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GENERAL SURGERY > Patologie Colonului > Flashcards

Patologie Colonului Flashcards

1
Q

Diverticuloza colonului -

Def, forme, localizare, patogenie, etiologie

A

Diverticul = este o extensie subforma de sac, care poate fi adeverat( lipseste strat muscular) sau falsa (exista toate structuri)
Localizare = 55% SIGMOID, 40% ALTE PARTS, 5-10% intreg colon
Patogenie: intre haustre si antimezostenica
Etio: dieta saraca de fibre
Scaderea tonus muscular

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2
Q

Diverticuloza colonica - clinic si paraclinic

A

Durere abd (cand rupe)
Episode de constipatie insotita de flatuenta (fibre low)
Greata (inflamatii)
Scaune normale +/- mucus si sange (rupe)

Paraclinic: irigografia/colonoscopia
Eco + ct spiral
Eco nu e de electie

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3
Q

Evolutie diverticul + complicatii

A 
Necomplicat sau
Diverticulita:
Hemoragii
Fistule
Peritonita localiza/generalizata
Diverticulita cronica (la diverticul adevarat)
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4
Q

Tx diverticuloza colonica

A 
Forme nedureroasa: 
Ab = 7-10 zile
Dieta lichidiana pt golirea diverticul
F. Dureroasa= 
Analgezie
Ab
Echilibrarea hidroelectrolitica
48 ore de decizie
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5
Q

Diverticulita complicata cu fistule

Dx clinic

A

Se pune pe vaza infectii urinara recurent
Pierderii de materii fecale prin urina
Pneumaturia

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6
Q

colita ulcerativa, notiuni generale

A

*Este o boala ulcerativa a colon cu evolutie indelungata
*Afecteaza partial/ total colon la niv mucoasei
Dar mereu rectul
* semne clinice in perioade de acutizare=
Scaune amestecat sange cu mucus
Are perioade de remisiune asx

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7
Q

CU - etiopatogenie/ patogenie

A

Etiopatogenie: afecteaza varstele 16-40, mec de aparitie include factori infectios/ alergici/ psihic/ vegetativ

Patologie:
Lez sunt la niv mucoasei si se extinde submucos, determina -> edem, pseudopolip inflamator, ulcerati

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8
Q

CU - clinic + paraclinic

A

Clinic:
* diarea cu puroi si sange
* febra
* alt starii gen
* nu prez semne de iritatie peritoneala dar durere difuze abd
* TR-> dureros, + sange + mucus +/- fistule perianale
Paraclinic:
*HLG -> leucocitoza, anemie, hipoprot, enzime hepatice, tulb hidroelectrolitice
* irigografia : asp tubular al zonei din rect si colon, pierdere lizereu, si asp de pavaj

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9
Q

CU - complicatii:

A 
Peritonita (prin supuratii colica)
Lez cutanate
Sangerari digestive 
Dilatarea importanta a colon
Stenoza rectala/colica
Extradigestive:
Lez articulare
Flebita
Fistule perianale care nu raspund la tx
Epitelioame coloide
Degenerarea maligna a lez rectale sau sigmoidiene
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10
Q 
CU - tx medical
Si chirurgical (indicatii)
A 
Antispastic
Antibiotic
Corticoterapie
Dieta
Tx sedativ

Chirurgical:
Forme severe
Forme complicate prin perforati/dilatarea masiva a colon
Forme cronice

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11
Q

BC - etiopatogenie + patologie

A

Afecteaza tineri
Etiologie ncunoscuta

Patologie:

Afecteaza intreg colon 50%
50% ileon terminal si colon drept
1/3 lez sunt prez pe rect

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12
Q

BC - leziuni macroscopice si microscopice

A 
Macro: 
* edem + fibroza la peret
* lumen si ingusteaza
* depozite de tesut gras in mesocolon
* hipertrofia ggl limfatice
Alternanta intre zone sanatoase si zone afectate “ de pavaj”

Micro: epiteloma granulomatoase cu cel gigante
Ulceratii af m + sm+ strat muscular

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13
Q

BC: clinic

A
  • durere difuza abd
  • diarea abundenta fara mucus!!
  • febra
  • alt stari gen
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14
Q

BC - (MANIFESTARI EXTRADIGESTIVE)

A
  • ARTRITA PERIFERICA
    SPONDILOARTRITA
    ERITEM NODOS
    CONJUNCTIVITA
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15
Q

BC - PARACLINIC:

