Nau'in ciwon siga na II

Calcium (2.3-2.75) 2.89

10.30.2002 Neman kansa da kuma tambayoyin farko na mara lafiya. Zazzabi 36.5 0 С. HELL 130/90 mmHg Kujerar ta zama al'ada ce, mara kyau, ado. Mai haƙuri yana gunaguni da zafi da ƙin ƙafa, jin zafi a cikin gidajen gwiwa. A kan bincika: fata na ƙafafun an sake ja, bushe, fashe. Yanayin fatar fata al'ada ne, mucous membranes na baki da lebe suna ruwan hoda, marasa canzawa.

1 ga Nuwamba, 2002 An gudanar da bincike mai ma'ana. Ba a lura da mahimman kuzari a cikin yanayin haƙuri ba. Zazzabi 36.7 0 С, hawan jini 130/85 mm Hg Kujerar ta al'ada ce. A kan bincike, mai haƙuri yana da nutsuwa, yana amsa tambayoyi da gaske. Plaarfafawa na rashin jin daɗi tare da canji a matsayin jiki, ɗagawa. Mai haƙuri yana motsawa sosai, yana ziyartar ɗakin motsa jiki, yana karɓar magani.

Nuwamba 4, 2002 Mai haƙuri yana cikin ƙoshin lafiya, tana cikin yanayi na abokantaka. Mai haƙuri yana jin daɗin gaisuwa, ya lura da ingantaccen ci gaba, idan aka kwatanta da lokacin kafin shigar da asibitin. Mai haƙuri ba ya gabatar da ƙarin gunaguni. A bangon baya na jiyya, yanayin fatar ƙafafun ya inganta, gyangyaɗi sun shuɗe. Abun ci yana da kyau. An yi wa kujera ado. Zazzabi 36.7 0 С. HELL 125/90 mmHg

Muna gano ciwon sukari a kan tushen gunaguni (polydipsia, polyuria, haɓaka mai yawa a cikin nauyin jiki), bayanan dakin gwaje-gwaje (gagarumin glycemia, glucosuria). A lokaci guda, yanayin ci gaba da hanya (tsawaita ci gaba na hankali, tsawaita rashi bayyanar cututtuka), ɗaukar nauyi, rarrabuwar kai ga maganin baka tare da wakilai na hypoglycemic (maninil) suna nuna nau'in ciwon sukari na II. Halin ya dace da tsananin matsakaici, saboda akwai rikice-rikice na ciwon sukari: retinopathy I (diabetic retinal phlebopathy, retinal hypertensive angiopathy a duka idanun), nephropathy I (edema, haɓaka hawan jini), microangiopathy da polyneuropathy na nesa (ƙararraki na jin zafi, ƙarancin ƙafafu, canje-canje na fata ƙananan kafafu). A yanzu, mai haƙuri yana cikin mataki na lalata, kamar yadda aka nuna ta yawan gunaguni da aka jera a sama da kuma matakin glycemia.

Etiopathogenesis. Babban lokacin pathogenetic na ciwon sukari mellitus II wani laifi ne na daidaituwa na hankali na masu karɓar sel zuwa insulin, a gefe guda, kuma a gefe guda, ɓarkewar bayanan sirri na sel beta na islet pancreatic kayan aiki. Waɗannan ƙetare an ƙaddara su bisa ga asalinsu, kamar yadda aka tabbatar da gado mai nauyi. Abinda ya haifar da damuwa a wannan yanayin shine, a fili, yaduwar nauyi da kuma canje-canje masu girma a cikin matakan hormonal yayin daukar ciki, haka kuma gestosis mai tsanani yayin daukar ciki na biyu.

Kwayoyi masu rage sukari: ciwon sukari 0.08 g 2 r / rana, Allunan 2 tare da abinci

Lipoic acid 0.025g 1tab sau 3 a rana

Nicotinic acid 0.05 g a cikin kwamfutar hannu 1. 3p / rana

IV pentoxifylline drip 100 MG a cikin 400 ml 0.9% NaCl

Vit. B1 (thiamine) 0.05 ampoules na 1 ml / m Numero 10

An shigar da mai haƙuri a cikin sashin a ranar 10/18/02 tare da alamun lalacewar nau'in ciwon sukari na II na mellitus. Makasudin maganin a wannan yanayin shine gyaran metabolism, inganta yanayin da kuma dakatar da ci gaba da rikitarwa. A kan tushen ilimin, yanayin haƙuri ya inganta, gunaguni na polyuria, polydipsia ya tsaya, saukar jini da glycemia ya ragu. An horar da mara lafiyar don bi ka'idodi masu mahimmanci don magance cutar. An kori mai haƙuri a gida cikin diyya. Nagari: rage cin abinci, iyakance adadin kuzari na abinci, yawan sinadarin carbohydrates mai sauƙin narkewa da kuma kasancewa da mafi kyawun abubuwan kariya: fats: carbohydrates = 20: 25: 55. Magunguna na magani tare da allurai 2 allunan sau 2 a rana tare da abinci. Lura a ƙungiyar endocrinologist na gida tare da gyaran shirin jiyya ya dogara da yanayin cutar. Argonlasercoagulation na kwayar ido biyu na idanun da kuma kara lura da oculist din an kuma bada shawarar. Yin rigakafin ci gaban ƙafafun sukari - kula da ƙafafun ƙafa, jarraba ƙafafun kafafu yayin ziyartar likita aƙalla 1 lokaci cikin watanni shida.

Hasashen: idan an bi diddigin shawarwarin, tsawan yanayin raunin cuta tare da rashi ci gaba ta hanyar rikitarwa zai yiwu.

Anamnesis na rayuwar cutar haƙuri, da gunaguni a kan m. Tsarin gwajin gwaji na mara lafiya, nazarin sakamakon. Tabbatacce game da ganewar asali: microbetiopathy na ciwon sukari na ƙananan ƙarshen. Tsarin magani game da wannan cuta, tsinkayar rayuwa.

Submitaddamar da kyakkyawan aikin ku zuwa tushe ilimi yana da sauƙi. Yi amfani da tsari a ƙasa

Dalibai, daliban da suka kammala karatun digiri, matasa masana kimiyya wadanda suka yi amfani da ginin ilimin a cikin karatunsu da aiki zasu yi matukar gode muku.

An buga shi a kan http://www.allbest.ru/

Makarantar koyar da ilimi ta jiha mai zurfi

"Jami'ar Likita ta jihar Saratov

su. V.I. Razumovsky Tarayya Hukumar Kiwon lafiya da ci gaban zamantakewa "

(GOU VPO Saratov State Medical University V.I. Razumovsky Roszdrav)

Shugaban Sashen: Doctor of Medicine, prof. Rodionova T.I.

Shekaru: 78 years old (02.08.1934)

Babban bincike na asibiti: Mellitus na II na ciwon sukari, wanda aka fara gano shi, mataki na lalata hanyoyin rayuwa.

Matsaloli: Ischemia na ƙwayar cuta mai ƙwaƙwalwa na gaurayen ƙwayoyin cuta. Rashin ciwon sukari shine matakin rashin cigaba. Maganin ciwon sukari da ke cikin ƙananan ƙarshen. Distal na ciwon sukari polyneuropathy. Fatalwar hepatosis.

Mai alaƙa: hauhawar jini a jiki 3 digiri, haɗari 4. Atherosclerosis na aorta, na jijiyoyin jini, jijiyoyin jijiyoyin jini. Yanayi bayan kwatankwacin ƙirjin hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

Bayan Fage: Yawan kiba na IIa.

2. Shekaru: Shekaru 78 (08/02/1934)

4. Adireshin: Saratov.

5. Kwarewa: dattijon kasa

6. Ranar shigar da asibitin: 12.10.12g.

7. Wanne cibiyar likitancin da ake magana a kai asibiti: asibiti a wurin zama

8. Rashin lafiya game da tsarin likitancin da ake magana a kai: Type II diabetes mellitus, aka fara gano shi, mataki na lalata hanyoyin tafiyar matakai.

9. Cutar asibiti:

Primary: Mellitus na ciwon sukari na II, wanda aka fara gano shi, mataki na lalata abinci na rayuwa.

Matsaloli: Ischemia na ƙwayar cuta mai ƙwaƙwalwa na gaurayen ƙwayoyin cuta. Rashin ciwon sukari shine matakin rashin cigaba. Maganin ciwon sukari da ke cikin ƙananan ƙarshen. Distal na ciwon sukari polyneuropathy. Fatalwar hepatosis.

Mai alaƙa: cututtukan zuciya na zuciya. Hauhawar jini na jijiya 3 digiri, hadarin 4. Atherosclerosis na aorta, na jijiyoyin jini, jijiyoyin mahaifa. Yanayi bayan kwatankwacin ƙirjin hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

Bayan Fage: Yawan kiba na IIa.

Upon Bayan shiga, mai haƙuri ya koka da bushe bushe, ƙishirwa kullun, yawan urination, gami da urination na dare, ƙara yawan fitsari, haɓaka sukari da jini zuwa 12 mmol / l,

Itching a cikin makwancin gwaiwa.

· Jin zafi, kumburi da kumburin kafafu,

Rashin ƙwaƙwalwar ajiya, ciwon kai na lokaci-lokaci ba tare da bayyananniyar asalin ba, danshi,

Raguwar ci, rage nauyin 7 kilogiram a cikin watanni 3 da suka gabata, rauni gaba ɗaya.

Yana ɗaukar kanta mai haƙuri tun Yuni 2012, lokacin da ta fara bikin gunaguni da ke sama. Kwayar cutar ta ci gaba a hankali. A farkon lokacin bazara, an bayyana gunaguni a matsakaici, ba a nemi likita ba.

A farkon Oktoba, yanayin haƙuri ya tsananta sosai (rauni ya karu, asarar nauyi shine 7 kilogiram, ƙishirwa ya fara damuwa sau da yawa, urination ya karu har sau 15 a rana, sau 3 da dare, itching a cikin inguinal yankin).

Tare da waɗannan gunaguni, mara lafiya ya juya zuwa asibitin a wurin zama. Mai ilimin ilimin kwantar da hankali na gida ya wajabta shi da karuwa a cikin glycemia zuwa 14 mmol / l kuma kasancewar acetone a cikin fitsari (+). An gano cutar: Mellitus na ciwon sukari na II, wanda aka fara gano shi, mataki na lalata metabolism. 10/12/12 An aika da mai haƙuri don asibiti a asibiti na 9, sashen gaggawa na endocrinology.

