Samenvatting gastro-enterologie
1. Aandoeningen van de slokdarm..................................................................5
1.1 Gastro-oesofageale refluxziekte (GERD)........................................................................................................5
1.2 Andere vormen van oesofagitis......................................................................................................................7
1.3 Zenker-divertikel............................................................................................................................................7
1.4 Dysfagie en achalasie.....................................................................................................................................7
1.5 Eosinofiele oesofagitis (EoE)..........................................................................................................................9
1.6 Maligne Slokdarmtumoren...........................................................................................................................10
1.7 Chirurgie van de slokdarm...........................................................................................................................10
2. Aandoeningen van maag en duodenum......................................................10
2.1 Gastritis en gastropathie..............................................................................................................................10
2.2 Ulcus duodeni en ulcus ventriculi.................................................................................................................10
2.3 Benigne en maligne tumoren van de maag.................................................................................................12
3. Aandoeningen v/d dunne darm..................................................................12
3.1 Initiële evaluatie bij vermoeden van dunnedarmaandoening......................................................................12
3.2 Malabsorptie.................................................................................................................................................14
3.3 Coeliakie – glutenintolerantie.......................................................................................................................14
3.4 Lactose – intolerantie...................................................................................................................................16
3.5 Bacteriële overgroei in de dunne darm........................................................................................................16
3.6 Andere oorzaken van chronische diarree tgv dunnedarmaandoening........................................................17
4. Chronische inflammatoire darmziekten (IBD).............................................18
4.1 Epidemiologie...............................................................................................................................................18
4.2 Etiopathogenese...........................................................................................................................................18
4.3 Differentiëren tussen CD en UC...................................................................................................................19
4.4 Kliniek, diagnose en behandeling bij ziekte van Crohn................................................................................19
4.5 Kliniek, diagnose en behandeling bij colitis ulcerosa...................................................................................21
4.6 Microscopische colitis...................................................................................................................................21
5. Disorders of gut-brain interaction (DGBI)...................................................22
5.1 Definitie DGBI...............................................................................................................................................22
5.2 Functionele dyspepsie..................................................................................................................................22
5.3 Prikkelbare – darmsyndroom (IBS)...............................................................................................................23
5.4 Functionele constipatie.................................................................................................................................25
5.5 Faecale incontinentie – conservatief beleid.................................................................................................26
5.6 Faecale incontinentie – chirurgisch beleid...................................................................................................27
6. Aandoeningen van anus en anaal kanaal...................................................27
6.1 Normale anatomie van anus en anaal kanaal..............................................................................................27
6.2 Anamnese.....................................................................................................................................................27
6.3 Proctologisch onderzoek..............................................................................................................................28
6.4 Proctologische aandoeningen......................................................................................................................28
6.5 Anorectitis....................................................................................................................................................33
6.6 Anaal carcinoom...........................................................................................................................................34
1
,7. Acute diarree........................................................................................... 34
7.1 Inleiding........................................................................................................................................................34
7.2 Pathofysiologie.............................................................................................................................................35
7.3 Etiologie........................................................................................................................................................35
7.4 Richtlijnen diagnostiek.................................................................................................................................36
7.5 Richlijnen beleid...........................................................................................................................................38
7.6 Indicaties voor opname................................................................................................................................39
8. Preventie colorectaal carcinoom................................................................40
8.1 Risicofactoren voor ontwikkelen van colorectaal carcinoom.......................................................................40
8.2 Colonpoliepen...............................................................................................................................................40
8.3 Secundaire preventie van colorectaal carcinoom........................................................................................41
9. Colorectaal carcinoom..............................................................................42
9.1 Symptomen..................................................................................................................................................42
9.2 Diagnostiek...................................................................................................................................................42
9.3 Colonkanker..................................................................................................................................................42
9.4 Rectumkanker..............................................................................................................................................42
9.5 Behandeling..................................................................................................................................................42
10. Gastro-intestinale bloeding.....................................................................43
10.1 Definities....................................................................................................................................................43
10.2 Initiële evaluatie bij GI-bloeding.................................................................................................................44
10.3 Hoge digestieve bloeding...........................................................................................................................44
10.4 Lage digestieve bloedingen.......................................................................................................................45
11. Aandoeningen v/d pancreas....................................................................47
11.1 Evaluatie van pancreaspathologie en exocriene pancreasfunctie.............................................................47
11.2 Acute pancreatitis......................................................................................................................................48
11.3 Chronische pancreatitis..............................................................................................................................49
11.4 Pancreastumoren.......................................................................................................................................50
12. Gastro-intestinale heelkunde..................................................................52
12.1 Slokdarm en maag.....................................................................................................................................52
12.2 Heelkundige problemen v/d dunne darm...................................................................................................56
12.3 Chirurgische aanpak van colorectaal carcinoom.......................................................................................58
12.4 Heelkundige urgenties...............................................................................................................................59
12.5 Corpora aliena in de tractus digestivus......................................................................................................61
