ZIEKTELEER (PROF.
DIERICKX)
Academiejaar ’23 – ‘24
0
,INHOUDSOPGAVE
H1: KANKER ................................................................................................................................. 1
ALGEMEEN .......................................................................................................................................... 1
Definitie en kenmerken ................................................................................................................. 1
statistieken .................................................................................................................................. 2
Indeling ........................................................................................................................................ 2
diagnostisch pad .......................................................................................................................... 3
Symptomen.................................................................................................................................. 3
Lokale effecten (primaire tumor of metastasen) .......................................................................................... 3
lonkgkanker ........................................................................................................................................... 3
borstkanker ........................................................................................................................................... 4
Darmkanker ........................................................................................................................................... 4
huidkanker............................................................................................................................................. 4
centraal zenuwstelsel tumoren ............................................................................................................... 4
hematologische tumoren ....................................................................................................................... 5
metastasen ........................................................................................................................................... 5
niet-specifieke symptomen ........................................................................................................................ 5
metabole effecten...................................................................................................................................... 5
Tumor lysis syndroom ............................................................................................................................ 6
paraneoplastische symptomen .................................................................................................................. 6
Myasthenia gravis .................................................................................................................................. 6
alarmsymptomen ...................................................................................................................................... 7
Performantiestatus ....................................................................................................................... 7
Diagnose ...................................................................................................................................... 7
Bloedresultaten ......................................................................................................................................... 7
tumormerkers ........................................................................................................................................ 8
Histologische classificatie.......................................................................................................................... 8
Staging ...................................................................................................................................................... 8
lymfomen .............................................................................................................................................. 9
Solide (vaste) tumoren ........................................................................................................................... 9
Beeldvorming......................................................................................................................................... 9
OORZAKEN ........................................................................................................................................ 10
Medicatie ....................................................................................................................................10
biologische agentia ......................................................................................................................10
beroepsblootstelling/omgevingsfactoren ......................................................................................11
straling ........................................................................................................................................11
voeding .......................................................................................................................................11
middelen.....................................................................................................................................11
PREVENTIE......................................................................................................................................... 12
primaire preventie .......................................................................................................................12
secundaire preventie ...................................................................................................................12
Borstkanker ..............................................................................................................................................12
baarmoederhalskanker .............................................................................................................................13
colorectale kanker ....................................................................................................................................13
longkanker................................................................................................................................................13
prostaatkanker .........................................................................................................................................13
Melanoom ................................................................................................................................................14
BEHANDELING .................................................................................................................................... 14
chemotherapie ............................................................................................................................14
celcyclus ..................................................................................................................................................14
ontwikkeling .............................................................................................................................................14
, Toediening en dosis ..................................................................................................................................15
Principes ..................................................................................................................................................15
Nevenwerkingen .......................................................................................................................................15
chemotherapie geïnduceerde nausea en braken (CINV) ..........................................................................15
Myelotoxiciteit (beenmergtoxiciteit) .......................................................................................................16
diarree ..................................................................................................................................................16
constipatie ...........................................................................................................................................16
orale mucositis .....................................................................................................................................16
Andere orgaantoxiciteit .........................................................................................................................16
andere ..................................................................................................................................................17
heelkunde ...................................................................................................................................17
profylactische (preventieve) heelkunde ......................................................................................................17
diagnose en staging ..................................................................................................................................17
met curatief opzet .....................................................................................................................................17
Met palliatieve opzet .................................................................................................................................17
andere procedures....................................................................................................................................18
Radiotherapie ..............................................................................................................................18
