Halin yana yaba mahimmin abu

Jami’ar Kiwon Lafiya ta Jihar Kuban

Sashen cututtukan Yara

Tarihin likita: *****, shekaru 8

Bayyanar cuta: Type 1 diabetes mellitus, mataki na lalata, lokacin cuta shekara 1

5 Hakika 8 kungiyar

Ranar shigar da asibiti:Satumba 7, 2010

Ranar haifuwa:Nuwamba 20, 2001

Mahaifiya: **********, shekara 37, uwargida.

Uba: **********, dan shekara 38, dan kasuwa mai zaman kansa

Binciken cutar ma'aikata:

Ciwon sukari guda biyu, nau'in 1, mataki na lalacewa, tsawon lokaci -1 shekara.

Bayyanar cututtuka a shigarwar: Ciwon sukari mellitus, type 1, tsawon lokaci cuta -1 shekara.

Mai haƙuri yana gunaguni da bushe bushe, urination akai-akai, yawan ci, zazzabin cizon sauro, rauni, raunin nauyi, rage hankali.

Yaron ya yi rashin lafiya a cikin shekarar da ta gabata, yarinyar ta damu da yawan jin bushewar baki, yawan urination, amai, tashin zuciya, rauni, nauyi asara. A shekara ta 2009, sun shigar da kararrakin nan tare da CRH a wurin zama, daga inda aka tura su zuwa Asibitin Kula da Yara a Krasnodar don yin nazari. An gano cutar a cikin Asibitin Clinical Yara: nau'in 1 mellitus na sukari, dangane da gwaje-gwajen da aka yi, matakin glucose na jini shine 16 mmol / l a cikin gwajin jini, kuma an kula da Lantus da Novoropid. An kori jariri wanda ke nuni da karin magani na waje da bin ka'idodin abinci. A cikin makonni biyu da suka gabata, yanayin yaron ya tsananta, kuma saboda haka an tura shi don yin gwajin CRH na yau da kullun a wurin zama a Asibitin Clinical Yara na Krasnodar don manufar jarrabawa da ƙarin magani.

Yaron daga ciki na farko, haihuwar farko. Cutar ciki ba ta da matsala. Isar da gaggawa. Aiwatar da kirji a ranar farko, ya ɗauki nono da yardan rai. Rashin shayarwa nono har zuwa shekara guda.

Girma da haɓaka gwargwadon tsufa.

A cikin shekarar farko ta rayuwa, ta sha wahala sau da yawa daga SARS.

BCG “M”: 11/29 / 01-0,05 w / c, daga 70 zuwa 2827

V1-18.02.02-DTP, 0.5 V / m, s 497-5

V2-20.03.02-DTP, 0.5 V / m, s 497-2

V3-18.05.02-DTP, 0.5 V / m, s 538-1

R1-21.05.03-DTP, 0.5 V / m, s 577-3

R2-19.12.08- DTP, 0.5 V / m, s244

V0-27.11.01-OPV, 4 cap.per.os. c 313

V1-15.02.01-OPV, 4 cap.per.os. c 342

V2-29.02.01- OPV, 4 cap.per.os. c 442

R1-21.05.02- OPV, 4 cap.per.os. c 363

R2-22.05.03- OPV, 4 cap.per.os. c 411

R3-20.07.03- OPV, 4 cap.per.os. c 416

R4-24.09.03- OPV, 4 cap.per.os. c 466

R5-24.06.04- OPV, 4 cap.per.os. c 466

R6-19.07.04- OPV, 4 cap.per.os. c 494

V1-21.11.02- “embryovac”, 0.5 v / m, s 105

V2-10.12.02- "embryovac", 0.5 v / m, s 105

V3-19.05.03- “embryovac”, 0.5 v / m, s 10

V1-24.11.02-ZhPV, 05 s / c, s 032

M2-20,12,07-ZhPV, 05 s / c, s 0851

V1-25.05.02-ZhKP, 0.5 s / c, s 617

V2-22.03.07-ZhKP, 0.5 s / c, s 932

SPh14.55k 1160 / ikh, 02 2 TE, mai inganci

SP 10.47k 060 / vii,

SP 10.47k 0607 / vii, 03.2TE, w / c

Mahaifiya, suna, shekara 37 - lafiya

Uba - cikakken suna, 38 years old - lafiya

Iya da uba suna lafiya, kakaninki suna lafiya.

Kammalawa: a cikin yaro, gado ba a ɗaukar nauyi ba.

Iyalin yaran suna zaune a wani gida mai zaman kansa. Akwai mutane biyar a cikin dangi. Yaron yana da ɗakin dabam, ɗakin yana tsabtace a kai a kai, yana da walƙiya. Tsarin ranar. Yaron ya halarci makaranta.

A cikin makonni 3 da suka gabata ban fita daga rijiyoyin ba, ban shiga cikin masu fama da cutar ba, kuma babu cututtukan hanji a cikin dangi. Kwayar cuta ta farji da ba ta da lafiya. Kasancewar tarin fuka da cututtukan da ake sa ran samu a cikin iyali ya musanta.

Ba a zubar da jini da jini ba.

Ba'a lura da kasancewar abinci mara izuwa, magunguna, sunadarai na gida, ƙanshi iri-iri, ƙura.

Kammalawa: tarihin rashin lafiyan ba a ɗaukar nauyi.

Halin yanzu na mai haƙuri:

Zazzabi shine 36.7 s, yanayin janar na mai gamsarwa, matsayin gado yana aiki, magana akan fuskarsa tana da nutsuwa, ma'ana.

Yarinya 8 years old. Girma: 134 cm, alamomin haɓaka suna cikin cibiyoyin 97, wanda ya dace da mai nuna alama sama da matsakaita. Tsarin jiki 26 kilogiram, ƙididdigar jiki yana tsakanin 25 da 75 centel, wanda ya dace da ƙimar matsakaici.

Kammalawa: haɓakar hormonal.

Fata da mucous membranes:

Fatar ta launin fata ce mai tsabta, mai tsabta, danshi a matsakaici, dumi, an kiyaye shi. Fatar ba ta da kauri. Damuwa ta fari fari ce, bazazzagewa, yawan bayyanar shine -1 minti daya, rashi bace shine minti 2.

Subcutaneous mai yana da talauci mai haɓaka, a ko'ina ana rarraba shi. Seals, subcutaneous emphysema, babu edema.

Palatine tonsils ruwan hoda, ba a kara girma ba.

Girma gashi gashi yayi.

Farantin ƙusa ba a canzawa, ruwan hoda mai launi.

Palpable submandibular, inguinal, linzamin tsage tsinkaye. A kan palpation, mara jin zafi, 0.5x0.5 cm a girma, guda, zagaye, ba a haɗa shi da kyallen takarda da ke tsakanin juna ba, hannu ne.

Shugaban yana da siffar al'ada.

Babu wata nakasar kwarangwal. Tsarin kashin baya daidai ne.

Hanyoyin haɗin gwiwa suna daga nau'i na al'ada, marasa jin zafi akan bugun jini. Yunkuri a cikin gidajen abinci kyauta ne, mara zafi. Babu hani akan motsi.

Tsokoki suna haɓaka kai tsaye, a ko'ina. An ajiye sautin Muscle Palpations marasa laushi.

Free numfashi ta hanci, babu sallama.

Muryar tayi kara, mai son kai. Matsayin mazaunin larynx daidai ne, babu kumburi.

Kirji na nau'in asthenic, ba tare da nakasa ba. Dukkanin kashi biyu na kirji suna shiga cikin ayyukan numfashi daidai. BH = 18 a minti daya, bugun zuciya = 78 a minti daya.

Irin nau'in numfashi na kirji. Lokacin numfashi, babu sa hannun hannu a cikin tsokoki na taimako.

Muryar rawar murya a sassan sassanya na kirji iri ɗaya ne.

Ana jin sautin bayyanar huhu a duk faɗin huhu.

