RA-1 MIDTERM SAMENVATTING 2022
GENEESKUNDE UVA
INHOUDSOPGAVE
SECTIE 1: METABOLE SYSTEEM EN DIABETES MELLITUS ................................................................................... 5
1.1. VERTERING, ENZYMEN EN ENERGIEHUISHOUDING ................................................................................ 5
Enzymen .......................................................................................................................................................... 5
Vertering ......................................................................................................................................................... 6
Energiehuishouding ........................................................................................................................................ 7
Stap 1: glyco-lyse (lysis van glucose) ........................................................................................................... 7
Stap 2: citroenzuurcyclus ............................................................................................................................ 8
Stap 3: oxidatieve fosforylering ................................................................................................................ 10
1.2. METABOLE ROUTES ............................................................................................................................... 13
Gluconeogenese ............................................................................................................................................ 15
Gevaste toestand .......................................................................................... Error! Bookmark not defined.
Gehongerde toestand ................................................................................... Error! Bookmark not defined.
Vetzuursynthese ........................................................................................................................................... 16
Vetsynthese................................................................................................................................................... 16
Lipolyse ......................................................................................................................................................... 18
Eiwitafbraak .................................................................................................................................................. 19
Ureumcyclus .................................................................................................................................................. 20
Ketogenese: energie ..................................................................................................................................... 22
Ketogenese en ketoacidose bij diabetes: .................................................................................................. 23
Glycogeen-metabolisme ............................................................................................................................... 23
1.3. INSULINE, GLUCAGON EN DIABETES MELLITUS .................................................................................... 24
Insuline en glucagon...................................................................................................................................... 24
Insuline: hoe wordt dit afgegeven?............................................................................................................... 27
Insuline en GLUT4 ......................................................................................................................................... 29
Insuline en het lichaam ................................................................................................................................. 30
Effect insuline op lever, adipocyte en spier .............................................................................................. 30
Glucagon ....................................................................................................................................................... 31
Glucagon en het lichaam ............................................................................................................................... 32
Opname van glucose ..................................................................................................................................... 33
GLUT’s ........................................................................................................................................................... 33
Km ................................................................................................................................................................. 34
Diabetes mellitus........................................................................................................................................... 36
DM type 1 .................................................................................................................................................. 38
Testen voor DM1 ................................................................................................................................... 38
DM type 2 .................................................................................................................................................. 39
DM2 medicatie ...................................................................................................................................... 40
Insuline schema’s ...................................................................................................................................... 42
Het HbA1c ................................................................................................................................................. 42
, Verschillen DM1 en hongertoestand ........................................................................................................ 43
Sectie 2: Maagproblemen, embryologie, anatomie en autonome zenuwstelsel ............................................. 44
2.1. PANCREAS ................................................................................................................................................. 44
Embryologie van de pancreas ....................................................................................................................... 44
Histologie ...................................................................................................................................................... 46
Histologie pancreas ................................................................................................................................... 46
Histologie glucagon en insuline ................................................................................................................. 47
2.2. BOVENBUIKKLACHTEN .............................................................................................................................. 48
Alarmsymptomen .......................................................................................................................................... 48
Maagklachten ................................................................................................................................................ 50
Helicobactor Pylori ................................................................................................................................ 51
Relaties met maagklachten ....................................................................................................................... 51
Behandeling van maagpijn ........................................................................................................................ 51
Ulcus .............................................................................................................................................................. 52
Typen ulcera .............................................................................................................................................. 52
2.3. EMBRYOLOGIE ........................................................................................................................................... 53
Holtes ............................................................................................................................................................ 53
Afwijkende anatomie .................................................................................................................................... 55
De lever ......................................................................................................................................................... 57
Lever en galblaas ........................................................................................................................................... 61
Embryologische vouwingen .......................................................................................................................... 61
verdere embryologie: open-dicht-open? ...................................................................................................... 62
intraperitoneaal en (primair of secundair) retroperitoneaal .................................................................... 63
Peritoneum............................................................................................................................................ 64
intraperitoneaal .................................................................................................................................... 65
primair retroperitoneaal ....................................................................................................................... 65
secundair retroperitoneaal ................................................................................................................... 65
Verdere embryologie .................................................................................................................................... 66
SECTIE 3: Zenuwstelsel en darmen ................................................................................................................. 67
3.1. ZENUWSTELSEL ..................................................................................................................................... 67
Autonoom zenuwstelsel ................................................................................................................................ 67
3.2. DARMEN ................................................................................................................................................ 69
Darmmotiliteit ............................................................................................................................................... 69
2 fases: nuchter en gevoed ....................................................................................................................... 70
Nuchtere fase ........................................................................................................................................ 70
