retinopatia in diabetul zaharat de tip ii non-insulinodependent 2003

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  • EXAMENUL DE ABSOLVIRE A COLII POSTLICEALE Calificarea profesional:asistent medical generalistProfesor ndrumator: Absolvent:Porojan Ileana Ioana Beschiu Ionela

    Ministerul Educaiei Naionale

    Colegiul naional Alma Medica coala Postliceal Sanitar Timioara,Timi

    August2013

  • Ochii , asemeni unor santinele, ocupa pozitia cea mai inalta a corpului. Marcus Tulius Cicero

  • MOTIVATIA

    CAP. I NOTIUNI GENERALE DESPRE NURSINGCAP. II DATE GENERALE ASUPRA BOLII DIABETICECAP. III NOIUNI DE ANATOMIE RETINIAN I FIZIOPATOLOGIA RETINOPATIEI DIABETICECAP. IV RETINOPATIA DIABETICACAP. V PLAN DE INGRIJIRE AL PACIENTILOR CU RETINOPATIE DIABETICA

    BIBLIOGRAFIE

  • Definitie: Diabetul zaharat reprezint o boal metabolic cu evoluie cronic i stadial ce se datoreaz lipsei relative sau absolute a insulineiClasificare:1. Diabet zaharat tip I2. Diabet zaharat tip II3. Diabet zaharat gestaional4. Diabet zaharat secundar5. Diabet zaharat iatrogen6. Scaderea toleranei la glucoz

  • n diabetul zaharat, tabloul clinic manifest este prezent tardiv n evoluia bolii, iar cnd apar simptomele, boala metabolic poate fi deja cu complicaii.polidipsie; polifagie;scdere ponderal;prurit vulvar;scderea potenei sexuale.

  • DiagnosticGlicemia jeunTestul de Toleranta la Glucoza Oralaglicozuriadozarea corpilor cetonici din urin, electrocardiograma examenul fundului de ochi, examenul de urin pentru proteinuria calitativ i cantitativ dozarea insulinei i peptidului C determinarea vitezei de conducere nervoas dozarea hemoglobinei glicozilate

    Complicatii:Acute:coma hipergicemic, hipoglicemica,acidocetozic i hiperosmolar;hipoglicemiile, mergnd pn la com hipoglicemic ;infeciile: urinare, pulmonare, genitale;TBC pulmonar;micozele interdigitale, vulvare i bucale.Cronice, microangiopatia si macroangiopatia diabetic :Nefropatia diabeticNeuropatia diabeticRetinopatia diabetic

  • o membran exterioar, fibroas o membran mijlocie, musculo-vascular o membran intrn, nervoas

  • Definitie: Retinopatia diabetic reprezint localizarea retinian a microangiopatiei diabetice.Modificrile histologice iniiale ale microangiopatiei evolueaz dup Kohner n 5 stadii:ngroarea membranei bazale dispariia pericitelor din peretele capilar;slbirea peretelui capilarobliterri de capilareanomalii microvasculare intraretiniene

  • Forma benign este o form neproliferativ, tipul ATipul B, retinopatia proliferant, prezint diverse stadii de evoluie (de la forme pariale i pn la forme totale).

  • Modificrile histologice iniiale ale microangiopatiei evolueaz dup Kohner n 5 stadii:ngroarea membranei bazale dispariia pericitelor din peretele capilar;slbirea peretelui capilarobliterri de capilareanomalii microvasculare intraretinieneAmbele forme de retinopatie sunt insotie de ischemie retiniana si modificari ale vitrosului

  • Dintre metodele de investigaie pot fi enumerate:

    Biomicroscopia fundului de ochi (prin lentila Goldmann, Volk sau oftalmoscop indirect);Angiofluorografia;Electroretinografia;Echografia;Fluorometria vitroas.

  • Tratamentul retinopatiei diabetice presupune in primul rand controlul diabetului regim igieno-dietetic corespunzator medicatie controlata:AntidiabeticeSulfamideBiguanideVasculare:antiagregante plachetare vasodilatatoare,

  • Fotocoagularea laserLaserul poate fi folosit la nivelul retinei, focaliznd o surs puternic de lumin pe ea. Raza ngust de laser ajunge la ochi i creeaz o arsur rotund la nivelul retinei.CriopexiaAblaia zonelor retiniene afectate criogenic prin aplicarea direct pe conjunctiv sau pe sclera posterioar dup o incizie conjunctival. VirectomiaPresupune excizia vitrosului, intervenia n sine constnd n a aciona pe o raz mare de aciune la nivelul segmentului posterior ocular.

