Spijsvertering & stofwisseling
Inhoudsopgave
Theorie..................................................................................................................................................4
Dunne darm.......................................................................................................................................4
Diarree...............................................................................................................................................4
Tonsillen............................................................................................................................................4
Ondervoeding....................................................................................................................................5
Aandoeningen.......................................................................................................................................6
Slokdarm............................................................................................................................................6
Dysfagie.........................................................................................................................................6
Achalasie........................................................................................................................................6
Slokdarmspasme............................................................................................................................7
Sclerodermie..................................................................................................................................7
Eosinofiele oesofagitis...................................................................................................................7
Reflux.............................................................................................................................................8
Plaveiselcelcarinoom.....................................................................................................................9
Adenocarcinoom............................................................................................................................9
Barrett oesophagus......................................................................................................................10
Maag................................................................................................................................................10
Ulcus pepticum............................................................................................................................10
Auto-immuun gastritis.................................................................................................................11
Helicobacter pylori gastritis.........................................................................................................11
Maagcarcinoom...........................................................................................................................11
Dunne darm.....................................................................................................................................12
Coeliakie......................................................................................................................................12
PDS (prikkelbare darm syndroom)...............................................................................................13
Short bowel syndrome.................................................................................................................13
Dikke darm.......................................................................................................................................13
Diverticulitis.................................................................................................................................14
Colorectaal carcinoom.................................................................................................................14
Poliep...........................................................................................................................................15
FAP (familiaire adenomateuze polyposis)....................................................................................15
IBD (inflammatory bowel disease)...............................................................................................15
Colitis ulcerosa.............................................................................................................................17
, Ziekte van Crohn..........................................................................................................................18
Galblaas...........................................................................................................................................19
Cholangiocarcinoom....................................................................................................................19
Cholelithiasis (galstenen).............................................................................................................20
Cholangitis...................................................................................................................................21
Cholecystitis.................................................................................................................................21
Cholestase (galstuwing)...............................................................................................................22
Choledochocystolithiasis..............................................................................................................22
Primaire biliaire cholangitis (PBC)................................................................................................22
Primaire scleroserende cholangitis (PSC).....................................................................................23
Pancreas..........................................................................................................................................23
Pancreatitis..................................................................................................................................23
Necrotische pancreatitis..............................................................................................................24
Insulinoom...................................................................................................................................24
Pancreascarcinoom......................................................................................................................24
Lever................................................................................................................................................25
Hepatische encefalopathie..........................................................................................................25
Hepatocellulair carcinoom (HCC).................................................................................................25
Hepatitis.......................................................................................................................................25
Heriditaire hemochromatose (ijzerstapelijksziekte)....................................................................27
Metabolic dysfunction-associated fatty liver disease (MAFLD)....................................................27
Ziekte van Wilson.........................................................................................................................28
Levercirrose.................................................................................................................................28
Portale hypertensie.....................................................................................................................30
Nieren..............................................................................................................................................30
Hydronefrose...............................................................................................................................30
Diagnostiek..........................................................................................................................................31
Bloed................................................................................................................................................31
Lab...............................................................................................................................................31
