Inhoud
Deel 1: Digestief stelsel ........................................................................................................................... 6
Hoofdstuk 1: Aandoeningen van de slokdarm .................................................................................... 6
1.1 Gastro – oesophageale refluxziekte (GERD) .............................................................................. 6
1.2 Andere vormen van oesophagitis ............................................................................................ 11
1.3 Zenker Divertikel ...................................................................................................................... 12
1.4 Dysfagie en achalasie............................................................................................................... 12
1.5 Eosinofiele oesophagitis .......................................................................................................... 15
1.6 Maligne slokdarmtumoren → zie hfdst. 12 ............................................................................. 16
1.7 Chirurgie van de slokdarm → zie hfdst. 12 .............................................................................. 16
Hoofdstuk 2: Aandoeningen van maag en duodenum ...................................................................... 17
2.1 Gastritis en gastropathie ......................................................................................................... 17
2.2 Ulcus duodeni en ulcus ventriculi ............................................................................................ 18
2.3 Benigne en maligne tumoren van de maag ............................................................................. 20
Hoofdstuk 3: Aandoeningen van de dunne darm ............................................................................. 21
3.1 Initiële evaluatie bij vermoeden van dunnedarmaandoening ................................................ 21
3.2 Malabsorptie ........................................................................................................................... 23
3.3 Coeliakie – glutenintolerantie.................................................................................................. 23
3.4 Lactose – intolerantie .............................................................................................................. 27
3.5 Bacteriële overgroei in dunne darm ........................................................................................ 28
3.6 Andere oorzaken van chronische diarree als gevolg van dunnedarmaandoening .................. 29
Hoofdstuk 4: Chronische inflammatoire darmziekten ...................................................................... 32
4.1 Epidemiologie .......................................................................................................................... 32
4.2 Etiopathogenese ...................................................................................................................... 32
4.3 Differentiëren tussen CD en UC ............................................................................................... 33
4.4 Kliniek, diagnose en behandeling bij ziekte van Crohn ........................................................... 35
4.5 Kliniek, diagnose en behandeling bij colitis ulcerosa .............................................................. 38
4.6 Microscopische colitis.............................................................................................................. 40
Hoofdstuk 5: Disorders of gut – brain interaction (DGBI).................................................................. 41
5.1 Definitie van disorders of gut – brain interaction (DGBI) ........................................................ 41
5.2 Functionele dyspepsie ............................................................................................................. 41
5.3 Prikkelbare darmsyndroom ..................................................................................................... 43
5.4 Functionele constipatie ........................................................................................................... 47
5.5 Faecale incontinentie – conservatief beleid ............................................................................ 51
5.6 Faecale incontinentie – chirurgisch beleid .............................................................................. 54
1
,Hoofdstuk 6: Aandoeningen van anus en anaal kanaal..................................................................... 55
6.1 Normale anatomie van anus en anaal kanaal ......................................................................... 55
6.2 Anamnese ................................................................................................................................ 56
6.3 Proctologisch onderzoek ......................................................................................................... 56
6.4 Proctologische aandoeningen ................................................................................................. 57
6.5 Anorectitis ............................................................................................................................... 67
6.6 Anaal carcinoom ...................................................................................................................... 69
Hoofdstuk 8: Preventie van colorectaal carcinoom ........................................................................... 70
8.1 Risicofactoren voor ontwikkelen van colorectaal carcinoom .................................................. 70
8.2 Colonpoliepen ......................................................................................................................... 71
8.3 Secundaire preventie van colorectaal carcinoom.................................................................... 74
Hoofdstuk 9: Colorectaal carcinoom ................................................................................................. 76
9.1 Symptomen ............................................................................................................................. 76
9.2 Diagnostiek .............................................................................................................................. 76
9.3 Colonkanker ............................................................................................................................. 77
9.4 Rectumkanker .......................................................................................................................... 77
9.5 Behandeling ............................................................................................................................. 78
Hoofdstuk 10 : Gastro – intestinale bloeding .................................................................................... 82
10.1 Definities................................................................................................................................ 82
10.2 Initiële evaluatie bij GI bloeding ............................................................................................ 82
10.3 Hoge digestieve bloedingen .................................................................................................. 83
10.4 Lage digestieve bloedingen ................................................................................................... 86
Hoofdstuk 11: Aandoeningen van de pancreas ................................................................................. 89