  • Pacienta S.P. sex feminin, 58 ani, cunoscuta diabetic de aproximativ 6 ani.Examenul oftalmologic evideniaz la: FO i AFG retinopatie diabetic proliferativ:dilatri venoase determinand hemoragii punctiforme i rotunde si exudate moi dispuse n buchet sau coroan.Pol anterior normal;TO normal.Tratamentul a constat n: regim igieno-dietetic insotit de sulfamide orale;vasodilatatoare: Stugeron (1 cp. = 125 mg) 1-2 cp. de trei ori pe zi si antiagregante plachetare: Aspirin (1 cp.= 500 mg) 1/2 cp. pe zi.S-a practicat fotocoagulare cu laser argon in repetate randuri.

  • Evaluare:Pacientul nu necesita spitalizare , procedura de fotocoagulare fiind repetata de mai multe ori.

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  • Evoluia retinopatiei diabetice proliferative:ameliorare 28.5 %;stabilizarea 43 %;agravare 28.5 %.

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  • 1. Addison D. J., Garner A., Ashton N.: Degeneration of intramural pericytes in diabetic retinophaty, Br. Med., 1970.2. Buzney S.M., MacDonald S., Gervino N.H.: Experimental retinal capillary wall. Interaction of endothelial cells and pericytes in vitro, Invest. Ophtalmol. Vis. Sci., 1984.3. Braverman I.M., Keh-Yen A.: Ultrastructural abnormalities of the microvasculature and elastic fibers in the skin of juvenile diabetics, J. Invest. Dermatol., 1984.4. Buzney S.M., Weiter J.J.: Pathogenesis of diabetic retinal angiopathy. Proposed mechanisms and current research, Int. Ophtalmol. Clin. (sous presse).5. Benson W. E., Marshall J., Spaeth G. L., Annual of Oftalmic Laser Surgery(Curent Medicine Inc. Philadelphia), 1992.6. Cunha-Vaz J. G.: Pathophisiology of diabetic rethinopaty, Br. J. Ophtalmol.,1978.7. Cheng H., Blach R. K., Hamilton A. M., Kohner E. M.: Diabetic maculopaty. A preliminary report, Trans. Ophtalmol. Soc. U. K., 1972.8. Coscas G., Gaudric A.: Non aphakic cystoid macular edema , Surv. Ophtalmol., 1984.9. Chisholm I. H., Bird A. C.: Photocoagulation of Macular Disease (In : Waltmann St. R.-Surgery of the Eye , vol. 2, Churchill Livingstone, New York-Edinburgh-London-Melbourne, 1988).10. Constable I. J., Lim A. S. M. :Laser. Its clinical uses in eye diseas, Churchill Livingstone, Edinburgh-London-Melbourne-New York, 1990.11. D'Amore P. A., Herman I. M.: The role of cytoskeletal proteins in the induction of capillary endothelial chemotaxis, Invest. Ophthalmol. Vis. Sci., 1984.12. Diabetic Rethinopathy Study Research Group: Report No. 7, A Modification of the Airlie House Classification of Diabetic Rethinopathy, Invest. Ophthalmol. Vis. Sci., 1981.13.Diabetic Rethinopathy Study Research Group: Report No. 6, Design,Methods and Baseline Results, Invest. Ophthalmol. Vis. Sci., 1981.14.De Laey J.J., Morizot-Leite E.: Grid photocoagulation for diabetic macula edema. Macular Symposium, San Diego, 1982.15.Feke G. T., Yoshida A., Green G. J., Buzney S. M., McMeel J.W.: Retinal cuirculatory changes during the natural history of diabetes, Invest. Ophthalmol. Vis. Sci., 1983.16.Frank R. N., Leion R. I., Kennedy A., Frank K. W.: Galactose induced retinal capillary basement membrane thickening. Prevention by sorbinil, , Invest. Ophthalmol. Vis. Sci., 1983.17.Fitzcharles M. A., Duby S., Waddel R. W., Banks E:, Karsh J.: Limitation of joint mobility (cheiroarthropathy) in adult noninsulin-dependent diabetic patients, Ann. Pleum.Dis.,1984.18.Federman J. L., Brown G. C., Felberg N. T., Felton S. M.: Experimental ocular angiogenesis, Am. Journal Ophtalmol.,1980.19.Folkman J., Haundenechild C.: Angiogenesis in vitro, Nature, 1980.20.Felton S. M., Brown G. C., Felberg N. T., Federman J. L.: Vitreous inhibition of tumor neovascularisation,Arch. Ophtalmol.,1979.21.Ferris F.L., Patz A.: Macular edema: a major complication of diabetic rethinopathy, Trans. New Orleans Acad. Ophtalmol., 1981.22.Fine B. S., Brucker A. J.: Macular edema and cystoid macular edema, Am. Journal Ophtalmol., 1981.23.Frank R. N.: Etiologic mechanisms in diabetic rethinopathy, (in: Ryan St. J., ed. Retina, vol. 2,The C.V. Mosby Company, St. Louis-Baltimore-Toronto, 1989.24.Glaser B. M., D'Amore P. A., Michels R. G., Brunson S. K:,Feneslau A. H., Rice T., Patz A.: The demonstration angiogenic activity from ocular tissues, Ophtalmologiy, 1980.