Mai haƙuri yana zaune a Saratov, a cikin ɗakinta. Ba ya aiki. Hanyoyi tun daga shekaru 18 marasa azanci ne. Menopause daga shekara 44. Da haihuwa 2, 2 ya ƙare cikin isar da gaggawa. Girma da haɓaka gwargwadon shekarunta.

Wurin aiki: fansho.

Farfesa Babu wani lahani a cikin tsawon kwarewar aiki.

Daga cikin cututtuka lura m na numfashi cututtuka, mura.

Cutar tarin fuka, huhu, hepatitis, HIV - musun.

Tarihin rashin lafiyan ba a ɗaukar nauyi.

Babu cututtukan gado a cikin iyali.

A cikin hulɗa tare da marasa lafiya na cutar ba.

Ba a yi da zubar da jini ba.

Dakatar da aikin tiyata: kama da nono na hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

Cututtukan rikice-rikice: Maganin hauhawar jini na digiri na 3, hadarin 4 an saita shi a 55 ta babban likita a cikin polyclinic a wurin zama, an tsara magunguna. Kullum yana shan magungunan antihypertensive (bai tuna sunan ba). Babu wani bugun zuciya, bugun jini.

Makasudin jarrabawa na haƙuri

A lokacin kulawa, yanayin mai haƙuri ya kasance mai gamsarwa. Kwarewa a bayyane. Matsayi: aiki. Bayanin kan fuska da idanu sun gaji.

Height: 150kg, Weight - 68,7 kg. BMI = 30.5. Zafin jiki 36.6 ° C

Fata da bayyane mucous membranes na launi na al'ada, ba tare da rashes pathological da pigmentation ba, fata na raguwa.

Canza yanayin fata na fatawar fata: fatar jiki ta bushe, hannaye da kafafu suna sanyi da taɓawa.

Yanayin kusoshi da gashi: siriri kusoshi, danshi. Gashi na bakin ciki.

Lymph nodes ba palpable.

Kwayar mai keɓaɓɓen kitse tana cikin mamayewa, yanada rarrabawa. Babu kumburi.

Tsarin tsoka: ba tare da Pathology ba.

Babu wani abin karatuttuka na kashin baya na kashin baya ko nakasar kasusuwa na kashin ƙashin ƙugu. Yunkuri a cikin dukkan gidajen abinci bashi da ciwo, cikakke.

Tsarin zuciya

Ba a canza nau'in kirji a yankin zuciya ba. Cikakken bugun zuciya, rawar carotid, kumburi na jugular, da kuma bugun jini ba su nan. Yawan zuciya shine 88 a minti daya.

Duban 90 doke / min, rhythmic, cikakken, girma mai kyau, ba damuwa. An ƙaddara Ripple a cikin ƙananan jijiya.

Rashin daidaituwa a sararin samaniya ta 5 shine 2 cm daga ciki zuwa hagu tsakanin tsakiyar layi. Apical impulse zube, high. Cardiac impulse, systolic, diastolic rawar jiki palpation ba'a ƙaddara shi ba.

Iyakokin dangi na rashin lafiya:

Dama - a cikin sararin intercostal 4 a gefen dama na sternum.

Manya - tsakanin hagu tsakanin hagu zuwa layi da kuma sasannin waje a matakin 3 intercostal space.

Hagu - a cikin sararin intercostal 5 cm a gaba daga tsakiya ta hagu - layin clavicular.

HELL -160/90. Sama da duka maki na auscultatory, sautunan suna da rhythmic, muffled. Sautin 1 a gwaggwanin kuma a wurin sauraron murfin tricuspid yana da ƙarfi kuma ya fi sautuka 2, sautin 2 a wurin sauraron aorta da na huhu ya yi ƙarfi 1. Sautunan jiji da hayaniya ba a jinsu.

Irin nau'in numfashi - kirji, babu hani akan motsi bangon kirji. Babu karancin numfashi a lokacin kulawa. Numfashi ta hanci ba shi da wahala. Nau'in numfashi diaphragmatic ne. NPV 16 motsi a cikin minti daya. Siffar kirji mai rauni ce, babu nakasa, ba ya jin zafi yayin bugun jini, dama da hagu suna haɗu da aikin numfashi. Tattaunawa sun tantance wani sauti mai sanɗa. Auscultation yana sauraron vesicular numfashi, babu wani tashin hankali, tsayuwa mai tsayi na fihun huhu a gaban 3 cm, a bayan 6 cm, filayen Krenig 7 cm.

Tsinkaye na kwalliya: a kan sashin daidaituwa na kirji, sautin iri daya ne, bayyanan kumburin hanji

ƙananan iyakokin huhun huhu

Ax line na gaba

Tsarin layi na tsakiya

Layin Axillary

Tsarin ciwan ciki na XI thoracic vertebra

Muarfin mucous na laushi mai taushi, mai laushi, farar faranti na bango, ƙyallen palatine: ruwan hoda, laushi, mai tsabta. Tonsils ba su wuce kima da artsine ba. Ruwan ciki na hankali yana sanitized. Desna bai canza ba. Harshen magana tare da farin shafi, bushe a tushen. Abun ciki yayi dai-dai, yana ta aiki, a dai-dai, ya shiga cikin numfashi. Ba a tantance abubuwan da ke gani ba, bazuwar yatsun herni da kuma faduwar hanjin da ke cikin ciki ba. An kawata kujera akai-akai.

Tare da palpation na sama, ciki yana da taushi, mai raɗaɗi a cikin hypochondrium na dama, babu rarrabuwar tsokoki na farji na ciki, ba a kara girman zobe. Alamar tsinkayen mara kyau ce. Peristalsis ya tsira.

Tare da palpation mai zurfi a cikin yankin ileal na hagu, an ƙaddara siffar sylindrical, densely na roba daidaituwa na sigmoid colon a cikin nau'i mai santsi, matsakaici mai tsayi tsinkaye, 1.5 cm a diamita, mara jin zafi, sauƙin gudun hijira. A cikin yankin yankin na dama, ana buga bugun ƙwayar cuta a cikin nau'in silima mai santsi, mara laushi. An bayyana ma'anar ta wucin gadi a cikin maraicil yankin a cikin nau'i na mai juzu'i mai kwance mai kwanciyar hankali mai ɗorawa zuwa ƙasa, matsakaici mai ɗaukar nauyi tare da diamita na 2,5 cm. Jin hayaniya akan ciki akan komai a ciki, ba a gano ɓacin rai ba.

Tare da palpation mai zurfi: gefen hanta yana haɓaka 0.5 cm daga ƙarƙashin gefen ƙimar farashi mai tsada.

Palpation na gall mafitsara - mafitsara mafitsara a lokacin al'aura. Tare da palpation mai zurfi, ba a yanke shawarar spleen.

Kujerar yau da kullun, ado ne.

Lokacin bincika yankin lumbar na launin ruwan fata, kumburi, ba a gano ƙwayar cuta ba. Babu tashin hankali na tsokoki na lumbar. Alamar buge ta kasance mara kyau a garesu. Kodan, ƙwanƙwasa lokacin bugun ciki ba a ƙaddara su ba. Cutar ciki ba ta da rai, mai sauri. Nocturia.

Tsarin jijiya da gabobin gabbai

Hankali ya tsira. Gabatarwa a cikin lokaci da sarari. Babu psychoses. Halin yana aiki. Mai fita. Reflexes (pharyngeal, na ciki, tendon - periosteal: ulnar, gwiwa, Achilles) - ba ya karye. Alamar motsin hanji (mai taurin wuya, alamar Kernig, Brudzinsky) ba ya nan.

Yara na al'ada siffar, girma, amsa da kyau zuwa haske. Juyawa tayi ta lumshe ido.

Babu matsalar rashin bacci. Waƙwalwar ajiya: rage. Lokaci na ciwon kai yana faruwa ba tare da bayyananniyar asalin ba. Hankali ya ragu, ji, kamshi ba ya da illa. A cikin matsayin Romberg ya tabbata.

Gina: hypersthenic. Kwayar mai keɓaɓɓen kitse tana cikin mamayewa, yanada rarrabawa.

Height: 150kg, Weight - 68,7 kg. BMI = 30.5

Nau'in mace.

Ba a kara girman hancin thyroid ba. Exophthalmos ba ya nan.

Akwai keta alfarma game da nau'in safofin hannu da safa, ana rage walwala da ƙwaƙwalwa.

Reducedarar yatsa da zafin jiki na yatsun ya ragu.

Yankin matsakaicin shine 118 cm, kewayen kwatangwalo shine 116. OT / O = 0.99.

Matsin jini na Systolic akan kafafu na 110 mm. Hg. Art.

Primary: Mellitus na ciwon sukari na II, wanda aka fara gano shi, mataki na lalata abinci na rayuwa.

Matsaloli: Ischemia na ƙwayar cuta mai ƙwaƙwalwa na gaurayen ƙwayoyin cuta. Rashin ciwon sukari shine matakin rashin cigaba. Maganin ciwon sukari da ke cikin ƙananan ƙarshen. Distal na ciwon sukari polyneuropathy.

Mai alaƙa: hauhawar jini a jiki 3 digiri, haɗari 4. Atherosclerosis na aorta, na jijiyoyin jini, jijiyoyin jijiyoyin jini. Yanayi bayan kwatankwacin ƙirjin hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

Bayan Fage: Yawan kiba na IIa.

1. Azumtar sukari na jini (sau 2 a mako)

2. Profile din glycemic

3. Babban gwajin jini (cikin tsauri)

4. Sugar a cikin fitsari yau da kullun (sau 2 a mako),

5. Maganin cholesterol, bayanin lipid

6. Transaminases (aspartic da alanine a cikin jini)

7. Urea, creatinine.

9. Fitsari Acetone Fitarwa

10. Babban bincike na fitsari (a cikin tsauri)

11. Gwaji bisa ga Nechiporenko, Zimnitsky.

12. Maganin bilirubin da gabobin sa

14. Reovasography na ƙananan ƙarshen,

15. Duban dan tayi

17. Tattaunawa da kwararru:

1. Yanayi: tsit

2. Tebur Na 9 (maganin rage cin abinci)

3. Kwalayen sukari masu rage nauyi.

4. Antihypertensive kwayoyi (don lura da hauhawar jini)

5.Alpha lipoic acid shirye-shiryen (lura da polyneuropathy)

6. Nootropics (lura da HIGM)

7. Maganin tsufa

9. Ziyarar Makaranta Makaranta

Bayanai na ƙarin hanyoyin bincike da kuma shawarar likitocin sauran fannoni

12/10/12. Gwajin sukarin jini

Guban jini: 17.6 mmol / L

Gwajin urine don sukari da acetone:

Fitsari mai saurin ciki: 3 g / L

Launi: haske mai rawaya

Epithelium: lebur: mai mahimmanci

Kwayoyin jini: sun canza 8-10 a s / s

Kwayoyin farin jini: 7.2 * 109 / L

Filatoji: 307 dubu

Neutroph sandunansu: 0

Neutroph kashi.: 69

Guban jini 16.30: 12. mmol / l

Guban jini 22.00: 13.3 mmol / l

Gwajin jini don RMP: korau.