11.1 Evaluatie van pancreaspathologie en exocriene pancreasfunctie......................................... 89
11.2 Acute pancreatitis .................................................................................................................. 91
11.3 Chronische pancreatitis ......................................................................................................... 95
11.4 Pancreastumoren (Berrevoet) ............................................................................................... 99
11.5 Types van pancreas resecties .............................................................................................. 104
Hoofdstuk 12: Gastro – intestinale heelkunde ................................................................................ 106
12.1 Slokdarm en maag ............................................................................................................... 106
12.2 Heelkundige problemen van de dunne darm ...................................................................... 123
12.3 Chirurgische aanpak van colorectaal carcinoom ................................................................. 128
12.4 Heelkundige urgenties ......................................................................................................... 133
12.5 Corpora aliena in tractus digestivus .................................................................................... 139
12.6 Stoma en fistel ..................................................................................................................... 140
12.7 Chirurgische beleid van fecale incontinentie....................................................................... 145
2
, 12.8 Heekunde bij kinderen ........................................................................................................ 148
Hoofdstuk 13: Pathologische anatomie van de gastro – intestinale tractus ................................... 163
13.1 Diagnostische stalen ............................................................................................................ 163
13.2 Inflammatie en immunopathologie ..................................................................................... 163
13.3 Neoplasie ............................................................................................................................. 168
Hoofdstuk 14: Icterus ...................................................................................................................... 174
14.1 Syndroom van Gilbert .......................................................................................................... 174
14.2 Billirubinemetabolisme ....................................................................................................... 174
14.3 Casus .................................................................................................................................... 174
14.4 Differentiaaldiagnose........................................................................................................... 174
14.5 Cholecystitis ......................................................................................................................... 175
14.6 Galstenen............................................................................................................................. 176
14.7 Gedilateerde galwegen ........................................................................................................ 176
14.8 Tumoren .............................................................................................................................. 176
Deel 2: Hepatologie + chirurgie ........................................................................................................... 177
Hoofdstuk 1: Leverlijden.................................................................................................................. 177
Hoofdstuk 2: Hepatocellulair falen .................................................................................................. 178
2.1 Oorzaken................................................................................................................................ 178
2.2 Algemene klinische kenmerken ............................................................................................. 178
2.3 Bijkomende kenmerken chronisch leverlijden....................................................................... 178
2.4 Biologie .................................................................................................................................. 179
Hoofdstuk 3: Hepatische encefalopathie ........................................................................................ 180
3.1 Pathogenese .......................................................................................................................... 180
3.2 Symptomen ........................................................................................................................... 180
3.3 Behandeling ........................................................................................................................... 180
Hoofdstuk 4: Icterus ........................................................................................................................ 182
4.1 Fysiopathologie...................................................................................................................... 182
4.2 Classificatie van icterus .......................................................................................................... 182
Hoofdstuk 5: Portale hypertensie .................................................................................................... 184
5.1 Definitie ................................................................................................................................. 184
5.2 Etiologie ................................................................................................................................. 184
5.3 Varices ................................................................................................................................... 185
5.4 Ascites.................................................................................................................................... 187
5.5 Hepatorenaal syndroom ........................................................................................................ 190
Hoofdstuk 6: Levercirrose................................................................................................................ 191
6.1 Definitie ................................................................................................................................. 191
3
, 6.2 Etiologie ................................................................................................................................. 191
6.3 Diagnose ................................................................................................................................ 191
6.4 Symptomen ........................................................................................................................... 191
6.5 Prognose ................................................................................................................................ 192
Hoofdstuk 7: Hepatitis ..................................................................................................................... 193
7.1 Infectieuze hepatitis .............................................................................................................. 193
7.2 Chronische auto – immune hepatitis .................................................................................... 199
