patologie digestiva i

8/12/2019 Patologie Digestiva i

1/19

PATOLOGIE DIGESTIVA IREFLUXUL GASTRO-ESOFAGIAN(RGE)RGE - Definiii Refluxul ga !"#-e #fagian - un fen#$en fi%i#l#gi&' n ! n *a a+ul ninu!uga !"i& n e #fag' ,e ine *a!#l#gi& &.n, $e&ani $ele an!i"eflux un! ,e* /i!e 0#ala ,e "eflux ga !"#-e #fagian (0RGE) - in&lu,e !#!ali!a!ea i$*!#$el#" *"#,u e ,e RGE E #fagi!a ,e "eflux (ER) - i%ea% le%iunile e #fagiene in,u e ,e RGE0RGE - P"e alen Difi&il ,e a*"e&ia! ,e#a"e&e1

- &"i!e"ii ,e ,iagn# !i& i$*"e&i e- a"ia2ili!a!e a i$*!#$a!#l#giei- e #luie na!u"al ne&un# &u! a 2#lii

0RGE e !e f"e& en! 1- *i"#%i %ilni& 3 45 ,in *#*ulaie n SUA- *i"#%i $ai ,e ,e&.! #,a! *e lun 3 675

ER e !e f"e& en! 1 8 95 ,in *#*ulaie n SUA- &"e/!e &u ." !a- in&i,ena e !e n *"e%en! n &"e/!e"e

RGE 3 Ex*"i$a"e &lini&0RGE - E!i#*a!#genie :au%e ,e #",in fi%i#l#gi& S& ,e"ea *"e iunii fin&!e"ului e #fagian infe"i#" (SEI)

- n $#, n#"$al' *"e iunea n SEI e !e ,e ;g- RGE a*a"e &.n, SEI e "elaxea% n afa"a ,eglu!iiei' au &.n, *"e iunea n SE

&a,e u2 7 $$>g ,in &au%a inge !iei ,e1- $e,i&a$en!e (an!iline"gi&e' 2en%#,ia%e*ine' ni!"ai' a$in#filin ' 2l#&ani ai &analel#" ,e :a;? ' xan!ine)

- ali$en!e (&i#la! ' g" i$i' &ea* ' u& ,e *#"!#&ale au ,e "#/ii)- &afea' al#l (&"e/!e e&"eia ga !"i& a&i, )' fu$a!

Di$inua"ea $#!ili! ii ga !"i&e

Afe&!a"ea &lea"an&e-ului e #fagian

0RGE - E!i#*a!#genie

:au%e ,e #",in $e&ani& >e"nia @ia!al - &a,e *"e iunea SEI :"e/!e"ea *"e iunii in!"a-a2,#$inale 3 #2e%i!a!e' a"&in ' a &i! ' !u$#"ia2,#$inale gigan!e L "gi"ea ung@iului >i Relaxa"ea *en ei ,iaf"ag$a!i&e 3 n &a%ul &"e/!e"ii #lu$ului !#"a&i& au *"ein!"a-a2,#$inale Tul2u" "i $#!#"ii e #fagiene - S&le"#,e"$ia


2/19

0RGE - E!i#*a!#genieA*a"iia /i e e"i!a!ea ER ,e*in, ,e1

3 :"e/!e"ea f"e& enei RGE 3 :"e/!e"e ,u"a!ei RGE 3 Efe&!ul ag"e i al "efluxului ga !"i& a u*"a $ua ei e #fagiene0RGE - Ta2l#u &lini& Si$*!#$e !i*i&e (*"e%en!e nu$ai n B ,in &a%u"i)

Pi"#%i 1- ,i nf#"! "e!"# !e"nal u2 f#"$ ,e a" u"- ag"a a! ,e &"e/!e"ea *"e iunii in!"a-a2,#$inale /i *#%iia &lin# !a!i& ,u* $a- a*a"e *# !*"an,ial- *"#$*! a$eli#"a! ,e an!ia&i,eRegu"gi!aii a&i,e

