RA-1 ENDTERM SAMENVATTING 2022
GENEESKUNDE UVA
INHOUDSOPGAVE
Sectie 1: Metabole systeem en diabetes mellitus ............................................................................................. 9
Deel 1: Vertering, enzymen en energiehuishouding ............................................................................................ 9
Enzymen .......................................................................................................................................................... 9
Begrippen .................................................................................................................................................... 9
Effecten van enzymen ............................................................................................................................... 10
Vertering ....................................................................................................................................................... 10
Soorten vertering ...................................................................................................................................... 10
Energiehuishouding ...................................................................................................................................... 11
Stap 1: Glyco-lyse (lysis van glucose) ........................................................................................................ 11
Stap 2: Citroenzuurcyclus .......................................................................................................................... 13
STAP 1: Klaarmaken voor de start ......................................................................................................... 13
Stap 2: De gehele cyclus ........................................................................................................................ 13
Stap 3: Oxidatieve fosforylering ................................................................................................................ 15
Aantal ATP gevormd .............................................................................................................................. 16
Zijstapje: Lactaat anaerobe glycolyse............................................................................................................ 16
Deel 2: Metabole routes .................................................................................................................................... 17
Metabole routes per cel compartiment samenvatting ................................................................................. 18
Wat vindt plaats in welke cel? ...................................................................................................................... 19
De gluconeogenese ....................................................................................................................................... 19
Gevaste toestand ...................................................................................................................................... 20
Gehongerde toestand ............................................................................................................................... 20
Vetzuursynthese (lipogenese) ....................................................................................................................... 20
Vetsynthese................................................................................................................................................... 21
Lipolyse (weer lysis!) ..................................................................................................................................... 21
Eiwitafbraak: ............................................................................................................................................. 22
Afval opruimen: ureumcyclus ....................................................................................................................... 23
Ketogenese: energie ..................................................................................................................................... 25
Ketogenese en ketoacidose bij diabetes: .................................................................................................. 25
Glycogeen-metabolisme ............................................................................................................................... 26
Deel 3: insuline, glucagon en diabetes mellitus ................................................................................................ 26
Insuline en glucagon: in samenspel .............................................................................................................. 27
Insuline .......................................................................................................................................................... 29
Vervolgstap insuline: binding .................................................................................................................... 30
Insuline en GLUT4 ..................................................................................................................................... 32
Insuline en het lichaam ............................................................................................................................. 33
Glucagon ....................................................................................................................................................... 34
Glucagon en het lichaam ........................................................................................................................... 34
Opname van glucose ................................................................................................................................. 35
1
, GLUT’s ........................................................................................................................................................... 35
Km ............................................................................................................................................................. 37
Diabetes mellitus........................................................................................................................................... 38
DM1 en DM2 ............................................................................................................................................. 38
Het HbA1C ................................................................................................................................................. 39
Verschil tussen diabetes type 1 en hongertoestand ................................................................................. 39
DM1 ........................................................................................................................................................... 40
Testen voor DM1 ....................................................................................................................................... 40
DM2 ........................................................................................................................................................... 41
Fase 1 .................................................................................................................................................... 41
Fase 2 .................................................................................................................................................... 41
DM2 lifestyle/genetics .............................................................................................................................. 42
DM2 medicatie .......................................................................................................................................... 42
Insulineschema’s: behandelingen ............................................................................................................. 44
Sectie 2: Pancreas, bovenbuikklachten, maagklachten (ulcus) ....................................................................... 45
Deel 1: Pancreas ................................................................................................................................................ 45
Embryologie .................................................................................................................................................. 45
Histologie pancreas ....................................................................................................................................... 47
DEEL 2: BOVENBUIKKLACHTEN ......................................................................................................................... 49
Alarmsymptomen! ........................................................................................................................................ 49
Maagklachten ................................................................................................................................................ 50
Helicobactor Pylori .................................................................................................................................... 52
Testen op H. Pylori ................................................................................................................................ 52
Relaties met maagklachten ....................................................................................................................... 52
Behandeling van maagpijn ........................................................................................................................ 52
Regimes ..................................................................................................................................................... 53
Ulcus (meervoud: ulcera) .............................................................................................................................. 53
