{"id":6617,"date":"2020-05-04T16:27:33","date_gmt":"2020-05-04T15:27:33","guid":{"rendered":"https:\/\/euromedic.rs\/pregledi\/gastroenterologija-sindrom-nervoznih-creva-copy\/"},"modified":"2020-10-07T10:53:02","modified_gmt":"2020-10-07T09:53:02","slug":"gastroenterologija-tumori-pankreasa-z-kese-zucnih-puteva-i-portna-hipertenzija","status":"publish","type":"post","link":"https:\/\/euromedic.rs\/pregledi\/specijalisticki-pregledi\/gastroenterologija\/gastroenterologija-tumori-pankreasa-z-kese-zucnih-puteva-i-portna-hipertenzija\/","title":{"rendered":"Gastroenterologija – Tumori pankreasa, \u017e. kese, \u017eu\u010dnih puteva i portna hipertenzija"},"content":{"rendered":"

TUMORI PANKREASA<\/strong><\/p>\n

Tumori pankreasa mogu biti benigni i maligni. Maligni tumori su znatno \u010desci sa vrlo lo\u0161om prognozom. Naj\u010de\u0161\u0107i su adenokarcinomi i neuroendokrini tumori.<\/p>\n

ADENOKARCINOMI<\/strong> naj\u010de\u0161\u0107e nastaju u kasnijim godinama,kod pu\u0161a\u010da, prekomernog kori\u0161\u0107enja alkohola, nekad je i pozitivna porodicna anamneza. Naj\u010de\u0161\u0107a tegoba je bol u predelu \u017eeluca sa sirenjem pozadi u le\u0111a, bezbolna \u017eutica, gubitak ne te\u017eini, slab apetit, oticanje stomaka. Dijagnoza se uspostavlja obi\u010dno kasno, nekad ultrazvukom, a uglavnom skenerom\u00a0<\/span>ili magnetnom rezonancom stomaka, po potrebi endoskopskim ultrazvukom sa biopsijom. Prognoza vrlo lo\u0161a, oko 1 % pre\u017eivljavanje 5 godina. Terapija\u00a0<\/span>hirurgija radikalna ili palijativna, hemioterapija (gemcitabin ) i zra\u010dna terapija.<\/p>\n

NEUROENDOKRINI<\/strong>\u00a0<\/span>tumori\u00a0<\/span>su manje agresivni, hormonski mogu biti aktivni\u00a0i\u00a0<\/span>neaktivni. Hormonski aktivni se ranije otkrivaju (insulinomi-pad \u0161e\u0107era sa drhtavicom\u2026). Hormonski\u00a0 <\/span>neaktivni (20%) se kasnije otkrivaju u fazi diseminovane bolesti. Mogu se javiti u sklopu multiplih endokrinih tumora sa Ca tireoidee, feohromocitomom, tu nadbubrega, hipofize. Simptomatologija zavisi od hormona koji lu\u010de (drhtavica I tahikardija \u2013 insulinom, prolivi – VIPom, ulceracije – gastrinom), dok hormon neaktivni\u00a0<\/span>se dijagostikuju tek kada se pojave bolovi, \u017eutica ili povra\u0107anje .Dijagnostikuju se laboratorijski odredjivanjem hormona\u00a0i<\/span>\u00a0<\/span>hromogranina A iz krvi, ultrazvukom, skenerom, magnetnom rezonancom, endoskopskim ultrazvukom, PET CT om ili scintigrafijom sa octreotidom. Terapija hirur\u0161ka i hemioterapija na koju vrlo dobro reaguju. \u00a0<\/span><\/p>\n

Ono \u0161to je najbitnije kod tumora pankreasa, je da treba misliti na njih i\u00a0 <\/span>u slu\u010daju bolova u predelu \u017eeluca,\u00a0<\/span>a\u00a0<\/span>ultrazvu\u010dni pregled I gastroskopiija ne obja\u0161njavaju tegobe, insistirati na slede\u0107em stepenu dijagnostike \u2013skeneru ili magnetnoj rezonanci.\u00a0<\/span><\/p>\n

