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}\viewkind1\viewscale100\margl0\margr0\margt0\margb0\deftab80\dntblnsbdb\expshrtn\p
aperw10760\paperh16440{\bkmkstart Pg326}{\bkmkend Pg326}\par\pard\ql
\li4943\sb0\sl-276\slmult0 \par\pard\ql\li4943\sb0\sl-276\slmult0
\par\pard\ql\li4943\sb0\sl-276\slmult0 \par\pard\ql\li4943\sb0\sl-276\slmult0
\par\pard\ql\li4943\sb88\sl-276\slmult0 \up0 \expndtw0\charscalex115
\ul0\nosupersub\cf1\f2\fs24 Chirurgie genera/a \par\pard\li2913\sb220\sl-
276\slmult0\fi0\tx5318\tx7185 \up0 \expndtw0\charscalex105 e) agenti
vaodilatatori\tab \up0 \expndtw0\charscalex105 (mlroglicerina)\tab \up0
\expndtw0\charscalex105 reduc presiunea portala prin\par\pard\li2913\sb31\sl-
276\slmult0\fi14 \up0 \expndtw0\charscalex105 reducerea rezistentei
vasculare;\par\pard\ql \li2913\sb21\sl-276\slmult0 \up0 \expndtw0\charscalex105 f)
antagonist! a-adrenergici: clonidina. \par\pard\li1987\sb0\sl-
276\slmult0\par\pard\li1987\sb101\sl-276\slmult0\fi0\tx5092 \dn3
\expndtw0\charscalex111 <" \ul0\nosupersub\cf3\f4\fs24\ul Tratamentul epj\tab
\up0 \expndtw0\charscalex111 \ul0\nosupersub\cf1\f2\fs24 i hemoranic
acut\par\pard\ql \li1924\sb0\sl-90\slmult0 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf2\f3\fs10 v \par\pard\ql \li2400\sb0\sl-216\slmult0 \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf1\f2\fs24 Hemoragia digestiva superioara
prin ruptura varicelor esofagiene are un pro-\par\pard\ql \li1857\ri421\sb0\sl-
306\slmult0\fi9\tx2395 \up0 \expndtw0\charscalex103 nostic grav. In ciuda unui
aparent progres terapeutic realizat in ultimii ani procen\up0
\expndtw0\charscalex105 tul mortalitatii dupa primal episod hemoragic se mentine
intre 10% i 40%. \line \tab \up0 \expndtw0\charscalex106 Atitudinea initials
consta in evaluarea cat mai corecta a gravitatii hemora \line \up0
\expndtw0\charscalex106 giei i inceperea urgenta a manevrelor de reanimare.
\par\pard\qj \li1857\ri413\sb0\sl-310\slmult0\fi532 \up0 \expndtw0\charscalex105
Cea mai mare urgenta o reprezinta refacerea volumului circulant in vederea \up0
\expndtw0\charscalex105 evitarii hipotensiunii^i afectariiJiepatjce.i renaje.
Protocolul de prioritati in tra \up0 \expndtw0\charscalex105 tamentul hemoragiei
digestive superioare cuprinde urmatoarele: \par\pard\ql \li2731\sb11\sl-276\slmult0
\up0 \expndtw0\charscalex107 &- se instaleaza mai multe linii venqase. depreferat
i un cateter venos \par\pard\li2918\sb30\sl-276\slmult0\fi0\tx8615 \up0
\expndtw0\charscalex119 \ul0\nosupersub\cf3\f4\fs24\ul
centr\ul0\nosupersub\cf1\f2\fs24 al, sqmj|h2i^ga^^\tab \up0 \expndtw0\charscalex119
\u8212? -\par\pard\ql \li2567\ri412\sb0\sl-320\slmult0\tx2923 \up0
\expndtw0\charscalex105 & - se reeolteaza sange pentru efectuarea citologiei
sangvine, hematocri-\line\tab \up0 \expndtw0\charscalex105 tului. functiei hepatice
i renale; \par\pard\ql \li2678\sb0\sl-274\slmult0 \up0 \expndtw0\charscalex104 o -
se pregatesc eel putin 6 unitati de sange izogrup-izoRh; \par\pard\ql
\li2630\ri348\sb25\sl-300\slmult0\tx6254 \up0 \expndtw0\charscalex105 c -Tn
c\ul0\nosupersub\cf3\f4\fs24\ul azul in\ul0\nosupersub\cf1\f2\fs24 care sunt