2 typen ulcera............................................................................................................................................ 54
Deel 3: embryologie .......................................................................................................................................... 54
Holtes ............................................................................................................................................................ 54
Pleuro-pericardiale membraan en pleuro-peritoneale membraan .............................................................. 56
Oesofagus en trachea, 28 dagen ................................................................................................................... 57
Afwijkende anatomie .................................................................................................................................... 57
De lever ......................................................................................................................................................... 58
Porta hepatis ............................................................................................................................................. 60
Lever en galblaas ....................................................................................................................................... 61
Embryologische vouwingen .......................................................................................................................... 61
Verdere embryologie: open-dicht-open?...................................................................................................... 63
Intraperitoneaal en retroperitoneaal ............................................................................................................ 63
Peritoneum............................................................................................................................................ 64
Intraperitoneaal .................................................................................................................................... 65
Primair retroperitoneaal ....................................................................................................................... 66
Secundair retroperitoneaal ................................................................................................................... 66
Verdere embryologie .................................................................................................................................... 66
Sectie 3: Zenuwstelsel en darmen .................................................................................................................. 67
Deel 1: Zenuwstelsel .......................................................................................................................................... 67
2
, Autonoom zenuwstelsel ................................................................................................................................ 67
Deel 2: Darmmotiliteit ....................................................................................................................................... 70
Darmmotiliteit ............................................................................................................................................... 70
2 fases: Nuchter en gevoed ....................................................................................................................... 71
Nuchtere fase ........................................................................................................................................ 71
Gevoede fase ......................................................................................................................................... 72
Medicatie maag-darm motoriek ............................................................................................................... 74
Maagperistaltiek ........................................................................................................................................... 74
Sectie 4: De lever............................................................................................................................................ 75
Lever: acuut leverfalen .................................................................................................................................. 77
Lever en paracetamol.................................................................................................................................... 78
Hepatische encefalopathie............................................................................................................................ 79
Sectie 5: Histologie ......................................................................................................................................... 80
Cel en omgeving ............................................................................................................................................ 80
Celcyclus ........................................................................................................................................................ 80
3 typen cellen en 3 soorten celdelingen ................................................................................................... 81
Verschillende aanpassingen ...................................................................................................................... 82
Hypertrofie Hartspiercel........................................................................................................................ 82
Sectie 6: Weefseltypen ................................................................................................................................... 83
Deel 1: Epithelen ............................................................................................................................................... 83
Naamgeving epitheel .................................................................................................................................... 83
Verschillende soorten epithelen ................................................................................................................... 84
De epidermis van de huid ............................................................................................................................. 84
Klieren: exo- en endocrien ............................................................................................................................ 85
Klieren: soorten ......................................................................................................................................... 86
Junctionele complexen ................................................................................................................................. 87
Cel-celverbindingen................................................................................................................................... 87
Cel-matrixverbindingen ............................................................................................................................. 88
Deel 2: Oesophagus en maag ............................................................................................................................ 89
Oesophagus ................................................................................................................................................... 89
Maag ............................................................................................................................................................. 90
Gastric pits ................................................................................................................................................ 91
Deel 3: De darm ................................................................................................................................................. 91
Histologie ...................................................................................................................................................... 92
Sectie 7: Histologie: stapeling ......................................................................................................................... 93
Deel 1: Basisvormen van stapeling .................................................................................................................... 93
Ophoping van stoffen .................................................................................................................................... 93
Verkeerde vouwing ....................................................................................................................................... 95
Alfa-1-antitrypsine .................................................................................................................................... 95
Lipofuchsine .............................................................................................................................................. 96
Defect of ontbrekend enzym ........................................................................................................................ 97
Opname van niet-afbreekbaar materiaal ...................................................................................................... 97
Hemochromatose...................................................................................................................................... 97
3
, Antracose .................................................................................................................................................. 98
Deel 2: Andere vormen van stapeling ............................................................................................................... 99
Stapeling van pigment ................................................................................................................................... 99
