Matenda a shuga a II

Calcium (2.3-2.75) 2.89

10.30.2002 Kufunsa wodwalayo komanso zoyambirira za wodwalayo. Kutentha 36.5 0 С. HELL 130/90 mmHg Mpando ndi wabwinobwino, wopanda, wokongoletsedwa. Wodwalayo amadandaula za kupweteka ndi kupsinjika kwa miyendo, kupweteka kwa mafupa. Pakufufuzidwa: khungu la miyendo labowola, louma, losweka. Mkhalidwe wa khungu ndi wabwinobwino, mucous nembanemba mkamwa ndi milomo ndi pinki, osasinthika.

Novembala 1, 2002 Kafukufuku wachitika. Mphamvu zazikulu mu mkhalidwe wa wodwalayo sizinawonedwe. Kutentha 36.7 0 С, kuthamanga kwa magazi 130/85 mm Hg Mpando ndi wabwinobwino. Pofunsidwa, wodekha amakhala wodekha, amayankha mafunso kwenikweni. Madandaulo a chizungulire ndikusintha kwa kayendetsedwe ka thupi, kukweza. Wodwala amayenda mwachangu, kupita kuchipinda chothandizira kulimbitsa thupi, kulandira kulandira mankhwala.

Novembala 4, 2002 Wodwala ali ndi thanzi labwino, ali muubwenzi. Wodwala amakhala wokondwa, akuwonetsa kusintha kwina, poyerekeza ndi nthawi yomwe alowe kuchipatala. Wodwala sawonetsa madandaulo owonjezera. Potengera momwe mankhwalawo amathandizira, khungu la kumapazi limayenda bwino, redness idasowa. Kulakalaka zabwino. Mpando umakongoletsedwa. Kutentha 36.7 0 С. HELL 125/90 mmHg

Timazindikira matenda a shuga pamaziko a madandaulo (polydipsia, polyuria, kuchuluka kwambiri kwa thupi), zambiri zasayansi (glycemia, glucosuria). Nthawi yomweyo, chikhalidwe cha kutukuka ndi maphunziridwe (kukula kwakapangidwe pang'onopang'ono, kusakhalapo kwawonekera kwamankhwala), cholowa chamtundu, kuzindikira kwa mankhwala amkamwa ndi othandizira a hypoglycemic (maninil) akuwonetsa mtundu II matenda ashuga. Vutoli limafanana ndi kusakhazikika kwenikweni, chifukwa pali zovuta za matenda ashuga: retinopathy I (diabetesic retinal phlebopathy, retinal hypertgency angiopathy in the both eyes), nephropathy I (edema, kuchuluka kwa magazi), microangiopathy ndi distal polyneuropathy (madandaulo a kupweteka, dzanzi la miyendo, kusintha kwa khungu. miyendo yotsika). Pakadali pano, wodwalayo ali pachiwopsezo cha kubwezera, monga momwe madandaulo ambiri atchulidwa pamwambapa komanso kuchuluka kwa glycemia.

Etiopathogenesis. Mphindi yayikulu ya pathogenetic ya matenda a shuga a mellitus II ndikuphwanya koyenera kwa mphamvu ya zolandila ma cell kupita ku insulini, mbali imodzi, ndipo, kumbali, kukayika kwapadera kwa maselo a beta a islet pancreatic zida. Zophwanya izi zimatsimikiziridwa mwabanja, monga zikuwonetsedwa ndi cholowa chovuta. Chochititsa chidwi pamilandu iyi,, zikuwoneka, kuwonjezeka kwakukulu kwa kulemera ndi kusinthika kwakukulu m'madzi a mahomoni panthawi yapakati, komanso gestosis yayikulu panthawi yachiwiri yapakati.

