SAMENVATTING
ZIEKTEMECHANISMEN
DEEL 1
,Inhoudsopgave
Inleiding ........................................................................................................................................................... 1
Ziekte versus gezondheid ................................................................................................................................. 2
Correcte omschrijving van ziekte en gezondheid ................................................................................................ 2
Biomedische benadering van gezondheid ..................................................................................................... 2
Visie van gezondheid en definitie van WHO .................................................................................................. 4
Ziektebeeld & ziektegedrag ................................................................................................................................ 5
Hoe verloopt een ziekteproces............................................................................................................................ 8
Etiologie van ziektes ...................................................................................................................................... 8
Prognose ........................................................................................................................................................ 9
Behandeling van ziekte ................................................................................................................................ 10
Hoe werkt een geneesmiddel? .................................................................................................................... 10
Waarom en hoe meten we gezondheid/ziekte? ............................................................................................... 11
Waarom meten we gezondheid? ................................................................................................................. 11
Volksgezondheid .......................................................................................................................................... 11
Welke gezondheidsindicatoren gebruiken we? ........................................................................................... 11
Epidemiologie .............................................................................................................................................. 16
Welke factoren bepalen gezondheid? ............................................................................................................... 17
Welke factoren bepalen gezondheid? ......................................................................................................... 17
Gezondheidsbevordering ............................................................................................................................. 18
Algemeen gezondheidsadvies ..................................................................................................................... 18
Public health care/openbare gezondheidszorg/publieke gezondheidszorg ................................................ 19
Wat omvat ziektepreventie? ............................................................................................................................. 19
Primaire preventie ....................................................................................................................................... 20
Secundaire preventie ................................................................................................................................... 20
Tertiaire preventie ....................................................................................................................................... 20
Quaternaire preventie ................................................................................................................................. 21
Ziektepreventie ............................................................................................................................................ 21
4 niveaus van preventie ............................................................................................................................... 21
Hoe stellen we diagnose van ziekte .................................................................................................................. 22
Medisch handelen ....................................................................................................................................... 22
Bijkomende onderzoeksmethoden .............................................................................................................. 23
Hoe is de gezondheidszorg georganiseerd? ..................................................................................................... 27
Echelonnering van de zorg ........................................................................................................................... 27
Organisatie GZHZ in België .......................................................................................................................... 28
Oxygenatie ..................................................................................................................................................... 31
Ademhaling en longventilatie ........................................................................................................................... 31
Ademhaling .................................................................................................................................................. 31
Het ademhalingsstelsel ................................................................................................................................ 33
Ventilatie ...................................................................................................................................................... 37
De gasuitwisseling ............................................................................................................................................ 42
Ventilatie-perfusie verhouding (V/Q) .......................................................................................................... 44
Waarop berust het transport van O2 en CO2?................................................................................................... 45
Rode bloedcellen/erytrocyten ..................................................................................................................... 45
Vorming en aanmaak van rode bloedcellen (erytropoëse) ......................................................................... 45
, Zuurstofdissociatiecurve (ODC) ................................................................................................................... 46
Regeling van de ademhaling en meting van de longvolumes .......................................................................... 46
Ademhalingscentrum in de hersenen .......................................................................................................... 47
Ademregulatie ............................................................................................................................................. 47
Ademhalingspatronen ................................................................................................................................. 48
Speciale vormen van AH .............................................................................................................................. 48
Longvolumes ................................................................................................................................................ 49
Parameters................................................................................................................................................... 50
Klachten veroorzaakt door longpathologie ...................................................................................................... 51
Anamnese .................................................................................................................................................... 51
Dyspneu ....................................................................................................................................................... 51
Restrictieve & obstructieve longpathologie ...................................................................................................... 54
Restrictieve aandoeningen .......................................................................................................................... 54
Obstructieve aandoeningen ........................................................................................................................ 54
Interpretatie flow/volume curve ................................................................................................................. 54
COPD ............................................................................................................................................................ 55
Pleurale effusie ............................................................................................................................................ 56
Pneumonie .................................................................................................................................................. 56
Longfibrose .................................................................................................................................................. 57
Astma bronchiale ......................................................................................................................................... 57
Hypoxie, hypercapnie & anemie ....................................................................................................................... 58
Hypoxie → onvoldoende O2 ........................................................................................................................ 58
Hypocapnie → te weinig CO2....................................................................................................................... 61
Hypercapnie → te veel CO2 ......................................................................................................................... 61
Belang van goede luchtkwaliteit ...................................................................................................................... 61
Samenstelling van de lucht .......................................................................................................................... 63
