cazuri clinice-drenaje
TRANSCRIPT
![Page 1: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/1.jpg)
Cazuri cliniceCazuri clinicedrenaj percutan drenaj percutan
eco-ghidateco-ghidat
Alexandru AndritoiuAlexandru AndritoiuSpitalul Clinic de Urgenta Spitalul Clinic de Urgenta
Militar CraiovaMilitar Craiova
![Page 2: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/2.jpg)
Abces hepatic Abces hepatic post-chemoembolizarepost-chemoembolizare
![Page 3: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/3.jpg)
Arch Surg 1998
![Page 4: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/4.jpg)
Complicatii vasculare-lezarea a. hepatice-embolie pulmonara (sunturi porto-
venoase)Complicatii non-vasculare-sdr.post-embolizare-Infectii: - abces hepatic/extrahepatic - bilom -sepsis-stricturi biliare-insuf. hepatica/renala-HDS (varice esofagiene)
Seminars in Interv Radiology 2006
![Page 5: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/5.jpg)
Abces hepatic <5 cm
PNAPNA Aspiratie percutanaAspiratie percutana
Abces hepatic >5 cm
PNDPND Cateter de drenajCateter de drenaj
Tratamentul percutan ghidat ecografic (PNA/PND): o alternativa sigura si eficienta la tratamentul chirurgical al abcesului
hepatic
![Page 6: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/6.jpg)
CaseCase 11
P. Stefan, 75 aniP. Stefan, 75 ani Ciroza hepatica vir. B-Cls. ACiroza hepatica vir. B-Cls. A CHC <2.5 cm segm. VIIICHC <2.5 cm segm. VIII AFP in crestere progresivaAFP in crestere progresiva Solutia oncologului:Solutia oncologului: TACE: apr.TACE: apr. 20142014
![Page 7: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/7.jpg)
Evolutie imediataEvolutie imediata
Deteriorarea starii generaleDeteriorarea starii generale Dureri intense in etajul abd. superiorDureri intense in etajul abd. superior Alterarea probelor hepaticeAlterarea probelor hepatice Degradare fizica si biologicaDegradare fizica si biologica SepsisSepsis
![Page 8: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/8.jpg)
CT-apr.2014CT-apr.2014
![Page 9: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/9.jpg)
Solutia terapeutica Solutia terapeutica aleasaaleasa
Drenaj percutan ghidat ecograficDrenaj percutan ghidat ecografic Protectie AB cu spectru largProtectie AB cu spectru larg Lavajul cavitatii cu solutie de Lavajul cavitatii cu solutie de
betadinabetadina
![Page 10: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/10.jpg)
![Page 11: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/11.jpg)
![Page 12: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/12.jpg)
![Page 13: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/13.jpg)
![Page 14: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/14.jpg)
![Page 15: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/15.jpg)
Drenaj purulentDrenaj purulent
![Page 16: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/16.jpg)
Culturi aspiratCulturi aspirat
E Coli, Klebsiella
![Page 17: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/17.jpg)
Lavaj betadinaLavaj betadina
![Page 18: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/18.jpg)
Nutritie parenteralacateter v.subclavie
![Page 19: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/19.jpg)
CT-10 apr.2014CT-10 apr.2014
Drenaj percutan
![Page 20: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/20.jpg)
Echo-mai 2015Echo-mai 2015
![Page 21: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/21.jpg)
iulie 2014US
RMN
CT
D = 6/5 cm
![Page 22: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/22.jpg)
CT-nov 2014CT-nov 2014
![Page 23: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/23.jpg)
EchoEcho apr. 2015apr. 2015
![Page 24: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/24.jpg)
Case 2Case 2 T Solomon, 56 aniT Solomon, 56 ani Neoplasm vezica biliaraNeoplasm vezica biliara Metastaze hepaticeMetastaze hepatice Biopsie ghidata echo (carcinom)Biopsie ghidata echo (carcinom) Depasit operatorDepasit operator Solutia oncologului:Solutia oncologului: Chimio+ChemoembolizareChimio+Chemoembolizare
![Page 25: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/25.jpg)
Evolutie imediata (7 z)Evolutie imediata (7 z)
Dureri abdominale (epigastru)Dureri abdominale (epigastru) Stare generala alterataStare generala alterata Febra 38 CFebra 38 C Sdr. biologic inflamatorSdr. biologic inflamator SepsisSepsis
![Page 26: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/26.jpg)
Solutia terapeutica Solutia terapeutica aleasa:aleasa:
Aspiratie/drenaj percutan ghidat Aspiratie/drenaj percutan ghidat EchoEcho
Drenaj ascitaDrenaj ascita Protectie AB Protectie AB
![Page 27: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/27.jpg)
Echo-Ficat LSEcho-Ficat LS
![Page 28: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/28.jpg)
![Page 29: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/29.jpg)
![Page 30: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/30.jpg)
![Page 31: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/31.jpg)
![Page 32: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/32.jpg)
![Page 33: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/33.jpg)
CT-drenajCT-drenaj
![Page 34: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/34.jpg)
Evolutie favorabilaEvolutie favorabila
Remisia febreiRemisia febrei Ameliorarea starii generaleAmeliorarea starii generale Disparitia imaginii ecograficeDisparitia imaginii ecografice Extragerea drenului dupa 4 zExtragerea drenului dupa 4 z
![Page 35: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/35.jpg)
Colangiocarcinom centrohilar
Icter mecanicCiroza hepatica-AscitaDrenaj biliar percutan
extern
![Page 36: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/36.jpg)
Case 3Case 3P. Gheorghe, 54 aniP. Gheorghe, 54 ani Ciroza hepatica vir B –Ascita refractaraCiroza hepatica vir B –Ascita refractara IcterIcter Tum hep centrohilara (Colangiocarcinom?)Tum hep centrohilara (Colangiocarcinom?) VSH 52 mm/hVSH 52 mm/h Tb 74.000/mmcTb 74.000/mmc INR 1.34INR 1.34 BRT 7.5 mg/dLBRT 7.5 mg/dL CA 19-9 58u/mL (N<35)CA 19-9 58u/mL (N<35)
![Page 37: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/37.jpg)
US-AbdomenUS-Abdomen
Ficat ciroticAscitaTumora centro-hilaraDilatatii CBIH
![Page 38: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/38.jpg)
RMN AbdomenRMN Abdomen macronodul tumoral centro-hilar si in
segm. IV-VIII, in hipersemnal T2, hiposemnal T1, heterogen postcontrast de 6/5 cm - ce determina obstructia cailor biliare intrahepatice
![Page 39: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/39.jpg)
Drenaj ascitaDrenaj ascita
![Page 40: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/40.jpg)
Colangiografie percutana
![Page 41: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/41.jpg)
Drenaj bilar extern-percutan
Z-4: angiocolita, sepsis, MSOF, exitus (Acynetobacter)
![Page 42: Cazuri clinice-drenaje](https://reader031.vdocuments.pub/reader031/viewer/2022013109/58a172641a28ab04278b5245/html5/thumbnails/42.jpg)