12.6 Stoma en fistel...........................................................................................................................................62
12.7 Chirurgisch beleid van faecale incontinentie.............................................................................................62
12.8 Heelkunde bij kinderen...............................................................................................................................62
13. Pathologische anatomie v/d gastro-intestinale tractus.............................66
14. Leverlijden............................................................................................. 66
15. Hepatocellulair lijden..............................................................................66
15.1 Oorzaken....................................................................................................................................................66
15.2 Algemene klinische kenmerken.................................................................................................................66
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, 15.3 Bijkomende kenmerken van chronisch leverlijden.....................................................................................67
15.4 Biologie.......................................................................................................................................................67
16. Hepatische ecefalopathie........................................................................68
16.1 Pathogenese...............................................................................................................................................68
16.2 Symptomen................................................................................................................................................68
16.3 Behandeling................................................................................................................................................68
17. Icterus................................................................................................... 69
17.1 Fysiopathologie..........................................................................................................................................69
17.2 Classificatie van icterus..............................................................................................................................69
18. Portale hypertensie................................................................................70
18.1 Definitie......................................................................................................................................................70
18.2 Etiologie......................................................................................................................................................70
18.3 Varices........................................................................................................................................................70
18.4 Ascites........................................................................................................................................................71
18.5 Hepatorenaal syndroom.............................................................................................................................72
19. Levercirrose........................................................................................... 73
19.1 Definitie......................................................................................................................................................73
19.2 Etiologie......................................................................................................................................................73
19.3 Diagnose.....................................................................................................................................................73
19.4 Symptomen................................................................................................................................................73
19.5 Prognose.....................................................................................................................................................74
20. Hepatitis................................................................................................ 74
20.1 Infectieuze hepatitis...................................................................................................................................74
21. Chronische immuungemedieerde cholestase............................................77
21.1 Primaire biliaire cholangitis (PBC)..............................................................................................................77
21.2 Primaire scleroserende cholangitis (PSC)...................................................................................................78
22. Nutritionele leveraandoeningen..............................................................79
21.1 Non-alcoholic fatty liver disease................................................................................................................79
23. Metabole genetisch bepaalde leveraandoeningen....................................80
23.1 Hereditaire hemochromatose.....................................................................................................................80
24. Leverlijden door chronische intoxicatie....................................................81
24.1 Alcoholisch leverlijden................................................................................................................................81
25. Toxiciteit door farmaca...........................................................................83
25.1 Intrinsiek (voorspelbare) hepatotoxische farmaca....................................................................................83
25.2 Idiosyncrasiedependente hepatotoxische farmaca....................................................................................84
26. Massa/tumor in de lever..........................................................................84
26.1 Primaire levertumoren................................................................................................................................84
26.2 Cysteuze leverletsels..................................................................................................................................85
26.3 Infectieuze oorzaken..................................................................................................................................86
26.4 Hydatidecyste – Echinococcus-cyste..........................................................................................................86
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, 27. Pathologisch-anatomische aspecten: pathologie v/d lever, galwegen en
pancreas...................................................................................................... 87
28. Galblaas en galwegen.............................................................................87
28.1 Congenitale aandoeningen v/d galwegen..................................................................................................87
28.2 Cholelithiasis..............................................................................................................................................87
28.3 Andere galblaasaandoeningen...................................................................................................................89
28.4 Choledocholithiasis.....................................................................................................................................89
28.5 Acute cholangitis........................................................................................................................................89
28.6 Choledocholithiasis zonder cholangitis......................................................................................................90
28.7 Biliaire pancreatitis.....................................................................................................................................90
28.8 Tumoren van galblaas en galwegen...........................................................................................................90
29. Buikwandpathologie...............................................................................91
29.1 Soorten breuken.........................................................................................................................................91
29.2 Indeling van buikwandbreuken..................................................................................................................91
29.3 Tumoren v/d buikwand...............................................................................................................................93
29.4 Hematoom in de rectusschede...................................................................................................................93
30. Abdominaal trauma................................................................................93
30.1 Algemene introductie en mortaliteit..........................................................................................................93
30.2 Soorten trauma..........................................................................................................................................94
30.3 Diagnose.....................................................................................................................................................94
30.4 Beleid van frequent beschadigde organen................................................................................................95
31. Leverchirurgie en levertransplantatie......................................................96
31.1 Inleiding en anatomie.................................................................................................................................96
31.2 Leverchirurgie............................................................................................................................................96
31.3 Orgaantransplantatie.................................................................................................................................97
32. Arbeidsgeneeskundige aspecten.............................................................97
