Nedeni bilinmeyen ate\u015f (NBA), en az 3 hafta s\u00fcre ile en az birka\u00e7 \u00f6l\u00e7\u00fcmde 38.3\u00b0C’ nin \u00fczerinde ate\u015f olmas\u0131 ve hastanede yat\u0131r\u0131larak yap\u0131lan incelemelerde bir hafta i\u00e7inde tan\u0131n\u0131n koyulamamas\u0131d\u0131r.<\/p>\n
N.B.A’ e yol a\u00e7an nedenler co\u011frafi b\u00f6lgelere, \u00fclkelerin geli\u015fmi\u015flik derecesine ve laboratuar olanaklar\u0131na g\u00f6re de\u011fi\u015febilmektedir.<\/p>\n
NBA Nedenleri<\/p>\n
Enfeksiyon hastal\u0131klar\u0131: NBA olgular\u0131n\u0131n yakla\u015f\u0131k yar\u0131s\u0131na yol a\u00e7arlar. Sistemik infeksiyonlar: \u00d6ncelikle t\u00fcberk\u00fcloz ve kalbin i\u00e7 zar\u0131n\u0131n ve kapaklar\u0131n\u0131n iltihab\u0131 (infektif endokardit) en s\u0131k NBA’ e neden olur. Bruselloz (Malta hummas\u0131), tifo, kronik menenjit (beyin zar\u0131 iltihab\u0131), listeriyoz, leptospiroz,\u00a0 toksoplazmoz, HIV (A\u0130DS) gibi baz\u0131 viral\u00a0 infeksiyonlar da NBE’ e yol a\u00e7abilir. Lokalize enfeksiyonlar: karaci\u011fer enfeksiyonlar\u0131 ve apseleri, periton i\u00e7i enfeksiyonlar, kar\u0131n i\u00e7i ve kas\u0131ktaki apseler, idrar yollar\u0131 enfeksiyonlar\u0131, di\u015f apseleri, sin\u00fczit, kemik, prostat iltihaplar\u0131d\u0131r. Ba\u011f dokusu hastal\u0131klar\u0131: Ate\u015f hastal\u0131\u011f\u0131n eklem ve di\u011fer bulgular\u0131 olmadan ortaya \u00e7\u0131kabilir. Ya\u015fl\u0131 hastalarda polimyaljia romatika ve temporal arterit NBA olu\u015fturabilir. Eri\u015fkin Still hastal\u0131\u011f\u0131, SLE ve romatoid artrit de ate\u015fle ortaya \u00e7\u0131kabilir. Neoplazmlar: Lenfomalar (\u00f6zellikle Hodgkin hastal\u0131\u011f\u0131), barsak kanserleri, karaci\u011fer ve b\u00f6brek kanserleri, l\u00f6semiler ate\u015fle ortaya \u00e7\u0131kabilir. Enfeksiyon yoklu\u011funda da t\u00fcm\u00f6rden salg\u0131lanan baz\u0131 Maddelere ba\u011fl\u0131 olarak ate\u015f olu\u015fabilir. De\u011fi\u015fik nedenler: S\u0131kl\u0131\u011f\u0131 %10\u201320 aras\u0131nda de\u011fi\u015fir. Baz\u0131 iltihapl\u0131 barsak hastal\u0131klar\u0131 (\u00fclseratif kolit, Crohn hastal\u0131\u011f\u0131), alkole ba\u011fl\u0131 karaci\u011fer hastal\u0131klar\u0131, pulmoner emboli (akci\u011ferde ani geli\u015fen damar t\u0131kan\u0131kl\u0131\u011f\u0131, tiroid bezi iltihab\u0131, ailevi Akdeniz ate\u015fi, Kalaazar gibi hastal\u0131klar ate\u015f nedeni olabilir. \u00a0<\/p>\n
TANI<\/p>\n
Anamnez: Seyahat, meslek, hayvanlara dokunma, al\u0131\u015fkanl\u0131klar, kulland\u0131\u011f\u0131 ila\u00e7lar, ba\u011f\u0131\u015f\u0131kl\u0131k sisteminde bask\u0131lanma olup olmad\u0131\u011f\u0131, ge\u00e7irdi\u011fi travma ve cerrahi i\u015flemler ve cinsel davran\u0131\u015f bi\u00e7imleri sorgulanmal\u0131d\u0131r.<\/p>\n