Exogeen pigment....................................................................................................................................... 99
Stapeling van kalk.......................................................................................................................................... 99
Amyloïd en amyloïdose ............................................................................................................................... 100
Sectie 8: Celdood en regeneratie .................................................................................................................. 101
Deel 1: Celdood ............................................................................................................................................... 101
Waarom celdood? ....................................................................................................................................... 102
Verlaging ATP .......................................................................................................................................... 102
Reacties bij weefselschade: mitochondriën ........................................................................................ 103
Opname van calcium ............................................................................................................................... 103
Membraanbeschadiging .......................................................................................................................... 103
Misvouwing van eiwitten ........................................................................................................................ 104
Reperfusieschade ........................................................................................................................................ 105
Kleuring en bloedmeting ............................................................................................................................. 105
Deel 2: Radicalen ............................................................................................................................................. 106
Redoxreacties .............................................................................................................................................. 106
Zuurstofradicalen ........................................................................................................................................ 106
Zuurstofradicalen: superoxide ................................................................................................................ 106
Zuurstofradicalen: vrij ijzer ..................................................................................................................... 107
Het probleem .......................................................................................................................................... 107
Verdedigingsmechanismen voor radicalen. ............................................................................................ 108
Deel 3: Necrose en apoptose ‘in depth’ ........................................................................................................... 109
Apoptose: stoffen........................................................................................................................................ 109
Apoptose: mitochondriaal vs. death receptor. ........................................................................................... 109
Apoptose: overlevingssignalen ................................................................................................................... 110
Necrose: verschillende soorten................................................................................................................... 110
Coagulatienecrose ................................................................................................................................... 110
Vervloeiingsnecrose ................................................................................................................................ 111
Necrose herkennen ................................................................................................................................. 112
Vetnecrose .............................................................................................................................................. 112
Verkazende necrose ................................................................................................................................ 113
Fibrinoïde necrose ................................................................................................................................... 113
Sectie 9: Regeneratie.................................................................................................................................... 114
Regeneratie: stamcellen ............................................................................................................................. 114
Regeneratie: verschil per weefsel ............................................................................................................... 114
Regeneratie ................................................................................................................................................. 115
Lever regeneratie ........................................................................................................................................ 116
Sectie 10: Immuunsysteem .......................................................................................................................... 117
Deel 1: Basis afweer ........................................................................................................................................ 117
Immuunsysteem: Pattern Recognition Receptors (PRR) ............................................................................. 118
Immuunsysteem: Dendritische cellen ......................................................................................................... 118
Immuunsysteem: Natuurlijke afweer ......................................................................................................... 118
4
, Deel 2: Ontsteking vs. infectie ......................................................................................................................... 119
Ontsteking ................................................................................................................................................... 119
Ontsteking: componenten .......................................................................................................................... 119
Vasculaire component ............................................................................................................................ 119
Exsudatieve component .......................................................................................................................... 121
Cellulaire component .............................................................................................................................. 124
Sectie 11: Ontsteking en ontstekingscellen .................................................................................................. 126
Deel 1: Mediatoren.......................................................................................................................................... 126
Lokaal gevormd ........................................................................................................................................... 126
Histamine: lokaal gevormde mediator .................................................................................................... 126
Serotonine: lokaal gevormde mediator .................................................................................................. 127
Eicosanoïden: lokaal gevormde mediator ............................................................................................... 127
Nitric oxide (stikstofoxide) (EDRF): lokaal gevormde mediator .............................................................. 127
Elders gevormd ........................................................................................................................................... 128
Belangrijke cascades ............................................................................................................................... 128
Complement cascade .............................................................................................................................. 130
Groeifactoren .............................................................................................................................................. 130
Deel 2: Cellen van het immuunsysteem........................................................................................................... 131
Granulocyten ............................................................................................................................................... 131
Leukocyten (= witte bloedcellen) ................................................................................................................ 131
Cellen van het immuunsysteem bij ontstekingen ....................................................................................... 132
Typen van uitbreiding ................................................................................................................................. 132
Ziektebeeld: granuloom .............................................................................................................................. 133
Ziektebeeld: Lepra ....................................................................................................................................... 133
Sectie 12: Galwegen en galweg-pathologie .................................................................................................. 135
Cholelithiasis ............................................................................................................................................... 135
