Ent

rocol
it
eleacut
e.Gast
roent
erocol
it
eleacut
e
DEFI
NITI
E.EPI
DEMI
OLOGI
E

=afect
iuni
caract
eri
zatepr
incr
ester
eanrdescaune,
av ol
umuluil
orsi
scader
eaconsi
stent
ei
acest
oradatedemalabsor
bti
atemporar
aaapeisiaelect
rol
i
til
or

- Debutbr
usc

- Dur
ata<2sapt

- Cauzademor
bidi
tat
esi
mor
tal
i
tat
einf
ant
il
a(sugar
i)i
ntar
il
esar
acesi
incel
eincur
sde
dezvol
tar
e

- Frecv
ent
aepisoadel
ordi
arei
cel
asugar
,gr
avi
tat
eal
orsunti
dicat
ori
aini
vel
ului
soci
o-
economi
cscazut
- Fr
ecv
ent
amaxi
ma:
Afr
ica,
asi
adeS-
E,Amer
icaS
- 90%di
ndecesesedat
oreazagr
avi
tat
iibol
i
iint
re0-
5ani
- Var
fur
iepi
demi
ce:
iar
na-SDAv
iral
e,v
ara-BDAbact
eri
ene
- BDAr
epet
ate-
>mal
nut
ri
ti
e->SDA
Pi
erder
il
einsumeazai
n25-
36hoscader
ede:

<5%di
nGr
eut
ateai
nit
ial
a->BDAusoar
a
5-
10%-
>BDAmedi
e
>10%-
>toxi
cozaanhi
dremi
ca(
decauzedi
gest
ive) coma deces

ETI
OLOGI
E

Fact
orif
avor
izant
i
a)
F.Const
it
uti
onal
i:-varstami ca
-greutatescazutalanast ere
-di
atezele( exudat
iva,alergi
ca)
b)F.demediu/deingrij
i
re: -i
gienadefici
taraindi
vi
dual
asi
amedi
ului
-cal
dur asif
rigulexcesi
v
Fact
ori
i
det
ermi
nant
i
A.Nei
nfecti
osi
a)gr
eselial
i
mentar
e: -canti
tat
ive:supr
a-subcali
ment at
ie
-cali
tati
ve:dil
uti
inecorespunzatoar
edel apte,exceseunil
ateral
e
alediet
ei,
alimentenecorespunzatoarepentruv ar
stasaucare
conti
ntoxinebacteri
enepr efor
mateet c.
b)medicament
e:antibi
oti
ccuspect rul
arg(ampi ci
li
na,t
etraci
cli
na,li
ncomicinaetc.)
-
 diareeadeant ibiotic;l
axative; coler
etice;sulf
atferoset c.
c)aler giadigest iva( aler
gialal apteledev aca)
d)mal nutrit
iasev era( di
areespont ana)
B.Inf
ect i
osi
a)infectiil
ocal izatel anivelulintesti
nului
-bact eriene: Esher ichi
aCol i
,Klebsiell
a, V.Choler
ae, St
af i
l
ococul,Clostr
idi
um
Per f
rigens; enteroinvazive:Salmonella,Shigell
a
-virale:Rot av i
rus, Astrovir
us, Adenov irus,cal
civi
rus,coronavir
uset c.
-par azitare:Gi ardialambl i
a, EntamoebaHi st
olyt
ica,Cryptospori
dium
b)infectiisistemi ce( parenterale):ITU,ot i
ta,pneumoni e,
sept i
cemie

*Condit
iichi
rur
gical
e:apendi
cit
a,i
nvagi
nati
aint
est
inal
a,obst
ruct
iapar
ti
alai
ntest
inul
ui,
B.Hi
rshprung(
falsadi
areemegadoli
gocol
on)
PATOGENIE