Luchtpollutie ................................................................................................................................................ 63
Stofwisseling .................................................................................................................................................. 69
Wat omvat het metabolisme? .......................................................................................................................... 69
Energie = ATP ............................................................................................................................................... 70
Afbraak van voedingsstoffen ............................................................................................................................ 71
Afbraak van calorische voedingsstoffen ...................................................................................................... 72
Energiewinning, anabolisme & katabolisme .................................................................................................... 77
Anabolisme & katabolisme .......................................................................................................................... 78
Voedingsstoffen nodig voor de energiebehoefte .............................................................................................. 81
Aanbevelingen voor de inname van voeding............................................................................................... 82
Regeling voedselinname ................................................................................................................................... 85
Obesitas ............................................................................................................................................................ 87
Gevolgen van obesitas ................................................................................................................................. 88
Oorzaken van obesitas ................................................................................................................................. 89
Aanpak van obesitas .................................................................................................................................... 89
Ondervoeding ................................................................................................................................................... 90
Oorzaken ...................................................................................................................................................... 90
Gevolgen ...................................................................................................................................................... 90
Klachten & afwijkingen door ziekten van de GI-tractus ................................................................................... 91
Pijn in de mond ............................................................................................................................................ 91
Foetor ex ore/halitose ................................................................................................................................. 91
Dysfagie ....................................................................................................................................................... 91
Odynofagie .................................................................................................................................................. 92
, Pyrosis (zuurbrand) ...................................................................................................................................... 92
Dyspepsie (= slecht gevoel bij maagstreek) of indigestie ............................................................................ 92
Regurgitatie ................................................................................................................................................. 92
Nausea, braken singultus (hik), ructus (boeren) .......................................................................................... 92
Meteorrhisme (opgespannen buik), borborygmie, flatulentie .................................................................... 92
Hematemesis (bloedbraken)........................................................................................................................ 92
Abdominale pijn .......................................................................................................................................... 93
Veranderingen van stoelgangspatroon, constipatie, diarree ....................................................................... 93
Klinisch onderzoek ............................................................................................................................................ 94
Inspectie ...................................................................................................................................................... 94
Percussie ...................................................................................................................................................... 94
Palpatie ........................................................................................................................................................ 94
Diagnose maagdarmziekten ............................................................................................................................. 95
Thermoregulatie ............................................................................................................................................... 98
Warmteafgifte .............................................................................................................................................. 99
Warmteproductie ........................................................................................................................................ 99
Lichaamstemperatuur.................................................................................................................................. 99
Hemostase ................................................................................................................................................... 101
Bloedstolling ................................................................................................................................................... 101
Werking van de bloedstolling .................................................................................................................... 101
Hemostase ................................................................................................................................................. 102
Stollingstesten ........................................................................................................................................... 109
Stollingsstoornissen ................................................................................................................................... 110
Behandeling van stollingsstoornissen ........................................................................................................ 114
De circulatie ................................................................................................................................................. 116
De hartfunctie en bloedsomloop .................................................................................................................... 116
Functies van het hart ................................................................................................................................. 116
Structuur van het hart ............................................................................................................................... 116
Bloedvoorziening en circulatie van het hart .............................................................................................. 118
Regeling van de hartactie .......................................................................................................................... 119
Bloeddruk en stroomsterkte ...................................................................................................................... 120
Theoretische opbouw van de bloeddruk/bloeddrukformule .................................................................... 120
Water- en zouthuishouding ............................................................................................................................ 124
Verdeling van water in het lichaam → vochtcompartimenten .................................................................. 124
Oedeem ..................................................................................................................................................... 126
Hart- en vaatziekten ....................................................................................................................................... 127
Anamnese cardiovasculair stelsel .............................................................................................................. 127
Klachten veroorzaakt door cardiovasculaire aandoenigen ........................................................................ 127
Diagnose van hart- en vaatziekten ............................................................................................................ 132
Hypertensie ............................................................................................................................................... 133
Hypotensie ................................................................................................................................................. 135
Hartfalen .................................................................................................................................................... 136
Atherosclerose ........................................................................................................................................... 137
Acuut coronair syndroom .......................................................................................................................... 137
Hartritmestoornissen................................................................................................................................. 137
Preventie van hart- en vaatziekten ............................................................................................................ 138