Auscultatory: respiration- ves musamman, babu tashin hankali. Ba a jin amo sautin tashin hankali.

Borderarancin kansar huhu:

Ax line na gaba

Tsarin layi na tsakiya

Layin Axillary

A kan palpation na na wucin gadi, carotid, radial, femsus, popliteal arteries, ana jiyo bugun jini.

A kan palpation na ciki 1.5 cm daga midclavicular layin a cikin V intercostal sarari, an apical impulse na matsakaici ƙarfi da aka ƙaddara.

Bugun tsoka-78 bebi / min.

Iyakokin zuciya masu rauni:

A tsakani tsakanin layin dama na dama da sirin dama

Hagu na layin waje

Na uku intercostal sarari

0.5 cm daga cikin layi na hagu midclavicular

Kusa da zuwa gefen hagu parasternal (daga ƙasa)

Nisawan Zuciya: 10 cm

Tsawon Zuciya: 12 cm

Nisa daga cikin jijiyoyin bugun jini 5.5 cm

A lokacin tashin hankali, sautunan a bayyane suke, rhythmic.

Harshen ya lullube cikin farin, rigar. Mucous membrane na ciki na lebe, cheeks, palate, pharynx wani launi ne mai launin ruwan hoda, mai tsabta.

6 V 4 III 2 1 1 II III 4 V 6

6 V 4 III 2 I 1 II III 0 V 6

Firmaƙƙarfan lafazin ingantaccen tsari, ba tare da lalata ba, babu canje-canje na mucosal

Faulal mai laushi yana da fasali, ta hannu.

Palatine tonsils a matakin arches, ba soldered zuwa gare su, matsakaici hyperiminated.

Siffar ciki shine zagaye, ciki abune da ya zama daidai, ba ya kumbura.

Tare da palpation na sama, ciki mai laushi. Alamar Shchetkina-Blumberg-korau.

An yi hanta hanta a gefen makullin tsada: gefen hanta mai kaifi ne, farfajiya mai laushi, mara nauyi, mara nauyi.

Girman hanta bisa ga Kurlov: 9cm-8cm-7cm.

Ciwon ciki ba mai palpable ba ne. Bayyanar cututtuka na Ortner, Murphy-korau.

Kwayar ba ta palpable ba ce. Ba a lura da jin ciwo a kan bugon ruwa a cikin yankin Shoffar da Desjardins ba.

Saifa ba palpable.

Lokacin bincika yankin lumbar na hyperemia, kumburi, babu kumburi. Kodan ba palpable. Wuraren yin aikinsu da na ura ba su da warkewa a jikin palpation.

Diuresis yana ƙaruwa, urination ba shi da ciwo, babu jinkiri a cikin urination.

Babu koma bayan ci gaba. Ciwon glandon thyroid ba mai palpable bane. Abubuwan halayen jima'i na farko sun dace da jinsi da shekaru.

Kwayoyin suna haɓaka bisa ga nau'in mace.

Ta hanyar balaga, halayen jima'i na sakandare suna da dabara:

Ma0 shine matakin yara na haɓakar glandar dabbobi masu shayarwa.

Kwarewa a bayyane. Ilimin hankali ya dace da matakin ci gaba da shekaru.

Halin mai haƙuri ya isa. Yarinyar tana da jama'a.

1. bushe baki

4. Yaren ya bushe bushe da plaque (fari),

7. Rage nauyi.

1. cututtukan cututtukan masu ciwon sukari

Tabbatacce game da ganewar asali:

Dangane da gunaguni na marasa lafiya: bushe bushe, yawan urination, tashin zuciya, ciwon kai, zazzaɓi, asarar nauyi.

Bai wa tarihin cutar: mara lafiya a cikin bara, damuwa game da kullun ji na bushe bushe, yawan urination, tashin zuciya, asarar nauyi. Matsayin glucose na jini a lokacin gwajin farko shine 16 mmol / L.

A cikin makonni biyu da suka gabata, yanayin ya tsananta, sakamakon wannan ne suka juya zuwa Asibitin Gundumar ta Tsakiya a wurin zama, daga inda aka tura ta asibiti ta shirya a Asibitin Clinical Yara da ke Krasnodar don dubawa da ci gaba da magani.

Kuna iya yin bincike: nau'in ciwon sukari na 1 na 1, tsawon lokacin karatun shine shekara 1. Za'a fayyace matakin yayin ƙarin jarrabawa.

3. scraping na enterobiosis (sau 3),

4.cal akan tsutsotsi,

6.BH na jini (glucose, bilirubin, ALT, AST, cholesterol),

7. Duban dan tayi na narkewa,

8. Tattaunawar likita, ƙwararren likitan fata don gano rikice-rikice.

1. farjin abinci (tebur mai lamba 9),

2. sauya magani:

Nazarin Paraclinical:

Kwayoyin farin jini (WBC) -6.16 x 10 / L (N = 5.0-10.0 x 10 / L),

Kwayoyin halittar jini (RBC) -4.53x10 / l (N = 3.5-4.5x10 / l),

Haemoglobin (HGB) -132 g / l (N = 110-120 g / l),

Matsakaicin matsakaicin sel jan jini (MCV) shine 84.1 fl (N = 75-95 fl),

Filastik (PLT) -349x10 / L (N = 150-350x10 / L),

Lymphocytes (LYM) -44.8% (N = 35-40%),

Monocytes (MONO) -7.38% (N = 5-8%),

Eosinophils (EOS) -4.74% (N = 3-6%),

Kammalawa: akwai karuwa a cikin glycosylated haemoglobin, wanda ke nuna zubar da cututtukan sukari.

Nuna gaskiya bai cika ba,

Musamman nauyi-1020 (N = 1005-1030),

Cellswayoyin jini-0-1-1 a cikin s / s,

Bilirubin - ba a samu ba

Kammalawa: An gano glycosuria a cikin binciken, wanda ke nuna kasancewar yanayin lalata ƙwayar cutar mellitus.

3. scraping don enterobiosis (3-ninka) -negative.

4. Kalori a kan kwaro na ciki - ba a gano ƙwai macijin ciki ba.

5. Jini a kan MPA-korau.

Jimlarubin jimlar shine 7.11 mmol / L (N = 8.5-20.5 mmol / L)

Triglycerides - 0.86 mmol / L (N = 0.5-3.4 mmol / L)

Cholesterol-3.68 mmol / L (N = 0.78-2.2 mmol / L)

Amylase -148 u / l (N = 17-115 u / l)

AST-21.00 u / l (N = 10-30 u / l)

ALT-29,00 u / l (N = 7-40 u / l)

Glucose-17.63 mmol / L (N = 3.5-5.5 mmol / L)

Kammalawa: matakan glucose mai girma suna nuni da hyperglycemia.

7. Duban dan tayi na narkewa kamar fili:

Kammalawa: ba a gano canje-canje na tsarin a cikin ramin ciki ba.

Kammalawa: a cikin yanayin neurological na bayyanar cututtuka ba a gano shi ba. Babu cuta ta jijiyoyin jiki. A lokacin bincike, babu alamun cutar sikari ta rashin lafiya.

Faifan optic na ƙwayar optic yana da launin shuɗi mai haske a cikin asussan, iyakokin sun bayyana sarai, akan faifai ba tare da ilimin haruffa ba.

Bayyanar cututtuka halayyar type 1 diabetes mellitus: polyuria, jin busasshen baki, glucosuria, asarar nauyi, suma halaye ne na wasu cututtuka, saboda haka nau'in 1 na ciwon sukari wanda ya bambanta da cututtuka irin su insipidus na ciwon sukari, ciwon suga na koda, wanda ake kira " barrantacce "glucosuria, nau'in ciwon sukari na 2.

Hakanan ana haifar da ciwon sukari mellitus ta polyuria. Amma ana kwatanta shi da ƙarancin dangi mai saurin fitsari, aglycosuria da normoglycemia, waɗanda basu dace da hoton asibiti na nau'in ciwon sukari na 1 ba.