TUMORI \u017dU\u010cNE KESE, \u017dU\u010cNIH PUTEVA I AMPULE VATERI\u00a0<\/span><\/strong><\/p>\n

Mogu biti benigni (polipi) i maligni adenokarcinomi.<\/p>\n

Benigni\u00a0<\/span>tumori (polipi) su uglavnom slu\u010dajan nalaz prilikom ultrazvu\u010dnog pregleda. Ne daju tegobe. Dijagnostikuju se\u00a0 <\/span>ultrazvu\u010dnim pregledom \u017e. kese. Ukoliko se prvi put\u00a0<\/span>vide kontrolni ultrazvuk treba uraditi za 6 meseci, pa zatim na 12 meseci\u00a0 <\/span>ukoliko nema\u00a0<\/span>zna\u010dajnijeg porasta. Kada predju 9mm, ako se radi o osobi preko 50 godina,ako iznenada izme\u0111u kontrola po\u010dnu rasti ili se pojavi zadebljanje pri bazi indikovano je operativno le\u010denje.\u00a0<\/span><\/p>\n

Maligni tumori su uglavnom adenokarcinomi koji se javljaju naj\u010de\u0161\u0107e posle\u00a0 <\/span>60 godina ,\u010desti su kod primarnog skleroziraju\u0107eg holangitisa i primarne bilijarne ciroze, a nastaju i iz polipa \u017e. kese. Simptomatologija je nespecifi\u010dna u vidu bolova, svraba, \u017eutice, tamne\u00a0<\/span>mokra\u0107e i belih stolica naro\u010dito kada su lokalizovani na ekstrahepati\u010dkim \u017eu\u010dnim putevima. Dijagnostikuju se ultrazvu\u010dnim pregledom, skenerom, magnetnom rezonancom i\u00a0 <\/span>holangiografijom,l aboratorijski povi\u0161enim vrednostima CA 19-9 I parametrima holestaze – GGT, AF. Prognoza vrlo lo\u0161a-1% pre\u017eivljavanje\u00a0<\/span>5 godina. Terapija hirur\u0161ka radikalna (vrlo mali procenat radikalnosti) I palijativna, ERCP sa stentovanjem, hemioterapija sa slabim rezultatima.<\/p>\n

Ono \u0161to mo\u017eemo uraditi je pratiti polipe\u00a0 <\/span>\u017e. kese i intervenisati preventivno, kao I pratiti pacijente sa\u00a0 <\/span>primarnim skleroziraju\u0107im holangitisom I primarnom bilijarnom cirozom. \u00a0 \u00a0<\/span><\/p>\n

Ampularni karcinom je maligna lezija u predelu Vaterove papile (gde se \u017eu\u010dni i pankreasni kanal ulivaju u tanko crevo). Glavni simptom je bezbolna \u017eutica\u00a0 <\/span>sa belim stolicama I tamnom mokra\u0107om. Nekad se mogu javiti i\u00a0<\/span>crne stolice. Dijagnostikuje se gornjom endoskopijom I duodenoskopijom sa biopsijama. Prognoza je mnogo bolja u odnosu na ostale maligne tumore pankreasa i \u017e. puteva sa pre\u017eivljavanjem od\u00a0<\/span>vi\u0161e od 40 % tokom 5 godina.Terapija lokalna hirur\u0161ka\u00a0<\/span>ekscizija I proksimalna pankreatektomija.<\/p>\n

PORTNA HIPERTENZIJA<\/strong><\/p>\n

Portna vena je glavna vena koja dovodi krv u jetru\u00a0 <\/span>iz stoma\u010dnih organa i nastaje od slezinske I mezenterijalnih vena. Ona dovodi oko 80 % cirkulacije u jetru, a preostalih 20% dolazi preko hepati\u010dke arterije. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/p>\n

