gastroenterologie sindroame pancreatice

7/25/2019 GASTROENTEROLOGIE SINDROAME PANCREATICE

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SINDROAME PANCREATICE

PANCREATITA ACUTA


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Pancreasul este un organ custructura glandulara,12-15c

lung!e,"#-11#ggreutate$%ascular!&at!a esteas!gurata de artera e&enter!casu'er!oara,s'len!ca,trunc(!ulcel!ac)'ancreat!co-duodenala-su'er!oara- anter!oara s!'oster!oara*$Drena+ul enos se ace

'r!n enele 'ancreat!ce tr!.utareene! s'len!ce s! 'ancreat!co-duodenale-ena s'eln!ca sau d!rect

!n ena 'orta$Inerat!a este agala


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D!n 'unct de edere unct!onalcu'r!nde0

Pancreasul endocr!n0 celule)glucagon*, celule )!nsul!na*,celuleD)soatostat!n*, celule

PP)'ol!'e't!de 'ancreat!ce*Pancreasul e/ocr!n0 compusi

anorganici )Na,3, Cl,.!car.onat!-4act!une neutral!&anta Cl, #,2-6l7!n*8compusi organici)en&!e'roteol!t!ce-4tr!'s!nogen8en&!ea!lol!t!ce-4 a!la&a8en&!e

l!'ol!t!ce-4l!'a&a*


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De9n!t!e0re're&!nta un 'roces!n:aator acut al 'rancreasulu! 'r!n

act!area !ntraglandulara a en&!elor'ancreat!ce a!nd ca eectautod!gest!a 'ancreat!ca

Et!olog!e0l!t!a&a .!l!ara,consuul dealcol, (!'erl!'!de!e,'ancreat!taered!tara, (!'er'arat!ro!d!a-4(!'ercalce!a, anoal!! structurale-

4ca! .!l!are,d!sunct!! ale s9ncterulu!Odd!,'ost o'erator,trauat!sea.do!nale,ERCP


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Et!olog!e0ed!caentoasa)cort!co!&!,estrogen!urose!d,ant!.!ot!ce-

4etron!da&ol, tetrac!cl!na* Ta.lou cl!n!c0

Durere a.do!nala acuta cu de.ut

.rusc la 2 ore du'a o asaco'!oasa,consuul de alcol sau ocol!ca .!l!ara8local!&ata !n e'!gastru,e&ogastru8cu !rad!ere !n .ara s'recoloana erte.ra sau lo.e8oarte!ntensa,constanta,cont!nua,re&!stenta la analge&!ce

o.!snu!te s! usoara ael!orare !n


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;retur! s! arsatur!0'recoce,a.undente, al!entare sau

.!l!oase,nu calea&a durereaTul.urar! de tran&!t)o'r!re*

S!ndro e.r!l

Icter !n ca&ul l!t!a&e! .!l!areDS8soc8!nsu9c!enta

renala8(TA8ta(!card!e8 'uls

9l!or8ta(!'nee8s!ndro asc!t!tc


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D!agnost!cul0

ananest!c)consu de alcool,l!t!a&a.!l!ara,e/ces al!entar*

E/aenulu! o.!ect!0a.doen dest!ns, sens!.!lla 'al'are,d!!nuare a &gootelor !ntest!nale

!nest!gat!!le 'aracl!n!ce0

1$ S!ndro en&!at!c0 a!la&e!e4#N*8a!la&ur!e8l!'a&a ser!ca)2#-g7dl*8 (!'er.!l!r!nu.!ne!e8(!'ertr!gl!cer!de!e8(!'oal.u!ne!e)?


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2$ Rad!ogra9a a.do!nala cu su.stantade contrast


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=$ ERCP)colang!o'ancreatogra9eretrograda endosco'!ca*


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2


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25$#6$16


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PANCREATITA CRONICA


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De9n!t!e0re're&!nta o aect!unecron!ca !n:aator!e nesu'urat!a

care asoc!a&a 9.ro&a s! le&!un!d!struct!e ale structur!lor'ancreasulu! e/ocr!n s! oca&!onalendocr!n

Et!olog!e0

Alcol!sul cron!c)6#-># d!n ca&ur!*0consuul &!ln!c !n! 15# l t!'de a! ult! an! asoc!at cu d!eta.ogata !n gras!! s! 'rote!ne

Tul.urar! eta.ol!ce0(!'ercalce!e8(! erl! o rote!ne!e


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Insu9c!enta e/ocr!na0a'are du'a o'er!oada !ndelungata de eolut!e a

.ol! 'r!n steatoree, scadere'onderala s! ala.sor.t!e de!ta!ne)A,D,3,E*

D!a.etul &a(arat0releat de aectarea4># d!n asa glandulara-4scaderea tolerante! la gluco&a-4d!a.et&a(arat cl!n!c an!est

D!agnost!cul0

E/'lorar! .!olog!ce0a!la&a s! l!'a&aser!ce crescute8scaderea tolerante! la

gluco&a8


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1$ Ecogra9a a.do!nala0

Poate relea od!9car! de

contur,d!ens!unestructura la n!elul'ancreasulu!8c(!stur!8calc!9car!


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6$ ERCP0steno&e s! d!latar! la n!elductal

5$ Ecoendosco'!a0'er!te d!agnost!culPC !nc!'!ente


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Trataentul0

Reg! !g!eno-d!etet!c0 a'ort calor!c

25##-


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Ta.lou cl!n!c0

1$ durer! a.do!nale)local!&ate !n

e'!gastru cu !rad!ere !n (!'ocondrulst!ng,accentuate'os'rand!al,ael!orata de 'o&!t!e

genu'ectorala sau se&anda*2$ scadere 'onderala)1## d!n

ca&ur!,greata,arsatur!,steatoree,*

# d!nca&ur!,a'are 'rogres!,este'rur!g!nos*


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D!agnost!c0

Inest!gat!! de la.orator0ane!e8

(!'ergl!ce!e8(!'er.!l!ru.!ne!e8arer! tuoral!)CA 1$*

E/'lorar! !ag!s!t!ce0

1$ R/ .ar!tat eso-gastro-duodenal2$ Ecogra9a a.do!nala


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Trataent0

1$ C(!rurg!cal)cu caracter rad!cal sau

'al!at!*2$ Endosco'!c)!nterent!e !n sco'

'al!at!*

gastroenterologie sindroame pancreatice

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