Inhoudsopgave
HOOFDSTUK 1: SEMIOLOGIE VAN HET ADEMSTELSEL.....................................................................................4
RESPIRATOIRE ANAMNESE.........................................................................................................................................4
RESPIRATOIRE KLACHTEN..........................................................................................................................................4
DYSPNEU...............................................................................................................................................................4
Speciale vormen...............................................................................................................................................5
Oorzaken:.........................................................................................................................................................5
hyperventilatiesyndroom.................................................................................................................................5
DYSPNEU METEN: SUBJECTIEF....................................................................................................................................5
borgschaal........................................................................................................................................................6
Medical research council (MRC).......................................................................................................................6
NYHA................................................................................................................................................................6
Saint George respiratory questionnaire: SGRQ................................................................................................7
BEHANDELING........................................................................................................................................................ 7
WHEEZE/STRIDOR...................................................................................................................................................7
HOEST...................................................................................................................................................................7
(sub) acute hoest..............................................................................................................................................7
chronische hoest...............................................................................................................................................8
SUPTUM/PHLEGM...................................................................................................................................................8
HEMOPTOË............................................................................................................................................................8
oorzaken van hemoptoë...................................................................................................................................9
BORSTPIJN............................................................................................................................................................. 9
borstwand pijn.................................................................................................................................................9
pleuritische pijn................................................................................................................................................9
retrosternale pijn..............................................................................................................................................9
SNURKEN...............................................................................................................................................................9
LICHAMELIJK ONDERZOEK........................................................................................................................................10
inspectie.........................................................................................................................................................10
HOOFDSTUK 2: STRUCTUUR EN FUNCTIE VAN ADEMHALINGSSYSTEEM........................................................12
HOOFDSTUK 3: VENTILATIE.......................................................................................................................... 15
HELIUM-VERDUNNING...........................................................................................................................................17
BODYBOX............................................................................................................................................................17
ADEMHALINGSPIEREN............................................................................................................................................17
TOTALE VENTILATIE V’E VS ALVEOLAIRE VENTILATIE V’A...............................................................................................18
HOOFDSTUK 4: SPIROMETRIE....................................................................................................................... 20
LONGFUNCTIETEST................................................................................................................................................ 20
GLOBAL LUNG FUNCTION INITIATIVE (GLI).................................................................................................................23
Conclusie GLI..................................................................................................................................................23
ASTMA EN COPD.................................................................................................................................................24
HOOFDSTUK 5: DIFFUSIE.............................................................................................................................. 26
CAPACITEIT VAN DE LONG ALS GASWISSELAAR.............................................................................................................26
WET VAN FICK.....................................................................................................................................................26
SINGLE BREATH DIFFUSIE-METING.............................................................................................................................27
HOOFDSTUK 6: GASTRANSPORT................................................................................................................... 29
Gastransport oiv diffusie................................................................................................................................29
Zuur-base evenwicht......................................................................................................................................29
HOOFDSTUK 7: CIRCULATIE.......................................................................................................................... 32
HOOFDSTUK 8: ADEMMECHANICA............................................................................................................... 35
ELASTICITEIT........................................................................................................................................................37
1
,HOOFDSTUK 9: ADEMREGULATIE................................................................................................................. 38
ADEMHALINGSFEEDBACK........................................................................................................................................40
CONCLUSIES.........................................................................................................................................................43
HOOFDSTUK 10: VENTILATIE-PERFUSIE VERHOUDINGEN..............................................................................44
HYPOVENTILATIE...................................................................................................................................................44
HOOFDSTUK 11: BLOEDGASSEN................................................................................................................... 48
HOOFDSTUK 12: LONGFUNCTIE.................................................................................................................... 54
statische longvolumes....................................................................................................................................54
HOOFDSTUK 13: ERGOMETRIE..................................................................................................................... 55
CARDIO PULMONAIRE OEFENING TEST.......................................................................................................................55