prezente semnele clinice de hemoragie se admi-\line\tab \up0 \expndtw-
8\charscalex100
^inget^TacTct\par\pard\sect\sectd\sbknone\cols2\colno1\colw2878\colsr40\colno2\colw
7702\colsr160\ql \li2783\sb0\sl-92\slmult0 \par\pard\ql \li2783\sb60\sl-
92\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf4\f5\fs8
^\par\pard\column \qj \li20\ri356\sb18\sl-302\slmult0\fi62 \up0
\expndtw0\charscalex106 \ul0\nosupersub\cf1\f2\fs24 - daca pacientul este
\ul0\nosupersub\cf3\f4\fs24\ul stabil\ul0\nosupersub\cf1\f2\fs24 hemodiiianilc^e
poate efectua endoscopia \up0 \expndtw0\charscalex104 digestiva superioara;
\par\pard\sect\sectd\sbknone \ql \li2817\sb19\sl-276\slmult0 \up0 \expndtw-
1\charscalex100 -\u8212? hematocritul trebuiejiientinut intre(25-350/^ prin
eectuareatransfuziei; \par\pard\qj \li2841\ri404\sb16\sl-310\slmult0\fi67 \up0
\expndtw0\charscalex103 - excesul de transfuzii poate provoca o recidiva precoce a
hemoragiei; \up0 \expndtw0\charscalex103 c- cand \up0 \expndtw-6\charscalex100 m
\up0 \expndtw0\charscalex102 ul d_e_grotrpmbina este prelungit pesteQ minute se
indica \up0 \expndtw0\charscalex103 transfuzia cu plasma proaspata; \par\pard\qj
\li2923\ri303\sb0\sl-300\slmult0\fi182 \up0 \expndtw-7\charscalex100
cancTtrombocitele scad sub 5GJ300 s e jnd i c a tran s fu z i ecu in as a
trom\up0 \expndtw-8\charscalex100 bocitara: \par\pard\qj \li2894\ri409\sb0\sl-
320\slmult0 \up0 \expndtw0\charscalex104 ^sc admmistreaza (actuloza
sau^\ul0\nosupersub\cf3\f4\fs24\ul citrat de m\ul0\nosupersub\cf1\f2\fs24 agneziu
pentru prevenirea \up0 \expndtw0\charscalex105 encetalopatiei porto-sistemice:
\par\pard\qj \li2908\ri413\sb0\sl-320\slmult0 \up0 \expndtw0\charscalex103
-"diLpa_stahiiizareahemodmamica se elimina aportul de sodiu pentru \up0
\expndtw0\charscalex104 minimal izarea ascitci. \par\pard\ql
\li2400\ri3309\sb280\sl-300\slmult0\tx3177 \up0 \expndtw0\charscalex105
Metodeterapeutice hemostatjeenechirurgjeaie: \line\tab \up0 \expndtw0\charscalex102
scleroterapia; \par\pard\ql \li2856\sb20\sl-276\slmult0 \up0
\expndtw0\charscalex102 (jyjjigatura endoscopica a varicelor; \par\pard\ql
\li2860\sb44\sl-276\slmult0 \up0 \expndtw0\charscalex104
(cyfo\ul0\nosupersub\cf3\f4\fs24\ul losir\ul0\nosupersub\cf1\f2\fs24
eaiuedicamentelor yasoactive; \par\pard\qj \li2783\ri1470\sb5\sl-
300\slmult0\fi72 \up0 \expndtw0\charscalex103 (t) tamponamentul hemostatic
(folosirea sondelor cu balon); \up0 \expndtw-1\charscalex100 l^e) embolizarea
varicelor. \par\pard\ql \li2385\sb40\sl-276\slmult0 \up0 \expndtw0\charscalex104 A.
Scleroterapia: \par\pard\ql \li2380\sb24\sl-276\slmult0 \up0
\expndtw0\charscalex103 - se poate aplica imediat din momentul precizarii
diagnosticului; \par\pard\ql \li5817\sb0\sl-115\slmult0 \par\pard\ql\li5817\sb0\sl-
115\slmult0 \par\pard\ql\li5817\sb0\sl-115\slmult0 \par\pard\ql\li5817\sb0\sl-
115\slmult0 \par\pard\ql\li5817\sb0\sl-115\slmult0 \par\pard\ql\li5817\sb0\sl-
115\slmult0 \par\pard\ql\li5817\sb0\sl-115\slmult0 \par\pard\ql\li5817\sb72\sl-
115\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf2\f3\fs10 -J -\u8212?