Tumormarkers.............................................................................................................................31
Röntgenfoto.....................................................................................................................................32
Barium slikfoto.............................................................................................................................32
Echo.................................................................................................................................................32
CT-scan............................................................................................................................................32
MRI..................................................................................................................................................32
Fecestest..........................................................................................................................................33
, Triple feces test (TFT)...................................................................................................................33
Duale feces test (DFT)..................................................................................................................33
Overig..............................................................................................................................................33
Manometrie (drukmeting)...........................................................................................................33
ERCP.............................................................................................................................................33
Behandelingen.....................................................................................................................................35
Bariatrische chirurgie (gastric bypass).........................................................................................35
J-Pouch........................................................................................................................................35
Whipple procedure......................................................................................................................35
Roux-en-Y gastric bypass.............................................................................................................36
Transarteriële chemo-embolisatie...............................................................................................37
Ablatie..........................................................................................................................................37
Levertransplantatie......................................................................................................................37
Maagresectie volgens Billroth......................................................................................................37
, Theorie
Dunne darm
Duodenum, jejunum, ileum
Opname van stoffen:
- Maag: ethanol, vitamine D
- Duodenum: ijzer, vitamine B, vitamin C, calcium, magnesium
- Jejunum: eiwitten, koolhydrate, vetten, vitamine A, vitamine D, vitamine E, vitamine K
- Ileum: vitamine B12, galzouten, galzuren
- Colon: water, korte keten vetzuren
Vitamine B12 te kort
Vetoplosbare vitamines: A, D, E, K
Wateroplosbare vitamines: B, C
Diarree
Clostridum dificile -> meest voorkomende verwekker van diarree bij een patiënt met antibiotica ->
deze komt altijd in de darm voor, maar door de verminderde afweer door antibiotica kan deze
omhoog komen
o Behandeling met metronizadol
o Groenige, stinkende ontlasting
Als de diarree wordt veroorzaakt door een bacterie, zijn de klachten vaak niet chronisch (gaan
vanzelf weg)
Differentiaaldiagnose:
- Infectie
o Parasiet -> giardia, wormen
o Bacterie -> salmonella, shigella, yersinia, campylobacter (SSYC)
o Virus -> norovirus
- Maligniteit (laag) -> coloncarcinoom
- IBD
- IBS (prikkelbare darmsyndroom)
- Medicatie -> NSAID’s, immuun- en chemotherapie, antibiotica, metformine, magnesium,
antihypertensiva
Diagnostiek:
- Feceskweek -> infectie
- Coloscopie -> IBD, maliniteit
- Bloed -> infectie, IBD, maligniteit
- Anamnese -> IBS, medicatie
Tonsillen
4 soorten:
- Adenoïd -> neustonsil
- Tubaire tonsil -> tonsilla tubaria
Inhoudsopgave
Theorie..................................................................................................................................................4
Dunne darm.......................................................................................................................................4
Diarree...............................................................................................................................................4
Tonsillen............................................................................................................................................4
Ondervoeding....................................................................................................................................5
Aandoeningen.......................................................................................................................................6
Slokdarm............................................................................................................................................6
Dysfagie.........................................................................................................................................6
Achalasie........................................................................................................................................6
Slokdarmspasme............................................................................................................................7
Sclerodermie..................................................................................................................................7
Eosinofiele oesofagitis...................................................................................................................7
Reflux.............................................................................................................................................8
Plaveiselcelcarinoom.....................................................................................................................9
Adenocarcinoom............................................................................................................................9
Barrett oesophagus......................................................................................................................10
Maag................................................................................................................................................10
Ulcus pepticum............................................................................................................................10
Auto-immuun gastritis.................................................................................................................11
Helicobacter pylori gastritis.........................................................................................................11
Maagcarcinoom...........................................................................................................................11
Dunne darm.....................................................................................................................................12
Coeliakie......................................................................................................................................12
PDS (prikkelbare darm syndroom)...............................................................................................13
Short bowel syndrome.................................................................................................................13
Dikke darm.......................................................................................................................................13
Diverticulitis.................................................................................................................................14
Colorectaal carcinoom.................................................................................................................14
Poliep...........................................................................................................................................15
FAP (familiaire adenomateuze polyposis)....................................................................................15