Cutar sankara tana tare da glucosuria, amma maida hankali akan glucose a cikin jini baya wuce matsayin al'ada, sabanin ciwon sukari na 1.

Glucosuria "mara ƙaranci" na iya faruwa a sakamakon rashin girman tsarin enzymatic na tirinles na koda, a cikin yara na farko na rayuwa, nau'in ciwon sukari na 1 wanda ke nuna kansa sosai a ƙarshen rayuwar kuma yana dawwama, mai dawwama.

Nau'in Mellitus na nau'in 2 kuma ana bayyana shi ta hanyar polyuria, asarar nauyi, jin daɗin kullun, amma sabanin nau'in 1 na ciwon sukari, marasa lafiya basa buƙatar maganin insulin.

Dalilin da ya shafi cututtukan asibiti:

Dangane da gunaguni na marasa lafiya: bushe bushe, yawan urination, tashin zuciya, ciwon kai, zazzaɓi, asarar nauyi.

Bai wa tarihin cutar: mara lafiya a cikin bara, damuwa game da kullun ji na bushe bushe, yawan urination, tashin zuciya, asarar nauyi. Matsayin glucose na jini a lokacin gwajin farko shine 16 mmol / L.

An kafa shi ne a kan binciken da aka yi niyya: yanayin yaro mai rauni mai sauƙi, jin daɗin rayuwa saboda ƙaruwar polyuria, jin bushewar baki, rauni, zazzaɓi, jin tashin zuciya, ciwon kai.

Dangane da bayanan gwaje-gwajen asibiti da na gwaji na asibiti: OAK (Satumba 8, 2010) - akwai karuwa a cikin ƙwayar glycosylated, OAM (Satumba 8, 2010) - An gano glycosuria a cikin bincike, jini BH - ƙara yawan glucose.

Ganin irin bayanan da ke sama, yana yiwuwa a yi gwaji: type 1 diabetes mellitus, mataki na lalata, tsawon lokaci shekara 1.

1. yawan adadin kuzari na yau da kullun: 1000+ (100 + 8) = 1800 kcal

2. Rukunan sunadarai, kitse da carbohydrates a kashi yau da kullun:

Carbohydrates-50% -900 kcal: 4 = 225 gr = 18.7 XE

Protein-30% -540 kcal-135 gr = 11 XE

Fat-20% -360 kcal-90 gr-7.6 XE

Base: 0.5 raka'a / kg x 26 = raka'a 13

Insulin aiki mai tsawo: Levemir -8: 00 da 22: 00-6.5 UNITS

Ultrashort insulin: Novoropid-6.5 IU

5. Rp: "Neuromultivit"

S. a ciki, 1 shafin. Sau ɗaya a rana

Halin matsakaici mai zurfi.

Mai haƙuri yana gunaguni da bushe bushe, saurin fitar urination, ƙishirwa, rauni, gajiya, ciwon kai.

A kan bincika: fata mai tsabta, bushe. Bakin mucous yana da ruwan hoda da launi, yana lullube harshe tare da farin kaya.

A kan palpation: ciki abune mai taushi, mara zafi.

A kan tashin hankali: vesicular numfashi, ba wheezing. Sautunan zuciya a bayyane suke, babu alamun karatuttuka.

Novoropid: raka'a 6.5 / rana - sau 4 a rana,

Rukunin Levemir-6.5 a 8:00 da 22:00

4.neuromultivitis 1 tab / rana

Halin matsakaici mai zurfi.

Mai haƙuri yana gunaguni da bushe bushe, saurin fitar urination, ƙishirwa.

A kan bincika: fata mai tsabta, bushe.

A kan tashin hankali: vesicular numfashi, ba wheezing. Sautunan zuciya a bayyane suke, babu alamun karatuttuka.

Novoropid: raka'a 6.5 / rana - sau 4 a rana,

Rukunin Levemir-6.5 a 8:00 da 22:00

4.neuromultivitis 1 tab / rana

Halin matsakaici mai zurfi.

Mai haƙuri yana gunaguni da bushe bushe, yawan urination, ƙishirwa, rauni, gajiya.

Bakin mucous yana da ruwan hoda da launi, yana lullube harshe tare da farin kaya.

Novoropid: raka'a 6.5 / rana - sau 4 a rana,

Rukunin Levemir-6.5 a 8:00 da 22:00

4.neuromultivitis 1 tab / rana

Suna, 'yar shekara 8, da ke zaune a *****, tana fama da jinya a Asibitin Clinical Yara, inda aka shigar da ita don yin niyya a cikin Asibitin Clinical Central, tare da bayyanar cututtuka na nau'in 1 na ciwon sukari mellitus, tsawon lokacin cutar ita ce shekara 1.

Mai haƙuri ya koka da bushe bakin, yawan urination, yawan ci, zazzabin cizon sauro, rauni, raunin nauyi, raguwar kulawa.

A karo na farko, yarinyar ta fara damuwa da alamun bayyanar sama shekara guda da suka gabata, wanda ta juya zuwa Asibitin Gundumar ta Tsakiya a wurin zama daga inda aka tura ta zuwa Asibitin Clinical Yara a Krasnodar don fayyace bayyanar cutar da ƙarin magani.

An kafa shi ne a kan binciken da aka yi niyya: yanayin yaro mai rauni mai sauƙi, jin daɗin rayuwa saboda ƙaruwar polyuria, jin busasshen baki, rauni, zazzaɓi, jin tashin zuciya, ciwon kai.

Dangane da bayanan gwaje-gwajen asibiti da na gwaji na asibiti: OAK (Satumba 8, 2010) - akwai karuwa a cikin ƙwayar glycosylated, OAM (Satumba 8, 2010) - bincike ya bayyana glycosuria, BH na jini - ƙara yawan glucose.

Dangane da bayanan da ke sama, an gano cutar: nau'in 1 ciwon sukari na mellitus, mataki na lalata, lokacin cuta 1 shekara.

1. Yarda da abinci (tebur lamba 9),

2. Yarda da tsarin magunguna (insulin therapy, bitamin therapy, enzyme far),

3. Tattaunawa tare da likitan ophthalmologist, neurologist don lura da kuzarin ci gaban rikice-rikice dangane da asalin cutar,

4. Regular marasa lafiya na yau da kullun (aƙalla sau 2 a shekara), don saka idanu akan ayyukan cutar,

5. Sanatorium-wurin shakatawa a wani mataki na gafarta cutar,

6. Aikin Jiki (yayi daidai da shekaru da kuma cutar).

Anamnesis morbi.

Yana ɗaukar kanta rashin lafiya tun Maris 2013, lokacin da gunaguni na rashin ƙarfi na gaba ɗaya, rage aiki, bushewar ƙishirwa, ƙishirwa, yunwar abinci, haɓaka abinci, karuwar urination, asarar nauyi mai nauyi kwatsam (bisa ga yarinyar, asarar 8 kilogram), matalauta barci da dare da yanayin bacci yayin rana, jin zafin zafi da zafin fuska. An magance waɗannan gunaguni ga likita na gida a wurin zama, matakin glycemia ya kasance 33 mmol / l. Wani likitan yara ne aka gabatar da shi daga Sashin Kula da Likitocin da ke Cibiyar Pedagogical na Cibiyar IODKB Endocrinology Department don yin binciken da ya dace, inda aka fallasa shi DS: Type I diabetes. A halin yanzu, matakan jini na jini, ƙishirwa, yawan urination, bushewar bushewa, tsinkaye lokaci-lokaci na ciwon kai, ciwon kai, gajeriyar numfashi, yawanci bayan ƙoƙarin jiki, suna ta da hankali. Ya yarda da Humalog a raka'a 30 a kowace rana, Lantus 18 raka'a 22.00 Kashi na yau da kullun insulin shine raka'a 48, ƙasa da 1 na kowace kilogiram na nauyin jiki, saboda kurakurai a cikin abincin. Kulawa da marasa haƙuri suna faruwa kowace shekara. Lokaci-lokaci ana gudanar da aikin jiyya shine gyada, trental, magnetotherapy zuwa ƙananan ƙarshen. An tura shi zuwa Cibiyar Kiwon Lafiya ta Jiha na IOKB don maganin marasa lafiya da jarrabawa don saka idanu kan matakan glucose, gyara jiyya da hana rikice rikice na ciwon sukari mellitus.

