Cuprins
 
CAPITOLUL I 

  I. ANATOMIA APARATULUI DIGESTIV

I.1.Segmentele tubului igesti!

I.". Gl#nele #ne$e #le tubului igesti!

I.%. An#t&mi# 'i(#tului

I.3.a.ARIA DE PROTECTIE A FICATULUI

I.%.b. LIGAMENTELE DE SUSTINERE

I.3.c. SEGMENTATIA FICATULUI

I.%.. STRUCTURA )ISTOLOGICA A *ICATULUI

I.%.e. VASCULARI+ATIA *ICATULUI

I.%.'. INERVATIA *ICATULUI

 

I.,. VE+ICULA -ILIARA

I.. *I+IOLOGIA *ICATULUI

I./. *UNCTIILE *ICATULUI

1.0. PATOLOGIA *ICATULUI

 

  CAPITOLUL II

II. CIRO+A )EPATICA

II.1. DE*INITIE

II.". *ORMAREA CIRO+EI

II.%. CLASI*ICAREA CIRO+ELOR

II.,. ETIOPATOGENIE

II..MOR*OPATOLOGIE

II./.TA-LOU CLINIC

II.0. *ORME CLINICE.

II..E2AMENE PARACLINICE SI DE LA-ORATOR

II.3. DIAGNOSTIC

 II.14.EVOLUTIE SI PROGNOSTIC

II.11.TRATAMENT

II.11.A. TRATAMENT C) COMPENSATE SI INACTIVE

II.11.-.TRATAMENTUL )IPERTENSIUNII PORTALE

II.11.C.TRATAMENTUL C) CU DECOMPENSARE PORTALA

II.1".COMPLICATIILE CIRO+EI )EPATICE

II.1".1. )EMORAGIA DIGESTIVA SUPERIOARA

II.1".".ENCE*ALOPATIA )EPATICA

II.1".%.ASCITA RE*RACTARA

II.1".,.IN*ECTAREA ASCITEI

II.1"..COMPLICATII RENALE
CAPITOLUL III
  ROLUL ASISTENTEI MEDICALE IN INGRI5IREA
-OLNAVULUI CU CIRO+A  )EPATICA
 

III.A.ROL IN PRO*ILA2IE
III.B.ROL INASIGURAREA CONDITIILOR DE MEDIU
III.C.ROL IN SEMIOLOGIA AFECTIUNILOR HEPATICE

III.D.ROL IN SUSTINEREA *UNCTIILOR ORGANISMULUI

III.D.1.*UNCTIILE VITALE
III.D.2.ALTE FUNCTII ALE ORGANISMULUI

III.E.ROL IN E*ECTUAREA UNOR INVESTIGATII PENTRU

STA-ILIREA DIAGNOSTICULUI

III.E.1.RECOLTAREA SANGELUI CAPILAR

III.E.".RECOLTAREA SANGELUI VENOS CU TRUS

VACUTAINER
III.E.3.URMARIREA BILANTULUI LICHIDIAN
III.E.4.GREUTATEA CORPORALA SI INALTIMEA

III.E..O-SERVAREA APETITULUI SI A MODULUI IN CARE -OLNAVUL RESPECTA

PRESCRIPTIILE MEDICALE
III.E./.PARACENTE+A 6PUNCTIA EVACUATORIE A ASCITEI )
III.E.0.LAPAROSCOPIA 6CELIOSCOPIA7

III.E..PUNCTIA -IOPSICA )EPATICA

III.E.3.SCINTIGRA*IA

III.E.14.ULTRASONOGRA*IA

III.E.11.ENDOSCOPIA

III.E.1".TOMOGRA*IE COMPUTERI+ATA 6TC7

III.E.1%.RE+ONANTA MAGNETICA NUCLEARA 6RMN7

III.*.ROL IN ADMINISTRAREA TRATAMENTULUI

III.*.1.ADMINISTRAREA MEDICAMENTELOR PE CALE ORALA

III.*.".ADMINISTRAREA MEDICAMENTELOR PE CALE PARENTERALA

III.*.".#.ADMINISTRAREA MEDICAMENTELOR PE CALE VENOASA

III.F.2.b.ADMINISTRAREA MEDICAMENTELOR PE CALE MUSCULARA
 

ISTORIC

Denumire !e "irr#$% re $ri&ine &re' %i in%emn &(ben*$r+$'(iu, reie%in! '

nume(e b$(ii  -$%+ !e+ermin+ !e 'u($re mr$u!e%'#i%  -i'+u(ui %i nu !e '$n%i%+en+ %
're%'u+. Lenne', 'rui *e bun !re*++e i %e +ribuie *+erni++e 'ir$ei, -irm in +r++u( %u,
'  -$%+ im*re%i$n+ !e 'u($re -i'+u(ui. U(+eri$r, Leibermei%+er %i E/(! '$n%i!er '
!enumire !e 'ir$ %u&ere mi !e&rb '$n%i%+en+ 're%'u+ !e'+ m$!i-i're !e 'u($re 
-i'+u(ui. De (un&u( +im*u(ui +ermenu( !e 'ir$ % i!en+i-i'+ 'u %'re($ -i'+u(ui,ui+n!u%e
*r$*e %emni-i'+i % !e 'u($re.
De%i *+erni++e 'ir$ei m 0u+ ' e%+e +ribui+ (ui Lenne', &re'ii %i r$mnii, 'u
mu(+e %e'$(e inin+e 'e%+iu, u !e%'rie% b$( ' $ +r$-ie %i in!ur+ie  -i'+u(ui.
Er%i%+r+u% !in A(e1n!ri in 34 i.C#r. -'e (e&+ur in+re %'i+ %i -i'+u( in!ur+.
Are+u% !in C*!$'#i in %e'.II.i.C#r. e%+e *rimu( 're -'e (e&+ur in+re in-(m+i -i'+u(ui %i
e0$(u+i 'e%+ui %*re 'ir$. e%(iu%, in 543, -'e '$re(+i !in+re e+i(i%m %i 'ir$. In 675,
8$#n Br$/ne !e%'rie %emne(e !e !e'$m*en%re (e 'ir$ei. M$r&in, in 96, e%+e *rimu( 're
!e%'rie *er+urbri(e 0%'u(re !in '!ru( CH.
De%'riere (ui Lenne' e%+e 'e mi '$m*(e+: ; -i'+u(, re!u% ( <3 !in !imen%iuni(e (ui
$bi%nui+e, %'un% in re&iune *e 're $ $'u*= %u*r-+ % e1+ern u%$r mme($n+ %i in're+i+,
 *rein+ $ 'u($re 0erui&(ben, !in++, *rn! in in+re&ime ('+ui+ !in+r$ m(+i+u!ine !e
&run+e mi'i, !e -$rm r$+un! %u $0i!, (e 'r$r !imen%iuni 0ri !e ( %mn+ !e mei
 *n ( 'e !e 'ne*. A'e%+e &run+e, u%$r !e %e*r+e un !e (+, nu *reen+u in+re e(e ni'i un
%*+iu in 're % *$+ re'un$%+e +e%u+ #e*+i' re%+n+: 'u($re ($r er '%+nie %u &(buie
r$%i+i', ( *eri-erie 0er!e, +e%u+u( ($r mi !e&rb ume!, $*', er ( *(*re mi !e&rb -(%'
!e'+ m$(e, %i ( %+rn&ere &run+e($r in+re !e&e+e nu %e *u+e +er'iui !e'+ $ mi' *$r+iune,
re%+u( !!e ( *(*re %en+i unei bu'+i !e *ie(e m$(e.>
L %'ur+ +im* !u* !e%'riere (ui Lenne'  in'e*u+ '$n+r0er% %u*r $ri&inii +e%u+u(ui
'$n?un'+i0. Unii $ +ribuie '$(brii +rmei !e re+i'u(in, %e'un!r ne'r$e(e %i '$(*%u(ui
($bu(r, ir (+ii -$rmrii !e +e%u+ '$n?un'+i0 n$u. An!r( %i B$u((n! '$n%i!eru ' -i'+u( e%+e
('+ui+ !in+r$ %ub%+n+ r$%ie %i un &(ben, %e*+uri(e *r$0enin! !in 'e%+ !in urm. L
R$@i+n%@ in 742 *re $ in+er*re+re mi m+ur: 'ir$ e%+e reu(++u( -$rmrii unui +e%u+
'$n?un'+i0 n$u, ' r%*un% ( *er+urbri(e 'ir'u(+$rii %i &re%iune in-(m+$rie.
 In 75, Freri'#% !i-eren+i 2 %+!ii in -$rmre 'ir$ei:
) %+!iu( ne$-$rmrii !e -ibre %i ( in-(m+iei=
 b) %+!iu( -$rmrii m$!u(i($r %i ( '$n+r'+iei.
A !$u '$n+r0er% in *+$&eni 'ir$ei %e re-er ( %+!iu( (eiunii *rimre. Du* "ermnn,
"+e+ %i Fie%%in&er, (eiune *rimr e%+e ($'(i+ ( ni0e(u( #e*+$'i+e($r, '$n%+n! in ne'r$
'e%+$r. R$@i+n%@ +ribuie un 'r'+er *rimr in-(m+iei +e%u+u(ui '$n?un'+i0. R$%%(e
'$n%i!er ' (eiune *rimr -e'+e '$n'$mi+n+ #e*+$'i+u( %i meen'#imu(.
 

CAPITOLUL I 

  I. ANATOMIA APARATULUI DIGESTIV

A*r+u( !i&e%+i0 e%+e ('+ui+ !in +$+(i++e $r&ne($r 're in!e*(ine%' im*$r+n+
-un'+ie !e !i&e%+ie %i b%$rb+ie  (imen+e($r *r/#ne%iune, m$!i-i'ri(e -ii'e %i '#imi'e (e
(imen+e($r, b%$b+i ;nu+rimen+e($r>, e1're+i rei!uri($r neb%$rbi+e).
A*r+u( !i&e%+i0 %e '$m*une !in:
   +ubu( !i&e%+i0
 ne1e(e 'e%+ui +ub

I.1.Segmentele tubului igesti!

A. Cavitatea bucala '$n%+i+uie *rim *$r+iune  +ubu(ui !i&e%+i0. E%+e %i+u+ ( *r+e
in-eri$r  -e+ei, %ub -$%e(e n(e, !e%u*r mu%'#i($r mi($#i$i!ieni, inin+e -rin&e(ui.
In '0i++e bu'( %e &%e%' !in+ii %i (imb:
  Din+ii %un+ -i1+i in (0e$(e(e !en+re (e m1i(ru(ui %i mn!ibu(ei *rin+r$ r+i'u(+ie
 *r$*rie&$m$-, %un+ in numr !e 32 %i %un+ !*++i *en+ru !r$bire, +iere %i m'inre
(imen+e($r.
 Limb e%+e un $r&n eminmen+e mu%'u($%, +%+ *(n%eu(ui bu'( %i -$rm+ !in+r$
r!'in -i1 !e $%u( #i$i! %i mn!ibu( b (imbii), '$r*u( %i 0r-u( *e1) (imbii.
Limb in!e*(ine%+e r$(uri im*$r+n+e in *r$'e%e(e !e m%+i'+ie %i !e&(u+i+ie, in 0$rbire %i in
 *er'e*ere &u%+u(ui (imen+e($r %i  %en%ibi(i++ii !e +'+, '(!, re'e, !urere.
 
B.  Farinfele e%+e un $r&n '0i+r, %i+u+ inin+e '$($nei 'er0i'(e, ( in+re+iere
'i($r eriene %i !i&e%+i0e. Re(ie (e&+ur in+re -$%e(e n(e %i (rin&e, *re'um %i !in+re
'0i++e bu'( %i e%$-&  n$-rin&e, $r$-rin&e, (rin&$-rin&e).

C.  Esofagul  e%+e re*reen++ !e un +ub mu%'u($mu'$% in (un&ime !e 253 'm, 're

in'e*e ( -rin&e %i %e +ermin ( ni0e(u( %+$m'u(ui *rin $ri-i'iu( 'r!i. Are r$( in !e&(u+i+ie.
 
D. Stomacul  e%+e un $r&n '0i+r m$bi(, reer0$r in+ermi+en+, re*reen+n! *$r+iune
'e mi !i(++  +ubu(ui !i&e%+i0. E%+e %i+u+ in e+?u( %u*rme$'$(i', in re&iune e*i&%+ri' %i
#i$*'$n!ru( %+n&. E( *rein+ !$u -e+e n+eri$r %i *$%+eri$r), !$u mr&ini %u 'urburi
mre %i mi' 'urbur) %i !$u $ri-i'ii: 'r!i *rin 're '$muni' 'u e%$-&u( %i *i($ru( 're
%i&ur (e&+ur 'u !u$!enu(.
 
E. Intestinul subtire e%+e %i+u+e in e+?u( in-rme$'$(i'. Se in+in!e !e ( $ri-i'iu( *i($ri'
 *n ( 0(0u( i(e$'e'(. E%+e -$rm+ !in +rei %e&men+e: !u$!en  *$r+iune -i1  in+e%+inu(ui
%ub+ire, re $ (un&ime !e 253 'm %i -$rm !e *$+'$0 !e%'#i% in %u% %i ( %+n&, in
'$n'0i++e 'rei %e in%'rie '*u( *n're%u(ui= in !u$!en %e !e%'#i!e %-in'+eru( O!!i, in 're
%e 0r% 'n(u( *n're+in %i '$(e!$'), ?e?un %i i(i$n  *$r+iuni(e m$bi(e (e in+e%+inu(ui %ub+ire 'e
%e in+in!e *n ( 0(0u( i(e$'e'( -r  *u+e -'e !e(imi+re in+re 'e%+e= ( 'e%+ ni0e(
 

mu'$% *rein+ un numr 're%'u+ !e 0i($i++i in+e%+in(e 're mre%' %u*r-+ !e

b%$rb+ie %i mi%'ri.
 
F. Intestinul gros e%+e u(+imu( %e&men+ ( +ubu(ui !i&e%+i0, *r$1. ,9 m, e%+e -$rm+ !in:
'e'um  %e&men+ %i+u+ %ub 0(0u( i(e$'e'( %i +ermin+ in+run -un! !e %'=
 *rein+ *en!i'e(e 0ermi-$rm), '$($n  '$n%+i+ui+ !in %e&men+e( %'en!n+, +rn%0er%, !e%'en!en+
%i %i&m$i! ), re'+u( u(+im *r+e  in+e%+inu(ui &r$% 're %e in+in!e 'u 'n(u( n(), nu% ;*$r+
!e ie%ire>!in +r'+u( !i&e%+i0).

I.". Gl#nele #ne$e #le tubului igesti!

A. Glandele salivare %un+ &(n!e e1$'rine (e 'r$r 'n(e %e !e%'#i! in '0i++e
 bu'(, e(e *r$!u' %(i0 'u ?u+$ru( 'rei %e re(ie !i&e%+i bu'(. E1i%+ +rei *ere'#i !e
&(n!e %(i0re mri: *r$+i!e, %ub(in&u(e %i %ubm1i(re %ubmn!ibu(re) %i numer$%e &(n!e
mi'i. E(e %un+ ('+ui+e !in 'e(u(e %er$%e %i mu'$%e.

B.  Pancreasul  e%+e $ &(n! mi1+, (un&i+ +rn%0er%( %i %e+ in+re *$r'$0

!u$!en( %i #i(u( %*(inei. Pn're%u( e1$'rin re $ %+ru'+ur +ubu($'in$% %emn+$re
&(n!e($r %(i0re. Ce(u(e(e 'ini($r *n're+i'i %e're+ %'u( *n're+i' 're e%+e '$(e'++ in !$u
'n(e mri: 'n(u( *rin'i*( ir%un& 'e %e !e%'#i!e in !u$!en im*reun 'u '$(e!$'u(, %i un
'n( ''e%$r Sn+$rini 'e %e !e%'#i!e in 'n(u( ir%un& %u in !u$!en.Pn're%u( en!$'rine
%e're+ #$rm$ni in %n&e, in%u(e(e Ln&er#n%: 'e(u( A %e're+ &(u'$&en, 'e(u( B %e're+
in%u(in).

C. Ficatul .
 

I.%. An#t&mi# 'i(#tului

Fi'+u( e%+e 'e( mi 0$(umin$% 0i%'er. E%+e un $r&n &(n!u(r 'u -un'+ii mu(+i*(e %i
im*$r+n+e in '!ru( e'$n$miei &ener(e  $r&ni%mu(ui.
Re*rein+ <2 !in &reu++e '$r*$(r ( n$un%'u+ %i <5 ( !u(+, 0n! 0ri+ii
in!i0i!u(e, %e1u(e %i !i&e%+i0e. Greu++e (ui ( '!0ru e%+e in+re 25&, 'e%+ -iin!
mi mre in +im*u( 0ie+ii !+$ri+ '$n+inu+u(ui in %n&e. Greu++e %*e'i-i' %e ri!i' in+re 45
95&, *r+i'u(r -iin! !en%i++e mi' %i *(%+i'i++e -$r+e mre.
 
 

 
Fi'+ %n+$%

I.3.a.ARIA DE PROTECTIE A FICATULUI

Fi'+u( e%+e un $r&n %ime+ri'. Ce mi mre *r+e  (ui *r$1im+i0 +rei *+rimi) %e
&%e%+e in ?um++e !re*+  b!$menu(ui %i numi re%+u( $ *+rime) %e &%e%+e in ?um++e
%+n&. E( r%*un!e !e'i #i*$'$n!ru(ui !re*+, e*i&%+ru(ui %i unei *r+i !in #i*$'$n!ru( %+n&.
Fi'+u(, ' %i %+$m'u(, *+run!e !n' in '$n'0i++e !i-r&mei 're ur' *n ( ni0e(u(
'$%+ei  'in'e, in'+ *r$+e'+i %i r*$r+uri(e (ui %e 0$r -'e %i 'u +$r'e(e. Re+inem ' in
e*i&%+ru !i%+in&em !$u $neun #e*+i', 'e((+ &%+ri'.
Ari !e *r$+e'+ie  -i'+u(ui %e in+in!e *e (ini me!i$'(0i'u(r in+re '$%+  5 %i
reb$r!u( '$%+(, *e (ini 1i(r me!ie in+re '$%+  6 %i  2, ir *r0er+ebr( in+re 0er+ebr
 7 %i   +$r'i'. L un in!i0i! n$rm$%+eni', -i'+u( %e *$+e *(* ( reb$r!, *e (ini
me!i$'(0i'u(r, in  2 ?um++e  in%*iru(ui *r$-$un!. Su*r-+ *(*bi( e%+e ne+e!,
e(%+i', -ii'+u( -iin! un $r&n '$m*re%ibi(, 'u $ *(%+i'i++e !+$ri+ '$n+inu+u(ui remr'bi( in
%n&e.
Fi'+u(ui i %e !e%'riu in '$n%e'in+ !$u -e+e:
 un in-eri$r, 0i%'er(
 %i un %u*eri$r, !i-r&m+i' *rein+ $ -+ %u*eri$r (iber *r% (iber)
%i un *$%+eri$r *r% --i1) '$n%i!er+e '  +rei -+.
 
 Fata superioara  %u  pars libera e%+e '$n0e1, mu(+ !u* b$(+ !i-r&mei. Pe e, (
ni0e(u( ($bu(ui %+n&, %e &%e%+e $ !e*re%iune +riun&#iu(r, 're '$re%*un!e 'en+ru(ui +en!in$% (
!i-r&mei %i e%+e (%+ !e inime%+e im*re%iune 'r!i'. P$r+iune %u*eri$r 0ine in r*$r+
 *rin in+erme!iu( !i-r&mei, 'u *(eur %i b *(mnu(ui !re*+, 'u inim %i *eri'r!u(, %i (
e1+remi++e %+n& 'u *(eur %i b *(mnu(ui %+n&. A'e%+e r*$r+uri e1*(i' !e 'e $ '$(e'+ie
 *(eur( !re*+ *$+e % !e*(%ee -i'+u( in ?$%= un b'e% %u un '#i%+ #i!ri' #e*+i' *$+e %
!e%'#i! in '0i++e *(eur( %i '#ir in *(mnu( !re*+, %u 'um $ *(& +$r'i' *$+e %
in+ere%ee *(mnu(, *(eur, !i-r&m %i -i'+u(.
 
 Fata posterioara  %u  pars affixa- e%+e $rien++ *$%+eri$r -iin! -i1+ !e !i-r&m *rin
+r'+uri -ibr$%e *urerni'e in !re*+u( 0er+ebre($r +$r'i'e T  %i T  %i ne'$*eri+ !e
 

 *eri+$neu. E%+e %+rb+u+ 0er+i'(, ( !re*+ ($bu(ui 'u!+, !e -$% 0enei '0e in-eri$re une$ri
'#ir %ub -$rm unui 'n( '$m*(e+ '$n%+i+ui+) in 're &%e%+e un (i&men+ !e -i1re ( 0enei.

 Fata inferioara  %u viscerala *e 'e%+ -+ %e &%e%+e $ re&iune !e$%ebi+ !e

im*$r+n+#i(u( -i'+u(ui. F+ e%+e *(n %i *ri0e%+e in ?$%, in*$i %i %*re %+n&. Pe 'e%+ -+
%e $b%er0 +rei %n+uri !i%*u%e in -$rm (i+erei ;H>, 'e $ im*r+ in !$i ($bi *rin'i*(i: ($bu( !re*r 
%i ($bu( %+n&, %i !$i ($bi ''e%$ri, ($bu( *+r+ %u n+eri$r %i($bu( 'u!+ %u *$%+eri$r. L$bu(
 *+r+ %e !e(imi+e *e -+ in-eri$r in+re mr&ine n+eri$r, #i(u( #e*+i' %i '$(e'i%+. L$bu(
'u!+ S*i&e() e%+e %i+u+e in*$i #i(u(ui #e*+i', in+re 0en '0 %i 'n(u( 0en$% Arn+iu%,
-iin! !ren+ !e 24 0ene #e*+i'e ''e%$rii, 're %e 0r% !ire'+ in 0en '0 in-eri$r.
 
Ce(e +rei %n+uri (e -e+ei in-eri$re %un+:
 %n+u( n+er$*$%+eri$r !re*+  !*$%+e%+e ( '*+u( n+eri$r 0ei'u( bi(ir, ir ( '*+u(
 *$%+eri$r 0en '0 in-eri$r
 %n+u( n+er$*$%+eri$r %+n& !*$%+e%+e (i&men+u( r$+un!, ir *$%+eri$r (i&men+u( Arn+iu%
 %n+u( +rn%0er%( %e in+in!e in+re 'e(e !$u %n+uri n+er$*$%+eri$re %i '$in'i!e 'u #i(u(
#e*e+i'.

 
 

I.%.b. LIGAMENTELE DE SUSTINERE

 
Men+in -i'+u( in ($? #e*+i' -iin! ?u++e %i !e: *re%iune in+r b!$min(, *r% --i1
%i 0i%'ere(e -(+e !e!e%ub+.
A'e%+e (i&men+e %un+:
 (i&men+u( -('i-$rm e%+e !i%*u% %&i+( *e -+ '$n0e1  -i'+u(ui in+re 'ei !$i ($bi
 *rin'i*(i, mr&ine (ui %u*eri$r in+inn!u%e !e ( $mbi(i' in %u%, *e (ini (b b!$min( %i
*$i *e -+ in-eri$r  !i-r&mu(ui, *n ( 0en '0 in-eri$r.
 (i&men+u( 0en$% Arn+iu% '$n+inu 0en $mbi(i'( ( -+ %i (i&men+u( r$+un! !u* n%+ere
 *n ( 0en '0 in-eri$r. Cn(u( Arn+iu% '$n!u'e ( -+ 'e mi mre *r+e  %n&e(ui
 *('en+r in 0en '0, -r % mi +re' *rin -i'+.
 (i&men+u( r$+un! re*rein+ $b(i+erre 0enei $mbi(i'(e !u* n%+ere %i +rn%-$rm+ in
(i&men+.
 (i&men+u( '$r$nr e%+e !i%*u% +rn%0er%( ( ni0e(u( -e+ei *$%+eri$re  -i'+u(ui, -iin! -$rm+
!in 'u+e(e *eri+$ne(e 'rni( %i 'u!(, in+re 're %e &%e%+e *r% --i1, +erminn!u%e (
'*e+e *rin (i&men+e(e +riun&#iu(re !re*+ %i %+n&.
 (i&men+u( e%$&%+r$!u$!en$#e*+i' mi'u( e*i*($$n %u $men+u( min$r) e( (e& -i'+u(
!e e%$-&, %+$m' %i !u$!en. Are in%er+i *e %n+u( +rn%0er%( ( -i'+u(ui, *$i %e '$n+inu
 *$%+eri$r urmn! %b+u( ($n&i+u!in( %+n& !e (un&u( '$r!$nu(ui -ibr$% Arn+iu%.
 (i&men+e(e ''e%$rii %un+ #e*+$ren(e, #e*+$'$(i'e %i #e*+$'i%+i'e, 'u r$( me'ni'
min$r, !r!e0ine im*$r+n+e in HTP.

F+ !i-r&m+i'  -i'+u(ui
 Ari nu!.2 (ini !e in%er+ie  (i&men+u(ui '$r$nr,
're %e '$n+inu 'u in%er+i 'e($r !$u (i&men+e +riun&#iu(re
!re*+ %i% +n&). 3 A*en!i'e -ibr$%.4 L$bu( %+n& ( -i'+u(ui.
5 Mr&ine in-eri$r 'u in'iur (i&men+u(ui r$+un! in 're
%e -(.6 Li&men+u( -('i-$rm %i 9 Li&men+u( r$+un! (
-i'+u(ui.7 Fun!u( 0ei'ii bi(ire %i+u+ in in'iur 'i%+i'.
 L$bu( !re*+ ( -i'+u(ui
 
 
 
F+ !i-r&m+i'  -i'+u(ui,*$r+iune
*$%+eri$r
 Li&men+u( -('i-$rm ( -i'+u(ui.2
F$i+ !r  (i&men+u(ui '$r$nr.3 L$bu(
!r ( -i'+u(ui, '$*eri+ !e *eri+$neu.4
Li&men+u( +riun&#iu(r !r.5 Ari nu!
%u *r% --i1.6 . '0 in-eri$r.9
L$bu( 'u!+ ( -i'+u(ui.7 Im*re%iune
e%$-&in. Li&men+u( +riun&#iu(r 
%+n&. L$bu( %+n& ( -i'+u(ui.
F$i+ %+n&  (i&men+u(ui '$r$nr .
 

I.3.c. SEGMENTATIA FICATULUI

Fi'+u( %emn+$r 'u *(mnu( %i rini'#iu(, re $ %+ru'+ur %e&men+r.

Fie're !in 'ei !$i ($bi !re*+ %i %+n&), *e b !i%+ribu+iei 0enei *$r+e, r+erei #e*+i'e %i 'i($r 
 bi(ire in+r#e*+i'e, *ermi+ !i0ire -i'+u(ui in 7 %e&men+e:
  ▫ %e&men+( I  '$re%*un!e ($bu(ui 'u!+
  ▫ %e&men+e(e II %i III  '$re%*un!e ($bu(ui %+n&, -$rme %e'+$ru( (+er( %+n&
  ▫ %e&men+( I  -$rme %e'+$ru( *rme!in !re*+ numi+ %i !re*+ n+eri$r 
  ▫ %e&men+e(e I %i II  -$rme %e'+$ru( (+er( !re*+ numi+ %i !re*+ *$%+eri$r.
Se&men+e(e I, , I, II, III '$re%*un! ($bu(ui !re*+ n+$mi'.

I.%.. STRUCTURA )ISTOLOGICA A *ICATULUI

Cu*rin!e '*%u( %i *ren'#imu( #e*+i'.

CAPSULA  .'*%u( G(i%%$n) e%+e ('+ui+ !in +e%u+ '$n?un'+i0 %i e(%+i'. E%+e !ub(+ (
e1+eri$r !e %er$% *eri+$ne(. L ni0e(u( #i(u(ui, '*%u( *+run!e in -i'+ $!+ 'u 0%e(e
%n&0ine r+er #e*+i' %i 0en *$r+), 'u 0%e(e (im-+i'e %i 'u ner0ii. In in+eri$ru( -i'+u(ui
+e%u+u( '$n?un'+i0 -$rme %e*+e %u +r0ee *$r+$bi(ire 'e im*r+ *ren'#imu( in ($bu(i %i
!*$%+e%' %i%+eme(e !e '$n!u'+e bi(ire %i -$rm+iuni 0%'u(re in+r#e*+i'e.

PARENCHIMUL HEPATIC  re ' uni++e m$r-$-un'+i$n( lobulul hepatic. L$bu( #e*+i'
re -$rm *irmi!( 'u b $rien++ %*re '*%u( %i 0r-u( %+rb+u+ !e 0en 'en+r$($bu(r. L
ni0e(u( !e '$n+'+ !in+re 2 %u mi mu(+i ($bu(i in0e'in+i, %e !e(imi+e un %*+iu n&u(r 
+riun&#iu(r *e %e'+iune +rn%0er%() !enumi+  spatiu port  %u spatiul Kiernan.
  In -r ($bu(ui #e*+i' ( ni0e(u( -i'+u(ui %e mi !e%'riu 2 uni++i -un'+i$n(e: lobul port   %i
acinul hepatic.
 

 obul hepatic port  e%+e 'en+r+ *e un 'n( bi(ir !in %*+i( *$r+ %i 'u*rin!e +$+(i++e uni++i($r 
%e're+$rii +ribui+e 'e(ui%i '$n!u'+ bi(ir. L$bu(ii *$r+(i %un+ uni++i(e 'u %e're+ie e1+ern (e
-i'+u(ui.
 !cinul hepatic 'u*rin!e +$+(i++e #e*+$'i+e($r iri&+e !e 'e(%i 0%, 're i%i 0r% bi( in
'e(%i 'n( bi(ir. A'inii #e*+i'i %un+ uni++i mi mi'i !e'+ ($bu(ii, ei in+rn! ++ in '$n%+i+u+i
($bu(u(ui #e*+i' '+ %i  'e(ui *$r+(. N$+iune !e 'in #e*+i' e1*(i' ++ -un'+i !e &(n! 'u
%e're+ie in+ern '+ %i -un'+i !e &(n! e1$'rin  -i'+u(ui.
L$bu( #e*+i' e%+e '$n%+i+ui+ !in:
  ▫  hepatocite  '$n%+i+uie 7 !in *$*u(+i 'e(u(r  -i'+u(ui. Au -$rm 'ub$i!(, re*rein+
!$i *$(i -un'+i$n(i, unu( 0%'u(r, (+u( bi(ir %i -e+e !i'en+e 'u 'e(u(e(e in0e'in+e. Ce(u(e(e
%inu%$i!e 'e(u(e ne#e*+$'i+e, ne*rn'#im+$%e) %un+ re*reen++e !e 'e(u(e(e en!$+e(i(e,
'e(u(e(e "u*--er, 'e(u(e(e (i*i-&e. In+re #e*r$'i+e %e &%e%' 'ni'u(e bi(ire in+r($bu(re -r
 *ere+i *r$*rii in 're %e !e%'r' bi(, *r$!u%u( !e %e're+ie ( 'e(u(e($r #e*+i'e. He*+$'i+e(e
 *rein+ 3 nu'(ei, 'i+$*(%m b$&+, $r&ni+e 'e(u(re: REN, RER, rib$$mi, mi+i$'$n!rii,
'$m*(e1 G$(&i.
  ▫  capilare si!soi"e  u $ !i%*unere r!ir in in+eri$ru( ($bu(u(ui re(in! un %i%+em '*i(r 
!e +i* *$r+, im+in% in+re !$u 0ene 'en+r$%i in+er$($bu(r). C*i(re(e %inu%$i!e %un+ *(%+e
in+re '$r!$ne !e #e*+$'i+e !e 're %un+ %e*r+e !e un %*+iu in&u%+  spatiul "isse.
S*+iu( Di%%e e%+e 'u*rin% in+re '*i(re(e %inu%$i!e %i #e*+$'i+e, e( '$n+inn! -(ui!u(
're 'ur&e %*re (im-+i'e %i $ne(e *$r+(e.
E( e%+e $'u*+ !e membrne b(  '*i(re($r, 'e(u(e(e meen&#im(e %i -ibre !e re+i'u(in.
T$+ in %*+i( Di%%e %un+ re*reen++e in 'e(u(e(e  Ito 'e(u(e(e 're %+$'#e &r%imi ;-+ %+rin&
'e((%>) 'e(u(e %+e(+e 'u r$( in me+b$(i%mu( 0i+minei A %i in *+$&ene 'iriei. Pe -ibre(e !e
re+i'u(in %e &%e%' 'e(u(e(e ne!i-eren+i+e 're in 0i+ *$%+n+( 0$r &ener *rin !i-eren+iere
numi 'e(u(e  Kupffer . Pere+e(e '*i(re($r %inu%$i!e e%+e -$rm+ !in en!$+e(iu 'e 'u*rin!e
'e(u(e(e "u*--er %i 'e(u(e(e en!$+e(i(e.
▫  caalic!le #iliare  %e -$rme in+re -e+e(e (+ur+e, in '$n+'+, (e #e*+$'i+e($r !in (me(e
#e*ri'e. E(e nu u *ere+e *r$*riu, e(e %un+ %*+e %ub -$rm unui %n+ in *ere+e(e in%u%i ( 'e(u(ei
#e*+i'e. S*re *eri-eri ($bu(u(ui, 'ni'u(i bi(ri u *ere+e *r$*riu %i ie%in! !in ($bu(, %e '$n+inu
'u 'n(e(e bi(ire in+er($bu(re. A'e%+e %e '$(e'+e , in -in(, in 'e(e 2 'n(e #e*+i'e, !re*+
%i %+n&, *reen+e in #i(u( -i'+u(ui.
▫  $ea cetrolo#!lara  in'e*e in+run '*+ $rb ;in !e&e+ !e mnu%>), !u* 're %e in!re*+
%*re mi?($'u( bei ($bu(u(ui, un!e %e '$n+inu 'u 0en %ub($bu(r. C*i(re(e %inu%$i!e !in
in+re&u( ($bu( #e*+i' %e !e%'#i!e in 0en 'en+r$($bu(r.
▫  tes!t "e s!stiere  e%+e re!u% -iin! re*reen++ !e -ibre !e re+i'u(in !in %*+i( Di%%e. A'e%+
+e%u+ %u%+ine '*i(re(e %inu%$i!e %i '$r!$ne($r 'e(u(re.
 

  e!ere #i+$($&i'  +e%u+u(ui #e*+i' n$rm(

I.%.e. VASCULARI+ATIA *ICATULUI

 
E%+e $ 'ir'u(+ie !ub(: nu+ri+i0 %i -un'+i$n(.

#asculari$atia nutritriva: +rn%*$r+ %n&e(e $1i&en+, 'e *r$0ine !in r+er #e*+i',
're, !u* rmi-i'+ii mu(+i*(e ($bre, %e&men+re %i in+er($bu(re), %e '*i+(ie, iri&n!
-$rm+iuni(e !in %*+i( in+er($bu(r *$r+(), %i -$rme $ re+e in ?uru( #e*+$'i+e($r. In -in(
'e%+e '*i(re %e 0r% in '*i(re(e %inu%$i!e (e 0enei *$r+e 0ei ne1).

#asculari$atia functionala: e%+e '$n%+i+ui+ !in rmi-i'+ii(e 0enei *$r+e, 're !u'e %n&e
'u %ub%+n+e(e nu+ri+i0e, b%$rbi+e !in in+e%+ine, *en+ru  -i me+b$(ire in -i'+. P$r+ %e
rmi-i', -$rmn! rmuri ($bre, %e&men+re, in+er($bu(re= u(+imi(e rmi-i'+ii -$rmn!
'*i(re(e %inu%$i!e. C*i(re(e %inu%$i!e '$n-(ui in 0en 'en+r$($bu(r 're '$n!u'e %n&e(e
%*re b ($bu(u(ui un!e 0 -i '*++ !e $ 0enu( '$(e'+$re 0en %ub($bu(r). ene(e
'$(e'+$re, !e '(ibru !in 'e in 'e mi mre, %e !e%'#i!e in 0ene(e %u*r#e*+i'e, ir in -in( in
0en '0 in-eri$r.

#asele limfatice  %e +ermin in mi'i &ru*uri !e &n&(i$ni in ?uru( #i(u(i #e*+i'. O *r+e
!in (im-+i'i(e !e ( %u*r-+ -i'+u(ui +r0er%e !i-r&mu( in (i&men+u( -('i-$rm %i in -in(
?un& ( &n&(i$nii me!i%+i(+i. A(+ &ru* '$m*ni 0en '0 in-eri$r %*re +$r'e,
+erminn!u%e in '+i0 mi'i &n&(i$ni %i+u+i in *$r+iune in+r+$r'i'.
 

I.%.'. INERVATIA *ICATULUI

 
E%+e !e +i* 0e&e++i0, -iin! %i&ur+ !e -ibre %im*+i'e *r$0enin! !in *(e1u( 'e(i'
 *rin'i*() %i *r%im*+i'*r$0enin! !in ner0u( 0& ), 're -$rme *(e1uri in ?uru( 0%e($r %i
'n(e($r #e*+i'e.

I.%.g. CAILE -ILIARE

 
 

  ▫  intrahepatice in'e*e 'u 'ni'u(e(e bi(ire !u* 're urme $ %erie %u''e%i0 !e 'ni'u(e(e
in+r($bu(re, *eri($bu(re, bi(i-ere), 're *n ( urm %e !u& in 'e(e !$u !u'+e #e*+i'e,
!re*+ %i %+n&.
  ▫  extrahepatice re*reen++e !e 'n(u( #e*+i' '$mun 'e %e une%+ 'u 'n(u( '%+i' !e (
0ei'u( bi(ir -$rmn! 'n(u( bi(ir '$mun '$(e!$'u() 'e %e !e%'#!e in !u$!en ( ni0e(u(
 **i(ei !u$!en(e, im*reun 'u 'n(u( *n're+i', 'e%+ unin!u%e %i -$rmn! ampula #ater  'e
%e !e%'#i!e in !u$!en *rin in+erme!iu( %-in+eru(ui O!!i. In ≈3 !in 'uri 'e(e !$u 'n(e %e
!e%'#i! %e*r+e in !u$!en.

I.,. VE+ICULA -ILIARA

E%+e un reer0$r ne1+ !e e1're+ie  bi(ei, in 're 'e%+ %e 'umu(e in in+er0(u(

!in+re *rnuri. E e%+e %i+u+ in -$% 0ei'ii bi(ire !e *e -+ 0i%'er(  -i'+u(ui.
 Dire'+i 0ei'ii e%+e *r$1im+i0 %&i+(. In re(i++e, !ire'+i ei e *u+in $b(i' !e ?$% in
%u%, !inin+e in*$i %i !e ( !re*+ ( %+n&. A'e%+ $b(i'i++e %*re %+n& e mu(+ mi
''en+u+ ( '$*i(.
ei'u( bi(ir re $ (un&ime !e *r$1im+i0  'm %i $ (r&ime !e 4 'm. C*'i++e e
!e 56 m(.
C(%i', '$(e'i%+u( e '$m*r+ 'u $ *r. i %e !e%'riu +rei *$r+iuni:  fundul% corpul  %i colul.
 Fundul ve$icii biliare e%+e r$+un?i+ in -$rm !e -un! !e %'. E( r%*un!e in'iurii 'i%+i'e !e *e
mr&ine in-eri$r  -i'+u(ui. E%+e in0e(i+ in *eri+$neu %i re $ mre m$bi(i++e= une$ri e%+e
 *+$+ %u ! ;0ei' in un!i+>.
  Corpul ve$icii biliare- e%+e *r+e ei !eren+ ( -+ 0i%'er(  -i'+u(ui. Se in&u%+e +re*++
%*re '$(= u(+im % *r+e e%+e !enumi+ infundiul .C$r*u( 0ei'ii 0ine in r*$r+ in %u% 'u -i'+u(
-$% 0ei'ii bi(ire), ir in ?$% 'u '$($nu( +rn%0er% %i 'u %e&men+u( %u*rme$'$(i' ( *$r+iunii
!e%'en!en+e  !u$!enu(ui $r&ne in 're *$+ *+run!e '('u(ii bi(iri !u* 'e in *re(bi( %
in%+(+ $ -i%+u().
  Colul- -$rme e1+remi++e *r$-un! %i %'u+i+  0ei'ii bi(ire. E%+e %i+u+   in %+n&
'$r*u(ui 0ei'ii, re $ -$rm 'r$ni' %i e%+e %inu$%, !e%'riin! !$u in-(e1iuni. C$(u( e%+e (iber, nu
!er ( -i'+ %i e%+e %u%*en!+ !e e( *rin+r$ *re(un&ire  $men+u(ui mi'. In+re -$i+e(e 'e%+ei
 *re(un&iri +re'e r+er 'i%+i'. In %u% %i ( %+n&, '$(u( 0ine in r*$r+ 'u rmur !re*+  0enei
 *$r+e, ir in ?$% 'u *$r+iune %u*eri$r  !u$!enu(ui %u 'u -(e1ur !u$!en( %u*eri$r).
#asculari$atia ve$iculei biliare e%+e %i&ur+ !e r+er 'i%+i', rmur (r&  r+erei #e*+i'e.
Dren?u( 0en$% %e -'e in 0en 'i%+i' %i !e i'i in %i%+emu( 0en$% *$r+.
 Inervatia ve$iculei biliare e%+e %i&ur+ !e +ermin+ii ner0$%e ++ !in %i%+emu( *r%im*+i', '+
%i !in 'e( %im*+i'.
 

 
Ci(e bi(ire e1+r#e*+i'e.
  .Fun!u( 0ei'ii bi(ire.2 C$r*u( 0ei'ii.3 In-un!ibi(u( 0ei'ii.4
C$(u( 0ei'ii.5 Du'+u( 'i%+i'.6 Du'+u( #e*+i' !re*+.9 Du'+u( #e*+i' %+n&.
  7 Bine+u(.  Du'+u( #e*+i' '$mun. Du'+u( '$(e!$'. Du$!enu(

I.. *I+IOLOGIA *ICATULUI

D+$ri+ bun!en+ei %(e iri&ri 'u %n&e -un'+i$n( %i nu+ri+i0 %i !+$ri+ +rn%-$rmri($r 
'#imi'e 're u ($', *e !re*+ 'u0n+ -i'+u( *$+e -i '$n%i!er+ un !e0r+ (b$r+$r (
$r&ni%mu(ui.
Fi'+u( re $ mre '*'i++e !e re&enerre, %+-e( ' !u* $ #e*+e'+$mie *r+i(,
re&enerre in'e*e !u* 24 !e $re %i %e +ermin !u* 4 i(e.
 Fun'+ii(e -i'+u(ui %un+ mu(+i*(e -iin! in!e*(ini+e ( ni0e(u( #e*+$'i+e($r. Fi'+u(:
▫  i *r+e ( !i&e%+i in+e%+in(,
▫  !e*$i+e in e( $ *r+e !in %ub%+n+e(e 're !e*%e%' ne0$i(e ime!i+e (e $r&ni%mu(ui,
▫  !e&r!e %i %in+e+ie !i-eri+e %ub%+n+e: 'ii &r%i, (i*$*r$+eine,
▫  r$( in me+b$(ire '$(e%+er$(u(ui,
▫  i *r+e ( men+inere '$m*$i+iei *(%mei,
▫  men+ine e'#i(ibru( &(u'i!i',
▫  +rn%-$rm &r%imi(e in -$rme 're %e $1i!e mi u%$r,
▫  %in+e+ie -ermen+ii ne'e%ri -un'+ii($r *r$*rii %u (e (+$r $r&ne,
▫  re&(e me+b$(i%mu( *ei %i '$n+r$(e !ebi+u( %n&0in,
▫  $*re%+e *+run!ere +$1ine($r in $r&ni%m,
▫  re r$( in -$rmre &($b(e($r r$%ii,
▫  in+er0ine in +erm$re&(re,
▫  re r$( in %in+e -'+$ri($r !e '$&u(re
▫  re r$( in me+b$(ire ('$$(u(ui,
▫  re -un'+ie n+i+$1i'.
 

I./. *UNCTIILE *ICATULUI

Fi'+u( in!e*i(ne%+e in $r&ni%m un r$( im*$r+n+, in+er0enin! in *r$*e +$+e

me+b$(i%me(e in+ermi!ire (e %ub%+n+e($r, in une(e *r$'e%e !e re&(re  #$me$%+ei, in
 *r$'e%e(e !e *rre  $r&ni%mu(ui.
 Fun'+ii(e -i'+u(ui *$+ -i &ru*+e in +rei mri '+e&$rii, %i nume:
A. -un'+i !e -$rmre %i e(iminre  bi(ei, re%*e'+i0 -un'+i bi(ir
B. -un'+ii(e me+b$(i'e, re%*e'+i0 *r+i'i*re -i'+u(ui ( -e(e me+b$(i%mu(ui in+erme!ir 
C. (+e -un'+ii, re%*e'+i0 re&(re !i-eri+e($r me'ni%me (e $r&ni%mu(ui.

 !. F&'C(I! )II!*!: -un'+i !e -$rmre  bi(ei %i !e e(iminre  bi(ei, mi *$r+ nume(e !e
biligene$a. Bi( e%+e %e're++ !e 'e(u(e(e *ren'#im+$%e in m$! '$n+inuu, in 'n+i++e !e 5
9m(<i, %i e%+e +rn%*$r++ *rin 'n(i'u(e(e in+r#e*+i'e %i e1+r#e*+i'e in 0ei'u( bi(ir,
un!e %e 'umu(e in *eri$!e(e !in+re me%e %i e%+e e(imin+ in in+e%+ine in +im*u( *r$'e%u(ui
!e !i&e%+ie.
Compo$itia bilei: 'e%+ re un &u%+ mr %i un mir$% %*e'i-i'. Cu($re ei 0ri,!u*
'um *r$0ine:
▫  !ire'+ !in -i'+&(ben uriu=
▫  !in 0ei'u( bi(ir&(ben uriu mi in'#i%=
▫  !in '$(e!$'&(ben !e%'#i%.
  Prin'i*(ii '$n%+i+uien+i i bi(ei %un+:
  * 5 9),
  %ruri bi(ire ) re*rein+ 'e( mi im*$r+n+ '$n%+i+uien+ ( bi(ei. Pr$'e%u( SB !i-er in
-un'+ie !e (imen++ie. E1.: 'n! (imen++i e%+e b$&+ in 'rne %i un+, *r$'e%u( ($r 're%+ere, ir 
(i*% 'e%+$r !u'e ( %'!ere (ui. SB ?un&e in in+e%+in +re' in 'ir'u(+i 0enei *$r+e %i ?un& !in
n$u in -i'+, un!e u r$( !e %+imu(i in -$rmre !e n$i SB. In -e(u( 'e%+ %e %+bi(e%+e un 'ir'ui+
( SB. numi+ circuitul enterohepatic al S). SB in!e*(ine%+e urm+$re(e -un'+ii:
  . ( ni0e(u( in+e%+inu(ui emu(%i$ne &r%imi(e %i *$+en+e (i*% *n're+i'
  2. -$rme 'u &r%imi(e '$m*(e'%i '$(eini'i in *, *ermi+n! %+-e( b%$rb+i &r%imi($r %i 
0i+mine($r (i*$%$(ubi(e A, D, E %i " 
  3. %+imu(e *eri%+(+i%mu( in+e%+in( r$( (1+i0
  4. men+ine e'#i(ibru( -($rei mi'r$biene  in+e%+inu(ui &r$%, '$mn!n! mi (e%, -($r !e
 *u+re-'+ie r$( n+i*u+ri!
  5. %+imu(e -$rmre bi(ei r$( '$(ere+i'.
  *i&men+i bi(iri ,5) %un+ re*reen++i !e bi(irubin %i bi(i0er!in= -iin! *r$!u%i !e
!e%imi(+ie i #em$&($binei %i e(iminn!u%e *rin bi(, ! 'e%+ei 'r'+eru( !e  -i un *r$!u%
!e e1're+ie.
  '$(e%+er$(u(, 2 & ) e%+e un *r$!u% !e $1i!re, *r$0ine !in %n&e %i !in -i'+= men+inere
r*$r+u(ui '#$(e%+er$(SB n$rm( <2 <3) re $ !e$%ebi+ im*$r+n+. Cn! %'!e %ub <3 %e
-0$rie *re'i*i+re '$(e%+er$(u(ui 're -$rme '('u(i bi(iri
  (e'i+in, ,)
  mu'in, e%+e *r$!u% !e *ere+ii 'i($r e1're+$re %i !e *ere+ii 0ei'u(ei
  'ii &r%i, 'i!u( uri', ure.
 

Me'ni%mu( %'ur&erii bi(ei: bi( *r$!u% in m$! '$n+inuu !e -i'+ %e %'ur&e *rin 'n(i'u(e(e
 bi(ire in+r#e*+i'e %i *$i *rin 'n(u( #e*+i' %i *$+ (u !$u !ire'+ii:
   in +im*u( !i&e%+iei %e 0r% in !u$!en *rin 'n(u( '$(e!$':
  in+re *rnuri %e 'umu(e in 0ei'u( bi(ir un!e %u-er *r$'e%e !e '$n'en+rre.
E(iminre bi(ei !in 0ei'u( bi(ir %e -'e *rin '+iune %iner&e+i'  '$n+r'+iei
0ei'u(ei bi(ire %i  re(1rii %-in'+eru(ui O!!i, !n! *$%ibi(i++e *+run!erii bi(ei *e '(e
'n(u(ui 'i%+i' %i '$(e!$' in !u$!en. A'e%+ me'#ni%m e%+e re&(+ *e '(e ner0$% %i um$r(.

 ). F&'C(IIE +E(!),ICE . Fi'+u( in!e*(ine%+e mi mu(+e -un'+ii me+b$(i'e:

  metabolismul glucidic
G(u'i!e(e %un+ b%$rbi+e ( ni0e(u( +r'+u(ui !i&e%+i0 %ub -$rm !e m$n$#ri!e, &(u'$,
&('+$ %i -ru'+$ %i ?un& *e '(e 0enei *$r+e ( -i'+. Ce mi mre *r+e e%+e !e*$i++ %ub
-$rm !e &(i'$&en in 'e(u(e(e #e*+i'e. Me+b$(i%mu( &(u'i!e($r re $ im*$r+n+ !e$!ebi+
 *en+ru *r$!u'ere ener&iei ne'e%re $r&ni%mu(ui= -un'+i -i'+u(ui in me+b$(i%m &(u'i!i' %e
nume%+e -un'+ie &(i'$&eni'
b metabolismul lipidic
Fi'+u( in+er0ine in me+b$(i%mu( (i*i!i' in!e*(inin! $ %erie !e r$(uri:
▫ inm&inre &r%imi %ub -$rm !e ;&r%imi !e reer0>
  ▫  m$bi(ie &r%ime !e reer0 !in !e*$i+e in %+ri(e !e inni+ie (e $r&ni%mu(ui -i'+u(
n+rene &r%ime !e reer0 !in %+r+u( 'e(u(r %ub'u+n+ *en+ru '$*erire ne0$i($r 
$r&ni%mu(ui )
  ▫ %in+e+ie 'iii &r%i %i &r%imi(e neu+re %ub -$rm !e -$%-$(i*i!e !' %e *r$!u'e $
+u(burre in -$rmre -ermen+e($r 'e !u' ( %in+e+ire 'e%+$r, %e 'umu(e in 'e(u(e(e
#e*+i'e 're *r$0$' $ !e0$(+re mre  +e%u+u(ui '$n?un'+i0 ( -i'+u(ui -$rmn! CH)
  ▫  $1i!e 'iii &r%i 'u *r$!u'ere !e ener&ie, CO2 %i *.
c metabolismul protidic
L ni0e(u( -i'+u(ui, *r$+i!e(e %u-er !i-er+i+e *r$'e%e !e %in+e %i !e !e&r!re ne'e%re
'$m*$i+iei *(%mei %i re-'erii 'e(u(e($r.
  ▫ %in+e+ie -ibrin$&enu( %i *r$+r$mbin, %ub%+n+e *r$+ei'e 'e in+er0in in '$&u(re
%n&e(ui= %e %in+e+ie in -i'+ %i +re'e in *(%m. Pen+ru %in+e *r$+r$mbinei e%+e ne'e%r
 *reen+ 0i+minei ".
  ▫  re+ine *r+i( *r$+eine(emin$'iii) in 0e!ere u+i(irii ($r in !i-eri+e *r$'e%e -$rmre
!e *r$+eine, %u*$r+ *en+ru n+i'$r*i)
  ▫  !e&r!e min$'iii 're %un+ u+i(i+i in 'e(u(e(e $r&ni%mu(ui -$($%in!ui *en+ru
%in+e &(u'i!e($r, (i*i!e($r %u -$rmn! m$ni'
  ▫  +rn%-$rm m$ni'u( -$rm+ in uree
  ▫  in+er0ine in +rn%-$rmre nu'(e$*r$+eine($r in 'i! uri'
d metabolismul substantelor minerale
  ▫  -i'+u( e%+e 'e( mi b$&+ $r&n in -ier, re -un'+ie !e !e*$i+ ( 'e%+ei in 'e(u(e(e "u*--er 
  ▫  %in+e+ie %i !e*$i+e 'u*ru( *r$0eni+ !in (imen+e, Cu re r$( '+(i+i' in %in+e
#em$&($binei
  ▫  i$nii !e N, ", C( *r$0in !in (imen+e, %e !e*$i+e in -i'+ im*reun 'u *, !e un!e
%un+ m$bi(i+i in $r&ni%m in -un'+ie !e ne'e%i++i(e 'e%+ui.
e metabolismul apei
 

Fi'+u( ?$' r$(u( !e re&(+$r ( *ei !in in+re&u( $r&ni%m. In %+rn% (e&+ur 'u me+b$(i%mu(
*ei e%+e %i -un'+i !e reer0$r %n&0in  -i'+u(ui, !+$ri+ 0%'u(ri+iei %(e b$&+e %i
 *r+i'u(ri++i($r 'ir'u(+iei in+r#e*+i'e.
In numi+e '$n!i+ii *$+e % re+in ( 2 ( !e %n&e, re&(n! %+-e( 'ir'u(+i !e in+$r'ere 
%n&e(ui in inim, in m$!u( 'e%+ -ere%+e inim !e $ 're%+ere bru%'  'n+i++ii !e %n&e.
 f metabolismul vitaminelor 
In -i'+ %e !e*$i+e 0i+mine(e A, B, B2, B2, D %i ".
  ▫  -i'+u( e%+e 'e( mi b$&+ $r&n in 0i+.A: 5. E %e !e*$i+e in 'e(u(e(e "u*--er %ub
-$rm !e e%+eri *en+ru  -i e(iber+ in $r&ni%m.
  ▫  i+.B ?un&e in -i'+ *rin b%$rb+ie in+e%+in(.
  ▫  i+.B2 %e b%$rbe !in in+e%+in %ub -$rm -$%-$ri(+, ir ( ni0e(u( -i'+u(ui %e une%+e 'u $
 *r$+ein %i ! n%+ere un$r -ermen+i $1i!n+i
  ▫  i+.B2 e%+e !e*$i++ in -i'+ *e 're( -ere%+e !e in-i(+r+ii &r%$%e
  ▫  i+.D %i " %e &%e%' !e*$i++e in -i'+ *r$0enin! !in b%$rb+i in+e%+in( in *reen+ bi(ei.

C. !(E F&'C(II !E FIC!(&&I 

Pe (n& -un'+ii(e enumer+e mi %u%, -i'+u( in!e*(ine%+e %i (+e -un'+ii !e im*$r+n+ !e$%ebi+
 *en+ru $r&ni%m:
. Functia hemaropoietica 'e%+ -un'+ie %e re-er ( -$rmre %i !i%r+u&ere &($bu(e($r r$%ii (
ni0e(u( -i'+u(ui. Fi'+u( -$rme &($bu(e(e r$%ii in *eri$! in+ru+erin, ir !u* n%+ere
'e%+ -un'+ie in'e+e -iin! *re(u+ !e (+e $r&ne #em+$*$ie+i'e m!u0 $%$%, %i%+em
re+i'u($en!$+e(ie(). G($bu(e(e r$%ii b+rne ?un%e in -i'+ %un+ !i%+ru%e, ir -ieru( !in
#em+$&($bin 'e %e !e*une i'i e%+e m$bi(i+ ( $r&ne(e #em+$*$e+i'e, *en+ru -$rmre !e
&($bu(e r$%ii n$i.
2.  Functia toxica  in 'ur%u( !i&e%+iei %e -$rme %i une(e %ub%+n+e +$1i'e in!$(u(, -en$(u() '
reu(++ ( '+iunii b'+erii($r !e *u+re-'+ie. D' 'e%+e %ub%+n+e ?un& in '$r* *r$!u'
in+$1i'+ii &r0e. Fi'+u( *rime%+e 'e%+i *r$!u%i *rin 0en *$r+, ii neu+r(ie, ii in'+i0e %i
ii e(imin *rin urin. T$+ in -i'+ %un+ in'+i0+i %i unii #$rm$ni. Re&(re -un'+iei n+i+$1i'e %i !e
 brier  -i'+u(ui e%+e re(i+ %e SNC %i #i*$-i.
3.  Functia de sinte$a a fermantilor in ficat    ( ni0e(u( 'e(u(e($r #e*+i'e %e -$rme %i %e
e(ibere m?$ri++e -ermn+i($r !in $r&ni%m: -$%-+e(e, +rn%mine(e, 'rb$1i(,
!e'rb$1i(, r&in, uree. Fi'+u( *r$!u'e 'e mi mre *r+e  -ermn+i($r.
4.  +entinerea echilibrului acido-ba$ic  -i'+u( in+er0ine ' un +m*$n in men+inere 'e%+ui
e'#i(ibru, e(ibern!, 0(en+e 'i!e %u (@(ine, !u* re'+i me!iu(ui re%*e'+i0.
5.  Functia termoreglabila '$n%+ in *r+i'i*re ( re&(re +em*er+urii '$r*u(ui. Tem*er+ur
( $mu( %n+$% 0ri in+re 36,4 %i 39,4 &r!e Ce(%iu%. Cn! $mu( %e -( in re*u% -i'+u( *rin
'+i0i++e % e%+e 'e( mi im*$r+n+ $r&n &ener+$r !e '(!ur.
 

 
 

1.0. PATOLOGIA *ICATULUI

Pricipalele #oli ale %icat!l!i :

   epatita virala acuta e%+e $ b$( in-e'+i$% +rn%mi%ibi(, *rn! %ub -$rm !e e*i!emii
%u *n!emii. E%+e *r$0$'+ !e 0iru%u( %*e'i-i','re in+r$!u% in $r&ni%m *e '(e !i&e%+i0 %u
''i!en+(, *e '(e *ren+er(, *r$0$' $ imb$(n0ire  in+re&u(ui $r&ni%m %i in m$! !e$%ebi+
 *ren'#imu(ui #e*+i'. B$( %e mni-e%+ *rin %emene !e in-e'+ie &ener( %i %im*+$me
!i&e%+i0e %i #e*+i'e, in%$+i+e %u nu !e i'+er.

  epatita cronoca %e in+e(e&e $ (eiune %i%+em+i+  -i'+u(ui, 'r'+eri+ *rin+r$ in-i(+rre

 *re!$minn+ *$r+(, 'u 'e(u(e m$n$nu'(e(e, (im-$'i+e, *(%m$'i+e %i *rin !e0$(+re n$rm(
 +e%u+u(ui '$n?un'+i0 !in -i'+. Din+re 'e%+e:
 95 !in 'uri *rein+ #e*+i+ 0ir( in n+e'e!en+e= #e*+i+ 'r$ni' %e
mni-e%+ ( 'e( *u+in 6 (uni !e ( !ebu+u( #e*+i+ei 0ir(e
    !in #e*+i+e(e 0ir(e e0$(ui '+re 'r$ni'ire
   2 !in 'ir$e %u''e! unei #e*+i+e '$rni'e.

  Sindromul icteric n$+iune !e i'+er re !$u in+e(e%uri:

   I'+eru( %im*+$m re*reen++ !e 'u($re &(ben  +e%u+uri($r 
   I'+eru( -e'+iune 'u*rinn! +$+(i++e +u(burri($r '#imi'e, -ii$*+$&eni'e
%i m$r-$($&i'e 're '$n!i+i$ne !i-eri+e(e %+ri i'+eri'e.
I'+ere(e %un+ 'r'+eri+e '(ini' 'u($re &(ben  +e&umen+e($r %i mu'$%e($r, ir um$r( *rin
're%+ere bi(irubinei in %n&e.

  Cancerul hepatic %ub 'e%+ !enumire %un+ 'un$%'u+e +um$ri(e m(i&ne (e -i'+u(ui:
 e*i+e(i$mu( *rimi+i0 %i %e'un!r)
 %r'$mu( *rimi+i0 %i %e'un!r)
  Chistul hidric hepatic e%+e $ b$( !+$r+ ($'(irii %i !e0($(+rii in -i'+  embri$nu(ui !e
Teni E'#in$'$'u%, 're e%+e un *ri+ ( -i'+u(ui.
  Ciro$a hepatica %u-erin+ 'r$ni', 'u e0$(u+ie *r$&re%i0, re*reen+n! %+!iu( 0n%+ ( un$r 
 *r$'e%e '+i0e in -i'+, in &ener( ire0er%ibi(e.
 

 
CAPITOLUL II
 

II. CIRO+A )EPATICA

II.1. DE*INITIE

Cir$ #e*+i' re*rein+ $ -e'+iune 'r$ni' #e*+i' 'u e0$(u+ie *r$&re%i0,

'r'+eri+ !in *un'+ !e 0e!ere #i%+i$*+$($&i' *rin+run *r$'e%% e1+en%i0e !e -ibr$ %i !e
re&enerre n$!u(r 'u !e$r&nire r#i+e'+urii #e*+i'e n$rm(e.

Din *un'+ !e 0e!ere m$r-$($&i' 'ir$ #e*+i' CH), %e 'r'+erie *rin:

 ▫  !i%+ru&ere 0ribi(  m%ei #e*+$'i+re *rin ne'r$e e1+in%e
▫  -$rmre %e*+uri($r '$n?un'+i0e
▫  *reen+ re&enerrii n$!u(re
 ▫  !e$r&nire r#i+e'+$ni'ii -i'+u(ui
 ▫  (+erre 0%'u(ri+iei.
Remniere %+ru'+ur(  -i'+u(ui !e+ermin +b($u( '(ini':
  (+erri 0%'u(re HTP #i*er+en%iune *$r+()
 !i%+ru&ere m%ei #e*+$'i+re in%u-i'ien+ #e*+i'
  in-(m+i *$r+( mni-e%+ri imun$($&i'e.
 