Hoofdstuk 8: Chronische immuungemedieerde cholestase............................................................ 201
8.1 Primaire biliaire cholangitis ................................................................................................... 201
8.2 Primaire scleroserende cholangitis ....................................................................................... 202
Hoofdstuk 9: Nutritionele leveraandoeningen ................................................................................ 204
9.1 Metabolic associated steatotic liver disease (MASLD) .......................................................... 204
Hoofdstuk 10: Metabole genetisch bepaalde leveraandoeningen ................................................. 206
10.1 Hereditaire hemochromatose ............................................................................................. 206
Hoofdstuk 11: Leverlijden door chronische intoxicatie ................................................................... 208
11.1 Alcoholisch leverlijden ......................................................................................................... 208
Hoofdstuk 12: Toxiciteit door farmaca ............................................................................................ 212
12.1 Intrinsiek (voorspelbare) hepatotoxische farmaca .............................................................. 212
12.2 Ideosyncrasiedependente hepatotoxische farmaca ............................................................ 212
Hoofdstuk 13: Massa/ tumor in de lever......................................................................................... 213
13.1 Primaire levertumoren ........................................................................................................ 213
13.2 Cysteuze leverletsels............................................................................................................ 216
13.3 Infectieuze oorzaken............................................................................................................ 217
13.4 Hyadatidecyste – Echinococcus – cyste ............................................................................... 217
Hoofdstuk 14: Pathologisch – anatomische aspecten: pathologie van de lever, galwegen, pancreas
......................................................................................................................................................... 221
14.1 Diagnostiek van leverziekten en ziekten van galwegen ...................................................... 221
14.2 Diagnostiek van pancreasziekten ........................................................................................ 237
Hoofdstuk 15: Galblaas en galwegen .............................................................................................. 240
15.1 Congenitale aandoeningen van de galwegen ...................................................................... 240
15.2 Cholelithiasis........................................................................................................................ 240
15.3 Andere galblaasaandoeningen ............................................................................................ 244
15.4 Choledocholithiasis.............................................................................................................. 245
15.5 Acute cholangitis ................................................................................................................. 246
15.6 Choledocholithiasis zonder cholangitis ............................................................................... 246
15.7 Biliaire pancreatitis .............................................................................................................. 247
4
Deel 1: Digestief stelsel ........................................................................................................................... 6
Hoofdstuk 1: Aandoeningen van de slokdarm .................................................................................... 6
1.1 Gastro – oesophageale refluxziekte (GERD) .............................................................................. 6
1.2 Andere vormen van oesophagitis ............................................................................................ 11
1.3 Zenker Divertikel ...................................................................................................................... 12
1.4 Dysfagie en achalasie............................................................................................................... 12
1.5 Eosinofiele oesophagitis .......................................................................................................... 15
1.6 Maligne slokdarmtumoren → zie hfdst. 12 ............................................................................. 16
1.7 Chirurgie van de slokdarm → zie hfdst. 12 .............................................................................. 16
Hoofdstuk 2: Aandoeningen van maag en duodenum ...................................................................... 17
2.1 Gastritis en gastropathie ......................................................................................................... 17
2.2 Ulcus duodeni en ulcus ventriculi ............................................................................................ 18
2.3 Benigne en maligne tumoren van de maag ............................................................................. 20
Hoofdstuk 3: Aandoeningen van de dunne darm ............................................................................. 21
3.1 Initiële evaluatie bij vermoeden van dunnedarmaandoening ................................................ 21
3.2 Malabsorptie ........................................................................................................................... 23
3.3 Coeliakie – glutenintolerantie.................................................................................................. 23
3.4 Lactose – intolerantie .............................................................................................................. 27
3.5 Bacteriële overgroei in dunne darm ........................................................................................ 28
3.6 Andere oorzaken van chronische diarree als gevolg van dunnedarmaandoening .................. 29
Hoofdstuk 4: Chronische inflammatoire darmziekten ...................................................................... 32
4.1 Epidemiologie .......................................................................................................................... 32
4.2 Etiopathogenese ...................................................................................................................... 32
4.3 Differentiëren tussen CD en UC ............................................................................................... 33
4.4 Kliniek, diagnose en behandeling bij ziekte van Crohn ........................................................... 35
4.5 Kliniek, diagnose en behandeling bij colitis ulcerosa .............................................................. 38
4.6 Microscopische colitis.............................................................................................................. 40
Hoofdstuk 5: Disorders of gut – brain interaction (DGBI).................................................................. 41
5.1 Definitie van disorders of gut – brain interaction (DGBI) ........................................................ 41
