Thema 1: diabetes mellitus .........................................................................................................................3
Fysiologie van suikerstofwisseling ............................................................................................................6
Etiologische classificatie van diabetes mellitus ........................................................................................7
Anamnese en lichamelijk onderzoek........................................................................................................9
Diagnosticeren van diabetes ..................................................................................................................10
Voedings- en leefstijladviezen ................................................................................................................12
Zelfcontrole, zelfregulatie, therapietrouw .............................................................................................14
Medicamenteuze behandeling bij type 1 ...............................................................................................14
Medicamenteuze behandeling bij type 2 ...............................................................................................16
Nieuwe medicatie...................................................................................................................................24
Controles ................................................................................................................................................25
Belangrijkste complicaties, hypo- en hyperglycaemie, ontregeling en ketoacidose .............................26
Diabetische voet .....................................................................................................................................31
Bij uitdroging/ziekte ...............................................................................................................................31
Culturele en sociale aspecten.................................................................................................................34
Ramadan.................................................................................................................................................34
Casus .......................................................................................................................................................35
Thema 2: dermatologie .............................................................................................................................36
Huid, lagen en functie ............................................................................................................................36
Lymfestelsel en functie...........................................................................................................................38
Globale werking van het immuunsysteem in relatie tot huidziekten ....................................................41
Allergie ....................................................................................................................................................42
Systematische beschrijving huidafwijking (volgens PROVOKE)..............................................................45
Meest voorkomende huidaandoeningen + differentiaaldiagnose .........................................................52
Eczeem – overzicht .................................................................................................................................53
Eczeem - contacteczeem ........................................................................................................................54
Eczeem – atopisch/ constitutioneel .......................................................................................................59
Eczeem – Seborrhoïsch...........................................................................................................................61
Eczeem/psoriasis anamnese/LO:............................................................................................................61
Psoriasis Van grieks psora: schurft. ........................................................................................................62
Maligniteit ..............................................................................................................................................65
Stadiumindeling bij een melanoom/ TNM .............................................................................................73
Donkere huid ..........................................................................................................................................74
Diverse culturele / psychosociale factoren ............................................................................................76
Communicatie afstemmen op diverse patiënten ...................................................................................77
Casus voorbeeld .....................................................................................................................................80
Thema 3: pijnlijke gewrichten ...................................................................................................................82
Anatomie van de grote gewrichten schouder, heup en knie .................................................................82
Oorzaken van gewrichtspijn ...................................................................................................................84
Groepen gewrichtsaandoeningen ..........................................................................................................84
Fysiologie van het immuunsysteem en immuunreacties .......................................................................85
Auto-immuniteit .....................................................................................................................................89
De belangrijkste stoorten immuunstoornissen ......................................................................................90
Anamnese ...............................................................................................................................................91
Lichamelijk onderzoek ............................................................................................................................92
Aanvullend onderzoek ............................................................................................................................95
Differentiaaldiagnose gewrichtsklachten ...............................................................................................97
Jicht .......................................................................................................................................................100
Fibromyalgie .........................................................................................................................................101
Diagnose reumatische artritis ..............................................................................................................102
Beleid ....................................................................................................................................................104
1
, Belangrijkste bijwerkingen van d-mard’s/biologicals en JAK-remmers ...............................................107
Kinderwens ...........................................................................................................................................108
Laaggeletterdheid.................................................................................................................................109
Thema 4: hartfalen ..................................................................................................................................110
Anatomie en pathofysiologisch mechanisme achter hartfalen ...........................................................110
Belangrijkste oorzaken .........................................................................................................................114
Klachten- en verschijnselenpatroon hartfalen .....................................................................................117
Anamnese en lichamelijk onderzoek....................................................................................................119
Aanvullend onderzoek ..........................................................................................................................121
Ernst van hartfalen volgens de NYHA-classificatie ...............................................................................121
Astma cardiale ......................................................................................................................................122
Atriumfibrilleren ...................................................................................................................................122
Differentiaaldiagnose ...........................................................................................................................123
Beleid ....................................................................................................................................................124
SLGT2-remmers ....................................................................................................................................131
Psychosociale gevolgen en de gevolgen voor de ADL ..........................................................................132
Acuut hartfalen .....................................................................................................................................133
Casus .....................................................................................................................................................135
Thema 5: rek uit de longen ......................................................................................................................140
Werking van de longen .........................................................................................................................140
Bloedgaswaarden .................................................................................................................................146
Astma en COPD pathofysiologie ...........................................................................................................151
Anamnese en lichamelijk onderzoek....................................................................................................159
Classificatie COPD .................................................................................................................................167
Globale zorgtraject ...............................................................................................................................168
Behandeling, medicatie ........................................................................................................................169
Complicaties .........................................................................................................................................177
NIV (non-invasieve mechanical ventilation) .........................................................................................178
COPD en fracturen................................................................................................................................179
Peri-operatieve risico’s bij COPD ..........................................................................................................179
Morele afwegingen bij niet instellen of staken van behandeling ........................................................181
Prognose COPD.....................................................................................................................................182
Farmacologie ............................................................................................................................................183
Persoonlijk behandelplan opstellen .....................................................................................................184
Bijwerkingen .........................................................................................................................................189
Wetenschap .............................................................................................................................................190
CAT........................................................................................................................................................190
Kwalitatief onderzoek...........................................................................................................................192
Practica .....................................................................................................................................................199
Labwaarden van alledaagse testen in de laboratoriumdiagnostiek ....................................................199
Thema 1: Gezamenlijke besluitvorming ...............................................................................................207
Thema 3: Bewegingsapparaat ..............................................................................................................209
Thema 4: Ethiek ....................................................................................................................................216
Anderhalve lijnszorg .............................................................................................................................218
2
,Thema 1: diabetes mellitus
3
, Diabètès: Oud Byzantijns-Grieks ‘ziekte die door het lichaam heen gaat’.
