Samenvatting Geneeskundige ziekteleer
Inhoudsopgave
Leveraandoeningen .......................................................................................................................................... 8
Algemeen ............................................................................................................................................................ 8
Icterus - hyperbilirubinemie ............................................................................................................................ 8
Onderzoek van de lever: bloedonderzoek ...................................................................................................... 8
Leverlijden versus leverinsufficiëntie .............................................................................................................. 9
Indeling hyperbilirubinemie ............................................................................................................................ 9
Hepatoencephalopathie .................................................................................................................................... 10
Pathofysiologie .............................................................................................................................................. 10
Symptomen ................................................................................................................................................... 10
Diagnose ........................................................................................................................................................ 10
Therapie ........................................................................................................................................................ 10
Prognose ....................................................................................................................................................... 11
Hepatitis (leverontsteking) ................................................................................................................................ 11
Virale hepatitis .............................................................................................................................................. 11
Bacteriële hepatitis ....................................................................................................................................... 11
Parasitaire hepatitis ....................................................................................................................................... 13
Toxische hepatitis .......................................................................................................................................... 13
Leververvetting .................................................................................................................................................. 15
Leververvetting bij het rund .......................................................................................................................... 15
Leververvetting bij het schaap ...................................................................................................................... 16
Hyperlipemie bij het paard............................................................................................................................ 17
Frequente(re) oorzaken icterus.......................................................................................................................... 17
Bovenste luchtwegen ..................................................................................................................................... 18
Klinische tekenen ............................................................................................................................................... 18
Differentiaaldiagnoses ...................................................................................................................................... 18
Sereuze neusvloei .......................................................................................................................................... 18
Purulente neusvloei ...................................................................................................................................... 18
Epistaxis ......................................................................................................................................................... 18
Hoesten ......................................................................................................................................................... 18
Stridor ........................................................................................................................................................... 18
Aandoeningen van de neus ............................................................................................................................... 19
Luchtweginfectie ........................................................................................................................................... 19
Infectieuze rhinitis ......................................................................................................................................... 19
Sinusitis ......................................................................................................................................................... 20
Neustumor .................................................................................................................................................... 20
Aandoeningen van de luchtzak – paard ............................................................................................................ 21
Luchtzaktympanie ......................................................................................................................................... 21
Luchtzakempyeem......................................................................................................................................... 21
Luchtzakmycose ............................................................................................................................................ 21
Aandoeningen van de farynx en larynx ............................................................................................................. 22
Infectieuze faryngitis ..................................................................................................................................... 22
Pharyngeal lymphoid hyperplasia (PLH) ........................................................................................................ 24
Aandoeningen farynx en larynx: hypoplasie zacht gehemelte, iDDSP, entrapment, epiglottiscyste ............. 24
Hemiplegie van de larynx – cornage ............................................................................................................. 25
1
, 4e branchiaalboogdefect .............................................................................................................................. 25
Farynxparalyse en -oedeem ......................................................................................................................... 26
Laryngitis/larynxoedeem ............................................................................................................................... 26
Aandoeningen van de trachea .......................................................................................................................... 26
Tracheastenose/-collaps ................................................................................................................................ 26
Tracheïtis ....................................................................................................................................................... 27
Diepere luchtwegen ....................................................................................................................................... 28
Klinische tekenen ............................................................................................................................................... 28
Probleem gebaseerde benadering .................................................................................................................... 28
Inspiratoire dyspnee ...................................................................................................................................... 28
Expiratoire dyspnee ....................................................................................................................................... 28
Tachypnee ..................................................................................................................................................... 28
Aandoeningen aan de diepe luchtwegen .......................................................................................................... 29
Longoedeem.................................................................................................................................................. 29
Pneumonie .................................................................................................................................................... 29
Longfibrose .................................................................................................................................................... 35
Pleurale effusie .............................................................................................................................................. 35
Pleuritis ......................................................................................................................................................... 35
Aandoeningen van de diepe luchtwegen ........................................................................................................ 37
EIPH ................................................................................................................................................................... 37
Niet-infectieuze luchtweginflammatie .............................................................................................................. 37
Pathogenese equine asthma ......................................................................................................................... 38
Indeling.......................................................................................................................................................... 38
Mild tot moderate asthma ............................................................................................................................ 38
Severe equine asthma ................................................................................................................................... 39
SPARAO.......................................................................................................................................................... 41
COPD ............................................................................................................................................................. 41
Equine asthma ............................................................................................................................................... 41
Niet-infectieuze luchtweginflammatie bij runderen? .................................................................................... 43
Pulmonaire hypertensie ................................................................................................................................ 43
Atelectase en surfactantdeficiëntie ............................................................................................................... 43
Pneumothorax ............................................................................................................................................... 44
Long, pleura en mediastinale tumoren ......................................................................................................... 44