Mankhwala ochepetsa shuga: shuga 0,88 g 2 r / tsiku, mapiritsi awiri omwe amadya

Lipoic acid 0,025g 1tab katatu pa tsiku

Nicotinic acid 0,05 g piritsi limodzi. 3p / tsiku

IV pentoxifylline drip 100 mg mu 400 ml 0,9% NaCl

Vit. B1 (thiamine) 0,05 ampoules a 1 ml / m Numero 10

Wodwalayo adalandiridwa ku dipatimentiyo pa 10/18/02 ndi zizindikiro zakunyumba kwa mtundu wachiwiri wa matenda a shuga. Cholinga cha mankhwala pankhaniyi chinali kukonza kagayidwe kazakudya, kukhazikika kwa mkhalidwewo ndi kuchepa kwa kupitirira kwa zovuta. Poyerekeza ndi momwe mankhwalawo amathandizira, mkhalidwe wa wodwalayo unasintha, madandaulo a polyuria, polydipsia anasiya, kuthamanga kwa magazi ndi glycemia kuchepa. Wodwalayo adaphunzitsidwa kutsatira malamulo oyenera pakuwongolera matenda. Wodwalayo adathamangitsidwa kunyumba ndikulipidwa. Yalangizidwa: Zakudya, kuchepetsa zakudya zopatsa mphamvu, kuchuluka kwa chakudya chambiri m'mimba ndikusunga kuchuluka kwamapuloteni: mafuta: chakudya = 20: 25: 55. Pharmacological mankhwala a shuga 2 mapiritsi 2 pa tsiku ndi chakudya. Kuwona ku endocrinologist wakomweko ndi kukonza pulogalamu yamankhwala kutengera ndi matendawa. Argonlasercoagulation ya retina ya maso onse awiri ndikuwunikira kwina kwamayendedwe amalimbikitsidwanso. Kupewa kwa chitukuko cha matenda ashuga - ukhondo kusamalira mapazi, kuyezetsa miyendo mukamachezera dokotala osachepera 1 m'miyezi isanu ndi umodzi.

Kuneneratu: ngati izi zikutsatiridwa, kubwezeretsedwa kwa matenda kwa nthawi yayitali popanda kukhalapo kwa kupitilira kwa zovuta.

Anamnesis wamoyo wodwala matenda, madandaulo ake atavomerezedwa. Konzani mawilo a wodwalayo, kuwunika zotsatira zake. Kulungamitsidwa kwa matendawa: matenda a shuga a shuga a m'munsi omwe ali m'munsi. Njira yothandizira matendawa, matendawo moyo.

Kutumiza ntchito yanu yabwino pamaziko azidziwitso ndikosavuta. Gwiritsani ntchito mawonekedwe pansipa

Ophunzira, ophunzira omaliza, asayansi achichepere omwe amagwiritsa ntchito chidziwitso m'maphunziro awo ndi ntchito adzayamika kwambiri.

Yolembedwa pa http://www.allbest.ru/

Sukulu yophunzitsa za boma yaukadaulo maphunziro apamwamba

"Saratov State Medical University

iwo. V.I. Razumovsky Federal Agency for Healthcare and Social Development "

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

Mutu wa Dipatimenti: Doctor of Medicine, prof. Rodionova T.I.

Zaka: zaka 78: (02.08.1934)

Chithandizo chachikulu cha zamankhwala: Mtundu Wachiwiri wa matenda a shuga ogwidwa ndi matenda osokoneza bongo, woyamba kupezeka, gawo la kuwonongeka kwa metabolic.

Zovuta: Matenda osokoneza bongo a ischemia a genesis osakanikirana. Matenda a shuga a retinopathy ndi gawo losakula. Matenda a shuga a shuga a m'munsi okhala m'munsi. Distal diabetesic polyneuropathy. Mafuta hepatosis.

Zokhudzana: Arterial matenda oopsa 3 madigiri, chiopsezo 4. Atherosulinosis ya msempha, matumbo, ziwongo. Mkhalidwe pambuyo poti bere lamanzere mu 2005 limapezeka ndi khansa, kenako chemotherapy.

Mbiri: Kulemera kwa IIa II.

2. Age: zaka 78 (08/02/1934)

4. Adilesi: Saratov.

5. Umodzi: nzika wamkulu

6. Tsiku lovomerezeka kuchipatala: 12.10.12g.

7. Ndi chipatala chiti chomwe chimatumizidwa kuchipatala: chipatala komwe amakhala

8. Kuzindikiritsa madokotala omwe akutchulidwa: Type II matenda a shuga, opezeka woyamba, gawo la kuwonongeka kwa kagayidwe kachakudya.

9. Matenda azachipatala:

Choyamba: Type II matenda a shuga, opezeka woyamba, gawo la kubwezeretsa kwa metabolic.

Zovuta: Matenda osokoneza bongo a ischemia a genesis osakanikirana. Matenda a shuga a retinopathy ndi gawo losakula. Matenda a shuga a shuga a m'munsi okhala m'munsi. Distal diabetesic polyneuropathy. Mafuta hepatosis.

Zokhudzana: Matenda a mtima. Arterial matenda oopsa 3 madigiri, chiopsezo 4. Atherosulinosis ya msempha, zamitsempha yamagazi, ziwiya. Mkhalidwe pambuyo poti bere lamanzere mu 2005 limapezeka ndi khansa, kenako chemotherapy.

Mbiri: Kulemera kwa IIa II.

· Atangolowa, wodwalayo adadandaula pakamwa pouma, ludzu losalekeza, kukodzanso kwamkodzo, kuphatikizapo kukodzetsa usiku, kuchuluka kwamkodzo, kuchuluka kwa magazi mpaka 12 mmol / l

Kuyenda m mapira.

