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Openai/6916315d-71c4-800d-a11f-d5bf0378dc6f
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==== 2) Konkrete DiagnostikâSchritte, die ich jetzt mit dem Team besprechen wĂźrde ==== A. Bildgebung/Endoskopie (DĂźnndarm fokussiert) * SomatostatinrezeptorâPET/CT (âśâ¸GaâDOTATATE) zur NETâSuche (Primärtumor + mesenteriale Fibrose). Wenn nicht verfĂźgbar: ENETSâZentrum ansteuern (s. unten). ESMO Open<ref>{{cite web|title=ESMO Open|url=https://www.esmoopen.com/article/S2059-7029%2825%2901747-8/fulltext|publisher=ESMO Open|access-date=2025-11-13}}</ref> * MRâ oder CTâEnterographie (SmallâBowelâProtokoll, radiologische Zweitmeinung) mit Augenmerk auf âmisty mesenteryâ, Pseudokapsel, âfatâringâsignâ, extrinsische ZĂźge, und auf kurze membranartige Stenosen (NSAIDââDiaphragmenâ). American Journal of Roentgenology<ref>{{cite web|title=American Journal of Roentgenology|url=https://ajronline.org/doi/10.2214/AJR.12.8493|publisher=American Journal of Roentgenology|access-date=2025-11-13}}</ref> '' Kapselendoskopie ''nur* nach PatencyâKapsel (StrikturâRisiko!) oder direkt DoppelballonâEnteroskopie (diagnostisch & therapeutisch, Biopsien/ ggf. Dilatation). PubMed Central<ref>{{cite web|title=PubMed Central|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC10445123/|publisher=PubMed Central|access-date=2025-11-13}}</ref> B. PathologieâZweitsichtung (Referenzpathologie fĂźr GI/Mesenterium) * Auf vorhandenen Mesenterialâ/Peritonealproben zusätzliche Färbungen/IHC erwägen: Congoârot (Amyloid), Synaptophysin/Chromogranin (NETâZellen in Fibrose), PASâD/PCR (Whipple), CD117/Tryptase (Mastzellen), ZiehlâNeelsen/PCR (Tbc), EosinophilenâScore. (Rationale s. o.) C. Motilität/Autoimmun * Antroduodenale Manometrie / Motilitätsdiagnostik bei persistierender âParalyseâ trotz Entlastung; AGIDâAntikĂśrperpanel: ANNAâ1(antiâHu), CRMP5, ganglionische AChRâAk u.âŻa. (MayoâPanel GID2). Bei positivem Profil Tumorsuche (paraneoplastisch) ergänzen. Mayo Clinic Laboratories<ref>{{cite web|title=Mayo Clinic Laboratories|url=https://www.mayocliniclabs.com/test-catalog/overview/92120|publisher=Mayo Clinic Laboratories|access-date=2025-11-13}}</ref> D. AszitesâAnalytik (siehe Checkliste) * SAAG (SerumâAszitesâAlbuminâGradient), Gesamtprotein, Zellbild mit Differential (Eosinophile?), Triglyceride (â chylĂśs), Amylase (â pankreatogen), ADA (â Tbc), Kulturen inkl. Mykobakterien und erneute Zytologie/Flow. PubMed Central<ref>{{cite web|title=PubMed Central|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC7578298/|publisher=PubMed Central|access-date=2025-11-13}}</ref> E. Endokrin/sonstiges * Hypothyreose sichern (fT4, TPOâAk) und behandeln; schwere Hypothyreose kann selten Ileus/Aszites triggern. (Hinweischarakter)
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