Urinair stelsel – Nier en urinewegen .............................................................................................................. 45
Congenitale afwijkingen .................................................................................................................................... 45
Acute nierinsufficiëntie ...................................................................................................................................... 45
Pre-renaal ...................................................................................................................................................... 45
Renaal............................................................................................................................................................ 45
Pathogenese/symptomen acute nierinsufficiëntie ....................................................................................... 46
Behandeling .................................................................................................................................................. 47
Chronische nierinsufficiëntie ............................................................................................................................. 47
Glomerulair ................................................................................................................................................... 47
Tubulair/interstitieel...................................................................................................................................... 47
Symptomen ................................................................................................................................................... 47
Diagnose ........................................................................................................................................................ 48
Behandeling .................................................................................................................................................. 48
Renale tubulaire acidose ................................................................................................................................... 48
Niertumor en niercysten .................................................................................................................................... 48
2
, Nierstenen – nefrolythiasis ................................................................................................................................ 48
Aandoeningen van de ureters ........................................................................................................................... 49
Congenitale ureter afwijkingen ..................................................................................................................... 49
Obstructie van de ureter ............................................................................................................................... 49
Ontsteking van de ureter............................................................................................................................... 49
Ruptuur van de ureter ................................................................................................................................... 49
Aandoeningen van de blaas .............................................................................................................................. 49
Cystitis ........................................................................................................................................................... 49
Blaasstenen ................................................................................................................................................... 50
Blaasruptuur .................................................................................................................................................. 50
Blaasatonie .................................................................................................................................................... 51
Blaastumoren ................................................................................................................................................ 51
Aandoeningen van de urethra ........................................................................................................................... 51
Congenitale urethra aandoeningen .............................................................................................................. 51
Uretritis ......................................................................................................................................................... 52
Urolithiasis - urethraobstructie ..................................................................................................................... 52
Urethratrauma .............................................................................................................................................. 52
Spieraandoeningen ........................................................................................................................................ 53
Inleiding ............................................................................................................................................................. 53
Anatomie ....................................................................................................................................................... 53
Fysiologie....................................................................................................................................................... 53
Normale spierfunctie .................................................................................................................................... 54
Symptomen ................................................................................................................................................... 54
Diagnostische mogelijkheden ............................................................................................................................ 54
Bloedonderzoek ............................................................................................................................................ 54
Spierbiopt ...................................................................................................................................................... 55
Inspanningstest ............................................................................................................................................. 55
Andere diagnostische testen ......................................................................................................................... 56
Congenitale/erfelijke aandoeningen ................................................................................................................. 56
Recurrent exertionale rhabdomyolyse (RER) ................................................................................................ 56
Polysaccharide storage myopathie PSSM ...................................................................................................... 57
Hyperkalemische periodische paralyse – HYPP ............................................................................................. 58
Maligne hyperthermie .................................................................................................................................. 59
Traumatische aandoeningen ............................................................................................................................. 59
Spiertrauma ................................................................................................................................................... 59
Infectieuze aandoeningen ................................................................................................................................. 60
Myositis ......................................................................................................................................................... 60
Immuungemedieerde aandoeningen ................................................................................................................ 60
Immuungemedieerde myopathie.................................................................................................................. 60
Metabole aandoeningen ................................................................................................................................... 60
PPID ............................................................................................................................................................... 60
Nutritionele aandoeningen ............................................................................................................................... 60
Nutritionele myopathie ................................................................................................................................. 60
Toxische aandoeningen ..................................................................................................................................... 61
Ionoforen intoxicatie ..................................................................................................................................... 61
Atypische myopathie ..................................................................................................................................... 61
Endocriene en metabole aandoeningen ......................................................................................................... 63
Equine metabool syndroom (EMS) .................................................................................................................... 63
Kenmerken .................................................................................................................................................... 63
3
, Pathogenese .................................................................................................................................................. 63
Endocrien gemedieerde laminitis.................................................................................................................. 63
Diagnose ........................................................................................................................................................ 64
Pituitary pars intermedia dysfunction (PPID) .................................................................................................... 65
Gezond paard ................................................................................................................................................ 65
Oud paard ..................................................................................................................................................... 65
Nieuwe bevindingen ..................................................................................................................................... 65
Klinisch .......................................................................................................................................................... 66
Diagnose ........................................................................................................................................................ 66
Behandeling .................................................................................................................................................. 67
Aandoeningen van de schildklier ....................................................................................................................... 67
DDX: Aandoeningen van de schildklier.......................................................................................................... 67
Neonatale hypothyroïdie............................................................................................................................... 67