Ululu, dzanzi komanso kutsekemera kwa mapazi,

Zowonongeka pamtima, kupweteka kwa mutu kwakanthawi popanda chidziwitso chowonekera, chizungulire,

Kuchepa kudya, kunenepa kwambiri kwa 7 kg pa miyezi itatu yapitayi, kufooka kwathunthu.

Amadziona kuti ndi wodwala kuyambira mu Juni 2012, pomwe adayamba kukondwerera madandaulo apamwambawa. Zizindikiro zimayamba pang'onopang'ono. Kumayambiriro kwa chilimwe, madandaulo adafotokozedwa mwapang'onopang'ono, sanawone dokotala.

Kumayambiriro kwa Okutobala, mkhalidwe wa wodwalayo unakulirakulira kwambiri (kufooka kunachuluka, kuchepa thupi kunali 7 makilogalamu, ludzu linayamba kuvuta pafupipafupi, kukodza kumakulirakulira mpaka ka 15 patsiku, katatu nthawi usiku, kuyabwa m'dera la inguinal).

Ndi madandaulo awa, wodwalayo adatembenukira kuchipatala komwe amakhala. Laborator Therapist adalembedwa ndi akatswiri azachipatala komanso kuchuluka kwa glycemia mpaka 14 mmol / l ndipo kupezeka kwa acetone mu mkodzo (+) kunapezeka. Matendawa anapangidwa: Mtundu Wachiwiri wa matenda a shuga a mellitus, woyamba kudziwika, gawo la metabolic decomproll. 10/12/12 wodwalayo adatumizidwa kuti akagonekere ku chipatala cha 9, dipatimenti yodzidzimutsa endocrinology.

Wodwalayo amakhala ku Saratov, m'nyumba yake. Sikugwira ntchito. Amayi kuyambira azaka za 18 samandipweteka. Kusiya kwa zaka 44. Omwe anali ndi pakati, 2 imatha mu kubereka mwachangu. Anakula ndikukula malinga ndi msinkhu wake.

Malo antchito: penshoni.

Prof. Panalibe chowopsa panthawi yonse yomwe amagwira ntchito.

Mwa matenda anati pachimake kupuma matenda, Influenza.

TB, syphilis, hepatitis, HIV - imakana.

Mbiri yakubadwa siyiri yolemetsa.

Palibe matenda obadwa nawo m'banja.

Kuphatikiza ndi odwala opatsirana kunalibe.

Kuika magazi sikunachitike.

Opaleshoni yoikidwiratu: kukhazikikanso kwa bere lakumanzere mu 2005 chifukwa cha khansa, ndikutsatiridwa ndi chemotherapy.

Matenda ophatikizika: Matenda oopsa a digiri ya 3, chiwopsezo 4 chidakhazikitsidwa ndi 55 ndi katswiri wamkulu mu polyclinic pamalo omwe akukhalamo, mankhwala adalembedwa. Amakonda kumwa mankhwala a antihypertensive (samakumbukira dzinalo). Panalibe matenda a mtima, mikwingwirima.

Kuunika koyenera kwa wodwalayo

Panthawi yoyang'aniridwa, mkhalidwe wa wodwalayo umakhala wokhutiritsa. Kuzindikira ndikudziwikiratu. Malo: otakataka Mawonekedwe pankhope ndi maso adatopa.

Kutalika: 150kg, Kulemera - 68.7 kg. BMI = 30.5. Kutentha kwa thupi 36.6 ° C

Khungu ndi ma mucous owoneka bwino amtundu wabwinobwino, popanda zotupa ndi ma pigmentation, khungu turgor limachepetsedwa.

Sinthani mu trophism ya khungu la malekezero: khungu louma, manja ndi miyendo ndiyabwino kukhudza.

Mkhalidwe wamisomali ndi tsitsi: misomali yochepetsera, makulidwe. Tsitsi limakhala loonda.

Ma lymph siwosakhazikika.

Mafuta am'madzi am'madzi okhazikika amapitilira patsogolo, ndikugawidwanso. Palibe chotupa.

Matenda a minofu: popanda matenda.

Palibe zotupa za msana kapena zopindika za mafupa amchifuwa. Kuyenda komwe kulumikizana konse ndi kopweteka, kwathunthu.

Mtima wamtima

Mawonekedwe a chifuwa m'dera la mtima sasintha. Mtima hump, kuvina kwa carotid, kutupa kwa mitsempha, ndi zotupa za epigastric kulibe. Mlingo wamtima ndi 88 pamphindi.

Kokani 90 kumenyedwa / mphindi, masanjidwe, odzaza, abwino, osapanikizika. Ripple mu zotumphukira mitsempha watsimikiza.