HOOFDSTUK 14: PATHOLOGIE VAN LONGZIEKTEN (NIET-NEOPLASTISCH).....................................................58
HISTOPATHOLOGISCHE PATRONEN............................................................................................................................58
Acute longschade diffuse alveoliare schade DAD.........................................................................................58
Neonatal respiratory distress syndroom.......................................................................................................59
Acute (lobaire) pneumonie............................................................................................................................59
Acute lobaire pneumonie...............................................................................................................................59
Chronische diffuse interstitiele longziekten..................................................................................................59
Acute bronchiolitis.........................................................................................................................................59
Bronchiolitis Obliterans syndroom................................................................................................................60
Chronische bronchitis....................................................................................................................................60
Emfyseem.......................................................................................................................................................60
Astma.............................................................................................................................................................61
Granulomateuze ontsteking..........................................................................................................................61
Granulomateuze ziekten van de long:...........................................................................................................61
Sarcoidose en de patholoog...........................................................................................................................63
Pneumoconiosis.............................................................................................................................................63
Hypersensiviteits pneumonitis (extrinsieke allergische alveolitis)................................................................65
Neuromusculaire ziekten en longziekten......................................................................................................65
Fetal akinesia sequence.................................................................................................................................65
Specifieke oorzaken acute longschade...........................................................................................................65
HOOFDSTUK 15: OBSTRUCTIEVE SLAAPAPNEU.............................................................................................67
DEFINITIE “SLAAPAPNEUSYNDROOM” SAS.................................................................................................................67
DIAGNOSE............................................................................................................................................................69
Polysomnografie............................................................................................................................................69
Cardiovasculaire effecten...............................................................................................................................71
behandeling....................................................................................................................................................72
HOOFDSTUK 16: CENTRAAL SLAAPAPNEUSYNDROOM CSAS.........................................................................73
HOOFDSTUK 17: NACHTELIJKE HYPOVENTILATIE.......................................................................................... 77
OBESITAS HYPOVENTILATIE SYNDROOM OHS.............................................................................................................78
CONCLUSIES.........................................................................................................................................................79
HOOFDSTUK 18: BEELDVORMING VAN DE THORAX......................................................................................80
HOOFDSTUK 19: DIEPTE EN HOOGTE FYSIOLOGIE......................................................................................... 81
HOOGTE............................................................................................................................................................. 81
hypoxie...........................................................................................................................................................82
Lichamelijke probelemen en toepassingen....................................................................................................84
besluiten op hoogte........................................................................................................................................85
DIEPTE................................................................................................................................................................86
Barotraumata bij duikers...............................................................................................................................88
2
, Decompressie aandoeningen bij Scuba..........................................................................................................90
besluiten op diepte.........................................................................................................................................90
HOOFDSTUK 20: MAATSCHAPPELIJKE ASPECTEN VAN ROKEN.......................................................................91
EMANCIPATIE.......................................................................................................................................................91
TECHNOLOGIE EN DESIGN........................................................................................................................................91
VERANDERE MINDSET: ROOKVRIJE STRATEN................................................................................................................92
CONCLUSIE..........................................................................................................................................................92
HOOFDSTUK 21: ROOKSTOPINTERVENTIE.................................................................................................... 93
HOOFDSTUK 22: BREATHOMICS................................................................................................................... 94
HOOFDSTUK 23: RESPIRATOIRE INSUFFICIËNTIE........................................................................................... 95
ZUURSTOFTHERAPIE.............................................................................................................................................101
CONCLUSIES.......................................................................................................................................................103
HOOFDSTUK 24: RESPIRATOIRE KINESITHERAPIE........................................................................................104
ADEMHALINGSFYSIOLOGIE.....................................................................................................................................104
RESPIRATOIRE INSUFFICIENTIE................................................................................................................................104
INTRAPULMONAIRE PRECUSSIVE VENTILATIE..............................................................................................................104
HOEST ASSISTENTIE..............................................................................................................................................105
HOOFDSTUK 25: KLINISCHE VOORBEELDEN: RESTRICTIEF EN OBSTRUCTIEF.................................................106
HOOFDSTUK 26: ROOKSTOP....................................................................................................................... 107
3
, HOOFDSTUK 1: SEMIOLOGIE VAN HET ADEMSTELSEL
Leer der ziekteklachten en tekenen
- Symptoom/klacht: subjectieve beschrijving door pt van een wijziging in
het lichaam of functie die op aandoening wijst
- Teken: afwijking bij lichamelijk onderzoek
- Syndroom: specifiek complex van symptomen en/of tekenen die naar
oorzaken verwijst
- Test: objectieve meting verricht aan bed of in lab/afdeling
RESPIRATOIRE ANAMNESE
1) Medische antecedentenk
2) Familiale anamnese
a. Astma, cystische fibrose (muco)
b. Kanker komt met clusters van symptomen
3) Roken?