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1. Aandoeningen van de slokdarm..................................................................5
1.1 Gastro-oesofageale refluxziekte (GERD)........................................................................................................5
1.2 Andere vormen van oesofagitis......................................................................................................................7
1.3 Zenker-divertikel............................................................................................................................................7
1.4 Dysfagie en achalasie.....................................................................................................................................7
1.5 Eosinofiele oesofagitis (EoE)..........................................................................................................................9
1.6 Maligne Slokdarmtumoren...........................................................................................................................10
1.7 Chirurgie van de slokdarm...........................................................................................................................10
2. Aandoeningen van maag en duodenum......................................................10
2.1 Gastritis en gastropathie..............................................................................................................................10
2.2 Ulcus duodeni en ulcus ventriculi.................................................................................................................10
2.3 Benigne en maligne tumoren van de maag.................................................................................................12
3. Aandoeningen v/d dunne darm..................................................................12
3.1 Initiële evaluatie bij vermoeden van dunnedarmaandoening......................................................................12
3.2 Malabsorptie.................................................................................................................................................14
3.3 Coeliakie – glutenintolerantie.......................................................................................................................14
3.4 Lactose – intolerantie...................................................................................................................................16
3.5 Bacteriële overgroei in de dunne darm........................................................................................................16
3.6 Andere oorzaken van chronische diarree tgv dunnedarmaandoening........................................................17
4. Chronische inflammatoire darmziekten (IBD).............................................18
4.1 Epidemiologie...............................................................................................................................................18
4.2 Etiopathogenese...........................................................................................................................................18
4.3 Differentiëren tussen CD en UC...................................................................................................................19
4.4 Kliniek, diagnose en behandeling bij ziekte van Crohn................................................................................19
4.5 Kliniek, diagnose en behandeling bij colitis ulcerosa...................................................................................21
4.6 Microscopische colitis...................................................................................................................................21
5. Disorders of gut-brain interaction (DGBI)...................................................22
5.1 Definitie DGBI...............................................................................................................................................22
5.2 Functionele dyspepsie..................................................................................................................................22
5.3 Prikkelbare – darmsyndroom (IBS)...............................................................................................................23
5.4 Functionele constipatie.................................................................................................................................25
5.5 Faecale incontinentie – conservatief beleid.................................................................................................26
5.6 Faecale incontinentie – chirurgisch beleid...................................................................................................27
6. Aandoeningen van anus en anaal kanaal...................................................27
6.1 Normale anatomie van anus en anaal kanaal..............................................................................................27
6.2 Anamnese.....................................................................................................................................................27
6.3 Proctologisch onderzoek..............................................................................................................................28
6.4 Proctologische aandoeningen......................................................................................................................28
6.5 Anorectitis....................................................................................................................................................33
6.6 Anaal carcinoom...........................................................................................................................................34
1
,7. Acute diarree........................................................................................... 34
7.1 Inleiding........................................................................................................................................................34
7.2 Pathofysiologie.............................................................................................................................................35
7.3 Etiologie........................................................................................................................................................35
7.4 Richtlijnen diagnostiek.................................................................................................................................36
7.5 Richlijnen beleid...........................................................................................................................................38
7.6 Indicaties voor opname................................................................................................................................39
8. Preventie colorectaal carcinoom................................................................40
8.1 Risicofactoren voor ontwikkelen van colorectaal carcinoom.......................................................................40
8.2 Colonpoliepen...............................................................................................................................................40
8.3 Secundaire preventie van colorectaal carcinoom........................................................................................41
9. Colorectaal carcinoom..............................................................................42
9.1 Symptomen..................................................................................................................................................42
9.2 Diagnostiek...................................................................................................................................................42
9.3 Colonkanker..................................................................................................................................................42
9.4 Rectumkanker..............................................................................................................................................42
9.5 Behandeling..................................................................................................................................................42
10. Gastro-intestinale bloeding.....................................................................43
10.1 Definities....................................................................................................................................................43
10.2 Initiële evaluatie bij GI-bloeding.................................................................................................................44
10.3 Hoge digestieve bloeding...........................................................................................................................44
10.4 Lage digestieve bloedingen.......................................................................................................................45
11. Aandoeningen v/d pancreas....................................................................47
11.1 Evaluatie van pancreaspathologie en exocriene pancreasfunctie.............................................................47
11.2 Acute pancreatitis......................................................................................................................................48
11.3 Chronische pancreatitis..............................................................................................................................49
11.4 Pancreastumoren.......................................................................................................................................50
12. Gastro-intestinale heelkunde..................................................................52
12.1 Slokdarm en maag.....................................................................................................................................52
12.2 Heelkundige problemen v/d dunne darm...................................................................................................56
12.3 Chirurgische aanpak van colorectaal carcinoom.......................................................................................58
12.4 Heelkundige urgenties...............................................................................................................................59