Yaro daga ciki Na dauki ciki. Isar da gaggawa, a sati 39. Haihuwar ta ci gaba ba tare da wahala ba. Babu hatsarin aiki a cikin uba, a cikin mahaifiyar (a lokacin daukar ciki ba ta yin aiki). Yakan fasa munanan halaye daga mahaifinsa tun yana ɗan shekara 18, 1-2 a rana. A lokacin daukar ciki, mahaifiyar ta sami toxicosis na farkon rabin - tashin zuciya, amai. Babu wata barazanar zubar da ciki. Kasancewar m cututtuka da magani a lokacin daukar ciki an hana. Bayanai game da maganin rashin lafiyar dabbobi na cututtukan ƙwayar cuta da cutar rashin bacci ya ɓace. Bayanai kan abinci mai gina jiki da abubuwan yau da kullun a'a. Kimantawa kan sikelin Apgar na maki 7-8. Girman haihuwa 3400g (4 corridor), tsayin jiki 52 cm (4 corridor), kewayen kirji 35cm (4 corridor), kewayen kai 34 cm (4 corridor).

FR a lokacin haihuwa shine matsakaici, daidaituwa, mesosomatotype.

Kammalawa: Akwai dalilai masu haɗari don haɓakar ƙwayoyin cuta: guba na 1 rabin ciki: tashin zuciya, amai, hayaki na biyu. Matsakaicin nauyin kwayoyin halitta (ƙungiyar haɗari).

Babu bayanai game da lokacin da yake ciki.

Bayanai game da rigakafin rigakafin:

Alurar riga kafi bisa kalandar alurar riga kafi ta ƙasa.

Cututtukan da suka gabata: Chickenpox, SARS sau 3-4 a shekara.

Index Resistance = 4/12 = 0.33, rage juriya, yawan cututtukan muni a kowace shekara = sau 4.

Tarihin Iyali: Mahaifiya - Evdokimova Tatyana Mikhailovna, ɗan shekara 26 - malami a cikin makarantar yara, ba mummunan halaye ba. Mahaifina - Mitenkov Maxim Vladimirovich 28 years - injiniya, halaye marasa kyau - suna murmushi daga 18 shekara 1-2 1-2 a kowace rana.

Kakata, a gefen mahaifina, tana da nau'in ciwon sukari irin na II tun tana ɗan shekara 60. Ita da danginta suna da cututtuka irin su tarin fuka, giya, cututtukan zuciya, cututtukan zuciya, da cututtukan zuciya.

Tushen asalin J = 0.25 - mara nauyi.

Kammalawa: Girman gado yana ɗaukar nauyi ta wurin abubuwan tarihin halitta.

Kayan abu da yanayin rayuwa:

Iyali na mutane 3-yaro, uwa, uba.

Iyalin suna zaune a wani ɗakuna mai kyau mai daki 2. Yaron ya halarci aji 8A.

Cutar rashin lafiyan abinci ga zuma, ta bayyana ne ta hanyar rashes a fuska.

Kammalawa: An gano abubuwan haɗari masu zuwa: toxicosis na 1 rabin ciki: tashin zuciya, amai, hayaki na biyu. Matsakaicin nauyin kwayoyin halitta (ƙungiyar haɗari). SARS sau 3-4 a shekara. Index Resistance = 4/12 = 0.33, an rage juriya, da yawaitar cututtukan muni a kowace shekara = sau 4 (galibi mara lafiya). Indexididdigar asali na J = 0.25 - mara nauyi, gado na ɗaukar nauyi ta hanyar ƙimar endocrinological, rashin lafiyan abinci ta nau'in histamine-mai sassaucin ra'ayi.

Babban halaye da kuma babban bayyanar asibiti na nau'in 1 ciwon sukari mellitus mai rikitarwa ta hanyar encephalopathy na ciwon sukari na 1 st, polyneuropathy na ciwon sukari na 2 st, cataract. Umarni da ka'idodi na yin wannan binciken, samuwar tsarin kulawa.

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/

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

Babban ganewar asali: Nau'in nau'in 1 na ciwon sukari, matsakaici, discompensated.

Matsaloli: Encephalopathy na ciwon sukari 1 tbsp; polyneuropathy na ciwon sukari 2 tbsp; kamuwa da cuta mai rikitarwa.

M cututtuka: a'a.

Gunaguni a lokacin kulawa

ciwon sukari mellitus polyneuropathy encephalopathy

Gunaguni na rauni, farin ciki.

Gunagunia lokacin karbar kudi

Tare da bincike mai aiki, mai haƙuri ya damu da ƙishirwa (har zuwa 3 a kowace rana), polyuria matsakaici (har zuwa 3 a kowace rana), bushe baki, asarar 20 kilogiram a cikin rabin shekara, rauni, gajiya, itching na fata, da kuma kasancewar hypoglycemia bayan digo, kusan sau 2 a mako (rauni, gajiya, pallor, dizzness, halin da bai dace ba), rage ƙwarjin gani (bayyanar tabo a gaban idanun), raunin ƙwaƙwalwar ajiya, yawan jan zafi a ƙarshen ƙarshen, gajeriyar numfashi na yanayin gauraye yayin ƙoƙarin jiki, asara. gashi a kai.

Tarihin cutar yanzu (Anamnesismorbi)

Mai haƙuri ya koyi cewa tana da ciwon sukari a cikin 2007, yana da shekaru 27, lokacin da alamun farko suka bayyana: saurin fitar urination, ƙishirwa na matsakaici, ƙoshin fata da jin zafi a cikin ƙananan ƙoshin, gajeriyar numfashi na yanayin gauraye yayin ƙoƙarin jiki. M farkon cutar. Marasa lafiya yana yin alaƙa da farkon alamun farko na cutar tare da SARS. A cikin 2007, an yi gwajin glucose na jini - 2.4 mmol / l - an fara yin shi a Asibitin Clinical City No. 1. Bayan kwanaki 4, sukari na jini - 22 mol / L. A cikin 2012, an tura mai haƙuri zuwa Clinical Hospital No. 2. A cikin asibiti, an gano mai haƙuri da nau'in 1 na ciwon sukari na tsananin rauni, ƙeta. Glycemia a farkon cutar 3-13 mmol / l, ya ɗauki Novorapid 4 + 5 + 5U, Levemir 10 + 15U. Harkar kiwon lafiya ta inganta a yayin warkarwa. Kasancewar biyan diyya ga metabolism metabolism shine. Mai haƙuri ya bi abinci A'a. 9.

Babu tsauraran rikice-rikice na ciwon sukari.

An haife ta ne a cikin garin Vladivostok a 1979, cikakken lokaci (nauyin jiki 3100 g, tsayi 47 cm), wacce aka haife ta a cikin iyali mai kyawawan yanayin zamantakewa. Na shiga makaranta tun ina da shekara 7, na gama aji 11. Bayan haka ta sami karatun sakandare.

Rashin lafiyar yara (tarin fuka, cutar Botkin, veins. cututtuka) ta musanta.

Tarihin gado ba nauyi.

Tarihin Gida: Yanayin gidaje yanada matukar kyau.

Tarihin Toxicological: ya musanta kyawawan halaye.

Tarihin Professionalwararru: Aiki, motsa jiki na aiki ba shi da kyau sosai, yana cin abinci akai-akai sau 3 a rana tare da haske, ƙarancin kalori, bayanin kula lokaci-lokaci mai motsa rai dangane da aiki.

