ntrducr

rc fn umn lng cmrtmntul fzc, shc, ntlctul cr l r fcr n

flul lu, st ncsr d un cmrtmnt lmntr. cst cmrtmnt st nsmblul rclr
d rsuns f d stmul ntrn su trn, cr slct rtul d lmnt su ntrrur ctulu
lmntr. Fn umn t dr n md rnl cnsumul, cnfrm nvlr rl l
rgnsmulu t dv cnsumul ctr un dzchlbru cntnt, cctt c rscnt, dr rfrt
dtrt stsfcr lcr d ngr numt lmnt l crr rt csv st cunscut c fnd
duntr snt umn. Dr dc L bl cr mr, gnrn crt rclul, duc
t slv (r. Bsh Mrn), tunc trbu s vtm mncrl grs, rll, smntn tc.
Durrl n rt drt r du msl cs, du msl bgt n grsm, cst
durr fnd d l vzc blr cr st blgt s s cntrct m mult c urmr buzulu d
lmnt m ls d grsm. Funcnr bl dnd d c c mncm, d cum mncm, d r
d cum trm. buzul d lmnt rfnt dn cr u fst lmnt fbrl lmntr, d r u fst
dugt -ur dtrmn sufrn l bl tulbur func .

rt gnrl

b#%l!^+a?

Ctlul 1: ntm fzlg fctulu clr blr

1.1. zr fctulu vzc blr

Fctul st un rgn glndulr cu func multl mrtnt n cdrul cnm
gnrl rgnsmulu fnd cl m vlumns vscr cr rrznt 1/20 dn grut t crr l l
nu-nscut 1/50 l dult, vnd vr ndvdul, sul dgstv. Grutt lu l cdvru
st ntr 1200-1500g, cst fnd m mr n tmul v dtrt cnnutulu n sng. Grut t
scfc s rdc ntr 1450-1750g, rtculr fnd dnstt mc lstctt frt mr.

Fgur 1. Fctul
Fctul st un rgn smtrc. C m mr rt lu (rmtv tr trm) s gst
n umtt drt bdmnulu num rstul ( trm) s gst n umtt stng . l
rsund dc hcndrulu drt, gstrulu un r dn hcndrul stng. Fctul, c
stmcul, trund dnc n cncvtt dfrgm cr urc n l nvlul cst cnc, nct
rtc rrturl lu s vr fc cu trcl. Rnm c n gstru dstngm du zn-un
htc, cllt gstrc.
r d rtc fctulu s ntnd ln mdclvculr ntr cst 5- rbrdul
cstl, ln lr md ntr cst 6- 12-, r rvrtbrl ntr vrtbr 8-
11- trcc. L un ndvd nrmstnc, fctul s t l l rbrd, ln mdclvcul r ,
n 2- umtt nsrulu rfund. Surf lbl st ntd, lstc, fctul fnd un rgn
b#%l!^+a?

cmrsbl, cu lstctt dtrt cnnutulu rmrcbl n sng. Fctulu s dscru n

cnscn du f:
- un nfrr, vscrl
- un surr, dfrgmtc- rznt ft surr lbr un strr
cnsdrt c tr f.
F surr - st cnv, mult du blt dfrgm. , l nvlul lbulu stng,
s gst drsun trunghulr, cr crsund cntrulu tndns l dfrgm st lst d
nm-st mrsun crdc. run surr vn n rrt rn ntrmdul dfrgm, cu
lur bz lmnulu drt, cu nm rcrdul, l trmtt stng cu lur b z
lmnulu stng. cst rrtur lc d c clc lurl drt t s dlsz fctul
n s; un bcs su un chst hdrc htc t s dschd n c vtt lur l ch r n lmnul
drt, su cum lg trcc t s ntrsz lmnul, lur, dfrgm fctul.
F strr - st rntt strr fnd ft d dfrgm rn trctur fbr s
urrnc n drtul vrtbrlr trcc 10 11 ncrt d rtnu. st strbtut
vrtcl, l drt lbulu cudt, d fs vn cv nfrr (unr chr sub frm unu cnl
cmlt cnsttut) n cr gst un lgmnt d fr l vn.
F nfrr su vscrl - cst f s gst rgun dsbt d mrt nt hlul fctulu. Ft st ln rvt n s, n sr stng . c st f t s bsrv tr
nur dsus n frm ltr H, c mrt n d lb rncl: lbul drr lbul stng, d
lb ccsr, lbul trt su ntrr slbul cudt su strr. Lbul trt s dlmt z f t
nfrr ntr mrgn ntrr, hlul htc clcst. Lbul cudt (Sgl) st stu t
n hlulu htc, ntr vn cv cnlul vns rntus, fnd drnt d 2-4 vn htc
ccsr, cr s vrs drct n vn cv nfrr. Cl tr nur l f nfrr sunt:
nul ntr-strr drt dstt l ctul ntrr vzcul blr, r l ctul
strr vn cv nfrr.
nul ntr-strr stng- dstt lgmntul rtund, r strr lgmntul
rntus.
nul trnsvrsl- s ntnd ntr cl du nur ntr-strr cncd cu hlul
htc.
Cl blr rrznt un sstm d cnl rn cr bl scrtt l nvlul htctlr
st trnsrtt sr dudn. Cnll stut n ntrrul fctulu fc rt dn structur cstu
b#%l!^+a?

s numsc cl blr ntrhtc. Cnll cr s gssc n fr fctulu rrznt cl

blr trhtc. Ductul htc cmun ductul cldc rrznt cl blr rncl, r
vzc blr ductul cstc frmz rtul dvrtculr. (ln, V., 1982, . 75)

ntrhtc- nc cu cncull blr du cr urmz sr succsv d

cncull (ntrlbulr, rlbulr, blfr), cr n l urm s dug n cl du duct

htc, drt stng.
trhtc- rrzntt d cnlul htc cmun c s unst cu cnlul cystc d l
vzcul blr frmnd cnlul blr cmun (cldcul) c s dschd n dudn l nvlul l
dudnl, mrun cu cnlul ncrtc, cst unndu-s frmnd mul Vtr c s
dschd n dudn rn ntrmdul sfntrulu dd. n (30% dn czur cl du c nl s dschd
srt n dudn.
D cl blr trhtc cu dr run mc rgnsmulu rlul lr st
frt mr ntru cmlul blncrtcdudnl. l rrznt unt d lgtur unc ntr
fct dudn, stfl rlznd trnztul bl sr trctul dgstv, r n vzc blr r lc
stcr, cncntrr rzrb bl. strr ntrgrt funclr clr blr trhtc
sgur trnztul nrml l bl, stfl rlzndus funcl d bz l cst, rcum:
nutrlzr rc cd mstculu lmntr sst dn stmc n ntstn, dgst grsmlr,
stmulr frmnlr scfc (lzl), stmulr bsrb czlr gr, ntrnr
rstltsmulu ntstnl lmnr unr rdu d cr
st un rzrvr nt d cr bl, n cr cst s cumulz n ntrvlul dntr
rnzur. st stut n fs vzc blr d f vscrl fctulu. Drc vzc st
rmtv sgtl. n rltt, drc un blc d s n sus, dnnt n d l
drt l stng. cst blctt sr stng mult m ccntut l cl.
Vzcul blr r lungm d rmtv 10 cm lrgm d 4 cm. C ctt d
50-60 ml.

1.2. Rrturl fctulu vzc blr

Fl fctulu sunt crnl cudl.
F crnl, dfrgmtc, ntd, unfrm, cnv, crt d rtnul vscrl
rntt vntr-drsl, st cnv n sns frntl sgtl n cntct cu f bdmnl
muchulu cru dnumr rt. st rntt frntl ntr lgmntl trunghulr drt

b#%l!^+a?

stng. Crlt cu rrturl , cst f fst, cnvn nl, cvdr-cmrtmntt n cmur

fr dlmtr rcs.
- Surf s vntrl st submrt n tr r, du vntr-trcc, drt stng,
ncdrnd r mlc, gstrc.
r trcc lbulu htc drt r, n hcndrul crsunztr, rrt cndr-cstl
V - drt cntct drct cu f ndrtl sub nvlul sulu l trul ntrcst l. st
rms brdul chrurgcl, ntru c rcssus-ul lurl cst-dfrgmtc ntrr nu cbr l
cst nvl.
r trcc lbulu htc stng r, n hcndrul stng, rrt crnl cu rbrdul
cndr-cstl l hmtrclu stng l nvlul crtllr cstl V V.
n r mlc, gstrc, fctul r rrt drct cu rtl bdmnl ntrr, l
nvlul unu trgn dlmtt crnl d rbrdul cndr-cstl (), drt V stng, r cudl, d
ln blc dntr crtll cstl () drt V stng . l st l bl rcut bl
dsur mlculu sulu f-mblcl.
Rrtt l brr surfcl lgmntulu flcfrm dntr surfl clr d lb,
drt stng, lzunl dzvltt l drt vr rznt un sndrm trcc, r cl dn rt
stng, un sndrm gstrc.
- Surf crnl ( lbulu stng) r rrt rml cu cntrul tndns rl cu
rt musculr stng dfrgm. L cst nvl, lcul d flud rtnl rmt glsr
srslr mztll ht-frnc, flt n cntct (funcnnd c rtcul d t
cndln). run ntrrtnl lbulu htc stng st ln su dscrt cncv, rznt
mrnt crdc r rrtur trnsdfrgmtc cu bz lur-ulmnr stng, vntrcul,
rl stng, cl drt rcrdul.
- Surf drt ( lbulu htc drt ntrrtnl cnv n tt snsurl), r
rrt, mdt d hmdfrgm, cu bz lur-ulmnr sltrl ( lurz bzl drt
t mblz cudl fctul l fl cum un bcs htc cntrc t fstulz scndnt n sul
lurl; rmtt lur-htc drt lc frcvn lglr trc-bdmnl cr
ntrsz unr cncmtnt lur, lmnul, dfrgm, rtnul rnchmul htc). L
cst nvl, lbul drt t rznt mrnt cstl.
- Surf drsl st frmt dn run trsrs dlmtt d lgmntl
crnr, trgnl rtnul lbulu cudt, ntr mntul ht-gstrc, l stng mzul

b#%l!^+a?

lgmntr ht-cv, l drt. r nlm mm d 6 - 10 cm, n rt mdn, cu

dscrtr rd sr cl du trmt lrgm (ul frntl) d 14 - 19 cm. st surf
cncv trnsvrsl, drmt n rt mlc, und rmn crurl vrtbrlr trcc , ,
, unr, , ltur d lnul vsculr rtc-cv sfgul bdmnl. Vrsnt fr frm
gmtrc rcs, trgnl su lsdl, cst curnd tr sctr dlmtt d fsur
lngtudnl ductulu vns rnn, sr stng, nul vn cv sr drt, dsz
crucfrm dvrgnt lurlr rtnl cr l ncdrz:
crnl, lgmntul flcfrm, ddublt strr n fl drt stng, cntnut
ltrl mdl cu lcl crnr surr mnm
cudl, nsr htc mntulu mc, cntnut rn fl sl cu lcl crn r
nfrr, drt stng.
F cudl, vscrl, scvt, dlmtt d crcumfrn mrgn nfrr
fctulu, st rntt drsl sr stng; st nrgult-ln, dscrt cnc v, cu mnn
mrsun surf s. cst f st submrt n tr sctr (drt, mlcu stng), d
tr nur, du sgtl, drt stng unul trnsvrsl, l hlulu htc frnt.
Mrgn nfrr su ntrr fctulu sr, n rt vntrl, cl du f l
cstu. r un trct blc, scndnt, d l drt sr stng, st scut nt mrct
s d uts. lr st msbl n rt drt, und st msct d rbrdul
cndr-cstl , n rt stng, l nvlul cstlr V, V; mnvr dvn rctcbl
nfrstrnl nlm d cv cntmtr , tt lungm, tunc cnd fctul nrml
cbr cu 1-2 cm n nsr. Mrgn rznt du nczur crsunztr trmt ntrr
fcru n sgtl. C drt, cstc, crsund fundus-ulu vzcul blr l ntrsc cu
mrgn nfrr fctulu.
trmtt stng, lbulu stng, st subr, ltzt crn-cudl stut l
ncun mrgn nfrr cu vrsntul dfrgmtc drsl; s nsnuz ntr fundus-ul
gstrc dfrgm (l cr st ft rn rlul rtnl l lgmntulu trunghulr stng su
ndcl fbrs l fctulu). n v ntrutrn, cst trmtt r rrt cu lul crnl
lnl, stu nturl rr ntlnt l dult.
Cl blr rn rtulu crtr l bl n dudn. Scrtt cntnuu d
htct stct tmrr, ntrrndl, n vzcul blr (und st cncntrt rn rzrb
hdrc scr d mucus) bl st ntrmtnt drnt n dudn n rdl dgstv.

b#%l!^+a?

Cmnnt blr dcululu frnt st frmt dn du run, ht-cldcn

(rncl) vzcul-cstc (ccsr).
run rtrdudnl cldculu t f lrt du dclr bsculr
mdl dudnulu. r lungm d 1-3 cm, rrt vntrl cu f strr run
rml rtlzt dudnulu (d cr st unr srt rntr- lm d rnchm
ncrtc); c s t nsnu un rcssus rtnl fcltnt ntru dsc ductl
cldcstm. Drsl, r rrt cu vn rt, rcdl vsculr ncrtc-dudnl, fsc
rtz drt, vn cv nfrr dculul rnl drt, r l stng, cu rtr gstr-dudnl
lmfndul rtrdudnl.
n run rtrcfl-ncrtc, dn cuz lnulu vsculr dcnt, cldcul ft
st dfcl d lrt fr rsc. Ductul rcurg f strr ncrsulu rntr-un n su
trvrsnd un cnl lungm d 3 cm. r rrtur, vntrl cu rtr ncr tc-dudn l
surr ntrr ductul ncrtc ccsr, drsl cu vn cv dculul rnl, sr stng
cu vn rt ductul ncrtc, r sr drt cu rt dscndnt dudnulu, rtr
lmfndul ncrtc-dudnl strr surr. Dclr rtrdudn-ncrtc ntru
unr vn cv nfrr (rctct ntru rm dt d chr, n tmul un gstrctm)
s rlzz frcvnt n ln strr fsc rtz drt (ntm l cfl-ncrs).

1.3. Structur fctulu vzc blr

Structur hstlgc fctulu curnd csul rnchmul htc.
Csul (csul Glssn) - st lctut dn sut cnunctv lstc. st dubl t l
trr d srs rtnl. L nvlul hlulu, csul trund n fct dt cu vsl sngvn
(rtr htc vn rt), cu vsl lmftc cu nrv. n ntrrul fctulu sutul cnunctv
frmz t su trv rtblr c mrt rnchmul n lbul dstsc sstml d
cnduct blr frmun vsculr ntrhtc.
rnchmul htc - r c untt mrffuncnl lbulul htc. Lbul htc r
frm rmdl cu bz rntt sr csul vrful strbtut d vn cntrlbulr. L nvlul
d cntct dntr 2 su m mul lbul nvcn, s dlmtz un su ngulr (trunghulr
7

scun trnsvrsl) dnumt su rt su sul rnn. n fr lbulu htc l nvlul

b#%l!^+a?

fctulu s m dscru 2 unt funcnl: lbul rt cnul htc.

Lbul htc rt - st cntrt un cnl blr dn sl rt curnd tt lt t
untlr scrtr trbut clu cnduct blr. Lbul rtl sunt untl cu scr trn
l fctulu.
cnul htc - curnd ttltt htctlr rgt d cl vs, cr vrs bl n
cl cnl blr. cn htc sunt unt m mc dct lbul, ntrnd tt n cnsttu
lbululu htc ct clu rtl. Nun d cn htc lc tt func d gl nd cu
scr ntrn ct func d glnd crn fctulu.
Lbul htc st cnsttut dn: (nglscu, N., 2001, . 52)
htct- cnsttu 80% dn ul clulr fctulu. u frm cubdl,
rrznt d l funcnl, unul vsculr, ltul blr ft dcnt cu clull nvcn t.
Clull snusd (clul nhtct, nrnchmts) sunt rrzntt d clull ndtll,
clull uffr, clull lfg. ntr hrct s gssc cncul blr ntrlbulr fr r
rr n cr s dscrc bl, rdusul d scr l clullr htc. Htctl rznt 1-3
nucl, ctlsm bgt, rgnt clulr: RN, RR, rbzm, mtcndr, cml Glg.
clr snusd- u dsunr rdl n ntrrul lbululu rlznd un sstm clr
d t rt, ntns ntr du vn (cntr- ntrlbulr). Clrl snusd sunt lst ntr
crdn d htct d cr sunt srt d un su ngust- sul Dss.
Sul Dss st curns ntr clrl snusd htct, l cnnnd fludul cr
curg sr lmftc znl rtl. l st cut d mmbrn bzl clrlr, clull
mznghml fbr d rtculn. t n sl Dss sunt rrzntt n clull t (clull c r
stchz grsm- ft strng clls)- clul stlt cu rl n mtblsmul vtmn n
tgnz crz. fbrl d rtculn s gssc clull ndfrnt cr n v stntl vr
gnr rn dfrnr num clul uffr. rtl clrlr snusd st frmt dn ndtlu
c curnd clull uffr clull ndtll.
cnlcul blr- s frmz ntr ftl lturt, n cntct, l htctlr dn lml
hrc. l nu u rt rru, l sunt st sub frm unu n n rtl nsu l clul
htc. Sr rfr lbululu, cncul blr u rt rru nd dn lbul, s cntnu cu
cnll blr ntrlbulr. cst s clctz , n fnl, n cl 2 cnl h tc, drt stng,
rznt n hlul fctulu.

b#%l!^+a?

Fgur 2. Vdr htlgc sutulu htc nrml

vn cntrlbulr- nc ntr-un ct rb (n dgt d mnu), du cr s ndrt
sr mlcul bz lbululu, und s cntnu cu vn sublbulr. Clrl snusd dn ntrgul
lbul htc s dschd n vn cntrlbulr.
sut d susnr- st rdus fnd rrzntt d fbr d rtculn dn sl Dss. cst
sut susn clrl snusd crdnlr clulr.
Clsc, clcstul cmrt cu r, s dscru tr run: fundul, crul clul.
Fundul vzc blr - st rtunt n frm d fund d sc. l rsund nczur cstc d
mrgn nfrr fctulu. st nvlt n rtnu r mr mbltt; unr st tzt
su d vzc n und.
Crul vzc blr - st rt drn l ft vscrl fctulu. S ngustz
trtt sr cl; ultm s rt st dnumt nfundul.Crul vzc vn n r rt n sus cu fc tul
(fs vzc blr), r n s cu clnul trnsvrs cu sgmntul surmzclc l run
dscndnt dudnulu (rgn n cr t trund clcul blr du c n rlbl s- nstlt
fstul).

b#%l!^+a?

Fgur 3. Cl blr
Clul - frmz trmtt rfund scut vzc blr. st stut n stng
crulu vzc, r frm crnc st snus, dscrnd du nflun. Clul st lbr, nu dr
l fct st susndt d l rntr- rlungr mntulu mc. ntr ftl cst rlungr trc
rtr cstc. n sus l stng, clul vn n rrt cu rmur drt vn rt, r n s cu
run surr dudnulu (su cu flur dudnl surr).

1.4. Vsl fctulu vzc blr

Fctul rznt, dn rd s mrfgntc tmur, du sstm vsculr, frnt
frnt, cnsrvt stntl. st un vscr cu vsculrz rtculr rn bundn , v l r
fluulu sngun nsurunr trctlr ndvdulzt l sstmlr ntr-rtl vns
htc.
Vsculrz fctulu st rrzntt d crcul dubl: nutrtv funcnl.
Vsculrz nutrtrv: trnsrt sngl gnt, c rvn dn rtr htc, cr,
du rmfc multl (lbr, sgmntr ntrlbulr), s ctlzz, rgnd frmunl

10

dn sl ntrlbulr (rtl), frmz r n urul htctlr. n fnl cst clr s

vrs n clrl snusd l vn rt (scu, ., 2004, . 22).
Vsculrz funcnl: st cnsttut dn rmfcl vn rt, cr duc sng cu
substnl nutrtv, bsrbt dn ntstn, ntru f mtblzr n fct. rt s r mfc ,
frmnd rmur lbr, sgmntr, ntrlbulr; ultml rmfc frmnd clrl snusd.
Clrl snusd cnfluz n vn cntrlbulr cr cnduc sngl sr bz lbululu und
%l!^+a?

b#

v f ctt d vnul clctr (vn sublbulr). Vnl clctr, d clbru dn c n c m

mr, s dschd n vnl surhtc, r n fnl n vn cv nfrr.

Vnl htc rznt urmtrl rtculrt, cr l dfrnz d rmfcl vn
rt:
- sunt drnt l rnchmul htc (bn scun)
- nu sunt nvlt n tc glssnn
- nu s nstmzz ntr l
- sunt vlvulr
- rznt tunc musculr cu sfnctr l dschdr n cv nfrr
- sunt lst drs-crnl
- u drc sgtl, vntr-drs-crnl sct d vnt, cu vrful strr sr
vn cv
- sl, trctl rmurlr d rgn l lr sunt stut ntr-un ln cr nl f d
sstmul rtl.
Du stu clbru, vnl htc s mrt n du gruur, surr nfrr.
Vsculrz vzcul blr st sgurt d rtr cstc, rmur lrg rtr
htc. Drnul vns s fc n vn cstc d c n sstmul vns rt.
Vsl lmftc s trmn n mc gruur d gngln n urul hlul u htc. rt dn
lmftcl d l surf fctulu trvrsz dfrgmul n lgmntul flcfrm n fn l ung l
gngln mdstl. lt gru cmnz vn cv nfrr sr trc, trmnndu-s n
cv mc gngln stu n run ntrtrcc.

1.5. Nrv fctulu vzc blr

nrv fctulu st d t vgttv, fnd sgurt d fbr smtc (rvnnd dn

11

lul clc rncl) s rsmtc(rvnnd dn nrvul vg ), cr frmz lur n urul

vslr s cnllr htc. st sgurt d fbrl nrvs mlnzt l fctulu.
Cmnnt lr rsmtc rvn dn nrv vg drt stng. Fltl rtsmtc rvn dn
gngln nrv rvrtbrl ntmr 7 - 10 cr ung, cl nrvlr slnhnc mr, l
gngln clc. Ru fbrlr nrvs s mstc n lurl clr d dcul, frnt
frnt.
L nvlul clu frnt, l lctusc du lur nrvs, ntrr strr, n urul

b#%l!^+a?

rtr htc rr, d l cr mrg flt ctr lmntl dcululu blr , cl

rmfclr trd rtl, sr sl rtl rnchmul htc. Fltl vgl, rdmnnt
stng, frmz nrv gstr-htc (Ltrt Bnnt) n rs cndns mntl. D c l
nrvz curbur drt stmculu urmz cl rtr htc stng, dstrbundu-s clr
blr ccsr. rsmtcul r fct tnc sur muscultur rtl f cltnt blscrtr, rlz sfnctrl, r rtsmtcul, nvrs (mrun cu cun vsmtr).
L nvlul dcululu htc frnt, fltl nrvs l frnculu drt lc sndrmul
durrs d l nvlul umrulu drt n tlg ht-bl-frnc.
Sndrmul d rt rtnl dfrgmtc st rcut c durr n drmtmul C4
drt, crsunztr umrulu rsctv. Durr rfrt r c substrt rrtr durr vscrl
ntr-un trtru cutnt cr rrznt drmtmul crsunztr mlmrulu l nvlul cru s-
dzvltt vscrul n v ntrutrn.
nrv vzcul blr st sgurt d trmn nrvs tt dn sstmul
rsmtc, ct dn cl smtc.

1.6. Fzlg fctulu vzc blr

Fctul r z strtgc l nvlul crcul. st rmul rgn cr vn n cnt ct cu
sngl du unr cstu l nvlul ntstnulu; cst mlc ftul c nu num c fc tul
vn n cntct drct cu nutrmntl bsrbt, nbtcl, tnl mcrrgnsml rvnt
dn ntstn, cr ncst rcsr rlbl nnt d trund n crcul sstmc dr
ftul c fctul ntrvn n rcsul d cr cmulr n lumnul ntstnl.
Dtrt bundn sl rgr cu sng funcnl nutrtv dtrt trnsfrmrlr
chmc cr u lc, drt cuvnt fctul t f cnsdrt un dvrt lbrtr l rgnsmulu.
12

Fctul r mr cctt d rgnrr, stfl c du htctm rl, rgnr r

nc du 24 d r s trmn du 14 zl.
Funcl fctulu sunt multl fnd ndlnt l nvlul htctlr. stfl fctul:
- rt l dgst ntstnl,
- dztz n l rt dn substnl cr dsc nvl mdt l rgnsmulu,
- dgrdz snttzz dfrt substn: cz gr, lrtn,
- rl n mtblzr clstrlulu,
- rt l mnnr cmz lsm,

b#%l!^+a?

- mnn chlbrul glucdc,

- trnsfrm grsml n frm cr s dz m ur,
- snttzz frmn ncsr funclr rr su l ltr rgn,
- rglz mtblsmul cntrlz dbtul sngvn,
- rt trundr tnlr n rgnsm,
- r rl n frmr glbllr r,
ntrvn n trmrglr,
- r rl n sntz fctrlr d cgulr
- r rl n mtblzr lclulu,
- r func nttc.

1.7. lr func htc func clr blr

Fctul ndlnst n rgnsm un rl mrtnt, ntrvnnd n r tt mtblsml
ntrmdr l substnlr, n unl rcs d rglr hmstz, n rcsl d rr
rgnsmulu. Funcl fctulu t f grut n tr mr ctgr, num:
func d frmr lmnr bl, rsctv func blr
funcl mtblc, rsctv rtcr fctulu l fzl mtblsmulu ntrmdr
lt func, rsctv rglr dfrtlr mcnsm l rgnsmulu.
Func blr - func d frmr bl d lmnr bl, m rt numl d
blgnz. Bl st scrtt d clull rnchmts n md cntnuu, n cnttt d 500700ml/z, st trnsrtt rn cnlcull ntrhtc trhtc n vzcul bl r, und
s cumulz n rdl dntr ms st lmnt n ntstn n tmul rcsulu d dgst.
13

Cmz bl: cst r un gust mr un mrs scfc. Culr vrz, du cum

rvn:
drct dn fct-glbn uru;
dn vzcul blr-glbn uru m nchs;
dn cldc-glbn dschs.
rncl cnsttun bl sunt:
- (95- 97%),
- srur blr (1%) rrznt cl m mrtnt cnsttunt l bl. rc ntul SB dfr n

b#%l!^+a?

func d lmnt. .: cnd lmnt st bgt n crn unt, rcntul lr crtr, r

ls cstr duc l scdr lu. SB ung n ntstn trc n crcul vn rt ung dn nu
n fct, und u rl d stmul n frmr d n SB. n flul cst s st blt un crcut l SB ,
numt crcutul ntrhtc l SB. SB ndlnt urmtrl func:
1. l nvlul ntstnulu mulsnz grsml tnz ls ncrtc
2. frmz cu grsml cmlc clnc n , rmnd stfl bsrb grsmlr
vtmnlr lslubl , D,
3. stmulz rstltsmul ntstnl- rl ltv
4. mnn chlbrul flr mcrbn ntstnulu grs, cmndnd m ls, flr d
utrfct- rl ntutrd
5. stmulz frmr bl- rl clrtc.
- gmn blr (0,5%) sunt rrznt d blrubn blvrdn; fnd rdu d
dzsml hmglbn lmnndu-s rn bl, d cst crctrul d f un rdus d
cr.
- clstrlul, (1-2 g ) st un rdus d dr, rvn dn sng dn fct; mnnr
rrtulu chlstrl-SB (nrml 1/20- 1/30) r dsbt mrtn . Cnd scd sub 1/3 s
fvrzz rctr clstrlulu cr frmz clcul blr;
- lctn (0,1%)
- mucn, st rdus d r clr crtr d r vzcul
- cz gr, cdul urc, ur.
Mcnsmul scurgr bl: bl rdus n md cntnuu d fct s scurg rn cnlcull
blr ntrhtc rn cnlul htc t lu du drc:
- n tmul dgst s vrs n dudn rn cnlul cldc:

14

- ntr rnzur s cumulz n vzcul blr und sufr rcs d cncntrr.

lmnr bl dn vzcul blr s fc rn cun snrgtc cntrc vzcul
blr rlr sfnctrulu dd, dnd sbltt trundr bl cl cnlulu cstc
cldc n dudn. cst mchnsm st rglt cl nrvs umrl.
Funcl mtblc. Fctul ndlnt m mult func mtblc:
mtblsmul glucdc. Glucdl sunt bsrbt l nvlul trctulu dgstv sub frm d
mnzhrd, glucz, glctz fructz ung cl vn rt l fct. C m mr
rt st dztt sub frm d glcgn n clull htc. Mtblsmul glucdlr r

b#%l!^+a?

mrtn ddbt ntru rducr nrg ncsr rgnsmulu; func fctulu n

mtblsm glucdc s numt func glcgnc
mtblsmul ldc. Fctul ntrvn n mtblsmul ldc ndlnnd sr d rlur:
- nmgznr grsm sub frm d grsm d rzrv
- mblzz grsm d rzrv dn dzt (n strl d nn l rgnsmulu fctul
ntrnz grsm d rzrv dn strtul clulr subcutnt ntru crr nvlr
rgnsmulu)
- snttzz cz gr grsml nutr sub frm d fsfld (dc s rduc
tulburr n frmr frmntlr c duc l snttzr cstr, s cumulz n clull h tc
cr rvc dzvltr mr sutulu cnunctv l fctulu frmnd CH)
- dz cz gr cu rducr d nrg, C2 .
mtblsmul rtdc. L nvlul fctulu, rtdl sufr dfrtt rcs d sntz d
dgrdr ncsr cmz lsm rfcr clullr.
- snttzz fbrngnul rtrmbn, substn rtc c ntrvn n cgulr
snglu; s snttzz n fct trc n lsm. ntru sntz rtrmbn st ncs r rzn
vtmn .
- rn rl rtnl(mncz) n vdr utlzr lr n dfrt rcs( frmr d
rtn, surt ntru ntcr)
- dgrdz mncz cr sunt utlz n clull rgnsmulu flsndu- ntru
sntz glucdlr, ldlr su frmnd mnc
- trnsfrm mncul frmt n ur
- ntrvn n trnsfrmr nuclrtnlr n cd urc
mtblsmul substnlr mnrl

15

- fctul st cl m bgt rgn n fr, r func d dzt l cst n clull uffr

- snttzz dztz curul rvnt dn lmnt, Cu r rl ctltc n sntz
hmglbn
- n d N, , Cl rvn dn lmnt, s dztz n fct mrun cu , d und sunt
mblz n rgnsm n func d ncstl cstu.
mtblsmul . Fctul c rlul d rgltr l dn ntrgul rgnsm. n strns
lgtur cu mtblsmul st func d rzrvr sngvn fctulu, dtrt vsculrz
sl bgt rtculrtlr crcul ntrhtc. n numt cnd t s rn l 2 l d
sng, rglnd stfl crcul d ntrcr snglu n nm, n mdul cst frt nm d

b#%l!^+a?

crtr brusc cntt d sng.

mtblsmul vtmnlr. n fct s dztz vtmnl , B1, B2, B12, D .
- fctul st cl m bgt rgn n v tmn : 95%. s dztz n clull uffr
sub frm d str ntru f lbrt n rgnsm.
- Vmn B1 ung n fct rn bsrb ntstnl.
- Vtmn B2 s bsrb dn ntstn sub frm fsfrlt, r l nvlul fc tulu s unt
cu rtn d ntr unr frmn dn
- Vtmn B12 st dztt n fct cr-l frt d nfltr grss
- Vtmn D s gssc dztt n fct rvnnd dn bsrb ntstnl n rzn
bl.
lt func l fctulu. lng funcl numrt m sus, fctul ndlnt lt
func d mrtn dsbt ntru rgnsm:
Func hmttc - cst func s rfr l frmr dsrtugr glbullr r
l nvlul fctulu. Fctul frmz glbull r n rd ntrutrn, r du ntr cst
func nctz fnd rlut d lt rgn hmttc (mduv ss, sstm rtculndtll). Glbull r btrn uns n fct sunt dstrus, r frul dn hmtglbn c s
dun c st mblzt l rgnl hmttc, ntru frmr d glbul r n.
Func tc - n cursul dgst s frmz unl substn tc (ndlul, fnlul) c
rzultt l cun bctrlr d utrfc. Dc cst substn ung n cr rduc ntc
grv. Fctul rmt ct rdu rn vn rt, nutrlzz, nctvz lmn rn
urn. t n fct sunt nctv un hrmn. Rglr func nttc d b rr fctulu
st rlzt s SNC hfz.

16

 Func d sntz frmnlr n fct - l nvlul clullr htc s frmz s

lbrz mrtt frmnlr dn rgnsm: fsftzl, trnsmnzl, crblz,
dcrblz, rgnz, ur. Fctul rduc c m mr rt frmnlr.
Mnnr chlbrulu cd-bzc - fctul ntrvn c un tmn n mnnr cstu
chlbru, lbrnd, vlnt cd su lkln, du rc mdulu rsctv.
Func trmrglbl - cnst n rtcr l rglr tmrtur crulu.
mrtur l mul snts vrz ntr 36,4 37,4 grd Clsus. Cnd mul s fl n r us
fctul rn ctvtt s st cl m mrtnt rgn gnrtr d cldur.
Vzcul blr cncntrz, cdfc, stchz lbrz bl. Cncntrr bl n
rdl ntrdgstv rmt stcr un cntt crscut d cz blr ntr-un vlum cnstnt
b#%l!^+a?

d bl. Cu ct st m mr rd ntrdgstv, cu tt st m m r c ntt t d cz bl r

rsnsbl ntru susnr dgst. ncunl rclulr d l nvlul tlulu vzc blr
sunt rmbl ntru lctrl nrgnc dn bl. stfl, bl st cncntrt rn ndrtr
nlr d sdu d clr.
Ldl dn cmz bl sunt rznt sub frm d grgt (mcl vzcul), r
bl vzculr rmn ztnc, cu tt c cncntr nlr d sdu crt st 300 mM du
rd ntrdgstv. tlul blr ndrtz sdul dn cmz bl l schmb cu n d
hdrgn. ct dn urm s cmbn cu nnul bcrbnc frmnd cd crbnc, cr v dsc
n bd d crbn . L nvlul mmbrn bzltrl tlulu vzc blr s gst
-z N +/+ cr mz sdul ctr lsm. n d clr trc rclulr n sng ntru
mnn nutrltt lctrc. M sunt bsrb n d clcu, dr cncntr c lculu n
vzcul blr st m mr dct n lsm, drc dstrbu nlr d clcu st dtrmnt
cnfrm chlbrulu Dnnn-Gbbs.

17

Fgur 4. Crcutul ht-ntr-htc

Dn t cnsttun ldc bl num cz blr u func utl num ct
rtc l crcutul ht-ntr-htc. Crcutul st utl drc furnzz htctulu

b#%l!^+a?

cntt mr dn cz blr scrt ntrr. cz blr cnug, cnsttun mr bl,

nu sunt bsrb n run rml ntstnulu drc sunt r lr u mlcul
r mr ntru trc rn ncunl rclulr; sunt fcnt rbsrb l nvlul lnulu
dstl rntr-un mcnsm d trnsrt ctv. D c sunt trnsrt rn sngl rtl l fc t,
und sunt r-tr scrt n bl ung dn nu n ntstn, rlznd crcutul htntr-htc l czlr blr (fg. 4).
L rsnl snts rmtv 8 mml d cz blr rcurg cntnuu crcutul
ht-ntr-htc; crcul st crscut n cursul rdlr dgstv. Numrul cclurlr
ht-ntr-htc rcurs d cz blr st n func d cnttt d lmnt ngr t d
frcvn lr. ngst un cntt md d lmnt fc c cst crcut (fg. 4) s f rcurs d
du r. cz blr sunt bsrb rn trnsrt ctv l nvlul lnulu trmnl; bsrb st
frt fcnt (rmtv 90% / cnttt d lmnt ngrt).
cz blr sunt trnsrt ctr fct rn sngl rtl; 60 - 80% dn cnugtl d cd
clc 99% dn cnugtl d cd chndzclc sunt lgt d lbumn. rm trc d
ctr fct st trm d fcnt (70 - 90%). c cz blr c r nu u fst tr ung n
crcul sstmc.
Drc rm trc htc nu st dntc ntru t cz blr s cnstt
cncntr dfrt ntr cz blr dn vzcul blr c lsmtc. l sm v f bg t n
18

c cz blr crr trc htc st mc. trc htc frcnt rmn cnstnt
n tmul rdlr ntrdgstv n cursul rdlr dgstv. cnttt frt mc d cz
blr nlg d lbumn ntr n fltrtul glmrulr; cu tt cst cz blr cnug sunt
bsrb ctv l nvl tubulr rnl stfl nct rdr urnr d cz blr st nglbl.