Soorten behandeling .................................................................................................................................18
toediening ................................................................................................................................................18
nevenwerkingen ........................................................................................................................................19
H2: HEMATOLOGIE ...................................................................................................................... 20
BLOED .............................................................................................................................................. 20
structuur .....................................................................................................................................20
Plasma .....................................................................................................................................................20
Definities.....................................................................................................................................20
bloedcellen .................................................................................................................................21
rode bloedcellen (RBC) .............................................................................................................................21
witte bloedcellen (WBC) ............................................................................................................................21
Bloedplaatjes (BP).....................................................................................................................................22
afwijkingen ..................................................................................................................................22
Te weinig bloedcellen ................................................................................................................................22
Anemie .................................................................................................................................................22
leucopenie............................................................................................................................................23
thrombocytopenie ................................................................................................................................23
Te veel bloedcellen ...................................................................................................................................23
polycythemie ........................................................................................................................................23
leucocytose ..........................................................................................................................................23
thrombocytose .....................................................................................................................................24
Ziektebeelden ...........................................................................................................................................24
acute leukemie .....................................................................................................................................24
lymfoom ...............................................................................................................................................24
systeemziekten .....................................................................................................................................25
lupus ................................................................................................................................................25
systeemsclerose ...............................................................................................................................25
IMMUUNSYSTEEM ................................................................................................................................ 25
Lymfoïde organen ........................................................................................................................26
primaire/centrale ......................................................................................................................................26
Beenmerg .............................................................................................................................................26
thymus (zwezerik) .................................................................................................................................26
Secundaire/perifere ..................................................................................................................................26
tonsillen en Mucosa-associated lymphoid tissue (MAlt) ..........................................................................26
lymfeklier..............................................................................................................................................26
Milt .......................................................................................................................................................26
, Overzicht ..................................................................................................................................................27
Cellen .........................................................................................................................................27
Aspecifiek = Natuurlijke of aangeboren immuniteit .....................................................................................27
Specifieke = Verworven of adaptieve immuniteit .........................................................................................27
T-lymfocyten .........................................................................................................................................28
B-lymfocyten ........................................................................................................................................28
structuur van antistoffen ...................................................................................................................29
H3: CARDIOLOGIE ....................................................................................................................... 29
BLOEDSOMLOOP ................................................................................................................................. 30
BEVLOEIING ....................................................................................................................................... 30
HOLTES ............................................................................................................................................ 30
KLEPPEN .......................................................................................................................................... 31
WAND.............................................................................................................................................. 31
WERKING.......................................................................................................................................... 31
hartcyclus ...................................................................................................................................32
prikkelgeleiding ...........................................................................................................................32
elektrocardiogram (EKG) ...........................................................................................................................32
SYMPTOMEN ...................................................................................................................................... 33
ONDERZOEKEN ................................................................................................................................... 33
ZIEKTEN ............................................................................................................................................ 34
acuut myocardinfarct ..................................................................................................................34
toepassing: acuut coronair syndroom ........................................................................................................34
Hartfalen .....................................................................................................................................35
hartritmestoornissen ...................................................................................................................35
toepassingen ............................................................................................................................................35
ziekte van de hartkleppen.............................................................................................................36
endocarditis .............................................................................................................................................37
pericarditis ..................................................................................................................................37
Tamponnade ...............................................................................................................................37
aneurysma van de abdominale aorta ............................................................................................37
perifere arteriële insufficiëntie ......................................................................................................38
