HSP-GU-260-008 Enterocolitis Necrosante

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  • 8/2/2019 HSP-GU-260-008 Enterocolitis Necrosante

    1/11

    K1fnjc8 @[T%J_%OGVORCKCINVN[ GOKRC[MGVO =214%440

    @c{tnvmn N%%%%%%%%%%%%%%,%%%%%%%%%%h www*n"w[necg Bcinqmr wwNH" *

  • 8/2/2019 HSP-GU-260-008 Enterocolitis Necrosante

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    Qor{ncg8 2MIKMN''CnM EM CRFOBCJCVMc''k'

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    K1fnjc8 @[T%J_%OGVORCKCINVN[ GOKRC[MGVO 214%440

    MIKMInH6M EM^CRFOBCJCVMc''k''c{tnvmn[necg Bcinqmr @C[TNVMINXMKNCG N Qor{n1g8 2_GNFMF FO ROKNOG GMKNFC[

    tro{ogvmg im ogaoreofmf `mg roknbnfc mi}ug vntc fo acreuim ogvormi.' Gnqoio{mueogvmfc{ fo amkvcro{ ngaimemvcrnc{ og {mgjro ( amkvcr fo mjrojmkn1g tim}uovmrnm)amkvcr fo gokrc{n{ vuecrmi) miam) cpnfc gnvrnkc) ngvoriou}ungm =%2) =2 ^ =0' Ic{ gnqoio{fn{engunfc{ fo amkvcr fo kroknenogvc otnforrgnkc. {o `mg qn{vc netinkmfc{ kcgmtmrnkn1g fo ogvorckcinvn{' ON u{c fo kmvovoro{ uebninkmio{ vmrgbnog `m {nfo netinkmfcog im ovnctmvcjognm'

    6' TROQOGKNCG ^ TRCECKNCGRokceogfmkncgo{ kcg Oqnfogknm NM8Mineogvmkn1g kcg iok`o emvorgmTrokmukn1g opvroem fo eofnkmeogvc{ mgvnmknfc{) bic}uomfcro{ fo @2Tmrm ic{ {njunogvo{ m{tokvc{ gc opn{vo {uanknogvo oqnfogknm knogvnankm tmrm oenvnrrokcrgogfmkncgo{ {ng orgb' ''''')''' w)'''' '''''''''''''''''')'))''')' NYin''''''gvmkncg cg,cr")= engnemN KnQ NNN Niiumwu qq QNN_==HNK@' NYiniiiwNNI ""QN qiI))

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    - K1fnjc8 @[T%J_%OGVORCKCINVN[ GOKRC[MGVO =214%440

    MIKMI'(i(M EM CRFO BCJCVM CK'c{tnvm-[necg Bcinqmr

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    %[mgjrmfc jm{vrcngvo{vngmi emkrc{kctnkc%Mivormkncgo{ og ic{ tmrmkiignkc{ (ioukcknvc{n{) ioukctognm) vrcebcknvctognm. '

    NN' OGVORCKCINVN[ KCGANREMFMNNM%Mueogvc fo ro{nfuc{) fn{vog{ncg mbfcengmi) oeo{n{) fcicr m im tmitmkncgmbfcengmi'%Kcetrcen{c {n{voemvnkc ( Gc vorrgcrro}uimkncg) mtgom) brmfnkmrfnm) iovmrjnm.%Rmfncjrmanm fo mbfceog kcg gouemvc{n{%@oko{ {mgjungciogvm{'inB%Mueogvc fo ro{nfuo{) fn{vog{ncg mbfcengmi) oeo[n[) fcicr m im tmitmkicgmbfcengmi'%Kcetrcen{c {n{vorgnkc) mknfc{n{) vrcebcknvctognm%Rmfncjrmanm fo mbfceog8 jm{ og tcrvmninM%Mueogvc fo ro{nfuc{) fn{vog{ncg mbfcengmi) oeo{n{) fcicr m im tmitmkncg%K`c}uo) KNF) gouvrctognm%Rmfncjrmaam fo mbfceog m{knvn{) tornvcgnvn{'NNNB%Vcfc = 4 mgvorncr em{ Gouectornvcgoc'OGAC]_O FNMJGC[VNKC8[o fobo {c{tok`mr im ogvnfmf og vcfc tmknogvo }uo tro{ogvo) ro{nfuc tor{n{vogvo)em~cr foi ;4/ 4 fo kmrmkvori{vnkm{ bninc{m{) qcenvc tor{n{vogvo) fn{vog{ncgmbfcengmi 4 {mgjrmfc jm{vrcngvo{vngmi bmhc' MN eceogvc fo im {c{tok`m {o{u{togfor{ im ^C) {o kcickmrm {cgfm crc}m{vrnkm) {o fobo {cinknvmr rmfncjrmanm fombfceog {netio) K@) oiokvrcinvc{ ~ jm{o{ mrvornmio{'[n vcfc{ ic{ o{vufnc{ {cg gcremio{) {o ngqo{vn}mrmg cvrm{ kmu{m{ fo im{ngvcemvcicjnm) kcec aioc m{cknmfc m {ot{n{ 4 gouecgnm) vrm{vcrgc{ fo im ecvninfmfjm{vrcngvo{vngmi) ovk) ~ {o rongnknmrm im qnm crmi {o}ug im oqciukncg kiagnkm ~ im{kmu{m{ ''[n {o ogkuogvrmg mivormkncgo{ {o ng{vmurmrm emgohc vormtouvnkc fo mkuorfc m imkim{nankmkncg'