Ctlul 2: Htt C
2.1. Dfn
Httl vrl sunt nfc l fctulu crctrzt rn dstruc htclulr, ncrz
b#%l!^+a?

utlz. L un cn htctl t s s rgnrz dr vrst nntt lt fcun

sct t cnduc l cmlc. Htt t C rrznt 20% dn ttlul httlr , cl m

rbbl st st-trnsfuznl. st dfnt c fnd fcun nflmtr fctulu, cuzt d
vrusul htt C, cr rsst m mult d 6 lun, s nst d mdfcr bchmc hstlgc
t dtrmn cmlc svr rcum crz htc crcnmul htclulr.
Htt vrusl C st bl nflmtr fctulu, dtrt unu vrus (vrusul C), c r
s trnsmt rndrnt rn sng
nfc nu st nst n gnrl d nc un smtm
L 15% dn rsnl nfctt, nfc vrl dsr sntn
ns l 85% dn czur, vrusul C rsst n rgnsm s multlc n fct, cz n c r
vrbm dsr htt crnc C.

2.2 tlg
Htt C nu st bl sul trnsmsbl rscul d cntmnr, ctnd un cntct
drct cu sngl nfctt, st sczut. tu, dc sunt urttr d vrus C, st rscul d v
cntmn ccdntl nturul. Rsc crscut d cntmnr st n urmtrl stu:

19

 Flsr d drgur ( cl ntrvns - rn c srng nstrl, rbbl c l

nzl) chr num cznl, sngulr
rnsfuz d sng rdus d sng nnt d1991 (du cst n, dtrmnr
sstmtc ntcrlr ntvrusl dtrmnt c rscul trnsfuznl s dvn r nul)
rsnl mdcl
tu su rcng (crc n dvrs zn l crulu)
Flsr n cmun cu rsn vnd htt C, unr bct scut, ts:
frfcu, lm d rs, tc
Cntmnr n tmul ntr nu-nscutulu d ctr mm nfctt.
Cu tt cst, n 20% dn czur, surs cntmnr rmn ncunscut
n md bnut fctr sutulu htc st smlr n tt turl d h tt vr l;
vrz num grdul d ncrz tsulr. Vrusurl httc rduc lzun l htctlr
ncrz drct rn cun sur htctlr su ndrct rn ctvr rclr mun
nflmtr rn cr sunt dstrus htctl nfctt vrl. Ultrr, rc ntgn vrl
ntcr v gnr n cntnur dstruc l clullr htc nfctt. dmul ntrstl

b#%l!^+a?

dtrmn scdr fluulu c urmr clbr clrlr sngun, h tsulr , n fnl

fbrz.

2.3. Smtmtlg
Htt C st bl tnl grv. Du m mul n d rsstn vrusulu n
rgnsm, cst t dtrmn frmr d cctrc fbrs (fbrz) l nvlul fctulu. n
numrs czur, stn cst lzun nu fctz durt d v. vlu t mrg ttu
sr crz (20% dn czur, chr n bsn rcru cnsum d lcl). cst dtrrr
mdc fctul s funcnz nrml t duc l r cmlclr.
Htt C st bl nsds. cst bl rznt frt un smn. Unr,
cntul cuz str d bsl rlungt dr, d cl m mult r, bl trc nbsrvt nu
rturb v ctdn. vlu sbl sr crz su cmlc s f c du m mul n.
Htt crnc C st bl cr n rznt s t trt. st un tr t mnt c r n mult c zut
t st multlcr vrl. D smn n mult czur t r rgrs bl ctr crz
cmlcl sl.

20

Rclm c m frcvnt st bsl. Mnfstr m un cmun sunt gr,

slbcun, mlg, rtrlg rdr n grutt. nfc cu VHC t f, d smn, nst
d tulburr cgntv. t cst smtm sunt nn-scfc nu rflct ctvtt bl su
svrtt cst (Mrcn, 1993, . 71). ds smtml t f cuzt d bl sub cnt (d
mlu, drs), t f dfcl d fc dstnc ntr dfrt bl. bs l c cl m cmun
smtm t f rznt n mult lt stu (nclusv, gruurl d cntrl n c drul clnc snt).
n 60-70% d czur cn cu HCV C nu rznt cuz dgnstcul s stblt cznl.
Htmgl d dfrt grd st rznt n crc 30% dn czur, r slnmgl n
10-15% dn czur. mntrnsfrzl t vr cnsdrbl n str nturl htt C crnc.
Mrtt cnlr u dr crtr ur l mntrnsfrzlr. n l trm dn cn
u vlr nrml l L src (ut, 2002, . 55). rmtv 25% dntr cn u
cncntr L src d m mult d du nrm, dr, d bc, m un d 5 r st lmt
surr vlrlr nrml.
Crtr d 10 r f d lmt surr nrmlulu sunt frt rr rlvt. st
crl slb ntr cncntrl mntrnsfrzlr htc hstlg. Chr cn cu
vlr nrml l L rznt dvz hstlgc d nflm crnc n mrtt czurlr

b#%l!^+a?

(Mthurn, 1998). Grdul d fctr st, d bc, mnm su ur l ct cn. n cnscn,

nrmlzr mntrnsfrzlr du tr ntvrl nu rflct nrt mbuntr
hstlgc.

2.4. mn d lbrtr
Bl s dstz rntr- sml nlz d sng:
cst s fc rn unr n vdn ntcrlr ndrt mtrv vrusulu C
(srlg vrl C).
Dc stt un rsc d cntmnr n cursul v trnsfuz d sng, sd d
tcmn, tc, st ncsr s f nfrmt mdcul.
Dstr bl st sbl rnnd d l str d bsl rlungt su d l
dscrr unr nlz d rutn vnd vlr mdfct.
Dvr fctr cclrz vlu bl rcum cnsumul d lcl, chr n cntt
mdrt t grb vlu htt sr crz. rr cmlt cnsumulu d lcl st

21

blgtr. mnr cnlr cu cuz cu smtm d tlg htc:

scrnng srlgc;
scrnng bchmc;
USG bdmnl.

2.5. Dgnstc mdcl dgnstc d ngrr (nursng)

Dgnstcul HCV C s cnfrm rn dtl d nmnz, rzulttl mnulu clnc, l
nvstglr nstrumntl d lbrtr. S rcmnd cnsult l sclst blnvlr:
cu dgnstcul rmr stblt d htt crnc,
cu HCV C mnfstr trhtc dgnstct ntru rm dt (bl utmun,
mnfstr cutnt, vsculr, bl ndcrn, tc.);
cu rgrs rd bl;
ntru nr trtmntulu ntvrl,
ntru rtz vtlt;
vlur crtrlr ntru stlzr. Stlzr st ncsr ntru fctur
ntrvnlr rcdurlr dgnstc trutc, cr nu t f cutt n cndl d

b#%l!^+a?

b#%l!^+a?

mbultru. Stlzr st rnl ntru cn cu r rgrs rd

mnfstrlr trhtc ntru nr trtmntulu tlgc.
Dgnstcul nfc VHC s bzz dtrmnr ntcrlr nt-VHC rn mtd
RN-VHC rn mtd mlculr snsbl (CR n rgmul rl-tm). ntru
dgnstcul d htt cut vrl C st ncsr d tstt RN-VHC, drc RNVHC r
nnt ntcrlr nt-VHC. n httl cut, n rzn ntcrlr nt-VHC + RNVHC - blnv trbu tst rtt st ctv stmn.
rzn nt-VHC + RN-VHC + nu rmt dstnc un crbr h tt
crnc vrl C d surunr un htt vrl cut d lt tlg l blnv cu h tt
crnc C ntru dgnstc crct sunt ncsr lt dt d lbrtr. rzn htt crnc C
s cnfrm rn rzn cncmtnt ntcrlr nt-VHC + RN-VHC +. L cn
mundfctr c rznt smn d htt, dr ntcr nt-VHC sunt ngtv, st ncs r d
dtrmnt RN-VHC.
rzn ntcrlr nt-VHC g G ztv sugrz d rzn nfc crnc cu
VHC. c nt-VHC g M ztv sunt crctrstc htt cut su rctvr h tt crnc

22

vrl C (dc vr f sc cu c nt-VHC g G). Dtctr ntcrlr nt-VHC g M nu st

sufcnt ntru dscrmn ntr htt cut vrl C htt crnc vrl C, drc un
cn cu htt crnc rduc ntrmtnt ntcr nt-VHC g M , tt dt, nu t cn
rsund l nfc cut cu VHC cu rducr ntcrlr nt-HCV g M.
stl srlgc ntru dtrmnr ntcrlr sunt d du tur: tst nzmtc
munlgc ( nzym mmunssy) tst rcmbnt (RB rcmbnnt mmunblst
ssy). Gnr 3- d tst r snsbltt d 95-98%. ctulmnt utltt clnc
RB st n cdr. Dtctr ntgnulu cr VHC. Un tst cntttv (rhtct VHC g, bbtt
Dgnstcs) fst rbt rcnt. cst tst curnd 5 ntcr dfr, st frt scfc (99,8%),
l fl d fcnt ntru dfrt gntur l VHC, dr rznt m un snsblt t ntru
dtrmnr htt crnc vrl C, dct rcr RN-VHC (crsunztr 600 - 1000 U /
ml RN-VHC).
ntgnul cr l VHC st crlt bn, dr nu cmlt lnr cu nvlurl src d RNVHC (Mrt, 2009, . 102) sunt bnut rzulttl fls-ngtv l cn cu dfcn d
muntt (Mdc, 2011, . 84). D c ntru mntrzr trtmntulu ntvr l ctu lmnt s
flssc tstl mlculr (dtrmnr nvlulu d vrm: RN-VHC, bzt utlzr
rc d lmrzr n ln (CR) n rgm rl-tm).

b#%l!^+a?

stl clttv flst ntru dtrmnr rzn su bsn VHC; ndct: n

czurl cnd s susctz nfc cut, dr cu tst ngtv ; ntru cnfrmr nfc
crnc cu VHC l cn cu ntcr nt-VHC ztv; ntru cn cu htt d tc,
ntru cn cu mtv cunscut ntru rzultt fls ngtv l tstr ntcrlr.
stl cntttv snl ntru stblr ndc trutc, ndvdulzr durt
cst rvznr rbblt d rsuns vruslgc.
Cl m rcnt tst ntru dtrmnr nvlulu d vrm (RN-VHC) sunt b z t
utlzr rc d lmrzr n ln (CR) n rgm rl-tm. l t dtct cntt mnm d
RN-VHC (n l 10- 20 U/ml) cuntfc cu rcz nvlurl RN-VHC d n l
rmtv 107 U/ml. Dtrmnr ncrctur vrl st mrtnt n dcursul tr
ntvrl.
Dtrmnr gntulu VHC s fc blgtru nnt d nr trtmntulu, tt
ntru lgr tulu d trtmnt vnd n vdr schml trutc dstnct n func d
gntul dntfct, ct ntru v rdc sur rsunsulu l trtmnt. Sunt v ld t

23

dfrt mtd ntru gntr, cl m mult - bzt tst CR. vlur svrt fbrz
htc st mrtnt n lur dczlr d trtmnt l htt crnc vrl C stm r
rgnstculu bl (Ghny t ll., 2009, . 120) Bs htc st nc rvt c mtd d
rfrn ntru vlu grdul d nflm stdul fbrz (bdm, . 122).
n ultm n u fst vdnt dfcn l bs htc u fst dzvlt t
tnsv vlut mtd ltrntv nn-nvzv ntru cn cu nfc crnc cu VHC.
cst nclud mrkr srlgc lstgrf trnztr ( ynrd t ll., 2010, . 619)
rfrmnl lr, utlzt sngur su mrun, u fst rrtt cmrbl cu bs htc.
(bdm, . 620) Mtdl nn-nvzv s-u dvdt dntfc cu cttt cn cu fbrz
usr su crz. l sunt m un cbl s dscrmnz fbrz mdrt svr.
HCV C ncst dfrnr cu urmtrl tlg: Htt d tlg vrl B, B+D, F,
G su cuzt d vru fculttv httr, Httl utmun, Bl lclc fctulu,
Sttz htc stthtt nnlclc, Httl tc ndus d dvrs subst n tc
su mdcmnt, Crz blr rmtv, Clngt sclrznt rmr, Bl Wlsn, Dfct d
lf-1 nttrsn, Hmcrmtz, Fbrz htc, fctr rztr fctulu, Clngt
crnc, Cncrul htc, Crz htc.

b#%l!^+a?

S mun dlmtr htt crnc d crz htc (bsn smnlr d

hrtnsun rtl clnc). frmr sufrn htc crnc dfuz n scr cu nsufcn
htclulr crnc /su cu sndrm d hrtnsun rtl sunt crctrstc CH. ntru
dfrnr rut st ncsr d dntfct frml clnc rtculr d htt: clsttc, cu
hrslnsm, cu mnfstr ndcrn, cu rfr, cu mnfstr utmun. Stblr
dgnstculu clnc d HCV C ncst crtfcr tlg vrl C bl, dntfc r h tt
crnc bz fctrlr ztv: lvr tnsmnzlr cu durt d mnm 6 lun, rzn
smnlr hstlgc d htt crnc. S u n csdrr fctr d cludr (bsn
smnlr srlgc, bchmc mrflgc ntru lt bl).

2.6. rnc d trtmnt

24

rtmntul nmdcmnts: tmzr rgmulu d v lmnt rnl

dmnuz rgrs rcsulu tlgc n fct rvn dzvltr cmlclr.
rtmntul mdcmnts: st ndct n sc d: rfl d cntrl l smnlr
mld, mlrr func htc; dmnur rgrs rcsulu tlgc n fct
rvnr cmlclr. rlungr trtmntulu ntvrl, ndct d mdcul sclst
htlg/gstrntrlg, strct sub gd sclstulu htlg/gstrntrlg.
rtmntul HCV C cu:
htrtctr
ntfbrtc
ntdnt
Rcmndbl (cnfrm ndclr mdculu sclst htlg / gstrntrlg):
mncz
munmdultr
trtmntul cmlclr trtmntulu ntvrl, cnfrm rcmndrlr scltlr.
n cz d htt crnc vrl C, cu ctvtt d dvrs grd rcsulu nfl m tr n
fct, s rcmnd ntfln Slmrn, cr u fct dvdt ntfbrtc htrtctr.

b#%l!^+a?

n cz d HCV C cu sndrm d clstz, s rcmnd trtmnt cu cd ursdclc, 515mg/kg ms cr, tm d 2-3 lun m mult su/ trtmnt cu dmtnn, 400-1600 mg/z.
n tr HCV C st utlzt rrtul uthtn BR, rmdu cu fct htrtctr,
ntdnt, mmbrnstblztr, rcum munmdultr.
cvrn, mdcmnt cu fct htrtctr, ntvrl d smn s rcmnd n
HCV C. Dn ctgr ntdntlr sunt utlzt vtmnl: cfrl (), Rtnl () cd
scrbc (C). Vtmntr (vtmnl dn gruul B, cd nctnc, cd flc) s rcmnd cnd
s cnstt scr HCV C cu ntc crnc lclc su cu sndrm d mlbsrb d
dfrt gnz.

2.7. vlu rgnstc

rgrs bl htc r lc rcursul m multr dcn, st cclr t n rzn
cfctrlr, cum r f: cnsumul d lcl, dbtul zhrt (l cr s r c VHC rdsun),
vrst nntt chz, cnfc cu vrusul mundfcn umn su cnfc cu l vru

25

httr.
Cnsumul d lcl: Chr cntt mdrt d lcl mrsc rlcr VHC, srsc
rgrs nfc crnc cu VHC cclrz lzunl htc (Gtt, 2009. . 109).
Sttz, d l mdrt n l svr, crlz cu dzvltr fbrz htc.
Vrst gnul: rgrs m rd st bsrvt l brb m n vrst d 40-55 n
(Svrtlh, 2007, . 144), n tm c rgrs m un rd st vzut l c (Chld, 1964, .
117).
Cnfcl vrl: rgrs nfc cu VHC st m rd l cn nfct cu HV,
htt cut B l un cnt cu htt crnc C t f m svr. fctr fctulu st d
bc m svr bl rgrsz m rd l cn cu dubl nfc: VHB / VHC.
tn: rgrs m lnt fst bsrvt l fr-mrcn (Strlng, 2004, . 153).
Rsunsul mun clulr scfc l VHC l gzd: fctr gntc dtrmnn cum r f
rs HL (Hrbr, 2007, . 90) ghdz, rbbl, rsunsul nflmtr. rz ll
HLDRB1 s r f sct cu rgrs m lnt bl lgt d nfc cu VHC.
Utlzr d z cu z d mrhun: t rvc rgrs mult m rd bl.
l fctr gzd: fntul GF B1 su NL-3 (dnutrn) stdul fbrz sunt

b#%l!^+a?

crlt cu rt d rgrs fbrz (mmr, 2011, . 169).

Fctr vrl: nfc crnc st sct cu grd vrbl d nflm htc d
rgrs fbrz, ndfrnt d gntul VHC d ncrctur vrl. Nu r s st nc un rl
smnfctv dfrtr gntur qussc sur rgrs fbrz su vlu bl. Cu t t
cst, cnfc cu m mult gntur t v un rzultt m ru cmrtv cu mnnfc.
Utlzr d strz: crt ncrctur vrl cu VHC.
n func d rzn cfctrlr, d l 10% n l 40% dntr cn cu nfc crnc
cu VHC s v dzvlt crz. Mrt lgt d cmlc l crz t v lc, l ncdn
d rmtv 4% n, n tm c crcnmul htclulr r n cst ul , l
ncdnt stmt d 1-5% n. cn dgnstc cu crcnm htclulr u
rbbltt d 33% d dcs n tmul rmulu n.

26

b#%l!^+a?

BBLGRF

nglscu N., rtt d chrurg, Bucurt, 2001.

Bgu Lucn, mbrlg vscrlr, 2011.
Cruntu rn Drg, Guc Smn lz, Hstrhtctnc hstfzlg htc, n:
rcvnu . dtr, tlg htc. umr htc, d. UMF Gr.., , 2008, . 25 46.
Chrc M., mfr M., nth t. D., ntm trunchulu, vl. , , Ltgrf UMF, , 1991,
. 172 - 219
Cnstntnscu N. M., ntm chrurgcl rtr. bdmn, vl. , d. cdm
mnlr d tn dn Rmn, Bucurt, 2012, . 103 - 223
Dcnscu, N., Rttnbrg, N., Nculscu, V., d., Ghd d ntm rctc, dtur Fcl,
27

mr, 1988.
Drg, Gh. S., d., ntm Gnrl sstmlr crulu mnsc, vl.1, d. Unvrst,
Crv, 2003.
Duc S., Cldcul. tlg, lrr, trutc chrurgcl, d. Dc, Clu-Nc, 1986, .
9 - 34
Frnndz, H. H., Rdrguz, R. L., Skdmr, F. M., kun, M. S., rctcl rch t mvmnt
dsrdrs. Dgnss nd surgcl nd mdcl mngmnt, Dms, 2007.
Grnt, .C.B., d. Mthd f ntmy. 8-th dn.,Wllms & Wlkns, Bltmr, 1971.
Luu, G., ntm mulu Lucrr rctc, dtur Unvrstr Crl Dvl, Bucurt, 2007.
Luu, G, ntm, dtur Unvrstr Crl Dvl, Bucurt, 2007.
ln, V., ntm mulu vl. 1; d. V, dtur Ddctc dggc, Bucurt, 1982.
ln, V., ntm mulu, dtur ll, Bucurt, 2010.
Mdcl, Bucurt, 1990.
Ruvr, H., ntm humn dscrtv tgrfqu t fnctnll, d. lm, rs, Mssn,

b#%l!^+a?

1978.
Sn, M., Cstch, ., Curs d ntm tlgc. d - rvzut dugt, dtur
Crmrnt, Bucurt, 2005.
Snlnkv, R.D., tls d ntm umn, Mscv, 1978.
Vculscu, .C., trcu, .C., ntm fzlg mulu, dtur Mdcl, Bucurt, 1964.
Mnul mdcl,dtur ll ,Mrk H. Brs dtr sf ndrw . Fltchr, hms V. ns, Rbrt
rtr, Mchl Brkwst s ustn L. ln,
rtt d nursng - Crn Mrcn,dtur MDCL
Mnul d rctc ntru lv scllr stlcl sntr, Crdntr Mrc Ncusr mft.
rtt d htgstrntrlg, L. Bulgscu, dtur Mdcl mlt
rtt d gstrntrlg clnc ,Vl. ,M. Grgrscu, . scu, dtur hnc
ctultt n htlg ,Mh Vculscu, dtur nfmdc
Bl ntrn 2, Crdntr rf. dr. Dn Grgscu, dtur Ntnl
Mnfstr sstmc n bll htc , crdntr Mrn ng,dtur Crl Dvl Bucurst
Htlg rctc ,Flr Vn
tul dsr htt s vrusurl htc ,Httl ,B,C,D,,rf Dr.drn Strnu -Crcl
,Crus ublshng

28

sct l bl htc lclc s l stthtt nlclc, dtur Unvrstr \"Crl

Dvl \"
Bl l fctulu s ncrsulu ,Cmn nsscu ,Mncrt rs
Ltz blr,dtur: cdm Rublc Sclst Rmn
Mdcn ntrn,,Crnlu Brundl
ctultt n tlg fctulu ,Mrc Grgrscu,Mrc Burn,dtur mdcl unvrstr
Bll fctulu, clr blr s ncrsulu VL - .Bulgscu
rtt d Htlg ,Mrc Grgrscu ,dtur Mdcl Ntnl
rtt d nursng ,Crn Mrcn
ngrr mulu blnv s mulu snts. Mnul ntru scll sntr stlcl, Flrn Chru
Mnul f NUrsng Dgnss ,Grdn Mrry
tls f clncl Htlgy,Gtln nd Struss
Htlgy ,by Hrssn ublstr Brtsh Md urnl ubl Gru, Surc f Wb f Scnc
Htlgy Hghlghts 2014 ,ublctn :nnlsf Htlgy
scu . (sub rd.): Chrurg fctulu. dtur Unvrstr Crl Dvl, Bucurt, 2004

b#%l!^+a?

Stndrng S, Gry H. Gry's ntmy, h ntmcl Bss f Clncl r ctc. Churchll

Lvngstn, 2008.
ntscu v., trncuc c., dudnul glndl n. Crlt mrflgc funcnl , dtur
ltr, bucurt, 1988.
G. . UN, MB, FRCS, FRCS, Surgcl ntmy f Cmmn Bl Duct, Lndn 1989
uvr ., Stlcs D., Rdulscu D., Gvrlscu S., Chrurg clr blr trhtc. hnc
chrurgcl, vl. , d. Md., Bucurt, 1989, . 7 - 29
mn ., ntm clnqu, m 3, hr-bdmn, Mln, 27 Ru d lcl d Mdcn,
75006 rs, 2009, . 291 - 312
Lrsn, Schnwlf, Blyl, Brur, Frncs-Wst, mbrylg Humn, d. 3, d Bck, rs,
2011, . 80 - 85, 435 - 350
Mldvnu R., Vld N., Fl V., lmnt d ntm chrurgcl, d. hnrss, , 2010, .
135 - 202
tr F., Lcz H., Durt S., rtqu ntmchrurgcl llustr, bdmn, Fsc , Gstn
Dn, rs, 1934, . 204 - 295
trvnu ., mfr M., durru D., Stn C., msfrl crbrl. Sstm nfrmnl, d.

29

ntct, Bucurt, 1999, . 189 - 194

Ruvr N., Dlms ., ntm humn, dscrtv, tgrhqu t fnctnnll, d. Mssn,
rs, 1997, . 434 - 460, 487 - 496
Sdlr . W., Lngmns Mdcl mbrlgy, d. -, 2007, d. Md. Cllst, Bucurt, . 206 211
Stlcc D., vc ., rbnscu Mr, dt. rc ., Hrtnsun rtl rn bstcl
rsnusdl, vl. , d. Md., Bucurt, 1987, . 242 - 249
Skndlks .., Sthn W. Gry, h. D, mbrlgy fr surgns. h mbrylgcl Bss fr th
rtmnt f Cngntl nmls, 2nd dtn, Wllms & Wllkns, Bltmr, Mrylnd, 21.202
US, 1993, 282 - 295
Stndrng Susn, lls H., Hly . C., GryS ntmy. h ntmcl Bss f Clncl rctc.
hrthynnth dtn, D lsvr, Churchll Lvngstn, 2005, dnburgh, Lndn, Nw Yrk,
Sydny, rnt, . 1213 - 1225; 1251 - 1256
rcvnu ., ntm chrurgcl fctulu. n: rcvnu . dtr, tlg htc. umr
htc, d. U.M.F. Gr. . , , 2008, . 15 - 24
rcvnu ., hnc chrurgcl, d. lrm, , 2003, . 237 - 282

b#%l!^+a?

stut L., Ltrgt ., rt dntm humn, m qutrm, Gstn Dn, rs, 1931, . 569
- 678
rnu ., mntum-ul mr. ntm funcnl chrurgcl, d. hnrss, , 1999, . 31 36
Ulrch Drws, tls d ch dmbrylg, d. Mdcn Scncs, Flmmrn, rs, 2006, . 190
- 192, 314 - 323
Vld ., Chrurg htc. sct ctul, d. Cs Cr d tn, Clu-Nc, 1993, . 1 - 18
Vculscu B., lscu C.., ntm fctulu, n: scu , dtr Chrurg fctulu,vl. , d.
Unvrstr Crl Dvll, 2004, . 9 40
Vzc blr (clcstul su "fr" ulr) st un sc d mc dmnsun, znt
mdt sub fct. r rlul d dzt bl scrtt d fct. Bl ut l dgst grsmlr
st lmnt dn vzc blr n ntstnul subr, rn ntrmdul unr cnl, c blr.
Clcul blr sunt cmu dn clstrl l cnsttun c s gssc n bl. C
dmnsun, t f m mc dct un bb d gru su m mr dct mng d glf. M r
mrtt cstr clculu nu un rblm, dr dc blchz un cnl crtr, ncst
trtmnt.
Ltz blr st fcun ds ntlnt, m ls l ul dult, 10 15% dntr
mn sunt urttr d clcul. Dntr s, frgvn l fm st surr: rrtul st d 4/1
30

5/1.
Ltz blr st cunscut n lt zn ggrfc c ur, rntul Mlcu, S.U.,
st bsnt n ndnz, frc Cntrl rr n nd.
rzn su bsn bl, rcum cmz clcullr dfr du zn ggrfc, du
s, mrtt clcullr fnd cmu dn m mult substn, frt un fnd ur.

C. . NUN D NM FLG
1.1. NM FCULU
Fctul st c m mr glnd n tubulu dgstv bdmnl dn crul umn, tt
n rd d dzvltr mbrnl ftl ct l dult.
r multl func:

func d rducr bl;

func mtblc multl

o rlucrr substnlr bsrbt rn mucs ntstnl;
func hmdnmc
o ntrvn n dstrbu ms crcultr sngvn dn rgnsm, rrtznd
dztnd sng du ncst, d c rzult c grutt s st vrbl l
mul vu, fnd d 1/50 dn grutt crulu l dult.
Fctul st glnd d cnsttu lstc, r dmnsunl sl sunt vr bl n r rt cu
vrst cu tul cnsttunl 22-25 cm dmtrul trnsvrsl, 15-22 cm d mtrul ntr-strr,
5-10 cm dmtrul vrtcl (nlm).
Stu tgrfc
Fctul st stut n tul bdmnl surmzclc sub blt dfrgmtc und cu l
htc dlmtt surr, strr, ltrl ntrr d muchul dfrgm, r nfrr d clnul
mzclnul trnsvrs.
Fctul s rctz rtl ntrr l bdmnulu n rgun hcndrulu drt, n
rt surr gstrulu rt stng hcndrulu stng. L htc cmunc lrg
cu l gstrc.
Fctul st dlmtt surr d ln cr trc rn cst V- d rt dr t
cbr blc sr stng nfrr d ln c unt rbrdul cstl drt l nvlul cst -
cu cl stng l nvlul cst V- trcnd sub ndcl fd. strr s rctz
ultml tr vrtbr lmbr.
Cnfgur trn
Fctul st un vd scnt blc, cu trmtt mr rntt l drt f cnv
surr.
r du f:
- surr (cnv) su f dfrgmtc;
- nfrr (ln su f vscrl)
r du mrgn:
- nfrr, scut cr nu dt rbrdul cstl drt;
- strr, rtunt n rrt cu dfrgmul.
f dfrgmtc fctulu, rtnul trc d fct dfrgm, frmnd lc
b#%l!^+a?

31

sgtl numt lgmntul flcfrm su susnsr cr cnn n l lgmntul flcfrm s u

susnsr cr cnn n l lgmntul rtund l fctulu cr mrchz lmt ntmc dntr
lbul drt stng.
F vscrl r 2 nur, nul nul sgtl drt sgtl stng mrt fcr n du
umt rntr-un n trnsvrsl.
Rrtur
F dfrgmtc vn n rrt rn dfrgm cu bz lmnulu drt, nm mcrd
cr l nvlul lbulu stng frmz mrsun crdc fctulu.
F vscrl vn n rrt cu rnchul drt, glnd surrnl drt, dudn, flur
drt clnulu, f ntrr stmculu sfgulu bdmnl. t cst ls f
vscrl mrsun cu cl num.
Sgmnt fctulu
Lmt rl ntr lbul stng lbul drt st ln c trc f vscrl rn fs
vzcul blr nul vn cv nfrr, r f dfrgmtc lmt s rctz l du
ltur d dgt l drt lgmntulu flcfrm.
Lbul stng r un sgmnt ltrl ltul mdl c s ntnd ntr cl du nur sgt l
curnznd lbul trt cudt.
Lbul drt st lctut dntr-un sgmnt ntrr unul strr, lmt dntr l fnd fsur
sgmntulu drt.
Fcr dn cl tru sgmnt r ct un dcul sgmntr, frmt dn rmur sgmntr,
un cnl blr sgmntr, rmur sgmntr vn rt, n fsur sgmntulu drt s gst
vn htc drt, r n c stng, vn htc stng.
Structur mcrscc fctulu. Fctul st un rgn ntrrtnl crt cu
rtnul vscrl htc st lctut dntr- strm cnunctv dn clul htc. Strm
cnunctv curnd mmbrn d nvl (Csul Glssn) dn cr lc stur cnunctv n
ntrrul rnchmulu htc cr dlmtz nut m mc numt lbul htc.
Untt structurl funcnl fctulu st lbulu htc frmt dn clul h tc
numt htct, clr snusd cr rvn dn rmfcl cn rt cnvrg ctr vn
cntrlbulr su cntrl dn cnlcul blr.
Htctl sunt dsus sub frm d lc clulr nstmzt ntr l, c frm z
r trdmnsnl, cu dsz rdcl ctr vn cntrl.
n churl cst rl s fl clrl snusd. ntr fl clulr cr vn n cntct s
fl cnlcull blr ntrhtc cr nu u r rr n cr htctl v rs rdu
d scr (bl). Ctr rfr frmz rtl rru numt clngl. cst c nlcul
blr s cntnu cu cnll ntrlbulr cr s vrs n m mult cnl ntrlbr.
r clrlr snusd sunt frm dn clul ltrl su uftr c rn sstmulu
rtculndtll (mcrfg) cu func fgctr cu rl mtblc ntru c l nc
trnsfrmr mtblc substnlr lut cr st cntnut d htct.
L rfr sul dntr d su tr lbul nvcn s chm sul rtl ntrlbulr, d
und lc rmur ntrlbulr vn rt, un rtr htc un cnl bl r ntrlbul r,
lmftc nrv.
Rmurl-ntrlbulr l vn rt s rmfc s dschd ntr-un clr snusd
rrtl n cr s dschd vn cntrlbulr, cr rrznt ctul d rgn l vnlr
htc cr trnsrt sngl dn fct n vn cv nfrr. t vsl, rtrl, vns dn
lbul u sfnctr l nvlul fcr rmfc cr rglz fluul sngun n fct.
b#%l!^+a?

32

Vsculrz nrv fctulu

Vsculrz nutrtv st dt d rtr htc, rmur rtr clc cr duc l
fct sngl gnt l nvlul nlulu s rmfc ntr- rmur lbr drt lt stng r
cst n rmur sgmntr, ultml rmfc fnd rmurl dn sl rtl.
Vsculrz funcnl st sgurt d vn rt cr dun sngl vns dn tt tubul
dgstv sub dfrgmtc cr l nvlul hlulu htc d rmur lb r dr t lt stng, dn
cr lc rmurl sgmntr, ultml rmfc clrzndu-s n lbul dnd n tr
clrlr ssnusd.
Sngl vns l fctulu st drnt n vn cv nfrr rn vnl htc: drt,
md stng; rgn lr fnd n vnl cntrl l nvlul lbululu htc, und s v rs
clrl snusd, cl 3 vn htc.
Lmftcl fctulu drnz lmf sr gngln htc clc ntru f nfrr
n c strnl, mdstnl ntrr ncrtclnl ntru f dfrgmtc.
nrv st sgurt d fbr cr mrun cu rtr htc vn dn lul clc dn
fbr rsmtc dn nrvul vg.
Cl blr ntrhtc trhtc
Cl blr ntrhtc nc dn cnlcull blr ntrlbulr cr s cntnu cu
cnll dn sul rt rr hlulu dn cnflun lr s frmz un c n l drt unul
stng , r rn unr cstr du cnl rzult cnlul htc cmun.
D c, nc cl blr trhtc cr sunt rrzntt d cl blr rncl cr
rzult dn unr cnlulu htc cmun cu cnlul cldc cr trnsrt bl n dudn d
vzcul blr cr st d ft un rzrvr d bl cr rn cnlul cstc s vrs n cldc rn
cr vzcul blr s lg d cl blr rncl.

b#%l!^+a?

1.2 NM VCUL BLR

Vzcul blr (fsc fll su clcstul) st un dvrtcul blr cr cnsttu un rgn
d dzt cncntrr bl. Scr blr fctulu st cntnu ns vcur n ntstn
st rtmt d rd dgstv, n rd ntrdgstv bl st dztt n vzcul bl r
und s cncntrz d r du zc d r rn bsr srurlr nrgnc, vlumul
d bl scrtt rd d tm dtndu-s cct rdus vzcul blr.
Vzcul blr st stut n fs vzcul blr d f vscrl fctulu n
sgmntul ntrr l nulu sgtl drt.
st un rgn cvtr vd, n frm d r su rfrm cu lungm md d 8-10 cm
grsm d 3-4 cm r tr run:
fundul vzcul blr st run m dltt st rntt sr mrgn
nfrr fctulu cr rznt l cst nvl nczur. S rctz rtl
ntrr l bdmnulu l lcul und ntlnt crtlul cst -, cnd vlumul
crt n czur tlgc;
crul vzcul blr cntnu fundul vzcul blr n drc scndnt sr
hl. F cr rvt sr fct dr d cst rntr-un mzu numt mzct. F
us su lbr vzcul blr vn n rrt cu clnul trnsvrsl cu rt
surr dscndnt dudnulu;

33

clul vzcul blr st dlt cnc c s cntnu cu cnlul cstc. n unghul

dntr cr cl cu dschdr sr stng, s gst dsr, un gngln M scgn
lmftc.
Structur vzcul blr
rtl st frmt dn 4 strtur: L trr s gst tunc srs, r f lt d
rtnu, sut cnunctv. Sub rtnu s fl strtul subsrs cr st un su d clv cu v s
nrv, cr l flssc chrurg n clcstctm.
Mlfrml blr cngntl t f svr, ncmtbl cu v. Cl mnr rmn
smtmtc, dr dstul d frcvnt vluz cu smtm dstc blr. nmll ctg t
sunt cnscn l ltr fcun blr (nflm, ltz, tc.).

nmll vzcul blr

nmll d frm sunt dgnstct clcstgrfc: vzcul blbt, vzcul n cs d
ns, n bnt frgn, vzcul stt, tc. Stz nflm dtrt dfcultlr d v cu r
t fvrz r clcullr.
Dvrtcul vzcul blr-smtmtc cnd s cmlc cu nflm su ltz.
nmll d z. cst un rblm dsbt n czul ntrvn chrurgcl ntru
ltz cmlct, frcvnt ntlnt.
Vzcul blr t f stut ntrhtc, trnsvrs, sub lbul htc stng, n lg mntul
flcfrm, surhtc, subcutnt tc.
nmll nfundbulcstc sunt m ds cngntl (cudur l cstculu, lumn ngust
tc.), m rr scundr unr drnt nflmtr su stnz fbrz cstculu.
vluz cu smtm dtrt dsknz.
nmll d numr. Clcstul dublu t v un sngur cnl cstc su du cnl
srt. Smtmtlg s dtrz cmlclr (nflm, ltz) dsknz sct.
Clcstul trlu st rrtt. gnz vzcul blr nu rduc rturbr dgstv
t f nst d dlt cmnstr clr blr.
Urmz tunc musculr cr st tunc fbrmusculr, drc fbrl musculr
ntd dsus m mult trnsvrsl f d ul vzcul s ntrsctz cu fbr cnunctv
lstc. Sr ntrr fbrl musculr u dsz lfrm. Vzcul blr nu sd
submucs, drc tunc mucs cu strtul rfund st zt drct tunc musculr.
Mucs frmz sr d cut numt lcl tunc mucs l vzcul blr.
b#%l!^+a?

Vsculrz nrv clr blr

Vsculrz clr blr. Vzcul blr r c surs rtrl rncl, rtr cstc
cr r rgn n rmur drt rtr htc rr. ung l clul vzcul blr s
rmfc:
- rmur ntrr cr rg rtl vzc f rtnl;
- rmur strr cr rg rtl crsunztr fs vzcul blr.
cst du rmur s nstnzz l nvlul fundulu vzcul blr. Vnl d f
drnt s vrs n rmurl ntrhtc l vn rt, r vnl dn rtl nvlt n rtnu
frmz sngur vn cstc, cr s vrs n vn rt su m frcvnt n r mur s lb r
drt.