Adulte paarden.............................................................................................................................................. 68
Thyroid adenoma .......................................................................................................................................... 68
Bijnier ................................................................................................................................................................ 68
Fysiologie....................................................................................................................................................... 68
Pheochromocytoma: functionele bijniermergtumor .................................................................................... 68
Parathyroide ...................................................................................................................................................... 68
Calcium .............................................................................................................................................................. 69
Regeling ......................................................................................................................................................... 69
Hypocalcemie paard ...................................................................................................................................... 69
Hypocalcemie rund – kalfsziekte ................................................................................................................... 69
Hypercalcemie ............................................................................................................................................... 69
Magnesium ....................................................................................................................................................... 70
Hypomagnesemie ......................................................................................................................................... 70
Kalium ............................................................................................................................................................... 70
Hypokalemie ................................................................................................................................................. 70
Hyperkaliemie ............................................................................................................................................... 70
ECG ................................................................................................................................................................ 70
Hyperkalemie ................................................................................................................................................ 70
Probleemgerichte aanpak .............................................................................................................................. 71
Algemeen .......................................................................................................................................................... 71
Doel ............................................................................................................................................................... 71
Samenvatting E-book..................................................................................................................................... 71
Klachten juist identificeren ............................................................................................................................ 73
Probleemlijst ................................................................................................................................................. 73
Opstellen van een relevante differentiaaldiagnose ....................................................................................... 73
Het diagnostisch plan .................................................................................................................................... 73
Het therapeutisch plan .................................................................................................................................. 73
Evidence based medicine .............................................................................................................................. 73
Probleemgerichte benadering van gastro-intestinale klachten bij kat en hond ................................................ 74
Halithose ....................................................................................................................................................... 74
Ptyalisme ....................................................................................................................................................... 74
Peysoptyalisme .............................................................................................................................................. 74
Dysfagie ......................................................................................................................................................... 74
Regurgiteren .................................................................................................................................................. 75
Braken ........................................................................................................................................................... 75
Diarree........................................................................................................................................................... 77
Tenesmus, dysschezie.................................................................................................................................... 78
Casus ............................................................................................................................................................. 79
4
Inhoudsopgave
Leveraandoeningen .......................................................................................................................................... 8
Algemeen ............................................................................................................................................................ 8
Icterus - hyperbilirubinemie ............................................................................................................................ 8
Onderzoek van de lever: bloedonderzoek ...................................................................................................... 8
Leverlijden versus leverinsufficiëntie .............................................................................................................. 9
Indeling hyperbilirubinemie ............................................................................................................................ 9
Hepatoencephalopathie .................................................................................................................................... 10
Pathofysiologie .............................................................................................................................................. 10
Symptomen ................................................................................................................................................... 10
Diagnose ........................................................................................................................................................ 10
Therapie ........................................................................................................................................................ 10
Prognose ....................................................................................................................................................... 11
Hepatitis (leverontsteking) ................................................................................................................................ 11
Virale hepatitis .............................................................................................................................................. 11
Bacteriële hepatitis ....................................................................................................................................... 11
Parasitaire hepatitis ....................................................................................................................................... 13
Toxische hepatitis .......................................................................................................................................... 13
Leververvetting .................................................................................................................................................. 15
Leververvetting bij het rund .......................................................................................................................... 15
Leververvetting bij het schaap ...................................................................................................................... 16
Hyperlipemie bij het paard............................................................................................................................ 17
Frequente(re) oorzaken icterus.......................................................................................................................... 17
Bovenste luchtwegen ..................................................................................................................................... 18
Klinische tekenen ............................................................................................................................................... 18
Differentiaaldiagnoses ...................................................................................................................................... 18
Sereuze neusvloei .......................................................................................................................................... 18
Purulente neusvloei ...................................................................................................................................... 18
Epistaxis ......................................................................................................................................................... 18
Hoesten ......................................................................................................................................................... 18
Stridor ........................................................................................................................................................... 18
Aandoeningen van de neus ............................................................................................................................... 19
Luchtweginfectie ........................................................................................................................................... 19
Infectieuze rhinitis ......................................................................................................................................... 19
Sinusitis ......................................................................................................................................................... 20
Neustumor .................................................................................................................................................... 20
Aandoeningen van de luchtzak – paard ............................................................................................................ 21
Luchtzaktympanie ......................................................................................................................................... 21
Luchtzakempyeem......................................................................................................................................... 21
