2024-
2025
Pathologie
spijsverteringsstelsel
PROF DR DE HERTOGH EN PROF DR ROSKAMS
JOZEFIEN CEULEMANS
,Bovenste GI-tractus ................................................................................................................... 4
De slokdarm............................................................................................................................ 4
1. Slokdarm: ontsteking ................................................................................................. 4
De normale slokdarm ..................................................................................................... 4
Reflux ziekte ................................................................................................................... 4
Andere vormen van oesofagitis ..................................................................................... 5
2. Slokdarm: Barret ........................................................................................................ 6
De maag: ontsteking............................................................................................................... 7
Gastritis .............................................................................................................................. 7
Acute hemorrhagische gastritis...................................................................................... 7
Chronische gastritis ........................................................................................................ 7
andere vormen gastritis ................................................................................................. 9
Peptische maagulcus .......................................................................................................... 9
Maag: tumor ......................................................................................................................... 10
algemeen .......................................................................................................................... 10
Inflammatoire darmziekten .................................................................................................... 10
Coeliakie ............................................................................................................................... 10
Inleiding ............................................................................................................................ 10
Definitie ............................................................................................................................ 11
Microscopie .................................................................................................................. 11
Differentieeldiagnose ................................................................................................... 11
Etiologie en pathogenese ............................................................................................. 11
Rol van PO ........................................................................................................................ 13
Diagnose ....................................................................................................................... 13
Opvolgen van patiënten onder glutenvrij dieet ........................................................... 13
Verwikkelingen detecteren .......................................................................................... 13
Colitis algemeen + specifieke vormen.................................................................................. 13
Microscopie normale colon .............................................................................................. 13
Symptomen en classificatie .............................................................................................. 14
Diagnose ........................................................................................................................... 14
Rol van PO ........................................................................................................................ 14
Acute zelflimiterende colitis ......................................................................................... 14
Specifieke infecties ....................................................................................................... 15
CIBD: colitis ulcerosa en ziekte van Crohn ........................................................................... 16
Definities .......................................................................................................................... 16
, Rol van PO ........................................................................................................................ 16
Chronische colitis ............................................................................................................. 16
Colitis ulcerosa ............................................................................................................. 17
Ziekte van Crohn........................................................................................................... 18
Differentieel diagnose .................................................................................................. 19
Microscopische colitis .......................................................................................................... 19
Colon neoformaties ................................................................................................................. 20
Colonpoliepen ...................................................................................................................... 20
Niet-neoplastische poliepen ............................................................................................ 20
Peutz-Jeghers poliep .................................................................................................... 21
Juveniele poliep ............................................................................................................ 21
Inflammatoire pseudopoliep ........................................................................................ 22
Nl mucosa ..................................................................................................................... 22
Hyperplastische poliep ................................................................................................. 23
Tussenvormen .................................................................................................................. 23
Sessiel serrated letsel ................................................................................................... 23
...................................................................................................................................... 24
Traditioneel serrated adenoom ................................................................................... 24
Neoplastische poliepen .................................................................................................... 24
Tubulair adenoom ........................................................................................................ 25
Villeus adenoom ........................................................................................................... 25
Andere .......................................................................................................................... 26
Coloncarcinoom ................................................................................................................... 26
Omvang van het probleem ............................................................................................... 26
Associaties, moleculaire pathologie ................................................................................. 26
Ontwikkeling................................................................................................................. 26
Presentatie colonCA ......................................................................................................... 27
Symptomen .................................................................................................................. 27
Rol van patholoog ............................................................................................................ 28
Type tumor ................................................................................................................... 28
Tumor graad ................................................................................................................. 29
Functionele lever pathologie .................................................................................................. 29
Algemene histologie en pathologie ..................................................................................... 29
Hele context leverhistologie ............................................................................................ 30
Hepatitis ............................................................................................................................... 31
, Spectrum van tekens ........................................................................................................ 31
Milde lobulaire hepatitis .............................................................................................. 31
Interfasehepatitis ......................................................................................................... 31
Bridging necrose ........................................................................................................... 32
Specifieke kenmerken hepatitis ....................................................................................... 32
Hepatitis C .................................................................................................................... 32
Hepatitis B .................................................................................................................... 33
Auto immune hepatitis................................................................................................. 33
...................................................................................................................................... 33
Toxische/xenobiotica ................................................................................................... 33
Steatohepatitis of metabool syndroom ............................................................................... 33
Fe depositie ...................................................................................................................... 35
Alfa-1 trypsine deficiëntie ................................................................................................ 36
Cholestatische leverziekten.................................................................................................. 36
Kenmerken van cholestase algemeen.............................................................................. 36
Specifieke ziekten ............................................................................................................. 37
Cholangiopathie: DD/ ................................................................................................... 39
Cirrogenese .......................................................................................................................... 39
Patronen ........................................................................................................................... 39
Regeneratie hepatocyten ................................................................................................. 40
Definitie cirrose ................................................................................................................ 41
Leverpathologie tumoren ........................................................................................................ 41
Goedaardige hepatocellulaire tumoren ............................................................................... 41
Focale nodulaire hyperplasie ........................................................................................... 41
Hepatocellulair adenoom ................................................................................................. 42
HNF1alfa mutatie ......................................................................................................... 42
B-catenine mutatie ....................................................................................................... 42
Inflammatoire adenomen ............................................................................................ 43
Carcinomen .......................................................................................................................... 43
Hepatocarcinogenese....................................................................................................... 43
Verschil dysplasie – maligne kanker................................................................................. 43
Kenmerken hooggradige dysplasie - kanker ................................................................ 44
Classificatie ....................................................................................................................... 44
Kankerstamcel .............................................................................................................. 44
Samenvatting.................................................................................................................... 46