Gwajin jinin kwayoyin:

jimlar furotin - 60g / l

urea - 7.7 mmol / l

creatinine - 114 μmol / l

jimlar bilirubin 14 μmol / l

kai tsaye: 4 micromol / l

kaikaice 10 μmol / l

Jimlar cholesterol: 6.2 mmol / L

Acid acid: 357 μmol / lita

13.10.12. Bayanin martaba

Guban jini 07.00: 9.4 mmol / l

Guban jini 12.00: 13.2 mmol / l

Guban jini 16.30: 15.0 mmol / l

Guban jini 22.00: 13.6 mmol / l

Fitsari Acetone - Mara kyau

Scraping akan I / g da feces akan I / g ta hanyar Kalantaryan (neg.)

Nazari cr. a kan RMP-EM syphilis tare da katin. antigen (neg.)

14.10.12 fitsari Acetone: mara kyau

Guban jini 12.00: 7.4 mmol / l

Guban jini 16.30: 11.4 mmol / l

Guban jini 22.00: 7.6 mmol / l

10/15/12 fitsari Acetone: mara kyau

Gwajin sukarin jini

Glucose na jini: 6.6 mmol / L

10.16.12 Samfurin Nechiporenko

Kwayoyin farin jini: raka'a 1250 / ml

Kwayoyin jini: 0 raka'a / ml

10.17.12 Binciken Bincike a cewar Zimnitsky:

06.00-09.00: mai yawa 200 ml., Takamaiman nauyi: 1010

09.00-12.00: mai yawa 200 ml., Takamaiman nauyi: 1012

12.00-15.00: yawan 200 ml., Muhimmiyar nauyi 1013

15.00-18.00: yawan 200 ml., Muhimmiyar nauyi 1012

18.00-21.00: yawan 200ml., Muhimmiyar nauyi 1011

21.00-00.00: adadin miliyan 100., Muhimmiyar nauyi 1013

00.00-03.00: adadin miliyan 100., Muhimmiyar nauyi 1012

03.00-06.00: yawan 200 ml., Muhimmiyar nauyi 1013

Diureis sau 800 a kowace rana.

Night diuresis 600 ml.

Jimlar diuresis: 1400 ml.

Launi: haske mai rawaya

Epithelium: lebur: mai mahimmanci

10/15/12. Rheovasography na ƙananan ƙarshen: Kammalawa: nau'in kewaya jini: babba a cikin dukkanin bangarori. Cikakke digaɗan jini yana raguwa sosai a ƙafafun dama, a cikin shinkin dama. An bayyana asymmetry na jini a cikin kafafu (a gefen hagu kasa da 40% a hannun dama) kuma a ƙafafu (26% ƙasa da hagu fiye da na dama). Rashin cika jini na ƙafar ƙafa / ƙananan ƙafa zuwa dama shine 1.35 (N = 1.4-1.6). Increasedara ƙarfin jijiyoyin jiki yana ƙaruwa a cikin ƙananan ƙafa da ƙafa a dama, ƙafar ƙafa ta hagu, da al'ada a cikin hagu na hagu.

ECG: Kammalawa: Tsarin sauti daidai ne, sinus. Yawan zuciya na bugun 77 a minti daya. Isarfin lantarki na zuciya yana kwance. Lationarya aikin tiyata. Canje-canje masu daidaituwa a cikin igiyar T a cikin myocardium na ventricle hagu.

Kammalawa: Alamomin Ultrasonic na mai hepatosis mai kitse. Zagewa a wuyan mai narkewar ciki. Rarrabe canje-canje a cikin koda. Hanyar ruwa ta biyu

Shawarar Neurologist: Gunaguni na rashin ƙwaƙwalwar ƙwaƙwalwa, ciwon kai mai maimaitawa ba tare da bayyananniyar ƙarancin haske ba, yawan hannaye da ƙafa. Ana nazarin ananesis. Makasudin: sani ya bayyana a sarari, lamba. Ellanshiya sami ceto Hangen nesa yana raguwa, tsinkaye launi bashi da illa. Pupilsaliban D = S, amsawar haske suna raye, ɗimbin harafin D = S, motsin gira a cikakke. Taro, an sami masaukin zama. Ana kiyaye fargaba a kan fuska, an kiyaye shi, ana kiyaye su. Nasolabial, gaban-gaban nada D = S; babu asymmetries lokacin da idanun suka kafe kuma hakora suke ba. Jin kunne al'ada ne. Kyauta kyauta, sassauci daga laushin laushi da na gaba bango pharyngeal mai kiyaye shi. Harshen harshe tare da tsaka-tsaki, ba ma'anar harshe. Abun hankali: nau'in hepesthesia na polyneuritic (a cikin "safofin hannu" da "safa"). Matsayi na Mota: ƙungiyoyi masu aiki a cikin cikakken girma, ƙarfin tsoka 5 maki, ba a canza sautin tsoka. Babu tsoffin ƙwayoyin tsoka. Tendon da lokutan sufurin sassauci D = S. Abun ciki D = S. Babu wasu sassaucin ra'ayoyi. A cikin matsayin Romberg ya tabbata barga ..

Binciko: Ischemia na ƙwayar cuta mai narkewa na asalin hade (atherosclerotic, ciwon sukari da asalin hauhawar jini). Distal na ciwon sukari mai haɓakar siginar ƙwaƙwalwar ƙwayar cuta ta motsa jiki. Shawarar: 1. Piracetam 20% -10.0 a sau daya a rana No. 5, sannan mexidol 125 mg sau 3 a rana tsawon wata 1.

Tattaunawa da mai tiyata na jijiyoyin jiki: Gunaguni na jin zafi, numbness a cikin ƙananan ƙarshen. Sanannu ne da bayanan RVG. Matsayi na localis: kewaya jijiya a cikin ƙarshen babban nau'in, an biya shi. Unanan cututtukan cututtukan cututtukan zuciya - za a adana su, a rage yawan kumbura.

Binciko: microangiopathy na ciwon sukari na ƙananan ƙarshen.

Nagari: Buƙatun kwamfutar hannu na Doxy-chem 0.5 zuwa 1 shafin. 2 / d tsawon watanni 4.

Tattaunawar likitancin Likita: Thealibin ya zama likita cikin nutsuwa (Sol. Mydriacili 0.5%). OU: Calm. M cornea ne m. Refusususus na hous mai haske ruwan hoda ne. Kudus: optic jijiya Disc kodadde ruwan hoda, bayyananniyar kan iyakoki. Arteries kunkuntar, mara daidaitaccen kamfani, yayi tawaye. Jijiyoyin suna dilated.

Bayyanar jini: Rashin ƙwayar cuta ta hanji ba ta yaduwa ba.

Nagari: Lura da likitan likitan ido a wurin zama.

Babban ganewar asali: Mellitus na ciwon sukari na II, wanda aka fara gano shi, lalata tsarin matakan hanyoyin rayuwa.

Matsaloli: Ischemia na ƙwayar cuta mai ƙwaƙwalwa na gaurayen ƙwayoyin cuta. Rashin ciwon sukari shine matakin rashin cigaba. Maganin ciwon sukari da ke cikin ƙananan ƙarshen. Distal na ciwon sukari polyneuropathy. Fatalwar hepatosis.

Mai alaƙa: hauhawar jini a jiki 3 digiri, haɗari 4. Atherosclerosis na aorta, na jijiyoyin jini, jijiyoyin jijiyoyin jini. Yanayi bayan kwatankwacin ƙirjin hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

Bayan Fage: Yawan kiba na IIa.

A kan jarrabawa, sanin ya bayyana a fili, yanayin ya kusanto zuwa gamsarwa.

Gunaguni na ƙishirwa, bushe bushe, ciwon kai. Fata yana da tsabta, launi na al'ada da laima.

Sautunan zuciya suna da karaya, muffled. A vesicular numfashi, ba wheezing. NPV 18 min

Palpation na ciki ba shi da jin zafi a duk sassan ciki.

Fiz. jiragen ruwa ba su karye ba

3. Rp.: Tab. Amaril 0.001 No. 20

D.S. A ciki, allunan 2 1 r / rana. Kafin karin kumallo.

4. Rp.: Tab. Metformin 0.5 No.20

D.S. A ciki. A 1 t 2r / s tare da abinci. Safiya da maraice.

5. Tab. Captoprili 0.025 No. 10

D.S. A ciki. 1 t. 2r / d. Awa daya kafin abinci.

6. Thiogamma 600 MG. + sodium chloride 0.9% 200 ml. lokaci guda 1 a rana sau ɗaya a 10.00.

7. Rp.: Tab. Cardiomagnil 0.075 No. 10

D.S. A kwamfutar hannu 1 kwamfutar hannu sau ɗaya a rana a 18.00.

8. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Gabatar da introvenally 2 ampoules 1 lokaci ɗaya kowace rana a 10.00.

9. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. A ciki. 1 t. 1 r / s. Da yamma.

A kan jarrabawa, sanin ya bayyana a fili, yanayin ya kusanto zuwa gamsarwa.

Babu gunaguni. Fata yana da tsabta, launi na al'ada da laima.

Sautunan zuciya suna da karaya, muffled. A vesicular numfashi, ba wheezing. NPV 17 min

Palpation na ciki ba shi da jin zafi a duk sassan ciki.

Fiz. jiragen ruwa ba su karye ba

3. Rp.: Tab. Amaril 0.001 No. 20

D.S. A ciki, allunan 2 1 r / rana. Kafin karin kumallo.

4. Rp.: Tab. Metformin 0.5 No.20

D.S. A ciki. A 1 t 2r / s tare da abinci. Safiya da maraice.

5. Tab. Captoprili 0.025 No. 10

D.S. A ciki. 1 t. 2r / d. Awa daya kafin abinci.