a. 1 pakje sigaretten/dag gedurende 1 jaar = 1 pakjaar
b. 20 jaar ½ pakje roken/dag = 10 pakjaar
c. Hoeveel, hoelang, wat, gestopt?
4) Professioneel – hobbies
a. Blootstelling aan mineralen, dampen, asbest
b. Dieren en vogels
c. Duur blootstelling
RESPIRATOIRE KLACHTEN
Kortademigheid = dyspneu
Hoest
Sputum = expectoratie
Bloed ophoesten = hemoptoë
Pijn op de borst = precordialgie
Piepen
Snurken
DYSPNEU
= ontregelde adem
Subjectieve ervaring van verhoogde ademarbeid (kwalitatief
onderscheiden sensaties die in intensiteit variëren
Fysiologisch bij inspanning
Pathologisch in rust of bij beperkte inspanning
Complexe en multifactoriële mechanismen centraal en perifeer een bron
hebben
Onevenwicht tussen neurogene stimulatie van ademspieren en ventilatie
die bereikt wordt door deze spieren
4
HOOFDSTUK 1: SEMIOLOGIE VAN HET ADEMSTELSEL.....................................................................................4
RESPIRATOIRE ANAMNESE.........................................................................................................................................4
RESPIRATOIRE KLACHTEN..........................................................................................................................................4
DYSPNEU...............................................................................................................................................................4
Speciale vormen...............................................................................................................................................5
Oorzaken:.........................................................................................................................................................5
hyperventilatiesyndroom.................................................................................................................................5
DYSPNEU METEN: SUBJECTIEF....................................................................................................................................5
borgschaal........................................................................................................................................................6
Medical research council (MRC).......................................................................................................................6
NYHA................................................................................................................................................................6
Saint George respiratory questionnaire: SGRQ................................................................................................7
BEHANDELING........................................................................................................................................................ 7
WHEEZE/STRIDOR...................................................................................................................................................7
HOEST...................................................................................................................................................................7
(sub) acute hoest..............................................................................................................................................7
chronische hoest...............................................................................................................................................8
SUPTUM/PHLEGM...................................................................................................................................................8
HEMOPTOË............................................................................................................................................................8
oorzaken van hemoptoë...................................................................................................................................9
BORSTPIJN............................................................................................................................................................. 9
borstwand pijn.................................................................................................................................................9
pleuritische pijn................................................................................................................................................9
retrosternale pijn..............................................................................................................................................9
SNURKEN...............................................................................................................................................................9
LICHAMELIJK ONDERZOEK........................................................................................................................................10
inspectie.........................................................................................................................................................10
HOOFDSTUK 2: STRUCTUUR EN FUNCTIE VAN ADEMHALINGSSYSTEEM........................................................12
HOOFDSTUK 3: VENTILATIE.......................................................................................................................... 15
HELIUM-VERDUNNING...........................................................................................................................................17
BODYBOX............................................................................................................................................................17
ADEMHALINGSPIEREN............................................................................................................................................17
TOTALE VENTILATIE V’E VS ALVEOLAIRE VENTILATIE V’A...............................................................................................18
HOOFDSTUK 4: SPIROMETRIE....................................................................................................................... 20
LONGFUNCTIETEST................................................................................................................................................ 20
GLOBAL LUNG FUNCTION INITIATIVE (GLI).................................................................................................................23
Conclusie GLI..................................................................................................................................................23
