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QUESTION 1 You have a hybrid Exchange Server 2016 organization. Some of the mailboxes in the research department are hosted on-premises. Other mailboxes in the research department are stored in Microsoft Office 365. You need to search the mailboxes in the research department for email messages that contain a specific keyword in the message body. What should you do? A. From the Exchange Online Exchange admin center, search the delivery reports. B. Form the on-premises Exchange center, search the delivery reports. C. From the Exchange Online Exchange admin SY0-401 exam center, create a new In-Place eDiscovery & Hold. D. From the Office 365 Compliance Center, create a new Compliance Search. E. From the on-premises Exchange admin center, create a new In-Place eDiscovery & Hold. Correct Answer: E QUESTION 2 You have an Exchange Server 2016 organization. You plan to enable Federated Sharing. You need to create a DNS record to store the Application Identifier (AppID) of the domain for the federated trust. Which type of record should you create? A. A B. CNAME C. SRV D. TXT Correct Answer: D QUESTION 3 Your company has an Exchange Server 2016 200-310 exam Organization. The organization has a four- node database availability group (DAG) that spans two data centers. Each data center is configured as a separate Active Directory site. The data centers connect to each other by using a high-speed WAN link. Each data center connects directly to the Internet and has a scoped Send connector configured. The company's public DNS zone contains one MX record. You need to ensure that if an Internet link becomes unavailable in one data center, email messages destined to external recipients can 400-101 exam be routed through the other data center. What should you do? A. Create an MX record in the internal DNS zone B. B. Clear the Scoped Send Connector check box C. Create a Receive connector in each data center. D. Clear the Proxy through Client Access server check box Correct Answer: AQUESTION 4 Your network contains a single Active Directory forest. The forest contains two sites named Site1 and Site2. You have an Exchange Server 2016 organization. The organization contains two servers in each site. You have a database availability group (DAG) that spans both sites. The file share witness is in Site1. If a power failure occurs at Site1, you plan to mount the databases in Site2. When the power is restored in Site1, you Cisco CCNP Security 300-207 exam SITCS need to prevent the databases from mounting in Site1. What should you do? A. Disable AutoReseed for the DAG. B. Implement an alternate file share witness. C. Configure Datacenter Activation Coordination (DAC) mode. D. Force a rediscovery of the EX200 exam network when the power is restored. Correct Answer: C QUESTION 5 A new company has the following: Two offices that connect to each other by using a low-latency WAN link In each office, a data center that is configured as a separate subnet Five hundred users in each office You plan to deploy Exchange Server 2016 to the network. You need to recommend which Active Directory deployment to use to support the Exchange Server 2016 deployment What is the best recommendation to achieve the goal? A. Deploy two forests that each contains one site and one site link. Deploy two domain controllers to each forest. In each forest configure one domain controller as a global catalog server B. Deploy one forest that contains one site and one site link. Deploy four domain controllers. Configure all of the domain controllers as global catalog servers. C. Deploy one forest that contains two sites and two site links. Deploy two domain controllers to each site in each site, configure one domain controller as a global catalog server D. Deploy one forest that contains two sites and one site link. Deploy two domain controllers to each site. Configure both domain controllers as global catalog servers Correct Answer: C QUESTION 6 How is the IBM Content Template Catalog delivered for installation? A. as an EXE file B. as a ZIP file of XML files C. as a Web Appli cati on Archive file D. as a Portal Application Archive file Correct Answer: D QUESTION 7 Your company has a data center. The data center contains a server that has Exchange Server 2016 and the Mailbox server role installed. Outlook 300-101 exam anywhere clients connect to the Mailbox server by using thename outlook.contoso.com. The company plans to open a second data center and to provision a database availability group (DAG) that spans both data centers. You need to ensure that Outlook Anywhere clients can connect if one of the data centers becomes unavailable. What should you add to DNS? A. one A record B. two TXT records C. two SRV records D. one MX record Correct Answer: A QUESTION 8 You have an Exchange Server 2016 EX300 exam organization. The organization contains a database availability group (DAG). You need to identify the number of transaction logs that are in replay queue. Which cmdlet should you use? A. Test-ServiceHealth B. Test-ReplicationHealth C. Get-DatabaseAvailabilityGroup D. Get-MailboxDatabaseCopyStatus Correct Answer: D QUESTION 9 All users access their email by using Microsoft Outlook 2013 From Performance Monitor, you discover that the MSExchange Database\I/O Database Reads Average Latency counter displays values that are higher than normal You need to identify the impact of the high counter values on user connections in the Exchange Server organization. What are two client connections 400-051 exam that will meet performance? A. Outlook on the web B. IMAP4 clients C. mobile devices using Exchange ActiveSync D. Outlook in Cached Exchange ModeE. Outlook in Online Mode Correct Answer: CE QUESTION 10 You work for a company named Litware, Inc. that hosts all email in Exchange Online. A user named User1 sends an email message to an Pass CISCO 300-115 exam - test questions external user User 1 discovers that the email message is delayed for two hours before being delivered. The external user sends you the message header of the delayed message You need to identify which host in the message path is responsible for the delivery delay. What should you do? A. Review the contents of the protocol logs. B. Search the message tracking logs. C. Search the delivery reports 200-355 exam for the message D. Review the contents of the application log E. Input the message header to the Exchange Remote Connectivity Analyzer Correct Answer: E QUESTION 11 You have an Exchange Server 2016 organization. The organization contains three Mailbox servers. The servers are configured as shown in the following table You have distribution group named Group1. Group1 contains three members. The members are configured as shown in the following table. You discover that when User1 sends email messages to Group1, all of the messages are delivered to EX02 first. You need to identify why the email messages sent to Group1 are sent to EX02 instead. What should you identify? A. EX02 is configured as an expansion server. B. The arbitration mailbox is hosted 300-320 exam on EX02.C. Site2 has universal group membership caching enabled. D. Site2 is configured as a hub site. Correct Answer: A
Home / Saúde / Doença de Caroli

Doença de Caroli

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Definição

doença de Caroli é um distúrbio congênito que compreende a dilatação cística multifocal dos ductos biliares intra-hepáticos segmentares. No entanto, algumas séries mostram que o envolvimento de ductos extra-hepáticos pode existir.