6. Thiogamma 600 MG. + sodium chloride 0.9% 200 ml. lokaci guda 1 a rana sau ɗaya a 10.00.

7. Rp.: Tab. Cardiomagnil 0.075 No.10

D.S. A kwamfutar hannu 1 kwamfutar hannu sau ɗaya a rana a 18.00.

8. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Gabatar da introvenally 2 ampoules 1 lokaci ɗaya kowace rana a 10.00.

9. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. A ciki. 1 t. 1 r / s. Da yamma.

A kan jarrabawa, sanin ya bayyana a fili, yanayin ya kusanto zuwa gamsarwa.

Babu gunaguni. Fata yana da tsabta, launi na al'ada da laima.

Sautunan zuciya suna da karaya, muffled. A vesicular numfashi, ba wheezing. NPV 19 min.

Palpation na ciki ba shi da jin zafi a duk sassan ciki.

Fiz. jiragen ruwa ba su karye ba

3. Rp.: Tab. Amaril 0.001 No. 20

D.S. A ciki, allunan 2 1 r / rana. Kafin karin kumallo.

4. Rp.: Tab. Metformin 0.5 No.20

D.S. A ciki. A 1 t 2r / s tare da abinci. Safiya da maraice.

5. Tab. Captoprili 0.025 No. 10

D.S. A ciki. 1 t. 2r / d. Awa daya kafin abinci.

6. Thiogamma 600 MG. + sodium chloride 0.9% 200 ml. lokaci guda 1 a rana sau ɗaya a 10.00.

7. Rp.: Tab. Cardiomagnil 0.075 No. 10

D.S. A kwamfutar hannu 1 kwamfutar hannu sau ɗaya a rana a 18.00.

8. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Gabatar da introvenally 2 ampoules 1 lokaci ɗaya kowace rana a 10.00.

9. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. A ciki. 1 t. 1 r / s. Da yamma.

Ynamarfafawa: tabbatacce (babu korafi).

mai ciwon sikila microangiopathy reshe

ХХХ, dan shekara 78, yana fuskantar magani a Sashen Endocrinology na 9 KGB daga 12.10 tare da cutar sankara

Primary: Mellitus na ciwon sukari na II, wanda aka fara gano shi, mataki na lalata abinci na rayuwa.

Matsaloli: Ischemia na ƙwayar cuta mai ƙwaƙwalwa na gaurayen ƙwayoyin cuta. Rashin ciwon sukari shine matakin rashin cigaba. Maganin ciwon sukari da ke cikin ƙananan ƙarshen. Distal na ciwon sukari polyneuropathy. Fatalwar hepatosis.

Mai alaƙa: hauhawar jini a jiki 3 digiri, haɗari 4. Atherosclerosis na aorta, na jijiyoyin jini, jijiyoyin jijiyoyin jini. Yanayi bayan kwatankwacin ƙirjin hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

Bayan Fage: Yawan kiba na IIa.

Bayyanar cutar sankarar mellitus an sanya shi ne a kan korafin masu ciwon suga na bushewar bushe, ƙishirwa, urination, yawan fitar dare, ƙara yawan fitsari, ƙaiƙayi a cikin inguinal yankin, da kuma haɓakar sukari na jini har zuwa 12 mmol / l. Abubuwan haɗari na wannan cutar sune:

Hypodynamia, kasancewar lokuta na wannan cutar a cikin iyali, kiba, damuwa, hauhawar jini, matsanancin ciki da haihuwa. (polyhydramnios, manyan 'ya'yan itace).

A cikin wannan mai haƙuri, abubuwan haɗarin sune: Hypodynamia, kiba IIa, hauhawar jijiyoyin jini (na dogon lokaci).

Type Nau'in II ya danganta da shekarun da cutar ta bayyana (shekaru 78), cutar ta ci gaba a hankali, an goge asibitin, an ɓoye hanyar cutar (gunaguni ya kasance matsakaici a farkon lokacin bazara, yanayin haƙuri ya tsananta sosai daga farkon Oktoba (rauni ya karu, ƙishirwa ya zama damuwa da kullun, urination ya karu har sau 15 a rana, wanda sau 3 a cikin dare, itching bayyana a cikin inguinal yankin).

For A karo na farko, an gano cututtukan asibiti a wurin zama a ranar 10/12/12 bisa ga lamuran marasa lafiya da ke cikin jinin haila. Sun kai 12 mmol / L.

De Rashin cutar ta samo asali ne daga glucose na azumi a cikin jini mai nauyin 9.7 mmol / L, post-trandial 15.0 mmol / L, 13.6 mmol / L a lokacin bacci.

Hadarin ciwon sukari:

Is Ischemia na ƙwayar cuta na ƙwayoyin cuta na gauraye da ƙwayoyin cuta (atherosclerotic, hauhawar jini, masu ciwon sukari) ya danganta da gunaguni na haƙuri na ciwon kai ba tare da bayyana asalin ba, jin ƙyashi, yankewa daga ƙwararren mahaifa (ƙwaƙwalwar ƙwaƙwalwar ajiya), bayanan bincike na haƙiƙa.

Rashin ciwon sikila shine matakin mara kan gado wanda ya danganci jarrabawar makasudi (hangen nesa), ra’ayin likitocin likitan mahaifa (OU: Calm. Veins dized

Micro Maganin ciwon sukari na ƙananan ƙarshen ya dogara ne akan jarrabawar ma'ana (fatar jiki tayi sanyi ga taɓa), bayanan jarrabawar likitan jijiyoyin bugun jini: Matsayin ɗalibai: ramawar jijiya a cikin ƙarshen babban nau'in. Alamun ciwon sikari na cutar sankara - ana kiyaye su, ya ragu, sakamakon Reovasography na ƙananan ƙarshen: ƙarewa: Cikewar dusar ƙanƙan jini yana raguwa sosai a cikin ƙafa a hannun dama, a cikin ƙafar ƙafa ta dama. An bayyana asymmetry na jini a cikin kafafu (a gefen hagu kasa da 40% a hannun dama) kuma a ƙafafu (26% ƙasa da hagu fiye da na dama). Rashin cika jini na ƙafar ƙafa / ƙananan ƙafa zuwa dama shine 1.35 (N = 1.4-1.6). Increasedara ƙarfin jijiyoyin jiki yana ƙaruwa a cikin ƙananan ƙafa da ƙafa a dama, ƙafar ƙafa ta hagu, da al'ada a cikin hagu na hagu.

Poly polyneuropathy na ciwon kai na damuwa ya danganta da gunaguni na haƙuri game da jin zafi, ƙarancin ƙarfi da ƙafar ƙafafu, bayanan gwajin maƙasudi (Akwai cin zarafin hankalin hankalin nau'ikan safofin hannu da safa, an rage hankalin jijiyar wuya).

He Hepatosis mai ɗanɗano ya dogara da bayanai daga sigar duban dan tayi da kuma binciken haƙiƙanin mai haƙuri (hanta yana haɓaka 0.5 cm daga gefen ƙimar farashi mai kyau).

· Yana da alaƙa: hauhawar jijiyoyin jini na digiri 3, hadarin 4. Atherosclerosis na aorta, na jijiyoyin jini, jijiyoyin ƙwayoyin cuta. Yanayi bayan kwatankwacin ƙirjin hagu a cikin 2005 saboda cutar kansa, sai kuma Chemotherapy.

· Bayan Fage: Matsayi mai nauyi na IIa (BMI 30.5).

Yayin zaman asibiti, yanayin mai haƙuri ya inganta (irin wannan gunaguni kamar bakin bushe, ƙishirwa kullun, urination akai-akai, har da daddare, ƙara yawan fitsari, itching a cikin inguinal yankin, jin zafi, ƙamus da sanyin ƙafafu sun ɓace)

Yayin da yake kwance a asibiti, mara lafiya ya sha magani kamar haka:

2. Rp.: Tab. Amaril 0.001 No. 20

D.S. A ciki, allunan 2 1 r / rana. Kafin karin kumallo.

3. Rp.: Tab. Metformin 0.5 No.20

D.S. A ciki. A 1 t 2r / s tare da abinci. Safiya da maraice.

4. Tab. Captoprili 0.025 No. 10

D.S. A ciki. 1 t. 2r / d. Awa daya kafin abinci.

5. Thiogamma 600 MG. + sodium chloride 0.9% 200 ml. lokaci guda 1 a rana sau ɗaya a 10.00.

6. Rp.: Tab. Cardiomagnil 0.075 No. 10

D.S. A kwamfutar hannu 1 kwamfutar hannu sau ɗaya a rana a 18.00.

7. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Gabatar da introvenally 2 ampoules 1 lokaci ɗaya kowace rana a 10.00.

8. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. A ciki. 1 t. 1 r / s. Da yamma

9. Ilimi a makarantar masu cutar siga.

Hasashen rayuwa

In mun gwada da dacewa a rayuwa saboda cutar sanadin cutar da kuma yawan matsaloli masu yawa,

-Ya dace da zamantakewa (mai iya aiki da yanayin daidaitawa, wannan cutar ba zata shiga rayuwar zamantakewa ba).

Ad Adrerence ga tsarin rage yawan abinci a jiki (1600 kcal) tare da hana abinci mai kitse mai yawa, raguwa a cikin kwarogin cholesterol (kasa da 300 mg a rana), yawan amfani da abinci a cikin fiber Cin guntu har sau 4-5 a rana. Untatawa gishiri da barasa.,

He Bayar da kulawa ga allunan rage kiwo,

Control Kula da glucose na jini sau daya a rana da sau 4 a rana sau 3 a mako.

Pre Yin rigakafin rikice-rikice (shan alpha-lipoic acid, nootropics, bitamin B6, magungunan antihypertensive).

· Lura daga likitan ilimin dabbobi, likitan zuciya, masana kimiyya, likitan mahaifa da kuma babban likita a asibitin unguwar.

