Post on 07-Jul-2018
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PATOLOGIA FICATULUI,PATOLOGIA FICATULUI,
PANCREASULUI SI APANCREASULUI SI ACAILOR BILIARECAILOR BILIARE20122012
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PATOLOGIA HEPATICAPATOLOGIA HEPATICA
► AGRESIUNE 5 raspunsuri:AGRESIUNE 5 raspunsuri:
1.1. D!nrs"n#a si a"u$u%ari in#ra"%u%ar:D!nrs"n#a si a"u$u%ari in#ra"%u%ar:& D!nrs"n#a 'a"u(%ara )#(*i", 'irusuri+D!nrs"n#a 'a"u(%ara )#(*i", 'irusuri+
& D!nrs"n#a spu$(asa )i%a+D!nrs"n#a spu$(asa )i%a+
& A"u$u% %ipi-: s#a#(aA"u$u% %ipi-: s#a#(a
2.2. N"r(a si ap(p#(aN"r(a si ap(p#(a: "(a!u%ar )"(rpi C(un"i%$an / ap(p#(a+: "(a!u%ar )"(rpi C(un"i%$an / ap(p#(a+
%i#i"a%i#i"aP(a# : "n#r(%(u%ara )is"$i, #(*i"+, $-i((na%a, prip(r#a%aP(a# : "n#r(%(u%ara )is"$i, #(*i"+, $-i((na%a, prip(r#a%a
)"%a$psi+)"%a$psi+
("a%a, - in#ra#a, in pun#i, su$asi'a, $asi'a("a%a, - in#ra#a, in pun#i, su$asi'a, $asi'a
3.3. In4a$a#iIn4a$a#i
.. R!nrarR!nrar
5.5. r(ar(a
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In's#i!ara "a#u%ui
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6IPERBILIRUBINE7IA SI COLESTA8A6IPERBILIRUBINE7IA SI COLESTA8A
► 6ipri%iruin$ia &6ipri%iruin$ia & 9 1,2 $!-%; 9 2 / 2,5 $!-% < i"#r9 1,2 $!-%; 9 2 / 2,5 $!-% < i"#r
► C%asi"ar:C%asi"ar:
1.1. N"(n=u!a#aN"(n=u!a#a )$(%i, pr%uar pa#("i#ara , "(n=u!ar)$(%i, pr%uar pa#("i#ara , "(n=u!ar
-"#u(asa )s-r Cri!%r / Na==ar, Gi%r#+-"#u(asa )s-r Cri!%r / Na==ar, Gi%r#+
2.2. C(n=u!a#aC(n=u!a#a: (%i pa#i" in#rins"i, (s#r i%iar; >& "(%s#aa: (%i pa#i" in#rins"i, (s#r i%iar; >& "(%s#aa
COLESTA8ACOLESTA8AI"#r > pruri#, BC, C(%, a" i%iari, FA; %ip(pr(#ina ? in s!I"#r > pruri#, BC, C(%, a" i%iari, FA; %ip(pr(#ina ? in s!
7a: "a# 'r-7a: "a# 'r-
7i: pi!$ i%iar in pa#("i#, #r($i i%, pr(%i -u"#a%, %a"uri i%iar7i: pi!$ i%iar in pa#("i#, #r($i i%, pr(%i -u"#a%, %a"uri i%iar
s#a-ii pr"(": r! "n#r(%(u%aras#a-ii pr"(": r! "n#r(%(u%ara (s#r "r / r(a p(r#a%a "ir(a i%(s#r "r / r(a p(r#a%a "ir(a i%
► I"#ru% n(u nas"u#u%uiI"#ru% n(u nas"u#u%ui
► 6ipri%iruin$ii r-i#ar6ipri%iruin$ii r-i#ar
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s#a#(a N"r(a $asi'a
C(%s#aa in#rap C(%s#aa *#rap
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INFECTIILE 6EPATICEINFECTIILE 6EPATICE
► -isun"#i pa#i"a a": p 'ira%a, p "i$i"a, pa#(pa#i a%"((%i"a,-isun"#i pa#i"a a": p 'ira%a, p "i$i"a, pa#(pa#i a%"((%i"a,