 
Fibr$ #e*+i' , +rn%-$rmre n$!u(r %i 'ir$, 're im*(i' ++ *r$'e%u( !e -ibr$
'+ %i *reen+ n$!u(i($r !e re&enerre !u* S. S#er($'@)

II.". *ORMAREA CIRO+EI

R%*un%u( -i'+u(ui ( &re%iuni e%+e m$n$+$n. E( re'+i$ne *rin '$(*%u( 'ini($r,

-$rmre !e %e*+uri '$n?un'+i0e %i re&enerre n$!u(r  #e*+$'i+e($r. In!e*en!en+ !e
e+i$($&ie, m$!i-i'ri(e #e*+i'e -in(e %un+ %emn+$re. De%i 'i(e !e ''e% ( 'ir$ %un+
0ribi(e  0iru%uri(e #e*+i'e, ('$$(, +$1i'e, -e'+re bi(ir), reu(++u( -in( 0 -i i!en+i'.
Fibr$ e%+e *r$'e%u( e%en+i( !e +re'ere !e ( in-(m+ii(e 'u+e %i '$rni'e (e -i'+u(ui ( 'ir$
#e*+i'. A'e%+ *r$'e%% !e *ri+ie  CH e%+e 'r'+eri+ !e:
▫  m$!i-i're 'n+i++i0 %i '(i++i0  'eu(e($r !in -i'+  en!$+e(i(e, "u**-e, (i*$'i+e) 're
%e +rn%-$rm in mi$-ibr$b(%+ %i !e0$(+ un *u+erni' *r+ %e're+$r !e '$(&en %i *r$+eine
-ibr$ne'+in, (minin).
  ▫  (+erre '$m*$i+iei %i !i%+ribu+iei m+ri'ei e1+r'e(u(re 're 're%+e 'n+i++i0 %i i%i
m$!i-i' '$m*$i+i. In m$! n$rm( -i'+u( '$n+ine ''.  m& !e '$(&en ( & !e +e%u+ #e*+i'.
A'e%+ e%+e ('+ui+ in *r$*$r+ie !e 9 !in *r+i e&(e !e '$(&en +i* I %i III, re%+u( !e 3 -iin!
'($&en +i* I, , I. In 'ir$ #e*+i' '$(&enu( 're%+e !e 56 $ri, ir +i*u( I !e0ine !$minn+
-+ !e +i*u( III r*$r+ 2: ). In '$m*$i+i m+ri'ei #e*+i'e '$(&enii *re!$min, -iin! %i 'e
mi bun!en+ -mi(ie !e *r$+eine !in $r&ni%m.
Fibr$&ene e%+e *re'e!+ !e e1*n%iune 'e(u(e($r I+$ (i*$'i+e) 'e %e -( n$rm( in
%*+iu( Di%%e %i !e*$i+e 0i+.A in $n  3 'inr. Un %*e'+ im*$r+n+ ( -ibr$&eneei i(
re*rein+ 'umu(re '$(&enu(ui ( ni0e(u( %*+iu(ui Di%%e.
Per*e+ure *r$'e%u(ui !e *r$(i-erre 'e(u(r e%+e %u%+inu+ !e:
 

▫  in+er0en+i 'i+$@ine($r %i  -'+$ri($r !e 're%+ere.

Ci+$@ine(e %un+ *r$+eine %emn+$re #$rm$ni($r 're '$$r!$ne !i-eren+iere 'e(u(r
%i men+in %u re%+ure #$me$%+ii(e -ii$($&i'e. E(e %un+ e%en+i(e *en+ru ;'$muni'ri(e>
!in+re -i'+ %i re%+u( $r&ni%mu(ui, *re'um %i *en+ru 'e(e !in in+eri$ru( (ui, re&(n! me+b$(i%mu(
min$'ii($r, *r$+eine($r, #i!r+i($r !e 'rb$n, (i*i!e($r %i miner(e($r. Fi'+u( *r$!u'e 'i+$@ine
 *r$in-(m+$re ' -'+$ru( !e ne'r$ +um$r( (- TNF(-), in+er(eu@in IL) %i
in+er(eu@in6 IL6). Ci+$@ine(e in#ib re&enerre #e*+i'.
F'+$rii !e 're%+ere #e*+i'i %un+: -'+$ru( !e 're%+ere e*i!erm(, -'+$ru( !e +rn%-$rmre
 're%+erii (-, -'+$ru( !e +rn%-$rmre  're%+erii be+e, -'+$ru( !e 're%+ere #e*+$'i+e($r 
#e*+$*$e+in) %i -'+$ru( !e 're%+ere  (e&+uri($r *en+ru #e*rin.
 ▫  %i !e 're%+ere numru(ui !e re'e*+$ri *en+ru 'e%+ ( ni0e(u( 'e(u(e($r e-e'+$re.
 Prima fa$a   -ibr$&eneei, 'e !e ini+iere, e%+e !e'(n%+ !e ne'r$ #e*+$'i+r
 *r$!u% !e in-(m+ie %u &re%iune !ire'+  ('$$(, Fe, Cu e+'.). Li*$'i+u( !e0$(+ re'e*+$rii
 *en+ru 'i+$@ine %i +re' in - !e 'e(u( !e +rni+ie. A !$u -, !e *er*e+ure  -ibr$&eneei,
're%+e 'n+i++e !e 'i+$@in 'u r$( *r$(i-er+i0 %i -ibr$&ene+i, *rin %e're+ie u+$'rin (i*$'i+e(e)
%u *r'rin 'e(u(e "u**-er, +r$mb$'i+e, m$n$'i+e) in+re+inn!u%e ++ *r$'e%u( !e *r$(i-erre
'e(u(r, '+ %i 'e( !e 're%+ere  m+ri'ei e1+r'e(u(re, ir (i*$'i+u( %e +rn%-$rm in
mi$-ibr$b(%+. A'+iune &en+u(ui &re%$r '$n+inu %i in+re+ine 'e%+ '%'! !e e0enimen+e 'e
0$r '$n!u'e ( '$n%+i+ui+e CH, reu(++ !in %$'iere -ibr$&eneei in+e%+ine 'u *r$(i-erre
'e(u(r.

II.%. CLASI*ICAREA CIRO+ELOR

Din mu(+i*(e(e '(%i-i'ri (e CH., 'e(e 're %e be *e 'ri+erii m$r-$($&i'e %i
e+i$($&i'e *r  -i 'e(e mi !e'0+e.
Clasi%icarea &or%olo'ica . E1i%+ !$u '(%i-i'ri m$r-$($&i'e:

 un *r$*u% !e 'e( !e( (e C$n&re% !e G%+r$en+er$($&ie !e ( H0n 56):

. Ciro$ele portale sau septale u ' *r$+$+i* 0e'#e 'ir$ Lenne'. Sun+ !e re&u( '$n%e'in+
un$r *r$'e%e !i%+r$-i'e, nu+ri+i$n(e %u ('$$(i'e, %u mi rr,  unei #e*+i+e e*i!emi'e. Se
'r'+erie, in e%en+, *rin !i%+ru&ere %+ru'+urii *rn'#imu(ui #e*+i' !e '+re un *r$'e%% !e
%'re($ !i-u  meen'#imu(ui, 'u e0$(u+ie %*re +r$-ie #e*+i' %i 'u in+ere%re mi (e% 
0%e($r !in +eri+$riu( *$r+( %i  'i($r bi(ire in+re#e*+i'e.
2. Ciro$ele postnecrotice %un+ !e $bi'ei '$n%e'u+i0e #e*+i+e($r 0ir(e. Se 'r'+erie *rin:
e1i%+en+ *r$'e%e($r re&ener+i0e, remniere '$m*(e+  +e%u+u(ui #e*+i', *reen+, *e (n&
n$!u(ii re&ener+i0i, !e $ne in+in%e !e !i%+r$-ii #e*+$'i+re, #i*er*(ii '$n?un'+i0e %i in-i(+r+e
in-(m+$rii.
3. Ciro$ele biliare %e %emn m$r-$*+$($&i' 'u 'ir$ *$r+(, re e(emen+e 'r'+eri%+i'e
 *en+ru 'ir$ *$%+ne'r$+i' %i, in *(u%, #i*er*(i 'n(i'u(e($r bi(ire, in-i(+r+ in-(m+$r *$r+(,
ne'r$e 'e(u(re *eri*$r+(e %i '$(e%+.

 (+ *r$*u% ( C$n&re%u( A%$'i+iei In+ern+i$n(e *en+ru S+u!iu( Fi'+u(ui !e ( A'*u('$

!in 94. Ai'i %e !i-eren+i *+ru +i*uri !e 'ir$e #e*+i'e:
. Ciro$a micronodulara  re&u(+e, m$n$($bu(r) %e 'r'+erie *rin %e*+uri '$n?un'+i0e
re(+i0e %ub+iri, !e &r$%ime uni-$rm, 'u n$!u(i !e re&enerre mi'i, 'u !imen%iuni uni-$rme.
%e(e -eren+e %i e-eren+e (e n$!u(u(ui %un+ in 'e mi mre *r+e in&($b+ in %e*+uri(e
 

'$n?un'+i0e %i numi $'i$n( *$+ -i re'un$%'u+e in in+eri$ru( n$!u(u(ui: %*+ii *$r+e %u 0ene
'en+r$($bu(re. Leiuni(e !e%'ri%e in+ere%e -ie're ($bu(, 'e%+ +i* !e 'ir$ -iin! 'un$%'u+ %i
%ub nume(e !e 'ir$ *$r+( %u %e*++. O (+ *r+i'u(ri++e  'e%+ui +i* !e 'ir$ r -i
 *er%i%+en+ -'+$ri($r 'u(i. Fi'+u( mi'r$n$!u(r r -i e1*re%i in'*'i++ii !e re&enerre 
'e%+ui, *e 're $ re&%im in e+i(i%m, m(nu+ri+ie, ( 0r%+ni'i %u nemi'i.
2. Ciro$a macronodulara nere&u(+, mu(+i($bu(r, *$%+ne'r$+i', *$%+'$(*%) %e 'r'+erie
 *rin %e*+uri '$n?un'+i0e (r&i, nere&u(+e %i n$!u(i mri, ine&(i, *n ( 5 'm in !ime+ru, 're
'$n+in '$n&($mern+e !e 'ini, 'u %*e'+ n$rm(. C$(*%u( ($bu(r *ree1i%+en+ e%+e mr'+ *rin
 ?u1+*$i+i in %e*+uri(e '$n?un'+i0e,  3 %u mi mu(+e %*+ii *$r+e. Re&enerre e%+e
!em$n%+r+ !e 0$(umu( 're%'u+ ( #e*+$'i+e($r, 'u nu'(ei mu(+i*(i %i !e *reen+ %+r+uri($r 
#e*+$'i+re 'u &r$%ime mi mre !e +rei $ri 0$(umu( unui #e*+$'i+).
3. Ciro$a mixta%  mi'r$ %i m'r$n$!u(r %$'i *r+i'u(ri++i(e 'e($r !$u +i*uri n+eri$r 
!e%'ri%e. M?$ri++e 'ir$e($r 6) in+r in 'e%+ '+e&$rie.
4. Ciro$a septala incompleta mu(+i($bu(r) in($'uie%+e 'ir$ *$%+#e*+i' %u 'ir$ +i* B 
(ui N&$. Re&enerre n$!u(r nu e%+e e0i!en+ in 'e%+ +i*, *e *rim *(n -iin! %e*+uri(e
'$n?un'+i0e. Cn! n$!u(ii %un+ mri, *ren'#imu( #e*+i' *$+e % ib !i%*$i+ie 'inr
n$rm(. Une(e %e*+uri '$n?un'+i0e %e +ermin bru%' in *ren'#im -r (e&+ur 'u %e*+uri(e
0e'ine %u %*+ii(e *$r+e.

Clasi%icare etiolo'ica .

. Ciro$a posthepatica e%+e '$n%e'u+i0 #e*+i+ei 'u+e 0ir$+i'e, in %*e'i(  'e($r 'u 0iru% B %i
n$nAn$nB. E0$(u+i #e*+i+ei 'u+e 0ir(e '+re 'ir$ %e -'e in m$! $b(i&+$riu *rin
in+erme!iu( #e*+i+ei '$rni'e &re%i0e. Sub r*$r+ m$r-$*+$($&i', 'ir$ *$%+#e*+i' *$+e -i
mi'r$n$!u(r, m'r$n$!u(r, mi1+ %u %e*+( in'$m*(e+, in -un'+ie !e e1+in!ere ne'r$ei
#e*+$'i+re '$n-(uen+e !in *eri$! 'u+  b$(ii.
2. Ciro$a etilica%e in+(ne%+e numi ( mrii '$n%um+$ri !e bu+uri ('$$(i'e.
3. Ciro$a toxica e%+e '$n%e'u+i0e #e*+i+e($r 'u+e +$1i'e %i in %*e'i(  'e($r *r$0$'+e !e
+e+r'($rur !e 'rb$n, +ri'($re+i(en %i (+i !eri0+i $r&b$'($r+i %i mi rr  'e($r *r$0$'+e !e
!i-eri+e me!i'men+e.
4. Ciro$a nutritionala re ' b e+i$($&i', in *rimu( rn!, m(nu+ri+i *r$+ein$'($ri' %i, in (
!$i(e rn!, !ie+e(e #i*er'($ri'e %i ner+i$n(e. Din *un'+ !e 0e!ere m$r*#$($&i' e0$(u+i %*re
'ir$ %e -'e *rin in+erme!iu( %+e+$ei #e*+i'e. In &ener( %*e'+u( #i%+$*+$($&i' ( 'ir$ei
nu+ri+i$n(e e%+e %emn+$r 'u 'e( ( 'ir$ei e+i(i'e.
5. Ciro$a biliara primitiva e%+e un +i* *r+i'u(r !e 'ir$ 're %e 'r'+erie, !in *un'+ !e
0e!ere m$r*#$($&i', *rin (eiuni n+$mi'e !i%+ru'+i0e (e 'n(i'u(e($r bi(ire in+re#e*+i'e,
-r -e'+re 'i($r bi(ire e1+r#e*+i'e %i 're %e mni-e%+ *rin+run +b($u '(ini' !e '$(e%+
in+re#e*+i'. Mi e%+e 'un$%'u+ %i %ub nume(e !e: 'ir$ '$(n&i$(i+i', '$(n&i+ 'r$ni'
!i%+ru'+i0 ne%u*ur+i0, 'ir$ 1n+$m+$%, b$( Hn$+.
6. Ciro$ele congestive %un+ *r$0$'+e !e %+ #e*+i' in+en%e %i *re(un&i+ *reen+ in
in%u-i'ien+ 'r!i' '$n&e%+i0e %i $b%+ru'+i 0ene($r %u*r#e*+i'e S!. Bu!!C#iri). A'e%+e
%e 'r'+erie *rin '$n&e%+ie *%i0 %i ne'r$ 'enr$($bu(r 'inii #e*+i'i %un+ !i-u %i
uni-$rm -e'++i), *re -ibr$ 'u in-(m+ie minim in $n  3 !e 0%'u(ri+ie  'ini($r 
 

#e*+i'i. Ini+i(, r#i+e'+$ni -i'+u(ui e%+e '$n%er0+, ir u(+eri$r, *rin !e0$(+re -ibr$ei
!i-ue, %e -$rme mi'r$n$!u(i.
9. Ciro$a sarcoido$ica e%+e '$n%e'u+i0e e0$(u+iei 'ir$&ene  #e*+i+e($r 'r$ni'e &rnu($m+$%e.
7. Ciro$a prin de$ordini genetice #em$'r$m+$ e%+e $ er$re &ene+i' !e me+b$(i%m 'e %e
'r'+erie *rin 'umu(re e1'e%i0 !e -ier in $r&ni%m, 're *$+e *r$!u'e $ 'ir$
#i*er+r$-i' 'u !e*$i+e mri !e #em$%i!erin in +e%u+u( #e*+i'.
. Ciro$ele criptogenice re*rein+ $ '+e&$rie re%+rn% !e 'ir$e  'r$r e+i$($&ie nu *$+e -i
!$0e!i+. Sub r*$r+ m$r*#$($&i', e(e *$+ -i mi'r$n$!u(re, m'r$n$!u(re, mi1+e %u %e*+(e
in'$m*(e+e.
  C(%i-i're m$r-$($&i' *reen++ re 0($re (imi++. Di0er%e(e +i*uri m$r-$($&i'e %un+
!i-i'i( !e !i-eren+i+ *rin PBH %i &reu !e '$re(+ 'u -'+$ri e+i$($&i'i, *+$&eni'i %i !e *r$&n$%+i',
 *u+n! re*reen+ numi %+!ii in e0$(u+i 0ribi(  'ir$ei. C(%i-i're !u* 'ri+erii e+i$($&i'e
e%+e mu(+ mi u+i(, in+ru'+ -'+$rii 'u(i !e+ermin +r+men+u( %i in mre m%ur im*rim
e0$(u+i '(ini' %i *r$&n$%+i'u(. Din ne-eri'ire, -'+$rii e+i$($&i'i %i *+$&eni'i %un+ !i-i'i( !e
re'un$%'u+ !u* %*e'+u( #i%+$($&i' 'n! 'ir$ e%+e 0n%+. In %+!ii(e in'i*ien+e, 'r'+eru(
&re%iunii #e*+$'i+re %i re'+i ( 'e%+ -urnie !ee in!i'+ii u+i(e 'u re-erire ( -'+$rii
e+i$($&i'i.

C(%i-i're e+i$($&i'  'ir$e($r #e*+i'e

A. Cir$ in-e'+i$%
.0iru%uri(e #e*+i'e
2.%i-i(i%
u( '$n&eni+(
3.*ri+i %'#i%+$%$mi mn%$ni)
B. Cir$ ('$$(i'
C. Cir$ '#imi'
.+$1i'e neme!i'men+$%e
2.+$1i'e me!i'men+$%e
D. Cir$ nu+ri+i$n( m(nu+ri+i %in&ur nu e%+e ''e*++)
.b*%%u( in+e%+in( *en+ru $bei++e
E. Cir$ bi(ir *rimi+i0e '#$(n&i+ 'r$ni' !e%+ru'+i0e, ne%u*ur+i0)
F. Cir$ '$n&e%+i0e in%u-i'ien+ 'r!i' '$n&e%+i0e, $b%+ru'+i 0ene($r %u*r#e*+i'e %u
%in!r$mu( Bu!!C#iri)
G. Cir$ %r'$i!$i' &rnu($m+$%)
H. Cir$ *rin !e-e'+e &ene+i'e
.&('+$%emi
2.&(i'$&en$ mi($*e'+in$)
3.+ir$in$e
4.in+$(ern+ ere!i+r ( -ru'+$
5.!e-i'i+u( !e (- n+i+ri*%in
6.+(%%emi %i (+e nemii #em$(i+i'e n+r%-erinemi %i nemi *iri!$1in!e*en!en+)
 

9.m(!i i((%$n
7.%u*rin'r're +e%u+uri($r %i $r&ne($r 'u -ier #em$'r$m+$)
.mu'$0i%'i!$ 'ir$ bi(ir in'$m*(e+e *$%+-ibr$ '#i%+i')
.+e(n&ie'+i ere!i+r #em$r&i' b$( O%(erRen!ueber)
.Abe+in$*r$+einemi
2.A(+e 'u%e
I. Cir$ 'ri*+$&eni'
8. A(+e +i*uri e+i$($&i'e !e 'ir$.

II.,. ETIOPATOGENIE

  CH e%+e $ b$( !e (r& r%*n!ire, 'un$%'u+ in +$+e +ri(e, !e ( 're nu -'e e1'e*+ie ni'i
$ r% %u n+i$n(i++e !in *$*u(+i &($bu(ui. Pe $ %++i%+i'  OMS e-e'+u+ in 55 !e +ri, %e
'$muni' nu( *e%+e 3  !e'e%e *rin 'ir$. In'i!en+ b$(ii ( ne'r$*%ie e%+e !e 23, ir in
 *$*u(+i !e %*i+( !e ,92. Pre!$min ( %e1u( m%'u(ine, in !e'!  5 !e 0r%+, 0r%+
me!ie -iin! '('u(+e ( 47,9 ni. In +r n$%+r %e inre&i%+re 2,4 !e'e%e *rin 'ir$ #e*+i'
(   !e ($'ui+$ri. Re*r+ire !u* 0r%+ e%+e -$r+e (r&, $%'i(n! in+re 2 %i 92 !e ni
'u m1imum !e -re'0en+ in !e'!e(e  5 %i  6, 0r%+ me!ie -iin! 57 ±  29 !e ni.
Pre*$n!eren+ %e1u(ui m%'u(ine e%+e !e 65, 0r%+ me!ie ( brb+e -iin! !e 6 ±  ni, ir (
-emei 43± 9 ni= 9,32 !in+re 'uri(e !e 'ir$ ( -emei -iin! %i+u+e %ub 0r%+ !e 5 !e ni.
  Etiolo'ia  Prin'i*(ii -'+$rii e+i$($&i'e %un+, !u* 'um m 0u+, 0iru%uri(e #e*+i'e %i
('$$(u(. Cir$e(e *$+ -i *r$!u%e !e -'+$ri me+b$(i'i: #em$'r$m+$, b$( i(%$n *rin
'umu(re !e -ier, re%*e'+i0e !e 'u*ru, &('+$emi, +ir$%in$ '$n&eni+( %u !e-i'i+u( !e
(-n+i+ri*%in. Sun+ !e%'ri%e 'ir$e #e*+i'e ( !ibe+i'i, ( !enu+ri+i, in b*%%u( in+e%+in(.

Alcool!l . S '$n%+++ ' 'ir$ %ur0ine !e 9 $ri mi -re'0en+ ( ('$$(i'ii 'r$ni'i !e'+
( ne('$(i'i. CH ('$$(i' %e '$n%+i+uie !u* $ *eri$! (un& !e '$n%um e1&er+ !e ('$$(
e+i(i'. Ri%'u( *re ( un '$n%um i(ni' !e *r$1im+i0 7&r. !e ('$$( *ur, +im* !e 5 ni.
A*ri+i %i !e0$(+re (eiuni($r #e*+i'e nu %un+ (e&+e !e -e(u( bu+urii ('$$(i'e, 'i numi !e
'$n+inu+u( ei in ('$$(.Brb+ii %un+ mi %en%ibi(i ( -e'+iune #e*+$+$1i'  ('$$(u(ui !e'+
-emei(e. Pr&u( '$n%umu(ui %e ('$$( !u* 're in'e*e !e0$(+re 'ir$ei e%+e %i+u+e ( 6m&<i
( brb+i %i ( 2m&<i ( -emei. Sen%ibi(i++e mi mre  -emeii *en+ru ('$$( %r !+$r
'$n'en+r+iei %'u+e !e ('$$( !e#i!r$&ene !in mu'$% &%+ri'  'e%+ei. In!e*en!en+ !e
'n+i++e %i !e !ur+ '$n%umu(ui !e ('$$(, numer$%i %ubie'+i nu !e0$(+ 'ir$. De%u*r
 *r&u(ui !e 5m&<i !e ('$$(, ri%'u( !e0$(+rii CH e%+e !e 5.
  S+u!iu( !e ( C$*en#& enumer -'+$rii 'e *$+ *ermi+e !e0$(+re 'ir$ei #e*+i'e
('$$(i'e: -'+$rii &ene+i'i, nu+ri+i$n(i %i '#ir '$n%umu( !e 'rne !e *$r'.
  In 'ir$ ('$$(i' %e $b%er0 $ 're%+ere  *re0(en+ei A' n+i HB%, ' %i e0i!en+ unei
imuni++i 'e(u(re -+ !e A& HB%. Pur++$rii !e A&HB% mni-e%+ $ %u%'e+ibi(i++e mi mre -+
!e ('$$(. E0$(u+i 'ir$&en e%+e !e+ermin+e !e 'n+i++e !e ('$$( '$n%um+, mi !e&rb,
!e'+ !e +i*u( bu+urii ('$$(i'e.In S.U.A., 'ir$ ('$$(i' *re!$min *rin+er bu+urii !e /#i%@=
in Frn+, I+(i, C#i( ( bu+$rii !e 0in= ir inAu%+r(i %i Germni ( ru+$rii !e bere. F'+$ru(
'$mun ( +u+ur$r 'e%+$r bu+urii e%+e ('$$(u(.
 

  A('$$(u( %i in !$e mi'i in!u'e in-i(+r+i &r%  -i'+u(ui, !rn u e1i%+ !$0ei ' 'e%+
(eiune *r$&re%e %*re 'ir$.A'e%+ in-i(+r+ie *re in0ribi( !u* $ri'e '$n%um !e ('$$(,
!r r*i! re0er%ibi(. In+ru'+ numi $ mi' *r+e !in+re bu+$ri 5) !e0$(+ 'ir$
#e*+i', in-i(+r+i &r% nu *re ' $ (eiune *re'ir$+i' $b(i&+$rie.
  Me+b$(ire ('$$(u(ui %e -'e *e '(e ('$$(!e#i!r$ei '+ %i  %i%+emu(ui mi'r$$m( !e
$1i!re  ('$$(u(ui reu(+n! un e1'e% !e (!e#i! 'e+i'. A'e%+ %e -i1e *e *r$+eine,
im*ie!i'n! %e're+i 'e%+$r %i *r$!u'n! $ &re%iune #e*+$'i+r !ire'+.
  C (eiuni *re'ir$+i'e 0em: -ibr$ *eri0enu(r, ($bu(r %i %inu%$i!(. In *+$&eni
-i'+u(ui ('$#$(i' in+er0in !e$r!ini imun$($&i'e: um$r(e %i 'e(u(re n+i'$r*i '$n+r
n+i&eni($r, re!u'ere (im-$'i+e($r T in %n&e(e *eri-eri' %i 're%+ere ($r ( ni0e(u( -i'+u(ui).
(ir!s!rile hepatice . Sun+ im*(i'+e in e+i$($&i 4 !in 'uri(e !e CH !in +r n$%+r.
In'i!en+ me!ie  #e*+i+ei 'u+e 0ir(e in n+e'e!en+e(e 'ir$e($r r -i !e 34. In+er0(u( !e (
#e*+i+ 'u+ ( 'ir$ e%+e 0ribi(,52 !e ni. Au -$%+ !u%e urm+$re(e r&umen+e in
-0$re r$(u(i 'ir$&en ( 0iru%uri($r -e*+i'e:
) %u*r0e&#ere *rin PBH re*e++e  b$(n0i($r !e #e*+i+ 'u+ 0ir(. Prin 'e%+ me+$!
!$i 'er'e+$ri u !e%'$*erir 2 'uri !e 'ir$ #e*+i' !u* #e$+i+e 0ir(e 'u+e %e0ere.
 b) %+u!iu( e*i!emi$($&i' ( 'e($r !$u b$(i, !em$n%+rn!u%e $ %u''e%iune e*i!emi$($&i' in+re
#e*+i+e(e 'u+e 0ir(e %i CH
e1.: in Dnemr' %u inre&i%+r+ !$u 0r-uri (e e*i!emiei !e #e*+i+ 0ir( 'u+
3, 44) !u* ( !$i(e 0( e*i!emi$($&i' 're%+e *ene+r+i CH.
  in Sue!i G$+eb$r& 265) %u inre&i%+r+ 45 #e*+i+e 0ir(e 'u+e, !in+re
're 4 u !e'e!+, ( ne'r$*%ie  -iin! 'ir$.
  in N$r0e&i 44) e*i!emie 'u  !e'e%e *rin CH.
') *reen+ HB, HD, HC %i HG in %eru( %i < %u -i'+u( b$(n0u(ui !e 'ir$.
Cr$ni'ire in-e'+iei 'u HB %e $b%er0 in  !in 'uri, ir r+ 'ir$&en in ,53 !in
'uri.
  Sun+ '$n!i!er+i !re*+ -'+$ri !e ri%' 'ir$&en: b%en+ 'ur+rii HB ( *e%+e 3 %*+mni !e
( !ebu+u( #e*+i+ei 'u+e, *er%i%+en+ %emne($r !e re*(i're  HB, +er*i '$r+i$ni' in -
'u+, 0r%+ 0n%+, %e1u( -eminine, e1'erbri(e 'u+e %e0ere re*e++e (e #e*+i+ei '$rni'e 'u
're%+ere (--e+$*r$+einei ( *e%+e m&<m( %i brin!in& ne'r$%i%.
  In in-e'+i 'r$ni' 'u HC e0$(u+i 'ir$&en  -$%+ $b%er0+ in 27 !in 'uri, 'ir$
re'un$%'n!u%e ( 4 (uni4 ni !e ( !ebu+u( in-e'+iei 'u HC= re*(i're HC %e re!u'e in
%+!ii(e 0n%+e (e 'ir$ei. Ri%'u( 'ir$&en e%+e mi mre in in-e'+i 'u 0iru% C +rn%mi% *e '(e
 *ren+er( +rn%-uii).In-e'+i 'u HG 're%+e 'r$ni'ire, r+ e0$(u+iei 'ir$&ene e%+e
ne'un$%'u+. S $b%er0+ %$'iere HG in 7 !in+re in-e'+ii 'u HC %i  !in+re in-e'+ii 'u
HB.

S!#statele hepatoto)ice . Sun+ '(%i-i'+e !u* $ri&ine ($r %+-e(:

I. T$1i'e in!u%+ri(e:
  A. Substante organice:
) #i!r$'rburi: benene, n-+(en.
 b) Deri0+i $++i i #i!r$'rburi($r: ni+r$benen, !i, +rini+r$benen
') Deri0+i #($&en+i i #i!r$'rburi($r:
 i me+(u(ui: '#($r$-$rm, +re+r'($rur !e 'rb$n
 i e+nu(ui: !i'($re+n, +ri'($re+nDDT)
 

 i #i!r$'rburi($r e+i(eni'e: +ri'($re+i(en, +e+r'($re+i(en

 i #i!r$'rburi($r beneni'e: !i'($rbenenu(
 i #i!r$'rburi($r n-+(eni'e: '($rn-+(enu(
!) mine %i !eri0+i
e) e+er$1ii: !i1nu(
-) -en$(i: -en$(, !i,+ri-en$(, !ini+r$'re$(
&) (!e#i!e: *r(!e#i! %i me+(!e#i!r

  B. Substante anorganice: r%en, 'r$m, Fe, Cu, M&, Mn, P, Pb.

II. T$1i'e 0e&e+(e:

Fin e%+e un &(i'$i! +erm$(bi( 're *r$0$' #em$(i, ir m$ni+$+$1in, un me%+e' !e
 *$(i*e*+i!e +erm$%+bi(e 're in!u' !i%+r$-i #e*+i', ren( %i mi$'r!i'.

III. Me!i'men+e:
  Me+i(!$*, *ir$inmi!, i$nii!, +e+r'i'(in, *r'e+m$(u(, une(e %u(-mi!e, in %*e'i(
'i+$%++i'e, '($rr$min, !eri0+i !e n!r$&eni, '$n+r'e*+i0e, !ie*m.

A'e%+e +$1i'e *rin '$n+'+ in!e(un&+ %i re*e++ 'u $r&ni%mu(, ' %i in -un'+ie !e !$,
!e+ermin (eiuni !e #e*+i+ +$1i',  'r$r %e0eri++e !e0i!e !e #e*+$+r$*i%mu( %i !$
+$1i'u(ui. Cr'+eru( %i %e0eri++e (eiuni($r #e*+i'e !i-er !e ( $ &ru* !e +$1ine ( (+, !r %i
in '!ru( 'e(ei%i &ru*e !e ( $ %ub%+n+ ( (+. E1.: #i!r$'rburi(e e+i(eni'e !e+ermin (eiuni
!i%'re+e, *e 'n! !eri0+ii e+nu(ui *r$!u' (eiuni !e&ener+i0e %e0ere. T$*$&r-i ne'r$e($r 
e%+e 0ribi( !e ( $ %ub%+n+ ( (+: 'en+r$($bu(r *en+ru #i!r$'rburi, *eri($bu(r *en+ru
-$%-$r.
  Me'ni%me(e *rin 're !i0er%e(e +$1i'e '+i$ne %u*r -i'+u(ui, *r$!u'n! (eiuni
ne'r$+i'e %i %+en$, %un+ '$m*(e1e. T$1i'e(e #e*+i'e %un+ -$r+e !i-eri+e in 'ee 'e *ri0e%+e
%+ru'+ur ($r '#imi'. E(e (+ere re+i'u(u( en!$*(%mi' %i mi+r$'$n!rii(e #e*r$'i+re,
 *r$!u'n! in#ibi+i %i%+emu(ui enim+i' mi'r$$m( im*(i'n! in me+b$(ire
me!i'men+e($r.
  Pr$+$+i*u( %ub%+n+e($r 'u '+iune #e*+$+$1i' !ire'+ e%+e CC(3 're !e+ermin !i%+r$-ie
&r% !i-u %i ne'r$ 'en+r$($bu(r. Ne'r$ #e*+$'i+r nu e%+e m%i0, %+-e( in'+ !'
 b$(n0u( %e 0in!e', 'ir$ e%+e rr $!%er0+. CC(3 in!u'e (eiune #e*+i' in '+e0 $re.
M?$ri++e b$(n0i($r 're %e 0in!e', re!$bn!e%' in+e&r( '*'i++e -un'+i$n( #e*+$'i+r.
Cu +$+e 'e%+e, in -$rme(e !e ne'r$e #e*+$'i+re m%%i0e ( in+$1i'+ii(e 'u CC(3 %u
!e%'ri% 'ir$e *$%+ne'r$+i'e.
  E-e'+e(e #e*+$+$1i'e (e me+#$+re1+u(ui u -$%+ $b%er0+e in urm *(i'rii 'e%+ui in m$!
%%+em+i' in +r+men+u( *%$rii%u(ui. Leiuni(e !in +im*u( +r+men+u(ui 'r$ni' 'u me+#$+re1+
%e 'r'+erie *rin %+e+$, ne'r$ #e*+$'i+r, -ibr$ 'u e0$(u+ie 'ir$&en.Me+#$+re1+u(
'+i$ne ' $ #e*+$+$1in in+rin%e'.
  L 0i+i'u(+$ri %e $b%er0 $ b$( 'r$ni' !e -i'+ 'u in'(uiuni !e 'u*ru in #e*+$'i+. B$( %e
'r'+erie *rin -$rmre !e &rnu($me !e +i* #i%+$'i+r, *rin +ume-'+i %i *r$(i-erre
'e(u(e($r "u*--er, -ibr$ *$r+(, '*%u(r. A'e%+e (eiuni *$+ % e0$(uee %*re 'ir$.
  P$+en+i(u( 'e%+$r %ub%+n+e +$1i'e e%+e in%u-i'ien+ 'un$%'u+.
 

Factorii !tritioali . R$(u( 'e%r$r in *r$!u'ere 'ir$ei e%+e !$0e!i+ !e e1i%+en+ m$!e(e($r 
!ie+e+i'e e1*erimen+(e %i !e r%*un%u( -0$rbi( ( (eiunii #e*+i'e in!u%e !e m(nu+ri+ie, ('$$(
!ie+e #i*r*r$+ei'e %u %u*er!ie+i'e. Nu % *u+u+ %+bi(i e1i%+en+ unei re(+ii 'u(e in+re
m(nu+ri+ie %i CH. Leiuni(e #e*+i'e 'e(e mi *r$*i+e !e 'ir$ u -$%+ in!u%e *rin m(nu+ri+ie
 *r$+ei' 're, !u* !mini%+rre unui %u*(imen+ !e *r$+eine in (imen++ie, %e '$re'+e
 *r$m*+.
  O (+ %+re !e nu+ri+ie %u%'e*+ibi( % *r$&re%ee %*re 'ir$ e%+e b*%%u( i(e$?e?un(,
e-e'+u+ in %'$*u( '$mb+reii $bei++ii m$rbi!e. O (+ men+iune %*e'i( +rebuie -'u+ %u*r
r$(u(ui 'ir$&en ( en!$+$1ime+riei !e $ri&ine in+e%+in( 're -0$rie !e0$(+re -ibr$ei.
 Ni0e(u( 're%'u+ ( en!$+$1ine($r !e+ermin #i*$&(i'emie. L 'ir$+i'i, en!$+$1inemi  -$%+
!e%'$*er+i in 9 !in 'uri. E in-(uen+e ne-0$rbi( e0$(u+i b$(ii, m$r+(i++e !u* 9 i(e
-iin! e0$(u+ ( 25 !in 'uri(e !e 'ir$ *rin en!$+$1inemie, -+ !e 5 in 'uri(e -r
en!$+$1inemie.
  Obei++e *rin *$r+ !ie+ #i*er'($ri') %e in%$+e%+e !e -i'+ &r%.
  Steato$a hepatica, in!u% !e !e$r!ini(e nu+ri+i$n(e,*$+e % imbr'e !$u +i*uri
m$r-$($&i'e:
 +i*u( A.'$re%*un!e -$rmei !e in-i(+r+ie &r%) re(i+ !e 'ren+ !e -'+$ri (i*$+r$*i %i !e
in+$1i'+i ('$$(i'. A'e%+ %e 'r'+erie *rin -*+u( ' *i'+uri(e !e &r%ime,!in
'i+$*(%m #e*+$'i+u(ui, *$+ % ?un& % $ $'u*e in in+re&ime, im*in&n! nu'(eu( ( *eri-erie.
Membrn #e*+$'i+u(ui '$m*rim+ !e &r%ime %e ne'r$e %i %e ru*e. Ru*+ur '#i%+e($r 
&r%e re*rein+ (e&+ur !in+re -i'+u( &r% %i CH.
 +i*u( B.'$re%*un!e !e&enere%en+ei &r%e) %e $b%er0 in '$n!i+ii e1+reme (e n$m(ii($r !e
*$r+ '($ri' inni+ie %i $!ei++e), in !ee'#i(ibre(e #$rm$n(e !ibe+ #r+). Nu %e -$rme
'#i%+e !e &r%ime 're % %e ru* %i !in 'e%+ 'u nu %e '$n'e*e e0$(u+i %*re 'ir$  'e%+ei
-$rme !e %+en$.
  O (+ me+$! !e r%*un%  -'+u(ui ( 'ren+e(e (imen+re, mi rr, e%+e necro$a
hepatocitara. Ne'r$ r *u+e -i *re0eni+ *rin !mini%+rre !e 0i+.E %i %e(eniu.
  Dee'#i(ibre(e !ie+e+i'e, in 'ee 'e *ri0e%+e *$r+u( !e &r%imi, &(u'i!e %i ('$$(, !ub(+e !e $
'ren+ !e *r$+eine, &en+i (i*$+r$*i %i une(e 0i+.B, re*rein+ -'+$rii 'ei mi im*$r+n+i in
 *r$!u'ere  steato$ei #e*+i'e, 'u *$%ibi(i++e e0$(u+iei %*re CH *en+ru %+e+$ !e +i* A in!u%
 *rin 'ren+ !e '$(in).  'ecro$a  #e*+i' !e $ri&ine (imen+r e%+e *r$!u% !e 'ren+ !e
 *r$+eine %i in %*e'i( !e 'i%+in, !e 0i+.E, %e(eniu, ' %i !e e1'e%u( !e &(u'i!e in '$n!i+ii(e unui
*$r+ re!u% !e *r$+eine.
Cir$ 'r!i'. E%+e $ -$rm !e e1'e*+ie  'ir$ei #e*+i'e= *re 'u -re'0en+ re!u% ,4 !in
'uri) in in%u-i'ien+ 'r!i' '$n&e%+i0e, *re!$minn+ in in%u-i'ien+e(e 'r!i'e 0e'#i. F'+$rii
#e*+$!inmi'i r%*un+$ri !e *r$!u'ere 'ir$ei %un+: %'!ere !ibe+u(ui 'r!i', 're%+ere
 *re%iunii in +riu( !re*+ %i #*$1i, ( 're %e *$+ !u& en!$'r!i+e b'+eriene, in-e'+ii
re%*ir+$rii. J$n #e*+i' 'e mi %en%ibi( ( #i*$1ie e%+e re*reen++ !e $n  3  'inu(ui,
%i+u+e in 0r'in++e 0enei 'en+r$($bu(re. A% %e e1*(i' ($'(ire ne'r$e($r #e*+$'i+re %i
*$i  'i'+ri'i($r '$n?un'+i0e in $n 'en+r$($bu(r. Te%u+u( '$n?un'+i0 -$rme ine(e 're
(e& 0ene(e 'en+r$($bu(re in+re e(e, ini+i( $'$(in! %*+ii(e *$r+e.
  Ciro*a car"iaca  %e in%$+e%+e rre $ri !e i'+er, e e1*rim+ *rin (bumine %'u+e, *r$+r$mbine
%'u+e, mni-e%+ri !e HTP, HDS *rin ru*ere 0ri'e($r e%$-&iene %u en%e-($*+ie #e*+i'.
Fi'u( e%+e mre, r$%u %i r$+un?i+. Rre $ri e%+e nere&u(+ %u n$!u(r. Pe %e'+iune 0ene(e *r 
 *r$eminen+e %i !i(++e. J$ne(e 'en+r$($bu(re %un+ r$%ii, ir *eri-eri ($bu(ui &(ben. Cir$
'r!i' e%+e $ 'ir$ 'en+r$$n(, 're re !re*+ '$n%e'in+ *ier!ere #e*+$'i+e($r !in 'e%+
 

$n  -i'+u(ui, *rin #i*$1ie 'en+r$($bu(r. Te%u+u( '$n?un'+i0 %e '$n!en%e +$+ in $ne(e
'en+r$($bu(re.
  O#str!ctia #iliara . Cir$ #e*+i' %e'un!r $b%+ru'+iei bi(ire e1r+#e$+i'e e%+e rr 
in+(ni+. P+$&eni 'ir$ei bi(ire %e'un!re nu e%+e bine 'un$%'u+. In in+reru*ere -(u1u(ui
 bi(ir, #e*+$me&(i %i !i(+re 'n(e($r bi(ire in+r#e*+i'e, %ur0in *r$m*+, urm+e !e
re&enerre 'n(e($r bi(ire. Ne'r$e(e %i in-(m+i *eri*$r+( %+imu(e -$rmre +e%u+u(ui
'$n?un'+i0. Se re(ie un +i* !e 'ir$ mi re&u(+ !e'+ +i*u( $bi%nui+ !e 'ir$
mi'r$n$!u(r.
Cue(e ere!i+re (e 'ir$ei %un+ numer$%e !r !e+in $ *$n!ere re!u% in e+i$($&i &ener( 
 b$(ii:
▫  'alacto*e&ia : %e !+$re%+e b%en+ei '$n&eni+(e  &$('+$$(-$%-+. Cir$ %e !e0$(+ !u*
mi mu(+e (uni !e %u*r0e+uire. De%i ne'r$ nu e%+e e0i!en+, re&enerre e%+e '+i0, reu(+n!
'ir$ m'r$n$!u(r. De0ine mni-e%+re '(ini' !in *rim %*+mn !e 0i+: i'+er %i
#e*+$me&(ie. Pr$&re%iune %*re 'ir$ %e in%+%(e in 36 (uni, !+$ri+ 'umu(rii
me+b$(i+i($r +$1i'i in #e*+$'i+e, !e0$(+n!u%e $ in-i(+r+ie &r%  'e%+$r.
▫  'lico'eo*a : $ !e$r!ine ere!i+r 're !u'e ( !e0$(+re CH. A'e%+ '$n%+ in 'umu(re
&(i'$&enu(ui in !i-eri+e +e%u+urii, in'(un! -i'+u(, rini'#iu(, in+e%+in(, mi$'r!u(, mu%'u(+ur
%'#e(e+i' %i 'r!i'. Prin+re mni-e%+ri(e '(ini'e 'e(e mi -re'0en+e, men+i$nm #i*$&(i'emi
in *eri$!e(e !e *$%+. Di&n$%+i'u( %e -'e *rin !e+erminre '+i0i++ii enim+i'e in bi$*%i
#e*+i'. Tr+men+u( e%+e in &ener( !ie+e+i', !r in -$rme(e &r0e %e *$+e re'ur&e (
n%+$m$ *$r+$'0, urm+ !e $ me(i$rre me+b$(i' %i +rn%*(n+u( !e -i'+.
▫  tiro*ie&ia ere"itara . E%+e un !e-e'+ &ene+i' 'e !u'e ( CH. F$rmre 'u+  +ir$einemiei
ere!i+re re e0$(u+ie (en+ *rin in%u-i'ien+ #e*+i' 'u+ in *rimu( n !e 0i+. In -$rm
'r$ni' !en$!mn+u( (e+( %ur0ine in *rim !e'! !e 0i+. Tir$ einemi %e 'r'+erie
 *rin 're%+ere (--e+ *r$+einei in %er %i *rin *reen+ min$'i!uriei. In -$rm 'r$ni', in 33
!in 'uri, %e !e0$(+ 'r'in$mu( #e*+$'e(u(r. Trn%*(n+u( !e -i'+ e-e'+u+ in *rimii !$i ni
!e 0i+ *re0ine !e0$(+re 'r'in$mu(ui #e*+$'e(u(r.
▫  itolerata ere"itara la %r!cto*a . Trn%mi+e un !e-i'i+ ( -ru'+$ei. B$( !e0ine '(ini'
mni-e%+ in m$men+u( 'n! %e in+r$!u'e in (imen++ie (imen+e 're '$n+in -ru'+$. M$r+e
 *$+e %ur0eni in +im*u( '$*i(riei %u ( +ineri.
▫  "e%icit "e al%a +,atitripsia . B$( %e 'r'+erie *rin %'!ere '$n%i!erbi(  enimei in
%er %i 're%+ere !e*$i+rii ei in #e*+$'i+. Si+u+i e%+e %emn+$re b$(ii i(%$n. In !e-i'i+u( !e
(- n+i+ri*%in, in #e*+$'i+e(e !e ( *eri-eri ($bu(u(ui, *e (n& enim re%*e'+i0e %e
'umu(e %i 'u*ru. He*+$'i+e(e 're '$n+in &rnu(e !e (-  %u-er *r$'e%e !e&ener+i0e.
▫  telea'iecta*ia he&ora'ica ere"itara . Se in%$+e%+e %i e !e%e !e 'ir$ n$!u(r, in 're
%e*+uri(e '$n?un'+i0e '$n+in numer$%e +e(en&ie'+ii 'u *ere+i %ub+iri. In I+(i u -$%+ %+u!i+e
%%e &ener+ii (e unei -mi(ii 'u 'e%+ b$(. L e'$&r-ie %u e0i!en+i+ n$m(ii (e 0%e($r 
#e*+i'e: '(ibru( r+erei, !i(+re 0ene($r #e*+i'e %i *$r+e.

  Pato'eia.  Prin'i*(e(e *r$'e%e *r$&eni'e 're in+er0in in #i%+$&ene CH %un+:

▫  ne'r$ 'e(u(e($r #e*+i'e.Du* !r!u( !e in+in!ere %un+:
   necro$a parcelara %u focala periferica *ie'eme( ne'r$%i%)
   necro$a parcelara diseminata nu m$!i-i' r#i+e'+$ni ($bu(r)
  necro$a masiva %i submasiva re%*$n%bi( !e *ri+i 'ir$e($r *$%+ne'r$+i'e)
▫  -ibr$&ene 'ir$+i'. Du* +i*u( (eiuni($r %un+:
   fibrilogene$acirotica
 

   fibro$a cu punct de plecare in spatiile porte 

 fibro$a intralobulara posrnecrotica -$rmre !e *$!uri *$r+$'en+r$($bu(re:
   bridging-necrosis
   bridging-fibrosis)
   screlo$a intralobulare pericelulara
 
 reversibilitatea fibro$ei hepatice
▫  re&enerre n$!u(r.

II..MOR*OPATOLOGIE

Macroscopic.

  A%*e'+u( m'r$%'$*i' ( -i'+u(ui e%+e %+u!i+ *rin (*r$%'$*ie, (*r$+$mie %u ( ne'r$*%ie.
L*r$+$mi nu 0 -i u+i(i+ ni'i$!+ in !i&n$%+i'u( 'ir$ei, in+ru'+ *$+e % &r0ee
in%u-i'ien+ #e*+i'. L*r$%'$*i e%+e u+i(i+ e1+reme !e rr.
   "imensiunile ficatului. ri in (imi+e -$r+e (r&i.Fi'+u( *$+e -i mre, *n ( 3@&, %u
+r$*#i', !e 6&.$(umu( -i'+u(ui !e*in!e !e &r!u( %+e+$ei, !e 'n+i++e !e +e%u+ '$n?un'+i0
ne$-$rm+, !e in+en%i++e re&enerrii #e*+$'i+e($r %i !e %+!iu( 'ir$ei.In %+!ii(e in'i*ien+e (e
CH, 'n! e1i%+ %+e$e e1+in%e, e1u!+ in-(m+$e %i e!em,-i'+u( e%+e
#i*er+r$-i'.He*+$me&(i e%+e -$r+e rr in 'ir$ *$%+ne'r$+i', *rn! mi -re'0en+ in 'e
 *$r+(. In %+!ii(e 0n%+e,*e m%ur 'e +e%u+u( -ibr$% %e '$n+r'+ %i re'+i in-(m+$rie %e
re!u'e, -i'+u( %e mi'%$re, !e0ine +r$*#i' %i !ur. $(umu( 'e($r !$i ($bi *$+e -i ine&(: unu(
#i*er+r$-i', 'e(((+ +r$-i'.
  Culoarea e%+e in &ener( mi !e%'#i% !e'+ in m$! n$rm(, !e ( &(ben uriu ( &(ben
!e%'#i%, !r *$+e -i %i brun r$%'+, 0reui %u &ri, !e*inn! !e &r!u( in-i(+r+iei &r%e, (
'$n&e%+iei, ( 'n+i++ii !e -ier, ( ne'r$ei, ( %+urrii in $1&en ( %n&e(ui r+eri( %i (
'$(e%+ei.
  Consistenta e%+e 're%'u+, -ibr$%, !n! ( *(*re $ %en+ie -erm !e !uri++e, u%$r !e
re'un$%'u+. Mr&ine n+eri$r  -i'+u(ui e%+e:
 !e 'e(e mi mu(+e $ri %'u+i+, %ub+i+, 'u re(ie-u( nere&u(+ %i -$r+e !ur
 (+e$ri *$+e -i r$+un?i+, in&r$%+ *rin *r$eminen+ m'r$n$!u(i($r.
  Suprafata ficatului e%+e nere&u(+, *re%r+ 'u n$!u(i -ini, uni-$rmi, ( 'r$r !ime+ru e%+e !e
5 mm, %e*r+e *rin $ne 'i'+ri'i(e. Su*r-+ -i'+u(ui %emn mi !e&rb 'u *ie(e !e
 *$r' +b'i+.
    'odulii de regenerare: u !imen%iuni !i-eri+e in -un'+ie !e 'ir$ %i !e !+!iu( ei e0$(u+i0.
Du* mrimi(e ($r %e !e$%ebe%':
 mi'r$n$!u(ri ,5 mm)e&( !e%emin+i *e %u*r-+ -i'+u(ui 'rui ii '$n-er un %*e'+
&run+$%.
 m'r$n$!u(ri 5 'm) 'u !imen%iuni ine&(e -iin! !i%emin+i neuni-$rm, in&#e%ui+i unu( in
(+u( %u !e*r++i *rin *(?e (r&i !e -ibr$.
  $(umu( %i numru( n$!u(i($r re-(e'+ in &ener( '*'i++e !e re&enerre. N$!u(ii mi'i %i
$ne(e !e -ibr$ (r&i +e%+ re!u'ere m%ei #e*+$'i+re.
 

  Capsula hepatica Glisson e%+e !e 'e(e mi mu(+e $ri in&r$%+, $*', !e 'u($re (b %i!e-ie
%u &(buie. Cn! 'ir$  e0$(u+ 'u in-(m+i '*%u(ei %e '$n%++ !eren+e !e in+in!ere
0ribi( in+re -i'+ %i $r&ne((e 0e'ine.
   !spectul macroscopic al ficatului pe sectiuni *e %u*r-+ !e %e'+iune *r beni !e +e%u+
'$n?un'+i0, !e &r$%ime %i in+in!ere 0ribi(e, 'u !i%*$i+ie in %e*+uri ine(re !e 'u($re (b
'enu%ie 'u*rinn! in+r$ re+e !e $'#iuri *ren'#imu( #e*+i'. In $'#iuri(e 'e%+ei re+e(e %e -(
+e%u+ #e*+i' !e re&enerre 're *re %e&men++ 'u !i%*$i+ie n$!u(r. N$!u(ii u &ener(,
'ee%i mrime, -$rm %i 'u($re ' 'ei !e *e %u*r-+ -i'+u(ui, %*e'+u( ($r 0riin! 'u 0r%+
 *r$'e%u(ui 'ir$&en.

  Microscopic .

   !spectul microscopic de ansamblu in!i--eren+ !e e+i$($&i %i !e +i*u( m$r-$*+$($&i' (

'ir$ei, %*e'+u( #e*+$($&i' e%+e !e *ren'#im -r&men++ *rin %e*+uri '$n?un'+i0e !e &r$%imi %i
!en%i++i 0ribi(e %e*rn! n$!u(ii !e re&enerre.
  !rhitectonia ficatului e%+e m$!i-i'+ %i !e$r&ni+:
 0enu( %u*r#e*+i' nu mi e%+e in 'en+ru( n$!u(u(ui 'i in &r$%ime %e*+u(ui '$n?un'+i0
 *erin$!u(r %u im*in% ( *eri-erie.
 !i%*$i+i -$rm+iuni($r !in %*+i( *$r+ 0enu(e r+eri(e %i 'n( bi(ir) i%i *ier!e !e %emene
re&u(ri++e.
   'odulii de regenerare %un+ -$rm+i in &($merri !e #e*+$'i+e r$+un?i+e, in'$n?ur+e in mre
 *r+e !e un %e*+ '$n?un'+i0. $(umu( 'e%+$r n$!u(i e%+e 0ribi(, in-eri$r %u e&( unui ($bu(
n$rm( in -$rme(e mi'r$n$!u(re.
  (esutul fibros re $ !i%*$i+ie 0ribi( !u* +i*u( 'ir$ei, in'$n?urn! n$!u(ii !e re&enerre %i
unin! 0ene(e %u*r#e*+i'e 'u %*+ii(e *$r+(e "iernn). M%e(e #e*+$'i+re %un+ in($'ui+e 'u
%e*+uri '$n?un'+i0e &r$%e. In ?uru( %*+ii($r "iernn %e -$rme $ -ibr$ %+e(r 'u *un'+ !e
 *(e're ( ni0e(u( e(emen+e($r *$r+(e 're !i-ue in ($bu(i.
   eparocitele in 'ir$e(e in'+i0e, '$m*en%+e, #e*+$'i+e(e *$+ % ib un %*e'+ mi'r$%'$*i'
re(+i0e n$rm(, %i&ur m$!i-i're '$n%+n! in $rien+re nere&u(+  *e -r&men+u( !e PBH) 
+r0ee($r #e*+$'i+re '$r!$ne Rem@).In -un'+ie !e e+i$($&ie %i !e %+!iu( e0$(u+i0 ( 'ir$ei %e
'$n%++ $ !i%+r$-ie #e*+$'i+r 0ribi(. P$+ % *r %emen !e %u-erin+ #e*+$'i+r:
'(ri-i're, b($nire.
  Sistemul vascular  e%+e in+en% (+er+. In &r$%ime %e*+uri($r '$n?un'+i0e *r numer$%e
%+ru'+uri 0%'u(re m$!i-i'+e. In-(m+i 0ene($r %u*r#e*+i'e %e $b%er0 mi (e% in 'ir$
e+i(i'.
   !rborele biliar  in 'ir$e(e bi(ire, 'n(e(e bi(ire !in %*+iu( *$r+ in-(m+e %i !e'(ibr+e.In
$ne(e !e -ibr$ *r 'n(i'u(e bi(ire ne$ -$rm+e *reen+e mi (e% in 'ir$e(e *$%+ne'r$+i'e.
Gr!u( !e !e0$(+re ( 'ir$ei e%+e *re'i+ in +rei %+!ii, !u* *r$*$r+i !e *ren'#im
'$n0re+i+ in n$!u(i !e re&enerre:
 %+!iu( : %e 'r'+erie *rin b%en+ n$!u(i($r !e re&enerre %u *reeen+ numi %*$r!i'
 'e%+$r.
 %+!iu( 2: '$re%*un!e ( K !in *ren'#im '$n0er+i+ in n$!u(i.
 %+!iu( 3: r#i+e'+$ni' ($bu(r e%+e in in+re&ime in($'ui+ *rin %+ru'+ur n$!u(r.
  S+!i(ire 'ir$ei  *ermi% $b%er0+i ' in numi+e +i*uri !e 'ir$, ' in 'ir$ bi(ir
 *rimi+i0e, in #em$'r$m+$ %i in 'ir$ '$n&e%+i0, re&enerre n$!u(r %e !e0$(+ in'e+.
 

C$re(re &r!u(ui 'ir$ei, *e !e $ *r+e, 'u numru( %i !imen%iuni(e 0ri'e($r e%$-&iene, *e !e

(+ *r+e,  r++ ' 0ri'e(e 0$(umin$%e %e -$rme in %*e'i( in 'ir$ mi'r$n$!u(r.

  Tbe( . Ti*uri(e m$r-$($&i'e (e 'ir$ei #e*+i'e

FIESSINGER 29)
He*+i+ 'r$ni' +r$-i'
%'i+$&en
Cir$ *$%+ne'r$+i'
m'r$n$!u(r M($r
Cir$ #i*er+r$-i' Hn$+
Gi(ber+
Cir$ #i*er+r$-i' !i-u
Gi(ber+ Grnier   *$%+#i*er+r$-i' Gi(ber+ %i
Cir$ &r%$% Hu+ine( %i
Sb$u+in
Cir$ ('$$(+uber'u($%
Hn$+
Cir$ &rnu(r T(m$
 N$rer$
Cir$ rei!u(r
Cir$ 'u !en$m
CIRO-A MICRONODULARA
ALBOT 3)
Cir$ +r$-i' Lrnne'
Cir$ +r$-$#i*er+r$-i'
Cir$ #i*er+r$-i' Hn$+
Gi(ber+
Cir$ &r%$% Hu+ine( %i
Sb$urin
Cir$ rei!u(
CAROLI 5)
Cir$ +r$-i' n$!u(r
Cir$ +r$-#i*er+r$-i' +i*
($b %+n& %u !re*+
Cir$ +r$-i' ne+e! !i-u
%ub'u+
Cir$ +r$-i' &r%
Cir$ +r$-i$'
Li**mn
Cir$ #i*er+r$-i' n$!u(r
Cir$ #i*er+r$-i' ne+e!,
!i-u1
 Cir$ #i*er+r$-i' &r%$%
( e+i(i'i %i $bei
Cir$ #i*er+r$-i' &r%$%
+enu+
Cir$ #i*er+r$-i'
#em$'r$m+$i'
Cir$ #i*er+r$-i'
#i*er'$m*en%+
Cir$ 'u !en$m

  C$re%*un!e 0e'#ii 'ir$e *$r+(e %u ('$$(i'e Lenne', %e 'r'+erie *rin e+i$($&i
 *re!$minn+ ('$$(i' %i 0ir(, *rin %+!iu( *re'ir$+i', mi (un& 'u $ *eri$! *remer&+$re !e
%+e+$ #e*+i'. C(ini' ei%+ ( in'e*u+ un -i'+ n$rm( %u mri+, *$i un -i'+ re!u% !e 0$(um,
$ %*(in mri+ 'u 'r'+er -ibr$'$n&e%+i0. E%+e in+ere%n+ %i *n're%u(. Se mni-e%+ *rin HTP,
%'i+, i'+er 'u 'r'+er e*i%$!i'.
Hi%+$($&i' -i'+u( %e 'r'+erie *rin:
 n$!u(i mi'i ø  ,2,3 'm, uni-$rmi in -$rm %i r%*n!ire. N$!u(ii %un+ -$rm+i !in
&($merri !e #e*+$'i+e, in 0ri+e %+!ii !e ne'r$ %u !i%+r$-ie re0er%ibi( %i in'$n?ur+i !e
%e*+uri '$n?un'+i0e %ub+iri.
 +e%u+u( '$n?un'+i0 !i%+$r%i$ne r#i+e'+$ni' n$rm(  -i'+u(ui. Se*+uri(e '$n?un'+i0e in
&ener( %un+ %ub+iri ø  2 mm, %i rre$ri &r$%e mi &r$%e !e 5 mm. Ori&ine +e%u+u(ui
'$n?un'+i0 *re !e%e in %*+ii(e *$r+e, e( *$+e % *re!$mine in $ne(e 'en+r$($bu(re
 !i%+r$-i #e*+$'i+r e%+e 0ribi(, in une(e #e*+$'i+e $b%er0n!u%e '$r*i &($bu($%i, !e
'u($re r$%ie . In 'ir$ ('$$(i' %e inre&i%+re !e0$(+re '$r*i($r M(($r, ($'(i+i !e
(un&u( %*+uri($r '$n?u'+i0e. C$r*ii M(($r %un+ *reen+i %i in (+e -$rme !e 'ir$ !e'+ 'ir$
e+i(i': 'ir$ bi(ir *rimi+i0, b$( i(%$n, 'ir$ nu+ri+i$n(.
 

 
Cir$ mi'r$n$!u(r
 

Cir$ mi'r$n$!u(r. In'r're &r%  #e*+$'i+e($r 

CIRO-A MACRONODULARA
 
Su *$%+ne'r$+i', *re !e $bi'ei ( +inerii 're u 0u+ #e*+i+ 0ir( ' %i ( !u(+i, !e
$bi'ei ( '$n%um+$rii bui0i !e ('$$(. In 'e%+ -$rm #i*$+r$-i mu%'u(r e%+e re!u%,
#e*+$me&(i e%+e m'r$n$!u(r, i'+eru( e%+e mi in+en%, *er%i%+en+ %*re !e$%ebire !e 'ir$
Lenne'. Sun+ -re'0en+e *$(ir+r(&ii, *ruri+u( %i +en!in+ ( m(i&nire. Fun'+i bi$*%i'
%+bi(e%+e !i&n$%+i'u( *unn! in e0i!en+ ne'r$e 'e(u(re.95 !in 'uri e0$(ue %*re e1i+u%
in 5.
  Hi%+$($&i -i'+u(ui %e 'r'+erie *rin:
 n$!u(i mri 'u ø 5 'm, neuni-$rmi ' -$rm %i !i%+ribu+ie
 %e*+uri(e '$n?un'+i0e %un+ mu(+ mi &r$%e
 r#i+e'+$ni -i'+u(ui e%+e mi *u+in '$m*re%i0, !i%+$r%iune 0%'u(r-iin! mi rr $b%er0+,
mi (e% in ($bu( %+n&. In 'e%+e $ne, 0%e(e -eren+e %u-er $ '$n%i!erbi( '$m*re%iune %i
!i%+$r%iune.
 (eiune #i%+$($&i'( 'e mi 'r'+eri%+i' e%+e 'i'+ri'e &r$%, nere&u(+, ( 're %e %$'i
%i %e*+uri -ine.
 *r$(i-erre n$!u(i($r !e re&enerre in+run %*+iu (imi++ *rin '$n+r'+i +e%u+u(ui -ibr$% %i
!i%+$r%iune r#u+e'+$ni'ii -i'+u(ui !u' ( '$m*re%iune 0%e($r 
 *rin re!u'ere (umenu(ui 0%'u(r %e in&reune -(u1u( %n&0in !e0$(+n!u%e %+-e( HTP.
 

Cir$ m'r$n$!u(r

CIRO-A MITA
 
A%$'i +i*u( mi'r$'u 'e( m'r$n$!u(r 

 
 

  Cir$ 'u n$!u(i++e mi1+

 

CIRO-A SEPTALA INCOMPLETA

  Hi%+$($&i' %e 'r'+erie *rin -$rmre !e %e*+uri '$n?un'+i0e %ub+iri, b$&+ 'e(u(ri+e,

're in'$n?$r %+ru'+uri #e*+$'i+re 'u %*e'+ n$rm(, -r n$!u(i !e re&enerre= *re ' $
-ibr$ 're in'$n?$r '$m*(e1e !e 'ini, &r!u( 'e%+ei -iin! in%u--i'ien+ ' % *er+urbe
0%'u(ri+i %+ru'+urii #e*+i'e.

Cir$ #e*+i' %e*+(('$$(i'

CIRO-A /ILIARA PRIMITI(A

  A*re *rin $b%+'$( in+r#e*+i', e%+e 0rin+ #e*+$'i+e($r +re'u+e in 'r$ni'ire= %e mi
nume%+e %i 'ir$ Hn$+. Fer'0en+ ei e%+e mi'.
  Fi'+u( e%+e #i*er+r$-i+, !ur, &rnu(+ %u n$!u(r, !e 'u($re 0er!e in'#i%.Cu($re 0er!e
in'#i% e%+e mi 'r'+eri%+i' *en+ru 'ir$ bi(ir %e'un!r.E1i%+ %*(en$me&(ie, i'+eru( e%+e
 *ermnen+, +e&umen+e(e u $ 'u($re ne&ri'i$%, ir *ruri+u( e%+e -re'0en+. E0$(u+i 'ir$ei
 bi(ire *rimi+i0e e%+e %+!i(: '$(n&i+, *r$(i-erre 'ni'u(r, -ibr$ %i in u(+imu( %+!ium
'ir$.
  Hi%+$($&i', %e $b%er0 '$(e%+, &rnu($me in %*+ii(e *$r+e,*r$(i-erre 'e(u(e($r "u*--er %i
!e*$i+e !e 'u*ru in #e*+$'i+.
  E0$(u+i 'e%+ei e%+e (en+ 55 ni, %-r%i+u( %e *r$!u'e *rin HTP %u '$m #e*+i'.
 
