ELABORARE METODICA

PENTRU STUDENII FACULTATEA MEDICIN GENERAL

TEMA :DERMATITA DE STAZ

ELABORAT DE D. . M., CONFERENIAR LA CATEDRA DERMATOVENEROLOGIE V. GOGU

ARGUMENTAREA Manifestrile !tanate "at#rate ins!fi ien$ei %en#ase r#ni e &IVC' s!nt (n #ntin! re)tere re*re+ent,n" -. / 01 2 "in t#tal!l 3#lna%il#r interna$i (n lini ele "er4at#l#5i e. Da la a easta a"!54 s*itali+rile (n"el!n5ate )i internrile re*etate ale a est#r 3#lna%i, *!te4 s*!ne "er4atita "e sta+, ! t#ate as*e tele 4#rf# / lini e *e are le (43ra , #nstit!ie # i4*#rtant *r#3le4 "e 4e"i in s# ial Din a este #nsi"erente a est a*it#l este in l!s (n *r#5ra4!l "e st!"ii la "is i*lina "er4at#%ener#l#5ie )i este ne esar a st!"en$ii fa !lt$il#r "e 4e"i in s !n#as a est #4*arti4ent. 6CO7UL DIDACTIC

I.

STUDENTUL TREBUIE S CUNOASC

DEFINIIA
DERMATITEI DE STAZ FACTORII CARE INTERVIN N APARIIA DERMATITEI DE STAZ MECANISMELE ETIOPATOGENICE A DERMATITEI DE STAZ STADIILE EVOLUTIVE A DERMATITEI DE STAZ

MANIFESTRILE CLINICE A DERMATITEI DE STAZ

EXAMENUL
PARACLINIC

PRINCIPIILE DE
TRATAMENT

PRINCIPIILE DE
PROFILAXIE

II.

STUDENTUL TREBUIE S POSEDE

-. Met#"i a #re t )i alit$i "e#nt#l#5i e 4at!re *entr! a sta3ili8 a' 4#ti%ele internrii 3' ante e"ente *ers#nale )i 9ere"#: #laterale ' ist#ri !l 4ala"iei 0. C!n#)tin$e s!fi iente (n !r4t#arele #4*arti4ente8 a' *r#*e"e!ti a 3#lil#r interne : *entr! a efe t!a 4in!$i#s e;a4en!l 5eneral al 3#lna%!l!i 3' se4i#l#5ia !tanat : *entr! a efe t!a alitati% e;a4en!l l# al al *a ient!l!i ' e;a4ene "e la3#rat#r )i alte e;*l#rri "' far4a #l#5ia lini : *entr! *res rierea !n!i trata4ent in"i%i"!al #re t at,t 5eneral ,t )i el t#*i <. De*rin"eri *ra ti e8 a' e%al!area test!l!i "e %itr#*resi!ne *entr! a a*re ia 5ene+a er!*$iil#r 4a !lare )i ara ter!l e"e4!l!i 3' efe t!area *r#3ei Tren"elen3!r5: Br#"ie ' efe t!area *r#3ei 7ert9es "' *res rierea re$etel#r =. G,n"ire lini , 3a+at *e !n#)tin$e te#reti e )i *ra ti e e *er4ite sta3ilirea )i ar5!4entarea "ia5n#sti !l!i lini ! *res rierea !lteri#ar a trata4ent!l!i a"e %at

III.

CUNOTINELE DE BAZ SE REFER LA URMTOARELE CAPITOLE STUDIATE:

-. 0. <. =. .. >.

Anat#4ia, fi+i#l#5ia, 9ist#l#5ia )i 3i# 9i4ia *ielii 6e4i#l#5ia 3#lil#r !tanate 7rin i*iile "e trata4ent (n "er4at#l#5ie C#la5en#+e Vas !lite aler5i e Der4at#+e aler5i e

IV.

LITERATURA

-. 0. <. =.

A. C#l$#i!. Der4at#%ener#l#5ie. B! !re)ti -??<. Dan F#rsea ).a. C#4*en"i! "e "er4at#l#5ie )i %ener#l#5ie. B! !re)ti -??>. N. Maier. 7at#l#5ie !tanat. Cl!@. -???. G9. M!)et C!rs!rile "e "er4at#%ener#l#5ie.

-. DEFINIIE 7rin "er4atita "e sta+ se s!3,n$ele5e t#talitatea 4#"ifi ril#r !tanate, l# ali+ate la ni%el!l 4e43rel#r inferi#are, "eter4inate "e ins!fi ien$a %en#as r#ni . 0. E7IDEMIOLOGIE A*ar la %,rst 4ai (naintat. Distri3!$ie e5al la a43ele se;e <. MOTIVELE INTERNARII 7ier"ere "e s!3stan$ *e 5a43e, e"e4e )i erite4, *l i "e as*e t e +e4atif#r4 &sa! n!', *l i # re sa! *i54entare, *a 9ete %ari #ase, le+i!ni atr#fi e, li*#"er4at#s ler#+a. =. ANTECEDENTE 7ER6ONALE )i BEREDO:COLATERALE Ca+!ri si4ilare "e ins!fi ien$ %en#as (n fa4ilie. La fe4ei se *#t a ent!a fen#4enele "e ins!fi ien$ %en#as ! # a+ia sar inil#r.