Cerebrovasculair accident (CVA) ..................................................................................................38
arteriële hypertensie ....................................................................................................................38
diepe veneuze thrombose ............................................................................................................39
longembool .................................................................................................................................39
H4: NEFROLOGIE ......................................................................................................................... 40
ANATOMIE ......................................................................................................................................... 41
onderdelen van het urinair stelsel .................................................................................................41
locatie nieren ..............................................................................................................................41
bouw van de nier .........................................................................................................................41
Bloedtoevoer naar de nieren ........................................................................................................41
Het nefron ...................................................................................................................................42
Glomerulus (vasculair) ..............................................................................................................................42
Tubulus (epitheliaal) .................................................................................................................................42
Werking van ADH op DTC en verzamelbuis .................................................................................................43
fysiologische processen ............................................................................................................................43
Bijnier .........................................................................................................................................43
Werking nieren ............................................................................................................................44
FUNCTIES NIEREN ............................................................................................................................... 45
,ONDERZOEKEN ................................................................................................................................... 45
urineonderzoek ...........................................................................................................................45
bloedonderzoek ..........................................................................................................................46
beeldvorming ..............................................................................................................................46
Andere onderzoeken ....................................................................................................................46
AANDOENINGEN ................................................................................................................................. 46
acute nierinsufficiëntie ................................................................................................................46
chronische nierinsufficiëntie ........................................................................................................47
nefrotisch syndroom ....................................................................................................................47
nierstenen ...................................................................................................................................48
pyelonefritis ................................................................................................................................48
, H1: KANKER
ALGEMEEN
DEFINITIE EN KENMERKEN
• Gekarakteriseerd door ongecontroleerde celdeling à groei van abnormaal weefsel
• Normaal vs kanker
Normaal Kanker
o Ontwikkeling en groei o Groei zonder de wetten van
o Volwassen weefsels het ecosysteem te
§ Homeostase behouden respecteren
– Stabiele toestand o Onaangepaste groei
– Herstel § Niet-adaptief:
§ Adaptief inspelen op wijzigende situaties zonder uitlokkende
– Hyperplasie = meer cellen aanmaken fysiologische
– Hypertrofie = grotere cellen aanmaken stimulus
– Flexibel en reversiebel § Niet flexibel of
reversibel: zonder
spontaan uitdoven
• Benigne vs maligne tumor
Benigne = goedaardig Maligne = kwaadaardig
Begrenzing Scherp Onregelmatig
Kapsel Frequent Zelden
Groeiwijze Niet-invasief Invasief
Groeisnelheid Laag Hoog
Necrose Zelden Frequent
Differentiatie Goed Slecht
Mitotische activiteit Laag Hoog
Metastasering Niet Wel
• Deling
1
DIERICKX)
Academiejaar ’23 – ‘24
0
,INHOUDSOPGAVE
H1: KANKER ................................................................................................................................. 1
ALGEMEEN .......................................................................................................................................... 1
Definitie en kenmerken ................................................................................................................. 1
statistieken .................................................................................................................................. 2
Indeling ........................................................................................................................................ 2
diagnostisch pad .......................................................................................................................... 3
Symptomen.................................................................................................................................. 3
Lokale effecten (primaire tumor of metastasen) .......................................................................................... 3
lonkgkanker ........................................................................................................................................... 3
borstkanker ........................................................................................................................................... 4
Darmkanker ........................................................................................................................................... 4
huidkanker............................................................................................................................................. 4
centraal zenuwstelsel tumoren ............................................................................................................... 4
hematologische tumoren ....................................................................................................................... 5
metastasen ........................................................................................................................................... 5
niet-specifieke symptomen ........................................................................................................................ 5
metabole effecten...................................................................................................................................... 5
Tumor lysis syndroom ............................................................................................................................ 6
paraneoplastische symptomen .................................................................................................................. 6
Myasthenia gravis .................................................................................................................................. 6
alarmsymptomen ...................................................................................................................................... 7
Performantiestatus ....................................................................................................................... 7
Diagnose ...................................................................................................................................... 7
Bloedresultaten ......................................................................................................................................... 7
tumormerkers ........................................................................................................................................ 8
Histologische classificatie.......................................................................................................................... 8
Staging ...................................................................................................................................................... 8
lymfomen .............................................................................................................................................. 9
Solide (vaste) tumoren ........................................................................................................................... 9
Beeldvorming......................................................................................................................................... 9
OORZAKEN ........................................................................................................................................ 10
Medicatie ....................................................................................................................................10
biologische agentia ......................................................................................................................10