Cututtukan da suka gabata: Awancen habba, rubella, CHD - tetralogy of Fallot, an fara aiki dashi a cikin 1989 saboda cututtukan zuciya mai tsananin gaske.

Tarihi na rashin lafiyar: ba nauyi.

Tarihin mahaifa: Kowane wata daga 14 shekara, sake zagayowar nan da nan. Ensesararraki marasa azanci, tsawon lokaci (kwana 4). Tsarin sake zagayowar kwanaki 28 ne. Babu ciki.

Abubuwan dubawa na manufaMatsayiyayi addu'a)

Babban yanayin haƙuri yana gamsarwa. Kwarewa a bayyane. Matsayi yana aiki. Jiki yana da asthenic. Abincin ya gamsu. Anthropometry: tsayi 165 cm, nauyi 49 kilogiram, ƙididdigar jiki na jiki 17,9, kewayon matsakaici 62 cm.

Fata da bayyane mucous membranes.

Fata: Fatar ta yi launin shuɗi, launin ruwan mucous na idanu, hanci, lebe, da baki suna ruwan hoda. Launin fata na yau da kullun, turgor ya ragu. Ba a lura da karuwar gumi ba. Fata danshi na al'ada ne. Tashin ƙashi, pigmentation, striae, amai, boils, suppuration, kasancewar lahani na ƙuraje, hyperkeratosis na ƙafa, rashin raunuka basa nan. Kamshin acetone daga bakin ba ya nan. Kusoshi na bakin ciki ne, na toshewa, gashi na mace.

Tsarin tsoka: Haɓakar tsoka da sautin al'ada ne. A kan bugun yatsa da motsi, tsokoki ba su da jin zafi, ba a gano rawar jiki da rawar jiki tsokoki na mutum ɗaya ba. Babu paresis da inna.

Tsarin maganin Osteoarticular: Lokacin bincika kasusuwa na kwanyar, kirji, ƙashin ƙugu, ƙafar ƙafa, ƙuraren murguɗa, curvatures na wasu rikice-rikice ba'a samo su ba. Palpation da tsinkaye ba su da jin ciwo.

Tsarin Lymphatic: Hannun bakin mahaifa, farji da na baya, kashi, parotid, submandibular, supraclavicular da subclavian, axillary, ulnar, inguinal, popliteal lymph nodes ba palpated.

Palpation na thyroid gland shine yake: ba palpable.

Tsarin numfashi.

Kirji na yau da kullun ne a tsari, mai kwalliya. Kashi na epigastric ya mike. Hannun kafaɗun kafada suna dacewa da kirji, yana motsawa zuwa layi kamar yadda ake yin numfashi. Fossae na supraclavicular da subclavian fossae an bayyana gamsuwa, waɗanda suke a matakin daidai, ba su canza sifofinsu lokacin numfashi.

Irin nau'in numfashi wanda aka cakuda shi da mafi yawan nono. Rhythmic numfashi - 18 a minti daya. Hannun dama da hagu na kirji suna motsawa gaba daya. Matsakaicin matakai na wahayin da karewa ba ya karye. Musclesayoyin tsokoki ba sa hannu cikin aikin numfashi.

Daidaitawar huhu

Sama da duka sassan huhun, sauti tsinkaye a bayyane yake ne.

Busa numfashi sama da duka kan huhu shine vesicular. Ba a jin jita-jita, hutu da amo na hargitsi.

Gwajin yankin zuciya

Yankunan zuciya ba a canza su da gani. An zartar da bayyanar da jijjiga a cikin sararin samaniya na V intercostal 1 cm a ciki daga layin tsakiyar tsakiyar clavicular. Ba'a yanke shawarar motsa zuciya yayin jarrabawa. Abubuwan bugun jini ba bayyane suke ba.

Palpation na zuciya

An buga murfin apical a cikin sararin samaniya na intercostal 1 cm a ciki daga layin tsakiyar tsakiyar, tare da yanki na murabba'in 2. gani, matsakaici ƙarfi, amplitude matsakaici. Babu sha'awar zuciya. Ba a gano alamar "cat purr" ba. Bugun jini a hannayen hannu biyu yayi, bugun baki daya ne a minti daya. HELL 110/70.

Yankin dama na ɓacin rai na zuciya yana kasancewa a cikin sararin ciki 4 na ciki 1 cm daga ciki daga gefen gefen murfin.

Upperarshen babba na zuciyar rauni yana kasancewa akan ƙananan gefen rijiyar ta 3.

Yankin hagu na kashin kwanciyar hankali ya kasance 1 cm daga ciki zuwa hagu zuwa tsakiyar tsakiyar layi zuwa sararin samaniya na 5.

A wuraren maki biyar na al'adun gargajiya, ana jin sautuna 2 da dakatarwa 2. A maki na 1 da na hudu, Ina jin sautin da yafi dacewa, tsawo, mara nauyi, ya biyo bayan dogon hutu, ya zo daidai da motsawar jijiya da bugun jini a gefe. A maki na 2 da na 3, ana sauraren sautin II mafi kyau, mai ƙarfi, gajeru, tsayi, yana biye da gajeriyar hutu fiye da sautin I, ba daidai da raɗaɗin apical da bugun jini a cikin jijiya ba, an lura da haɓaka sautin II sama sama da bawul ɗinrtic. Ba a jin kararraki da kararraki. Babu wata hayaniya a cikin tashin hankali.

Cutar narkewa da gabobin ciki.

Jarrabawa

Ksarfin mucous, mai laushi da taƙarar wuya, da baya na makogwaro akwai ruwan hoda, ɗumi, mai tsabta. Tonsils ba su wuce kima da artsine ba. Ba a canza launin gum ba, launin shuɗi mai haske, baya zubar jini, baya rauni. Haushi ba shi canzawa. Odo, fasa a cikin sasannin bakin da herpes labialis ba ya nan. Harshen ruwan hoda mai ruwan hoda, babu fashe-fashe, rauni, babu kumburi.

Abun ciki na madaidaicin tsari, mai kwantar da hankali, yana cikin aikin numfashi. Babu bayyananniyar rigar ciki da ciki. Hanyar sadarwar subcaneous na venous akan bangon gefe da ciki kuma ba a bayyana shi ba. Hernia, rarrabuwar tsokoki na ciki na farji ba a hango su a gani. Bango na ciki na da taushi, cikakke, mara jin zafi, latsawan ciki ba shi da ƙaranci, babu wasu wuraren rashin jini.

Tsarin hanta bisa ga hanyar Kurlov

Yankin babba na wulakancin hanta a hanun tsakiyar clavicular layin yana matakin matakin VI rib (aya na farko).

Babban layi a kan tsakiyar mediya - wanda aka kaddara bisa ka'ida, zana layi daga matakin da aka samu ta hanyar zurfin kan iyakar ta hanyar layin tsakuwa zuwa tsakiyarta tare da layin mediya na gaba (maki 3).

Borderarshen iyakar hanta yana kan madaidaicin tsakiyar layin clavicular a matakin ƙananan gefen ƙananan tsararraki (maki 2), akan layin mediya na gaba - a kan iyakar babba da tsakiyar tazarar tsakanin tsarin xiphoid da cibiya (maki 4), a gefen hagu na tsada wani baka - a matakin VII rib (aya 5).

Girma ta farko ita ce nisan da ke tsakanin manya da ƙananan iyakokin hanta tare da layin tsakiyar clavicular - 9 cm (tsakanin maki 1 zuwa 2).

Girma na biyu shine nisan da ke tsakanin maki na uku da na huxu, maɓallin na uku shine ma'amala ta kewayawa ta hanyar da aka dawo dashi daga ayarin kusan zuwa tsakiyar tazara - 8 cm.

Girman hanta na uku ko na ciki wanda yake tsakanin maki 3 da 5. 5 maki yayi dace da ƙananan iyakar hanta tare da hagu mai tsada - 7 cm.