Mecani
smedeapar
areal
eor
gani
smul
ui: scader
eaaci
dit
ati
igast
ri
ce

cr
est
ereamot
il
it
ati
ii
ntest
inal
e

al
ter
areasecr
eti
eidemucus

mi
crof
lor
asapr
ofi
ta

TABLOUCLI
NIC

- Debutacutcuscaunedi
areice(
numeroase,l
ichi
de/
consi
stent
ascazut
a,v
olum cr
escut
cu/f
araelement
epatol
ogice:mucus,
puroi,
sange
- Poat
efi
precedatdeanor
exi
e,v
arsat
uri
saust
agnar
eponder
ala
- Febr
apoat
einsot
iacest
esemne
- Cut
rat
amentadecv
at,
epi
soadel
eseaut
oli
mit
eazai
n72h
- Dacaseaccent
ueazasi
mpt
omel
e->SDAdedi
fer
it
egr
avi
tat
i(SDA=sdrdedeshi
drat
areac)
BDAsi
mpl
a(f
aradeshi
drat
are,
far
aident
if
icar
eet
iol
ogi
ca,
boal
acomuna)

Ceamai
frecv
ent
aimbol
nav
irel
asugar+copi
lmi
c
I
ndi
spozi
ti
e,r
efuzal
i
ment
ar,
eri
tem f
esi
er
Debutcuscaunedi
arei
ce(
semi
consi
stent
e,gr
unoase,
cumucus)
Col
i
ci
f
ebr
a
Met
eor
ism abdomi
nal
usor
Ev
olut
ief
avor
abi
l
aincat
evazi
l
e
BDACUSDA
 - Si
mpt
omel
enuser
emi
t
- Pi
erder
ideapasi
elect
rol
i
tipr
indi
aree,
var
sat
uri
,tr
anspi
rat
ie,
necompesat
e SDA
SDA<5%

Canti
tat
eade El
ect
rol
i
ti(
mEq%)
pi
erderi

Na Cl K

v
arsat
uri 10 10 2

di
aree 6 6 6

hi
per
ter
mie 2 2 2

SDA5-
10%

- Deshi
drat
aremedi
e,ext
racel
ular
(DEC)cel
mai
frecv
ent
- Na<130mEq/
l
- Sepi
erdeNa-
>deshi
drat
arepr
edomi
nantsal
i
na-
>apaf
uge
i
ntr
acel
ular-
>hi
per
hidr
atar
ecel
ular
acuedem cel
ebr
al:
- Faci
esi
ncer
canat
,suf
eri
nd,
ochi
inf
undat
iinor
bit
e
- Font
anel
aant
eri
oar
adepr
imat
a
- Tahi
car
die
- Ol
i
gur
ia
- Pl
i
ucut
anatper
sist
ent
- Far
atul
bur
ari
alest
ari
ideconst
ient
a
- Buzear
se,
mucoasabucal
auscat
a,set
evi
e

SDA>10%

- Faci
est
oxi
c,suf
eri
nd,i
ncer
canat
,nasef
il
at,
pri
vi
ref
ixa,
cli
pitr
ar
- FAdepr
imat
amul
t,pl
i
ucut
anatabdomi
nal
per
sist
entcuaspectdecar
pauda/f
runzade
var
za
- Tahi
car
die,
hTA,
ext
remi
tat
ireci
,ci
anot
ice,
pul
sfi
l
ifor
m,gr
euper
cept
ibi
l
- Tahi
pneecur
espi
rat
iisuper
fi
cial
esaur
espi
rat
iepr
ofunda,
per
iodi
ca(
Kussmaul
),di
spnee
- Apat
ie,
somnol
ent
a,l
etar
gie,
coma,
conv
ulsi
i
,hi
pot
oni
e,modi
fi
car
ider
efl
exe
- Ol
i
goanur
ie(
IRAdecauzapr
erenal
a)
 - Tur
gordeconsi
stentpastoasa-
semndealar
ma- >deshi
drat
areint
racel
ular
a(DI
C)cu
Na>150mEq,deshi
dratar
eapoasa=>encefal
opatiehemoragi
ca

EXAMENDELABORATOR
1)Examenecopr
ologi
ce
a)Copr
ocult
uri
:i
zoleazagermeni
ii
nai
ntedeadmini
str
areadeant
ibi
oti
c;ant
ibi
ogr
ama;
i
ndent
if
icatul
pinient
erot
oxi
cesauenter
oinv
azi
vedeEColi
b)Excopr
opar
azi
tar
:Gi
ardi
alambl
i
a(f
ocar
edi
arei
cei
ncol
ect
ivi
tat
idecopi
i
)
c)Exv
irusol
ogi
cenusef
acder
uti
nai
dent
if
icar
otav
irusur
iI
F
d)Coproci
togr
amaor i
ent
arerapi
daet
iol
ogicasipat
ogeni
ca:predomi
nent
a
l
imfocit
e=>vir
ala;
predominent
aPMN( neutr
ofi
l
e)=>bacter
iana
2)Al
teex
amenebact
eri
ologi
ce:
hemocul
tur
i,ur
ocul
tur
i
3)Testebioumor
ale:
HLG(l eucoci
tozacuneutr
ofi
li
e,t
romboci
topeni
eint
rai
nfect
ioscu
i
nfecti
icuGnegati
vi)
,reactant
iidefazaacut
a,i
onogramaseri
ca,
4)Test
eser
ologi
ce