 

 
Cir$ bi(ir *rimr
 
CIRO-A /ILIARA SECUNDARA .

  A*re *rin $b%+'$( e1+r#e*+i', e%+e *re'e!+ !e mni-e%+ri bi(ire e1+r#e*+i'e 'e !u' (
i'+er me'#ni', -iin! ne'e%r *reen+ 'e%+ui *e $ *eri$! mi (un& *en+ru ' % *r 'e%+
+i* !e 'ir$. I'+reu( e%+e *ermnen+ %i i $ nun+ brun 0eruie, -i'+u( e%+e #i*er+r$-i', 'u $
'$n%i%+en+ 're%'u+ %i $ %u*r-+ ne+e!. E1i%+ %*(en$me&(ie, *ruri+ %e*r+$r, ir %'i+ *re
in - -in(.
  Hi%+$($&i', e 'r'+erie *rin %emne !e '$(e%+, ($'(i+e ( in'e*u+ 'en+r$($bu(r, ir *e
m%ur 'e %e !e0$(+ n$!u(ii !e re&enerre *re!$min ( *eri-eri 'e%+$r. M$!i-i're 'e mi
'r'+eri%+i' e%+e 're%+ere numru(ui 'ni'u(i($r bi(iri 're *ermi+ $ bun !i-eren+iere !e 'ir$
 bi(ir *rimi+i0, in numru( 'n(i'u(i($r bi(iri e%+e *re'ibi(i re!u%. N$!u(ii !e re&enerre in
%+!ii(e 0n%+e -$rme n$!u(i in &#ir(n!, 're in'(u!e numer$%i ($bu(i. He*+$'i+e(e !in
0e'in++e %un+ +ume-i+e %i in'r'+e 'u *i&men+ bi(ir.
 

  Cir$ bi(ir %e'un!r

 CIRO-A CARDIACA

  E%+e $ -$rm rr %i '$n+r$0er%+ !e 'ir$. Se !e0$(+ mi (e% ( b$(n0ii 'u *eri'r!i+
'$n%+ri'+i0 %u in%u-i'ien+ +ri'u%*i!in. C$n&e%+i 'r$ni' *re(un&i+  -i'+u(ui !e+ermin
+r$-i %i ne'r$ 'en+r$($bu(r.

II./.TA-LOU CLINIC

Mni-e%+ri(e '(ini'e %un+ !e$%ebi+ !e *$(i-$rme, in+ere%n! *r$*e +$+e *r+e(e %i %i%+eme(e:

  Se&e cliice speci%ice : *rime(e %emen (e b$(ii *$+ % *r ( $ri'e 0r%+, mi -re'0en+
in+re 3465 !e ni.
▫   !srenia si scaderea capacitatii de efort : %un+ %emen -re'0en+ in+(ni+e, ne%*e'i-i'e 're *$+
e1*rim $ in%u-i'ien+ #e*+$'i+r %u $ '$m*(i'r+ie  CH
▫   !norexia si scaderea ponderala: *re !u* $ e0$(u+ie mi (un&  b$(ii. An$re1i e%+e
''en+u+ !e (+erre mir$%u(ui %u e1i%+en+ unei *+$($&ii &%+r$!u$!en(e. E e%+e m%'+
( ('$$(i'i, ( 're nu *re ini+i( %'!ere *$n!er( !+$ri+ *$r+u(ui '($ri' !e 9'(.<& *e 're
(e -urnie ('$$(u( %u *rin re+en+i #i!r$%(in e!eme, %'i+).
▫  "isconfort abdominal% flatulenta% balonare% somnolenta postprandiala% greturi% varsaturi.
▫  "ureri addominale/ %u*$r+bi(e, !e%e ($'(i+e in #i*$'$n!ru( !re*+ %i !e'(n%+e !e e-$r+uri
%i $r+$%++i%m. Ob%er0+e in e+i$($&i 0iru%(#e*+i' e1*rimn! in-(m+i #e*+i' '+i0.
  Se&e "e "e#!t:
 

▫   Icterul   %e re&%e%+e in 7,7 !in 'uri %i %e in%+(e in%i!i$% -iin! in%$+i+ !e urini #i*er'r$me
%i mi rr !e *ruri+ 'u+n+. E( %e !+$re in'*'i++ii -i'+u(ui !e  merb$(i bi(irubin.
▫   emateme$a %e re(ie in urm ru*erii 0ri'e($r e%$-&iene %i e%+e men+i$n+ ' %emn !e
!ebu+ in  !in 'uri.
▫  !scita !ebu+ !ire'+ in 2 !in 'uri.

  Perioa"a "e stare :

▫  +anifestari hemoragipare: &in&i0$r&ii, e*i%+1i%, e'#im$e.
▫  "enutritia e0i!en+ in 25 !in 'uri mni-e%++ *rin re!u'ere !e*$i+e($r !e &r%ime !e *e
 br+e %i  m%ei mu%'u(re in 'ee%i re&iune. Gr%ime !e *e br+e %'!e 'u 3 ( brb+i %i 'u
4 *en+ru -emei. De%i e+i(i'i u in&e%+ie re!u% !e (imen+e i%i men+in e'#i(ibru( nu+ri+i$n(
+im* in!e(un&+ !+$ri+ *$r+u(ui '($ri' *rin '$n%um e1%'e%i0 !e ('$$(.
▫   Icterul   in *eri$! !e %+re %e in%+(e in 3495 !in 'uri. Se mni-e%+ *rin '$($r+ie
&(ben  +e&umen+e($r, %'(ere($r %i mu'$%e($r, une$ri *ruri+ %i urini #i*er'r$me.
 
E)a&e!l o#iecti$ : -urnie !+e !i-eren+i+e !u* %+!iu( e0$(u+i0 ( b$(ii.
▫   In perioada compensate %+re !e nu+ri+ie *$+e -i bun, im*re%i$nn! 'u un &r! !e
#i*$+r$-ie mu%'u(r %i !e (+erre  -nere($r: rre-'+i *i($i++ii 1i(re %i *ubiene, (
!i%*$i+i *i($i++ii !e *e -+ n+eri$r  +$r'e(ui %emnu( C#/$%+e'@) 'rui i %e +ribuie
!$u %emni!i'+ii: un 'r'+eri+ +i*u(ui '$n%+i+u+i$n( 're e1*une ( !e0$(+re 'ir$ei %i
(+ 'r'+erie %emnu( #$rm$n( ( 'ir$ei +r$-i *ru(ui, un&#ii in -$rm !e %+i'( !e
'e%$rni'
▫   In perioada decompensate b$(n0ii %un+ !enu+ri+i 'u -'ie% %u*+ %i 'u +r$-i mu%'u(+urii
e1+remi++i($r: *ie(e e%+e !e 'u($re &(buie, %ub+i+, ne+e!e, u%'+, *er&men+$%, '(!
re*reenrn! *e+e (be !u* '$m*re%iune.
▫   In stadiul asctic avansat  e%+e 0er$%imi( '$m*++i 'u $menii !e%en+i !e '$*ii, 'u
b!$meniu( r$+un! %i e1+remi++ii(e %ub -$rm !e be+e, %u 'u $mu( +i* *in?en.
▫  (egumentele %un+ *(i!e, *i&men++e +er$%, 'u *e+e '-enii *e &mbe %i -+ 'un$%'u+e ' ;*e+e
#e*+i'e>, b$(n0ii %emnn! -$r+e mu(+ in+re ei mre -mi(ie  'ir$+i'i($r). Te&umen+e(e !e0in
%i e(e +r$-i'e, *r *e+e rubinii %i *e b!$men %e -$rme %+riuri *i&men+re.  Palmele rosii
'r'+eri+e *rin '$n&e%+i eminen+e($r +enr %i #i*$+enr, *re'um %i  0r-uri($r !e&e+e($r 
'e%+ -iin! e1*re%i n%+m$e($r r+eri$0en$%e !e ( 'e%+ ni0e(). E(e %e $b%er0 ( 'ir$+i'i
in 35 !in 'uri !r *$+ % %e in+(ne%' %i in %r'in, %+ri -ibri(e, b$(i '%e'+in+e.  *etractia
aponevro$ei palmare !e +i* Du*u+ren in%$+e%+e 'ir$ ('$$(i' in 66 !in 'uri.
▫   Icterul  ( 'ir$+i'i i'+eru( *$+e -i *ermnen+ %u e*i%$!i'. In e1*(i're *+$&eniei i'+eru(ui (
'ir$+i'i %un+ im*(i'+e *+ru *r$'e%e !i-eri+e:  re+en+i bi(ir
   m$!i-i're #e*+$'e(u(r
   $b%+'$(e ( ni0e(u( 'n(e($r bi(ire in+r#e*+i'e
   #em$(i.
▫  Stelute vasculare %*i!er ne0u%) %u *ien?enii 0%'u(ri, *re in ;*($ie> $!+ 'u *ri+i
%'i+ei in re&iune !e'$(+eu(ui, *e -+, &+, umeri, re&iune %u*eri$r  +$r'eu(ui %i mi rr *e
n+ebr+e, mini, bue, ure'#i, *ie(e '*u(ui '(0i+ie). O%+eu(+ 0%'u(r e%+e ('+ui+ !in +rei
'$m*$nen+e:  *un'+u( 'en+r(*r$eminen+, *u(%+i(, r$%u *rin%
   rmuri *i'i$re) r!ire
   $n e!em+$%.
 

Di%*r ( *re%iune %i re*r ( '+e0 %e'un!e !u* in'e+re *re%iunii. S+e(u+e(e 0%'u(re %e
$b%er0 mi -re'0en+ in 'ir$ ('$$(i' %i %un+ !e !$u $ri mi -re'0en+e in *reen+ 0ri'e($r 
e%$-&iene. E(e nu %un+ *+$&$m$ni'e *en+ru 'ir$, e(e in%$+e%' #e*+i+ ('$$(i', 0ir(, *$+
*re in 'ur%u( %r'inii %u ( in!i0ii %n+$%i.
▫   Fanerele un&#ii(e *$+ *reen+ (inii(e (ui Muer'@e beni (bi'i$%e !i%*u%e +rn%0er%( %i
'$rre(+e 'u #i*$*r$+einemi !in CH. Se mi in+(ne%' !i%*$i+i (unu(ei %u %*e'+u( !e un&#ie
(b, (+e !e 3mm, %%$'i+e 'u +e(n&ie'+iii %ubi'en+e, un&#i *r$1im( 0n! %*e'+ r$
 *(. Pru(, 1i(r, *ubin *$+e % !i%*r.

Tu(burri en!$'rine

▫  Ginecomastia mrire !e 0$(um  &(n!e($r mmre). A(+uri !e rem$(ire %i #i*$+r$-i

+e%+i'u(e($r, im*i+en+ %e1u( %i ( -emei +u(burri(e men%+ru(e %i -ri&i!i++e -' *r+e !in
%in!r$mu( en!$'rine ( 'ir$ei. An$m(ii(e en!$'rine %e !+$re%' in%u-i'ien+ei #e*+$'i+u(ui in
me+b$(ire #$rm$ni($r, in '$n?u&re e%+r$&eni($r, #ier%$m+$+r$*i%mu( %e'un!r %u
#i*er&(i'emiei, *re'um %i un$r 'u%e i+r$&ene %*ir$n$('+$, '$r+i$n).
  Gine'$m%+i e%+e in+(ni+ in %+!ii(e 0n%+e (e 'ir$ei 'u %in!r$m HTP %i %e '$re(e
 bine 'u *reen+ %'i+ei,  0ri'e($r e%$-&iene %i  %+e(u+e($r 0%'u(re. E *re mi -re'0en+ in
'ir$ ('$$(i'= une$ri e%+e uni(+er( %u *re!$minn! in *r+e %+n&. Gime'$m%+i %e
+ribuie #$rm$nu(ui %$m+r$+r$* #i*$-ir %u *r$(e'+inei.
  Hi*$+r$-i %i rm$(ire +e%+i'u(e($r %e !+$re%' +r$-iei e*i+e(iu(ui &emin+i0 %i in&r$%rii
(minei *r$*rie  +ubi($r %emini-eri. Sin!r$mu( #e*+$+e%+i'u(e($r % !e%'rie% +un'i 'n!
r*$r+u( !in+re 'n+i++e !e #$rm$ni +r$&eni %i e%+r$&eni %'!e. A'e%+ %in!r$m '$n%+ in +r$-ie
+e%+i'u(r %i %emen !e -eminire: *ru( 'e*#(i' !e0ine mi rr %i mi m$(e= *i($i++e 1i(r
%i +$r'( e%+e re!u% %i *ru( *ubin re $ !i%*$i+ie !e +i* -eminin.
Diminure (ibi!$u(ui %i  *$+en+ei %un+ $bi%nui+e in CH, rre$ri ' %im*+$me !e !ebu+.
C*'i++e %e1u( %e me(i$re *r(e( 'u '$m*en%re CH. Femei(e %e *(n& !e -ri&i!i++e,
( $ +nr %e $b%er0 men$ree, ir in *remen$*u me+r$r&ii !+$r+e #i*er*(iei
en!$me+ru(ui.
▫   ipertrofia paroptidiana *re mi -re'0en+ in 'ir$ ('$$(i' 5 !in 'uri, e%+e
ne!urer$% %i re0er%ibi( *u+n! %%i re!u' r*i! 0$(umu( *e m%ur me(i$rrii -un'+iei
#e*+i'e. G(n! e%+e m$(e nu %e -( %ub +en%iune %in u e%+e -i1+e !e re&umen+e(e %u*ri'en+e.
Imbr' $ -$rm +r*e$i!i( !i%+$r%i$nn! -$rm ure'#ii. F(u1u( %(i0r e%+e re!u%. In
in+er%+i+iu( &(n!u(r %e $b%er0 e!em, in-i(+r+ie &r% %i -ibr$.
▫  ipotiroida e%+e $b%er0+ in %+!ii(e 0n%+e (e CH.

Tu(burri me+b$(i'e.

▫   Intoleranta la gluco$a in 7 !in 'uri 'e%r in+$(ern+ i %*e'+u( unui diabet $aharat 
mni-e%+, 'e%+ *re!$minn! in 'ir$ ('$$(i'. De$r!in(e me+b$(i%mu(ui &(u'i!e($r in CH
0ri !e ( #i*re&(i'emie %u in+$(ern+ m$!er+ ( &(u'$ in <33<4 !in 'uri, *n (
!ibe+ #r+ '(ini' mni-e%+ in 5 !in 'uri. Dibe+u( #e*+$&en e%+e beni&n e'#i(ibrn!u%e
!e 'e(e mi mu(+e $ri *rin re!u'ere *$r+u(ui (imen+r !e &u('i!e ne'e%i+n! in%u(in
e1'e*+i$n(). C(ini' %e mni-e%+ *rin #i*er&(i'emie, m$!er+ &(i'$urie, m$!er+ in+$(ern+ (
&(u'$, #i*erin%u(inemie %i rei%+en+ *eri-eri' ( in%u(in ' in $bei++e).
 

▫   iponatriemie %e e1*(i' ++ *rin !i(u+ie '+ %i *rin *ier!eri. Se're+i in e1'e%  #$rm$nu(ui
n+i!iure+i' ADH) !e+ine r$( e%en+i( in *r$!u'ere #i*$n+remiei !i(u+i$n(. In m?$ri++e
'uri($r #i*$n+remi e%+e e1*re%i #i*$+$ni'i++ii &ener(e 'u e1*re%iune -(ui!u(ui in+r'e((u(r 
%i '$n%+ru'+i %*+iu(ui e1+r'e(u(r.
▫   ipopotasemie e%+e *r$0$'+ !e *$r+u( re!u% !e ", re&im #i*er&(u'i!i', *er-uii 'u &(u'$
're -0$rie *+run!ere " in 'e((u(e, e(iminre urinr 're%'u+ !e " *rin +er*i 'u
!iure+i'e= &r0+ !e 0r%+uri, !iree, +r+men+ !iure+i'
▫   Febra in%$+e%+e -re'0en+ 'ir$ !e'$m*en%+e, e %e *$+e !+$r unei b$(i nere'un$%'u+e,
in-e'+ii b'+eriene %u *$+e *rein un %emn %i%+emi' ( !e'$m*en%rii 'ir$ei. Febr in &ener(,
nu !e*%e%+e 39,7 C e%+e '$n+inu %in u %e in%$+e%+e !e -ri%$ne. In in%u-i'ien+ #e*+i' e %e
 *$+e !+$r in'*'i++ii -i'+u(ui !e -ri%$ne. In in%u-i'ien+ #e*+i' e %e *$+e !+$r
in'*'i++ii -i'+u(ui !e  in'+i0 %+er$iii *ir$&eni 'e%+ +i* !e -ebr nu r%*un!e (
+r+men+u( n+ibi$+i'. D' -ebr !e*%e%+e 37 C %i %e in%$+e%+e !e -ri%$n, +rebuie%' 'er'e++e
(+e 'u%e: in-e'+re %'i+ei, in-e'+ie urinr, in-e'+ie bi(ir, +uber'u($ *(eur$*eri+$ne( %u
#em$r&ie !i&e%+i0e.
▫   epatomegalia mrire !e 0$(um  -i'+u(ui *re in 7 !in 'uri. Fi'+u( re '$n%i%+en+
're%'u+ *n ( !uri++e. Mr&ine n+eri$r e%+e %'u+i+ %i %u*r-+ nere&u(+, !e $bi'ei
 *re%r+ 'u n$!u(i. $(umu( ($bi($r -i'+u(ui *$+e -i ine&(. $(umu( mre ( -i'+u(ui e%+e
!+$r+: 'n+i++ii !e &r%ime, %e*+uri($r '$n?un'+i0e, n$!u(i($r !e re&enerre %i une$ri !e
%u*r!u&re unui !en$'r'in$m. C#ir %i in 'uri(e +r$-i'e, -i'+u( e%+e mre ( in'e*u+
 *en+ru ' *$i % %e mi'%$ree *n ( !i%*ri+i %ub reb$r!u( '$%+(.
▫  Splenomegalia 0$(umu( %*(inei e%+e !ire'+ *r$*$r+i$n( 'u ni0e(u( *re%iunii *$r+(e. E e%+e
 *(*bi( in 5 !in 'uri, 0n! '$n%i%+en+ 're%'u+.S*(en$me&(i &i&n+ %e !+$re !e
mu(+e $ri unei +r$mb$e  0enei %*(eni'e. S*(in re %*e'+ brun r$%i+i', 'u '*%u( in&r$%+, e
-iin! re%*$n%bi( !e %e'#e%+rre in *r$*$r+ii 0ribi(e  +r$mb$'i+e($r ( in-e'+ii.

 
S*(en$me&(i ( un b$(n0 'u 'ir$ mi'r$n$!u(r
 

▫   !scita 'e mi 'r'+eri%+i' mni-e%+re '(ini'  CH in *eri$! !e'$m*en%+e.A%'i+

re*rein+ 'umu(re !e (i'#i! in '0i++e *eri+$ne( !+$ri+ 're%+erii *re%iunii 0en$%e
 *$r+(e %i re!u'ere *r$+eine($r *(%m+i'e, +u(burri($r 'ir'u(+iei (im-+i'e. Cn+i++e (i'#i!u(ui
!e %'i+ 0ri !e ( 35 ( . *n ( 2 (.
  L in%*e'+ie b!$menu( e%+e mri+ !e 0$(um 0n! %*e'+ !e ;!e%&>, 'n! b$(n0u( e%+e in
$r+$%++i%m %i %*e'+ !e ;b+r'in>, 'n! b$(n0u( e%+e in '(in$%++i%m, ir in %'i+e(e bun!en+e,
%ub +en%iune, %e i -$rm b!$menu(ui ;in $bu>. Se '$n%++ $ #ernie $mbi(i'( $n-($'e()
're re %*e'+ !e ;!e&e+ !e mnu%>. Pe *ere+e(e b!$min( %e $b%er0 'ir'u(+i '$(+er(
'r'+eri%+i' 're re(ie %*e'+u( 'un$%'u+ !e ;'* !e me!u>. L *er'u+ie %e *une in
e0i!en+ m+i++e 'r'+eri%+i', !i%*u% in ;*$+'$0>'u '$n'0i++e in %u% %i !e*(%bi( *e
-(n'uri $!+ 'u %'#imbre *$i+iei b$(n0u(ui in *+. Preen+ %'i+ei in&reune *(*re
-i'+u(ui %i  %*(inei.

Cir'u(+i '$(+er( ;'*u( !e me!u%>)

C(%i-i're %'i+ei !u* '$n'en+r+i in *r$+eine:

  ) %'i+e 'u '$n'en+r+ie in *r$+eine '$re%*un+$re (i'#i!u(ui in+er%+i+i( n$rm(
  b) %'i+e 'u '$n'en+r+ie in *r$+eine '$re%*un+$re (i'#i!u(ui in+er%+i+i( !in 'ir$e
  ') %'i+e 'u '$n'en+r+ie mre in *r$+eine *re!$min in CH)
▫   Edemele *r in -e(e 0n%+e, !e $bi'ei in%$+e%' %'i+ !r *$+ *re %i in!e*en!en+ !e
%'i+ in'i!en+ 6 !in 'uri. A*r !e re&u( %ub -$rm un$r e!eme !e'(i0e, &mbiere. Sun+
'$n%e'in+ +u(burri($r #i!r$e(e'+ri'e -iin! *r$0$'+e !e re+en+i !e N %i H2O, 're%+erii*re%iunii
#i!r$%++i'e %i *ermebi(i++ii '*i(re,#i*$(bumiei= %un+ +re'+$re %i re'i!i0n+e. De mu(+e $ri
!i%*r !imine+ in urm re*u%u(ui !in +im*u( n$*+ii. A'umu(re !e (i'#i! in '0i++e *(eur(
( 'ir$+i'i mi e%+e 'un$%'u+ %i %ub nume(e !e e-uiune *(eur( 'ir$+i'.
▫   ipertensiunea portala re*rein+ 're%+ere *re%iunii %n&e(ui in 0en *$r+ %i in rmuri(e ei=
e%+e *reen+ ( b$(n0ii 'u CH. Cue(e *ri+iei ei ( 'ir$+i'i %un+ re*reen++e !e: $b%+'$(u(
$r&ni' %i -un'+i$n( in+r#e*+i'. Sn&e(e *$r+( %i&ur 2<3 !in iri&+i -i'+u(ui, in +im* 'e
%n&e(e r+eri( !$r<3.
 

  Ob%+'$(u( $r&ni': 're%+ere rei%+en+ei ( 'ur&ere %n&e(ui in %i%+emu( '0 in-eri$r 

e%+e *r$0$'+ !e *reen+ unui $b%+'$( $r&ni', in+r#e*+i'. A(+erre %+ru'+urii ($bu(i($r 
#e*+i'i %i !e0$(+re e1'e%i0 #i*er*(ei +e%u+u(ui '$n?un'+i0 in %*+ii(e *$r+e %i !in in+eri$ru(
($bu(i($r #e*+i'i) re(ie $ !i%+ru&ere  *+u(ui '*i(r %i un br? in+r#e*+i' ( 'ir'u(+iei
 *$r+e. In 'ir$e(e m'r$n$!u(re %e in+(ne%' '$m*re%iuni *e rmuri(e 0ene($r %u*r#e*+i'e,
%+n?enin! !ren?u( %n&e(ui *$r+(. Ob%+'$(u( $r&ni' e%+e *r$0$'+ %i !e (eiuni(e
 *ren'#im+$%e %i in+er%+i+i(e !i-ue, 're 'ree $ +en%iune 're%'u+ ( ni0e( %inu%$i!(.
  Ob%+'$( -un'+i$n(: ( ni0e(u( rmi-i'+ii($r -ine (e r+erei #e*+i'e !e *r$!u'e $
%'!ere  rei%+en+ei 0%'u(re *rin (+erre me'ni%me($r -un'+iei %-in'+ere($r 0%'u(re,
ne'e%re e'#i@ibrrii r*$r+u(ui !in+re 'n+i++i(e !e %n&e r+eri( %i *$r+(, 're ?un& ( ni0e(u(
'*i(re($r %inu%$i!e.
  In 'ir$ %e *r$!u'e in *rin'i*( *rin b($'? %inu%$i!( %i *$%+%inu%$i!(. L in'e*u+ HTP, e%+e
'$m*(e+ '$m*en%+e %i numi u+i(ire me+$!e($r *r'(ini'e $ *$+ !e%'$*eri. Dren?u( %n&e(ui
!in 0en *$r+ %i -eren+e(e 'e%+ui '+re 0ene(e %u*r#e*+i'e e%+e im*ie!i'+ %i *re 'ir'u(+i
'$(+er(. Semne(e m?$re (e HTP %un+:
 0ri'e e%$-&iene
 #em$r$ii
 'ir'u(+ie '$(+er( %ub'u+n+, b!$min(
 %*(en$me&(i

Tu(burri !i&e%+i0e

▫   +ucoasa bucala e%+e 'rmin+ ir ( ni0e(u( '$mi%uri($r bu'(e *r une$ri r&!e
'$n%i!er+e e1*re%i 'ren+ei !e rib$-(0in. P$+ *re *e+e%ii, e'#im$e %u *ur*ur 'e %e *$+
in%$+ii !e #em$r&i ( ni0e(u( mu'$%e($r: e*i%+1i% %u &in&i0$r&ii. Une$ri %e *r$!u' -em$r&ii
-rin&iene, (rin&iene.
▫  #arice esofagiene si gastrice re*rein+ !i(++i 0ri'$%  n%+$m$e($r *$r+$'0e !in
%ubmu'$% e%$-&u(ui in-eri$r %i  mrei +uber$i++i  %+$m'u(ui. Ru*ere E re*rein+ un
 *eri'$( in e0$(u+i CH 're *$+e 0e 'r'+er (e+(.

 
ri'e e%$-&ien
 

▫  &lcerul gastro-duodenal  in u('er$&ene 'ir$+i'i($r in+er0in -'+$ri *r+i'u(ri ne'un$%'u+i

in+ru'+ %e're+i 'i!i'  %+$m'u(ui nu e%+e 're%'u+, ir (ui He(i'$b'+er P($ri nu i %
!em$n%+r+ $ %emni-i'+ie u('eri&en ( 'ir$+i'i. In 'e%+e '$n!i+ii '*+ %emni-i'+ie mi mre
(+i -'+$ri: !e +i*u( (+errii mu'u%u(ui, !iminurii rei%+en+ei mu'$%ei &%+r$!u$!en(e, %+ei
0en$%e, !e-i'i+e($r nu+ri+i$n(e.
▫   *efluxul gastro-esofagian -re'0en+ in CH 'u !e'$m*en%re %'i+i', -iin! '$n%e'in+
#i*er*re%iunii b!$min(e. A'e%+ re-(u1 %e remi+e $!+ 'u !i%*ri+i %'i+ei.
 Gastrita e%+e '$n%e'in+ ++  HTP '+ %i  '$n%umu(ui !e ('$$(. G%+r$*+i *$r+( e%+e
re'un$%'u+ in 5 !in+re 'ir$+i'ii 'u #em+$me= en!$%'$*i e0i!en+i *e+e r$%ii %i 0i%inii in
- %e0er. A'e%+e %emen *r ( 'ir$+i'ii 'u 0ri'e %u*u%e %'re($rii.
▫   "iareea -re'0en+ in 'ir$ ('$$(i'. In+er0ine $ m(b%$rb+ie ( ni0e( in+e%+in(, ir ('$$(u(
%u %ub%+n+e(e !in '$m*$i+i bu+uri($r ('$$(i'e *$+ *r$0$' !iree.
▫   emoroi$ii re*rein+ !i(++i 0ri'$%  n%+$m$e($r *$r+$'0e !in+re 0ene(e
#em$r$i!(e in-eri$re %i 0ene(e #em$r$i!(e mi?($'ii %i %u*eri$re.A'e%+e n%+$m$e %un+
%i+u+e in %ubmu'$% re'+u(ui.Une$ri #em$r$iii %un+ 0$(umin$%i, %u*r+$ri, %n&ere 'u
u%u+in+ %i %e *$+ '$m*(i' 'u +r$mb$-(ebi+.
▫   emoragiile gastrointestinale %un+ *r$0$'+e !e ru*ere E %i &%+ri'e, (e( %e e1+eri$rie
 *rin #em+eme %i me(en in%$+i+e !e nemie 'u+ *$%+ #em$r&i'.
▫   itia$a ve$iculara nu e%+e $ 'm*(i'+ie !ire'+  CH 'i $ '$m*(i'+ie  '$m*(i'+iei 'e%+ei:
#i*er%*(eni%mu( 're *r$0$' #em$(i. Bi( ( 'ir$+i'i re $ '$n'en+r+ie re!u% in 'ii bi(iri.
A'e%+ !ee'#i(ibru -0$rie *ri+i '('u(u($r bi(iri.
▫   Pancreatita cronica *re!$min in 'ir$ ('$$(i'. A(+uri !e &%+ri+ 'r$ni' '$n+ribuie (
 *r$!u'ere m(b%$rb+iei %i ( (+erre %+rii !e nu+ri+ie.

M$!i-i'ri #em+$($&i'e

▫   !nemia feripriva e%+e *r$0$'+ !e *ier!eri(e !e %n&e !e ( ni0e(u( mu'$%ei &%+ri'e, E

ru*e, 0ri'e re'+(e %u !e un u('er %$'i+.
▫   !nemia megaloblastica -re'0en+ ( 5 !in 'uri, *r$0$'+ !e !e-i'i+u( !e 'i! -$(i' %i
!e*$i+rii !e-i'i+re  0i+.B2 in -i'+, '+en+e($r nu+ri+i$n(e %i m(b%$rb+iei in+e%+in(e.
A'e%+ *$+e -i %$'i+ (eu'$ %i +r$mb$'i+$*eniei.
▫   !nemia hemolitica in 'e%+ ' eri+r$'i+e(e %un+ *(+i+e, u%$r #i*$'r$me 'u !ime+er 
0ribi(e. Leu'$'i+$ e%+e n$rm( %u 're%'u+, +r$mb$'i+$ e%+e 're%'u+. Anemi #em$(i+i'
nu r%*un!e ( ni'i $ m%ur +er*eu+i' %*e'i-i' %u ( '$r+i'$+er*ie.
▫   "efecte de coagulare re*rein+ *rin'i*( mni-e%+re #em+$($&i'(  CH. F'+$rii !e
'$&u(re, %in+e+i+i !e #e*+$'i+, %'!e *r$*$r+i$n( 'u &r!u( in%u-i'ien+ei #e*+i'e. Din+re 'ei
mi -e'++i %un+: -'+$ru( II *r$+r$mbin), -'+$ru( II *r$'$n0er+in), -'+$ru( I C#i%+m%)
%i -'+$ru(  S+ur+ Pr$/er). A'e%+i -'+$ri -0$rie *r$'e%u( *r$+r$mbini'. Ei %un+
%in+e+i+i in in+eri$ru( #e*+$'i+u(ui, *rin in+erme!iu( 0i+eminei ", 'e re r$( !e '$enim. In
 *rimu( rn! %un+ in+ere%+i -'+$rii: II, urm+ !e II %i , ir u(+imu( -e'++ e%+e -'+$ru( I.
P$+e -i !e*rim+ %i %in+e -'+$ru(ui I -ibrin$&en) %i  *r$''e(erin), 'e%+i -iin! -'+$ri
in!e*en!en+i !e 0i+. ". L !e$r!ini(e '$&u(rii *r$0$'+e !e %'!ere -'+$ri($r enumer+i,
!u&m e1'e%u( !e -ibrin$(iin, !e-i'i+u( in b%$rb+i 0i+. ", +r$mb$'i+$*eni !in '!ru(
#i*er%*(eni%mu(ui %i *ermebi(i++e '*i(r 're%'u+. C$&u(re in+r0%'u(r !e%emin+
 *$+e in+er0enii in %+!ii(e 0n%+e !e CH !e'$m*en%+.
 

▫   eucopenie e%+e +ribu+i #i*er%*(eni%mu(ui, (eu'$'i+e(e re*rein+ *rime(e e(emen+e -i&ur+e

re+inu+e in %*(in !in 'u mrimi %i %u*r-e+ei ($r in+in%e 'u mre '*'i++e !e !eren+.
($re me!ie  (eu'$'i+e($r 27 !e (eu'$'i+e< mm3.
▫  (rombocitopenia  +ribu+i #i*er%*(eni%mu(ui, 0($re me!ie 92<mm. In+re
+r$mb$'i+$*enie %i %*(en$me&(ie nu e1i%+ in+$+!eun $ '$re(+ie e0i!en+, !e$re'e *$+ -i
 b$(n0i 'u %*(in mre %i numr 're%'u+ !e +r$mb$'i+e.
▫   emoli$a *$re %ur0eni !e%e !u* %un+uri *$r+$'0e. Hem$(i 'u+ in%$+i+ !e
#i*er(i*emie, %+e+$ #e*+i' %i nemie #em$(i+i' e%+e 'un$%'u+ %ub nume(e !e  sindrom
 0ieve. B$(n0ii *rein+ !ureri b!$m$n(e %i -ebr.
▫  (ulburarile hemo$ta$ei in+ere%e +im*u( *(%m+i', +im*u( *('#e+r %i +im*u( 0%'u(r 'e
in+er0in in #em$%+ -ii$($&i'.

Tu(burri re%*ir+$rii

▫  idrotoraxul  -re'0en+ ( 5 !in 'uri. Au -$%+ !e%'ri%e !u$ -$rme '(ini'e: #i!r$+$r1 minim
%i #i!r$+$r1 im*$r+n+. In m?$ri++e 'uri($r #i!r$+$ru( #e*+i' e%+e ($'(i+ in *(eur
!re*+, !r *$+e %ur0enii %i bi(+er(. Pr$!u'ere #i!r$+$r1u(ui e%+e e1*(i'+e *rin +re'ere
!ire'+  (i'#i!u(ui !e %'i+ !in '0i++e *eri+$ni( in 'e *(eur( *rin in+erme!iu( -i%uri($r 
!i-r&m+i'e. Ni0e(u( *r$+eine($r +$+(e,  '$(e%+er$(u(ui %i (i*i!e($r e%+e mi 're%'u+ in
re0r%+u( *(eur( !e'+ in 'e( *eri+$ne( !e$re'e * e%+e b%$rbi+ mi re*e!e !e 0%e(e
 *(eur(e. T$r'$'en+e nu e%+e %u-i'ien+ *en+ru +r+men+,e %e in%$+e%+e !e *r'en+e
e0'u+$re *en+ru  nu 're un &r!ien+ !e *re%iune in+re %'i+ %i '0i++e *(eur(, &r0n!
re0r%+u( *(eur(. In 63 !in 'uri %e in%+(e %i re0r%+ *eri'r!i'.
▫  Sindromul hepato-pulmonar  !e-ine%+e #i*$1emi %e0er, *$+en+i( re0er%ibi(, %u%'e*+ibi( %
in%$+e%' %+!ii(e 0n%+e (e b$(i($r !e -i'+. E %e !+$re unei !i(++ii 0%'u(re
in+r*u(m$nre in+en%e. A'e%+ %m*+$m %e remi+e !u* +rn%*(n+u( #e*+i'.
▫   ipertensiunea pulmonara primara re $ *re0(en+ mi', mi mu(+ !e K !in 'e%+e 'uri
%un+ %im*+$m+i'e, re%+u( mni-e%+n!u%e *rin !i%*nee !e e-$r+ %i 0ri'e e%$-&iene *reen+e,
%in'$*, !urere *re'$r!i( %u #em$*+iie.

Tu(burri ren(e

▫  Semne urinare: $*%iuri re*rein+ e(iminre in+ri+  (i'#i!e($r in&er+e. In %+re n$rm(
(i'#i!e(e %e e(imin in *r$1im+i0 4 $re !u* in&e%+ie. L 'ir$+i'i 'e mi mre *r+e !in *
in&er+ in 'ur%u( i(ei %e e(imin !e $bi'ei n$*+e ni'+uri).
   niuri re*rein+ nere&u(ri++e ri+mu(ui !iureei 're 0ri !e ( $ i (
(+.
   iuri re*rein+ !iure -$r+e mi' !r '$n%+n+ -r 0ri+ii i(ni'e in
-e(e 0n%+e (e b$(ii.
   *r$iuri re*rein+ 're%+ere 'n+i++i !e urin e(imin+e in 2 $re, -+ !e
'n+i++e (i'#i!u(ui in&er+. In - '$m*en%+e  CH 'n+i++e +$+( !e urin 're %e e(imin in
2 $re !u* in&e%+i   5 m( * *$+e +in&e  6 m(.
▫  Sindromul hepato-renal 1S*) re*rein+ $ in%u-i'ien+ ren( 'u+ -un'+i$n( ' reu(++ (
unei 0%$'$n%+ri'+ii r+eri(e ren(e in+en%e. Li*%e%' %emne(e !e (+erre m$r-$($&i' ren(.
Rini'#iu( !e ( 'e%+i b$(n0i, *u+n! -i +rn%*(n++ 'u %u''e%%. Se mni-e%+ *rin: %'!ere
e(iminrii !e N, $(i&urie, 're%+ere *r$&re%i0  ureei %i 're+ininei %n&0ine, *r$+einurie %i
 

%'!ere TA. In 'e%+e 'uri !e SHR 're%+e !ebi+u( 'r!i' !e*%e%+e  (<min+u), %'!e
rei%+en+ 0%'u(r %i %e re!u'e *re%iune %n&0in %i%+emi'. 595 !in+re 'ir$+i'ii !e'e!+i
re*rein+ %emen !e in%u-i'ien+ ren(.

Tu(bu+ri 'r!i$0%'u(re

36 !in 'uri(e !e CH !e0$(+ $ %+re 'ir'u(+$r #i*er!inmi' 'r'+eri+ *rin 're%+ere
!ebi+u(ui 'r!i' %i re!u'ere rei%+en+ei *eri-eri'e. A'e%+e m$!i-i'ri %un+ *reen+e in re*u% %i
e1'erb+e !e e--$r+.
  Din *un'+ !e 0e!ere '(ini' %e mni-e%+ *rin: +#i'r!ie, *u(% %(+re+, e1+remi++i '(!e,
 *u(%+ii '*i(re, %'ur+re +im*u(ui !e 'ir'u(+ie.
  A%'i+ *rin 're%+ere *re%iunii b!$min(e %i %'!ere in+$r'erii 0en$%e *$+e re!u'e !ebi+u(
'r!i', in 'e%+ %en% '+i$nn! +er*i !iure+i', #em$r&i %i !e$r!ini(e mi$'r!i'e.

Tu(burri ner0$%e

▫  Semne neuropsihice +u(burri(e neur$*%i#i'e %e 'r'+erie *rin %+enie -ii' %i *%i#i',

me(n'$(ie, +u(burri !e '$m*$r+men+ %i %'!ere '*'i++ii !e mun'.
   +u(burri(e neur$0e&e++i0e %e 'r'+erie *rin *(*i++ii, +#i'r!ie,
+rn%*ir+ii bun!en+e, 'rie !e mi&rene %i $%'i(+ii (e TA.
   +u(burri %en$ri(e unii b$(n0i *$+ *reen+ *re%+eii (e membre($r 
in-eri$re 're *r n$*+e %in u %e (ini%+e%' !e'+ ( m$bi(ire ;?mb% %n% re*u>)= +u(burri
!e 0e!ere in %e%ire nun+e($r !e 'u($re in 'ir$ e+i(i'.
  Tu(burri(e ner0$%e re*rein+ (+erri (e neur$ni($r, 're %un+ $ '$n%e'in+  &re%iuni($r 
0iru%uri($r #e*+i'e,  un$r %ub%+n+e +$1i'e en!$&ene mini'), *re'um %i  #i*$1iei &ener+e
!e +u(burri(e 'ir'u(+iei, re%*ir+iei.
  A'e%+e %e '$n%+i+uie in %in!r$me, %i nume:
   encefalopatia hepato-portala %i coma hepatica 

II.0. *ORME CLINICE.

  Cir$e(e %e *$+ '(%i-i' !u* urm+$re(e 'ri+erii:

  Din *un'+ !e 0e!ere e+i$($&i':
  . 'ir$ *$%+#e*+i'
  2. 'ir$ ('$$(i'
  Du* '+i0i++e *r$'e%u(ui in-(m+$r:
  . 'ir$ in'+i0
  2. 'ir$ '+i0e
  Du* %+!iu( e0$(u+i0:
  . 'ir$ '$m*en%+e: ) in'+i0
  b) '+i0e
  2. 'ir$ !e'$m*en%+e: ) 0%'u(r
  b) *ren'#im+$%
 

CIRO-A POSTHEPATICA

  Cir$ *$%+#e*+i' e%+e e&( re*r+i+ in+re %e1e, 'u $ u%$r *re*$n!eren+ *en+ru %e1u(
-eminin. r%+ me!ie e%+e !e 46 ±5 ni. Sim*+$m+$($&i '(ini' e%+e in &ener( %emn+$re
'u +i*u( m'r$n$!u(r. Gine'$m%+i, !e&e+e(e #i*$'r+i'e %i re+r'+i *r$n$ne0r$ei *(mre %e
in+(ne%' -$r+e rr. In %'#imb, *(me(e r$%ii eri+r$ *(mr) %un+ !e $b%er0+ie 'uren+. Fi'+u(
inre&i%+re $ +en!in+ mr'+ %*re +r$-ie.
  In 'ir$ *$%+#e*+i' m% #e*r$'i+r -un'+i$n( e%+e mi re!u% !e'+ in 'ir$ ('$$(i'.
($ri(e me!ii (e (buminemiei %un+ 2,25 ±,42&<!(, (e in!i'e(ui !e *r$+r$mbin 59 ±2,
're%+e I&G %i I&M, ir ASAT<ALAT 3,9<37,2. Cir$ *$%+#e*+i' e%+e $ -$rm %e0er !e 'ir$
e1*rim+ *rin %'ur+re !ur+ei !e %u*r0e+uire %i *rin in!i'e mi mre !e (e+(i++e
 

CIRO-A ALCOOLICA
 
Cir$ ('$$(i' *re!$min ( %e1u( m%'u(ine 'u 0r%+ me%ie mi 0n%+ in+ru'+
'$n%+i+uire ei %e -'e !u* un '$n%um in!e(un&+ minimum 2 ni) !e 'n+i++i mri !e ('$$(
74±3&<i). Tb($u( '(ini' e%+e mi &$m$+$% in 'ir$ ('$$(i', *re!$minn! +u(burri(e
!i%*e*+i'e, n$re1i, %'!ere *$n!er( %i mni-e%+ri(e #em$r&i*re. S+e(u+e(e 0%'u(re,
i'+eru(, &ine'$m%+i, !e&e+e(e #i*$'r+i'e %i re+r'+i *$ne0r$ei *(mre %e $b%er0 mi(+ mi
-re'0en+, u(+imi(e +rei *r$*e in e1'(u%i0i++e in 'ir$ ('$$(i'. De'$m*en%re e!em+$
%'i+i' %i in %*e'i( #i!r$+$r1u( !re*+ %un+ !e %emene mu(+ mi -re'0en+e. Fi'+u( e%+e mri+
!e 0$(um in 66 !in 'uri !+$ri+ in'r'rii 'u &r%imi  'e%+ui. M% #e*+$'i+r re%+n+
e%+e mi mre !e'+ in 'ir$ *$%+#e*+i' %i* e m%ur remi%iunii %+e+$ei 'e%+ %e
me(i$re e0i!en+. ($ri(e me!ii (e bi(irubinei %un+ ,3 ±,9m&<!(, (e -$%-+ei (@(ine
6764u.i. %i (e '$(e%+er$(emiei 26 ±74m&<!(. Pre!$min 're%+ere I&A.
 

 
Fi'+ &r% ( ('$$(

B$(i %$'i+e 'ir$ei ('$$(i'e %un+ *n're+i+ 'r$ni' %i !ibe+u( #r+. E0$(u+i 'ir$ei
('$$(i'e e%+e mi beni&n %i !e !ur+ mi mre !e'+ in 'ir$ *$%+#e*+i'.

CIRO-A INACTI(A
 
Cir$ in'+i0 imbr' %*e'+u( '(ini' ( unei 'ir$e %+bi(i+e, (ini%+i+e. L *un'+i bi$*%i'
#e*+i' in-i(+r+u( (im-$*(%m$'i+r (i*%e%+e %u e%+e ne%emni-i'+i0. Pie'eme( ne'r$%i% (i*%e%+e
!e %emene. Gm &($bu(ine($r %i imun$&($bu(ine(e inre&i%+re 're%+eri m$!er+e: &m
&($bu(ine ,±,34&<!(, I&G 23 ±u.i.,I&A 369±4 u.i., I&M 26±56u.i.,n+i'$r*ii %eri'i
ne%*e'i-i'i (i*%e%' %u %un+ in *r$*$r+ii ne%emni-i'+i0e.

CIRO-A ACTI(A
  Cir$ '+i0 e%+e mi &$m$+$%, b$(n0u( *(n&n!u%e !e %+enie, in*e+en+, *re
%'!ere *$n!er(, !i%*e*%ie &$%, %in!r$m #em$r&i*r, r*i%$!e i'+eri'e %i %ub-ebri(i++e.
E1*($rri(e imun$($&i'e e0i!en+i 're%+ere mr'+ (e &m&($bu(ine($r %i  I&G %i I&M
 *re'um %i *reen+ n+i'$r*i($r ne%*e'i-i'i 'ir'u(+iei. In 'e%+e -$rme %e in+(ne%' !e%e
e*i%$!e '$(e%++i'e %i #e*+$'i+$(i+i'e, 're re!u'e m% #e*+$'i+r re%+n+ !' nu %e
in+er0ine ( +im* 'u $ me!i'+ie '$re%*un+$re, &r0e e0$(u+i %i &rbe%' !e'$m*en%re
'ir$ei.
 

 
Cir$ '+i0

CIRO-A COMPENSATA

  Prin 'ir$ '$m*en%+e %e in+e(e& *rime(e %+!ii e0$(u+i0e (e 'e%+ei, inin+e in%+(rii
%'i+ei, e!eme($r %i  mni-e%+ri($r 0n%+e !e in%u-i'ien+ #e*+i' i'+er, mni-e%+ri
#em$r&i*re)= %u*rin!ere 'e%+ui %+!iu nu e%+e u%$r, in+ru'+ *'ien+ii nu %e re'un$%'
 b$(n0i %i u $ %im*+$m+$($&ie %r'. L*r$%'$*i %i *un'+i bi$*%i' '$n-irm %u*$i+i
'(ini' ?un&n! ( !e-eren+iere -$rmei in'+i0e !e -$rm '+i0. De%'$*erire b$(ii e%+e mi
u%$r ( b$(n0ii 'un$%'u+i %i +r++i *en+ru #e*+i+ 'r$ni' &re%i0. A*ri+i %*(en$me&(iei,
in!urre -i'+u(ui, 'u %u*r-+ nere&u(+ %i mr&ine %'u+i+,  *(me($r #e*+i'e %i e0en+u( 
0ri'e($r e%$-&iene %i  %+e(u+e($r 0%'u(re %un+ !+e e%en+i(e *en+ru re'un$%+ere b$(ii.
Ciroza compensata inactiva
Are $ %im*+$m+$($&ie !i%'re+ $b$%e(, in*e+en+). Hi%+$($&i' *r -en$mene !e -ibr$, !r 
%un+ -$r+e bine (imi++e.
Ciroza compensate activa
  Sur0ine 'u %+enie mr'+, in*e+en+, %'!ere *$n!er(. A*re i'+eru(, %in!r$mu(
#em$r&i*r %i une$ri *r %i %+ri -ebri(e. Bi$'#imi' %e '$n%++ TGO,TGP 're%'u+e, SH
're%'u+, -ibrin$&en %'u+= ir #i%+$($&i' *re -ibr$ %i re&enerre in+en%e.

CIRO-A DECOMPENSATA (ASCULARA 0portala1

 
Re*rein+ %+!iu( in 're e%+e !e re&u( re'un$%'u+ 'ir$ !u* *ri+i %'i+ei %i
''en+ure %*(en$me&(iei %i  'ir'u(+iei '$(+er(e 0ri'e e%$-&iene %i &%+ri'e). Cr'+ere(e
'ir$&ene (e %'i+ei $mbi(i' e1'en+ri' %*re *ube %i !e*(%+, 'ir'i(+ie '$r+er( !e +i* *$r+(,
%*(en$me&(ie, -i'+ 'ir$+i' 'u '$n'0i++e %u*eri$r !e*(%bi( *e -(n'uri %i 0ri'e(e
 

e%$-&iene) ne -ere%' !e '$n-uii. In%+(re %'i+ei e%+e *re'e!+ %i<%u in%$+i+ !e $(i&urie,
e!eme &mbiere, me+e$ri%m ''en+u+, !ureri b!$min(e. A%'i+ %ub +en%iune %e *$+e in%$+i !e
n%r' e!em &ener(i+ in%$+i+ !e 'umu(re !e (i'#i! in '0i++i(e %er$%e (e $r&ni%mu(ui).
Cre%+ere bru+(  HTP *$+e !e'(n% $ HDS *rin ru*ere un$r 0ri'e e%$-&iene %u &%+ri'e,
'e !e+ermin #em+eme %i me(en. In 'e%+ %+!iu (bumine(e %'! %i *r %emen !e
!ee'#i(ibru -un'+i$n( +ubu($ren( %i !e #i*er(!$%+er$ni%m %e'un!r.

 
Cir$ in - +ermin(

CIRO-A DECOMPENSATA PARENCHIMATOASA

  Re*rein+ %+!iu( 'e( mi 0n%+ ( 'ir$ei, !e 'e(e mi mu(+e $ri in%$+i+ !e !e'$m*n%re
0%'u(r *$r+().
  Din *un'+ !e 0e!ere '(ini' im*re%i$ne %emne(e !e en'e-($*+ie #e*+i' 'r$ni': %+enie
mr'+, (en+$re in+e(e'+u(, !e$rien+re +em*$r$%*+i(, !e(ir, +u(burri !e 0$rbire, -e+$r 
#e*+i', -(**in&+rem$r, #(u'in+ii *+ie, eu-$rie).
In *(u% %e men+i$ne %'!ere *$n!er(, i'+er, e!eme %i %'i+e, ir *rin %in+e !e -'+$ri !e
'$&u(re in e1'e% !u'e ( *ri+i !e #em$r&ii !i-ue.
  Une(e +u(burri en!$'rine !u' (: &ine'$m%+ie, +r$-ie +e%+i'u(r, +r$-ie mmr %i u+erin
'u %+eri(i++e, +u(burri men%+ru(e %i %'!ere *ru(ui *ubin %i 1i(r ( mbe(e %e1e. De
%emene in+(nim #i*$+r$-ie mu%'u(r ( membre(e %u*eri$re %i +r$-i mu%'u(+urii +$r'i'e,
 bue 'rmin+e, %+e(u+e 0%'u(re.

II..E2AMENE PARACLINICE SI DE LA-ORATOR

EPLORARI PARACLINICE
  A'e%+e e1*($rri %er0e%' !i&n$%+i'u(ui *$i+i0 *en+ru re'un$%+ere 'ir$ei, !i&n$%+i'u(ui
!i-eren+i( %i !i&n$%+i'u(ui *en+ru e0(ure &r!u(ui !e in%u-i'ien+ #e*+i', &r!u(ui !e
'+i0i++e  *r$'e%u(ui in-(m+$r %i %u*rin!erii '$m*(i'+ii($r.
 

 Punctia biopsica hepatica 1P): -urnie m+eri(u( *en+ru e1menu( #i%+$($&i', 'rui ii
re0ine r$(u( in '$n-i&urre !i&n$%+i'u(ui !e CH, in %+bi(ire +i*u(ui m$r*#$($&i' ( 'e%+ei, 
%e0eri++ii (eiuni($r #e*+i'e %i *en+ru e0i!en+iere %emne($r !e '+i0i++e meen'#im( %i 
&r!u(ui !e %+e+$ #e*+i'. Me+$! !e in-$rm+ii %u*r *r$&n$%+i'u(ui %in e *ermi+e %
urmrim reu(++e(e +r+men+u(ui. C $ri'e me+$! 're im*(i' $ in+er*re+re %ubie'+i0, e%+e
e1*u% er$ri($r !e, !r '$mbin+ 'u (*r$%'$*i %i e'$&r-i in !i'e(e !e er$re ( me+$!ei %e
re!u'e %ub .
  Me+$! e%+e '$n+rin!i'+ ( 0$(n0ii 'u in!i'e(e !e *r$+r$mbin %ub 6, ( 'ei 'u
+r$mb$'i+$*enie %ub 5 mm, ( 'ei 'u n&i$'$(i+ 'u+ %i ( 'ei 'u %'i+ in-e'++.
Di&n$%+i'u( #i%+$($&i' !e CH %e be *e remniere r#i+e'+$ni'ii -i'+u(ui, *rin %e*+uri
'$n?un'+i0e e1+in%e %i in %+!ii(e 0n%+e *rin *reen+ n$!u(i($r !e re&enerre.
Ti*uri(e m$r-$($&i'e (e CH nu %e re'un$%' in+$+!eun ( e1menu( #i%+$($&i', ne'e%i+n!
une$ri '$n-run+re (*r$%'$*i'. Sr!i(ire CH e%+e e0(u+ numi *rin e1menu( #i%+$($&i'
!u* *r$*$r+i !e *ren'#im +rn%-$rm+ in n$!u(i: *n (  *en+ru %+!iu( I= 5 *en+ru
%+!iu( II %i  *en+ru %+!i(u( III..

 Ecografia e%+e e1*($rre im&i%+i' nein0i0 %u%'e*+ibi( % -urniee m1imum !e in-$rm+ii

 *en+ru !i&n$%+i'u( *$i+i0 ( CH. E'$&eni++e -i'+u(ui e%+e #e+er$&en, %+r(u'i+$re in 'ir$
('$$(i' 'u %+en$, in 'e%+e 'uri %$'iin!u%e %i +enure *$%+eri$r  im&inii.
  Dimen%iuni(e -i'+u(ui *$+ % 0riee in mbe(e %en%uri, -iin! !e re&u( mi mre in %+!ii(e
 *re'$'e (e 'ir$ei ('$$(i'e. Semne(e !e HTP %un+ *reen+e in m$! '$n%+n+ %i e1*rim+e *rin
%*(en$me&(ie 'u !ime+ru( ($n&i+u!in( !e *e%+e 2'm, '(ibru( 0enei %*(eni'e e%+e mi mre !e
 mm , '(ibru( 0enei *$r+e !e *e%+e 5 mm %i r*$r+u( !in+re ($bu( 'u!+ %i ($bu( !re*+ e%+e
mi mre !e ,65 !+$rn!u%e '$n+r'+iei ($bu(ui !re*+ *rin e1'e%u( !e +e%u+ '$n?un'+i0.
  In %+!ii(e 0n%+e %'i+ r%+e !e !i-eren+i+ in '0i++e *eri+$ne(, %ub!i-r&m+i',
 *eriren(= in&r%re *ere+e(ui 0e%i'u(r %u !ubu(u '$n+ur ( 'e%+ui e%+e '$n%i!er+ ' un %emn
 *+$&$m$ni' *en+ru !i-eren+iere %'i+ei 'ir$&ene !e %'i+ !in 'n'eru( #e*+i'.

 
E'$&r-i e0i!en+i HTP, 0en *$r+ !e 5mm

 aparoscopia me+$! *ermi+e 0iu(ire m$!i-i'ri($r !e 0$(um (e -i'+u(ui, %*e'+u( %i

'u($re %u*r-e+ei 'e%+ui, '+ %i '$n%i%+en+ mr&inii in-eri$re  -i'+u(ui.
 

  L*r$%'$*i e%+e in!i'+ in %+!ii(e in'i*ien+e *en+ru !i-eren+iere 'ir$e($r !e #e*+i+

'r$ni' &re%i0 !e +i* B

Computerul tomografic 1C( e0(ue 'u mi mu(+ 'ur+e+e !imen%iuni(e %i -$rm -i'+u(ui,
' %i !en%i++e 'e%+ui. R*$r+u( !in+re ($bu( 'u!+ %i ($bu( !re*+ ( -i'+u(ui !e *e%+e ,65 e%+e
mi u%$r !e !e+ermin+ ( CT. In #em$'r$m+$ %e inre&i%+re 're%+ere !en%i++ii -i'+u(ui.
He*+$me&(i *re!$min ( ni0e(u( ($bu(ui %+n& %i 'u!+. Se *$+ $b%er0 %emen !e HTP:
%*(en$me&(ie, '(iber mri (e 0ene($r %*(eni' %i *$r+, %'i+. CT ii re0ine r$(u( e%%en+i( in
e0i!en+iere #e*+$mu(ui &re-+ *e CH.
 *e$onanta magnetica nucleara 1*+'  e%+e mi %en%ib(i !e'+ e'$&r-i %i CT in 0e!ere
re'un$%+erii CH. RMN 0iu(ie %+ru'+uri(e 0%'u(re 'u -(u1u( in+en%, ' %i %un+uri(e *$r+$
'0e.
Scintigrafia   -$%+ !e*%i+ in 'ur+e+e e0(urii !imen%iuni($r, -$rmei %i -un'+i$n(i++ii
-i'+u(ui !e 'e(e((+e me+$!e im&i%+i'e mi m$!rene. R!i$i$+$*u( T'm +e'#ne+iu) 're e%+e
in+r$!u% in $r&ni%m *er $%, *ren+er( %u *rin in#(+ie e%+e -i1+ ( ni0e(u( %i%+emu(ui re+i'u($
en!$+e(i(, -urnin! in-$rm+ii re-eri+$re ( !imen%iuni(e -i'+u(ui, %*(inei %i '+i0i++ii
%i%+emu(ui re+i'u($en!$+e(i(. Fi'+u( 'ir$+i', !in 'u %+ru'+urii *ren'#im+$%e nere&u(+e %i 
!i%+ribu+iei ine&(e  -(u1u(ui %n&0in re un %*e'+ in+en% #e+er$&en. CT %i e'$&r-u( -urnie
!+e mi e1'+e in *ri0in+ 0$(umu(ui %i &reu++ii -i'+u(ui.0ei ne1).
 Endoscopia  e%+e -$($%i+ mi (e% *en+ru !e*i%+re E. In ' !e #em$r&ie  'e%+$r
en!$%'$*i +rebuie % %+bi(e%' %e!iu( %n&errii.
  Ri%'u( 're%'u+ !e %n&erre ( 0ri'e($r 0$(umin$%e e%+e unnim 're%'u+. ri'e(e 'u un
!ime+ru !e *e%+e 5mm, !e '$($r+ie 0i$(e+&ri, 'u *un'+e r$%ii, mni-e%+e ri%'u( 'e( mi mre !e
#em$r&ie.
A'e%+me+$! mi e%+e -$($%i+ %i *en+ru e0i!en+iere u('eru(ui &%+r$!
 

 
ri'e e%$-&iene 0u+e ( en!$%'$*ie

 *adiografia baritata a esofagului *en+ru e0i!en+iere 0ri'e($r %e *r'+i' in +$+e 'uri(e, -iin!

$ me+$! %im*(, nein0i0. Te#ni'  -$%+ me(i$r+e *rin u+i(ire unei %u%*en%ii &r$%e !e
 briu, %emi%$(i!, *rin *(i're ei !u* m% %u !u* un *rn *r$+ei' %i in '$n!i+ii(e mne0rei
(%(0. Prnu( !e *r$b %i mne0r (%(0 mre%' -(u1u( %i *re%iune in 'ir'u(+i %*(#ni',
-0$rin! %+-e( !e%+in!ere %i in '$n%e'in+ $ mi bun 0iu(ire  0ri'e($r. E1menu(
 bri++ %i en!$%'$*i !e%'$*er E ( 'ir$+i'i in 'ee%i *r$*$r+ie, !e 5 !in 'uri.

E$plp&r#ri #ngi&gr#'i(e
  Sun+ in!i'+e numi ( 'ir$+i'ii 're ri!i' *r$b(eme %*e'i(e !e !i&n$%+i' %i +r+men+ (
HTP, mi (e% !u* #em$r&ie. In 0e!ere %+bi(irii in!i'+iei unei n%+$m$e *$r+$%i%+emi'e,
e1*($rre n&i$&r-i' !e0ine $b(i&+$r

Splenoportografia *r'+i'e % renun++ ( 'e%+ me+$! !e$re'e 're%+e ri%'u( #em$r&iei
%*(eni'e, ei i %e !+$re 'e(e mi bune im&ini (e rb$ru(ui 0%'u(r *$r+(. Me+$! $-er
0n+?u( m%urrii '$n'$mi+en+e  *re%iunii %*(eni'e, 're in &ener( '$re%*un!e *re%iunii
 *$r+(e. L %*(en$*$r+$&r-ie 1u( %*(en$*$r+( *re !i(++, $n!u(+, 'u 0en *$r+ 0er+i'(i+
%i 'u *+ mre %*(eni'. Cir'u(+i in+r#e*+i' e%+e %r', in %+!ii(e 0n%+e imbr'n!
im&ine 'r'+eri%+i' !e rb$re u%'+.
 

 
A'e%+ n&i$&r-ie !em$n%+re 'ir'u(+i %n&e(ui *$r+( %i *(eni' %*re '$(+er(e(e e%$-&iene

 !rteriografia celiaca sau me$enterica superioara *$+e !e+ermin %e!iu( #em$r-iei !i&e%+i0e.
In+en%i++e im&inii 'e%+ei me+$!e e%+e in-eri$r 'e(ei $b+inu+e ( %*(en$*$r+$&r-ie. E *$+e
e0i!en+i( %'ur&ere %ub%+n+ei !e '$n+r%+ ( ni0e(u( (eiuni($r r+eri(e %u '*i(re ' in b$(
u('er$%. Rre$ri e0i!en+i #em$r&i !in 0ri'e. Ar+eri$&r-i e0i!en+i un +rie'+ %inu$%
( r+ere($r in+r#e*+i'e, re*reen+n! im&ine &ener( !e +ribu%$n. Ar+eri$&r-i mi
-urnie in-$rm+i *en+ru  !i-eren+i #e*+$mu( !e n$!u(ii !e re&enerre.