Asymptomatisch...................................................................................................................................... 135
Trias van symptomen .............................................................................................................................. 135
Onderzoek ............................................................................................................................................... 136
Cholecystectomie ........................................................................................................................................ 136
Choledocholithiasis (CBD-obstructie).......................................................................................................... 136
ERCP (endoscopische retrograde cholango pancreaticografie) .............................................................. 136
Cholecystitis ................................................................................................................................................ 137
Acalculeuze cholecystitis ............................................................................................................................. 137
Geelzucht/icterus ........................................................................................................................................ 137
Hepatitis ...................................................................................................................................................... 138
Primaire biliaire cholangitis (PBC) ............................................................................................................... 139
Primaire scleroserende cholangitis (PSC) .................................................................................................... 139
Sectie 13: Adaptieve immuniteit .................................................................................................................. 140
T-cellen ........................................................................................................................................................ 140
Verschillende soorten T-cellen ................................................................................................................ 143
T-helpercel (Th-cel) ............................................................................................................................. 143
Cytotoxische T-cel (Tc-cel)................................................................................................................... 143
CD4-T-cel ................................................................................................................................................. 143
CD8 → Tc-cel (cytotoxische T-cel) ........................................................................................................... 144
5
, Signalen ................................................................................................................................................... 144
B-cellen........................................................................................................................................................ 145
Antilichamen ............................................................................................................................................... 146
Bare lymphocyte syndrome type 1 ............................................................................................................. 149
Immuunrespons .......................................................................................................................................... 149
Rijksvaccinatie ............................................................................................................................................. 149
Sectie 14: Huidafwijkingen ........................................................................................................................... 150
Deel 1: ‘Beschrijf het met PROVOKE’ ............................................................................................................... 150
P - Plaats ...................................................................................................................................................... 150
R – Rangschikking ........................................................................................................................................ 150
O – Omvang ................................................................................................................................................. 150
V – Vorm...................................................................................................................................................... 151
O - Omtrek................................................................................................................................................... 152
Kleur ............................................................................................................................................................ 152
Efflorescentie .............................................................................................................................................. 152
Deel 2: Bacteriën ............................................................................................................................................. 153
Gram+ en Gram- | Endotoxinen en exotoxinen .......................................................................................... 153
gramkleuring ........................................................................................................................................... 153
Ziehl Neelsen-kleuring ............................................................................................................................. 154
bacterien: vormen ....................................................................................................................................... 155
pathogenen in het algemeen ...................................................................................................................... 155
Deel 3: Bacteriële huidinfecties ....................................................................................................................... 156
Erythrasma .................................................................................................................................................. 156
Folliculitis (puist) ......................................................................................................................................... 156
Impetigo (krentenbaard) ............................................................................................................................. 156
Impetiginisatie............................................................................................................................................. 156
Pitted keratolysis (keratolysis plantare sulcatum) ...................................................................................... 156
Cellulitis/Erysipelas (wondroos) .................................................................................................................. 157
Ecthyma-ulcus ............................................................................................................................................. 157
Ecthyma gangraenosum .............................................................................................................................. 157
Erysipeloïd (vlekziekte) ............................................................................................................................... 157
Furunkel/furunculose (diepe puist) ............................................................................................................ 157
karbunkel .................................................................................................................................................... 157
Necrotiserende wekendeleninfectie (NSTI) ................................................................................................ 157
Panaritium (fijt) ........................................................................................................................................... 158
Paronychia (omloop) ................................................................................................................................... 158
Staphylococcal Scalded Skin Syndrome (SSSS) ............................................................................................ 159
Whirlpool-dermatitis ................................................................................................................................... 159
Erythema migrans ....................................................................................................................................... 159
Bijtwonden .................................................................................................................................................. 159
Acne vulgaris ............................................................................................................................................... 159
Acne ectopica/inversa (hidrdadenitis suppurativa) .................................................................................... 159
Toxische shock-syndroom (TSS) .................................................................................................................. 160
Overig: fistel ................................................................................................................................................ 160
Overzicht van belangrijkste ziekteverwekkers ............................................................................................ 160
Sectie 15: Toevoegingen over pathogenen ................................................................................................... 160