is"$i"a si "(n!s#i'a, (s#r " i% *#rapis"$i"a si "(n!s#i'a, (s#r " i% *#rap
► 6EPATITELE @IRALE ACUTE6EPATITELE @IRALE ACUTE
► @irusuri pa#(#r(p: A, B, C, D, E, F, G; a%#%: Eps#in Barr, "i#($!a%(;@irusuri pa#(#r(p: A, B, C, D, E, F, G; a%#%: Eps#in Barr, "i#($!a%(;
► Hep A:Hep A: au#(%i$i#, #rans$ "a%&(ra%a, nu -# "r(ni"iar s#ar -au#(%i$i#, #rans$ "a%&(ra%a, nu -# "r(ni"iar s#ar -
pur#a#(r;pur#a#(r;
► -! sr(%(!i": A" )I!7+ an#i @6A-! sr(%(!i": A" )I!7+ an#i @6A
► Hep B:Hep B: parn#ra%; p(a# -#: 6@A, 6CP, 6CA, 6 u%$in, pur#a#(r, (n- p#parn#ra%; p(a# -#: 6@A, 6CP, 6CA, 6 u%$in, pur#a#(r, (n- p#
► ris" "ar"in($ris" "ar"in($
► -! sr(%(!i": A!6Bs, A!6B", I!7 an#i6B", n#i6B-! sr(%(!i": A!6Bs, A!6B", I!7 an#i6B", n#i6B, I!G an#i6Bs, I!G an#i6Bs
► Hep C:Hep C: parn#ra%; 9 50 pr(!rsi %a "r(ni"iar "ir(a; pur#a#(rparn#ra%; 9 50 pr(!rsi %a "r(ni"iar "ir(a; pur#a#(r
► "rs#ri pri(-i" a% #ransa$ina%(r; ris" "ar"in($"rs#ri pri(-i" a% #ransa$ina%(r; ris" "ar"in($
► Hep D:Hep D: parn#ra%, n"si#a in"#i prsis# "(n"($i# Bparn#ra%, n"si#a in"#i prsis# "(n"($i# B
► in"#ia si$u%# < us(ara u%$inan#a )rar "r(ni"iar+in"#ia si$u%# < us(ara u%$inan#a )rar "r(ni"iar+
► in"#ia supraa-au! < 3 p(si: 6@B us(ara #rans in u%$inin"#ia supraa-au! < 3 p(si: 6@B us(ara #rans in u%$in
► p a" s'ra %a un pur#a#(rp a" s'ra %a un pur#a#(r
► (a%a "r(ni"a pr(!rsi'a "ir(a(a%a "r(ni"a pr(!rsi'a "ir(a
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► Hep E:Hep E: #rans$ n#ri"a, au#(%i$, nu "r(ni"iaa#rans$ n#ri"a, au#(%i$, nu "r(ni"iaa
► $(r#a%i# ina%#a %a F insar"ina#$(r#a%i# ina%#a %a F insar"ina#
► Morfologia hepatitelor acuteMorfologia hepatitelor acute
► Asp"# si$i%ar in-i - #ip 'ira%:Asp"# si$i%ar in-i - #ip 'ira%:
D!nrs" 'a"u(%araD!nrs" 'a"u(%ara C(%s#aa )in"(ns#an#+C(%s#aa )in"(ns#an#+
S#a#(a / rar )6@C+S#a#(a / rar )6@C+
N"r(a / %i#i"a < "i#(%ia > in =ur a!ra# 7" N"r(a / %i#i"a < "i#(%ia > in =ur a!ra# 7"
ap(p#(a < pa#("i# "(n-nsa#, in#ns (in( ap(p#(a < pa#("i# "(n-nsa#, in#ns (in(
"auri !ra': n"r(a in pun#i, $asi'a, su$asi'a"auri !ra': n"r(a in pun#i, $asi'a, su$asi'a
In4a$a#i: in%#ra# $i*# in sp p(r#; pa#i#a - in#ra#a, 6#r( >6p%aIn4a$a#i: in%#ra# $i*# in sp p(r#; pa#i#a - in#ra#a, 6#r( >6p%a
"% "%
r!nrarr!nrar
► Ma:Ma: "a# $ari#, "apsu%a -s#insa, r(su !a%n / 'rui"a# $ari#, "apsu%a -s#insa, r(su !a%n / 'rui
► 6 u%$inan#a: "a# ,$(a%, "apsu%a %ar!a6 u%$inan#a: "a# ,$(a%, "apsu%a %ar!a