 Paracente$a exploratorie %e *r'+i' $ri !e '+e $ri e%+e %u%*e'+ *reen+ %'i+ei. E%+e me+$!
'e mi !ire'+ *en+ru '$n-irmre e1i%+en+ei %'i+ei %i *en+ru e1menu( bi$'#imi' %i 'i+$($&i' (
'e%+ei. In ' !e 'n+i++e re!u% b$(n0u( 0 -i %e+ in !e'ubi+ (+er( %+n& %u in *$i+ie
&enu*e'+$r(. Pr'en+e %e 0 e-e'+u in re&iune !e'(i0 %u %e men+ine b$(n0u( in
$r+$%++i%m +im* !e  minu+e *en+ru  -0$ri '$(e'+re (i'#i!u(ui %'i+i' in re&iune !e'(i0
 '0i++ii *eri+$ne(e %i *$i %e e-e'+ue *un'+i$nre in 'e%+ $n. P$i+i &enu*e'+$r(
 *$+e -i in($'ui+ 'u %u%*en!re b$(n0u(ui in !e'ubi+ 0en+r(, 'u b!$menu( in+re !$u *+uri %i
in 'e%+ ' %e *un'+i$ne in re&iune *r$mbi(i'(. Li'#i!u( !e %'i+ $b+inu+ e%+e %u*u%
e1menu(ui m'r$%'$*i' %i bi$'&imi' !$re *r$+eine($r,  &(u'$ei, 'i+$($&i' %i b'+eri$($&i').
  M'r$%'$*i', in CH (i'#i!u( !e %'i+ e%+e '(r, !e 'u($re &(ben 'i+rin in+en%i++e 'u($rii
&(bene !e*in!e !e 0($re bi(irubinei %i !e '$n'en+r+i in *r$+eine  (i'#i!u(ui). Li'#i!u( %er$
%n&0in$(en+ %u&ere e1i%+en+ unui %in!r$m #em$r&i*r in '!ru( CH %u e1i%+en+
'r'in$m+$ei !' 'u($re e%+e *%&er %e !+$re !e 'e(e mi mu(+e $ri in+e*rii unui
0%). Li'#i!u( +u(bure %u&ere *eri+$ni+, ir (i'#i!u( 'rem$% %'i+ '#i($%, *r$0$'+ *rin
$b%+ru'+i ne$*(i'  (im-+i'e($r. Re'+i Ri0(+ e%+e in &ener( ne&+i0e, ir '$n'en+r+i in
 *r$+eine %ub 2,5 &<!(. In 'ir$ 'r!i', in %'i+e(e mu(+i*un'+i$n+e, in-e'++e %u 'ir$e(e (
're %e %$'i *n're+i+ re'+i Ri0(+ e%+e *$i+i0, 'u '$n'en+r+i in *r$+eine !e 2,53,5
&<!(. C$n'en+r+i mi mre in *r$+eine %e $b%er0 in %'i+e(e in-(m+$rii %i ne$*(i'e. L
emenu( 'i+$($&i' *re rre 'e((u(e en!$+e(i(e %i (eu'$'i+e, *re!$minn! (im-$'i+e(e.
E1menu( b'+eri$($&i' rmne %+eri( in %'i+e(e nein-e'++e.
 

Teste e e$pl&r#re 'un(ti&n#l# 8ep#ti(#

  In -un'+ie !e - e0$(u+i0  CH 'e%+e +e%+e %un+ %u nu m$!i-i'+e: in *eri$! !e !ebu+
%i' e !e '$m*en%re  'ir$ei $ mre *r+e !in 'e%+e +e%+e *$r -i in (imi+e n$rm(e, !e$re'e
-i'+u( reu%e%+e % !e%-%$re in' $ '+i0i++e -un'+i$n( %+i%-'+$re. In - !e'$m*en!+
in%, +e%+e(e -un'+i$n(e #e*+i'e %u m$!i-i'+e.

   +odificari en$imatice

(ransamina$e serice *r$+ein  '$enim

  TGO<ASAT  %*r++min$+rn%-er  +rn%min &(u+mi' $1('e+i'
  0.n.  ♂  59 u.i.<(
  0.n.  ♀ = 5-15 u.i./l
  TGP<ALAT  (ninmin$+rn%-er  +rn%min &(u+mi' *iru0i'
0.n. ♂  523 u.i.<(
0.n  ♀  5 u.i.<(
Cre%+ere ($r e%+e m$!er+ 0riin! in r*$r+ 'u &r!u( !e CH

L'++!e#i!r$&ene LDH) enme 'i+$*(%m+i' ('+ui+ !in !$u +i*uri !e %ubuni++i: 2H

#er+inim) %i 2M mu%'u(emu%'#i) %$'i+e in +e%u+uri(e !u(+e in 5 i$enime: LDH %i
LDH2 in +e%u+uri(e !in mi$'r!, 'reier, rini'#i), ir LDH4 %i LDH5 in mu%'#i %'#e(e+i'i, -i'+)
%i LDH3 in +e%u+uri(e -e+(e %i une(e +e%u+uri +um$r(e m(i&ne.
  0.n.  25 u.i.<( in %er 
  In b$(i(e #e*+i'e e0$(u+i0e LDH5 're%+e 'u 525 !in 0($re +$+(.

G(u+m+ !e#i!r$&ene GLDH) enim 'e '+i$ne in mi+$'$n!rii(e #e*+i'e %i nu *re in

%er in '$n!i+ii n$rm(e
  ($ri !e re-erin+  ♂  4 u.i.<(
  ♀  3 u.i.<(
  GLDH in!i' $ (eiune in+(ni+ in ne'r$ #e*+i'.

Sorbitol-dehidrogena$a SDH) $ enim 'u %*e'i-i'i++e mre #e*+$'i+r 're nu %e &%e%+e in

m$! n$rm( in %n&e
  ($ri !e re-erin+ in %er:Q,2 u.i<(
  Cre%+e m$!er+ in CH.

,rnitin- carbamiltransfera$a 1,C( $ enim #e*+$'i+r 'u mre %*e'i-i'i++e, '+i0e in 'i'(u
"reb%
0.n.  mu.i.<(
  In 'ir$ bi(ir *rimi+i0e 're%+eri(e %un+ '$n%+n+e ir in CH %un+ m$!er+e.

 I$ocitrat-dehidtogena$a $ enim 'e %e &%e%+e in 'i+$*(%m 'e(u(e($r 0n! in %er 0($ri !e 6
7 u.i.<(
  In CH ni0e(u( ri!i'+ ( 'e%+$r re %emni-i'+ie *r$&n$%+i' %e0er.
 

 +elatdehidrogene$a $ enim 'u re'+ie !e $1i!re. Are !$u -$rme:

   un mi+$'$n!ri(
   un 'i+$*(%m+i'
  0.n.  2,55 mi.i.<m( in %er 
  Are 0($re '(ini' re!u% in CH

M&i'i(#ri miner#le

Sideremia 're%+e *e%+e 0($ri(e n$rm(e in -e(e e0$(u+i0e (e CH

  0.n.  ♀ 6 Y 3
  ♂  9 Y 5

Cu*remi  're%+eri m$!er+e in '#

   -i'+u( e%+e *rin'i*(u( $r&n !e !e*$i+re ( CU, ir e(iminre 'e%+ui %e -'e *rin
 bi(, in in+e%+ine. Or&ni%mu( !u(+ '$n+ine 5m& Cu.
  0.n.  ♂  94 Y
  ♀  7 5 Y

M&i'i(#ri 8em#t&lgi(e

Hem$&rm r+e $ nemie m$!er+e.

Tr$mb$'i+$*eni in ?ur !e  <mm , (eu'$*eni 'u 0($re me!ie !e 27 ±62<mm,
e1*rim &r!u( #i*er%*(eni%mu(ui %i ni0e(u( *re%iunii *$r+(e.
Leu'$'i+e(e %un+ 're%'u+e numi in 'ir$ ('$$(i'.

Pr&teinele pl#sm#ti(e9ele(tr&'&re:#

 !lbumina '$m*$nen+ m?$r  *r$+eine($r *(%m+i'e, re*reen+n! 556 !in +$+(u( ($r.
  ($ri b%$(u+e  45,5&.
   -i'+u( n$rm( %in+e+ie i(ni' & !e (bumin in +im* 'e ( 'ir$+i'i numi
*r$1im+i0 4&.
  L *'ien+ii 'u 'ir$ !e'$m*en%+e (bumine(e %un+ %'u+e. ($ri (e (buminemiei %ub 3&
 in!i' *ri+i %'i+ei 0($re 'ri+i'  2,5&). Hi*$(buminemi e%+e %$'i+ 'u 're%+ere
&m&($bu(ine($r.
  R*$r+u( (bumin<&($bu(ine A<G) e%+e %u*runi+r, in m$! n$rm( ,2 ,7, !r *$+e !e0eni
%ubuni+r in 'ir$e(e #e*+i'e !e'$m*en%+e.
  Pre%iune '$(($i! $%m$+i' re(i+ in *r$*$r+ie !e 7 !e (bumin) *$+e -i '('u(+ 'u
?u+$ru(  formulei )2orneboe:
  324 ) A5 G 6+4
  Pre%iune 'ri+i' *en+ru *ri+i %'i+ei e%+e !e 4,2.

Ceruloplasmia e%+e *r$+ein *(%m+i' +rn%*$r++$re !e 'u*ru.

 

  O 're%+ere  '$n'en+r+iei %e in+(ne%+e in 5 !in *'ien+ii 'u b$( i(%$n. O %'!ere 
'$n'en+r+iei ne!+$r+ b$(ii i(%$n %e *$+e in+(ni in 'uri(e %e0ere !e 'ir$ !e'$m*en%+e.

(ransferinele  e%+e *r$+ein +rn%*$r++$re !e -ier.

  ($ri %'u+e %e in+(ne%' in CH.

Gamaglobulinele re*rein+ 7±2 ,,4 &) !in *r$+eine(e +$+(e, in '$n%+i+uire ($r in+rn!
%i n+i'$r*ii. Cre%+ere &m&($bu(ine($r e%+e !ire'+ *r$*$r+i$n( 'u &r!u( !e in-(m+ie
#e*+i'. Hi*er&m&($bu(inemi *$+e -i +ribui+ *ri+iei u+$n+i'$r*i($r n+i+i%u(ri, !r 
-'+$ru( m?$r i( re in'*'i++e -i'+u(ui !e  e(imin n+i&ene(e in+e%+in(e. B$(n0ii 'u 'ir$
 *rein+ $ 're%+ere  n+i'$r*i($r %eri'i !e n+i&ene(e in+e%+in(e, !e$re'e %n&e(e !in 'e%+
$n $'$(e%+e -i'+u( *e '(e n%+$m$e($r *$r+$%i%+emi'e.

 Imunoglobulinele 're%+ere 'e%+$r e%+e e0i!en+i+ *rin imun$e(e'+r$-$re.

  0.n. I&G 2 u.i.<m(
  I&A  925 u.i<m(
  I&M 2 u.i.<m(
  In 'ir$ bi(ir %e $b%er0 're%+ere I&M, in 'ir$ ('$#$(i' I&A, in 'ir$ *$%+ne'r$+i'
I&G.
  An+i'$r*ii: A'. An+imi+$'$n!ri(i *en+ru !i&n$%+i'u( 'ir$ei bi(ire *rimi+i0e
  A'. An+i+i%u(ri *en+ru !i&n$%+i'u( 'ir$ei '$m*en%+e in'+i0e
 !lcoolemia
  A*re 're%'u+ in 'ir$ ('$$(i'.
  0.n. ,2&<(

Testul (u br&msul'&n't#lein# 6-SP7

  Te%+ !e e1*($rre '$m*(e1 %i '$m*(e+  -un'+i($r #e*+$'i+u(ui. A(bumine(e %i&ur
+rn%*$r+u( %n&0in ( BSP. Pr$be(e !e BSP %e e-e'+ue *rin in?e'+re i.0.  5m&<@&'$r*
re(in!u%e +e%+u( '(%%i' ( re+en+iei BSP ( 5 %i ( 45 %u '(ern'eu( ( BSP. Re+en+i !e
BSP ( 5 nu !e*%e%+e 35, ir ( 45 5.
Te%+u( 'u BSP re 0($re '(ini' *en+ru !i&n$%+i'u( 'ir$e($r.

Cle#r#n(e9ul (u r&: -eng#l I 1%1

  Te%+u( e%+e %emn+$r 'u 'e( *en+ru BSP, -iin! *$%ibi( %i e-e'+u+e %imu(+n  'e($r !$u
+e%+e. Se !mini%+re $ !$ %+n!r! !e 5& in!i--eren+ !e &reu++e b$(n0u(ui.
C(er'eu( 'u r$ Ben&( re*rein+, !e%+u( !e -i!e(, m% #e*+$'i+e($r -un'+i$n(e %i *ermi+e
e-e'+ure '$n'$mi+en+  %'in+i&rmei #e*+i'e %i bi(ire.

Determin#re# sistemului ;#li;rein#9br#i;inin#

  He*r$'i+u( %in+e+ie @(i@rein$&enu(.
  0.n.  9±24 SD m$(i<m(<#
  S'!ere @(i@rein$&enu(ui e%+e un in!i'iu mi %en%ibi( !e'+ +im*u( !e *r$+r$mbin *en+ru
*re'iere %e0eri++ii b$(ii #e*+i'e.
 

  In 'ir$e re ($' 're%+ere ni0e(u(ui br!i@ininei, im*(i' in %'!ere rei%+en+ei 0%'u(re
 *eri-eri'e, in 're%+ere !ebi+u(ui 'r!i' %i in !e+erminre in%u-i'ien+ei ren(e -un'+i$n(e.

Tesutul e in(#r(#re (u meti&nin#

  Pen+ru *re'iere &r!u(ui !e in%u-i'ien+ #e*+i' in 'ir$e. Din+re +$+i min$'iii
me+i$nin re '$n'en+r+i 'e mi mre in %er %i in urin. In *reiu e-e'+uri +e%u+u(ui %e
%u*rim me!i'+i %i %e !mini%+re un re&im #i*$*r$+ei' 3& *r$+eine<i).
  B$(n0u( in&er  ?eun,  & me+i$nin. Se re'$(+e !$u *r$be !e urin, un in n$*+e
 *remer&+$re re%u+u(ui %i (+ ( 24# !u* in&erre me+i$ninei. In *rim *r$b me+i$nin %e
&%e%+e in 'n+i++i mi'i 3m&), ir 'e !e !$u, ( %ubie'+u( n$rm(, nu !e*%e%+e 3 !in
'n+i++e in&er+.
  Me+i$ninuri %e '$re(e bine 'u &r!u( in%u-i'ien+ei #e*+i'e, ir in 'ir$e 'e%+ !e*%e%+e
.

Pr&b# iure:ei minut#te

  A* e%+e 0e#i'u(+ in -i'+ !e $ m$(e'u( (bumini' %i e(iber+ *$i in %n&e. Curb
!iureei !u* in&erre   m( * in !e'ur% !e , re'$(+n! urin !in 3 in 3, +im* !e 3
$re, re -$+m !e '($*$+, 'u !iure m1im (  !$u %u  +rei *r$b.
  Pe m%ur 'e in%u-i'ien+ #e*+i' *r$&re%e, 'urb %e +ur+e%+e %i !iure m1im *re mi
+r!i0 $*%iurie). S!. De HTP %i !e'$m*en%re %'i+i' !in 'ir$e '$n%+i+uie -'+$ri !e+erminn+i
in in%+(re $*%iuriei.

Testul g#l#(t&:uriei pr&!&(#te 6pr&b# -#uer7

  E1*($re -un'+i &(i'$!eni'  -i'+u(ui. Te%+u( *$+e -i e-e'+u+ *rin !mini%+rre $r( 
&('+$ei, !r %e *re-er '(e i.0. u+i(in! e'#i0(en+u( !$ei !e 35 m&<@& '$r* !in+r$ %$(u+ie
!e &('+$ !e 3, !$n!u%e &('+$emi in %n&e(e '*i(r !in  in  minu+e.
  Tim*u( !e in?um++ire re $ 0($re me!ie n$rm( !e ,7. C$n'en+r+i %n&0in 
&('+$ei ( 4 e%+e !e 29m&, ir ( 6 !e 9m&. ($re !i&n$%+i'  +e%u+u(ui e%+e
0ribi( in #e*+i+e(e '$rni'e, 'ir$e %i +um$ri #e*+i'e.

*#(t&rii (&#gul#rii

(impul de protrombina  +e%+u( Oui'@) e1*($re '$m*(e1u( *+$+r$mbini' *r$+r$mbin,

 *r$'$n0er+in, -'+$ru( S+ur+ %i *r$''e(erin)
  0.n.,53,5
  T. in CH e%+e *re(un&i+.
  In!i'e(e !e *r$+r$mbin 0ri in+re 75. S'!ere 'e%+ui %ub 4 %emni-i' un
 *r$&n$%+i' %e0er in CH.

 Fibrinogenul plasmatic in 'ir$e(e 0n%+e e%+e %'u+ %ub 2m& 'u e1'e*+i 'ir$ei
'r!i'e in 're e%+e 're%'u+, 0n! 0($re *r$&n$%+i' &r0.
   ipide totale
 

  Sun+ u%$r %'u+e in CH.

  0.n.59m&
  Glicemia
  E%+e %'u+ in CH.
  0.n.72m&.
  Colesterolul 
  Fi'+u( e%+e %ur% m?$r !e '#$(e%+er$( en!$&en 'ir'u(n+ %i e%+e, !u* %i%+emu(
ner0$%,$r&nu( 'e( mi b$&+ in '#$(e%+er$(. Pen+ru %in+e 'ii($r 0i(iri -i'+u( -$($%e%+e 7
!in '$(e%+er$(u( #e*+$'i+r. Ir re%+u( +re'e in bi( %ub -$rm !e '$(e%+er$( (iber.
0.n.725m&
  C$(e%+er$(u( +$+( %'!e in 'ir$e(e !e'$m*en%+e %i 're%+e in 'ir$ bi(ir *rimi+i0.
   !ci$ii biliari
  Sun+ '$m*$nen+i e%en+i(i i bi(e i'e reu(+ !in '+b$(i%mu( '$(e%+er$(u(ui. C$n'en+r+i
'ii($r bi(iri in %er e%+e !e: 2,26<m( 6 mM$(<() re*reen+n! < !in '$n'en+r+i ($r in
 bi(. In i'+ere(e !in 'ir$ bi(ir 'i!u( +ur'$(i' e%+e in *r$*$r+ie mi 're%'u+ !e'+ 'i!u(
&(i'$'i' in m$! n$rm( r*$r+u( !in+re 'e%+i -iin! !e 2<3).
   )ilirubina
  E%+e in &ener( u%$r 're%'u+
0.n. +$+(  ,95±,7m&
  in!ire'+  ,2,7m&
  !ire'+  ,,2m&.
 
&robilinogen reu(+ *rin re!u'ere b'+erin  bi(irubinei in in+e%+ine -iin! *r+i( re%$rbi+ in
'ir'u(+i *$r+( 5) %i !e&r!+ in -i'+, re%+u( 425m&<24#) e%+e e(imin+ *rin -e'(e
%+er'$bi(in$&en) %i urin ' ur$bi(in$&en ,23,3m&<24).
  Ur$bi(in$&enu( *re 're%'u+ in i'+eru( !in CH.

   En$ime indicatoare ale disfunctiei excreto-biliare

  A'e%+e %un+: &m &(u+mi(+rn%*e*+i!, -$%-+ ('(in, (eu'imin$*e*+i! %i 5
nu'(e$+i!.
Y-glutamiltranspeptida$a GT) e%+e ($'(i+ in +e%u+uri, *n're%, %*(in, in+e%+ine %ub+ire.
  0.n.♂624u.i.<(
  ♀5u.i.<(
 YGT e%+e '$n%i!re+ $ enim !r %i un mr@er ( b$(ii #e*+i'e !e 'u ('$$(i', un
in!i'+$r in m$ni+$rire 'ure($r !e !ein+$1i're.

 Fosfata$a alcalina FA) e%+e 're%'u+ m$!er+ in CH.

  0.n.47u.i.<(
  FA 're%+e -$r+e mu(+ ( b$(n0ii ( 're 'ir$ % '$m*(i'+ 'u un !en$'r'in$m.
 eucinaminopeptida$a  LAP) e%+e $ *e*+i! *reen+ ( ni0e( e*i+e(iu(ui bi(ir in *n're%,
rini'#i %i mu'$% in+e%+in(.
  0.n. %eri'e522u.i.<(
34nucleotida$a 5N) e%+e $ enim.
  0.n. %eri'e25mu.i.<(
  ($ri(e n$rm(e (e 5N %eri'e %i (e 're%+erii FA *$+ %emni-i' re&enerre #e*+i'.
 

II.3. DIAGNOSTIC

DIAGNOSTICUL PO+ITIV
  Pr$'e%u( !e re'un$%+ere  unei 'ir$e #e*+i'e %e !e%-%$r in +rei e+*e:
) %u%*i'i$nre 'e%+ui in b
  ▫ i%+$ri'u( '(ini',
  ▫  e1menu(ui $bie'+i0
  ▫  e1mene($r &e (b$r+$r.
 b) '$n-irmre m$r&$($&i'  !i&n$%+i'u(ui !e 'ir$ *rin:
  ▫ (*r$%'$*ie
  ▫ *un'+ie bi$*%i' #e*+i'
') %+bi(ire 'uei,  %+!iu(ui m$r*#$($&i' %i e0$(u+i0 ( 'ir$ei, ( '$m*(i'+ii($r, ( b$(i($r 
%%$'i+e %i  'r'+eru(ui '+i0 %u in'+i0e ( *r$'e%u(ui in-(m+$r.

DIAGNOSTICUL DI*ERENTIAL
  Di-er !u* %+!iu( e0$(u+i0 ( 'ir$ei %i !u* %im*+$mu( !$minn+.
▫ in 'uri(e !e %'i+:  *eri+$ni+ +uber'u($%
   *eri+$ni+ 'r'in$m+$%
   !e'$m*en%ri(e 'r!i'e re*e++e
▫  in %+!iu( '$m*en%+:  #e*+i+ 'r$ni' &re%i0 +i* B
   #e*+i+ 'r$ni' %'(er$&en 0in!e're unei #e*+i+e &re%i0e)
   -i'+u( ('$#$(i' ne'ir$+i'
▫  'n! e1i%+ #e*+$me&(ie:  +um$ri(e #e*+i'e beni&ne '#i%+ #i!+i')
   'n'eru( #e*+i'
   -i'+u( !e %+
   b$(i !e %%+em (eu'emie, (im-$&rnu($m+$)

  Tbe(  Di&n$%+i'u( !i-eren+i( ( #e*+$me&(iei i'+eri&ene

 
HEPATITE   HEPATITE   CANCER   CIROJA
IROTICE TOICE HEPATIC   HEPATICA
  A B
Debu+ 'u+     
Debu+ 'u       ± ±   ±
 *r$!$m
  
Febr   ±   ±
S+e(u+e 0%'u(re     
P(me #e*+i'e     -    
He*+$me&(ie   ± ± ±    
S*(en$me&(ie       ±
A%'i+      ±   
A!en$*+ie   ± ±       ±
 

En'e-($*+ie     

 II.14.EVOLUTIE SI PROGNOSTIC

  E0$(u+i mi beni&n  'ir$e($r #e*+i'e in u(+im *eri$! %e +ribuie:

) renun+rii ( *r'en+ee(e e0'u+$rii, 're %*$(iu $r&ni%mu( !e (bumin %i e(e'+r$(i+i,
&r0n! %+-e( in%u-i'ien+ #e*+i' %i *re'i*i+n! %in!r$mu( #e*+$ren(=
 b) *(i'rii 'u !i%'ernmn+  !iure+i'e($r %i  n+i(!$%+er$ni'e($r=
') re'un$%+erii %i +r+rii '$re%*un+$re  -$rme($r '+i0e !e CH=
!) unei in+e(e&eri %i +r+men+ mi %+iin+i-i'e (e '$m*(i'+ii($r.
  E0$(u+i CH e%+e *r$&re%i0, ir &ener( ire0er%ibi(, une(e %+u!ii re'en+e u !em$n%+r+e '
-ibr$ *$+e -i %+$*+ %u *$+e % re&eneree %ub +r+men+. Cir$e(e %'i+$&ene e0$(ue
r*i! 2 ni, in +im* 'e 'ir$e(e bi(ire u e0$(u+ie mi in!e(un&+ 55 ni.
  Pr$&n$%+i'u( CH % me(i$r+ '$n%i!erbi( in u(+imi(e 3 !e'enii.In 'uri(e !e CH in 're
%'i+ 'e!e r*i! ( re*u%, !ie+ %u !iure+i'e %i' n! (bumin !e*%e%+e 3#, *r$&n$%+i'u(
e%+e bun.

Tbe( 2 Cue(e !e !e'e%

AFECTIUNI INTALNITE CIROJA POSTNECROTICA CIROJA ALCOOLICA

In%u-i'ien+ #e*+i' 67 27
Hem$r&i !i&e%+i0  36
In-e'+ii(e 2 2
In%u-i'ien+ ren(  5
Cn'eru( #e*+i' 32 4

  In CH 'u !e'$m*en%re *$r+(, -'+$rii !e *r$&n$!+i' 'ei mi *ei$r+i0i %un+:

) %'i+ re-r'++
 b) #i*$(buminemi 3&<!(
') %'$ru( C#i(! mi mre !e 
!) en'e-($*+i #e*+i'
e) #i*erbi(irubinemi
-) 're%+ere YGT
&) 0r%+ 0n%+.
  Semni-i'+i *r$&n$%+i' %u*r ri%'u(ui !e !e'e% in HDS *rin ru*ere E e%+e:
) 're%+ere ureei %n&0ine
 b) %'i+ %ub +en%iune re-r'++
') #i*erbi(irubinemi
!) numru( +rn%-uii($r ne'e%re
e) re*e+re #em$r&iei
  Sr'in &r0e e0$(u+i CH, m$+i0 *en+ru 're %e re'$mn! in+reru*ere 'e%+ui in
 *rimu( +rime%+ru. Peri'$(u( 'e( mi mre *en+ru mm e%+e re*reen++ !e 're%+ere *re%iunii
in+rb!$min(e, 're *$+e *r$0$' ru*ere E.
  Pen+ru *re'iere %e0eri++ii CH %e u+i(ie in *re%en+ '(%i-i're 'e%+ei !u* %i%+emu(
C#i(!Pu&#.
 

Tbe( 3 C(%i-i're 'ir$e($r #e*+i'e !u* C#i(!Tur'$++e m$!i-i'+ !e Pu&#)

 
 PUNCT 2 PUNCTE 3 PUNCTE
En'e-($*+ie Ab%en+ C$n-uie C$m
A%'i+ Ab%en+ Di%'re+ In +en%iune
Bi(irubin %eri' 2m&<m( 2,3m&<m(  3m&<m(
A(bumin %eri'  35&<( 2735&<( Q 27&<(
Tim*u( !e *r$+r$mbin  3 %e'  4%e'.  !e %e'.
GRADARE C(% A  56 *un'+e  Fun'+ie #e*+i' bun
  C(% B  9 *un'+e  Fun'+ie #e*+i' re!u% me!iu
  C(% C  5 *un'+e  Fun'+ie #e*+i' re!u% %e0er 

  Pr$&n$%+i'u( in CH mi *$+e -i -$rmu(+ !u* m$!(i++e !e r%*un% ( +r+men+. B$(n0ii

're %e me(i$re !u* 2 %*+mni !e re*u% ( *+, !ie+e !e%$!+e, %u*rimre ('$$(u(ui %i (
're %'i+ %i e!eme(e %e re!u'e '$n%+n+, %u ( +r+men+ !iure+i' %im*(u, %e bu'ur in &ener(
!e e0$(u+ie -0$rbi(. B$(n0ii ( 're %'i+ nu %e re!u'e !u* 3 %*+mni !e !ie+ !e%$!+,
+er*ie !iure+i' %i re*u% ( *+, u *r$&n$%+i' %e0er -iin! menin++i !e '$m #e*+i' %u
ru*ere 0ri'e($r.

II.11.TRATAMENT

II.11.A. TRATAMENT C) COMPENSATE SI INACTIVE

  Tr+men+u( CH '$m*en%+e rei! in *rin'i*( in re'$mn!ri *r$#ibi+i0e !e in+eri'ere 

$+i'r$r mnr0re !un+$re -i'+u(ui %i in m%uri !e %u%+inere %i %imu(re  -un'+ii($r %i
re&enerrii #e*+i'e.
  Din+re m%uri(e re%+ri'+i0e %u*rimre ('$$(u(ui e%+e 'e mi im*$r+n+, in+ru'+ % !$0e!i+
' %u*r0e+uire e%+e %emni-i'+i0 mi mre ( 'ir$+i'ii 're u in'e++ % be. B$(n0ii 're
(u're 'u +$1i'e in!u%+ri(e 'u +r$*i%m #e*+i' 0$r -i %'$%i !in me!iu( re%*e'+i0e. De %emene
%un+ in+eri%e me!i'men+e(e #e*+$+$1i'e, ir in!i'+ii(e '#irur&i'(e 0$r -i (imi++e ( 'e(e
im*eri$% ne'e%re.
  Repa!s!l
  Re*u%u( ( *+ %e 0 *re(un&i ( 2 $re *e i, *ermi+n!u%e $ '+i0i++e !e *r$!u'+ie in
 *$i+ie %en! !e m1imum 7 $re %i in+run %in&ur %'#imb !e i. B$(n0ii 0$r -i %*i+(i+i !e 2
$ri *e n, '+e 34 %*+mni in 0e!ere '$n+r$(u(ui.
  Se re'$mn! mer%u( *e ?$% %i $ '+i0i++e -ii' u%$r in 0e!ere *re0enirii +r$-iei
mu%'u(re, ' %i in 0e!ere %+imu(rii *e+i+u(ui %i  in+re+inerii unei %+ri &ener(e mu(+umi+$re.
  Dieta
  Die+ +rebuie % %i&ure un re&im (imen+r '$m*(e+ %i b$&+ in 0i+mine. A*$r+u( '($ri'
in!i'+ e%+e !e 345 '($rii<@&'$r*<i in -un'+ie !e %+re !e nu+ri+ie, 'u $ r+ie *r$+ei' !e 
,5&<@&'$r* %i &(u'i!e 34&<i %ub -$rm !e:
 -in$%e: *ine, (u+uri, m'r$ne, &ri%, *%+e -in$%e
 (e&ume %i -ru'+e *r$%*e+e
 

 r0+uri: !$0(e'ei,m$r'$0i,%-e'(
 *r?i+uri !e '%, mrme(!, !u('e+uri, miere, ?e(euri
  A(imen+e *remi%e: brn !e 0'i, '%, 'rne !e nim( +nr, *e%+e !e * !u('e, *ine (b
-r %re, (*+e, *%+e -in$%e, #r 335&<i), $re, 'n+i++i mi'i !e &r%ime nim(, u(eiuri
0e&e+(e un+ 5&<i), %mn+n %u -ri%' 5&<i.
  C$n%umu( !e *r$+eine e%+e !e+ermin+ !e *reen+ %u !e b%en+ en'e-($*+iei %i !e %+re
!e nu+ri+ie  *'ien+i($r. D' 'e%+ e%+e bun %i nu %un+ %emene !e en'e-($*+ie, 'n+i++e !e
 *r$+eine 0 -i !e &<@&'$r*<24 $re. L !enu+ri+i -r %emene !e en'e-($*+ie 'n+i++e *$+e -i
're%'u+.
  L *'ien+ii 'u en'e-($*+ie '$n%umu( *r$+ei' %e re!u'e ( 244&<24 $re in -$rme(e u%$re %i
me!ii %i %e e1'(u!e ( *'ien+ii 'u en'e-($*+ie 0n%+ *n ( re0enire.
  In ' !e %$'iere  *n're+i+ei '$rni'e 0$m e0i+ !u('iuri(e '$n'en+r+e, (u+uri(e, e1'e%u(
!e 'ru!i++i, in ' !e %$'iere  !ebi+u(ui r+i !e &(u'i!e 0 -i re!u% ( 25&<i.
  A*$r+u( !e %$!ium 0 -i re!u% %i in 'e%+ %+!ium *en+ru  *re0eni in%+(re %'i+ei, m$+i0
 *en+ru 're %e 0$r e1'(u!e (imen+e(e b$&+e in %re: 'rne !e 0', mi(e, *$r', *e%+e !e mre,
mee(uri, mr&rin, m%(ine, 'i$'$(+, ''$, *e miner(e.
  In m(nu+ri+i *r$+e$'($ri' ne'$n+r$(+ %e 0 re'ur&e ( nu+ri+i *ren+er( +$+(, 're !e
$bi'ei, !u* +rei %*+mni, me(i$re %+re !e nu+ri+ie. L 'e%+i %e *$+ $b%er0 &r0re
in%u-i'ien+ei #e*+i'e, !ee'#i(ibre me+b$(i'e %u in-e'+re '+e+eru(ui. In %'$*u( *re0enirii
'e%+$r !e$r!ini %e re'$mn! %u*(imen+re !ie+ei 'u in', in+ru'+ !e-i'i+u( !e Jn n+rene
en'e-($*+ie #e*+i'.

  Tr#t#ment mei(#ment&s 68ep#t&pr&te(t&r7

  Su*(imen+re 'u 0i+mine !in &ru*u( B *e '(e $r( %i *ren+er(, !mini%+rre i(ni' 
!$u '*%u(e !e E%%en+i( 33 -$r+e, %un+ $**$r+une in CH.
  In 'uri(e !e m(b%$rb+ie %e 0 re'ur&e ( '(e *ren+er(, !mini%+rn!u%e in+rmu%'u(r 
%u in *er-uie en!$0en$% $ !+ %u !e !$u $ri *e %*+mn, 0i+ B 25m&, 0i+.B6 25m&,
0i+ E 5 m&.
  A'i!u( $r$+i', !mini%+r+ in 'ure *re(un&i+e 25 !e i(e<(un) %ub -$rm *re*r+u(ui  Purinor ,
re re*u++i ree'#i(ibru(ui %in+eei !e nu'(e$+i!e. A'i!u( %*r+i' !e+ine r$( in %in+e 'ii($r 
nu'(ei'i %i  un$r enime. Silimarina  in 'ure *re(un&i+e in-(uen+e -0$rbi( !i%+r$-i
#e*+$'i+r, mi (e% in 'ir$ ('$$(i'. A'i!u( ur$!e$1i'$(i' '+i$ne *rin m$!i-i're
'$m*$i+iei bi(ei, *$%$(&i 'e%+ei 0riin! in+re 595m&<i.
  A(+e m!i'men+e #e*+$*r$+e'+$re -$($%i+e in CH '$m*en%+e: %*r++ !e r&inin ,
r&inin %$rbi+$(, %*+$-$r+, #e*bi$n+  !r?., me'$*r -$r+e, +r$-$*r= *e b !e *(n+e:
#e*+$!rin$(, *(0$bi(, re&$*r, (i052. i+mine: 0i+. C26m#<i, 0i+ A %i 0i+ D.

  Mei(#ti# 'ibr&epres&#re
  Ter*i n+i-ibr$n+ *$+e -i re(i+ -ie *rin in#ibre un$r %+!ii im*(i'+e in %in+e %i
!e*$i+re '$(&enu(ui, -ie *rin %+imu(re in!e*r+rii 'e%+ui.
  Colchicina *$%$($&i 'e%+ei e%+e !e m&<i, 5 i(e *e %*+mn. Su $b%er0+ rre$ri
e-e'+e !0er%e, 're '$n%+u mi (e% in !iree, !ureri b!$min(e, ur+i'rie.
   Penicilamina e%+e un me!i'men+ 'u '+iune '$m*(e1 n+i-ibr$&en %i !e '#e(+$r !e 'u*ru.
Se *(i' numi in +r+men+u( b$(ii i(%$n, *en+ru re!u'ere in'r'rii 'u 'u*ru  -i'+u(ui.
   Inhibitorii de histidina-decarboxila$a !in+re 'e%+i  *(i'+ in +r+men+u( C#
trito5ualona in !$ !e 66m&<i. Du* 6 %*+mni !e +r+men+ %e inre&i%+re %'!ere
 

mr'+  min$+rn%-ere($r,  #i%+minemiei %i !i%*ri+i %e*+uri($r '$n?un'+i0e ' %i 

in-i(+r+e($r 'e(u(re !e une(e %*+ii *$r+e. Nu %u $b%er0+ e-e'+e !0er%e.
   !lte medicamente fibrodepresoare: corti$onicele, 're in#ib %in+e '$(&enu(ui %i 
 *r$'$(&enei, Y %i a inrerferonii %i prostgandinele.

II.11.-.TRATAMENTUL )IPERTENSIUNII PORTALE

  In 0e!ere re!u'erii *re%iunii *$r+(e %e in+er0ine -ie *rin %'!ere !ebi+u(ui %*(#ni', 'u
?u+$ru( me!i'+iei 0%$'$n%+ri'+$re, -ie *rin !iminure rei%+en+ei *$r+$#e*+i'e, 'u ?u+$ru(
me!i'men+e($r 0%$!i(++$re. In 'e%+ %'$* !i%*unem !e +rei mi?($'e +er*eu+i'e:
  ) +r+men+u( me!i'men+$%, 're %$'i βb($'n+ii ne%e(e'+i0i, 0%$!i(++$re(e,
0%$'$n%+ri'+$re(e, ni+ri+ii, m$(%i!$min %i b($'n+ii 'n(e($r !e '('iu
  2) %'(er$re en!$%'$*i'  0ri'e($r e%$-&iene
  3) '#irur&i !e %#un+.
  B($'n+ii β!rener&i'i ne%e(e'+i0i %un+ 'ei mi r%*n!i+i in +r+men+u( HTP !in '!ru( CH.
 Propranolonul   ' %i 'ei((+i Bb($'n+i n!$($(, +en$($(, me+in!$($( %i %$+($() re!u'e *re%iune
 *$r+( bru+( in CH. A'e%+e me!i'men+e in+er0in *rin+run e-e'+ !ub(u in re!u'ere !ebi+u(ui
'r!i' %i mre%' rei%+en+ 'ir'u(+iri '$(+er(e. Pr$*rn$($(u( %e !mini%+re in +$+e CH, e(
!iminun! %emni-i'+i0 ri%'u( *rimei #em$r&ii *rin ru*ere 0ri'e($r e%$-&iene %i me(i$re
%u*r0e+uire. D$ %'i(e in+re 76m&<i.
  %$!i(++$re(e re!u'e *re%iune *$r+( *rin %'!ere rei%+en+ei 0%'u(re in+r#e*+i'e %i
 *rin %'!ere -(u1u(ui 0en$% *$r+(. Din 'e%+ '+e&$rie -' *r+e nitritii  organici 'u '+iune
ime!i+ ni+r$&(i'erin) %u 'u '+iune *re(un&i+ i%$%$rbi! m$n$ni+r+), blocantii canalelor de
calciu si potasiu.
  A!mini%+rre i%$%$rbi!u(ui re!u'e *re%iune r+eri( %i &r!ien+u( *re%iunii 0en$%e
#e*+i'e. D$ me!ie e%+e !e 4 m&<i. A%$'iere ni+r+i($r 'u β b($'n+e(e e%+e mi e-i'ien+
!e'+ βb($'n+ii %in&uri in *re0enire #em$r&iei *rin ru*ere E.
,cteotida re e--e'+ #i*$+en%$re %i n+i#i*er!inmi'e mi e0i!en+e !e'+ *r$*rn$($(u(.
Tr+men+u( in!e(un&+ 'u $'+e$+i! %'!e *re%iune *$r+( %i me(i$re 'r'+eru(
#i*er!inmi' ( 'ir'u(+iei *$r+(e.
   )osentanul  %'!e *re%iune *$r+( !e $ mnier !e*en!en+ !e !$, re!u'n!$ in 'ir$
 bi(ir %i mi$'r$n!u(r.
  Clonidina %'!e *re%iune *$r+(, re!u'e rei%+en+ 0%'u(r ren(, -r  m$!i-i'
!ebi+e(e %n&0ine ren(e %i -r  're%+e -i(+r+u( &($meru(r. D$ me!ie e%+e !e 5 μ&<i.
  B($'n+ii 'n(e($r !e '('iu. Re*rein+ '(% !e me!i'men+e #e+er$&ene 're u in '$mun
in#ibre 'n(e($r !e '('iu, *r$*ie++e (r& -$($%i+ in 'r!i$($&ie. A'e%+i u *r$*ie++i
0%$!i(++$re %i n+ri+mi'e. C*i !e %erie i b($'n+i($r 'n(e($r !e '('iu %un+: nifedipina,
verapamil  %i diltia$em. D$e(e uu(e !e !i(+iem %un+ !e: 3m&<67#, e-e'+e(e !0er%e -iin!
in &ener( min$re 'e-(ee, *re%+ei, e!eme).
  An+&$ni%+i i re'e*+$ri($r !e 5#i!r$1i+ri*+min. S !em$n%+r+e '  serotoninei ii re0ine un
r$( im*$r+n+ in 're%+ere rei%+en+ei *$r+(e. S $b%er0+ 're%+ere %en%ibi(i++ii in 0ene(e
meen+eri'e, 're *$+e -i b($'+ 'u ritanserina %i  6etanserin. Du* !mini%+rre 'e%+$r 
me!i'men+e %u $b%er0+ e-e'+e !0er%e im*$r+n+e, e(e !e+erminn! *re%iune *$r+( *rin
(+erre rei%+en+ei in+r#e*+i'e.
 

  M$(%i!$min e%+e un me!i'men+ 0en$!i(++$r 'u *r$*ie++i n+in!in$%e, %imi(re ni+ri+i($r.

S $b%er0+ %'!ere im*$r+n+  HTP in 'ir$ ('$$(i' !u* !mini%+rre m$(%i!$minei.
A'e%+ %e !mini%+re *e '(e $r(, in !$e !e 24m&.
  A%$'iere *r$*rn$($(u(ui ( m$(%i!$min &r0e %'!ere !ebi+u(ui 'r!i', 're
n+rene !u* 'e%+ %i %'!ere *re%iunii r+eri(e me!ii.

II.11.C.TRATAMENTUL C) CU DECOMPENSARE PORTALA

  Se !re%e 'u *re'!ere '$mb+erii %'i+ei. Tr+men+u( %'i+ei %e 0 %ub$r!$n -'+$ri($r 

e+i$*+$&eni'i %i -'+$ri($r *re'i*i+n+i i 'e%+ei.

  I. Repa!s!l la pat si restrictia so"ata  re*rein+ *rimu( mi?($' +#er*eu+i' !e b in

'$mb+ere %'i+ei. Re*u%u( ( *+ e'#i0(e 'u %u*rimre +$1i'e($r #e*+i'e,in'(u%i0
('$$(u(%i 'u !ie+e '$re%*un+$re -iin! $b(i&+$riu %$'i+ 'e%+ei. Re*u%u( in-(uen+e
-0$rbi( HTP *re'iin!u%e ' 5 !in+re %'i+e %e remi+e numi ( re*u%.
  B +r+men+u(ui %'i+ei e%+e re%+ri'+i %$!+. O b(n+ %$!+ ne&+i0e 'u 4mEV N %e
in%$+e%+e !e *ier!ere   ( !e *. A!mini%+rre unui *(u% !e 4mEV N -0$rie re+inere
  ( * %i 're%+ere in &reu++e 'u &.
  Re%+ri'+i %$!+ +rebuie % -ie %+ri'+, *$r+u( !e %re -iin! %ub 5m& %u 22mEV<i. In -r
%u*rimrii %ri !e bu'+rie, b$(n0u( +rebuie % e1'(u! !in (imen++ie %i (imen+e(e 'u un b$&+
'$n+inu+ in %re: mee(uri, un+, %r+, brne+uri, *ine, *r$!u%e !e *+i%erie, %'$i'i, '$n%er0e, *e
'rb$&$%e, %u'uri !e -ru'+e, *re*r+e in!u%+ri(e.
  In %'i+e re%+ri'+i !e (i'#i!e %e *(i' in m$men+u( in 're n+remi %'!e %ub 2mEV<(.

  II.Trata&et!l "i!retic  'uri(e 're !u* $ %*+mn !e re%+ri'+ie %$!+ nu inre&i%+re

$ %'!ere *$n!er( !e 'e( *u+in @&, $ !iure !e *e%+e 2m(, %un+ '$n%i!er+e  nu r%*un!e
( !ie+ -r %re, ne'e%i+n! !u&re +er*iei !iure+i'e.W
  Din+re '(%e(e !e !iure+i'e *(i'+e in +r+men+u( %'i+ei 'ir$+i'u(ui men+i$nm:
  ▫  diureticele tia$idice *r$0$' $ !iure b$&+ nu numi in *$+%iu 'i %i in %$!ium. E(e
 b($'#e re%$rb+i %$!iu(ui, !r u !e0n+?u( unei mri *ier!eri !e *$+%iu. Din+re 'e%+e
enduron, renese, brinaldix, fontilix) clortalidona re $ '+iune mi (en+ *re(un&in!u%e 2436#,
 *e 'n! 'e(e((+e +ii!i'e %e 'r'+erie *rin+r$ *eri$! !e (+en+ !e 2#.
  ▫ furosemid  '+i$ne *r$m*+, 0n! $ !ur+ !e '+iune %'ur+ *n ( 7#. Are !e0n+?u(
unei *ier!eri im*$r+n+e !e " %i C(, 're%+erii ureei %n&0ine, %i in%+(rii in%u-i'ien+ei ren(e.
  ▫ acidul etacrinic re un me'ni%m !e '+iune %emn+$r -ur$%emi!ei, !r e-i'ien+ !iure+i'
mi mre ( 'ir$+i'i, m$+i0 *en+ru 're in *$-i! unui &r! min$r !e #e*+$1i'i+re e%+e *re-er+
in +r+men+u( %'i+ei 'ir$&ene. P$%$($&i $%'i(e in+re 25m&, *re-ern!u%e !mini%+rre
( 2 i(e. A'i!u(ui e+'rini' I %e %$'i '($rur !e *$+%iu %i 'n+i++i mri !e (einHC(, *en+ru
 *rein+m*in ('$( me+b$(i'.
  ▫  diuretice pteridinice %un+ %ub%+n+e ne%+er$i!iene. Din 'e%+ &ru* -' *r+e +rim+erenu(
%i mi($ri!u( 're %e !mini%+re in !$ i(ni' !e m& *en+ru *rimu( %i & *en+ru ( 2(e.
  ▫  diureticele antialdosteronice b($'#e '+iune (!$%+er$nu(ui, in!u' &ine'$m%+i (
 brb+e %u %e're+i ('++e ( -emei. De'(n%e $ !iure m$!er+, b$&+ in %$!ium, !r 
'$n'$m$+en+ e'$n$mi%e%' *$+%iu(. P$%$($&i e%+e 0ribi( 4m&.
 

  ▫ diureticele osmotice manitol  2, gluco$a 2. E(e *r$0$' ree1*n%iune 0$(emiei *rin

+r&ere *ei !in %e'+$ru( 'e(u(r.
  Tr+men+u( !iure+i' %e in'e*e 'u  spironolactona  %u amilorid . D$ ini+i( !e
%*ir$n$('+$n e%+e !e m&<i, in ' !e (i*%  unui r%*un% !iure+i' '$re%*un+$r, urmrin!
 -i 're%'u+ *n ( 2m&<i in in+er0(e !e 5 i(e. A'e%+ e%+e e-i'ien+ in 5 !in 'uri.
D$ $*+im !e mi($ri! e%+e !e m&<i. S*ir$n$('+$n re $ !ur+ !e 0i+ !e 24# ( n$rm(i,
ir in CH e%+e mi *re(un&i+, m$+i0 *en+ru 're %e re'$mn! !mini%+rre in+r$ %in&ur *ri
( 24#.
  D' %ub %*ir$n$('+$n %'!ere *$n!er( %i n+riure nu %un+ '$re%*un+$re %e 0 mi
!$ *n ( 4m&<i %$'iin!u%e %i -ur$%emi! in !$e *r$&re%i0e !e ( 4 ( 6m&<i.

  III.Parecete*a totala terape!tica  !+$ri+ *ier!eri($r !e *r$+eine %i n+renrii !e$r!ini($r 

#i!r$e(e'+r$(ini'e, 'e%+ me+$!  -$%+ &r0+ !e numer$%e '$m*(i'+ii: %in!r$m #e*+$
ren(, en'e-($*+ie #e*+i', #i*$n+remie. O *r'en+e !e 5( ir$%e%+e 5& !e *r$+eine ( un
 b$(n0 're *rein+ $ 'n+i++e !e *r$+eine re!u%.
  A'e%+ *r$'e!eu nu e%+e re'$mn!bi( in %+!ii(e 0n%+e (e CH C#i(! C) %u in 'uri(e 'u
 bi(irubinemie *e%+e  m&<!(, 'u in!i'e !e *r$+r$mbin %u 4, 'u +r$mb$'i+e %ub 4 <mm %i
're+inin *e%+e 3m&<!(.
  In($'uire (buminei e1+r%e *rin *r'en+e +er*eu+i' 'u (bumin umn !e%$!+, in
ri+m !e 6&<( %'i+ e0'u+, e%+e '$%+i%i+$re. In($'uire (buminei umne 'u dextran 78, 'u
 plasma umana %un+ mi ie-+ine %i %u !$0e!i+ ( -e( !e e-i''e.
  Pr'en+e +er*eu+i' +$+( e(imin %'i+ mi r*i! !e'+ +r+men+u( !iure+i' in%
0n+?u( !iure+i'i($r e%+e 'e( !e  re!u'e ri%'u( *ri+iei in-e'+ii($r.

  I(.Trata&et!l ascitei re%ractare  %'i+ re-r'+r !e-ine%+e %u*rin'r're #i!ri' !in

'!ru( CH 'e nu r%*un!e ( !ie+ -r %re %i +r+men+ !iure+i' in+en%i0e.
  Ab%en+ r%*un%u(ui ( +r+men+ %e mni-e%+ *rin (i*% %'!erii *$n!er(e, !iure %i
n+riure ne'$re%*un+$re %i !e0$(+re '$m*(i'+ii($r ( !iure+i'e ;($/ %(+ %n!r$me>,
%in!r$m #e*+$ren().
  C m%ur +er*eu+i' men+i$nm in *rimu( rn! u(+r-i(+rre %i rein-ui %'i+ei, 'u ?u+$ru(
unui *r+ 'un$%'u+ %ub !enumire !e ; arti%icial s!pport a" he&o"eto)i%icatio i se$ere
or'a %ail!re7 'un$%'u+ %i %ub nume(e !e Rho"iacit.
  E%+e un *r+ !e u(+r-i(+rre 're e%+e '*bi( % in!e*r+e 3 ( !e %'i+<i, *rin
in+erme!iu( unui '+e+er !e !i(i m$n++ ( *eri+$neu, ( 'rei 0$(um *rin '$n'en+rre
 *r$+eine($r %i in!e*r+re i$ni($r !e %$!ium i( re!u'e ( *r$1im+i0 5m( %i i( rein?e'+e
in+r0en$%.
  S'!ere *$n!er( e%+e mi mre !e'+ 0$(umu( %'i+ei u(+r-i(+r+e, in+ru'+ *rin rein-ui
 *r$+eine($r !in (i'#i!u( !e %'i+ 're%+e !iure.
  Dur+ me!ie !e %*i+(ire 'u 'e%+ *r$'e!eu e%+e !e 9 i(e, *e 'n! in *r'en+e
+er*eu+i' +$+( e%+e !e  i(e.
  Re 'umu(re %'i+ei in in!i'e(e !e %u*r0e+uire %un+ %imi(re in 'e(e !$u *r$'e!ee, !+
re'ir'u(+i e%+e mi ie-+in.
  A(+ *r$'e!eu *(i'+ e%+e s!t!l peritoeo,8!'!lar  're '$n%+ in *(%re in '0i++e
 *eri+$ne(  unui '+e+er Le een, %i '$ne'+re 'e%+ei %ub'u+n+, 'u un '+e+er !in 0en
 ?u&u(r in+ern. In urm 'e%+ei (e&+uri %e rein-ue %'i+ in %i%+emu( 0en$%.
 

  C+e+eru( e%+e *re0u+ 'u $ 0(0 're *ermi+e 'ir'u(+i in+run %in&ur %en%, !in '0i++e
 *eri+$ne( %*re 0en ?u&u(r.
  Dur+ %*i+(irii e%+e !e 2 !e i(e, ir re'i!i0 %'i+ei ( un n  -$%+ inre&i%+r+ in 95 !in
'uri.

  C$m*(i'+ii(e !+e !e 'e%+ *r$'e!eu %un+ '(%i-i'+e in:

) ($'(e:  #em+$m ($'(
   in-e'+ie *rie+(
   *ier!ere %'i+ei
   in-e'+re %'i+ei
 b) &ener(e:  -ebr
   e!em *u(m$nr 'u+
   +u(burri !e '$&u(re
   #em$r&ie !i&e%+i0e %u*eri$r
  M$r+(i++e %ur0ine in 2 !in 'uri, -iin! *r$0$'+ mi (e% !e #em$r&i m%i0 *rin
ru*ere E %u &r0re in%u-i'ien+ei #e*+i'e.

II.1".COMPLICATIILE CIRO+EI )EPATICE

II.1".1. )EMORAGIA DIGESTIVA SUPERIOARA

  Cu 'e mi !ire'+  %n&errii e%+e re*reen++ !e ru*ere 0ri'e($r e%$-&iene, urm+e
!e &%+ri+ er$i0, u('eru( &%+r$!u*!en( %i in 'uri mi rre, ne%emni-i'+i0e, *$(i*i,
e%$-&i+, 'n%er, TBC, (im-$m.
  F'+$rii *re!i'+i0e *en+ru %n&erre E %un+ re*reen++i !e !imen%iuni(e 'e%+$r %+!iu(
III %u I), !e *reen+ *un'+e($r r$%ii %i !e &r!ien+u( *re%iunii 0en$%e *$r+(e.

Ta#lo! cliic :
 ru*ere E %e *r+i'u(rie *rin 0$(umu( mre ( #em+emeei, 'r'+eru( e1*($i0 (
'e%+ei, in%$+i+ !e %+re !e %$' %i urm+ !e me(en bun!en+.
 !e 'e(e mi mu(+e $ri b$(n0u( in+r in en'e-($*+ie #e*+i' %i !e0ine i'+eri'.
 inin+e e1+eri$ririi #em$r&iei, in+e%+in( %e *$+e um*(e 'u %n&e, b$(n0u( *reen+n!
%emne(e nemiei 'u+e.
 !u* in%+(re HDS, 0$(umu( %*(en$me&(iei !e re&u( %e re!u'e
 0ri'e(e &%+ri'e in%$+e%' E in 55 !in 'uri= m?$ri++e 'e%+$r 0ri'e *r$0in !in !i(+re
0ene($r &%+ri'e *$%+eri$re %u %'ur+e, !e 'ee %un+ ($'(i+e !e *re-eri$n+ in re&iune
-$rni1u(ui %u  mi'ii 'urburi
 G %un+ rre$ri mri, in 'e%+ e0en+u(i++e *re%iune *$r+( e%+e %'u+ e0i!en+iin!u%e un
%un+ &%+r$ren( im*$r+n+, in '$n!i+ii inre&i%+rn!u%e un ri%' %'u+ *en+ru HDS.
  Pre%iune *$r+( %i ri%'u( #em$r&i' %'! !+$ri+ %un+u(ui *$r+(%i%+emi' e--i'ien+, 'e%+
!in urm e1*(i'n! %i -re'0en+ mi mre  en'e-($*+iei #e*+i'e.

  E)a&ee cliice
 en!$%'$*i in ur&en+ e0i!en+i E, G, %+bi(in! n+ur %i %e!iu( %n&errii, -iin! 'u*(+ 'u
!mini%+rre en!$0en$% !e  fluoresceina.
 e'$&r-i b!$min( %e *r'+i' !e ru+in in e0i!en+iere %emne($r !e HTP
 

 u(+r$%$n$&r-i e%+e u+i( *en+ru i!en+i-i're 0ri'e($r &%+ri'e

  +e%+e(e bi$'#imi'e nu %un+ '*bi(e % !i-eren+iee HDS !e $ri&ine 0ri'$% !e 'e
e1+r0ri'$%
 r+eri$&r-i meen+eri' *$+e -i *r'+i'+ *en+ru  e1'(u!e $ri&ine r+eri(  HDS %i *en+ru
 0iu(i %i%+emu( *$r+(

  Pro'ostic
  Pr$&n$%+i'u( HDS *rin ru*ere E e%+e &r0+ !e ri%'u( mre 9 ( re%n&errii in *rime(e
%*+mni !u* #em$r&ie. Ri%'u( re*e+rii HDS !u*  n %'!e ( 23. M$r+(i++e e%+e
e0(u+e in me!ie ( 6 !in 'uri. Su*r0e+uire !e*in!e !e reer0e(e -un'+i$n(e #e*+i'e. In
%+!iu( 'e( mi 0n%+ ( CH %u*r0e+uire ( 2 %*+mni e%+e e0(u+e ( 5, ir ( un n (
.

  Tratata&et
  B$(n0u( 0 -i %*i+(i+ !e ( in'e*u+ ( !e'+i !e renimre, *(i'n!u%e:
▫ un '+e+er 0en$% *en+ru re-'ere 0$(emiei
▫ +r+men+ #em$%++i'
▫ %$n! Le0ine in %+$m' *en+ru e0'ure %n&e(ui
▫ e0(ure #em$%+ei %i in+r$!u'ere in-uiei !e manitol  're % ''e(eree e0'ure %n&e(ui
!in +ubu( !i&e%+i0e
▫ '(i%m e0'u+$re urmrin! e0'ure %n&e(ui !in +ubu( !i&e%+i0e
▫  !' %'i+ e%+e %ub +en%iune %e -'e !e'$m*en%re %'i+ei *rin *r'en+e +er*eu+i'
e0'u+$re
▫  *e '+e+eru( 0en$% %e in+r$!u'e  ( !e %n&e +$+( i$!ru*, in -un'+ie !e #em+$'ri+ %i !e
%e0eri++e !e$r!ini($r #em$!inmi'
▫ *e '+e+eru( 0en$% %e 0$r mi !mini%+r -'+$r '$&u(n+ 1protrombina% fibtinogena) %i m%
+r$mb$'i+r. In ' !e -ibrin$(i %u !e '$&u(re 0%'u(r !i%emin+ %e !u& heparina
▫  in b%en+ %n&e(ui %e 0$r !mini%+r &(u'$ 2m(, (bumin umn 2m(,
 *(%m, !e1+rn %u mni+$( 25m(. Nu e%+e re'$mn!bi( %eru( -ii$($&i'
▫  *e %$n! &%+ri' %e -'e in-uie '$n+inu +im* !e 2,5 $re,  5 ( %$(u+ie !e mni+$( 4,
!u&n!u%e ( -ie're (i+ru '($rur !e *$+%iu & %i %u(-+ !e ne$mi'in 25m&. S*(+ur
!i&e%+i0e 'u m$ni+$( *r$0$' !iree $%m$+i'.
▫ %e mi !mini%+re ranitidina in 0e!ere '$mb+erii re-(u1u(ui &%+r$e%$-&in
  In 0e!ere *re0enirii en'e-($*+iei #e*+i'e %e re'ur&e %i ( me+$!e(e '(%i'e: re%+ri'+i
(imen+r!e *r$+eine, !mini%+rre !e me+r$ni!$(.

 emosta$a %e %i&ur *rin urm+$re(e me+$!e:

▫ me+$! me'ni' 'u ?u+$ru( %$n!e($r 'u b($n%e B(@em$re %u Lin+$nN'#(%, 're %e
 *(%e 'u b($nu( in-eri$r in %+$m' ( ni0e(u( 'r!iei. A'e%+ %e um-( *rimu( %i *$i %e um-(
%i b($ne(e !in e%$-&.
  Hem$%+ me'ni' '$n+r$(e #em$r&i in 45 *n (  !in 'uri. In ' !e
'$n+inure  #em$r&iei, -ie ' b($ne(e nu %un+ bine *(%+e %in u u *re%iune %u-i'ien+, -ie '
#em$r&i re (+ %ur%.
  In ' !e men+inere  %$n!ei in e%$-& mi mu(+ +im* %e re'$mn! !e%um-(re in+ermi+en+
 b($ne($r !in 6# '+e , *en+ru  e0i+ (eiuni(e !e !e'ubi+.
  In &ener( %e re'$mn! ' %$n! % nu -ie men+inu+ *e ($' mi mu(+ !e 24 !e $re.
 

▫ #em$%+ #em$!inmi' *re'e!e %u %e !mini%+re '$n'$mi+n+ 'u #em$%+ me'ni',

!i%*une !e !$u '+e&$rii !e me!i'men+e in 'e%+ %en% 0%$'$n%+ri'+$re re!u' -(u1u( %n&0in
 *$r+( %i *re%iune *$r+() %i 0%$!i(++$re '+i$ne *rin re!u'ere rei%+en+ei 0%'u(re
in+r#e*+i'e). S'!ere &r!ien+u( !e *re%iune 0en$% #e*+i' %e '$re(e 'u %'!ere
 *re%iunii in 0ri'e(e e%$-&iene.
  #asopresina %e !mini%+re in *er-uie en!$0en$% 24U in m( !e1+r$ 5, +im* !e
, ir %'!ere *re%iunii *$r+(e %e inre&i%+re !u* 456. A(+e 0%$'$n%+ri'+$re -$($%i+e in
#em$%+ -rm'$($&i' %un+ !e +i*u( &(*re%iuni, -eni((nin %i %$m+$%++in 'e %'!e
'$n!i!erbi( *re%iune *$r+(.
  Somatostatina e%+e $ +e+r'i'(in en!$&en n+ur( 'e re!u'e -(u1u( %n&0in %*(n#ni', e
0n! mi *u+ine e-e'+e !0er%e !e'+ 0%$*re%in in e%+e un 0en$!i(++$r *u+erni' %i un
$-&iene me+$'($*rmi!, !$m*eri!$(u(), 'u +$+e 'e%+e '+iune ($r %u*r HDS *rin ru*ere
E e%+e ne%i&ur.
  Me!i'men+e(e 're '$n+r'+ %-in'+eru( e%$-&in in-eri$r r re!u'e -(u1u( %n&0in in 0ri'e(e
e%$-&ieneme+$'($*rmi!, !$m*eri!$(u(,) 'u +$+e 'e%+e '+iune ($r ($r %u*r HDS *rin
ru*ere E e%+e ne%i&ur.

  Sclero$a varicelor esofagiene e%+e $ me+$! 'e +r$mb$e E *rin in?e'+re un$r &en+i
%'(er$n+i, -$($%in!u%e un en!$%'$* %*e'i( *re0u+ 'u !$u 'n(e, !e '(ibru 3,9mm %i 'u un
 b($n. A'u( *en+ru in?e'+re %ub%+n+ei %'(er$n+e re '(ibru !e 23G %i !e*%e%+e (imi+e(e
en!$%'$*u(ui 'u 34mm. Me+$! re!u'e %emni-i'+i0 ne'e%ru( !e +rn%-uii, r+ re%n&errii %i
m$r+(i++e *re'$'e. B$(n0ii 're nu r%*un! ni'i (  !$u %e!in+ !e %'(er$re, inre&i%+re
$ m$r+(i++e !e , ir 'e%+e 'uri +rebuin! (u+ in !i%'u+ie $*$r+uni++e unei in+er0en+ii
'#irur&i'(e !e !eri0+ie *$r+( e-e'+u+ in ur&en+. Me+$! '$n%+ in in%+i(re unui &en+
%'(er$n+ ime!i+ !e%u*r ?$n'+iunii &%+r$e%$-#iene *en+ru E %i ( 3'm %ub ?$n'+iune
&%+r$e%$-&in *en+ru 0ri'e(e &%+ri'e. A&en+u( %'(er$n+ *$+e -i oleatul de etanolamina
5, alcool etilic 5 %u polidocanol . In?e'+re %ub%+n+ei %e *r'+i' in+r0ri'$%, *r0ri'e(
%u '$mbin+, 0$(umu( %$(u+iei %'(er$n+e nu +rebuie % !e*%e%' 4m(<0ri', e !e+erminn!
#em$%+ *rin -0$rire +r$mb$ei ($'(e %u *rin '$m*re%iune. Se!in+e(e !e %'re($re %e
re*e+ %*+mn(, in+r$ %e!in+ *$+ -i %'re($+e 34 0ri'e, 'u 2m( &en+ %'re($+ *en+ru
-ie're. Din+re '$m*(i'+ii(e 'e%+ei me+$!e min+im u('er+ii(e %u*er-i'i(e, b'+eriemi
+rni+$rie, ne'r$ e%$-&in %i *er-$++i. 0ei ne1).
 

