2014 02 paronychia
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Transcript of 2014 02 paronychia
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M.TebbesSpoedeisende Hulp Arts KNMG
Bovenste Extremiteit
Panaritium / Paronychia
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Terminologie
Diagnostiek
Differentiaal diagnose
Behandeling
Bovenste Extremiteit
Panaritium / Paronychia
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Terminologie
Bovenste Extremiteit
Panaritium / Paronychia
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Paronychia
Para = naast, onyx= nagel
“omloopje”
Ontsteking laterale nagelriem evt met abces
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Eponychia
Ontsteking gehele nagelriem evt met abces
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Panaritium (subcutaneum)
• diepe infectie van de vinger
• „fijt”• infectie van vinger(top)• cave osteomyelitis• staph. aureus
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Panaritium tendineum
• Infectie peesschede buigpees• Let op (snij)wonden• meestal staph. aureus• tekenen van Kanavel:
• Roodheid en zwelling vinger• Pijn bij passieve flexie/extensie• Flexiestand in rust• Drukpijn volaire zijde tot in handpalm
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Diagnostiek
klinische diagnose
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Anamnese
Voorgeschiedenis, comorbiditeit (vaatlijden, diabetes)
Immuunstatus
Trauma (snij/bijtwond, corpus alienum)
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Lichamelijk onderzoek
Rubor, calor, dolor, tumor, functio laesie
Abces?
(Crepitaties, subcutaan emfyseem)
(Adenopathie)
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Aanvullend onderzoek (evt.)
X-foto: corpus alienum, fractuur, osteomyelitis
Laboratorium: weinig toegevoegde waarde
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Differentiaal Diagnose
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Herpes infectie
Herpes Simplex
Lijkt op abces, echter geen vaste zwelling
2-3 weken self limiting
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Candida infectie
Rode periunguale zwelling
Witgele verkleuring nagel
Onycholysis
Vingers: itraconazol 1d 200mg 3 mnd
Tenen: terbinafine 1d 250mg 3 mnd
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Jicht tophi
Stapeling urinezuur
Kleine harde plekjes
Indien open: korrelig substantie
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Maligniteit
metastase: long, mama, nier, darm, schildklier, prostaat
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Behandeling
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Paro/eponychia:• Sodabad /nat verband (EBM?)
• Antibiotica: Amoxicilline/Clavulaanzuur 3 dd 500/125mg, (bij allergie penicilline clindamycine 3d 600mg)
• Abces: drainage!
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Bovenste ExtremiteitPanaritium/paronychia
Behandeling
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Bovenste ExtremiteitPanaritium/paronychia
Behandeling
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Bovenste ExtremiteitPanaritium/paronychia
Behandeling
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LITERATUUR
Handletselboekje (pdf internet)
www.uptodate.com: paronychia/handinfection
NHG-standaard
Kleine chirurgische ingrepen - Kleeman
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Vragen
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TAKE HOME MESSAGE
• Vooral klinische diagnose
• Abces = draineren!!
• Denk aan differentiaal diagnose
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