    Tmmngm 6 fo ==

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    N Kcfn}c8 @[T%J_%OGVORCKCINVN[ GOKRC[MGVO =214%440

    ) MIKMi' CnM EM CRFO BCJCVM F'K'*nc{tnvmi[necg Bcinqmr NN @C[TNVMINXMKNCG

    _GiCMF FO ROKNOG GMKNFC[N q " 2or{ncg8

    GC [O @M OGKCGVRMFC OQNFOGKNM KNOGVnANKM OG IC[ [NJ_NOGVO[[NJGC[8 mtmrnogknm fo im{ fotc{nkncgo{) tro{ogknm fo {mgjro ckuivm 4 tro{ogknm fotmvc}ogc{ o{toknankc{ kcec ngfnkmfcro{ fo ogvorckcinvn{ gokrc{mgvo 4 ro{nfuc{}m{vrnkc{ kcec trofnkvcr fo im en{em'O{ fo mgcvmr }uo oi kumfrc tuofo {or fo fnaakni fim}gc{vnkc o{toknmi eogvo og ic{troemvurc{ eogcro{ fo ='?44 jr tcr {u tckm {ngvcemvcicjnm mug og km{c{ fokcetrcen{c ngvo{vngmi {oqorc) Og o{vc{ km{c{ oi kumfrc tuofo {or {niogvo mugtro{ogvmgfc gokrc{n{ ~ toracrmkncg) tmr ic }uo {o fobo qnjnimr oi tmvrcg fofn{vrnbukncg jm{oc{c) im {c{tok`m fo ii}unfc og im kmqnfmf tornvcgomi ~ im kminfmf foifrogmho'

    1' VRMVMENOGVCOGAC]_O VORMTO_VNKC8[o rominxmrm oi emgohc ~ {ojunenogvc {o}ug oi jrmfc fo {oqornfmf m{n8OKGNM8Ecgnvcrnm kunfmfc{ ngvoreofnc{) {u{togfor qnm crmi) {cgfm crc }m{vrnkm m bckmi'Rmfncjrmanm mbfceog = qox mi fim 4og km{c fo fovorncrc kingnkcNgnknc fo o{}uoem mgvnbn1vnkc troqnm vcem fo `oeckuivnqc{ ( metnkningm jogvmenkngmog ngaokkncgo{ voetrmgm{ 4 mf}unrnfm{ og im kceugnfmf) ~ Tntormkningm Vmxcbmkvmrg%menlmkngm tmrm tmknogvo{ `c{tnvminxmfc{ og im ugnfmfRooqmiumkn1g m im{ :2 `crm{8Rmfncjrmanm v1rmp gcremi) buogm oqciukncg kingnkm ~ kuivnqc{ gojmvnqc{8 {u{togformgvnbn1vnkc{ ~ rongnknm im qnm crmi'Og km{c fo fovorncrc kiignkc) tor{n{vogknm fo rmfncjrmanm mgcrem-) 4 kuivnqc{ tc{nvnqo{{o trcicg}mrm oi vrmvmenogvc tcr : fim{'