 
S$n! Sen&%+@enB(@em$re
 

 igaturarea #E  *e '(e en!$%'$*i' re*rein+ $ me+$! !e +r+men+ (+ern ( %'(er$re

'e%+$r. En!$%'$*u( e%+e *re0u+ 'u un !i%*$i+i0 ( e1+remi++e !i%+( 're *ermi+e
$*er+$+u(ui % !e%-%$re un ine( e(%+i' in ?uru( *$r+iunii !i%+(e  mu'$%ei e%$-&iene 're
'$n+ine '$($ne(e 0ri'$%e. Sun+ ne'e%re 42 %emene *(i'ri !e ine(e e(%+i'e *en+ru  %e
%i&ur #em$%+. Me'ni%mu( $b(i+errii %$'i un *r$'e%% !e ne'r$ %i !e in-(m+ie 'u
+rn%-$rmre %+r+u(ui mu'$% %i %ubmu'$% *rin -$rmre 'i'+ri'i($r. Din+re '$m*(i'+ii(e
me+$!ei %e men+i$ne !i%'$m-$r+u( re+r$%+ern( %i *r$!u'ere u('er+ii($r e%$-&iene
%u*er-i'i(e. Li&+urre 'u bn! e(%+i' nu e%+e e-i'ien+ *en+ru 0ri'e(e %+$m'
 

Li&+urre 'u ?u+$ru( unei benii e(%+i'e

 

   Emboli$area #E   re*rein+ (+ (+ern+i0e +er*eu+i', e-e'+un!u%e *e '(e *er'u+n+

+rn%#e*+i'. D+$ri+ -*+u(ui ' %e in%$+e%+e !e m$r+(i+%+e im*$r+n+, (e&+ !e *un'+i %i
'+e+erire $rb  0enei *$r+e, e%+e rre$ri u+i(i+.
Se mi *r'+i' une$ri '+e+erire %e(e'+i0e  0ene($r 're -urnie %n&e E 0en
&%+ri' %+n&, 0ene(e &%+ri'e %'ur+e) $b(i+ern!u%e 'u bure++e !e &e(+in Ge(-$m) %u 'u
+r$mbin u%'+. Du* 5 (uni r+e re%+rn&erii e%+e e0(u+e ( 9.
  Hem$%+ *e '(e en!$%'$*i' mi *$+e -i e-e'+u+ 'u ?u+$ru( &en+i($r +ermi'i. Din+re
'e%+i u '+iune *rin '$n+'+: e(e'+r$'$&u(re, +erm$'$&u(re, 'ri'$&u(re= %i '+iune (
!i%+n+ -$+$'$&u(re 'u r (%er. A*(i're &en+i($r -ii'i *$+e % *r$!u' r%uri ($'(e.

  (ratamentul chirurgical  e%+e +r -$($%i+ !+$ri+ *er-e'+i$nrii, in u(+imii ni,  me+$!e($r !e

#em$%+ ne%n&ern!, en!$%'$*i, %i  r+ei mri !e '$m*(i'+ii  '#irur&iei *$r+(e ( 'ir$+i'i.
  Sun+uri(e *$r+( %i%+emi'e !u* +$*$&r-i ($r %e '(%i-i' in:
▫ !eri0+i *$r+$'0e +r$n'u(re 're !u* n%+$m$ %e !i-eren+i in:
   n%+$m$ +ermin$(+er( in 're e1+remi++e %e'+i$n+  0enei *$r+e
e%+e n%+$m$+ ( -+ (+er(  0enei '0e in-eri$re 0ei ne1).
 n%+$m$ *$r+$'0 (+er$(+er( '$n%+ in n%+$m$re 0enei *$r+e
'u 0en '0 in-eri$r ( ni0e(u( -e+e($r (+re(e
   n%+$m$ !ub( e%+e $ 0rin+  !eri0+iei *$r+$'0e (+er$(+er(e in
're 0en *$r+ %e n%+$m$e 'u mbe(e '*e+e ( -+ (+er(  0enei '0e in-eri$re 0ei
ne1)
  In!i'+ii(e 'e%+$r %un+uri *$r+$'0e +$+(e %e -' %+i e1+reme !e rr !in 'u r+ei mri 
en'e-($*+iei #e*+i'e, *e !e $ *r+e, ir *e !e (+ *r+e !+$ri+ '$m*r$mi+erii +rn%*(n+u(ui !e
-i'+.
▫ !eri0+ii(e *$r+$'0e *$r+(e r!i'u(re) u+i(ie &re-$ne 'u un !ime+ru (imi++:
   n%+$m$ %*(en$!i%+( ren( 0en %*(eni' e%+e %e'+i$n+ ( ni0e(u(
 ?$n'+iunii %(e 'u 0en meen+eri' %u*er+i$r %i n%+$m$+ ( 0en ren( %+n& 0ei
ne1)
 n%+$m$e(e meen+eri'$'0e u -$%+ im&in+e in m$! %*e'i( *en+ru
HTP *rin $b%+'$( *re%inu%$i!( %u *en+ru CH %*(ene'+$mi+e. 0ei ne1)
▫  *r$'e!ee !e !e0%'u(rire !in+re 'e%+e %un+ 'i++e %*(ene'+$mi, !e0%'u(rire
e%$&%+ri' %i +rn%e'+i e%$-&in. A'e%+e *r$'e!ee %u*r0e&#e+e +im* in!e(un&+ inre&i%+re
$ e0$(u+ie -0$rbi( in 7 !in 'uri.
▫ %un+uri(e *$r+$%i%+emi'e in+r#e*+i'e +rn%?u&u(re TIPS) %e *(%e un %+en+ !e me+( in+re
+eri+$riu( 0enei *$r+e %i +eri+$riu( 0enei #e*+i'e. S+en+u( e%+e me+((i', e1*n!bi(, 'u un '(ibru
!e 72mm. E%+e *re0u+ 'u un b($n &$n-(bi( '*bi( % re!u' &r!ien+u( *re%iunii *$r+(e
%ub 2mmH&. Prin $*rire #em$r&iei %i %'!ere *re%iunii *$r+(e *re&+e%+e b$(n0u( *en+ru
+rn%*(n+ !e -i'+. In +im* 'e%+e *r$+ee %e $b%+rue in 24 !in 'uri, ri%'u( !e $b%+ru'+ie
e%+e 'u ++ mi mre 'u '+ reer0e(e -un'+i$n(e (e -i'+u(ui %un+ mi bune. M$r+(i++e
ime!i+ e%+e e0(u+e ( 2, ir %u*r0e+uire (  n ( 75.
 

II.1".".ENCE*ALOPATIA )EPATICA

  De-ine%+e $ri'e +u(burre neur$*%i#i' 're *re in e0$(u+i unei b$(i 0n%+e !e -i'+, in
b%en+ unei 'u%e neur$($&i'e !ire'+e. Din *un'+ !e 0e!ere '(ini' %e 'r'+erie *rin
%$'iere *er+urbri($r -un'+ii($r 'erebr(e, (e -un'+iei neur$mu%'u(re %i (e 0i&i(en+ei.
 
Epi"e&iolo'ie
  A*r$1im+i0  !in +$+(i++e e*i%$!e($r !e EH %ur0in ( 'ir$+i'i. In e0$(u+i CH,EH,
 *$+e % *r in 9 !in 'uri. EH !e0ine '(ini' mni-e%+ ( 47 !in+re 'ir$+i'ii +r++i
'$n%er0+$r, ( 35 !in+re 'ei %u*u%i %un+uri($r *$r+(%i%+emi'e %i ( 2435 !in+re %un+uri(e
%*(en$ren(e.
 
Pato'eie
▫ conceptia sunetului porto-cav
  E%+e 'e( mi 0e'#i %i +ribuie '$m #e*+i' in+$1i'+iei 'reieru(ui 'u %n&e(e *$r+( 're
$'$(e%+e -i'+u( %i ?un&e ( 'reier neneu+r(i+ !e '+re -i'+.
▫ conceptul intoxicatiei amoniacale
  E%+e %u%+inu+ !e 're%+ere ni0e(u(ui m$ni'u(u(ui in %n&e e%+e '$n%e'in+ in'*'i++ii
-i'+u(ui !e  -i1 %i neu+r(i e1'e%u( !e mm$ni'. Am$ni'u( (+ere !ire'+ '+i0i++e
neur$(e'+ri', in#ibn! &enerre *$+en+i(e($r e1'i++$rii, %i in#ibi+$rii *$%+%in*+i'i
▫ conceptul sineregic
  L '+iune +$1i'  m$ni'u(ui %e !u& %i '+iune n$'i0  'ii($r &r%i 'u (n+uri %'ur+e,
 mine($r %i  -en$(i($r. De-i'i+u( !e in' e%+e !e%e $b%er0+ ( 'ir$+i'i, +ribuin!ui%e un r$(
 *re'i*i+n+ in !e'(n%re EH *rin !e$r!ini(e *e 're (e n+rene in me+Vb$(i%mu( ureei.
  Prin+re (+e +e$ri *ri0in! $ri+i HE min+im:
 '$n'e*+u( neur$+rn%mi+erii -(%e,
 '$n'e*+u( %er$+$niner&i',
 '$n'e*+u( (+errii me+b$(i%mu(ui ener&e+i' 'erebr(.

  Factorii precipitati
  F'+$+ii !e'(n%+$ri i EH ( 'ir$+i'i in $r!ine -re'0en+ei %un+:
▫ %e!+i0e(e %i n(&e+i'e(e '+iune +$1i'  'e%+$r %e !+$re%+e in+rierii me+b$(irii ($r (
ni0e(u( -i'+u(ui, 'ee 'e !u'e ( %u*r!$re.
▫  #em$r&i !i&e%+i0e %u*eri$r *rin ru*ere 0ri'e($r, -e'+e *er-ui #e*+i' *rin
re!u'ere 0$(emiei, '$m*r$mi+n!ui %+-e( %+re -un'+i$n(
▫ buu( !e !iure+i'e in ' !e %u*r!iure %e re!u'e 0$(emi %i in m$! %e'un!r e%+e (+er+
iri&+i -i'+u(ui,  rini'#iu(ui %i  'reieru(ui.
▫ uremi
▫ !e$r!ini(e e(e'+r$(i+i'e
▫  *$r+u( (imen+r e1&er+ !e *r$+eine *re*r+e(e !in 'rne in e1'e% ( 're %e %$'i %i
 bu+uri(e ('$$(i'e re*rein+ 'u (imen+r 'e mi -re'0en+  !e'(n%rii EH
▫ '$n%umu( !e ('$$(
▫ *r'en+ee bun!en+e
▫ in-e'+ii(e 'ir$+i'i %un+ mi *u+in rei%+en+i ( in-e'+ii, %u%'e*+ibi(i++e ($r -+ !e 'e%+ -iin!
+ribui+e %+rii !e nu+ri+ie.
 

  Ta#lo! cliic
  Tb($u( '(ini' e%+e !$min+ !e e(emen+e 're '$n-er 'e%+ui %*e'+ e0$'+$r.Tu(burri(e
!i%'re+e !e '$n%+ien+ %i %+eri1u( *re'e!e 'u mu(+ +im* inin+e $ %+re &r0 !e '$m #i*er+$n.
  In b%en+ HDS ' -'+$r *re'i*i+n+, +u(burri(e !e '$n%+iin+ %i (e *er%$n(i++ii %e in%+(e
in &ener( in%i!i$%. Se remr' e%+$m*re '+i0i++ii min+(e, %emen !e ?u!e'+ er$n+,
'$n-uie.
  Tb($u( '(ini' e%+e '$m*(e1, e%+imn! -e'+re +u+ur$r %e&men+e($r SNC. De$r!ine
 *rin'i*( '$n%+ in (+erre men+( $r&ni' %$'i+ *er+urb%ri($r neur$($&i'e.
  Mni-e%+ri(e '(ini'e !e*en! !e in+en%i++e -'+$ru(ui e+i$($&i'.
  Ini+i( +u(burri(e !e '$n%+ien+ '$n%+u in %$mn$(en+, 're *r$&re%e %*re in0er%re
ri+mu(ui !e %$mn.
  B$(n0u( e%+e !e%e &%i+ in %+re !e %$mn, !r %$mnu( 'e%+ui nu %e !i-eren+i 'u nimi'
!e %$mnu( -ii$($&i'.
  B$(n0u( r%*un!e &reu %i<%u in!e'0+ ( in+rebri, e%+e !e$rien++ in +im* %i %*+iu, i%i
re&%e%+e *re$'u*ri %+er$+i*e %i nem$+i0+e.
  I%i m$!i-i' '$m*$r+men+u( $bi%bui+ !e0enin! $ -ire !e$rien++, in%$+i+ !e iri+bi(i++e,
in%+bi(i++e -ii', une$ri eu-$ri (+ernn! 'u *+ie, (+e$ri b$(n0u( e%+e 'u*rin% !e $ %+re !e
&i++ie ne?u%+i-i'+, mi mu(+ %u mi *u+in &re%i0.
M$!i-i'ri(e *er%$n(i++ii %e 'r'+erie *rin+run '$m*$r+men+ *ueri(, iri+bi(i++e,
 *ier!ere in+ere%u(ui *en+ru -mi(ie.
  De+eri$rre in+e(e'+u( %e mni-e%+ *rin+r$ i!e+ie in'e+ini+ %i (en+$re in+e(e'+u(, *u+n!
% e0$(uee *n ( %+ri '$n-ui$n(e %e0ere.

  A%*r1i, 're e0i!en+i in'*'i++e !e re*r$!u'er -i&ure %im*(e 'u ?u+$ru( be+e($r !e
'#ibri+ !u ( !e%enu(ui e%+e un (+ e(emen+ ( EH. Pen+ru  e0$(u *r$&re%iune %in!r$mu(ui %e
 *r'+i' +e%+u(  *eitan. S'riere e%+e !e$r!$n+, 'u &re%e(i, me(i$rre 'e%+ei '$re%*un!
imbun++irii %in!r$mu(ui en'e-($*+i'. In '!ru( +u(burri($r !e '$m*$r+men+, b$(n0u( nu i%i
mi re'un$%+e %($nu(, *+u(, urine %i !e-e' in ($'uri ne'$re%*un+$re.
  $rbire e%+e in'e+ini+ %i m$rmi+, ir 0$'e m$n$+$n, %i !i%-&i !e0ine e0i!en+, (
'e%+ !u&n!u%e in+$1i'+i 0erb(=.
  In 'uri(e ne+r++e, b$(n%0u( !e0ine mi &reu !e +rei+, *eri$!e(e !e 0e&#e %e %'ur+e, ir 
'$n-ui %i !e$rien+re !e0ine mi e0i!en+e. In 'e(e !in urm %e in%+(e '$m, $ '$m
'(m '$m*rbi( %$mnu(ui.

  Tbe( 4. S'( '$mei !e ( G(%&$/

  ribi(e Te%+ R%*un% Nr *un'+e

O'#i De%'#i%i S*$n+n   4
L '$mn! 0erb(   3
L !urere   2
Fr r%*un%   
Ce( mi bun r%*un% L '$mn! 0erb( E-e'+u+ 6
m$+$r 
L %+imu(i !urer$% Durere ($'(i+   5
F(e1ie n$rm(   3
E1+en%ie   2
 

Fr r%*un% 
Ce( mi bun r%*un% Orien++ %i '$n0er%+ie   5
0erb( De$rien++ %i   4
'$n0er%+ie
Cu0in+e in!e'0+e   3
Sune+e in'$m*ren%i0e   2
Fr r%*un%   

T$+( 35

  Pe m%ur 'e%e &r0e '$m, re-(e1e(e !i%*r, re-(e1u( -$+$m$+$r -iin! u(+imu( 're
!i%*re.
  Une$ri %e in+en%i-i' i'+eru(, *r %n&erri (e mu'$%e($r, e'#im$e, b$(n0u( !e0ine -ebri(,
!i%*nei', 'u re%*ir+ie !n' %i *r$-un!. Hi*er+ermi %i in-e'+i &r0e '$m. B$(n0u(
 *$+e % !e'e!ee in '$m *r$-un! -r %i re!$bn!i '$n%+iin+= in (+e 'uri '$m e%+e
0i&i(en+: b$(n0u( *re +re, *u+n!u%e m$bi(ie, %e ri!i' in %eu+ %i i%i '$n%er0 *r+i(
-'u(++i(e !e *er'e*+ie.
  An$m(i neur$($&i'( 'e mi 'r'+eri%+i' e%+e ;-(**in& +rem$r> %+eri1i%) re*reen+n!
in+reru*ere bru%' %i !e %'ur+ !ur+  '$n+r'+iei mu%'u(re. A%+eri1u( e%+e *re%en+ in *e%+e
 %in 'uri(e !e EH. Mer%u( e%+e +'+, e( %e mi *$+e mni-e%+ *rin mi%'ri %in'r$ne, !in
'$+e, %$(!, *i'i$r. In'$m +rem$ru( !i%*re.
  Trebuie % men+i$nm in '!ru( %emi($$&iei EH %i #i*er0en+i(+i, une$ri in+en%e,
r%*un+$re !e ('($ &$%. B$(n0u( in '$m #e*+i' e1#( un mir$% '!0eri', !e
%n&e !e'$m*u% %u !e 'ine u!. In+en%i++e -e+$ru(ui e%+e *r(e( 'u %$mn$(en+ %i &r!u(
'$n-uiei.

  Tbe( 5 S+!ii(e '(ini'e (e en'e-($*+iei #e*+i'e

S+!iu Tu(burri men+(e

  I C$n-uie u%$r, e-$rie %u !e*re%ie, %'!ere +en+iei, %'!ere bi(i++ii !e 
e-e'+u Te%+e men+(e, iri+bi(i++e, -e'+re %$mnu(ui
  II Ame+e(, (e+r&ie, mre !i-i'u(++e in  e-e'+u +e%+e men+(e, !e$rien+re
in+ermi+en+
  III S$mn$(en+ !r *$%ibi(i++e !e +reire, im*$%ibi(i++e !e  e-e'+u +e%+e men+(e,
!e$rien+re 'u re%*e'+re  +im*u(ui %i ($'u(ui, '$n-uie mr'+, mneie, e*i%$!e
!e -urie, 0$rbire *reen+ !r in'$m*re%i0
  I C$m

  E)plorari cliice
▫  m$niemi in &ener( inre&i%+re0($ri !e *e%+e 9u&<!(. Ni0e(u( m$ni'u(ui in %n&e(e
0en$% ne re-(e'+ '$n'en+r+i m$ni'u(ui in %n&e(e -urni+ +e%u+uri($r. Ni0e(u( m$ni'u(ui
r+eri( %e '$($re 'e( mi bine 'u %e0eri++e EH.
▫ LCR e%+e !e re&u( '(r %i %ub *re%iune n$rm(. L b$(n0ii EH %e inre&i%+re $ 're%+ere
m$!er+  '$n'en+r+iei *r$+ei'e, !r 'u $ 'e(u(ri++e n$rm(. Ni0e(u( m$ni'u(ui in LCR 
re-(e'+ 'e( mi -i!e( '$n'en+r+i 'erebr(  m$ni'u(ui.
 

▫  e(e'+r$en'e-($&rm $ri'e b($'? -un'+i$n( 'erebr( !e+ermin m$!i-i'ri (e '+i0i++ii

e(e'+ri'e. In EH %e inre&i%+re re!u'ere %in'r$n bi(+er(  -re'0en+ei un!e($r %i 're%+ere
m*(i+u!inii 'e%+$r. M$!i-i'ri(e EEG in'e* in re&iune -r$n+( %u 'en+r( %i, *e m%ur 'e
e(e %e &r0e %e e1+in! *$%+eri$r ( +$+e rii(e. E0(ure EEG nu e%+e %u-i'ien+ *en+ru
!i&n$%+i're EH, !r *$+e -i u+i( 'n! EEG %un+ urmri+e in !inmi'.0ei ne1)
▫ '$m*u+eru( +$m$&r-i' 'erebr( e%+e in!i'+ *en+ru  !e%'$*eri (+e 'u%e (e '$mei: #em+$m
%ub!ur(, b'e% 'erebr(, +um$ri. In EH, CT e0i!en+i in+$+!eun un e!em 'erebr( &ener(i+
%u ($'(i+. De %emene, ( +$+i 'ir$+i'ii !e%'$*er un &r! !e +r$-ie 'erebr(, '#ir in
'$n!i+ii(e unei 'ir$e bine '$m*en%+e.
▫  re$nn+ m&ne+i' nu'(er e%+e %u*eri$r CT *en+ru e0i!en+iere e!emu(ui 'erebr( %i
 *en+ru e0(ure '$n+inu+u(ui in * ( %ub%+n+ei 'erebr(e.
▫  +$m$&r-i 'u emi%iune !e *$i+r$ni $-er *$%ibi(i++e in0e%+i&+iei numi+$r %i%+eme !e
neur$+rn%mi+ere ' 'e(e 'u re'e*+$ri !e !$*mine %u ben$!ie*ine.

  Dia'ostic
  Ori'e n$m(ie *%i#i' in%$+i+ !e +remur+uri 're *re in e0$(u+i unei 'ir$e e%+e in *rimu(
rn! %u%*e'++ !re*+ EH. Preen+ -$e+uru(ui %i  %+eri1u(ui %un+ r&umen+e im*$r+n+e in
-0$re 'e%+ei.

Tbe( 6 Di&n$%+i'u( !i-eren+i( ( en'e-($*+iei #e*+i'e

A-e'+iune Te%+u( !i&n$%+i'

Leiuni in+r'rniene
Sn&erre
Tum$ri TC
Ab'e%e
In-e'+ii Pun'+ie ($mbr
Menin&i+ Te%+e 0iru%$($&i'e
En'e-($*+ie TC
En'e-($*+ii +$1i'e A('$$(emie
A('$$( TC

  Trata&et
▫ +r+men+u( -'+$ri($r *re'i*i++e 'e%+i $!+ !e%'$*eri+i +rebuie in!e*r++i %i<%u +r++i
X +r+men+e(e b+e *e i*$+e m$ni'(:
    restrictia aportului de proteine ( in'e*u+ %e %in+e+ie $ri'e *$r+ (imen+r !e *r$+eine.
R+i '($ri' !e minimum 6'($rii<i e%+e '$*eri+ 'u bu+uri !u('i %u *rin in+r$!u'ere *e
%$n! &%+ri'  unei %$(u+ii !e &(u'$ 2 %u !e !e1+r$ 4.
  Pe m%ur 'e b$(n0u( i%i re0ine !in %+re !e $bnubi(re %i m$niemi +in!e % %e
n$+m(iee %e rein+r$!u'e r+i *r$+ei' in'e*n! 'u 2&<i %i 're%'n! !in 3 in 3 i(e *n ( $
r+ie !e 9&<i.
  Am$ni'u( e%+e *r$!u% !e -($r mi'r$bin !in '$($n %i !e 'ee '(i%me(e e0'u+$rii %un+
!e$%ebi+ !e u+i(e.
    inhibarea productiei amoniacului intestinal   in 'e%+ %'$* %e -$($%e%+e me!i'+i
n+iin-e'+i$% 'u n+ibi$+i'e neb%$rbbi(e, !e +i*u( neomicinei, paromomicinei %u bacitracinei.
A'e%+e re!u'e *r$!u'+i -($rei b'+eriene '$($ni'e m$ni$&ene+i'e. D$ i(ni' !e ne$mi'in
 

e%+e !e 24& im*r+i+ in 4 !$e. 95 !in 'uri(e %u*u%e +r+men+u(ui 'u ne$mi'in %e
me(i$re. A'e%+ +r+men+ +rebuie (imi++ (  (un !e i(e !+$ri+ e-e'+e($r !0er%e !e +i*
ne-r$+$1i'.
  Di#ri!e(e ne!i&erbi(e, !e +i*i( lactulo$ei, +r0er%e in+e%+in( %ub+ire %i ?un&e ( ni0e(u(
'$($nu(ui un!e %un+ '+b$(i+e !e -($r b'+erin. A'iii $r&ni'i reu(++i re!u'e P#u( !in
'$($n. A'i!i-e're re e-e'+e b'+eri$%++i'e %i %'!e *r$!u'+i !e mm$ni'. In +r+men+u(
 *re(un&i+ n+rene !i%'$m-$r+ b!$min( !e +i*u( b($nri($r %i !ureri($r. A'e%+ e%+e m$+i0u(
 *en+ru 're %e re'$mn! in($'uire 'u un (+ !i#ri! mi *u+in $%m$+i' lactibolul .
    inhibitorii de ure$a %'!e m$niemi *rin e-e'+u( %i%+emi' 'e in#ib ure. A!mini%+rre
'i!u(ui 'e+$#i!r$1mi' %'!e ni0e(u( m$ni'u(ui %n&0in ( unii b$(n0i, !r !e+ermin
numi $ ne%emni-i'+i0 me(i$rre '(ini'. A!mini%+rre A' n+iure !e+ermin %'!ere
ni0e(u(ui !e mm$ni' %i 're%+ere e1're+iei urinre !e uree. Ri%'uri(e 'e%+ui +r+men+ !e*%e%'
in% bene-i'ii(e.
  stimularea fixarii metabolice a amoniacului %+imu(re 'i'(u(ui !e -$rmre  ureei *rin
!mini%+rre  !$i *re'ur%$ri !e uree  r&inin %i $rni+in) r *u+e % 're%' e(iminre
urinr  m$ni'u(ui
▫ +r+men+e b+e *e i*$+e neur$+rn%mi++$ri($r -(%i:
    administrarea endovenoasa a aminoaci$ilor cu lanturi laterale %e -$($%e%' -ie %in&ur 
min$'i! 'u (n+uri (+er(e  0(in), -ie '$mbin+i  3 %emene min$'ii 0(in,
$rni+in, r&inin). S $b%er0+ me(i$rre +b($u(ui '(ini' %i 're%+ere %u*r0e+uirii.
  evadopa %e !mini%+re $r( %u i.0. in !$ !e 4&<i. S !$0e!i+ e-i''e in +reire
 b$(n0u(ui !in '$m. E-e'+u( %r !+$r re-'erii !e*$i+e($r !e neur$+rn%mi++$ri -ii$($&i'i
 !$*mine, nere*ine-rin).
    )romcriptina e%+e un (@($i! %emi%in+e+i' 're '+i$ne ' un n+&$ni%+%*e'i-i' (
re'e*+$ri($r !e !$*mi$n. Se !mini%+re in !$ i(ni' !e 5 m& %i me(i$re %+re
'(ini' %i mre%+e -(u1u( %n&0in 'erebr(, me(i$re '$n%umu( 'erebr( !e $1&en %i mre%+e
'$n%umu( 'erebr( !e &(u'$. Sub '+iune 'e%+ei in 5 !in 'uri %e n$rm(ie %i EEG.
    reechilibrarea hidroelectrica si proteica !mini%+rre (buminei umne !e%$!+e 4m()
me(i$re '$n%i!erbi( 0$(umu( *(%m+i', '$re'+e #i*$(buminemi %i %+imu(e !iure.
Pen+ru '$re'+re !e-i'i+u(ui ener&e+i' %i me(i$rre %+rii !e nu+ri+ie %e 0$r !mini%+r
en!$0en$% %$(u+ii !e &(u'$ 2 %i 0i+mine !in &ru*u( B.
  Tr+men+u( in *r'+i' '(ini', re ' $bie'+i0 e%%en+i( ( +r+rii EH ( 'ir$+i'i, men+inere in
0i+  b$(n0u(ui *n I %e 0 *r$'ur -i'+u( *en+ru +rn%*(n+

II.1".%.ASCITA RE*RACTARA
A%'i+ re-r'++ !e-ine%+e %'i+ 'e nu r%*un!e ( me!i'+i !iure+i'. E %e 'r'+erie *rin
#i*er'+i0re %i%+emu(ui n+riure+i'.
  A%'i+ re-r'+r in'(u!e !$u %ub+i*uri:
  ▫ %'i+ !iure+i'rei%+en+ e%+e %'i+ 're nu *$+e -i m$bi(i+ %u re*re *re'$'e %in u
 *$+e -i *re0eni+ !in 'u (i*%ei !e re*u% ( !ie+ #i*$%$!+ %i +r+men+ !iure+i' in+en%i0e
  ▫ %'i+ !iure+i'in%+bi( e%+e %'i+ 're nu *$+e -i m$bi(i+ %u re*re *re'$'e %in u
 *$+e -i *re0eni+ !in 'u !e0$(+rii !e '$m*(i'+ii in!u%e !e !iure+i'e.
  Trata&et!l
 

  Tr+men+u( *re%u*une !mini%+rre !iure+i'e($r $%m$+i'e mni+$( 23m(), re-'ere

0$(emiei *rin !mini%+rre in *er-uie !e (bumin umn 2, *(%m, &(u'$2
2m(. D' %'i+ e%+e %ub +en%iune 0 -i e0'u+e 'u %u -r re!mini%+rre.
  M$n+re TIPSu(ui, me!i'+i 0%$'$n%+ri'+$re '*bi( % re!u' 0%$!i(++i %*(#ni' %i
%i%+emi' %un+ !e %emene u+i(e *rin '+iune !e !e'+i0re  %i%+eme($r n+in+ri&ene en!$&ene.
Se *(i' 'u e-e'+e bene-i'e %i &(*re%in. Une$ri, +$+u%i %e *(i' %i 0%$*re%in in +r+men+u(
%'i+ei re-r'+re.

II.1".,.IN*ECTAREA ASCITEI
In -un'+ie !e e1menu( b'+eri$($&i', !e numr+$re (im-$'i+e($r %i  *reen+ei %u b%en+ei
unei %ur%e !e in-e'+ie '#irur&i'( e%+e '(%i-i'+ in:
▫ in-e'+re %*$n+n  %'i+ei
   *eri+$ni+ b'+erin %*$n+%n PBS)
   b'+eri%'i+ m$n$mi'r$bin neneu+r$-i(
   %'i+ neu+r$-i( 'u 'u(+ure ne&+i0e
  ▫ *eri+$ni+e b'+eriene %e'un!re
   *er-$r+ii in+e%+in(e
   ne*er-$r+i0
  Din+re 'e(e +rei +i*uri !e in-e'+ie %*$n+n  %'i+ei *r$+$+i*u( e%+e re*reen++ !e PBS.
  P+$&eni PBS e%+e e1*(i'+e !e +rn%($'re -($rei in+e%+in(e *rin +r0er%re mu'$%ei
in+e%+inu(ui %i in-e'+re (im-$'i+e($r meen+eri'e.
  Ta#lo! cliic
  75 !in+re PBS %un+ mni-e%+e '(ini', !r %im*+$me(e %i %emne(e !e in-e'+ie %un+ !i%'re+e %i
&reu !e in+er*re++. Une$ri m$!i-i'ri min$re in %+re men+(  b$(n0u(ui *$+ % re*rein+e
%in&uru( %emn ( in-e'+iei.
  Din+re 'e(e((+e %emne, in $r!ine -re'0en+ei ($r, min+im:
  ▫ -ebr
  ▫ !urere b!$min(
  ▫ %+re !e +en%iune  *ere+e(ui b!$min(
  ▫ i'+eru(.
  In 'uri(e in 're *r'en+e e1*($r+$rie nu e0i!en+i in-e'+i, !i&n$%+i'u( 'e%+ei
 *$+e -i in+ri+ %u i&n$r+. Din 'u 'e%+ei in+riere +r+men+u(ui -0$rie *r$&re%i
in-e'+iei in %+!ii ire0er%ibi(e %u (e+(e. HDS 'u %u -r %+re !e %$' %e in%$+e%+e une$ri !e
!e0$(+re b'+eriemiei %*$n+ne %u  PBS. In 'e%+ ' in-e'+re %'i+ei e%+e +ribui+ 're%+erii
 *ermebi(i++ii mu'$%ei in+e%+in(e *en+ru b'+erii. E%'#eri'#i C$(i, %+re*+$'$'ii %i "(eb%ie((
re*rein+ 'u m?$ri++ii e*i!$!e($r !e PBS %u !e b'+eri%'i+ m$n$mi'r$bin
neneu+r$-i(.
  Factorii "e risc
  ▫ '$n'en+r+i %'u+ in *r$+eine  (i'#i!u(ui !e %'i+
  ▫ !e-i'i+u( !e $*%$nin
  ▫ *r'en+e
  ▫ #em$r&i !i&e%+i0e
  ▫ *r$'e!ee in0%i0e *(i'+e *en+ru e0(ure +r+men+u(ui HD en!$%'$*ie, '+e+er).
  Di&n$%+i'
 

  De+eri$rre %+rii &ener(e  'ir$+i'u(ui 'u %'i+ ri!i' %u%*i'iune in-e'+rii 'e%+ei !in
urm, mi (e% !' %e %$'i !ureri b!$min(e %i -ebr.
  Pen+ru !i&n$%+i're 'e%+ei in-e'+ii %e re(ie un e1men b'+eri$($&i' ( (i'#i!u(ui !e
%'i+. Cu($ri(e *$r % e0i!en+iee *reen+ in numr mre  neu+r$-i(e($r %i 
 *$(im$r-$nu'(ere($r.
  Cu e1'e*+i *er-$r+iei 0ei'u(uei bi(ire, in 'e(e((+e '$n!i+ii 'u(+uri(e (i'#i!u(ui !e %'i+
e0i!en+i numer$%e b'+erii. E1menu( r!i$($&i' '$n-irm %i ($'(ie %e!iu( *er-$r+iei.
  Trata&et
  Tr+men+u( em*iri' 'u n+ibi$+i'e %e 0 !mini%+r in $ri'e %'i+ 're %$'i %emne %i
%im*+$me !e in-e'+ie, in+ru'+ b'+eri%'i+e(e *$+ e0$(u %*re $ *eri+$ni+ b'+erin %*$n+n. In
+r+men+u( n+iin-e'+i$% em*iri' %e re'ur&e !e re&u( ( n+ibi$+i'e 'u %*e'+ru (r& !e '+iune. In
 *re%en+ %e re'ur&e ( !$ !e 2& i.0. ( 72 $re in+er0(. Li'#i!u( !e %'i+ !e0ine %+eri( !u*
 *rim *ri !e 'e-$+1im in 76 !in 'uri. In PBS, in+er0enin! !e re&u( -($r ner$b,
'e-$+1imu( %e 0 %$'i 'u me+r$ni!$(. F($r mi'r$bin !in *eri+$ni+ b'+erin %*$n+n
e%+e %en%ibi( in *r$*$r+ie !e  ( '($rm-eni'$(, ' %i ( m?$ri++e 'e-($%*$rine($r !e
&ener+i  III.

II.1"..COMPLICATII RENALE
 !e$r!ini (e %$!iu(ui 'ir$+i'ii mni-e%+ $ '*'i++e remr'bi( !e re+en+ie  N, n+riure
( 'e%+i -iin! e1+rem !e re!u%. A'e%+ re+en+ie -0$rie 'umu(re (i'#i!u(ui !e %'i+, e
-iin! %i e0enimen+u( ini+i( 're *re'e!e -$rmre %'i+ei, %i e!eme.
  re+en+i #i!ri' in%u-i'ien+ '*'i++ii ren(e !e !i(u+ie %ur0ine -re'0en+ ( 'ir$+i'i.
Hi*$n+remi, e1*re%i in'*'i++ii !e e1're+ie  *ei, e%+e -re'0en+ $b%er0+ ( 'e%+i.
  Sin!r$mu( #e*+$ren( !e-ine%+e in%u-i'ien+ ren( *r$&re%i0 're %ur0ine ' reu(++ (
0%$'$n%+ri'+iei r+eri(e rn(e in+en%e !in '!ru( CH. E%+e 0$rb !e in%u-i'ien+ ren(
-un'+i$n( 'r'+eri+ *rin b%en+ (eiunii ren(e *rimre. In%+(re %in!r$mu(ui #e*+$ren(
e%+e *re'e!+ !e 'e(e mi mu(+e $ri !e *r'en+ee e0'u+$rii 0$(umin$%e, !e buuri
!iure+i'e, %u !e HDS *rin ru*ere E. In &ener( e%+e 0$rb !e 'ir$ %'i+$&en, 'u %'i+
re-r'+r, 'u e1+remi++i re'i !+$ri+ 0%$'$n%+ri'+iei *eri-eri'e, 'u #i*$n+remie %i 're%+ere
 *r$&re%i0  're+ininei. Sin!r$mu( #e*+$ren( %e *$+e remi+e *rin '$re'+re #i*$0$(emiei %u
 *rin m$n+re !e %un+ *eri+en$0en$%. Trn%*(n+u( !e -i'+ re in!i'+ie m?$r in %in!r$mu(
#e*+$ren(, !u* e-e'+ure +rn%*(n+u(ui -un'+i ren( re0enin! ( n$rm(.
 

CAPITOLUL III

 
ROLUL ASISTENTEI MEDICALE IN INGRI5IREA
-OLNAVULUI CU CIRO+A  )EPATICA

B$(n0ii 'u 'ir$ #e*+i' 0$r -i in+ern+i in %e'+i !e &%+r$en+er$($&ie, +r+men+u(

'e%+$r ne'e%i+n! *eri$!e mi (un&i !e +im*, im*unn!u%e re*u%u( -ii' %i *%i#i' (
 b$(n0u(ui *re'um %i un numi+ re&im (imen+r.
  Pe b 'e($r +rei r$(uri !e*en!en+, in!e*en!en+, in+er!e*en!en+) %i%+en+ me!i'( 0 0e
 *r$&rm *re%+bi( 'e 0 +rebui % 'u*rin!:
 %u*r0re&#ere -un'+ii($r 0i+(e (e b$(n0u(ui=
'$r!re !e in&ri?ire u+$n$me %i !e(e&+e=
 '+iuni ( in!i'+i me!i'u(ui=
 m%uri !e $r&nire %i re$r&nire  ($'u(ui !e mun'.

III.A.ROL IN PRO*ILA2IE

  M%uri(e *r$-i('+i'e !e+in $ im*$r+n+ *rim$r!i( in *re0enire '$n%+i+uirii CH %i !u*

-$rmre 'e%+ei in *re0enire '$m*(i'+ii($r. M%uri(e *r$-i('+i'e %e !re%e in *rimu( rn!
-'+$ri($r e+i$($&i'i 0iru%uri(e #e*+i'e B, D, C, G, -i'+u( ('$#$(i', +$1i'e(e #e*+$+r$*e
me!i'men+$%e, !e$r!ini nu+ri+i$n(e), -in! '$mmune 'u m%uri(e !e *r$-i(1ie (e #e*+i+ei
'$rni'e. in!e're #e*+i+ei '$rni'e *rin +r+men+ !i-eren+i+, 'u in+er-er$n in -$rme(e !e
e+i$($&ie 0ir( %i '$r+i$ni'e in -$rme(e u+$immune, re!u'e 'u *r$1im+i0 7 r+ 'ir$&en.
  In 0e!ere !e*i%+rii ( +im*  b$(ii '$rni'e !e -i'+ 'u *$+en+i( 'ir$&en %i %u*unerii 'e%+ei
unui *(n !e +r+men+ e-i''e %u e1*erimen++ 'u e-e'+e bene-i'e, -un'+i$nre 'bine+u(ui !e
!i%*en%rire  #e*+i'i($r. A'+i0i++e 'e%+$r 'bine+e %e 0$rien+ 'u *re'!ere %u*r
0''inrii '$n+r HB,  '$*ii($r in &ener( %i  '+e&$rii($r 'u ri%' !e '$n+minre: *er%$n(
%ni+r #em+$($&, %+$m+$($&ie, '#iru+&ie, *er%$n( !e (b$r+$r), imun$!e*rim+i, +uber'u($%i
'u %*i+(ire *re(un&i+ %i re*e++, *r$%+i+u+e, #$m$%e1u(ii.
  A'e%+e 'bine+e 0$r '$(b$r 'u 'en+re(e !e '$mb+ere  e+i(i%mu(ui %i 0$r $r&ni
%u*r0e&#ere *$*u(+iei e1*u%e +r+men+u(ui 'u me!i'men+e #e*+$+$1i'e %u 're 0in in
'$n+'+ ( ($'u( !e mun' 'u +$1i'e in!u%+ri(e.
  Din+re mi?($'e(e !e *re0enire  '$m*(i'+ii($r -'e *r+e +r+men+u( 're 0ie remi%iune
in-(m+iei '+i0e, ree'#i(ibrre #i!r$e(e'+r$(i+i' %i nu+ri+i$n(, !ie+ !e'0+, +r+men+u(
'$re%*un+$r ( %'i+ei %i e0i+re me!i'men+e($r #e*+$+$1i'e me+i(!$*, i$nii!,
'$n+r'e*+i0e, eri+r$mi'in).
  Tr+men+u( 'ur+i0 0 -i in!i0i!u(ier !u* %+!iu( e0$(u+i0 ( CH, !u* *reen+ %u
b%en+ in-(m+iei '+i0e, %+re nur+i+i$n(  b$(n0u(ui, !e -e'+iuni(e %%$'i+e %i !e
'$m*(i'+ii. Ter*eu+i' CH !i%*une !e *u+ine m%uri %*e'i-i'e: !e*(e+i !e -ier in
#em$'r$m+$, !mini%+rre *eni'i(inei in b$( i(%$n, '$r+i$ni'e(e in #e*+i+ u+$imun %i
in+er-er$nu( in #e*+i+ 'r$ni' '+i0e !e+ermin+e !e 0iru%uri(e #e*+i'e.
 

III.-.ROL INASIGURAREA CONDITIILOR DE MEDIU

Am*(%re b$(n0i($r 'ir$+i'i %e 0 -'e in %($ne mi mi'i, (ini%i+e, un!e *eri'$(u( !i-urii
un$r in-e'+ii e%+e mi mi' %i $!i#n *%i#i'  b$(n0i($r e%+e %i&ur+.
  B$(n0ii 'u CH %un+ -$r+e %en%ibi(i -+ !e &ermenii *+$&eni %i !e 'ee e%+e in!i'+ ' in
%($nu( 'e%+$r % nu -ie %i b$(n0i 'u %+-i($'$'ii 'u+n+e %u in-e'+ii *u(m$nre.
  Tem*er+ur 'merei +rebuie men+inu+ ( 72C
  P$i+i 'e mi bun *en+ru b$(n0i in *+ e%+e !e'ubi+u( !$r%(, *$i+ie 're %i&ur $ bun
iri&re  -i'+u(ui. In 'ur%u( 'rie($r %'i+$&ene, b$(n0u( +rebuie (%+ %%i (e& %in&ur *$i+i
'e mi '$m$!, 're e%+e !i'++e in *rimu( rn! !e 0$(umu( %'i+ei.

III.C.ROL IN SEMIOLOGIA A*ECTIUNILOR )EPATICE

  CH e%+e une$ri %im*+$m+i' !e 'e(e mi mu(+e $ri in%, e *rein+ -en$mene '$m*(e1e, !e
''e %i%+en+ me!i'( +rebuie % 'un$%' bine %emi$($&i -e'+iuni($r #e*+i'e, in &ener(, 
CH in *r+i'u(r, *en+ru  %+i % in+er0in in %'$*u( in(+urrii mni-e%+ri($r ne&+i0e.
  Sin!r$mu( !i%*e*+i' %e *$+e mni-e%+ %ub -$rm !e:
   b($nri *$%+*rn!i(e
   in*e+en+
   &re+uri
   !ureri m$!er+e in #i*$'$n!ru( !re*+
  Sin!r$mu( #em$r&i*r e%+e %i e( *re%en+ in -e'+re #e*+i' *rin:
   &in&i0$r&ii
   e*i%+1i%
   e'#im$e %*$n+ne
   HDS 'u #em+eme %i me(en
   Inspectia generala r+:
▫  %+e(u+e 0%'u(re *un'+ 'en+r( eri+em+$% 're !i%*re ( '$m*re%ie, !in 'e%+ *(e'n!
+rie'+e -ine %er*ui+$re !e 0%e mi'i e'+i+e
▫ bue 'rmin+e
▫ !e&e+e #i*$'r+i'e
▫ ;'* !e me!u> %ub $mbi(i'
▫ i'+er 
▫ *ruri+
▫ +r$-ie +e%+i'u(r
▫ &ine'$m%+ie.
  He*+$me&(i e1menu( -i'+u(ui %e -'e *rin *(*re %i *er'u+ie
   mr&ine %u*eri$r  m+i++ii #e*+i'e %e !e+ermin *rin *er'u+ie *e (ini
me!i'(0i'u(r=
   mr&ine in-eri$r  -i'+u(ui %e !e+ermin *rin *(*re
  In CH *u+em 0e ini+i( #e*+$me&(ie, !r !e re&u(, in -e mi e0$(u+i0e, -i'+u( e%+e !e
!imen%iuni re!u%e, 'u %u*r-+ ne+e! %u me!u(r, !e '$n%i%+en+ -erm.
  I'+eru( %e !+$re in'*'i++ii -i'+u(ui !e  me+b$(ie bi(irubib.
  Se mni-e%+ *rin '$($r+ie &(ben  +e&umen+e($r, %'rere($r %i mu'$%e($r, une$ri *ruri+ %i
urini #i*er'+$me.
 

  A%'i+ re*rein+ 'umu(re !e (i'#i! in '0i++e *eri+$ne( !+$ri+ 're%+erii *re%iunii

0en$%e *$r+(e %i re!u'ere *r$+eine($r *(%m+i'er, +u(burri($r 'ir'u(+iei (im-+i'e. Cn+i++e
(i'#i!u(ui !e %'i+ 0ri !e ( 35 ( *n ( 2 (.
L in%*e'+ie b!$menu( e%+e mri+ !e 0$(um 0n! %*e'+ !e ;!e%&>, 'n! b$(n0u( e%+e in
$r+$%++i%m %i %*e'+ !e ;b'+r'in>, 'n! b$(n0u( e%+e in '(in$%++i%m, ir in %'i+e(e bun!en+e,
%ub +en%iune, %e i -$rm b!$menu(ui ;in $bu>. Se '$n%++ $ #ernie $mbi(i'( $n-($'e()
're re %*e'+ !e ;!e&e+ !e mnu%>. Pe *ere+e(e b!$menu(ui %e $b%er0 'ir'u(+i '$(+er(
'r'+eri%+i'.
  S*(en$me&(i e%+e *(*bi( in 5 !in 'uri, 0n! '$n%i%+en+ 're%'u+. S*(en$me&(i
&i&n+ %e !+$re !e mu(+e $ri unei +r$mbie  0enei %$(eni'e. S*(in re un %*e'+ brun
r$%i+i', 'u '*%u( in&r$%+, e -iin! re%*$n%bi( !e %e'#e%+rre in *r$*$r+ii 0ribi(e 
+r$mb$'i+e($r ( in-e'+ii.
  Hi*er+en%iune *$r+( re*rein+ 're%+ere *re%iunii %n&e(ui in 0en *$r+ %i in rmuri(eei=
e%+e *reen+ ( b$(n0ii 'u CH. Cue(e *ri+iei ei ( 'ir$+i'i %un+ re*reen++e !e: $b%+'$(u(
$r&ni' %i -un'+i$n( in+r#e*+i'. Sn&e(e *$r+( %i&ur 2<3 !in iri&+i -i'+u(ui, in +im* 'e
%n&e(e r+eri( !$r <3. Semne(e m?$re (e HTP %un+:
   0ri'e e%$-&iene
   #em$r$ii
 'ir'u(+ie '$(+er( %ub'u+n+, b!$min(
   %*(enime&(i.
  En'e-($*+i *$r+( e%+e un %in!r$m neur$($&i' %e'un!r HTP, 'r'+eri+ !e *reen+
;-(**in& +rem$r>u(ui %+eri1i%),  un$r +u(burri neur$($&i'e 'u $bnubi(re *n ( %+re !e
+$r*$re %i '$m.

III.D.ROL IN SUSTINEREA *UNCTIILOR ORGANISMULUI

III.D.1.*UNCTIILE VITALE
   Functiile vitale include: re%*ir+ie, *u(%, +en%iune r+eri( %i +em*er+ure. E(e %un+ -re'0en+
u+i(i+e ' in!i'+$ri i %+rii !e %n++e %u !e b$(.
  A%i%+en+ me!i'( +rebuie %:
 *re&+e%' *'ien+u(
'un$%' 0ri+ii(e n$rm(e (e -un'+ii($r 0i+(e
 '$muni'e me!i'u(ui m$!i-i'ri(e %emni-i'+i0e.

  OBSERAREA SI MASURAREA RESPIRATIEI

 

De-ini+ie E%+e -un'+i $r&ni%mu(ui *rin 're %e re(ie *$r+u( !e O2 ne'e%r   

 *r$'e%e($r 0i+(e in *r(e( 'u e(iminre in +m$%-er  CO2 reu(++ !in
r!eri(e 'e(u(re.
S'$* E0(ure -un'+iei re%*ir+$rii  *'ien+u(ui -iin! un in!i'iu ( e0$(u+iei b$(ii,
( *ri+iei un$r '$m*(i'+ii %i ( *r$&n$%+i'u(ui.
E(emen+e   -re'0en+ mi%'ri($r re%*ir+$rii
  !e   m*(i+u!ine mi%'ri($r re%*ir+$rii
e0(u+   %ime+ri mi%'ri($r re%*ir+$rii
  +i*u( !e re%*ir+ie
  ri+mu( re%*ir+$r 
  !i%*nee
  %u&#i+u( %i +u(burri(e 0$'ii
M+eri(e  -$ie !e +em*er+ure
  *i1 (b%+ru
  'e% 'u %e'un!r 
In+er0en   *$i+i *'ien+u(ui e%+e !e'ubi+ !$r%(
  +ii(e   %em u%$r mn *e %u*r-+ %+ern(  *'ien+u(ui
%i%+en+ei   numrm mi%'ri(e !e ri!i're  +$r'eu(i +im* !e  minu+
   *u+em numr mi%'ri(e re%*ir+$rii -r  *(i' mn *e %u*r-+
+$r'e(ui *'ien+u(ui, numrm *rin $b%er0re %i %u*r0e&#ere mi%'ri($r 
'u+iei +$r'i'e
  '$n%emnre 0($rii $b+inu+e *e FT -ie're (inie $ri$n+( re*rein+ !$u
re%*ir+ii
  *re'iere 'e($r((+e e(emen+e (e -un'+iei re%*ir+$rii %e -'e *rin %im*(
$b%er0re  mi%'ri($r +$r'e(ui
($ri   !$(e%'en+ 525 re%*<minu+
n$rm(e  !u(+ 67 re%*<minu+ Y72 re%*<minu+
  Z 67 re%*<minu+
  0r%+ni' 525 re%*<minu+
MASURAREA PULSULUI

De-ini+ie E1*n%iune ri+mi'  r+ere($r 're %e '$n*rim *e un *(n $%$% %i e%+e

%in'r$n 'u %i%+$( 0en+ri'u(r
S'$* E0(ure -un'+iei 'r!i'e %i  %i%+emu(ui 'ir'u(r r+eri(
E(emen+e  -re'0en+
  !e  ri+mi'i++e
e0(u+  m*(i+u!ine
 'e(eri++e
 +eniune
M+eri(e  'e% 'u %e'un!r 
 *i1 < 'rei$n r$%u *en+ru n$re &r-i'
 -$i !e +em*er+ure
L$'uri !e Ori'e r+er ''e%ibi( *(*rii %i 're *$+e -i '$m*rim+ *e un *(n $%$%:
m%urre  r+er r!i(
 r+er -emur(
 r+er #umer(
 

 r+er 'r$+i!
 r+er +em*$r( %u*er-i'i(
 r+er *e!i$%
In+er0en  re*rre r+erei
  +ii(e  -i1re !e&e+e($r *(*+$re in!e1, me!iu %i ine(r) *e +rie'+u( r+erei
%i%+en+ei  e1er'i+re unei *re%iuni u%$re %u*r *ere+e(ui r+eri( 'u 0r-u( !e&e+e($r 
 *en+ru  *er'e*e un! !e %$'
 %e numr *u(%+ii(e *er'e*u+e +im* !e  minu+
 e-e'+um *(*re bi(+er( 'u %'$* '$m*r+i0e
 *u(%u( *$+e -i m%ur+ !e mi mu(+e $ri *e i 'u %'*$ $rien++i0 *en+ru
'$n!ui+ +er*eu+i'
 %e '$n%emne in FT 0($re $b+inu+ -ie're (inie $ri$n+(  -$ii
re*rein+ *+ru *u(%+ii
 !i-r&m *u(%u(ui e%+e $b+inu+ *rin unire *un'+e($r 'e re*rein+ 0($re
'+u(  *u(%u(ui 'u *un'+u( 'e re*rein+ 0($re n+eri$r  *u(%u(ui
($ri  !u(+ 67*u(%<minu+
n$rm(e  0r%+ni' 7 *u(%<minu+

  MASURAREA TENSIUNII ARTERIALE

De-ini+ie Pre%iune e1er'i++ !e %n&e(e 'ir'u(n+ %u*r *ere+i($r r+eri(i

S'$* E0(ure -un'+iei 'r!i$0%'u(re -$r+ !e '$n+r'+ie  inimii, re*rein+
!e+erminre !e e(%+i'i++e %i '(ibru( 0%e($r)
E(emen+e  +en%iune r+eri( %i%+$(i'  TA m1
 !e  +en%iune r+eri( !i%+$(i'  TA min
e0(u+  +en%iune !i-eren+i(  !i&eren+ !in+re TA m1 %i TAmin
 #i*er+en%iune r+eri(
 #i*$+en%iune r+eri(
M+eri(e  +en%i$me+ru  *r+ *en+ru m%urre TA: 'u mer'ur Ri0R$''i= 'u mn$me+ru,
ne'e%re $%'i($me+ru P'#$n= e(e'+r$ni'e
 %+e+$%'$* biuri'u(r 
 +m*$n !e 0+, '$m*re%e
 %$(u+ii !ein-e'+n+e
 -$ie !e +em*er+ure
 *i1 (b%+ru
Me+$!e  *(*+$rie me+$! !ire'+)
!e!e+er  u%'u(++$rie me+$! in!ire'+)
minre  $%'i($me+ri'
In+er0en  %$&urre re*u%u(ui -ii' %i *%i#i' !e 5 ( b$(n0u(ui
+ii(e  %*(re *e mini
%i%+en+ei  %e *(i' mn%e+ *neum+i' *e br+u( *'ien+u(ui, %*ri?ini+ %i in e1+en%ie,
!e%u*r *(i'ii '$+u(ui
 *$i+i *'ien+u(ui *$+e -i !e'ubi+ !$r%( %u %en!
 %e -i1e membrne %+e+$%'$*u(ui *e r+er #umer( nu e%+e $b(i&+$riu -i1re
'e%+ei %ub mr&ine in-eri$r  mn%e+ei)
 

 in'#i!em %u** !e ( *r !e 'u'iu' %i *$m*m er *n ( !i%*ri+i &$m$+e($r 

 *u(%+i(e
 %e !e'$m*rim *r$&re%i0 eru( !in mn%e+ *rin !e%'#i!ere %u**ei, *n %e
 *er'e*e *rimu( &$m$+ r+eri( TA m1)
 %e '$n+inu !e'$m*rimre *n %e u!e u(+imu( &$m$+ r+eri( TA min)
 in!e*r+m mn%e+ !e *e br+u( *'ien+u(ui
 inre&i%+rm 0($ri $b+inu+e in FT 'u $ (inie $ri$n+(, %$'$+in!u%e *en+ru -ie're
(inie  -$ii $ uni++e H&, !e%u*r (iniei &r$%e %e n$+e TA m1 ir TAmin !e!e%u*+=
%*+i( !in+re 0($ri %e #%ure -$rmn!u%e un !re*+un&#i 'e re*rein+ &r-i' TA
($ri  ( !u(+i TAm1  54mmH&
n$rm(e   TAmin  95mmH&
 ( 0r%+ni'i TAm1  5mmH&
  TAmin  mmH&

Ten%iune 0 -i '$n+r$(+ 'u re&u(ri++e !e *re-erin+ !imine+ ( 'eei $r %i in+$+!eun

( 'e(%i br+. A*(i're mn%e+ei in'$rre'+ !u'e ( 0($ri er$n+e (e TA. Mn%e+ nu +rebuie
 *(%+ ( ni0e( !i-eri+ !e 'e( ( inimii. Se *$+ inre&i%+r 0($ri er$n+e ( *'ien+ii 'e *rein+
'$n0u(%ii, +remur+uri, imbr'min+e 'e '$m*rim 'ir'u(+i ( ni0e(u( br+u(ui.

MASURAREA TEMPERATURII

De-ini+ie Ne'e%i++e $r&n%i%u(ui !e %i men+ine +em*er+ure in (imi+e Fii$($&i'e

!+$ri+ *r$'e%u(ui !e +erm$re&(re
S'$* E0(ure -un'+iei !e +erm$re&(re %i +erm$&ene
L$'uri   1i(
  !e   *(i' in&#in(
m%urre   '0i++e bu'(
  re'+
  0&in
M+eri(e   +erm$me+ru m1im(
ne'e%re   +m*$n !e !e 0+, '$m*re%e %+eri(e
  %*un, *r$%$*
  +0 me!i'(
  re'i*ien+ 'u %$(u+ie !ein-e'+n+
  (ubri-in+
 

  ('$$( me!i'in(
  'e%
 *i1 (b%+ru
In+er0en+ii(e   *re&+ire m+eri(e($r (n& *'ien+
%i%+en+ei   %*(re *e mini
  %e %'$+e +erm$ne+ru( !in %$(u+i !ein-e'+n+, %e '(+e%+e %i %e %+er&e 'u
$ '$m*re% %i %e %'u+ur 'u mi%'ri ener&i'e
 %e 0eri-i' !' e%+e in reer0$r H&
  !u* -$($%ire %e re+r&e %i %e in+r$!u'e in %$(u+i !ein-e'+n+
.M%urre in 1i(
   %e %e *'ien+u( in *$i+ie !e !e'ubi+ !$r%(, %en!, %emi%en!,
!e'ubi+ (+er( %+n&< !re*+ 'u '*u( *e *ern
  %e ri!i' br+u( *'ien+u(ui
  %e %+er&e 1i( *rin +m*$nre 'u *r$%$*u( *'ien+u(ui
  %e %e +erm$me+ru( 'u reer0$ru( !e H& in 'en+ru( 1i(ei, *r(e( 'u
+$r'e(e
  %e *r$*ie br+u( !e +run'#i, 'u n+ebr+u( -(e'++ *e %u*r-+ n+eri$r
 +$r'eu(ui ( in'$n%+ien+i, !inmi'i, &i++e 'e%+ *$i+ie 0 -i
men+inu+ !e '+re %i%+en+
  +erm$me+ru( %e men+ine +im* !e 
 2 M%urre in '0i++e bu'(
  'u 5 inin+e !e m%urre *'ien+u( nu 0 '$n%um (i'#i!e '(!e< re'i
%i nu 0 -um
  %e in+r$!u'e +erm$me+ru( in '0i++e bu'(, %ub(in&u( %u *e (+ur
e1+ern  r'!ei !en+re
  *'ien+u( e%+e ru&+ % in'#i! &ur %i%  re%*ire *en %
  +erm$me+ru( %e men+ine +im* !e 5
 3 M%urre re'+(
  %e m%$r !u* $ K !e $r !e re*u% b%$(u+e
  %e -'e +$(e+ re&iunii n(e
  %e (ub+e-i +erm$me+ru(
   %e %e *'ien+u( in !e'ubi+ (+er( 'u membre(e in-eri$re in
%emi-(e1ie, %i&urn!uI in+imi++e
   %e in+r$!u'e bu(bu( +erm$me+ru(ui in re'+ *rin m$%'ri!e r$++ie %i
inin+re 'ir' 45'm
  %e men+ine +im* !e 5
  +em*er+ure re'+( e%+e mi mre !e'+ 'e 1i(r 'u ,5C mi mre
!e'+ 'e 1i(r
  Se n$+e 0($re $b+inu+ *rin+run *un'+ '$re%*un+$r !+ei %i
+im*u(ui i(ei, %$'$+in!u%e *en+ru -ie're (inie $ri$n+(, !$u !i0iiuni
!e &r!e. Prin unire 'e%+$r %e $b+ine 'urn +ermi'.