*-\par\pard\sect\sectd\fs24\paperw10760\paperh16440{\bkmkstart Pg327}{\bkmkend
Pg327}\par\pard\ql \li3887\sb0\sl-276\slmult0 \par\pard\ql\li3887\sb0\sl-
276\slmult0 \par\pard\ql\li3887\sb0\sl-276\slmult0 \par\pard\ql\li3887\sb0\sl-
276\slmult0 \par\pard\ql\li3887\sb28\sl-276\slmult0 \up0 \expndtw0\charscalex108
\ul0\nosupersub\cf1\f2\fs24 Hipertensiunea portala \par\pard\ql \li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb0\sl-46\slmult0 \par\pard\ql\li4223\sb0\sl-
46\slmult0 \par\pard\ql\li4223\sb8\sl-46\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf7\f8\fs4 jn' \par\pard\ql \li4401\sb0\sl-92\slmult0
\par\pard\ql\li4401\sb84\sl-92\slmult0 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf4\f5\fs8
\\\par\pard\sect\sectd\sbknone\cols2\colno1\colw3424\colsr60\colno2\colw7136\colsr1
60\ql \li2443\sb194\sl-414\slmult0 \up0 \expndtw0\charscalex114
\ul0\nosupersub\cf6\f7\fs36 Cord\par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb0\sl-92\slmult0 \par\pard\ql \li1670\sb0\sl-92\slmult0 \par\pard\ql
\li1670\sb1\sl-92\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf4\f5\fs8
^\par\pard\ql \li1728\sb43\sl-115\slmult0\tx2217 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf2\f3\fs10 yt \up0 \expndtw-1\charscalex100 *3\tab \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf4\f5\fs8 *\par\pard\ql \li1896\sb0\sl-
72\slmult0\tx3273 \up0 \expndtw-1\charscalex100 <\tab \up0 \expndtw-1\charscalex100
&\par\pard\ql \li1718\sb0\sl-92\slmult0 \par\pard\ql \li1718\sb0\sl-92\slmult0
\par\pard\ql \li1718\sb0\sl-92\slmult0 \par\pard\ql \li1718\sb0\sl-92\slmult0
\par\pard\ql \li1718\sb0\sl-92\slmult0 \par\pard\ql \li1718\sb0\sl-92\slmult0
\par\pard\ql \li1718\sb0\sl-92\slmult0
\par\pard\ql \li1718\sb0\sl-92\slmult0 \par\pard\ql \li1718\sb38\sl-92\slmult0
\up0 \expndtw-1\charscalex100 #\par\pard\ql \li1449\sb0\sl-414\slmult0 \par\pard\ql
\li1449\sb0\sl-414\slmult0 \par\pard\ql \li1449\sb0\sl-414\slmult0 \par\pard\ql
\li1449\sb0\sl-414\slmult0 \par\pard\ql \li1449\sb0\sl-414\slmult0 \par\pard\ql
\li1449\sb288\sl-414\slmult0 \up0 \expndtw0\charscalex112
\ul0\nosupersub\cf6\f7\fs36 Arteriole\par\pard\column \ql \li3763\sb0\sl-92\slmult0
\par\pard\ql \li3763\sb0\sl-92\slmult0 \par\pard\ql \li712\sb31\sl-
92\slmult0\tx3333 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf4\f5\fs8 ^\tab
\up0 \expndtw0\charscalex127 \u9632?r:' 'c,:^,\\\par\pard\ql \li3763\sb0\sl-
92\slmult0 \par\pard\ql \li481\sb46\sl-92\slmult0 \up0 \expndtw-1\charscalex100 t
<\par\pard\ql \li3763\sb0\sl-92\slmult0 \par\pard\ql \li419\sb18\sl-
92\slmult0\tx774\tx865 \up0 \expndtw-1\charscalex100 \\\tab \up0 \expndtw-
1\charscalex100 *>\tab \up0 \expndtw-1\charscalex100 ^\par\pard\ql \li299\sb0\sl-
108\slmult0\tx813\tx981 \up0 \expndtw-5\charscalex75 \ul0\nosupersub\cf8\f9\fs12
s \ul0\nosupersub\cf2\f3\fs10 h \ul0\nosupersub\cf8\f9\fs12 <r \up0
\expndtw0\charscalex101 s \ul0\nosupersub\cf4\f5\fs8 &\ul0\nosupersub\cf8\f9\fs12
U\tab \up0 \expndtw0\charscalex53 \ul0\nosupersub\cf4\f5\fs8 *\u8226?