ASTMA EN COPD.................................................................................................................................................24
HOOFDSTUK 5: DIFFUSIE.............................................................................................................................. 26
CAPACITEIT VAN DE LONG ALS GASWISSELAAR.............................................................................................................26
WET VAN FICK.....................................................................................................................................................26
SINGLE BREATH DIFFUSIE-METING.............................................................................................................................27
HOOFDSTUK 6: GASTRANSPORT................................................................................................................... 29
Gastransport oiv diffusie................................................................................................................................29
Zuur-base evenwicht......................................................................................................................................29
HOOFDSTUK 7: CIRCULATIE.......................................................................................................................... 32
HOOFDSTUK 8: ADEMMECHANICA............................................................................................................... 35
ELASTICITEIT........................................................................................................................................................37
1
,HOOFDSTUK 9: ADEMREGULATIE................................................................................................................. 38
ADEMHALINGSFEEDBACK........................................................................................................................................40
CONCLUSIES.........................................................................................................................................................43
HOOFDSTUK 10: VENTILATIE-PERFUSIE VERHOUDINGEN..............................................................................44
HYPOVENTILATIE...................................................................................................................................................44
HOOFDSTUK 11: BLOEDGASSEN................................................................................................................... 48
HOOFDSTUK 12: LONGFUNCTIE.................................................................................................................... 54
statische longvolumes....................................................................................................................................54
HOOFDSTUK 13: ERGOMETRIE..................................................................................................................... 55
CARDIO PULMONAIRE OEFENING TEST.......................................................................................................................55
HOOFDSTUK 14: PATHOLOGIE VAN LONGZIEKTEN (NIET-NEOPLASTISCH).....................................................58
HISTOPATHOLOGISCHE PATRONEN............................................................................................................................58
Acute longschade diffuse alveoliare schade DAD.........................................................................................58
Neonatal respiratory distress syndroom.......................................................................................................59
Acute (lobaire) pneumonie............................................................................................................................59
Acute lobaire pneumonie...............................................................................................................................59
Chronische diffuse interstitiele longziekten..................................................................................................59
Acute bronchiolitis.........................................................................................................................................59
Bronchiolitis Obliterans syndroom................................................................................................................60
Chronische bronchitis....................................................................................................................................60
Emfyseem.......................................................................................................................................................60
Astma.............................................................................................................................................................61
Granulomateuze ontsteking..........................................................................................................................61
Granulomateuze ziekten van de long:...........................................................................................................61
Sarcoidose en de patholoog...........................................................................................................................63
Pneumoconiosis.............................................................................................................................................63
Hypersensiviteits pneumonitis (extrinsieke allergische alveolitis)................................................................65
Neuromusculaire ziekten en longziekten......................................................................................................65
Fetal akinesia sequence.................................................................................................................................65
Specifieke oorzaken acute longschade...........................................................................................................65
HOOFDSTUK 15: OBSTRUCTIEVE SLAAPAPNEU.............................................................................................67
DEFINITIE “SLAAPAPNEUSYNDROOM” SAS.................................................................................................................67