Di
agnost
icul
pozi
ti
val
BDA

- Dgdeboal
a
- Dgdegr
avi
tat
e(SDA)
- Dget
iol
ogi
c(anal
i
zascaunul
ui)
Diagnost
icul di
ferenti
al(falsel
ediarei)
- Diareeadet r
anziti
eann
- Diareeasugar uluialimentatnatural
- Coloni r
itabil
- Diareeadeapendi citaacuta,i
nvaginat
ieint
esti
nal
a
FORMECLI NICo-ETIOLOGI CEl anou-nascuti
BDApar azi
tare:Giardioza-BDAt ipicapri
nlezar
eamicrov
il
il
or;
apar
edef
ici
tdel
act
aza

- Ti
piccu:
scauneapoase,
expl
ozi
ve,
uratmi
rosi
toar
e
- Met
eor
ism,
dur
eri
epi
gast
ri
ce,
anor
exi
e,er
uct
ati
e,gr
etur
i,v
arsat
uri
- Poat
etr
enal
uni
dezi
l
e(BDcr
)saupoat
edev
eni
recur
ent
a
BDAvi
ral
e

- Fr
ecv
ent
e,a2acauzacai
mbol
nav
ire
- Di
areeosmot
ica
 - Al
ter
ari
alemor
fol
ogi
eiv
il
ozi
tat
il
ori
ntest
inal
e
- Fact
ori
ifav
ori
zant
isuntr
epr
ezent
ati
de:
var
stascazut
a,sezonr
ece
- I
ncubat
iascazut
a:48h
- Debutbr
usccuv
arsat
uri
,febr
ascazut
a,di
areeapoasa

*Rot
avi
rusuril
e
- Pri
mul agentet
iol
ogicident
ifi
cati
ncel
ulel
eduodenal
e
- Morbidi
tatesimort
ali
tatecrescut
e
- Fr
ecv
entl
a6-
24l
uni
- Adul
tif
ormeusoar
esauasi
mpt
omat
ici
-nusuntpr
otej
ati
- Sugar
iial
i
ment
ati
lasansuntpr
otej
ati
- Ti
pic:
diar
eeapoasa,
uneor
isange,
SDA,
febr
a
- Dur
ata2-
8zi
l
e
- Di
agnost
icul
del
abor
ator
:ELI
SA,
cul
tur
adi
nscaun
- Tr
atament
:rehi
drat
areor
ala/
par
ent
eral
a
- Vacci
nareeficace-Rotarix
: v
acci
noral
cu2dozedel
a12spt
*Al
tevi
rusur
i:adenovirus,enter
ovi
rus,
coronav
irus

Ent
rocol
it
aul
cer
onecr
oti
ca
- Demar
egr
avi
tat
e:ul
cer
ati
e,necr
ozaf
ocal
a,per
for
ati
ial
eint
etsi
nul
uisubt
ir
esi
col
on
- Fr
ecv
entl
apr
emat
uri
- Fact
ori
fav
ori
zant
i:i
schemi
e/hi
poxi
elanast
ere,
rarcol
apsneonat
al
- Colonizar
eaintesti
nul
ui-
>favori
zatadeIgAsscazut
ealemucoasei
int
est
inal
e,aci
dit
ate
gastri
cascazuta
CLINIC
-Instabi
li
tat
et er
mica,i
ri
tabi
li
tat
e,cri
zedeapnee,ol
igur
ie
-Var
sat
uri
-Di
stensi
eabdomi
nal
a
-Scaunesangv
inol
ent
esaumel
ena
-Pneumoper
it
oneu

