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Chirurgie > Chir > Flashcards

Chir Flashcards

1
Q

pre hepatic icter

A
  • hemoliza excesiva
  • brb ind
  • urina normala, scaun N
  • fara prurit
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2
Q

icter intrahepatic

A 
- defect de conjugare
defect de transport
– secretie anormala 
— Ind+dir 
—urina neagra
—scaun col normal
— fara prurit
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3
Q

icter posthep

A 
— obstr mecanica a flux biliar
—brb conj
—scaun acolic
—urina bruna
—prurit prezent
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4
Q

icter benign

A

infectios hepatic
chirurgical posthepatic
prehepatic

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5
Q

icter obstructiv dd icter chir de cel medical

A

— istoric de dureri abdominale, febra, frisoane
—icter nedureros + scadere in G , prurit, scaun decolorate
— crestere brb dir + FA crescuta + GGT crescut
—colecit/formatiuni tumorale abdominale palpabile +/- adenopatii supraclaviculare stg —cancere avansate

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6
Q

etiologie

A
  1. congenital
    —atrezie
    —agenezie
    —ectazie -intrahep -b Caroli— extrahep ß dilatatii chistice diverticuli
  2. iatrogenic
    —leziuni CBP dupa colecistectomie
    —stenoze CBP post op - ischemice cauter/ oddiene -dupa ERCP
    —corpi straini - fragmente de sonda, endoproteze colmatate, material de sutura
  3. litiazica
  4. stenoze CBP
    - pancr acuta/cr
    - cholangita scleroasa primitiva
  5. chiste coledociene
  6. tumori benigne
  7. parazitica ( ch, ascarid)
  8. stenoza oddiana
  9. traumatisme -hemobilie
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7
Q

severitate obstructie alterari in

A
  • functia renala si hemodinamica
  • functia hepatica ( sint de proteina, eliminare toxine! metabolism)
  • coagulare - deficit de protb
  • imunitate
  • cicatrizare
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8
Q

clinica colica coledociana

A

— icter benign litiazic
—triada charcot
—pentada reynold

  • debutul si istoricul pot sugera etiopatogenia
  • ex clinic poate ajuta la rarefierea dg
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9
Q

icter benign

A

—debut brutal
—dupa colica
—frisoane si febra
—urmate de prurit

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10
Q

triada charcot

A

—icter
—febra
—durere hipocondru dr

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11
Q

pentada reynold

A 
—durere hipoc dr
—icter
—febra
—hipotensiune
—tulburari de stres mental
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12
Q

dg clinic situatii rare icter

A

— debut insidios
—asociat unui sd dispeptic discret
—cholestaza intrahepatica
—asemanator cu tb clinic al unei boli cronice hepatice

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13
Q

bioumoral icter

A
  1. brb serica
    — creste fractiunea directa van der Bergh = conjugata
    — direct/total > 0,4 2,5mg/dl. 43 umoli/L
    —coloratie icterica vizibila in lumina naturala
  2. pig biliari
    — in urina prezenti= urina hipercroma
  3. urobilinogen
    — scade sub 1mg/24 ore // dispare in obstructiile complete
  4. enzimele hepatocutare ( transaminazele! GGT pot creste moderat in ev unui icter obstructiv sever)
  5. FA creste serica
  6. colesterol peste 300mg/dl
  7. HLG = leucocitoza! anemie hemolizica!eozinofilie
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14
Q

ercp

A

— obstructii inferioare CBP

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15
Q

colangio RMN

A

— CI Ercp
noninvaziv
diagnostiv

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16
Q

echoendoscopia

A

— cai biliare si pancreas
—calculi CBP retroduodenal
— ghidare biopsii cefalopancreatice

17
Q

PTC

A

— dg si terapeutic
— localizari intrahepatice proximale
—invaziv

18
Q

litiaza coledociana

A

— 10-15 din lit biliare
— frecvent peste 50
— peste 70 ani mai mult de 50%

19
Q

etiopatogenice litiaza coledociana

A

litiaza migrata
autohtona
restanta

20
Q

litiaza coledociana

A

— litiaza primitiva
se form de la infeput in ductul biliar comun
calculi pigmentari, muleaza lumenul ductului, culoare bruna, consist moale

— litiaza sec de conjugare - provine din vezicula biliara si aj in CBP fie transcistic! fie in urma costituirii unei fistule = calculi cu caractere veziculare = de colesterol

21
Q

Forma grava de litiazá CBp

A
  • cu icter Continuu
  • inclavare
  • icter + angiocolita
  • angiocolita ictero uremigenica
  • accese febrile pseudopalustre
  • icter rubinic
  • oligo anurie —-> uree si creatinina crescute
  • alterare raida stare generala
22
Q

litiaza disimulata - anicterica

A 
f dureroasa
casectizanta
cu semne coledociene minore
muta 
dispeptica
23
Q

complicatii

A 
— icter mecanic
— angiocolita
# supurata 
- colangita = insuf hepato renala
- pericolangita 
#nesupurata + a. cronice = ciroza 
— insuf hepatorenala
— pancreatita acuta = spasm, edem! reflux biliopancr.
— ciroza biliara secundara = pr scleroinflam portal si lobular
24
Q

indicatii dezobstr radiologica

A

— insuf resp, CV grave
— stenoza piloro duodenala
— stomac rezecat tip bilroth 2
papila necateterizabila

25
Q

litiaza complexa

A 
— calculi autohtoni > 2cm
— panlitiaza
—litiaza intrahep
— megafoledoc aton
— dilatatie chistica coledociana
— recidive lit CBP
— stricturi CBP
26
Q

dezobstr CBP

A

— transcistic
— sfincterotomie oddiana
— coledocotomie

27
Q

drenaj biliar extern

A

— transcistic
— kehr
— axial

28
Q

drenaj biliar intern

A

— anastomoza coledoco jejunala sau duodenala

jejun = Y

29
Q

complicatii dilatatii chistice CBP

A 
— angiocolita
—icter
—litiaza
— pancreatita
— degenerare maligna 
— abcese hepatice
— ciroza / HTP
— ruptura chist
30
Q

tratament chist coledocian

A
  1. excizie hepatojejunostomie Y
  2. excizie
    3 transduod exciz
    transduod sfincteroplastie
    endosc sfincterotomie

Chirurgie (2 decks)

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