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► Morfologia hepatitelor croniceMorfologia hepatitelor cronice
► < 'i-n#a "%ini"a i("i$ sr(%(!i"a - (a%a p "(n#inua sau< 'i-n#a "%ini"a i("i$ sr(%(!i"a - (a%a p "(n#inua sau
"u r"urn#"u r"urn# 9 %uni > -('a-a is#(%(!i"a - in4a$ si n"r(a;9 %uni > -('a-a is#(%(!i"a - in4a$ si n"r(a;
► Cau: 'irusuri, -"i#Cau: 'irusuri, -"i# 1 AT, i%s(n, a%"((%is$, $-i"a$n#,1 AT, i%s(n, a%"((%is$, $-i"a$n#,
au#(i$unau#(i$un► Us(ar / $(-ra# / s'rUs(ar / $(-ra# / s'r
► F(r$ us(arF(r$ us(ar: in4a$ in sp p(r#; ara n"r(a: in4a$ in sp p(r#; ara n"r(a
► F(r$ $(-F(r$ $(-: piece-meal necrosis: piece-meal necrosis
► Forme severeForme severe: bridging necrosis: bridging necrosis
► A!r!a# %i$(i- in sp p(r# < 6@CA!r!a# %i$(i- in sp p(r# < 6@C► 6pa#i#a - in#ra#a "(n#inua > n"r(a in pun#i < a"#ar6pa#i#a - in#ra#a "(n#inua > n"r(a in pun#i < a"#ar
pr(!rsi'apr(!rsi'a
► T r(s < a"#ar ir'rsii%a T r(s < a"#ar ir'rsii%a
► Hepatopatia alcoolicaHepatopatia alcoolica
► 9 0 !i )B 0&0!; F 20!+9 0 !i )B 0&0!; F 20!+
1.1. S#a#(aS#a#(a: r'rsi in 2& sap#; $a"r('; p(a# $i"r(' % pa#("i#ara )-!nrs" 'a"u(%,
"(rpi 7a%%(rH+ > P7N > r(a pri'nu%ara"(rpi 7a%%(rH+ > P7N > r(a pri'nu%ara
3.3. Cir(a a%"((%i"aCir(a a%"((%i"a < a#r("a, $i"r(n(-u%ara< a#r("a, $i"r(n(-u%ara
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Hepatita cronicamoderata
P
Pi"$a% n"r(sis
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CIO!A HEPATICACIO!A HEPATICA
► < #r$n na%, ir'rsii% a% un(r 'aria# pa#(pa#ii "r, -ni#a prin 3< #r$n na%, ir'rsii% a% un(r 'aria# pa#(pa#ii "r, -ni#a prin 3
"ara"#ri#i"i:"ara"#ri#i"i:
"#"# $epturi %&roa$e$epturi %&roa$e
'#'# noduli de regenerarenoduli de regenerare "u -i$ns 'ariai%: $i"r(n(-u%i )"u -i$ns 'ariai%: $i"r(n(-u%i ) 3 $$+; 3 $$+;
$a"r(n(-u%i )9 "$+ in"(n= - r(a$a"r(n(-u%i )9 "$+ in"(n= - r(a
(#(# Di$trugerea difu)a a arhitecturiiDi$trugerea difu)a a arhitecturii pa#i"pa#i"
► C%asi"ar $(r(%(!i"a:C%asi"ar $(r(%(!i"a:
1.1. C micronodularaC micronodulara )" Lann" " p(r#a%a+: D 3 $$; n(-u%i uni, ni)" Lann" " p(r#a%a+: D 3 $$; n(-u%i uni, nir(as n, ara sp p(r# si ' "n#r(%(u%ar;r(as n, ara sp p(r# si ' "n#r(%(u%ar;
7a: "(nsis# -ura; -i$ns N s"au# "rs"u#7a: "(nsis# -ura; -i$ns N s"au# "rs"u#
" a%"((%i"a < s#a#(a" a%"((%i"a < s#a#(a
Cau: a%"((%is$, $("r($a#(a, " i%, (s#r "r a 4u* 'n(s,Cau: a%"((%is$, $("r($a#(a, " i%, (s#r "r a 4u* 'n(s,