An buga shi akan Allbest.ru

Dukkanin takardu

Dangane da bayanan gwaji na waje, ainihin binciken da aka yi na gabobin ciki na haƙuri da kuma sakamakon binciken dakin binciken da kuma kayan aiki, binciken na asibiti shine cutar sankarau da kuma tabbacinsa. Tsarin jiyya. Hasashen rayuwa.

tarihin likita 19.6 K, an ƙara 05/18/2015

Gunaguni na haƙuri game da kasancewa a shigar. Etiology na cutar, bambancin ganewar asali da kuma gaskatawar ganewar asibiti dangane da sakamakon binciken haƙuri da kuma gwajin gwaje-gwaje. Maganin ciwon sukari da kuma tsarin karatun.

tarihin likita 44.0 K, an ƙara 02/06/2015

Anamnesis na rayuwar mai haƙuri, gunaguni a kan shigarwar. Tsarin bincike na abokin ciniki, kimanta sakamakonsa. Dalilin binciken shine cutar Guillain-Barré. Maganin etiology da pathogenesis na cutar, ma'anar hanyoyin magani don haƙuri. Karin ci gaba na cutar.

tarihin likita 44.4 K, an ƙara 1/11/2013

Gunaguni na haƙuri a lokacin dubawa. Anamnesis na rayuwa da cuta. Janar jarrabawa na haƙuri. Bayyanar cututtuka: nau'in ciwon sukari na 1. Bayyanar cututtukan da ke tattare da cuta: cututtukan hepatitis C. Jiyya na cututtukan da ke tattare da cuta da kuma rikice-rikice: abinci da insulin far.

tarihin likita 55.0 K, an ƙara 05.11.2015

Hankula gunaguni na ciwon sukari. Siffofin bayyanar cututtukan ciwon sukari na microbetiopathy da ciwon sukari na angiopathy na ƙananan ƙarshen. Shawarwarin rage cin abinci don ciwon sukari. Tsarin gwajin haƙuri. Fasali na lura da ciwon sukari.

tarihin likita 29.0 K, an ƙara 03/11/2014

Haƙuri gunaguni a kan m. Anamnesis na rayuwa da cuta. Binciken sakamakon dakin gwaje-gwaje da gwajin kayan aiki.Hikimar gano cutar shine cututtukan cututtukan abinci. Haɓaka shirin mara lafiya na marasa lafiya, hanyoyin kariya da kuma tsinkayar cutar.

tarihin likita 29.4 K, an ƙara 12/08/2015

Gunaguni na haƙuri a kan shigar, anamnesis na rayuwa da cuta. Cikakken bincike game da yanayin yanayin mai haƙuri. Binciken sakamakon bincike. Halin da aka gano don gano asali shine atherosclerosis na arteries na ƙananan ƙarshen, Cutar Lerish. Developirƙiri shirin magani.

tarihin likita 29.8 K, an ƙara 10/29/2013

Anamnesis na rayuwar mai haƙuri da rashin lafiya, gunaguni game da shigarwar. Babban bincike game da yanayin mai haƙuri. Hankali don ganewar asali shine cututtukan jijiyoyin zuciya, hauhawar jini, saiti na III, mataki na III. Tsarin kula da haƙuri da hangen nesa game da rayuwa.

tarihin likita 43.3 K, an ƙara 1/28/2013

Plaaƙarar da mara lafiya ya yi lokacin shigar da shi Asibiti. Janar yanayin da sakamakon bincike na gabobin da tsarin mai haƙuri, bayanai daga dakin gwaje-gwaje da nazarin kayan aiki. Hikimar ƙirar asibiti shine nau'in ciwon sukari na II. Kula da cutar.

tarihin likita 22.2 K, an ƙara 03/03/2015

Gunaguni na haƙuri a ranar shigar, anamnesis na rayuwarsa da rashin lafiya. Shirin tantancewa da kuma gano cutar. Hankali don ganewar asali shine gyara-inguinal hernia, sake dawowa. Etiology, pathogenesis, hanyoyin magani da rigakafin cutar.

tarihin likita 32.1 K, an ƙara 04/12/2012

Tarihin likita: Type 2 diabetes mellitus, matsakaici, ƙididdigewa

Cikakken suna haƙuri: ________
Shekaru 65 da haihuwa
Ranar haifuwa: 04/11/1939
Kwarewa da wurin aikin: mai son fansho
Jinsi: mace
'Yan ƙasa: Ukrainian
Wuri: ____________
Ranar karbar: 04/13/2004 a 17.05
Wane ne ya ba da umurni: SOP kamar yadda aka tsara

Gunaguni na haƙuri
Marasa lafiya na koka da damun ƙishirwarta, bushewar baki, karuwa da yawan fitsari da aka saki, ƙoshin fata, kwanan nan raguwar kamuwa da gani, zafi a ƙafar dama, kullun, ciwo, matsewa, ɗigon yatsunsu na yatsun da yatsun, lokaci-lokaci. .
Mai haƙuri yana nuna rauni, gajiya yayin aikin gida. Additionalarin ƙarin binciken ya gano cewa mai haƙuri ya damu da rashin jin daɗi, ciwon kai tare da haɓakar hawan jini zuwa 200/130 mm. Hg. Art. Yayin motsa jiki, akwai jin zafi mai zafi a bayan sternum, yana haskakawa zuwa hagu, ƙafar kafada ta hagu, wanda ke wucewa tare da amfani da nitroglycerin. Marasa lafiya yana cikin damuwa da wahalar dawo da kai. Yayin binciken, an lura cewa akwai raguwa cikin ƙwaƙwalwar ajiya: yana da wahala mai haƙuri ya tuna da ranar haihuwa, sunaye, sunayen titi, da sauransu.

Tarihin likita
Mai haƙuri ya koyi cewa tana rashin lafiya tare da ciwon sukari a cikin 2002, lokacin tana da shekaru 63, lokacin da aka gudanar da bincike na rigakafi a asibitin an sami karuwar glucose na jini. Likita na gida ya ba da shawarwari game da abincin, ana magana da shi ga endocrinologist, wanda aka gano tare da nau'in ciwon sukari na II, an sanya magani, sunan wanda mai haƙuri ba ya tunawa. A lokacin ganewar asali, mai haƙuri ya lura da kullun jin ƙishirwa da haɓakar urination. An gudanar da wannan magani ne a sashen ilimin halittar halittar halittu na SOKB, wanda likitocin zuciya suka nemi shawara, an tabbatar da gano cutar: CHD. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art. Bayan jiyya, yanayin ya inganta.
Bayan fitarwa, ana ba da shawarar likitan cikin gida ya lura da kula da matakan glucose 1 lokaci / wata. Ban bi shawarwarin ba, Na sha magunguna ba tare da kullun ba. Sau daya a shekara sai ta sami taimakon inpatient na rigakafi. A yanzu haka, an shirya mata tiyatar kariya da gyara.

Anamnesis na rayuwar haƙuri

An haife ta a ranar 04/11/1939, an haife ta a cikin dangi mai halin zamantakewa mai kyau. Ciyar da dabi'a. A cikin dangi ta girma kuma aka haife ta da youngerar uwanta biyu. A lokacin ƙuruciya, da wuya ta sha wahala daga lokacin sanyi. Ba a karɓi bayanai game da sauran cututtukan cututtukan yara ba.
Lokacin balaga ba ta da matsala, babu jinkiri ko hanzarta balaga. An kafa haihuwar daga shekara 13, ba mai raɗaɗi ba, lokacin haila yana ɗan shekara 48. Babu raunin rauni, raunin da ya faru, fashewar harsashi. Ta samu aikin tiyata tun tana da shekaru 13-14 saboda cutar sankara. Haihuwar 3, ɗayan ya mutu tun yana ɗan ƙarami, ba a ƙidaya yawan zubar da ciki ba. Mai haƙuri yana cikin rukunin jama'a na jama'a. Kayan aiki
isasshen tsaro. Gidaje yana da ingantaccen tsari, tun a 1989, har zuwa yau yana zaune a cikin ɗakuna mai dakuna uku, fida mai kyau, haske, ɗumi abu ne na al'ada. Abincin na yau da kullun, mai kyau, marasa cin ganyayyaki. Tufafin sun dace da yanayin canjin yanayi da halin zamantakewar mai haƙuri.
Mai haƙuri yana da ilimin sakandare, mai dafa abinci. A yanzu haka ya yi ritaya. Ta yi aiki a ɗakin cin abinci a Frunze plant. Yanayin aiki bai haifar da cin zarafin abincin mai haƙuri ba. Hadarin masana'antu, babu raunin da ya faru.
Iyaye sun mutu cikin tsufa. Ba zai yiwu a sami wani bayani game da gado ba. 'Yan uwa suna cikin koshin lafiya. Yara suna cikin koshin lafiya. Ba shi da labarin halin lafiyar sauran dangi na jini.
Tarihin rashin lafiyar jiki game da abinci, magani, inhalation, magungunan ƙwayoyin cuta ba a ɗaukar nauyi ba.
Ba ya shan taba, baya shan barasa, baya shan kwayoyi. Hankali, cututtukan da ke ɗaukar jima'i, hepatitis ya musanta. Ba a zubar da jini ba. Ban kasance tare da masu dauke da cutar ba; ban yi tafiya a waje da Ukraine ba tsawon shekaru 3 da suka gabata.

Nazarin manufa
Janar dubawa
Janar yanayin yana gamsarwa. Kwarewa a bayyane. Matsayi yana aiki. Bayyanar fuska a rayuwa. Height 175 cm, nauyi 80 kg. Nau'in jiki normosthenic. Motsi, ƙato - ba a canza ba, aka ci gaba daidai, gwargwado. Mai haƙuri yana da saduwa, isasshe, magana da himma. Cikakken tunani, tunani mara kyau, ƙwaƙwalwar ƙwaƙwalwar ajiya. Bayyanar fuska: talakawa, rayuwa. Fata ne kodadde. A ƙananan ƙarshen marmara, taro-cyanotic. An lura da Hyperkeratosis, musamman da aka ambata a cikin soles. Fata na fata yana raguwa, yana kiyaye adiyar fata. Danshi yana matsakaici. Babu abubuwan da aka samo asali. An zartar da tabo a game da bangon ciki na ciki a cikin yankin iliac na dama. Ofarfafa tsarin fata, sinuosity da yaduwar jijiyoyin ƙwalwa ba a lura dasu ba. Mucous membranes na conjunctiva, sassan hanci yana ruwan hoda, mai tsabta, babu fitarwa. Launi na al'ada. Gashi yana da launi, mai tsabta. Ba a samo cin zarafin haɓakar gashi ba ta hanyar haɓaka da yawa akan jiki ko aske. Hannun ƙusoshin suna da laushi, mai laushi, ba tare da jujjuyawar abubuwa ba, an canza yatsun kafa - an faɗaɗa, mai juye, launin rawaya mai duhu.
Kwayar mai keɓaɓɓiyar kitse an inganta ta, a rarraba shi ba tare da daidaituwa ba, tare da rinjaye a cikin akwati. Pastocin, babu edema. Abubuwan tsokoki na gabar jiki da gangar jikinsu suna samun gamsuwa sosai, sautin da karfi suna raguwa, babu rauni. Hypotrophy na tsokoki na wurare masu tsakuwa na ƙafa, kafafun kafa an lura. Babu wasu wuraren da suka kamu da matsanancin rashin ƙarfi, paresis, da inna.
An kafa tsarin kashi daidai. Babu nakasar kwanyar, kirji, ƙashin ƙugu ko ƙasusuwa. Babu ƙafafuffen lebur Yanada daidai ne. Palpation ba shi da raɗaɗi. Hanyoyin haɗin gwiwa ba su haɓaka, babu hani akan motsi mai motsawa da aiki, jin zafi yayin motsi, ɓarkewa, canje-canje na saiti, hauhawar jini da kumburi da ƙwayayen laushi na kusa
A cikin binciken kofofin nono, tsinkayen mahaifa ba palpated. Lokacin bincika ƙwayoyin mammary gland, ba a gano canje-canje na cututtukan cuta ba.
Ciwon glandon thyroid ba mai palpable bane. A kan bincike, babu wani canji a siffar wuya.