Portna hipertenzija nastaje usled pove\u0107anog otpora prolasku krvi kroz jetru sa retrogradnim pove\u0107anjem pritiska i \u0161irenjem krvnih sudova koji je prave. Ona mo\u017ee biti posthepati\u010dna, hepati\u010dna ili prehepati\u010dna. Hepati\u010dna je naj\u010de\u0161\u0107a i\u00a0 <\/span>nastaje zbog oste\u0107enja jetre (ciroza I fibroza jetre razli\u010dite etiologije). Poshtepati\u010dna se javlja kod tromboze hepati\u010dkih vena (Budd-Chiari sindrom),konstriktivni perikarditis . Prehepati\u010dka nastaje kod tromboze portne vene ili tromboze lijenalne vene. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/p>\n

Kao posledica portne hipertenzije nastaje pro\u0161irenje krvnih sudova jednjaka, \u017eeluca, sa portnom gastropatijom, re\u0111e hemoroidalnih I umbilikalnih vena, slobodna te\u010dnost u trbuhu, uve\u0107anje slezine sa\u00a0<\/span>znacima hipersplenizma (anemija, leukopenija, trombocitopenija)\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/p>\n

Dijagnoza se postavlja fizikalnim nalazom, uve\u0107anje jetre i slezine, pro\u0161irenje umbilikalnih vena (caput meduse), laboratorijski patolo\u0161kim vrednostima jetrinih enzima, sni\u017eenom sintetskom funkcijom jetre, sni\u017eenim vrednostima eritrocita, leukocita I trombocita. Ultrazvu\u010dnim pregledom se konstatuju promene na jetri, pro\u0161irena portna vena preko 12mm, lijenalna vena preko 9mm, uve\u0107ana\u00a0<\/span>slezina preko 120 mm x 45mm, prisustvo ascita, prisustvo kolaterala. Doplerom\u00a0<\/span>naj\u010de\u0161\u0107e sni\u017eene brzine protoka\u00a0 <\/span>uz sni\u017eenje DI i\u00a0<\/span>uz arterijalizaciju krvotoka i skoka brzine i pro\u0161irenje hepati\u010dke arterije i njenih grana,mo\u017ee se uo\u010diti i tromboza portne i te\u017ee lijenalne vene (MSCT) ili hepati\u010dkih vena. Biopsijom se dokazuje ciroza (retko se radi) ili fibroskenom(neinvazivna metoda).U slu\u010daju da je uzrok tromboza treba uraditi i parametre koagulacije i eventualne trombofilije.<\/p>\n

Terapija\u00a0 <\/span>se sastoji u le\u010denju osnovnog oboljenja I konsekutivnih komplikacija. Radi smanjenja portne hipertenzije pristupa se ili hirur\u0161kim intervencijama – splenorenalni \u0161ant (portokavalni napu\u0161ten) ili devaskularizacionim procedurama (Sigiara) kod velikih variksa gde ligature ne poma\u017eu\u00a0<\/span>ili nehirur\u0161kim TIPS (transjugularni portosistemski sant).<\/p>\n

Zaka\u017eite Va\u0161 specijalisti\u010dki pregled gastroenterologa.\u00a0<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

TUMORI PANKREASA Tumori pankreasa mogu biti benigni i maligni. Maligni tumori su znatno \u010desci sa…<\/p>\n","protected":false},"author":1,"featured_media":6619,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[479],"tags":[78,441],"class_list":["post-6617","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gastroenterologija","tag-gastroenetrologija","tag-tumori-pankreasa"],"yoast_head":"\nGastroenterologija - Tumori pankreasa, \u017e. kese, \u017eu\u010dnih puteva<\/title>\n<meta name=\"description\" content=\"Tumori pankreasa mogu biti benigni i maligni. Maligni tumori su znatno \u010desci sa vrlo lo\u0161om prognozom. 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