Mellitus: Glucose in de urine, artsen proefden de urine van patiënten.
Diabetes: Chronische verhoging van de bloedglucoseconcentratie.
Circa 1.000.000 mensen in Nederland, waarvan 100.000 type 1.
Koolhydraat is een keten aan elkaar gekoppelde glucose.
Heel lang = zetmeel. Heel kort = fructose en lactose.
Alvleesklier is nodig om lange ketens in stukjes te knippen.
Glucose wordt bewaard in het lichaam: lever bevat glycogeen (opslag).
Om suiker los te maken: glucogenolyse (glycogeen omzetten in glucose).
Opslag is voldoende voor circa 24 uur. Daarna spier/vetverbranding (spier = aminozuren):
gluconeogenese. Glucose en ketonen komen dan vrij.
Insuline is een sleutel voor een cel om glucose door te laten gaan. Zonder insuline komt glucose niet in
de cel. Heel hoog suikergehalte in bloed, geen opname, afvallen: DM 1. Insuline wordt gemaakt in de
eilandjes van Langerhans in de alvleesklier. Het zorgt er dus voor dat je suiker goed kunt gebruiken.
Suiker wordt opgeslagen of gebruikt. Suikergehalte in het bloed daalt.
4
Fysiologie van suikerstofwisseling ............................................................................................................6
Etiologische classificatie van diabetes mellitus ........................................................................................7
Anamnese en lichamelijk onderzoek........................................................................................................9
Diagnosticeren van diabetes ..................................................................................................................10
Voedings- en leefstijladviezen ................................................................................................................12
Zelfcontrole, zelfregulatie, therapietrouw .............................................................................................14
Medicamenteuze behandeling bij type 1 ...............................................................................................14
Medicamenteuze behandeling bij type 2 ...............................................................................................16
Nieuwe medicatie...................................................................................................................................24
Controles ................................................................................................................................................25
Belangrijkste complicaties, hypo- en hyperglycaemie, ontregeling en ketoacidose .............................26
Diabetische voet .....................................................................................................................................31
Bij uitdroging/ziekte ...............................................................................................................................31
Culturele en sociale aspecten.................................................................................................................34
Ramadan.................................................................................................................................................34
Casus .......................................................................................................................................................35
Thema 2: dermatologie .............................................................................................................................36
Huid, lagen en functie ............................................................................................................................36
Lymfestelsel en functie...........................................................................................................................38
Globale werking van het immuunsysteem in relatie tot huidziekten ....................................................41
Allergie ....................................................................................................................................................42
Systematische beschrijving huidafwijking (volgens PROVOKE)..............................................................45
Meest voorkomende huidaandoeningen + differentiaaldiagnose .........................................................52
Eczeem – overzicht .................................................................................................................................53
Eczeem - contacteczeem ........................................................................................................................54
Eczeem – atopisch/ constitutioneel .......................................................................................................59
Eczeem – Seborrhoïsch...........................................................................................................................61
Eczeem/psoriasis anamnese/LO:............................................................................................................61
Psoriasis Van grieks psora: schurft. ........................................................................................................62
Maligniteit ..............................................................................................................................................65
Stadiumindeling bij een melanoom/ TNM .............................................................................................73
Donkere huid ..........................................................................................................................................74
Diverse culturele / psychosociale factoren ............................................................................................76
Communicatie afstemmen op diverse patiënten ...................................................................................77
Casus voorbeeld .....................................................................................................................................80
Thema 3: pijnlijke gewrichten ...................................................................................................................82
Anatomie van de grote gewrichten schouder, heup en knie .................................................................82
Oorzaken van gewrichtspijn ...................................................................................................................84
Groepen gewrichtsaandoeningen ..........................................................................................................84
Fysiologie van het immuunsysteem en immuunreacties .......................................................................85
Auto-immuniteit .....................................................................................................................................89
De belangrijkste stoorten immuunstoornissen ......................................................................................90
Anamnese ...............................................................................................................................................91
Lichamelijk onderzoek ............................................................................................................................92
Aanvullend onderzoek ............................................................................................................................95
Differentiaaldiagnose gewrichtsklachten ...............................................................................................97
Jicht .......................................................................................................................................................100
Fibromyalgie .........................................................................................................................................101