Gwajin gwaji na numfashi

Hanci ya zama al'ada. Kwayar na numfashi na sama maiwucewa ce, babu fitowar mara jijiyoyin jiki. Jirgin sama mai ƙoshi ba tare da wari ba.
Thean kirji kwandishan ɗin ne, kuma ana yin shimfidar wuri a kan matakin. Fossae na supraclavicular da subclavian suna da matsakaici, yayin da numfashi baya canzawa. Hannun kafada suna daidaituwa, suna motsawa gaba ɗaya zuwa bugun.
Irin nau'in numfashi mai gauraye. Motsa jiki numfashi - 16 a minti daya. Hannun dama da hagu na kirji suna motsawa gaba daya. Musclesayoyin tsokoki ba sa hannu cikin aikin numfashi.
Palpation na kirji mara ciwo ne. Kirji ya na da karfi, ana jin sautin rawar murya tare da karfin daidai a bangarorin daidaituwa. Babu kama-karya da tsinkewa. Babu wani tashin hankali a tsaka-tsakin yanayi.
Tare da daidaitawa tsinkaye a cikin bangarorin da ke da sigari, sauti na huda iri ɗaya ne a ɓangarorin biyu, an kiyaye haɗarin sonority.
Tare da tsinkayen ɗabi'a, iyakokin huhunnun suna tsakanin iyakoki na al'ada, jimlar motsi na huhu shine 6 cm.
Tare da kamuwa da hucin huhu tare da nutsuwa da tilasta numfashi, ƙaddara numfashin iska wanda ya shafi dukkan huhun huhun. Ba a gano ƙarin amo na numfashi ba.

Nazarin tsarin zuciya

Lokacin da aka bincika yankin zuciya na bugun zuciya, tozartar jini a cikin aorta, bugun jini a kan jijiyoyin bugun zuciya, da kuma bugun jini ba a samu ba. Entararrawar motsa daga cikin ƙwayar zuciya ba ta jin zafi. An ƙaddamar da tasirin apical yayin jarrabawa da bugun ƙafa a cikin sararin samaniya na V, tsakanin daga layin midclavicular ta 2 cm, ba zubar da jini ba, kusan 2 cm fadi, ba a ƙarfafa. Ba'a gano takamaiman ventricular Babu alamar bayyanar cututtuka.
Tare da tsinkayewar zuciya, iyaka tana danganta da raunin zuciya:
1. Dama - 1.5 cm a waje daga gefen dama na sternum.
2. babba - gefen babban gefen rijiyar III.
3. Hagu - 1.5 cm a waje daga layin tsakiyar tsakiyar clavicular.
Girman ƙwayar jijiyoyin jiki shine 6.5 cm.
Yayin tashin zuciya tare da nutsuwa da kwanciyar hankali da jinkirta, ana jin karayar zuciya mai rauni, ana jin karar karauka, kwancen ba daidai bane, bugun zuciya = 78 beats / min. Rarrabewa da bifurcation na sauti, zuciya ba a sami ƙarin sautuna ba. Rashin ƙarfi, mai laushi, gajere na gunaguni na systolic an ƙaddara. Yanayin hayaniya baya canzawa lokacin da mara lafiyar ya canza matsayi. Babu wata hayaniya a cikin tashin hankali.
Halin da ake iya gani da kuma bugun jijiyoyin jijiyoyin jiki, alamarin rawar carotid, bugun zuciya ba. Veayoyin gabbai ba su da cunkoson. Babu jijiyoyin bugun jini da “medutai medusae”. Ba a gano bugun bugun zuciyar ba. Searfin jijiya a cikin taskoki na radial duka yana da tamani guda, bugun jini shine farji ,mic ɗin shine 78 a minti ɗaya, babu rashi ƙarancin bugun, bugun buguwa mai ƙarfi, mai ƙima, gaba ɗaya mara ƙima a cika. Ana bugun bugun bugun zuciya a kan na lokaci, carotid, fematun, jijiyoyin bugun jini. A a.dorsalis pedis ba palpable bane.
Hawan jini - 200/130 mm Hg, iri ɗaya a hannuwan biyu.

Tsarin narkewa

Gasannin bakin suna zaune a daidai matakin, lebe suna da ruwan hoda, ba tare da rashes da fasa ba. Kwayoyin mucous na bakin ciki shine ruwan hoda, mai tsabta, mai haske. Ba a canza gumis ba. Harshe ba a haɓaka, babu ƙira. Sama, mai fatalwa, ba tare da sifofi ba. Tonsils ba su wuce kima da artsine ba.
Abun ciki na asali ne. Rage ruwa a cikin ciki ba amintaccen ruwa ba. Ba a samo alamun cuta na tashin hankali na jini ba, a cikin hanyar jellyfish da cibiyar sadarwar jijiyoyin da ke ƙarfafa bangon ciki na ciki. Babu alamun ƙarancin yanayi, bayyananniyar ruɓaɓɓen ruɓaɓɓen haske, karin haske game da binciken da aka samo.
Tare da kusan palpation na herni protrusions a cikin cibiya, inguinal yankunan, a fannin yankin farin ciki na ciki. Babu rashin tausayi. Alamar Shchetkina - Blumberg korau.
Tare da matsewa mai zurfi na sihiri mai zurfi, sigmoid colon is located daidai, 3 cm a diamita, na roba, bango mai santsi, har ma, ta hannu, mara zafi, babu jita-jita. Caecum an sanya shi daidai, diamita 3 cm, na roba, bangon yana da santsi, har ma, matsakaici, korarre, mara jin zafi a kan bugiya, babu jita-jita. Wanda yake jujjuyawar juzu'i da ganuwa, ba mai palpable ba.
Kwayar ba ta palpable ba ce. Palpation na tsinkayen wurin ba shi da ciwo.
Tare da tsinkayar hanta na Kurlov, girman shine 10/9/8 cm, bi da bi. A kan hancin hanta, ba a gano ciwo ba, ƙananan gefen hanta ba ya fita daga ƙasan ƙimar tsada. Lokacin bincika yankin na maganin ƙwayar cuta, ba a sami canje-canje ba. Palpation na tsinkayen yanki mara ciwo ne, alamar Courvoisier, Musse, Ortner korau.
Girman diamita daga ciki shine 6 cm, tsawonsa shine 12 cm, ƙananan gefen ba mai palpable bane.

Nazarin tsarin urinary

Kodan hagu da dama a kwance da a tsaye ba palpable bane. Alamar Pasternatsky ba ta da kyau a garesu. Mafitsara ba palpable bane, sautin haskakawa sama da tsakar gidan ba tare da laushi ba. Palpation daga cikin ureter maki ne mara zafi. Rage ciki ba shi da wahala, mai zaman kansa, har zuwa 2l / rana.

Nazarin tsarin juyayi

A kan bincika, akwai wasu asymmetry na fuska, santsi na nasolabial folds na gefen hagu. Bayyanar fuska tana da rauni, baya aiki. Magana, sautin murya ba a damun shi. Babu karkacewar harshe. Yara suna motsawa daidai da juna, amsawa zuwa haske da masauki iri ɗaya ne, wanda aka saba bayyanawa. Akwai raguwar hangen nesa. Tabbatar da daidaituwa na tabbata. Lokacin da aka bincika a cikin girman supine, alamar tashin hankali (Lasegue) yana da kyau, musamman aka ambata a hannun dama. Ba'a gano wasu maganganu na canji ba, raunin tendon ba tare da sifofi ba, D = S. Raunin hankali da jijiyoyin jiki suna raguwa a ƙananan ƙarshen daga gwiwoyi. A wasu wuraren ba a canza su ba. Babu wata rawar jiki da yatsun hannayen hannu.

Tabbatacce game da ganewar asali
Ya danganta da gunaguni na mai haƙuri: ƙishirwa, bushe bushe, fitowar fitowar fitsari, jin zafi a ƙafafun dama, na yau da kullun, jin zafi, matsewa, ƙarancin yatsun lokaci, jin zafi a ƙafafu,
tarihin likita: a 2002 bincikar lafiya tare da nau'in ciwon sukari na II na ciwon sukari a lokacin kafa wanda haƙuri ya lura da kullun abin jin ƙishirwa da haɓakar urination, an tabbatar da bayyanar cututtuka tare da shirye-shiryen magani a cikin sashen endocrinology,
Bayanin bincike na haƙiƙa: fatar jiki ta zama mara nauyi, an yi birgima a kan ƙananan ƙarshen, an ambaci-cyanotic, hyperkeratosis, musamman an ambata a cikin soles, fata an rage raguwar ƙusa, ƙusa a cikin yanayin hauhawar jini da nakasawa a kan yatsun kafa, hypotrophy na tsokoki na interosseous sarari na ƙafa, ƙananan kafa, bugun jini A.dorsalis kafafu ba palpable bane, ana rage jin zafi da kashin hankali akan ƙananan ƙarshen daga gwiwoyi,
za a iya yin maganin farko
1. babba: Type 2 na ciwon sukari mellitus, matsakaici, ƙididdigewa,
2. rikitarwa: cututtukan ciwon sukari na jijiyoyin ƙananan ƙarshen.
Dangane da gunaguni na mai haƙuri game da: dizziness, ciwon kai tare da haɓaka hawan jini har zuwa 200/130 mm. Hg. Art. bayyanar zafi mai zafi a bayan tsananin lokacin motsa jiki, yana haskakawa zuwa ga hagu, hagu kafada, wanda ke wucewa tare da amfani da nitroglycerin, ji na palpitations,
Tarihin likita: a 2002, likitan likitan zuciya ya nemi shawararsa, ya kamu da cutar cututtukan zuciya. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art.,
bayanan bincike na haƙiƙa: an ƙaddamar da tasirin apical yayin jarrabawa da bugun jini a cikin sararin samaniya na intercostal, na waje daga layin midclavicular ta 2 cm, ba zubar da jini ba, kusan 2 cm fadi, tare da tsinkaye na zuciya, iyakar hagu na ma'anar bugun zuciya shine 1.5 cm waje daga hagu tsakiyar layin-clavicular line, tare da tashin hankali na zuciya, raunana zuciya sauti, karammiski timbre, ana jin karar haruffa ba daidai bane, rauni ne, mai taushi, gajeriyar systolic gunaguni, halayen hayaniya baya canzawa idan aka canza matsayin mai haƙuri, bugun bugun ari. michen, siga, tukuru, cika, jini - 200/130 mm Hg,
Zaku iya yin gwajin farko game da cututtukan da ke tattare da cuta: CHD. Atherosclerotic cardiosclerosis. Angina pectoris. Symptomatic arterial hauhawar jini. NK IIA Art.