2025
Pathologie
spijsverteringsstelsel
PROF DR DE HERTOGH EN PROF DR ROSKAMS
JOZEFIEN CEULEMANS
,Bovenste GI-tractus ................................................................................................................... 4
De slokdarm............................................................................................................................ 4
1. Slokdarm: ontsteking ................................................................................................. 4
De normale slokdarm ..................................................................................................... 4
Reflux ziekte ................................................................................................................... 4
Andere vormen van oesofagitis ..................................................................................... 5
2. Slokdarm: Barret ........................................................................................................ 6
De maag: ontsteking............................................................................................................... 7
Gastritis .............................................................................................................................. 7
Acute hemorrhagische gastritis...................................................................................... 7
Chronische gastritis ........................................................................................................ 7
andere vormen gastritis ................................................................................................. 9
Peptische maagulcus .......................................................................................................... 9
Maag: tumor ......................................................................................................................... 10
algemeen .......................................................................................................................... 10
Inflammatoire darmziekten .................................................................................................... 10
Coeliakie ............................................................................................................................... 10
Inleiding ............................................................................................................................ 10
Definitie ............................................................................................................................ 11
Microscopie .................................................................................................................. 11
Differentieeldiagnose ................................................................................................... 11
Etiologie en pathogenese ............................................................................................. 11
Rol van PO ........................................................................................................................ 13
Diagnose ....................................................................................................................... 13
Opvolgen van patiënten onder glutenvrij dieet ........................................................... 13
Verwikkelingen detecteren .......................................................................................... 13
Colitis algemeen + specifieke vormen.................................................................................. 13
Microscopie normale colon .............................................................................................. 13
Symptomen en classificatie .............................................................................................. 14
Diagnose ........................................................................................................................... 14
Rol van PO ........................................................................................................................ 14
Acute zelflimiterende colitis ......................................................................................... 14
Specifieke infecties ....................................................................................................... 15
CIBD: colitis ulcerosa en ziekte van Crohn ........................................................................... 16
Definities .......................................................................................................................... 16
, Rol van PO ........................................................................................................................ 16
Chronische colitis ............................................................................................................. 16
Colitis ulcerosa ............................................................................................................. 17
Ziekte van Crohn........................................................................................................... 18
Differentieel diagnose .................................................................................................. 19
Microscopische colitis .......................................................................................................... 19
Colon neoformaties ................................................................................................................. 20
Colonpoliepen ...................................................................................................................... 20
Niet-neoplastische poliepen ............................................................................................ 20
Peutz-Jeghers poliep .................................................................................................... 21
Juveniele poliep ............................................................................................................ 21
Inflammatoire pseudopoliep ........................................................................................ 22
Nl mucosa ..................................................................................................................... 22
Hyperplastische poliep ................................................................................................. 23
Tussenvormen .................................................................................................................. 23
Sessiel serrated letsel ................................................................................................... 23
...................................................................................................................................... 24
Traditioneel serrated adenoom ................................................................................... 24
Neoplastische poliepen .................................................................................................... 24
Tubulair adenoom ........................................................................................................ 25
Villeus adenoom ........................................................................................................... 25
Andere .......................................................................................................................... 26
Coloncarcinoom ................................................................................................................... 26
Omvang van het probleem ............................................................................................... 26
Associaties, moleculaire pathologie ................................................................................. 26
Ontwikkeling................................................................................................................. 26
Presentatie colonCA ......................................................................................................... 27
Symptomen .................................................................................................................. 27
Rol van patholoog ............................................................................................................ 28
Type tumor ................................................................................................................... 28
Tumor graad ................................................................................................................. 29
Functionele lever pathologie .................................................................................................. 29
Algemene histologie en pathologie ..................................................................................... 29
Hele context leverhistologie ............................................................................................ 30
Hepatitis ............................................................................................................................... 31
, Spectrum van tekens ........................................................................................................ 31
Milde lobulaire hepatitis .............................................................................................. 31
Interfasehepatitis ......................................................................................................... 31
Bridging necrose ........................................................................................................... 32
Specifieke kenmerken hepatitis ....................................................................................... 32
Hepatitis C .................................................................................................................... 32
Hepatitis B .................................................................................................................... 33
Auto immune hepatitis................................................................................................. 33
...................................................................................................................................... 33
Toxische/xenobiotica ................................................................................................... 33
Steatohepatitis of metabool syndroom ............................................................................... 33
Fe depositie ...................................................................................................................... 35
Alfa-1 trypsine deficiëntie ................................................................................................ 36
Cholestatische leverziekten.................................................................................................. 36
Kenmerken van cholestase algemeen.............................................................................. 36
Specifieke ziekten ............................................................................................................. 37
Cholangiopathie: DD/ ................................................................................................... 39
Cirrogenese .......................................................................................................................... 39
Patronen ........................................................................................................................... 39
Regeneratie hepatocyten ................................................................................................. 40
Definitie cirrose ................................................................................................................ 41
Leverpathologie tumoren ........................................................................................................ 41
Goedaardige hepatocellulaire tumoren ............................................................................... 41
Focale nodulaire hyperplasie ........................................................................................... 41
Hepatocellulair adenoom ................................................................................................. 42
HNF1alfa mutatie ......................................................................................................... 42
B-catenine mutatie ....................................................................................................... 42
Inflammatoire adenomen ............................................................................................ 43
Carcinomen .......................................................................................................................... 43
Hepatocarcinogenese....................................................................................................... 43
Verschil dysplasie – maligne kanker................................................................................. 43
Kenmerken hooggradige dysplasie - kanker ................................................................ 44
Classificatie ....................................................................................................................... 44
Kankerstamcel .............................................................................................................. 44
Samenvatting.................................................................................................................... 46