34

Vnl c blr rncl frmz un l vns rcldcn cr drnz n vn

rt n flun s.
Lmftcl drnz lmf stfl:
- cl dn rt drnt drnz rl lmf sr lmftcl dn rgun nvcnt
fctulu;
- cl dn rstul rtlu mrg sr un gngln l clulu vzcul blr n g ngln
htc d l nvlul dcululu htc.
Lmftcl sunt trbutr gnglnlr htc blr.
nrv clr blr. Func cml clr blr st rglt cl nrvs
umrl.
nrv st sgurt d fbr vgttv (smtc rsmtc) cr vn dn lul
htc ntrr strr. Dn lul ntrr lc fbr ntru cnlul cstc vzcul blr,
r dn cl strr rmur ntru cldc cnlul htc cmun. Cl blr cnn sr d
fbr frnt cu tc d mln cr cnduc stmul durr d l cst nvl.
Cnlul htc s unt cu cnlul cstc frmnd cnlul cldc, cr mrun cu vn
rt rtr htc frmz dculul htc.
Cnlul cldc r run surdudnl cr lst cnd cstcul htcul s unsc
sr frm cldcul, urmz run rtrdudnl stut n r surr
dudnulu, run rtrncrtc dn culu ncrsulu cr s v rs n mul
Vtr su mul ht-ncrtc mrun cu cnlul ncrtc Wrsung.
mul s dschd n dudn l nvlul l dudnl mr. n rt trmnl clr
du cnl, rsctv mul Vtr s fl sfnctrul dd.
b#%l!^+a?

1.3 FLG VCUL BLR

1.3.1. Bl
rrtl cmz bl
Scr blr (bl) rrznt rdusul ctvt crn fctulu, n 24 h fctul rduc
rmtv 800 ml bl.
rrtl bl. Bl r gust mr un mrs rt. Culr st n func d
rvnn:
- bl vzculr r culr nchs, cstn st cunscut sub dnumr bl B;
- bl cldcn r culr glbn-ur st cunscut sub dnumr bl ;
- bl htc st clr st cunscut sub dnumr d bl C.
Bl r dnstt curns ntr 1,010-1,035, bl vzculr vnd dnstt m mr, Hul dn cnlul cldc htc vrz ntr 7,4-8 r H-ul cl vzculr ntr 6 7, dc sl b
cd.
rsun smtc bl st gl cu c lsm (300 msm/1).
Bl st un lchd lcln, nu st un suc dgstv rru-zs, drc nu cnn nzm, dr
ttu dn un rl mrtnt n scl n dgst ldlr, rn cz blr.
Cmz bl dfr du rvnn s.
Bl scrtt d fct (bl htc) cnn 97% , 3% rzduu usct, nu cnn mucus.
Bl vzculr st mult m cncntrt, r 58% , 15% rzduu cnn mucus.
Bl rrznt cl d cr ntru num cnsttun chmc cr cnsttu rzduu

35

usct num: gmn blr, clstrlul, numt drgur (fnlftln srur d t)

rrtt cr st l bz cfr clr blr clcstulu.
rncl cnsttun chmc bl sunt: cz blr, mucusul gmn blr,
clstrlul fsfldl.
cz blr rrznt fctr rn cr bl ntrvn n dgst. n bl s gssc tru cz
blr, cr ntr n cnsttu vtmn D, clstrlulu hrmnlr strz: cdul clc,
cdul dclc, cdul chndclc , cdul ltclc. ct cz sunt cnug n clul
htc cu glcclul turn frmnd cdul glclc d l cdul turclc, r ct n
mdul lcln blr frmz srur d N , frm sub cr s lmn n dudn (glcn tul d
N turcltul d N). urn rvn dn cstn. cdul clc rvn dn clstrl.
Rlul cl m mrtnt l czlr blr s rct n bsrb ldlr vt mnlr
lslubl. cz blr rct ntns cun stmulnt sur blgnz, dc r cun
clrtc.
Srurl blr sunt suus un crcul ntrhtc, 90% dn srurl blr lmn t rn
bl rvn dn cst cclu, 10% fnd snttzt, ntrrur crcul nu scd cnnutul cstr
n bl c c dmnstrz stn unu mcnsm rgltr l sntz.
Srurl blr rct mrtnt multl rlur n dgst bsrb ldlr, rn
cun tnsctv rducnd mulsnr ldlr frnd surf m mr ntru cun
lzlr.
Srurl blr ctvz lz ncrtc, dr nu c ntstnl.
Ls bl dn ntstn duc l rdr rn scun 2/3 dn ldl ngrt, r n czul un
bsn rlungt r hvtmnz cml.
gmn blr sunt rdu d lmnr ctblsmulu hmglbn, lund ntr dn
Hb us n lbrtt rn dstrugr glbullr r l nvlul fctulu. u un rl fzlgc d u
culr glbn-vrzu bl culr crctrstc mtrlr fcl.
gmn blr sunt blrubn blvrdn. Blvrdn s fl n bl umn n c ntt t
mc, cnsttund rnclul gmnt dn bl srlr.
Blrubn ntr rn dscmunr nrml Hb (clrntul glbullr r) st
substn d culr brun-vrzu. cst trc n sng, n fct d und st lmnt n bl.
n sng blrubn s gst n cntt mc sub frm:
- blrubn drct su cnugt cu vlr nrml d 0,2 mg%;
- blrubn ndrct su ncnugt cu vlr nrml ntr 0,8-1 mg%.
Cnd blrubn dn sng dt lmtl nrml trc n urn, mrmndu- cst
culr brun-rct. n czul unr bstcl n lmnr bl su n bl d fc t, cncntr
lsmtc gmnlr blr crt ct clrz ntns urn suturl dnd ctr.
rn urn s lmn zlnc 1-2 g gmn blr, r rn mtrl fcl 150 mg.
Clstrlul s gst n rr d 1-2% vnd rvnn gn (lmntr)
ndgn (mtblc). S bsrb cu uurn dn ntstn dc st suc ncr tc ncs r
ntru lmnr slublzr s.
Fctul snttzz dn clstrl, cz blr cr lmn rn bl n ntstn. Fc tul
lmn numt cnttt d clstrl rn bl, r rstul st utlzt ntru frmr
lrtnlr cu dnstt m mc.
Sub frm dfrtlr tur d lrtn, clstrlul st dscrct n crcul und st
trs utlzt d clul.
b#%l!^+a?

1.3.2. Rlul srurlr blr n dgst

36

Bl r un rl mrtnt ntru dgst bsrb ldlr. D bl nu cnn frmn

dgstv (nzm) rn rzn srurlr blr ct func dgstv. Srurl blr sunt
substn tnsctv, l scd tnsun surfcl cturlr d grsm fvrzz
mulsnr lr.
L nvlul ntstnulu subr, srurl blr frmz cu cz gr nslubl n ,
cml clnc mcl hdrslubl cr t trvrs ur mmbrn clullr ntstnl. st
fvrzt, stfl bsr ldlr vtmnlr lslubl.
Cmll clnc uns n ntrct sunt dsfcut n cdul n cdul grs c v f
cnvrtt n trglcrd sr blr cr trc n sngl rt s rntrc l fct, d und st
nu crtt. cst st crcutul ht-ntr-htc d cnmsr srurlr srurlr blr
ntru crr sntz s chltut nrgc.
Srurl blr u rlul d stmul rstltsmul ntstnl, scr blr fc tulu,
dc func clrtc rlul d rvn utrfc rtnlr n ntstnul grs dc rl
ntutrd.
l slublzz clstrlul mdc mrun cu fsfldl r d clcul
blr. ntru mnn clstrlul n bl n str d slublt t st ncs r c r rtul srur
blr/clstrl s f d 20/1.
1.3.3. Mcnsmul scr blr. lmnr bl
Bl frmt cntnuu n clull rnchmts htc n clull uffr ung rn
cnlul htc cnlul cstc n vzcul blr d und st lmnt ntrmtnt n func d
lmnt rn cnlul cldc n ntstn.
Rlul dtrmnnt n mcnsmul d lmnr ntrmtnt bl st ndlnt d
cntrcl vzcul blr d rlr sfnctrulu dd cr cnst ntr- ngr r
muscultur crculr l flun cnlulu cldc n mul Vtr.
n rdl ntrdgstv cldcul st cntrctt r rsun dt 50-70 mm Hg.
Bl nmgznt n vzcul blr s cncntrz rn rbsr srurlr mnrl,
utndu- rduc vlumul d 10 r.
S dug n schmb mucus crtt d mucs vzcul, bl vzculr dvnnd stfl m
vscs dtrt mucusulu. lmnr bl st rdus d cntrc vzcul blr rl r
sfnctrulu cldcn.
Vzcul s cntrct rtmc d 2 r n l 6 r mnut. S rduc stfl crtr
rsun dn vzcul dn cnll htc n l 250-300 mm Hg cr chvlz rsun
scr blr scr nctz, fnmn cr nu r lc n cnd nrml ntru c sfnctrul
dd cdz.
Cuz dclntr ulz bl n dudn n cnd nrml, st rrzntt d
lmnt. Cnttt cltt bl vcut, dnd dc d flul lmnt, clstkntcl
cl m fcnt sunt rrzntt d grsm: glbnuul d u, untul, smntn, cdul lc,
lctn, ulul d lv, d ccs, d fct, d mrun.
rtnl, m ls crn sd l un rl clcstkntc.
Glucdl sunt lst d cst fct, r ltl rn cnnutul su n grsm stmulz
scr blr mdfc rtmul vcur vzculr.
b#%l!^+a?

1.3.4. Rglr scr cr blr

Func d cr bl s numt clrz, r fctr cr stmulz s numsc fctr
clrtc. Func d cr bl dn vzcul blr s numt clgg st stmul t d

37

substn clgg.
Rglr cstr du rcs s fc cnugt rn mcnsmul nurumrl.
Mcnsmul nrvs st sgurt d cntrul d blscrtr dn bulb cr rn ntrmdul
vgulu ct clrz func clgg vzcul blr.
st un mcnsm nrvs lcl d vcur bl.
n rd dntr ms sfnctrul dd st d 30 cm, n mmntul trundr lmntlr n
dudn r lc rn rfl lcl gnrl rlr sfnctrulu dd cntrc rtlu vzc
cu lmnr bl.
Sstmul nrvs smtc r fct us, dtrmnnd rlr vzc cntrc
sfnctrulu dd.
Mcnsmul umrl cnst n cun unr substn sur scr cr blr.
fct clrtc u srurl blr hrmn dudnl c htcrnn. Scr cstr hrmn
st stmult d lmnt grs c smntn, glbnuul d u, tc
fct blgn u hrmn dudnl, clcstknn ncrznn.
Scr clcstknn st dtrmnt d cntctul mucs dudnl cu HC cu
dvrs lmnt cu cnnut ldc dfr d ncrznn rn ftul c nu nflunz scr
ncrtc. Glucdl nhb scr blr.
st substn frmcdnmc cu rl sur mtrct vzculr:
- ctlcln rvc cntrc vzculr utrnc, ccntut d zrn dmnut d
trn;
- hstmn r fct smntr cu ctlcln;
- scrtn r cun mdst, dr sgur;
- curuln r v cun d cntrc vzcul blr rlr sfnctrulu dd;
- mrfn, nctn, zrnln, drnln, nrdrnln, gstrn, nu u rl sur mtrct
vzculr.
1.3.5. Funcl vzcul blr
Bl st scrtt d fct cntnuu n cnttt d 1-2 l/z, vrnd n func d crcul
srurlr blr d cun dfrtlr substn sur clrz.
1. Func d cncntrr st c m mrtnt s dtrz n rmul rnd cct d
bsrb tlulu vzculr. Vzcul blr r cctt d nmgzn 8 ml d cz
blr, c c crsund l 3 g d cd clc. Func d cncntrr s rlzz rn rcsl d
trnsrt ctv l lctrllr. Mucs vzculr st m rmbl ntru c tn, dct ntru
nn. lt substn bsrbt l nvlul tlulu vzculr sunt substn lslubl d tul
blrubn lbr, cdul chndclc, fsfld. gmn blr srurl blr s bsrb n
mc msur, bsrb lr crt n cnd tlgc c: nflm su rt vzcul.
2.Func scrtr cnst n scr d glcrtn, rdmnnt l nvlul clulu vzcul
cunscu sub dnumr d mucus, mucn, mucrtn, mclzhrd, glcrtn. cst
sunt d ft rtn bgt n glucd. Cnttt scrtt st c d 20ml/z crscnd n ltz
vzculr.
3.Func mtr cnst ntr- ctvtt sntn, rtmc lnt vzcul cr sgur
rsun d 10-30 mm n rdl d rusl rzrvrulu blr.
b#%l!^+a?

1.3.6. Funcl clr blr rncl

. Func d cncntrr. Mucs cldculu st dtt cu cctt d bsrb
smntr cl vzcul blr, stfl nct ntr cl du rnzur cnd bl h tc
stgnz n cldc r lc cncntrr cst cu crtr blrubn l 6-13 mg f d 3-5 mg

38

n bl htc.
. Func scrtr cnst n scr mucusulu d ctr glndl mtcs l tlulu
cnlcullr cr n lumnul cldculu s v mstc cu bl stgnt.
. Mbltt c blr rncl. n cst frm rrl sunt mrt un susn
dr stn unr mcr rstltc l trmt nfrr vtrn cldculu, r l c
cntrcl rl su ttl htcldcn rcum func sfnctrn htculu cmun
u rl mrtnt n cr blr.
V. ctvtt sfnctrulu dd cnst ntr- ctvtt bzt dschdr (dstl)
nchdr (sstl), rtmc unr ntrrut d cntrc vlnt. Crtrl d rsun rduc
lungr clr du fz, rturbnd cst ctvtt.
C. . LG L BLR
2.1. Dfn
Ltz blr s dfnt c fnd rzn d clcul n vzcul blr cl bl r
ntrhtc trhtc.
cst bl st frcvnt l tt vrstl num l 10-15% n ul dult, dr cu
rdlc r l sul fmnn, dtrt dfrn d cmz bl.
Ltz blr t f smtmtc, fnd dscrt c urmr unu mn rdlgc,
un ntrvn chrurgcl n tul surmzclc su l ncrs.
Cnd st smtmtc, rnclul smtm, st clc blr cr st un sndrm durrs
rstc, c r du cnsumul d lmnt clcstkntc s lclzz n hcndru drt
/su gstru; lus fnmnl d nsr.
Ltz blr s t cmlc rzultnd ltz cldculu, hdrsul vzculr, fstul
blr, lus blr, tc.
rtmntul gn-dttc, tt l clc, ct ntr crz st frt mrt nt, d r
trtmntul clsc chrurgcl m nu trtmntul lrscc cnsttu trtmntul d lc,
dr cr nu rmt n ttltt, smtmtlg ntru cr blnvul s- ntrnt.
b#%l!^+a?

2.2ncdn. Fctr tlgc fvrzn

fcun st rltv frcvnt, n ul dult 5-10% dn mn sunt urttr d
clcul. ncdn st n cntnu crtr rll cu c nvlulu d tr durt d v.
Frcvn ltz blr st c m mr l vrstnc, dr t f gst l rc vrst,
chr l c.
Crtr ncdn ltz blr dt cu vrst fst lct rn ccntur stz
vzculr l btrn (v sdntr, rt lmntr m rdus, mrtltt dfrgmtc dmnu t,
rn mcrr blgnz rn dfctul scr d hrmn sul.
Fml rznt fnmn clnc d ltz blr d rmtv tr r m frcvnt dct
brb. lc dfrn dntr s s fl n cmz bl: cncntr, substnl sld
sunt m mr l fm, r rrtul dntr cz clc dzclc st d r du r m
mr l brb dct l fm, n l dl rnd l fm hrmn strgn dtrmn vrl
vzcul blr cr dmnu rmnstrul, n l trl rnd t ntrvn s rcn cr crt
clstrlul fvrzz stz n clcst n cl blr , rn rsun ntr bdmnl crscut

39

 rn hrmn d srcn, cr dtrmn htn.

Rlul fctrlr fst sugrt d mr frcvn ltz blr n numt r (ur,
rntul Mlcu, S.U.) rn bsn n lt zn ggrfc (ndnz, frc Cntr l) s u
rrtt (nd).
Fml n unl trbur d ndn mrcn fc ltz blr n rr d st 50% n
msfr nrdc dmn clcul frm dn clstrl crbnt d clcu, r n znl trc l
cl d blrubnt d clcu. n n du cl d-l dl Rzb Mndl su mdfc t bcurl
lmntr dt cu cst crscut ltz clstrlc. nnt d rzb rdmnu clcul d
blrubn. Fml fc m frcvnt clcul d clstrl.
Fctr d rsc ntrvn n r ltz blr sunt rrznt d dbt zhrt,
bztt, gut, ltz rnl, stm brnc, unl frm d rumtsm. Ltz blr t r
nnt, cncmtnt su n urm cstr fcun.
Fctr fvrzn sunt rrznt d sdntrsm, buzur d grsm rtn, surmn,
trum shc, nrsctr rlr d ms, cnst, mbrcmnt rnl, fctr d stz
blr, mlfrml cngntl l clr ntstnl, m ls nfc l clr blr.
2.3. ttgn
Mcnsmul d frmr clcullr blr rzult dn cun unu mcnsm cml l
cr rtc ntrcun m multr fctr fzc-chmc, mtblc, d stz nfcl.
Fctr fzc-chmc mtblc dtrmn mdfcr l cmnntlr bl cu
rturbr stblr cldl.
Fctrul mtblc st cl m mrtnt, ltgnz blr rducndu-s n du stu:
- csul d substn cnnut:
clstrlul crt n lmnt bgt, n grsm, n bztt cnd s
dmnstrz hlmnt;
blrubn crt n hmlz cnd s dstrug mult hmt, n tlsm n crz
blr.
- dfctul d substn slublznt cr u rlul d mnn clstrlul, snttzt n fc t,
n str d slubltt n bl.
cst substn sunt rrzntt d cz blr fsfld.
cz blr scd n tulburr l sntz htc, n rc l clnulu lnulu, n
dvrs nfc ntstnl. C urmr cst scdr, rct clstrlul, l fl blrubn
clcu.
Fctrul stz fvrzz sursturr bl rn urmtr fctr fvrzn stz:
- mcnc clcst stt, mlfrmt
- funcnl clcst htn.
Stz t f rlzt rn bstruc cstc ddn rn tn vzculr, rn vr nt
tmc l rtulu crtr blr su rn mcrstz crt d mdfcr dstrfc
(clstrlz, clcstz). Srcn st un fctr d stz.
Fctr nfc rtc l frmr clcullr blr n m mult mdur: mdfc
cmz h-ul bl nfctt; c rzultt l rcslr nflmtr vr r dtrsutur clul r
mucus cr mrun cu mcrrgnsml vr frm mtrlul ncsr ntru mtrc clcululu.
ncrtt r ut v un rl ttgnc. Rfulr d suc dudnl ncrtc n
cnll blr t rct clstrlul.
ntrvnl ntru ulcrul gstr-dudnl t fvrz r ltz n rml lun du
r, m ls vgtm rzc.
b#%l!^+a?

40

Sunt drmt mcnsml rfl nzmtc cr cntrct clcstul dschd sfnctrul

dd. Clrz dmnu du vgtm.
Bll fctulu, n rmul rnd crz u fst studt s- uns l cncluz c r rtul
dntr cl du s nu st dfrt n rvn ncdn clcullr blr l crtc.
Dbtul st sct ltz blr, gsndu-s clcul l dbtc.
nfcl u un rl mrtnt. n urm nfc bl s rduc cnnutul cst n srur
blr, cctt d rsrb mucs nflmt fnd mrt. L ltzc s u dscrt n bl
clcst, strtcc, schrch cl cr r ut rcd su urm frmr clculr drc
grmn t dcnug srurl blr hdrlz glcurnlblrubn.
Rzc ll fvrzz frmr clcullr rn rducr rbsr czlr blr
nml hmltc cr fc c blrubn lbr s ung n cs n bl.
Cnd cun fctrlr ltgntc nctz, clcul rmn l vlumul lr nl rr t
dmnu.
Cmz clcullr
Clcul sunt frm dn blrubnt d clcu, clstrl, crbnt d clcu, cd lmtc,
rtn, curu, fr mgnzu, m cnn mtr rtc (clul, sfrmtur clulr, mucus,
bctr) st cr s dun clstrl su srur.
Clsfcr clcullr:
- clcul d clstrl sunt sltr, rtunz su vlr, cnn 98-99% clstrl, r rstul c lcu
rtn, sunt trnsrn ntru rzl , surf lr st grnult u sct rdr;
- clcul d blrubn sunt cmu dn blrubnt d clcu survn l c cu rducr csv d
blrubn, sunt mc, multl, cu sct unfrm, frm vl cu sur f rugs, sunt dur, c l
rzl t r n fcunl crrduc hmlz tlgc (ctr hmltc);
- clcul d crbnt d clcu sunt lb-cnu u surf ntd dmnsunl vrbl. Sunt
c l rzl sunt rr ntln;
- clcul cmbn u n cntru un clcul rdr dn clstrl r nvlul lr r structur clcullr
mct;
- clcul mct (st 80%) sunt numr, d frm ldrc, ft, nu sunt mgn, sunt frm
dn clstrl, blrubnt d clcu, u culr lb su cnuu dschs n l nchs s u ngru,
dtrt gmntulu. ct clcul s nssc frcvnt d nflm stc, urmr stz rn
bstruc cstculu sunt rdc.
S rsuun c rmul frmt r f clculul d clstrl cr r bstru cstcul r frm
nfc c c r dtrmn crtr cstu rn dunr succsv n strtur cncntrc d
clstrl blrubnt d clcu. C m frcvnt lclzr clcullr st vzc blr, nclusv
cnlul cstc. Cnlul cldc cnn clcul n 12% dn czur. Clcul d dmnsun mc s t
gs n cl blr ntrhtc t srv c unct d lcr ntru frmr c lcullr m
mr n cl trhtc.
n mrtt czurlr, rzn clcullr nu rduc lzun ntmc c lzun
nflmtr cut su crnc: ctrl, suurtv, ulcrtv, gnguns (clcstt cut
crnc).
Clculul dn cnlul cstc t s funcnz c su, rmnd ntrr bl n
vzcul mdcnd vcur , ducnd stfl l dlt vzcul. Dc bstruc cstculu
st cmlt, vzcul s clud dn crcul bl, cnnutul rd cul r g lbn rn
bsrb blrbn d ctr mucs nflmt dvn lb, r n ntrrul clcstulu s
frmz dvrt ung rzultnd hdrsul rru-zs l vzcul su mucclul.
Cmz clcullr dfr du zn ggrfc du s, mrtt clcullr sunt
b#%l!^+a?

41

cmu dn m mult substn, frt un fnd ur.

Ltz cldcn st urmr mgrr clcullr dn clcst n 90% dn czur, n cst cz
nu st usr d stblt dc clcul sunt frm lc, rvn dn vzcul su sunt ntr h tc. n
gnrl clcul d rgn clcstc cnn m mult clstrl, r c frm n cl bl r sunt
bg n blrubnt.
2.4. Smtmtlg mnul bctv
Smtmtlg ltz blr st n func d lclzr clcullr d cmlcl
cuzt d ct t s mbrc m mult frm:
- ltz blr smtmtc ltnt r n 50% dn czur t f dgnstct cu
cz unr lrr rdlgc su rntr- ntrvn chrurgcl;
- clc blr cnsttu mnfstr clnc c m crctrstc st un sndrm durrs
rstc dtrmnt d cntrc rfl vzcul /su clr blr, c rsuns l rzn
clcullr.
Durr dn clc blr r un dbut brusc, r n dsb nt du cnsumul d
lmnt clcstkntc, lut n sr rsctv c n dscrt cr crt brusc n ntnstt.
Crctrul durr st frt vrt, blnvul dscrnd durr sub frm d crm, trsun,
sfr, rsun, lvtur d umnl, rutur. Durt st vrbl n func d cmlc d
tr d l ctv mnut n l 1-2 r s t rt 3-4 zl. Du un n nt lgc durr
cdz l 1-4 r, rrr r nctz sntn, lt r s rlungt nu cdz n l
trr vzcul blr.
Durr st frcvnt rstc, s ccntuz n dcubt ltrl stng n nsr rlungt,
mnvr Murhy ccntuz durr.
Cuzl d r l durr sunt rrzntt d:
- buzul d lmnt clcstkntc (u, grsm, cclt, frc, mnz, brnztur
grs frmntt);
- rdus clclzc (fsl, mzr, vrz);
- trd l crulu rdus d mlc d trnsrt;
- mdcmnt, d mlu substnl dt dmnstrt ntru clcstgrf;
- frtur fzc nbnut;
- mcrl nclusv rsrtr srsc durr, blnvul st: gtt, ns, ncrcnd dfrt
z ntlgc: cc d uc, dcubt drsl, z gnuctrl, ltl;
- l fm clc blr t r nnt d mnstru su n tmul , r n tmul
srcn;
- mdfcr brut l bcurlr lmntr:
o lclzr durr s fl n gstru /su n hcndrul drt n rgun
vzcl. Cnd durr st lclzt num n hcndrul drt nsmn c
clculul st nclvt n cstc su st nflm nfundbulcstc;
o rdr durr s t fc d- lungul rbrdulu cstl drt, sr mlt
umr, dr t v rdr scndnt n hmtrcl drt, n umrul
drt, subsculr trctul frnculu. rdr tc l durr s ntlnsc
n hcndrul stng, n cln trcc, rtrstrnl n hgstrul su
rmblcl.
n 20% dn czur durr rmn cnstnt n gstru fr rdr, vnd un crctr
rmnnt cu crbr n numt r l zl n.

b#%l!^+a?

42

ntnstt durr fst cmrt cu c dn nfrctul d mcrd d trt lc lzr tc

dn rgun rcrdl.
Durr dn clc blr t f ntrct cu:
- durr dn ncrtt cut su crnc. tunc cnd durr dn clc blr st
lclzt n hcndrul stng sugrz fctr ncrtc (clcstncrtt);
- durr dn ngn ctrl st durr rcrdl cr t rd n gstru, l
nvlul umrulu cr cdz du nctr frtulu su du dmnstrr d ntrglcrn sub
lngul. cst durr r durt d ctv scund, mnut fr s dsc 15 mnut;
- durr d clc rnl cr st durr vlnt, rstc, ntrmtnt lclzt
lmbr, cu rdr dscndnt n flncur, rgnl gntl trn. Unr f ntrn cs,
st nst d gt shmtr, tulburr mcnl, fnmn dgstv (vrstur, b lnr
bdmnl, rr trnztulu ntstnl).
Fnmnl clnc d nsr clc blr sunt:
- grur, vrstur lmntr bls, ntlrn l grsm, blnr st r nd l, durr
gstrc ncrctrstc, gust mr m ls dmn l sculr, rzs, dss gzs,
cnst, ruct. cst fnmn sunt dtrmnt d lmnt sunt d scurt durt (2-3
zl);
- smtm bctv: fbr ctrul.
ctrul n ltz vzculr st un fnmn rr trnztru dscrt r c urmr un
cmlc, s ntlnt frcvnt n ltz cstculu cldculu, r cnd r l 24 d r, du
clc blr sugrz ltz cldcn, cst fnd ntns rsstnt.
msur dzvltr ctrulu, urn dvn nchs, mtrl fcl s dclrz. ctrul s
t ns mnfst ntr- frm ur rn blrubnm blrubnur trctr.
Smtmtlg clsc ltz cldculu st rlzt d trd: durr, ctr fbr. n
cst cz durr rdz m mult sr umrul drt, ctdt sr hcndru umrul stng.
Fbr trduc rzn nfc st nst d lucctz.
n cst cz clr ctrc tgumntlr mucslr s nstlz l scurt tm du
crz durrs, r du ctv zl rgrsz ungnd l ctr mcnc nst d rurt.
Smtm gnrl cfl, str d gt, cnvuls tnc clnc, m ls ssmflc,
crz d lur, snz d tnsun ntrcrnn, ml, urtcr, rtm lfrm cu crctr d
flt l fml cu lbltt sshmnl; rr tus sc, dscrt, ndus rfl.
mnul bctv
nsc gnrl r n vdr str gnrl blnvulu (blnvul st gtt ns),
grdul d nutr t d l clr ctrc su subctrc mucslr tgumntlr.
L nsc hcndrulu drt s t bsrv bmbr rtund su vl cr n tmul
nsr s dlsz n s.
lr s fc cu blnd cu gr c mnl mntrulu s nu f rc. n md nrml
vzcul blr nu st lbl, st brdbl cnd st frt mrt d vlum n ltz bl r
cmlct (stz d clcst, hdrs vzculr, tumr su vzcul umlut cu clcul, clcstc
cut).
Cnsstn st vrbl du cuz cr fc vzcul lbl, r snsbltt l
rsun cunt dvrs grd, d l ls d durr n l hrstz cntr ctur rtlu
bdmnl.
lr un n vdn un unct durrs vzculr, unctul cstc, stut l ntrtr
mrgn trn drtulu bdmnl cu rbrdul cstl. rsun cstu unct st nttd un
durrs r durr s ntnsfc mult n tm c subctul nsr dnc.
b#%l!^+a?

43

Smnul Murh cnst n lr vzcul blr n nsr frt cnd s vdnz

snsbltt. L mnul bctv r uls cclrt, rsr lnc surfcl.
2.5. nvstg d lbrtr
mnl d lbrtr r mdfct unndu-s bz mnul snglu, urn
mtrlr fcl.
mnul snglu:
- Hmlucgrm vdnz:
hmglbn sczut vlr nrml 13-14,5 g/dl;
numr nrml d lucct n clc blr ncmlct crscut (lucctz) n
clc blr cu nflm cut surdugt.
vlr nrml 4000-8000 lmnt/mm cub.
- VHS crscut vlr nrml:
l brb: 1-10 mm/h; 7-15mm/2h;
l fm: 2-16 mm/h; 12-17mm/2h.
clstrl crscut (hrclstrlm) vlr nrml -180- 280mg%;
clcu crscut (hrclcm) vlr nrml 9 12 mg%;
blrubn crscut (hrblrubnm) vlr nrml:
blrubn drct 0 0,25 mg%;
blrubn ndrct 0 0,75 mg%;
blrubn ttl 0 1 mg/dl.
- trnsmnz crscut vlr nrml:
trnsmnz glutmc lctc 2 20 u.;
trnsmnz glutmc ruvc 2 16 u..
- fsftz lcln crscut vlr nrml: 2 4 u. Bdnsky.
Fsftz lcln st rs grdulu d bstruc.
mnul urn vdnz urn mdfct cu:
- crtr urblngbulu;
- blrubn n strl ctrc;
- mlz urnr crscut vlr nrml 45-85 u.W.
mnul mtrlr fcl.
n mtrl fcl r hcl su cl, du clc blr utnd f gs clcul.
mnul rdlgc st snl ntru cnfrmr cuz clc blr.
Rdgrf sml, gl fr substn d cntrst vdnz bl clcc su clcul
rdc, cu cnnut crscut d clcu.
mrtnt st lclzr clcullr n zn clcstulu.
Rdgrf cu substn d cntrst clcstulu clr blr, vdnz clcul
rdtrnsrn, dr c rdc s rlzz rn dmnstrr r rl su
ntrvns substnlr d cntrst nu s fctuz n crz.
1- Clcstgrf rl rrznt rdgrfr vzcul blr umlut cu substn d
cntrst, dmnstrt d bc cl rl. Substn d cntrst flst st r zblul s u cdul
nc.
cst mtd vdnz rzn clcullr rdtrnsrn dr rdc, rczz
frm func clcstulu.
Rzblul s dmnstrz n cnttt d 3 g (4 cmrmt) cu 14-16 r n nt
b#%l!^+a?

44

mnulu, r cdul nc n c dz (6 cmrmt) cu 10-14 r nnt.

2 Clnggrf vns rrznt cfr clr blr nclusv clcstulu, ln cu
substn d cntrst dmnstrt cl ntrvns. Substn d cntrst flst st bl nul
cr s nctz lnt ntrvns (6-8 mnut) l dult 20 ml rn slu 30% s u 50%. c st
mtd vdnz ltz cldculu bstruc cstculu.
Dc nc du bln vzc blr nu s vzulzz du rmtv 30 d mnut, s
mun frm frmcdnmc, cu mrfn, ntru dtrmn hrtn sfntrulu dd.
n mr mrtt czurlr s v cfc cldcul vzcul blr dc nu st
clus cstcul nu st bstrut.
ubul dudnl smlu rrznt ntrducr un snd nhrn dncl d lr n
dudn, rlznd cmuncr ntr dudn mdul trn.
st nvstg gru d surtt d ctr blnvul ltzc cr vdn z bl B
vzculr cr st bsnt su n cnttt mc, slb cncntrt cr cnn crstl d
clstrl, blrubnt d clcu lucct, bl cldcn d culr glbn- ur bl C
htc cr st clr rvn dn fct.
Ls d scurgr bl ndc un sfnctr dd nchs (bstcl cnlul cldc, ssm,
ltz, nlsm).
Nrml bl st d sct clr, tlgc bl st tulbur, vscs n ngclt,
cldct.
Ls d scurgr bl B du dmnstrr MgS4 sugrz un bstcl lculu
vzcul blr rsctv l cnlulu cstc (clcul, tumr). vcur n cnttt mr, clr t
nchs rt htm blr, r r trdv bl B n cnttt mc, slb clr t sc t
cu durr n hcndrul drt, rntz sr hrtn clr blr.
Ls bl C survn n bstruc cnlulu htc cmun.
ubul dudnl mnutt st mtd dnmc d ltr func sfnctrulu
vzcul blr. S urmrt dbtul blr ntndu-s dn 5 n 5 mnut r c bln vulu
crctrl bl rcltt.
cgrf vzcul blr rmt vzulzr clcullr blr n 95% dn czur r
vntul f d clcstgrf c s fctuz l blnv ctrc.
Cntrndc l rdgrf cu substn d cntrst: fcun htblr cut,
nsufcn rnl, rc lrgc l d, str fbrl, n crz. stz mn r st n mr rt
cu cgrf.
ubul dudnl nu s fctuz n crz.

b#%l!

^+a?

2.6. Dgnstcul ztv

Dgnstcul ztv s bzz :
- nmnz, dc stn clclr blr n ntcdnt;
- mnul clnc cr st mrtnt n ltz blr cnd s vdn z clcl bl r
tc, rtt dclnt rn btr lmntr. Dntr fnmnl d nsr l clclr bl r
rzn unu ctr su subctr ldz ntru ltz blr;
- mnl rdlgc cr dscr stn clcullr n vzcul blr, n cstc su
cldc su t vdn vzcul clus, n urgn c n clcstl cut n ctrl
bstructv, dgnstcul nu t f utt d mn rdlgc, l v f bzt crtr clnc. n
ctrl bstructv utlzm clnggrf lrscc su rn cttrum sub cntrl.
- dudnscc, m ls n czurl rlungt n cr rgn rl ctrulu nu st

45

ur d stblt; mnul rclnc cr r un rl htrtr n ncrttudn d gnstc, rtnd

mdfcr l vlrlr nrml l mnl fctut;
- tubul dudnl cr dclnz durr, l cr tmul vzcul st bsnt su nrml
su rn cr bnm bl n cr s dscr crstl d clstrl, blrubn t d c lcu. Grut
d dgnstc utm ntmn n clcl blr tc m ls c lclzr durr su n cl n
cr tblul clnc st dmnt d unl fnmn d nsr (lus r ltc, frsn urmt d
scnsun trmc, clc fr durr su cu mdst n n hcndru drt), n cst stu st
mrtnt nmnz stblndu-s lgtur dntr lmntl clcstkntc r cstr
fnmn.
2.7. Dgnstcul dfrnl
Dgnstcul dfrnl s rlzz n cl du crcumstn n cr blnvul s rznt l
mdc num n rzn clc blr n bsn cst.
n rzn clc blr dgnstcul dfrnl s fc cu lt ccdnt rstc
smntr rn ntnstt smtmlr, rn lclzr durr n c rgun su ntr- zn
rt.
Clc rnl su urtrl drt n cr durr r d bc sdul d ntnstt mm n
rgun lmbr, dr t rd dscndnt trctul urtrulu, n zn rgnlr gntl.
Mcrl rsrtr nu ntnsfc durrl d rgn rnurtrl, dr st fnmn
urnr cr nssc clc (dsur, lkur) r hmtur /su lucctur l mnul
urn.
ndct cut nu rdc rblm d dgnstc, tunc cnd sdul ndclu st nrml,
drc durr sntn m ls l lr r sdul mm n fs lc drt d und
t rd n tt bdmnul n cz d rtnt cut.
L lr rr musculr su cntrctur bdmnl n cz d rfr ndculr
s gst n c zn.
ndct cut rdc rblm d dgnstc tunc cnd z ndclu st nrml,
scndnt /su rtrcl.
D smn, gngrn ndculr clcstc cut t vlu cu smtmtlg
smntr nc d l dbut (fbr, frsn, nsufcn crcultr cut). Cnd st
ncrttudn d dgnstc s rcmnd ntrvn chrurgcl.
Ulcrul gstr-dudnl rfrt r un tblu clnc m drmtc nstlndu-s rmt
cntrctur bdmnl s t vdn clnc rdlgc rzn numrtnulu.
ncrtt cut dbutz cu fnmn d nsr m drmtc m zgmts rntr
cr nsufcn crcultr cut, mrgnd n l c. Durr cu rdr n br mblzz
blnvul. Crtr d st cnc r nlz dmnstrz stn ncrtt.
fcunl lur-ulmnr sunt m ur d dfrnt, dbutul lr st cu scnsun
trmc cr rcd durr, unr frsn slmn. S nssc frcvnt d ungh, tus, smn
sttcustc rdlgc d lurt, numn su nfrct ulmnr.
ngn ctrl nfrctul mcrdc nfrr crz cnfuz cnd durr rcrdr
rdz n zn clcstulu. ntru lucdr dgnstculu u mrtn: r durr lgt d
frt su dgst, durt m scurt cst, rtrcdr sntn n rus su l ntrglcrn
ntru crz d ngr; nmll trsulu lctrcrdgrfc ntru nfrctul mcrdc nfrr.
cluz rtr mzntrc ntr rr n dscu dgnstculu dfrnl, durr fnd ntns,
dfuz, nst d grur, vrstur urmt l scurt tm d mtrsm.
b#%l!^+a?