III.D.".ALTE *UNCTII ALE ORGANISMULUI

 

  MASURAREA SI NOTAREA DIUREJEI

De-ini+ie Re*rein+ *r$'e%u( !e -$rmre %i e(iminre  urinei !in $r&ni%m

+im* !e 24#
S'$* Ob+inere !e in-$rm+ii *ri0in! %+re m$r-$-un'+i$n(  *r+u(ui
urinr %i  in+re&u(ui $r&ni%m, 'n+i++e %i '(i++e urinei
-urnie !+e im*$r+n+e *en+ru %+bi(ire e0$(u+iei b$(i($r %i 
 bi(n+u(ui in&e%+ie< e1're+ie
M+eri(e   0%e 'i(in!ri'e 'u &+ !e 24 ( &r!+e *e beni !e (eu'$*(%+ 'u
ne'e%re 'rei$n !erm+$&r- 
  -$i !e +em*er+ure
  *i1 (b%+ru
E(emen+e   ri+mu( mi'+iuni($r: n$rm( 56 (<24# ( brb+i
  !e    45 (<24# ( -emei
e0(u+   *+$($&i' 'n+i++e 're%'u+ *$(iurie
   'n+i++e re!u% $(i&urie
   (i*% urinei nurie
  +u(burri(e !e mi'+iune:
   *$(@iurie mi'+iuni -re'0en+e, 'u 'n+i++i mi'i
   i%'#iurie re+en+ie !e urin) im*$%ibi(i++e !e  urin
   !i%urie e(iminre urinii 'u !i-i'u(++e %i !ureri
   ni'+uri in0er%re r*$r+u(ui !in+re numru( mi'+iuni($r %i
'n+i++e !e urin emi% n$*+e -+ !e 'e emi% in 'ur%u( i(ei
   enureie *ier!ere in0$(un+r !e urin in +im*u( n$*+ii
In+er0en   *re&+ire m+eri(e($r *rin 'ur+re re'i*ien+i($r, '(+ire ($r 'u
  +ii(e * !i%+i(+ *en+ru  nu %e m$!i-i' '$m*$i+i urinei, %e '$*er,
%i%+en+ei %e e+i'#e+e, %e n$+e nume(e b$(n0u(ui %i ( %($nu(ui
  %e e!u' b$(n0u( % urinee numi in urinr %i%  nu run'e urin
  %e in'e*e '$(e'+re !imine+, ( $ numi+ $r, %i %e +ermin in
iu urm+$re ( 'ee%i $r
  %e 'i+e%+e &r!+i 're in!i' urin emi% in 24#
   n$+re 0($rii $b+inu+e FT *en+ru -ie're (inie $ri$n+( %e
%$'$+e%+e m( urin
  0%e(e '$(e'++e %e !e*$i+e in in'*eri r'$r$%e %i '$*erire
 %e *re0eni !e%'$m*unere urinei
In+er*re+   0($ri n$rm(e: -emei   4m(<24#
re reu(   brb+e  2  7m(<24#
++e($r    'u($re:
   n$rm(  &(ben !e%'#i% urin !i(u+
  brun in'#i% urin '$n'en+r+e
   *+$($&i'  brun in'#i% in i'+er 
  r$%ie !e%'#i% in #em+urie
  (b%+ru0er!e in +r+men+ 'u (b%+ru !e CH2
  '-eniur$%u in +r+men+ 'u '#inin
 mir$% '#r'+eri%+i' in -un'+ie !e (imen++ie
  %*e'+: n$rm( '(r +rn%*ren+
 

  *+$($&i' +u(bure %n&e, *ur$i, mi'r$be, '('u(i)

OBSERAREA SI NOTAREA SCAUNULUI

De-ini+ie Re%+uri(e (imen+e($r %u*u%e *r$'e%e($r !e !i&e%+ie, e(emen+e !in

$r&ni%m *rin nu%, *rin '+u( !e-e'+iei
S'$* Ob+inere !e in-$rm+ii ne'e%re *en+ru %+bi(ire !i&n$%+i'u(ui %i
urmrire e0$(u+iei b$(i($r +ubu(ui !i&e%+i0e %i  &(n!e($r ne1e
E(emen+e !e $b%er0+
-re'0en+  0($ri n$rm(e 2 %'une<i
  0($ri *+$($&i'e +rn%i+ 're%'u+ 36 %'une<i!iree
  23 %'une<i%in!r$m !ien+eri'
   %'un ( 34 i(e'$n%+i*+ie
   $*rire +rni+u(ui -r %'uni(eu%
$rru(  -ii$($&i': ri+mi', !e $bi'ei ( 'ee%i $r  i(ei
  *+$($&i': *ier!ere $rru(ui $bi%nui+ '$n%+i*+ie %u !iree
'n+i++e  0($ri n$rm(e i(ni' 52&
  0($ri *+$($&i'e mri+ in -e'+iuni(e *n're%u(ui, *$+e ?un&e (
'+e0 @& in n$m(ii !e !e0$(+re  '$($nu(ui
   re!u% in '$n%+i*+ie
   -$r+e re!u% in !ein+erie 5&
'$n%i%+en+  -ii$($&i' *%+$%, $m$&en
  *+$($&i' u%'+, '$n%i%+en+ 're%'u+ in '$n%+i*+ie
   '$n%i%+en+ %'u+ in !iree %'une m$i)
   (i'#i!, *$% in %*e'i( !u* *ur&+i0e %(ine
-$rm  -ii$($&i' 'i(in!ri' 'u !ime+ru( !e 35'm, (un&ime 0ribi(
  *+$($&i' !e *n&(i' %u 'rei$n in 'n'er re'+(
   -i(i-$rm in %+en$  re&iunii re'+(e
   !e bi(, &($b in '$n%+i*+ie
'u($re  -ii$($&i' brun
  *+$($&i' &(ben uriu in !iree
   0er!e 'n! bi(irubin %e $1i!e in '$($n
   in'#i% in '$n%+i*+ie
   brunin'#i% in i'+eru( #em$(+i'
   (bi'i$% ' r&i( in i'+eru( me'#ni'
   ne&r ' *ur*ur %i (u'i$% in #em$r&i in *$r+iune
%u*eri$r  +ubu(ui !i&e%+i0e me(en
   r$%ie in #em$r&i in *$r+iune in-eri$r  +ubu(ui !i&e%+i0
mir$%u(  -ii$($&i' -e'($i!
  *+$($&i' 'i! in ' !e -ermen++ie in+e%+in(
   -e+i! in ' !e *u+re-'+ie
 

   rn'e! 'n! in %'un e1i%+ &r%imi ne!i&e%+i0e

E1e'u+ie
In+er0en   %e %e*r *+u( !e re%+u( %($nu(ui 'u *r0n
  +ii(e   %e in!e*r+e *+ur %i 'er'e-u( 're '$*er *'ien+u(
%i%+en+ei   %e *+$+e?e *+u( 'u mu%mu %i (e
  %e !ebr' *'ien+u( *r+e in-eri$r)
  %e ri!i' *'ien+u( %i %e in+r$!u'e bine+u( '(! %ub re&iune %'r(
  %e '$*er 'u in0e(i+$re *n +ermin '+u( !e-e'+iei
  %e e-e'+ue +$(e+ re&iunii *erin(e
  %e in!e*r+e bine+u( 'u +en+ie
   %e '$*er 'u '*'u( %u in0e(i+$re %*e'i( *re&+i+ %i %e
in!e*r+e !in %($n
  %e %+rn& m+eri(e(e -$($%i+e
  %e imbr' *'ien+u(, %e re-'e *+u(
  %e eri%e%+e %($nu(
  %e %*( mini(e *'ien+u(ui
  %'unu( '$*eri+ %e *%+re *en+ru 0ii+ me!i'( in ($'uri %*e'i(
men?+e
 N$+re   n$+re %'une($r in FT %e -'e *rin %emen '$n0en+i$n(e
%'une($r     m$(e  <
   !iree  
   mu'u%  1
   *ur$i  P
   %n&e  S in 'rei$n r$%u
   &run?$%  
  !' numru( %'une($r e--e'+u+e in+r$ i e%+e -$r+e mre, %e n$+e
numru( +$+( urm+ !e %emnu( '$n0en+i$n( re%*e'+i0e e1: 4< 4
%'une m$i)

III.E.ROL IN E*ECTUAREA UNOR INVESTIGATII PENTRU

STA-ILIREA DIAGNOSTICULUI

III.E.1.RECOLTAREA SANGELUI CAPILAR

E1mene(e  #em$(eu'r$&rm
uu(e !e  e1mene m$r-$($&i'e -r$+iu, *i'+ur &r$%)
%n&e:  !$re !e #em$&($bin
 !e+erminre +im*u(ui !e %n&erre %i '$&u(re
 !e+erminre &ru*e($r %n&0ine
M+eri(e  'e, '$m*re%e, mnu%i %+eri(e
ne'e%re
 

 %$(u+ie !ein-e'+n+, +m*$ne !e 0+

 (me !e&re%+e, (me(e *en+ru -r$+iuri
 *i*e++e P$n+in *en+ru nimr+$re e(emen+e($r -i&ur+e).
In+er0en  *re&+ire *%i#i' !e%'riere '+iunii %i  ne'e%i++ii e-e'+urii 'e%+ei
  +ii(e  *$i+i$nre *'ien+u(ui in -un'+ie !e %+re &ener( %i -e'+iune !r 
%i%+en+ei $b(i&+$riu 'u mn %*ri?ini+
 %*(m mini(e *'ien+u(ui 'u * '(! %i %*un, %i (e u%'m '$rre'+
 !u* !e&re%re, !ein-e'+m !e&e+u( %i inin+e !e  '$n+inu ne %i&urm
' e%+e '$m*(e+ u%'+
 %+rn&em !e&e+u( 'u *u+ere %*re %u*r-+ 're $ 0$m *un'+i$n, !e
$bi'ei *u(* !e&e+e($r ine(r %i me!in !e ( mn %+n&) +im* !e 3
%e'un!e e0i+n! '$m*rimre *re(un&i+
 *un'+i$nm !e&e+u( 'u 'u( %+eri( *rin+r$ mi%'re r*i! %i -erme !e%+u(
!e *r$-un! *en+ru $b+inere %*$n+n  %n&e(ui
 %+er&em *rim *i'+ur !e %n&e 'u '$m*re% %+eri( %i *$i re'$(+m
%n&e(e *en+ru e1mene(e ne'e%re.
In+er*re+re reu(++e($r 

Hem$(eu  0.n: eri+r$'i+e  ♂  4,55,5 mi(.<mm

'$&rm   ♀ = 4,24,7 mi(<mm
  re+i'u($'i+e  5 ‰
   #em$&($bin ♂  5±2&<m(
  ♀  3±2&<m(
 (eu'$'i+e  427<mm
   *$(inu'(ere neu+r$-i(e ne%e&men++e  ,5
   *$(inu'(ere neu+r$-i(e %e&men++e  459
   e$in$-i(e  3
   b$-i(e  
   (im-$'i+e  24
   m$n$'i+e  47
   +r$mb$'i+e  5 4 <mm
Tim*ii !e +im*u( ui'@ 0.n.  ,53,5>
'$&u(re +im*u( H$/e(( 0.n.  3>23>
-ibrin$&en 0.n.  24m&
 

III.E.".RECOLTAREA SANGELUI VENOS CU TRUS

VACUTAINER

  Si%+emu( 'u+iner !e re'$(+re  %n&e(ui 0en$% '$n%+i+uie %i *rein+ $ +e#ni' %im*(,

%i&ur men+inn! in% *re'u+ii &ener(e ':
  ▫ %*(re mini($r 'u * %i %*un, !ein-e'+re ($r 
  ▫ e'#i*men+ !e *r$+e'+ie: mnu%i, m%', #(+ %.
 

  ▫ e0i+re e1*unerii ( '$n+minre 'u &en+i in-e'+i$%i

  ▫ men+inere %e'uri++ii *er%$n(u(ui me!i'(.
  Re'$(+re %n&e(ui *rin *un'+ie 0eni% *en+ru in0e%+i&+ii !e (b$r+$r, %e *r'+i' !imine+
 *e nemn'+e, in +im*u( -ri%$ne($r %u ( in!i'+i me!i'u(ui in!i--eren+ !e $r.

M+eri(e  X e'#i*men+ !e *r$+e'+ie: mnu%i, m%', #(+ %.

ne'e%re   X in -un'+ie !e '$!u( !e 'u($re ( !$*u(ui *reen+m +uburi(e
'u+iner:
   r$%u  'u+iner *en+ru '#imie '(ini'
   0er!e 'u+iner 'u (i+iu #e*rin *en+ru n(ie bi$'#imi'e
     'u+iner SST[ *en+ru '#imie '(ini'
   m$0 'u+iner ETA"3 *en+ru n(ie #em+$($&i'e
   (b%+ru 'u+iner *en+ru !e+erminri !e '$&u(re
   ne&ru 'u+iner %e!i+iner) *en+ru !e+erminri !e SH
 ▫ #$(!er 
 ▫ ' in 'r'% % *r$+e'+$re, 0eri-i'm in+e&ri++e benii !e %in&urn+
%i 0(bi(i++e +ermenu(ui !e u+i(ire
 ▫ &r$u e(%+i'
 ▫ %$(u+ie !ein-e'+n+
 ▫ +m*$ne !e 0+, '$m*re%e %+eri(e, *n%men+ !ei0
 ▫ +uburi(e 'u+iner '$re%*un+$re n(ie($r 'eru+e
 ▫ $r!ine *re(e0rii in +uburi e%+e:
   -('$ne *en+ru #em$'u(+ur
   +uburi -r !i+i0i
   +uburi *en+ru !e+erminri !e '$&u(re 'i+r+e !e N
   +uburi 'u !i+i0i EDTA

In+er0en  ▫ *re&+ire *%i#i' %i in%+(re *'ien+u(ui *en+ru re'$(+re

  +ii(e  X %*(re mini($r 'u * %i %*un, !ein-e'+re ($r 
%i%+en+ei  X 0eri-i're %i '$m*(e+re !+e($r *ri0in! *r$be(e %n&0ine !e re'$(++
in!i'+e !e me!i'
 ▫ (e&ere %i *re&+ire m+eri(u(ui *en+ru *un'+i 0en$%
 ▫ *(i're &r$u(ui
 ▫ !ein-e'+re ($'u(ui !e e(e'+ie
 ▫ e-e'+ure *un'+iei 0en$%e
 ▫ e-e'+ure re'$(+rii
 ▫ *(i're *n%men+u(ui !ei0
 ▫ re$r&nire me!i'u(ui
 ▫ +rimi+ere +uburi($r ( (b$r+$r 
 ▫ m$n+re #$(!er':
   +inem 'u( 'u mbe(e mini
   e-e'+um $ mi%'re !e r%u'ire !in+r$ *r+e %*re 'e((+ 0n! ($'
%+-e( ru*ere benii !e %i&urn+
 

   in!e*r+m 'r'% *r$+e'+$re !e 'u($re (b

   %e in%urube '*+u( (iber ( 'u(ui in #$(!er, nu %'$+em in'
'r'% !e *e 'e(((+ '*+ ( 'u(ui
Pun'+i 0en$%
   (e&em ($'u( *un'+iei %i i( !ein-e'+m
   men+inem br+u( *'ien+u(ui in'(in+ in ?$% 'u *umnu( %+rn%
   in+in!em *ie(e, 'u ?u+$ru( *$(i'e(ui, ( 45 'm %ub ($'u( *un'+iei,
 *en+ru im*bi(ire 0enei %i -'i(i++e *ene+rrii 'u(ui
   !e+%m 'r'% '$($r+  'u(ui
   in+r$!u'em 'u( in 0en
    in+r$!u'em +ubu( in #$(!er *u'n! ri*i$re(e (+er(e (e
#$(!eru(ui 'u in!e1u( %i me!iu%u(, ir 'u *$(i'e(e im*in&em +ubu(
 *re%iune !e im*in&ere %e e-e'+ue numi %u*r #$(!eru(ui nu %i
%u*r 'u(ui -(+ in 0en
   '*+u( '*+u%i+ ( 'u(ui %+r*un&e !i-r&m &um+  '*+u(ui
+ubu(ui 'u+iner, ir %n&e(e 0 -i %*ir+ in +ub
   'n! %n&e(e nu mi 'ur&e in +ub 'e%+ 0 -i %'$%
   #$(!eru( e%+e men+inu+ %+bi(
   in +im*u( re'$(+rii unui n$u +ub, +ubu( !e? um*(u+ %e re%+$rn !e
'+e0 $ri *en+ru  %e me%+e' 'u !i+i0u( !in +ub
   !u* re'$(+re '$m*rimm ($'u( *un'+iei 35 minu+e 'u un +m*$n
%+eri( imbib+ in %$(u+ie n+i%e*+i', ir ( *'ien+ii 'u +r+men+
n+i'$&u(n+ %u n+i&re&n+ *('#e+re !ur+ '$m*re%iei +rebuie
mri+ %i *(i'm *n%men+ !ei0
 
C$m*(i' ▫ !' %n&e(e nu e%+e %*ir+ in +ub '$n+r$(m ' 'e%+ % -ie '$rre'+
+ii *$%ibi(e im*in% in #$(!er 
  ▫ !' %n&e(e nu 'ur&e, nu m *un'+i$n+ '$rre'+ 0n %i im*in&em %u
re+r&em 'u( -r ( %'$+e !in 0en
 ▫ ++ +im* '+ 'u( %e &%e%+e %ub *ie(e +ubu( e%+e 0i!+ ir %n&e(e 0 -i
%*ir+ ime!i+ 'e m *un'+i$n+ '$rre'+ 0en
 ▫ #em+$m *rin in-i(+rre %n&e(ui in +e%u+u( *eri0en$%
 ▫ %+r*un&ere 0enei *er-$rre *ere+e(ui $*u%
 ▫ me+e(i, *($re, (i*$+imie
In+er*re+re reu(++e($r 
SH  0.n. ♂  37mm<( $r
   75mm<2 $re
  ♀  52mm< $r
   2mm<2 $re
ET  0.n. ♂  45
  ♀ = 42%
 
 

III.E.%.URMARIREA -ILANTULUI LIC)IDIAN

  Pen+ru  urmri bi(n+u( (i'#i!in in $r&ni%m, e%+e ne'e%r % %e n$+ee ++ in+rri(e '+ %i
ie%iri(e  !iure m%ur+ 'u e1'+i++e %i (+e *ier!eri).
  In+rri(e %un+ '$n%+i+ui+e *rin * !in (imen+e %i bu+uri *, %u*, 'ei) *e !e $ *r+e %i *rin
* *r$0eni+ !in me+b$(i%mu( 'e((u(r, *e !e (+ *r+e.
In une(e 'uri %un+ %i (+e in+rri: *er-uie, +rn%-uie.
  Ie%iri(e %un+ '$n%+i+ui+e *rin urin, %'un %i *ier!eri in%en%ibi(e '(e *u(m$nr %i 'u+n+)
%u *$+ -i *ier!eri n$rm(e, *+$($&i'e: *ier!erei in ' !e -ebr, 0r%+uri, !iree, %*ir+ii,
-i%+u(e, !ren?e 're *$+ -i !e %emene, m%ur+e, e0(u+e '+ mi e1'+ %i n$++e *en+ru bi(n+u(
(i'#i!in.
  Pen+ru -ie're &r! *e%+e 39 C %e 0 '('u( $ *ier!ere %u*(imen+r !e 5m(. Se 0 n$+ !e
%emene !e '+ $ri  -$%+ %'#imb+ un *n%men+ %i &r!u( !e imbibre. Se e%+ime ' *rin+r
un *n%men+ bun!n+ imbib+ %e *$+ *ier!e 'ir' 59m( *.
Un bi(n+ e'#i(ibr+ in+re in+rri %i ie%iri men+ine $ #i!r+re '$n%+n+.

  Bi(n+ in+rri ie%iri

  In+rri Ie%iri
Bu+uri ≅  Urin ≅ 5
A(imen+e ≅  S'un ≅ 
Me+b$(i%m ≅3 Pier!eri in%en%ibi(e ≅ 7
Per-uie in -un'+ie !e Pier!eri n$rm(e
'n+i++e *er-ubi()  0$m
 !iree
 -ebr
 -i%+u(e

III.E.,.GREUTATEA CORPORALA SI INALTIMEA

  Cun$%+ere &reu++ii '$r*$r(e e%+e im*$r+n+ *en+ru *re'iere %+rii !e nu+ri+ie 

 b$(n0u(ui, *en+ru %+bi(ire !$ei +er*eu+i'e !e me!i'men+e, *en+ru %+bi(ire ne'e%i++ii
'($ri'e  $r&ni%mu(ui, '+ %i *en+ru urmrire e0$(u+iei b$(i($r.
  Cantarirea pacientilor adulti se face cu a2utorul cantarelor .
 'n+rire $bi%nui+  b$(n0i($r %e -'e +$+!eun !imine+ *e nemn'+e !u* 'e b$(n0u( 
0u+ %'un %i urin, 0n! 'e(e%i #ine %i !' e%+e *$%ibi( 'u 'e(%i 'n+r=
 *en+ru 'n+riri mi e1'+e %e 0 %'!e !in &reu++e +$+( &reu++e imbr'min+ei
   "eterminarea inaltimii corporale- taliometru.
 b$(n0u( e%+e %e+ in *i'i$re %ub 'ur%$ru( +(i$mer+u(ui %i e%+e in0++ % %+e '+ mi !re*+
 r*$r+u( &reu++e<in(+ime e%+e !e 4,2 ( brb+e %i 3, ( -emei
 b$(n0ii !u(+i %e 'n+re%' ( in+ernre, *$i !e 2 $ri *e %*+mn, *re'um %i in iu *(e'rii
 

 in une(e -e'+iuni %u in 'ur%u( un$r +r+men+e e%+e ne'e%r ' b$(n0u( % -ie 'n+ri+ in -ie're
i
 in -e'+iuni(e in%$+i+e !e e!eme in%u-i'ien+ 'r!i', -e'+iuni ren(e, in ' !e 'ir$
%'i+$&en) b$(n0u( +rebuie 'n+ri+ i(ni', *en+ru ', *rin inre&i%+rre '$n'$mi+en+  &reu++ii
'$r*$r(e,  (i'&i!e($r '$n%umm+e %i  !iureei, % ne *u+em $rien+ %u*r &r!u(ui !e re+en+ie
(i'#i!in
 'n+rire e%+e $bi(&+$rie in +im*u( +r+men+u(ui 'u me!i'men+e !iure+i'e
 &reu++e '$r*$r(  b$(n0u(ui +rebuie n$++ *e FT n$+re %e -'e in @&, ir rubri'
reer0+ 'e%+ui %'$*.

III.E..O-SERVAREA APETITULUI SI A MODULUI IN CARE -OLNAVUL RESPECTA

PRESCRIPTIILE MEDICALE

 !petit   *$-+ !e mn're

 Inapetenta  (i*% *$-+ei !e mn're
 !norexie  %'!ere %u (i*% *$-+ei !e mn're
Scop $b%er0re *e+i+u(ui urmre%+e !e%'$*erire %i '$mb+ere in*e+en+ei %u n$re1iei
 b$(n0u(ui.
  Pen+ru '$mb+ere in*e+en+ei %i n$re1iei b$(n0u(ui %e *r$'e!e %+-e(:
X %e 0eri-i' !' in*e+en+ b$(n0u(ui e%+e +$+( %u re*u(%i (ui %e mni-e%+ numi -+ !e
(imen+e(e !in re&im
▫ %e %i&ur %er0ire me%ei in+run '!ru '+ mi e%+e+i'
▫ *en+ru b$(n0ii in*e+en+i me%e(e %e %er0e%' ( in+er0( !e 23 $re, 'u *$r+ii mi'i
▫ %e %er0e%' b$(n0i($r (i'#i!e re'i, u%$r 'i!i-i+e, 'u (mie, (+ernn!u(e *en+ru  %e %i&ur $
0rie++e '+ mi mre
▫ b$(n0u(ui in*e+en+ nu i %e !mini%+re (i'#i!e #i*er#r+e &u%+u( !u('e *r$0$' re(+i0e
re*e!e $ %en+ie !e *(e+i+u!ine %i -0$rie !e%e !iree)
▫ *r$-i+n! !e %e+e b$(n0u(ui i %e *$+ $-eri e(emen+e nu+ri+i0e %ub -$rm (i'#i!
▫  %e %i&ur ne'e%ru( '($ri' 253'(<i) *rin !mini%+rre !e *re*r+e (i'#i!e
#i*er'($ri'e
▫ in m$!u( in 're *e+i+u( in'e*e % re0in, %e !mini%+re b$(n0u(ui $ (imen++ie %$(i!,
re*r+i+ in 45 me%e
▫ %e 0 urmri ' b$(n0u( % '$n%ume numi (imen+e '$n-$rm *re%'ri*+ii($r me!i'(e.

III.E./.PARACENTE+A 6PUNCTIA EVACUATORIE A ASCITEI )

  Ascita  'umu(re !e (i'#i! in '0i++e *eri+$ne( 're *rin 0$(umu( %u in -r !e ?en,
!e'$n-$r+ *$+e *r$0$' +u(burri 'ir'u(+$rii *rin *re%iune e1er'i++ %u*r !i-r&mu(ui %u
e!eme !e '$m*re%iune (e membre($r in-eri$re *rin *re%iune e1er'i++ %u*r 0enei '0e
in-eri$re.
 

 
E'$&r-ie #e*+i': -i'+ 'u %+ru'+ur in$m$&en, %u*r-+ nere&u(+ in
 *reen+ %'i+ei

De-ini+ie Tr0er%re *ere+e(ui b!$min( 'u *+run!ere in '0i++e *eri+$ne( *rin

in+erme!iu( unui ' %u +r$'r 
S'$* ▫ e1*($r+$r
   *un'+ie e1*($r+$rie  b!$menu(ui 'u %'$* !i&n$%+i' re(i+ *rin
+r0er%re *ere+e(ui b!$min(
   re'$(+re (i'#i!u(ui *en+ru e1minre
   !e+erminre %u*rin-e'+iei b'+eriene  (i'#i!u(ui !e %'i+
▫ +#er*eu+i'
   *un'+ie e0'u+$rie *en+ru '$(e'+i (iber !e (i'#i! bun!n+ %'i+
   !mini%+rre +r+men+e($r n+ib'+eriene
M+eri(e ▫ %$(u+ie %e*+i' *en+ru 'rere 'm*u(ui 'u+n+, %$(u+ii n+i%e*+i'e *en+ru mini
ne'e%re ▫ +m*$ne %i '$m*re%e %+eri(e, 'm*uri %+eri(e *er-$r+e
▫ m%', b$ne+, mnu%i '#irur&i'(e %+eri(e
▫ 'e !e 46mm %+eri(e 'u '(ibru re!u%
▫ ' %*in( %i +r$'r %+eri( in 'u( m$n+rii '+e+eru(ui *eri+$ne(
▫ %erin&i %+eri(e !e 2m(, ne%+ei' ($'( 1i(in ),
▫ +uburi *en+ru re'$(+re (i'#i!u(ui
▫ '+e+er mu(+i*er-$r+ !e u+i(ire uni' %i re'$r! %+eri( *en+ru '+e+er 
▫ -('$ne !e #em$'u(+ur er$be %i ner$be *en+ru in%mn+re !ire'+ 'u (i'#i!
▫ *en%e '#irur&i'(e %+eri(e, bi%+uriu *en+ru in'ii 'u+n+, *$r+ ', ', -ir %in+e+i'
▫ %ub%+n+e me!i'men+$%e n(e*+i'e %i +$ni'r!i'e
▫ mu%m, (e %ub *'ien+
▫ 0% !e '$(e'+re  (i'#i!u(ui e0'u+e
▫ in ' !e '$m*en%re %i%+emi' *rin *r$!u%e !e um*(ere  *+u(ui 0%'u(r %un+
 *re&+i+e *r$!u%e !in (bumin umn
Or&ni ▫ *un'+i %e e1e'u+ in 'bine+u( !e +r+men+e %u in %($n
 

re me!iu ▫ (umin$i++e %i +em*er+ur !e'0+

  (ui ▫ i$(re *'ien+u(ui *rin+run *r0n
▫ %e in+eri' '+i0i++i(e !e 'ur+enie %u 0ii++$rii
▫ in%+rumen+ru( *re&+i+ *e m% !e +r+men+ e%+e '$*eri+ 'u un 'm* %+eri(
E-e'+ure ▫ 'e( 're $ re(ie e%+e me!i'(, in% '$$*erre %i%+en+e($r e%+e *re+i$% %i
 *un'+iei in!i%*en%bi(
▫ *$+ -i -e'++e !$u +i*uri !e *un'+ie:
   *un'+i 'u 'u( *en+ru re'$(+re !e (i'#i! in %'$* !i&n$%+i' %u e0'ure
(imi++ *en+ru 0$(um !e %'i+
   *un'+i 'u +r$'r 're *ermi+e m$n+re '+e+eru(ui *eri+$ne( in 0e!ere
e0'urii '$m*(e+e, imme!i+e !e (i'#i! 'n+i++i mri)
 
MEDIC A.M. A.M.2
  Me!i'u( %e+ ( %+n& Pre&+e%+e ($'u( *un'+iei, P$i+i$ne *'ien+u( '$re%
 *'ien+u(ui re*ere ($'u( %erin& 'u ne%+ei'  *un+$r !u* *re&+ire
 *un'+iei  *+u(ui 'u mu%m, (e,
'er'e- 
Dein-e'+e ($'u( *un'+iei %i
 *rein+ me!i'( %erin& 'u
ne%+ei'
E1e'u+ ne%+ei ($'(  ▫  *re&+e%+e mnu%i(e Men+ine *$i+i *'ien+u(ui
 *ere+i($r *(n 'u *(n '#irur&i'(e %i 'm*uri(e
%+eri(e !e'u*+e 'en+r(
▫  b!i?$ne !in n$u !u*
ne%+eie 'u +in'+ure !e i$!
($'u( *un'+iei
▫  %er0e%+e mnu%i(e
'#irur&i'(e %i 'm*u( %+eri(
Imbr' mnu%i(e %i %e Pre&+e%+e 'u( !e *un'+ie, Su*+0e&#e *'ien+u( %i
'm*u( %+eri( %erin& !e 2m( %u in 'u( '$n-$r+u( 'e%+ui
in'iiei 'u+n+e bi%+uriu(
 *en+ru in%er+ie %i (e %er0e%+e
E1e'u+i *un'+iei 'u ' %u ▫ *re&+e%+e m+eri(ui ne'e%r  M$ni+$rie e1*re%i -e+ei
in'iie 'u+n+ 'u bi%+uriu( in  *en+ru re'$(+re (i'#i!u(ui  b$(n0u(ui, *u(%u(, re%*ir+i,
'u( *un'+iei 'u ' %erin& %e !e%+in+ (b$r+$ru(ui in 'u($re +e&imen+e($r 
!*+e ime!i+ !u* 0e!re e-e'+urii e1menu(ui
re+r&ere mn!renu(ui, ir   bi$'#imi', b'+eri$($&i'
in%er+i '+e+eru(ui re ($' ▫  +un'i 'n! %e re(ie
$!+ 'u mn!renu( in 'u( e0'ure (i'i!u(ui *re&+e%+e
in'iiei) +ubu(+ur %+eri(e, r'$r!u(
%+eri(, r$bine+u( %+eri( %i 0%u(
!e '$(e'+re
eri-i' *reen+ (i'#i!u(ui %i ▫  re'$(+e (i'#i!u( in +uburi E0(ue %+re &ener( 
!*$%+e +ubu(+ur in %u e*rube+e  *'ien+u(ui *en+ru !urere,
mnier %+eri(e *en+ru ▫  in ' !e e0'ure n1ie++e, -'ie%, '$n-$r+
e0'ure %u*r0e&#e %'ur&ere
 

(i'#i!u(ui in 0%u( '$(e'+$r 

E0i+ um*(ere '$m*(e+  eri-i' mi%'ri(e re%*ir+$rii
0%u(ui '$(e'+$r  (e *'ien+u(ui
Su*r0e&#e Pre&+e%+e *r$!u%e(e !e Men+ine *$i+i *'ien+u(ui 'u
!e'$m*rimre '0i++ii um*(ere (e %e'+$ru(ui 0eri-i're '$n-$r+u(ui
b!$min(e ( *rim 0%'u(r *en+ru '$m*en%re 'e%+ui %i in ' e1'e*+i$n(
 *r'en+e nu %e e0'ue %i%+em+i' in 'u( !e in+reru*ere  %'ur&erii
mi mu(+ !e 45 (i+ri) e0'uri($r -re'0en+e !e (i'#i! (i'#i!u(ui m$bi(ie (
'ir$) in!i'+i me!i'u(ui *'ien+u(
 *en+ru %'#imbre *$i+iei
E0'ure (i'#i!u(ui %'i+i' ne'e%i+ une$ri *e%+e 36 +i*m in 're *'ien+u( e%+e %u*r0e&#e+
 *ermnen+ *en+ru %+re &ener( %i '$m*(i'+ii *$%ibi(e 0i+e !e e0'ure nu +rebuie % -ie mi
mre !e  (i+ru ( 5)
Re+r&e 'u( *rin+r$ mi%'re B!i?i$ne ($'u( *un'+iei 'u S+rn&e 'er'e-u( in ?uru(
r*i! %i e-e'+ue m%? +in'+ure !e i$! %i *(i' b!$menu(ui *en+ru
ener&i' *e ($'u( *un'+iei  *n%men+ %+eri(, u%'+,  b!i?$nre -i1n!u( '+ mi
E0'ure 0$(umu(, 'u($re '$m*re%i0 %i&ur 
(i'#i!u(ui e0'u+e %i n$+e Trn%*$r+ ur&en+ m+eri(u( Re$r&nie %($nu( %u
!+e(e in FO e1+r% ( (b$r+$r !u* 'bine+u( !e +r+men+
!e+erminre 0$(umu(ui !e
(i'#i! e0'u+
 E0(ue 0$(umu(, 'u($re Trn%*$r+ ur&en+ m+eri(u( Re$r&nire %$(u(ui %u
(i'#i!u(ui e0'u+e %i n$+e e1+r% ( (b$r+$r !u* 'bine+u( !e +r+men+
!+e(e in FO !e+erminre 0$(umu(i !e
(i'#i! e0'u+
C$n!ui+ ▫ *$i+i$nm *'ien+u( !u* bn!?re '$m*re%i0 '+ mi '$m$! in*+ 0n!
 *$%+*un'+ie &ri? ' ($'u( *un'+iei % -ie '+ mi %u% *en+ru  e0i+ *re%iune (i'#i!u(ui rm%
  in b!$men %u*r ($'u(ui *un'+iei
X 'rem '$n!i+ii !e me!iu $*+ime *en+ru +em*er+ure, (umin$i++e, +m$%-er !e
$!i#n %i (ini%+e
▫ e0(um -un'+ii(e 0i+(e !u* *un'+ie
▫ m%urm 'ir'um-erin+ b!$min(  *'ien+u(ui !u* in!e*r+re bn!?u(ui
'$m*re%i0 !u* 56 $re)
▫ 'n+rim *'ien+u(
▫  ( in!i'+i me!i'u(ui re'$(+m *r$be *en+ru !e+erminre i$n$&rmei %i
're+ininei !u* 47 !e $re !e ( e0'ure
▫ m$ni+$rim +en+ -un'+i ren(
▫  *en+ru ree'#i(ibrre #i!r$e(e'+r$e(e'+r$(i+i' ( in!i'+i me!i'u(ui b$r!m
'(e 0en$% *en+ru *er-uii
▫ ( $ri'e m$!i-i're  -un'+ii($r 0i+(e, !e'$($rre ''en+u+e %u +en!in+ (
(i*$+imii, '$(*% nun+m !e ur&en+ me!i'u(
C$m*(i' In +im*u( *un'+iei:
+ii *$%ibi(e ▫ *un'+i$nre in+r$ $n in -r riei !e m+i++e
  ▫ *un'+iei (b +un'i 'n! 'u( nu  -$%+ (e% in -un'+ie !e '$r*$(en+ b$(n0u(ui
▫ !urere 're%'u+ ( m$n++u( %i !em$n++u( %erin&ii %u ( unui +ub *e ' *rin
m$bi(ire 'e%+ui
 

▫ (ere unui 0%

▫ #em+$m 're im*une #em$%+
▫ '$(*% *rin !e'$m*rimre bru+( %i bru%'  '0i++ii b!$min(e
▫ #em+eme %i me(en *rin !e'$m*rimre bru%'
 Du* *un'+ie:
▫ #em$r&ie in+ern
▫ !ee'#i(ibru #em$e(e'+r$(i+i'
▫ in%+(re unei in%u-i'ien+e ren(e -un'+i$n(e
▫  -re'0en+ *$%+*un'+ie (i'#i!u( 'ur&e *rin $ri-i'iu( *un'+i$n( +un'i 'n!
'$m*re%i ($'( nu  -$%+ e-e'+u+ ener&e+i'
▫ *eri+$ni+ *rin *er-$rre in+e%+inu(ui
▫ #i*$*r$+einemie %i %+ri !e '%e'+ire  $r&ni%mu(ui *rin *un'+ii e0'u+$re
re*e++e

REACTIA RI(ALTA
  Re'+i Ri0(+ '$n%+ in e1minre bi$'#imi'  (i'#i!u(ui e0'u+e *rin *un'+ie.
  M+eri(e:
▫ *#r '$ni' !e 2m(
▫ 5m( * !i%+i(+
▫ %$(u+ie !e 'i! 'e+i' &('i(
▫  *i*e+e
  E1e'u+ie:
X in *#ru( '$n$' %e *un 5m( !e * !i%+i(+ %i $ *i'+ur !e %'i! 'e+i' &(%'i(, %e !u& 
2 *i'+uri !in (i'#i!u( !e 'er'e++
▫ re'+i e%+e *$i+i0 'n! *i'+ur !e (i'#i! %e +rn%-$rm in+run n$r ' un ;-um !e +i&r>,
'ee 'e in%emn ' (i'#i!u( e0'u+e e%+e b$&+ in (bumine, -iin! !e n+ur in-(m+$rie,
 *ur+n! nume(e !e e1u!+
▫ re'+i e%+e ne&+i0e 'n! *i'+ur !e (i'#i! '!e in *#r -r % *r$!u' m$!i-i'ri e%+e
(i'#i! %r' in (bumine %i *$r+ nume(e !e +rn%u!+.
III.E.0.LAPAROSCOPIA 6CELIOSCOPIA7
 
 

De-ini+ie E1*($rre '0i++ii *eri+$ne(e, !e%+in% in *re(bi( *rin *neum$*eri+$neu

in+r$!u'ere !e re in '0i++e *eri+$ne(), 'u ?u+$ru( *r+ numi+
(*r$%'$*, in+r$!u% +rn%*rie+(, *rin+run +r$'r.
S'$* E1*($r+$r
▫ %e re(ie *rin e1minre !ire'+, *rin in%*e'+i %u*r-e+ei -i'+u(ui, %*(inei,
'$(e'i%+u(ui, 'i($r bi(ire e1+r#e*+i'e, *ere+i($r b!$menu(ui, !i-r&mu(ui,
+ubu( !i&e%+i0e, *r+e($r &eni+(e Bi$*+i'
▫ %e *$+ *re(e0 -r&men+e e1.: *un'+i bi$*%i'  -i'+u(ui) *en+ru e1mene
#i%+$*+$($&i'e
Ter*eu+i'
▫  %un+ *$%ibi(e in+er0en+ii '#irur&i'(e: *en!i'e'+$mie, 0&$+$mie,
'$(e'i+e'+$mie, $0re'+$mie

L*r$%'$*u(

▫ re -$rm +ubu(r %i e%+e *re0u+ 'u un %%+em $*+i' %i $ %ur% !e (umin re'e %i %e in+r$!u'e in
'0i++e *eri+$ne( *rin+run +r$'r 
▫ +r$'ru(, 'u $ &r$%ime !e 72mm, re ( e1+remi++e *r$1im( un 0en+i( 're $*re%+e ie%ire
eru(ui !in '0i++e *eri+$ne(
▫ mn!rinu( %+i(e+, !e*%in! (un&ime +ubu(ui 'u 'm, 'u 0r-u( %'u+i+ 'u 23 +i%uri, re r$(u( !e
 %i&ur *+run!ere +r$'ru(ui in '0i++e *eri+$ne(
▫ *rin e( %e in+r$!u'e, *$i (*r$%'$*u( 're e%+e *re0u+ 'u un %%+em !e -ibre $*+i'e *rin 're
im&ine e%+e +rn%mi% ( un m$ni+$r)
▫ un %%+em !e i(umin+ %i un %%+em !e %*(re  (en+i(ei
▫ %i%+emu( !e i(umin+ e%+e -$rm+ !in+run be'e(e'+ri' !i%+( 'u (umin re'e nu r!e 0i%'ere(e),
'$ne'++ ( re+eu e(e'+ri' *rin in+erme!iu( unui +rn%-$rm+$r 
▫ ( e1+remi++e *r$1m(  be'u(ui %e +%e 0i!e$'mer, '$ne'++ %i e ( un m$ni+$r 

M+eri(e X 'm*uri %+eri(e, mnu%i %+eri(e

ne'e%re ▫ -en$brbi+(, me*r$bm+, +r$*in -i$(e
▫ %ub%+n+e !ein-e'+n+e
X *r+ *en+ru in%u-(re eru(ui
X %i%+em !e %*ir+ie
▫ 24 %erin&i !e 2m(
X bi%+uriu
X *en%e #em$%++i'e
X -ir !e '+&u+, &r-e *en+ru %u+ur)
X (*r$%'$*u( 'u +$+e ne1e(e (ui %+eri(
X %ub%+n+e n(e*+i'e %i 'r!i$+$ni'e in 'u( un$r e0en+u(e '$m*(i'+ii
 

Pre&+ire ▫ %e nun+ *'ien+u( %i i %e e1*(i' im*$r+n+ %i ne'e%i+%+e +e#ni'ii

 *'ien+u(ui ▫ in iu *re'e!en+ e1menu(ui, i %e !mini%+re un re&im #i!ri'
▫ in %er *re'e!en+ %i in !imine+ i(ei !e e1men, i %e e-e'+ue '(i%m
e0'u+$rie
▫ 'u $ K !e $r inin+e in+er0en+iei i %e *$+e !mini%+r $ -i$( !e -en$brbi+(
%u 4m& me*r$bm+ %i ,5m& +r$*ine
 ▫  %e r!e %u*r-+ *r$%  b!$menu(ui %i %e %*( +e&umen+u( 'u benin
i$!+ %u be+!in
In+er0en ▫  !u* %e!ere %i e-e'+ure ne%+eiei ($'(e %u &ener(e, me!i'( in!u'e
  +ii(e (*r$%'$*u( in '$n!i+ii !e %e*%ie
%i%+en+ei ▫ *ere+e(e b!$min( e%+e in!e*r++ !e 0ri'e *rin in%u-(re !e er %u & %+eri(
▫  ne%+ei &ener( e%+e ne'e%r in 'u( in+er0en+i($r '#irur&i'(e %u
&in$'$($&i'e
AM  ▫  in +im*u( (*r$%'$*iei %i&ur in%+rumen+ru( %$(i'i++ !e me!i' %i !u*
e-e'+ure in%*e'+iei '0i++ii b!$min(e %u  in+er0en+ii($r '#irur&i'(e
 *n%e *(&i(e %+ur+e
▫ %i&ur re$r&nire me!i'u(ui
AM 2 ▫ '$n+r$(e in +im*u( (*r$%'$*iei -un'+ii(e 0i+(e (e *'ien+u(ui
▫ 0eri-i' e0en+u(e(e mi%'ri !e 0en+i(+ie 'u+e !e in'r're r+i-i'i( 
'0i++ii b!$min(e
▫ $b%er0 %i %$(i'i+ *'ien+u(ui % '$muni'e 0erb( %u n$0erb( *ri+i !urerii
($'(e %u irr!i+e
▫ !u* in+er0en+ie +rn%*$r+ *'ien+u( in %($n 'u re*u% ( *+ 24# in !e'ubi+
!$r%(
▫ %$(i'i+ *'ien+u(ui ' +im* !e 46 $re %n u %e (imen+ee
▫ %u*r0e&#e *(& %i %i&ur *n%men+ '$m*re%i0
▫ *(i' *un& 'u &#e+ ( ni0e(u( -i'+u(ui, !' e1minre  -$%+ in%$+i+ !e
 *un'+ie bi$*%i'
▫ !' +rni+u( in+e%+in( %e $*re%+e %e e-e'+ue $ '(i%m e0'u+$rie

In'i!en+e ▫ %ub-ebri(i++e
%i ''i!en+e ▫ #em$r&ii
▫ !i%-&ie
▫ !ureri re+ri$%+ern(e
▫ 'e-(ee, in%$mnie
Re$r&nire ▫ in *rin'i*iu +$+e in%+rumen+e(e %un+ mne0r+e ' %i 'um r -i '$n+min+e
 me!iu(ui ▫ %e 'ur+e, %e %*( in%+rumen+e(e %i %e *re&+e%' !e %+eri(ire
▫ +m*$ne(e !e 0+, '$m*re%e(e %i !e%euri(e re(1+e %un+ '$(e'++e in re'i*ien+e
%*e'i(e %i !u%e ( in'iner+$r 
▫ %( !e e1minre e%+e %+eri(i+ *rin re u(+r0i$(e+e
 
 

III.E..PUNCTIA -IOPSICA )EPATICA

De-ini+ie In+r$!u'ere unui ' !e *un'+ie in+run $r&n *ren'#im+$% *en+ru re'$(+re unui
-r&men+ !e +e%u+. Pun'+i %e *r'+i' *e -i'+, %*(in, rini'#i, &n&(i$ni (im-+i'i,
 *(mni, +um$ri %$(i!e
S'$* E1*($r+$r e1menu( #i%+$*+$($&i' ( +e%u+u(ui *en+ru %+bi(ire !i&n$%+i'u(ui %u
 *en+ru *re'ire %+!iu(ui imb$(n0irii
L$'u( Pun'+i #e*+i' $rb %u %ub '$n+r$( e'$&r-i' *en+ru !i&n$%+i'u( !i-eren+i((
 *un'+iei -e'+iuni($r #e*+i'e *ren'#im+$%e)
▫ -+ n+eri$r %u (+er(  -i'+u(ui *e (ini me!in ime!i+ %ub reb$r!u( '$%+(
%u in *(in m+i++e -i'+ mri+ !e 0$(um)
Bi$*%ie +in+i+ 'u ' -in !i&n$%+i'u( un$r #em+$me&(i 'u e+i$($&ie ne*re'i+)
▫ !e (un&u( (iniei 1i(re *$%+eri$re in %*+i( I %u  in+er'$%+( !re*+
Bi$*%ie #e*+i' in+rb!$min( 'u ?u+$ru( (*r$%'$*u(ui)
M+eri(e ▫ m+eri(e !e *r$+e'+ie  *+u(ui %u  m%ei !e '$n%u(++ie
ne'e%re ▫ m+eri(e !e !ein-e'+ie ($'(
▫ ne%+ei'
▫ *n%men+, 'm*uri %+eri(e
▫ (me !e mi'r$%'$*, 0%e 'u 5m( %er -ii$($&i'
▫ me!i'men+e: 'r!i$+$ni'e, #em$%++i'e, %n&e i$&ru*, i$R#
▫  in%+rumen+e %i m+eri(e %+eri(e: 23 'e imSi(0ermn, %erin&i %i 'e *en+ru
ne%+eie, mnu%i, +m*$ne, +ru% *er-uie, *en%e #em$%++i'e
▫  %erin& %*e'i( 're *ermi+e 'rere !e *re%iune ne&+i0e 'u %*irre
-r&men+e($r 'e(u(re %i e1*unere ($r *e un %u*$r+

In+er0en ▫ *reen+ %i%+en+e($r me!i'(e e%+e b%$(u+e ne'e%r

  +ii(e ▫ %i%+en+ me%i'( *$i+i$ne *'ien+u(, !u* $ *re&+ire *re(bi( *%i#i', in
%i%+en+ei !e'ubi+ !$r%( 'u +run'#iu( u%$r ri!i'+ %u !e'ubi+ (+er( %+n& 'u mn !re*+ %ub
'*
▫ %i&ur +$(e+ b$(n0u(ui %i !ein-e'+re $nei +e&umen+re
▫ %er0e%+e me!i'u(ui mnu%i(e %+eri(e, ne%+ei'u(, 'm*uri(e %+eri(e
▫ %i&ur %u*r0e&#ere *'ien+u(ui *en+ru %+re &ener( %i -un'+ii 0i+(e
▫ e-e'+ue mn$*ere(e !e '$(b$rre me!i'%i%+en+ *en+ru bi$*%ie:
 men+ine mn!renu( %+eri(
   *re! me!i'u(ui in%+rumen+ru( !e'0+ %+!iu(ui !e in+er0en+ie
   *rei -r&men+u( !e +e%u+ re'$(++ in +uburi %*e'i(e *en+ru *r$be %i
e+i'#e+e '$re%*un+$r 
   e-e'+ue *n%men+u( !ei0 %u '$m*re%i0 !u* bi$*%ie
   *re! me!i'u(ui m+eri( !e %u+ur ( ne0$ie
▫ !u* bi$*%ie re$r&nie ($'u( !e mun'
▫ +rimi+e !e ur&en+ ( (b$r+$r m+eri(u( re'$(++
▫ +rimi+e !e ur&en+ ( (b$r+$r m+eri(u( re'$(++
▫ %u*r0e&#e ($'u( *un'+iei *en+ru e0en+u(e(e m$!i-i'ri+ume-iere, #em$r&ie
▫ %i&ur *$i+i$nre *'ien+u(ui in -un'+ie !e '$m*re%iune ($'u(ui
▫ !mini%+re me!i'+ie n+i(&i', ( in!i'+i me!i'u(ui
▫ %u*r0e&#e *u(%u(, TA, *n%men+u( 24 !e $re
 

▫ ( ($'u( *un'+iei *$+e *(i' $ *un& !e &#e+

▫  ( ne0$ie '$muni' me!i'u(ui $ri'e '$m*(i'+ie *ru+ in +im*u( %u !u*
e-e'+ure *un'+iei
 
A''i!en+e ▫ #em$r&ie 're %e '$mb+e *rin !mini%+rre !e #em$%++i'e
▫ %$' *un'+i$n(
▫ +u%e in%+n+nee

 
 

III.E.3.SCINTIGRA*IA

De-ini+ie F$($%ire i$+$*i($r re'+i0i 're %e -i1e in $r&ni%mu( e1min+ !e+erminn! $

#r+  $r&ni%mu(ui
S'$* E1*($r+$r  
Sub%+n+ T'm +e#ne+iu)
-$($%i+
Te#ni' ▫  r!i$$+$*u(, inin+e !e  -i e(imin+e *rin bi(, %e -i1e *en+ru un +im* *e
#e*+$'i+e %u *e 'e(u(e(e "u*-er 
▫ r!i+ii(e 'e%+ui %un+ '*++e 'u *r+e !e %'in+i(+ie  'mer !e %'in+i(+ie
▫  'e%+ !u* 'e !e+e'+e %ur% !e r!i+ie *rin+run %%+em !e -i%re,
0iu(ie %ub -$rm un$r im&ini ($'(ire i$+$*u(ui emi++$r 
▫  inin+e %i%+emu(ui !e -i%re %e +%e, un '$m*u+er 're in+er0ine (
imb$&+ire *$%ibi(i++i($r !e $b+inere  im&inii
▫ 'mer !e %'in+i(+ie mi -i%e reu(++u( 'u ?u+$ru( unui $%'i($%'$*, *e 're
im*u(%uri(e emi%e !e r!i+ie, *r %ub -$rm !e %'n+eieeri (umin$%e, bine
($'(i+e= 'e%+e %'n+eieri im*re%i$ne $ %u*r-+ -$+$%en%ibi( 're %e
inne&re%+e in r*$r+ 'u numru( im*u(%uri($r 
M%uri !e ▫ %+$'u( !e i$+$*i re'+i0i %e *%+re in reer0$re !e *(umb
 *r$+e'+ie ▫ %e (u're numi %ub *r$+e'+i *r0ne($r !e *(umb
▫ *$(ure *ie(ii %e e0i+ *rin -$($%ire mnu%i($r !e 'u'iu'
▫ nu %e (u're 'u i$+$*ii !' e1i%+ rni, &rie+uri
▫ #ine !e *r$+e'+ie $b(i&+$rii
▫  *'ien+u( in0e%+i&+ 'u i$+$*i r!i$'+i0i 0 -i i$(+ !e re%+u( *'ien+i($r -iin!
%ur% !e r!i+ii

III.E.14.ULTRASONOGRA*IA

De-ini+ie Me+$! !e !i&n$%+i' b+ *e u(+r%une+e

S'$* E1*($+$r *en+ru %+bi(ire !i&n$%+i'u(ui
Te#ni' ▫ e'$&r-i u+i(i+ *en+ru -$rmre im&inii u(+r%une+e(e
▫ u(+r%une+e(e *+run! in +e%u+uri(e $r&ni%mu(ui %i ( ($'u( !e in+(nire  !$u me!ii
'u !e%+in+i !i-eri+e, $ *r+e  0ibr+ii($r '$r*u%'u(re %un+ re-(e'++e
▫ !in inre&i%+rre 'e%+$r u(+r%une+e re-(e'++e %e '$n%+i+uie im&ine e'$&r-i'
X *r+e(e %un+ -$rm+e !in:
 +rn%u!u'+$r emi++$r %i re'e*+$r !e u(+r%une+e)
  - un %i%+rem !e *re(u'rre  e'$u+i($r inre&i%+r+e !e +rn%!u'+$r 
   un %i%+em !e -i%re *e 're %e -$rme im&ine *r$*riui%
   une(e *r+e %un+ *re0u+e 'u !i%*$i+i0e !e -$+$&r-ie %i 0i!e$ inre&i%+rre, 'u
're im&ine *$+e -i *%+r+, %++i' %u in !inmi' ei
In+er0en ▫ *re&+ire *%i#i' %i in%+(re *'ien+u(ui *en+ru e1minre in *$i+ie !e'0+
  +ii(e !e'ubi+ !$r%(, *$i !e'ubi+ (+er( !re*+
%i%+en+ei ▫ mini%+re *'ien+u(ui in *re?m e1minrii $ me!i'+ie b%$rbn+  &e($r 
%u ( ne0$ie un *ur&+i0
 

▫ re'$mn! *'ien+u(ui re%+ri'+ie (imen+r b%$(u+ 'u 2 $re inin+e !e e1minre

▫ in+in!e *e %u*r-+ '$r*u(ui *'ien+u(ui un &e( %*e'i(, 'u r$( !?u'0n+ *en+ru $
mi bun '*+re  %un+e+e($r !e '+re +r!u'+$r 
A''i!en+e ▫ e'$&r-i e%+e (i*%i+ !e $ri'e e--e'+ ne!$ri+ %u*r $r&ni%mu(ui

III.E.11.ENDOSCOPIA

De-ini+ie E1minre *rin 0iu(ire '$mbin+ 'u -$+$&r-ie, bi$*%ie, r!i$&r-ie %i

 *ermi+e numi+e '$n!ui+e +er*eu+i'e ( ni0e(u( $r&ne($r '0i+re %u '0i++i (e
$r&ni%mu(ui
S'$* ▫ e1*($+$r 
▫ +er*eu+i'
M+eri(e ▫ en!$%'$*u(:
ne'e%re   - *r+ $*+i' *re0u+ 'u un !i%*$i+i0 *en+ru i(uminre %i un %%+em !e
+rn%mi+ere  im&inii
   *rein+ $ '$r! 're %i&ur mi%'re '*u(ui *r$1im(
   +ub -(e1ibi( 'm, !in -ibr !e %+i'(= 'e%+ *rein+ un 'n( *en+ru
%*ir+ie, un 'n( *en+ru in+r$!u'ere unei *en%e %i un 'n( *en+ru %*(re
(en+i(e($r 
▫ m%+i %i mnu%i %+eri(e
▫ +m*$ne %i '$m*re%e %+eri(e
▫ *en%e %i *$r++m*$n %+eri(
▫ %erin&i, 'e %i 'm*uri %+eri(e
▫  me!i'+ie n+i'$(iner&i'  +r$*ine), ne%+ei' ($'( 1i(in ), n+i%*%+i'e,
%e!+i0e
▫ %*ir+$r, %$(u+ie *er-ubi( %i +ru% *en+ru *er-uii
▫ %e 0eri-i' e+n%i++e +ubu(+urii en!$%'$*u(ui
▫ %e 0eri-i' %ur%e(e !e (umin

Pre&+ire ▫ in-$rmre 'e%+ui !e%*re $*$r+uni++e in0e%+i&+iei

 *'ien+u(ui ▫ e!u're *'ien+u(ui *en+ru  %er0i m% !in %er *re'e!en+ inin+e !e $r
7°°, ir in !imine+ in0e%+i&+iei %n u mnn'e, % nu be *en+ru  e0i+
%++i$nre re%+uri($r (imen+re in %+$m' 'u im*$%ibi(i++e e-e'+urii
in0e%+i&+iei
▫  in%$+im *'ien+u( in %( !e e1minre %i !mini%+rm une(e me!i'men+e (
in!i'+i me!i'u(ui: n+i'$(iner&i'e, &en+i +en%i$'+i0i, %e!+i0e u%$re
▫ *$i+i$nre *'ien+u(ui in !e'ubi+ (+er( %+n& 'u '*u( %*ri?ini+ -erm *e *ern,
membre(e in-eri$re u%$r -(e'++e
▫  %$(i'i+m in '$n+in$re *'ien+u(ui '$$*erre, %i&urn!uI '$n-$r+u( *%i#i' %i
-ii' 
In+er0en AM.
  +ii(e ▫  *re! me!i'u(ui in%+umen+e(e in -un'+ie !e %e!iu( %i 'r'+eru( in+er0en+iei
%i%+en+ei 0iu(ire, bi$*%ie, (i&+ur !e 0ri'e e%$-&iene)
▫ *re&+e%+e e*rube+e %+eri(e, re'i*ien+e *en+ru re'$(+re !i-eri+e($r -r&men+e 'u
 

!+e(e *er%$n(e (e b$(n0u(ui, FO %i e1minre %$(i'i++

AM.2
▫  %i&ur *$i+i *'ien+u(ui %u*r0e&#ere *ermnen+ *en+ru *u(%, TA,
!i%'$m-$r+, ne(ini%+e, '$($rre +e&umen+e($r, re%*ir+ie, !urere, -(+u(en+
▫ %i&ur +rn%*$r+u( *'ien+u(ui ( %($n, '$n-$r+u( *en+ru $!i#n
▫ e!u' *'ien+u( *en+ru in+er!i'+i ' +im* !e 2 $re % e0i+e #i!r+re *en+ru
(imen+re *n ( *ri+i %en%ibi(i++ii n$rm(e !e !e&(u+i+ie)

III.E.1".TOMOGRA*IE COMPUTERI+ATA 6TC7

De-ini+ie Ob+inere im&inii unui %+r+ $re're !in+r$ *$r+iune  $r&ni%mu(ui. Prin'i*(u(
TC %e be *e re'$n%+ru'+i bi!imen%i$n(  unei 'u*e +$m$&r-i'e re(i+
 *rin $r!in+$r in'e*n! 'u mu(+i*(e m%ur+$ri !e b%$rb+ie  re($r  $b+inu+e
 *rin r!ri$&r-iere unei re&iuni !e+ermin+e
S'$* E1*($r+$r  
Pre&+ire A.M. %i&ur pregatirea psihica= *'ien+u(ui i %e e1*(i':
 *'ien+u(ui   ▫ ne'e%i++e e-e'+urii e1minrii,
  ▫ 'r'+eru( n$n&re%i0 ( e1minrii,
  ▫ '$n!i+ii(e in 're %e !e%-%$r e1minre
  ▫ !ur+ +im*u(ui !e e1minre 3minu+e)
  ▫ &r!u( !e ir!iere minim
  ▫ im$ni(i++e *e *r'ur%u( e1minrii

A.M. %i&ur %i pregatirea fi$ica:

  ▫ in%$+im *'ien+u( ( %( !e e1minre
  ▫ in!e*r+m $bie'+e(e r!i$$*'e n%+uri, bi?u+erii, *r$+ee !en+re e+'.)
  ▫ !mini%+rm %ub%+n+ !e '$n+r%+ !u* +e%+re 'e%+ei
  ▫ CT nu %e re(ie in ' !e: %r'in, +i?e me+(i'e, 0(0e 'r!i'e me+(i'e,
 *'em@er 'r!i'
In+er0en ▫ 0eri-i' %ub%+n+ !e '$n+r%+ 0(bi(i++e,
  +ii(e    in+e&ri++e
%i%+en+ei ▫ +e%+re %ub%+n+e($r !e '$n+r%+ ( *'ien+ *en+ru *re0enire re'+iei n-i('+i'e
▫ !mini%+rre %ub%+n+e($r !e '$n+r%+ *er$%,
   i.0.,
   *er-uie
Te#ini' ▫ -i'+u(, $r&n 0i+( %i &(n! 'u %e're+ie in+ern %i e1+ern, in 'u( mni-e%+ri($r 
E1menu(ui  *+$($&i'e !e+ermin mu(+i*(e %i 0ri+e *er+urbri -un'+i$n(e
!e -i'+ ▫ *$i+i$nm *'ien+u( in !e'ubi+ !$r%( 'u br+e(e in+en%e in %u% !u* 're %e
!mini%+re i.m.2m& !e &(u'&$n% %i re(ie *rim %erie !e '(i%ee
▫  !$u %erie %e '(i%ee %e re(ie !u* in?e'+re i.0.  %$(u+ii($r !e '$n+r%+
6'm<m(.
 

III.E.1%.RE+ONANTA MAGNETICA NUCLEARA 6RMN7

De-ini+ie RMN re*rein+ $ me+$! !e in0e%+i&re, '$n%i!re+ +$*u( im&i%+i' in !i&n$%+i'u(

'(ini'.E%+e $ me+$! nein0i0, 're nu ne'e%i+ *re&+ire *re(bi(  *'ien+u(ui,
nu 'ue !i%'$m-$r+ *'ien+u(ui
Te#ini' ▫  m&ne+i%mu( nu'(er e%+e $ '$n%e'in+  mi%'rii %r'ini(($r e(e'+ri'e,  r$++iei
e(e'+r$nu(ui in ?uru( *r$*riei 1e
▫  '$n+r%+u( im&inii RMN e%+e %i&ur+ !e !i-eren+ !in+re in+en%i++e %emne($r 
 *r$0eni+e !e ( !$u +e%u+uri %i *$+e -i mri+ *rin !mini%+rre !e &en+i !e '$n+r%+
▫ m$!u( !e '+iune ( 'e%+$r &en+i e%+e in!i+e'+, *rin m$!i-i're m&ne+i%mu(ui
($'( %i re%*e'+i0e  +im*i($r !e re(re  +e%u+uri($r 
A*(i'+ii ▫ im&ini (e !e*(%rii '#imi'e, *r$+ini'e *en+ru *<(i*i!e
'(ini'e ( ▫ *$%ibi(i++e 0iu(irii 0%e($r %n&0ine
ni0e(u( ▫ e0(ure -e'+iuni($r ( 'e( mi in(+ &r! !e in0e%+i&re  $r&ne($r e1.: -i'+,
-i'+u(ui %*(in, +r'+ !i&e%+i0
In+er0en A.M. %i&ur pregatirea psihica= *'ien+u(ui i %e e1*(i':
  +ii(e   ▫ ne'e%i++e e-e'+urii e1minrii,
%i%+en+ei   ▫ 'r'+eru( n$n&re%i0 ( e1minrii,
▫ '$n!i+ii(e in 're %e !e%-%$r e1minre
  ▫ !ur+ +im*u(ui !e e1minre

A.M. %i&ur %i pregatirea fi$ica:

  ▫ in%$+im *'ien+u( ( %( !e e1minre
  ▫ !mini%+rm %ub%+n+ !e '$n+r%+ !u* +e%+re 'e%+ei
  ▫ %i&ur +rn%*$r+u( *'ien+u(ui ( %($n, '$n-$r+u( *en+ru $!i#n
  ▫ %i&ur %u*r0e&#ere *ermnen+  *'ien+u(ui *en+ru !i%'$m-$r+, ne(ini%+e,
'$($rre +e&umen+e($r 

III.*.ROL IN ADMINISTRAREA TRATAMENTULUI

  Re&u(i in !mini%+rre me!i'men+e($r:

▫ re%*e'+re me!i'men+u(ui *re%'ri%
▫ i!en+i-i're me!i'men+u(ui
▫ 0eri-i're '(i++ii me!i'men+u(ui
▫ re%*e'+re 'i($r !e !mini%+rre
▫ re%*e'+re $rru(ui !e !mini%+rre %i ri+mu(ui *re%'ri% !e me!i'
▫ re%*e'+re !$ei *re%'ri%e
▫ re%*e'+re %$mnu(ui -ii$($&i' ( b$(n0u(ui
▫ e0i+re in'$m*+ibi(i++ii !in+re me!i'men+e
▫ nun+re ime!i+  &re%e(i($r !e !mini%+rre  me!i'men+e($r 
▫ *re0enire in-e'+ii($r n$$'$mi(e *rin re%*e'+re m%uri($r !e %e*%ie.
 

   +edicamentele  %un+ %ub%+n+e !e $ri&ine 0e&e+(, nim(, miner( %u '#imi',

+rn%-$rm+e *rin $*er+ii -rm'eu+i'e in+r$ -$rm !e !mini%+rre -$($%i+e ( *re0enire,
me(i$rre %u 0in!e're b$(i($r.
  Pen+ru $ -$($%ire '$re'+  me!i'men+e($r +rebuie % 'un$%+em:
▫ !$ +er*eu+i'  'n+i++e u+i(i+ *en+ru $b+inere e-e'+u(ui +er*eu+i' !$ri+
▫  !$ m1im  'n+i++e 'e mi mre %u*$r++ !e $r&ni%m -r *ri+i un$r -en$mene
+$1i'e
▫ !$ +$1i'  'n+i++e 're *r$0$' re'+ii !un+$re $r&ni%mu(ui
▫ !$ (e+(  'n+i++e 're *r$0$' m$r+e *'ien+u(ui.