Zowopsa zomwe zimapangidwira mu 5thostostal space ndi 2 cm kuchokera kunja kuchokera kumanzere apakati a clavicular. Apical kukhudzika kutayika, kwakukulu. Kukopa kwamtima, systolic, palastation yakunjenjemera sikumatsimikizika.

Malire a kukhumudwa kwamtima:

Kumanja - m'malo 4 oyimitsa pambali yakumanja kwa sternum.

Pamwamba - pakati pa mizere yamanzere yamkati ndi yamphamvu pamlingo wa malo atatu oyambira.

Kumanzere - mu malo asanu oyambira 2 cm kuchokera kunja kuchokera kumanzere apakati - mzere wa clavicular.

HELL -160/90. Pamwamba pa mfundo zonse zabwino, matani amtambo, osokonekera. Kamvekedwe ka 1 paphiri komanso pamawu omvera a tricuspid ndi kutalika komanso kutalika kuposa matayala awiri, mamvekedwe 2 pomvetsera pachithunzi cha aorta ndipo thunthu la m'mapapo limakhala lokwezeka.

Mtundu wa kupuma - chifuwa, palibe zoletsa pazosunthika za khoma pachifuwa. Palibe kupuma movutikira panthawi yoyang'anira. Kupumira m'mphuno sikovuta. Mtundu wa kupuma ndi diaphragmatic. Kuyenda kwa NPV 16 miniti. Mawonekedwe a chifuwa ndi ma hypersthenic, palibe kuchema, samapweteka pakhungu, mbali yakumanzere kumanzere ikuchita nawo chimodzimodzi kupuma. Percussion adatsimikiza phokoso lodziwika bwino la m'mapapo. Kuzindikira kumamvetsera kupuma kwamaso, popanda kugudubuzika, kutalika kwa nsonga zamapapo kutsogolo kwa 3 cm, kumbuyo kwa 6 cm, minda ya Krenig 7 cm.

Kuphatikiza kwapang'onopang'ono: pamagawo ofanana pachifuwa, phokoso limakhala voliyumu yomweyo, pulmonary yomveka

malire a m'mapapu

Mzere wakutsogolo wakunja

Mzere wa axillary wapakati

Mzere wowonjezera

Njira zowonjezera za XI thoracic vertebra

Masaya mucous amkati zofewa komanso zolimba, khoma lachipilala lam'mbuyo, zipilala za palatine: pinki, lonyowa, loyera. Matani samapitilira pazingwe za palatine. Mkamwa wamkamwa umayeretsedwa. Desna sinasinthe. Lilime ndi zokutira yoyera, youma pamizu. Mimba ndimayimidwe, mwachangu, mofatsa, imapuma. Ma peristalsis owonekera, chiwonetsero cha hernial ndi kufalikira kwa mitsempha yamimba yam'mimba sizikudziwika. Mpando umakongoletsedwa nthawi zonse.

Ndi palpation yapamwamba, m'mimba ndi yofewa, yopweteka mu hypochondrium yoyenera, palibe kusiyanasiyana kwa minofu ya abctin abdominis, mphete ya umbilical siikukulitsidwa. Zizindikiro za peritoneal zimakhala zoipa. Peristalsis adapulumutsidwa.

Ndi palpation yakuya kumanzere kwa leal dera, mawonekedwe a cylindrical amatsimikizika, kupindika kokhazikika kwa kolonasi mwa mawonekedwe a mawonekedwe osalala, owoneka mwamphamvu, 1.5 cm mulifupi, osapweteka, osasunthika mosavuta. M'chigawo cholondola chakumaloko, cecum imakhala paliponse ngati silinda yofewa, yofewa. Danga lozungulira limafotokozedwa ngati dera loyenda mozungulira momwe limasunthira pansi, silinda yolimba yokhala ndi mainchesi 2,5. Phokoso limayenda pakatikati pamimba yopanda kanthu, palibe kuzindikira komwe kudapezeka.

Ndi palpation yakuya: m'mphepete mwa chiwindi limatuluka ndi 0,5 cm kuchokera m'mphepete mwa chipilala choyenera.

Kukhazikika kwa chikhodzodzo - ndulu ya ndulu nthawi yamkaka sikunatsimikizike. Ndi khunyu lakuya, ndulu sizimatsimikizika.

Mpando umakhala tsiku ndi tsiku, wokongoletsedwa.

Mukamasanthula dera lumbar la redness, kutupa, zilonda sizinapezeke. Palibe kusokonezeka kwa minofu ya lumbar. Chizindikiro cha kumenya sichili bwino mbali zonse ziwiri. Impso, chikhodzodzo pa palpation sizikudziwika. Kuchiritsa sikupweteka, mwachangu. Nocturia.