ZIEKTEMECHANISMEN
DEEL 1
,Inhoudsopgave
Inleiding ........................................................................................................................................................... 1
Ziekte versus gezondheid ................................................................................................................................. 2
Correcte omschrijving van ziekte en gezondheid ................................................................................................ 2
Biomedische benadering van gezondheid ..................................................................................................... 2
Visie van gezondheid en definitie van WHO .................................................................................................. 4
Ziektebeeld & ziektegedrag ................................................................................................................................ 5
Hoe verloopt een ziekteproces............................................................................................................................ 8
Etiologie van ziektes ...................................................................................................................................... 8
Prognose ........................................................................................................................................................ 9
Behandeling van ziekte ................................................................................................................................ 10
Hoe werkt een geneesmiddel? .................................................................................................................... 10
Waarom en hoe meten we gezondheid/ziekte? ............................................................................................... 11
Waarom meten we gezondheid? ................................................................................................................. 11
Volksgezondheid .......................................................................................................................................... 11
Welke gezondheidsindicatoren gebruiken we? ........................................................................................... 11
Epidemiologie .............................................................................................................................................. 16
Welke factoren bepalen gezondheid? ............................................................................................................... 17
Welke factoren bepalen gezondheid? ......................................................................................................... 17
Gezondheidsbevordering ............................................................................................................................. 18
Algemeen gezondheidsadvies ..................................................................................................................... 18
Public health care/openbare gezondheidszorg/publieke gezondheidszorg ................................................ 19
Wat omvat ziektepreventie? ............................................................................................................................. 19
Primaire preventie ....................................................................................................................................... 20
Secundaire preventie ................................................................................................................................... 20
Tertiaire preventie ....................................................................................................................................... 20
Quaternaire preventie ................................................................................................................................. 21
Ziektepreventie ............................................................................................................................................ 21
4 niveaus van preventie ............................................................................................................................... 21
Hoe stellen we diagnose van ziekte .................................................................................................................. 22
Medisch handelen ....................................................................................................................................... 22
Bijkomende onderzoeksmethoden .............................................................................................................. 23
Hoe is de gezondheidszorg georganiseerd? ..................................................................................................... 27
Echelonnering van de zorg ........................................................................................................................... 27
Organisatie GZHZ in België .......................................................................................................................... 28
Oxygenatie ..................................................................................................................................................... 31
Ademhaling en longventilatie ........................................................................................................................... 31
Ademhaling .................................................................................................................................................. 31
Het ademhalingsstelsel ................................................................................................................................ 33
Ventilatie ...................................................................................................................................................... 37
De gasuitwisseling ............................................................................................................................................ 42
Ventilatie-perfusie verhouding (V/Q) .......................................................................................................... 44
Waarop berust het transport van O2 en CO2?................................................................................................... 45
Rode bloedcellen/erytrocyten ..................................................................................................................... 45
Vorming en aanmaak van rode bloedcellen (erytropoëse) ......................................................................... 45
, Zuurstofdissociatiecurve (ODC) ................................................................................................................... 46
Regeling van de ademhaling en meting van de longvolumes .......................................................................... 46
Ademhalingscentrum in de hersenen .......................................................................................................... 47
Ademregulatie ............................................................................................................................................. 47
Ademhalingspatronen ................................................................................................................................. 48
Speciale vormen van AH .............................................................................................................................. 48
Longvolumes ................................................................................................................................................ 49
Parameters................................................................................................................................................... 50
Klachten veroorzaakt door longpathologie ...................................................................................................... 51
Anamnese .................................................................................................................................................... 51
Dyspneu ....................................................................................................................................................... 51
Restrictieve & obstructieve longpathologie ...................................................................................................... 54
Restrictieve aandoeningen .......................................................................................................................... 54
Obstructieve aandoeningen ........................................................................................................................ 54
Interpretatie flow/volume curve ................................................................................................................. 54
COPD ............................................................................................................................................................ 55
Pleurale effusie ............................................................................................................................................ 56
Pneumonie .................................................................................................................................................. 56
Longfibrose .................................................................................................................................................. 57
Astma bronchiale ......................................................................................................................................... 57
Hypoxie, hypercapnie & anemie ....................................................................................................................... 58
Hypoxie → onvoldoende O2 ........................................................................................................................ 58
Hypocapnie → te weinig CO2....................................................................................................................... 61
Hypercapnie → te veel CO2 ......................................................................................................................... 61
Belang van goede luchtkwaliteit ...................................................................................................................... 61
Samenstelling van de lucht .......................................................................................................................... 63