6
GENEESKUNDE UVA
INHOUDSOPGAVE
Sectie 1: Metabole systeem en diabetes mellitus ............................................................................................. 9
Deel 1: Vertering, enzymen en energiehuishouding ............................................................................................ 9
Enzymen .......................................................................................................................................................... 9
Begrippen .................................................................................................................................................... 9
Effecten van enzymen ............................................................................................................................... 10
Vertering ....................................................................................................................................................... 10
Soorten vertering ...................................................................................................................................... 10
Energiehuishouding ...................................................................................................................................... 11
Stap 1: Glyco-lyse (lysis van glucose) ........................................................................................................ 11
Stap 2: Citroenzuurcyclus .......................................................................................................................... 13
STAP 1: Klaarmaken voor de start ......................................................................................................... 13
Stap 2: De gehele cyclus ........................................................................................................................ 13
Stap 3: Oxidatieve fosforylering ................................................................................................................ 15
Aantal ATP gevormd .............................................................................................................................. 16
Zijstapje: Lactaat anaerobe glycolyse............................................................................................................ 16
Deel 2: Metabole routes .................................................................................................................................... 17
Metabole routes per cel compartiment samenvatting ................................................................................. 18
Wat vindt plaats in welke cel? ...................................................................................................................... 19
De gluconeogenese ....................................................................................................................................... 19
Gevaste toestand ...................................................................................................................................... 20
Gehongerde toestand ............................................................................................................................... 20
Vetzuursynthese (lipogenese) ....................................................................................................................... 20
Vetsynthese................................................................................................................................................... 21
Lipolyse (weer lysis!) ..................................................................................................................................... 21
Eiwitafbraak: ............................................................................................................................................. 22
Afval opruimen: ureumcyclus ....................................................................................................................... 23
Ketogenese: energie ..................................................................................................................................... 25
Ketogenese en ketoacidose bij diabetes: .................................................................................................. 25
Glycogeen-metabolisme ............................................................................................................................... 26
Deel 3: insuline, glucagon en diabetes mellitus ................................................................................................ 26
Insuline en glucagon: in samenspel .............................................................................................................. 27
Insuline .......................................................................................................................................................... 29
Vervolgstap insuline: binding .................................................................................................................... 30
Insuline en GLUT4 ..................................................................................................................................... 32
Insuline en het lichaam ............................................................................................................................. 33
Glucagon ....................................................................................................................................................... 34
Glucagon en het lichaam ........................................................................................................................... 34
Opname van glucose ................................................................................................................................. 35
1
, GLUT’s ........................................................................................................................................................... 35
Km ............................................................................................................................................................. 37
Diabetes mellitus........................................................................................................................................... 38
DM1 en DM2 ............................................................................................................................................. 38
Het HbA1C ................................................................................................................................................. 39
Verschil tussen diabetes type 1 en hongertoestand ................................................................................. 39
DM1 ........................................................................................................................................................... 40
Testen voor DM1 ....................................................................................................................................... 40
DM2 ........................................................................................................................................................... 41
Fase 1 .................................................................................................................................................... 41
Fase 2 .................................................................................................................................................... 41
DM2 lifestyle/genetics .............................................................................................................................. 42
DM2 medicatie .......................................................................................................................................... 42
Insulineschema’s: behandelingen ............................................................................................................. 44
Sectie 2: Pancreas, bovenbuikklachten, maagklachten (ulcus) ....................................................................... 45
Deel 1: Pancreas ................................................................................................................................................ 45
Embryologie .................................................................................................................................................. 45
Histologie pancreas ....................................................................................................................................... 47
DEEL 2: BOVENBUIKKLACHTEN ......................................................................................................................... 49
Alarmsymptomen! ........................................................................................................................................ 49
Maagklachten ................................................................................................................................................ 50
Helicobactor Pylori .................................................................................................................................... 52
Testen op H. Pylori ................................................................................................................................ 52
Relaties met maagklachten ....................................................................................................................... 52
Behandeling van maagpijn ........................................................................................................................ 52
Regimes ..................................................................................................................................................... 53
Ulcus (meervoud: ulcera) .............................................................................................................................. 53