.. FACTORII CARE INTERVIN CN A7ARIIA DERMATITEI DE 6TADA

fact !" #$t$!%"&a&'" %ari ele 9i"r#stati e se 9ele "e fle3it *r#f!n" "is*la+iile #n5enitale %en#ase

fact !" fa( !")a&'"

#rt#stati+4!l *rel!n5it, (n s*e ial la *ers#anele ! an!4ite *r#fesi!ni

3#lile en"# rine a #3e+itatea, 9i*ertir#i"ia, ins!fi ien$a estr#5eni

3#lile ar"i#:%as !lare !4 ar fi ins!fi ien$a ar"ia , 9i*ertensi!nea arterial, arteri#s ler#+a, t!l3!rrile "e rit4 ar"ia afe $i!nile *!l4#nare (n s*e ial ins!fi ien$a r#ni res*irat#rie

afe $i!nile a*arat!l!i #ste#:arti !lar a)a a re!4atis4e an il#+ante, *i i#r!l *lat, se 9ele "e fra t!r 3#lile 4eta3#li e &(n s*e ial "ia3et!l'

3#lile "i5esti%e, 4ai ales ins!fi ien$a 9e*ati

%,rsta (nnaintat

>. MECANI6ME ETIO7ATOGENICE A DERMATITEI DE 6TADA

sta+a %en#as

3l# area ir !la$iei

re)tera *resi!neii inter a*ilare

sta5narea *las4ei (n s*a$i!l *eri a*ilar

$#$%+, ($& - -a+ f,$.$#$%+,

s "erea %#l!4!l!i *las4ati (n a*ilare

a5l!tinarea ele4entel#r san5!ine

3l# area ir !la$iei

*+!*+!a

an#;ie l# al ! *er4ea3ilitate a*ilar res !t

tre erea 9e4atiil#r (n s*a$i!l *eri a*ilar ! s*ar5ere !lteri#ar

eli3erearea 9e4#5l#3inei are se transf#r4 (n 9e4#si"erin

#$!%at"ta *"/%$&ta!0 1" *+!*+!"c0

"if!+ia *las4ei )i a *r#teinel#r *las4ati e (n s*a$i!l *eri a*ilar

*r#teinele se a !4!lea+ (n e; es )i "eter4in # rea $ie fi3r#3lasti

Fi3r#3la)tii (n e; es se ret #la5en (n antitate 4are

#$!% 2 3"* #$!%"ta -c,$! #$!%"f !%0

eli3erearea s!3stan$el#r 3i#l#5i a ti%e &9ista4ina, ser#t#nina ). a.'

infla4a$ie )i rea $ii "e ti* e;e4at#s s!*rainfe $iile te5!4entare le+i!ni ale *eretel!i %en#s

#$!% 2 $*"#$!%"ta $c)$%at"f !%0

sat5narea s,n5el!i la ni%el!l %enel#r

t! %. f,$."ta (a!"c a-0 s!*rainfe $iile te5!4entare

s!s*en"area ir !la$iei )i "e*#li4eri+area s!3stan$ei f!n"a4entale

s "erea e 9i*a4ent! : l!i en+i4ati el!lar, "i4in!area a ti%it$ii it#*las4ati e *,n la "is*ari$ia a*a it$ii "e re*r#"! ere a el!le : l#r

+,c$!+, c! &"c (a!"c -

tra!4atis4e 4in#re

E. MANIFE6TARILE CLINICE AL DERMATITEI DE 6TADA

$#$%+, ($& - 4f,$.$#$%+,5

la in e*!t !n e"e4 al3, 4#ale, ne"!rer#s, neinfla4at#r, tran+it#ri! )i are las 5#"e!, iar ! ti4*!l "e%ine *er4anent )i n! 4ai las 5#"e! & #nstit!ie *ri4a 4anifestare are *re e"e !ne#ri ! ani "e +ile instalarea le+i!nil#r !tanate'

#$!%at"ta *"/%$&ta!0 1" *+!*+!"c0 &"er4atita # r'

*ete *i54entare )i *!r*!ri e, e n! "is*ar la *resi!ne )i a! !l#are r#)ie sa! 5al3en : 3r!n. 6!nt "e "iferite "i4ensi!ni )i n! se (ns#$es "e se4ne s!3ie ti%e. O "at instalate, *ersist %re4e (n"el!n5at 9iar "!* (nlt!rarea %ari el#r &*#ate #nstit!i *ri4a 4anifestare a ICV'