    =08Ecgnvcrnxmkn1g kunfmfc{ ngvog{nqc{Ngnknc fo in}unfc{ NQ% Guvrnkn1g tmrogvormi (Rokcrfmr }uo {o vrmvm fo ug kumfrcmbfcengmi) {o {ujnorog mtcrvo{ mivc{) qijnimr o{vmfc fo `nfrmvmkncg.'O{vufnc kcetiovc fo {ot{n{'Jm{o{ mrvornmio{ ~ kcrrokkn1g fo mknfc{n{ rgovmbcinkm kcg bnkmrbcgmvc'Gmfm qnm crmi% [cgfm crc}m{vrnkmKcgvrci rmfncic}nkc ~ ecgnvcrnxmkn1g eofnkm o{vrnkvm kmfm 6 m 1 `crm{Kcgvrci fnmrnc fo K@ jm{o{) oiokvrcinvc{

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    OGVORCKCINVN[ GOKRC[MGVONN NK1fnjc8 @[T%J_% N214%440N MIKMIF M EMQCR

    FOBCJCVMc')k)

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    Emgohc mgvnbncvnkc {o}ug fnm}gc{vnkc fo {ot{n{' Og km{c fo fovorncrc kingnkc)tor{n{vogknm fo rmfncjrmanm mgcremi) 4 kuivnqc{ tc{nvnqo{ {o trcicg}mrm oi vrmvmenogvctcr : fnm{'NNM8Ecgnvcrnm og kunfmfc{ ngvoreofnc{Ngnknc fo guvrnkncg tmrogvormn[cgfm crc jm{vrnkmGmfm qnm crmiNgnknc fo o{}uoem mgvnbncvnkc ( Metnkningm jogvmenkngm og {ot{n{ voetrmgm 4tntormkningm%vmxcbmkvme , mengc}iukc{nfc og {ot{n{ vmrfnm ngvrm `c{tnvmimrnm.) {nopn{vog amkvcro{ fo rno{jc {o fobo fmr kubrnenogvc tmrm o{vmanickckceovnkningcro{n{vogvo kcg qmgkcenkngm {noetro kcg oi mqmi foi kcenvo fo mgvnbncvnkc{.Rmfnc}rmaim fo mbfceog kmfm 1 `crm{ `m{vm fo{mtmrnkncg fo -m gouemvc{n{ ~ -uojcfnmrnc 4 og km{c fo fovorncrc kiignkcQmicrmkncg tcr knrujim tofnmvrnkm'[o trcicg}mrm oi vrmvmenogvc engnem tcr : fnm{'

    inB8Ecgnvcrnxmkncg kunfmfc{ ngvog{nqc{O{vufnc kcetiovc fo {ot{n{'Krn{vmicnfo{ og bcic{ tmrm emgvogor o{vmfc fo `nfrmvmkncg ctvnec' Ecgnvcrnm o{vrnkvmfo in}unfc{'Jm{o{ Mrvornmio{ ~ kcrrokkncg fo mknfc{n{ eovmbcinkm'[cinknvmr truobm{ fo kcm}uimkncg'Ngnknc fo in}unfc{ NQ% Guvrnkncg tmrogvormi (Rokcrfmr }uo {o vrmvm fo ug kumfrcmbfcengmi) {o {ujnorog mtcrvo{ mivc{) qnjnnmr o{vmfc fo `nfrmvmkncg.Rotc{c Jm{vrnkc ( gmfm qnm crmi. % [cgfm crc }m{vrnkm fo buog kminbro ( =4AR.Qmicrmkncg ngeofnmvm tcr knrujnm tofnmvrnk{'Kcgvrcio{ rmfncic}nkc{ ~ ecgnvcrnxmkncg eofnkm o{vrnkvm kmfm 6 m 1 `crm{Kcgvrci fo K@) jm{o{ mrvornmio{ oiokvrcanvc{ fnmrnc) `m{vm qornankmr o}uninbrnc ~eohornm'Emgohc mgvnbncvnkc (Metnkningm Jogvmenkngm) eovrcgnfmxciVmxcbmkvme , mengc}iukc{nfc ~#c Qmgkcenkngm {n `m~ rno{jc{eovnkningc ro{n{vogvo.Trcicg}mkncg foi vrmvmenogvc ogvro =4 m =6 fim{) {o}ug }oreog'M~ugc fo : m =4 fnm{'Vrmg{au{ncg fo tim}uovm{ ~ tim{em {n `m~ ngfnkmkncg

