Download - Prac 1 Tract Digestivus
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Proximale tractus digestivus
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A5
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A6
Spierlagen oesofagus• bovenste 1/3 = dwarsgestreept
spierweefsel• onderste 1/3 = glad spierweefsel• middelste 1/3 = glad + dwars
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A6
1. onderste oesofagussfincter: zorgt voor een hogedrukzone (10-20 mmHg) over een lengte van 3 à 4 cm. Draagt hierdoor bij aan het voorkomen van gastro-oesofageale reflux.
1. diafragma (hiatus oesophageus)
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3. klepwerking door de hoek van His (hoek van de fundus met de oesofagus)
4. positieve intra-abdominale druk (vs. de lagere intrathoracale druk)
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Hoek van His
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• Plaveiselepitheel (oesofagus) eenlagig cilindrisch epitheel (gaster)
• Overgang thv onderste oesofagussfincter
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A8 - Bloedvoorziening
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A8
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A8
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A8
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A8
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A8
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A8
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A9
• 403 + plaatje blz. 82 en 83
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A9
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A9
______
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A11
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Casus B
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B1
• Leverstigmata– Caput medusae– Erythema palmare– Spider naevi– ascites
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• Erythema palmare
• Spider naevi
• Caput medusae
• Ascites
Meneer Molenaar
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B4 - ballontamponade
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B6
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B6 portocavale anastomosen
• Porto-systemische anastomosen verbinding portale veneuze systeem en systemische veneuze systeem– Oesofagus– Rond de navel– Rectum– paracolisch
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Portal-systemic anastomoses
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B6
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lobus hepatis sinister
lobus hepatis dexter
lobus caudatus
lobus quadratus
B6
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lobus hepatis sinister
lobus hepatis dexter
lobus caudatusarea nuda
lobus quadratus
B6
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lobus hepatis sinister
lobus hepatis dexter
lobus caudatusv. cava inferior area nuda
lobus quadratusgalblaas (vesica biliaris)
B6
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lobus hepatis sinister
lobus hepatis dexter
lig. teres hepatislig. falciformhepatis
lobus caudatusv. cava inferior area nuda
lobus quadratusgalblaas (vesica biliaris)
B6
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lobus hepatis sinister
lobus hepatis dexter
lig. teres hepatislig. falciformhepatis
lobus caudatusv. cava inferior area nuda
lobus quadratusgalblaas (vesica biliaris)
porta hepatis (leverhilus)
B6
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B8
• Lig. teres hepatis = geoblitereerde v. umbilicalis
• Lig. falciforme = voorheen onderdeel vh ventrale mesenterium vd maag (lever ontstaat in ventrale mesenterium vd maag)
• Lig. venosum = ductus venosus
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B9
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Casus C
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C2
• Double duct sign
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C5
• 246, 247, 251, 222 (duodenum!!)
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C6
Lig. hepatoduodenale - Dr. Alva• Ductus rechts• Arterie links• Vena achter
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C7
• Het pancreas of de pancreas?
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C7
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• ventrale pancreasaanleg processus uncinatus + onderste gedeelte pancreaskop
• dorsale pancreasaanleg overige pancreasonderdelen
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• ventrale en dorsale pancreaswegen fuseren. distale gedeelte dorsale pancreasgang sluit
aan op ventrale pancreasgang die samenkomt met de ductus choledochus ter plaatse van de papilla duodeni major (Vater) = ductus pancreaticus.
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• Het proximale gedeelte vd dorsale pancreasgang oblitereert of blijft bestaan als ductus pancreaticus accessorius (papilla duodeni minor).
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C8
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Foutieve ontwikkeling pancreas: pancreas annulare
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C8 pancreas annulare
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C9 blz. 249
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Peritoneale verhoudingen 1
• Intraperitoneaal• Retroperitoneaal
• Primair retroperitoneaal: strukturen zijn nooit binnen het peritoneum gelegen. (nieren, bijnieren, gonaden)
• Secundair retroperitoneaal: strukturen zijn eerst binnen het peritoneum gelegen en vervolgens is het dorsaal mesenterium verkort, waardoor ze weer retroperitoneaal zijn komen te liggen. (duodenum, pancreas, colon ascendens en descendens)
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Peritoneale verhoudingen 2
• Omentum majus (omentum = schort)• Bursa omentalis• Omentum minus
ligamentum hepatoduodenalisvena portaea.hepatica propriaductus choledochus
• Ligamentum falciforme (falx = sikkel)• Ligamentum teres hepatis (teres = rond)• Foramen omentalis (foramen epiploicum)