*\ul0\nosupersub\cf8\f9\fs12 A\tab \up0 \expndtw0\charscalex50
\ul0\nosupersub\cf2\f3\fs10 <r-\par\pard\ql \li558\sb36\sl-92\slmult0 \up0
\expndtw-2\charscalex100 \ul0\nosupersub\cf4\f5\fs8 Vt\par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li5313\sb0\sl-92\slmult0 \par\pard\ql
\li5313\sb0\sl-92\slmult0 \par\pard\ql \li1849\sb66\sl-92\slmult0 \up0 \expndtw-
3\charscalex88 \u8226?***.\par\pard\ql \li2708\sb44\sl-340\slmult0 \up0
\expndtw0\charscalex117 \ul0\nosupersub\cf6\f7\fs36 Scleroterapic\par\pard\ql
\li2608\sb175\sl-414\slmult0 \up0 \expndtw0\charscalex120
Tamponament\par\pard\ql \li20\sb287\sl-414\slmult0\tx2661 \up0
\expndtw0\charscalex111 Varice\tab \up0 \expndtw0\charscalex114
Ligaturi\par\pard\ql \li2651\sb1\sl-348\slmult0 \up0 \expndtw0\charscalex118
elastice\par\pard\ql \li4622\sb0\sl-414\slmult0 \par\pard\ql \li4622\sb0\sl-
414\slmult0 \par\pard\ql \li4622\sb0\sl-414\slmult0 \par\pard\ql \li4622\sb0\sl-
414\slmult0 \par\pard\ql \li1158\sb102\sl-414\slmult0 \up0 \expndtw0\charscalex109
~~
Vasopresina\par\pard\sect\sectd\sbknone\cols3\colno1\colw3581\colsr110\colno2\colw1
338\colsr160\colno3\colw5441\colsr160\ql \li1459\sb33\sl-414\slmult0 \up0
\expndtw0\charscalex116 mezenterice\par\pard\column \ql \li4176\sb0\sl-
46\slmult0 \par\pard\ql \li4176\sb0\sl-46\slmult0 \par\pard\ql \li4176\sb0\sl-
46\slmult0 \par\pard\ql \li505\sb21\sl-46\slmult0 \up0 \expndtw-1\charscalex78
\ul0\nosupersub\cf7\f8\fs4 \u9632?*\u9632?*"\par\pard\ql \li20\sb32\sl-
138\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf8\f9\fs12 k\par\pard\ql
\li629\sb0\sl-134\slmult0 \up0 \expndtw-1\charscalex100 r\par\pard\column \ql
\li20\sb129\sl-414\slmult0 \up0 \expndtw0\charscalex122 \ul0\nosupersub\cf6\f7\fs36
Somatostatina\par\pard\ql \li7291\sb0\sl-92\slmult0 \par\pard\ql \li7291\sb0\sl-
92\slmult0 \par\pard\ql \li7291\sb0\sl-92\slmult0 \par\pard\ql \li7291\sb0\sl-
92\slmult0 \par\pard\ql \li7291\sb0\sl-92\slmult0 \par\pard\ql \li7291\sb0\sl-
92\slmult0 \par\pard\ql \li7291\sb0\sl-92\slmult0 \par\pard\ql \li7291\sb0\sl-
92\slmult0 \par\pard\ql \li7291\sb0\sl-92\slmult0 \par\pard\ql \li7291\sb0\sl-
92\slmult0 \par\pard\ql \li7291\sb0\sl-92\slmult0 \par\pard\ql \li2132\sb6\sl-
92\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf4\f5\fs8 y.j t
\par\pard\sect\sectd\sbknone \ql \li2160\sb0\sl-276\slmult0
\par\pard\ql\li2160\sb0\sl-276\slmult0 \par\pard\ql\li2160\sb135\sl-
276\slmult0\tx2644 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf1\f2\fs24
Fig. \tab \up0 \expndtw0\charscalex104 3. ModalitSti de tratament in hipertensiunea
portals \par\pard\qj \li916\ri1333\sb205\sl-300\slmult0\fi518 \up0
\expndtw0\charscalex104 - recidiva hemoragiei este de aproximativ 50% daca
scleroterapia este apli\up0 \expndtw0\charscalex102 cata ca metoda unica;
\par\pard\qj \li916\ri1326\sb4\sl-320\slmult0\fi527 \up0 \expndtw0\charscalex109 -