TRATAMENT
Obiect
ive:
- Cor ect
areast
ari
idedeshi
drat
aresi
ment
ir
east
ari
idehi
drat
areopt
ime
- Asi
gurar
eaaport
ului
nut r
iti
onalnor
malpr
inr
eal
iment
arepr
ecoce
A.Rehi
drat
area-pecaleor al
a=diet
ahi
dri
ca
-parenteral
1.Di
etahi
dri
ca
Scop:-punei
nrepaust
ubul
digest
iv,
-i
nlocui
est
epi
erder
il
edeapasi
elct
rol
i
ti,
-scadeapor
tul
cal
ori
c,
-combat
eaci
doza,
-ment
inedi
ureza,
-combat
eset
ea

Sef
olosescSRO(sar
uri
der
ehi
drat
areor
ala)
GESOLcompozi
ti
e:

compozi
ti
a g/
lapa Mmol
/lapa

Cl
orur
adesodi
um 3,
5 Na-
90

Cl
80

Bi
car
bonat
edesodi
um 2,
5 30

Cl
orur
adepot
asi
u 1,
5 20

gl
ucoza 20 111

- Seadmi nistreazainpr i
mele4hlacopiii<2ani
,canti
tat
i de50-
100ml SROdupa
fi
ecar
escaundi arei
csau10ml /kgdinSROdupaf i
ecarescaundiarei
cemis,dupa
i
ncepereat ratament ul
ui
- Cubiberonul /l
inguri
ta,mesefr
act i
onat
e-dacanuv ar
sa
- Durat
a6- 12zi le
- Seadmi nistreazasi dupacor
ectareadeshi
drat
ari
ii
npar alel
cudiet
adetranzi
tie
- Nuseut il
izeazaceai i
ndeshi
dratare
2.Pecal
epar
ent
eral
a
Scop-r
efacer
eav
olumui
vascul
ar
-
reechi
l
ibr
areh-
e
-
repausdi
gest
ivabsol
ut
-
rel
uar
eadi
urezei

I
ndi
cat
ii
:-SDA>10%
-Di
areepr
ofuza
-Var
sat
uri
i
ncoer
cibi
l
e
 -Mal
absor
bti
eer
edi
tar
aagl
ucozei
-Hi
per
nat
remi
esev
era>160
*Cant
itat
eadel ichideadmi nistr
atesecal culeazainfunctiede:
- Pierderi
- Nev oi f
izi
ologi ce
- Def i
cientepr eexi st
ente
- Acoper api erder il
eapar ut
edupai ncepereatrat
ament ului
(dacapi
erder
il
edi
gest
ive
cont i
nua)
*Canti
tateamedi enecesar a:
SDAmedi e:
-100ml /kglann
-150ml /kglasugar
SDAsev era:
-150ml /kglann
-200ml /kglasugar
*Nev
oiledeel ectroliti:
- Na1- 2mEq/ kg/zi
- K 2mEq/ kg/ zi
- Ca1- 2mEq/ kg/zi
- Mg1mEq/ kg/ zi
- HCO31- 3mEq/ kg/zi(i
npr ezentasemnel orcli
nicedeacidoza)
I
ncol apsulhi povol emic
-inpr i
mel e15mi n-ivcuser i
nga10- 15ml /
kg( cor
espundpi er
der
il
orde10-
15%
dingr eutate)di nsolutiepolielect
roli
tica
Di
etadet ranzit
ie
-vegetaleantidiarei
ce150ml /kg/ziptmax24h
-DO( decoctor ez)<3l uni;MO( mucilagiuorez)>3l
uni pr
epar
at5%gl
ucoza
-SM (supamor cov i
)30%<3l uni;SM 50%>3l uni
-MOef icientcar egim ali
mentarina2- aetapadetranzit
ie
-preparateindust ri
al-pudrader oscov e
-mor covi
si orezinpulbere

B.Real
imentarea
Int
roducer ealapt eluianteriorimbol naviri
i
Lasugaral iment atnat uralser eiarapidalimentar
eacuLM dupar ehi
dratar
e
orala;uneor inuser ecomandadi etedet ranzi
ti
e,f
ieparti
al(
LM +SRO)
Sugarul ali
ment atarti
ficial
<6l uni -prepar atepart i
al/compl etdelactozate diar
eeascadeactiv
itat
ea
di
zahar idazelorint esti
nale
>6l uni -prepar atefaragl utensi faralapte:OP(orezpasat)
,BV(branzadev aci
),
morcov if
iert
i,carnef i
art
a,banana
Dupaapar i
tiascaunel orl
egat e: fai
noscugl uten
Lapteleest ereintrodusdupacat evazil
e