    c Tntormkningmfo o{vmanickckc

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    Qor{ncg8 2

    ninMEcgnvcrnxmkncg kunfmfc{ ngvog{nqc{O{vufnc kcetiovc fo {ot{n{) ro{orqm fo [mgjro (}icbuic{ rchc{ ~ tim{em.Jm{o{ mrvornmio{ ~ kcrrokkncg fo mknfc{n{ rgovmbcinkm kcg bnkmrbcgmvo'Romgnemkncg kcg krn{vmicnfo{ tmrm `nfrmvmkn1g ctvnemNgnknc fo in}unfc{ NQ% qnjnimr `ntc o `ntorjinkoenm'Guvrnkncg tmrogvormi (Rokcrfmr }uo {o vrmvm fo ug kumfrc mbfcengmi) {o {ujnorogmtcrvo{ mivc{ m{ojurmr ogvro oi =44 ~ oi =?4/ foi ro}uornenogvc fnmrnc. qnjnimr o{vmfcfo `nfrmvmkncg.Rotc{c ~ frogmho jm{vrcngvo{vngmi) [cgfm crc }m{vrnkm fo buog kminbro'Qmicrmkncg tmr knrujim tofnmvrnkm ngeofnmvm'Imtmrcvcrgim opticrmvcrnm 4 fo{kcrgtro{ncg mbfcengm- kcg frogo{ tornvcgomio{'Kcgvrci fo K@) jm{o{ mrvornmio{ oiokvrcinvc{ fnmrnc{ `m{vm }uo {o o{vmbioxkmo}uninbrnc'Emgohc mgvnbncvnkcTrcicgjmkn1g foi m~ugc ogvro =4 m =6 fim{ {o}ug joreog'M~ugc : m =4 fnm{'Vrmg{au{ncg fo tim}uovm{ ~ `oecfornqmfc{ {n `m~ ngfnkmkncg[ctcrvo ngcvrctnkc ~ {ctcrvo qogvnimvcrncNNNBEcgnvcrnxmkncg kunfmfc{ ngvog{nqc{Qogvnimkncg eokmgnkm'O{vufnc kcetiovc fo {ot{n{' Truobm{ fo kcm}uimkncgRo{orqm fo {mgjro (Jicbuio{ rchc{ ~ tim{em.Romgnrgmkncg kcg krn{vmicnfo{ tmrm o{vmfc fo `nfrmvmkncg ctvnrgcNgnknc fo Na}unfc{ NQ kcrrokkn1g fo mknfc{n{ kcg bnkmrbcgmvoEmgohc mgvnbncvnkc (kubrnenogvc tmrm jrme go}mvnqc{) ogvorcbmkvornm{) ~mgmorcbnc{.Guvrnkncg tmrogvormi (rokcrfmr }uo {o vrmvm fo ug kumfrm mbfcengmi) {o {ujnorogmtcrvo{ mivc{) kcg Nn}unfc{ ogvro oi =44 ^o- =?4/ foi ro}uornenogvc fnmrnc tmrm kubrnrim{ torfnfm{ tcr vorkor o{tmknc) qnjnimr o{vmfc fo `nfrmvmkncg.Rotc{c ~ frogmho jm{vrnkc) [cgfm crc }m{vrnkm fo buog kminbro'Ngvorkcg{uivm ngeofnmvm kcg knrujnm tofnmvrnkm) trotmrmr tmrm knrujnm'Imtmrcvcenm opticrmvcrnm qr{ frog tornvcgomi (troemvuro opvroec.Kcgvrci fo K@) jm{o{ mrvornmio{ oiokvrcinvc{ fnmrnc) `m{vm o{vmbninxmkncg'Trcicg}mkncg foi m~ugc ogvro =4 m =6 fim{'Vrmg{au{ncg fo tim}uovm{ {n `m~ igfakmkncg

    K1fnjc8 @[T%J_%OGVORCKCINVN[ GOKRC[MGVO 214%440[necg Bcinqmr

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    MIKMIFnM EM^CRFOBCJCVM F'K'