46

Dschnzl blr t f d du tur:

- htn vzculr (clcsttm) s dfrnz d ltz blr rn ftul c n
sndrmul dstc blr t r cnst ltrnnt cu dr; mgrn; vzcul blr
lbl, r n tubul dudnl r bl B vzculr, hrcncntrt, n cnttt mr cr s
scurg tm ndlungt. Clcstgrf vdnz vzcul blr mr cu cntrc slb du
rnzul Bydn;
- hrtn vzculr s dfrnz rn r durrlr ntns du lmnt
clcstkntc nst d dr ntrrndl. ubul dudnl st durrs, bl B vzculr s
scurg dscntnuu r clcstgrf vdnz vzcul blr mc cu vcur rd.
Clc blr nltzc sunt dt d fcun blr nflmtr nltzc cr u c
smtmtlg urmtrl: n n hcndrul drt, grur, gust mr n gur, blnr.
cst clc blr nltzc s dsbsc d cl ltzc rn mnl r dlgc l
cr s vdnz clcul rdc rdtrnsrn.
l m t f dt d fcun nnflmtr su clcstz l rndul lr dtrmnt d
dzvltr grt unr lmnt structurl l vzcul blr num dzvltr mucs
musculr rtlu vzculr d dnmmtz, dzvltr unr clul d clstrz,
dzvltr lmntlr nrvs d nurmtz, r clcfr vzcul d vzcul clcr su
d rln.
n bsn clc blr s fc dgnstcul dfrnl l fnmnlr dstc blr, l
durrlr cr r sugr clc blr. Mr mrtn r mnul rdlgc l cr n ls
mgnlr clcr t f lut n dscu:
- hrn htl st sugrt d trcl cu dschdr lrg cnfrmt d mnul brt t
l sfgulu stmculu n z rndlnburg; frcvnt st sct ltz blr;
- ulcrul gstr-dudnl st frcvnt l brb s crctrzz rn rtmctt
rdctt durr;
- hrn gstrc st frt durrs rduc rfl tulburr l trnztulu
gstrntstnl, cr st ur d rcunscut dc blnvul cntrct much dr bdmnl;
- rlul mucs lrc. Smtmtlg cstu sugrz m dgrb un ulcr
dudnl;
- dvrtculz dudnl r smtmtlg dstc durrs, ur d rcunscut l
mnul brtt;
- nvrlg funcnl, zn zstr, lurt dfrgmtc t f ur lmnt rn
nmnz mn clnc cmlt.

b#%l!^+a?

2.8. Cmlc
Dc s fc bstrc d clcstt crnc cr st un rcs nflmtr, cr nst
r blgtru rc ltz blr s t rc c 1 dn 5 blnv fc cmlc (20%).
Cmlc mcnc:
- ltz cldcn cmlc 25% dn czurl d ltz vzculr rn mgrr unu c lcul
n cl blr rncl. blul clnc t f nltr fnd dmnt d fnmn
clcstc, r ctrul nu st rznt ttdun. mrtn ntru dgnstc r mnul
rdlgc. Smtm rznt: durr ntns, ctr fbr.
- hdrclcstul (hdrsul vzculr) s dtrz bstrur gtulu vzcul blr su
cstculu. Vzcul blr st dstns, st lbl sub rbrdul cstl, c tumr rtund
lstc, n tnsun frt durrs. Dstndr clcstulu dtrmn subr rlr lu.
n vzcul s gst bl su un lchd clr, lbcs su lmd, dnumt bl lb, fndc

47

nu r cnsttun blr, c st rdusul scr mucs clcstulu. Hdrsul vzcul r

t s dsr rn dzbstruc sntn.
- fstul blr st dsr cnscn un ulcr lcl rdus d rzn clcullr cr
rdz rtl clcstc rrr st urmr un clcstt cut. Fstul s t
dschd n dudn, stmc, cln su n rbrl blr rrznt mdltt rn cr
clcul s t lmn sntn.
- lusul blr rrznt rducr su mcrr d clcul blr n ntstn l nvlul
lnulu trmnl unulu rducnd cluz ntstnl. Clcul sunt lmn rntr-
fstul clcstdudnl.
Cmlc nfcs :
- clcstt cut st c m frcvnt cmlc st cnscn bstruc gtulu
clcstulu cr s mnfst rn clc blr sndrm tc-stc. t dtrmn
bcs rclcstc, fstul, bcs htc, cngrn clcstc su rfr lbr n
mr cvtt rtnl.
- clcstt crnc.
- ncrtt cut st fcun crctrzt ntm-tlgc rn nflm
dmts, hmrgc, nvrtc su nvrtc-hmrgc. Clnc s mnfst c un
sndrm durrs bdmnl cut vlnt nst unr d str d c dtrt unu rcs d
utdgst glnd ncrtc.
- ncrtt crnc. Durr st ntns cu lclzr n gstru n hcndrul stng sub
rbrdul cstl, st rmnnt ccntut st rndl su du cnsumul d lcl.
r mldgst cu scun sttrc, mlnutr rn scdr ndrl dbt zhrt
dtrt lzr ncrsulu ndcrn.
lt cmlc:
- httl crnc stlt sunt rs fctur fctulu n sufrnl blr bstructv
nfctt, d rgul ltz blr, m rr cldcn. r nflm cnlcullr t f
bstrut tt rn tumfc ndtlulu, ct rn trmb blr, n urul cn lcullr s
frmz lzun d rclngt, mnfstt rn nfltrt grnulctr d tndr vrbl.
Cncrul vzcul blr st un dn cl m grv cmlc. st 90% dn c ncr r
vzcul ltzc. Sdul durr st n gstru n hcndrul drt cu r dr str r, l
ncut st d ntnstt mdrt, dn c n c m rnunt, rsstnt, grvt ncturn.
ntrmtnt r clc blr.
- ddtl sunt rcs nflmtr stnznt cu vlu rcurnl cr s dzvlt r
cnstnt n lgtur cu ltz cldcn. Smtmtlg cnst n ctr ndult durr
ntrmtnt n hcndrul drt cu rdr sr stng. Vrbltt ctrulu s d tr z
cmnnt dmtr mdfcr sstc trnztr. Cu tmul s rduc lzun
rductbl (dslzc sclrznt). Dgnstcul t f dfrnt cnfundndu-s cu
ctrul mcnc cu rc bstcl cl blr rncl. Clnggrf dc st
ztv vdnz cldcul dltt cu vcur ntrzt.
- crz blr scundr st rr ntlnt, r n ctrl mcnc, d bc rn lt z
cldcn, cmlct d ngclt vlu ntrmtnt cr rmt durt lung
clstz.
- hmclcstul s dtrz hmrglr n cvtt vzculr.
- hmbl st rr.
2.9. rtmntul
rtmntul gnrl s drsz fctrlr ttgntc ncrmn n dtrmnsmul ltz

b#%l!^+a?

48

blr (tulburr mtblc, stz, fctr nutrnl) cnst n:

- cmbtr bzt rntr-un rgm hclrc.
- cmbtr hrlrtnm rntr-un rgm src n grsm nturl su n hdr d
crbn;
- gn lmnt;
- stngr rcslr nflmtr;
- cnsumul mdrt d lcl tutun.
rtmntul rflctc.
rn lmnt s urmrt mdcr tulburrlr mtblc dmnur rtulu
clrc, ndsb sm ldlr. ulburrl mtblc s drsz hrclstrlm,
bzt hrflculnm.
Rgmul lmntr d fnd st un rgm d crur vzculr.
lmnt r c sc rvnr frmr clcullr, dr vtr dclnr crzlr
durrs dt c clcul s-u frmt.
Dt r c sc vtr rtulu csv l ldlr, l lmntlr cu cnnut crscut n
clstrl, vnd n vdr c rgnsmul snttzz clstrl rnnd d l lmnt grs.
S rduc lmntl bgt n clstrl n rmul rnd grsml d lu: crn , fc tul gr s,
cclt, glbnuul d u, crrul, rnch, fctul d vc, strd, grsm nml grsm rt.
S cntrndc l blr lmntl f d cr ct s cmrt c lrgc.
n st rfrbl s f cnsumt vch, rt n cnttt mdr t. Vr f vt t
msl cs cr suun rgnl dgstv unr frtur dsbt cr cnn cntt
mrtnt d grsm.
S vt flsr lclulu c rtv dr n tmul ms s t cnsum cnttt
mdrt d vn, cr s nu f vch cd. S rcmnd rtul d fbr vgttv ntru scdr
clstrlulu.
L blnv cu dfct d cz blr, st sbl c dmnstrr ndlungt cdulu
chndlc n dz zlnc d 500 mg, s rvn frmr clcullr.
Cmbtr sndrmlr d mlbsr sgurr funcnlt nrml fctulu
clr blr ntrvn n cl sns. rducr brutl grut nu st ndct, drc t
fvrz frmr clcullr.
rtmntul curtv s drsz mnfstrlr durrs, bl ltzc, cmlclr sl.
rtmntul gn-dttc l clc blr
- dt (rgm hdrzhrt) tmul clc s cnsum num c d t sunt r, l t
crmt ndt cu c, su d lgum, cmtur, rur d lgum fruct, n lb
usct, st fns, gr, rz, brnz d vc, crn slb rsl;
- msur gnc rus l t, lc lcl d cldur hcndrul drt, cu fct
ntsstc, r cnd blnvul st fbrl s susctz clcstc cut cldur st
cntrndct s rcurg l ung cu gh.
rtmntul mdcmnts l clc blr urmrt s cmbt ssmul s tnuz
durr (ntsstc s nlgtc) st un trtmnt d urgn:
- trn 1 fl 1 mg subcutnt l 12 h su scbutl fl d 10 mg l 8-12 h n scr
cu vrn fl d 40 mg .m., trn l 1 mg .m. su 0,5 mg .v. vntul cmbn t cu
ln 1% cu mfln 240 mg .v.
- lgclmn, r s cmrmt su fl 2ml 50% nu s dmnstrz ntr musculr (.m.)
su fn .m. su .v. Lnt 1-3 fl/z 5 ml.
- S m t ncrc ntrglcrn su ntrlul d ml cr rct cun ltc sur
b#%l!^+a?

49

cntrc sfnctrlr blr c mflnul.

Dc cl d m sus nu sunt fcnt s dmnstrz mlgn, cr st un cu n dz
d 100 mg (1fl 2ml) .m. su .v. 1 ml dlut n 10 ml slu glucz t ztnc. c st st
un ntlgc ntsstc utrnc cru clc blr ncmlct nu- rzst. S vt
dmnstrr drc st rscul tcmn.
n lc d mlgn s m t dmnstr unul dn cl du mstcur ntsstc l 6 8 h.
- ln su nvcn 1% 10ml, trn 0,5 mg dc d fl vrn 1 fl 40 mg.
- mfln 1 fl, trn fl, vrn 1 fl.
- lzdnul n suztr, c lgmznul n nc ntrmusculr (fl 25 mg) sunt
utl ntru fctul lr ntsstc, sdtv ntvmtv. C ntvmtv s rcm nd
suztr d mtrl.
Mlgnul, mrfn, dhdrmrfn (hdrmrfn, hdrmrfn-trn, hdrmrfnsclmn) sunt c sunt cntrndct n clc ntru c dtrmn s smul sfntrulu
dd t msc un bdmn cut chrurgcl.
Num du c s- stblt rn mn clnc tnt c nu st vrb d un bdmn cut
chrurgcl su tunc cnd clcl blr sunt vlnt, rlungt nu cdz l trtmnt s
t dmnstr d rfrn hdrmrfn-trn ct 1-2 fl/z n nc subcutnt.
n tt clcl blr s dmnstrz ntbtc, mcln 500 mg/6 h .m.
rtmntul mdcmnts ntr crz:
- clrtc n dz mc clbl 1-3 drur/z; fbln 1 cmrmt, 250 mg, 1-2
cmrmt du ms; rwchl 3-5 ctur d 3-4 r/z.
- ntbtc ntrmtnt mcln 500 mg/6 h .m.
- s cntnu mdc ntsstc cl rl scbutl 1-2 cmrmt/z, 1 cmrm t=10
mg, bllrgn, brgfn, fbnl.
cst mdc ntsstc durz 2-3 stmn du clc t rvn clc
tunc cnd ntsstcl sunt dmnstrt l rml smn l cst:
- nstl snd dudnl slu d tr su clrfrm ntru rduc s smul
sfnctrulu dd, cst fnd urmt d ntrducr d ul d msln cldu s u d
rfn n ltz cldcn;
- ltz mdcmnts clcullr d clstrl (chnd, chndlul, CDC) dr cdul
ursdzclc (dlurl) csul d 250 mg dmnstrt sngur 10-20 mg/kg cr/z su n
scr cu chndlul n dz gl d 7 mg/kg cr/z 1-2 n fvrznd dzlvr
clcullr d clstrl n 50 60% dn czur, rn dmnur sntz htc scdr
cncntr clstrlulu dn bl.
rtmntul hdrmnrl .
Cur ntrn cu dcrbnt ur sulfurt l Slnc Mldv, lnt, Clmnt,
Ccult r fct clrtc fct d lcnzr bl.
Curl nul cu mnrl sunt ndct l ltzc fbrl cu clc blr r c
durrs mdrt, fr clcul nctv n cstc su cldc. st ncsr un mn mdcl cr s
dcd dc un cnt trbu s urmz su nu cur blnr.
Nu s rcmnd cst trtmnt clr cu fnmn nflmtr cut, c ltz blr n
fz durrs, cu ctr. rbu s trc cl un tr lun d l smn mnfstr cut n l
trmtr n stun.
Durt un cur st d tr stmn.
t mdcul stblt c zvr c rcdur sunt ndct, c dz n c rtm. n lt z
blr nu s tt tr clcullr cu utrul lr, n schmb s t sr l cun
b#%l!^+a?

50

lnttr, vntul l nctnr vlu fcun.

rtmntul chrurgcl
. Lttrt trcrrl st mtd d lz clcullr blr rn mlc fzc
(ultrsunt, rznn mgntc, lsr).
Du trtmnt s dmnstrz cd chndzclc rwchl, s fctuz
clcstgrf /su cgrf d cntrl.
Cntrndc: nfc clr blr, vzcul nfuncnl clcul m mr d 3 cm.
Cmlc: bstruc cldculu rn frgmntr clcullr.
S bn rzultt ztv n 50-80% num dn clcul clstrlc nu rvn rcurn
cstr.
B. rtmntul ndscc l ltz clcstulu ltz cldcn cnst n
sfnctrctm ddn rmblzr cldculu trgr clcullr cu utrul
ndsculu.
ndc: Bl cu rsc rtr, clcul rzdul du clcstctm.
C. rtmntul chrurgcl clsc
rcd: clcstm, cldlttm, clcstctm ltl.
ntrvn chrurgcl st ndct n frm clnc mnfst m ls n cmlc.
Clcstctm s- mus dtrt ftulu c nu s gss nc mtd fcc ntru cr s rzlv
clcul cr s rmt blnvulu str d cnfrt rmnnt. n l dl rnd s- dvdt c
mrtltt rn clcstctm st frt sczut ntru czurl ncmlct (0,3%), r n ls
clcstctm, blnvul msur c vnsz n vrst r m mult cmlc cr s
ltsc cu mrtltt d 20%. Clcstctm nu rmt smtmtlg ntru c r s- r t
blnvul, c dr mlrz d 5-10%, r cmlcl du ntrvn s rduc n 10% dn
czur.
ndcl mr d clcstctm sunt:
- cmlc cut: clcstt cut, rfr blr, hmbl, fstul blr. n rfr
blr n hmbl s rz d urgn. n clcstt cut un rz du rcr
nflm cut, cu ntbtc, n cst cz chrurgul r cnfrt n lg ntru ntrvn
cmlt trtmntul mdcl t d rzultt mnnd ntrvn ntru mult
stmn, ns l d tm gngrn vzculr sblt nstlr unr cmlc
nsds (fstul), sub ntbtr lc ntrvn l cld, cr st ndct bslut
num n rtnt blr, n hmfl cnd sunt smn gnrl svr d tnfc
(clcstt gngrns) su cnd sunt smn ttl d mm (rr musculr):
- ltz cldcn dmnstrz rdlg su num bnut clnc (subctr, sndrm
clmc frust).
- Clcul vzculr rdc cu vzcul nfuncnl.
- fctr fctulu.
- Smn d ncrtt crnc.
- Dbt zhrt.
- Cncr vzculr.
- Crdt crnrn sct.
Dtrt mbuntr rgtr rrtr st rtr, nstz thnc
chrurgcl, cntrndcl r su rdus:
- nsufcn rnl dcmnst;
- nsufcn ulmnr svr;
- Cncrul cu lt lclzr;

b#%l!^+a?

51

nsufcn ulmnr vnst;

Crz htc.
cst cntrndc sunt vlbl num ntru ltz blr fr cmlc cut.
rgtr rrtr cnst n crctr fcunlr sct (hrflculnm, clt
funcnl, hrn htl, mgrn, tulburr nvrtc tc) cmlclr (htt crnc,
ncrtt crnc). L bz r v f mnt n cnd s v bn scdr ndr l
sufcnt ntru c r s s fc fr rscur mr. L nstz s vr vt nstzcl cu
httctt (hltnul) su cr nduc n htc s v v n vdr s sgur un bun
grd d rlr.

D. rtmntul lrscc
rncul cnst n crr un numrtnu n scul ntrducr ndsculu n
cvtt bdmnl fr rcl lrr unr vscr.
Lrsc dvnt un mn d rutn ntru dgnstcr fcunlr bdmnl.
Ncstt un bun nstz lcl l unctul ntrducr trcrulu st vdnt n scl ntru
tgumnt rtnu n scul vtr durrlr l mblzr trcrulu n tmul lrr c vt
bdmnl. Du ntrducr culu n cvtt bdmnl s nctz 15-20 cmc r cu C2
cr vt rscul mbl gzs.
Lcul d ntrducr lrsculu st ls n func d: dmnsunl cvt
bdmnl, sdul vntullr cctrc, dtl bnut l lr bdmnulu, stn
frmunlr tumrl bdmnl, rblm d dgnstc. rmdc gnrl st ncsr m
ls l blnv n n czul rtlu bdmnl frt tnc. L cl s rfr nstz
gnrl.
Lrsc rmt vzulzr nsctr vzcul blr, dc nu st msct d
drn cum s ntml n ltz blr.
nsc cvt bdmnl t f cmltt cu lt nvstg d dgnstc c: bs
cu ns, cu cul, Mnghn, su unc sr drt sub cntrlul vdr. cst nvstg
sunt utl ntru stbl un dgnstc hstlgc su cstlgc s t rctc l nvlul fc tulu,
sln, ncrsulu, rtnulu, lmftclr rnchlr.
Cntrndc: sndrmul hmrgr, nsufcn crdrsrtr grv, rtnt cut,
cluz ntstnl.
Du crctr d urgn tulburrlr d cgulbltt, lrsc dvn sbl fr
rscur c: hmtmul rtl, hmrgl ntrrtnl. stn cctrclr bdmnl t
mdc lrr bdmnl dtrt rnlr rtnl. n sct l crtc st rscul
nfc cst su rscul rdr lchdulu d sct cr t f vtt rn rnctr cstu:
- bztt t fc msbl mnr rgnlr bdmnl;
- vrst nntt str gnrl rcr nu cntrndc lrsc dc cst st
ndsnsbl.
ndc: fcun htc, ctr, sct,tumr bdmnl, sndrm bdmnl cut.
Lrsc st surr scntgrf ultrsngrf n dstr fctulu lclc.
n clcstt cut lrsc vdnz vzcul blr, mrt d vlum, sub tnsun,
cu clr ru rns, cu r ngr, drn l lnul dn vcntt. M t furnz
nfrm utl ntru dgnstcul ndct cut. S t bsrv rutur l fctulu, lzun
trumtc l clr blr, l stmculu, dudnulu ntstnulu.
b#%l!^+a?

52

2.10.Cndut d urgn n clc blr

Clcl blr d ntnstt durt mc, fr cmlc, t f tr t l dmclu rn:
rus l t, rgm lmntr, nlgtc, ntstc (lzdn, scbutl, fldn tblt).
Clcl blr nst d vrstur (cu tulburr hdrlctrltc) l cl m mc smn d
vlu nfvrbl ncst ntrnr d urgn ntru nvstg trtmnt mdcchrurgcl.
n stl:
- rcltr snglu ntru mnr d urgn: numrr lucctlr, blrubnm,
trnsmnz, ngrm sngun, rzrv lcln, zt, glcm, mlzm
- mnul urn (urblngn, gmn blr)
- tn! Nu s fc n crz tub dudnl su clcstgrf cu substn d cnstrst
- rus l t; lmt (c d mul su mnt)
- clmrf durr:
sstnt mdcl rgtt mdcmnt nstrumtr strl ntru trtmnt, dr nu v
dmnstr blnvulu nc un clmnt fr ndc mdculu, ntru nu msc vlu
cut bl su rfr.
ntsstc: rrl (lzdn, fldn, scbutl n tblt)
- rntrl:
Scbutl cmus 2-3 fl
Sulft d trn 0,5 mg s.c.d 2-3 r z
vrn, 2-4 fl n 24 r
Ntrglcrn dmnstrt sublngul su nctbl rduc ssmul sfnctrulu dd
cntrcl hrtn l vzcul blr; nu r nc un fct n htn s u
tn
ntlgc: lgclmn, ntdrn, frtrl.
Dc nu cdz clc, s rcurg l mlgn 100-150 mg l ntrvl d 6-8 r, mdcmnt
cr r vntul d nu rvc ssmul muscultur ntd.
tn! Nu s dmnstrz mrfn, drc ccntuz ssmul clr blr.
- Clmr vrsturlr (blnvul vrs, dc nu s t dmnstr nmc rrl):
mtrl suztr
rcn fl
lgmzn fl
- Cmbtr nfc:
ntbtc: ncln (s lmn un rn cl blr) 6-10 ml U/z, ttr ccln (nu
s lmn rn cl blr)2-3 g/z, mcln 2-3 g/z rrl su .m. (s lmn
blr).
- Crctr tulburrlr hdrlctrltc cd-bzc n func d rzulttl d lbrtr.
- dmnstrr d sdtv ntru clmr str d gt (hdrzn, brbturc, brmur)
- ung d gh hcndrul drt.
- n cz d vlu nfvrbl s rcurg l trtmnt chrurgcl.
b#%l!^+a?

2.11. vlu. rnstc

vlu st dstul d mrvzbl, unl czur t rmn ltnt tt v, ltl t f
zgmts l scurt tm du r clcullr.

53

Blnv cu clcst cut ltzc trbu sclz r drc un clcst cut

t rfr t dtrmn rtnt gnrlzt su un lclzt. Unr rcsul
suurtv cntnu s dzlv sub cst rtnt lclzt cu bcs lcl, vnd rsunt
mrtnt sur str gnrl blnvulu.
Cnd st clcul unul dn cnll htc su cldc r ctrul dtrt
clcullr bstructv. Du n numt tm d l smtmtlg, ttul r tndn d rgrsun:
ctrul cdz, fnmnl durrs dsr, scunl s rclrz, blrubn rvn l nrml.
t cst dnt c rgnsmul rut s vcuz clculul dn cldc n dudn stu
fvrbl su fnmnl nflmtr sur dugt s-u tnut ssmul surdugt l
cldculu cdt, drt urmr bl s strcr lng clcul r crcutul nrml. Cnd
st n cntnur clcul n cldc smtmtlg r du rd d tm, stfl: durr,
fbr, ctr.
Cnd ctrul durz m mult d 7-8 zl st blgtr ntrvn chrurgcl trr
clcululu cr st sngur mtd d vndcr blnvulu vtr cmlclr gr v. S- u
vdnt urmtrl frm vlutv l ltz:
- ltnt clnc n 11% dn czur n cndl lmnt, d crur blr;
- mlrr clnc n 62% dn czur, rducr mrtn cuzlr subctv ls
cmlclr;
- vlu stnr n 11% dn czur, mnnr cuzlr nl n fd tr
smtmtlg rstrclr dttc;
- grvr n 16% dn czur cu r unr cmlc.
Fnmnul d rtr clclr fc dn ndvd un mr sufrnd, r msur c frcvn
lr crt srt rscul cmlclr. clc blr, d bc nu st rcul s n
mrtt czurlr nu st urmt d cmlc.
rgnstcul n gnrl dnd d rsctr dt d nflml surdugt st
grvt d ncdn mr cmlclr.
b#%l!^+a?

CNCLU
Ltz blr st dstul d frcvnt, n scl l fm; ntrtr duc l r unr
cmlc, r trtt rn trtmnt clsc chrurgcl d lc su m sgur rn tr t mnt
lrscc d ultm r nu rn trtmntul mdcmnts cr s drsz cmlc lr
mnfstrlr clnc. Bl s vndc, dr smtmtlg ntru cr blnvul s- ntrnt nu s
rmt n ttltt.

C.. MD D NVSGR
3.1. Clcstgrf
Clcstgrf rrznt rdgrfr vzcul blr (clcstulu) umlut cu substn
d cntrst, dmnstrt cl rl.
rgtr mtrllr cnst n rgtr unu rnz cmus dn u, smntn unt cu
n su 50g d cclt, crbun nml, trfrmnt, substn c (RBL su cd
nc); nthstmnc.

54

rgtr shc fzc cntulu:

- s nun cntul s lc ncstt fctur thnc;
- s dmnstrz cntulu cu 2-3 zl nnt mnr crbun nml d 2 r z, ct
du tblt rgm hrrtdc;
- cu 1-2 zl nnt fctur clcstgrf s dmnstrz cntulu un rgm dttc
ur dgrbl, vtnd lmntl cu cnnut bgt n clulz hdrcrbnt cncntrt;
- n zu rcdnt mnulu, l rl 12, s dmnstrz cntulu un rnz cmus dn
u, smntn unt cu n ( rvc cntrc utrnc glr vzc bl r); d c
cst rnz rvc ccs durrs, l t f nlcut cu 50g cclt s u cu snd
vcutr;
- du ms s fctuz clsm vcutr cu sr fzlgc su c d mul cldu,
ntru vcur gzlr dn cln;
- s tstz tlrn d rzbl: du ms l rl 16, s dmnstrz cntulu ntru
bsrv dc nu r hrsnsbltt l d. Dc r r, snz d rsur,
furnctur, thcrd, grur, urtcr, ml, str d ru gnrl, cntul r
hrsnsbltt l d s ntrru dmnstrr.
Dc cntul surt bn dul (nu r smtm d ntlrn l 20-30 mnut) s
dmnstrz clllt 3 tblt d rzbl n dcurs d 5 mnut.
- s z cntul n dcubt ltrl, tm d 30-60 mnut;
- nnt d fctur rdgrf s fctuz cntulu clsm vcutr;
- cntul st cndus l srvcul d rdlg (du 14-16 r rsctv 10-14 r, cnd
vzcul blr s uml cu substn d cntrst);
- cntul v f utt s s dzbrc z ms d mnr, n czul n cr vzcul
nu s- umlut cu substn c, s m dmnstrz 4 tblt d r zbl (s u 6 t blt d
cd nc), r mnr s rt 3 z;
- s dmnstrz rnzul Bydn (du glbnuur d u frct cu 30g z hr s u 50g
cclt);
- s fctuz rdgrf n sr, l 30-60-90 mnut.
ngrr cntulu du fctur thnc:
- cntul v f utt s s mbrc v f cndus l t;
- s ntz mnul n f d bsrv.
D l dmnstrr substn d cntrst n l trmnr mnr, cntul nu v
rm mncr, butur, mdcmnt su urgtv nu v m fum. cdul nc s
dmnstrz tblt dn 10 n 10 mnut, cu un fr l sfrm.
b#%l!^+a?

3.2. Clnggrf
Clnggrf rrznt rdgrfr clr blr, nclusv clcstulu ln cu
substn d cntrst, dmnstrt cl ntrvns.
rgtr mtrllr bln, nthstmnc, hmsuccnt d hdrcrtzn,
mdcmnt d urgn (glucz ntru rfuz, rmrgn, nrrtrnl), rt d rfuz, rt
d gn-tr, srng d 20 mm c strl ntru nc ntrvns, mtrl ntru
clsm.
rgtr shc fzc cntulu:
- nun cntul s lc ncstt thnc;
- n dmn mnr s fctuz clsm vcutr;

55

cntul nu ncst rgtr dttc.

str tlrn cntulu l d (substn d cntrst):
- s nstlz n scul cnunctvl l unu ch ctur dn fl d bln; n cz d rc
hrrgc n dcurs d 5 mnut r hrm cnunctvl chulu rsctv s u
rurt ntns;
- s nct ntrvns frt lnt 1 ml d substn s survgh z cntul ntru
bsrv dc r rc hrrgc (r dm l f, cfl, dsn, grur
vrstur);
- dc r smnl rc, s ntrru dmnstrr blnulu;
- rc hrrgc s cmbt urgnt cu nrrtrml, s dmnstrz gn s nun
mdcul rnmtr.
dmnstrr substn d cntrst:
- dc tlrn rgnsmulu st bun, cntul st zt ms rdlgc;
- s dmnstrz substn c nclzt l tmrtur crulu frt lnt (n dcurs d 10
mnut); l dul fl d 20 ml bln 30-50%; l c 1 ml su 0,45 subst n ctv
klcr;
- du trmnr nc s cut rdgrfl. Cl ntrhtc trhtc s
cfz n 15-20 mnut, dc flml cutt nu r vzbl cl blr, l 40
mnut du trmnr nc, s dmnstrz 2-3 lngur sr d cdn 2%.
ngrr cntulu du thnc:
- cntul v f utt s s mbrc, v f cndus n sln nstlt cmd n t;
- s ntz mnul n f d bsrv.
Srul d cdn s dmnstrz mdt du nctr blnulu l blnv cu
clcstm su l cr Clnggrf s rt. rnzul Bydn s dmnstr z du cut r
rdgrf, vnd scul rvcr cntrdc vzcul blr, fctundu-s rdgrf
ultrr n sr l ntrvl d tm d 30-60-90 mnut. cst nu s dmnstrz l cn cu
clcstm, cu clculz blr, bl Bsdw, nsufcn rnl cut, ctr.

b#%l!^+a?

3.3. ubul dudnl

Sndul su tubul dudnl rrznt ntrducr un snd lnhrn dncl d lr,
rlznd cmuncr ntr dudn mdul trr.
Sc:
lrtr:
- trgr cnnutulu dudnl frmt dn cnnutul gstrc, bl (, B, C), suc ncrtc
scr rr;
- rcr func blr htc, clr trhtc;
- Dscrr unr mdfcr ntm-tlgc l rgnlr cr du sctul, cnttt,
cmz chmc su mrflgc sucurlr trs rn snd;
- vdnr unr bl rztr l dudnulu su clr blr.
rutc:
- Drnr clr blr ntrducr unr mdcmnt cr u cun drct sur
fctulu, clr blr su tubulu dgstv. cst vr cn f lcl, f s vr rsrb
rn r ntstnl, ungnd rn vn rt n fct, d und vr f crtt mrun
cu bl n cl blr, urmnd cl crcul ntr- htc;
- lmnt rtfcl s ntrduc lchd hdrtnt lmnt lchd n rgnsmul

56

cnlr ncntn su cu msbltt d nghr;

- sr cntnu: n czul cluzlr su subcluzlr ntstnl; du ntrvn
chrurgcl tub dgstv (strtr).
Gnrlt:
- s vrfc ttdt rmbltt clr blr;
- s t lclz rcsl tlgc htblr, rn srr bl vzculr d c
htc dn cnnutul suculu dudnl;
- nlz suculu ncrtc urmrt dzr frmnlr dn cnnutul lu;
- rcltr suculu ncrtc s fc rn tubul dudnl.
rgtr mtrllr:
- d rtc: mum lz, rt d cucuc su lt mtrl mrmbl, rs;
- strl: snd nhrn, du srng d 20 ml, mnu d cucuc strl, ns hmsttc,
md d cultur, rubt;
- nstrl: tv rnl, tv mdcl, sttv ntru rubt, hr cu rmt, rn
clndrc dur su tur rult, hrt d turnsl r su lbstr;
- mdcmnt: sulft d mgnzu 30%, ul d msln, nvcn, slu ncsr hdrtr
lmntr ( mtrll s lg n func d scul sndulu);
- cntul v f rgtt fzc shc.
shc:
- s nfrmz cntul;
- s lc ncstt thnc.
Fzc:
- cntul v f nmnct;
- s zlz tul cu un rvn;
- s rtz cu mum lz;
- s z cntul n z znd l mrgn tulu
- s rtz rul dn mtrl lstc;
- s ndrtz rtz;
- s d tv rnl s n sub brb.
cu ntrducr snd:
- sstnt s sl mn mbrc mnu strl;
- rnd snd umzt ct m r d lv ntrduc cu blnd rn c vt t buc l
su nzl n n frng;
- cr cntulu s rsr dnc, cu gur dschs s nght d ctv r n cnd lv
trc n sfg;
- cu mcr blnd ut nntr snd n l mrcul d 45 cm l rcd dntr,
mmnt n cr s cnsdr c snd trcut d crd truns n stmc;
- s z cntul n dcubt ltrl drt, cu trunchul ur rdct cul n s, csl
flctt bzn;
- s ntrduc rn clndrc sub rgun htc;
- s mng ur snd sr lr n l mrcul d 60 cm;
- s cntnu ntrducr sd cu rbdr tn cncmtnt cu cun d nghr d
ctr cnt (1-2 cm l 3-5 mnut);
- cnd dvzun 75 cm s fl l rcd dntr. lv snd uns n dudn (du cc 1-1
r d l trundr n stmc;
Vrfcr z snd:

b#%l!^+a?

57

dc nu s scurg bl su lchdul scurs nu r sctul bl s vrfc dc snd uns n

dudn su nu s- nclct n stmc;
- s nsufl 60 ml d r rn snd cu srng du un mnut s sr; dc snd uns n
dudn s rcurz m un d 20 ml;
- s ntrduc 10 ml d lt cr nu m t f trs dc snd uns n dudn, d r t
f trs dc s fl n stmc; s fc cntrl rdlgc, snd urmrndu-s sub cr n,
fnd vzbl dtrt mrgnr cu srur d lumb.
Ctr bl:
- du 1-1 d l trundr snd n stmc, l ctul lbr l snd r bl ,
cldcn d culr glbn-ur, cr s clctz ntr- rubt;
- s vrfc rc suculu dudnl cu hrt d turnsl;
- s ntrduc rn snd 40 ml slu sulft d mgnzu 33%, strl, nclzt l tmr tur
cmr ntru fvrz drnr bl vzculr;
- s nchd trmtt lbr snd rn nndr su cu rn;
- du 15-30 mnut s dschd snd s clctz 30-40 ml bl vscs d cul r
cstn bl B, vzculr;
- l ndc mdculu s t rclt 3-5 ml bl B ntr- rubt strl su md d cultur
ntru mn bctrlgc;
- du vcur bl B s clctz bl clr cr rvn drct dn fct bl C htc,
cst fnd n cnttt m mr s v ct ntr-un rcnt crsunztr;
- trgr snd s fc du c s nsufl cv ml d r s nchd ctul lbr cu
ns;
- trmtt snd s v n sub nvlul stmculu cntulu ntru mdc scurgr
cnnutulu n frng su n cvtt bucl; s glt cnnutul snd s z n
tv rnl.
ngrr ultrr cntulu:
- s fr un hr cu rmt ntru cltr gur;
- s trg mucztl d f brb;
- s ndrtz rul dn mtrl lstc;
- s z cntul n z cmd.
rgtr rdusulu ntru mn d lbrtr:
- s dtrmn cnttt d bl bnut;
- s tchtz rcntl;
- s trmt rbl l lbrtr.
ccdnt:
- nndr snd dtrt cntrclr rlr stmculu n tmul snz d vrstur;
- nclcr snd n stmc;
- grur vrstur;
- msbltt drnr: bl cuzt d un bstcl funcnl (ssmul sfnctrulu dd)
su ntmc (cgulr bl vscs, mlfrm, cmrsun rn tumr d vcntt).
Sunt stu cnd snd nu trund n dudn dtrt ssmulu lrc n cst c z s
ncrc nutrlzr suculu cd stmcl cu bcrbnt d sdu slu 10%-20-40 ml .
Rlr ssmulu lrc s fc rn dmnstrr d mdcmnt ntsstc.
n czul nndr snd n stmc trgr s v fc cu tn cl bucl cu utrul
un stul lngul un ns.
Rlr sfnctrulu dd s t rlz rn ntrducr 5-10 ml nvcn slu 1-2
b#%l!^+a?