Planarin shirin jarrabawa

1. Gwajin jini na asibiti.
2. Nazarin fitsari na asibiti.
3. Gwajin jinin kwayoyin.
4. RW No. 371 na 04/13/04.
5. Binciken feces na kwaro.
6. Gwajin jini domin glucose.
7. Binciken hanji don glucose.
8. Binciken fitsari a cewar Nechiporenko.
9. Binciken hanji don asarar furotin yau da kullun.
10. Reovasography.
11. ECG
12. Hoton daukar hoto na OGK. Lamba 35
13. Tattaunawa tare da likitan likitan ido.
14. Tattaunawar likitan zuciya.
15. Gwajin jini don wayoyin lantarki.

Sakamakon binciken dakin gwaje-gwaje da kayan aiki

1. Gwajin jini na asibiti daga 04/14/04
Hemoglobin - 112 g / l
Kwayoyin jini - 3.5 * 1012 / l
Alamar launi - 0.9
ESR - 6 mm / h
Kwayoyin farin jini 4.8 * 10 ^ 9 / L
Neutrophils bar 2%
Kashi Na Farko 76%
Eosinophils 2%
Kayan Kashi na 17%
Monocytes 3%
2. Gwajin jini na asibiti daga 04/23/04
Hawan jini - 116 g / l
Kwayoyin jini - 3.6 * 1012 / l
Alamar launi - 0.9
ESR - 8 mm / h
Kwayoyin farin farin 4.4 * 10 ^ 9 / L
Neutrophils bar 2%
Kashi na kashi 70%
Eosinophils 4%
Sasarin
Monocytes 3%
Leukocytes 2-3 a s / sp.
Kwayoyin jini 0-1 a n / a.
Epithelium - babu
Babu gishiri
3. Nazarin fitsari na asibiti wanda aka sanya ranar 04/22/04
Launin fitsari bambaro ne mai rawaya
Nuna M - Bayyanar
Musamman nauyi - 1025
Hankalin yana da ɗan acidic
Amintaccen - Rare
Glucose - 2%
Kwayoyin farin jini 1-2 cikin n / a.
Kwayoyin jini 0-1 a n / a.
Epithelium - babu
Babu gishiri
4. Binciken kwayoyin halittar jini 04/14/04
Jimlar furotin - 76.3 g / l
Albumin - 54%
Globulins - 46%
Urea 3.7 mmol / L
Halittar jini 0.07 mmol / L
Cholesterol 7.1 mmol / L
VLDL 0.38 mmol / L
CRP - -
Seromucoids - 0.28 mmol / L
5. RW No. 371 na 04/13/04. - neg.
6. Binciken feces na kwaro.
Res.: Ba a gano ƙwai ba.
7. Gwajin jini don glucose daga 04/13/04
8˚˚ Guban jini - 7.06 mmol / l
12˚˚ Guban jini - 11.02 mmol / l
18˚˚ Guban jini - 9.2 mmol / l
22˚˚ glucose na jini - 8.2 mmol / l
8. Binciken hanji don glucose daga 04/14/04
Glucose a cikin fitsari - 1.25g.
9. Binciken fitsari a cewar Nechiporenko daga 04.15.04
Kwayoyin farin jini - 3.01 * 10 ^ 6
Kwayoyin jini - 0.9 * 10 ^ 6
10. Rashin bincike akai-akai don asarar furotin yau da kullun daga 04/15/04
Protein a cikin fitsari - 0.064 g / rana.
11. Reovasography.

Hagu na dama
PI tibia 1.2 1.4 0.8 - 1.2
PI ƙafa 1.0 1.5 1.0

12. ECG
Kammalawa: Matsakaicin matsayin wutar lantarki na zuciya.
Firamillation na atrial, tachysystolic form. Yawan zuciya 90 / min. Hypertrophy na ventricular myocardium na hagu tare da nauyinta. Bambanci canje-canje a cikin myocardium.
14. Hoton rediyo na OGK. Lamba 35
Ba a gano Pathology OGK ba.
15. Tattaunawa tare da maganin oculist.
Vis OD - 0.8
OS - 0.8
Objectally: girgije na farko a cikin ruwan tabarau.
Asusun: HD ruwan hoda ne mai launin shuɗi, contours a bayyane yake, jijiyoyin sun cika kansu, cike da jini.
Kammalawa: Ciwon fata na kashin baya. Kama farat ɗayawar idanu biyu.
16. Tattaunawar likitan zuciya.
Kammalawa: ciwon zuciya. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art.
17. Gwajin jini don wayoyin lantarki.
Potassium - 6.1 mmol / L
Sodium - 160 mmol / L
Calcium - 2.3 mmol / L
Chlorides - 107 mmol / L

Cutar sankara ta Hankali (Henenko-Cushing)
Hyperglycemia abu ne mai fasali a cikin yanayi, daidaituwa na metabolism metabolism na faruwa lokacin da cutar ta warke. Hyperglycemia ne m, high, gano a kan komai a ciki, sau da yawa tare da glucosuria

Ciwon Rashin Cutar
Glucosuria baya dogara da adadin carbohydrates da ake gudanarwa, ba a haɗuwa da hauhawar hyperglycemia ko raunin carbohydrate. Babu cututtukan angio da neuropathies. Glucosuria ya dogara da adadin carbohydrates da ake sarrafawa, tare da hauhawar hyperglycemia ko raunin carbohydrate mai rauni.

Ciwon sukari insipidus
Ba a haɗu da Polyuria tare da glucosuria, ƙarancin dangi na fitsari da kuma hyperglycemia Polyuria ba a hade tare da glucosuria, babban yawan fitsari na fitsari da kuma hyperglycemia

Tabbatarwar bayyanar cututtuka ta ƙarshe
Ya danganta da gunaguni na mai haƙuri: ƙishirwa, bushe bushe, fitowar fitowar fitsari, jin zafi a ƙafafun dama, na yau da kullun, jin zafi, matsewa, ƙarancin yatsun lokaci, jin zafi a ƙafafu,
tarihin likita: a 2002 bincikar lafiya tare da nau'in ciwon sukari na II na ciwon sukari a lokacin kafa wanda haƙuri ya lura da kullun abin jin ƙishirwa da haɓakar urination, an tabbatar da bayyanar cututtuka tare da shirye-shiryen magani a cikin sashen endocrinology,
Bayanin bincike na haƙiƙa: fatar jiki ta zama mara nauyi, an yi birgima a kan ƙananan ƙarshen, an ambaci-cyanotic, hyperkeratosis, musamman an ambata a cikin soles, fata an rage raguwar ƙusa, ƙusa a cikin yanayin hauhawar jini da nakasawa a kan yatsun kafa, hypotrophy na tsokoki na interosseous sarari na ƙafa, ƙananan kafa, bugun jini A.dorsalis kafafu ba palpable bane, ana rage jin zafi da kashin hankali akan ƙananan ƙarshen daga gwiwoyi,
hanyoyin bincike da kayan aiki na haɓaka: haɓaka glucose a cikin kewayon 7.5 - 11,02 mmol / l, halayyar rana, kasancewar glucose a cikin fitsari na 1.25 g,
shawarwari na kwararru masu alaƙa: ƙarshen mahaɗin optometrist - cututtukan fata masu fama da cutar sankara. Farkon rikicewar idanun idanun biyu,
bambancin ganewar asali
Kuna iya yin binciken karshe:
• Primary: Type 2 diabetes mellitus, matsakaici, keɓaɓɓu,
• Damuwa: Cutar rashin lafiyan dake tattare da tasoshin ƙananan ƙarfin. Ciwon sukari na kashin baya na retina. Kama farat ɗayawar idanu biyu.
Dangane da gunaguni na mai haƙuri game da: dizziness, ciwon kai tare da haɓaka hawan jini har zuwa 200/130 mm. Hg. Art. bayyanar zafi mai zafi a bayan tsananin lokacin motsa jiki, yana haskakawa zuwa ga hagu, hagu kafada, wanda ke wucewa tare da amfani da nitroglycerin, ji na palpitations,
Tarihin likita: a 2002, likitan likitan zuciya ya nemi shawararsa, ya kamu da cutar cututtukan zuciya. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art.,
bayanan bincike na haƙiƙa: an ƙaddamar da tasirin apical yayin jarrabawa da bugun jini a cikin sararin samaniya na intercostal, na waje daga layin midclavicular ta 2 cm, ba zubar da jini ba, kusan 2 cm fadi, tare da tsinkaye na zuciya, iyakar hagu na ma'anar bugun zuciya shine 1.5 cm waje daga hagu tsakiyar layin-clavicular line, tare da tashin hankali na zuciya, raunana zuciya sauti, karammiski timbre, ana jin karar haruffa ba daidai bane, rauni ne, mai taushi, gajeriyar systolic gunaguni, halayen hayaniya baya canzawa idan aka canza matsayin mai haƙuri, bugun bugun ari. michen, siga, tukuru, cika, jini - 200/130 mm Hg,
bayanan dakin gwaje-gwaje da hanyoyin bincike na kayan aiki:
Conclusionarshen ECG - matsayin al'ada na ƙashin lantarki na zuciya. Firamillation na atrial, tachysystolic form. Yawan zuciya 90 / min. Hypertrophy na ventricular myocardium na hagu tare da nauyinta. Bambanta canje-canje na myocardial,
Tattaunawar likitan zuciya: ƙarshe - IHD. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art.,
zaku iya gano cutar tapo: CHD. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art.