Fizik muayene: Deri, t\u0131rnak yataklar\u0131 ve mukozalar\u0131n ve g\u00f6z dibinin muayenesi tan\u0131da \u00f6nemli ipu\u00e7lar\u0131 sa\u011flar. Hastan\u0131n \u015fikayet ve bulgular\u0131na g\u00f6re ilgili bran\u015f hekimi taraf\u0131ndan t\u00fcm v\u00fccut muayenesi yap\u0131lmal\u0131d\u0131r.<\/p>\n
Tarama testleri: Tam kan say\u0131m\u0131, sedimentasyon h\u0131z\u0131, idrar tetkiki, ayr\u0131nt\u0131l\u0131 biyokimyasal ve mikrobiyolojik testler ve akci\u011fer grafisi yap\u0131labilir.<\/p>\n
Ekokardiyografi: Kalp kapak iltihaplar\u0131 ve t\u00fcm\u00f6rlerinin ortaya \u00e7\u0131kart\u0131lmas\u0131nda kullan\u0131l\u0131r.<\/p>\n
Ultrasonografi ve bilgisayarl\u0131 tomografi: Kar\u0131n i\u00e7i Apse, g\u00f6\u011f\u00fcs ve kar\u0131ndaki lenf bezleri ve t\u00fcm\u00f6rleri de\u011ferlendirmede kullan\u0131l\u0131r.<\/p>\n
Manyetik rezonans g\u00f6r\u00fcnt\u00fcleme: Beyin ve omurilikteki apselerin g\u00f6r\u00fcnt\u00fclenmesinde duyarl\u0131d\u0131r.<\/p>\n
\u0130ntraven\u00f6z piyelogram: B\u00f6brek i\u00e7i ve \u00e7evresindeki apseler ve b\u00f6brek t\u00fcm\u00f6rlerini saptamada yararl\u0131d\u0131r.<\/p>\n
Mide- barsak sistemin radyolojik incelemeleri: \u00dclseratif kolit, Crohn hastal\u0131\u011f\u0131 ve sindirim sistemi kanserlerinin tan\u0131s\u0131nda kullan\u0131l\u0131r.<\/p>\n
Kemik grafileri: Kemik a\u011fr\u0131lar\u0131 varsa osteomyelit (kemik iltihab\u0131) ve kemik t\u00fcm\u00f6rlerinin saptanmas\u0131 i\u00e7in \u00e7ekilebilir.<\/p>\n
T\u00fcm v\u00fccut kemik sintigrafileri: Kemik metastazlar\u0131 ve osteomyelitin saptanmas\u0131nda d\u00fcz kemik grafilerinden daha duyarl\u0131 bir y\u00f6ntemdir.<\/p>\n
\u0130ndium\u2013111 i\u015faretli l\u00f6kosit veya imm\u00fcnoglobulin kullanarak n\u00fckleer sintigrafi: B\u00f6lgesel apseleri ortaya \u00e7\u0131karmak i\u00e7in yap\u0131labilir.<\/p>\n
Kemik ili\u011fi aspirasyonu ve k\u00fclt\u00fcr\u00fc: Aspirasyon ile l\u00f6semi tan\u0131s\u0131 konabilir. Kemik ili\u011fi aspirasyon k\u00fclt\u00fcr\u00fc ile de Malta hummas\u0131, tifo ve baz\u0131 mantar infeksiyonlar\u0131n\u0131n tan\u0131s\u0131 konabilir.<\/p>\n
Kemik ili\u011fi biyopsisi: L\u00f6semi, lenfoma, kemik ili\u011fine metastaz yapm\u0131\u015f t\u00fcm\u00f6rler ve t\u00fcberk\u00fclozun tan\u0131s\u0131nda yard\u0131mc\u0131 olur.<\/p>\n
Lenf bezi biyopsisi: Malignitelerin (lenfoma, metastaz) ve gran\u00fclomat\u00f6z hastal\u0131klar\u0131n (t\u00fcberk\u00fcloz, sarkoidoz) tan\u0131s\u0131nda yard\u0131mc\u0131 olur.<\/p>\n