12.5 Corpora aliena in de tractus digestivus......................................................................................................61
12.6 Stoma en fistel...........................................................................................................................................62
12.7 Chirurgisch beleid van faecale incontinentie.............................................................................................62
12.8 Heelkunde bij kinderen...............................................................................................................................62
13. Pathologische anatomie v/d gastro-intestinale tractus.............................66
14. Leverlijden............................................................................................. 66
15. Hepatocellulair lijden..............................................................................66
15.1 Oorzaken....................................................................................................................................................66
15.2 Algemene klinische kenmerken.................................................................................................................66
2
, 15.3 Bijkomende kenmerken van chronisch leverlijden.....................................................................................67
15.4 Biologie.......................................................................................................................................................67
16. Hepatische ecefalopathie........................................................................68
16.1 Pathogenese...............................................................................................................................................68
16.2 Symptomen................................................................................................................................................68
16.3 Behandeling................................................................................................................................................68
17. Icterus................................................................................................... 69
17.1 Fysiopathologie..........................................................................................................................................69
17.2 Classificatie van icterus..............................................................................................................................69
18. Portale hypertensie................................................................................70
18.1 Definitie......................................................................................................................................................70
18.2 Etiologie......................................................................................................................................................70
18.3 Varices........................................................................................................................................................70
18.4 Ascites........................................................................................................................................................71
18.5 Hepatorenaal syndroom.............................................................................................................................72
19. Levercirrose........................................................................................... 73
19.1 Definitie......................................................................................................................................................73
19.2 Etiologie......................................................................................................................................................73
19.3 Diagnose.....................................................................................................................................................73
19.4 Symptomen................................................................................................................................................73
19.5 Prognose.....................................................................................................................................................74
20. Hepatitis................................................................................................ 74
20.1 Infectieuze hepatitis...................................................................................................................................74
21. Chronische immuungemedieerde cholestase............................................77
21.1 Primaire biliaire cholangitis (PBC)..............................................................................................................77
21.2 Primaire scleroserende cholangitis (PSC)...................................................................................................78
22. Nutritionele leveraandoeningen..............................................................79
21.1 Non-alcoholic fatty liver disease................................................................................................................79
23. Metabole genetisch bepaalde leveraandoeningen....................................80
23.1 Hereditaire hemochromatose.....................................................................................................................80
24. Leverlijden door chronische intoxicatie....................................................81
24.1 Alcoholisch leverlijden................................................................................................................................81
25. Toxiciteit door farmaca...........................................................................83
25.1 Intrinsiek (voorspelbare) hepatotoxische farmaca....................................................................................83
25.2 Idiosyncrasiedependente hepatotoxische farmaca....................................................................................84
26. Massa/tumor in de lever..........................................................................84
26.1 Primaire levertumoren................................................................................................................................84
26.2 Cysteuze leverletsels..................................................................................................................................85
26.3 Infectieuze oorzaken..................................................................................................................................86
26.4 Hydatidecyste – Echinococcus-cyste..........................................................................................................86
3
, 27. Pathologisch-anatomische aspecten: pathologie v/d lever, galwegen en
pancreas...................................................................................................... 87
28. Galblaas en galwegen.............................................................................87
28.1 Congenitale aandoeningen v/d galwegen..................................................................................................87
28.2 Cholelithiasis..............................................................................................................................................87
28.3 Andere galblaasaandoeningen...................................................................................................................89
28.4 Choledocholithiasis.....................................................................................................................................89
28.5 Acute cholangitis........................................................................................................................................89
28.6 Choledocholithiasis zonder cholangitis......................................................................................................90
28.7 Biliaire pancreatitis.....................................................................................................................................90
28.8 Tumoren van galblaas en galwegen...........................................................................................................90
29. Buikwandpathologie...............................................................................91
29.1 Soorten breuken.........................................................................................................................................91
29.2 Indeling van buikwandbreuken..................................................................................................................91
29.3 Tumoren v/d buikwand...............................................................................................................................93
29.4 Hematoom in de rectusschede...................................................................................................................93
30. Abdominaal trauma................................................................................93
30.1 Algemene introductie en mortaliteit..........................................................................................................93
30.2 Soorten trauma..........................................................................................................................................94
30.3 Diagnose.....................................................................................................................................................94
30.4 Beleid van frequent beschadigde organen................................................................................................95
31. Leverchirurgie en levertransplantatie......................................................96
31.1 Inleiding en anatomie.................................................................................................................................96
31.2 Leverchirurgie............................................................................................................................................96
31.3 Orgaantransplantatie.................................................................................................................................97
32. Arbeidsgeneeskundige aspecten.............................................................97
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