Tsinkaita ciki bisa tsarin Obraztsov

Determinedarshen gefen baƙin ciki an ƙaddara shi tare da gefen ƙimar farashi ta hagu a matakin X haƙarƙarin zuwa wurin bayyanar sautin maras nauyi (aya 1).

Determinedarshen gefen baƙin ciki yana ƙaddara akan layi a cikin shugabanci na farkon zuwa wurin da ya faru da sauti maras kyau (aya na 2).

Tsawon baƙin ciki yanki ne wanda yake haɗa maki 1 da 2 - 6 cm.

An ƙaddara diamita mara ƙyashi ta hanyar hanyar magana daga mahaɗa zuwa tsakiyar mafitsara a cikin shugabanci daga sauti mai bayyana zuwa maras kyau, gwargwadon perpendicular, wanda ke rarraba tsinkayen a cikin rabin, har sai sautin maras kyau ya bayyana (aya ta 3). Matsayi na 4 ana ƙaddara tsinkaye daga ƙasa zuwa sama, amma zuwa ɓangaren ɓangaren na murƙushewar, wanda ke rarraba tsawon baƙin cikin rabi, har sai sautin maras kyau ya bayyana. Yanki yana haɗa maki 3 da 4 - diamita na baƙin ciki - 4 cm.

Nazarin Pancreatic

Palpation na koda

maganin huhu baya palpable.

Babu kumburi da rauni na fata sama da kodan.

Kodan ba palpable. Jin zurfin palpation a cikin tsinkayen kodan da ureters mara ciwo ne.

Alamar bugawa mara kyau ce. Rage ciki kyauta ne, mara zafi ne, mai sauri. Diuresis ya wadatar.

Kwarewa a bayyane. Sirrin al'ada ne. Mai haƙuri ya amsa tambayoyin daidai. A yanayin da ya dace. Ba a lura da raunin magana ba. An lura da ɗan fushi, ƙarancin ƙwaƙwalwa. Asymmetries na fuska, santsi na nasolabial Musulunci, karkatar da harshe zuwa gefen can. Yara suna motsawa daidai, amsawa zuwa haske da masauki yana da jinkiri. An daidaita ayyukan motsi, amintacce. Tendon reflexes ba tare da fasali ba. Haushi da jijiyoyin jiki sun ragu akan yatsun kafa, a wasu yankuna kuma ba a canza su. Babu wani rawar jiki da yatsun gaba daya.

Wata gabar jiki: fata yana da dumi, launin fata al'ada ne. Babu canje-canje trophic a cikin wurare na interdigital, kyallen yatsunsu, kumburi a kan bayan baya na hannaye, ƙafa, kafafu da aka samo. Kayan jijiyoyin jijiyoyin ƙananan ƙarshen al'ada ne.

Yawan gashi na mace. Ana lura da asarar gashi a kai. Ganuwar dabbobi masu shayarwa an rage girmanta.

Primary: nau'in cutar sankarar mellitus ta 1 matsakaici mai ƙarfi, lalata.

Abubuwan haɗari: Ciwon ɗuwa mai ciwon sukari 1 tbsp; polyneuropathy na ciwon sukari 2 tbsp; kamuwa da cuta mai rikitarwa.

1. Gwajin jini na asibiti.

2. Babban binciken fitsari.

3. Acetone a cikin fitsari.

4. Yawan canzawar yau da kullun a cikin glucose na jini.

5. Bilirubin, gwajin hanta.

6. Halittar jini.

7. Matsayin potassium a cikin jini.

8. Duban dan tayi na glandar thyroid.

10. Tattaunawa tare da likitan ophthalmologist: jarraba jari.

Anamnesis na cutar

Yana ɗaukar kanta rashin lafiya tun 1986 (shekaru 36), lokacin da gunaguni masu zuwa suka bayyana: ƙaruwar ƙishirwa (har zuwa lita 8 a rana), yawan urination, ƙaruwa mai rauni, raunin nauyi mai nauyi (sama da watanni 4 mara haƙuri ya ɓace 13 kg). Kwayoyin cuta ko wasu cututtukan cututtuka masu mahimmanci kafin wannan bai lura ba. Na juya neman taimako a watan Oktoba 1986, lokacin da kamshin acetone daga bakina ya bayyana. Asibiti.Matsayin glycemia shine 18 mmol / l; glucose da jikin ketone a cikin fitsari. An gano mai haƙuri da nau'in I diabetes mellitus, an wajabta maganin insulin. Bayan makonni 3, an saki mai haƙuri a cikin halin diyya. A cikin 1988, ya sake komawa cikin asibiti tare da alamun ƙetare iyaka (tsananin ƙishirwa da polyuria da safe, yunwa, gumi da maraice da maraice). Matsayin glucose baya tunawa. Mai haƙuri ya daidaita sashin insulin. An shirya wannan asibiti, a cikin watan Fabrairun 2005 mai haƙuri ya fara lura da abubuwan mamaki na rashin kuɗi (bushe bushe, ƙishirwa, polyuria, rauni), ya tafi likita, an kwantar da shi a asibiti.

ANAMNESIS NA RAYUWA

Girma da haɓaka kullun. Na shiga makaranta tun ina da shekara bakwai. Ya kammala karatun aji 8 da makarantun koyar da sana’a. Daga baya ya yi aiki a matsayin direba.

A duk tsawon rayuwa, abinci mai gina jiki ya cika cikin inganci da ƙimantarwa. Kar ku sha taba. Barasa baya cinyewa.

Yana zaune a falo. Yanayin gidaje na gamsarwa. Ana kiyaye ka'idodin tsabtace mutum a kai a kai.

Yana zaune a amintaccen yanayi a cikin muhalli da kuma tsabtace-cututtukan cututtuka. Ban tuntuɓi marasa lafiya na kamuwa da cuta ba. Ban tafi waje da yankin Smolensk ba. Ba a fitar da jini da allurar ba.

Babu tarihin cutar rashin lafiyar.

Da wuya, ARVI ba shi da lafiya (1 lokaci a cikin shekaru 1.5). A lokacin ƙuruciya, ya sha fama da ƙugu, rubella da pox kaji. Daga bayanan aiki: appendectomy. Babu wani tarihin cutar tarin fuka da cututtukan da ke ɗaukar jima'i.

BAYANIN GASKIYA

Tsarin Jiki 76 kg

Yawan zuciya = 76 be da minti daya.

HELL = 120/80 mm. Hg. Art.

A lokacin kulawa, yanayin mai haƙuri yana da gamsarwa. Cikakken sani, halin aiki, isasshen amsa ga wasu. Amsa tambayoyi tare da nishaɗi, na jin daɗin jama'a. Maganar ta yi daidai, gabatarwa a bayyane yake, pronunciation daidai ne. Ayyukan motsa jiki da na tunani sun dace da shekaru.

Halin fata da membran mecoranes

Fata mai tsabta, mai launin fata. Gangar jikin mucous na gani mai ruwan hoda, mai tsabta, danshi. Haɗakar idanu ita ce launin shuɗi. Ba a canza launin da zazzabin cizon sauro ba. Fata danshi yana da matsakaici, elasticity yana tsakanin iyaka al'ada. Babban kauri na fatar fata a cikin bangarorin suma iri daya ne. Kwayar cuta ta ƙarshe "-".

Ba a fadada hanyar sadarwa ba

An inganta shi cikin matsakaici, an rarraba shi a duk faɗin jiki.

An adana ƙwayar turgor. Babu bayyanannun edemas.

KYAUTA - SIFFOFIN MUSULMI

Tanjikin ƙanjamau mai kafaɗa. Girman sararin intercostal a sassan sassan mai daidai ne. Nau'in jiki na Normostenic. Kirji daidai ne, ba tare da lalatawa ba.