Luchtpollutie ................................................................................................................................................ 63
Stofwisseling .................................................................................................................................................. 69
Wat omvat het metabolisme? .......................................................................................................................... 69
Energie = ATP ............................................................................................................................................... 70
Afbraak van voedingsstoffen ............................................................................................................................ 71
Afbraak van calorische voedingsstoffen ...................................................................................................... 72
Energiewinning, anabolisme & katabolisme .................................................................................................... 77
Anabolisme & katabolisme .......................................................................................................................... 78
Voedingsstoffen nodig voor de energiebehoefte .............................................................................................. 81
Aanbevelingen voor de inname van voeding............................................................................................... 82
Regeling voedselinname ................................................................................................................................... 85
Obesitas ............................................................................................................................................................ 87
Gevolgen van obesitas ................................................................................................................................. 88
Oorzaken van obesitas ................................................................................................................................. 89
Aanpak van obesitas .................................................................................................................................... 89
Ondervoeding ................................................................................................................................................... 90
Oorzaken ...................................................................................................................................................... 90
Gevolgen ...................................................................................................................................................... 90
Klachten & afwijkingen door ziekten van de GI-tractus ................................................................................... 91
Pijn in de mond ............................................................................................................................................ 91
Foetor ex ore/halitose ................................................................................................................................. 91
Dysfagie ....................................................................................................................................................... 91
Odynofagie .................................................................................................................................................. 92
, Pyrosis (zuurbrand) ...................................................................................................................................... 92
Dyspepsie (= slecht gevoel bij maagstreek) of indigestie ............................................................................ 92
Regurgitatie ................................................................................................................................................. 92
Nausea, braken singultus (hik), ructus (boeren) .......................................................................................... 92
Meteorrhisme (opgespannen buik), borborygmie, flatulentie .................................................................... 92
Hematemesis (bloedbraken)........................................................................................................................ 92
Abdominale pijn .......................................................................................................................................... 93
Veranderingen van stoelgangspatroon, constipatie, diarree ....................................................................... 93
Klinisch onderzoek ............................................................................................................................................ 94
Inspectie ...................................................................................................................................................... 94
Percussie ...................................................................................................................................................... 94
Palpatie ........................................................................................................................................................ 94
Diagnose maagdarmziekten ............................................................................................................................. 95
Thermoregulatie ............................................................................................................................................... 98
Warmteafgifte .............................................................................................................................................. 99
Warmteproductie ........................................................................................................................................ 99
Lichaamstemperatuur.................................................................................................................................. 99
Hemostase ................................................................................................................................................... 101
Bloedstolling ................................................................................................................................................... 101
Werking van de bloedstolling .................................................................................................................... 101
Hemostase ................................................................................................................................................. 102
Stollingstesten ........................................................................................................................................... 109
Stollingsstoornissen ................................................................................................................................... 110
Behandeling van stollingsstoornissen ........................................................................................................ 114
De circulatie ................................................................................................................................................. 116
De hartfunctie en bloedsomloop .................................................................................................................... 116
Functies van het hart ................................................................................................................................. 116
Structuur van het hart ............................................................................................................................... 116
Bloedvoorziening en circulatie van het hart .............................................................................................. 118
Regeling van de hartactie .......................................................................................................................... 119
Bloeddruk en stroomsterkte ...................................................................................................................... 120
Theoretische opbouw van de bloeddruk/bloeddrukformule .................................................................... 120
Water- en zouthuishouding ............................................................................................................................ 124
Verdeling van water in het lichaam → vochtcompartimenten .................................................................. 124
Oedeem ..................................................................................................................................................... 126
Hart- en vaatziekten ....................................................................................................................................... 127
Anamnese cardiovasculair stelsel .............................................................................................................. 127
Klachten veroorzaakt door cardiovasculaire aandoenigen ........................................................................ 127
Diagnose van hart- en vaatziekten ............................................................................................................ 132
Hypertensie ............................................................................................................................................... 133
Hypotensie ................................................................................................................................................. 135
Hartfalen .................................................................................................................................................... 136
Atherosclerose ........................................................................................................................................... 137
Acuut coronair syndroom .......................................................................................................................... 137
Hartritmestoornissen................................................................................................................................. 137
Preventie van hart- en vaatziekten ............................................................................................................ 138
