Retinopatia in Diabetul Zaharat de Tip II Non-Insulinodependent 2003

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EXAMENUL DE ABSOLVIRE A ȘCOLII POSTLICEALE Calificarea profesională:asistent medical generalist Profesor îndrumator: Absolvent: Porojan Ileana Ioana Beschiu Ionela Ministerul Educației Naționale Colegiul național „Alma Medica ” Școala Postliceală Sanitară Timișoara,Timiș August 2013

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retinopatia DZ asistenta

Transcript of Retinopatia in Diabetul Zaharat de Tip II Non-Insulinodependent 2003

  • EXAMENUL DE ABSOLVIRE A COLII POSTLICEALE Calificarea profesional:asistent medical generalistProfesor ndrumator: Absolvent:Porojan Ileana Ioana Beschiu Ionela

    Ministerul Educaiei Naionale

    Colegiul naional Alma Medica coala Postliceal Sanitar Timioara,Timi

    August2013

  • Ochii , asemeni unor santinele, ocupa pozitia cea mai inalta a corpului. Marcus Tulius Cicero

  • MOTIVATIA

    CAP. I NOTIUNI GENERALE DESPRE NURSINGCAP. II DATE GENERALE ASUPRA BOLII DIABETICECAP. III NOIUNI DE ANATOMIE RETINIAN I FIZIOPATOLOGIA RETINOPATIEI DIABETICECAP. IV RETINOPATIA DIABETICACAP. V PLAN DE INGRIJIRE AL PACIENTILOR CU RETINOPATIE DIABETICA

    BIBLIOGRAFIE

  • Definitie: Diabetul zaharat reprezint o boal metabolic cu evoluie cronic i stadial ce se datoreaz lipsei relative sau absolute a insulineiClasificare:1. Diabet zaharat tip I2. Diabet zaharat tip II3. Diabet zaharat gestaional4. Diabet zaharat secundar5. Diabet zaharat iatrogen6. Scaderea toleranei la glucoz

  • n diabetul zaharat, tabloul clinic manifest este prezent tardiv n evoluia bolii, iar cnd apar simptomele, boala metabolic poate fi deja cu complicaii.polidipsie; polifagie;scdere ponderal;prurit vulvar;scderea potenei sexuale.

  • DiagnosticGlicemia jeunTestul de Toleranta la Glucoza Oralaglicozuriadozarea corpilor cetonici din urin, electrocardiograma examenul fundului de ochi, examenul de urin pentru proteinuria calitativ i cantitativ dozarea insulinei i peptidului C determinarea vitezei de conducere nervoas dozarea hemoglobinei glicozilate

    Complicatii:Acute:coma hipergicemic, hipoglicemica,acidocetozic i hiperosmolar;hipoglicemiile, mergnd pn la com hipoglicemic ;infeciile: urinare, pulmonare, genitale;TBC pulmonar;micozele interdigitale, vulvare i bucale.Cronice, microangiopatia si macroangiopatia diabetic :Nefropatia diabeticNeuropatia diabeticRetinopatia diabetic

  • o membran exterioar, fibroas o membran mijlocie, musculo-vascular o membran intrn, nervoas

  • Definitie: Retinopatia diabetic reprezint localizarea retinian a microangiopatiei diabetice.Modificrile histologice iniiale ale microangiopatiei evolueaz dup Kohner n 5 stadii:ngroarea membranei bazale dispariia pericitelor din peretele capilar;slbirea peretelui capilarobliterri de capilareanomalii microvasculare intraretiniene

  • Forma benign este o form neproliferativ, tipul ATipul B, retinopatia proliferant, prezint diverse stadii de evoluie (de la forme pariale i pn la forme totale).

  • Modificrile histologice iniiale ale microangiopatiei evolueaz dup Kohner n 5 stadii:ngroarea membranei bazale dispariia pericitelor din peretele capilar;slbirea peretelui capilarobliterri de capilareanomalii microvasculare intraretinieneAmbele forme de retinopatie sunt insotie de ischemie retiniana si modificari ale vitrosului

  • Dintre metodele de investigaie pot fi enumerate:

    Biomicroscopia fundului de ochi (prin lentila Goldmann, Volk sau oftalmoscop indirect);Angiofluorografia;Electroretinografia;Echografia;Fluorometria vitroas.

  • Tratamentul retinopatiei diabetice presupune in primul rand controlul diabetului regim igieno-dietetic corespunzator medicatie controlata:AntidiabeticeSulfamideBiguanideVasculare:antiagregante plachetare vasodilatatoare,

  • Fotocoagularea laserLaserul poate fi folosit la nivelul retinei, focaliznd o surs puternic de lumin pe ea. Raza ngust de laser ajunge la ochi i creeaz o arsur rotund la nivelul retinei.CriopexiaAblaia zonelor retiniene afectate criogenic prin aplicarea direct pe conjunctiv sau pe sclera posterioar dup o incizie conjunctival. VirectomiaPresupune excizia vitrosului, intervenia n sine constnd n a aciona pe o raz mare de aciune la nivelul segmentului posterior ocular.