Luchtzakmycose ............................................................................................................................................ 21
Aandoeningen van de farynx en larynx ............................................................................................................. 22
Infectieuze faryngitis ..................................................................................................................................... 22
Pharyngeal lymphoid hyperplasia (PLH) ........................................................................................................ 24
Aandoeningen farynx en larynx: hypoplasie zacht gehemelte, iDDSP, entrapment, epiglottiscyste ............. 24
Hemiplegie van de larynx – cornage ............................................................................................................. 25
1
, 4e branchiaalboogdefect .............................................................................................................................. 25
Farynxparalyse en -oedeem ......................................................................................................................... 26
Laryngitis/larynxoedeem ............................................................................................................................... 26
Aandoeningen van de trachea .......................................................................................................................... 26
Tracheastenose/-collaps ................................................................................................................................ 26
Tracheïtis ....................................................................................................................................................... 27
Diepere luchtwegen ....................................................................................................................................... 28
Klinische tekenen ............................................................................................................................................... 28
Probleem gebaseerde benadering .................................................................................................................... 28
Inspiratoire dyspnee ...................................................................................................................................... 28
Expiratoire dyspnee ....................................................................................................................................... 28
Tachypnee ..................................................................................................................................................... 28
Aandoeningen aan de diepe luchtwegen .......................................................................................................... 29
Longoedeem.................................................................................................................................................. 29
Pneumonie .................................................................................................................................................... 29
Longfibrose .................................................................................................................................................... 35
Pleurale effusie .............................................................................................................................................. 35
Pleuritis ......................................................................................................................................................... 35
Aandoeningen van de diepe luchtwegen ........................................................................................................ 37
EIPH ................................................................................................................................................................... 37
Niet-infectieuze luchtweginflammatie .............................................................................................................. 37
Pathogenese equine asthma ......................................................................................................................... 38
Indeling.......................................................................................................................................................... 38
Mild tot moderate asthma ............................................................................................................................ 38
Severe equine asthma ................................................................................................................................... 39
SPARAO.......................................................................................................................................................... 41
COPD ............................................................................................................................................................. 41
Equine asthma ............................................................................................................................................... 41
Niet-infectieuze luchtweginflammatie bij runderen? .................................................................................... 43
Pulmonaire hypertensie ................................................................................................................................ 43
Atelectase en surfactantdeficiëntie ............................................................................................................... 43
Pneumothorax ............................................................................................................................................... 44
Long, pleura en mediastinale tumoren ......................................................................................................... 44
Urinair stelsel – Nier en urinewegen .............................................................................................................. 45
Congenitale afwijkingen .................................................................................................................................... 45
Acute nierinsufficiëntie ...................................................................................................................................... 45
Pre-renaal ...................................................................................................................................................... 45
Renaal............................................................................................................................................................ 45
Pathogenese/symptomen acute nierinsufficiëntie ....................................................................................... 46
Behandeling .................................................................................................................................................. 47
Chronische nierinsufficiëntie ............................................................................................................................. 47
Glomerulair ................................................................................................................................................... 47
Tubulair/interstitieel...................................................................................................................................... 47
Symptomen ................................................................................................................................................... 47
Diagnose ........................................................................................................................................................ 48
Behandeling .................................................................................................................................................. 48
Renale tubulaire acidose ................................................................................................................................... 48
Niertumor en niercysten .................................................................................................................................... 48
2
, Nierstenen – nefrolythiasis ................................................................................................................................ 48
Aandoeningen van de ureters ........................................................................................................................... 49
Congenitale ureter afwijkingen ..................................................................................................................... 49
Obstructie van de ureter ............................................................................................................................... 49
Ontsteking van de ureter............................................................................................................................... 49
Ruptuur van de ureter ................................................................................................................................... 49
Aandoeningen van de blaas .............................................................................................................................. 49
Cystitis ........................................................................................................................................................... 49
Blaasstenen ................................................................................................................................................... 50
Blaasruptuur .................................................................................................................................................. 50
Blaasatonie .................................................................................................................................................... 51
Blaastumoren ................................................................................................................................................ 51
Aandoeningen van de urethra ........................................................................................................................... 51
Congenitale urethra aandoeningen .............................................................................................................. 51
Uretritis ......................................................................................................................................................... 52
Urolithiasis - urethraobstructie ..................................................................................................................... 52
Urethratrauma .............................................................................................................................................. 52
Spieraandoeningen ........................................................................................................................................ 53
Inleiding ............................................................................................................................................................. 53
Anatomie ....................................................................................................................................................... 53
Fysiologie....................................................................................................................................................... 53
Normale spierfunctie .................................................................................................................................... 54
Symptomen ................................................................................................................................................... 54