A

IRIGOGRAFIA:
LIPSA PROGRESIE SUBST BARITATE
* STENOZA

COLONOSCOPIA:

ULCERATII ELIPSOIDALA PE ZONE MUCOASE NORMALE
AF DIVERSE SECTIONI ALE COLON

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16
Q

BC - COMPLICATIILE:

A 
ABCESE
FISTULE EXTERNE SI INTERNE (ILEUM SI COLON)
COLON SI VEZICA URINARA
* HEMORAGII MASIVE
PERITONITA 
MALIGNIZARE
17
Q

BC - TX

A

MEDICAL:
SALAZOPIRIN
METRONIZDAZOL
DIETA HIPERCALORICA

CHIRURGICAL: INDICATII:
MEDICAL INEFICIENT
COMPLICATII

18
Q

Volvulus cec - ETIOLOGIE

A

DISPOZITA ANATOMICA A COLON DR
- ADULT 30-40 ANI
AF BARBATII MAI FREC

19
Q

VOLVULUS CEC - FACTORI ANATOMICI SI FACTORI FAVORIZANTI

A

FACTORI ANATOMICI:
* lipsa fixari post (lipsa fascia de coalescenta)

Factori favorizanti:

  • aderente postop
  • tumori intestin subiri
  • adenopatii mesenterica
  • boli care af junctiune ileocecale
  • chist de mezenter
20
Q

Volvulus cec - model de aparitia

Si factori provocator

A
  • distensia colon si cecu
  • obstructie colon prin distensia
  • stenoze colon dr si sigmoid

—-

  • hiper/hipotonia musculaturi colon drept
21
Q

Volvulus cec - dx clinic si paraclinic:

A

Durere colicativa abd localizata in hemiabd drept, asociata cu greata + varsaturi si oprirea tranzit Care survin in crize dupa perioade de constipatii
Distensia abd in hemiabd drept cu tumora rotunda
In FID, senzatie libera,
La pac cu volvulus cronic, durere dispare dar repare

PARACLINIC:
Irigografia
Cecu prez subhepatic
Junctiunea ileocecale localizat anormal

22
Q

Complicatii volvulus cec

A

Strangularea colon -> ischemie -> perforatii
Distensia rapida

Ocluzia intestinale

23
Q

Volvulus acut - semne _ dx paraclinic

A

Durere abd brusc aparuta periombilical
Varsaturi abundenta
Oprirea completa a tranzit digestiv

Paraclinic:
Rx abd standard -> colectie gazoasa
Irigografia -> filling defect colon dr (datorita torsiuni)

24
Q

Volvulus sigmoidian, notiuni, etiopatogenie

A

60% din volvulus colon (frec)
Af barbati 4:1
Apare prin torsiunarea sigmoid in jurul mezosigmoid

Etiopatgenie:
Sigmoid lung = mezou lung
Mezou ingust -> putin t adipos -> risc mare
Aderente

25
Q

Volvulus sigmoidian - factor declansator

A

Constipatie
Efort fizic exagerat
Efort de nastere la femei

26
Q

Volvulare sigmoid - ap

A

Torsiune poate sa fi partial/total

Partial nu produce ocluzia intestinal
Total -> bucla sigmoidiana dilata -> necroza

27
Q

Volvulus sigmoidian - DD

A 
Cu orice alt sin cu ileus paralitic (functional):
Ileus biliar
Peritonite
Volvulus cecal
Cancer colon stg daca a avut: 
Pierdere de greutate
Distensia abd cadrul colic
28
Q

Tumori benigne ale colon

A

Tumora epiteliale si conjunctive
Epitaliale -> polip
Conjunctive -> lipoma

29
Q

investigatii paraclinici a polip

A
  • irigografia cu dublucontrast
    Imagine cu gap, f b delimitat
    Nu e prez nici un semn de malignizare (semiton, pintin oprirea umpleri)

Tre colonscopia cu biospie

30
Q

Polipoza - dx clinic:

A

Dureri abd mod/ severa
Diareea recurenta
Scaun cu mucus si stiuri sanguinolente

31
Q

Lipoma in colon

A

Este o tumora beninga, situat in strat submucous
Frec la fremei
Pe cec sau colon drept
Dx prin biopsie

32
Q

Tumora cistica sigmoidiana

A

Tumora gazoasa, poate fi asociat cu diverticuloza colonica

“Pneumatoza inestinala

GENERAL SURGERY (4 decks)

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