Gevoede fase ......................................................................................................................................... 71
Maagperistaltiek ................................................................................................................................... 73
Medicatie maag-darm motoriek ................................................................................................................... 74
3.3. DE LEVER ............................................................................................................................................... 74
leverfalen ...................................................................................................................................................... 77
Acuut leverfalen ........................................................................................................................................ 77
De lever en paracetamol ........................................................................................................................... 78
Hepatische encefalopathie........................................................................................................................ 79
3.4. HISTOLOGIE ........................................................................................................................................... 80
Cel en omgeving ............................................................................................................................................ 80
, Celcyclus ........................................................................................................................................................ 81
3 typen cellen ................................................................................................................................................ 81
verschillende aanpassingen van de cel ......................................................................................................... 83
Hypertrofie ................................................................................................................................................ 83
3.5. WEEFSELTYPEN...................................................................................................................................... 85
Verschillende epithelen ................................................................................................................................ 85
de epidermis ................................................................................................................................................. 86
Klieren: exo- en endocrien ............................................................................................................................ 87
Klieren: soorten ............................................................................................................................................. 87
Junctionele complexen ................................................................................................................................. 88
Cel-celverbindingen................................................................................................................................... 89
Cel-matrixverbinding ................................................................................................................................. 90
Oesofagus en maag ....................................................................................................................................... 91
De darm ......................................................................................................................................................... 97
Stapeling........................................................................................................................................................ 98
1. Ophoping van stoffen ........................................................................................................................ 98
2. verkeerde vouwing ............................................................................................................................ 99
3. Defect of ontbrekend enzym .......................................................................................................... 100
4. opname van niet-afbreekbaar materiaal ........................................................................................ 101
SECTIE 4: CELDOOD EN REGENERATIE .......................................................................................................... 104
4.1. Celdood...................................................................................................... Error! Bookmark not defined.
Necrose ....................................................................................................................................................... 104
apoptose ..................................................................................................................................................... 104
waarom celdood?........................................................................................................................................ 104
1. verlaging van atp ............................................................................................................................. 105
reacties bij weefselschade: mitochondriën............................................................................................. 105
2. opname van calcium ....................................................................................................................... 105
3. Membraanbeschadiging .................................................................................................................. 106
4. misvouwing van eiwitten ................................................................................................................ 106
reperfusieschade ..................................................................................................................................... 106
kleuring.................................................................................................................................................... 107
radicalen ...................................................................................................................................................... 107
redoxreacties........................................................................................................................................... 107
zuurstofradicalen .................................................................................................................................... 107
zuurstofradicalen: superoxide ............................................................................................................. 108
zuurstofradicalen: vrij ijzer .................................................................................................................. 110
het probleem ....................................................................................................................................... 110
verdedigingsmechanismen voor radicalen.......................................................................................... 111
necrose an apoptose ‘in depth’ .................................................................................................................. 111
apoptose: stofjes ..................................................................................................................................... 111
apoptose: mitochondriaal vs death receptor .......................................................................................... 111
apoptose: overlevingssignalen ................................................................................................................ 112
Necrose: coagulatienecrose .................................................................................................................... 113
vervloeiingsnecrose................................................................................................................................. 113
necrose herkennen ................................................................................................................................. 114
vetnecrose ............................................................................................................................................... 114
verkazende necrose ................................................................................................................................ 114
fibrinoide necrose ................................................................................................................................... 115
, Regeneratie ..................................................................................................................................................... 116
Regeneratie: stamcellen ............................................................................................................................. 116
verschil per weefsel..................................................................................................................................... 116
interactie tussen cellen en matrix ............................................................................................................... 117
leverregeneratie .......................................................................................................................................... 117
GENEESKUNDE UVA
INHOUDSOPGAVE
SECTIE 1: METABOLE SYSTEEM EN DIABETES MELLITUS ................................................................................... 5
1.1. VERTERING, ENZYMEN EN ENERGIEHUISHOUDING ................................................................................ 5
Enzymen .......................................................................................................................................................... 5
Vertering ......................................................................................................................................................... 6
Energiehuishouding ........................................................................................................................................ 7
Stap 1: glyco-lyse (lysis van glucose) ........................................................................................................... 7
Stap 2: citroenzuurcyclus ............................................................................................................................ 8
Stap 3: oxidatieve fosforylering ................................................................................................................ 10
1.2. METABOLE ROUTES ............................................................................................................................... 13
Gluconeogenese ............................................................................................................................................ 15
Gevaste toestand .......................................................................................... Error! Bookmark not defined.