poate determina unele complicatii ca pneumonia de aspiratie, ulceratia \up0
\expndtw0\charscalex102 esofagiana, stenoza esofagiana $in foarte rar, perforate
esofagiana. \par\pard\ql \li4886\sb0\sl-276\slmult0 \par\pard\ql\li4886\sb261\sl-
276\slmult0 \up0 \expndtw-4\charscalex100 323
\par\pard\sect\sectd\fs24\paperw10760\paperh16440{\bkmkstart Pg328}{\bkmkend
Pg328}\par\pard\ql \li4896\sb0\sl-276\slmult0 \par\pard\ql\li4896\sb0\sl-
276\slmult0 \par\pard\ql\li4896\sb0\sl-276\slmult0 \par\pard\ql\li4896\sb0\sl-
276\slmult0 \par\pard\ql\li4896\sb68\sl-276\slmult0 \up0 \expndtw0\charscalex115
\ul0\nosupersub\cf1\f2\fs24 Chirurgie generala \par\pard\ql \li2342\sb224\sl-
276\slmult0 \up0 \expndtw0\charscalex107 B. Ligatura elastied a varicelor:
\par\pard\ql \li2332\sb24\sl-276\slmult0 \up0 \expndtw0\charscalex106 -constain
strangularea varicelor, ce vadeterminastaza, favorizandtromboza; \par\pard\ql
\li2332\sb24\sl-276\slmult0 \up0 \expndtw0\charscalex105 - se practica in special
pentru varicele mari. \par\pard\ql \li2337\sb44\sl-276\slmult0 \up0
\expndtw0\charscalex114 C. Reducerea presiunii portale i a fluxulni venos portal
se poate face \par\pard\ql \li1804\sb26\sl-322\slmult0 \up0 \expndtw-
12\charscalex95 \ul0\nosupersub\cf9\f10\fs28 prin urmatoarele mecanisme:
\par\pard\ql \li2860\sb56\sl-276\slmult0 \up0 \expndtw0\charscalex106
\ul0\nosupersub\cf1\f2\fs24 - vasoconstrictie splanhnica cu reducerea influxului
venos potal; \par\pard\ql \li2865\sb44\sl-276\slmult0 \up0 \expndtw0\charscalex106
- reducerea debitului cardiac; \par\pard\ql \li2860\sb64\sl-276\slmult0 \up0
\expndtw0\charscalex104 - dilatatia venelor splanhnice; \par\pard\ql
\li2860\sb64\sl-276\slmult0 \up0 \expndtw0\charscalex107 - reducerea rezistentei
vasculare intrahepatice; \par\pard\ql \li2860\sb44\sl-276\slmult0 \up0
\expndtw0\charscalex104 - reducerea volumului plasmatic. \par\pard\qj
\li1809\ri486\sb25\sl-300\slmult0\fi527 \up0 \expndtw0\charscalex110 Se realizeaza
prin intermediul mai multor substante vasoactive, cele mai \up0
\expndtw0\charscalex102 importantc fiind: \par\pard\ql \li2870\sb40\sl-
276\slmult0 \up0 \expndtw0\charscalex102 a) vasopresina: \par\pard\qj
\li3124\ri480\sb5\sl-300\slmult0 \up0 \expndtw0\charscalex108 -este medicamentul
eel mai folositin tratamentul hemoragiilorva-\line \up0 \expndtw0\charscalex102
riceale \par\pard\qj \li3124\ri477\sb20\sl-300\slmult0 \up0 \expndtw0\charscalex100
- produce vasoconstrictie pe arterioiele precapilare splanhnice i scade \line \up0
\expndtw0\charscalex106 fluxul sangvin intestinal cu diminuarea consecutiva a
fluxului san-\line \up0 \expndtw0\charscalex107 gvin portal; \par\pard\ql
\li3124\sb40\sl-276\slmult0 \up0 \expndtw0\charscalex106 - poate produce
hipertensiune, retentie hidrica, bradicardie; \par\pard\qj \li2870\ri469\sb25\sl-
300\slmult0 \up0 \expndtw0\charscalex105 b) trigliceril-vasopresina are reactii
adverse mai putine decat vasopre \up0 \expndtw0\charscalex105 sina i se poate