Diagnose reumatische artritis ..............................................................................................................102
Beleid ....................................................................................................................................................104
1
, Belangrijkste bijwerkingen van d-mard’s/biologicals en JAK-remmers ...............................................107
Kinderwens ...........................................................................................................................................108
Laaggeletterdheid.................................................................................................................................109
Thema 4: hartfalen ..................................................................................................................................110
Anatomie en pathofysiologisch mechanisme achter hartfalen ...........................................................110
Belangrijkste oorzaken .........................................................................................................................114
Klachten- en verschijnselenpatroon hartfalen .....................................................................................117
Anamnese en lichamelijk onderzoek....................................................................................................119
Aanvullend onderzoek ..........................................................................................................................121
Ernst van hartfalen volgens de NYHA-classificatie ...............................................................................121
Astma cardiale ......................................................................................................................................122
Atriumfibrilleren ...................................................................................................................................122
Differentiaaldiagnose ...........................................................................................................................123
Beleid ....................................................................................................................................................124
SLGT2-remmers ....................................................................................................................................131
Psychosociale gevolgen en de gevolgen voor de ADL ..........................................................................132
Acuut hartfalen .....................................................................................................................................133
Casus .....................................................................................................................................................135
Thema 5: rek uit de longen ......................................................................................................................140
Werking van de longen .........................................................................................................................140
Bloedgaswaarden .................................................................................................................................146
Astma en COPD pathofysiologie ...........................................................................................................151
Anamnese en lichamelijk onderzoek....................................................................................................159
Classificatie COPD .................................................................................................................................167
Globale zorgtraject ...............................................................................................................................168
Behandeling, medicatie ........................................................................................................................169
Complicaties .........................................................................................................................................177
NIV (non-invasieve mechanical ventilation) .........................................................................................178
COPD en fracturen................................................................................................................................179
Peri-operatieve risico’s bij COPD ..........................................................................................................179
Morele afwegingen bij niet instellen of staken van behandeling ........................................................181
Prognose COPD.....................................................................................................................................182
Farmacologie ............................................................................................................................................183
Persoonlijk behandelplan opstellen .....................................................................................................184
Bijwerkingen .........................................................................................................................................189
Wetenschap .............................................................................................................................................190
CAT........................................................................................................................................................190
Kwalitatief onderzoek...........................................................................................................................192
Practica .....................................................................................................................................................199
Labwaarden van alledaagse testen in de laboratoriumdiagnostiek ....................................................199
Thema 1: Gezamenlijke besluitvorming ...............................................................................................207
Thema 3: Bewegingsapparaat ..............................................................................................................209
Thema 4: Ethiek ....................................................................................................................................216
Anderhalve lijnszorg .............................................................................................................................218
2
,Thema 1: diabetes mellitus
3
, Diabètès: Oud Byzantijns-Grieks ‘ziekte die door het lichaam heen gaat’.
Mellitus: Glucose in de urine, artsen proefden de urine van patiënten.
Diabetes: Chronische verhoging van de bloedglucoseconcentratie.
Circa 1.000.000 mensen in Nederland, waarvan 100.000 type 1.
Koolhydraat is een keten aan elkaar gekoppelde glucose.
Heel lang = zetmeel. Heel kort = fructose en lactose.
Alvleesklier is nodig om lange ketens in stukjes te knippen.
Glucose wordt bewaard in het lichaam: lever bevat glycogeen (opslag).
Om suiker los te maken: glucogenolyse (glycogeen omzetten in glucose).
Opslag is voldoende voor circa 24 uur. Daarna spier/vetverbranding (spier = aminozuren):
gluconeogenese. Glucose en ketonen komen dan vrij.
Insuline is een sleutel voor een cel om glucose door te laten gaan. Zonder insuline komt glucose niet in
de cel. Heel hoog suikergehalte in bloed, geen opname, afvallen: DM 1. Insuline wordt gemaakt in de
eilandjes van Langerhans in de alvleesklier. Het zorgt er dus voor dat je suiker goed kunt gebruiken.
Suiker wordt opgeslagen of gebruikt. Suikergehalte in het bloed daalt.
4