Di fagie /i #,in#fagie 3 e$nifi& f"e& en! ER e e"0RGE - Ta2l#u &lini& Si$*!#$e a!i*i&e - e$nifi& &el $ai f"e& en! & a a* "u! # $*li&aie Du"e"e "e!"# !e"nal Si$*!#$e "e *i"a!#"ii (!u e' uf#&a"e' ,i *nee n#&!u"n ' &"i%e ,e a !$) ,a!#"a!ea *i"aiei ninu!ului ga !"i& "eflua! Si$*!#$e ORL (la"ingi! ' ,i f#nie' *a"e !e%ii fa"ingiene) Ane$ie ( n!#!,eauna !"e2uie & u!a! # *# i2il $*li&aie1 @e$#"agie' &an&e"0RGE - Ex*l#" "i *a"a&lini&eIn e !igaii ne&e a"e *en!"u e alua"ea 0RGE1

En,# *ie ,ige !i u*e"i#a"0a"iu *a a+P@-$e!"ie /i $an#$e!"ie e #fagian

:.n, !"e2uie efe&!ua!eCDiagn# !i& in&e"!Si$*!#$e a!i*i&e (,u"e"e *"e",ial ' i$*!#$e *ul$#na"e au ORL)Si$*!#$e a #&ia!e &u $*li&aii (,i fagie' #,in#fagie' & ,e"e *#n,e"al

inex*li&a2il ' >DS' ane$ie)R *un ina,e& a! la !"a!a$en!Si$*!#$e "e&u"en!e

En,# *ia n 0RGE P"i$a ex*l#"a"e *a"a&lini& ,e efe&!ua! E i,enia% au ex&lu,e1 3 # le%iune e #fagian 3 # le%iune ga !"#-,u#,enal 3 # @e"nie @ia!al Pe"$i!e 2i#* ie"ea le%iunil#"

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3/19

:el $ai f"e& en! e !e n!.lni! ER :la ifi&a"ea Sa a" ille" :la ifi&a"ea L# Angele ( 9 #"l, :#ng"e #f Ga !"#en!e"#l#g )En,# *ia n 0RGE:la ifi&a"ea Sa a" ille" a ER

G"a,ul I 3 le%iuni @i*e"e$i&e' nenfluen!e n e #fagul infe"i#"

G"a,ul II 3 le%iuni e"#%i e' exu,a!i e' nfluen!e' ne&i"&u$fe"eniale

G"a,ul III 3 le%iuni ,ifu%e' @e$#"agi&e' &i"&u$fe"eniale

G"a,ul IV 3 $*li&aii ( !en#% ' ul&e"):la ifi&a"ea L# Angele a ER

S!a,iul A 3 &el *uin # %#n ,e *ie",e"e ,e u2 !an (e"#%iune) H = $$

S!a,iul 0 3 &el *uin # *ie",e"e ,e u2 !an = $$' nenfluen!e

S!a,iul : 3 # *ie",e"e ,e u2 !an ex!in *e 6-9 *liu"i' ne&i"&u$fe"enialS!a,iul D 3 *ie",e"e ,e u2 !an &i"&u$fe"enial0a"iu *a a+ n 0RGE U!ili!a!e n!"# e" a! Nu e i,enia% le%iunile ,e ER P#a!e e i,enia 3 !ul2u" "i $#!#"ii e #fagiene (a&ala%ia)

3 !en#% e #fagian 3 @e"nie @ia!al n *#%iie T"en,ele$2u"gP@-$e!"ia n 0RGE #a" P@-ul n e #fagul infe"i#" *e !i$* ,e ;9 @ ( i !e$ >#l!e") De$#n !"ea% ,u"a!a RGE :#"elea% *"e%ena RGE &u a*a"iia i$*!#$el#" ex!"a,ige !i e U/u"ea% ,iagn# !i&ul ,ife"enial' n *e&ial la *ii0RGE - Diagn# !i& ,ife"enialAl!e 2#li ale e #fagului1 3 e #fagi!a *# !&au !i& 3

e #fagi!e i"ale /i fungi&e 3 &an&e" e #fagian 3 a&ala%ia 3 !en#%a e #fagian 3 ,i e"!i&uli e #fagieniSi$*!#$ele ex!"a,ige !i e ale 0RGE 3 angina *e&!#"i au a !$ul &a",ia& 3 ,e2u!ul &"i%el#" ,e a !$ 2"#n/i& (la *ii)

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4/19

Al!e 2#li ale !"a&!ului ,ige !i u*e"i#" (ul&e"ul ga !"i& /i ,u#,enal' &an&e"ul ga !"i&'