TRATAMENTETI
OLOGI
C
 Antibacter i
ancuant ibi ot i
c( chi mi oterapi ce),uneor iinuti
l
Indi
catii
:
Di ar eebact er iana
Char act erent er oinv aziv( f
ebr a,mucus, pur oi,sange, t
enesme, coprocit
ograma +
PMN)
Epi demi idedi ar eei ncol ecti
v it
at i
Ev olut ienef av or abi l
a>3zi ledet ratamentf araant i
bioti
c
Asoci er eadei nf ectiisist emi ce
Di ar eel av ar st a<3l uni
I nasoci erecuhandi capur ibiologi ce
Sugar ii dincol ect ivi
tat i
/cudef icitimun
Demul teor iant i
biot icel enusuntnecesar e
50%cuet iologi ev i
rala
Unel ei nfect ii bact erienesev indecaspont an
Ef ectel ebenef icesuntmi nime
Pr oducef ect enoci vepr i
nel ei nsel e=>di sbioze, aparit
iadesuser ezist
ente
Shigell
a: TMP-SMZ( Cot rimoxazol )
, Bisept ol( Sept ri
n)5- 7mg/ kg/ziin2pr izep.o.
Ampi cili
na100- 150mg/ kg/ ziin4pr izepo, iv,i
m
Fur azol i
don6mg/ kg/ zi in4pr izepo
Cef al ospor ineI II-Cef triaxona-i nShi gell
af l
exner i
Vibri
ochol era-Tet raci clina>12ani ;50mg/ kg/ ziin4pr izepo3zi le(afecteazacarti
l
ajele)
-Fluor oqui nolone-i nsi tuat i
igrav e
-Cot rimoxazol
Salmonel la-Ampi ci l
ina, Cot r
imoxazol 5-7mg/ kgin2pr izepo( Nebi r
on)
-Aci dnal idixi c30- 50mg/ kg/ zi
-Fuor oqui nol one
E.Coli
:boal asev erasi stemi ca, lasugarmi c,nou- nascut
-Cot rimoxazol 5- 7mg/ kg/ ziin2pr izepo, 3zi le
-Col i
mi ci
na10mgpo
-Aci dnal idi xic
-Cef alospor i
neI II
Campy lobact erj ejuni i -Er i
tromi cina, Tet r
aciclina>12ani
Clostri
dium -Vancomi ci na
Giardi
a-Met roni dazol ,Ti nidazol
TRATAMENTPATOGENI C
a)Agent i i
nt er medi ar i-Smect a
- Absor bantsi pr ot ect oral mucoasei intest i
nal e
- Scadedur at adi areei ,crest econsi stentscaunul ui
- Adsor btiat oxi nel orbact eriene
b)Agent i i
nhi bi t
or iai mot ricitatiidigest ive( i
nt estinale)
- I modi um 2mgcps
- Nuseadmi ni st reazal asugar i<2ani
- Ri scdest azai nt estinal a=>i leussi megacol ont oxic riscdeagr av ar
eprinstaza
c)Agent i ant isecr etor i
- Hi drasec( ant isecr et orint estinal )
- Pul ber eor ala10mg, 30mg, 100mg
 - Doza=1, 5mg/ kgx3/zi
- Seasoci azacuSRO
d)Probi
otice
- Mi croorganismenepat ogenei nger
atevii
- Echi l
ibreazaecosist
emul intesti
nal
- Ref acecapacitateanaturaladeapar ar
eaorgani
smul
ui
- Linex, Ecofl
orina

Ul
cer
ulgast
ri
csiduodenal
- Ul
cerulacut=pi
erdereadesubst
antacar
einter
eseazamucoasa,
submucoasasi
musculara,
cumarginil
enet
edesifundul
inf
lamat

- Ul
cer
ulcr
oni
c-ar
elocdi
str
uct
iamuscul
arei
sir
etr
act
iasai
ntr
-unbl
ocscl
eros

- Ul
cer
elesuntr
ezul
tat
ulaut
odi
gest
iei
mucoasei
gast
ri
cesi
duodenal
e

- Rapor
tul
UG/
UD=9/
1

ETI
OPATOGENI
E-apar
it
iaul
cer
ului
l
acopi
iest
einr
elat
iecu:

- I
nfect
iacuHel
i
cobact
erpy
lor
i

- I
ngest
iademedi
cament
e

FI
ZIOPATOLOGI
E

- Di
fer
it
alaUGf
atadeUD

- Rezul
tadi
ndezechi
l
ibr
ulf
act
ori
l
ordeapar
aresi
deagr
esi
une

- UG-scadef
unct
iadeapar
are = scadecal
i
tat
eamucusul
ui

+scadesecr
eti
adebi
car
bonat
e

+scadef
luxusangv
inl
ani
vel
ulmucoasei
gast
ri
ce

+anomal
i
idemot
il
it
ategast
ri
c

Ref
luxbi
l
iopi
l
ori
c

- UD-cr
est
eagr
esi
vi
tat
eacl
orhi
dropept
icaasupr
amucoasei
duodenal
e

Fact
ori
predi
spozant
i

- Fact
orgenet
ic

- Fr
ecv
ent
acr
escut
alaper
sonaecugr
upadesange0I

- Agr
egar
eaf
ami
l
ial
 Fact
ori
fav
ori
zant
i

o Gener
ali
:st
ressemot
ional
,oboseal
a,somni
nsuf
fi
cient

o Al
i
mentar
i:meseneconcor
dant
e,consum depr
ajel
i
,rant
asur
i,condi
ment
,fumat
,
medi
camente(
AINS)

o Hel
i
cobact
erpy
lor
i-t
rai
est
einmucoasagast
ri
ca

Asoci
atUG/
UD(
80-
100%di
ncazur
i)

Neut
ral
i
zeazaaci
dit
atea

Det
ermi
naapar
it
iagast
ri
tei
acut
e/cor
nice

Pr
edomi
nai
nant
ru,
seext
indespr
efundul
stomacul
ui

Di
agnost
iculinf
ect
ieicuHpy-endoscopi
ecubi
opsi
e(2pr
elev
ari
ant
ral
ela2cm i
n
j
urul
pil
orul
uisi2pr
elevar
ifundi
ce)

Seevident
iazapr
inmet
ode:
nei
nvazi
ve/i
nvazi
ve,
dir
ect
e(cul
tur
a,exH-
P)/i
ndi
rect
e
(ser
ologi
ce)

Met
odenei
nvazi
ve

1.Test
ulr
espi
rat
orcuur
eemar acuC13
cat

- evi
dent
iazaact
ivi
tat
eaur
eazi
caabact
eri
eidupai
nger
areur
eemar
cat
a
13
C

- t
estpozi
ti
v-i
ndi
caoi
nfect
ieact
ive

- met
odabunaptcont
rol
uler
adi
car
ii

2.Test
eser
ologi
ce

- I
denti
fi
caraspunsuli
mmunol ogi
cumoralal
gazdeil
ainfect
iacuHpy
at
cantiHpydinclasaIgGaparla2-
3saptdelai
nfect
ie,
scaddupa4-6
l
unidelaeradi
careainf
ect
iei

3.I
dent
if
icar
eaant
igenel
orbact
eri
enei
nscaun

Met
odei
nvazi
ve

1.Examenhi st
o-pat
ologi
c(H-
P)al
unei
lezi
uni
gast
ri
ce/
duodenal
e,chi
ar
cancergastr
ic;

- Ar
atat
ipul
gast
ri
tei
 - Cont
rol
uler
adi
car
iii
nfect
iei

2.Cul
tur
a-sensi
bil
i
tat
e90-
95%

-Sepoat
edet
ermi
naant
ibi
ogr
ama

3.Testr
api
dal
ureazei
-pr
inf
ragment
eobt
inut
elabi
opsi
eint
roducei
nur
ee

4.PCR

UG-pemi
cacur
bur
alani
vel
ulant
rul
uipy
lor
ic

For
mecl
i
nico-
endoscopi
ce

Ulcerepi
gastr
ic(port
iuneaver
ti
val
aami
cii
cur
bur
i)
Ulceralmari
icurburi(medi
e)
Juxta-
pil
ori
c(stenoza)
Juxta-
cardi
al(r
iscdifagi
e)