Mchitidwe wamsempha ndi ziwalo zamagetsi

Kuzindikira kwasungidwa. Yoyambira mu nthawi ndi malo. Palibe ma psychoses. Khalidwe limagwira. Ochokera. Reflexes (pharyngeal, m'mimba, tendon - periosteal: ulnar, bondo, Achilles) - wosweka. Zizindikiro za meningeal (khosi lolimba, chizindikiro cha Kernig, Brudzinsky) kulibe.

Ophunzira a mawonekedwe abwinobwino, kukula kwake, amayankha bwino pakuwala. Kusuntha kwa mawonekedwe amaso kwathunthu.

Palibe vuto la kugona. Memory: yafupika. Mutu wopweteka nthawi ndi nthawi umachitika popanda kudziwika bwino. Masomphenya amachepetsedwa, kumva, kununkhira sikukuwonongeka. M'malo a Romberg khola.

Manga: hypersthenic. Mafuta am'madzi am'madzi okhazikika amapitilira patsogolo, ndikugawidwanso.

Kutalika: 150kg, Kulemera - 68.7 kg. BMI = 30.5

Tsitsi la mtundu wachikazi.

Chithokomiro cha chithokomiro sichikukulitsidwa. Exophthalmos palibe.

Pali kuphwanya kwamvetsetsa kwamtundu wamasamba ndi masokosi, kumva kwamtopola kumachepetsedwa.

Zosangalatsa komanso kutentha kwa zala kumachepetsedwa.

Kutalika kwa chiuno ndi 118 masentimita, kutalika kwa chiuno ndi 116. OT / O = 0.99.

Kuthamanga kwa magazi kwa systolic pamiyendo ya 110 mm. Hg. Art.

Choyamba: Type II matenda a shuga, opezeka woyamba, gawo la kubwezeretsa kwa metabolic.

Zovuta: Matenda osokoneza bongo a ischemia a genesis osakanikirana. Matenda a shuga a retinopathy ndi gawo losakula. Matenda a shuga a shuga a m'munsi okhala m'munsi. Distal diabetesic polyneuropathy.

Zokhudzana: Arterial matenda oopsa 3 madigiri, chiopsezo 4. Atherosulinosis ya msempha, matumbo, ziwongo. Mkhalidwe pambuyo poti bere lamanzere mu 2005 limapezeka ndi khansa, kenako chemotherapy.

Mbiri: Kulemera kwa IIa II.

1. Kusala magazi (2 kawiri pa sabata)

2. Mbiri ya Glycemic

3. Kuyesa magazi konse (mwamphamvu)

4. Shuga mumkodzo wa tsiku ndi tsiku (2 kawiri pa sabata),

5. Serum cholesterol, mbiri ya lipid

6. Transaminases (aspartic ndi alanine mu seramu yamagazi)

7. Urea, creatinine.

9. Mimbulu Acetone Qualitatively

10. Kusanthula kwapadera kwamkodzo (mumphamvu)

11. Yesani malinga ndi Nechiporenko, Zimnitsky.

12. Serum bilirubin ndi zigawo zake

14. Kukonzanso zam'munsi,

15. Kupanga kwa Ultrasound (chiwindi, ndulu ya ndulu, kapamba, ndulu),

17. Kuyang'ana akatswiri:

1. Njira: yokhazikika

2. Gawo No. 9 (chithandizo cha zakudya)

3. Mankhwala ochepetsa shuga.

4. Mankhwala a antihypertensive (zochizira matenda oopsa)

5.Alpha lipoic acid kukonzekera (chithandizo cha polyneuropathy)

6. Nootropics (chithandizo cha HIGM)

7. Mankhwala othandizira antiplatelet

9. Ulendo wopita ku Sukulu ya Matenda a shuga

Zambiri za njira zowerengera zowonjezera ndikufunsira kwa madokotala azinthu zina

12/10/12. Kuyesedwa kwa magazi

Magazi a m'magazi: 17.6 mmol / L

Kuyesa kwa mkodzo kwa shuga ndi acetone:

Mafuta a Urine: 3 g / L

Mtundu: wachikasu

Epithelium: flat: yofunika

Maselo ofiira: asinthidwa 8-10 mu s / s

Maselo oyera: 7.2 * 109 / L

Mapulatifomu: 307,000

Neutroph ndodo: 0

Neutroph gawo. 69

Magazi a shuga 16.30: 12. mmol / l

Magazi a shuga 22,00: 13.3 mmol / l

Kuyesa kwa magazi kwa RMP: koyipa.