DIAGNOSE............................................................................................................................................................69
Polysomnografie............................................................................................................................................69
Cardiovasculaire effecten...............................................................................................................................71
behandeling....................................................................................................................................................72
HOOFDSTUK 16: CENTRAAL SLAAPAPNEUSYNDROOM CSAS.........................................................................73
HOOFDSTUK 17: NACHTELIJKE HYPOVENTILATIE.......................................................................................... 77
OBESITAS HYPOVENTILATIE SYNDROOM OHS.............................................................................................................78
CONCLUSIES.........................................................................................................................................................79
HOOFDSTUK 18: BEELDVORMING VAN DE THORAX......................................................................................80
HOOFDSTUK 19: DIEPTE EN HOOGTE FYSIOLOGIE......................................................................................... 81
HOOGTE............................................................................................................................................................. 81
hypoxie...........................................................................................................................................................82
Lichamelijke probelemen en toepassingen....................................................................................................84
besluiten op hoogte........................................................................................................................................85
DIEPTE................................................................................................................................................................86
Barotraumata bij duikers...............................................................................................................................88
2
, Decompressie aandoeningen bij Scuba..........................................................................................................90
besluiten op diepte.........................................................................................................................................90
HOOFDSTUK 20: MAATSCHAPPELIJKE ASPECTEN VAN ROKEN.......................................................................91
EMANCIPATIE.......................................................................................................................................................91
TECHNOLOGIE EN DESIGN........................................................................................................................................91
VERANDERE MINDSET: ROOKVRIJE STRATEN................................................................................................................92
CONCLUSIE..........................................................................................................................................................92
HOOFDSTUK 21: ROOKSTOPINTERVENTIE.................................................................................................... 93
HOOFDSTUK 22: BREATHOMICS................................................................................................................... 94
HOOFDSTUK 23: RESPIRATOIRE INSUFFICIËNTIE........................................................................................... 95
ZUURSTOFTHERAPIE.............................................................................................................................................101
CONCLUSIES.......................................................................................................................................................103
HOOFDSTUK 24: RESPIRATOIRE KINESITHERAPIE........................................................................................104
ADEMHALINGSFYSIOLOGIE.....................................................................................................................................104
RESPIRATOIRE INSUFFICIENTIE................................................................................................................................104
INTRAPULMONAIRE PRECUSSIVE VENTILATIE..............................................................................................................104
HOEST ASSISTENTIE..............................................................................................................................................105
HOOFDSTUK 25: KLINISCHE VOORBEELDEN: RESTRICTIEF EN OBSTRUCTIEF.................................................106
HOOFDSTUK 26: ROOKSTOP....................................................................................................................... 107
3
, HOOFDSTUK 1: SEMIOLOGIE VAN HET ADEMSTELSEL
Leer der ziekteklachten en tekenen
- Symptoom/klacht: subjectieve beschrijving door pt van een wijziging in
het lichaam of functie die op aandoening wijst
- Teken: afwijking bij lichamelijk onderzoek
- Syndroom: specifiek complex van symptomen en/of tekenen die naar
oorzaken verwijst
- Test: objectieve meting verricht aan bed of in lab/afdeling
RESPIRATOIRE ANAMNESE
1) Medische antecedentenk
2) Familiale anamnese
a. Astma, cystische fibrose (muco)
b. Kanker komt met clusters van symptomen
3) Roken?
a. 1 pakje sigaretten/dag gedurende 1 jaar = 1 pakjaar
b. 20 jaar ½ pakje roken/dag = 10 pakjaar
c. Hoeveel, hoelang, wat, gestopt?
4) Professioneel – hobbies
a. Blootstelling aan mineralen, dampen, asbest
b. Dieren en vogels
c. Duur blootstelling
RESPIRATOIRE KLACHTEN
Kortademigheid = dyspneu
Hoest
Sputum = expectoratie
Bloed ophoesten = hemoptoë
Pijn op de borst = precordialgie
Piepen
Snurken
DYSPNEU
= ontregelde adem
Subjectieve ervaring van verhoogde ademarbeid (kwalitatief
onderscheiden sensaties die in intensiteit variëren
Fysiologisch bij inspanning
Pathologisch in rust of bij beperkte inspanning
Complexe en multifactoriële mechanismen centraal en perifeer een bron
hebben
Onevenwicht tussen neurogene stimulatie van ademspieren en ventilatie
die bereikt wordt door deze spieren
4