0RGE 3 E #luie Jn,elunga! ' &u *e"i#a,e 2une al!e"n.n, &u al!ele $ai "ele Jn R#$.nia' &a%u"ile ne$*li&a!e un! # "egul S!ilul ,e ali$en!aie #&&i,en!al (2 u!u"i &a"2#ga%#a e' $.n& "u"i g"a e)fa #"i%ea% a*a"iia &a%u"il#" e e"e' $*li&a!e ,e ER0RGE 3 :#$*li&aii

K ER ,e ,ife"i!e g"a,e;K Ul&e" *e*!i& e #fagian6K S!en#% e #fagian9K >DS 3 n gene"al e $anife ! &a$elen ' e$n ,e ER e e" au ul&e"

0RGE 3 :#$*li&aii=K E #fagul 0a""e!! 3$e!a*la%ie e*i!elial (ga !"i& au in!e !inal ) a e*i!eliului &uan#"$al' &a /i n e&in a in,e& "ii ER e !e # !a"e *"e$align ' &u $a"e "i & ,e $aligni!a!e (6


5/19

E i!a"ea $e,i&a$en!el#" &a"e &a, *"e iunea SEI1 2l#&anii :a;? ' ni!"aii'xan!inele' an!iline"gi&ele' feina0RGE - T"a!a$en!0K e,i&aie1

K An!i e&"e!#"ii 3 &a, e&"eia ga !"i& a&i,

0l#&anii >; 1 - Rani!i,in =< $g ,e ; #"i *e %i- Fa$#!i,in 9< $g %i- Ni%a!i,in =< $g ,e ; #"i *e %i

Sun! an!i e&"e!#"ii ,e *"i$ in!enie' e a,$ini !ea% ;-7 *! $.ni au &@ia" $a$ul! In@i2i!#"ii *#$*ei ,e *"#!#ni1 - O$e*"a%#l ;< $g ,e ; #"i *e %i

- Pan!#*"a%#le 9< $g %i - Lan #*"a%#le 6< $g %i - Ra2e*"a%#le ;< $g %i - E #$e*"a%#le 9< $g %i

Sun! "e%e" ai f#"$el#" e e"e' "e i !en!e' e a,$ini !"ea% 9-M *! $.ni' &@

$ai $ul! n &a%u"ile $*li&a!e0RGE - T"a!a$en!;K P"#&@ine!i&e 1 e!#&l#*"a$i, 3 < $g' &u 6< nain!e ,e $a (&"e/!e !#nu ul SEI) D#$e*e"i,#n - < $g' &u 6< nain!e ,e $a (nu a"e efe&!e ex!"a*i"a$i,ale) :i a*"i,e - < $g' &u 6< nain!e ,e $a (in,u&e a"i!$ii &a",ia&e)

6K An!ia&i,e 1 S "u"i ,e $agne%iu /i alu$iniu ( aal#x' N# al#x' Rennie) &u a&iuneneu!"ali%an! ,i"e&! ' efe&! i$*!#$a!i& a,e ea *e&!a&ula"

Algina! ,e #,iu (Ga i n' Nilen) 3 f#"$ea% un !"a! *"#!e&!i ,ea u*"a$ua ei e #ga !"i&e9K P"#!e&!#a"e ale $ua ei1 Su&"alfa!ul ( u&"#% *#li ulfa!a! ,e alu$iniu ) leag "u"ile 2ilia"e /i *e* ina

!i$ulea% e&"eia ,e *"# !aglan,ine0RGE - T"a!a$en!:K En,# *i& S!"i&!u"ile e #fagiene 3 ,ila!a"e &u ,ila!a!#a"e Sa a" au &u 2al#na/e ,e *"e iun >e$#"agia ,ige !i u*e"i#a" 3in+e&ii &u A,"enalin ' f#!#agula"e A"g#n0ea$e"' a*li&aii ,e @e$#&li*u"i E #fagul 0a""e!! - f#!#agula"e &u *la $ &u A"g#n Fun,#*li&a!u" en,# *i&

DK :@i"u"gi&al F#a"!e "a" ne&e a"' n &a%u"ile "e%i !en!e la !e"a*ia $e,i&a$en!#a Ex!"e$ ,e "a" n R#$.nia Fun,#*li&a!u"a Ni enUL:ERUL GASTRO -DUODENAL

