Talk:Casus 19/@comment-25124951-20140720111718

Oorzaken van icterus

 Icterus door voornamelijk niet geconjugeerd bilirubine 

 Hemolyse: extravasculaire oorzaken 

 ·          -  Hereditaire sferocytose (neonaat 65%)

 ·           - Thalassemie   (heel jong)

 ·           - Sikkelcelanemie (heel jong)

 ·           - G6PD-deficiëntie

                                    Vit. B 12 en foliumzuur deficiëntie - Gebruikers van medicijnen die de foliumzuurstofwisseling verstoren  <span style="mso-bookmark:OLE_LINK8">''<span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica"> ( foliumzuurantagonisten ) - Een verminderde opname vanuit de darm (absorptie). - Bij  <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family: "Helvetica","sans-serif";mso-bidi-font-family:Helvetica;color:#092F9D; text-decoration:none;text-underline:none">aids <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica">-patiënten  <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family: "Helvetica","sans-serif";mso-bidi-font-family:Helvetica"> is de foliumzuurabsorptie significant verminderd, onafhankelijk van het stadium van de ziekte. - Bij darmaandoeningen als   <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family: "Helvetica","sans-serif";mso-bidi-font-family:Helvetica;color:#092F9D; text-decoration:none;text-underline:none">coeliakie <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica">,  <span style="mso-bookmark: OLE_LINK8"><span style="font-size: 10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family:Helvetica; color:#092F9D;text-decoration:none;text-underline:none">colitis ulcerosa <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica"> en de  <span style="mso-bookmark: OLE_LINK8"><span style="font-size: 10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family:Helvetica; color:#092F9D;text-decoration:none;text-underline:none">ziekte van Crohn <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica"> kan de absorptie van folaat en foliumzuur gestoord zijn. - Verhoogde verliezen. Dit kan onder meer het geval zijn bij: Folaatverliezen via  <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family: "Helvetica","sans-serif";mso-bidi-font-family:Helvetica;color:#092F9D; text-decoration:none;text-underline:none">hemodialyse <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica"> -  <span style="mso-bookmark: OLE_LINK8"><span style="font-size: 10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family:Helvetica; color:#092F9D;text-decoration:none;text-underline:none">Alcohol <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica"> verstoort de heropname van foliumzuur vanuit de darm in de enterohepatische cyclus. - Een verstoorde activatie van foliumzuur. Dit kan het geval zijn bij:  <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family: "Helvetica","sans-serif";mso-bidi-font-family:Helvetica;color:#092F9D; text-decoration:none;text-underline:none">alcoholici <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica">. Alcoholisme is een veelvoorkomende reden van foliumzuurdeficiëntie. ''

<p class="MsoNormal" style="margin-top:0cm;margin-right:0cm;margin-bottom:1.0pt; margin-left:72.0pt;mso-pagination:none;mso-layout-grid-align:none;text-autospace: none"><span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica">Mensen met  <span style="mso-bookmark: OLE_LINK8"><span style="font-size: 10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family:Helvetica; color:#092F9D;text-decoration:none;text-underline:none">leverziekten <span style="mso-bookmark:OLE_LINK8">''<span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica">. - Tekort aan het enzym of de  <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family: "Helvetica","sans-serif";mso-bidi-font-family:Helvetica;color:#092F9D; text-decoration:none;text-underline:none">cofactor <span style="mso-bookmark:OLE_LINK8"><span style="font-size:10.0pt;font-family:"Helvetica","sans-serif";mso-bidi-font-family: Helvetica"> die nodig is voor de productie van geactiveerd folaat in het lichaam. ''

<p class="MsoNormal"> Hemolyse: intravasculaire oorzaken 

<p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l7 level1 lfo3"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·          -  Auto-immuun-hemolytische anemie

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l7 level1 lfo3"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·         -   Mechanisch (kunstklep in hart)

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l7 level1 lfo3"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Geneesmiddelen

<p class="MsoListParagraphCxSpLast" style="text-indent:-18.0pt;mso-list:l7 level1 lfo3"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Toxinen, infecties, hoge temperatuur

<p class="MsoNormal"> Gestoorde conjugatie 

<p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l3 level1 lfo4"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·         -   Icterus neonatorum

<p class="MsoListParagraphCxSpLast" style="text-indent:-18.0pt;mso-list:l3 level1 lfo4"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·         -  Erfelijk

<p class="MsoNormal"> Icterus door voornamelijk geconjugeerd bilirubine 

<p class="MsoNormal"> Galwegobstructie 

<p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l5 level1 lfo5"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·          -  Posthepatisch: tumor van galwegen, Papil van Vater, pancreassteen of stenen in de ductus choledochus

<p class="MsoNormal"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol">  -    Intrahepatisch: primaire scleroserende cholangitis (zelden)

<p class="MsoNormal"> Gestoorde excretie van bilirubine

<p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l1 level1 lfo6"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·          -  Erfelijk

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l1 level1 lfo6"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - (beginnende) hepatitis

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l1 level1 lfo6"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Intrahepatische cholestase (geneesmiddelen)

<p class="MsoListParagraphCxSpLast" style="text-indent:-18.0pt;mso-list:l1 level1 lfo6"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Postoperatief

<p class="MsoNormal"> Icterus door geconjugeerd en niet geconjugeerd bilirubine 

<p class="MsoNormal"> Acute hepatitis 

<p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l6 level1 lfo7"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Infectieus: hepatitis virussen EBV, CMV, andere micro-organismen, geneesmiddelen en toxinen

<p class="MsoListParagraphCxSpLast" style="text-indent:-18.0pt;mso-list:l6 level1 lfo7"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Niet infectieus: alcohol, geneesmiddelen en toxinen

<p class="MsoNormal"> Chronische hepatitis 

<p class="MsoNormal"> Cirrose 

<p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l4 level1 lfo8"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Alcohol

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l4 level1 lfo8"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Postviraal

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l4 level1 lfo8"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·            - Metabool: ziekte van Wilson, hemochromatose

<p class="MsoListParagraphCxSpMiddle" style="text-indent:-18.0pt;mso-list:l4 level1 lfo8"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Biliair: primaire biliaire cirrose (90% vrouw)

<p class="MsoListParagraphCxSpLast" style="text-indent:-18.0pt;mso-list:l4 level1 lfo8"><span style="font-size:11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol"> ·           - Cardiovasculair: decompensdation cordis, pericarditis, trombose van de levervenen, syndroom van Budd-Chiari (zelden)