ipr'i#a$in(a A, un% (r$ - 6CAipr'i#a$in(a A, un% (r$ - 6CA2.2. C macronodularaC macronodulara )p(s#n"r(#i"a, p(s#pa#i#i"a+: D< "$, n(-u%i - -i$ns)p(s#n"r(#i"a, p(s#pa#i#i"a+: D< "$, n(-u%i - -i$ns
'aria; "(n#in sp p(r#, ' "n#ra%'aria; "(n#in sp p(r#, ' "n#ra%
7a: "a# -ur, $ari# $i"s(ra#7a: "a# -ur, $ari# $i"s(ra#
"au: 'ira%a, un% (r$ - 6CA au#(i$una"au: 'ira%a, un% (r$ - 6CA au#(i$una
3.3. C mi*taC mi*ta
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CIO!A HEPATICACIO!A HEPATICA
► C%asi #i(%(!i"a:C%asi #i(%(!i"a:
1.1. C p(s#a%"((%i"aC p(s#a%"((%i"a )0&J0+: $i"r(n(-u% > s#a#(a a#a"uri rp#a# -)0&J0+: $i"r(n(-u% > s#a#(a a#a"uri rp#a# -
pa#i#a a%"((%i"a < s"%r(a pri"n#r(%(u%ara, "a# a#r(a#, arapa#i#a a%"((%i"a < s"%r(a pri"n#r(%(u%ara, "a# a#r(a#, aras#a#(a, "u $a"r(n(-u%i asp"# $i*#; pa#("i# < "(rpi 7a%%(rHs#a#(a, "u $a"r(n(-u%i asp"# $i*#; pa#("i# < "(rpi 7a%%(rH
2.2. C p(s#pa#i#i"aC p(s#pa#i#i"a: "a# a#r(", $a"r(n(-u%i, r(a > %H; F #inr; pr(!n: "a# a#r(", $a"r(n(-u%i, r(a > %H; F #inr; pr(!n
rr'a# < 6TP si insu pa#("%. A!6Bs > & ris" - "ar"in($rr'a# < 6TP si insu pa#("%. A!6Bs > & ris" - "ar"in($
3.3. C i%iaraC i%iara
a.a. " i% pri$ara" i% pri$ara: % - aa < in4a$ "u -is#ru!ra " i% $i"i in#rap;: % - aa < in4a$ "u -is#ru!ra " i% $i"i in#rap; ini#ia%: (%i#rara -u"#%(r $i"i > !ranu%(a$ini#ia%: (%i#rara -u"#%(r $i"i > !ranu%(a$
in4a$ > "(%s#aa n"r(a r(a > n(-u%i r!nr < " $i"r(in4a$ > "(%s#aa n"r(a r(a > n(-u%i r!nr < " $i"r(
#i(%(!i K;#i(%(!i K;
i"#r (s#ru"#i' "r, $a%as(r#i, (s#($a%a"i, (s#(p(r(ai"#r (s#ru"#i' "r, $a%as(r#i, (s#($a%a"i, (s#(p(r(a
A" an#i$i#(" > I!7 < $" au#(i$unA" an#i$i#(" > I!7 < $" au#(i$un -"s < 6TP > n"a%(pa#i pa#i"a-"s < 6TP > n"a%(pa#i pa#i"a
.. " i% s"un-ara )(s#ru"#i'a+:" i% s"un-ara )(s#ru"#i'a+: rara; "(ns" (s#r " i% *#rap; "($p%irara; "(ns" (s#r " i% *#rap; "($p%i
prin "(%an!i#a a"s pprin "(%an!i#a a"s p
".". "(%an!i#a s"%r(an#a pri$ara"(%an!i#a s"%r(an#a pri$ara: B: B9 F; > "(%i#a u%"ra#a9 F; > "(%i#a u%"ra#a
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CIO!A HEPATICACIO!A HEPATICA
.. Cau !n#i"Cau !n#i"
a. $("r($a#(aa. $("r($a#(a
. i%s(n: " $a"r(n(-u%. i%s(n: " $a"r(n(-u%". -"i# -". -"i# - 1 AT: !%(u% (in(, ia%in -1 AT: !%(u% (in(, ia%in - 1 AT in "i#(p%1 AT in "i#(p%
pa#("i#pa#("i#
pr(%i - " i%pr(%i - " i%
na% < asp"# - 6CA si "ir(ana% < asp"# - 6CA si "ir(a
5.5. Cau au#(i$un: $ani 6CBCau au#(i$un: $ani 6CB