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6/19

DEFINIIE: UGD # n!"e"u*e"e &i"&u$ &"i ' uni& au $ul!i*l ' a n!inui! ii *e"e!elui ga !"i& au ,u#,enal' n #i! ,e # "ea&ie fi2"#a ' n&e*.n, ,e la $ua /i *u!.n, *ene!"a *.n la e"#a

UL:ERUL GASTRO -DUODENAL

:#n&e*ia e&@e 3 n# a&i,' n# ul&e"Q M6 3 a""en /i a" @all fa& leg !u"a n!"e *"e%ena n !#$a& a >elia&P l#"i /i *a!#gene%a 2#lii ul&e"#a e P"e alena &lini& 1 = - P nega!i e Te#"ia &la i& a ,e%e&@ili2"ului n!"e1 Fa&!#"ii ag"e i i (&"e &ui) Fa&!#"ii ,efen i i ( & %ui)

u2 influena1 Fa&!#"il#" ,e $e,iu Fa&!#"il#" in,i i,uali' gene!i&iUGD - Fi%i#*a!#l#gieAK Fa&!#"i ,e ag"e iune1

7


7/19

K Infe&ia &u >P ge"$en G"a$ -' *i"ala!' flagela! $e&ani $ ,e !"an $i!e"e fe&al-#"al u" a ,e infe&ie 3 a*a l#&ali%a! la in!e"faa $e$2"an a*i&al

&u !"a!ul ,e $u&u fa&!#"ii ,e *a!#geni!a!e1 secreia de ureaz (scindeaz ureea cu eliminare de amoniu i creeaz un pHalcalin) secreia de fosfolipaz i proteaze (diger mucusul i mucoasa apicalgastric) citoto ina !acuolizant >P nu &"e/!e *e $ua a ,u#,enal ' &i nu$ai *e *la+ele ,e $e!a*la%ie ga !"i&("ea&ie ,e a* "a"e la @i*e"a&i,i!a!ea ga !"i& )UGD - Fi%i#*a!#l#gieAK Fa&!#"i ,e ag"e iune1

K Infe&ia &u >P >P a"e efe&! ul&e"#gene!i&1 direct prin procesul inflamator declanat de to inele micro"iene indirect prin secreia de ureaz pH alcalin #n $urul celulelor secretoare degastrin %ipersecreie acid;K >i*e" e&"eia a&i, 3 "#l $ai ale n UD

:au%e1 - &"e/!e"ea nu$ "ului ,e &elule *a"ie!ale >:l e&"e!#"ii *"in$e&ani $ gene!i& au @i*e"ga !"ine$ie

- @i*e"!#nie agal - @i*e" en i2ili!a!ea &elulel#" *a"ie!ale la !i$ula"ea agal - @i*e"$#!ili!a!ea ga !"i& 2#$2a",a"ea ,u#,enului &u >:l

- @i*#$#!ili!a!e ga !"i& !a% ga !"i&Pe l.ng e&"eia ,e >:l &"e/!e /i &ea ,e *e* in ' en%i$ *"#!e#li!i&6K A&i%ii 2ilia"i 3 a&i#nea% &a ,e!e"geni a u*"a li*i,el#" ,in $ua a ga !"i&UGD - Fi%i#*a!#l#gie0K Fa&!#"i ,e a* "a"e1

K P"ee*i!eliali1u&u ul . ,e u*"afa 3 e #*une "e!"#,ifu%iei >?

- lu2"ifia% $ua aSe&"eia ,e >:O&' - &"eea% *> neu!"u (4) la ni elul e*i!eliului

;K E*i!eliali 3 in!eg"i!a!ea $e$2"anei a*i&ale a $ua ei ga !"#-,u#,enale' &u +#n&iuni

in!e"&elula"e !".n e /i $a"e &a*a&i!a!e ,e "egene"a"e6K P# !e*i!eliali 3 ,e na!u" a &ula"

- &a*ila"e &u "#l nu!"i!i ' ,e a*#"! ,e >:O&-' /i ,e *"elua"e a> ? UGD - Fi%i#*a!#l#gie:K Fa&!#"i ,e $e,iu1

K Fu$a!ul1 - &a,e e&"eia al&alin *an&"ea!i&

4


8/19

- anulea% $e&ani $ele in@i2i!#"ii ale e&"eiei a&i,e;K e,i&a$en!e1A *i"ina /i AINS1 - $e&ani $ ,i"e&!' * !"un, n $e$2"ana a*i&al /i eli2e"ea% >?