2 typen ulcera............................................................................................................................................ 54
Deel 3: embryologie .......................................................................................................................................... 54
Holtes ............................................................................................................................................................ 54
Pleuro-pericardiale membraan en pleuro-peritoneale membraan .............................................................. 56
Oesofagus en trachea, 28 dagen ................................................................................................................... 57
Afwijkende anatomie .................................................................................................................................... 57
De lever ......................................................................................................................................................... 58
Porta hepatis ............................................................................................................................................. 60
Lever en galblaas ....................................................................................................................................... 61
Embryologische vouwingen .......................................................................................................................... 61
Verdere embryologie: open-dicht-open?...................................................................................................... 63
Intraperitoneaal en retroperitoneaal ............................................................................................................ 63
Peritoneum............................................................................................................................................ 64
Intraperitoneaal .................................................................................................................................... 65
Primair retroperitoneaal ....................................................................................................................... 66
Secundair retroperitoneaal ................................................................................................................... 66
Verdere embryologie .................................................................................................................................... 66
Sectie 3: Zenuwstelsel en darmen .................................................................................................................. 67
Deel 1: Zenuwstelsel .......................................................................................................................................... 67
2
, Autonoom zenuwstelsel ................................................................................................................................ 67
Deel 2: Darmmotiliteit ....................................................................................................................................... 70
Darmmotiliteit ............................................................................................................................................... 70
2 fases: Nuchter en gevoed ....................................................................................................................... 71
Nuchtere fase ........................................................................................................................................ 71
Gevoede fase ......................................................................................................................................... 72
Medicatie maag-darm motoriek ............................................................................................................... 74
Maagperistaltiek ........................................................................................................................................... 74
Sectie 4: De lever............................................................................................................................................ 75
Lever: acuut leverfalen .................................................................................................................................. 77
Lever en paracetamol.................................................................................................................................... 78
Hepatische encefalopathie............................................................................................................................ 79
Sectie 5: Histologie ......................................................................................................................................... 80
Cel en omgeving ............................................................................................................................................ 80
Celcyclus ........................................................................................................................................................ 80
3 typen cellen en 3 soorten celdelingen ................................................................................................... 81
Verschillende aanpassingen ...................................................................................................................... 82
Hypertrofie Hartspiercel........................................................................................................................ 82
Sectie 6: Weefseltypen ................................................................................................................................... 83
Deel 1: Epithelen ............................................................................................................................................... 83
Naamgeving epitheel .................................................................................................................................... 83
Verschillende soorten epithelen ................................................................................................................... 84
De epidermis van de huid ............................................................................................................................. 84
Klieren: exo- en endocrien ............................................................................................................................ 85
Klieren: soorten ......................................................................................................................................... 86
Junctionele complexen ................................................................................................................................. 87
Cel-celverbindingen................................................................................................................................... 87
Cel-matrixverbindingen ............................................................................................................................. 88
Deel 2: Oesophagus en maag ............................................................................................................................ 89
Oesophagus ................................................................................................................................................... 89
Maag ............................................................................................................................................................. 90
Gastric pits ................................................................................................................................................ 91
Deel 3: De darm ................................................................................................................................................. 91
Histologie ...................................................................................................................................................... 92
Sectie 7: Histologie: stapeling ......................................................................................................................... 93
Deel 1: Basisvormen van stapeling .................................................................................................................... 93
Ophoping van stoffen .................................................................................................................................... 93
Verkeerde vouwing ....................................................................................................................................... 95
Alfa-1-antitrypsine .................................................................................................................................... 95
Lipofuchsine .............................................................................................................................................. 96
Defect of ontbrekend enzym ........................................................................................................................ 97
Opname van niet-afbreekbaar materiaal ...................................................................................................... 97
Hemochromatose...................................................................................................................................... 97
3
, Antracose .................................................................................................................................................. 98
Deel 2: Andere vormen van stapeling ............................................................................................................... 99
Stapeling van pigment ................................................................................................................................... 99