Kuyesa kwamwazi wamagazi:

mapuloteni onse - 60g / l

urea - 7.7 mmol / l

creatinine - 114 μmol / l

bilirubin yonse 14 μmol / l

mwachindunji: 4 micromol / l

osalunjika 10 μmol / l

Cholesterol chonse: 6.2 mmol / L

Uric acid: 357 μmol / lita

13.10.12. Mbiri ya Glycemic

Magazi a shuga 07.00: 9.4 mmol / L

Magazi a shuga 12.00: 13.2 mmol / l

Magazi a shuga 16.30: 15.0 mmol / l

Magazi a glucose 22.00: 13.6 mmol / l

Mimbulu Acetone - Yovuta

Kudumphira pa I / g ndi ndowe pa I / g ndi njira ya Kalantaryan (neg.)

Phunzirani cr. pa RMP-EM syphilis yokhala ndi khadi. antigen (neg.)

14.10.12 Akochita mkodzo Acetone: alibe

Magazi a shuga 12.00: 7.4 mmol / l

Magazi a shuga 16.30: 11.4 mmol / l

Magazi a shuga 22,00: 7.6 mmol / l

10/15/12 Mimbulu Acetone: yoyipa

Kuyesedwa kwa magazi

Magazi a Magazi: 6.6 mmol / L

10.16.12 Citsanzo Nechiporenko

Maselo oyera oyera: mayunitsi a 1250 / ml

Maselo ofiira: 0 mayunitsi / ml

10.17.12 Urinalysis malinga ndi Zimnitsky:

06.00-09.00: kuchuluka kwa 200 ml., Kukoka kwapadera: 1010

09.00-12.00: kuchuluka kwa 200 ml., Kukoka kwapadera: 1012

12,00-15,00: chiwerengero cha 200 ml., Mphamvu yapadera yokoka 1013

15,00-18,00: chiwerengero cha 200 ml., Mphamvu yapadera yokoka 1012

18.00-21.00: kuchuluka kwa 200ml., Kukoka kwapadera kwa 1011

21.00-00.00: chiwerengero cha 100 ml., Kukoka mwachindunji 1013

00.00-03.00: chiwerengero cha 100 ml., Mphamvu yapadera yokoka 1012

03.00-06.00: kuchuluka kwa 200 ml., Kukoka kwapadera kwapadera 1013

Daily diuresis 800 ml.

Usiku diuresis 600 ml.

Chiyero chonse: 1400 ml.

Mtundu: wachikasu

Epithelium: flat: yofunika

10/15/12. Kukonzanso kwamagawo akumunsi: Mapeto: Mtundu wamagazi. Kudzaza magazi kwadzaza kumachepetsedwa kuphazi kumanja, kumaso kumanja. Ma asymmetry operekera magazi m'miyendo adawululidwa (kumanzere osakwana 40% kumanja) ndi kumapazi (26% mochepera kumanzere kuposa kumanja). Chiyerekezo cha kudzaza magazi kwa phazi / mwendo wotsika kumanja ndi 1.35 (N = 1.4-1.6). Kukaniza kwamitsempha yamagawo kumakulitsidwa m'miyendo ndi kumapazi kumanzere, phazi lamanzere kumanzere, komanso kwabwinobwino mwendo wamanzere.

Mapeto: Mapeto: Chingwecho ndi cholondola, sinus. Kugunda kwamtima kwa 77 pamphindi. Chitsulo chamagetsi chamtima ndichowongoka. Kuphwanya intraventricular conduction. Kusintha kwapang'onopang'ono mu T wave mu myocardium ya ventricle yamanzere.

Kutsiliza: Zizindikiro za akupanga za hepatosis yamafuta. Kugoneka khosi la ndulu. Kusintha kwa kapamba. Bilateral hydrocalicosis.

Kufunsira kwa Neurologist: Zovuta za kukumbukira, kusinthasintha kwa mutu popanda kutulutsa kwina, kuwonekera kwa manja ndi mapazi. Ma anamnesis amaphunziridwa. Cholinga: Kuzindikira kumawonekera, kulumikizana. Wonunkhira wapulumutsidwa. Masomphenya amachepetsedwa, mawonekedwe amtundu ndi okhazikika. Ana asukulu D = S, momwe kuwala kumachitikira, palsebral fissures D = S, kayendedwe ka timaso tokwanira. Kutembenuka, malo osungidwa. Kuzindikira kumaso kumasungidwa, ma corneal, conjunctival reflexes amasungidwa. Ma Nasolabial, mafelemu apatsogolo D = S; palibenso ma asymmetries pamene maso ali ndi mawonekedwe ndi mano amawombera. Kumva ndizabwinobwino. Kumeza kwaulere, Reflex kuchokera kukhoma kofewa komanso kumbuyo kwa pharyngeal kosungidwa. Mumalirime pakati pa lilime, osatulutsa mawu. Kuzindikira: polyneuritic mtundu hepesthesia (mu mawonekedwe a "magolovu" ndi "masokosi"). Gawo lamoto: Kuyenda kogwira nawo kuchuluka kwathunthu, mphamvu ya minofu 5 mfundo, kamvekedwe ka minofu sikasinthidwe. Palibe ma atrophies amisempha. Tendon ndi periosteal Reflexes D = S. Mimba D = S. Palibenso zoziziritsa kukhosi. Pamalo a Romberg khola ..