Etiopathogenesis
Wannan cuta ce ta polyetiological.
Matsayi:
1. Insulin - dogara da ciwon sukari mellitus - ƙarancin insulin - nau'in 1.
2. Insulin shine mai ciwon sikila mai cin gashin kansa. Yana faruwa tare da karancin insulin. A cikin jinin irin waɗannan marasa lafiya, insulin na al'ada ne ko haɓaka. Zai iya zama kiba kuma tare da nauyin jiki na yau da kullun.
Insulin - mellitus na ciwon suga - cuta ce ta cututtukan fata. Tushen ci gabanta sune:
1. Laifi a cikin 6 - chromosome da ke da alaƙa da tsarin HLA - D3, D4. Wannan lahani gado ne.
2. Kwayoyin cuta na kumburi, kyanda, Coxsackie, yanayi mai matukar damuwa, wasu sunadarai. Yawancin ƙwayoyin cuta suna kama da ƙwayoyin beta. Tsarin rigakafi na al'ada yana tsayayya da ƙwayoyin cuta. Idan yana da lahani, toshewar Islet ta hanyar ƙwaƙwalwar ƙwayoyi ta faru. B lymphocytes suna samar da ƙwayoyin cytotoxic. Kwayoyin beta suna mutuwa, kuma karancin samarwar insulin yana tasowa - ciwon sukari mellitus.
Mellitus mai ciwon sukari mai zaman kanta yana da lahani na ƙwayar cuta, amma ya bayyana ba tare da aiwatar da abubuwan waje ba.
1. Laifi a cikin ƙwayoyin beta kansu da kasusuwa na waje. Insulin insulin na iya zama muhimmi da haɓaka (tare da matakin glucose na jini na 6.5 mmol / l).
2. Hankalin kyallen takarda zuwa insulin ya ragu.
3. Canje-canje a cikin tsarin insulin.
Insulin mai cin gashin kansa yana lalata kiba. A wannan yanayin, ƙwayoyin suna buƙatar ƙarin insulin, kuma masu karɓa a cikin sel basu isa ba.

Jiyya
1. Yawan abinci 9.
Ana yin lissafin abinci mai gina jiki yana yin la’akari da yanayin gaba ɗaya, jinsi, alamu masu nauyin tsayi da farashin kuzari (na wani nau'in aiki). Al'ada: 30 kcal / kg na nauyin jiki. Weightwararren likita na wannan haƙuri shine 55 kg. Lissafi: 75x30 = 2250 kcal / rana.
Yawancin abinci - sau 5-6 a rana. Ana bada shawarar rarraba rabe na yau da kullun:

Volumearar Abinci a cikin%
Farko karin kumallo 8 hours 20%
Abincin rana 12 a rana. 10%
Abincin rana 14 h. 20-30%
Abin ci 17 hours 10%
Abincin dare 19 hours 20%
Na biyu abincin dare 21 hours 10%
2. Yanayin tsaye.
3. inara cikin jiki. kaya.
4. Diabeton MR 30mg, 1 kwamfutar hannu 1r / d da safe minti 30 kafin abinci.
5. Asfirin 325 kwamfutar hannu inside ciki 1 r / d a cikin 19˚˚.
6. Nitrogranulong 0.005, 1 kwamfutar hannu a cikin 3 r / d.
7. Captopril 25mg ½ kwamfutar hannu a ciki 2p / d.
8. Sol. Vit B6 5% - 2.0 ml intramuscularly 1 r / d kowace rana.
9. Mildronate 5.0ml a ciki 1r / d.
10. Piracetam 5.0 ml a ciki, 1 r / d.
11. Furosemide 2.0 ml na cikin kullun kowace rana.
12. Asparkam 1 kwamfutar hannu a cikin 3 r / d.
13. Eufilin 0.15 da dare.

20.04.04
Mai haƙuri ya koka da ƙishirwa, bushe bushe bayan cin abinci, polyuria, sweating, rauni, rauni na ƙafar yanayi mara iyaka, ba tare da bayyanar da ƙaƙƙarfan wuri ba, matsakaici mai ƙarfi, tasowa da wucewa ba ga wani dalili bayyananne ba.
Abin nufi: yanayin mai haƙuri yana gabatowa mai gamsarwa. Fatar ta yi launin shuɗi. Babu kumburi. BH = 18 / minti. A cikin huhu, vesicular numfashi, ba wheezing. Zab = 82 / min, cika mai gamsarwa da tashin hankali, wanda bai dace ba. HELL = 180/100 mmHg A lokacin tashin zuciya, ya raunana, ana jin karar sauti mai karafi, kararrakin ba daidai bane, bugun zuciya = 82 beats / min. Rashin ƙarfi, mai laushi, gajere na gunaguni na systolic an ƙaddara. Harshen yana da tsabta, ba a karko. Abun ciki akan palpation mai taushi ne, mara zafi. Kujerar ta al'ada ce. Diuresis game da 2l., Mai zaman kanta.
Alƙawura: ci gaba da lura bisa ga alƙawura.

29.04.04
Mai haƙuri ya koka da ƙishirwa, bushe bushe bayan cin abinci, polyuria, rauni, jin zafi a kafafu ya ragu, ba tare da bayyananne ba, tsananin matsakaici, tashi da wucewa ba ga wani dalili bayyananne ba. Bayanan kula suna kyautatawa cikin walwala.
Abin nufi: yanayin gamsarwa ne. Fatar ta kodadde ruwan hoda, mai tsabta. BH = 16 / minti. A cikin huhu, vesicular numfashi, ba wheezing. Zab = 76 / min, cika mai gamsarwa da tashin hankali, na yau da kullun, rashin rashi. HELL = 160/100 mm Hg Tare da yawan tashin zuciya, ana jin sautunan da ke raunana, rudani na zuciya ba daidai bane, bugun zuciya = 76 bpm. Rashin ƙarfi, mai laushi, gajere na gunaguni na systolic an ƙaddara. Harshen yana da tsabta. Abun ciki akan palpation mai taushi ne, mara zafi. Kujera tayi daidai 2p / d. Diuresis game da 2l., Mai zaman kansa.
Alƙawura: ci gaba da lura bisa ga alƙawura.
Don sokewa: piracetam, furosemide.

02.05.04
Mai haƙuri yayi gunaguni da bushe bushe bayan cin abinci, rauni, polyuria.
Abin nufi: yanayin gamsarwa ne. Fatar ta kodadde ruwan hoda, mai tsabta. BH = 16 / minti. A cikin huhu, vesicular numfashi, sama da duka farfajiya. Zab = 80 / min, na lokaci-lokaci, babu rashi bugun jini. HELL = 160/100 mm Hg Tare da tashin zuciya, ana jin sautunan da suka raunana, rudani na zuciya ba daidai bane, bugun zuciya = 80 beats / min. Rashin rauni, mai laushi, gajere na gunaguni na systolic; lokacin da aka canza matsayin jikin, baya canza kayan jikinta. Ba a haraji harshe ba. Abun ciki akan palpation mai taushi ne, mara zafi. Kujera tayi daidai 2p / d. Diuresis game da 2l., Mai zaman kanta.
Alƙawura: shirya don fitarwa 03.04.04.
Cancel: Sol. Vit B6 5%, Mildronate.

Epic rikicin
An kwantar da mai haƙuri Karpenko Aleksandra Nikolaevna a cikin sashen endocrinology na Asibitin Musamman daga 04/13/04 zuwa 05/03/04. An karɓa cikin yanayin da aka shirya tare da koke-koke na damun ƙishirwarta, bushewar baki, polyuria, itching na fata, kwanan nan raguwar kamuwa da gani, zafi a ƙafar dama, kullun, ciwo, matsewa, ɗigon lokacin yatsun da yatsun kafa, yanayin zafi a ƙafafu . An gudanar da binciken. An yi nazarin alamu na dakin gwaji: nazarin fitsari na asibiti daga 04/22/04 - glucose - 2%, gwajin jini don glucose daga 04/13/04 - 8˚˚ glucose jini - 7.06 mmol / l, 12˚˚ glucose jini - 11.02 mmol / l, 18˚˚ glucose na jini - 9.2 mmol / l, 22˚˚ glucose jini - 8.2 mmol / l, ECG - matsayin al'ada na tsinkayen lantarki na zuciya, atrial fibrillation, form tachysystolic. Canjin zuciya 90 / min, hagu jini na ventricular myocardial tare da nauyin sa, yaduwar canje-canje a cikin myocardium. Kwararren likitan ido Kammalawa: Ciwon fata na kashin baya. Kama farat ɗayawar idanu biyu. Kwararren likitan zuciya. Kammalawa: ciwon zuciya. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Symptomatic arterial hauhawar jini. NK IIA Art. Gano tare da babban - Type 2 ciwon sukari mellitus, matsakaici, subcompensated,
rikitarwa - Cutar malaria na jijiya daga cikin ƙananan tasirin. Ciwon sukari na kashin baya na retina. Maganin rikicewa na farko na idanu biyu, wanda ke ɗaurewa - cututtukan zuciya na ischemic. Atherosclerotic cardiosclerosis. Angina pectoris. Firamillation na atrial, tachysystolic form. Gudanar da magani. An kori mai haƙuri a cikin yanayin mai gamsarwa zuwa gida. Nagari: ci gaba da jiyya tare da magunguna wadanda aka tsara akan marasa aikin, mai yiwuwa ne ta zahiri. kaya, saka idanu na sukari na jini, magani na inpatient na rigakafi 1 lokaci a shekara.

Jerin abubuwan da aka ambata

Balabolkin M.I. Endocrinology: Littattafai. izni. --- M.: Medicine, 1989. 416 pp (Littattafan Littattafai Na Littattafan suban ƙasa da na ƙasa).
Potemkin V.V. Endocrinology. --- M.: Magani, 1986. 432 p., Rashin lafiya.
Medvedev V.V., Volchek Yu.Z. Gwajin Nazarin Clinical: Littafin Jagora don Likitoci / Ed. V.A. Yakovleva. --- St. Petersburg: Hippocrates, 1995. --- 208 p.
Mashkovsky M.D. Magunguna A sassa biyu. Kashi na 1., Kashi na 2 --- M.: Medicine, 1993.