Lokaci yana da tsawo. Siffar yatsun babba da na ƙananan baya ba tare da canje-canje ba, ba a gano ƙafafun lebur ba.

Hadin gwiwa mara canzawa, kamannin al'ada, bb. M motsi da aiki motsi a cikin gidajen abinci cikakken. Ba a canza kyallen takarda a cikin gidajen abinci ba.

Tsokoki na ƙananan ƙarshen ya kasance mai haɓaka da ma'ana. Sautin muscle na al'ada ne. Clearfin tsoka ya dace da jinsi da shekaru. Ba a gano Paresis da inna ba. Tsokoki b / w.

Tsarin KYAUTA.

Numfasawa ta hanci kyauta ne, babu jin zafi akan tsinkayar sinuses. Larynx talakawa ne. Muryar tana cikin nutsuwa. Babu fitowar hanci daga hanci. Kwayoyin mucous na bakin ciki shine ruwan hoda. Harshen tsabta, danshi, papillae ba su da hauhawar jini, ba fasa. Palatine tonsils ba a haɓakawa ba, babu plaque. Bangon baya na pharynx ba shine hyperemic ba, ba tare da plaque ba.

Kodan yana da sifar kamar mazugun ruɓaɓɓu, mai daidaituwa, duka biyun halbs ɗin suna daidai da hannu a cikin ayyukan numfashi. Babu kumburi da koma baya na wurare masu tsada. Girman sararin intercostal a sassan sassan mai daidai ne. Musclesayoyin tsokoki ba sa hannu cikin aikin numfashi. Cikakken kusurwa na madaidaiciya - ban gwiwowin kafada suna daga da kwatancin. Numfashi na ciki NPV = 18, bugun jini = 76, rabo daga NPV da yawan zuciya = 1: 4.2. A vesicular numfashi. Babu dyspnea a hutawa.

Chest b / w, na roba. Muryar rawar jiki al'ada ce, ana yin su daidai da sassan kan kirji.

Tare da tsinkayar tunani a duk yankin huhu, an fayyace ma'anar sauti na huhun zuciya. Tare da tattaunawar yanayin magana:

Bordersananan kannukan huhu

• l. medioclavicularis 6th rib
• l. axillaris media 8 rib 9 rib
• l. scapularis 9 rib rib 10
• l. tsari mai fasasshewa na Th 11

Motsi daga cikin ƙananan gefuna na huhu

• l. axillaris media 3 cm 3 cm

A vesicular numfashi, babu sauti na biyu na numfashi. Bronchophony a wurare masu daidaituwa ba a canza su ba.

Tsarin CARDIOVASCULAR.

Yankin zuciya bai canza ba. Zuciyar zuciya bata nan. Ba a gano musabbabin zuciya ba. Ba a lura da jijiyoyin bugun carotid na kumburi na jijiyoyin mahaifa, kumburi da kuma juyewar bangarorin tsakiya. Ba a bayyana hanyar sadarwar cibiyoyin ba.

Pulse 76 / min., Synchronous, iri ɗaya a kan hannayen biyu, rhythmic, cika al'ada da tashin hankali, ba a hanzarta ba, uniform. Ba a gano ƙwanƙwarar ƙwayar ƙwayar cuta ba.

An bayyana ma'anar ta apical a cikin sararin intercostal na biyar 1.5 cm daga ciki daga layin midclavicular, ba a zubar ba, murabba'in 1 cm, tsayin 1 mm, na matsakaici ƙarfi.

LABARIN KASAR CARDIAC.

Abubuwan da ke Iyakokin iyaka

gefen dama na hagu daga bakin amintaccen gefen hagu na murfin

bar 1.5 cm a ciki daga kusa da kushin hagu

layin karan tsaye

babban rib 3 na rib

Sautin zuciya ya bayyana sarai, rhythmic. Babu amo.

Kwayoyin mucous na bakin ciki shine rigar ruwa mai ruwan hoda. Harshen tsabta ne, danshi, papillae ba a faɗaɗa su, ba fasa. Babu hakoran hakora. Ba a canza gyambuna ba, ba a yi jini ba. Bangon baya na pharynx, mai ƙarfi mai laushi mara nauyi ba shi da hauhawar jini, ba a rufe shi ba, babu raunuka. Falatine tonsils ba su tallatawa daga gefen bangarorin palatine, ba su da ƙazamin magana, ba tare da plaque ba. Hauwa ba ta karye. Yankin abinci ta hanyar esophagus kyauta ne, mara zafi ne. Abun ciki zagaye ne da tsari, daidaituwa, girmansa daidai. Peristalsis a cikin ido ba bayyane ba. Ba a bayyana hanyar sadarwa ba. Ba a gano bambance-bambance a cikin kususwa na ciki da hernias ba. Tsokoki na bangon ciki na ciki da gangan suna shiga cikin aikin numfashi. An bayar da kujera, lokaci 1 a rana, aiki na rashin nasara b / b.

Tare da palpation na sama, ciki yana da taushi, mara jin zafi. Sautin tsoka na bangon ciki na matsakaici ne. Ba a samu talakawa masu ciki ba Ba a gano tsaurara da banbance-bancen cikin tsokoki na bangon ciki ba. Hankalin tare da gefen ƙimar farashi, lafiyayyar ba ta faɗaɗa.

Tare da zurfin hanyoyin motsa jiki mai zurfi na yanayin ɗabi'a a cewar Obraztsov - Strazhesko:

- a cikin yankin Ileal na hagu, sigmoid colon an palpated a cikin nau'i na santsi, na roba, mara zafi, dan kadan igiyar hannu d = kimanin. 2 cm, ba jita-jita.

- a yankin dama na Ileal, an huɗa danshin a cikin yanayin mai laushi, na roba, mara zafi, ba jita-jita ba, igiyar sililin dan kadan d = kimanin. 2 cm

-Waikin mallaka mai jujjuyawar an buga shi 1.5 cm sama da cibiya a cikin nau'i mai laushi, na roba, mara zafi, babu jita-jita, iyakantaccen motsi Silinda d = kimanin. 2 cm

- a yankin yanki na dama na gaba, an hauhalar ƙawancen ƙawancen kwalliya azaman mai laushi, na roba, silinda mara zafi d = kimanin. 1.5 cm, iyakance motsi, ba jita-jita ba.

- a yankin yanki na hagu na hagu, an sauko daga wuyan wuyan an bayyana shi azaman mai santsi, na roba, silinda mara jijiya d = kimanin. 1.5 cm, iyakance motsi, ba jita-jita ba.

- Yankin karamin hanji ba shi da ciwo a kan bugun jini.

Hanta a kan palpation: 0,5 cm .. Ya shimfiɗa daga saman ƙasan tsada. Lowerarsashinta ya ɗaure - na roba, mara zafi, mai laushi, har ma.

Tare da hasashe: girman hanta a cewar Kurlov:

- tare da layin midclavicular dama 11 cm.

- a cikin tsakiyar 9 cm.

- gefen gefen baka (hagu), girman gwal shine 6.5 cm.

Bayyanar cututtuka na Kerr, Ortner, bugun oblique, Squirsky, Murphy, Jonas, Boas, Mussi - Georgievsky, Courvoisier - ba su da kyau a lokacin kulawa.

Kwayar ba ta palpable ba ce. Kwayar cutar Kach, Boas, Mendel, Mayo - Robson, Jonahs - alama ce.

Ciki kan allurar iska. A 2 cm sama da cibiya, babban curvature na ciki yana palpated a cikin nau'i na santsi, taushi, na roba, na bakin ciki m.

Saifa ba palpable. Girman tattaunawar shine 4: 6 cm.

Palpation na mesenteric l / y a cikin yankin Stenberg ba shi da raɗaɗi.

Fata a cikin yankin lumbar na launi na yau da kullun, ba'a lura da hyperemia. Bayyani bugu na gani a fuska, wata gabar jiki, da ƙananan baya ba a lura dashi. Babu kamshin gaskiya a fuska. Abun ciki yayi dai-dai, wanda aka zagaye shi da sifa, ba ya yin tasiri fiye da gefen gefan farashi masu tsada. Mafitsara ba ya tallafar bayan mahaifa.