Diagnosis: Matenda osokoneza bongo a ischemia a osakanikirana (atherosulinotic, diabetes komanso hypertonic). Distal diabetesic symmetric polyneuropathy sensory-motor gawo. Yalimbikitsa: 1. Piracetam 20% -10.0 mu kamodzi pa tsiku No. 5, ndiye mexidol 125 mg katatu pa tsiku kwa mwezi umodzi.

Kuonana ndi dokotala wamankhwala opaleshoni: Zodandaula za kupweteka, dzanzi m'malo ochepa. Zodziwika bwino ndi RVG. Mkhalidwe wamtundu: kuzungulira kwazinthu kumadera amtundu waukulu, kumalipidwa. Zizindikiro za matenda ashuga angiopathy - pulsation mu zotumphukira amasungidwa, yafupika.

Diagnosis: Matenda a shuga a shuga a m'munsi omwe ali m'munsi.

Yalimbikitsa: Mapiritsi a Doxy-chem mapiritsi 0,5 mpaka 1 tabu. 2 / d kwa miyezi 4.

Kufunsira kwa Ophthalmologist: Wophunzirayo amadzipaka mwamphamvu (Sol. Mydriacili 0.5%). OU: Mtima. Ziphuphu ndizowonekera. Refus Reflex ndi pinki. Fundus: pinki ya kuwala ya pinki, malire. Mitsempha yochepetsedwa, yopanda mawonekedwe, opindika. Mitsempha yake imasenda.

Diagnosis: Matenda a shuga a retinopathy osapindika.

Yalangizidwa: Kuyang'aniridwa kwa ophthalmologist kumalo komwe mumakhala.

Chidziwitso chachikulu: Mtundu Wachiwiri wa matenda a shuga a mellitus, omwe adadziwika koyamba, kuwonongeka kwa magawo a metabolic.

Zovuta: Matenda osokoneza bongo a ischemia a genesis osakanikirana. Matenda a shuga a retinopathy ndi gawo losakula. Matenda a shuga a shuga a m'munsi okhala m'munsi. Distal diabetesic polyneuropathy. Mafuta hepatosis.

Zokhudzana: Arterial matenda oopsa 3 madigiri, chiopsezo 4. Atherosulinosis ya msempha, matumbo, ziwongo. Mkhalidwe pambuyo poti bere lamanzere mu 2005 limapezeka ndi khansa, kenako chemotherapy.

Mbiri: Kulemera kwa IIa II.

Pakufufuzidwa, kuzindikira kuli bwino, momwe ziriri pafupi kwambiri.

Madandaulo, ludzu mkamwa, mutu. Khungu limakhala loyera, labwinobwino komanso losalala.

Mitima yamtima imakhala ya phokoso. Kupuma kwamasamba, popanda kugudubuza. NPV 18 min

Kukhanda kwamimba sikumapweteka paliponse pamimba.

Fiz. katundu sawonongeka

3. Rp. Tab. Amaril 0.001 No. 20

D.S. Mkati, mapiritsi 2 1 r / tsiku. Tisanadye chakudya cham'mawa.

4. Rp. Tab. Metformin 0,5 No.20

D.S. Mkati. Pa 1 t / 2r / s ndi zakudya. M'mawa ndi madzulo.

5. Tab. Captoprili 0.025 No. 10

D.S. Mkati. 1 t 2r / d. Ola limodzi asanadye.

6. Thiogamma 600 mg. + sodium chloride 0,9% 200 ml. kudzera mu mtsempha wa magazi nthawi 1 pa tsiku 10: 10.

7. Rp. Tab. Cardiomagnil 0.075 No. 10

D.S. Mkati piritsi limodzi kamodzi patsiku ku 18,00.

8. Rp: Sol. Pyracetam 20% - 5 ml. D.S. Fotokozerani ma intrales awiri amkati nthawi 1 pa 10:00.

9. Rp. Tab. Sinvastatini 0.01 No.20

D.S. Mkati. 1 t 1 1 / s. Madzulo.

Pakufufuzidwa, kuzindikira kuli bwino, momwe ziriri pafupi kwambiri.

Palibe zodandaula. Khungu limakhala loyera, labwinobwino komanso losalala.

Mitima yamtima imakhala ya phokoso. Kupuma kwamasamba, popanda kugudubuza. NPV 17 min

Kukhanda kwamimba sikumapweteka paliponse pamimba.

Fiz. katundu sawonongeka

3. Rp. Tab. Amaril 0.001 No. 20

D.S. Mkati, mapiritsi 2 1 r / tsiku. Tatsala kadzutsa.