Karaci\u011fer i\u011fne biyopsisi: Karaci\u011fer b\u00fcy\u00fck olan ve karaci\u011fer fonksiyon testleri bozuk olan NBA’ li hastalarda uygulanabilir.<\/p>\n
Deri ve kas biyopsileri: Baz\u0131 ba\u011f dokusu ve damar iltihab\u0131 ile giden hastal\u0131klar\u0131n tan\u0131s\u0131nda yard\u0131mc\u0131d\u0131r.<\/p>\n
Temporal arter biyopsileri: Temporal arterit tan\u0131s\u0131n\u0131 koymada yard\u0131mc\u0131d\u0131r.<\/p>\n
\u00dcst ve alt gastrointestinal sistem endoskopisi: \u0130nce barsak lenfomalar\u0131, iltihapl\u0131 ba\u011f\u0131rsak hastal\u0131klar\u0131 ve ba\u011f\u0131rsak kanserlerin tan\u0131s\u0131nda de\u011ferlidir.<\/p>\n
Bronkoskopi: Birlikte yap\u0131lan biyopsi ile bron\u015f kanseri, sarkoidoz ve t\u00fcberk\u00fcloz tan\u0131s\u0131nda kullan\u0131l\u0131r.<\/p>\n
Tan\u0131sal laparotomi: \u0130lk \u00fc\u00e7 basamakta yap\u0131lan invazif ve invazif olmayan y\u00f6ntemler ile tan\u0131 koyulamayan olgularda cerrahi i\u015flem ile kar\u0131n a\u00e7\u0131larak yap\u0131l\u0131r. Hastal\u0131kl\u0131 g\u00f6r\u00fclen organlardan biyopsi yap\u0131l\u0131r.<\/p>\n
HAZIRLAYAN: Dr. C\u00fcneyt M\u00fcderriso\u011flu<\/p>\n
KAYNAK Cerrahpa\u015fa \u0130\u00e7 Hastal\u0131klar\u0131, 2007 \u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"
Nedeni bilinmeyen ate\u015f (NBA), en az 3 hafta s\u00fcre ile en az birka\u00e7 \u00f6l\u00e7\u00fcmde 38.3\u00b0C’ nin \u00fczerinde ate\u015f olmas\u0131 ve hastanede yat\u0131r\u0131larak yap\u0131lan incelemelerde bir hafta i\u00e7inde tan\u0131n\u0131n koyulamamas\u0131d\u0131r. N.B.A’ e yol a\u00e7an nedenler co\u011frafi b\u00f6lgelere, \u00fclkelerin geli\u015fmi\u015flik derecesine ve laboratuar olanaklar\u0131na g\u00f6re de\u011fi\u015febilmektedir. NBA Nedenleri Enfeksiyon hastal\u0131klar\u0131: NBA olgular\u0131n\u0131n yakla\u015f\u0131k yar\u0131s\u0131na yol a\u00e7arlar. Sistemik infeksiyonlar: \u00d6ncelikle t\u00fcberk\u00fcloz ve kalbin[Devam\u0131n\u0131 Oku…]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[22524],"tags":[23152,23148,23153],"_links":{"self":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13227"}],"collection":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/comments?post=13227"}],"version-history":[{"count":0,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13227\/revisions"}],"wp:attachment":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/media?parent=13227"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/categories?post=13227"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/tags?post=13227"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}