- $e&ani $ in,i"e&!' *"in in@i2a"ea &i&l##xigena%ei /i 2l#&a"eain!e%ei *"# !aglan,inel#" E;' F; /i I;

:#"!i !e"#i%ii afe&!ea% $u&u ul /i in!e%a ,e *"# !aglan,ine6K Ali fa&!#"i (in&"i$inai ,a" f " ,# e%i !a!i !i&e n ing !#a"e)1!"e ul' n u$ul &"#ni& ,e al#l' ,i e" e ,ie!e ali$en!a"e

DK Fa&!#"i in,i i,uali' gene!i&i Ag"ega"ea fa$ilial a" e"i gene!i&i1 - g"u*ul anguin O' n *e&ial u2!i*ul ne e&"e!#" ,e an!igen g"u* anguin n ali

UGD 3 Ta2l#u &lini&Du"e"ea 3 i$*!#$ul &a",inal n ul&e" L#&ali%a"e 3 *"e,#$inan! e*iga !"i&

Ri!$i&i!a!e 3 f#a$ea ,u"e"#a Q n UD Pe"i#,i&i!a!e a"ea *e"i#,i&i!a!e 3 $ai ale !#a$na /i *"i$ a"a i&a *e"i#,i&i!a!e 3 n &u" ul %ilei I"a,ie"ea #,ifi&a"ea &a"a&!e"el#" ,u"e"iiV " !u"i 3 n gene"al a&i,e

#,ifi& "i ale a*e!i!uluiSi$*!#$e ,i *e*!i&e1 e"u&!aii' $e!e#"i $' aie!a!e *"e&eRa"' ,e2u! ,"a$a!i& *"in >DS (@e$a!e$e% /i au $elen )

UGD 3 Diagn# !i& *a"a&lini&KEn,# *ia - e !e #2liga!#"ie *en!"u ,iagn# !i& *e"$i!e1

e alua"ea "e&! a ul&e"ului 2i#* ie"ea (UG) e alua"ea in,e& "ii ul&e"ului e alua"ea unei @e$#"agiiJn UG e !e #2liga!#"ie 2i#* ia *en!"u a e !a2ili 2enigni!a!ea

S!a,iali%a"e e #lu!i n UG1A (a&u!e) 3 a&u!> (@ealing) 3 n &u" ,e in,e&a"eS ( &a") 3 &i&a!"i&e1 - S &i&a!"i&e "#/ie' in !a2il

- S; &i&a!"i&e al2 ' ,efini!i 3 e *#a!e #*"i !"a!a$en!ulJn UD !a,iile un! $ai e !#$*a!e (ul&e"e $ai $i&i)UD &u in,e&a"e $ai len! 1 ul&e"ul linia" /i ul&e"ul * !a! (Q ala$iQ ul&e")

UGD 3 Diagn# !i& *a"a&lini&

M


9/19

;K Exa$en "a,i#l#gi& 3 2a"iu *a a+ :a $e!#, a,+u an! (&.n, e u *i&i#nea% # !ul2u"a"e ,e e a&ua"e ga !"i& ) Nu e !e *e"$i &a un UG fi ,iagn# !i&a! nu$ai "a,i#l#gi&' f " 2i#* ie Ul&e"ele u*e"fi&iale nu un! i%uali%a!e Ran,a$en! ,iagn# !i& $ai 2un - 2a"iu *a a+ &u ,u2lu n!"a ! 3 nu egalea%

en,# *ia6K :@i$i $ul ga !"i& 2a%al au !i$ula! 3 nu $ai un! ,e a&!uali!a!eUGD 3 Diagn# !i& *a"a&lini&9K De!e"$ina"ea >elia&!e" P l#"i E!a* #2liga!#"ie' n e,e"ea !"a!a$en!ului e!i#l#gi& al UGD e!#,e ,i"e&!e1 En,# *ie &u 2i#* ii :ul!u" Te !ul u"ea%ei e!#,e in,i"e&!e1 De!e"$ina"ea A& an!i>P n e"

Te ! "e *i"a!#" &u u"ee $a"&a! &u :6

au :9

De!e"$ina"ea A& an!i >P n ali De!e"$ina"ea 2a&!e"iei n &aun T#a!e au # en i2ili!a!e ,e *e !e DS

UGD 3 :#$*li&aii Hemoragia digesti! superioar

*ea mai frec!ent ( +,) Hematemez -elenUGD 3 T"a!a$en!

