Scrigroup - Documente si articole

Username / Parola inexistente      

Home Documente Upload Resurse Alte limbi doc  

CATEGORII DOCUMENTE





Alimentatie nutritieAsistenta socialaCosmetica frumuseteLogopedieRetete culinareSport

MALFORMATII ALE TUBULUI DIGESTIV

sanatate

+ Font mai mare | - Font mai mic







DOCUMENTE SIMILARE

Trimite pe Messenger
Metodologia prezentarii de caz clinic
Pneumoniile si infectiile pulmonare necrozante – test grila
Masajul
Muschiul utilizeaza ATP pentru actiunea mecanica
HEPATITA ACUTA VIRALA A
Socul cardiogen
VISCUL - proprietati
ERUPTIA DENTARA
CHIRURGIA ROBOTICA
Dietoterapia in pancreatita cronica

MALFORMATII ALE TUBULUI DIGESTIV

          Stenoza hipertrofica de pilor –frecventa la barbate



                                                         -dezvoltata sub actiunea unor factorii genetici

               Teorii patogeniceàteoria malformativa(copilul s-ar naste cu tumora care creste trptat)

                                          àteoria spasmului hipertrofiant

                                          àteoria endocrina

               Anatomopatologic –(M)-pilorul creste in volum,dur la palpare,vascularizatie evidenta(mai putin pe linia mediana-avascular)

                                             -(m) pe sectiune mucoasa groasa de 1cm

               Simptome :-varsatura-alba in jet,exploziva,la 14-21 zile dupa nastere,se produce imediat post-prandial sau la un interval de 10-12 minute.Cu timpul intervalul creste la 30 minà1-2 h datorita dilatarii stomacului

                                              *intre mese copilul e agitate,tipa de foame

                                 -stagnare in greutate apoi scadere

                                 -urini hipercrome

                                 -scaune rare sub forma de scibal?

                                 -pliu cutan lenes,facies simian

               Ex.abdominal- tumefactie in zona epigastrica

                              Local- abdomen suplu, nedureros ,se poate palpa oliva pilorica in decubit drept sub rebordul drept

               Laborator- Cl,Na,pH (pt.alcaloza),urea sge,neprot.crescute

               Imagistic- transit Ba àimagine patognomonica-canal pyloric filiform, alungit

                                                                                           -stomac”in chiuveta”(Ba stagneaza 24h)

              Forme clinice – 1)precoce-in primele zile dupa nastere

                                        2)clasica/comuna-zilele 14-21

                                        3)tardiva-la varsta de 3 luni

                                        4)hemoragica-datorata leziunii mucoasei gastrice <= lupta pt.invingerea obstacolului pyloric

                          *sdr.Rovirolta- varsaturi + malpoz.eso-cardio-tuberozitare

            Dg.diferential- regurgitatie,greseli de alimentatie, intoleranta la lapte,spasm pyloric, duplicatie pilor, varsaturi din boli infectioase, stenoza duodenala prin diaphragm incomplete, stenoze extrinseci duodenale, malpozitie eso-cardio-tuberozitare(varsaturi rosiatice datorita esofagitei peptice)

            Tratament – faraàexitus datorita denutritiei sau brohopneumoniei de aspiratie

                             -medical-mese mici repetate, antispastice,perfuzii cu glucoza,ser fiziologic  à ramolisment oliva pilorica si ar disparea prin maturarea inervatiei intramurale.

                             -chirurgical- pilotomie extramuc. Fredet(Ramsted)àincizie epigastru mediu/transvers; se repereaza pilorul, se incizeaza lejer in zone avasculare, se diseca pana in? la mucoasa, se evidentiaza, se verifica pasajul gastro-dd,se inchide peretele abd.

            Complicatii- perforarea mucoasei(se repara prin artificiu Zamson) => pneumoperitoneu

          Stenoza duodenala

                                   àla 1/5000 de nou-nascti

                                   àfactorii malformanti actioneaza in S6-S8



                  Mecanismul de producere – se explica prin teoria Tandler:tulburari de vacuolizare a tubului intestinal primitive.