Gehongerde toestand ................................................................................... Error! Bookmark not defined.
Vetzuursynthese ........................................................................................................................................... 16
Vetsynthese................................................................................................................................................... 16
Lipolyse ......................................................................................................................................................... 18
Eiwitafbraak .................................................................................................................................................. 19
Ureumcyclus .................................................................................................................................................. 20
Ketogenese: energie ..................................................................................................................................... 22
Ketogenese en ketoacidose bij diabetes: .................................................................................................. 23
Glycogeen-metabolisme ............................................................................................................................... 23
1.3. INSULINE, GLUCAGON EN DIABETES MELLITUS .................................................................................... 24
Insuline en glucagon...................................................................................................................................... 24
Insuline: hoe wordt dit afgegeven?............................................................................................................... 27
Insuline en GLUT4 ......................................................................................................................................... 29
Insuline en het lichaam ................................................................................................................................. 30
Effect insuline op lever, adipocyte en spier .............................................................................................. 30
Glucagon ....................................................................................................................................................... 31
Glucagon en het lichaam ............................................................................................................................... 32
Opname van glucose ..................................................................................................................................... 33
GLUT’s ........................................................................................................................................................... 33
Km ................................................................................................................................................................. 34
Diabetes mellitus........................................................................................................................................... 36
DM type 1 .................................................................................................................................................. 38
Testen voor DM1 ................................................................................................................................... 38
DM type 2 .................................................................................................................................................. 39
DM2 medicatie ...................................................................................................................................... 40
Insuline schema’s ...................................................................................................................................... 42
Het HbA1c ................................................................................................................................................. 42
, Verschillen DM1 en hongertoestand ........................................................................................................ 43
Sectie 2: Maagproblemen, embryologie, anatomie en autonome zenuwstelsel ............................................. 44
2.1. PANCREAS ................................................................................................................................................. 44
Embryologie van de pancreas ....................................................................................................................... 44
Histologie ...................................................................................................................................................... 46
Histologie pancreas ................................................................................................................................... 46
Histologie glucagon en insuline ................................................................................................................. 47
2.2. BOVENBUIKKLACHTEN .............................................................................................................................. 48
Alarmsymptomen .......................................................................................................................................... 48
Maagklachten ................................................................................................................................................ 50
Helicobactor Pylori ................................................................................................................................ 51
Relaties met maagklachten ....................................................................................................................... 51
Behandeling van maagpijn ........................................................................................................................ 51
Ulcus .............................................................................................................................................................. 52
Typen ulcera .............................................................................................................................................. 52
2.3. EMBRYOLOGIE ........................................................................................................................................... 53
Holtes ............................................................................................................................................................ 53
Afwijkende anatomie .................................................................................................................................... 55
De lever ......................................................................................................................................................... 57
Lever en galblaas ........................................................................................................................................... 61
Embryologische vouwingen .......................................................................................................................... 61
verdere embryologie: open-dicht-open? ...................................................................................................... 62
intraperitoneaal en (primair of secundair) retroperitoneaal .................................................................... 63
Peritoneum............................................................................................................................................ 64
intraperitoneaal .................................................................................................................................... 65
primair retroperitoneaal ....................................................................................................................... 65
secundair retroperitoneaal ................................................................................................................... 65
Verdere embryologie .................................................................................................................................... 66
SECTIE 3: Zenuwstelsel en darmen ................................................................................................................. 67
3.1. ZENUWSTELSEL ..................................................................................................................................... 67
Autonoom zenuwstelsel ................................................................................................................................ 67
3.2. DARMEN ................................................................................................................................................ 69
Darmmotiliteit ............................................................................................................................................... 69
2 fases: nuchter en gevoed ....................................................................................................................... 70
Nuchtere fase ........................................................................................................................................ 70