ipriprMM!%(u%in$i; A" an#inu"%ari, a" an#i&$us"i n#-!%(u%in$i; A" an#inu"%ari, a" an#i&$us"i n#-
p# -! s %i$ina a%# "aup# -! s %i$ina a%# "au
.. Cau 'as"u%ar: insu "ar- "(n!s#i' "r; s-r Bu--&Ciari; Cau 'as"u%ar: insu "ar- "(n!s#i' "r; s-r Bu--&Ciari;
'n(&("%ui'a'n(&("%ui'aJ.J. Cau n"un(s"u# < "ir(a "rip#(!n#i"aCau n"un(s"u# < "ir(a "rip#(!n#i"a
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CIO!A HEPATICACIO!A HEPATICA
► CO7PLICATII:CO7PLICATII:
► Hiperten$iunea portala +HTP,:Hiperten$iunea portala +HTP,: "#:"#:
1.1. Sun#uri 'n(as p(r#(&sis#$i"Sun#uri 'n(as p(r#(&sis#$i"
2.2. As"i#aAs"i#a
3.3. Spn($!a%i "(n!s#i'a > iprsp%nis$Spn($!a%i "(n!s#i'a > iprsp%nis$
► In$uf hepatocelularaIn$uf hepatocelulara
►
Carcinom hepatocelularCarcinom hepatocelular
: #ar-i'; 10 -in "auri: #ar-i'; 10 -in "auri
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N(-u%i r!n, r(a > " i%,'as p(r#a%
Cir(a a%"((%i"a & s#a#(a
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S$n "%ini" in"ir(a
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HTP
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T-MOI HEPATICET-MOI HEPATICE
► BENIGNE: Epi#%ia% / a-n($, a$ar#($ si a-n($ "ai i%iarBENIGNE: Epi#%ia% / a-n($, a$ar#($ si a-n($ "ai i%iar► "is#a-n($ i%iar"is#a-n($ i%iar
► C(n=un"#i' / $an!i($ "a'rn(sC(n=un"#i' / $an!i($ "a'rn(s► $an!i(n-(#%i($ inan#i%$an!i(n-(#%i($ inan#i%► 7ALIGNE: Pri$ar / CARCINO7UL7ALIGNE: Pri$ar / CARCINO7UL
1.1. Car"in($u% pa#("%u%arCar"in($u% pa#("%u%ar
& 0 & (%i pr*is#n#: "ir(a, 6CB, 6CC, a%"((%, $("r($a#(a, -"i#& 0 & (%i pr*is#n#: "ir(a, 6CB, 6CC, a%"((%, $("r($a#(a, -"i#
1AT1AT& 7a: $u%#in(-u%ar $asi' -iu; rar n(-u% s(%i#ar7a: $u%#in(-u%ar $asi' -iu; rar n(-u% s(%i#ar
& $(a%, "nusiu 'rui )i%a+$(a%, "nusiu 'rui )i%a+
& 7i: #ra"u%ar )sinus(i-a%+, r(%a$%ar, psu-(!%an-u%ar, p%($(r 7i: #ra"u%ar )sinus(i-a%+, r(%a$%ar, psu-(!%an-u%ar, p%($(r
& "% #u$(ra% pa#("i#;"% #u$(ra% pa#("i#; i$p p# -! < pr(-u"ra - i%ai$p p# -! < pr(-u"ra - i%a
2. C "(%an!i("%u%ar2. C "(%an!i("%u%ar
& %("a%iar: i% pa#i" priri"%("a%iar: i% pa#i" priri"
& E#i(%: 0 K; 10 < as("ia# "u RCU6, Car(%i, r(a p "(n!ni#a%aE#i(%: 0 K; 10 < as("ia# "u RCU6, Car(%i, r(a p "(n!ni#a%a
& 7a: $u%#in(- $asi'7a: $u%#in(- $asi'
& 7i: #uu%(&a"inar A" $u"(s"r#(r7i: #uu%(&a"inar A" $u"(s"r#(r
& C%u% pi#%iu% -u"#%(r i%C%u% pi#%iu% -u"#%(r i%
3. ". pa#(&"(%an!i("%u%ar3. ". pa#(&"(%an!i("%u%ar. pa#(%as#($: rar; 3 ani; "($p(n pi# > $n"i$a%a )"% ui+. pa#(%as#($: rar; 3 ani; "($p(n pi# > $n"i$a%a )"% ui+
