efectueaza neurotomia postganglionara (procedeul Losioka- Vasabaiasi), neurotomia marginala (procedeul Napalkov- Trunin) etc. Mortalitatea postoperatorie dupa rezectia pancreatoduodenala oscileaza intre 3 si 20%, dupa rezectia caudala 2,5-13%, pancreatojejunostomia longitudinala 1-5%, dupa operatii pe sistemul nervos vegetativ 0-1%. Rezultate bune si satisfacadtoare s-au constatat dupa rezectia pancreatoduodenala — in 60-80%, dupa pancreato- jejunostomia longitudinala 65-85%. Dupa operatiile pe sistemul nervos vegetativ rezultate pozitive s-au fixat in mai putin de 50% si durerea ameliorarii e foarte scurta-peste 2-6 saptamani durerile se reintorc.