    %Tmknogvo{ og kcgfnkncgo{ kingnkm{ }uo kcgvrmngfn}uog nm knrujam8 kcmjuictmvnm{oqorm) kmrfnctmvnm{ kcetiohm{ 4 fo{kcetog{mfm{) amiim ro{tnrmvcrnm o ngo{vmbninfmf`orgcfngmrgvkm'Og km{c fo }uo gc `m~m eohcrim foi kumfrc kiignkc oi tmknogvo fobo {or iNoqmfc mknru}nm kumgfc im{ kcgfnkncgo{ kiignkm{ vc torenvmg) {n oi tmknogvo eohcrm o- frogfobo {or rovnrmfc kumgfc o{vo ngmkvnqc ~ rominxmr {noetro o{vufnc kmg kcgvrm{vo (vrmg{nvo ngvo{vngmi 4 kcicg tcr ogoem. tmrm oqmiumr {okuoim{'[o fobo rokcrfmr }uo im eohcrim fo{tuo{ fo ug frog gc o{ ngeofnmvm) = 4 }uotrneorc eohcrm o{ im o{vmbnincmf goecfngmenkm) im kumi fobo {or km{n ngeofnmvm)tc{vorncreogvo im ioukcknvc{n{) gouvrctognm ~ vrcrgbcknvctognm) rokcrfmgfc }uo imTKR o{ im }uo em{ iogvmeogvo rgohcrm) tcr = 4 }uo gc [0 fobo uvnnnxmr kcectmrmrgovrc tmrm kcg{nformr vrmvmrgnogvc }unrur}nkc em{ mrgtinc'Fo{tuo{ fo ug frog ngvo{vngmi) m to{mr fo = 2 = eohornm fo tmrmkiignkc{)arokuogvoeogvo tor{n{vog {njgc{ fo fn{augkn1g ngvo{vngmi) kcec tor{n{vogknm fo ugtim{vr1g ngvo{vngmi kcg mu{ogknm fo trcjro{n1g fo im mnromkn1g ngvo{vngmi) TKRoioqmfm fo{tuo{ fo ? fim{ 4 {njgc{ oqnfogvo{ fo cb{vrukkn1g ngvo{vngmi) {cgngfnkmkn1g fo imtmrcvcenm kumgfc oi tmknogvo o{vo og im{ eohcro{ kcgfnkncgo{kingnkm{ fo{tuo{ foi frogmho'Im{ kcetinkmkncgo{ em{ vmrfim{ tuofog {or o{vogc{n{ ngvo{vngmi 4 an{vuimogvorck1inkm'

    IMTMRCVCEnM OPTICRMVCRNM8Tuofo kcgiioqmr c{vcrgim{ trcpnrgmio{) mgm{vcec{n{ vorengc voengmi) ro{okkncgo{metinm{) ~ oi ngvo{vngc kcrvc tuofo {or ugm kcrgtvnkmkncg arokuogvo'GCVM8Im OKG o{ ugm ogaoreofmf fo {ojunenogvc og im ugnfmf fo roknog gmknfc{' MNeceogvm foi fnmjg1{vnkc fobo mqn{mr m im ugnfmf fo qn}nimgknm otnfoenci1jnkm'

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    ;' Kngknggmvn K`nifrog*{ @c{tnvmi Eofnkmi Kogvor' Oqnfogko%bm{of kmro junfoingoacr gokrcvnxngj ogvorckcinvn{ (GOK. mecgj qor~ icz bnrv` zonj`v ngamgv{'Kngknggmvn ([email protected] Kngknggmvn K`nifrog*{ @c{tnvmi Eofnkmi Kogvor< 244: Aob' =2T \>H8< roaorogko{i YMNYMvYM- kngknggm vnk nifrog{ ("'r"'''SN N N Niq H' QQQQQqiNQHaii %fqNHNN_Y '''' 'Qw6' H Kcrrom) Tngorc{ EA) Miacg{c [ Miacg{c' Emgohc fo im ogvorckcinvn{gokrcvnxmgvo og oi roknog gmknfc8 Juam fo trmkvnkm kiignkm bm{mf m og imoqnfogknm' _KNG%[cknofmf Kcicebnmgm fo Gocgmvcicjnm Qci'1 Gc =) 24418tmj 1%;4'

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