58

%.
rbu vtt srr cnnutulu snd l trgr , bsl cntulu rn
rlungr durt sndulu st 3 r; grbr nntr snd; dr dur t d cu (3
r).
3.4. ubul dudnl mnutt

st mtd dnmc d lrr sfnctrulu vzcul blr.

rn cst mtd s urmrt dbtul blr ntndu-s dn 5 n 5 mnut r c bln vulu
crctrl bl rcltt. ubul dudnl mnutt r 5 tm:
tmul (cldcn) s scurg un mstc d bl cldcn, suc ncrtc dudn l, n
cnttt d 10-15 ml; du 5 mnut s ntrduc 40 ml ul d msln;
tmul (dd nchs) r l 4 mnut d l ntrducr ululu d msln dur z 3-6
mnut ( nu s scurg bl);
tmul (scurgr bl ), durz 3 mnut;
tmul V (vzculr) r bl B, durz 20-25 mnut s scurg 25-30 ml dn bl;
tmul V (htc) nc cu sr bl C.
n sfrt, s dmnstrz rn snd 30-40 ml d sulft d mgnzu 33% ntru vrfc
dc vzcul s- vcut cmlt.

b#%l!^+a?

3.5. cgrf
st mtd mdrn d mr vtr c rmt bnr d mgn ultrsnc, cr sunt
utl ntru dgnstc (chst, nfrm tc.), cnst n rcr dfrtlr grd d dnstt
suturlr, rn msur vrlr n cul rflctt d vbrl ultrsnr un d gnstcul
tumrlr d fct, l unr crz htc, l clcullr blr, vluz clbrul cldculu l
blnv cu ctr rtnnl, un dgnstcul unr bl d ncrs cut su crnc,
sudchsturlr ncrtc, cncrulu d ncrs.
Bnfcz d dgnstc cgrfc bl ur-gntl, bl crdc, nvrsml rt
bdmnl, tumr bdmnl cu unct d lcr ncunscut. cgrf st rcmndt d mdc,
tunc cnd dgnstcul nu utut f us rn clllt mtd uzul d lrr.
3.6. lt mtd d nvstgr
mgrf s rctc n vntultt cfr nmgn vzcul. S rfr
fctur n fz d vcur cnd cncntr d substn d cntrst st m rdus.
Clcstmtr st mtd d clculr vlumulu vzcul blr cu utrul
clcstgrf.
Clnggrf lrscc cnst n cttrzr vzcul rn lrsc. rn cst
cl s bn clnggrf d bun cltt.
Mnlrtm cnst ntr- ncz lmtt subfdn cu lungm d 5 cm cr
dschd cvtt rtnl rmndu-n nsc sur f fctulu fctur
cncmtnt urmtrlr nvstg: clnggrf trnshtc, bs htc
mntrtgrf.
st mtd d c, utl ntru stblr cuz unu ctr clsttc cr nu s- ls t
dzvlut cu mtd nsngrnd us.
ndsc c blr rncl (cldsc) ncst thnc rtur dsbt,

59

cnsttu mlcul cl m sgur d dgnstc n ltz cldcn su n ltz cnlulu htc.

C.V. DUC NRU SN.
MSUR D RVNR BLLR DGSV
Msur d rfl rmr :
- vzz rducr numrulu d czur n d mblnvr.
- Cnst n :
-dsnsrzr rsnlr cu rsc crscut, rsn cu trn ulcrs (dscndn dn
fml, n cr unul su mb rn u ulcr gstrdudnl) ;
-dsnsrzr rsnlr cu smtm nscfc ;
-ducr ul rvnd gn buc-dntr (dnt bun
cr s sgur mstc) ;
-ducr ul rvnd gn lmntr.
- lmt chlbrt cntttv clttv.
- rgtr lmtlr fr cs d cndmnt, frbn su rc.
- rrul lmt ms rgult.
- gn shnrvs srvr ms n cnd d rlr nrvs, mbn lcut.
- ducr ul rvnd bndnr bcurlr duntrt.
- lclsmul fumtul cr fvrzz r bl stmculu, fctulu.
b#%l!^+a?

rfl scundr : urmrt, rn msurl lut, c n vlu bllr dgstv , d

stnt, s nu r cmlc grv, s rlzz rn dsnsrzr blnvlr dgstv .
rfl trr s rlzz rn cun dstnt dmnur ncctlr crnc d
rducr nvltlr funcnl l blnvlr.
NGRR CNLR CU FCUN L CLR BLR
ngcltl sunt nflm l clr blr trhtc /su ntrhtc fr fctr
vzc blr.
Clcsttl sunt nflm l vzc blr cut su crnc.
Dschnzl blr sunt tulburr funcnl l clr blr trhtc cu su fr
mdfcr rgnc lcl. S t mnfst sub frm d hr- su hknz.

Culgr dtlr :
Crcumstn d r :
ncdn mm l fm ntr 30-50 n, cr rznt mlfrm cngntl, ltz
blr ;
cnt cu tulburr nurndcrn .
mnfstr d dndn :
n gclcstt, fbr 39-40C, frsn, durr clctv, subctr su ctr l 1-2 zl du
dbut ;
n clcsttl cut frsn, fbr 39-40C, str gnrl ltrt, durr ntns n
hcndrul drt, cu rdr n umrul drt su n st, vrstur blr, ctr ;
n dsknz blr hkntc grur, vrstur blr, cnst, drs, ntn,

60

snz d lntudn n hcndrul drt ;

n dsknz blr hrkntc durr rtt sub frm d clc n hcndrul drt.

rblml cntulu :
ltrr cnfrtulu ;
hrtrm ;
rsc d dshdrtr ;
ntt.

bctv :
mlrr cnfrtulu fzc shc l cntulu ;
chlbrr hdrlctrltc ;
cmbtr hrtrm.

ntrvnl sstnt :
sgur rusul fzc, shc lmntr n rd cut bl ;
survghz vrsturl cntttv clttv ntz n f d tmrtur ;
rchlbrz hdrlctrltc cntul cu rfuz ntrvns cu sr fzlgc, glucz
33%, bcrbnt d sdu, du dtl ngrm ;
sgur lmt : n rdl durrs rgm hdrc mbgt cu fns, su d
zrzvt, brnz d vc, crn frt d us u d vt. n rdl d lnt sunt
cntrndct lmntl grs : crn, unc, mzlurl, rll, cnsrvl ;
rgtt cntul ntru mnl rdlgc cgrfc n vdr stblr
dgnstculu. mnul rdlgc tubul dudnl s fc du c u cdt fnmnl
cut ;
rcltz sng ntru ntru mn d lbrtr : VSH, hmgrm, blrubn ;
dmnstrz trtmntul ntsstc (vrn, scbutl, trn), ntmtc
ntnfcs ncu (mcln, gntmcn) rscrs d ctr mdc ;
survghz drr ntnd crctrstcl mlcl nfrmclgc (ung cu
gh) flst tru dmnur
mntrzz tmrtur crrl, ulsul tnsun ;
nstrut cntul rvnd rgmuld v du trnr dn stl, l nv s- r r
lmntl num rn thnc sml (frbr, frgr nbur) s vt csl lmtr ;
rgtt shc cntul n vdr ctulu chrurgcl tunc cnd mdcul htrt cst
cndut trutc .
b#%l!^+a?

C.V. F HNC
1.1.

RCLR SNGLU NRU VSH

bctvl rcdur
- dtrmnr rdt cu cr s rduc sdmntr (zr rgrsv) hmtlr fundul

61

rubt dn sngl ncgulbl lst n rus

rgtr mtrllr
- tv mdcl/crucr
- srng d 2ml, c strl su hldr c dublu crt cu cucuc
- ntcgulnt slu d ctrt d N 3,8% su tub vcutt cu ntcgulnt strl (cc ngru)
- sttv, rubt curt, usct
- slu dznfctnt, tmn d vt
- mnu d unc flsn
- gru, tv rnl, mum
- rcnt ntru clctr durlr
rgtr cntulu
) shc:
- nfrm lc cntulu rcdur
- bn cnsmmntul nfrmt
- ncur susn cntul
b) fzc:
- tnn cntul s nu mnnc s st n rus fzc
- vrfc dc rsctt rcmndrl
- zn cntul n dcubt drsl cu mmbrul surr srnt t c
ntru unc vns
- sgur ntmtt cntulu
- lg vn c m ur brdbl
b#%l!^+a?

fctur rcdur:
) rn mtd clsc
- sl mnl cu sun
- dznfct mnl cu lcl
- mbrc mnu d rtc
- sr n srng 0,4ml ctrt d N 3.8%
- cr cul srng cu ccul
- z srng cmrs strl
- lc grul c ntru unc vns
- uncn vn
- dzlg grul
- sr n srng 1,6ml sng
- rtrg cul du lcr tmnulu cu lcl
- rct cmrsun sur tmnulu 2-3'
- trnsfr mstcul sng/ctrt n rubt gt ur
- z rubt n sttv
b) rn mtd vcutt
- sl mnl/dznfct-l/un mnu d unc flsn
- mnt cul dublu l hldr rn nurubr
- ndrt cucucul d c - rt surr
- lc grul

62

- uncn vn
- dzlg grul
- f tubul vcutt dstnt rcltr VSH
- uml n l smn rcntul cu sng
- rtrg cul du lcr tmnulu cu lcl
- rct rsun sur tmnulu d 2- 3'
- gt lnt tubul vcutt
ngrr cntulu
- z cntul n z cmd, lc bnd dzv nn lrgc dsur tmnulu
- bsrv fcsul, tgumntl, cmrtmntul cntulu
- bsrv lcul unc
Rrgnzr lculu d munc
- clct durl n rcnt scl cnfrm U
- ndrt mnul
- sl mnl
Ntr rcdur
- nt rcdur n dsrul/lnul d ngrr
- nt rc cntulu n tmul rcdur
b#%l!^+a?

rgtr rdusulu ntru lbrtr

- tcht rubt su vcutnrul ntru lbrtr
- cmlt f d lbrtr
- trnsrt mdt rdusul l lbrtr
vlur fcct rducr
rzultt ttt/drt:
- unc vns s dsfr fr ncdnt
- cntul rm str d cnfrt
- sngl nu s cgulz nu s hmlzz
- nu r hmtmul lcl
rzultt ndrt
- cntul rznt ml, lr ccntut, ltm
- S rduc cgulr snglu
- S rduc hmlz snglu
- Grl d clctr.
- Cr crdul mdculu cntulu ntru rtr rcltr
- rfrr vn r hmtmulu
- lc cmrs rc un ungunt cr fvrzz rsrb
1.2.

RFU

rfuz st ntrducr cl rntrl, ctur cu ctur slulr mdcmnts

ntru rchlbrr hdrnc vlmc rgnsmulu.

63

Sc: -hdrtr mnrlzr rgnsmlu, dmnstrr mdcmntlr;

-durtv- dlund fvrznd cr dn rgnsm rdulr
-cmltr rtnlr su ltr cmnnt sngvn;
-lmnt cl rntrl.

tc;

Mtrl ncsr: tv mdcl crt cu un cm strl, trus ntru rfuzt slu

strl; slul hdrtnt; gru d cucuc, tv rnl, sttv ntru rfuz, 1-2 srng d 5-10
cm cu c ntru nc ntrvns su ntrmusculr strl; rn tr, mu m , lz; 1-2
ns strl; ns hmsttc; cslt cu cmur strl; cslt cu cmrs strl; subst n
dznfctnt lcl, tnctur d d; rmlst, frfc vt.
rgtr mtrllr: s rgtsc nstrumntl mtrll ncsr;
-s sct clfnul strl d flcn;
-s dsfc rtul d rfuz s nchd rstubul;
-s ndrtz tc rtctr d trcr s trund cu l rn dul flcnulu, s
dchd cu ns hmsttc mdt sub c, tubul d r s ndrtz tc rtctr d c
s trund cu cst n flcn rn dul d cucuc fr tng trcrul;
-s susnd flcnul surt;
-s fz tubul d r l bz flcnulu cu bnd d rmlst vnd gr s d sc
nvlul slu su substn mdcmnts.
-s ndrtz ns hmsttc dschznd drumul rulu n flcn.
-s ndrtz tc rtctr d ctul rtc l tubulu, s rdc dsur
nvlulu substn mdcmnts dn flcn s dschd ur rstubul lsnd s curg lchdul
n dsztvul d rfuz curtrul fnd rzntl.
-s cbr rgrsv rtcul n cnd tubul s uml cu lchd fnd lmnt cmlt
bull d r.
-s rdc curtrul n z vrtcl s nchd rstubul rtul rmnnd trnt
sttv.
b#%l!^+a?

cntul: -shc- s nun blnvul cnvngndu-l d mrtn thnc;

-fzc- s z blnvul n t, n dcubt drs l, ct m cmd, cu ntbr ul n
tns rn; sub brul ls s z rn tr crt cu mu m un cm strl; s
cr blnvul cu nvltr d flnl.
hnc: -sstnt sl mnl cu sun;
-mnz clt vnlr cntulu;
-s lc grul d cucuc l nvlul brulu;
-s dznfctz lc ctulu cu lcl, s bdnz cu tnctur d d;
-s cr blnvulu s nchd umnul s fctuz unc vn ls;
-s vrfc z culu n vn, s ndrtz grul s dtz mbul rtulu
d rfuz l c;
-s dschd mdt rstubul, ntru rmt scurgr lchdulu n vn s rglz
vtz d scurgr lchdulu d rfuzt, cu utrul rstubulu, l 60 ctur /mnut s u n func
d ncst;
-s fz cu bnzl rmlst run tubulu n vcntt cstu, d l
blnvulu;

64

-s survghz rmnnt str blnvulu mdul d funcnr rtulu.

ngrr ultrr blnvulu: s z blnvul cnfrtbl n tul su; s
dmnstrz blnvulu lchd cldu; s survghz.
Rrgnzr lculu d munc: s ndrtz nstrumntrul flst s rgtt ntru
strlzr, s runc cl, srngl tmnl n cutl scl.

1.3.

CR VRSURLR

bctvl rcdur
vtr murdrr lnr
vtr srr cnnutulu gstrc n cl rsrtr
rgtr mtrllr
- 2 tv rnl curt, usct
- Mum
- lz
- hr cu
- rvl d hrt, rs

b#%l!^+a?

rgtr cntulu
) shc:
- ncur cntul s rsr dnc ntru rduc un snz d vm
- sgur cntul c sunt lng l
b) Fzc:
- Rdc cntul n z znd dc str rmt su z-l n
dcubt cu cul ntrs ntr- rt cu un rs su lz sub c
fctur rcdur:
- ndrt rtz dntr dc st
- Susn cu mn frunt cntulu r cu cllt tv rnl sub brb
su lng f cntulu n func d z
ngrr cntulu
- fr cntulu un hr cu s- cltsc gur clct ntr-
tv rnl curt
- trg gur cntulu cu un rvl su fr- rvlul dc str
rmt
- ut-l s s z ntr- z cmd
- Survgh tnt cntul zt n dcubt s nu- sr cnnutul
stmcl dc vrstur s rt
Rrgnzr lculu d munc

65

- ndrt tv rnl dn sln

- Gl, sl dznfct tv (dc nu st nv s str
cnnutul)
- Sl mnl
Ntr rcdur
Nt:
- Dt, r
- Cnnutul (mucs, lmntr, bls, fcld, sng)
- Cnttt, mrsul
- Smtm rmrgtr
- lt cuz l blnvulu
vlur fcct rcdur
Rzultt ttt
- cntul rm str d cnfrt, fr snz d vm
Rzultt ndrt
- snz d vm s mnn, vrstur s rt
- sftu cntul s rsr dnc
- nu srv c tv cr cnn vm drc sml vdr dclnz rflul d vm
- nun mdcul
- vrstur cnn sng, rstur d mdcmnt su lmnt
- str vrstur rznt- mdculu
- rclt mstr dn vrsturl cr cnn rstur d mdcmnt su lmnt ngrt (dc st
ndct)
b#%l!^+a?

C.V. SUDU D C. LN D NGRR

CUL
Dt rsnl
Num rnum: Sndu Crmn
S: F
Dt ntr: 12. 08. 1957
Vrst: 52 n
Str cvl: cstrt, 2 c
Dmclu: Mldvn, ud. lm
cu: vnztr
Nnltt: rmn
Rlg: rtd

66

Blnv s ntrnz sc Chrurg, stlulu Urzcn, n dt d 23 nur 2010

cu dgnstcul d ltz blr.
Mtvl ntrnr:
- durr cu dbut brusc (cnt dscr c lvtur d umnl), cu lclz r n g stru,
rdr d-lungul rbrdulu cstl drt, sr umrul drt
- durr rut n urm cu rmtv r
- st nst d grur, vrstur lmntr
- cfl, str d gt
ntcdnt rsnl blnv fst rt d ndct l vrst d 14 n, r n rznt
sufr d H ntru cr trtmnt.
bnun d v munc: lcut l curt, mrun cu sul un cl;s ntrn dn
slrul l sulu; nu r un rgm d v crct (ms nrgult, fumz, cnsum du cfl
z)
strcul bl: dn dscul urtt cu cnt rs c n ultml 48 d r, fcut buz d
grsm, d dulcur, r l srvc rdct grut.
Blnv fst ntrnt l stl ntru nvstg trtmnt fnd trnt n st r
mlrt.
Rcmndr: rgm lmntr fr grsm, dulcur m ls cclt, tutun.
b#%l!^+a?

NV
FUNDMNL

Nv d b d
mnc

RBLM

SURS D
DFCUL

BCV

Grl n
rrr
lgr
lmntlr

Ls d cuntn

cnt s
b un rgm
lmntr
snts

Nv d lmn

Dshdrtr
Grur
Vrstur

ltrr mucslr
clr dgstv
rstltsmulu
ntstnl

cnt s
b str d
bn fr
grur
vrstur

Nv d s mc
v bun
stur

Durr
gstrc
Crm
bdmnl
Durr
Grur
Vrstur

Dzchlbru durr
ntt
Strs

cnt s f
chlbrt
shc

Durr
ntt
Stu d crz

Blnv s
b un smn
lntt fr
durr

Nv d drm
s dhn

b#%l!^+a?

NRVN
UNM
DLG
sstnt mdcl
nv blnv cum
s rr lmntl
snts
ntr-un md cr s-
lc.
ut blnv n
tmul vrsturlr
srnnd-
Rduc su
rtrtul d
lchd lmnt
rgtt shc
cnt nnt
r

lmnt
rntr
cnt
ndc
mdculu
rfuzb
lc
trtmnt
mdcm
ndct d
ntmt
srur mn
dmnst
trmntu
rscrs d

bsrv dc rd
d dhn crsund
ncstlr
rgnsmulu
-nv cntul cum
s cut thnc d
rlr

dmnst
sdtv l
ndc
mdculu

67

Nv d nv s strz sntt

gnrn
Blnv nu r
cuntn
dsr bl

Durr
Nlnt
gt

cnt s
cumulz
cuntn n

Stmulz drn
d cuntr
Mtvz
mrtn
cumulr d n
cuntn

68

CUL
Dt rsnl
Num rnum: chm Crngu
S: F
Dt ntr: 23.10. 1970
Vrst: 39 n
Str cvl: cstrt, un cl
Dmclu: Brz, ud. lm
cu: rfsr
Nnltt: rmn
Rlg: rtd
Blnv s ntrnz, l stlul Urzcn sc Chrurg, n dt d
31.07.2010, cu dgnstcul d ltz blr.
Mtvl ntrnr:
- durr (dscrs c nt crm bdmnl), s ccntuz n dcubt ltrl
stng, cu lclzr n hcndrul drt rgun vzcl, s mnn n ur d
r s rt l 2 3 zl
- durr st nst d grur vrstur lmntr
- gust mr dmn
- ctr
- cnst
- ml, urtcr, ntt
ntcdnt rsnl ng
bnun d v munc: cnt lcut l cs, 4 cmr, vnturl
fml rvn dn slrul l sulu, lus lc clulu; nu fumz, cnsum
cf z, msl sunt rgult, dr cnn grsm, rl, cclt (lmnt
clcstkntc, clclzc).
Blnv fst ntrnt ntru nvstg, mdcul chrurg rgrmnd-
ntru r (clcstctm), du z. n tunc blnv v n rgm, num
cu cur su.

b#%l!^+a?

NV
FUNDMNL

RBLM

SURS D
DFCUL

BCV

NRVN
UNM

Nv d b d
mnc

Vrstur
lmntr
Gr

ntt
Strs
Durr

Nv d lmn

Durz r
n lmt nrml
trnsr
mdrt
Vrstur

Durr
Frc
d
r
Str d bl

Nv d s mc
v bun
stur

Nv d drm
s dhn

cntul s nu m
rznt grur
vrstur

rgtsc
mtrll ncsr
ut cnt n tmul
vrsturlr, susnnd-
n z d dcubt
ltrl, ctz lchdul
d vrstur n tv
rnl,
tul
fnd
rtt cu mum
lz duc l
cuntn mdculu.

Rlur
ut cnt s s
trnztulu
dlsz
n
l
ntstnl
tlt
utnm
n bsrv ntz durz
stsfcr
n F..
nvlr
Dfcultt d Durr
cnt s s ut cnt s s
s dls, d s ntt
mt
fr t rdc s s
rdc
dfcultt
dlsz
rcmnd s s
lmb ct m mult,
ntru
rlur
tnusulu musculr
Cnttt
Schmbr
cnt s
Crz
un
mdu
ncrsunztr mdulu
bnfcz d
dcvt: lnt, sln
d dhn
mbnt (mdu smn crsunztr rst, lnr curt
t, durr
stlcsc)
clttv
d
t

cr,
cntttv
tmrtur d 20C
b#%l!^+a?

Nv d nv s strz sntt

Dzntrs
t
zlr
stlcsc

Strs
cnt
s- lrz nv d
Stu d crz mrsc ntrsul cuntr cnt
Durr
d nv
lbrz bctv d
studu cu blnv
rgnzz ctvt d
duc
ntru
sntt:
cnvrbr,
dmnstr rctc

l
n
m

m
n
m

m
r
m
c

CUL
Dt rsnl
Num rnum: Drguu lnr
S: F
Dt ntr: 07.07. 1949
Vrst: 61 n
Str cvl: vduv, 3 c
Dmclu: Grndu, ud. lm
cu: nsnr
Nnltt: rmn
Rlg: rtd
Blnv, s ntrnz sc d chrurg, stlulu Urzcn, ntru
clcstctm, fnd dgnstct cu, clc blr smtmtc, n urm un
cgrf bdmnl.
Mtvl ntrnr: blnr strndl, ntlrn l grsm.
ntcdnt rsnl: ndcctm l 7 n, r d hrn htl l 55
n, H snl d l 52 n.
bnun d v munc: lcut l cs, 3 cmr, cnd rcr d
v, vnturl blnv sunt d 350 l rrzntnd ns lunr; ms nrgult, nu
cnsum cf su gr.
strcul bl: fm frm c, nu r r un rgm lmntr crct, cnsum
grsm, rl, dulcur n scl cclt, du fkr ms s smt b ln t,
r durr gstrc.
n du z cnd st rgrmt ntru r, blnv v n un rgm
lmntr, dsmn du r.
b#%l!^+a?

NV
FUNDMNL

RBLM

Nv d b d
mnc

Nv d lmn

Nv d s mc
v bun stur

SURS D
DFCUL

BCV

ntn
Gr
ngst d
lmt c nu
stsfc nvl
rgnsmulu
Blnr,
crm
bdmnl

ntt
Durr
bsl

cnt s f
chlbrt
hdrlctrltc

Rgm lmtr
strtr
Dmnur
mblt

S b scun
fr dfcultt

Dfcultt n
s rdc, s
z
mrg

Durr
ntt
Frc s nu s
dchd lg

cnt s f
chlbrt
shc
S nu m

b#%l!^+a?

NRVN
UNM
lc cnt c n
rml zl du r
r v s mnnc dct
su d zrzvt
strcurt, c nndulct
su rt d but.
Dtrmn cnt s
ngr cnttt
sufcnt d lchd
Urmrt ntz n F.
cnsstn frgvn
scunlr
rgtt shc cnt
n vdr rcr thnc
d ngrr
Rd ncrdr cnt

D
Du t
rscr
chrurg
rnt
nsttu
glucz
L nd
mdcu
-fctu
clsm
sml

dmn
trtm
d md

rtr

rznt durr

c mbltt s st
trctr c t
rlu mrsul

Nv d drm
s dhn

t
stn
bsl
Slbcun

ntt
Durr
Strs

S- dsr
uzr n
scurt tm

rst slnul
Schmb lnr d t
d cr
ntcmt un rgrm d
dhn crsunztr
rgnsmulu

Nv d nv s strz sntt

Dzntrs
Rfuzul d
nv (
cunt)

svtt
Strs
zlr
stlcsc

cnt s
dbndsc
bcur,
ttudn
drndr n

dntf bcurl
drndrl grt l
blnvulu
Crctz drndrl
duntr snt
n lc d frmr
drndrlr gnc, d
lmntr rnl,
md d v chlbrt

dmn
sdtv
ndc

lgr cst tm nu fst ntmltr, c dtrt czustc d crz

htc ntlnt n stl chr rntr un cunscu, surrnzndu-m frcvnt dn c
n c m mr un dntr fcunl grv,crnc l fctulu.
cst lucru s ntml dtrt nglr str d sntt d ctr mult rsn,
rn lmnt grt,dmnstrr ntmnsv mdc cu grsvtt htc,
ntrtr su trtr ncrct bllr nfcs.Bnnls c nu utm nvnu c
cu crz gntc,blrsu cngstv.
dt nstlt bl (cntul fl rn cntrl ntmltr su rn
rzntr l mdc cu numt smtmtlg), ct trc rn 3 std (du tr
lu gl):
1. ngr rlt (cntul st nmct,umbl fr nt);
2. dsrr (tm, vnv, frustrr, drs);
3. cctr (rcunt nvtbltt rdr rrgnzz v).
Sunt czur n cr cn lz l "frmc" "vrtr" su tt flul d
rctc luzr n srn c cst cun vr f m fcc dct trtmntl
mdcl.Cu tt frturl dus d mdc, ct nu t bn trtr crzlr,
mrt survnnd rn r cmlclr.Dr, d rmtv 3 n, m st ns:
trnslntul htc. C cr u vut nrcul s bnfcz d cst, t rlung
v,cu numt cntrl rdc, ns ntru cll rmn srn mlrr
smtmtlg ntrzr ct sbl cmlclr, cu utrul clctvulu
mdcl.
N rmn srn unr n dscrr n dmnul mdcn, rn cr cst
fcun fctulu s t f vndcbl n ttltt.
"sstnt mdcl r dtr mrl d ntrn srn, dr st nndct n cultv
srn drt". (RLG MR)
"n cs fcru m s fl ct cut ndr cr strz nltrt srn,
c cl dn urm dr lst mulu mnt. r func nstrumntl n cut r
"bnlu" rdut rct d bsurd r f mlcl flst ntru ndlnr sr n,
mul nu v nct nc cl s l ntrbunz.Cc c c r brnt clu snts
frct, t f fundmnt l srn ntru cl blnv su lvt d srt.Srn st tt
d mrtnt c fr s-r schmb chr cdrul stnl umn".
CLUL
b#%l!^+a?

NM FLG FCULU
1.1 FCUL
st c m mr glnd dn rgnsm, stut n tul surmzclc, n rt
drt, sub dfrgm, dsur clnulu, l drt stmculu.r cnsstnt frm
culr brun.L cdvru cntrt 1500gr r l ndvdul vu s dug nc 800-1000
gr,ct cntrt sngl dztt d fct. r frm unu vd tt blc vnd 28 cm n
sns trnsvrsl 16 cm n sns ntr-strr.Fctul r surf surr, un
nfrr, mrgn nfrr mrgn strr, m lt.
Ft surr (dfrgmtc) st dvzt n 2 lb (stng drt) rn
lgmntul flcfrm, ntns d ft surr fctulu l dfrgm. Lbul stng st
m mc dct cl drt. rn ntrmdul dfrgm ft surr vn n rrt cu nm
73

 cu bzl clr d lmn.

Ft nfrr (vscrl) st rcurs d 3 nur:
-sntul trnsvrs rrznt hlul fctulu, lcul d ntrr r l lmntlr dculu
htc (ntr rtr htc, vn rt, nrv htc, s lmftcl cl blr);
-sntul lngtudnl stng cnn, n sgmntl ntrr, lgmntul rtund, rvnt rn
bltrr vn mblcl, r n sgmntul strr crdnul fbrs rntus (cr l ft
fc lgtur ntr vn mblcl vn cv nfrr);
-sntul lngtudnl drt rznt, n sgmntul ntrr, fs cstc, n cr s rgst
vzcul blr, r n sgmntul strr vn cv nfrr.
Cl 3 nur mrt ft vscrl n 4 lb:
-lbul stng rznt mrsun gstrc ;
-lbul drt vn n rrt cu sr d rgn: unghul drt l clnulu,
flur surr dudnulu, glnd surrnl drt rnchul drt;
-lbul trt rznt mrsun gstrc;
-lbul cudt rznt rcsul lr rcsul cudt.
Mrgn nfrr st scut:rznt du nczur nczur lgmntulu
rtund nczur cstc.
Mrgn strr rn ft surr fctulu. s fl r nud
fctulu, cr st lst d rtnu dr ntm l dfrgm rn trctur cnunctv.
b#%l!^+a?

1.2 SRUCUR FCULU

L trr, fctul st crt d rtnul vscrl. D ft surr
fctulu, rtnul s rsfrng dfrgm, frmndu-s stfl lgmntul flcfrm.D
ft nfrr s rsfrng stmc, frmndu-s mcul ln (lgmntul gstrdudn-htc). rtnul d ft surr nfrr fctulu s rsfrng
rtl strr l cvt bdmnl, frmndu-s stfl lgmntul crnr.L cl
du trmt (stng drt), cl du f l lgmntulu crnr s r un
d cllt, frmnd lgmntl trunghulr stng drt, cr ung l dfrgm.
Sub rtnul vscrl s fl csul fbrs fctulu (csul Glssn).D
f rfund lc stur cnunctv-vsculr, cr trund n rnchmul
htc.ntr cst stur s dlmtz lbul htc, cr sunt unt ntmc
funcnl l fctulu.Lbul sunt vzbl cu chul lbr s rznt c nt gr nul
d mrm unu bb d m.rv n su, u frm d rmd cu 5-6 ltur.
L ntlnr tr lbul st sl rtl, cr cnn rtr rlbulr
(rmur dn vn rt), vn rlbulr (rmur dn vn rt), un cnlcul bl r
rlbulr vs lmftc, tt nvlt ntr- strm cnunctv dndnt d c sul
Glssn.Lbulul htc st frmt dn clul htc (htct),dn clr snusd
cr rvn dn clrzr vn rlbulr, dn vn cntlbulr sr cr cnvrg
snusdl dn cnlcull blr nrlbulr.
Htctl sunt dsus n su sub frm unr lc su lm, frmt dntr-un
sngur rnd d clul.ntr lm s dlmtz s n cr s rgssc clr snusd.n
grsm un lm, ntr htctl dcnt s frmz cnlcul blr
ntrlbulr. Htctl sunt rltv mr, d frm ldrc r scun sub
74

sctul lgnl.Fcr htct vn n cntct cu clrl snusdl (lul

vsculr) cu cnlculul blr ntrlbulr (lul blr).Htctul t s- vrs
scr f n cnlcull blr (scr crn), f n snusd (scr ndcrn).
Cnlcull blr ntrbulr nu u r rr, r lr fnd rrznt d
ns htctl.Sr rfr lbululu ct r rr u numl d clngl
(cnlcul Hrng).cst cnvrg ctr cnlcull blr rlbulr dn sl rtl,
cr, l rndul lr, s dschd n cnlcull blr ntrlbulr.ntr rt clrlr
snusd lml clulr htc st sl Dss, cu vlr d clr lmftc.
Vn rlbulr d l nvlul sulu rtl trund n lbul htc
frmz snusdl htc. n clrl snusd s rmrc rzn unr clul stlt,
clul ltrl uffr, cr rn sstmulu rtcul-ndtll.nnt d frm
snusdl, rmur rlbulr vn t rznt un sfnctr lbulr, numt sfnctr d
ntrr.Snusdl cnvrg sr vn cntrlbulr, stut n cntrul lbulu.
nnt d s dschd n vn cntrlbulr, snusdul st rvzut cu un
sfnctr d r.Rmur rlbulr rtr htc,du c d rmur cr
vsculrzz lmntl sulu rtl, trund n lbul s ndrt sr
snusdul htc, n cr s trmn.L lcul d trundr n snusd st un sfnctr
musculr rtrlr.Snusdl lbulu htc rrznt dc,lcul d ncun l snglu
rtrl, dus d rtr htc, sngl rtl dus d vn rt.Rlul sfnctrlr
rlzz d rt, un sstm d lg fluul sngun l nvlul fctulu, r d
lt, d glz rsun snglu.
Vnl cntrlbulr rssc lbul d bz lr dvn vn
sublbulr(clctr).l s unsc frmz vnl htc (2-3), cr sunt trbutr
VC. l rssc fctul l nvlul mrgn strr.

b#%l!^+a?

Vsculrz fctulu
1. Vsculrz nutrtv trnsrt sngl gnt, c rvn dn rtr
htc, rmur trunchulu clc, cr du rmfc multl (lbr,sgmntr
ntrlbr), s clrzz, rgnd frmunl dn sl ntrlbulr (rtl)
frmz r n urul htctlr.n fnl, cst clr s vrs n c l rl
snusd l vn rt.
2. Vsculrz funcnl st cnsttut dn rmfcl vn rt, cr
dduc sngl cu substn nutrtv, bsrbt dn ntstn.Vn rt s rmfc frmnd
rmur lbr, sgmntr ntrlbr.Sstmul rt st un sstm vsculr, rcd t
urmt d cl t d vs (clr-vn-clr).Clrl snusd cnvrg sr vn
cntrlbr, cr drnz, n fnl sngl sr cl 2-3 vn surhtc n V C .
nrv vgttv fctulu rvn dn lul clc rncl (smtc) dn
nrv vg (rsmtc).
Cl blr
Cl blr sunt cnduct rn cr bl, scrtt cntnuu d htct,ung n
dudn num tunc cnd ung c rdu dgst gstrc. Cl blr rznt du
r:un ntrhtc,lt trhtc.
Cl blr ntrhtc sunt cnlcull blr ntrlblr, clngll,
cnlcull rlbulr ntrlbulr.
Cl blr trhtc curnd un cnl rncl (htcldc) un rt
dvrtculr (frmt dn vzcul blr cnlul cstc).
75

Cnlul htc cmun s frmz dn unr, l nvlul hlulu, clr du

cnl htc,stng drt.r lungm d 4-5 cm un clbru d 5mm.D l rgn
s,cbr sr stng n,fnd stut cu clllt lmnt l ndcululu htc,
ntr cl du f l lnulu mc.
Cnlul cldc tn d l lcul und, n cnlul htc cmun, s dschd cnlul
cstc n l l mr d l nvlul dudnulu n trctul su dscr un rc cu
cncvtt sr drt.r lungm d 5-6 cm un clbru d 5-6 mm. S dschd
mrun cu cnlul rncl l ncrsulu n mul ht-ncrtc (Vtr);l
nvlul cstu s fl sfnctrul dd.
Cnlul cstc lg cl blr rncl cu vzcul blr.cst r rlul d
cnduc bl n rdl ntrdgstv sr vzcul blr.
Vzcul blr (clcstul)st un rzrvr n cr s dztz bl n rdl
ntrdgstv s cncntrz rn bsrb d scr d mucn d ctr tlul
clcstulu.Clcstul st stut ft vscrl fctulu, cund sgmntul ntrr l
nulu sgtl drt.r frm d r, cu lungm d 8-10 cm lm d 4
cm.Cctt st d 50-60 cm3.rznt un fund , un cr un cl.

b#%l!^+a?

1.3 FUNCL FCULU

Fctul ndlnt n rgnsm sr d func n vdr mnnr cnstnt
mdulu ntrn (hmstz), func cr-l fc ndsnsbl v.
1. func d scr bl (blgnz)-funct scfc hmtctulu;
2. func mtblc substntl bsrbt l nvlul ntstnulu sunt trnsrtt
cl vn rt l fct, und sufr sr d trnsfrmr chmc:
- rlul fctulu n mtblsmul glucdc: cnst ntr- sr d r c c u c
rzultt mnnr cnstnt cncntr glucz n sng.cst rc s rlzz n
cdrul unr rcs cml (glcgngnz, glcngnz, glcgnlz);
- rlul fctulu n mtblsmul ldc:-ldl bsrbt l nvlul ntstnulu sunt
rlut d htct, l nvlul cru u lc:dr czlr gr, sntz trglcrdlr,
fsfldlr clstrlulu;
- rlul fctulu n mtblsmul rtc:-mncz cr rvn dn rcsl d
ctblsm l rtnlr r dn bsrb ntstnl sunt suu unr rc d dgrdr,
dzmnr, trnsmtr tc.,r sunt utlz ntru sntz d rtn;
- rlul fctulu n mtblsmul hrmnlr gluccrtzz sunt mtblz
clusv d ctr fct, strgn u sdul rncl l mtblzr n fct, hrmn
trdn sunt nctv lmn rn bl,r hrmn mdulsurrnln u cclu
ntrhtc frt lmtt.
3. func fctulu n cgulr rt dntr fctr cr ntrvn n csul d
cgulr (fbrngnul,rtrmbn, hrn) sunt sntzt n fct.
4. func d dzfr sr d substn tc rdus n rgnsm (mmnc,
fnl,tc.) su truns ccdntl, sunt mtblzt l nvlul fctulu trnsfrmt n
rdu c t f rutlz d rgnsm r lmn.
5. func d dzt l nvlul htctulu t f dztt gm lrg d
cmu:
- vtmnl ,,B2,B6,B12, cdul flc cdul nttnc, s gssc n
cntt mult surr clr dn lt rgn r dn sng;
- mtll fr, curu;
76

- rt dn vlumul sngun stgnnt.