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T-MOI HEPATICET-MOI HEPATICE
► SARCOA7E: an!i(sar"($, $an!i(n-(#%i($ pi#%i(i-, sar"($SARCOA7E: an!i(sar"($, $an!i(n-(#%i($ pi#%i(i-, sar"($
n-i, L7S, R7Sn-i, L7S, R7S
► TU7 7ALIGNE SECUNDARE )7ETASTATICE+ TU7 7ALIGNE SECUNDARE )7ETASTATICE+
► < $a=(ri#a#a #u$ $a%i!n p< $a=(ri#a#a #u$ $a%i!n p
► Sursa: pu%$(n, !% $a$ara, "(%(n, pan"rasSursa: pu%$(n, !% $a$ara, "(%(n, pan"ras
► 7a: n(-u%i $u%#ip%i >& n"r(a "n#ra%a7a: n(-u%i $u%#ip%i >& n"r(a "n#ra%a
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PATOLOGIA CAILO BILIAEPATOLOGIA CAILO BILIAE
► Li#iaa i%iaraLi#iaa i%iara: a"#(ri ris": (i#a#, s* F, 'ars#a 0 )FFF+: a"#(ri ris": (i#a#, s* F, 'ars#a 0 )FFF+
► C%asi"ar: "a%" "(%s#r(%i"i )J5&5+C%asi"ar: "a%" "(%s#r(%i"i )J5&5+
►
pi!$ i%iari )10&20+pi!$ i%iari )10&20+► "ar(na# Ca"ar(na# Ca
► $i*#i$i*#i
► C($p%i"a#i: "(%"is#i#a )a" "r+, i"#r (s#r, pan"ra#i#a a",C($p%i"a#i: "(%"is#i#a )a" "r+, i"#r (s#r, pan"ra#i#a a",
"ar"in($ "(%"is#, i%us 'i"u%ar"ar"in($ "(%"is#, i%us 'i"u%ar
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COLESTEROLO8A: "aua K / pr(ai% a"iasi a"#(ri"ar s"a- s(%ui%i#a#a "(%s# in i%a; r"' as(" "u(r$ara "a%" - "(%
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PATOLOGIA CAILO BILIAEPATOLOGIA CAILO BILIAE
► C(%"is#i#C(%"is#i#
1.1. C(%"is#i#a a"u#aC(%"is#i#a a"u#a
& "a%"u%(asa"a%"u%(asa: 0&5 -in "auri; i%a pr(!rsi' "(n"n#ra#a < iri#an#: 0&5 -in "auri; i%a pr(!rsi' "(n"n#ra#a < iri#an#"i$i""i$i"
& (s#ru"#ia "rs# prsiuna, 'as"u% "($pr($isa / n"r(a(s#ru"#ia "rs# prsiuna, 'as"u% "($pr($isa / n"r(a
> in'ai a"# s"un-ara> in'ai a"# s"un-ara
& n"a%"u%(asan"a%"u%(asa: as(" "u D8, s(", ar#ri#, sp#i"$ii, #rau$: as(" "u D8, s(", ar#ri#, sp#i"$ii, #rau$
& 7a: 'i"u%a $ari#a, pa#a#a, *u-a# p supra )pur(i < $pi$7a: 'i"u%a $ari#a, pa#a#a, *u-a# p supra )pur(i < $pi$'i"u%ar+'i"u%ar+
& 7i: in4 a": "(n!s#i, -$, r(iuni, u%"ra#ii, n"r(a, P7N7i: in4 a": "(n!s#i, -$, r(iuni, u%"ra#ii, n"r(a, P7N
& E'(% > "($p%i": (r$ us(ar: r(%u#i "r(ni"iar "a%"u%iE'(% > "($p%i": (r$ us(ar: r(%u#i "r(ni"iar "a%"u%i
& (r$ s'r: pr(!rsi / "(%"is#i#a !an!rn(asa, pr(r.(r$ s'r: pr(!rsi / "(%"is#i#a !an!rn(asa, pr(r.
2.2. C(%"is#i#a "r:C(%"is#i#a "r: r"'r"' as("ia#a "u "a%"u%ias("ia#a "u "a%"u%i7a: "a%"u%i, pr# in!r(sa#, nr!7a: "a%"u%i, pr# in!r(sa#, nr!
