Chir

Question 1

pre hepatic icter

Answer 1

• hemoliza excesiva
• brb ind
• urina normala, scaun N
• fara prurit

Question 2

icter intrahepatic

Answer 2

- defect de conjugare
defect de transport
– secretie anormala 
— Ind+dir 
—urina neagra
—scaun col normal
— fara prurit

Question 3

icter posthep

Answer 3

— obstr mecanica a flux biliar
—brb conj
—scaun acolic
—urina bruna
—prurit prezent

Question 4

icter benign

Answer 4

infectios hepatic
chirurgical posthepatic
prehepatic

Question 5

icter obstructiv dd icter chir de cel medical

Answer 5

— istoric de dureri abdominale, febra, frisoane
—icter nedureros + scadere in G , prurit, scaun decolorate
— crestere brb dir + FA crescuta + GGT crescut
—colecit/formatiuni tumorale abdominale palpabile +/- adenopatii supraclaviculare stg —cancere avansate

Question 6

etiologie

Answer 6

1. congenital
   —atrezie
   —agenezie
   —ectazie -intrahep -b Caroli— extrahep ß dilatatii chistice diverticuli
2. iatrogenic
   —leziuni CBP dupa colecistectomie
   —stenoze CBP post op - ischemice cauter/ oddiene -dupa ERCP
   —corpi straini - fragmente de sonda, endoproteze colmatate, material de sutura
3. litiazica
4. stenoze CBP
   - pancr acuta/cr
   - cholangita scleroasa primitiva
5. chiste coledociene
6. tumori benigne
7. parazitica ( ch, ascarid)
8. stenoza oddiana
9. traumatisme -hemobilie

Question 7

severitate obstructie alterari in

Answer 7

• functia renala si hemodinamica
• functia hepatica ( sint de proteina, eliminare toxine! metabolism)
• coagulare - deficit de protb
• imunitate
• cicatrizare

Question 8

clinica colica coledociana

Answer 8

— icter benign litiazic
—triada charcot
—pentada reynold

• debutul si istoricul pot sugera etiopatogenia
• ex clinic poate ajuta la rarefierea dg

Question 9

icter benign

Answer 9

—debut brutal
—dupa colica
—frisoane si febra
—urmate de prurit

Question 10

triada charcot

Answer 10

—icter
—febra
—durere hipocondru dr

Question 11

pentada reynold

Answer 11

—durere hipoc dr
—icter
—febra
—hipotensiune
—tulburari de stres mental

Question 12

dg clinic situatii rare icter

Answer 12

— debut insidios
—asociat unui sd dispeptic discret
—cholestaza intrahepatica
—asemanator cu tb clinic al unei boli cronice hepatice

Question 13

bioumoral icter

Answer 13

1. brb serica
   — creste fractiunea directa van der Bergh = conjugata
   — direct/total > 0,4 2,5mg/dl. 43 umoli/L
   —coloratie icterica vizibila in lumina naturala
2. pig biliari
   — in urina prezenti= urina hipercroma
3. urobilinogen
   — scade sub 1mg/24 ore // dispare in obstructiile complete
4. enzimele hepatocutare ( transaminazele! GGT pot creste moderat in ev unui icter obstructiv sever)
5. FA creste serica
6. colesterol peste 300mg/dl
7. HLG = leucocitoza! anemie hemolizica!eozinofilie

Question 14

ercp

Answer 14

— obstructii inferioare CBP

Question 15

colangio RMN

Answer 15

— CI Ercp
noninvaziv
diagnostiv

Question 16

echoendoscopia

Answer 16

— cai biliare si pancreas
—calculi CBP retroduodenal
— ghidare biopsii cefalopancreatice

Question 17

PTC

Answer 17

— dg si terapeutic
— localizari intrahepatice proximale
—invaziv

Question 18

litiaza coledociana

Answer 18

— 10-15 din lit biliare
— frecvent peste 50
— peste 70 ani mai mult de 50%

Question 19

etiopatogenice litiaza coledociana

Answer 19

litiaza migrata
autohtona
restanta

Question 20

litiaza coledociana

Answer 20

— litiaza primitiva
se form de la infeput in ductul biliar comun
calculi pigmentari, muleaza lumenul ductului, culoare bruna, consist moale

— litiaza sec de conjugare - provine din vezicula biliara si aj in CBP fie transcistic! fie in urma costituirii unei fistule = calculi cu caractere veziculare = de colesterol

Question 21

Forma grava de litiazá CBp

Answer 21

• cu icter Continuu
• inclavare
• icter + angiocolita
• angiocolita ictero uremigenica
• accese febrile pseudopalustre
• icter rubinic
• oligo anurie —-> uree si creatinina crescute
• alterare raida stare generala

Question 22

litiaza disimulata - anicterica

Answer 22

f dureroasa
casectizanta
cu semne coledociene minore
muta 
dispeptica

Question 23

complicatii

Answer 23

— icter mecanic
— angiocolita
# supurata 
- colangita = insuf hepato renala
- pericolangita 
#nesupurata + a. cronice = ciroza 
— insuf hepatorenala
— pancreatita acuta = spasm, edem! reflux biliopancr.
— ciroza biliara secundara = pr scleroinflam portal si lobular

Question 24

indicatii dezobstr radiologica

Answer 24

— insuf resp, CV grave
— stenoza piloro duodenala
— stomac rezecat tip bilroth 2
papila necateterizabila

Question 25

litiaza complexa

Answer 25

``` — calculi autohtoni > 2cm — panlitiaza —litiaza intrahep — megafoledoc aton — dilatatie chistica coledociana — recidive lit CBP — stricturi CBP ```

Question 26

dezobstr CBP

Answer 26

— transcistic — sfincterotomie oddiana — coledocotomie

Question 27

drenaj biliar extern

Answer 27

— transcistic — kehr — axial

Question 28

drenaj biliar intern

Answer 28

— anastomoza coledoco jejunala sau duodenala | jejun = Y

Question 29

complicatii dilatatii chistice CBP

Answer 29

``` — angiocolita —icter —litiaza — pancreatita — degenerare maligna — abcese hepatice — ciroza / HTP — ruptura chist ```

Question 30

tratament chist coledocian

Answer 30

1. excizie hepatojejunostomie Y 2. excizie 3 transduod exciz transduod sfincteroplastie endosc sfincterotomie