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chirurgie - rezi > 5. C.I. Extractie > Flashcards

5. C.I. Extractie Flashcards

1
Q

C.I. relative sau absolute

A

se vor stab in functie de :

  • afect locale in sfera OMF
  • medicatie cronica pt trat.afect gen
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2
Q

DIATEZE HEMORAGICE - etiol

A

tulb hemostaza primara

  • defect per.vasc
  • afect. Trombocitelor

tulb hemostaza sec (coagulopatii)

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3
Q

Vasculopatii

A

purpure det. de malformatii per vas

purpure autoimune

purpure infectioase

purpure etiol asociata

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4
Q

≤50.000/mm3 - Trombocitopenii - purpure prin:

A

trombocitopenii (congenitale / dobandite)

distrugere in exces a T

repartitie anormala a T

consum excesiv al T

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5
Q

Trombocitopatii

A

primare (genetice)

secundare

post-medicamentoase :

  • medicm care act asupra membr T
  • medicm care interf cu calea PGE
  • medicm care interact cu fosfodiesteraze
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6
Q

Coagulopatii

A

ereditare

secundare

mixte (boala von Willebrand)

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7
Q

Coagulopatii ereditare

A

Hemofilie

severa - hemoragii spontane-c% fact VIII/IX < 1%

moderata - hemoragii prod de traume min. - c% fact VIII/IX ≤ 5%

usoara - hemoragii prod de traume maj / post interv chir - c% fact VIII/IX ≤25%

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8
Q

Coagulopatii secundare

A

deficit de sinteza fact coag depend de vit K

consum rapid de fact coag

formare de Ac specif antifact coag

hemoragii asoc circ extracorporeala

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9
Q

Trat anticoagulant - ACO

A

ACO - ef.acenocumarol - 36-72 ore (=>intrerupere 3 zile inainte de extr)

pac cu prot valvulare metalice - inlocuire ACO cu heparina (terapia “punte) pana cand se aj la INR≤1,5

Apoi heparina se intrerupe cu 6 ore inainte de extr (hep nefractionata)

cu 12 ore inainte (hep fractionata)

se reia adm hep dupa 6 ore de la extr (daca exista hemostaza ef)

12 ore ore de la extr (tendinta pers sangerare)

ACO se reia in noaptea aceleasi zile (concomitent cu hep pt 48-72 ore)

Heparina se opreste cand INR ajunge la val tinta

In caz hemoragie postextr tardive :

intrerupere temp anticoag

antagonizare cu vit K (fitomenadiona)-

i.m. 10-20mg

cond spitalizare - adm concomitenta de plasma congelata

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10
Q

Trat anticoag - NACO

A

NACO - instalare rapida ef anticoa

-timp ½ scurt

se opreste cu 1-3 zile inainte de extr (in functie de medic specialist)

nu e nev asoc cu heparina

reluare adm dupa min 24 ore post-extr

Eval ef.NACO -dabigatran- dozare APTT- risc hemoragic ≥70 msec

Nu exista posibilitati de antagonizare eficienta in cazul hemoragiilor post extr tardive

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11
Q

DIABET ZAHARAT

A

vasculopatie periferica, vindec def

Risc scazut <140mg/dl; HBA1c 4%-6,2 %

asimptomatici

fara complicatii

control bun metabolic

regim stabil

Risc moderat <200mg/dl; HBA1c 6,2%-7%

ocazional simptome; putine complicatii

echilibru met. rezonabil

fara istoric rec hipoglicemie/acidoza

Risc crescut >200mg/dl; HBA1c>7%

epis.frecv hipoglicemie/acidoza

multiple complicatii

slab control metabolic

nevoia de a ajusta trat.