Diagnostische mogelijkheden ............................................................................................................................ 54
Bloedonderzoek ............................................................................................................................................ 54
Spierbiopt ...................................................................................................................................................... 55
Inspanningstest ............................................................................................................................................. 55
Andere diagnostische testen ......................................................................................................................... 56
Congenitale/erfelijke aandoeningen ................................................................................................................. 56
Recurrent exertionale rhabdomyolyse (RER) ................................................................................................ 56
Polysaccharide storage myopathie PSSM ...................................................................................................... 57
Hyperkalemische periodische paralyse – HYPP ............................................................................................. 58
Maligne hyperthermie .................................................................................................................................. 59
Traumatische aandoeningen ............................................................................................................................. 59
Spiertrauma ................................................................................................................................................... 59
Infectieuze aandoeningen ................................................................................................................................. 60
Myositis ......................................................................................................................................................... 60
Immuungemedieerde aandoeningen ................................................................................................................ 60
Immuungemedieerde myopathie.................................................................................................................. 60
Metabole aandoeningen ................................................................................................................................... 60
PPID ............................................................................................................................................................... 60
Nutritionele aandoeningen ............................................................................................................................... 60
Nutritionele myopathie ................................................................................................................................. 60
Toxische aandoeningen ..................................................................................................................................... 61
Ionoforen intoxicatie ..................................................................................................................................... 61
Atypische myopathie ..................................................................................................................................... 61
Endocriene en metabole aandoeningen ......................................................................................................... 63
Equine metabool syndroom (EMS) .................................................................................................................... 63
Kenmerken .................................................................................................................................................... 63
3
, Pathogenese .................................................................................................................................................. 63
Endocrien gemedieerde laminitis.................................................................................................................. 63
Diagnose ........................................................................................................................................................ 64
Pituitary pars intermedia dysfunction (PPID) .................................................................................................... 65
Gezond paard ................................................................................................................................................ 65
Oud paard ..................................................................................................................................................... 65
Nieuwe bevindingen ..................................................................................................................................... 65
Klinisch .......................................................................................................................................................... 66
Diagnose ........................................................................................................................................................ 66
Behandeling .................................................................................................................................................. 67
Aandoeningen van de schildklier ....................................................................................................................... 67
DDX: Aandoeningen van de schildklier.......................................................................................................... 67
Neonatale hypothyroïdie............................................................................................................................... 67
Adulte paarden.............................................................................................................................................. 68
Thyroid adenoma .......................................................................................................................................... 68
Bijnier ................................................................................................................................................................ 68
Fysiologie....................................................................................................................................................... 68
Pheochromocytoma: functionele bijniermergtumor .................................................................................... 68
Parathyroide ...................................................................................................................................................... 68
Calcium .............................................................................................................................................................. 69
Regeling ......................................................................................................................................................... 69
Hypocalcemie paard ...................................................................................................................................... 69
Hypocalcemie rund – kalfsziekte ................................................................................................................... 69
Hypercalcemie ............................................................................................................................................... 69
Magnesium ....................................................................................................................................................... 70
Hypomagnesemie ......................................................................................................................................... 70
Kalium ............................................................................................................................................................... 70
Hypokalemie ................................................................................................................................................. 70
Hyperkaliemie ............................................................................................................................................... 70
ECG ................................................................................................................................................................ 70
Hyperkalemie ................................................................................................................................................ 70
Probleemgerichte aanpak .............................................................................................................................. 71
Algemeen .......................................................................................................................................................... 71
Doel ............................................................................................................................................................... 71
Samenvatting E-book..................................................................................................................................... 71
Klachten juist identificeren ............................................................................................................................ 73
Probleemlijst ................................................................................................................................................. 73
Opstellen van een relevante differentiaaldiagnose ....................................................................................... 73
Het diagnostisch plan .................................................................................................................................... 73
Het therapeutisch plan .................................................................................................................................. 73
Evidence based medicine .............................................................................................................................. 73
Probleemgerichte benadering van gastro-intestinale klachten bij kat en hond ................................................ 74
Halithose ....................................................................................................................................................... 74
Ptyalisme ....................................................................................................................................................... 74
Peysoptyalisme .............................................................................................................................................. 74
Dysfagie ......................................................................................................................................................... 74
Regurgiteren .................................................................................................................................................. 75
Braken ........................................................................................................................................................... 75
Diarree........................................................................................................................................................... 77
Tenesmus, dysschezie.................................................................................................................................... 78
Casus ............................................................................................................................................................. 79
4