6. cctt d rgnrr du htctm rl rgnrr nc du
24 d r, tng mmul n 4-5 zl s trmn n 14 zl.
7. sntz frmnlr, mnnr chlbrulu cd-bzc,chlbrr rturbrlr
crcultr tc.

b#

%l!^+a?

Scr blr
Bl rdusul d scr l htctlr, st scrtt rmnnt d ctr fct
(500-700 ml/z). ntr ms,sfnctrul dd fnd nchs, bl s clctz ,rn rbsrbt
, s cncntrz n clcst, d und st lmnt n dudn n tmul dgst.
Bl st un lchd vrd (bl clcstc) su glbn (bl htc), lcln (h 7-8),
mr, cnnnd 97-98% , lctrl, blrubn blvrdn (rdu d dgrdr
hmglbn), srur blr,chlstrl, lctn.C m mr rt srurlr blr s
rzrb (crcutul ht-ntr-htc) dr mc rt st dgrdt sub cun
bctrlr ntstnl.
Crcutul ntr-htc
Crcutul ntr-htc st rcrculr srurlr blr dn ntstnul subr n
n fct.uns n lnul trmnl,90-95% dn srur sunt bsrbt ctv n crcul
rtl. Fctul l trg dn sngl rtl l scrt dn nu n bl . S rurl rst nt
sunt crtt n mtrl fcl.stfl, srurl blr t rcrcul d 6-8 r z.
Srurl blr u du rlur mrtnt:
1. d dtrgnt sur ldlr dn lmnt, crr tnsun surfcl
rduc,rmnd frgmntr lr.
2.ut
l
bsrb
dn
trctul
ntstnl
l
czlr
gr,
mnglcrdlr,clstrlulu ltr ld, rn frmr cu cst unr cml
numt mcl.
n ls srurlr, n ntstn s rd, rn mtrl fcl,40% dn ldl ngrt.
Cntrlul scr blr
Vlumul scr blr cnnutul n srur s rglz srt. rt blndndnt s rfr l cnttt d lctrl scrtt zlnc d fct c r st
stmult d scrtn.rt bl-dndnt s rfr l cnttt d srur scrtt d
fct st drct rrnl cu cnttt d srur rbsrbt d ctr h tct dn
crcul rtl.cst nu st sub cntrl hrmnl su nrvs drct.Clcstknn
dtrmn crtr dbtulu blr ndrct, rn stmulr lbrr d bl dn clcst.
Fctul st ur smlu un mr ln rductr d bl
(Brthln)

77

b#%l!^+a?

CLUL
NRDUCR
2.1 SRC
Dnumr d krrhs r rgn grc nsmn glbn rtclu, numl
fnd dtrmnt d culr glbn-rtcl fctulu sn u d cnsstnt crscut.
D- lungul tmulu trmnul d crz s- dntfct cu sclrz fctulu,
utndu-s r smnfc s d culr. Cu mult scl nnt lu Lnnc, grc
rmn u dscrs bl c trfr ndur fctulu. rsstr tus dn
lndr n 304 .H. fc lgtur dntr sct fctul ndurt. rtus dn Cdch
n sclul .H. st rmul cr fc lgtur ntr nflm fctulu vlu lu sr
crz. n 1685, .Brwn dscr smnl d dcmnsr l crz. Mrgn n 1761, st
rmul cr dscr rturbrl vsculr n cdrul crz htc.
Lnnc dscr crz n flul urmtr: fctul, rdus l 1/3 dn dmnsunl
bnut, scuns n rgun cr cu; surf s trn, glbn, dnt, r
n ntrgm lctut dntr- multtudn d grun mc, rtund su vd. cst grun,
ur d srt un d lt, nu rzntu nc l nc un s u n c r s s t
rcunt sut htc rstnt. Culr lr r cstn su glbu-rstc, lrfr
78

vrd, sutul lr m ml , l strngr grunlr ntr dgt nu s ut trcu dct

mc run; rstul dd l lr snztun buc d l ml.
L scurt tm du dscrr lu Lnnc ncut cntrvrs sur rgn
sutulu cnunctv.Un trbuu clbrr trm d rtculn, scundr ncrzlr
clsulu lbulr, r l frmr d sut cnunctv nu. ndrl Bullnd cnsdru
c fctul st lctut dntr- substn r un glbn, sturl rvnnd dn cst
dn urm.L Rktnsky n 1842 r ntrrtr m mtur:crz st rzulttul
frmr unu sut cnunctv nu, c rsuns l rturbrl crcultr l grsun
nflmtr.
n 1850, Frrchs dfrnz du std n frmr crz:
1. stdul nurfrmr d fbr l nflm;
2. stdul frmr ndullr l cntrc.
du cntrvrs n tgn crz s rfr l sdul lzun rmr. Du
ckrmnn, rtz Fssngr, lzun rmr st lclzt l nvlul htctlr,
cnstnd n ncrz cstr.Rktnsky trbu un chrctr rmr nflm sutulu
cnunctv. Rssl cnsdr c lzun rmr fctz cncmtnt htctul
mznchmul.

b#%l!^+a?

2.2 NCDN
Crz rtl st rsndt n tt lum, curnznd tt rsl
nnltl.n rnt s ntlnt m ls n Chn, nd, v St tl M l zn.
n frc d Sud, frc d st nsull Crb lrg rsndt un t nutrn l d
crz (bl wshrkr), smntr n mult rvn cu crz rtl, cr cnsttu
un dntr rblml d sntt ublc n cst rgun.
n ur d Vst, mrc d Nrd, mrc d Sud, crz st sct d bc
cu lclsmul crnc. n Chn nd cfrl vrz d l 4 l 7% su m mult n frc
d st 6,7%, r n Chl 8,5%. Rwntr stblt c, n ur , mrt lt t rn crz
st m rdct n tl c m sczut n Nrvg.
Mr rsndr crz rtl sugrz c ncdn st lgt m mult d
fctr d mdu dct d fctr rsl.
Crz stncrtc r n 8,4% dn 550 czur d crz rrtt d Mllry.
n ngl, und lclsmul st mult m un frcvnt dct n trcut, crz stncrtc
dvnt rltv m frcvn. S dmt c crz s rduc l rmtv 7 dn 1000
d czur d htt vrl.t vrstl sunt ntrst. n sttstc s cnstt ntr 4 77
n, cu md l 36 n.
Dgnrscnt htlntculr nu st frcvn, dr nc csv d rr mbl
s u fst fctt, cu ur rndrnt l brbt.
Crz nfntl uvnl. n gruul d vrst drtc, crz nu st tt d rr
cum s crd ltdt r s f n crtr. Ftul s dtrz, n rt, srr
mblnvrlr rn htt vrl , n rt, rlungr durt d survur clr cu
bl fbrchstc ncrsulu, n cr dzvltr un crz vntultt
frcvn. n gruul d vrst drtc, crz rtl r s f trm d rr,
mrtt czurlr ncdrndu-s n tul ncrtc n cl blr bstructv.

79

b#%l!^+a?

CLUL
DSCRR CRLR HC
DFN
Crzl htc sunt sufrn crnc cu vlu rgrsv, crctrzt
mrhlgc rn dzrgnzr rhtctur htc dtrt mtlz sutulu
cnunctv, dtrmnt d dstruct htctr rgnrr ndulr; blgc, rn
ltrr svr sndrmlr d ctvr mznchml, d hrtnsun rtl
nsufcnt htctr rn sbltt crbr sndrmulu crt-blr
clu d htctlz; clnc, rn std vnst d nsufcn htc, nst d
smnl d hrtnsun rtl.
n fcr cz t rdmn unul su m mult sndr m, crzl mbrcnd mult
sct rtculr.
3.1 GN
n ttgn crzl htc ntrvn n m mult cuz:
1. cuz nfcts- cu un lc mrtnt n r nstr, cl m mult dntr l
fnd d ntur vrtc, rn vrusul httc;clllt czur rn vrusurlr nhtc,
sflsulu, tubrculz ltr nfc bctrn;
2. cuz nutrtnl- rn crnt d rtn, d fctr ltr su d vtmn;
3. cuz tc- lclul (fctul unu m snts t mtblz m mult d 160180 gr/z; rscul d crz r l un cnsum zlnc d ~ 180gr lcl tm d 10-15 n)rn cun s sttgn, tnl ndustrl (cmu rgnfsfrc, drtznt,
nsctcd) , n ultmul tm, mdcmntl cu grsvtt htc, cum sunt;
- ntbtcl: clrmfncl,cln, ncln, rtrmcn;
- nstzcl; clrfrm, hltn;
- ntrumtcl rlntl musculr: fnlbutzn, srur d ur;
- hrmn vtmnl: crtcstrz, strgn, cntrctv rl, vtmn ;
- nlgzcl: rctml, vrn.
4. nmgznr n fct unr substn: dztr frulu n fct n lt
80

rgn rvc hmcrmtz, r dztr curulu st rsnsbl d r

dgnrscnt htlntculr;
5. stgnr bl (n czl blr): s t dtr unr bstcl
trhtc.Stz blr t s f rmtv,rn htt crnc clsttc, c urmr
un htt vrl , rbbl, cu ntrvn unu mchnsm mmunlgc.
6. cuz dsmtblc: bztt, dbt;
7. cuz ndcrn: hrflculnm, hrtrd;
8. fctr gntc:
- du unl stud, crz st m frcvnt sct cu gruul d sng ();
- s-u dscrs m mult czur d crz l c fml;
- mr mrtt lclclr crnc nu dzvlt CH cst dtrt, rntr
l fctr, rzstn gntc;
- s crd c unl gru rsl su ntc sunt m rzstnt
( ngr dn SU)
ltl m susctbl (vr, ndn mrcn) l dzvltr crz.
Crz crdc st nc cntrvrst. Nu sunt sufcnt dcmnsrl
crdc rtt ntru ung l crz , rbbl c n r ntrvn fctr
crgn m mrtn.M dgrb t st crz htc l crdc, cnd r
ltrr funcnl htc slnmgl.
Fctr rznt m sus u mrtn ngl n tlg CH; dc ntru un
vm dvz cncludnt, cst lssc l l.n lus, n mult czur nu utm stbl nc
cuz (crz dtcsu crtgntc).
buzul d lcl htt vrl t B rrznt rncll cuz.n unl r,
c d mlu Frn, rdmn tlg lclc,n r nstr rdmn tlg
vrtc.
S vrbt tt m mult d lurtlg crzlr: ntrvn cncmtnt su
ds succsv m multr fctr (lclsm+ mlnutr+ htt vrl) l cl
blnv.
b#%l!^+a?

3.2 NMLG
. Mcrscc:
Vlumul fctulu vrz n func d mmntul vlutv l crz ;c rgul,
mrtt czurlr rznt sr stdul trmnl l 3vlut lr un fct mc, trhc, cu
grutt d 600-900gr.n fz hrtrfc crzlr, cnd rcsul d rgnrr ndulr
rnchmts st ctv, vlumul fctulu st mr, grutt lu utnd d 3 kg.
Culr fctulu st n gnrl m clr dct n md nrml, st vrbl n
func d tul d crz.
Surf fctulu st nrgult,mmlnt, dtrt ndullr d rgnrr
crr dmnsun vrz n func d tul mrhlgc l crz:mcrndul cu dmtrul
sub 1mm, dsmn tt surf fctulu mcrndul cu dmtrul bnut ntr
3-4 cm (dr n unl czur dnd 10 cm). Culr ndullr st dfrt
(glbn,vrzu,r,brun)n func d ncrcr gmntr vrst lr.Cnsstnt
fctulu st dur.
scun s bsrv ndul d rgnrr dntc cu c d surf
fctulu,rn n churl un rl d sut cnunctv d culr lb-cnus.
B. Mcrscc:
81

sctul mcrscc d nsmbu, ndffrnt d tul tlgc l crz, st cl

l un rmnr l rhtctur nrml fctulu. rnchmul htc st frgmntt d
sturl cnunctv cr ncnr ndul d rgnrr, r rrl nrml l fctulu
lssc. Sunt rznt smn clulr d rgnrr (mtz clulr, clul b su
multnuclt), sttz ncrz clulr, frmr d ncnlcul blr un nfltrt
nflmtr (lmfct, lsmct)dscrt.

b#%l!^+a?

3.3 FLG
Hrtnsun lr (H)
nstlr H mrchz trcr d l htt crnc (HC) l crz
htc(CH).
Crtr rsun n crcul rtl st dtrmnt d blcr sstmulu rt
l dfrt nvl:
.ntrhtc:CH ( rn ndul d rgnrr, c m frcvnt cuz);
b.rhtc: trmbz vn slnc, scurtcrcutr crcul htc dtrt
rsstnt vn mblcl;
c.sthtc: sndrmul Budd-Chr (trmbz vn surhtc).
Cnscnl fztlgc l nstlr H sunt urmtrl:
.dzvltr su ccntur nstmzlr rtcv (crdsfgn,
hmrdl, bdmnl cutnt);
b.slnmgl;
c.fvrzr r sct;
d.dmnur dbtulu sngun rtl l nvlul fctulu rducr rtulu d
ygn substn nutrtv.
cst cnscn fztlgc s trduc ln clnc rn rznt crcul
vns cltrl bdmnl,slnmgl sct.
ulburrl hdrlctrltc
cst sunt frcvnt, ntlnt n crz crr vlu s
f c, n
mns mrtt czurlr d l fz cmnst vsculr (rsctc) l un d
dcmnsr vsculr (sctc).
a) sct dmul
n mcnsmul d frmr sct crgn ntrvn m mul
fctr:hlbumnm- n CH, scdr rsun nctc lsm (scundr
hlbumnm) sct cu crtr rsun hdrsttc (scundr H) dtrmn
ccntut trcr lctrllr dn sgmntul rtrl l clrlr n sctrul
ntrstl dmnur rbsrb lctrllr dn ntrstu n sgmntul vns
l clrlr, rzulttul fnd r sct dmulu.
L fl c n czul H, nc hlbumnm sngur nu rduc r sct;
ntru nstlr cst st ncsr scr clr d fctr (hlbumnm
H), mb rzn n CH dcmnst vsculr;
- crtr rmblt clr;
- tulburr crcul lmftc;
b) tulburrl mtblsmulu sdulu
D c vlr bslut, sdul ttl l rgnsmulu st crscut n crzl
sctgn, ntrm cstr blnv st dsr sczut c urmr ntrvn dlu
82

(rtn d dt c d sdu), dl trutc, schmbul ntr n d

sdum c d tsu su rgmulu lmntr dsdt.
c) tulburrl mtblsmulu tsulu :
Htsm-st scundr trtmntulu cu durtc hrldstrnsmulu,
rtulu lmntr rdus, dmnstrr d crtcstrz, rfuzlr cu sr glucnt
rdrl dgstv.Htsm t duc l cm htc.
d) tulburrl mtblsmulu fsfclcc
CH cu vlu ndlungt t f nst d strz scundr,rbbl,
nsufcnt d bsrb ntstnl clculu vtmn D, crntlr lmntr d
clcu su ltr fctr.
) chlbrul cd-bzc
n mrtt czurlr d CH dcmnst vsculr, st lclz mtblc
rsrtr.

b#%l!^+a?

ctrul
ctrul dn CH cunt urmtrl cuz:
- usu cut d htt vrl su lclc;
- clstz ntrhtc (ltz su clngt);
- usu d htctlz cu tulburr cnugr cr bllrd;
- hrhmlz rn hrslnsm.
Hmrgl
n r hmrglr ntrvn m mult mcnsm:
- H- dtrmn r vrclr sfgn gstrc cr, rn rur, rduc
hmrg dgstv (hmtmz n scl mln);
- tulburr l hmstz: - tmul lsmtc- nsufcnt htclulr s nst
d un dfct glbl l fctrlr lsmtc cgulr; - tmul vsculr frgltt
vsculr.
- l fctr ulcr gstrc su dudnl, gstrt hmrgcl.
ulburr ndcrn
D n cursul vlu CH s-u dscrs nml trdn, hfzr
crtcsurrnl, sngur tulburr cr, ln clnc, trg tn st nsufcnt
gndc.L brbt v r trf tstuculr bltrl mtnt sul, r l
fm dmnur lbdulu, tulburr l cclulu mnstrul; l mbl s s cnst t
hlztt.Hrstrgnsmul st mlct rducr stlulr vsculr
rtmulu lmr.M r gncmst, trf mmr utrn, strltt.
Un dntr tulburrl cl m mrtnt st ntlrn l glucz, cr n mult
czur mbrc sctul unu dbt zhrt mnfst.Mcnsm mlct:
- crtr scr d glucgns;
- crtr rzstn l nsuln;
- trtmntul cu durtc, tzdc crtcstrz.
ulburr crd-vsculr
Hrvlm rzn nurlr rtrvns ntrnz crtr dbtulu
crdc, cu sbl r dsn cnz.L mrtt s ntlnt
htnsun rtrl scundr stcr un mrtnt cntt d sng n sstmul rt
83

scdr rzstn l nfc.

ulburr rsrtr
nsufcn rsrtr rstrctv s ntlnt n crzl cu sct vlumn s
cr dtrmn mngr dfrgmulu n sus. r brntlr numn st
fvrzt d scdr rzstn l nfc. n 10% CH dcmnst vsculr st nst
d hdrtr unltrl (cl m frcvnt n drt).

b#

%l!^+a?

ulburr dgstv
S-u dscrs sr d mnfstr bucfrngn ( dlr lmb, usccun
mucs lbl tc.) scundr crntlr vtmnc. Ulcrul gstrc dudnl rcum
ltz vzculr sunt m frcvnt. L blnv crtc cr nu u ulcr, crctr
scr gstrc vdnz hcdtt. rt dntr blnv rznt nsufcn
ncrtc crn.

ulburr rnl
n CH, n cud un hrvlm glbl, vlumul sngun fcc st sczut
cst r rrcursun sur trtrulu rnl (sndrm ht-rnl, cdz tubulr
rnl).
ulburr nrvs
r smtmlr tst rzn unu stdu vnst l crz.
lt tulburr
) fbr mdrt, nst dsr un usu vlutv. M t f rznt n
nfc bctrn, ulmnr, cutnt;
b) nm r c urmr unr mcnsm multl :
- nm hcrm scundr un hmrg dgstv;
- nm hmltc rr;
- nm mcrctr c urmr cun mdultc lclulu crnt d
B 12 cd flc.
c) scdr rzstn l nfc r n cntrst cu crtr gmglbulnlr,
cr rrznt surtul mmunlgc d ntcr.
3.4 CLSFCR
. Mrflgc:
) crz mcrndulr crz lclc;
b) crz mcrndulr crz sthttc (vrl, tc);
c) crz mt crz blr rmtv, crz blr scundr.
B. ttgnc:
) crz lclc (rtl su grs ): crz trfc (lnnc), crz hrtrfc
(hnt-glbrt);
84

b) crz sthttc (stvrl);

c) crz blr: rmtv scundr (clsttc clngtc);
d) crz tc: ndustrl (lumb, bnzn, rsnu), mdcmnts (znzd,
ttrccln tc.);
) crz nutrnl: mlnutr rtc (bl wshrwr);
f) crz cngstv: nsufcnt crdc glbl, rcrdt cnstrctv, sndrmul
Budd- Chr, crz crdc (bl ck);
g) crz gntc: (mtl tzursmz): dgnrscnt htlntculr (bl
Wlsn), hmcrmtz dtc (dbt brnzt);
h) crz slngn (Bnt).
b#%l!^+a?

CLUL V
BLU CLNC
Clnc, ndffrnt d tlg, smtmtlg CH, cu unl rtculrt, st
smntr.L rt dntr blnv, fcun t rmn ltnt, fr rs
clnc, bnut ns, CH vluz n du rd, un cmnst, rltv src n
mnfstr clnc, lt dcmnst und, smtmtlg clnc d bgt
vrt nct n mrtt czurlr, st sufcnt ntru stbvlr dgnstculu.
4.1 RD CMNS
n cst rd st m mult smtm smn clnc dr cr, lu t
ndvdul, nu u nc scftt.
- smtm dgstv : ntnt (ntru crn grs), snz d stt rcc,
mtrsm, fltulnt, durr vg bdmnl, tulburr d trnst (cnst/ dr);
- smtm d rdn nrvs: rscbltt, nsmn, cmrur, cfl, ml,
stn fzc ntlctul;
- lt smtm: scdr lbdulu, tulburr l cclulu mnstrul, mnfstr
lrgc (urtcr, rurt),sngrr l mucslr du trumtsm mnm (gngvrg
du r gngvl).
mnul bctv t vdntl:
- str d dnutr, m ccntut l f;
- smn cutnt: rtrz lmr, rtrz fcl cu vrczt l mlr (l
lclc),stlu vsculr, hlztt (n scl ubn), chmz;
- subctr l rt dntr blnv;
- mnul bdmnulu lv htmgl, bnut mdrt, ndurrs,
cnsstnt frm, mbl, cu surf nrgult.
bdmnul st ur dstns, tmnc (sct lst) unr rznt dscrt
crcul cltrl.n unl czur s t l lul nfrr l sln.
rbu sublnt c nu tt cst smn s ntlnsc ssct l cl blnv;
d mult r, cu c htmgl, mnul bctv st ngtv.Rzult c n
85

cst rd, ntru stblr dgnstculu,sunt ncsr mn cmlmntr,

dntr cr du sunt snl: lrsc unc bs htc.

4.2 RD DCMNS
Mdul d nstlr dcmnsr CH t f rgrsv su brusc (n cursul un
nfc ntrcurnt, hmrg dgstv tc.). D mdltl d dcmnsr sunt strns
lgt ntr l, s flssc currnt dnumrl d dcmnsr vsculr 9sct)
rnchmts (ctr, ncflt rtl lus ccntur slnmgl
crcul rtcv,cm htc). n cst rd clnc CH st dsbt d bgt
n smtm smn fzc.
sct rrznt c m crctrstc mnfstr clnc crz.Cnttt
lchdulu sctc vrz d l 3-5 l l st 20 l. L nsc,bdmnul st mrt d
vlum (cntrstnd cu f, trcl mmbrl surr, cr dsr sunt ntr- st r d
mcr),cu sct dfrt du cum blnvul st mnt n rtsttsm (sct d
dsg)su clnsttsm (sct d btrcn).Cnd cnttt d lchd st bundnt
s cnstt hrn mblcl(n dgt d mnu). rtl bdmnl s bsrv
crcul cltrl crctrstc.lr bdmnulu, bnut ndurrs, n d
snz d rzstn sml su lstc. Cmbnnd lr cu rcu s bn smnul
vlulu. rcu n rd mttt cu chrctr hdrc n tcv.
sct t f nst d dm l mmbrl nfrr, lb, m, hdrtr, d
bc cu sdul n drt. ctrul survn sdc n unl crz, c smn d rbur rn
ncrz htctr, n ltl cum sunt crzl blr r un ctrctr rmnnt.
Crcul cltrl r d bc sdul surmblcl l bz ntrr trclu
(rs nstmzlr rtcv surr), m rr submblcl n fsl lc
(rs nstmzlr rtcv nfrr).
Smn cutnt. Stlul vsculr u sdul bnut gt, rt surr
trclu, zn clrulu, ft, umr.rtmul lmr r c rst lclzt n
rgunl tnr htnr (mn htc);cmrsun fc s dsr rtmul,
l s lbt, dr rst rvn ndt c cmrsun nctz. l blnvulu st
n gnrl subt, usct, unr cu zn d hrgmntr, chmz su urur. L
crtc tlc r vrczt fn l nvlul mlr rlr nsulu. r mdfcr
l unghlr- crtr frglt, ungh lb. lztt l nvlul ft ntrr
trclu l brb st dsr mult dmnut su chr bsnt, rul ubn mbrc
unr un mdl smntr clu d fm, r l mbl s lztt lr st
rdus.
ulburr ndcrn: gncmst, rdr lbdulu, mtn, trf
tstculr, tulburr l cclulu mnstrul. Dbtul zhrt r d 2-3 r m frcvnt,
utnd f chlbrt num rn rgm lmntr, rr ncstnd trtmnt rl cu
ntdbtc num cnl cu nsuln.
ulburr nrvs s ntlnsc n tt cursul vlu crz. D mult r, rzn
un smnlnt, un stn cssv su str d nlnt cu nsmn t f smn
rmntr ntru drm htc c v urm.
ulburr dgstv: tt smtml dscrs l rd cmnst s
ccntuz. r rfluul gstrsfgn, hmrz, ulcrul gstrc dudnl (m
frcvnt l c cu nstmz rtcv) unr gstrt crnc (st m mult cnscn
b#%l!^+a?

86

lclsmulu).
ulburr crd-vsculr: dbtul crdc cr st d rgul crscut n crzl
dcmnst vsculr. Blnv rznt ds lt, dsn cnz dscrt
trmtlr, ulsul st thcrdc, r tnsun rtrl m sczut dct l
nrml.Mnfstr ulmnr: scdr stur n ygn snglu rtrl, mnfstr
d t brntc.
ulburr hmtlgc: nm c m bnut frm st hcrm
(scundr hmrg dgstv) clllt tur fn rr. Lucctl trmbctl t f
nrml su sczut (hrslnsm). Lucctz r n cmlc d t
nfcs.rturbr rnl. n stdl vnst, durz scd; nsufcnt rnl st
ntlnt ntr- rr n l 11%. Fbr st dsr rznt n crz lclc un
rblm dfcl d dgnstc (nfc bctrn).Unr ns, n stdul trmnl, CH s
t ns d htrm. Mdfcr htslnc. Fctul s mcrz rgrsv d
vlum, dt cu vlu bl; slnmgl st rznt n 50% dn czur.
ulburr d nutr: sunt m ccntut dct n rd cmnst, mul
ungnd n stdul fnl d c.
lt mnfstr : hrtrf glndlr rtd, tulburr mtblc.
b#%l!^+a?

4.3 MN RCLNC
mnl d lbrtr rm rn mtd bctv mdfcrl survnt n
mrflg, fzlg bchm rgnsmulu, dn cst mtv l cnsttu un utr
rs, d mult r ncsr ntru stblr dgnstculu, nsttur trtmntulu
urmrr vlu bl.
Dgnstcul rclnc trbu s s srn cl rb cr s t cut cu
uurn, rd du un rcnt smnfctv d rzultt ztv.
1. lrr funcnl
stl d lrr funcnl ftulu sunt mdfct su nu n func d fz
vlutv CH. stfl, n rd d dbut c d cmnsr, rt mrtnt
cstr tst t f n lmt nrml drc fctul rut nc s dsfr ctvtt
funcnl stsfctr. Dn cntr, n rd dcmnst, tstl sunt mdfct, dr
cum dgnstcul st ur d stblty clnc nu st ncsr, n r ctc, fctu r
ntrg gm d rr, c num lgr clr m fdl.
- lrr func blr:
* crtr blrubnm, n gnrl d t mt (n crzl htc, crzl
blr rmtv, sndrmul Budd-Chr);
* urblngn urnr (n crzl htc);
* crtr mdrt fsftz lkln n sr (n CH, crz blr
rmtv,sndrmul Budd-Chr).
- sndrmul d htctlz:
* sdrm crscut (n crzl tlc,hmcrmtz dtc, CH, crz
blr rmtv, sndrmul Budd-Chr );
* crtr trnsmnzlr, mdrt vrbl n rrt cu grvr lzunlr
mtblc dn htct.
- sndrmul htrv:
* hlbunm (n CH, sndrmul Budd-Chr), r cvscnstnt ntlnt;
* scdr fbrngnulu lsmtc (n CH);
87

* rlungr tmulu d rtrmbn (tm Quck 250%); (n CH, sndrmul BuddChr);

* hrglcm, cnd crz st sct cu dbtul zhrt;
* ld ttl (crscut n crz blr rmtv sczut n CH ) clstrl
sczut (n CH crscut n crz blr rmtv);
* rtn nrml BS n sng (st 5% l 45 mn.).
- sndrmul d hrctvtt mznchml:
* tstl d dsrtnm su d lbltt src sunt stv (st ncsr tstul
cu tml);
* lctrfrz rtnlr lsmtc vdnz crtr glmglbulnlr cu
~ 2/3 dn czur (n CH n crz blr rmtv).
- nvstg hmtltc:
* dtrmnr hmglbn, numrulu d hmt, lucct trmbct;
* nm mdrt (n CH crz blr rmtv);
*lucn /su trmbctn, n func d rzn hrlnsmulu (n CH
hmrmtz dtc).
b#%l!^+a?

lrr mrflgc
- lrsc st mtd sml, dr cr dduc dt snl ntru
dgnstcul CH. lng rtul su dgnstc, cst rcz grdul d vlu
bl (s vdnz sctul mcrscc l fctulu);
- BH s t fc drt, n tmul lrsc su n fr , c l
ntrcstl (s urmrt sctul hstlgc l crz).
Scntgrm htc
- vdnz hctr htc (m mult su m un mgn) substn
rdctv fr mr trhtc (slnc).
lrr vsculr
Slnrtgrf d rl sur str ntmc funcnl sstmulu
r tr ntrhtc (vdnnd n scl vrc gstrc sfgn).
lrr rdlgc
mnul rdlgc brtt s-gstr-dudnl st bn d fctut n tt
czurl ntru vdnr vrclr sfgn unu vntul ulcr gstrc su
dudnl sct.
lrr ndscc
sfgsc- cu rtur fbrtc rrznt mtd drct ntru
vdnr vrclr sfgn, surr cl rdlgc.
lt lrr
- lrr lchdulu d sct (sct mcrscc, rc Rvlt, ctlg) rn
unc lrtr bdmnl;
- ncflgrm- dc blnvul rznt smtm nurshc (und tht dlt);
- dtrmnr munlgc 9munlctrfrz, ntcr ntnuclr
ntctlsmtc, gHBs, lf-ft-rtn).
88

Drc smnl clnc sunt vdnt, r rbl funcnl sunt ltrt

nunfrm, ntru dgnstcul CH sunt sufcnt urmtrl nvstg: ndcl d
rtrmbn Quck, rtn BS, blrubn src urblngnul urnr, hmlucgrm
cmlt, scntgrm htc, mnul brtt sfgn lrsc n trms.
4.4 DGNSC V
b#%l!^+a?

n stdul cmnst l CH dgnstcul st dfcl dtrt smtmtlg

src. Htmgl cu ntcdnt d htt vrl /su tlsm crnc sugrz
dgnstcul, cr st cnfrmt d mnl rclnc, dntr cr cl m v lr s
sunt :ndcl d rtrmbn, rtn BS, scntgrm htc, BH lrsc.
n stdul rcmnst, dgnstcul st rltv ur dtrt smnlr clnc
rclnc vdnt (fct trhc, slnmgl, crcul clstrl, sct, ctr,
hmrg dgstv, mnl rclncdn stdul cmnst mnus BH).
4.5 DGNSC DFRNL
Dgnstcul dfrnl v f dsbt d l cz l cz, du rdmnnt
smtmlr.
- sct;
- dgnstcul d sndrm sctc s fc rn cludr bzt bdmnl
rtn d urn (l mbl s), srcn chstulu vrn, mn clnc
rclnc dcvt;
- dgnstcul tlgc du sttstc, cl m frgvnt czur l sct sunt
nlz 50%, crz htc 30%, nsufcnt crdc 10% lt cuz 10%.sct, n
fr CH, rcunt cuz dvrs:
- nflmtr:rtnt (tubrculz stc, clgnzc) trdus rn fbr,
cntrctur bdmnl rzn d udt;
- nlzc;mtstz dgstv, gntl tc.;
- crdc:nsufcnt crdc glbl, rcrdt cnstrctv;
- sndrmul nfrtc;
- mlnutr 9hrtnm, dr cu hclstrlm fr smn urnr);
- mdm;
- sndrmul Dmns- Mgs (fm tnr cu sct tumr vrn).
- ctrul:sndrmul ctrc dn CH s v dsb d ctrul htclulr, bstructv
hmltc d cuz dvrs.
- htmgl : - lzun dfuzc htc: htt (vrl su mdcmnts),
htt crnc ctv, CH lclc, stncrtc (cu c stdulu vnst, cnd
fctul st mc), crz blr rmtv, tubrculz htc, sfls htc, ltsrz
ctrhmrgc, stcm, bruclz, lukm, bl Hdgkn;
- stz blr: clcul cldcn, tumr mlgn su bngn l clr blr;
- stz vns: nsufcnt crdc glbl, rcrdt cnstrctv, sndrmul
Budd- Chr;
- fcun zs d surncrcr: sttz htc, mldz, hmcrmtz,
bl Wlsn.
- un dgnstc dfrnl cr v f fcut cu tn, st cl cu htt crnc
grsv cu htt crnc crgn; n htt crnc st smn d rsrv
funcnl htc: lbumnm rmn st 3,5g % ndcl d rtrmbn st 50%,
89

BS st 6%, cu tmul d mbuntr sub 10 mnut, hrtnsun rtl st fr

rflu.
rczr fc ns unc htc, rtnd n htt strr rhtctnc
htc.
4.6 FRM CLNC
b#%l!^+a?

Crz lclc (Lnnc, rtl, stl, mcrndulr s ntlnt m

frcvnt l brb, du 40 d n.
ncdnt CH lclc st drct rrnl cu durt (20-25 n) sn u cu
cnttt d cnsum tnlc, fnd mm n ur d Vst mrc, n unl r
ungnd n l 90%. n r nstr frcvn st vlut l 40%, stundu-s du
c d tlg vrl.
Dbutul st, d bc, nsds. Blnvul dclr, ds, c vut ndgst n
d- rndul, c s- smt d vgr, su btrn nnt d-vrm c nu tut nmc
sur bl ctul, n c u survnt blnr bdmnl, ctrul su hmrg.
Crz Lnnc vluz cu fct nl hrtrfc (sttz), trhc,
lnfrt rfrc, hrtrf glndlr rtd n 20-30%, dcmnsr
rnchmts vsculr, nm mcrctr, gmglbuln crscut. L BH
dvrs std l fctulu lchlc, n lus, rznt crlr Mlry (frgmnt d
rgnt clulr). rtmnt cmun l CH.
Crz sthttc (stvrl, stncrtc, mcrndulr): st cnscn
un htt cut cu vrus B (gHBs) su nn-nn-B, trcnd rn stdul d h tt
crnc ctv.
ncdnt ntru r nstr st n md d 60%, r ntru rl vst-urn
0,5-3%, ntlnndu-s l rc vrst m frcvnt l fm.Dbutz cu ndsz,
nr, gr, vrstur, durr bdmnl, fcl dclrt,urn ntns clrt.n
cst frm, fctul st bnut rdus d vlum d l ncut, htrf musculr st
rdus, ctrul st m ntns, rsstnt rcc
Sunt frcvnt dcmnsrl vsculr rnchmts, lrtrlgl, rurtul
tndn d mlgnzr (155). Sunt rznt hrblrubnm, hrtrnsmnzm
hrgmglbulnm. BH stblt dgnstcul, unnd n vdn nfltrt
lmflsmctr ncrz clulr.rtmnt cmun l CH.
Crz blr:
) crz blr rmtv- st bl rr ntlnt, rdmnnt l fm, ntr 4060 d n. Crz Hnt, rut rn bstcl ntrhtc st vrnt clsttc
httlr trcut d crnczr. Fctul st mr, cu sct d stz blr, fn, nrgul t,
slnmgl, ctrul st rmnnt, rurt, lzun d grt, nctm, l ngrt,
sr, nsmn, mlndrm (l ngrcs), dr d t sttrc ncnstnt, str
gnrl ttul s mnn mult tm bun, fbr durr bdmnl sunt rr ntlnt;
unr r hcrnsm dgtl ulcr dudnl; blrubnm crscut urblngnur
rmnnt, fsftz lcln crscut. n stdul fnl, r sct, dm, hmrg
dgstv. Hstlgc-mnsn lmfd rblr (chrctrstc), fbrz rtl
ntrlbulr mdrt.
rtmnt rducr grsmlr l 40-50 gr/z, dmnstrr d vtmn
lslubl (,D,) dtrt ls srurlr blr, mundrsv (crtcstrz
murn). n fz dcmnst trtmntul gnrl.
b) crz blr scundr r rn bstruc clr blr trhtc. Du
90

mcnsmul d rducr t f :
- clsttc rn stz blr rlungt (dtrt ltz cldcn, nlsmulu
clr blr, stnz cldcn strtr). Smtm dntc cu CB, dr ctrul
st m ntns, cu nun brunvrzu durrl dn hcndrul drt cu chrctr
clctv, r tstul ntru ntcr-ntmtcndr st ngtv.
- clngtc rn nfc blr rlungt. Smtm dntc, n lus fbr
lucct l tubul dudnl.
Sunt du tur d crz blr scundr un lzun bstructv crnc n sstm
blr trhtc:
) dtrt trz cngntl cnllr blr s ntlnt num l c;
b) dtrt unr rcs trumtc su tlgc ntrsnd cnll blr s
ntlnt l dul.
rtmnt tlgc (ntbtc chrurgcl ) dmnstrr vtmnlr
lslubl , D, .
Crz cngstv:
- crz crdc cngst vns crnc fctulu dtrt nsufcnt
crdc glbl rcrdt cnstrctv (bl ck).
b#%l!^+a?

