1 / 38

DIAREEA CRONICA CONSTIPATIA CRONICA

DIAREEA CRONICA CONSTIPATIA CRONICA. DIAREEA. Scaun normal: 3/zi - 3/sapt; 100-200 g/zi. Diaree > 200 g scaun/zi; consistenta scazuta, numar mare scaune. Cantitate mare de scaun: secretie marita de anioni / absorbtie scazuta de electroliti. Mecanisme: osmotic, secretor, lezional.

awena
Download Presentation

DIAREEA CRONICA CONSTIPATIA CRONICA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DIAREEA CRONICA CONSTIPATIA CRONICA

  2. DIAREEA • Scaun normal: 3/zi - 3/sapt; 100-200 g/zi. • Diaree > 200 g scaun/zi; consistenta scazuta, numar mare scaune. • Cantitate mare de scaun: secretie marita de anioni / absorbtie scazuta de electroliti. • Mecanisme: osmotic, secretor, lezional. • Diaree cu cantitate normala de scaun.

  3. MECANISM OSMOTIC • Laxative saline, lactuloza, orlistat, etc. • Deficienta dizaharidaze (lactaza etc). • Afectarea intestinului subtire (virala, Whipple, celiaca, mastocitoza, amiloidoza, ischemie, limfom).

  4. MECANISM OSMOTIC 2 • Scaderea suprafetei intestinale. • Insuficienta pancreatica. • Malabsorbtie saruri biliare (bacterii, Crohn)

  5. MECANISM SECRETORIU 1 • Laxative: bisacodil, ulei ricin. • Medicatii: colchicina, teofilina, diuretice, neuroleptice. • Toxine bacteriene: Vibrio, E. coli, Clostr. • Cauze hormonale: VIP (WaDrHkAcl), serotonina, calcitonina (MEN), gastrina (alergatori), glucagon, PG.

  6. MECANISM SECRETORIU 2 • Neuropatie vegetativa (DZ). Etilism. • Ciclu acizi biliari: postcolecistectomie, Crohn, proliferare bact. • Inflamatie mucoasa: colita limfocitara, colagenica. • Tulburari transport: adenom vilos, clorhidroree cong.

  7. MECANISM LEZIONAL 1 • Boli inflamatorii intestinale: BC, CU. Infectii active: • Virale (rotavirusuri, Norwalk). • Parazitare (Giardia, Cryptosporidium , Ciclospora, Entamoeba). • Bacteriene (E. coli, Shigella, Salmonella, Yersinia, Clostridium).

  8. MECANISM LEZIONAL 2 • Infectii cronice: Nematode, Entamoeba, Clostridium, Shigella, TBC. • Ischemie: ateroscleroza, vasculite. • Diverse: Behcet, iradiere, proctite, alergii proteine lapte, soia, gastroent. eoz.

  9. DIAREE CU CANTITATE NORMALA DE SCAUN • Sindrom de intestin iritabil. • Hipertiroidism. • Proctite infectioase, ulcerative. • Incontinenta fecala: fisuri anale / perianale, postoperatorii, hemoroizi, neuropatii, sclerodermie. • Fecaloame / tumori - falsa diaree.

  10. DIAREEA CRONICA • Diaree cronica > 3 – 4 saptamani. • AHC: boala celiaca, boala inflamatorie, pancreatita Factori de risc 1 • Viata personala, obiceiuri alimentare. • Calatorii, consum alimente / apa potential contaminate. • Profesie: contact potential germeni, toxine, radiatii.

  11. ANTECEDENTE / ISTORIC Factori de risc 2: • DZ, sclerodermie, boli endocrine, iradiere, ateroscleroza, etilism, boli psihice. • Interventii chirurgicale. • Tratamente cronice / recente. • Fenomene asociate: febra, dureri abd, variatii TA, AV, sangerari, incontinenta.

  12. EXAMEN FIZIC 1 • Stare generala, TA, AV, temp, pliu cutanat. • Tegumente , mucoase: icter, paloare, petesii / echimoze, ulceratii, noduli, cheilita, glosita. • Edeme, scadere ponderala. • Artrite, afectare neurologica, afectare CV, oftalmologica, pulmonara.

  13. EXAMEN FIZIC 2 • Palpare abdomen: hepatosplenomegalie, mase palpabile. • TR: hemoroizi, fisuri, tonus sfincter, aspect scaun etc.

  14. EVALUARE I • Tip diaree: volum mare / normal? • Volum normal – intestin iritabil. • Volum < 1 L/24 ore – diaree osmotica sau lezionala. • Volum > 1 L/24 ore – diaree secretorie. • Raspuns la oprire alimentatie: stop = osmotica; continua = lezionala.

  15. EVALUARE II • Steatoree. Numar leucocite. • Coproculturi. Examen coproparazitologic. • HLG, VSH, CRP. • Electroliti (Na, K, Ca etc) serici si fecali. pH fecal.

  16. EVALUARE III • Teste hepatice (TGO, TGP, bilirubina, GGT, F. Alc., albumine / proteine, TQ). • Fe, B12, folati, colesterol, T3, T4. • Sigmoido / colonoscopie + / - biopsii.