                                  -exista 2 tipuri de mecanisme:

                                                                        a)intrinseci: 1)agenezie partiala a                                           duodenului,cand capetele se termina in deget de manusa

                                                                                            2)atrezieàunite prin cordon fibros

                                                                                             3)diaphragm complet

                                                                                             4)diaf. Incomplete

                                                          *** diafr.= repliu mucoasa dublu inserat pe peretele abdominal

                                                                        b)extrinseci 1)pancreas inelar

                                                                                            2) pseudochist congenital de coledoc

                                                                                            3)duplicatie dd

                                                                                            4)pensa aort-mezenterica

                  Anatomopatologic – (M)-duodenul supraadiacent mult crescut in volum,cel subadiacent redus

                                                  -in a)-1,2,3 restul anselor hipoplazice neaerate

                   Simptome – difera in functie de obstacol:

                                                                 àsupravaterian- varsaturi albe

                                                                 àsubvaterian- varsaturi galbene

                                                                 àin obstacol –complet-varsaturi in primele zile dupa nastere

                                                                                       -incomplet-tardiv

                                   -scadere in greutate

                                   -semne de deshidratare(pliu lenes)

                                   -BP de aspiratie

                        Local – abdomen excavat(obstacol complet);proba Faber(-)àin……..ce se elimina nu se regasesc cellule cornoase

                  Rx. – imagine in “talere de balanta”(una din imagini-aer in stomac cealalta, aer in dd.)

                         -in obstructia completaàrestul tubului digestive neaerat

                  Dg.diferential – malformatii ale intestinului cu ileus mecanic(meconial)

                                                                                              peritonica meconiala

                                         -obstacol supravaterian cu spasm pyloric,forma precoce in stenoza hipertrofica diafr.prepiloric,malformatii eso-cardio-tuberozitare.

                  Tratament – fara exitus in formele complete

                                   -chirurgical – refacerea continuitatii –pt a)1,2 duodden-jejuno Xa

                                                                                                             duoden-duoden Xa termino-terminal

                                                                                                       3,4extirpare + refacere   

                                                                                                    b)operatie de ocolire a duodenului(dd-jejun Xa)




                

                                      Malformatii intestinale – 1/1000 de nou-nascuti

                                            àagenezie, aterezie, diafr.complet/incomplet

                                    Teorii – t.lui Tandker

                                                 t.lui Simpson : in viata fetala poat aparea mici perforatii la nivel intestinal ce genereaza peritonite,perforatii ce se vindeca spontan, care se exprima prin agenezie.

                                                 t.lui Forgue & Riche : resorbtia in exces a cavitatii viteline

                                                 t.Courioi : vascularizatie improprie =>nu se dezvolta corespunzator

                                   Anatomopatologic – (M)-intestinul supraadiacent mult dilatat ,restul hipoplazicàaspect de microcolon.

                                   Simptome – la malformatii sus situate – varsaturi biloase

                                                                                                -nu/putin elemente mecanice

                                                                                                -abdomen relative normal,usoara distensie epigastrica intre varasturi

                                                                                 Rx – imagini hidroaerice

                                                    -la malformatii jos situate – dupa 12-48 h varsaturi biloase initial apoi cu continut intestinal

                                                                                              -abdomen meteorizat

                                                                                 Rx – imagini hidroaerice in etajul sup

-         imagini opace in etajul inf

                                                                                 Irigografie – microcolon

                                     Evolutie spontana – exitus prin perforatie diastazica sau peritonita sau prin BP de aspiratie

                                     Tratament – chirurgical- refacerea continuitatii tubului digestive

                         Ileus mechanic(meconial scrie cineva in curs…da..) = ocluzie intestinala prin                                              ,gros adherent de mucoasa.

                               àapartine mucoviscidoza = boala scleroatrofica a tuturor glandelor care deriva din tubul digestive primitive

                              ànecomplicat – abdomen destinsin flanc drept + impastare

                              àcomplicat – volvulus , perforatie +/_ peritonita meconiala

                                                   -abdomen drept destines + subombilical + impastare

                              àRx. – imagini hidroaerice

                              àIrigografie – microcolon

                              àevolutie – exitus prin BP din cadrul mucoviscidozei

                              àtratament – fluidificare  : clisma cu gastrografin(substanta hipoosmolara a acidului diacetilNH2 tiiodobenzoic)

                                                 -ileostomie/rezectie in acea zona(rezectie-cel mai complic)








Politica de confidentialitate

DISTRIBUIE DOCUMENTUL

Comentarii


Vizualizari: 844
Importanta: rank

Comenteaza documentul:

Te rugam sa te autentifici sau sa iti faci cont pentru a putea comenta

Creaza cont nou

Termeni si conditii de utilizare | Contact
© SCRIGROUP 2019 . All rights reserved

Distribuie URL

Adauga cod HTML in site