Exogeen pigment....................................................................................................................................... 99
Stapeling van kalk.......................................................................................................................................... 99
Amyloïd en amyloïdose ............................................................................................................................... 100
Sectie 8: Celdood en regeneratie .................................................................................................................. 101
Deel 1: Celdood ............................................................................................................................................... 101
Waarom celdood? ....................................................................................................................................... 102
Verlaging ATP .......................................................................................................................................... 102
Reacties bij weefselschade: mitochondriën ........................................................................................ 103
Opname van calcium ............................................................................................................................... 103
Membraanbeschadiging .......................................................................................................................... 103
Misvouwing van eiwitten ........................................................................................................................ 104
Reperfusieschade ........................................................................................................................................ 105
Kleuring en bloedmeting ............................................................................................................................. 105
Deel 2: Radicalen ............................................................................................................................................. 106
Redoxreacties .............................................................................................................................................. 106
Zuurstofradicalen ........................................................................................................................................ 106
Zuurstofradicalen: superoxide ................................................................................................................ 106
Zuurstofradicalen: vrij ijzer ..................................................................................................................... 107
Het probleem .......................................................................................................................................... 107
Verdedigingsmechanismen voor radicalen. ............................................................................................ 108
Deel 3: Necrose en apoptose ‘in depth’ ........................................................................................................... 109
Apoptose: stoffen........................................................................................................................................ 109
Apoptose: mitochondriaal vs. death receptor. ........................................................................................... 109
Apoptose: overlevingssignalen ................................................................................................................... 110
Necrose: verschillende soorten................................................................................................................... 110
Coagulatienecrose ................................................................................................................................... 110
Vervloeiingsnecrose ................................................................................................................................ 111
Necrose herkennen ................................................................................................................................. 112
Vetnecrose .............................................................................................................................................. 112
Verkazende necrose ................................................................................................................................ 113
Fibrinoïde necrose ................................................................................................................................... 113
Sectie 9: Regeneratie.................................................................................................................................... 114
Regeneratie: stamcellen ............................................................................................................................. 114
Regeneratie: verschil per weefsel ............................................................................................................... 114
Regeneratie ................................................................................................................................................. 115
Lever regeneratie ........................................................................................................................................ 116
Sectie 10: Immuunsysteem .......................................................................................................................... 117
Deel 1: Basis afweer ........................................................................................................................................ 117
Immuunsysteem: Pattern Recognition Receptors (PRR) ............................................................................. 118
Immuunsysteem: Dendritische cellen ......................................................................................................... 118
Immuunsysteem: Natuurlijke afweer ......................................................................................................... 118
4
, Deel 2: Ontsteking vs. infectie ......................................................................................................................... 119
Ontsteking ................................................................................................................................................... 119
Ontsteking: componenten .......................................................................................................................... 119
Vasculaire component ............................................................................................................................ 119
Exsudatieve component .......................................................................................................................... 121
Cellulaire component .............................................................................................................................. 124
Sectie 11: Ontsteking en ontstekingscellen .................................................................................................. 126
Deel 1: Mediatoren.......................................................................................................................................... 126
Lokaal gevormd ........................................................................................................................................... 126
Histamine: lokaal gevormde mediator .................................................................................................... 126
Serotonine: lokaal gevormde mediator .................................................................................................. 127
Eicosanoïden: lokaal gevormde mediator ............................................................................................... 127
Nitric oxide (stikstofoxide) (EDRF): lokaal gevormde mediator .............................................................. 127
Elders gevormd ........................................................................................................................................... 128
Belangrijke cascades ............................................................................................................................... 128
Complement cascade .............................................................................................................................. 130
Groeifactoren .............................................................................................................................................. 130
Deel 2: Cellen van het immuunsysteem........................................................................................................... 131
Granulocyten ............................................................................................................................................... 131
Leukocyten (= witte bloedcellen) ................................................................................................................ 131
Cellen van het immuunsysteem bij ontstekingen ....................................................................................... 132
Typen van uitbreiding ................................................................................................................................. 132
Ziektebeeld: granuloom .............................................................................................................................. 133
Ziektebeeld: Lepra ....................................................................................................................................... 133
Sectie 12: Galwegen en galweg-pathologie .................................................................................................. 135
Cholelithiasis ............................................................................................................................................... 135