' a#r( ipr#r( ' a#r( ipr#r(
7i: in4 "r in pr#: %H, P%, E7i: in4 "r in pr#: %H, P%, E
"a%"i"ar s"un-ara < 'i"u%a - p(r#%an"a%"i"ar s"un-ara < 'i"u%a - p(r#%an
(s#ru"#ia "is#i": i%a r(ri#a, pi# $u"(s"r#(r < i-r(ps 'i"u%ar(s#ru"#ia "is#i": i%a r(ri#a, pi# $u"(s"r#(r < i-r(ps 'i"u%ar
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PATOLOGIA CAILO BILIAEPATOLOGIA CAILO BILIAE
Tumorile .e) &iliareTumorile .e) &iliare
ni!n < rarni!n < rar
► CarcinomulCarcinomul: in 0&0 as(" "u "a%"u%i )1 -in "a%"u%( -'(%#a: in 0&0 as(" "u "a%"u%i )1 -in "a%"u%( -'(%#a
"ar"in($+"ar"in($+
► F$i, J0 aniF$i, J0 ani
► Si$p#: -urri a-, i"#r, s"a-r GSi$p#: -urri a-, i"#r, s"a-r G
► 7a: papi%ar sau '!#an# in!r(sar -iua a pr#%ui; (ri!in
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PATOLOGIA PA/CEA0-L-I E1OCI/PATOLOGIA PA/CEA0-L-I E1OCI/
► PANCREATITELEPANCREATITELE
1.1. PANCREATITA AC )6E7ORAGICA+PANCREATITA AC )6E7ORAGICA+
& E#i(% K / "a%"u%i, a%"((%E#i(% K / "a%"u%i, a%"((%& Pa#(!ni:Pa#(!ni:
& 7(-% prin r4u*7(-% prin r4u*
& 1. n"r(a pri-u"#a%a )(s#r a$pu%ara1. n"r(a pri-u"#a%a )(s#r a$pu%ara
& r4u* i%iar, a"#i' ni$a#i"a < "i"%u -is#r+r4u* i%iar, a"#i' ni$a#i"a < "i"%u -is#r+& 7(-% a"#ara "% a"inar7(-% a"#ara "% a"inar
& 2. n"r(a pri%(u%ara )prui : s(",2. n"r(a pri%(u%ara )prui : s(",
& ip(#r$i+ip(#r$i+
& 3. n"r(a pan%(u%ara )pr(!rsi - %a 1 2,3. n"r(a pan%(u%ara )pr(!rsi - %a 1 2,
& sau - %a in"pu#+sau - %a in"pu#+
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PATOLOGIA PA/CEA0-L-I E1OCI/PATOLOGIA PA/CEA0-L-I E1OCI/
► 7(r(pa#(%(!i: % un-a$ < -is#ru"#i #isu%ara ni$a#i"a: pr(#a,7(r(pa#(%(!i: % un-a$ < -is#ru"#i #isu%ara ni$a#i"a: pr(#a,%ipa )"i#(s#a#(n"r(a+, %as#aa )$(ra!ii+ > in%#ra# in4a$%ipa )"i#(s#a#(n"r(a+, %as#aa )$(ra!ii+ > in%#ra# in4a$
► 7a: (r$ us(ar < -$ in#rs#i#; r'rsii%7a: (r$ us(ar < -$ in#rs#i#; r'rsii%► (r$ s'r < $(ra!ii(r$ s'r < $(ra!ii► ("ar a%i"i(as - n"r(a parn"i$("ar a%i"i(as - n"r(a parn"i$► ("ar a% "r#(as - "i#(s#a#(n"r(a("ar a% "r#(as - "i#(s#a#(n"r(a► > & (r$ar - a"s> & (r$ar - a"s
► 7i: (r$ us(ar < a"#a# 'as $i"i; arii r-us - n"r(a7i: (r$ us(ar < a"#a# 'as $i"i; arii r-us - n"r(apri-u"#a%pri-u"#a%
► (r$ s'r < n"r(a parn"i$ *#insa(r$ s'r < n"r(a parn"i$ *#insa► "i#(s#a#(n"r(a"i#(s#a#(n"r(a► $(ra!i, #r($( 'n(as$(ra!i, #r($( 'n(as
► P7NP7N► Dis#ru"#ia insu%%(r "($a ipr!%i"Dis#ru"#ia insu%%(r "($a ipr!%i"► Eni$% a"#i'a# -iuaa: %("a%Eni$% a"#i'a# -iuaa: %("a%► ' %i$a#i" #s a-($in' %i$a#i" #s a-($in► ' s! / #u% "(a!u%ar, ip(#nsiun, $(r' s! / #u% "(a!u%ar, ip(#nsiun, $(r
!as#r(&in#s#!as#r(&in#s# SOC SE@ERSOC SE@ER
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PATOLOGIA PA/CEA0-L-I E1OCI/PATOLOGIA PA/CEA0-L-I E1OCI/
► PANCREATITA CRONICAPANCREATITA CRONICA
► E#i(%: a%"((%is$ "rE#i(%: a%"((%is$ "r