5.2 Functionele dyspepsie ............................................................................................................. 41
5.3 Prikkelbare darmsyndroom ..................................................................................................... 43
5.4 Functionele constipatie ........................................................................................................... 47
5.5 Faecale incontinentie – conservatief beleid ............................................................................ 51
5.6 Faecale incontinentie – chirurgisch beleid .............................................................................. 54
1
,Hoofdstuk 6: Aandoeningen van anus en anaal kanaal..................................................................... 55
6.1 Normale anatomie van anus en anaal kanaal ......................................................................... 55
6.2 Anamnese ................................................................................................................................ 56
6.3 Proctologisch onderzoek ......................................................................................................... 56
6.4 Proctologische aandoeningen ................................................................................................. 57
6.5 Anorectitis ............................................................................................................................... 67
6.6 Anaal carcinoom ...................................................................................................................... 69
Hoofdstuk 8: Preventie van colorectaal carcinoom ........................................................................... 70
8.1 Risicofactoren voor ontwikkelen van colorectaal carcinoom .................................................. 70
8.2 Colonpoliepen ......................................................................................................................... 71
8.3 Secundaire preventie van colorectaal carcinoom.................................................................... 74
Hoofdstuk 9: Colorectaal carcinoom ................................................................................................. 76
9.1 Symptomen ............................................................................................................................. 76
9.2 Diagnostiek .............................................................................................................................. 76
9.3 Colonkanker ............................................................................................................................. 77
9.4 Rectumkanker .......................................................................................................................... 77
9.5 Behandeling ............................................................................................................................. 78
Hoofdstuk 10 : Gastro – intestinale bloeding .................................................................................... 82
10.1 Definities................................................................................................................................ 82
10.2 Initiële evaluatie bij GI bloeding ............................................................................................ 82
10.3 Hoge digestieve bloedingen .................................................................................................. 83
10.4 Lage digestieve bloedingen ................................................................................................... 86
Hoofdstuk 11: Aandoeningen van de pancreas ................................................................................. 89
11.1 Evaluatie van pancreaspathologie en exocriene pancreasfunctie......................................... 89
11.2 Acute pancreatitis .................................................................................................................. 91
11.3 Chronische pancreatitis ......................................................................................................... 95
11.4 Pancreastumoren (Berrevoet) ............................................................................................... 99
11.5 Types van pancreas resecties .............................................................................................. 104
Hoofdstuk 12: Gastro – intestinale heelkunde ................................................................................ 106
12.1 Slokdarm en maag ............................................................................................................... 106
12.2 Heelkundige problemen van de dunne darm ...................................................................... 123
12.3 Chirurgische aanpak van colorectaal carcinoom ................................................................. 128
12.4 Heelkundige urgenties ......................................................................................................... 133
12.5 Corpora aliena in tractus digestivus .................................................................................... 139
12.6 Stoma en fistel ..................................................................................................................... 140
12.7 Chirurgische beleid van fecale incontinentie....................................................................... 145
2
, 12.8 Heekunde bij kinderen ........................................................................................................ 148
Hoofdstuk 13: Pathologische anatomie van de gastro – intestinale tractus ................................... 163
13.1 Diagnostische stalen ............................................................................................................ 163
13.2 Inflammatie en immunopathologie ..................................................................................... 163
13.3 Neoplasie ............................................................................................................................. 168
Hoofdstuk 14: Icterus ...................................................................................................................... 174
14.1 Syndroom van Gilbert .......................................................................................................... 174
14.2 Billirubinemetabolisme ....................................................................................................... 174
14.3 Casus .................................................................................................................................... 174
14.4 Differentiaaldiagnose........................................................................................................... 174
14.5 Cholecystitis ......................................................................................................................... 175
14.6 Galstenen............................................................................................................................. 176
14.7 Gedilateerde galwegen ........................................................................................................ 176
14.8 Tumoren .............................................................................................................................. 176
Deel 2: Hepatologie + chirurgie ........................................................................................................... 177
Hoofdstuk 1: Leverlijden.................................................................................................................. 177