Também é classificado como cisto de colédoco do tipo V, segundo a classificação de Todani.

doença de Caroli é uma doença hepática congênita rara, caracterizada por dilatações císticas não obstrutivas dos ductos biliares intra-hepáticos e raramente extra-hepáticos.

O que é a Doença de Caroli?

Como um distúrbio hereditário do trato biliar, a doença de Caroli pode causar vários sintomas infelizes naqueles que desenvolvem essa condição.

As pessoas com esta síndrome podem sofrer infecções freqüentes, bloqueio do trato biliar e função renal prejudicada como resultado da doença, o que causa a dilatação dos ductos biliares localizados no interior do fígado.

Não há cura para a doença, mas os sintomas causados pela doença podem ser controlados por intervenções médicas e cirúrgicas.

doença de Caroli é um distúrbio genético hereditário raro que faz com que o sistema biliar do corpo se desenvolva anormalmente.

O sistema biliar, que coleta a bile produzida pelo fígado e se livra dela no trato gastrointestinal, é composto por um sistema de ductos.

No sistema biliar normal, pequenos ductos no fígado se combinam e formam ductos maiores que eventualmente se conectam à vesícula biliar e ao intestino delgado.

Com a doença de Caroli, os ductos dentro do fígado, que são tipicamente pequenos em diâmetro, aumentam de tamanho.

Doença de Caroli
Indivíduos com doença de caroli podem apresentar redução da função renal

Os sintomas da doença de Caroli se desenvolvem a partir dos ductos biliares dilatados localizados no fígado.

Ter ductos aumentados pode levar à estagnação do líquido biliar, colocando os pacientes em maior risco de infecção do trato biliar ou do fígado.

A estagnação do fluido poderia eventualmente levar à obstrução do fluxo biliar; isso pode causar aumento dos níveis de bilirrubina no sangue, levando à icterícia.

Muitos pacientes também apresentam anormalidades na função de seus rins porque desenvolvem cistos renais, que comprimem os rins e inibem sua capacidade de filtrar adequadamente o sangue.

Um diagnóstico da doença de Caroli é tipicamente feito com base em estudos de imagem. Técnicas radiográficas, como ultrassonografia, colangiopancreatografia retrógrada endoscópica, tomografia computadorizada e angiorressonância magnética, podem ser utilizadas para avaliar se a doença está presente.

Uma variedade de anormalidades laboratoriais, tais como níveis elevados de bilirrubina no sangue ou estudos elevados da função hepática, também poderiam dar suporte a esse diagnóstico.

O tratamento da doença de Caroli geralmente depende do gerenciamento dos sintomas causados pelas anomalias congênitas.

Infecções do fígado ou vias biliares podem ser tratadas com antibióticos. Muitos médicos dão aos pacientes com esta medicação que ajudam a dissolver diferentes componentes da bílis, permitindo que ela flua mais livremente. Às vezes, uma colangiopancreatografia retrógrada endoscópica (CPRE ou CPER) pode ser realizada como uma medida terapêutica para remover pedras do trato biliar que se formaram como resultado do fluxo biliar lento.

Doença de Caroli
Colangiopancreatografia retrógrada endoscópica (CPRE ou CPER)

Muitas vezes, a doença de Caroli pode ser confundida com a síndrome de Caroli, que é uma anomalia congênita relacionada, mas distinta.

Pacientes com síndrome de Caroli têm as mesmas características clínicas daqueles que sofrem da doença de Caroli, mas também experimentam problemas com a função do fígado. Como resultado, esses pacientes freqüentemente desenvolvem cirrose hepática e necessitam de transplante de fígado para sobreviver.

Patologia

Patologicamente, a doença de Caroli pertence ao espectro da doença hepática fibropolicística que resulta da malformação in utero da placa ductal 4. Há uma alta associação com anomalias fibrocísticas dos rins que compartilham o mesmo defeito genético (gene PKHD1, fibrocistina / poliductina, região cromossômica 6p21).

A placa ductal é uma camada de células precursoras hepáticas que circundam os ramos venosos da porta e é o anlage dos ductos biliares intra-hepáticos. A manifestação da malformação da placa ductal depende do nível da árvore biliar afetada.

Assim, o tipo simples de doença de Caroli resulta do desenvolvimento anormal dos grandes ductos biliares.

Em contraste, no tipo periportal da doença de Caroli (ou síndrome de Caroli), tanto os ductos biliares intra-hepáticos centrais quanto as placas ductais dos ductos biliares periféricos menores são afetados, com o último levando ao desenvolvimento de fibrose.

Na outra extremidade do espectro da doença fibropolicística estão os complexos de Von Meyenburg, também conhecidos como hamartomas biliares, que resultam de discretos focos de malformação da placa ductal que afetam os menores ductos biliares.

Fonte: radiopaedia.org/www.wisegeek.org/rarediseases.org/www.livingnaturally.com/www.sciencedirect.com

 

 

 

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