Asymptomatisch...................................................................................................................................... 135
Trias van symptomen .............................................................................................................................. 135
Onderzoek ............................................................................................................................................... 136
Cholecystectomie ........................................................................................................................................ 136
Choledocholithiasis (CBD-obstructie).......................................................................................................... 136
ERCP (endoscopische retrograde cholango pancreaticografie) .............................................................. 136
Cholecystitis ................................................................................................................................................ 137
Acalculeuze cholecystitis ............................................................................................................................. 137
Geelzucht/icterus ........................................................................................................................................ 137
Hepatitis ...................................................................................................................................................... 138
Primaire biliaire cholangitis (PBC) ............................................................................................................... 139
Primaire scleroserende cholangitis (PSC) .................................................................................................... 139
Sectie 13: Adaptieve immuniteit .................................................................................................................. 140
T-cellen ........................................................................................................................................................ 140
Verschillende soorten T-cellen ................................................................................................................ 143
T-helpercel (Th-cel) ............................................................................................................................. 143
Cytotoxische T-cel (Tc-cel)................................................................................................................... 143
CD4-T-cel ................................................................................................................................................. 143
CD8 → Tc-cel (cytotoxische T-cel) ........................................................................................................... 144
5
, Signalen ................................................................................................................................................... 144
B-cellen........................................................................................................................................................ 145
Antilichamen ............................................................................................................................................... 146
Bare lymphocyte syndrome type 1 ............................................................................................................. 149
Immuunrespons .......................................................................................................................................... 149
Rijksvaccinatie ............................................................................................................................................. 149
Sectie 14: Huidafwijkingen ........................................................................................................................... 150
Deel 1: ‘Beschrijf het met PROVOKE’ ............................................................................................................... 150
P - Plaats ...................................................................................................................................................... 150
R – Rangschikking ........................................................................................................................................ 150
O – Omvang ................................................................................................................................................. 150
V – Vorm...................................................................................................................................................... 151
O - Omtrek................................................................................................................................................... 152
Kleur ............................................................................................................................................................ 152
Efflorescentie .............................................................................................................................................. 152
Deel 2: Bacteriën ............................................................................................................................................. 153
Gram+ en Gram- | Endotoxinen en exotoxinen .......................................................................................... 153
gramkleuring ........................................................................................................................................... 153
Ziehl Neelsen-kleuring ............................................................................................................................. 154
bacterien: vormen ....................................................................................................................................... 155
pathogenen in het algemeen ...................................................................................................................... 155
Deel 3: Bacteriële huidinfecties ....................................................................................................................... 156
Erythrasma .................................................................................................................................................. 156
Folliculitis (puist) ......................................................................................................................................... 156
Impetigo (krentenbaard) ............................................................................................................................. 156
Impetiginisatie............................................................................................................................................. 156
Pitted keratolysis (keratolysis plantare sulcatum) ...................................................................................... 156
Cellulitis/Erysipelas (wondroos) .................................................................................................................. 157
Ecthyma-ulcus ............................................................................................................................................. 157
Ecthyma gangraenosum .............................................................................................................................. 157
Erysipeloïd (vlekziekte) ............................................................................................................................... 157
Furunkel/furunculose (diepe puist) ............................................................................................................ 157
karbunkel .................................................................................................................................................... 157
Necrotiserende wekendeleninfectie (NSTI) ................................................................................................ 157
Panaritium (fijt) ........................................................................................................................................... 158
Paronychia (omloop) ................................................................................................................................... 158
Staphylococcal Scalded Skin Syndrome (SSSS) ............................................................................................ 159
Whirlpool-dermatitis ................................................................................................................................... 159
Erythema migrans ....................................................................................................................................... 159
Bijtwonden .................................................................................................................................................. 159
Acne vulgaris ............................................................................................................................................... 159
Acne ectopica/inversa (hidrdadenitis suppurativa) .................................................................................... 159
Toxische shock-syndroom (TSS) .................................................................................................................. 160
Overig: fistel ................................................................................................................................................ 160
Overzicht van belangrijkste ziekteverwekkers ............................................................................................ 160
Sectie 15: Toevoegingen over pathogenen ................................................................................................... 160
6