Unl dfrn ntr crz lnnc (lclc) crz stncrtc (sthttc)

CR LNNC
NCDN:
1. lclsm
2. htt vrl
D CLNC:
1. sul
2. vrst
3. fctul
4.hrtrf glndlr
rtd
5.lnvrt rfrc
6.cntrctur Duuytrn
7. cncrul htc
8.dcmnsr vsculr
(sct)
9.dcmnsr
rnchmts(ctr, H)

CR
SNCRC

Frcvnt
Rr

R r
Fcvnt

rdmn l brb
bnut st 40 n
Htmgl n stdul
cmnst
20-30% dn czur

rdmn l fm
rc vrst
bnut rdus d vlum
d l ncut
Rr

Frcvn
25-30% dn czur
Sub 5% dn czur
Frt frcvn

Frt rr
Rr
rmtv 15% dn
czur
Frcvn

Frcvn

Frt frcvn

91

b#%l!^+a?

D BLGC:
1. nm mcrctr
2. gmglbulnl
3. ntcr
ntfbrn musculr
ntd,
ntcr ntnuclr
D
NMLGC
Mcrscc
1. vlumul fctulu
2. dmtrul ndullr
3. tul d crz
Mcrscc
1. sttz
2. cr Mllry
3. sctul fbrz

Frcvn
Crscut
bsn

Rr
Mult crscut
rzn l 25-30% dn
czur

Mrt d vlum lung rd,

trfc
Sub 0,5 cm
Mcrndulr

Nrml su mc d l
ncut
bnut st 2 cm
Mcrndulr

Frcvn
rzn
Stur cr unsc sl rt
Vrbl

Rr
bsn
Fr sstmtzr
(dtrt clsulu)
Vrbl (c ml
ncrss n us
vlutv)

4. ncrz htclulr

Htmgl ulstl cu bsn sndrmulu d H (chrctrstc), dr rflu

ht-ugulr rznt. Mcrscc s bsrv cngst cntrlbulr, fbrz mm
cntrznl ncrz htclulr. Smnl crdc clnc, rdlgc CG
rczz dgnstcul.
rtmnt- crdtnc durtc; trtmntul gnrl.
- sndrmul Budd-Chr- bstruc vnlr surhtc d cuz dvrs
(cngntl, trmbz, nflm, nlz).
Htmgl vlumns durrs, sct, slnmgl mdrt,
crcul cltrl, bsn rfluulu htugulr (chrctrstc). st htc
nsmnfctv cu c rtn BS crscut ltcm.
rtmn - cmbtr sct trtmntul chrurgcl ntru ndrtr
bstclulu vns (rzultt ncnstnt).
Crz htc gntc (mtl- tzurzmz):
) dgnrscnt htlntculr (bl Wlsn).
nml gntc c s crctrzz rn bsrb ntstnl crscut curulu,
dtrt un crnt ndgn d crullsmn, cu dunr csulu d mtl l
nvlul SR l fctulu fbrz scundr (crz) n nuclul lntculr mmbr n
Dcmnt crn (nlul ysr- Flschr, d culr brun n urul crn). nstlr
smtmlr r lc ntr vrst d 10-25 d n num cu ttul cn l du 40 d
n.
r mnfstr htc ( ctr rcdvnt, sct, hmtmz, smntr clr
b#%l!^+a?

92

dn crz Lnnc) mnfstr nurlgc: l c- rgdtt mrsulu, stngc

mcrlr fn, ltrr scrsulu, blnvul mnnc m nct, fctz vrbr, st
mntn, unr lzv;dsfg, trmurtur, rnt mbl, slr, lmb rgd,
mmbr rgd, str d dmnt, tulburr d cmrtmnt, hrrctvtt mtv.
L dult r mcr smtrc, rgdtt, dsrtr, dsfg, rc
schzfrnd, nl sr- Flschr. Crullsmn src st sczut, hcurm,
fsftur, glczur. Durt bl vrz d l ctv stmn l 41 d n, ns d bc
d l 13 n, n frm d bl cut.
rtmnt- dmnstrr d gn chltr curulu (D- ncllsmn 1,5- 2,5
gr/z tm d 1 n, dz d ntrnr (1gr/z), dtmn) trtmntul cmun l CH.
b) hmcrmtz dtc, (hmsdrz, dbt brnzt).
nml gntc c s crctrzz rn bsrb ntstnl crscut frulu,
dtrt unu dfct nzmt, cu dunr csulu d mtl n fct, ncr s, sln,
tgumnt, mcrd, glnd ndcrn. Bl st m frcvn l brb ntr 40- 60 d
n.
Fctul st mrt d cnsstnt crscut, d culr rtc: lzundgnrtv
ncrtc fbrz r n fct n rgnll mntt; rc ntru gmnt frc (rls)
st ztv n tt cst rgn. Str gnrl st ltrt, stnd stn
ccntut, tgumntl sunt gmntt n brun- cnuu (brnzt), m ls f
ntbr, l st subr usct, dscumt (slzs), trf tstculr,
mnr, slnmgl, hlztt, stlu vsculr, rtm, smltm d nsufcnt
crdc cngstv. Dbtul, d grvtt mlc ur, st rznt n mr
mrtt czurlr.
rtmnt sngrr rtt (500ml/ stmn), gn chltr frulu
(Dsfrl 1mg/z .m.), trtmntul cmun l CH dbtulu brnzt.
c) crz nfntl uvnl (glctzm, bl Guchr, Nmnn-ck )vlu clnc st vrbl vdnt dnd d tlg. rbu susct c cu un
strc d ctr rlungt, l vrst frt mc, htslnmgl, c cr nu crsc
cr nu s dzvlt.
Sndrm bntn:
) bl Bnt, cu rd rmrgtr n cr st rznt num
slnmgl : r smn d hrslnsm m trzu, du cv n, survn
smnl crz trfc sctgn;
b) crz htc slnmglc, cr vluz cu hslnsm hmtlgc.
N: t CH nl sunt hrtrfc (cu c crz sthttc cr
st trfc d l ncut CB cr rmn rmnnt hrtrfc): msur c CH
s dcmnsz, fctul s trfz, r slnmgl s ccntuz.
4.7 CMLC

b#%l!^+a?

1. Hmrg dgstv surr (HDS)

HDS r frcvnt, fnd rvct d rur vnlr flt sub rsun
crscut n cndl H, d rgul l nvlul vrclr sfgn.
Rutur vrclr dtrmn n scl hmtmz, dsr msv, mnfstt
sub frm d vrstur cu sng rst, ru dschs su nchs l culr (tr nsfrmr
hmglbn n hmtm sub cun HC dn stmc). C rgul, rc hmtmz s
nst d rzn snglu n scun, dr cst vrz d l un sct tc mlnc
93

(scun ngru c cur lucs) l unul nrml, dr cu hmrg cult stv.

n func d ntnstt hmrg, smtml clnc vrz d l sml
stn l cl cr tst nstlr str d c hmrgc.
Mrtltt du HDS (Stlul Gnrl dn Msschustts)
71 blnv crz mr
1 lun
6 lun
12 lun
2 n
4 n
7 n

16
29
38
46
55
58

23%
41%
54%
65%
77%
82%

19 blnv Sndrm Bnt

mr
1
5%
1
5%
1
5%
1
5%
5
26%
8
42%

Stdl d dbut vlu cm htc

MNFSR
RDRML

RCM

SUR

SR
SHC
ufr, unr
drsun. Str
cnfuznl
bsn su gru d
bsrvt. Ur
lntr shc.
Dzrntr.
Cnfuz mntl.
D rgul ufr,
smnln,
tulburr d
cmrtmnt.
Smn r
cntnuu, dn cr
ns blnvul t
f trzt. Cnfuz
mntl mrct.
rdr cmlt
cuntn. Rc
l stmul rznt
su bsn, n
func d
rfunzm cm.

RMR
Dsr rznt, dr
dscrt.

MDFCR
CG
D rgul bsn.

D bc rznt
ur vdntbl.

r ttdun
rznt.

D bc rznt
(dc blnvul
t cr)

r ttdun
rznt.

D bc bsnt
(tn musculr).

Dsr rznt.

b#%l!^+a?

SUBCM SU
CM

rgnstcul mdt st dsbt d grv, mrtltt fnd ntr 50- 70%.

94

rgnstcul m ndrtt st, d smn, grv, mr mrtt dcdnd n

urmtrl 12 lun (rn rtr hmrg su cm htc).
2. ncflt htrtl (H) su cm sud-htc.
S nstlz d bc rd, n ctv r st dclnt d hmrg
dgstv, d lmnt cu rtn n cs, d dsbctr ntstnl su d
dmnstrr unr mdcmnt cum sunt clrur d mn, slurctl durtcl
mrcurl.
Cuz ncflt cnsttu ntcr SNC cu substn cr rzult dn
dgrdr rtnlr ntstnl su cr nu u utut f mtblzt d fct (:
mnc).
sct clnc:
- tulburr d cuntn cmrtmnt: str d t, lntr ntlctul,
rtbltt, gt, ufr, grsvtt, cmrtmnt bzr rnd, crz d gt
shmtr ltrnnd cu str d smnln, tulburr mncl, dlr hlucn. ntrun stdum vnst r trr rgrsv cr mrg n l str cmts dn
cr, dn cnd n cnd, blnvul s trzt brusc, cmlt dzrntt, gtt, c , s
rcd n str cmts;
- tulburr nurlgc: flng trmr ( mcr scurt, nvluntr d fltns l mnlr dgtlr, smntr cu btl rlr l sr), hrtn
musculr znl, rfl sttndns v, unr smnul Bbnsk un- su b
ltrl;
- ftr htcus: mrs utrnc, zbtr, l rulu rt d ctr blnvul
cmts (mrs d lut, mucg, mr utrd, dvlc ct, fn rst cst);
- Hrvntl: st rsnsbl d lclz rsrtr cu hcn. n func
d ntnstt fnmnlr clnc, H fst mrt n 4 grd:
- Grdul - tulburr d cmrtmnt, cnfuz, dzrntr;
- Grdul - mnfstrl s ccntuz, blnvul fnd cmlt dzrntt
smnlnt;
- Grdul - smnlnt cntnu dn cr blnvul t f trzt;
- Grdul V d cm rfund bsn rc l stmul durr
vlu H s fc f sr mrt, f , m ds, dn cntr, sr rgrsun,
cnd dn cuz dclnt t f crctt r rnchmul htc nu s gst ntr-un
stdum vnst d dstrugr.
3. Sndrmul ht-rnl (SHR)
n r lu, un rl mr fst trbut substnlr tc rdus d fctul
blnv su clr cr nu t f ndrtt dn crcul dn cuz nsufcnt h tc, d r
vscnstrc rnl. Lucrul cl m ntrsnt st c rnch blnvulu crtc sunt
nrml ntmc hstlgc. SH r r nttdun l blnv cu CH
dcmnst vsculr rnchmts; n md bnut crz st d tlg lclc.
blnv u sct n cnttt rcbl rtn mr d sdu.
rgnstcul st grv, frt un blnv vnd ns s survusc.
4. Cncrul htc.
st m frcvnt l brbt dct l fm, ncdnt mm fnd du vrst d 50
d n. ln clnc, htmgl, durr l nvlul hcndrulu drt fbr sunt
smnl cl m mrtnt . ln bchmc, crtr fsftz lkln src,
rznt unu lchd d sct sngunlnt VSH-ulu cclrt, cr ns v f stblt
rn lrsc BH drt.

b#%l!^+a?

95

5. rmbz trmbflbt rtl .

Survnr cst cmlc st suscnt cnd r trd: fbr+durr
bdmnl+ ccntur sct.
6. nfc ntrcurnt.
Dfrt nfc( ulmnr, cutnt, tc.),t r rcnd n cursul vlu un
CH.
7. lt cmlct- ncrcrr strngulr hrn mblcl, rutur
mblculu ( rtnt cut), cluz ntstnl, rtnt crnc bclr, nfc
ntstnl, stcm.
4.8 VLU . RGNSC
1. CRL HC SCGN
vlu st rgrsv rctt d r unr cmlc mr, stfl nct
mrtt blnvlr dcdz n m un d 2 n d l r sct.
rgnstcul st cu mult m ntunct. Unl msur t, ttu, mlr
rgnstcul: bstnnt lclc, trtmntul rmt l ccdntlr nfcs, rcum
vtr rrlr trutc.
2. CR BLR RMV
vlu, n bsn un trutc scfc st lnt, rvrsbl, r d d
m mul n (5-10-15) n cnd blnvul s rd rn fnmn d nsufcn h tc
grv, rctt d HDS su nfc ntrcurnt.
rgnstcul, d m bun dct l CH sctgn, rmn sumbru. S rcz c
cu ct ctrul st m ntns, cu tt rgnstcul st m grv. Cmlc l ntunc
m mult rgnstcul.
3. CR BLR SCUNDR
vlu st rgrsv, ungndu-s du n l nstlr sndrmulu d H
nsufcn htc grv. rgnstcul dnd n mr msur d ntur bstclulu,
rmn ns cu mult m bun dct n clllt tur d crz, dc s rut c bstclul
s f nlturt ntr- fz ncnt.
4. HMCRM DC
vlu st lnt, durt survur fnd d 4-8 n d l stblr
dgnstculu, blnv dcdnd rn cm htc, HDS su nsufcnt crdc. Chr
n rzn unu trtmnt dcvt susnut, rgnstcul rmn rzrvt, vnd n vdr
rscul rdct l cstr blnv d dzvlt cncr htc.
5. BL WLSN
Fr trtmnt vlu st rgrsv, survur ndnd vrst d 40 d
n. rgnstcul st bun dc trtmntul s lc crrct nnt nstlr lzunlr
rvrsbl n crr fct . Mrt s rduc rn cm htc, HDS su nfc
ntrcurnt.
6. SNDRMUL BUDD-CHR
rgnstcul dnd n rmul rnd d fcun d bz, stfl nct survur
blnvlr vrz d l ctv lun l cv n.
7. CR NFNL UVNL
rgnstcul ndrtt l mrt turlr d crz uvnl st dfvrbl, n
scl dc s- nstlt H.

b#%l!^+a?

96

CLUL V
RMNUL CRLR HC
5.1.RMNUL
rtmntul crzlr urmrt surmr cuzlr, cmbtr rcsulu
nflmtr rclr munlgc n cs, cmbtr rcsulu nflmtr
rclr munlgc n cs, stmulr rgnrr htc rvnr cmlclr.
rtmntul trbu s f ndvdulzt, cml, mtdc sstmtzt. S rcmnd
stlzr l 4-5 lun n cursul dcmnsrlr.
RUSUL: st blgtru l t n crzl dcmnst.n cl cmnst,
rusul v f rltv, n l 14 r/z c lun d rus cmlt l t. Vr f
ntrzs frturl fzc cl ntlctul.
D: trbu s sgur un rgm lmntr cmlt bgt n vtmn.
rtnl vr f dt n rr d 1,5g/kg/z, rtul fnd rdus n c zurl cu H.
Glucdl s rcmnd n cnttt d 400g/z. Ldl vr f lmtt l 60-80g/z fnd
rfrt cl d rgn vgtl; n crzl blr t crt n l 120g/z sub frm d
ul. Rstrcl vr rv lclul, cnsrvl, fumturl, mzlurl, brnzturl
frmntt. Dt crtclr v n sm d tulburrl dgstv d nsr. n mdul d
rrr culnr s vr ntrzc rll, ssurl cu rnt, cndmntrl rtnt. n
czurl cu sct s v rduc rtul d lchd, r rgmul v f hsdt.
RMNUL LGC: s v drs fcunlr rsnsbl d r
crzlr su clr cr cnsttu lmnt d grsvtt htc. stfl, n crzl
blr cu bstcl trhtc s v rcd l ndrtr bstclulu. n nfcl
clr blr s vr fc trtmnt cu ntbtc sub ndc ntbgrm. Sflsul v f
trtt cu ncln; n hmcrmtz s v ncrc lmnr frulu n cs rn
msun rtt d sng; n dgnrscnt htlntculr s v fc trtmnt cu
D.
RMNUL GNC: Crtctr, cu cun ntnflmtr,
durtc d stmulr ttulu, r ndc n crzl cu hrslnsm, sct
clstz. Nu s v d crtzn n czurl d trmbz rtl. r munsursv nu
st rcmndbl n crz. ntru stmulr rgnrr htctr s rscru tr ct
htc cncntrt, bn urfct, cu vtmnl B1, B2, B12, C, r rt c
Mcr, urnr, Ltrsn. ntu sttz htc s rcmnd fctr ltr. D c
r tulburr n scr blr, s rcmnd clgg. n sndrml hmrgrs
dmnstrz vtmn 1 sub cntrlul ndclu d rtrmbn. n hrslnsm s f c
crtctr, s dmnstrz ms trmbctrs, l nv, s lz l
slnmgl. n crzl rmtv s rcmnd vtmnl lslubl , D, , r r t
cu clcu frmn ncrtc.
RMNUL SC: Dt v f hsdt, bgt n tsu, rn sucur d
fruct, fruct usct ur rstrc d lchd. Clnsttsmul st un fctr mrtnt
ntru mbuntr durz. Dntr durtcl flst sunt d rfrt rmtrn
(300mg/z), mlrd (30mg/z), tcrn,Fursmd, Nfr, Ufr. S flssc cu mult succs

b#%l!^+a?

97

srnlctnl (ldctn). ntru bn bun durz trbu crctt hvlm

rn rfuz cu slu hrtn d glucz, cu lbumn umn, cu ms rtrctr, cu
Mntl; l nv, s t fc trnsfuz cu sng ttl, crtcul surtnd bn sngl
gru nm. rcntz nu s rcmnd. S v fc num l ncsstt, dc sct
nz funcl crdrsrtr; s sct cntt d mmum 4-51, cncmtnt
dmnstrndu-s .v. lbumn umn su Dtrn 70. rcntz st urmt d tr
durtc d ntrnr. n cursul tr sct, s urmrt rn cntrr zlnc l c
r, c blnvul cu sct, fr dm l mmbrl nfrr, s rd 1,5kg/z, r cl cu
dm 2-3kg/z.
RMN CHRURGCL: slnctm ndct n rmul stdu l crz
d t bntn n hrslnsmul svr. nstmzl rtcv cut s surm H.
Lgtur vsulr d vrc sfgn su gstrc.
rtmntul CH cmnst:
S vr vt frturl fzc mr, lmnt trbu s f bgt(2500-3000cl),
chlbrt cu rt d rtn (1,5-2g/kg c) cu rtul nrml d glucd ld cu cz
gr nstur. lclul v f surmt dfntv. S vr dmnstr sulmnt
vtmnc (C B), rl su rntrl nblznt (Nsm, M dl). n crz
stncrtc st ndct crtctr (rdnsn 0,5-1 mg/kg , mcrndu-s trtt
dzl) munsursr (murn 100-200 mg/z) su Clrmbucl, tt flst cu
rudn. scr rdnsn (0,20 mg/kg c) cu ctsttc (4mg/24r) mrt fctul
fvrbl rduc rscul r cncrulu htc.
rtmntul CH dcmnst:
- trtmntul sndrmulu dmts s fc rn rus l t, rgm dsdt,
crtctr 30-40mg/z durtc tzdc 2-4 cmrmt/z (Nfr), Fursmd 40 mg
su drn 50 mg, 2-4 cmrmt/ z, durtc smtc (mntl), rmtrn 2-4/ z,
Srnlctn (ldctn) 4-6c/z tc. Durtcl s dmnstrz n cur d 2-3 zl/
stmn nttdun sub cntrl. unc vcutr s rctc num n cz d
ncsstt;
- trtmntul sndrmulu d nsufcn htc rsuun rus l t, dt
chlbrt cu rrt rtc suffcnt, nblznt d sntz (mdl, nsm), vtmn
(B6, B12 cd flc). Crtctr s rcmnd num n rzn fnmnlr
nflmtr. Slnctm s rctc n crz uvnl cu hrslnsm. S m
dmnstrz, du cz, vtmn , fbrngn, lsm n hmrg dfuz n czur
scl cd sln- mncrc;
- trtmntul nm rfuz d sng, cd flc, vtmn B12, fr( Glubfr),
crtctr, unr chr slnctm;
- trtmntul HDS rfuz d sng zgru, substtunt lsmtc (Dtrn
70), unr lcr snd cu bln Sgstkn- Blckmr, hmsttc, rtrhfz,
r ntru rvnr ncflt rtl, scundr hmrg, s rcmnd clsm
vcutr, dmnstrr d nmcn 4-6 g/z. n czurl trm s fc lgtur
vrclr.
- trtmntul ncflt rtl s rduc rtnl sub 1g/kg c, s
dmnstrz ntbtc n cz d nfc (ttrccln s mcln 2g/z,nmcn 3-4
g/z, l cr s dug Mcsttn). nttdun s cmbt cnst cu ltv. n czur
scl s dmnstrz lfctglutrt d rntdn, 40-60g/z;
- trtmntul cm htc rvct d hrmnm, tulburr
hdrlctrltc svr su nsufcn htc grv, rsuun un nsmblu d msur

b#%l!^+a?

98

cr s drsz fctrulu tlgc. ntru mcrr mngnz, s cmbt

cnst cu ltv, flr rtltc cu nmcn 3-4 g/z su ttrccln 2-3g/z.
Rgmul trbu s f hrtc. n czur dsbt s dmnstrz lctulz,
lfctglutrt d rntdn, cd glutmc su clrhdrt d rgnn n rfuz. ntru
rchlbrr
mtblc
s
rcmnd
rfuz
d
glucz,
ndrgn
nblzn(tststrn), crtcz (HHC 300mg/z), clrur d tsu 3-6g/z clrur
d clcu.
rtmntul cm htc ncst n rmul rnd msur d cntrl gndttc: nvstgr tmrtur ulsulu l 4-6 r, mn clnc gnrl, dzr l
1-2 zl N +, Cl-, + n sng urn, rzrv lcln ur, dz r l 3 zl
blrubnm.
Frt mrtnt sunt msurl d ngrr: rsr cmr, gn blnvulu
rufr, schmbr frcvn z blnvulu. Rgmul lmntr rvd un rt
chlbrt d lchd (cr zl rcdnt +500ml), surmr rtnlr
rntrducr cuntn (ct 10-20g/z); dc blnvul nght s d sucur ndulct, dc
nu , glucz 205 snd su cttr .v.n l 200ml/z. S vr dug 0,2-0,5 g N+/z
ct 1,5 + l fcr ltru d slu gluczt.
rtmntul tgnc cnst n clsm nlt, nmcn su ttrccln,
hmdlz, mnftr: cd glutmc, cd srtc, lrngn. S m t d cd
succnc,cd mlc,cstn, vtmn. Gluccrtcz du rzultt bun. Vr f crctt
tulburrl smtml sct : hmrg, gt nurshc, nfcl. n cm cu
slr tsc s dmnstrz clrur d tsu (2-4g/z) n rfuz d glucz.
rnslntul htc r ndc lmtt (crz htc nlclc, crz
blr rmtv, bl Wlsn) ltltt strtr crscut. munsurs cu
cclsrn mlrt survur du trnslnt. st cntrndct l c st 65 d
n n czul crcnmulu htc.
rtmnt nturst CH t f trtt cu suc d rstsc. S b lngur
z, ntr-un hr cu . L fl d ffcnt st tnctur d rstsc, 20 d ctur d 3
r z, nnt mslr rncl.
RFL
sbltl trutc l CH cnsttut rmn rdus n gnrl nfcnt;
rzult dc c mrtn cu ttul dsbt rrznt trtmntul rflctc l cst
fcun cr, n mr, curnd:
1. msur cr vzz rdcr, su cl un scdr brbdtt rn htt
vrl (msur gn-sntr cr rvsc , lmntl sgn rsnl, slcnr
dntrlr d sng rn dtrmnr g HBs, zlr blgtr blnvlr cu htt
vrl); dt rut ns htt vrl l un blnv, tt tn s v ndrt ctr
trtmntul dsnsrzr blnvulu n cnd rclul trcr n crnctt
drut;
2. cmbtr fctrlr susctbl s mblnvsc fctul: lmnt
dzchlbrt;lclsm; buzur mdcmnts tc.;
3. trtr l tm crct bllr cr fvrzz httl crnc: ltz
blr,
fcunl
bstructv
l
clr
blr
trhtc,
sflsul,
dbtul,rctclt,ulcrul,nfcl;
4. rfl cmlclr, rn cmbtr cuzlr dclntr d cmlc:
dsbctr ntstnl, ntrvn chrurgcl nndct, dt nrnl, mdc
ntmstv.

b#%l!^+a?

99

CLUL V
. RCULR D NGRR L BLNVLR CU
H-BLR

FCUN

L mrtt blnvlr cu CH trbu vut n vdr ftul c smtmtlg

ht-blr ds scund bl nfcs, d rgn vrl, su cnscnl
cst, cr strz nc un rcr grd d cntgztt nc mult tm du
vndcr rnt su rl bl nl.
6.1 MLSR BLNVLR
mlsr blnvlr ht-blr s v fc n sln mc, lntt, und
rclul dfuzr unr nfc st m mc dhn shc blnvlr st sgur t.
Blnv cu CH sunt frt snsbl f d nfc, dn cst mtv nu vr f z n
sln und s ngrsc blnv cu ngn,stflcc cutnt su nfc ulmnr.
6.2 NGRRL GNRL
n rd cut bllr htc , blnv trbu s rsct rusul bslut
fzc shc. bcul unr blnv n scl cu rcur ntlctul d utlz tmul
trcut n stl cu stud su lctur m grl, n czul blnvlr cu sufrn h tc
trbu cmbtut. Sculr blnvulu dn t htrt mdcl dszl lu rvnd
cuntumul mcrlr durt zlnc d rsr tulu trbu rsctt d sstnt.
ctvtt shc su fzc rcc t rvc rcdv su grvr rcurbl.
z c m bun ntru blnv n t st dcubt drsl, z cr sgur
bun rgr fctulu. n cursul crzlr sctgn, blnvul trbu lst s- l g l
b#%l!^+a?

100

z c m cmd, cr st dctt n rmul rnd d vlumul sct. n c zul cstr

rusul l t st ndct drc mlrz fltrr glmrulr dmnu scr
d hrmn ntdurtc fvrznd stfl durz hdrc.
L fctur gn crrl s v n cnt d ftul c l dmtt
crtclr st m snsbl dc ncst tn mrt. n cursul ctrlr, bln v
sufr ds d rurt, cr ncrc s-l dmnuz rn grt. sstnt v v gr
c unghl cstr blnv s f tt scurt, rtund, lt cu tn ntrnut
curt,ntru rduc ct m mult rclul lzr nfctr tgumntlr cu cz
grtlr. lt cvt bucl s v fc cu dsbt tn, fndc blnv ds s
lng d un gust mr n gur.
6.3 LMN
lmnt blnvulu crtc trbu s f:
- cmlt chlbrt, curnznd tt rncl lmntr: rtn(1-1,5g/kg
c/z) ncsr rgnrr clulr (dr rducr su surmr lr n cz d H), glucd
(300-400g/z) ntru mnnr un cncntr stsfctr glcgnulu dn
htct, ld (60-80g/z) ntru rtul lr clrc mr; n lus, lmnt trbu s
f sufcnt d bgt n vtmn lctlt;
- ndvdulzt, n func d fz vlutv crz, rznt cmlclr
cstnt ltr fcun.
lmnt crtclr trbu s f frcnt n dz mc, dr cnsummt
frcvnt. cst d rt fvrzz drnul blr rmnnt, d lt rt
sgur rtul d clr l blnv ntn. n CH blnv nu vr f suu unr
rgmur rstrctv svr n rdl d clm.
Blnvul v cnsum zlnc crn, brnz d vc, u,lt l msl d
dmnts rnz; v vt cnsumul cstr lmnt sr; crn v f cnsumt frt
su l grtr (d vc , mnzt, sr,st lb); nu s v cnsum crn d gsc , r t ,
vnt, st grs. Brnz d vc st un lmnt ncsr rn rtul d rtn, d
smn csul, urd. Nu s ndc brnzturl frmntt. Sunt ndct ull frt su
hur (n ), 2-3/ stmn, ull n dfrt rrt culnr.
Ltl rdusl lctt sunt d smn ndct; cnd blnvul surt gru
ltl dulc, s v ncrc mstcul lu cu c (n rr gl) su cu fns.
Fnsl rscrs crtculu sunt: rz, crtf, mcrn, grs, n lb m vch su
rt.
Lguml sub frm d stur, rur su crud, trbu rgtt cu lm
untdlmn. Sunt rcmndt mrcv, dvlc, sfcl, ln, fsl vrd, sncul,
ltucl. S ntrzc vrz, fsl lb bb, gull, rdul, vntl.
Fructl bgt n vtmn glucd sunt rcmndt sub frm crud, sucur,
ct su frt n cmt. Nu s rcmnd mgdll, nucl, lunl.
Dntr dulcur sunt d rfrt mr, zhrul mrmld, fnd bn tlrt, d
smn rturl cu lut frgd (fr drd su rf d ct) c rturl usc t.
Blnvul nu v cnsum rtur cu crm d cc cclt. Grsml nu sunt ntrzs
crtculu n fr clr d rvnn nml, dntr cr num untul fnd rms n
cnttt mc (20-30g/z). S rfr ulul d grmn d rumb, fl r-s rlu
mrgrn.
b#%l!^+a?

101

rbu mnnt c sunt cmlt ntrzs cmlt buturl lclc,

lmntl cnsrvt, fumturl, mutrul, rul c , n gnrl, mncr trbu s
f gtt fr sr, fnd sufcnt sr dn lt, zrzvtur fruct.
Cnd crz s scz cu lt bl su r cmlc, rgmul lmntr v f
ndct d mdc n func d bl sct.
Rlzr unu rgm hsdt lrg(1500-2000 mg N+), st rltv sml s
bn rn surmr sr d buctr n tmul rgtr cnsumr slmntlr, l c r
s dug ntrzcr n rrtlr cmcl su d cs fcut cu sr, rcum
lr mnrl clrursdc. ntru rlzr rgmulu dsdt mdu (500-1000 mg
N +), l msurl lut m sus s dug rtul cntrlt l ltlu drvtlr, ulr,
crn d mclr. n sfrt, ntru rlz un rgm dsdt strct, l msurl rcdnt
s vr dug rtul cntrlt l unr lgum.
rbu sublnt c rgmul dsdt mdu su m ls cl strct st gru tlr t
( cctt)d blnv; l st n gnrl mntn ntrnz nr. ntru rvn
cst, s rcmnd rgtr mncr cu lm, trunl,tc.
RGMUL DN CR HC CMNS
Rgm hsdt lrg (1500-2000 mg N+)
Mc dun 50 g n lb (vntul rt)
- 150 g brnzd vc su 100g c
- 10 g unt, 50 g mrmld, 200 ml lt
r 10 1 bscut 200 ml lt su 1 u ml su mlt l bur
rnz su d zrzvt su su crm d crtf cu zrzvt
- 200 g crn slb (grtr, rsl) su 200 g st lb, 50 g
n lb
- 150 g crtf ur s fr
- slt vrd su zrzvtur(c cstrv,c, vrz)
- 2 mr rst su 200 g gltn d fruct
r 16 30g n lb +100 g brnz d vc+10g unt
- 300 ml lt su 200 ml suc d fruct
Cn crn su t c l rnz su 150 g brnz d vc
- 50 g n lb
-zrzvtur c l rnz
-250g slt d fruct su 300ml cmt su fruct c l rnz
b#%l!^+a?

L culcr 1 bscut+200ml lt
RGMUL DN CR HC DCMNS
Rgm hsdt mdu(cu un cnnut c dt 500mgN+)
102

Mc dun 300 ml lt fr sr
- 50 g n fr sr
- 30 g mrmld
r 10 200 g fruct (ct su gltn)
rnz su crm d zrzvt su su crm d fulg d vz
- 80 g crn slb d vc, sr su st
- 50 g n fr sr
- 200 g fruct
r 16 30 g n fr sr
- 15 g unt dsrt
- 30 g mrmld
- 20 g c cu zhr
Cn crn su t c l rnz
- 50 g n fr sr+ 10 g unt fr sr
- c cu zhr su 200 ml lt dsdt
Rgm hsdt strct(~ 300 mg N +)
Mc dun 50g n lb fr sr+20g unt fr sr+30g dulc
r 10 200g fruct
rnz 50 g n lb fr sr
- 70 g crn slb (grtr) su 70 g st slb
- 150g lgum vrz
- 100 g crtf
- 150 g gltn d fruct
r 16 50 g n lb fr sr
- 50 g mrmld
- c +20g zhr
Cn 150g su crm d fulg d vz
- 50 g n lb fr sr
- crn su st cl rnz
- 50 g slt
- 40g dulc +2 bscu fr sr

b#%l!^+a?

6.4 SURVGHR BLNVULU

Survghr rvd urmrr culr sclrlr tgumntlr (ctrzr,
rsctv dzctrzr),rurtul, culr scunlr, r ftrulu htc, rtul d
lchd, culr cnttt urn, grutt crrl, frmr, rsctv dsr
dmlr vntull mdfcr d cmrtmnt. L blnv cu sct sstnt trbu
s msr zlnc crcumfrn bdmnl.
103

6.5 LRRL
sstnt fctuz rcltr d sng, urn, fcl l trmt cnfrm lnulu
d lrr l lbrtr ntru fctur rblr funcnl l fctulu vzc
blr. sgur trmtr su trnsrtul blnvulu ntru mnrl cgrfc,
rgtt blnvul ntru unc bdmnl, lrscs u unc bsc fctulu.
n cz d sct vlumns, rgtt blnvul, ntrumntl mtrll ntru
unc vcutr.
ngrrl trbu fctut n cuntn cmlclr sbl, cr sstnt
trbu s l rvd l rcunsc. Dntr cst cl m frcvnt sunt hmr g
smnl rvsttr l cm htc.n cst czur, r blg c l c m
mc suscun s nun mdcl. n lgtur cu hmrg dgstv, mnnm c sr
dsbr d lt hmrg dgstv, sngl trvzt trbu lmnt dn tubul
dgstv rn clsm rtt, cc mtblzr lu n cz d rzrbt nu st sbl d
ctr fctul blnv, rdusl d dzsmlr r ut rvc cmlc ncfltc.
6.6 MDC
Mdc blnvlr cu fcun ht-blr trbu fcut du ndc
mdculu. Crtctr ntbtr s vr fc cu rcul cntrll bnut.
trctl d fct, vtmnl, mdcmntl munsursv, durtcl nu ncst
thnc dsbt. ntru crctr dfctulu rtc s fc rfuz d lbumn umn, r
ntru rctr clrz drnul blr n fr d mdc crsunztr, s fc
snd vcutr.
n tr bllr ht-blr s utlzz ds lcl cld- m r r cl rc
cr mbuntsc crcul l nvlul fctulu u fct ssmltc sur vzc
clr blr. rgtr blnvlr ntru trnr ncst munc susnut d duc
sntr rvnd rsctr dhn, rgmulu dttc, rcum bstnn l lcl.
Blnv su rntr vr f nstru sur mdulu d rrr lmntlr.
rbu vut n vdr ftul c bll ht-blr t f d tlg nfc s s u
rrznt cnscnl unr stfl d bl l crr tnl d cntgztt nc nu s-
stns. Dn cst mtv sstnt, n l vrfcr cntrrulu, trbu s n cnt d
nrml d scurtt rtc munc ntru rvnr nfclr ntrstlcst.

b#%l!^+a?

104

. CDRUL CNCUL L VRGN

HNDRSN
rc ctvtt c s drt f rfsnl urmrt s s srn b z
tnfc. Cu tt dvrstt trlr cnctlr dsr ngrr l tt u numt
nlgr rvnd rsn ngrt, sntt ngrrl (nursng-ul).
Cnc ndvdulu du V.Hndrsn: ,,ndvdul st nttt b-sh-scl
frmnd un ndvzbl (nun rvnd glbltt ndvdulu). l r ncst
fundmntl (cmmun tuturr) cu mnfstr scfc cr l stsfc sngur dc
s smt bn. l tnd sr utnm n stsfcr ncstlr sl.
lgr d ctr cnt ndndn n stsfcr clr 14 nv st lul
rfs d sstn mdcl. ntru ut lc mdlul cnctul l V. Hndrsn
sstnt trbu s t c: nv fundmntl st ncsstt vtl, snl fnt
umn ntru - sgur str d bn, n rr fzc mntl.
b#%l!^+a?