beroepsblootstelling/omgevingsfactoren ......................................................................................11
straling ........................................................................................................................................11
voeding .......................................................................................................................................11
middelen.....................................................................................................................................11
PREVENTIE......................................................................................................................................... 12
primaire preventie .......................................................................................................................12
secundaire preventie ...................................................................................................................12
Borstkanker ..............................................................................................................................................12
baarmoederhalskanker .............................................................................................................................13
colorectale kanker ....................................................................................................................................13
longkanker................................................................................................................................................13
prostaatkanker .........................................................................................................................................13
Melanoom ................................................................................................................................................14
BEHANDELING .................................................................................................................................... 14
chemotherapie ............................................................................................................................14
celcyclus ..................................................................................................................................................14
ontwikkeling .............................................................................................................................................14
, Toediening en dosis ..................................................................................................................................15
Principes ..................................................................................................................................................15
Nevenwerkingen .......................................................................................................................................15
chemotherapie geïnduceerde nausea en braken (CINV) ..........................................................................15
Myelotoxiciteit (beenmergtoxiciteit) .......................................................................................................16
diarree ..................................................................................................................................................16
constipatie ...........................................................................................................................................16
orale mucositis .....................................................................................................................................16
Andere orgaantoxiciteit .........................................................................................................................16
andere ..................................................................................................................................................17
heelkunde ...................................................................................................................................17
profylactische (preventieve) heelkunde ......................................................................................................17
diagnose en staging ..................................................................................................................................17
met curatief opzet .....................................................................................................................................17
Met palliatieve opzet .................................................................................................................................17
andere procedures....................................................................................................................................18
Radiotherapie ..............................................................................................................................18
Soorten behandeling .................................................................................................................................18
toediening ................................................................................................................................................18
nevenwerkingen ........................................................................................................................................19
H2: HEMATOLOGIE ...................................................................................................................... 20
BLOED .............................................................................................................................................. 20
structuur .....................................................................................................................................20
Plasma .....................................................................................................................................................20
Definities.....................................................................................................................................20
bloedcellen .................................................................................................................................21
rode bloedcellen (RBC) .............................................................................................................................21
witte bloedcellen (WBC) ............................................................................................................................21
Bloedplaatjes (BP).....................................................................................................................................22
afwijkingen ..................................................................................................................................22
Te weinig bloedcellen ................................................................................................................................22
Anemie .................................................................................................................................................22
leucopenie............................................................................................................................................23
thrombocytopenie ................................................................................................................................23
Te veel bloedcellen ...................................................................................................................................23
polycythemie ........................................................................................................................................23
leucocytose ..........................................................................................................................................23
thrombocytose .....................................................................................................................................24
Ziektebeelden ...........................................................................................................................................24
acute leukemie .....................................................................................................................................24
lymfoom ...............................................................................................................................................24
systeemziekten .....................................................................................................................................25
lupus ................................................................................................................................................25
systeemsclerose ...............................................................................................................................25
IMMUUNSYSTEEM ................................................................................................................................ 25
Lymfoïde organen ........................................................................................................................26
primaire/centrale ......................................................................................................................................26
Beenmerg .............................................................................................................................................26
thymus (zwezerik) .................................................................................................................................26
Secundaire/perifere ..................................................................................................................................26