  17. DIAREE CU VOLUM NORMAL • Evaluare anorectala. • Volum scaun. • Sindrom intestin iritabil.

  18. DIAREE OSMOTICA • Ac anti gliadina / endomisium, anti TTG. • IS – biopsii, culturi, Rx, EDS (dd), capsula endoscopica. • ERCP, CT abd., ecoendoscopie. • Teste secretii exocrine, trat. enzime pancreatice. • Teste respiratorii subst. marcate (C14 trioleina). Test D – xiloza. • Test Schilling diferite variante.

  19. DIAREE PRIN LEZIUNI DE MUCOASA • Test D – xiloza. • IS – biopsii, culturi, Rx, EDS (dd), caps. • Irigografie, inclusiv cu dublu contrast. • Colonoscopie + biopsii. • CT, RM abdominal. • Angiografie.

  20. DIAREE SECRETORIE • Volum scaun cu sau fara alimente. • pH scaun N (acid diaree osmotica) electroliti scaun ( diaree osmotica) • Colonoscopie + biopsie. • Dozari hormonale: gastrina, VIP, calcitonina, serotonina etc. • CT abd. Ecoendoscopie.

  21. TESTE NEGATIVE / DIAREEA CONTINUA! • Abuz de laxative. • Autoclisme. • Reluarea anamnezei si a examenului fizic. • Extinderea investigatiilor. • Falsa diaree. Probleme psihice. • ?

  22. COMPLICATII • Deshidratare. • Malabsorbtie. • Spitalizari. • Tratamente / diete costisitoare. • Interventii chirurgicale. • Pierderea capacitatii de munca / zile de concediu medical. • Costuri personale / sociale..

  23. TRATAMENT • Tratament etiologic. • Restrictii alimentare. • Tratament antibiotic local (Rifamixina 200 mg x 3- 6/zi) / general - antibiograma. • Tratament probiotice – Biotics, Enterol.

  24. TRATAMENT • Tratamente simptomatice: antidiareice opioide (loperamid 2 mg x 2- 3/zi), argile (diosmectita 3 g x 2- 3/zi). • Racecadotril 100 mg x 3 / zi - blocant • Tratamentul complicatiilor.

  25. CONSTIPATIE CRONICA • Definitie: < 3 scaune / saptamana. • Cea mai frecventa acuza digestiva. • Cauze: obstructie mecanica, boli neurologice / musculare, boli endocrine / metabolice, medicatii, idiopatice.

  26. OBSTRUCTIE MECANICA COLON • Cancer colorectal. • Boala inflamatorie intestinala. • Stricturi colonice / anale. • Corpi straini intrarectali. • Hemoroizi, fisuri anale. • Endometrioza.

  27. BOLI NEUROLOGICE / MUSCULARE • Neuropatie periferica si vegetativa. • Sindrom de coada de cal. Leziuni mieloradiculare. Neurofibromatoza. • Sclerodermie, DM/PM. B. Parkinson • Boala Chagas. Boala Hirschprung. • Amiloidoza. Distrofii musculare. • Pseudoobstructie intest. Scleroza mult.

  28. BOLI ENDOCRINE / METABOLICE • Diabet zaharat. Hipotiroidie. • Feocromocitom. Insuf. hipofizara. • Glucagonom. • Porfirie. • Hipopotasemie. Hipercalcemie

  29. MEDICATII • Opioide. Anticolinergice. Antidepresive. • Neuroleptice. Antiparkinsoniene. • Anticonvulsive. Antihipertensive. • Suplimente Fe / Ca. Antiacide cu Al. • Sulfat de Ba. • Intoxicatii metale grele (Pb, As, Hg).

  30. IDIOPATICE • Intestin iritabil. • Megacolon, dolicocolon. • Prolaps rectal. • Dissinergie rectosfincteriana.

  31. ANTECEDENTE ISTORIC • Antecedente familiale. • Durata / aparitie. • Boli / medicatii concomitente / recente. • Simptome / semne concomitente: genitourinare, cutanate, CV, etc. • Scaun ?

  32. EXAMEN FIZIC • Evidentiere cauze digestive / nondigestive. • Palpare mase abdominale, hepatice etc. • TR, tonus sfincter, aspect scaun. • Prolaps mucoasa rectala, fisuri. • Examen ginecologic.

  33. EXAMENE DE LABORATOR • Scaun. • HLG, VSH. • Teste tiroidiene. • Ca. • Porfirine. • Teste autoimunitate. • etc

  34. EXPLORARI • Sigmoidoscopie, colonoscopie + biopsii. • Irigografie. • Manometrie anorectala. • Defecografie. • CT, RM.

  35. COMPLICATII • Hemoroizi. • Prolaps mucoasa. • Sangerari. • Fisuri anale. • Obstructie, perforatii.

  36. TRATAMENT • Exercitiu fizic. Aport fibre 20 – 30 g / zi. • Aport adecvat lichide. • Crestere volum scaun (psyllium, metilceluloza) macrogol – Forlax. • Lubrifiante (ulei parafina).

  37. TRATAMENT • Laxative osmotice (lactuloza 5 – 10 g x 1 – 3 / zi). Solutii PEG - Fortrans . • Lubiprostone inh. – canale Cl. • Laxative emoliente – docusate.

  38. TRATAMENT 2 • Laxative iritante (senna – Regulax, Rixative). • Prokinetice: tegaserod (serotonina) - 2-6 mg x 2 / zi, trimebutine 100 mg x 3 /zi, PG, colchicina. • Clisme. Supozitoare. • Tratament chirurgical.

More Related