IBD (inflammatory bowel disease)...............................................................................................15
Colitis ulcerosa.............................................................................................................................17
, Ziekte van Crohn..........................................................................................................................18
Galblaas...........................................................................................................................................19
Cholangiocarcinoom....................................................................................................................19
Cholelithiasis (galstenen).............................................................................................................20
Cholangitis...................................................................................................................................21
Cholecystitis.................................................................................................................................21
Cholestase (galstuwing)...............................................................................................................22
Choledochocystolithiasis..............................................................................................................22
Primaire biliaire cholangitis (PBC)................................................................................................22
Primaire scleroserende cholangitis (PSC).....................................................................................23
Pancreas..........................................................................................................................................23
Pancreatitis..................................................................................................................................23
Necrotische pancreatitis..............................................................................................................24
Insulinoom...................................................................................................................................24
Pancreascarcinoom......................................................................................................................24
Lever................................................................................................................................................25
Hepatische encefalopathie..........................................................................................................25
Hepatocellulair carcinoom (HCC).................................................................................................25
Hepatitis.......................................................................................................................................25
Heriditaire hemochromatose (ijzerstapelijksziekte)....................................................................27
Metabolic dysfunction-associated fatty liver disease (MAFLD)....................................................27
Ziekte van Wilson.........................................................................................................................28
Levercirrose.................................................................................................................................28
Portale hypertensie.....................................................................................................................30
Nieren..............................................................................................................................................30
Hydronefrose...............................................................................................................................30
Diagnostiek..........................................................................................................................................31
Bloed................................................................................................................................................31
Lab...............................................................................................................................................31
Tumormarkers.............................................................................................................................31
Röntgenfoto.....................................................................................................................................32
Barium slikfoto.............................................................................................................................32
Echo.................................................................................................................................................32
CT-scan............................................................................................................................................32
MRI..................................................................................................................................................32
Fecestest..........................................................................................................................................33
, Triple feces test (TFT)...................................................................................................................33
Duale feces test (DFT)..................................................................................................................33
Overig..............................................................................................................................................33
Manometrie (drukmeting)...........................................................................................................33
ERCP.............................................................................................................................................33
Behandelingen.....................................................................................................................................35
Bariatrische chirurgie (gastric bypass).........................................................................................35
J-Pouch........................................................................................................................................35
Whipple procedure......................................................................................................................35
Roux-en-Y gastric bypass.............................................................................................................36
Transarteriële chemo-embolisatie...............................................................................................37
Ablatie..........................................................................................................................................37
Levertransplantatie......................................................................................................................37
Maagresectie volgens Billroth......................................................................................................37
, Theorie
Dunne darm
Duodenum, jejunum, ileum
Opname van stoffen:
- Maag: ethanol, vitamine D
- Duodenum: ijzer, vitamine B, vitamin C, calcium, magnesium
- Jejunum: eiwitten, koolhydrate, vetten, vitamine A, vitamine D, vitamine E, vitamine K
- Ileum: vitamine B12, galzouten, galzuren
- Colon: water, korte keten vetzuren
Vitamine B12 te kort
Vetoplosbare vitamines: A, D, E, K
Wateroplosbare vitamines: B, C
Diarree
Clostridum dificile -> meest voorkomende verwekker van diarree bij een patiënt met antibiotica ->
deze komt altijd in de darm voor, maar door de verminderde afweer door antibiotica kan deze
omhoog komen
o Behandeling met metronizadol
o Groenige, stinkende ontlasting
Als de diarree wordt veroorzaakt door een bacterie, zijn de klachten vaak niet chronisch (gaan
vanzelf weg)
Differentiaaldiagnose:
- Infectie
o Parasiet -> giardia, wormen
o Bacterie -> salmonella, shigella, yersinia, campylobacter (SSYC)
o Virus -> norovirus
- Maligniteit (laag) -> coloncarcinoom
- IBD
- IBS (prikkelbare darmsyndroom)
- Medicatie -> NSAID’s, immuun- en chemotherapie, antibiotica, metformine, magnesium,
antihypertensiva
Diagnostiek:
- Feceskweek -> infectie
- Coloscopie -> IBD, maliniteit
- Bloed -> infectie, IBD, maligniteit
- Anamnese -> IBS, medicatie
Tonsillen
4 soorten:
- Adenoïd -> neustonsil
- Tubaire tonsil -> tonsilla tubaria