  Ci !e !mini%+rre  me!i'men+e($r:

▫ $r(
▫ 'u+n+ %u mu'$%
▫ urinr
▫ *ren+er(:  in+r!ermi'
   %ub'u+n+
   in+rmu%'u(r 
   in+r0en$%
▫ (+e 'i:  in+rr+eri(
   in+r$%$%
   in+r'r!i'

III.*.1.ADMINISTRAREA MEDICAMENTELOR PE CALE ORALA

De-ini+ie C(e $r( e%+e '(e n+ur( !e !mini%+rre  me%i'men+e($r, 'e%+e *u+n!u
%e re%$rbi ( ni0e(u( mu'$%ei bu'(e %i  in+e%+inu(ui %ub+ire %u &r$%
S'$* Ob+inere e-e'+e($r ($'(e %u &ener(e (e me!i'men+e($r:
▫ e-e'+e ($'(e:
   -0$rire %u in#ibre *eri%+(+i%mu(ui in+e%+in(
   !e0$(+re mu'$i++i($r !e *e *ere+ii &%+r$in+e%+in(i
   %u%+inere *r$'e%u(ui !e 'i'+rire  u('er+ii($r 
   *r$+e'+i mu'$%ei &%+$in+e%+in(e
   '$re'+re *r$'e%e($r !i&e%+i0e %u -ermen++i0e
   !ein-e'+re +ubu(ui !i&e%+i0e
▫ e-e'+e &ener(e:
   re%$rb+i re ($' ( ni0e(u( mu'$%e($r !i&e%+i0e, *+run! in %n&e %i
'+i$ne ( ni0e(u( in+re&u(ui $r&ni%m  n+ibi$+i'e, %e!+i0e, 'r!i$+$ni'e,
n+i'$&u(n+e, 0%$!i(++$re)
C$n+rin!i  Nu %e 0$r !mini%+r *er$r( me%i'men+e +un'i 'n!:
  '+ii ▫ %un+ in'+i0+e %u !e'$m*u%e !e %u'uri(e !i&e%+i0e
▫ e%+e ne'e%r  %e $b+ine e-e'+e r*i!
▫ u e--e'+ iri+n+ %u*r mu'$%ei !%+ri'e
▫ re-u !in *r+e *'ien+u(ui
 

▫ '(e !i&e%+i0e nu %i&ur re%$rb+i

▫ in+er0en+ii '#irur&i'(e ( ni0e(u( +ubu(ui !i&e%+i0e
▫ -e'+iuni (e mu'$%ei bu'(ei %u mu'$%e($r !i&e%+i0e
▫ (i*% re-(u1u(ui !e !e&(u+i+ie ++ *en+ru %$(i!e '+ %i (i'#i!e
▫ e0i+re %i%+emu(ui 0enei *$r+e
F$rm !e ▫ (i'#i!e %$(u+ii, mi1+ure, in-uii, +in'+ure, e1+r'+e, u(eiuri
 *reen+re ▫ %$(i!e *u(beri, +b(e+e, !r?euri, &rnu(e, mu'i(&ii
Pre&+ire  Pacientul 
!mini%+r ▫  e%+e in-$rm+ %u*r e-e'+e($r urmri+e *rin !mini%+rre me!i'men+u(ui
rii me!i' re%*e'+i0e %i  e0en+u(e($r e-e'+e %e'un!re
men+e($r  ▫ i %e !u in *$i+ie %emi%en! !' %+re (ui *ermi+e
 +ateriale
▫ (in&ur, (in&uri+, *i*e++e, %+i'( *i'ur+$re, *#r &r!+, 'e%'
▫ *, 'ei, (*+e
A!mini%  ichidele
+rre    %ir$*uri, u(uiuri, *e miner(e, emu(%ii
me!i'    %e m%$r !$ uni' 'u *#ru(
men+e($r     mi1+uri(e, %$(u+ii(e, emu(%ii(e %e m%$r 'u (in&uri+,
   +in'+uri(e e1+r'+e(e %e !$e 'u *i*e+
   me!i'men+e(e (i'#i!e %e *$+ !i(u 'u 'ei, * %u %e !mini%+re ' +re,
*$i *'ien+u( be *, 'ei
Solidele
   +b(e+e, !r?euri(e %e %e *e &ur *'ien+u(ui %i %e in&#i+ ' +re
   +b(e+e(e 're %e re%$rb ( ni0e(u( mu'$%ei %ub(in&u(e %e %e %ub (imb
   une(e *u(beri %e !i$(0 in *, *$i %e !mini%+re %ub -$rm %e %$(u+ii

C*'i++e *r$1im+i0  *#ru(ui, (in&uri($r -$($%i+e:

 *#r *  2& *
 'e%' '-e  5& *
  (in&ur  5& *= 2& %ir$*= 2,5& u(ei
  (in&uri+  5& *= 6,5& %ir$*= 4,5& u(ei
 & %$(u+ie *$%  225 *i'+uri
 & %$(u+ie ('$$(i'  665 *i'+uri
 & %$(u+ie u(ei$%  455 *i'+uri
 & +in'+ure ('$$(i'  56 *i'+uri.
  C*'i+re *r$1im+i0  me!i'men+e($r %ub -$rm !e *u(beri:
  (in&uri+ r%  ,52,5&
  (in&uri+ 'u 0r-  2,55&
  0r- 'u+i+  ,5&.

  Me"ica&ete a"&iistrare pe cale orala9

Me!i'men+e #e*+$*r$+e'+$re

  ESSENTIALE FORTE '*%u(e

 

 !ctiune terapeutica: n$rm(ie -un'+ii(e #e*+i'e (+er+e

   re%+bi(e%+e e'#i(ibru( ener&e+i' ( -i'+u(ui
   n$rm(ie me+b$(i%mu( (i*i!i'
 Indicatii: in 'ir$ #e*+i'
   in in+$1i'+ii
   in !e&enere%'en+ &r%  -i'+u(ui
   +er*i *re %i *$%+$*er+$rie #e*+$bi(ir
 +od de administrare: 2 '*%u(e !e 3 $ri<i
 *eactii adverse: nu %un+ 'un$%'u+e
Contraindicatii: nu %un+ 'un$%'u+e

  ITAMINA C '$m*rim+e 25m&, 5m&

 !ctiune terapeutica: n+i$1i!n+
   imun$%+imu(+$r 
   '$mb+e $b$%e( %i %+re%%-u(
   '$n+ribuie ( -$rmre '$(&enu(ui
   ''e(ere 0in!e're *(&i($r 
   %'!e ni0e(u( '$(e%+er$(u(ui in %n&e
 Indicatii: &in&i0i+e
   #em$r&i !+$r+e -r&i@i++ii '*i(re
 b$(i &r0e
   in+er0en+ii '#irur&i'(e
 +od de administrare: 24 '$m*rim+e<i
 *eactii adverse: *re'i*i+re ur+i($r %i $1(+i($r in urin 'i!
   rre$ri !iree
Contraindicatii:  (i+i ren(
   #em$'r$m+$

  ITAMINA A  D !r?euri 4 u.i.

 !ctiune terapeutica: -0$rie b%$rb+i in+e%+in(
   !e*unere C in $%e
   '+iune +r$-i' %u*r e*i+e(ii($r 
 Indicatii: !u* b$(i in-e'+i$%e '$rni'e
   in '$n0(e%'en+
   +u(burri !e !e0$(+re  !in+ii($r 
 +od de administrare: 2 '$m*r<i
 *eactii adverse: n$re1ie
   *$(iurie
   -+i&bi(i++e
 #e*+$me&(ie
   !e*unere C in !i-eri+e +e%u+uri
Contraindicatii:  in #i*er0i+min
   in #i*er'('emie
   *ru!en+ ( b$(n0ii im$bi(i+i

ITAMINA E '*%u(e m$i &e(+in$%e

 

 !ctiune terapeutica: e%+e un e(emen+ nu+ri+i0e e%%en+i(

   n+i$1i!n+ bi$($&i' *en+ru $ %erie !e e(emen+e nu+ri+i0e
 Indicatii: b$(i (e 'i($r #e*+$bi(ire
   in %+ri !e in-er+i(i++e m%'u(uin %i -eminine
   in ' !e %ubnu+ri+ie
 +od de administrare:  '*% !e 2 1<i
 *eactii adverse: !iree, !ureri b!$min(e
Contraindicatii: #i*er%en%ibi(i++e ( 0i+min E

  SILIMARINA '$m*rim+e ,9&

 !ctiune terapeutica: *%+re in+e&ri++e %i %i&ur -un'+i$n(i++e n$+m(  membrnei
'e(u(re ( ni0e(u( %+ru'+uri($r #e*+i'e
   *r$+e?e -i'+u( im*$+ri0 !i-eri+e($r n$1e ('$$(, +$1ine)
   %+imu(e re%+urre *ren'#imu(ui #e*+i' (e+
 Indicatii: 'ir$e '$m*en%+e
   in%u-i'ien+ #e*+i'
   #e*+i+e '$rni'e 0ir(e)
   *r$-i('+i'e in +im*u( !mini%+rrii un$r %ub%+n+e #e*+$+$1i'e
 +od de administrare: 2'$m*r<31<i+ im* !e 36 %*+mni
 *eactii adverse: nu %e 'un$%'
Contraindicatii: nu %e 'un$%'

  HEPABIONTA !r?euri
 Indicatii: 'ir$
   -i'+
   -e'+iuni #e*+i'e +$1i'e
 +od de administrare: 3 !r?<i
 *eactii adverse: +rn%*ir+ii
   +#i'r!ie
   ur+i'rie
Contraindicatii: #i*er%en%ibi(i++e ( 'i!u( (-(i*$i'

MECOPAR FORTE '$m*rim+e 25m&

 !ctiune terapeutica: #e*+$*r$+e'+$re
   #e*+$+r$-i'e
 Indicatii: 'ir$e #e*+i'e 'u in-i(+r+ie %i !e&enere%'en+ &r%
 +od de administrare: 3 '$m*r ( m%
 *eactii adverse: nu re
Contraindicatii: en'e-($*+ie *$r+(
   '$m #e*+i'
   in%u-i'ien+ ren( &r0

  HEPATODRAINOL %$(u+ie in+ern

 !ctiune terapeutica: me!i'men+ #$me$*+#i'
 Indicatii: +u(burri #e*+$ bi(ire
 +od de administrare: 2 *i'+uri !e 3 1<i 'u 5 inin+e !e m%
 

 *eactii adverse: nu %e 'un$%'

Contraindicatii: nu %e 'un$%'

  LI52 '$m*rim+e n+ur(e

 !ctiune terapeutica: '$n+ine  *(n+e me!i'in(e 'u e-e'+e #e*+$*r$+e'+$re
   (1+i0
   !iure+i'
   %+imu(e *e+i+u(
 Indicatii: in 'ir$e #e*+i'e
   #e*+i+e 'u+e %i '$rni'e
   in*e+en+
 +od de administrare: 23 '$m*r. De 34<i
 *eactii adverse: nu re
Contraindicatii: nu re

FARCOIT B2 '*%u(e &e(+in$%e

 !ctiune terapeutica:*re0ine *ri+i nemiei
   men+ine 0i+(i++e '$r*u(ui %i  *e+i+u(ui in (imi+e n$rm(e
 re&enere 'e(u(e(e #e*+i'e
   re!u'e '$(e%+er$(u( in %n&e %i in -i'+
 Indicatii: +u(burri #e*+i'e:
   #e*+i'e in-e'+i$%e
   *r%i+i%m in+e%+in(
   ('$#$(i%m 'r$ni'
   HTA
   $bei++e
   +er$%'re($
 +od de administrare: 2 '*% !e 31<i !u* me%e

Me!i'+ie n+iin-(m+$rie

  COLCHICINA '$m*rim+e m&

 !ctiune terapeutica n+iin-(m+$r 
 Indicatii: b$(i in-(m+$rii '$rni'e
 +od de administrare: m&<i 5i(e<%*+mn
 *eactii adverse: ur+i'rie
   nemie, &re+
   ($*e'ie, 0r%+uri
Contraindicatii: in%u-i'ien+ #e*+i'
   %u-erin+e ren(e

  PROPRANOLOL '$m*rim+e 5m&

 !ctiune terapeutica: b($'n+ be+!rener&i'
   !iminu !ebi+u( 'r!i'
   in#ib %e're+i !e renin
 Indicatii: inin+e %i in +im*u( in+er0en+ii($r '#irur&i'(e
 

   *r$-i(1i HDS ( 'ir$+i'i

 +od de administrare: 2m& !e 2 $ri *e i 're%'n! !$ 'u *ru!en+
 *eactia adversa: &re+
   0$m
   !iree
   #(u'in+ii
   in ' !e HDS ri%'u( *rbu%irii 'ir'u(+$rii
Contraindicatii: %$' 'r!i$&en
   %+m br$n%i'
   #i*$&(i'emie

Me!i'+ie 0%$!i(++$re

  NITROGLICERINA '$m*rim+e
 !ctiune terapeutica: 0en$!i(++$re %'n! um*(ere 0en+ri'u(r
 re!u'e *re%iune *$r+( *rin %'!ere rei%+en+ei 0%'u(re in+r#e*+i'e
   %'!e -(u1u( 0en$% *$r+(
 Indicatii: in ' !e #i*er+en%iune *$r+(
 +od de administrare:  '$m*rim+ %ub(in&u( !e 2$ri<i
 *eactii adverse: 'e-(ee
   #i$*+en%iune r+eri(
Contraindicatii:in%u-i'ien+ 'r!i'
   #i*er+en%iune in+r'rnin
   %$', '$(*%.

  ENDOTELON '$m*rim+e 5m&, 5m&

 !ctiune terapeutica: me(i$rre %im*+$me($r 'ir'u(+$rii !in in%u-i'ien+ 0en$(im-+i'
*i'i$re &re(e %i !ureri)
 Indicatii: in +r+men+u( !?u0n+ ( (im-e!emu(ui um-(re br+u(ui)
 +od de administrare: 3 '$m*r. Dimine+ %i %er
 *eactii adverse: (er&ie
   &%+r$in+e%+in(e
   rr 'e-(ee
Contraindicatii: #i*er%en%ibi(i++e ( en!$+e($n

  CLONIDINA '$m*rim+e
 !ctiune terapeutica: %'!e *re%iune *$r+(
   re!u'e rei%+en+ 0%'u(r ren(
 Indicatii: HTP
 +od de administrare: 23 '$m*r<i
 *eactii adverse: #i*$%(i0+ie
   br!i'r!ie
   '$n%+i*+ii
   me+e(i
Contraindicatii: in %r'in
   in in%u-i'ien+ #e*+i'
 

   in IMA re'en+

Me!i'+ie !iure+i'

  SPIRONOLACTONA !r?euri 25m&

 !ctiune terapeutica: !iminu e1're+i *$+%iu(ui %i m$niu(ui
   im*ie!i' reb%$rb+i N %i C(
   %'!e 'i!i++e urinii
   e-e'+u( %e in%+(e (en+, !u* $ *eri$! !e (+en+ !e 24 i(e, +in&e 0($ri
m1ime !u* 59 i(e %i *er%i%+ in' 23 i(e !u* !mini%+rre u(+imei !$e
   e--e'+ #i*$+en%$r 
 Indicatii: in re+en+ii #i!r$%(ine 'u #i*er(!$%+er$ni%m %e'un!r 
   e!eme(e %i %'i+ !in CH
   #i*er+en%iune e%en+i(
 +od de administrare: 4 !r?<i %i !' !u* 5 i(e !e +r+men+, in e!eme(e rei%+en+e nu %e %e
$b+ine un e--e'+ !iure+i' !e'0+ %e re'$mn! %$'iere !iure+i'i($r +ii!i'e
 *eactii adverse: %$mn$(en+
   eru*+ii 'u+n+e
 '$m #e*+i' +rni+$rie
   &ine'$m%+ie
   men$ree
Contraindicatii: in IRA
   in in%u-i'ien+ #e*+i' &r0
   in nurie

  FUROSEMID '$m*rim+e 4m&

 !ctiune terapeutica: !iure+i' -$r+e '+i0e, 're%+e -$r+e mu(+ e(iminre ren( !e %re
   re!u'e *re%iune r+eri(
 Indicatii: e!eme 'ir$+i'e
 +od de administrare: 2 '$m*r.<i 34 i(e<%*+mn
 *eactii adverse: !e#i!r+re
 &r0re !ibe+u(ui
   #i*$m&neemi
Contraindicatii: !e-i'i+e e(e'+r$(i+i'e
   %+re *re'$m+$% ( 'ir$+i'i
   *ru!en+ ( !ibe+i'i= in%u-i'ien+ ren( 'u+

A(+e me!i'men+e !mini%+r+e *er$%

  NIFEDIPIN '*%u(e<!r?euri
 !ctiune terapeutica: b($'n+ ( 'n(e($r !e '('iu
   !i(+e 0%e(e %n&0ine *eri-eri'e 'u e--e'+ n+i#i*er+en%i0
   re $ '+iune 'r!i$*r$+e'+$re
 !i(+re 0%e($r '$r$nriene
 Indicatii: in #i*er+en%iune *$r+(
   ri+mii
 

 +od de administrare: '$m*r !e 2 $ri<i

 *eactii adverse: +#i'r!ie
   'e-(ee
   me+e(i
   bu-euri
Contraindicatii: %$' 'r!i$&en
   #i*er%en%ibi(i++e ( ni-e!i*in

  LACTULOSE %ir$*
 !ctiune terapeutica: %'!e ni0e(u( *r$!u%e($r +$1i'e !in in+e%+in( &r$%
   *ermi+e *r$-i(1i %i +r+men+u( e--i'ien+ ( #i*erm$niemiei !in b$(i(e
#e*+i'e
   *ermi+e n$rm(ire *r+u(ui !e *r$+eine *e '(e (imen+r
 Indicatii: '$m #e*+i'
   '$n%+i*+ie 'r$ni'
   #i*erm$niemie !in b$(i(e #e*+i'e
 +od de administrare: 23 (in&uri !e 3$ri<i
 *eactii adverse: -(+u(en+ %i !iree.

  CLORAMFENICOL '*%u(e
 !ctiune terapeutica: n+ibi$+i' 'u %*e'+ru (r&
 Indicatii: *eri+$ni+e 'u+e %e*+i'e
   %'i+ in-e'+i$%
 +od de administrare: 5m&<@&'$r*<i +r+men+u( !ure in me!ie !e 56 i(e
 *eactii adverse: +u(burri !i&e%+i0e: !i%+en%ie b!$min(
   +u(burri !e me+b$(i%m
 #(u'in+ii, !e(ir 
Contraindicatii: i'+er, nemie #em$(i+i', (eu'$*enie.

  RANITIDIN '$m*rim+e 5, 3m&

 !ctiune terapeutica: n+iu('er$% in#ibn! %e're+i 'i! &%+ri'
 Indicatii: in +r+men+u( -e'+iuni($r &%+r$in+e%+in(e:
   u('er &%+r$!u$!en(,
   e%$-&i+ !e re-(u1
   *re0ine #em$r&ii(e &%+r$!u$!en(e
 +od de administrare: in u('er &%+ri' 5m& $ri2<i 4 %*+mni)
   e%$-&i+ !e re-(u1 5m&$ri 2<i 7 %*+mni)
 *eactii adverse: 0er+i?
   %$mn$(en+
   !ureri r+i'u(re
   '!ere *ru(ui
Contraindicatii: #i*er%en%ibi(i++e ( rni+i!ine
   %+$m' iri++
   '$*ii %ub  ni.
 

III.*.".ADMINISTRAREA MEDICAMENTELOR PE CALE PARENTERALA

De-ini+ie C(e *ren+er( e%+e '(e 're $'$(e%+e +ubu( !i&e%+i0e.

In?e'+i in+r$!u'ere %ub%+n+e($r me!i'men+$%e (i'#i!e in $r&ni%m, *rin
in+erme!iu( un$r 'e 're +r0er%e +e%u+uri(e, 'u( -iin! !*++ ( $ %erin&
A0n+?e ▫ !$?u( e%+e '$rre'+ %i e1'+
▫ e-e'+u( %e in%+(e r*i!, b%$rb+i -iin! u%$r
▫ *$%ibi(i++e !mini%+rrii !e me!i'men+e ( 'ei in'$n%+ien+i, ( 'ei 'u HDS,
0r%+uri
S'$* ▫ +er*eu+i'
▫ e1*($r+$r
M$! !e ▫ in?e'+ie in+r!ermi' &r$%ime !ermu(ui
!mini% ▫ in?e'+ie %ub'u+n+ %ub *ie(e, in +e%u+u( 'e((u(r %ub'u+n+
+rre ▫ in?e'+i in+r0en$% in 0en
▫ in?e'+i in+rr+eri( in r+ere
▫ in?e'+i in+r'r!i' in inim
▫ in?e'+i in+rme!u(r in m!u0 r$%ie  $%e($r 
▫ in?e'+i %ubr#n$i!in in %*+i( r#n$i!in
Pre&+ire *en+ru in?e'+ii %i m+eri(u( ne'e%r 
▫ 0eri-i'm me!i'men+e(e *re%'ri%e !e me!i'
▫ 0eri-i'm ' %$(u+i in?e'+bi( % -ie '(r, +rn%*ren+, ne*re'i*i++
▫ in 'u( emu(%ii($r in?e'+bi(e, e(e %e 0$r &i+ inin+e !e u+i(ire
Serin&i ▫ %+eri(e, 'u $ '*'i++e in -un'+ie !e %$(u+ie me!i'men+$%
▫ *en+ru in?e'+i in+r!ermi' %e -$($%e%' %erin&i !e ,5m(, &r!+e in %u+imi !e m(
▫ *en+ru in?e'+i i.0. %e *re-er %erin& 'u mb$u( %i+u+e e1'en+ri'
▫ %e *re-er %erin&i(e !e uni' -$($%in+, in mb(?u( in!i0i!u( !e$re'e *rein+
0n+?e(e: '$n!i+ii m1ime !e %+eri(i++e
   e'$n$mie !e +im*
   mni*u(re u%$r
   ri%' %'u+ !e '$n+minre  *'ien+u(ui
A'e ▫ %e &%e%' im*reun 'u %erin& in 'e(%i mb(? %u in mb(?e %e*r+e
▫ %e -$($%e%' !$u 'e unu( *en+ru %*irre in %erin&  %$(u+ii($r %i (+u( *en+ru
in?e'+re
▫ %un+ !e (un&imi, '(ibru, (umen !i-eri+ 'u bi$u (un& %u %'ur+
Me!i' ▫ !ire'+ in?e'+bi(, in -i$(e %u -('$ne 'u !$ uni' %u mi mu(+e !$e
men+u( ▫ in!ire'+ in?e'+bi(e *u!re %u *r$!u%e (i$-i(i+e, in -i$(e %u -('$ne 'u !$* !e
'u'iu', in%$+i+e %u nu !e %$(0en+
A(+e ▫ +m*$ne %+eri(e !e 0+ %i +i-$n
m+eri(e ▫ %$(u+ii !ein-e'+n+
▫ *i(e !in me+( *en+ru !e%'#i!ere -i$(e($r 
▫ +0i+ ren(
▫ &r$u !in 'u'iu'
▫ *erni+
Te#ni' m$+$rii %erin&' %i %i*irre %$(u+ii($r 
▫ 0eri-i'm in+e&ri++e mb(?u(ui 'u(ui %i ( %er$n&ii
▫ 0eri-i'm +ermenu( !e 0(bi(i++e
 

▫ e1-$(iem *r+i( mb(?u( %erin&ii !e uni' -$($%in+ %i ( 'u(ui !in %*re *r+e in-eri$r
▫ men+inem 'u( in mn %+n& %i -i1m mb$u( %erin&ii -(+e in mn !re*+ *rin r$+ire
▫ in 'e%+ m$men+ re+r&em 'u( !in 'r'% % *r$+e'+$re
▫ in 'u( in?e'+ii($r i.0., %.'.,i.m., nu e ne'e%r !ein-e'+i &+u(ui -i$(ei
▫ (i'#i!u( !in &+u( -i$(ei re0ine *rin mi%'ri !e r$++ie in -i$(e *r$*riui%
▫ +un'i 'n! &+u( -i$(ei *rein+ un ine( 'ir'u(r %u e%+e *un'++ nu 0em ne0$ie !e *i( *en+ru
+i+u( -i$(ei 'e%+ %e ru*e ( *re%iune m$!er+
▫ -i$( !e%'#i% e%+e men+inu+ 'u *$(i'e(e, in!e1u( %i me!inu( minii %+n&i
▫ 'u( %e in+r$!u'e in -i$( -r  +in&e mr&ini(e !e%'#i!erii, mini(e -iin! -+ in -+ ( ne0$ie
%*ri?ini+e in 0+-uri(e !e&e+e($r mi'i
▫ in!e1u( minii !re*+e i( men+inem *e ri*i$re(e %erin&ii, ir 'u *$(i'e(e %i me!inu( e-e'+um
mi%'re !e +r'+iune %u*r *i%+$nu(ui, %erin& -iin! %*ri?ini+ ( mb$u 'u !e&e+u( mi' (
minii %+n&i
▫  in 'e%+ m$! %$(u+i !in -i$( e%+e %*ir+e, 0n! &ri? ' (i'#i!u( !e %*ir+ % '$*ere
 *ermnen+ 0r-u( 'u(ui, -r  +in&e -un!u( %+i'(ei
▫ !u* in'r're, e(iminm bu(e(e !e er !in %erin& -(+ in mn %+n& 'u 'u( in!re*++ in
%u% %u u%$r in'(in+= (e e(iminm *rin im*in&ere *i%+$nu(ui in %u% *n ( *ri+i *i'+urii !e
(i'#i! in 0r-u( 'u(ui
▫ in!e*r+m 'u( -$($%i+ *en+ru  %*ir %$(u+i !in -i$( %i -i1m 'u( *en+ru e-e'+ure in?e'+iei

III.*.".#.ADMINISTRAREA MEDICAMENTELOR PE CALE VENOASA

 
IN:ECTIA INTRA(ENOASA

E1e'u+i ▫ %i%+en+ i%i %*( mini(e

in?e'+iei ▫ (e&em ($'u( *un'+iei %i i( !ein-e'+m
▫ men+inem br+u( *'ien+u(ui in'(in+ in ?$% 'u *umnu( %+rn%
▫  in+in!em *ie(e, 'u ?u+$ru( *$(i'e(ui, ( 45'm %ub ($'u( *un'+iei, *en+ru
im$bi(ire 0enei %i -'i(i++e *ene+rrii 'u(ui
▫ %e e1e'u+ *un'+i 0en$%
▫ %e '$n+r$(e !' 'u( e%+e in 0en
▫ %e in!e*r+e %+ 0en$% *rin !e%-'ere &r$u(ui
▫ %e in?e'+e (en+, +inn! %erin& in mn %+n&, ir 'u *$(i'e(e minii !re*+e %e
*% *e *i%+$n
▫ %e 0eri-i' *eri$!i' !' 'u( e%+e in 0en
▫ %e re+re&e bru%' 'u(, 'n! in?e'+re % +ermin+
▫ ( ($'u( *un'+iei %e *(i' +m*$n imbib+ in ('$$(, '$m*re%i0
In&ri?ire ▫ %e men+ine '$m*re%iune ( ($'u( in?e'+iei '+e0 minu+e
u(+eri$r ▫ %e %u*r0e&#e in '$n+in$re %+re &ener(
 *'ien
+u(ui
  In'i!en+e %i ''i!en+e In+er0en+ii
▫ in?e'+re %$(u+iei in +e%u+u( *eri0en$% ▫ %e in'er' *+run!ere 'u(ui in (umenu(
mni-e%++ *rin: +ume-iere +e%u+uri($r, !ureri 0%u(ui, '$n+inun!u%e in?e'+i %u %e
 

in'er' in (+ ($'

▫ -eb(&i *r$!u% *rin in?e'+re -$r+e r*i!  ▫ in?e'+re (en+
%$(u+iei %u  un$r %ub%+n+e iri+n+e
▫ 0(uri !e '(!ur, %en+i !e u%''iune  &urii ▫ in?e'+re (en+
▫ #em+$m *rin %+r*un&ere 0enei ▫ %e in+reru*e in?e'+i
▫ me+e(i, (i*$+imie, '$(*% ▫ %e nun+ me!i'u(

PERFU-IA

De-ini+ie In+r$!u'ere *e '(e *ren+er(, *i'+ur 'u *i'+ur,  %$(u+iei me!i'men+$%e

 *en+ru ree'#i(ibrre #i!r$e(e'+r$(i+i', #i!r$i$ni' %i 0$(emi'  $r&ni%mu(ui,
+r+men+
M+eri(e ▫ %$(u+i !e *er-uie
ne'e%re ▫ *er-u$ru( ('+ui+ !in: +r$'r '$*eri+ 'u 'r'% +rn%*ren+
   +ubu(+ur !in m+eri( *(%+i'
   'mer !e 0iu(ire  *i'+uri($r *re0u+ 'u -i(+ru
   '(em %u r$bine+ !e in'#i!ere
   mn%$ri !in m+eri( *(%+i', e(%+i', &(benbrun
   *$r+' 'u 'r'% *r$+e'+$re
▫  *$m* !e *er-uie: re un %%+em e(e'+r$ni' *r$*riu *en+ru !mini%+rre
%$(u+ii($r. Per-u$re(e 0n! $ (un&ime 0ribi( in+re ,52m, 'u re&(re
 *r$&rm+  0$(umu(ui %i -i1re r+ei !e -(u1
   !e men+i$n+: %e -$($%e%' numi +ru%e !e *er-uie 'u *re%iune *$i+i0
▫ *$m* !e *er-uiein?e'+ie: *rin 'e%+ %%+em *$+ -i -$($%i+e %imu(+n mi mu(+e
%erin&i %u !$r un %in&ur, e(e -iin! '+i$n+e !e un *r$*u(%$r (iner 'u *i%+$n
 in 'e%+ m$! %un+ !mini%+r+e in !$e !e mre
e1'+i++e %$(u+ii in?e'+bi(e *rin *r$&rmre %i 0n! un !ebi+ in+re  %i m(<#
Ambe(e %i%+eme %un+ *re0u+e in ' !e in+reru*ere %u mi'%$rre r+ei !e -(u1 'u
(rm 0iu( %i u!i+i0.
▫  *ie%e in+erme!ire: 'e%+e %un+ m$n++e in 'u( *'ien+i($r 're ne'e%i+ *er-uii
%imu(+ne 0n! un numr 0ribi( !e 'i !e !mini%+rre
 e(e %e nume%' *$bine+e in 'u( r$bine+u(ui +ri-i' *$+ -i
r'$r!+e %imu(+n ( 'ee%i (inie 0en$% 2 *er-uii, ir ( %'#imbre +ru%ei !e
 *er-uie, e( %e *$+e in'#i!e $*rin! re-u(re %$(u+iei *er-ubi(e
▫ +m*$ne %+eri(e !e 0+ %i +i-$n
▫ %$(u+ii !ein-e'+n+e
▫ *i(e !in me+( *en+ru !e%'#i!ere -i$(e($r 
▫ +0i+ ren(
▫ &r$u !in 'u'iu'
▫ *erni+

In+er0en ▫ 0eri-i'm me!i'men+e(e *re%'ri%e !e me!i'

  +ii(e ▫ 0eri-i'm ' %$(u+i % -ie '(r, +rn%*ren+, ne*re'i*i++
 

%i%+en+ei ▫ 0eri-i'm +ermenu( !e 0(bi(i++e

▫ *re&+ire *%i#i' %i in%+(re *'ien+u(ui in *$i+ie !e'0+
M$n+re ▫ in!e*r+m mb(?u( %$(u+iei *er-ubi(e %i rm+ure me+(i' b!i?$nn! !$*u(
 *er-uiei &um+ 'u %$(u+ie !ein-e'+n+ %i -i1m *e %++i0 -('$nu( %u *.0.'.
▫ in!e*r+m mb(?u( +ru%ei !e *er-u+ %i in'#i!em r$bine+u( '(em) !e -i1re 
numru(ui !e *i'+uri
▫ in!e*r+m 'r'% *r$+e'+$re !e *e +r$'r %i i( in+r$!u'em *rin !$*u( &um+ in
-('$n -r  +in&e +r$'ru( 'u !e&e+e(e
▫ !e%'#i!em r$bine+u( '(em) !e -i1+  numru(ui !e *i'+uri %i um*(em 'mer !e
0iu(ire  *i'+uri($r 'm 2<3 ni'i$!+ '$m*(e+)
▫ e(iminm bu(e(e !e er !in +ubu(+ur, *rin um*(ere 'e%+ei 'u %$(u+i !in -('$n
▫ rein'#i!em r$bine+u( '(em) !e -i1re  numru(ui !e *i'+uri
E1e'u+i ▫ %i%+en+ i%i %*( mini(e
 *er-uiei ▫ (e&em ($'u( *un'+iei %i i( !ein-e'+m
▫ men+inem br+u( *'ien+u(ui in'(in+ in ?$% 'u *umnu( %+rn%
▫in+in!em *ie(e, 'u ?u+$ru( *$(i'e(ui, ( 45'm %ub ($'u( *un'+iei, *en+ru
im$bi(ire 0enei %i -'i(i++e *ene+rrii 'u(ui
▫ %e e1e'u+ *un'+ie 0en$%
▫ %e '$n+r$(e !' 'u( e%+e in 0en
▫ %e in!e*r+e %+ 0en$% *rin !e%-'ere &r$u(ui
▫ %e %+bi(e%+e r+ !e -(u1  *er-uiei *rin !e%'#i!ere r$bine+u(ui
  *i'+uri  0$(umu( +$+( 1 *i'+uri<m(
  minu+ +im*u( +$+( !e in-uie in minu+e
▫ %'#imbre -('$ne($r %e e-e'+ue -r in+r$!u'ere !e er in 0en
▫ !' in +im*u( *er-uiei me!i'( re'$mn! !mini%+rre !e 0i+mine, e(e'+r$(i+i,
n+ibi$+i'e, '(mn+e, in *er-iuie b!i?i$nm
In'i!en+e ▫ in?e'+re %$(u+iei in +e%u+u( *eri0en$% mni-e%++ *rin: +ume-iere +e%u+uri($r,
''i!en+e !ureri
▫  -(eb(&i *r$!u% *rin in?e'+re -$r+e r*i!  %$(u+iei %u  un$r %ub%+n+e
iru+n+e
▫ 0(uri !e '(!ur, %en+i !e u%''iune  &urii
▫ #em+$m *rin %+r*un&ere 0enei
▫ me+e(i, (i*$+imie, '$(*%

 
Me"ica&ete a"&iistrate pe cale $eoasa :

  ASPATOFORT -i$(e
 !ctiune terapeutica: *r$+e'+$r ( e'#i*men+u(ui enm+i' #e*+i'
   #e*+$+r$*
 Indicatii: #e*+i+ 'r$ni'
   *re'$m #e*+i'
   en'e-($*+ie
   ('$$(i%m
 +od de administrare: 2 -i$(e in 3m( %$(u+ie &(u'$+ i$+$n, in+r$ $r
 *eactii adverse: %$mn$(en+
 

   mi'%$rre ni0e(u(ui *(%m+i'

Contraindicatii: (er&ie ( 0i+ B6

  ARGININASORBITOL %$( *er-ubi(

 !ctiune terapeutica: -urnire %ub%+r+ ener&e+i' 'e(u(e($r #e*+i'
 Indicatii: in '$me #e*+i'e %u en'e-($*+ie #e*+i'e
 +od de administrare: 27m& r&inin<@&'$r* in *r$1im+i0 4 $re
   27m& r&inin<@&'$r*<i
 *eactii adverse: &re+
   0$m
   eri+em
   'e-(ee
   *re%+eii
Contraindicatii: IRA, in+$(ern+ ( -ru'+$

  DETRAN 9%$( *er-ubi(

 !ctiune terapeutica: in '$n'en+r+ie !e 6&<( in %$(u+ie '($r$%$!i' i$+$ni' re *r$*ie++i
'$(($i! $%m$+i'e %imi(re 'u (e $(%mei %n&0ine
 '+iune n+i+r$mbb$+i'
 Indicatii: #em$r&ie
   !e#i!r+ri
   in%u-i'ien+ 'ir'u(+$rie *rin %$' +$1i'
 +od de administrate: ur+i'rie
   %*%m br$n%i'
Contraindicatii: +r$mb$'i+$*enie mr'+
   in%u-i'ien+ 'r!i' '$n&e%+i0e
   IRA, e!em *u(m$nr

  ALBUMINA UMANA -('$ne m( 5

 !ctiune terapeutica: %$(u+ie *r$1im+i0 i$$%m$+i' 'u *(%m, '$n+ribuie ( re-'ere
0$(emiei
 Indicatii: %+ri !e #i*$*r$+einemie 'u %u -r e!eme
   in r%uri &r0e
 +od de administrate: *er-uie i.0. ini+i( 5m(, %e re*e+ ( ne0$ie= %e -$($%e%+e numi %$(u+i
'(r, in'(i+ ( +em*er+ure '$r*u(ui
 *eactii adverse: in ' !e !e-i'i+ !e *$m* *r$0$' %u*rin'r're 'ir'u(+$r
   e!em *u(m$nr 
   0$m
   -ebr
Contraindicatii: nemi &r0e, in%u-i'ien+ 'r!i' %i +rum+i%me
  MANITOL 2
 !ctiune terapeutica: !iure+i' $%m$+i' neme+b$(ibi( !e $r&ni%m
   '$n+ribuie ( %'!ere *re%iunii in+r'rniene
   're%+e *re%iune +um$rii *$%e
 Indicatii: e!em 'erebr( 'u HIC, #i*er+en%iune in+r'e(u(r
 +od de administrare: i.0. *er-ubi( 25m(<i 'u ri+m !e 4*i'<min
 

Contraindicatii: !e%#i!r+re *re!$minn+ in+r'e(u(r.

  HEPARINA -i$(
 !ctiune terapeutica: n+i'$&u(n+ !e +i* -ii$($&i' e--e'+ r*i!, !e !ur+ %'ur+ 47#
 Indicatii: +r+men+ !e ur&en+ ( -e'+iuni($r +r$mb$emb$(i'e
   in HDS
 +od de adminidtrare: i.0. in?e'+ie  u.i.< m(
   *er-uie 5 u.i.
   *er-uie '$n+inu   u.i. ( 7#
 *eactii adverse: -r&i(i++e '*i(r
   HTA %e0er
   #em$r&ie 'erebr(
   u('er &%+r$!u$!en(

  METOCLOPRAMID -i$(e
 !ctiune terapeutica: n+i0$mi+i0
   -0$rie &$(ire %+$m'u(ui *rin %+imu(re *eri%+(+i%mu(ui &%+ri' %i
re(1re %-in'+eru(ui *($ri'
 Indicati: &re+ %i 0r%+uri
   e%$-&i+ !e re-(u1
   !i%*e*%ie
   -'i(i+re en!$%'$*iei
   ne%+ei' in %'$*u( e0'urii '$n+inu+u(ui &%+ri'
 +od de administrare:  -( !e 23 $ri<i in -un'+ie !e %i+u+ie
 *eactii adverse: %$mn$(en+
   me+e(i
   &ine'$m%+ie in 'ur *re(un&i+e
Contraindicatii: #em$r&ie &%+r$in+e%+in(
   (er&ie ( me+$'($*rmi!

  CEFOTAIM
 !ctiune terapeutica: n+ibi$+i' 'u %*e'+ru (r&
 Indicatii: in-e'+ii %e0ere in+rb!$min(e %i &ener(i+e %e*+i'emi
 +od de administrare: i.0. & ( 67# -r  %e !e*%i 2&<24#
 *eactii adverse: (er&ie
   +u(burri !i&e%+i0e: '$(i+, !iree
   +u(burri #em+$($&i'e
   +u(burri #e*+i'e: 're%+e TGO %i TGP
Contraindicatii: #i*er%en%ibi(i++e ( 'e-($%*$rine

III.*.".b.ADMINISTRAREA MEDICAMENTELOR PE CALE MUSCULARA

L$'uri !e ▫ mu%'#ii 0$(umin$%i, (i*%i+i !e +run'#iuri im*$r+n+e !e 0%e %i ner0i,  'r$r (ere
e(e'+ie r *u+e *r$0$' ''i!en+e
 

e1. muschii fesieri

▫ '!rnu( %u*er$e1+ern -e%ier reu(+ !in in+re+iere unei (inii $ri$n+(e, 're +re'e
 *rin mr&ine %u*eri$r  mre(ui +r$#n+er *n !e*u*r %n+u(ui in+er-e%ier, 'u $
(+ 0er+i'( *er*en!i'u(r *e mi?($'u( 'e(ei $ri$n+(e
▫  'n! *'ien+u e%+e 'u('+, %e 'u+ ' re*ere *un'+u(e Smir$0 %i Br+#e(m
 punctul Smirnov  e%+e %i+u+e ( un (+ !e !e&e+ !e%u*r %i in*$i mre(ui
+r$#n+er=  punctul )arthelm9 e%+e %i+u+e ( unire +reimii e1+erne 'u 'e(e !$u +reimi
in+erne  unuei (inii 're une%+e %*(in i(i' n+er$%u*eri$r 'u e1+remi++e
%n+u(ui in+er-e%ier)
▫ 'n! *'ien+u( e%+e in *$i+ie %en!, in?e'+i %e -'e in +$+ re&iune -e%ier,
!e%u*r (iniei !e %*ri?in
In+er0en ▫ %i%+en+ i%i %*( mini(e
+ii(e ▫ (e&em ($'u( *un'+iei %i i( !ein-e'+m
%i%+en+ei ▫ %e in+in!e *ie(e in+re in!e1u( %i *$(i'e(e minii %+n&i %i %e in+e* *er*en!i'u(r 
 *ie(e 'u r*i!i++e %i %i&urn+, 'u 'u( m$n++ ( %erin&
▫ %e 0eri-i' *$i+i 'u(ui *rin %*irre
▫ %e in?e'+e (en+ %$(u+i
▫ %e re+r&e bru%' 'u( 'u %erin& %i %e !ein-e'+e ($'u(
▫ %e m%e u%$r ($'u( in?e'+iei *en+ru  '+i0e 'ir'u(+i
In'i!en+e %i ''i!en+e In+er0en+ii
▫ !urere 0ie, *rin +in&ere ner0u(ui %'i+i' ▫ re+r&ere 'u(ui, e-e'+ure in?e'+iei in (+
%u  un$r rmuri (e %(e $n
▫ *r(ii *rin (ere ner0u(ui %'i+i' ▫ %e e0i+ *rin re%*e'+re $ne($r !e e(e'+ie 
▫ #em+$m *rin (ere unui 0% in?e'+iei
▫ ru*ere 'u(ui ▫ e1+r&ere mnu( %u '#irur&i'(
▫ %u*ur+ie %e*+i' ▫ %e *re0ine *rin -$($%ire un$r 'e %u--i'ien+ !e
(un&i *en+ru  *+run!e in m% mu%'u(r
▫ emb$(ie *rin in?e'+re ''i!en+( in+run ▫ %e *re0ine *rin 0eri-i're *$i+iei 'u(ui
0%  %$(u+ii($r u(ei$%e

Me"ica&ete a"&iistrate pe cale &!sc!lara :

  TROFOPAR*u(bere
 !ctiune terapeutica: #e*+$*r$+e'+$re
   !iminu #i*er%*(eni%mu(
   me(i$re -un'+ii(e me+b$(i'e (e #e*+$'i+u(ui
 Indicatii: #e*+i+ 'r$ni'
   'ir$ #e*+i'
 +od de administrate: 2m(<i i.m. +im* !e 3 !e i(e %e*r+e *rin *u%e !e 34 (uni in 'ir$e
Contraindicatii: re'+ii (er&i'e ( +r$-$*r 

  CORTIJON ACETAT
 !ctiune terapeutrica: *r$+e?e $r&ni%mu( in '$n!i+ii !e %+re%%
   n+iin-(m+$rie
   n+i(er&i'
 

   're%+e %e're+i &%+ri'

   %+imu(e SNC
   -0$rie re+en+i #i!r$%(in
In!i'+ii: %+ri !e !e#i!r+re
   in%u-i'ien+ %u*rren(
 +od de administrare: i.m. 5m&<i
 *eactii adverse: u('er &%+r$!u$!en(
   re+en+ie #i!r$%(in
   +u(burri $'u(re
   &r0re in-e'+ii($r 
Contraindicatii: e!eme
   in%u-i'ien+ 'r!i'
   u('er &%+r$ !u$!en(

  INTRONA \ in+er-er$n)
 !ctiune terapeutica:in#ib re*(i're 0ir(
 Indicatii: in +r+men+u( *r$-i('+i' ( CH !e e+i$($&ie 0ir(
 +od de administrare: i.m. 335mi(.u.i.<%*+mn
 i.m. 5mi(. u.i.<i
   i.m. mi(. u.i.<%*+mn 624 !e %*+mni
 *eactii adverse: -ri%$ne
   in%$mni %'!e '*'i++e !e '$n'en+rre
   %'!ere *$n!er(
Contraindicatii: #i*er%en%ibi(i++e ( in+er-er$n \

III.*.INTRODUCREA SONDEI -LAC<MORE

  Pen+ru '$m*re%i %e&men+r  e%$-&u(ui %i  'r!iei in 0e!ere unui +m*$nmen+ e%$-&in

%e -$($%e%' mi mu(+e +i*uri !e %$n!e !in+re 're 'e mi -$($%i+ e%+e %$n! B('@m$re.

S'$* Re(ire #em$%+ei in HDS *rin ru*ere 0ri'e($r e%$-&iene

▫ 'n! 'n+i++e !e %n&e *ier!u+ e%+e mre %i<%u *er%i%+en+
▫ 'n! +u(burri(e #em$!inmi'e nu %e re%+bi(e%' !u* um*(ere 0%'u(r 'u m(
M+eri(e ▫ %$n!B('@m$re 'u !ub( b($n? %+eri(e
ne'e%re ▫ %$n! &%+ri', (rin&$%'$*
▫ %erin&i !e 2m(
▫ '$m*re%e %+eri(e
▫ *r+ !e %*ir+ie 0% '$(e'+$r 
▫ me!i'+ie: %$(u+ie n$0$'in ne%+eie), %ub%+n+ (ubre-in+
In+er0en ▫ *re&+ire *%i#i' !e%'riere '+iunii %i  ne'e%i++ii e-e'+urii 'e%+ei
  +ii(e ▫ %e e0'ue '$n+inu+u( &%+ri'
%i%+en+ei ▫ 0eri-i' e+n%ie++e %i -un'+i$n(i++e b($n%e($r 
▫ (ubre-i %$n!
▫ 0eri-i' *r+u( !e %*ir+ie
 

▫ re*rein+ *e %$n! !i%+n+ n%$mbi(i'

▫ ne%+ei $ri-i'ii($r n(e
E1e'u+ie ▫ %e in+r$!u'e %$n! en!$n(, e%+e im*in% *r$&re%i0 %i *rin mi%'ri !e !e&(u+i+ie
0 -i in&#i+i+ *n ( mr'? re-(u1u( !e %n&e %u %u' &%+ri' !$0e!e%+e *reen+ ei
in %+$m')
▫ %e um-( b($n%u( &%+ri' 'u 225m( er 
▫ %e +r&e %$n! %+-e( ' b($n%u( % -ie in !re*+u( ?$n'+iunii e%$-&$'r!i(e
▫ %e -i1e ( $ri-i'iu( n%( *rin+run %%+em !e *rin!ere &u(er%)
▫ %e um-( b($nu( e%$-&in 'u 67m( er 
▫ %e %*ir '$n+inu+u( %$n!ei
▫ %e +%e ( %$n! *un& '$(e'+re 're 0 -i %i+u+ !e'(i0
▫ %e 0eri-i' *ermnen+ *re%iune !in b($n%e *rin in+erme!iu( men$me+ru(ui +%+
▫ *re%iune ne'e%r %i&urrii #em$%+ei e%+e !e 56mm#&
▫ %e %u*r0e&#e -i1re, *ermebi(i++e %$n!ei, TA %i *u(%u(
▫ %e %u*r0e&#e e*i%$!u( #em$r&i'
▫ *en+ru *re0enire i%'#emiei mu'$%ei %i u('erre bei e%$-&u(ui %e '$n+r$(e
 *re%iune b($n%u(ui, %e !eum-( *eri$!i' b($n%u( e%$-&in ( 4 $re +im* !e 5
minu+e)
▫  !' %n&erre nu e%+e '$n+r$(+, b($n%u( &%+ri' %e um-( ( 3m(, !r 
0$(umu( !e re %n u !e*%e%' m( in b($n%u( e%$-&in
 

S*i+(u(
 

  C#: (lini( nr.1

Peri$! !e in&ri?ire.3.265.3.26

Pre*etarea ca*!l!i

  D.n R.M., in 0r%+ !e 54 !e ni, 'u !$mi'i(iu( in Br%$0, '%+$ri+ !e 25 !e ni,

 *en%i$nr, -$%+ +e(e-$ni%+, !e n+i$n(i++e r$mn, !e re(i&ie $r+$!$1, %e *rein+ ( %e'+i !e
&%+r$en+er$($&ie  S*i+(u(ui S-. I$n *e !+ !e.3.26, 'u !i&n$%+i'u( !e ciro$a hepatica 
virala C.

 Moti$ele iterarii

  L in+ernre *'ien+ R.M.  'u+ urm+$re(e %emne %ubie'+i0e:

 !urere m$!er+ in e*i&%+ru
   n1ie++e
   '$n%+i*+ie
   in*e+en+
   %+enie -ii' mr'+
   *ruri+ +e&umen+r 
  L e1menu( '(ini' %u '$n%+++ urm+$re(e %emne $bie'+i0e:
   %*(en$me&(ie m$!er+
 -i'+ 'u mr&ine in-eri$r ( 2,3'm %ub reb$r!u( '$%+( 'u '$n%i%+en+ 're%'u+
   u%$r %'!ere *$n!er(
   +e&umen+e %ubi'+eri'e= %+eu(+e 0%'u(re *e +$r'e

 Pro%il!l paciet!l!i

  Dn R.M. e%+e in *re%en+ *en%i$nr +rie%+e im*reun 'u %$+u( in+r$ &r%$nier, 0n! '
%ur% !e 0eni+ *en%i !e 2 5  (ei. In urm !i%'u+iei 'u *'ien+ m '$n%+++ ' e%+e
in&ri?$r+, *en+ru %$r ei 're 0 %u-eri $ in+er0en+ie '#irur&i'(. Din 'e%+ 'u
'$muni're 'u !$mn R.M. nu  !e'ur% n$rm(, !umneiei -iin! &i++e, n1i$% r%*unn!
*r$*e m$n$%i(bi' ( in+rebri(e *u%e.

 Perceptia starii "e saatate

  In u(+imi(e 5 (uni *'ien+ nu  mi urm+ +r+men+u( *re%'ri% !e me!i', *unn! *e *rimu(
 *(n *r$b(eme(e -mi(iei +$+e 'e%+e !u'n! ( &r0re %in+$me($r !e? *reen+e. M$!u( !e
0i+ ( *'ien+ei, in u(+imu( +im*,  -$%+ !ee'#i(ibr+ urmn! un re&im (imen+r ne!e'0+ %i
$re !e %$mn in%u-i'ien+e. Nu '$n%um ('$$( %u +u+un.
  Din n+e'e!en+e(e -ii$($&i'e reie%e ' *rim men%+ru+ie  0u+$ ( 0r%+ !e 5 ni, u(+im
men%+r ( 45 !e ni men$*u),  0u+ un '$*i( %i un %in&ur 0$r+. In 9  -$%+ %*i+(i+,
 

 *rim $r, *en+ru e1+ir*re unui -ibr$m u+erin, in -r 'e%+ui nu  mi %u-eri+ ni'i $
in+er0en+ie '#irur&i'(. T$+ !in n+e'e!en+e *'ien+ re(+e ' in urm 'u 5 ni,  -$%+
!i&n$%+i'+ 'u #e*+i+ 'r$ni', 'u 0iru% C *e 're nu  +r++$.
  An+e'e!en+e #ere!$'$(+er(e nun e !u ni'i $ in-$rm+ie in (e&+ur 'u '+u( b$( 
 *'ien+u(ui ni'i un membru ( -mi(iei nu  %u-eri+ !e 'e%+ b$().

 Istoric!l #olii act!ale

  P'ien+ re(ie ' b$( '+u(  -$%+ !e%'$*eri+ *e !+ !e 5 -ebrurie 9, in +im*u(
unei in+er0en+ii '#irur&i'(e !e e1+ir*re  unui -ibr$m u+erin in C(ini' !e '#irur&ie &ener( 
S*i+(u(ui Mi(i+r, un!e in+r$*er+$r % $b%er0+ %+ru'+ur m'r$%'$*i'  -i'+u(ui mri+ !e
0$(um %i 'u $ '$n%i%+en+ !ur ( *(*re.
  L 2 (uni !e ( 'e%+ in+er0en+ie '#irur&i'( i % e-e'+u+ $ *r$b !e *un'+ie bi$*%i' 'e 
'$n-irm+ !i&n$%+i'u( !e 'ir$ #e*+i' 0ir( C.
  In mbu(+$r  urm+ +r+men+ 'u Li052 5 i(e !u* 're ( in+reru*+)= 0i+mine !in &ru*u(
BB %i B6 i.m. 6 7 i(e= 0i+min C 2 '$m*rim+e *e i 7 i(e= He*+$!rin$(2 !e *i'+uri !e 3
$ri *e i 'u 5 minu+e inin+e !e m% %i Me+$'($*rmi!  -i$( i.m. ( ne0$ie. T$+e 'e%+e
me!i'men+e -iin! in+reru*+e !e 5 (uni.
  A'um %e in+erne *en+ru ree0(ure %i +r+men+.

 Protocol &e"ical

  L e1menu( -ii' &ener( *e *r+e %e '$n%++:

   %+re &ener( (+er+= %+re !e nu+ri+ie %(b
   +(i,65
  &reu++e57 @&
   &n&(i$ni %u*er-i'i( ne*(*bi(i
   -nere n$rm(e
   +e&umen+e %ubi'+eri'e %+e(u+e 0%'u(re *e +$r'e(e %u*eri$r 
   ROT *reen+e bi(+er(
 %i%+emu( mu%'u(r n$rm$+$n, n$rm$@ine+i'
 %i%+emu( $%$% in+e&ru, m$bi(
 *r+ re%*ir+$r 
   nu *rein+ &$m$+e re%*ir+$rii %u %u-(uri
   nr. re%*ir+ii  2r<minu+
   n1ie++e mni-e%++ *rin ##i*nee
   %$n$ri++e *u(m$nr n$rm(
   'i re%*ir+$rii *ermebi(e
   +$r'e n$rm( '$n-$rm+
*r+ !i&e%+i0e
   '0i++e bu'( n$rm( 'u !en+i+ie '$m*(e+ %i (imb -r !e*$i+e
   +rn%i+ in+e%+in( in'e+ini+
   in*e+en+
 -i'+ %i 'i bi(ire
   -i'+: !ime+ru( *er#e*+i' 3'm n$rm( 'm)
   (imi+ %u*eri$r  in %*+iu( I in+er'$%+(
 

   (imi+ in-eri$r ( 2,3'm %ub reb$r!

   -i'+ 'u %u*r-+ nere&u(+, !e '$n%i%+en+ 're%'u+
   %*(in 're%'u+ m$!er+ %*(en$me&(ie
 %i%+em ner0$%
   $rien++ +em*$r$%*+i(
   *%i#i' n1ie++e mr'+
 *r+ 'r!i$ 0%'u(r 
   nu *rein+ !ureri *eri'$r!i(e
   %$'u( *e1in %e %im+e in %*+i(  in+er'$%+(% %+n& *e (ini me!i$'(0i'u(r
   *u(%  6<minu+ u%$r ''e(er+ !+$r+ n1ie++ii
   TA  35<65mmH&

 I$esti'atii e%%ect!ate pe perioa"a spitali*arii

  An(i %n&e(ui:

.3.26 3.3.26 5.3.26 ($ri n$rm(e

  Hem$&rm
Hb ,7 4,3& 6&
Leu'$'i+e 75<mm3 7<mm3 427mm3
neu+r$-i(e NS   5
neu+r$-i(e S 93 92 459
e$in$-i(e 2 2 3
Lim-$'i+e 23 23 24
m$n$'i+e 6 6 47
Tr$mb$'i+e 45.mm3 5.mm3 54mm3
T.. 4,3> 4 24>
T.G.P 7u.i 6u.i 26u.i
T.G.O 3u.i 24u.i 22u.i
C$(e%+er$( 6m&  727m&
Bi(irubin T ,m&  ,6m&
Bi(irubin D ,6m&  ,,4m&
Cre+inin ,97m&  ,6,2m&
Uree 24m&  24m&
Pr$+eine 6,& 6,3 6,7,6m&
  I$n$&rm
 N+  45mEV  3952mEV
" +   4mEV  3,75,mEV4
C(] 5mEV  4mEV
C+   4,7mEV  4,55,mEV
G(i'emi 79m&  72m&
A(bumine 4,7 47 45
G($bu(ine \    5,9 5,5 3,56,5
G($bu(ine \ 2   ,3 ,2 62
G($bu(ine ^ 9 9,6 5
G($bu(ine _ 3,5 27 67
 

SH 26mm<# 7mm<# 4mm<# 23mm<#

ET 37 36 3 4± 5
Tm$( 9uML 5uML 4uML 4uML
Ur$'u(+ur  %+eri(  %+eri(

Eco'ra%ie a#"o&iala   .3.26)

   -i'+ 'u %+ru'+ur ne$m$&en, '$n+ur nere&u(+, '$n%i%+en+ 're%'u+
   *n're% $m$&en
   '$(e'i%+ 'u !ub(u '$n+ur, -r '('u(i, !e%+ine% !e 0$(um
   %*(in !e%+in% !e 0$(um  %*(en$me&(ie
   0en *$r+  mm #i*er+en%iune *$r+( in'i*ien+)
   '0i++e *eri+$ne( nu 0iu(ie (i'#i! !e %'i+

Co&p!ter to&o'ra%   2.3.26)

  Fi'+ u%$r mri+ in !imen%iune, '$n+ur b$%e(+ 'u %+ru'+ur !i-u ne$m$&en ( !mini%+rre
%ub%+n+ei !e '$n+r%+ 'u %*e'+ *$(in$!u(r. C$(e'i%+ mu(+ !i%+in%, *ere+i in&r$%+i, -r '('u(i.
S*(en$me&(ie m$!er+ 'u %+ru'+ur $m$&en. C0i++e *eri+$ne( -r (i'#i! !e %'i+.

 Trata&et!l &e"ical aplicat pe perioa"a i'ri8irii

PERIOADA MEDICAMENTUL
.3.26 E%%en+i(e -$r+e 92m&<i
L'+u($%e 3& 13<i
C$('#i'in m&<i
.3.26 E%%em+i(e -$r+e92m&<i
Li052 4+b<i
L'+u($%e 3& 13<i
C$('#i'in m&<i
C('iu &(u'$ni' m(<i
Die*m +b<i
3.3.26 E%%en+i(e -$r+e92m&<i
Li052 4+b<i
C$('#i'in m&<i
C('iu &(u'$ni' m(<i
Die*m +b<i
5.6.26 E%%en+i(e -$r+e92m&<i
Li052 4+b<i
C$('#i'in m&<i

   '(i%m e0'u+$rie *e !+ !e .3.26

 Apreciere !rsi'
 

 P'ien+ *rein+ $ re%*ir+ie !i-i'i( !+$ri+ %ur%e($r !e $r!in *%i#$($&i': n1ie++e, %+re%u(,
%i+u+i !e 'ri in 're %e -(, mni-e%++ $rin +#i*nee nr. re%*ir+ii 2r<minu+).Timbru( 0$'ii
e%+e !e in+en%i++e %'u+ mni-e%++ *rin 0$'e %+in%. Pu(%u( e%+e !e %emene u%$r ''e(er+
7<minu+, ir TA %e -( in (imi+e n$rm(e.
 B$(n0 nu%i *$+e %+i%-'e ne0$i !e  %e (imen+ %i #i!r+ !+$ri+ in*e+en+ei *reen+e !e
*r$1im+i0 2 (uni %i  !ureri($r m$!er+e in e*i&%+ru. Di&e%+i, !e %emene, %e -'e 'u
!i-i'u(++e, (imen+e(e, -iin! &reu b%$rbi+e ( ni0e(u( in+e%+inu(ui %'!ere *eri%+(+i%mu(ui
in+e%+in(. Prein+ $ #i!r+re in%u-i'ien+ -iin! +r!u% *rin *ier!erei in &reu++e, %(bi'iune,
+e&umen+e %i mu'$%e u%'+e %i urini '$n'en+r+e.
 Cn+i++e !e urin emi% in *rim i e%+e !e 5m(, 'u $ -re'0en+ !e 35 mi'+iuni *e i.
D+$ri+ *$r+u(ui re!u% in (i'#i!e, urini(e emi%e %un+ u%$r '$n'en+r+e. Prein+ '$n%+i*+ie
%'un ( 6 i(e) emi% 'u !i-i'u(++e, ' urmre  unuei #i!r+ri in%u-i'ien+e %i unei (imen++ii
%r'e in rei!uri, !r %i !in 'u%e %im*+$m+i'e *reen+ 'ir$ei #e*+i'e %i  #em$r$ii($r).
C$n%+i*+i e%+e in%$+i+ !e -(+u(en+, 'rm*e %i !ureri b!$min(e.
 Din 'e%+ 'u *rein+ !i-i'u(++e in  %e !e*(%, 'e%+ -iin! in&reun+ %i !e %+eni -ii'
mr'+.
 S$mnu( e%+e *er+urb+, !in 'ee%i 'u *%i#$($&i' n1ie++e, *reen+n! in%$mnii +ermin(e
!u* $ !$rmire n$rm(, %e +ree%+e %in u mi *$+e !$rmi. T$+e 'e%+e %un+ +r!u%e *rin
iri+bi(i++e $ %+re !e +en%iune *%i#i' '$n+inu mni-e%++ *rin ne(ini%+e, -rmn+re, %$mn
in+reru*+ %i %u*er-i'i(.
 Prein+ !i-i'u(++e in  %e imbr' !+$ri+ !ee'#i(ibre($r !e $r!in -ii': !urere, %(bire
-ii'= !e $r!in *%i#$($&i': n1ie++e %i %+re%u(.
 L ni0e(u( ne0$ii !e  *r$+e? +e&umen+e(e *rein+ !i-i'u(++e !+$ri+ *reen+ei *ruri+u(ui, 
+e&umen+e($r u%'+e 'e *$+ !u'e ( (+erre in+e&ri+rii *ie(ii *rin *ri+i (eiuni($r !e &r!?. L
ni0e(u( mu'$%ei n(e *rein #em$r$ii 'e !u' ( (+erre mni-e%+ri($r !e in!e*en!en+ (
'e%+ ni0e(.
 Ne0$i !e  e0i+ *eri'$(e(e, !e %emene, e%+e (+er+ !+$ri+ 0u(nerbi(i++ii 're%'u+e -+ !e
 *eri'$(: $r&ni%m %(bi+, $b$i%+, n1ie++ii %i !urerii. De %emene !e#i!r+re *re!i%*une
+e&umen+e(e ( (ere.
 C$muni're e%+e in%u-i'ien+ !+$ri+ %ur%e($r !e $r!in *%i#i' n1ie++e, %+re%%, %i+u+i !e
'ri  %*i+(ire), !r %i %ur%e($r !e $r!in -ii': !ureri e*i&%+ri'e, 'rm*e b!$min(e,
!ee'#i(ibru( #i!r$e(e'+r$(i+i'.
 Ne0$i !e  %e re'ree e%+e %i e (+er+ !+$ri+ !ureri($r, n1ie++ii %i +ri%+e+ii mni-e%++ *rin
in!i%*$i+ie 're im*ie!i' *'ien+ % %e in0e%e(e%'
 Prein+ !e*en!en+ %i ( ni0e(u( ne0$ii !e  in0+ !+$ri+ !urerii 'e !u'e ( m$!i-i'ri (e
ri+mu(ui re%*ir+$r %i 'r!i', ( ne(ini%+e, iri+bi(i++e, +em, n1ie++e %en+imen+e !e +en%iune *e
're (e %im+e *'ien+ in -+ *r$b(eme($r 0ie+ii.

 Ne$oi %!"a&etale la care #ola$a pre*ita "epe"eta :

. Ne0$i !e  e(imin:
  ▫ b%en+ %'unu(ui
  ▫ !ee'#i(ibru ( e(iminri($r  
2. Ne0$i !e  re%*ir %i  0e $ bun re%*ir+ie:
  ▫ !i-i'u(++e in re%*ir+ie
3. Ne0$i !e  %e (imen+ %i #i!r+:
 

  ▫ !ee'#i(ibru nu+ri+i$n( %i #i!ri'

  ▫ !i-i'u(++e in  urm re&imu( (imen+r 
4. Ne0$i !e  e0i+ *eri'$(e(e:
  ▫ (+erre %+rii &ener(e
  ▫ *$+en+i( !e !ee'#i(ibru -ii' %i *%i#i'
5. Ne0$i !e %i *%+r +e&umen+e(e %i mu'$%e(e in+e&re:
  ▫ !ee'#i(ibru( in+e&ri++ii +e&umen+e($r %i mu'$%e($r 
6. Ne0$i !e  !$rmi:
  ▫ $re in%u-i'ien+e !e %$mn
9. Ne0$i !e  '$muni':
  ▫ '$muni're ine-i'ien+
7. Ne0$i !e  %e mi%' %i  0e $ bun *$%+ur:
  ▫ in+$(ern+ ( '+i0i++e
. Ne0$i !e  %e imbr' %i !ebr'
  ▫ !i-i'u(++e in  %e imbr'
. Ne0$i !e  %e re're:
  ▫ im*$%ibi(i++e !e  %e re're
. Ne0$i !e  in0+:
  ▫ %'!ere '*'i++ii !e '$n'en+rre

S*i+(u( '(ini'
 

  C#: (lini( nr."

  Peri$! !e in&ri?ire 2.3..3.26

 Pre*etarea ca*!l!i

  Dnu( D.M., in 0r%+ !e 6 !e ni, 'u !$mi'i(iu( in Timi%$r, '%+$ri+ !e 25 !e ni,

 *en%i$nr, -$%+ in&iner, !e n+i$n(i++e r$mn, %e *rein+ ( %e'+i !e &%+r$en+er$($&ie 
S*i+(u(ui S- I$n *e !+ !e 2.3.26, 'u !i&n$%+i'u( !e ciro$a hepatica de etiologie mixta
decompensate vascular si parenchimatos.