#$!% 2 3"* #$!%"ta -c,$! #$!%"f !%0 &"er4#s ler#+a'

infiltra$ie elasti &(n sta"i!l ini$ial' e a*t ! ti4*!l !n ara ter s ler#s, "!r. Cn sta"i!l ini$ial, *e f#n"!l !n!i e"e4 r#ni , (n e* sse f#r4e+e *l i )i n#"#+it$i infiltrati%e, "!rer#ase, a #*erite "e !n te5!4ent r#)! )i al". C! ti4*!l le+i!nea ia as*e t "e *la , "e%ine "!r, s ler#as, a"er "e te5!4ent, f#r4,n" !n 3l# "e #nsisten$ le4n#as. Cn sta"iile tar"i%e *la a "e%ine atr#fiat )i 9i*er*i54entat

#$!% 2 $*"#$!%"ta $c)$%at"f !%0 &e +e4a %ari #as'

"e #3i ei se as# ia+ ! fle3e"e4!l )i a re5!l (43ra t#ate as*e tele e%#l!ti%e ale e +e4ei &erite4, 4i r#%e+i !le, +e4!ire, *!$!ri ser#ase, r!ste, s !a4e'. 6e (ns#$e)te "ese#ri "e !n *r!rit %i#lent, 9in!it#r, 3#lna%ii *r#"! ,n"!:)i *rin s r*inat i4*#rtante le+i!ni are #nstit!ie *!n t!l "e *le are a !n!i !l er %ari #s

t! %. f,$."ta (a!"c a-0

!n #r"#n "!r, infla4at#r, "!rer#s, !)#r t!4efiat, ! te4*erat!r l# al res !t, sit!at *e traie t!l !n!i *a 9et %ari #s. Cn @!r!l #r"#n!l!i se #3ser% !ne#ri # rea $ie erite4at# : e"e4at#as a te5!4ent!l!i. N! las se 9ele

+,c$!+, c! &"c (a!"c -

"efe t ! *ier"ere "e $es!t !tanat e e%#l!ea+ fr ten"in$ la %in"e are s*#ntan. C#nstit!ie ea 4ai fre %ent )i ea 4ai 5ra% #4*li a$ie !tanat *r#"!s "e sta+a %en#as. Ul erele %ari #ase *#t fi "est!l "e *r#f!n"e, a@!n5,n" 9iar *,n la #ase )i a! ele 4ai %ariate f#r4e lini e DIAGNOSTICUL

F. DIAGNO6TICUL DERMATITEI DE 6TADA

*! .a T!$&#$,$&.+!/2 B! #"$

3#lna%!l!i !l at i se a*li !n 5ar#! la r" ina 4e43r!l!i, "!* are este ri"i at (n *#+i$ie %erti al. Da "!* ,te%a 4in!te %enele (n e* s se !4*le "e @#s (n s!s, (nsea4n la a est ni%el s!nt *erf#rante ins!fi iente, *rin are s,n5ele "in siste4!l *r#f!n" refl!ia+ (n el s!*erfi ial

*! .$,$ c,"&"c$
*! .a P$!t3$-

3#lna%!l!i, aflat (n *#+i$ie %erti al )i ! %ari ele "ilatate, I se a*li !n 5ar#! s!3 5en!n 9i )i este *!s s 4ear5 ! *as (ntins, ti4* "e . 4in!te. Da %ari ele "is*ar (nsea4n %enele *r#f!n"e )i *erf#rantele s!nt 3!ne )i e;ist # ins!fi ien$ s!*erfi ial. Da %ari ele se a ent!ea+ )i a*ar "!reri, se instalea+ ins!fi ien$a *r#f!n" )i a*erf#rantel#r

-c", %$t!"a %$%.!$, ! "&f$!" a!$

f,$. %a& %$t!"a

!a#" /!af"a ) &$" +,c$!at$

*! .$,$ *a!ac,"&"c$
f,$. /!af"a ") t *"c0 +,ta!- & /!af"a D **,$! f t *,$t"-% /!af"a

?.

TRATAMENTUL MANIFE6TARILOR A IVC I DERMATITEI DE 6TADA

c,"& -tat"-%+, *!$,+&/"t

t!ata%$&t+, "&-+f"c"$&'$" ($& a-$

t!ata%$&t+, c3"!+!/"ca,

*!$- t$!a*"a &*rin #4*resie e;tern as!*ra %enel#r %ari #ase, (4*ie"i sta+a )i e"e4!l'

-c,$! t$!a*"a

f,$. t &"c$ 4($& !+t &+,: # 6"+%+,5

f".!"& ,"t"c$

f,$. t &"c$ 4%a" a,$- 9& ca) #$ $#$%5

*!$*a!at$ #"+!$t"c$

a&t""&f,a%at a!$ &$-t$! "#$

a&t"." t"c$

t!ata%$&t+, ,$)"+&", ! c+ta&at$

a&t"a/!$/a&t$ 4#$6t!a&2 785 (a) #",ata&t$ t!ata%$&t , ca, 4%$#"ca%$&t - 1" ,a-$!2 t$!a*"$5 t!ata%$&t c3"!+!/"ca, *!"& a+t /!$f$ #$ *"$,$