► a%#i a"#: iprpara#ir(i-, ipr#i!%i"ri-$i, #rau$, r(a "is#i"aa%#i a"#: iprpara#ir(i-, ipr#i!%i"ri-$i, #rau$, r(a "is#i"a
► 7(r(pa#(%(!i:7(r(pa#(%(!i:
► 1.1. Pancreatita cr calci%antaPancreatita cr calci%anta / %a a%"((%i"i/ %a a%"((%i"i
► 7a: r$, "a%"u%i -u"#a%i, "a%"i"ari R*7a: r$, "a%"u%i -u"#a%i, "a%"i"ari R*
► 7i: a#r( %(u%ara r(a7i: a#r( %(u%ara r(a
► in4a$ "rin4a$ "r
► -(puri pr(#i" (in( in -u"#% $i"i-(puri pr(#i" (in( in -u"#% $i"i
► (s#r -u"#%(r $ai $ari < "is#uri(s#r -u"#%(r $ai $ari < "is#uri
► Fina%: $ar par# -in pan"rasu% *("rin < -is#rusaFina%: $ar par# -in pan"rasu% *("rin < -is#rusa
► 22# Pancreatita cr o&$tructi.a# Pancreatita cr o&$tructi.a: as("ia#a "u "a%"u%(a a%# "au -: as("ia#a "u "a%"u%(a a%# "au -(s#r(s#r
► C% $ai a"#a# < "apu% pan"rasC% $ai a"#a# < "apu% pan"ras
► A"#ara r(&in4a$ nu s# %(u%araA"#ara r(&in4a$ nu s# %(u%ara
C($p%i"a#ii: psu-("is#uri )4ui- "u n pan"r+ si "is#uri - r#n#i )(s#rC($p%i"a#ii: psu-("is#uri )4ui- "u n pan"r+ si "is#uri - r#n#i )(s#r
p "ana%u% prin"ipa%; "is#uri a-'ara# "u s"r pan"ra#i"a+p "ana%u% prin"ipa%; "is#uri a-'ara# "u s"r pan"ra#i"a+
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PATOLOGIA PA/CEA0-L-I E1OCI/PATOLOGIA PA/CEA0-L-I E1OCI/
► TU7ORI TU7ORI
► A.A. EPITELIALE BE/IG/EEPITELIALE BE/IG/E
"#"# Chi$tadenom microchi$ticChi$tadenom microchi$tic )sr(s, (!a# in !%i"(!n+)sr(s, (!a# in !%i"(!n+
rar; $i 'rs#ni"; "(rp si "(a-arar; $i 'rs#ni"; "(rp si "(a-a
7a: $u%#i%("u%ar;7a: $u%#i%("u%ar; 10 "$ 10 "$
7i: #ap#a# - pi# #ur#i# (!a# in !%i"(!n7i: #ap#a# - pi# #ur#i# (!a# in !%i"(!n
'#'#Ci$tadenom mucino$Ci$tadenom mucino$$i, "(rp si "(a-a$i, "(rp si "(a-a
7a: $u%#i%("u%ar, $ar, $u"us7a: $u%#i%("u%ar, $ar, $u"us
7i: pi# "i%in-ri" $u"(&s"r#(r7i: pi# "i%in-ri" $u"(&s"r#(r
► B.B. EPITELIALE MALIG/E: CACI/OM-LEPITELIALE MALIG/E: CACI/OM-L
► A-n("ar"in($; 0&J0 < "apA-n("ar"in($; 0&J0 < "ap► C%ini": rar / pan"ra#i#a a" sau #r($(4i#a $i!ra# )s$nC%ini": rar / pan"ra#i#a a" sau #r($(4i#a $i!ra# )s$n
Tr(ussau+ Tr(ussau+
► $a#$a, $%na )in'ai s#($a", -u(-n+$a#$a, $%na )in'ai s#($a", -u(-n+
► 50 < i"#r )> ' pa%pai%a < s$n C(ur'(isir+50 < i"#r )> ' pa%pai%a < s$n C(ur'(isir+
► 25 & $asa pa%pai%a a-($ina%25 & $asa pa%pai%a a-($ina%
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CACI/OM-L PA/CEATICCACI/OM-L PA/CEATIC
► 7a: rau -$ar"a#; 2 / J "$7a: rau -$ar"a#; 2 / J "$
!a%n&a%i"i(s&"nusiu!a%n&a%i"i(s&"nusiu
Cap: -s in%#raa "(%-(", "ana% pan"r prin"ipa%Cap: -s in%#raa "(%-(", "ana% pan"r prin"ipa%
► 7i: AC )0+ > s#r($a r(asa7i: AC )0+ > s#r($a r(asa
Ds in'ai prinura%aDs in'ai prinura%a Rar: a-n(s"ua$(s p%($(r "u "% !i!an#Rar: a-n(s"ua$(s p%($(r "u "% !i!an#
► Fr"' in $($ -! < s#a-ii a'ansa#Fr"' in $($ -! < s#a-ii a'ansa#
► 7#s#: "a#, !!% %i$, pri#(nu, pu%$7#s#: "a#, !!% %i$, pri#(nu, pu%$
► Pr(!n: rr'a# )0 -"s in %uni+Pr(!n: rr'a# )0 -"s in %uni+