Gevoede fase ......................................................................................................................................... 71
Maagperistaltiek ................................................................................................................................... 73
Medicatie maag-darm motoriek ................................................................................................................... 74
3.3. DE LEVER ............................................................................................................................................... 74
leverfalen ...................................................................................................................................................... 77
Acuut leverfalen ........................................................................................................................................ 77
De lever en paracetamol ........................................................................................................................... 78
Hepatische encefalopathie........................................................................................................................ 79
3.4. HISTOLOGIE ........................................................................................................................................... 80
Cel en omgeving ............................................................................................................................................ 80
, Celcyclus ........................................................................................................................................................ 81
3 typen cellen ................................................................................................................................................ 81
verschillende aanpassingen van de cel ......................................................................................................... 83
Hypertrofie ................................................................................................................................................ 83
3.5. WEEFSELTYPEN...................................................................................................................................... 85
Verschillende epithelen ................................................................................................................................ 85
de epidermis ................................................................................................................................................. 86
Klieren: exo- en endocrien ............................................................................................................................ 87
Klieren: soorten ............................................................................................................................................. 87
Junctionele complexen ................................................................................................................................. 88
Cel-celverbindingen................................................................................................................................... 89
Cel-matrixverbinding ................................................................................................................................. 90
Oesofagus en maag ....................................................................................................................................... 91
De darm ......................................................................................................................................................... 97
Stapeling........................................................................................................................................................ 98
1. Ophoping van stoffen ........................................................................................................................ 98
2. verkeerde vouwing ............................................................................................................................ 99
3. Defect of ontbrekend enzym .......................................................................................................... 100
4. opname van niet-afbreekbaar materiaal ........................................................................................ 101
SECTIE 4: CELDOOD EN REGENERATIE .......................................................................................................... 104
4.1. Celdood...................................................................................................... Error! Bookmark not defined.
Necrose ....................................................................................................................................................... 104
apoptose ..................................................................................................................................................... 104
waarom celdood?........................................................................................................................................ 104
1. verlaging van atp ............................................................................................................................. 105
reacties bij weefselschade: mitochondriën............................................................................................. 105
2. opname van calcium ....................................................................................................................... 105
3. Membraanbeschadiging .................................................................................................................. 106
4. misvouwing van eiwitten ................................................................................................................ 106
reperfusieschade ..................................................................................................................................... 106
kleuring.................................................................................................................................................... 107
radicalen ...................................................................................................................................................... 107
redoxreacties........................................................................................................................................... 107
zuurstofradicalen .................................................................................................................................... 107
zuurstofradicalen: superoxide ............................................................................................................. 108
zuurstofradicalen: vrij ijzer .................................................................................................................. 110
het probleem ....................................................................................................................................... 110
verdedigingsmechanismen voor radicalen.......................................................................................... 111
necrose an apoptose ‘in depth’ .................................................................................................................. 111
apoptose: stofjes ..................................................................................................................................... 111
apoptose: mitochondriaal vs death receptor .......................................................................................... 111
apoptose: overlevingssignalen ................................................................................................................ 112
Necrose: coagulatienecrose .................................................................................................................... 113
vervloeiingsnecrose................................................................................................................................. 113
necrose herkennen ................................................................................................................................. 114
vetnecrose ............................................................................................................................................... 114
verkazende necrose ................................................................................................................................ 114
fibrinoide necrose ................................................................................................................................... 115
, Regeneratie ..................................................................................................................................................... 116
Regeneratie: stamcellen ............................................................................................................................. 116
verschil per weefsel..................................................................................................................................... 116
interactie tussen cellen en matrix ............................................................................................................... 117
leverregeneratie .......................................................................................................................................... 117