K Igien#-,ie!e!i&1 Die!a ali$en!a" $ul! $ai lax ,u* in!"#,u&e"ea an!i e&!e!#"iil#" $#,e"ne E i!a"ea ali$en!el#" a&i,e' iui *i* "a!e Nu &afea n *lin *u eu ul&e"#


10/19

In!e"%i&e"ea fu$a!ului 3 -a ,e$#n !"a! en,# *i& & fu$a!ul n!."%ie in,e&aul&e"ului In!e"%i&e"ea n u$ului ,e1 A *i"in An!iinfla$a!#"ii ne !e"#i,iene

:#"!ii%iUGD 3 T"a!a$en!;K e,i&a$en!# 1

aK An!i e&"e!#"ii' e a,$ini !"ea% 7-M *! $.ni (,u"a!a ,e in,e&a"e a le%iunul&e"a!e)

0l#&anii >; 1 - :i$e!i,in


11/19


12/19

Tu$#"i $e%en&@i$ale1 Sa"a$e (fi2"#-' li*#-' $i#-' angi#- a"a$e' a"$ul a*# i) >e$angi#*e"i&i!#$ul

*arcinomul gastric.natomie patologica

a&"# *i&-en,# *i& /i in a%ie *a"ie!al 1:a"&in#$ul in&i*ien! (ea"l ga !"i& &an&e") li$i!a! la $ua u2$ua '

H;&$' $e!a !a%e "e,u e (M5- 6


13/19

T; 3 !u$#"a in a,ea%a $u &ula"a *"#*"ie i u2 e"#a aT;A 3 !u$#"a in a,ea%a $u &ula"a *"#*"ieT;0 3 !u$#"a in a,ea%a u2 e"#a aT6 3 !u$#"a in a,ea%a e"#a a (*e"i!#neul i &e"al fa"a in a%ia !"u&!u"il#" a,ia&en!T9 3 !u$#"a in a,ea%a #"ganele ,in +u"

*arcinomul gastric*ai de e tensie Li$fa!i&1 !aiile ggK I' II' III >e$a!#gen1 $e!a fi&a!' *l $.n' #a e' &"eie" Pe"i!#neal 1 &a"&in#$a!#%a *e"i!#neal ' $e!a # a"iene (!K "u& en2e"g) Di"e&! (n!igui!a!e)1 l#n !"an e" ' *an&"ea ' *lin ' fi&a!' e*i*l##n (li$fa!i&e *a"ie!ale) 1 ,u#,en ("a")' e #fag (f"e& en!)

*arcinomul gastric*ai de e tensiePe"i!#neal 1 &a"&in#$a!#%a *e"i!#neal ' $e!a # a"iene (!u$#"i "u& en2e"g)

*arcinomul gastric*ai de e tensieDi"e&!

(n!igui!a!e)1 l#n !"an e" ' *an&"ea ' *lin ' fi&a!' e*i*l##n (li$fa!i&e *a"ie!ale)1 ,u#,en ("a")' e #fag (f"e& en!)

*arcinomul gastricDiagnostic clinicSi$*!#$e ,ige !i e1 e*iga !"algii' & ,e"e *#n,e"al ' g"ea ' " !u"i' an#"exie' >DS(@e$a!e$e% /i $elen )TK ux!a&a",iale-,i fagie' ,u"e"i "e!"# !e"naleTK ux!a*il#"i&e- !en#% *il#"i& &u " !u"iKExK O2ie&!i 1 & ,e"e *#n,e"al ' !egK *ali,e!u$#" *al*a2il e*iga !"i& ' *e"i#$2ili&alA &i! !u$#"i # a"iene (!u$#"i "u& en2e"g)>e*a!#$egalieA,en#*a!ie u*"a&la i&ula" ( K Vi"&@#W-T"#i ie")S K Pa"ane#*la%i&e (fle2i!e $ig"a!#"ii' ane$ie @e$#li!i& ' nef"#*a!ie $e$2"an#a ',e"$a!#$i#%i!a' ,e"$a!i!e e2#"ei&e)