Cl 14 nv fundmntl sunt:
1. d rsr v bun crcul;
2. d b mnc;
3. d lmn;
4. d s mc v bun stur;
5. d drm s dhn;
6. d s mbrc dzbrc;
105

7. d mnn tmrtur crulu n lmt nrml;

8. d f curt, ngrt, d rt tgumntl mucsl;
9. d vt rcll;
10. d cmunc;
11. d cn cnfrm rrlr cnvngr vlr, d rctc rlg;
12. d f rcut n vdr rlzr;
13. d s rcr;
14. d nv cum s- strz sntt.
Fcr dn cst nv cmrt dfrt dmnsun l fnt umn num:
- dmnsun blgc (bfzlgc)
- dmnsun shlgc;
- dmnsun sclgc;
- dmnsun culturl;
- dmnsun srtul.
. SUD D C
Czul nr.
NUM:.
RNUM: .
VRS: 62 n
MDU: urbn
D NRNR: 4.01.2010
D RNR: 19.01.2010
L SLR: 16 L
DGNSC L NRNR: Crz htc d tlg mt (VHC+
tnlc) dcmnst rtl rnchmts
DGNSC L RNR: crz htc d tlg mt (tnlc
+vrl, VHC) dcmnst rtl rnchmts, scr Chld C., cmlct cu rtnt
sntn bctrn.
MVL NRNR:fbr, frsn,dr 4-5 scun/z
CNSUM D MDCMN: rnln 10 mg d 3 r /z
CND D V MUNC:
- cut- nsnr
- lmntt- rgm htc dsdt
- lcl - nu
- tutun 10 gr /z d 30 d n
NCDN HRD-CLRL:
- mm-dcdt nrczt
- tt- dcdt BC
NCDN RSNL LGC: CH d tlg mt (vr l C
tnlc)dcmnst rtl; scr Chld C. cu BS.
BSRV L NRNR: fbr, frsn, sndrm drc dbutt n urm cu
12 r: ld ctrc, bdmn dstns rn L n cnttt mdrt.
SRCUL BL: blnv n vrst d 62 d n, fr ntcdnt d HV s u
b#%l!^+a?

106

sblt d nfctr cu vrusur htc, dr cnsumtr crnc d tnl, dgnstct d

nul trcut cu CH d tlg mt, dcmnst rtl, cu vrc sf gn gr d -:
scr Chld C.,cmlct cu rtnt bctrn sntn s ntrnz cuznd fbr (39*
C), frsn, scun drc 4-5/z , s, c frgmnt nl clrt,,vrm, dbutt
n urm cu 24 r. Blnvul urmt trtmnt cu rnln nl tb (40mg) l 8 r,
rvn l 10 mg d 3 r /z srnlctn 6 d /z du cr bndnt.
MN RCLNC
HMGRM: hmglbn -10,4g , lucct-44200
RMBCGRM : trmbct- 118000/mm3
HMS- CGULR: -30,2%, fbrngn- 199% VSH- 17/h
MN BCHMC SNGUN;glcm-160mg%, ur-39,9mg%, cd
urc-7,6mg%, crtnn2,1%, chlstrl ttl-134mg%, G175, G-132, fsftz
lcln 93, blrubn ttl-4,4 mg%, blrubn drct-3,2mg%.
NGRM RRC URNR:N+S-136,+S-4,3, Cl+S-104
MNR CLGC: ctlg fltv dgstv nu s- dzvltt flr
mcrbn, lchd d sct- nr. lmnt 4233(glucz144, rtn1,5 , lbumn 0,6,
LDH250).
NDSC DGSV SURR- vrc sfgn grd
RMN:
- V:S glucz 5% 1500ml+v.B1,B6,C500ml 1f. dn grcr/500ml.glucz,
C1-2 ung-zll1-15
- d 1g/z- zu 1
- Sucrln 1tb d 3 r/z- zll 2-15
- fzl 1g l 8 r-zu 1
- Rchyn 2g/z zll 1-7
- Crnl 100 mg/z zu 1
- Crnl 1f/12 r- zll 2-3
- rnll 2 tb/z zll 1-15
- Ftmndn 2f/z- zll 2-15
- crdn 3tb/z zll 2-15
CR: l ntrnr-cnt cu str rltv bun, nutrt, cu tgumnt ur
ctrc, rlur subcrtnt, chlbrt hmdnmc, cu fct l rbrd slnmgl,
sct, fr flng. S- nt trtmnt cu Rchng 2g/z Crnl, flsccv cu
vlu fvrbl.
RCMNDR: rgm dsdt, cu sulmnt d CL;trtmnt cu r nll,
crdn,cd flc, ftmndn; cntrl clnc st ~ 2 stmn.
b#%l!^+a?

LN D NGRR NR. 1.

107

V
MNL
mnn
ur crulu n
rml

RBLM D
SN
Fbr rdct 39*C
Frsn

SURS D
DFCUL
- scdr
rzstn
rgnsmulu l
nfc
- gnt nfcs
(ntrbctr)

lmn

-ltrr mucs
ntstnl (dr)

-gnt nfcs
(ntrbctr)

-cntul s
rznt scun
nrml n trmn
d 1-2 zl

-trnsrt

Fbr rdct

Dmnur
trnsrlr
msur scdr
tmrtur
crrl

-trnsrt
bundnt
-dr ccntut

mbuntr
durz
msur

b#%l!^+a?

- lmnr urnr
nsufcnt cntttv
(durz~800ml)

108

BCV

NRVN

-cntul s f
fbrl n trmn
d 24 d r
- dsr
frsnulu n
trmn d 2 r.

-msr
tmrtur dn r
n r, zlnc
dmn sr
- dm.butur rc
su cld(nnd
cnt d r
frsnulu)
-dm. Cflsrn
fzl 1gl 8
r+Rchyn 1g l
12 r
-sgur lmnt
hdrc n rml
24-48 r
- n rm z c
nndulct(mnt,
mul), su d
mrcv, zm d
rz
-trtt ntrduc
mc cntt d
crn slb, frt,
brnz d vc,
n lb rt,
-rcltz scun
ntru crcultur
-dm fluchnln:
Crnl 100 mg d
2 r /z,
crnl 1f l 12 r
-hdrtr
rfuzbl: glucz
5%1000ml+vtmn
tr
-schmb lnr d
t d cr
-hdrtr
rfuzbl
-trtmntul cuz
dclntr
- ncrc
stmulr vcur
stfl: un

VLU

- l 2 r d l s
cntul nu m
frsn
- du 24 d r
st fbrl 36,5

-du 2 zl c
rznt scun
dr d cnsstn
- ncnd dn
cntul rzn
scun/ z d c
nrml

-du 2 r c
rznt trnsr
fzlgc

cntul rzn
mbuntt (10
1200ml)

-rtnt hdrsdt

mlrr str
gnrl

-dm gmbr
mdrt
-lchd d sct n
cnttt mdrt

trvzr
lsmtc

Dmnur
dmlr
sct n mm
15-17 zl

s lmnt

Dfcultt n urm
dt

Ls d cuntr
lmntlr
rms su
ntrzs

cntul s-
urmz rgmul
n fcr z nc
dn rm z d
trnr

s mc, d
bun stur

Dscmfrt
bdmnl,
blbrsm, blnr,
zgmt hdrrc

Susctr d
fctr gstrc

Dmnur
dscnfrtulu
bdmnl n
trmn d 2
stmn

v bun
crult

-crcult cltrl
-vrc sfgn
slnmgl

Hrtnsun
rtl
trmbctn

Dmnur su
str
crcul
cltrl,
vrclr
slnmgl

rt
l

gumnt
mucs subctrc

Hrscr d
blrubn

Str
ctrulu

b#%l!^+a?

109

cmrs cld
rgun ubn,
ls rbntul
dschs, ntrduc
mnl cntulu
n cld
-msr zlnc
durz
-hdrtz rl
rfuzbl cntul
-cntrst zlnc
l c r
cntul
-rgm dsdt cu
sulmnt d CL
-crtctr
rnll2 tb /z
-nvt c s
rsct rgmul
lmntr
- lc c
rscurl l cr s
suun nrs dt
-ntrduc rgmul
dsdt,CL
-lmtz mcrl
-fctuz
rcltrl ntru
mnr ctlgc
bctrlgc
- dm n rm z
d 1 g/z , ,
n l
trnr,sucrlt
3tb/z, cu 30 mn
nnt d ms
-rcltz rb
sngun
-crtctr:
rnll 2tb/z
Vtmntr:B1,
B6,B12
- dm rvntv
ftmndn
- rsct rgmul d
crur htc

-cntul rzn
dm gmbr
-cntul rzn
cnttt mdr

cntul rsc
d crur ht

cntul rzn
dscmfrt bd
dmnut

cntul rzn
crcultr md

cntul rzn
tgumnt mu

drm s

Dfcultt n s
dhn

-ntt
-nlnst

cntul s
t drm 7-8
r nt
1-2 r z

cmunc

Dfcultt n
cmuncr , n,
tmdtt

Nncrdr n
rsnlul mdcl

s rcr

Rfuz d ndln
ctvt rcrtv

-slbcun
-strs
-bsl

n l
mbrcr/dzbrcr

Ls ntmt

cn du
du vlr

ngrr f d
smnfc rr
stnt

- ncctr bl
- frc d mrt

cntul s-
rm nvl
cu m mult
ndrznl n 23 zl
cntul s
ndlnsc
ctvt
rcrtv n 3-4
zl
cntul s s
t
mbrc/dzbrc
fr n
Dmnur
ngrrr
cntulu n
trmn d 5 zl

f rcut
rlzr

Dfcultt d -
sum rlul d
blnv

Ncctr bl

cntul s
ndlnsc
srcn lgt d
rlul su n
trmn d 5-6
zl

nv

Rfuz d nv

Ncctr bl

cntul s-
rm cctul
d nv n
trmn d 5-6
zl

s mbrc

b#%l!^+a?

Czul nr.

110

Crtctr;r
nll 2tb/z
-vtmntr
-furnzz
lc
mntr ntru
cnt
-clmz cntul
-cstg ncrdr
cntulu
-sgur un mdu
clm,lntt

subctrc

- sgur mdul
crsunztr
- sgur thnc d
rlr:.V., cr,
rvst
-rsctr
ntmt
cntulu

cntul ndl
ctvt rcrt

- dtrmn
cntul s-
rm rrl
cnvngr vlr
- l sgur d
cnfdnltt
strz scrtl
- nfrmz
cntul sur
drtulu su d
lu dcz cr-l
rvsc
- l cnvng d
mrtn lr
rsnsblt c-
rvn
-mtvz
mrtnt
cumulr d n
cuntn dsr
bl s

cntul - r
ncrdr n sn

cntul rzn
mbuntt

cntul
nvl cu m m
ndrznl

cntul s
mbrc/dzbrc

cntul su
d blnv

cntul st d
fl nut ds

NUM:LNDRSCU
RNUM:FLRN
VRS:50D N
MDU: urbn
D NRNR:7.04.2010
D RNR:13 .04.2010
L SLR:6 zl
DGNSC L NRNR:htt crnc d nvstgt
DGNSC L 3 L: crz blr rmtv
DGNSC L RNR: crz blr rmtv stdul -V,
clcstctm ntru clstrlz vzculr(1999)
MVL NRNR: durr n hcdrul drt, sd ctrc
CNSUM D MDCMN: d- snl
CND D V MUNC:
- cut-rfsr
- lcunt-d
- lmnt:ncmlt(rgm)
- lcl: cznl
- tutun:nu
NCDN HRDCLRL: mm hrtnsv
NCDN RSNL LGC:
- clcstctm1999 (stlul crts), ndcctm
NCDN RSNL FLGC:
- mnrh:13 n
- N=3;S=13
- cclu: rgult
- mnuz: l 48dn
SCUR BSRV L NRNR: ctr sclrtgumntr; fct l 2 cm sub
rbrd, dscrt snsbl l lr;unct gstrc surr snsbl l lr.
SRCUL BL: cnt n vrst d 50 d n, fr sd HV
cunscut,clcstctmzt n 1999 rt l stlul Crts, n fbrur 2007 rznt
durr n hcndrul drt, sd ctrc, ntru cr s rntrnz l stlul Crts,
und n rl 2010 s fctuz RC rctcndu-s lsfnctrtm ndscc cu
mlrr ur smtmtlg tstlr bchmc. BH fctuz n m 2010
l stlul Crts dscr fbrz n s rt bgt nfltrt nflmtr lmflsmctr, htct cu rzn d frgmnt blr ctlsmtc.
MN RCLNC:
Hb -11,2G/DL
Ht 34,9%
L 3200/ML
N 60
M6
r 86000/mm3
MNUL URN:
H cd
Dnstt-1009
lbumn - bsn
b#%l!^+a?

111

V
MNL
s mc
n stur

Glucz bsn
Urblngn crscut
MN BCHMC SNGVN:
Glcm 113mg%
Ur 17,2mg%
Crtnn 0,6%
Clstrl 231mg%
G 148
G 144
Fsftz lcln 587
Blrubn ttl 4 mg%
RMN:
1. Fnbrbtl 1tb/z (zll 1-5)
2. Crflcn 400mg d 2 r/z
3. rnll 40 mg /z
4. mrn 20 mg d 2 r /z
5. Scbutl 2f
6. Sucrlft 1g l 6-8 r
7. Dcrbclm 2 tb d 3 r /z
CR: n clnc nstr, l ntrnr, cnt cuz n mdrt n HD,
ctr sclr-tgumntr, st fbrl, rznt buz crmnt, htslnmgl.
chgrfc: cstructur ndulr fctulu, mdfcr vsculrz rt
ntrhtc t CH, H, slnmgl. DS rlv vrc sfgn cu stur r.
stl srlgc ntru mrkr vrl htc. L BH: crtr hstlgc ldnd ntru
CB. S- nt trtmnt cu Ursflk 12-14 gr/kg cr, rnll, mrzl, nsmnt
l mucs gstr- sfgn.
RCMNDR L RNR:
-nsnr su ctvt ctdn mnm cu vtr frtulu fzc rlungt
- rgm lmntr hldc
- trtmnt mrzl su rntdn
- ml 2tb d 3 r/z
- rnll 10 mg d 3 r/z
- cntrl st 3 lun.

b#%l!^+a?

RBLM D
SN
Dfcultt n s mc

LN D NGRR NR. 2
SURS D
BCV
DFCUL
Durr sntn
cnt s s
mdrt n
t mc fr
hcndrul drt
durr n trmn
d 4-5 zl

112

NRVN
rcmnd cnt
rus
- dntfc zl
cr dmnuz
ntnstt durr
-mdct ntlgc:

cnt
mcr

rsr d
n crcul

- htslnmgl
- gngvrg l r
- buz crmnt

trmbctn

vt

bdmn snsbl l
lr

fctr gstrc?

ltrr tgumntlr
mucslr

-ctr
sclrtgumntr
-rurt tgumntr
-mc lzun d
grt

Str
ctrulu
rurtulu ct m
mult tm sbl

s dhn

Dfcultt n s dhn

-rurt tgumntr
-n n hcndrul
drt

cnt s
rznt smn
mbuntt n
mm 1
stmn

s mbrc

n n urt
mbrcmnt cu mnc
scurt

Mc lzun d
grt

cmunc

rturbr cmuncr
fmll

Ndtr l
rlul d blnv

cnt s s
t mbrc
fr s- f n
d crul n
scurt tm
cnt s
rznt
cmuncr
fmll
mbuntt n
trmn d 1-2
stmn
cnt s
rm
ntrsul ntru
sn n trmn d
1 stmn
cnt s s
t rl
rcursul 10-15
mnut

rt
l

f rcut n
lzr

s rcr

Dfcultt d s rlz
%l!^+a?

Dzntrs n ndln
ctvt rcrtv

b#

rturbr stm
d sn

Str drsv

113

Dmnur
tulburrlr
sngun n
trmn d 2
stmn
cnt s
rznt
bdmn
ndurrs n
trmn d 10 zl

scbutl 2 f /z
- duc cntul d
r dntur fr
rvc sngrr
- crtctr
rnll 40 mg /z
- rcmnd cnt
rtr zn
bdmnl d dfrt
trumtsm
- dmnstrz
ntulcrs
nsmnt gstrc
- t unghl cnt
-survghz rurtul
ctrul
-rcltz blrubn
-dmnstrz
crtcz
- rst cmr
- dmnstrz
sdtv:fnbrbtl
1tb sr
- ncrc s nltur
sursl d dfcultt
-ncurz cnt
- fr surt
shlgc

cnt
tulburr
nmdf

cnt
bdmn
l lr

cnt
mdfcr
smnfc

cnt
smn mb

cnt
dscrt
crul

- fr surt
shlgc
- dscut cu fml
rblml cnt
- ncrc
mbuntr
cmuncr
- ncurz cnt
- fr surt
shlgc

cnt
cmunc
mbunt

- lc thnc d
rlr: cr, .V. ,
rvst
- rcmnd cnt

cnt
dstns

cnt
schmbt
gnd

lmbr n r lbr

Czul nr.
NUM: BRNCU
RNUM : VCR
VRS 12 n
MDU : urbn
D NRNR: 24.02.2010
D RNR: cntul rmn stlzt ntru cntnur nvstglr
n vdr fctur trnslntulu htc(dntr:mm).
DGNSC L NRNR: bl Wlsn cu fctr htc
nurlgcl.Sndrm trrmdl dstnc. Mgcln cngntl rt (41,101)
SRCUL BL: cnt n vrst d 12 n cu mgcln cngntl rt l 4
n 10 lun nuzrs ncturn rmr st dgnstct n nur 2009 l stlul
brg, sc nurlgy dtrc, cu bl Wlsn cu fctr nurlgcl htc .
Smtmtlg nurlgcl dbutt n ugust 2008 cu hrslvt, mdfcr vrbr
cu sct dzrtrc, mstc dfcl, dfcultt l scrs, mcr nvluntr l culu,
trsrr, mn stng cu stur nrml. Sub trtmnt crnc cu curl 750 mg/z
vlu fvrbl smtmlr nurlgc. ftlmlgc nl sr- Flschr (+).
Blgc curm 16,8%, crullsmn 0,13 mg% LD 130 mm,LS 100MM,V
14MM, sln 13 cm. Nurlgc nstgmus dzntl nzbl, dfcult l dglut
ntru lchd, vrbr ur nznt,
MVL NRNR: s ntrnz n clnc ntru cmltr
nvstglr n vdr trnslntulu htc.
MN RCLNC:
Hb 13,8g
Ht 43,3%
L 4200/mm3
r 55000/mm3
MN BCHMC:
Sdu 134mq/1(L)
tsu 3,7 mq/1
Glucz 71 mg%
Ur 18,8 mg%
Clcu 8,7m q/1
Fsfr 4,4 mg%
Blrubn ttl 0,7mg%
Crtnn 0,6%
cd urc 2,0mg%(L)
rtn ttl 6,9 g %
lbumn 3,6g%
13,9 sc,83,8%
- 31,6 sc
NR 1,16
b#%l!^+a?

114

L 66
S 48
LDR 554UW
Clstrl 136 mg%
Fbg 232mg/dl
VSH 5mm/h
mlz 76
Fr 109
MN D URN:
Dnstt H cd
lbumn rr,fn
Glucz bsn
Urblngn nrml
Sdmnt urnr:tl lt - rr, lucct rr, hmt frcvnt.
CRRLGC:
Frtur grn flr lmrf lvur,fung
Cultur:
- bsnt Slmnll, Shgll
- rsnt rr cln d lvur Cndd Fung
RLG:
Scun frmt, brun nchs, mcrclulzc, sts. rztlgc ngtv n cst
rb.
MN FLMLGC:
V 1, l ntrr - nl sr- Flschr(+)
N HV 1/2 :0,03 ngtv
URCULUR: s- dzvltt cnc sub 100000 grmn/ml.
C BDMNL: surf htc nrgult, chlt rn M ndul,
cstructur htc nmgn rdmnnt M ndulr cu cgntt crscut, fr
CBH dstns;ncrs mgn;fr L n lvs.
MN RDLGC: 100/60 mmHg,V- 70/mn, zgmt crdc
nrml.R. sgstrntstnl:sfg, stmc, dudn nrml.ntstn subr cu
tgrf nrml, cu trnst m ccntut cu mdrt hrscr. L 3 r s
cfz clnl, cr r frmt dn rct sgmd, m nmgn cft
dtrt rsturlr lmntr, fr frmun tumrl mucs ur m dzrgnzt.
RMN:
1. rgm htc
2. multvtmn 2cs /z
3. curnl 750mg/z
4. crflcn 500 mg l 12 r
5. cldr 1fl 10 ml sr
b#%l!^+a?

115

LN D NGRR NR.3

V
MNL
s lmnt

RBLM D
SN
- dfcult d
dglut ntru
lchd.
- mstct
dfctr

SURS D
DFCUL
fctr nurlgc

s mc
bun stur

Mnfstr
nurlgc: mcr
nvluntr l

fctr nurlgc

b#%l!^+a?

BCV

NRVN

Fcltr
dglut
mstc n 3-4
stmn

- duc cntul ntru

b cu nghtur mc
ds.
- uurz mstc rn
rrr unr mncrur
lchd su smsld
(su, urur).
- trtmnt crnc cu
Curnl 750 mg/z.
- vtmn tr
Multvtmn 2 cs/z
- duc cntul ntru
vtr rr rnr.
- survghz cntul.

mlrr
mnfstrlr
nurlgc n

116

S- bn
mlr
dfcult
dglut
mstc

cntu
mnfst
nurlg

lmnr

cmunc

rsr
un crcul

crulu, trsrr,
mn stng cu
stur nrml,
nstgmus,
dfcultt l scrs
-ms nvluntr
d urn.
- urn tulbur

mm 3-4
stmn

- dmnstrz Curnl
750 mg/z
- rgrmz cntul
ntru un nu mn
nurlgc
- tz mum sub
crf.
- sgur gn lcl
du fcr lmnr.
- dmnstrz Curnl
trtmnt crnc.
- dmnstrz
chmtrc urnr
Crflcn 500 mg l
12 r (zll 9-12)
- duc cntul ntru
vrb rr, d s fc
nls.
- trtmnt crnc cu
Curnl.
- trtmnt crnc cu
Curnl.

mlr

fctr nurlgc
nfc urnr
(cnc)

cntul s-
t cntrl
msl d urn
n 2-3 stmn.
cntul s
rznt urcultur
strl n 6-7 zl

Vrbr cu sct
dzrtrc

Ssm l rgnlr
d fn

mbuntr
rnun
suntlr n 3-4
stmn

- vrbr ur
nznt.
- dsn

Ssm l rgnlr
d fn

mbuntr
rsr n 3-4
stmn

- mdfcr rgnc
sngun

- htslnmgl.
- curn.
- nl srFlschr

Dmnur
mdfcrlr n
trmn d 3-4
stmn

- rcltz rb
sngun.
- rgrmz cntul
ntru mnr
rclnc
- trtmnt crnc cu
Curnl
- vtmntr
Multvtmn

cntu
ltrr
sngun

mbuntr
tgumntlr
mucslr n 3-4
stmn
cntul s
rznt muntt
mbuntt

- trtmnt crnc cu
Curnl
- vtmntr
Multvtmn
- mlsz cntul n
sln cldurs, frt
d cn cu ngn,
nfc ulmnr su
stflcc cutnt.
- vtmntr

cntu
tgumn
mucs

b#%l!^+a?

rt
l

gumnt
mucs ld

- trbctn
- blrubnm
crscut

vt

rdsz l
nfc

Scdr munt
rgnsmulu

117

cntu
dr vl
cntu
urcultur

cntu
rnun
mbunt

cntu
rsr
mbunt

cntu
rds
nfc

drm, d s

Dfcultt d
drm

- ntt
- strss
- ngrrr

s rcr

Nlcr d
ndln ctvt
rcrtv

lctsl

s mbrc
c

Dzntrs f d
nut vstmntr

Vrst

nv

Dfcultt d
nv

- fctr nurlgc
- mdu stlcsc.

cntul s
bnfcz d un
numr d r d
smn
crsunztr
vrst
cntul s
ndlnsc
ctvt
rcrtv n
mm 6 r
cntul s-
lg
mbrcmnt
dcvt n 1-2
zl
cntul s t
nv ncnd
dn zu 14- d
ntrnr

Multvtmn
- rst cmr.
- lc thnc d
rlr.
- crz un clmt d
ncrdr clm

cntu
8 r/n

- lnfcr d ctvt
rcrtv

cntu
ndln
ctvt

- cntntzz cntul
sur mrtn nut,
chr n stl.

cntu
ntrs n
mbrc/

- sgur mdu clm,

lntt
- sgur mtrl
nfrmtv

cntu
rn n
ctl

N
N NR.1.
RCN
(UNC BDMNL, UNC RNL)
rcntz rrznt trvrsr rtlu bdmnl trundr n cvtt
rtnl cu utrul unu trcr, n vdr vcur un clc lbr d lchd. n cz c
trvrsr rtlu bdmnl s fc num cu sc d dgnstc, tunc vrbm d
unc lrtr bdmnulu.
rgtr blnvulu lgr lculu d unc. S ntnd sub blnv
mum trvrs. Blnvul, du c - glt vzc urnr, st culct s t, l
mrgn tulu, cu trunchul ur rdct, su n dcubt ltrl.
unc s fc d rgul n fs lc stng, l lcul d ntlnr trm trm
cu c mlc ln sn-mblcl (ll Mnr-Rchtr) su n rgun
submblcl, l mlcul ln mblc-ubn. Lcul unc s vrfc rn rcu;
s cut nttdun n ln mttt.
hnc: mdcl sl dznfctz mnl, r sstnt bdnz cu d
lcul ls ntru unc, rznt mdculu srng cu nvcn ntru cutr
nstz lcl. Du nstz s bdnz dn nu rgun , dc fctul s-
nstlt, s trc l unc rru-zs. Cu mcr brusc d n r, mdc l trund
cu trcrul rndculr surf bdmnl n cvtt rtnl, n l
rfunzm ft n rlbl cu dgtul nd cnul trcrulu. l fz cnul n

b#%l!^+a?

118

z cu mn stng rtrg mndrnul cu c drt. Lchdul nc s curg rn

cnul. vcur lu t s durz 1-2 r. Du vcur cntt drt d lchd,
mdcul, rntr- mcr brusc ndrtz trcrul.
Rlul sstnt:
- rcltz rbl strl d lbrtr (100-200ml)
- schmbr z blnvulu dc n tmul vcur scurgr lchdulu s
rt n md brusc
- trbu s cunsc mtvl rr curntulu d lchd msurl c trbu lut
- survghz str gnrl, culr ft, ulsul, rsr, ntru
rcunt cmlcl.

ccdnt.
n urm vsdlt cssv rn dcmrmr brusc cvt s v
nrru mdt unc s vr dmnstr blnvulu substn nltc, dn cst
mtv s t nstl hmrg ntrn su trrzt.
ngrr du unc.
Blnvul st culct n t, ct m cmd. z lu st stfl ls, c lcul
unc s f ct m sus, ntru vt rsun lchdulu rms n bdmn sur
rfculu struns d trcr dc scurgr n cntnur lchdulu.
N NR.2.
UNC BSC FCULU (BH)
rn unc bsc s nlg sctr unu frgmnt dntr-un rgn
rnchmts, cu utrul unu c d unc. Scul st d suun frgmntul d sut
trs mnulu hsttlgc. n cst fl, uncl bsc sunt unc lrtr.
rgtr blnvulu lgr lculu unc. nnt d cutr unc
s vr cntrl tmul d sngrr cgulr, trmbctm, rcum tmul d
rtrmbn ntru vtr ccdntlr hmrgc. Dn cl mtv, cu 2 zl nnt d
cutr unc, blnvul v rm, du ndc mdculu, mdc cgulnt
tncclr: vtmn k, clcu, vtmn C, cr s v cntnu nc 1 z du unc.
unc htc s rctc, tt ft ntrr, ct c ltrl fctulu. n
rmul cz, blnvul v f culct n dcubt drsl, cu trunchul ur rdct; n l dl cz
n dcubt ltrl. n mbl czur, blnvul v z mn drt sub c, unc s v
cut ln md-clvculr, mdt sub rbrdul cstl, dc fctul st mrt, n
ln mttt; dc fctul s mnn n lmt nrml su sub cst lmt, tunc unc
s v cut d- lungul ln lr strr n sl l -l su l -l
ntrcstls.
hnc rlul sstntlr: dntr cl 2 sstnt cr sst unc bsc
un sgur z dcvt blnvulu l survghz n cursul unc. Dc
unc s cut l cl, tunc v f clul n z drt. Cllt sstnt
rznt mdculu nstrumntl, d c trbu s b mnl rfct strl. v
fr mdculu ns ntru lgr trcrulu , du ntrducr cnul n rgnul
b#%l!^+a?

119

uncnt, v str mndrnul n str d strltt, du cr v srv mdculu

srng d 20 ml cu utrul cru cst v fc 1-2 sr nrgc.Dc r s
cut cu cul Mnghn, du trvrsr suturlr dntr l fct, sstnt, cr
mnut srng rcrdt l c rn tubul d cucuc, v rmbulz cul cu sr
fzlgc dn srng, du cr, rn rtrgr stnulu, v rlz rsun ng tv d
sr n c tubul d cucuc. n cst mmnt, mdcul trund cu cul n sutul
htc, rtrgndu-l mdt tt sub frm d sr. sutul clndrc smuls, v f
dscrct dn c cu utrul srulu fzlgc, rms n srng.
Dc s utlzz cul Vm - Slvrmn, unc fctulu nu ncst nc
sr. Du ndrtr culu, sstnt bdnz lcul unc cu tnctur d d
lc un nsmnt strl, cr l fz cu mlstru.
ccdnt. n unl czur, unc t f urmt d hmrg su clrg,
cr s rsc, d bc, sub nflun hmsttclr cr l rmt m r r
ncst ntrvn scl.
ngrr blnvulu du unc. Du unc htc blnvul v f ntrs
mdt u sctr culu rt drt. rgun uncnt s v lc
cmrs rc su ung cu gh. Blnvul nu s v rdc dn t tm d 24-48 d r.
N NR.3.
LRSC
Lrsc st lrr cvt rtnl, n rlbl dstns rn
numrtnu, cu utrul unu nstrumnt tc numt lrsc, ntrdus trns rtl
rntr-un trcr. rn cst mtd s t mn drct, rn nsc, surf
fctulu, vzcul blr, rt dn cl blr, fnd mtd vlrs n dgnstcul
dfrnl l crzlr. Cu utrul lrsc s t drunct bsc fctulu.
mnul lrscc, l scl cu rfl chrurgcl, s fc ntr-un dn sll d
r stc. L scl cu rfl mdcl ntrvn s fc n cmr d trtmnt, n
cnd stc.
sstnt s v ngr d bln d culr nchs, fndc lrsc s cut
n cnd d smbscurtt su l ntunrc. n strumntl mtrll vr f rgtt
ms cu un cm strl.
rgtr blnvulu. rgtr shc susnr mrlulu blnvulu n
tmul mnr r mrtn dsbt. n tmul mnulu, tubul dgstv trbu
s f gl, dn cst mtv, n rzu mnulu, blnvul v rm un rgm lchd, r
ntrvn s v fc dmn nmnct, Sr dmn s v fc blnvulu ct
clsm vcutr. Dc str blnvulu nu cntrndc, blnvul v rm , cu
umtt d r nnt d ntrvn, fl d fnbrbtl su 400 mg d mrbmt
umtt d mg trn. Blnvul v f trnsrtt n sl d mnr s u d r
culct ft ms. S v rd surf rs bdmnulu, s sl
tgumntl cu bnzn s dznfctz cu tnctur d d.
hnc rlul sstntlr. Lrsc ncst 3 sstnt: un srvt
mdcul n cnd strl, cllt survghz susn mrlul blnvulu l nv l
dduc n zl crut d mdc, tr v f rzrvt ntru cmltr g zulu dn
cvtt rtnl, rcum ntru ntrvn n cz d stu nrvzut.
ntrducr rulu n cvtt rtnl s fc d bc n fs lc stng,
b#%l!^+a?

120

dc l lcul bnut l rcntz. sstnt mdcl v srv mdcul cu nvcn,

nmnz cul d unc, nvtnd blnvul s- ntrsc muscultur
bdmnl su s- rdc cul n cl sc. ntr tm ncrc srng d 10-12 ml d
clrur d sdum, cu cr mdcul v fc vrfcr, rn sr nctr. D c
z culu crsunztr, tunc s v rrt rtul d numtr l c, cu
cr s v ntrduc gzul n cvtt rtnl.
Du nstlr nstz lcl rtlu bdmnl, sstnt nmnz
mdculu un bsturu strl, cu cr v ncz l, trunznd rn suturl cnunctv
n l muscultur. nmnz trcrul, slctnd dn nu blnvul ntru ntrr
mm muscultur bdmnl. s v ngr d nclzr sstmulu, cr, dc
st ntrdus rc n cvtt bdmnl, s v cr cu vr d . rnclzr s
t fc cu cmrs cld su cu rtul Fhn.
Du trmnr nsc ntrbdmnl vntul ntrvn, mdcul
ndrtz sstmul tc dn trcr, dschd vntculu cstu ntru d drumul
rulu dn cvtt rtnl, slctnd blnvul s un n funcun rs
bdmnl. Dcmrmr rltv bun bdmnulu nu r nc cnscn nlcut
subctvsu bctv.nnt d ndrtr cnul, s ntrduc rn cst
ntbtcl rgtt n slu s nchd lg bdmnl.
ncdnt ccdnt. L un blnv r duntrvnt str d
subfbrltt, cr dsr sntn n 1-2 zl. Lrsc t s rduc hmr g
rn lzun vsculr, nfzm subcutnt, lzun surfcl su m rfund l
fctulu, rsur surfcl surf fctulu. n fctl s rvn strlzr
cntncs nstrumntlr mtrllr.
ngrr du lrsc. Du trmnr lrsc, blnvul v f
trnsrtt n sln, nut strct l t tm d 24 r sur vgh t nc 4-5 zl. m d 2
r du trmnr ntrvn nu mnnc nmc, r n zu rsctv rmt num
lchd. Dc mnr fst nst d unc bsc, cz su lt ntrvn, n
zu mnr s v lc ung cu gh rgun rsctv. n zu urmtr
blnvul v f trms ntru cntrl rdlgc bdmnl. drtr grflr s fc n
5- z.

b#%l!

^+a?

UNC VNS
rn unc vns s nlg rcltr d sng dn lumnul un vn cu
utrul unu c. Scul unc:
- lrtr- cnd s urmrt crctr dvrslr cnstnt blgc l
rgnsmulu;
- trutc- unc urmrt trgr un cntt m mr d sng ;
- d f trnsfuzt l l blnv.
Stblr lculu unc rgtr blnvulu . Lcul clsc d cutr
unclr vns st l nvlul lc ctulu und vnl ntbrulu - cflc bslcnstmzz. L lgr vn s vr lu n cnsdrr vntull cntrndct,
c :mmbru rlzt, rcs suurtv, drmt, czm, trumtsm, tc. unc
vns t f cutt l nv l vnl ntbrulu, rcum f t drs l
mnlr, l vn mllr ntrn, vn ugulr, vn tmrl surfcl vn
subclvculr. L sugr c mc, s v cut l vnl crnn.
Blnvul st culct st ct m cmd, s dscr brul ls, vnd gr
121

c hnl sn u mdc crcul d rntrcr, s nvt blnvul s n brul n

bduc tns mm. lc ctulu v f dznfctt dgrst cu lcl su
bnzn dt. L nvlul unr trm nfrr brulu cu c mlc s lc g rul
lstc, strngndu-l n fl nct s s rsc cmlt crcul vns, fr ns s s
cmrm rtr, c c s cntrlz rn lr ulsulu rdl. s cr
blnvulu s- strng bn umnul. Dc vnl nu s umlu n sufcnt msur, s v
cntrl cltt ulsulu rdl l nv s v lrg ur grul rn mcr nrgc d
dschdr nchdr umnulu d fl tns ntbrulu s t ctv
rtul d sng rtrl n mmbrul rsctv. Dc unc vns s cut l vnl
ugulr blnvul v f culct st, cu cul ur s trn.
hnc. stnt s z ft n f cu blnvul cu mn stng fz
vn. L mmbr fr vn s fc rn cmrmr trmt n mn stng, n
fl c lcl s f stut l 4-5 cm sub lcul nc, rctnd cu cst cmrsun
trcun n s sur suturlr vcn. n rgunl cr mn rtrulu nu l t
curnd, vn v f ft ntr lcl ndul mn stng.
Srng s n n mn drt bn ft ntr lc rstul dgtlr. cul s
ntrduc nttdun n drc blc, du cr s v rr cu vrful rzstnt rtlu
vns n drc ulu lngtudnl l vn. rvrsr rtlu vns d snz
nvngr un rzstnt lstc cul nntz n gl. n cst mmnt, drc culu s
schmb n drc ulu vn s nntz n ntrrul nc 1-2 cm. n mmntul
trundr culu n vn r sngrr cr trbu rvct rn srr stnulu.
Du trmnr ms d sng, s lbrz vn d sub rsun grulu,
s rct rsun sur vn uncnt cu tmnul nbbt n slu
dznfctt, chr l lcul d trundr culu rntr- mcr brusc n drc ulu
vsulu, s ndrtz cul dn vn.
Cmrsun sur vn s mnn tm d 1-3 mnut, nnd brul n z vrtcl.
ccdnt:
- hmtm
- sufuzun sngun
- rfrr rtlu us l vn
- ml
- str d lr ccntut
- cls su ltm
ngrr dt du unc.Du trmnr ntrvn s fc tlt rgun, s
schmb lnr stt cu sng s survghz blnvul.
b#%l!^+a?

CNCLU
Cl tr czur crctt ngrt u rzntt ntrs dn unct d vdr trtc,
fnd n gnrl czur grv, cu tlg dvrs mnfstr scfc, n func d
vrst, dr d frm clnc, ntrs rctc, ncstnd un tblu lrg d ntrvn
122

utnm dlgt.
rn grvtt bl n sn, ct rn ncdn n rndul ul rmnt,
cnsdr c studul d f rrznt ns rvcr n fz fnl frmr n
rsun d sstnt mdcl.

b#%l!^+a? b#%l!^+a? b#%l!^+a? b#%l!^+a? b#%l!^+a?

123