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Witte raven

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roos koopman

on 25 October 2012

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Transcript of Witte raven

A.G.M.M. Koopman Het is zwart en wit en staat in de wei 2 witte raven in de polder Syndroom van McKittrick-Wheelock villeus adenoom van het rectum Man 73 jaar Immunoglobulin G4-related disease Vrouw, 83 jaar VG: Iris tumor linker oog
Chronische pancreatitis
Pancreatectomie
DM
CVA
COPD

A: Hoestklachten
Afgevallen
Roken +++
Alcohol -

CT:


PA: Aspecifieke ontsteking

Lab: IgA 4.39, IgG4 1.62




5% van de adenomen Villeus adenoom Hematochezia McKittrick-Wheelock Niet specifieke klachten Geelzucht of pancreatitis McKittrick-Wheelock Familiaire component 40% maligne ontaarding Symptomen Electrolyten verstoring Diarree Pre-renale nier insufficiëntie VG: HT
Chronische NI e.c.i.
Chronische vermoeidheid

SEH: 2x gecollabeerd
5 dagen diarree

LO: fors gedehydreerd

Lab: Na: 131, K 3.1, Kreat 126,
eGFR 32

Col: grote villeuze poliep

PA: Villeus adenoom Literatuur Pubmed: 29 artikelen Case-reports 4,5,6,7,8,9,10,11,12,13, 14, 15, 16 Geslacht: 7 mannen
6 vrouwen

Mediane leeftijd: 65 jr (range: 30-78)

Diarree: 13 patienten
Duur: 5 dagen - 2 jaar
Hypokaliemie: 13 patienten
Hyponatriemie: 13 patienten
Nierfunctie: 8 patienten

Rectaal toucher: 2 patienten 13 artikelen Behandeling Elektrolyten

Resectie Referenties Up-to-date Systemische ziekte

Opgezwollen laesies

Plasmacellen IgG4-positief

Storiforme fibrosis

Serum IgG4 (60-70%) IgG 4 1.82

BSE 17 1.




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2. Popescu A, Orban-Schiopu A, Becheanu G, Diculescu M. McKittrick–Wheelock syndrome —
a rare cause of acute renal failure. Rom J Gastroenterol 2005; 14: 63-66.
3. Snhitka T, Friedman MHW, Kidd E, Mackenzie W. Villous tumors of the rectum and colon characterized by severe fluid and electrolyte loss.
Surg Gynecol Obstet 1961; 112: 609-621.
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13. Saunders MD. Acute colonic pseudo-obstruction. Gastrointest Endosc Clin N Am 2007; 17: 341-360.
14. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome). An analysis of 400 cases.
Dis Colon Rectum 1986; 29: 203-210.
15. Jetmore AB, Timmcke AE, Gathright JB Jr, et al. Ogilvie’s syndrome: colonoscopic decompression and analysis of predisposing factors.
Dis Colon Rectum 1992; 35: 1135-1142.
16. Kamisawa T, Funata N, Hayashi Y, et al. A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol 2003;38:982-4.
17. Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med 2001;344:732-8.
18. Deshpande V, Gupta R, Sainani NI, et al. Subclassification of autoimmune pancreatitis: a histologic classification with clinical significance.
Am J Surg Pathol 2011;35:26-35.
19. Stone JH, Khosroshahi A, Hilgenberg A, Spooner A, Isselbacher EM, Stone JR. IgG4-related systemic disease and lymphoplasmacytic aortitis.
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