Hoofdstuk 2: Hepatocellulair falen .................................................................................................. 178
2.1 Oorzaken................................................................................................................................ 178
2.2 Algemene klinische kenmerken ............................................................................................. 178
2.3 Bijkomende kenmerken chronisch leverlijden....................................................................... 178
2.4 Biologie .................................................................................................................................. 179
Hoofdstuk 3: Hepatische encefalopathie ........................................................................................ 180
3.1 Pathogenese .......................................................................................................................... 180
3.2 Symptomen ........................................................................................................................... 180
3.3 Behandeling ........................................................................................................................... 180
Hoofdstuk 4: Icterus ........................................................................................................................ 182
4.1 Fysiopathologie...................................................................................................................... 182
4.2 Classificatie van icterus .......................................................................................................... 182
Hoofdstuk 5: Portale hypertensie .................................................................................................... 184
5.1 Definitie ................................................................................................................................. 184
5.2 Etiologie ................................................................................................................................. 184
5.3 Varices ................................................................................................................................... 185
5.4 Ascites.................................................................................................................................... 187
5.5 Hepatorenaal syndroom ........................................................................................................ 190
Hoofdstuk 6: Levercirrose................................................................................................................ 191
6.1 Definitie ................................................................................................................................. 191
3
, 6.2 Etiologie ................................................................................................................................. 191
6.3 Diagnose ................................................................................................................................ 191
6.4 Symptomen ........................................................................................................................... 191
6.5 Prognose ................................................................................................................................ 192
Hoofdstuk 7: Hepatitis ..................................................................................................................... 193
7.1 Infectieuze hepatitis .............................................................................................................. 193
7.2 Chronische auto – immune hepatitis .................................................................................... 199
Hoofdstuk 8: Chronische immuungemedieerde cholestase............................................................ 201
8.1 Primaire biliaire cholangitis ................................................................................................... 201
8.2 Primaire scleroserende cholangitis ....................................................................................... 202
Hoofdstuk 9: Nutritionele leveraandoeningen ................................................................................ 204
9.1 Metabolic associated steatotic liver disease (MASLD) .......................................................... 204
Hoofdstuk 10: Metabole genetisch bepaalde leveraandoeningen ................................................. 206
10.1 Hereditaire hemochromatose ............................................................................................. 206
Hoofdstuk 11: Leverlijden door chronische intoxicatie ................................................................... 208
11.1 Alcoholisch leverlijden ......................................................................................................... 208
Hoofdstuk 12: Toxiciteit door farmaca ............................................................................................ 212
12.1 Intrinsiek (voorspelbare) hepatotoxische farmaca .............................................................. 212
12.2 Ideosyncrasiedependente hepatotoxische farmaca ............................................................ 212
Hoofdstuk 13: Massa/ tumor in de lever......................................................................................... 213
13.1 Primaire levertumoren ........................................................................................................ 213
13.2 Cysteuze leverletsels............................................................................................................ 216
13.3 Infectieuze oorzaken............................................................................................................ 217
13.4 Hyadatidecyste – Echinococcus – cyste ............................................................................... 217
Hoofdstuk 14: Pathologisch – anatomische aspecten: pathologie van de lever, galwegen, pancreas
......................................................................................................................................................... 221
14.1 Diagnostiek van leverziekten en ziekten van galwegen ...................................................... 221
14.2 Diagnostiek van pancreasziekten ........................................................................................ 237
Hoofdstuk 15: Galblaas en galwegen .............................................................................................. 240
15.1 Congenitale aandoeningen van de galwegen ...................................................................... 240
15.2 Cholelithiasis........................................................................................................................ 240
15.3 Andere galblaasaandoeningen ............................................................................................ 244
15.4 Choledocholithiasis.............................................................................................................. 245
15.5 Acute cholangitis ................................................................................................................. 246
15.6 Choledocholithiasis zonder cholangitis ............................................................................... 246
15.7 Biliaire pancreatitis .............................................................................................................. 247
4