administra discontinuu; \par\pard\qj \li2865\ri461\sb0\sl-310\slmult0 \up0
\expndtw0\charscalex109 c) somatostatina i octreotidul - reduc presiunea portala
fara a avea \line \up0 \expndtw0\charscalex106 repercusiuni asupra circulatiei
sistemice. Octreotidul este de 20 de ori \line \up0 \expndtw0\charscalex106 mai
puternic decat somatostatina, are durata lunga de actiune i reduce
\par\pard\li2860\sb18\sl-276\slmult0\fi4\tx7627 \up0 \expndtw0\charscalex103
gradientul presional venos portohepatic cu 30\tab \up0 \expndtw0\charscalex107
\ul0\nosupersub\cf11\f12\fs14 /0.\par\pard\li2860\sb26\sl-276\slmult0\fi4 \up0
\expndtw0\charscalex107 \ul0\nosupersub\cf1\f2\fs24 d) beta-blocantele
(propranololul) -are efecte atat asupra circulatiei\par\pard\li2860\sb31\sl-
276\slmult0\fi9 \up0 \expndtw0\charscalex108 sistemice cat i splanhnice. Alte
betablocante folosite sunt nadololul,\par\pard\li2860\sb32\sl-276\slmult0\fi9
\up0 \expndtw0\charscalex107 nipradilolul etc.;\par\pard\li2860\sb31\sl-
276\slmult0\fi0\tx5270 \up0 \expndtw0\charscalex106 e) agenti vaodilatatori\tab
\up0 \expndtw0\charscalex107 (nitroglicerina) - reduc presiunea portala
prin\par\pard\li2860\sb36\sl-276\slmult0\fi9 \up0 \expndtw0\charscalex107 reducerea
rezistentei vasculare;\par\pard\ql \li2865\sb21\sl-276\slmult0 \up0
\expndtw0\charscalex105 f) antagoniti a-adrenergici; clonidina; \par\pard\qj
\li1814\ri475\sb0\sl-320\slmult0\fi528 \up0 \expndtw0\charscalex105 A.
Tamponamentul folosind sonde hemostatice (Sengstaken-Blakemore i \up0
\expndtw0\charscalex106 Linton-Nachlas): \par\pard\ql \li2856\sb5\sl-276\slmult0
\up0 \expndtw0\charscalex106 - se face sub intubatie orotraheala; \par\pard\ql
\li2856\sb24\sl-276\slmult0 \up0 \expndtw0\charscalex105 -este foarte importanta
plasareacorectaasondei pentru rea I izarea efec-\par\pard\ql \li2865\sb64\sl-
276\slmult0 \up0 \expndtw0\charscalex103 tului hemostatic: \dn2 \expndtw-
2\charscalex100 \ul0\nosupersub\cf10\f11\fs6 r \par\pard\qj \li2851\ri469\sb0\sl-
310\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf1\f2\fs24 -
tamponamentul servete pentru controlul temporar al hemoragiei. ul \up0
\expndtw0\charscalex106 terior
trebuie efectuata terapia definitiva prin mijloace endoscopice i \up0
\expndtw0\charscalex106 chirureicale: \par\pard\qj \li2856\ri417\sb0\sl-310\slmult0
\up0 \expndtw0\charscalex110 - cea mai frecventa i mai grava complicate este
aspiratia bron$ica \up0 \expndtw-11\charscalex82 (1 \up0 \expndtw0\charscalex108
0%); se previne prin aspiratie eso-gastrica sistematica ?i intubatie \up0
\expndtw0\charscalex103 orotraheala. \par\pard\ql \li5769\sb0\sl-253\slmult0
\par\pard\ql\li5769\sb31\sl-253\slmult0 \up0 \expndtw0\charscalex109
\ul0\nosupersub\cf5\f6\fs22 324
\par\pard\sect\sectd\fs24\ul0\nosupersub\cf999999\f1000000
\pard\fs32 ATTENTION!\fs24\par
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