 Moti$ele iterarii

  P'ien+u( D.M. 'u ( in+ernre %im*+$me %ubie'+i0e:

 in*e+en+
 -+i&bi(i++e
 %+enie -ii' mr'+
%'!ere *$n!er(
  In urm e1menu(ui '(ini' e-e'+u+ ( in+ernre %u $b%er0+ %i urm+$re(e %emne $bie'+i0e:
 %+e(u+e 0%'u(re *e +$r'e(e %u*eri$r 
 %*(en$me&(ie
 !i%*nee
mrire !e 0$(um  b!$menu(ui %*e'+ !e b+r'in
 !e%'umre -ur-ur'ee *e &mbe
 +e&umen+e *(i!e, %ubi'+eri'e
 e!eme &mbiere re'i, !e '$n%i%+en+ 're%'u+ !ure)

 Pro%il!l paciet!l!i

  Dnu( D.M. in *re%en+ *en%i$ner +rie%+e im*reun ($'uie%+e %in&ur in+r$ &r%$nier, 0n!
' %ur% !e 0eni+ *en%i !e 2 2  (ei. E%+e $ *er%$n '$muni'+i0, $ -ire !e%'#i% ,
re'e*+i0e ( $ri'e %-+ %u in!rumre !in *r+e e'#i*ei me!i'(e.

 Perceptia starii "e saatate

  M$!u( !e 0i+ ( *'ien+u(ui D.M. nu  -$%+ bine e'#i(ibr+, 0n! un *r$&rm !e (u'ru
e1+enu+e, 'u un $rr ( me%e($r !e'(+, $!i#n in%u-i'ien+, '$n%um !e +i&ri *n ( 0r%+ !e
35 !e ni un *'#e+ *e i ), '$n%um m$!er+ !e ('$$(, 'e u !u% in +im* ( e-e'+ure %e0er 
-un'+ii($r #e*+i'e.
 

  An+e'e!en+e(e #ere!$'$(+er(e %un+ ne&+e, ir !in+re n+e'e!en+e(e -ii$($&i'e *'ien+u(

men+i$ne:
   b$(i(e '$*i(riei: 0ri'e(, $rei$n
   nu *rein+ (er&ii me!i'men+$%e
 'ir$ #e*+i' !i&n$%+i'+ in urm 'u 6 ni

 Istoric!l #olii act!ale

  P'ien+u( e%+e 'un$%'u+ 'u 'ir$ #e*+i', !e e+i$($&ie mi1+, '$m*en%+e 0%'u(r %i
 *ren'#im+$%, !e 6 ni, in urm unui '$n+r$( !e ru+in e-e'+u+ ( 'mer !e &r!  S*i+(u(ui
S- I$n 0n! !re*+ 'ue: b($nri *$%+*rn!i(e, %+enie -ii', u%$r mrire !e 0$(um 
b!$menu(ui, in*e+en+.
  In urm e1minri($r e-e'+u+e: bi$'#imie TGO, TGP, e(e'+r$-$re) %i *r'(ini'e e'#$
b!$min() i % *u% !i&n$%+i'u( !e CH.
  De +un'i %e -( %ub $b%er0+ie me!i'(, e-e'+un! *eri$!i' '$n+r$(e me!i'(e. Ambu(+$r
 urm+ +r+men+'u: S*ir$n$('+$n 7'*<i, Fur$%emi! 2'*<i, E%%en+i(e -$r+e 2'*<i.
  A'um %e in+erne *en+ru ree0(ure %+!iu(ui CH %i &r0re %+rii &ener(e: mrire
'$n%i!erbi( !e 0$(um  b!$menu(ui, %+enie -ii' mr'+, in*e+en+ %i e!eme &mbiere.

 Protocol &e"ical act!al

  E1menu( '(ini':
   +(ie .9m
   &reu++e 69#&
   %+re &ener( me!i$'re
 +e&umen+e %i mu'$%e:
   *(i!e
   *reen+ !e %+e(u+e 0%'u(re *e +$r'e(e %u*eri$r 
   'ir'u(+ie '$(+er( *e -(n'uri
   *(me #e*+i'e
   e!eme &mbiere !ure %i re'i
   !e%'umre -ur-ur'ee *e &mbe
 &n&(i$ni %u*er-i'i(i ne*(*bi(i
 %i%+em $%$%: n$rm$-un'+i$n(
 %i%+em mu%'u(r: ( ni0e(u( membre($r %e $b%er0 $ %'!ere  m%ei mu%'u(re
 *r+u( re%*ir+$r:
   CRS (iber 
   !i%*nee !e e-$r+
   +$r'e %ime+ri' 'u %$n$ri++e *u(m$nr n$rm(
   Nr. re%*ir+ii  2<minu+
 *r+u( 'r!i$0%'u(r:
   &$m$+e 'r!i'e nere&u(+e
   %$' *e1in *re%en+ in %*+i(  in+er'$%+(% %+n& *e (ini me!i$'(0i'u(r
   +en%iune r+eri( 7<6mmH&
   e!eme *reen+e &mbiere !e '$n%i%+en+ !ur
 *r+u( !i&e%+i0e
 

   b!$men mri+ !e '$(um 'u m+i++e !e*(%bi( *e -(n'uri, in +en%iune= -i'+

ne*(*bi(
   '0i++e bu'( n$rm( 'u !en+i+ie e-i'ien+
   %*(in *(*bi( %*(en$me&(ie
   +rni+ in+e%+in( in'e+ini+
 *r+ urinr 
   !iure 5m(<24#ni'+urie
   ($?e ren(e (ibere ne!urer$%e
   mi'+iuni !urer$%e
   e(iminre urinii %e -'e 'u !urere in '0i++e re!u% $(i&urie) %i 'u mre
&reu++e!i%urie)
 %i%+em ner0$%
   $rien++ +em$*r$%*+i(
   *%i#i' *$i+i0

 I$esti'atii e%%ect!ate pe perioa"a spitali*arii

  An(i %n&e(ui:
  2.3.26 9.3.26 .3.26 ($ri n$rm(e
  Hem$&rm
Hb .7& 2.5& 4.5& 6&
Leu'$'i+e 25<mm 36<mm 4<mm 427mm
neu+r$-i(e N ,3 ,9 2,7 5
neu+r$-i(e S 66 6 63 459
e$in$-i(e 5 4 4 3
(im-$'i+e 23 2 2 24
m$n$'i+e 2 2 3 47
Tr$mb$'i+e 25.mm 42.mm 5.mm 54mm
.S.H. 25mm< $r 7mm< $r 3mm< $r mm<$r
T.. 2 9> 9> 24>
T.G.P. 9 u.i. 69 u.i. 63 u.i. 26 u.i.
T.G.O. 73 u.i. 97 u.i. 96 u.i. 22 u.i.
C$(e%+er$( 229m& 226m&  727m&
Bi(irubin T 4,72m& 3,m& 2,9m& ,6m&
Bi(irubin D 2,65m& ,7m& ,92m& ,4m&
Cr+inin ,3m&   ,6,2m&
A'i! urei' 6,7m&   26m&
Uree 3m&   24m&
Pr$+eine 6,3& 4,& 9,7& 6,7,6m&
Li*i!e +$+(e 67m&
  Imun$&rm
 N+   49m&  49m& 3952mEV
" +   5mEV   3,75,4mEV
C(] 4mEV
C2+   4,mEV   4,55,5mEV
G(i'emi 4m& 9m&  72mEV
 

A(bumine 42 44 42 45

G($bu(ine\    5,9 5,6 5,9 3,56,5
G($bu(ine\ 2   6, 6,35 6,54 62
G($bu(ine^ 9,32 9,34 9,35 5
G($bu(ine_ 3 3 3 67
Ur$'u(+ur  %+eri(  %+eri(

Eco'ra%ie a#"o&iala  5.3.26)

   -i'+'u!ime+ru( 'rni$'u!( 9'm
   ($bu( !re*+  ,5'm
   'u %+ru'+ur ne$m$&en, 'u '$n%i%+en+ %'u+
   %*(in !i(++, $m$&en
   '$(e'i%+ 'u *ere+ii in&r%+i %i mr&ine !ub(
   0en *$r+  3mm
   rini'#i n$rm(i
   (i'#i! !e %'i+ *re%en+ in 'n+i++e mre in '0i++e *eri+$ne(

 Trata&et!l &e"ical aplicat pe perioa"a i'ri8irii

  PERIOADA MEDICAMENTUL
25.3.26 %*ir$n$('+$n 2m&<i
-ur$%emi! 4m&<i
e%%en+i(e -$r+e 92m&<i
(bumin  -(  m( %$(u+ie i.0
!e1+rn 9 -( m(
1i(in  -  5m(
6.3.26 %*ir$n$('+$n 2m&<i
-ur$%emi! 4m&<i
e%%en+i(e -$r+e 92m&<i
(bumin -(  m( %$(u+ie i.0.
!e1+rn 9 -( m(
1i(in  -  5m(

-en$brbi+( m&<i
 

Ter*eu+i' %u e-e'+u+ in %'$* e0'u+$r *un'+ii b!$min(e *r'en+ee) 36.3.26

reu(+n! ( -ie're *un'+ie  (i+ri !e (i'#i! !e %'i+, in +$+( 29 !e (i+ri e0'u+e *e *eri!
%*i+(irii.

 Apreciere !rsi'

 B$(n0u( *rein+ $ re%*ir+ie !e-i'i+r, !i%*nee ( e-$r+ me!iu, !in 'u !inmiei %i  %'i+ei
 *reen+e in 'n+i++e mre, 'u $ -re'0en+ re%*ir+$rie !e 2 re%*<minu+= mu'$% re%*ir+$rie e%+e
 

ume!, ne*reen+n! %e're+ii. $'e nu e%+e (+er+ %in u *rein+ &$m$+e re%*ir+$rii, 'i(e
re%*ir+$rii %u*eri$re -iin! (ibere.
 L ni0e(u( +e&umen+e($r e!eme(e %un+ re'i !r$ri+ iri&rii in%u-i'ien+e  *ie(ii, TA e%+e %'u+
7<6mmH&) 'u un *u(% in me!ie !e 7 b+i<minu+.
 C0i++e bu'( *rein+ !en+i+ie bun, 'u mu'$% bu'( ume! !i&e%+i e%+e (en+, *ren+
in*e+en+, ne'e%i+ re&im (imen+r !e 'ru+re  #i*$(i*i!i', #i*er*r$+ei', !e%$!+), b$&+ in
0i+mine.
 E(iminre urinr e%+e !e-i'i+r, 'u $ 'n+i++e !e urin %'u+ 5m()  $(i&urie= ir
%'unu( e%+e n$rm( <i)
 P'ien+u( *rein+ !i-i'u(++e in !e*(%re !+$ri+ 0$(umu(ui b!$min( 're%'u+, ( !i%*neei (
e-$r+uri mi'i %i ( +r$-iei mu%'u(re.
 S$mnu( nu e%+e %+i%-'+$r ne'e%i+n! me!i'+ie !?u0n+ -en$brbi+(), 'u !e%e +reiri
n$*+e !+$ri+ ni'+uriei.
 L ni0e(u( +e&umen+e($r +$r'e(ui %u*eri$r %e $b%er0 %+e(u+e(e 0%'u(re, !e%'umre
-ur-ur'ee *e &mbe %i e!eme &mbiere re'i. Te&umen+e(e %un+ *(i!e, %ubie'+eri'e.
 P'ien+u( *rein+ -+i&bi(i++e, e%+e 0urnerbi( -+ !e *eri'$(e !+$ri+ '$n!i+iei -ii'e *re're
%(bire -ii', !inmie, (i*% !e e--$r+).
 DNUL. D.M. e%+e $ -ire !e%'#i%, '$muni'+i0, 'u uu !ebi+ 0erb( m$!er+, 0n! un (imb?
'(r, e1*rimre u%$r %i $ im&ine *$i+i0 !e %ine.
 P'ien+u( e%+e !e re(i&ie $r+$!$1, re (iber++e !e*(in !e '+iune %i %n++e men+( $*+im.
 P'ien+u( *rein+ in+ere% *en+ru $ri'e %-+ %u in!rumre !in *r+e e'#i*ei me!i'(e.

 Ne0$i -un!men+(e ( 're b$(n0u( *rein+ !e*en!en+:

. Ne0$i !e  e(imin=
  ▫ e(iminre urinr ine-i'ien+ 'n+i++i0
2. Ne0$i !e  re%*ire
  ▫ !i-i'u(++e in  re%*ire
3. Ne0$i !e  %e (imen+ %i #i!r+
  ▫ *e+i+ !iminu+
4. Ne0$i !e  %e mi%' %i m$bi(ie
  ▫ in+$(ern+ ( '+i0i++e
5. Ne0$i !e %i *%+r +e&umen+e(e %i mu'$%e(e in+e&re
  ▫ !i-i'u(++e in %i *%+r in+e&ri++e +e&umen+e($r 
6. Ne0$i !e  !$rmi %i  %e $!i#ni
  ▫ -re'0en+e *er+urbri (e %$mnu(ui
9. Ne0$i !e  e0i+ *eri'$(e(e
  ▫ *r$bbi(i++e +in&erii in+e&ri++ii -ii'e
 

S*i+(u( C(ini' S- Lu'

  C#: (lini( nr.%

  Peri$! !e in&ri?ire 4.46.4.26

 Pre*etarea ca*!l!i :

  Dnu( I.M., !e 63 ni, *en%i$nr, '%+$ri+ ,'u un '$*i(, !e re(i&ie $r+$!$1. Se in+erne *e
!+ !e 2.4.26 'u !i&n$%+i'u( !e ciro$a hepatica decompensata vascular si parachimatos:
eri$ipel al gambei drepte: sindrom hepatorenal.

 Moti$ele iterarii /

  Se in+erne !e ur&en+ 'u urm+$re(e %emne %ubie'+i0e:

   %$mn$(en+ !iurn(
   b($nre %i in*e+en+
   -ebr %i -ri%$n
   re%*ir+ie %u*er-i'i(
   &re+, 0r%+uri (imen+re %i bi(ire
   !urere 0ie ( ni0e(u( #i*$'$n!ru(ui !re*+
   +reiri n$'+urne re*e++e
   *ruri+
  L e1menu( '(ini' e-e'+u+ ( 'mer !e &r! %u '$n%+++ urm+$re(e %emne $bie'+i0e:
   +#i'r!ie
   +#i*nee
   e!eme (e membre($r in-eri$re
   #i*$+en%iune
   i'+er 'u+n+
   $(i&urie
   -i'+ ne*(*bi(
   eru*+ie 'u+n+ r$%ie 0i($'ee ( ni0e(u( &mbei !re*+e
   %*(en$me&(ie
 
 Pro%il!l paciet!l!i :

  Dnu(. I.M. e%+e '%+$ri+ !e 35 !e ni, ($'ue%+e in+run *r+men+ !e 3 'mere, %$+i
(u're, -iu( (u're %i e(. eni+uri(e m+eri(e (e -mi(iei %un+ bune.
  In'er're !e  '$muni' 'u *'ien+u( nu  !+ reu(++ !e$re'e 'e%+ *rein+ $ %+re
&ener( (+er+ !+$ri+ %+!iu(ui 0n%+ ( b$(ii, *'ien+u( -iin! *e%%imi%+ in (e&+ur 'u
e0$(u+i b$(ii.
 
 

 Perceptia starii "e saatate :

  P'ien+u(  urm+ +r+men+u( *re%'ri% !e me!i' re'$mn!+ !u* *eri$!e(e !e %*i+(ire !r 
 b$(  0n%+ ine0i+bi(.
  Din n+e'e!en+e(e -ii$($&i'e reie%e ' *'ien+u(  !e0$(++ 'e%+ b$( !e 9 ni, in urm
unui '$n%um !e ('$$( e1'e%i0 %i in!e(un&+.
An+e'e!en+e(e #ere!$'$(+er(e in '!ru( 'e%+ei b$(i nu *rein+ ni'i $ %emni-i'+ie, b$( -iin!
!$bn!i+ *rin+run re&im !e 0i+ ne!e'0+.

 Istoric!l #olii act!ale :

  P'ien+ 'un$%'u+ 'u CH *e -$n! +$1i'e+i(i' !in , urmn! +r+men+ #e*+$*r$+e'+$r
in+ermi++en+ %i re&im (imen+r. A mi -$%+ %*i+(i+ in re*e++e rn!uri *en+ru e!eme %i %'i+,
#em$r&ie !i&e%+i0e %u*eri$r !e ( ni0e(u( 0ri'e($r e%$-&iene %i -en$men !e en'e-($*+ie
 *$r+(.
  In u(+imi(e 4 (uni, 'e%+ e%+e  +rei in+ernre *en+ru %in!r$m e!em+$u%  e!eme %i %'i+),
-r r%*un% ( +er*i !iure+i'.
  A'+u( in+ernre e%+e *re'i*i++e %i !e *ri+i unei eru*+ii r$%ii0i$('ee ( ni0e(u( &mbei
!re*+e, !urer$% 'u 're%+ere +em*er+urii ($'(e.

 Protocol!l &e"ical :

  L e1menu( -ii' &ener( *e *r+e %e '$n%++:

   %+re &ener( (+er+
   %+re !e nu+ri+ie !imunu+
   +(i .99m
   &reu++e 9@&
   +e&umen+e(e %un+ in +en%iune !in 'u e!emu(ui, *rein+ eru*+ie eri+em+$%
0i$('ee, i'+er %i *ruri+ 'u+n+
   &n&(i$ni %u*er-i'i(i ne*(*bi(i
   ROT *reen+e bi(+er(
   %i%+em $%$%in+e&ru
   %%+em mu%'u(r n$rm$+$n, n$rm$@ine+i'

 *r+ re%*ir+$r:
   CRS (iber 
   +$r'e n$rm( '$n-$rm+
   re%*ir+ie %u*er-i'i(
   +#i*nee
   nu *rein+ &$m$+e re%*ir+$rii
  n+. r%*.26r<min

 *r+ 'r!i$0%'u(r:
   nu *rein+ !urere
   %$' *e1n *re%en+ in %*+i(  in+er'$%+(% %+n& *e LMC
 

   *rein+ +#i'r!ie
   *u(% 77*<min
   #i*$+en%iune TA:<62mmH&
   *rein+ e!eme

 *r+ !i&e%+i0e:
   '0i++e bu'( n$rm( 'u !en+i+ie '$m*(e+
   *rein+ &re+, 0r%+uri (imen+re
   in*e+en+
   +rn+ in+e%+in( in'e+ini+

 -i'+ %i 'i bi(ire

   -i'+ ne*(*bi(
   %*(en$me&(ie

 *r+ urinr:
   !iure 3m($(i&urie

 *r+ ner0$%:
   $rien++ +em*$+$%*+i(
   *%i#i' n1ie++e mr'+

 In0e%+i&+ii *e *eri$! %*i+(irii

An(i bi$'#imi'e:

 
 

 NEOIA MANIFESTAR  SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE AUTONOME DELEGATE   EALUARE
MENTAL   EMA DEPENDENTA CULTATE   NOSTIC
A
.Ne0$i X !ee'#i(i X b%en+ X *$r+ #i!ri' %i X !ee'#i X *'ien+ % nu mi X e0$(ue %+re *'ien+ei X ('+u($%e .3.26
!e   bru ( %'unu(ui +im* !e nu+ri+i$n( (ibru (  *rein+e !ee'#i(ibru ( %i&ur un re&im !e%$!+, 'u 3&13<i X nu *rein+
e(imin e(iminri($r  5 i(e ine-i'ien+ e(iminri($r  -un'+iei !e e(iminre in 6 0i+mine ne'e%re re-'erii X '$('#i'in %'un
X !iminure (e&+e !e un i(e -un'+iei #e*+i'e m&<i X *rein+ 'rm*e
 *eri%+(+i%mu(ui *$r+ #i!ri' %i&urre unui re&im  %er0e%' *'ien+ 'u (i'#i!e %i !ureri
in+e%+in( %i (imen+r b$&+ in 'e '$n+in 'n+i++e mre !e b!$min(e
nu+ri+i$n( 'e(u($ &(u'i!e '$m*$+ !e *rune, 'ei X &reu++e
in%u--i'ien+   !e mu%e+e( in!u('i+) 57@&
▫  b($nri X (imen++ie %i X ( $r 6. .6.26) m X '(i%m X in urm '(i%mei
%r' in ne'$re%*un X % *rein+e +rni+ e-e'+u+ '(i%m e0'u+$rie e0'u+$rie e0'u+$rii
rei!uri +$r  in+e%+in( n$rm( un  *en+ru  !iminu 'rm*e(e  *eri%+(+i%mu(
▫ (i*% e1er'ii($r X (i*% %'un *e i emi% -r b!$min(e %i e0'ure in+e%+in( %
-ii'e e1er'i+ii($r !i-i'u(++e '$n+inu+u(ui in+e%+in( re(u+ !u&n!
-ii'e ( 'e%+ %i
(1+i0e(e -$($%i+e
▫'$n%+i*+ie ▫ #em$r$ii ▫ me!iu !e ▫ !iminure !ureri($r ▫ bi !e %eu+ 5 % er 'ei ▫ #em$r$$n 3.326
in-(m+i 'u %*i+( *rin (i*% #em$r$i!(e !e &(bene(e %u !e'$'+ !e 2 %u*$i+.<i X %'un *re%en+ !e
 *ruri+ %i !urere !e in+imi!+e %i mrr  '$n%i%+en+ m$(e
'$n-$r+ X !ureri
b!$min(e
!iminu+e
X &reu++e
57@&
35.3.26
X %'un n$rm(
X'rm*e(e %i
!ureri(e
b!$min(e  u
!i%*ru+
X &reu++e
57@&
 

  MANIFESTARI SURSA   INTERENTII

 NEOIA PROBL   DE DE DIFI   DIAG   OBIECTIE AUTONOME DELEGATE   EALUARE
FUNDA  EMA DEPENDENTA CULTATE   NOSTIC
MENTALA
2. Ne0$i !e ▫ !i%*nee X %+ur+ie Fii': ▫ '(ern'e ▫ % *rein+e $ ▫ eri%e%' %($nu( %i %i&ur .3.26
re%*ir !e +i* in%u-i'ien+ 'u ▫ %u*r-+ re%*ir+$r re%*ir+ie n$rm( in '$n!i+ii $*+ime !e ▫ +#i*nee
+#i*nei'  $1i&en  re%*ir+$rie ine-i'ien+ 24 !e $re +em*er+ure %i umi!i++e  *reen+
▫-+i&bi(i $r&ni%mu(ui re!u% (e&+ !e ▫ e0$(ue &r!u( !e -e'+re  ▫ %+re !e
++e X re%*ir+ii %'ur+e ▫ %'!ere m$!i-i're re%*ir+iei ne(ini%+e
%i %u*er-i'i(e '*'i++ii !e m*(i+u!inii ▫ (ini%+e%' *'ien+ !u* 're ▫ in+$(ern+ (
e1*n%iune re%*ir+$rii $ in0+ +e#ni'i !e re%*ir+ie e-$r+
+$r'i' mni-e%++ ▫ *'ien+ % *rein+e ▫ !$*+ $ *$i+ie 're %I 2.3.26
▫ u%''iune  *rin !i%*nee mu'$%e re%*ir+$rii -0$riee re%*ir+i %en! ▫ +#i*nee
mu'$%ei n(e %i $b$%e( ume!e %i in+e&re $ in *+ in !e'ubi+ !$r%(, !iminu+
▫ in+$(ern+ (  *en+ru $ mi bun iri&re  ▫ %+re !e
e-$r+ -i'+u(ui %i !iminure  !urerii ne(ini%+e re!u%
▫ m$bi(ie *%i0'+i0 'u 35.3 26
  !$re e-$r+u(ui %i  ▫ nu mi
'$n%umu(ui !e ener&ie  *rein+
P%i#i': ▫ % beni-i'iee !e $ ▫ ii !mini%+re ne'e%ru( !e !i-i'u(++e in 
▫ n1ie++e #i!r+re '$re'+ %i (i'#i!e b$&+e in 0i+mine re%*ire
'$re%*un+$re ▫ n1ie++e
S$'i(: ▫ % -ie e'#i(ibr+ ▫ !i%'u+ 'u *'ien+ re!u%
▫ me!iu -ii' %i *%i#i'  *r$b(eme(e 'e u &ener+
in!e'0+ ▫ % %e !iminue 'e%+ ne(ini%+e
▫ %*+iu n1ie++e
&($mer+
▫ 0en+i(re
in%u-i'ien+

 
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
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3. Ne0$i !e ▫!ee'#i(i ▫ in*e+en+ ▫ !iminure ▫ (imen+ X % bene-i'iee  !e X -r'+i$ne ne'e%ru( .3.26
 %e (imen+  bru nu+ri ▫ %'!ere *e+i+u(ui +ie un re&im (imen+r '($ri' in mi mu(+e me%e: ▫ *e+i+ %'u+
%i #i!r+ +i$n( %i  *$n!er( %e'un!r in!e'0+  b$&+ in 0i+mine, 3 me%e %i 2 &u%+ri ▫ nu *rein+ %'un
#i!ri' ▫ %+re !e %+rii e0$(u  *rin !e-i'i+ '($rii %i -ibre X re&im !e 'ru+re ▫ *rein+ -(+uen+
%(bi'iune +i0e  b$(ii (e&+ !e #e*+i'  -r &r%imi) ▫ !ureri e*i&%+ri'e
▫ $bi%nuin+e !ee'#i(ibru ▫ liv-52 4tb/zi
▫ in&e%+ie !e  *re&+i+ !ie+e+i' ▫  in&e%+iem(
(imen+re !ureri %i ▫ essentiale
(imen+e 're nu X !mini%+re me!i'+i 2.3.26
%+i%-' ne0$i(e !e-e'+u$%e in*e+en+) forte
X % -ie e'#i(ibr+ re%*e'+n! !$ %i '(e ▫ *e+i+ in 're%+ere
$r&ni%mu(ui mni-e%++ #i!r$e(e'+r$(i+i' %i 720mg/zi
!e !mini%+rre *en+ru ▫ +rn%i+ in+e%+in(
 *rin ▫ calciu
nu+ri+i$n( me(i$rre *r$'e%u(ui  *re%en+
%'!ere gluconic 1f/zi
in-(m+$r #e*+i' ▫in&e%+ie3m(
 *$n!er( %i X %i&ur un re&im ▫ 
$b$%e( (imen+r b$&+ in e1're+ie2m(&
▫ !i-i'u(++e ▫ me%e ▫ 'ren+e ▫ % 'un$%' 0i+mine %i !e%$!+ %'un
in  urm nee'#i(ibr+e in-$rm+i0e *$r+u( '($ri' ▫&reu++e 57@&
re&imu( (i*% !e ne'e%r e0$(u+iei ▫ e0(ue 'un$%+in+e(e 35.6.26
'un$%+ere   b$(ii  b$(n0ei (e&+e !e ▫ *e+i+ *re%en+
0($ri($r 0($re nu+ri+i$n(  ▫ %'un *re%en+
nu+ri+i0e (e (imen+e($r  ▫ !ureri e*i&%+ri'e %i
(imen+e($r ▫ in0+ *'ien+ 'rm*e b!$min(e
'$n-$rm im*$r+n+ re%*e'+rii !iminu+e
%+!iu(ui re&imu(ui !n!ui ▫ in&e%+ie5m(
 b$(ii) +$+e in-$rm+ii(e ne'e%re ▫ 
e1're+ie4m(5&
%'un
 

 NEOIA   MANIFESTARI SURSA     INTERENTII

FUNDA PROBL   DE DE DIFI   DIAG OBIECTIE   EALUARE
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4.Ne0$i !e ▫0u(nerbi(i ▫-+i&bi(i++e X !iminure ▫ !e-i'i+ !e X m$ni+$rire -un'+ii($r 0i+(e ▫ liv-52 .3.26
 e0i+ ++e -+ !e ▫ n1ie++e m$bi(i++ii  *r$+e'+ie %i ▫ % !i%*r '$n%+i*+i in 24 !e $re 4tb/zi ▫ TA37<9
 *eri'$(e(e  *eri'$(e ▫ %+re !e*re%i0 X *ier!ere %e'uri++e ▫ % nu *rein+e '$m*(i'+ii ▫ essentiale ▫ *u(%9*<minu
!ee'#i(ibru ▫ $r&ni%m %(bi+ %n++ii %i  ▫ #i!r+re %i %i&urre *$r+u(ui nu+ri+i$n( '$n-$rm forte ▫*e+i+ %'u+
-ii' %i in!e*en %+!iu(ui !e b$( 720mg/zi ▫ '$n%+i*+ie
 *%i#i') !en+ei ▫ *'ien+ % bene-i'iee !e un me!iu !e %i&urn+ ▫ colchicina ▫ &reu++e57@&
▫ ri%' 're%'u+  *%i#i' %i -ii' 1mg/zi 2.3.26
▫ ri%' ▫ %+re !e %(bi'iune !e ▫ *'ien+ % 'un$%' m$!(i++i !e re(1re %i ▫ analize ▫TA35<9
 *$+en+i( !e ▫ !i%'$m-$r+ '$m*(i'+ii !iminure  n1ie++ii %i %+rii !e*re%%i0e (e&+e !e cerute ▫ *u(%7*<minu
in-e'+ie ▫ (i*% in+imi++ii  *rin %*i+(ire - !"# ▫*e+i+ in 're%+e
+e&umen+r ▫ (i*% '$muni'rii,  *reen+ ▫ *'ien+ % -ie e'#i(ibr+ *%i#i' *en+ru e0i+re -enzime ▫ +rn%i+ in+e%+in
(e&+ !e  '$n-$r+u(ui *%i#i'  *ruri+u(ui n1ie++ii - re(u+
 *reen+ ▫ (i*% !e ▫ *re&+e%' m+eri(e(e ne'e%re *en+ru re'$(+re electrofore- ▫&reu++e57@&
 *ruri+u(ui 'e 'un$%+ere  n(ie($r %i !mini%+re me!i'+i za 35.3.26
 *$+e !u'e ( m$!(i++i  $ %u*r0e&#e ++ *en+ru  $b%er0 *ri+i $r'r$r -$%  ▫TA39<9
(eiuni !e ($r !e '$m*(i'+ii -bilirubina $ ▫ *u(%96*<minu
&r!? *rin re(1re %i  $bie'+i0 in*(ini+ si & ▫%+re &ener(
'$n+minre re!u'ere  ▫ 'ree $ mbin+ *('u+: 'mer (ini%+i+, eri%i+, 'u -creatinina  bun
'u b'+erii n1ie++ii m$bi(ier re!u%, +em*er+ure !e 2C,0en+i(+ie re!u% -uree ▫ n1ie++e
▫ *r$b(eme ▫ 0$rbe%' 'u *'ien+ %i $ %-+uie%' % nu %e in&ri?$ree -colesterol !imunu+
(e&+e !e %i%  ib in're!ere in e'#i* !e in&ri?ire
+r+men+ %i ▫ -$($%e%' mi?($'e !e re(1re *%i0
re%+ri'+ii(e ▫ %i&ur re&im !e *r$+e'+ie *rin in(+urre !e e1'i+n+i
me!i'(e u!i+i0i, 0iu(i %i &u%++i0e
▫ me!iu( !e
%*i+(
▫ %en+imen+ !e ▫ %e*rre
▫ *er+urbre -ru%+rre !e -mi(ie
im&inii !e ▫ *ier!ere
%ine !+$ri+ u+$n$miei
 b$(ii ▫ %(bi'iune
 

 NEOIA MANIFESTARI SURSA     INTERENTII

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5.Ne0$i !e ▫ -e'+re ▫ %en%ibi(i++e Fii': ▫(+erre X  *'ien+ % *rein+e +e&umen+e %i mu'$%e X ('$$( men+$(+ .3.26
%i *%+r in+e&ri++ii +e&umen+r X -e'+re #e*+i' +e&umen+e in+e&re in 47 !e $re X *u!r !e +(' ▫ *rein+ *ruri+
+e&umen+e(e +e&umen+e ▫ %+e(u+e 0%'u(re *r$'e%% ($r %i X %n u mi *rein+e *ruri+ in 47 !e $re men+$(+ ▫ i%i -'e +$(e+
%i mu'$%e(e ($r %i ▫ *ruri+ in-(m+$r) mu'$%e($r  %in&ur
in+e&re mu'$%e($r  ▫ !iminure X %(bi'iune ▫  in+e(e% ' nu
m$bi(i++ii (e&+ P%i#i' +rebuie % %e mi
!e %+#eni -ii' X n1ie++e %'r*ine
X (i*% !e 'un$ X % %+ie % %e u+$in&ri?e%' in 47 !e $re 2.3.26
%+ere  in&ri?iri($r ▫ *ruri+u( e%+e
 *re0en+i0e %i !iminu+
'ur+i0e  ▫ %+re !e
+e&umen+e($r  %(bi'iune 
!i%*ru+
▫ (i*% ▫ nu%i *$+e X !urere ▫ !e-i'i+ !e ▫ in(+urre n1ie++ii %i  %(bi'iunii 35.3.26
u+$n$miei %i&ur %in&ur X %+re !e u+$in&ri?ire ▫ *re0enire !e%#i!r+rii *rin %i&urre ▫ nu *rein+
 *rin i&ien *er%$n( !i%'$m-$r+ (e&+ !e (i'#i!e($r %i e(e'+r$(i+i($r ne'e%ri  *ruri+
in+$(ern+ ( i(ni' X $b$%e( ne*u+in+ ▫ *'ien+ % *rein+e un %*e'+ in&ri?i+ ▫ +e&umn+e
'+i0i++e ''en+u+ ▫ e-e'+ue m%?e %i +m*$nre 'u ('$$( 'ur++e, in+e&re
men+$(+ *en+ru !iminure *ruri+u(ui
▫ #i!r+e *'ien+
▫ %i&ur $ (en?erie !e '$r* 'ur+e, m$(e %i
(e?er
▫ '$mb+ *rin+r$ i&ien '$re%*un+$re 
mini($r:+iere un&#ii($r 
▫ in(+ru n1ie++e !i%'u+n! 'u *'ien+
▫ %u%+in *'ien+ %i $ ?u+ ( in&ri?ire i&ienei
'$r*$r(e, +$(e+ '0i+++ bu'(e &(i'erin
 b$r1in), *ru( *ie*+n+
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE EALUARE
MENTALA   EMA DEPENDENTA CULTATE   NOSTIC AUTONOME DELEGATE
6.Ne0$i !e ▫ $re in%u-i ▫ %+enie X n1ie++e ▫ in%$mni ne ▫ *'ien+ % *rein+e ▫ in0+ *'ien+ % *r'+i'e ▫ !ie*m .3.26
 !$rmi %i  'ien+e !e ▫ $'#i in'er'n+i ▫ !urere (e&+ !e $re !e %$mn +e#ni'i !e re(1re, e1er'i+ii +b<%er ▫ *'ien+ 
%e $!i#ni %$mn ▫ iri+bi(i++e ▫ me!iu !e n1ie++e %i %u-i'ien+e 'n+i++i0 re%*ir+$rii inin+e !e 'u('re !$rmi+ 45 $re
▫ ne(ini%+e %*i+( !urere, %i '(i++i0 in 47 !e  *e n$*+e, 'u
▫ %$mn in+reru*+, e1'i++i mni-e%++ $re +reiri re*e++e
▫ %$mn %u*er-i'i( -ii'e)  *rin ▫ %+re n1i$%
in%u-i'ien+ ▫ in'*'i++e !e  ▫ +r+men+e $b$%e(, ▫ *'ien+ % ▫ %i&ur (ini%+e n$'+urn, 2.3.26
%i %e !e%+in!e ▫  ne(ini%+e %i  bene-i'iee !e eri%e%' 'mer inin+e !e ▫ *'ien+ 
ne$!i#ni+$r  ne'un$%+ere in'*'i++e '$n-$r+ -ii' %i *%i#i' 'u('re !$rmi+ 6 $re *e
mi?($'e($r !e  %e n$*+e
!e !e%+in!ere $!i#ni ▫ % !iminue ▫ !i%'u+ 'u *'ien+ *en+ru  ▫ ( *rn 
n1ie++e *'ien+ei i!en+i-i' 'u n1ie++ii %i !$rmi+  $r
in 24 !e $re e0(ue &r!u( 'e%+ei ▫ n1ie++e
re!u% m$!er+
35.3.26
▫ *'ien+ 
!$rmi+ 9 $re *e
n$*+e -r % %e
+ree%'
▫ n1ie++e
re!u%
 

 NEOIA MANIFESTARI SURSA     INTERENTII

FUNDA   PROBL   DE DE DIFI DIAG   OBIECTIE   EALUARE
MENTALA   EMA DEPENDENTA CULTATE  NOSTIC   AUTONOME DELEGATE
9. Ne0$i !e ▫'$muni're ▫ ne(ini%+e !ureri ▫ n1ie++e ▫ (+erre ▫ *'ien+ % %e ▫ $ ?u+ %%i e1*rime ▫ .3.26
 '$muni' ine-i'ien+ b!$min(e  %i+u+i !e '$muni'rii !*+ee ( me!iu( !e ne0$i(e %i %en+imen+e(e ▫ *'ien+ e%+e
▫ !e-i'i+ in %i 'ri%*i+(ire 0erb(e %*i+( in 47 !e $re ▫ 0$rbe%' 'u e %i in'er' % n1i$%
e1*rim !$rin+e(e ▫ %'#imbre !+$ri+ ▫ % !iminue n1ie++e $ (ini%+e%' in *ri0in+ ▫ '$muni'
%i em$+ii(e m$!u(ui !e 0i+ %+re%%u(ui ▫ *'ien+ %n u ib %+!iu(ui b$(ii in 're %e -$r+e &reu 'u
%en+imen+( !e !e*en -( e'#i* me!i'(
!en+ ▫ %'u(+ 'u +en+ie +emeri(e 2.3.26
▫ *'ien+ % '$muni'e  *'ien+ei %i $ in'ur?e, $ ▫ n1ie++e
'u *er%$n(u( !e %u%+in % !e*%e%' !iminu+
in&ri?ire 'u u%urin+ m$men+u( !e !i-i'u(++e ▫ *'ien+ e%+e in
▫ *un in+rebri %'ur+e %i !i%*$i+ie bun
'(re, !n! *$%ibi(i++e 35.3.26
 *'ien+ei %mi r%*un! ▫ n1ie++e
%'u+
▫ '$muni' 'u
u%urin+
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
MENTALA   EMA DEPENDENTA CULTATE  NOSTIC   AUTONOME DELEGATE
7 Ne0$i !e  ▫ in+$(ern+ ▫ !i-i'u(++e !e   ▫!iminure ▫!iminure ▫ *'ien+ %%i ▫ %i&ur r*u%u( ( *+ .3.26
%e mi%' %i ( '+i0i++e rmne in *$i+ie +$nu%u(ui m$bi(i++ii re'*e+e in!e*en!en+ ▫ in+$'me%' *'ien+ei un ▫ %+enie -ii'
m$bi(i '+i0e mu(+ +im* mu%'u(r  -ii'e (e&+e in mi%'re in 3 i(e  *r$&rm !e '+i0i++e ▫ (&$'(min  ▫ b$(n0
▫ +$(ern+ %'u+ ▫ 'rm*e !e %n++e ▫ re-'ere ▫ in(+ur !urere *rin -i$( i.m. ( re%*e'+
( e-$r+ ▫ !ureri  *re'r e'#i(ibru(ui !mini%+rre !e n+i(&i'e ne0$ie  *r$&rmu( !e
▫ mer% ne%i&ur  b!$min(e %(bi'iune, nu+ri+i$n( %i ▫ %i&ur un '(im+ !e (ini%+e re*u% ( *+
▫ $b$%e( ▫ +em !e  '!e ▫ n1ie++e $b$%e(), #i!r$e(e'+r$(i+i'  *en+ru  %e $!i#ni 2.3.26
▫  m*(i+u!ine ▫ e*uire mni-e%++ ▫ in(+urre +emerii %i ▫ ii e1*(i' *'ien+ei 'um %%i ▫ *'ien+ %e
re!u% in mi%'ri  *rin re!re in're!erii in !$ee e-$r+u( $!i#ne%+e
+$(ern+ -$r+e(e *r$*rii ▫ n1ie++e
%'u+ ( !iminu+
'+i0i++i ▫ +em %i
-ii'e me!ii $b$%e( %'u+
▫ -'e e1er'i+ii !e
m$bi(ire
35.3.26
▫ %e m$bi(ie
-r *r$b(eme
▫ e%+e e'#i(ibr+
#i!ri' %i
nu+ri+i$n(
▫ *rein+ %+re !e
'$n-$r+
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
MENTALA   EMA DEPENDENTA CULTATE  NOSTIC AUTONOME DELEGATE
 Ne0$i !e  ▫ !i-i'u(++e ▫ $b$%e( ( e-$r+ ▫!ee'#i(ibru ▫ nu %e ▫ *'ien+ % nu mi ▫('+uie%' un *r$&rm !e .3.26
%e imbr' %i in  %e !e  %e imbr' %i !e $r!in  *$+e  *rein+e !i-i'u(++e in m$bi(ire *ermi% !e %+!iu( ▫ %+enie -ii'
!ebr' imbr' %i !ebr' -ii':!ureri imbr' %i  %e imbr' in e0$(u+i0 ( b$(ii, 'u ▫ !i-i'u(++e in 
!ebr' ▫ !ein+ere% in b!$min(e %i !ebr' +ermen !e 3 i(e '$n%er0re ener&iei %e imbr'
+inu+ 0e%+imen+r %+enie %in&ur ▫ !ureri(e %i 'rm*e(e urmrin! +$(ern+ ( e-$r+ ▫ n1ie++e
▫ !ee'#i(ibru % %e !iminue mr'+
!e $r!in ▫ % nu mi *rein+e ▫ !i%'u+ 'u *'ien+ 2.3.26
 *%i#i':n1ie++e n1ie++e  *r$b(eme(e 'e $ im*ie!i' % ▫ %+enie
%i %+re%% %i *%+ree in+ere%u( *en+ru !iminu+
0e%+imen++ie ▫ u%$r
!i-i'u(++e (
imbr'+
35.3.26
▫ %+enie %i
n1ie++e re!u%
▫ nu *rein+
!i-i'u(++e in  %e
imbr' %i
!ebr'
 

 NEOIA PROBL MANIFESTARI SURSA DIAG   INTERENTII

FUNDA EMA   DE DE DIFI  NOSTIC OBIECTIE   EALUARE
MENTALA DEPENDENTA CULTATE AUTONOME DELEGATE
 Ne0$i !e ▫  ▫ in!i%$*i+ie 'e X !ureri ▫ (+erre ▫ %+imu(e *'ien+ % X in!rum *'ien+ % -' .3.26
 %e re're im*$%ibi(i im*ie!i' *'ien+ X n1ie++e %+rii !e e-e'+uee '+i0i++ii  *(imbri in &r!in %*i+(u(ui ▫ in!i%*$i+ie
++e !e  %e % %e in0e%e(e%' X +ri%+e+e '$n-$r+ re're+i0e X !i%'u+ 'u *'ien+ %ubie'+e +$+(
re're ▫ !iminure 'e ii %+imu(e in+ere%u( 2.3.26
n1ie++ii X -'i(i+e ''e%u( ( bib(i$+e' ▫ b$(n0 %e
▫ *r$'urre !e re0i%+e %*i+(u(ui re(e 'i+in!
%i 'r+i 'r+i re(i&i$%e
35.3.26
▫ -'e *(imbri
%'ur+e *rn
&r!in %*i+(u(ui
▫ n1ie++e
!imunu+
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
MENTALA   EMA DEPENDENTA CULTATE  NOSTIC   AUTONOME DELEGATE
 Ne0$i !e ▫in'*'i++e ▫ n1ie++e ▫ ne(ini%+e ▫ (+erre ▫ %%i e1*rime ▫ e1*(i' *'ien+ei im*$r+n+ .3.26
 in0+ !e '$n'en+r ▫ !urere 'u '*'i++ii in+e(e&ere urmrii *re%'ri*+ii($r me!i'(e ▫ '*'i++e !e
re ▫ &i++ie m$!i-i're !e '$n'en in-$rm+iei *rimi+e in %i $ r$& %mi re!e in-$rm+i '$n'en+rre
▫ +em ri+mu(ui +rre +ermen !e  i  *rimi+ %'u+
re%*ir+$r  ▫ %%i !iminue 2.3.26
▫ iri+bi(i++e n1ie++e %i% %i ▫ *'ien+
'n(iee  *rein+ in+ere%
'*'i++e !e ( e1*(i'+ii(e
'$n'en+rre %u*r e'#i*ei !e
in-$rm+ii($r *rimi+e in&ri?ire
35.3.26
▫ *'ien+ %+ie
re&u(uie *e 're
+rebuie % (e
urmee *en+ru
e-e'+ure
+r+men+u(ui
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
MENTALA   EMA DEPENDENTA CULTATE  NOSTIC   AUTONOME DELEGATE
 Ne0$i !e  ▫ e(imin ▫ !i-i'u(++e in  ▫in%u-i'ien+ ▫ (+erre ▫  *'ien+u( % nu mi ▫ e0(ue %+re b$(n0u(ui ▫%*(in$('+$n 2..3.26
e(imin urin in%u urin  !i%urie #e*+i' -un'+iei !e  *rein+e !ee'#i(ibru( ( %i&urn! un re&im !e%$!+, 2m&<i ▫ !iuree 5m(
-ii'ien+ e(iminre -un'+iei !e e(iminre in  b$&+ in 0i+mine ▫ -ur$%emi! ▫ (i'#i!e *er$%
'n+i++i0  urinr  i(e 4m&<i 
$(i&urie ▫ %'i+ ▫ m$!i-i're (e&+ !e ▫ % bene-i'iee !e $ ▫ ('+uie%' un *r$&rm !e ▫ e%%en+i(e ▫ *rein+ e!eme
▫ e!eme e(imin+$ri %'!ere 'ir'u(+ie bun, -r '+i0i++e in (imi+ +$(ern+ei -$r+e ▫ %'un *re%en+
 *rin re+en+ie -i(+r+u(ui e!eme %i %'i+ in  i(e  *en+ru -0$rire 'ir'u(+iei 92m&<i ▫ G 69@&
!e (i'#i!e &($meru(r  ▫ in&ri?ire *$%+ *r'en+e: ▫ *r'en+e 3<3.26
▫ % -ie e'#i(ibr+  *$i+i$nre *'ien+u(ui e0'u+$rie ▫ !iure
#i!r$e(e'+r$(i+i' %+-e( in'+ % %e e0i+e 7 'u 1i(in m(
   *re%iune (i'#i!u(ui rm% in 5m( ▫ (i'#i!e !mini%
b!$men %u*r ($'u(ui +r+e PE 3
 *un'+iei ▫ PE: ▫ G 62@&
 'ree '$n!i+ii !e me!iu (bumin ▫ e!eme *er%i%
$*+ime *en+ru $!i#n %i umn 3m( +en+e
re(1re  !e1+rn 9 ▫ !ime+ru
 e0(ue -un'+ii(e 0i+(e !u* m( b!$min( %'u+
 *un'+ie 45.3.26
 m%$r 'ir'um-erin+ b!$mi ▫ !iure7m(
n( ▫ %'un *re%en+
 'n+re%' *'ien+u( ▫ e!eme *er%i%
 m$ni+$rie +en+ -un'+i +en+e
ren( ▫ !ime+ru b!$
▫ m$n+e *er-ui %i $ min( %'u+
urmre%' ▫ G 62,5@&
6.3.26
▫ !iure5m(
▫ (i'#i!e
!mini%+r+e
PE3
▫ G 57,554@&
▫ !ime+ru( b!$
min( mu(+ !imi
nu+
▫ e!eme(e %u
!iminu+
 

 NEOIA MANIFESTARI SURSA     INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG OBIECTIE   EALUAR 
MENTALA   EMA DEPENDENTA CULTATE  NOSTIC   AUTONOME DELEGATE
2. Ne0$i !e ▫ !i-i'u(++e ▫ !i%*nee ( e-$r+uei ▫  *r$'e% ▫ '(ern'e X  *'ien+u( % re%*ire ▫ e0(ue &r!u( !e -e'+re  ▫ %*ir$n$('+$n 2.3.26
 re%*ir in  re%*ir mi'i re%*ir+ii !i%+ru'+i0 ( u( -r *r$b(eme in 2 i(e re%*ir+iei 2m&<i ▫ !i%*nee (
-re'0en+e +#i*nee) ni0e(u( re%*ir+$r ▫ eri%e%' %($nu( %i %i&ur ▫ -ur$%emi! e-$r+uri mi'i
%i %u*er-i'i(e -i'+u(ui %i ine-i'ien+ '$n!i+i $*+ime !e +em*er+ure 4m&<i ▫ e!eme %i %
▫ %'!ere 'ir'u(+iei (e&+ !e %i umi!i++e ▫ e%%en+i(e -$r+e  *reen+e
e1*n%iunii  *$r+(e '*'i++e ▫ ii !$*+ $ *$i+ie '$re'+ %i 92m&<i 3.3.26
 *u(m$nre re%*ir+$rie '$m$! 're %I -0$riee ▫ *r'en+e ▫ !i%*nee
▫ (+erre ▫ %'i+ in 'n+i++e ▫ *reen+ re!u% X !iminure %'i+ei re%*ir+i %en!u( 'u e0'u+$re ( !iminu+
'ir'u(+iei m%i0 %'i+ei %i  mni-e%++ X % bene-i'iee !e $ +run'#iu( ri!i'+ ( un un&#i !e !+$ri+
e!eme($r   *rin 'ir'u(+ie !e'0+ 45  *r'en+eei
+#i*nee X % nu mi *rein+e ▫ in'er' % re!u'e ni0e(u( ▫ %'i+ %i
$b$%e( e!eme in 'e( mu(+ 5 e!eme($r *ri !mini%+rre e!eme(e *er%
i(e +r+men+u(ui *re%'ri% !e ▫re*u% ( *+
X % -ie e'#i(ibr+ me!i' re%*e'+n! !$, '(e, !+$ri+ e0'
#i!ri' %i urmre%' e-e'+u( 'e%+$r %'i+ei
45.3.26
▫ !i%*nee
!iminu+
X i%i !$e
e-$r+u( -'n
e1er'i+ii *%i
'+i0e
..3.26
X *'ien+u( nu
 *rein+ +u(bu
re%*ir+$rii
X e!eme(e %i
%'i+ %u
!iminu+
'$n%i!erbi(
 

 NEOIA MANIFESTARI SURSA   INTERENTII

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
MENTALA   EMA DEPENDENTA CULTATE   NOSTIC   AUTONOME DELEGATE
3. Ne0$i !e ▫ in*e+en+ ▫ !i-i'u(++e in  %e ▫ %u-erin+ ▫#i!r+re %i ▫ *'ien+u( % -ie ▫ e0(ie 'un$%+in+e(e ▫ e%%en+i(e -$r+e 2.3.26
 %e (imen+ (imen+ %i #i!r+ #e*+i' (imen++ie e'#i(ibr+ #i!ri' %i  *'ien+u(ui (e&+ !e 0($re 92m&<i ▫ *e+i+ %'u+
%i  %e #i!r+ !+$ri+ 're nu nu+ri+i$n( in 3 i(e, nu+ri+i$n(  (imen+e($r  ▫ !iure 5m(
!e&u%+u(ui *en+ru %+i%-' +inn! '$n+ !e ▫ %i&ur un re&im (imen+r ▫ (i'#i!e
(imen+e ne0$i(e re+en+i !e (i'#i!e  b$&+ in 0i+mine %i !e%$!+ !mini%+r+e *er
$r&ni%mu(ui ▫ ('+uire unii ▫ re'%+in& *e+i+u( +re*++, $% 
re&im (imen+r  *rin me%e -r'+i$n+e %i ▫ G 69@#
'$n-$rm ne'e%i++i($r  *reen++e in+r$ -$rm 3.3.26
$r&ni%mu(ui *en+ru   *('u+, +r'+i0 ▫!iurem(
-i e'#i(ibr+ ▫ 'n+re%' i(ni' *'ien+u( ▫ e0'u+e (
#i!r$e(e'+r$(i+i' %i ▫ m$n$+$rie in&e%+i %i %'i+
nu+ri+i$n( e1're+i ▫ PE3m(
▫ *er$%2m(
▫ *e+i+ !iminu+
▫ G 62@&
45.3.26
▫*e+i+ *re%en+
▫ 
!iure95m(
in 47 !e $re
▫ *er$% 5m(
 *e 24 !e $re
▫ G 62,5@&
6.3.26
▫ *e+i+ *re%en+
▫ !iure5m(
▫ e0'u+e (
▫ PE3m(
▫ *er$% 2m(
▫G57,5@&
.3.26
▫ e'#i(ibr+
#i!r$e(e'+r$(i+i'
%i nu+ri+i$n(
 

 NEOIA   MANIFESTARI SURSA   INTERENTII

FUNDA PROBL   DE DE DIFI   DIAG   OBIECTIE   EALUARE
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4 Ne0$i !e  ▫ in+$(ern+ ▫ -+i&bi(i++e ▫ *reen+ ▫!iminure ▫ *'ien+u( %%i ▫ e0(ue %i +e%+e +$(ern+ ( 3.3.26
 

%e mi%' %i ( '+i0i++e ▫ mi%'ri in'e+ini+e %'i+ei, '+i0i++ii re%*e'+e in!e*en!en+ e-$r+ in 0e!re '$n%er0rii ▫ *'ien+u(
m$bi(i e!eme($r  -ii'e !e*(in in mi%'ri in 3 ener&iei re%*e'+ *r$&r
▫ %+enie i(e ▫ in+$'me%' b$(n0u(ui un mu( !e re*u% (
-ii' X +re'ere +re*++ ( $  *r$&rm !e '+i0i++e  *+
m$bi(ire mi '+i0e ▫ %'!ere e!eme($r *rin ▫ %+enie
re&im !e%$!+ ▫ %'i+ u%$r
!iminu+
45.3.26
▫  *r'en+e ▫ *'ien+u( %e
▫ re*u% $b(i&+$riu ▫ *r'en+e X !iminure %'i+ei ▫ in&ri?e%' b$(n0u( !u* e0'u+$rie 7( $!i#ne%+e
( *+ !+$ri+ e0'u+$rie e!eme($r in 3 i(e e-e'+ure *r'en+eei ▫ e!eme(e nu u
 *r'en+eei %i&urn!ui *$i+i '$re'+ in 'e!+
 *+ ▫ -'e e1er'i+ii !e
m$bi(ire
'-7(0)(200'
X %'i+ u%$r
!iminu+
X%+enie  !i%*
ru+
7.3.26
▫ *'ien+u( e%+e
e'#i(ibr+ #i!ri'
%i nu+ri+i$n(
.3.26
▫ *acientul se
mobilizeaza
fara *robleme
in limita
tolerantei
 

 NEOIA MANIFESTARI SURSA   INTERENTII

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MENTALA   EMA DEPENDENTA CULTATE   NOSTIC   AUTONOME DELEGATE
 

5 Ne0$i !e ▫!i-i'u(++e ▫ !e%'umre ▫  *reen+ X *$+en+i( ▫ *'ien+u( % *rein+e ▫ %i&ur $ (en?erie !e '$r* ▫ ('$$( men+$(+ 2.3.26
%i *%+r +e in %i *%+r -ur-ur'ee *e %'i+ei in !e (+erre  +e&umen+e(e in+e&re 'ur+e, -in %i (e?er X 'reme ▫ *'ien+u( i%i
&umen+e(e in+e&ri++e &mbe 'n+i++e +e&umen+e($r  in 2 i(e ▫ e-e'+ue m%?e 'u 'r`me em$(ien+e e-e'+ue %in&ur 
%i mu'$%e(e +e&umen+e($r  ▫ e!eme &mbiere m%i0 (e&+ !e ▫ re!u'ere e!eme($r  #i!r+n+e X *r'en+e +$(e+
in+e&re  *reen+ ▫ '$re'++e ▫ #i!r+e *'ien+u( in (imi+ e0'u+$rie ( ▫ e!eme in
%'i+ei %i  e'#i(ibru(ui#i!r$ re&imu(ui$ *re%'ri% +en%iune
e!eme($r  e(e'+r$(i+i' ▫ in&ri?e%' *'ien+u( !u* 357.3.26
▫ %'i+ ▫ !iminure %'i+ei  *r'en+e ▫ i%i e-e'+ue
+$(e+ ?u++
▫ e!eme(e %un+
!iminu+e
▫ %'i+ in
'n+i++e re!u%
.3.26
▫ *'ien+u( %e
u+$in&ri?e%+e
-r *r$b(eme
▫ e!eme(e %i
%'i+ %un+ mu(+
!iminu+e
 

 NEOIA MANIFESTARI SURSA   INTERENTII

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6 Ne0$i !e  ▫ -re'0en+e ▫ +reiri !e%e in ▫ *reen+ ▫ (+erre X *'ien+u( % %e ▫ re'$mn! re*u%u( ( *+ ▫ -en$brbi+( 2(0)(200'
!$rmi %i  %e  *er+urbri +im*u( n$*+ii %'i+ei m$!u(ui !e $!i#ne%' %i % ▫ %i&ur eri%ire %($nu(ui m&<i ▫  *'ien+u( nu
$!i#ni (e %$mnu  !$rmi !$rm 67 $re<i ▫ 'ree un '(im+ (ini%+i+  *$+e !$rmi iu
(ui (e&+ !e ▫ 'reere '$n!i+ii($r  %'i+= n$*+e
▫ ni'+uri  *reen+ !e '$m-$r+ *en+ru %e +ree%+e
ni'+uriei -'i(i++e re(1rii, -re'0en+ ni'+urie
$!i#nei %i %$mnu(ui 6.3.26
▫ !iminure %'i+ei %i ▫ *'ien+u(
'$re'+re ni'+uriei ▫ e-e'+ure *r'en+eei ▫ *r'en+e !$rme ( *rn 4
$re, !u*
e-e'+ure
 *r'en+eei
.3.26
▫ b$(n0u( re un
%$mn $!i#ni+$r
-r +reiri

 NEOIA MANIFESTARI SURSA INTERENTII

 

FUNDA   PROBL   DE DE DIFI   DIAG   OBIECTIE   AUTONOME DELEGATE EALUARE

MENTALA   EMA DEPENDENTA CULTATE  NOSTIC
9 Ne0$i !e  ▫ *$+en+i( ▫ *$+en+i( !e ▫ *reen+ ▫ ri%' X % nu *r ▫  re%*e'+ n$rme(e !e %e*%ie ▫ %'#imbre !e .3.26
e0i+ !e +in&ere in-e'+re  %'i+ei %'i+ei 're%'u+ !e '$m*(i'+ii ( %'#imbre bn!?u(ui  *n%men+ ▫ *e *r'ur%u(
 *eri'$(e(e  in+e&ri++ii ▫ e-e'+ure in-e'+ie *rin in-e'+re %'i+ei ▫ m$ni+$rie -un'+ii(e 0i+(e %*i+(iri nu u
 *r'en+eei e-e'+ure  -ebr *e%+e37°C ▫ m$ni+$rie (i'#i!e(e *ru+
*rin  *r'en+eei in&er+e %i e(imin+e '$m*(i'+ii
nere%*e'+re %i *reen+
 n$rme($r (eiuni($r
!e %e*%ie) !e ( ni0e(u(
&mbe($r 
▫ (eiuni ▫ *ruri+
!e'%urm+e *e +e&umen+r 
&mbe

 NEOIA   MANIFESTARI      
FUNDA DE OBIECTIE INTERENTII EALUARE
MENTALA
INDEPENDENTA   AUTONOME
 

7 Ne0$i !e ▫ re $ +em*er+ur !e ▫ m%urre i(ni'  +em*er+urii ▫ m%urre +em*er+urii !imine+ %i %er Obie'+i0 re(i+
 men+ine 36,9°C ▫ +em*er+urme!iu(ui mbien+ % -ie !e X eri%e%' i(ni' %($nu(
+em*er+ure ▫ +e&umen+e '(!u+e 225°C X (en?eri % -ie '$n-$rm 'u +em*er+ure %($nu(ui
'$r*u(ui in ▫ +rn%*ir+ii minime ▫ %i&urre unei (en?erii !e '$r* !e'0+
(imi+e n$r ▫ %en+i !e bine -+ !e
m(e -ri& %i '(!ur
 Ne0$i !e ▫ *'ien+u( re '*'i++e ▫ b$(n0u( +rebuie in'ur?+ % %e imbr'e ▫in0+ *'ien+u( 'um +rebuie % %e imbr'e in Obie'+i0 re(i+
 %e imbr' !e  %e imbr' %i !ebr' %i !ebr'e %in&ur, % %e imbr'e 'u 'ei %*i+(
%i !ebr' %in&ur   *('e ▫ in'ur?e *'ien+u( *en+ru %i ((e&e %in&ur
▫ i%i ((e&e %in&ur ▫ %+imu(re in+ere%u(ui *en+ru +inu+ imbr'min+e
imbr'min+e '$n-$rm ▫ nu !i%'u+ &u%+uri(e *'ien+u(ui
0r%+ei %i n$+im*u(ui
 Ne0$i !e ▫ '$muni' -r *r$b(eme 'u ▫ *%+rre 'e%+ei ne0$i in (imi+e n$rm(e ▫ !i%'u+ 'u *'ien+u( reme 're %I -' *('ere Obie'+i0 re(i+
 '$muni' 'ei !in ?ur 
. Ne0$i ▫ *'ien+u( e%+e !e re(i&ie ▫ % ?u+ *'ien+u( in %+i%-'ere ne0$ii i( in!rum %*re bi%eri' %*i+(u(ui Obie'+i0 re(i+
!e  *r'+i' $r+$!$1 !e re(i&ie ▫ nu -' '$men+rii %u*r re(i&iei *'ien+u(ui
re(i&i ▫ nu i( im*ie!i' nimi' %%i
%+i%-' re(i&i
2 Ne0$i ▫ *'ien+u( re $ -mi(ie %i ▫ 'rere !e '+i0i++i 're %i !e ▫ %$(i'i+r+e *'ien+u(ui % *r+i'i*(e ( in&ri?ire Obie'+i0 re(i+
!e  -i u+i( un ($' bine !e-ini+ in '!ru( %en+imen+u( !e u+i(i++e ▫ 'rere %en+imen+u(ui !e u+i(i++e
'e%+ei
▫ re '*'i++e !e  (u
!e'iii %i %e %im+e u+i(
3 Ne0$i ▫ e%+e in!e*en!en+ ▫  *'ien+u( % %e *$+ re(1 %i re're ▫ %i&ur '$n!i+ii(e ne'e%re re(1rii Obie'+i0 re(i+
!e  %e ▫ %e re're 'i+in! ▫ %+imu(re in+ere%u(ui *en+ru '+i0i++i ▫ -'i(i+e ''e%u( ( bib(i$+e'
re're ▫ re $ %en+ie !e re(1re re're+i0e ▫ im*rumu+ 'r+i, ire, re0i%+e
%i %en+imen+ !e mu(+umire
4 Ne0$i ▫ re ne0$ie !e in-$rm+ie ▫ % in0+ *'ien+u( 'um % %e in&ri?e%' ▫ +e%+e ni0e(u( !e 'un$%+ere Obie'+i0 re(i+
!e  in0+ ▫ *rein+ '*'i++e !e ▫ %+imu(re in+ere%u(ui !e%*re b$(, ▫ i( in0+ 'um % % e in&ri?e%'
'$n'en+rre 'n! I %e +r+men+ %i re&im ▫ m %i&ur ' *'ien+u( 'un$%+e re&imu(
e1*(i' (imen+r 

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▫  ▫  ▫  ▫ X ▫  ▫ 
▫ 

 NEOIA MANIFESTARI SURSA   INTERENTII

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▫  ▫  ▫  ▫ X ▫  ▫ 
▫