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Chirurgie OMF > Contraindicatii extractie > Flashcards

Contraindicatii extractie Flashcards

1
Q

Absolute

A
  • Leucemie acuta
  • IM recent- mai recent de 6 luni
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2
Q

Contraindicatii relative locale?

A
  1. Lez inflamatorii acute mucoasa orala (stomatite, afte)
  2. Sinuzita max rinogena
  3. Procese inflam/infectioase acute (pericoronarite, abcese/celulite, flegmoane)
  4. Tumori maligne
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3
Q

Contraindicatii generale extractie?

A

Depind de terenlul pacientului si de gradul unor conditii:

  • afectiuni c-v
  • diateze hemoragice
  • terapie antitrombotica
  • DZ
  • Leucemii cronice
  • Tulb. hepatice
  • Inf HIV/SIDA
  • Imunosupresoare
  • Corticoterapia
  • Radioterapie
  • Sarcina
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4
Q

Ce microorganism e tinta principala in antibioprofilaxie?

A

streptococii orali

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5
Q

Enumera pacientii cu risc inalt pt endocardita infectioasa?

A
  1. proteza valvulara (transcatater/hemografturi)
  2. endocardita inf in antecedente
  3. afectiune cianogena cardiaca congenitala netratata
  4. af. cardiace congenitale corectate chirurgical, cu sunt rezidual sau regurgitare valvulara
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6
Q

Protocol standard risc major/mediu antibioprofilaxie

A

amoxicilina 2 g, doza unica, per os/im–1 h inainte

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7
Q

Doza AB la copii

A

50 mg/kg…maxim 2g

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8
Q

Protocol alternativ pt antibioprofilaxie?

A
  • cefalosporina 2g iv –adulti 50 mg/kg –copii
  • cefazolina/ceftriaxona 1g iv–adulti 50 mg/kg–copii
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9
Q

Protocol alternativ pt pacienti alergici la beta-lactamine/ care au luat beta-lactamine in ultimele 2 sapt

A
  • clindamicina 600 mg (la copii 20 mg/kg…maxim 600)
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10
Q

Cefalosporinele la ce grupe de pacienti sunt contraindicate?

A
  • anafilaxie
  • angioedem
  • urticarie

toate astea dupa adm de penicilina/ampicilina

sensibilitate incrucisata

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11
Q

Cauze diateze hemoragice

A
  1. Tulburare hemostazie primara
  2. Tulburare coagulare
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12
Q

Cauze dereglare hemostazie primara

A
  1. Vasculopatii-purpure- defect struct sau deficit functional al peretilor vasculari
  2. Nr scazut trombocite(<= 50.000/mm3)- purpure trombocitopenice (trombocitopenii)
  3. Trombocite cu functionalitate alterata- trombocitopatii
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13
Q

Tipuri de purpure vasculare (vasculopatii):

A
  • Purpure determinate de malformatii de structura ale vaselo sangvine (teleangiectazie, fragilitate capilara I/II
  • Purpure vasculare autoimune (alergice, septicemie fulminanta, medicamentoase)
  • Purpure vasculare infectioase (bacteriene, virale, parazitare)
  • Purpure vasculare de etiologie asociata (autosensibilizare la hematii, psihogena, dermatologice, prin paraproteinemie)
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14
Q

Nr scazut de trombocite<= 50.000mm3 -Purpure trombocitopenice,

TROMBOCITOPENII:

A
  • p.t. cu productie scazuta de trombocitopenii (amegacariocitare congenitale sau dobandite)
  • p.t prin distrugere in exces de trombocitopenii (autoimune, virale)
  • p.t prin repartitie anormala a trombocitelor
  • p.t. prin consum excesiv de trombocite
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15
Q

Prezenta unor trombocite cu functie alterata:

TROMBOCITPATII

A
  • t. primare (genetice)
  • t. secundare
  • t. post-medicamentoase (ampicilina, propranolol, alte med ce interfera cu sinteza PG(-AINS, aspirina, antiagregante) sau cu fosfodiesterazele
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16
Q

Cauze dereglare hemostazie secundara (coagulare)

A
  1. Coagulopatii ereditare
  2. Coagulopatii secundare
  3. Coagulopatii mixte (vW)
17
Q

Care sunt coagulopatiile ereditare?

A
  • alterari ale fibrinogenului
  • deficit ereditar de factor II,V, VII, X, XI, XII (HAgeman), de prekalikreina, de kininogen (HMWK), XIII
  • Hemofilie (deficit factor VIII-hemofilia A, deficit IX-hemofilia B)
18
Q

Apreciere severitate clinica a hemoragiei la hemofilici

A
  • hemofilie severa: VIII/IX <1%: hemoragii spontane
  • hemofilie moderata: VIII/IX<= 5%: hemoragii la traume minime
  • hemofilie usoara: VIII/IX<=25%: hemoragii provocate la traume majore/postinterventii chir.
19
Q

Substitutie pt Hemofilia A/B in caz de operatie

A

A: sange integral proaspat, plasma proaspata/congelata, crioprecipitat congelat (f VIII), f VIII recombinat

B: plasma proaspata/congelata, concentrat de complex protrombinic, conc. de f IX, f IX recombinat

20
Q

Coagulopatii secundare

A
  • deficit sinteza factori coagulare dependentide vit.K
  • consum rapid de factori coagulare: CID/loc
  • formare Ac specifici anti-factori coagulare(f. 7-10,13, f. vW)
  • hemoragii asociate cu circulatia extracorporeala, post-transfuzii masive
21
Q

Coagulopatii mixte- boala vW

A
  • cauza= deficit f wW=gp ce mediaza adeziuna trombovitelor la peretele lezat si stabilizarea f procoagulant VIII
22
Q

Forme ale bolii vW

A
  • Forma usoara/moderata: deficit<=25%. niveluri normale/scazute fVIII
  • Forma severa: deficit grav cu deficit sever de fVIII
23
Q

Care sunt indicatiile coagulatelor orale?

A
  • tratament curativ/profilaxie I al tromboflebitelor profunde membre si al tromboemboliei pulmonare
  • profilaxia I/II a emboliei sistemice
  • profilaxie antitrombotica a protezelor valv metalice si bypass aorto-coronarian
  • sdr antifosfolipidic
  • trombofilii asociate cu sarcina
24
Q

Ce medicamente cuprinde terapia anticoagulanta?

A
  1. clasice-orale-ACO -antivitamine K; acenocumarol (Sintrom, Trombostop)
  2. noile anticoagulante orale (NACO): inhibitori directi de trombina; dabigatran (pradoxa), inhibitori de factor X activat-rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Lixiana)
25
Q

Terapia antiagreganta ce medicamente cuprinde?

A
  1. Inhibitori COX-1–aspirina, triflusal
  2. Inhibitori receptori P2Y12: ireversibili si reversibili
  3. Inhibitori de tromboxan sintetaza–indobufen (indobustrin)
  4. Blocanti receptori glicoproteici GP IIb/IIa: Abciximab (ReoPro), tirofiban (Aggrastat), eptifibatida (integrilin)

Chirurgie OMF (16 decks)

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