Ul
cerdubl
u

Al
por
ti
uni
ior
izont
ale(
mal
i
gn)

Simptome-dur ere-cr ampapost prandi ala

-calmat adeal iment e
-cedeazal aal cali
ne
-respect amar easi micaper iodicitate
-tendi nt adecr onicizare
UD-factor
i fav orizanti:fumat , al
cool ,st
r ess
Formecl inico- endoscopi ce
Ul cer ul asimpt omat ial sugar ului
Ul ceral f
eteiant er i
oar e( riscper for ati
e)
Ul ceral f
eteipost er i
oar e( ri
schemor agie)
Ul cer emul ti
ple( col est aza, act i
uneaant iinfl
amat ori
i)
Locali
zar e: l
ani velulbubl bului ,genunchi super iorsi por ti
uneainalt
aDI I
Simptomat ologi e-dur ereepi gast ri
ca
-Pirozis, eruct atii
,const ipatie,dur eriperiombil
ical
e
*Al
tei
nvestigat iidiagnost ice
- ExamenRxcupast abar it
at a( evidentiereni sa)-i ndicastenozapi l
ori
ca/duodenal
a
- Tubaj gast r i
c:sdrZol l
inger ,recidiv adupai ntervent i
echi r
urgi
cala
- Ev aluar eahemor agiil
orocul tei nscaun: r
eact ii
frecv entpositi
ve
*
Ulcersecundar
- Lezi
uni
ulcer
oasemul
ti
ple,
frecv
entpemar
eacur
bur
a(agent
imedi
cament
osi
:aspi
ri
na,
 AINS)
- Cauzei nf
ect i
oase: vi
rusHer pessi mpl ex, CMV, Candi daal bicans
- Cauzei nf
lamat or ii
:boalaCr ohn, gast r
itacueozi nof i
l
ie( alergi
ialiment ar
e)
- Ulcerdest r
ess( agresiuni):
-neur ol ogice, coma, intervent i
ineurochi rurgi
cale
-traumat i
sm cr anian
-tumor i cerebr ale, meni ngitapur ulenta,ar suri
-MPCgr adI II(mal nutri
tiapr oteincalorica)
-SDA>10%
-det resar espi r
at orieacut agr av a
-IRA
-insuf i
ci entahepat ica
SI
MPTOMATOLOGI E
Lanou-nascut-t abloudeper itonita/ocl uzie
-Rx pneumoper it
oneu, hemor agiegr ava
-fact orif
av ori
zant i-pr emat uritate,hipoxie, staretoxica, detresa
r
espi rat
or i
e,hipogl icemi e
<70ani -fr
ecv entacr escut a-cauzef r
ecv ent e: aspir
ina, corti
zon, stress
-Compl icat i
i:hemor agie,per forati
e
-Dur eriabdomi nal recurente, varsaturirepet ate
-UD=UG
7-
18ani-f ete=bai eti mai frecv entUD
-sdrdur er osabdomi nal
-compl icat i
i=>dur erenoct urna, l
adi stantdemese, scadereponder al
a,anemi
e

TRATAMENT
1.Regimigieno- dieteti
c
- Repausl apat
- Indepart arest ress
- Ev i
tareal iment eiritant e
- Mesef recv ente- 6or i/zi
2.Medicament os: control secr eti
eaci dgast ri
c
IPP: Omepr az ol,Pant opr azol
Blocant irecept oriH2: Cimet i
di na, Raniti
dina,
Ni zat i
dina
Tamponar eaaci ditatii:-ant iaci de: Al
magel
-ci toprot ectie:Venter(sucr al
fat)
-st imul areabar i
ereipr
ot ectoare:Bismutcoloi
dal
3.Inf
ecti
ecuHpy
o Triplater apie:Omepr azol +Met ronidazol+Cl ari
tromi ci
na/Amoxicil
i
na
sau
Ranitidina/ Nexium +Bi smutsubci trat+Met roni
dazol +
Clarit
romi ci
na/ Amox
o Doz efol osite:
- Amoxici
li
na-100mg/ kgc/ziin3doze
-25-50mg/ kgc/zii
n3doze
- Cl
ari
tr
omi ci
na-15mg/ kgc/ziin2doze
- Metr
onidazol-15-
20mg/ kgc/zii
n3doze
- Omeprazol-1-2mg/kgc/zii
n2pr i
ze