Stomac

Question 1

Factori agresori stomac:

Answer 1

-hipersecretie HCl, pepsinogen
-tulburari de motilitate: evacuare, reflux
-HP

Question 2

Factori protectori stomac

Answer 2

-mucus+bicarbonat
-metabolism normal cel epiteliale
-factor epidermal de crestere
-prostaglandine
-irigare sg adecvata

Question 3

Tip ulcer(acut/cronic)

Answer 3

Acut: leziune exulcerativa Dieulafoy(eroziune), unica, izolata, se vindeca fara cicatrice

Cronic: lipsa de substanta situata pe o zona de inflamatie, se vindeca cu cicatrice

Question 4

Dg ulcer: tranzit baritat

Answer 4

Semne directe: nișa Haudeck(profil), imagine in cocarda(fata)

Semne indirecte: hipermotilitate, convergenta pliuri, deformari bulb

Question 5

Chimism gastric

Answer 5

-bazal
-test Kay: histamina
-test Hollander: insulina

Question 6

Ulcere de stres:

Answer 6

Cushing: tcc
Curling: arsuri
Bilroth: stari septice
Verbank: transfuzii multiple
Operatii multiple(ht, ischemie)
Insuf resp/renala(acidoza)
Tulb neuropsihice (secr+motil)

Question 7

Clasificarea Moutier ulcer de stres

Answer 7

Abraziune: pana la m. mucoasei
Eroziune(exulc.): submucoasa
Ulceratie: poate depasi musculara

Question 8

Triada ewald, ulcer de stress

Answer 8

Durere tip ulceros
Hiperaciditate
Hemoragii

Question 9

Clasificarea Forrest hds

Answer 9

I. Leziune cu sangerare activa
II. Leziune cu semne de sangerare recenta
III. Leziune cu potential de sangerare

Question 10

Roluri duoden

Answer 10

1. Digestie(se intalnesc 3 sucuri)
   2.Motilitate(D2, zona rol pacemaker)

Question 11

Factori favorizanti ulcer g-d

Answer 11

Genetici: nr crecut de cel oxintice
Fumatul, alimente, alcool
Ais, ains
Stress biologic
Variatii climaterice
Boli: amiliidoza, policitemie, boli pulmonare cr., hematologice

Question 12

Particularitati ulcer zollinger-ellison

Answer 12

Durere intensa, iradiere posterioara, fara periodicitate, exacerbata nocturn, cedeaza greu la antisecretorii
!Diaree, varsaturi, scadere ponderala
Asociata frv cu alte tumori endocrine

Question 13

Proceduri chirurgicale ulcer

Answer 13

Vagotomie

Bulbantrectomie(1/2)+vagotomie:
Ulcere duodenale

Rezectie 2/3:
U gastrice johnson 2

Rezectie modelanta(Madlener), etajata: u subcardiale

Rezectie de excludere:
U postbulbare

Gastrectomie totala:
Z.E

Question 14

Triada mondor

Answer 14

App ulcer + abdomen de lemn+ durere

Question 15

Fazele stenozei gastrice

Answer 15

Faza organofunctionala (compensata)
Faza de asistolie gastrica (decompensata) ->sdr de ocluzie inalta

Question 16

Clasificare complic. CLAVIEN DINDO

Answer 16

Minore:
1.nu necesita trat
2.trat medicamentos
3.trat endo, radio, chir

Majore
4.ati
5 deces

Question 17

Complicatii postoperatorii ulcer

Answer 17

Mecanice:
1.esofagita de reflux
2.inflamatii anastomoza
3.sdr de ansa aferenta/eferenta, hernii interne

Functionale
4.Sdr postprandial precoce/tardiv, tulb de nutritie
5.diaree
6.recidiva
7.cancer de bont

Question 18

Tumori benigne in ordinea incidentei:

Answer 18

Polipi
Adenoame
Fibroame
Lipoame
Mixoame
Leiomioame
Schwanoame
Angioame
Insulinoame

Question 19

Tumori maligne gastrice

Answer 19

Adenocarcinom 93%
Limfom 3%
Leiomiosarcom 1.5%
Gist
Altele

Question 20

Localizare carcinom gastric

Answer 20

Zona A antru 50 %
Zona M corp
Zona C fornix,cardie

Question 21

Clasificare macro carcinom gastric

Answer 21

Vegetant, ulcerat, ulcero-vegetant, infiltrativ, linita plastica(pangastric), schiros, coloid

Question 22

Clasificare histologica carcinom gastric

Answer 22

Papilar, tubular, inel cu pecete, mucinos, adenopavimentos, carcinoid

Question 23

Statii ganglionare stomac

Answer 23

I: paracardiali dr, stg, micii curburi, marii curburi, suprapilorici, subpilorici

II: a coronara, hepatica comuna, tr celiac, hil splina, splenica

III: lig.hepato-dd, retro dd-pancreatic, baza mezenter, a.colica medie, paraaortici

Question 24

Simptome carcinom gastric in ordinea prevalentei

Answer 24

Scadere ponderala
Durere
Greata
Anorexie
Disfagie
Melena
Sațietate precoce
Durere tip ulceros
Transpiratia extrem.

Question 25

Semne specifice carcinom gastric

Answer 25

Joseph- masa tumorala ombilic.
Blummer- induratia Douglass
Virchcow- supraclav stg

Question 26

Semne paraneoplazice:

Answer 26

Tromboflebita migratorie
Acantozis nigricans
Hiperpigmentatii
Nodulu de permeatie cutanata
Neuromuopatii
Tulb de memorie
Ataxie