*arcinomul gastricDiagnostic paraclinic EDS ? 2i#* ie (9-M f"ag$K)

6


14/19

T"an%i! 2a"i!a!1 La&un ( *i&uli' e$i!#nu"i) Ni/ $align ( n&a !"a! n n!u"ul ga !"i&) Rigi,i!a!e *a"ie!al (lini!a *la !i& ) S!en#%a an!"al $align T:' eg"afie !an,a",' R N Eg"afia in!"alu$inal 1 infil!"a"ea *a"ie!"al ' a,en#*a!iile *e"iga !"i&e I"ig#g"afia a" e"ii !u$#"ali >i*# a&l#"@i,"ia

*arcinomul gastricDiagnostic paraclinic*arcinomul gastricE!aluarea pacientilor Ana$ne%a $*le!a Exa$en &lini& Ra,i#g"afie *ul$#na"a En,# *ie ,e !"a&! ga !"#in!e !inal u*e"i#" >e$#g"a$a $*le!a ? !e !e ,e agula"e :T PET

*arcinomul gastric4ratament T"a!a$en!ul in &an&e"ul ga !"i& in&i*ien! (T ' afe&!an, $ua a i u2$ua 2enefi&ia%a ,e !e@ni&i en,# *i&e ("e%e&!ie en,# *i&a a $ua ei 3 E R) ila*a"# *i&e

e!a !a%ele li$f#gangli#na"e in &an&e"ul ga !"i& in&i*ien! ,e*in, ,e ,i$en iunile!u$#"ii' in a%ia u2$ua ei' la2a ,ife"en!ie"e a !u$#"ii' in a%ia a &ula"a i li$fa!i&

Indicatiile pentru E-/: tumori "ine diferentiate sau moderat diferentiate5dimensiuni 6 &7mm5 a"senta ulceratiei si fara e!identa in!aziei

Een,# *ia e !e u!ila in a*"e&ie"ea in a%iei !u$#"ale i in ele&!ia *a&ien!&a"e #" 2enefi&ia ,e E R

*arcinomul gastric4ratament:#$*lex1 &@i"u"gi&al (exe"e%a "a,i&al #nl#gi& R#) ?

&@i$i#!e"a*ie (in!"a en#a in!"a*e"i!#neal @i*e"!e"$i& ) ? "a,i#!e"a*ieIn,i&aii *!K !"a!a$en!ul &@i"u"gi&al1

9


15/19

S!, I'II- in,i&aie a2 #lu! S!, III'IV 3 "e%e&ii *alia!i e n a2 ena $e!a !a%el#" au a,en#*a!iil#" /i a al!#"n!"ain,i&aii :#$*li&aii (>DS' #&lu%ii' *e"f#"aii' fi !ule ga !"#li&e) 3 in!e" enii *alia!i e

*arcinomul gastric4ratament P!K &an&e"ele ga !"i&e ,i !ale ga !"e&!#$ia u2!#!ala a"e "e%ul!a!e #nl#gi&$*a"a2ile &u ga !"e&!#$ia !#!ala in a $ai *u!ine $*li&a!ii

P!K &an&e"ele ga !"i&e *"#xi$ale !"a!a$enul &@i"u"gi&al e !e n!"# e" a! ,a&a ga !"e&!#$ia *"#xi$ala i ga !"e&!#$ia !#!ala un! a #&ia!e &u ,i fun&!ii nu!"i!i#n *# !#*e"a!#"ii

P!K !u$#"ile ,e &a",ia 3 !u$#"i *"#xi$ale 3 ga !"e&!#$ie !#!ala*arcinomul gastric4ratament Di e&!ia D 1 ex&i%ia *a"!ii ,i !ale a !#$a&ului au a in!"egului !#$a& &u $a"

i $i&ul e*i*l##n

Di e&!ia D;1 2u" a #$en!ala' f#i!a &"aniala a $e%#l#nlui !"an e" i a"iilea &ula"eY *lene&!#$ia ( !a!iile