tonsillen en Mucosa-associated lymphoid tissue (MAlt) ..........................................................................26
lymfeklier..............................................................................................................................................26
Milt .......................................................................................................................................................26
, Overzicht ..................................................................................................................................................27
Cellen .........................................................................................................................................27
Aspecifiek = Natuurlijke of aangeboren immuniteit .....................................................................................27
Specifieke = Verworven of adaptieve immuniteit .........................................................................................27
T-lymfocyten .........................................................................................................................................28
B-lymfocyten ........................................................................................................................................28
structuur van antistoffen ...................................................................................................................29
H3: CARDIOLOGIE ....................................................................................................................... 29
BLOEDSOMLOOP ................................................................................................................................. 30
BEVLOEIING ....................................................................................................................................... 30
HOLTES ............................................................................................................................................ 30
KLEPPEN .......................................................................................................................................... 31
WAND.............................................................................................................................................. 31
WERKING.......................................................................................................................................... 31
hartcyclus ...................................................................................................................................32
prikkelgeleiding ...........................................................................................................................32
elektrocardiogram (EKG) ...........................................................................................................................32
SYMPTOMEN ...................................................................................................................................... 33
ONDERZOEKEN ................................................................................................................................... 33
ZIEKTEN ............................................................................................................................................ 34
acuut myocardinfarct ..................................................................................................................34
toepassing: acuut coronair syndroom ........................................................................................................34
Hartfalen .....................................................................................................................................35
hartritmestoornissen ...................................................................................................................35
toepassingen ............................................................................................................................................35
ziekte van de hartkleppen.............................................................................................................36
endocarditis .............................................................................................................................................37
pericarditis ..................................................................................................................................37
Tamponnade ...............................................................................................................................37
aneurysma van de abdominale aorta ............................................................................................37
perifere arteriële insufficiëntie ......................................................................................................38
Cerebrovasculair accident (CVA) ..................................................................................................38
arteriële hypertensie ....................................................................................................................38
diepe veneuze thrombose ............................................................................................................39
longembool .................................................................................................................................39
H4: NEFROLOGIE ......................................................................................................................... 40
ANATOMIE ......................................................................................................................................... 41
onderdelen van het urinair stelsel .................................................................................................41
locatie nieren ..............................................................................................................................41
bouw van de nier .........................................................................................................................41
Bloedtoevoer naar de nieren ........................................................................................................41
Het nefron ...................................................................................................................................42
Glomerulus (vasculair) ..............................................................................................................................42
Tubulus (epitheliaal) .................................................................................................................................42
Werking van ADH op DTC en verzamelbuis .................................................................................................43
fysiologische processen ............................................................................................................................43
Bijnier .........................................................................................................................................43
Werking nieren ............................................................................................................................44
FUNCTIES NIEREN ............................................................................................................................... 45
,ONDERZOEKEN ................................................................................................................................... 45
urineonderzoek ...........................................................................................................................45
bloedonderzoek ..........................................................................................................................46
beeldvorming ..............................................................................................................................46
Andere onderzoeken ....................................................................................................................46
AANDOENINGEN ................................................................................................................................. 46
acute nierinsufficiëntie ................................................................................................................46
chronische nierinsufficiëntie ........................................................................................................47
nefrotisch syndroom ....................................................................................................................47
nierstenen ...................................................................................................................................48
pyelonefritis ................................................................................................................................48
, H1: KANKER
ALGEMEEN
DEFINITIE EN KENMERKEN
• Gekarakteriseerd door ongecontroleerde celdeling à groei van abnormaal weefsel
• Normaal vs kanker
Normaal Kanker
o Ontwikkeling en groei o Groei zonder de wetten van
o Volwassen weefsels het ecosysteem te
§ Homeostase behouden respecteren
– Stabiele toestand o Onaangepaste groei
– Herstel § Niet-adaptief:
§ Adaptief inspelen op wijzigende situaties zonder uitlokkende
– Hyperplasie = meer cellen aanmaken fysiologische
– Hypertrofie = grotere cellen aanmaken stimulus
– Flexibel en reversiebel § Niet flexibel of
reversibel: zonder
spontaan uitdoven
• Benigne vs maligne tumor
Benigne = goedaardig Maligne = kwaadaardig
Begrenzing Scherp Onregelmatig
Kapsel Frequent Zelden
Groeiwijze Niet-invasief Invasief
Groeisnelheid Laag Hoog
Necrose Zelden Frequent
Differentiatie Goed Slecht
Mitotische activiteit Laag Hoog
Metastasering Niet Wel
• Deling
1
