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SINDROAME FICAT (2.HEPATITA ACUTA (etiologie virala A-E
- fecal-oral A,E
…
SINDROAME FICAT
1.HEPATOMEGALIC
Etiologie
-
-
Acumulare substante hepatic
- steatoza
- tezaurismoze (sfingolipide, glicogen)
- Wilson
- Hemocromatoza
- amiloidoza
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Infiltrat hepatocelular- limfom, leucemie
2.HEPATITA ACUTA
etiologie virala A-E
- fecal-oral A,E
- sexual, parenteral, perinatal B,C,D
- asimptomatic
- sdr. pseudogripal, gastrointestinal, reumatologic
-
Complicatii
- hepatita fulminanta
- cronicizare
- Hcc
- colestaza
-
- debut insidios
- persistenta de 6 L
- inflamatie, necroza, fibroza
Etiologie
- viral (B,C,D)
- autoimun
- medicamentos (anticonceptionale, TBCstatice)
- etanol
- criptogenetic
SIMPTOME
- astenie persistenta la efort minim
- dispepsie
- hepatalgie efort
EXAMEN OBIECTIV
- ferm
- suprafata anterioara neteda
- margine ant rotunjita
- splenomegalie
- stelute vasculare
- sdr hemoragipar
- manifestari sistemice ( mialgii, artralgii, vasculita, GN)
PARACLINIC
- sdr hepatocitoliza ondulant
- ALAT- > viral, Ai
- ASAT-> etanolic
- markeri virali
- markeri Ai
- PBH
- ECO
- adenopatie in Hil ( HCV)
- hipertrofie lob stg ( etanol)
- stadiu final, ireversibil al bolilor hepatice
- distorsiune arhitectura ( necroza) , fibroza, nodul regenerativ
Etiologie
- hepatita cronica
- Wilson
- Hemocromatoza
- Budd-Chiari
- D A1AT
- Sarcoidoza, TBC, sifilis, colangita biliara si pancreatica
Manifestari
- encefalopatie hepatica
- icter
- ascita
- HSmegalie
- tendinta de micsorare hepatica cu atrofie
-
INCLUDE
- SDR HTP
- SDR ASCITIC
- SDR ICTERIC
- SDR HEMORAGIPAR
- SDR NEUROENDOCRIN
5.HTP
-
-
CLINIC
TRIADA
- circulatie colaterala
- splenomegalie congestiva
- ascita
- flancuri, cap de meduza
- varice esofagiene, gastrice (gastropatie portal hipertensiva), duodenale, hemoroizi
- hipersplenism
- circulatie hiperkinetica ( puls amplu, hTA, extr. calde)
INVESTIGATII
- ECO -> dilatari venoase
- Endo sup/inf -> circ colat + tratament
- cu peritoneu indemn si HTP = decompensare vasculara si parenchimatoasa la cirotic
SIMPTOME
- asimptomatic in cantitati mici
- dureri abd
- dispnee
- anorexie
- varsatura
EO
- aspect batracian
- matitate deplasabila
- semnul valului
- edem gambier hipoALB-emic
Investigatii
- img
- paracenteza-> examen citologic- > Dx transsudat (HTP) / peritonita bact. spontana / exsudate (inf, colagenoze, neo)
7.ENCEFALOPATIA
HEPATICA
complicatie variabila, recidivanta, reversibila a cirozei
SIMPTOME
- confuzie
- alterare perf. intelectuala
- somnolenta
- dezorientare
- tulb personalitate
- modif stare constienta
- coma
EO
- asterixis
- foetor hepatic
- spasticitate, hiperreflexie
**- biologic -> amonemie >100ug/dl- factori favorizanti **( tulb tranzit, infectii, aport proteic, diuretice, sedative, hemoragii dg)
- Dx cu alte fectiuni neuro organice-> CT, RMN
HDS
- rupere varice
- ulcer
- Mallory-Weiss
- gastrite
SIMPTOME
- hematemeza si/sau melena
- anemie ( asimpt <500ml)
- ameteli
- transpiratii
- astenie
- tahicardie
- hTA
- SOC (>2l)
-
-
-
-
ICTERIC
-
CLASIFICARE
PREHEPATIC
CARACTERISTICI
- FLAVIN
- paloare
- splenomegalie
- tulburari crestere/ forma craniu, facies
- ANEMII HEMOLITICE
- ANEMIE BIERMER
- RESORBTIE HEMATOM
- DEFECTE EREDITARE CONJUGARE ( GILBERT, C-NAJJAR)
BIOLOGIC
- BRI / CONJUGATA
- ANEMIE HEMOLOTICA
- UBG +
- SBG +
HEPATIC
CARACTERISTICI
- RUBIN
- spider nevi
- ginecomastie
- circ. colat
- ascita
- splenomegalie
- asterixis
- HEPATITA ACUTA/CRONICA/ ISCHEMICA
- CIROZA
- SARCINA
- INTOXICATII
- DEFECTE EREDITARE EXCRETIE ( ROTOR, DUBIN-JOHNSON)
- MEDS ( ACO, STEROIZI)
BIOLOGIC
- BRD + BRI
- SDR HEPATOCITOLIZA +/- COLESTAZA
- UBG +
POSTHEPATIC
CARACTERISTICI
- VERDIN
- urini colurice, scaune acolice
- TRIADA CHARCOT(4)
- Courvoisier-Terier, PRURIT, simptome alarma (2)
- icter intermitent, HDS (3)
- icter, prurit fara durere (5)
- icter, prurit, xantelasma, astenie (1)
- COLESTAZA INTRA/EXTRAHEPATICA
- LITIAZA BILIARA
- CBP (1)
- COLANGIOCARCINOM (5)
- STENOZA CAI BILIARE
- NEO CAP PANCREAS (2)
- PANCREATITA CRONICA
- PSEUDOCHIST
- AMPULOM VATERIAN (3)
- LIMFOM
- ANGIOCOLITA (4,3)
BIOLOGIC
- BRD/ NECONJUGATA
- SDR COLESTAZA/HEPATOCITOLIZA
- UBG -
- SBG -
COMPLICATII RENALE
SDR HEPATORENAL
-
-
DG
- Cl <40ml/ min
- creatinina > 1.5 mg%
- fara med. nefrotoxic/ soc/ deshidratare
- fara ameliorare la expansiune volemica
- proteinurie <500mg/24h
- fara obstructie ur
-
-
HCC
- frecvent la inf. virale C, B
- AFP ca marker tu
COLESTAZA
- discfunctie sinteza, exctretie, drenaj
EXTRAHEPATIC
- HEMERALOPIE
- HEMORAGII SPONTANE
- OSTEOPOROZA, DISTROFIE, MALACIE
- TULBURARI NEURO/ SEXUALE
- obstructie (CBP, litizaza, neo, stricturi, CS)
- compresiune (neo pancreatic, ampulom, pancreatita cronica)
INTRAHEPATIC
- PRURIT, leziuni grataj
- ICTER OBSTRUCTIV +/- durere
- XANTELASMA, XANTOAME-
- ductopenie (CBP, Colangita sclerozanta, colangocarcinom, angiocolita, medicamente)
- hepatite
- medicamente (estrg, steroizi, aco, carbamazepina, cimetididna)
- sarcina, colestaza **intrahepatica recurenta benigna**
BIOLOGIC
- cresc enz. de colestaza (FA,GGT)
- creste BRD
- cresc lipidele serice
- creste TP
IMAGISTIC
-