  • Pacienta S.P. sex feminin, 58 ani, cunoscuta diabetic de aproximativ 6 ani.Examenul oftalmologic evideniaz la: FO i AFG retinopatie diabetic proliferativ:dilatri venoase determinand hemoragii punctiforme i rotunde si exudate moi dispuse n buchet sau coroan.Pol anterior normal;TO normal.Tratamentul a constat n: regim igieno-dietetic insotit de sulfamide orale;vasodilatatoare: Stugeron (1 cp. = 125 mg) 1-2 cp. de trei ori pe zi si antiagregante plachetare: Aspirin (1 cp.= 500 mg) 1/2 cp. pe zi.S-a practicat fotocoagulare cu laser argon in repetate randuri.

  • Evaluare:Pacientul nu necesita spitalizare , procedura de fotocoagulare fiind repetata de mai multe ori.

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  • Evoluia retinopatiei diabetice proliferative:ameliorare 28.5 %;stabilizarea 43 %;agravare 28.5 %.

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    25.Gu X., Fry G., Lata G.,Packer A., Hoak J., Kalebic T.,Hayreh S. S.: Ocular neovascularisation, Invest. Ophthalmol. Vis. Sci., 1984.26.Glaser B. M., Connor T. B., Davis J. L., Kalebic T., Liotta L.: Vascular endothelial cell degradation of basement membranes, Invest. Ophthalmol. Vis. Sci., 1983.27.Glaser B. M:, D'Amore P. A., Michels R. G., Feneslau A. H., Patz A.:Demonstrative of vasoproliferative activity from mammalian retina, J. Cell. Biol., 1980.28.Gitlin J. D., D'Amore P. A.: Culture of retinal capillary cells using selective growth media, Microvasc. Res., 1983.29.Glaser B. M., Graeber J., Davis G. L., Lehmann M.: Retina derived stimulator of vascular endothelial cell prostacyclin release, Invest. Ophthalmol. Vis. Sci., 1984.30.Gaudric A., Coscas G.: Photocoagulation perifoveolaire dans les oedemes musculaires cystoides des occlusion veineuses, Bull. Soc. Ophtalmol. Fr.,1980.31.Gass J. D.: Idiopathic juxtafoveolar retinal telangiectasis. Arch. Ophtalmol., 1982.32.Hill C. R., Kissum R. d:, Weiss J. B., Garner A.:; Angiogenic factor in vitreous from diabetic rethinopathy, Experimentiam, 1983.33.Haut J., Van Effenterre G., Flamand M.,,Dureuil J., Cahiza M.: Traitement de l'oedeme cystoide maculaire par photocoagulation perifoveolaire au laser argon, Bull. Soc. Ophtalmol. Fr., 1980.34.Henkind P., Bellhorn R. W., Schall B.:Retinal edema: postulated mechanisms in the Blood-Retinal barriers, J. Cunha-Vaz, edit. Plenum Press New York.35.Jalkh A., Takahashi M., Topilov H. X., Trempe C. L., McMeel J. W.: Prognostic value of vitreous findings in diabetic retinopathy, Arch. Ophtalmol.,1982.36.King G. L., Buzney S. M., Kahn C. R.: Differential responsiveness to insulin of endothelial and support cells from micro- and macrovessels, J. Clin. Invest., 1983.37.Kalebic T., Garbisa S.., Glaser B., Liotta L. A.: Basement membrane collagen. Degradation by migrating endothelial cells, Science, 1982.38.Kohner E. M., Porta M.: Vascular abnormalities in diabets and their treatement, Trans. Ophtalmol. Soc. U.K., 1980.39.Kohner E. M., Hamilton A. M., Saunders S. J., Sutcliffe B. A., Bulpitt C. J.:The retinal blood flow in diabets, Diabethology,1975.40.Koenig F., Ramioul E., Bandello F., Soubrane G.: Evolution de la retinopatie precoce. Etude clinique et angiografique, Bull. Mem. Soc. Fr. Ophtalmol., 1985.41.Kearns M., Hamilton A. M., Kohner E.M.: Excessive permeability in diabetic maculopathy, Br. J. Ophtalmol., 1979.42.Little H. L.: Alteratins in blood elements in the pathogenesis of diabetic retinopathy, Ophtalmology, 1981.43.Luttz G.A., Thompson D.C., Gallup J. Y., Mello R.J., Patz A., Feneslau A.:Vitreous an inhibitor of retinal extract-induced neovascularisation, Invest. Ophthalmol. Vis. Sci., 1983.44.L'Esperance F.A., Jame W.A.: The problem of diabetic retinopathy, (in: Little M., Jack R.L., Patz A., Forsham P.: Diabetic Retinopathy),Georg. Thieme, Verlag-Stuttgart-New York, 1983.45.McMeel J.W., Trempe C.L., Franks E.B.: Diabetic Maculopaty, Trans. Am. Acad. Ophtalmol.-Otolaryngol.1977.46.Murphy R.P., Patz A.: The natural history and management of nonproliferative diabetic retinopathy in diabetic retinopathy, Thieme Stratton, New York, 1983.47.Mogo M.: Mic enciclopedie de medicin intern,ed. Didactic i pedagogic,1986.48. Olteanu M.: Tratat de oftalmologie, vol. 1-2, 1989.49. Olteanu M., Carstocea B., Dordea S.: Retinopatia diabetic-etiopatologie,tratament, Oftalmologia nr. 3, 1982.

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