    25.Gu X., Fry G., Lata G.,Packer A., Hoak J., Kalebic T.,Hayreh S. S.: Ocular neovascularisation, Invest. Ophthalmol. Vis. Sci., 1984.26.Glaser B. M., Connor T. B., Davis J. L., Kalebic T., Liotta L.: Vascular endothelial cell degradation of basement membranes, Invest. Ophthalmol. Vis. Sci., 1983.27.Glaser B. M:, D'Amore P. A., Michels R. G., Feneslau A. H., Patz A.:Demonstrative of vasoproliferative activity from mammalian retina, J. Cell. Biol., 1980.28.Gitlin J. D., D'Amore P. A.: Culture of retinal capillary cells using selective growth media, Microvasc. Res., 1983.29.Glaser B. M., Graeber J., Davis G. L., Lehmann M.: Retina derived stimulator of vascular endothelial cell prostacyclin release, Invest. Ophthalmol. Vis. Sci., 1984.30.Gaudric A., Coscas G.: Photocoagulation perifoveolaire dans les oedemes musculaires cystoides des occlusion veineuses, Bull. Soc. Ophtalmol. Fr.,1980.31.Gass J. D.: Idiopathic juxtafoveolar retinal telangiectasis. Arch. Ophtalmol., 1982.32.Hill C. R., Kissum R. d:, Weiss J. B., Garner A.:; Angiogenic factor in vitreous from diabetic rethinopathy, Experimentiam, 1983.33.Haut J., Van Effenterre G., Flamand M.,,Dureuil J., Cahiza M.: Traitement de l'oedeme cystoide maculaire par photocoagulation perifoveolaire au laser argon, Bull. Soc. Ophtalmol. Fr., 1980.34.Henkind P., Bellhorn R. W., Schall B.:Retinal edema: postulated mechanisms in the Blood-Retinal barriers, J. Cunha-Vaz, edit. Plenum Press New York.35.Jalkh A., Takahashi M., Topilov H. X., Trempe C. L., McMeel J. W.: Prognostic value of vitreous findings in diabetic retinopathy, Arch. Ophtalmol.,1982.36.King G. L., Buzney S. M., Kahn C. R.: Differential responsiveness to insulin of endothelial and support cells from micro- and macrovessels, J. Clin. Invest., 1983.37.Kalebic T., Garbisa S.., Glaser B., Liotta L. A.: Basement membrane collagen. Degradation by migrating endothelial cells, Science, 1982.38.Kohner E. M., Porta M.: Vascular abnormalities in diabets and their treatement, Trans. Ophtalmol. Soc. U.K., 1980.39.Kohner E. M., Hamilton A. M., Saunders S. J., Sutcliffe B. A., Bulpitt C. J.:The retinal blood flow in diabets, Diabethology,1975.40.Koenig F., Ramioul E., Bandello F., Soubrane G.: Evolution de la retinopatie precoce. Etude clinique et angiografique, Bull. Mem. Soc. Fr. Ophtalmol., 1985.41.Kearns M., Hamilton A. M., Kohner E.M.: Excessive permeability in diabetic maculopathy, Br. J. Ophtalmol., 1979.42.Little H. L.: Alteratins in blood elements in the pathogenesis of diabetic retinopathy, Ophtalmology, 1981.43.Luttz G.A., Thompson D.C., Gallup J. Y., Mello R.J., Patz A., Feneslau A.:Vitreous an inhibitor of retinal extract-induced neovascularisation, Invest. Ophthalmol. Vis. Sci., 1983.44.L'Esperance F.A., Jame W.A.: The problem of diabetic retinopathy, (in: Little M., Jack R.L., Patz A., Forsham P.: Diabetic Retinopathy),Georg. Thieme, Verlag-Stuttgart-New York, 1983.45.McMeel J.W., Trempe C.L., Franks E.B.: Diabetic Maculopaty, Trans. Am. Acad. Ophtalmol.-Otolaryngol.1977.46.Murphy R.P., Patz A.: The natural history and management of nonproliferative diabetic retinopathy in diabetic retinopathy, Thieme Stratton, New York, 1983.47.Mogo M.: Mic enciclopedie de medicin intern,ed. Didactic i pedagogic,1986.48. Olteanu M.: Tratat de oftalmologie, vol. 1-2, 1989.49. Olteanu M., Carstocea B., Dordea S.: Retinopatia diabetic-etiopatologie,tratament, Oftalmologia nr. 3, 1982.

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