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12
Q

Extractia la diabetici

A

la ½ intervalului dintre 2 mese

glicemie constanta <180mg/dl

la risc scazut : vasoconstr 1:200.000

la risc mediu: vasoconstr doar cu a.plexala sau

fara vasoconstr cu a.tronculara perif

la risc crescut: se va temporiza extr

colaborare cu nutritionist

extr cand glicemie<180mg/dl

sutura plaga

antibioterapie de protectie

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13
Q

Extractia in LEUCEMII CRONICE

A

se impune sutura + antibioprofilaxie

Complicatii :

gingivostomatita ulcero-necrotica

alveolita

necroza osoasa

osteomielita

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14
Q

TULB.HEPATICE

A

pertubarea sintezei fact.coag :

protrombina

fibrinogen

vit. K
tulb. sinteza proteica =>aparare deficitara

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15
Q

HIV/SIDA

A

postextractional - poate aparea osteonecroza

Ritonavir - rol inhibitor osteoclastogeneza

corticosteroizii - factor risc major asoc cu aparitia osteonecrozei

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16
Q

IMUNOSUPRESOARE

A

ANTIBIOPROFILAXIE postextr:

pac transplantati (profilaxie rejet alogen)

afect.autoimune : lupus, psoriazis, artrita reumatoida, scleroza multipla, boala Crohn)

Inhibitori IMDH - azatioprina (Imuran)

  • leflunomida (Arava)

Inbitori calcineurinei - Ciclosporina

  • tacrolimus

Inhibitori mTOR - sirolimus

  • everolimus

agenti biologici - rituximab

17
Q

CORTICOTERAPIA

A

analogi sintetici hormoni corticosuprarenala

scurt act: Prednison, Metilprednisolon (Medrol), Hidrocortizon

ef.retard: Dexametazona

Trat>3 luni= lunga durata => ↑ risc infectii

Antibioterapie + ig. riguroasa - postextr

suprarenalele nu funct normal=>↓ rasp la stres al organismului

ef.persistent si dupa terminarea trat.corticoid

de aceea se indica preoperator ↑dozei corticosteroid (pt a evita ↓TA)

18
Q

RADIOTERAPIA in extremit cefalica

A

dupa 3 luni apar

modif in struc osoasa:

-in mom vindecarii osoasa - exista risc latent de apoptoza in mom diviziunii osteoblastelor

modif struct ale microvascularizatiei osoase:

-fibroza per vasc

frecv extractia dupa trat rx se complica cu osteoradionecroza

Se indica extr inainte cu 18-21zile inainte trat.rx

extr cu lambou, care sa acopere in intregime os alv

Metode noi rxterapie:

  • rxterapia conformativa
  • rxterapia cu modularea IMRT
19
Q

CHIMIOTERAPIA

A

influenta asupra seriei albe si a trombocitelor

det. supresie medulara
tulb. apar la 3 sapt de la incetare trat

Extractia e posibila doar cand leucocite>2000/µl si Trombocite>50.000/µl

20
Q

ANTIRESORBTIVE OSOASE si ANTIANGIOGENICE

A

RISC de osteonecroza max

1.-inhibitori de osteoclaste (bifosfonati)

t½=10 ani

2.-Ac monoclonali anti-RANKL (denosumab)

risc

Ac monoclonali cu ef.antiangiogenic - cazuri de osteonecroza in afect neoplazice

21
Q

ANTIRESORBTIVE OSOASE

A

utilizate in:

mielom multiplu, metastaze osoase

osteoporoza

boala Paget, osteogeneza imperfecta

fav aparitia osteonecrozei maxilarelor

  • mai frecv la adm parenterale si la comorbiditati=D.Z.
  • complic osoasa -dupa 3-6 luni de trat/
  • dupa 36 luni (in cazul adm orala)

Nu se indica oprirea trat ci:

  • extr atraumatica
  • antibioterapic spectru larg min 7-10zile
22
Q

SARCINA

A

(per embrionara)-embriogeneza = fecundatie - sapt 8 i.u.

(per fetala)-organogeneza=sf sapt 8 i.u. - nastere (40sapt)

risc malformatii congenitale 1-5%

fact teratogeni in embriogeneza=>anom. de struct ale tes si organelor

in organogeneza=>intarzierea cresterii

anomalii SNC

deces

in per fetala dupa 28 sapt - poate apare risc nastere prematura

chirurgie - rezi (10 decks)

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