16/19

Ga !"e&!#$ie u2!#!al 1 9 = !#$a&' $a"e /i $i& e*i*l##n' 2ul2 ,u#,enal'li$fa,ene&!#$ie "egi#nal K- &an&e"ul in&i*ien!' &an&e"ul ,i !al !i* in!e !inal !K I' IIGa !"e&!#$ie !#!al 1 n!"eg !#$a&ul' 2ul2ul' $a"e /i $i& e*i*l##n'li$fa,ene&!#$ie -&an&e" in&i*ien! $ul!i&en!"i& au *"#xi$al' &an&e"ul e #lua!'&an&e"ul ,i !al ,ifu%KGa !"e&!#$ia l "gi! 1 !#$a& ? #"gane e&ine in a,a!e (l#n !"an e" ' *an&"ea -

e #fag)- &an&e"ul in a%i n #"ganele e&ine*arcinomul gastric4ratament c%irurgical radical*arcinomul gastric4ratament c%irurgical radical*arcinomul gastric4ratament c%irurgical radical*arcinomul gastric4ratament c%irurgical radicalGa !"e&!#$ie u2!#!al 1 9 = !#$a&' $a"e /i $i& e*i*l##n' 2ul2 ,u#,enal'

li$fa,ene&!#$ie "egi#nal K- &an&e"ul in&i*ien!' &an&e"ul ,i !al !i* in!e !inal !K I' II*arcinomul gastric4ratament c%irurgical radical*arcinomul gastric4ratament c%irurgical radical*arcinomul gastric4ratament c%irurgical radicalGa !"e&!#$ie !#!al 1 n!"eg !#$a&ul' 2ul2ul' $a"e /i $i& e*i*l##n'li$fa,ene&!#$ie -&an&e" in&i*ien! $ul!i&en!"i& au *"#xi$al' &an&e"ul e #lua!'&an&e"ul ,i !al ,ifu%K

*arcinomul gastric4ratament c%irurgical radicalGa !"e&!#$ia l "gi! 1 !#$a& ? #"gane e&ine in a,a!e (l#n !"an e" ' *an&"ea -e #fag)- &an&e"ul in a%i n #"ganele e&ine

*arcinomul gastric4ratament c%irurgical radicalRen !"u&ia ,u* ga !"e&!#$ie u2!#!al - G A1 Rei&@el -P#l a >#ff$ei !e" - Fin !e"e" Pe an n ZQ

Ren !"u&ia ,u* ga !"e&!#$ia !#!al 3 E A Pe an n #$egaQ Pe an n ZQ

*arcinomul gastric4ratament c%irurgical radicalRen !"u&ia ,u* ga !"e&!#$ie u2!#!al - G A1

7


17/19

Rei&@el -P#l a >#ff$ei !e" - Fin !e"e" Pe an n ZQ

*arcinomul gastric4ratament c%irurgical radicalRen !"u&ia ,u* ga !"e&!#$ia !#!al 3 E A Pe an n #$egaQ Pe an n ZQ (,ife"i!e !i*u"i ,e "e%e" #")

*arcinomul gastric4ratament paliati! O2 !"u&!ie1 !en!' la e"' "a,i#!e"a*ie' &@i"u"gie Nu!"i!ie1 en!e"ala' nu!"i!i#ni ! :#n!"#lul ,u"e"ii1 "a,i#!e"a*ie au $e,i&a!ie >e$#"agie1 "a,i#!e"a*ie' &@i"u"gie au !e"a*ie en,# *i&a

*arcinomul gastric4ratament c%irurgical paliati!:a"&in#$ ,i !al1 Ga !"#en!e"#ana !#$#% F#"a+ !u$#"al la e" En,#*"#!e%a"e

:a"&in#$ *"#xi$al1 Ga !"# !#$ie +e+un# !#$ie ,e ali$en!aie

*arcinomul gastric*%imioterapie Efe&! *alia!i la *a&ien!ii &u &an&e" ga !"i& a an a! &"e &an,u-le &ali!a!ea

u*"a ie!ui"ea

Exe$*le1 = flu#"#u"a&il'$i!#$i&in' e!#*# i,e' &i *la!in

S!an,a",ul ,e au" in M< *!K *a&ien!ii &u &an&e" ga !"i& a an a!1 = FU,#x#"u2i&in i $i!#$i&in

Pa&li!axel' ,#&e!axel' i"in#!e&an' UFT

4


18/19

*arcinomul gastric*%emoiradiere Pa&ien!i &u "e%e&!ie R


19/19

e!a !a%e @e*a!i&e

F# fa!a%a al&alina ,e *e !e

patologie digestiva i

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