Palpation a cikin yankin lumbar, sacrum da ƙananan ƙarshen ba su bayyana edema ba. Kodan a cikin matsayin supine da a tsaye ba palpated, palpation bashi da ciwo. Mafitsara ba palpable bane. Abun jin zafi da bugun jini a tare da ureters marasa ciwo ne.

Alamar Pasternatsky ba ta da kyau a garesu. Mafitsara bata wuce mahaifa. Ba a gano kasancewar ruwa mai laushi cikin rami na ciki ba.

Ruwa ba shi da raɗaɗi, sau 4-5 a rana. Launin fitsari bambaro ne mai rawaya.

Glandar mahaifa: tsayi 175 cm, tayi daidai da shekaru da jinsi. Babu wuce haddi ko kasawa. Subcutaneous mai nama yana ci gaba ta hanyar daidaitacce, rarraba shi daidai.

Thyroid: ba a kara girma ba.

Kwayar Parathyroid: jijiya da ƙoshin fata suna da matsakaici.

Thymus: nono ba haɓaka

Gland shine yake: tsarin tsoka da kasusuwa ana haɓaka su bisa ga shekaru da jinsi. Fata yana da launin fata. PZhK an rarraba shi a ko'ina. HELL = 12080. Babu wani gishirin gishiri. Babu gunaguni daga ƙwayar gastrointestinal.

Pancreas Mai haƙuri ya koka da yawan ci, busasshen baki, ƙishirwa (galibi da safe da maraice) zuwa lita 3 a kowace rana, asarar nauyi sama da watanni 3 ta 5 kilogiram. Urin saurin hanzari, urination da daddare (1 lokaci).

Gonads: Kwayoyin na waje an kafa su daidai.

Epiphysis: babu alamun girman girma a cikin kwanyar. Ciwon kai, maƙarƙashiya, bradycardia - babu.

Kuna iya saukar da cikakken sigar tarihin ilimin likita na endocrinology anan.

CIGABA DA MUTANE

A lokacin karbar kudi:

Marasa lafiya na koka da yawan ci, tare da palpitations, bushe baki, ƙishirwa (galibi da safe da yamma) zuwa 3 a kowace rana, asarar nauyi fiye da watanni 3 by 5 kg. Urin saurin hanzari, urination da daddare (1 lokaci). Damuwa game da raunin girma daga Disamba - watan, cramps, jin zafi a ƙafa, gindi, yanki inguinal, ƙwaƙwalwar ajiya.

KYAUTAR Cutar

Yana ɗaukar kanta mai haƙuri tun Yuni na 1996 (shekaru 36), lokacin da gunaguni masu zuwa suka bayyana: ƙaruwar ƙishirwa (har zuwa lita 8 a kowace rana), yawan urination, ƙaruwa mai rauni, raunin nauyi mai nauyi (fiye da watanni 4 mara haƙuri ya ɓace 13 kg). Raunin kafa ya bayyana. Kafin wannan, ban lura da kwayar cuta ko wata cuta mai tsanani ba. Na je asibiti a watan Oktoba 1996, lokacin da kamshin acetone daga bakina yake. Asibiti. Matsayin glycemia shine 18 mmol / l; glucose da jikin ketone a cikin fitsari. An gano mai haƙuri da nau'in ciwon sukari na nau'in, an sanya maganin insulin na al'ada - raka'a 54 / rana. Bayan makonni 3, an saki mai haƙuri a cikin halin diyya. Bayan fitarwa, ta kan lura da yanayin rashin kwanciyar hankali a kullun (sau da yawa da dare), tare da yin gumi, rauni, rawar jiki, da kuma tsananin jin yunwar. Ba a rage adadin insulin ba. Watanni shida bayan haka, yawan lokutan irin wannan yanayi ya ragu. A cikin 1997, an sake kwantar da ita a asibiti tare da alamun rashin kuɗi (tsananin ƙishirwa da polyuria da safe, yunwa, gumi da maraice da dare), jin ciwo a kafafu. Glycemia baya tunawa. Mai haƙuri ya daidaita (rage) kashi na insulin. Bayan wannan asibiti, an lura da yanayin hypoglycemic ba akai-akai ba. Binciken don glycemia an yi shi sau 1 a wata a asibitin. Na kiyaye abincin, amma kashi na insulin bai canza ba dangane da adadin carbohydrates. Asibitoci masu zuwa - a shekara. A shekara ta 1999, ta yi karatu a makarantar masu ciwon sukari, amma ba ta kiyaye fitila ba, ba ta kirga adadin guraben abinci a abinci ba. A wannan shekarar ta sami rukuni na rashin ƙarfi na III don cutar ta ainihi. An shirya wannan asibiti, a cikin Disamba 2000, mai haƙuri ya fara lura da abubuwan mamaki na lalata (bakin bushe, ƙishirwa, polyuria, rauni), ya tafi likita, an kwantar da shi a asibiti.

Tarihin mahaifa:

Duk wata-wata daga shekaru 14, aka kafa zagayen kai tsaye. Mai raɗaɗi mai raɗaɗi, yalwatacce, tsawon lokaci (5 kwana). Zaman zagayawa shine kwana 26. 6 masu ciki 3 haihuwa (79, 82, 85)

Ya ƙaryata game da tarin fuka, cututtukan da ke ɗaukar jima'i, hulɗa tare da marasa lafiya na kamuwa da cuta. A shekara ta 1982, tana da cutar hepatitis.

Ban lura da bayyanar cututtuka na rashin lafiyan kowane irin ƙwayoyin cuta ba, abinci, magani.

Tarihin Zubarwa: Babu zub da jini.

Fata da mucous membranes

Fatar ta yi kauri, zafi na yau da kullun. A fata ne na roba, m, nama turgor kiyaye su. Ba a bayyana ƙarancin kitse ba, kauri mai ninka a cibiya shine cm 1 Gashin gashi, daidaitacce, yayi dace da bene. Ana lura da kwancewar alopecia da necrobiosis a kafafu. Nailsusoshin ƙusa da hannu da ƙafafu suna da m, launin toka-launi a launi, mai tsabta. Mucous ido yana da ruwan hoda, mai laushi, mai tsabta. Sclera bai canza ba. Harshen yana ɗan ƙara girma a cikin girman, tare da gefuna sune abubuwan hakora.

Tsarin numfashi

Ba a canza nau'in hanci ba, maƙogwaron ba ya lalata. Numfashi ta hanci kyauta ne, babu fitarwa. Hoarseness of murya, aphonia, no tari. Rhythmic numfashi, numfashi - 17 / min, irin kirji numfashi. A kirji ne mazugi-mai siffa, mai fasali. A kan jarrabawa, babu lalata jikin kirji. Siffar kirji ta al'ada ce. Dukansu suna hallara suna wasan kwaikwayo na numfashi. Hannun kafaɗun kafada da maƙulli suna daure a kirji, mai fasali. Ana magana da falmarar supira- da subclavian.

Palpation na kirji juriya na al'ada ne, babu wuraren da aka gano rauni, rawar jiki murya a cikin wurare masu sihiri iri ɗaya ne.

Tsinkaye na kwatankwacinsa: A duk yankuna na huhu, bayyanar sautin a bayyane take.

Tattaunawa na halin mutum: An ƙayyade iyakokin huhunnun a matakin da aka saba, tsayuwa mai tsayi na ƙwanƙwasa huhu a gaban shine 3.5 cm daga murƙushe zuwa dama da hagu. Komawa - a matakin layi na kwance a kusoshi ta hanyar juyawar hanyar jijiyoyin jini na mahaifa a cikin huhu biyu. Filayen Krenig: a hannun dama - 5 cm, a hagu - 5.5 cm.