4. Rp. Tab. Metformin 0,5 No.20

D.S. Mkati. Pa 1 t / 2r / s ndi zakudya. M'mawa ndi madzulo.

5. Tab. Captoprili 0.025 No. 10

D.S. Mkati. 1 t 2r / d. Ola limodzi asanadye.

6. Thiogamma 600 mg. + sodium chloride 0,9% 200 ml. kudzera mu mtsempha wa magazi nthawi 1 pa tsiku 10: 10.

7. Rp. Tab. Cardiomagnil 0.075 No. 10

D.S. Mkati piritsi limodzi kamodzi patsiku ku 18,00.

8. Rp: Sol. Pyracetam 20% - 5 ml. D.S. Fotokozerani ma intrales awiri amkati nthawi 1 pa 10:00.

9. Rp. Tab. Sinvastatini 0.01 No.20

D.S. Mkati. 1 t 1 1 / s. Madzulo.

Pakufufuzidwa, kuzindikira kuli bwino, momwe ziriri pafupi kwambiri.

Palibe zodandaula. Khungu limakhala loyera, labwinobwino komanso losalala.

Mitima yamtima imakhala ya phokoso. Kupuma kwamasamba, popanda kugudubuza. NPV 19 min.

Kukhanda kwamimba sikumapweteka paliponse pamimba.

Fiz. katundu sawonongeka

3. Rp. Tab. Amaril 0.001 No. 20

D.S. Mkati, mapiritsi 2 1 r / tsiku. Tatsala kadzutsa.

4. Rp. Tab. Metformin 0,5 No.20

D.S. Mkati. Pa 1 t / 2r / s ndi zakudya. M'mawa ndi madzulo.

5. Tab. Captoprili 0.025 No. 10

D.S. Mkati. 1 t 2r / d. Ola limodzi asanadye.

6. Thiogamma 600 mg. + sodium chloride 0,9% 200 ml. kudzera mu mtsempha wa magazi nthawi 1 pa tsiku 10: 10.

7. Rp. Tab. Cardiomagnil 0.075 No. 10

D.S. Mkati piritsi limodzi kamodzi patsiku ku 18,00.

8. Rp: Sol. Pyracetam 20% - 5 ml. D.S. Fotokozerani ma intrales awiri amkati nthawi 1 pa 10:00.

9. Rp. Tab. Sinvastatini 0.01 No.20

D.S. Mkati. 1 t 1 1 / s. Madzulo.

Mphamvu: Zabwino (palibe zodandaula).

matenda a shuga a shuga a shuga

ХХХ, wazaka 78, akuthandizidwa ku dipatimenti ya endocrinology ya 9 KGB kuyambira 12,10 ndi matenda

Choyamba: Type II matenda a shuga, opezeka woyamba, gawo la kubwezeretsa kwa metabolic.

Zovuta: Matenda osokoneza bongo a ischemia a genesis osakanikirana. Matenda a shuga a retinopathy ndi gawo losakula. Matenda a shuga a shuga a m'munsi okhala m'munsi. Distal diabetesic polyneuropathy. Mafuta hepatosis.

Zokhudzana: Arterial matenda oopsa 3 madigiri, chiopsezo 4. Atherosulinosis ya msempha, matumbo, ziwongo. Mkhalidwe pambuyo poti bere lamanzere mu 2005 limapezeka ndi khansa, kenako chemotherapy.

Mbiri: Kulemera kwa IIa II.

Kuzindikiritsa matenda a shuga mellitus kunapangidwa pamaziko a kudandaula kwa matenda ashuga mkamwa owuma, ludzu, kukodzanso kwamkodzo, kukodza usiku, kuwonjezeka mkodzo, kuyabwa m'dera la inguinal, ndi kuchuluka kwa shuga mpaka 12 mmol / l. Zomwe zimayambitsa matendawa ndi:

Hypodynamia, kupezeka kwa milandu ya matenda am'banja, kunenepa kwambiri, kupsinjika, matenda oopsa, kubereka kwambiri komanso kubereka mwana. (polyhydramnios, zipatso zazikulu).

Mwa wodwala, zovuta zomwe zinali pachiwopsezo chinali: Hypodynamia, grade IIa kunenepa kwambiri, matenda oopsa oopsa (kwanthawi yayitali).

· Mtundu Wachiwiri ukutengera zaka zomwe matendawa adawonetsa (zaka 78), matendawa adayamba pang'onopang'ono, kuchipatalako adathetsa, matendawa adabisika (madandaulo anali ochepa pakadutsa chilimwe, mkhalidwe wa wodwalayo udakulirakulira kuyambira koyambirira kwa Okutobala kusokoneza pafupipafupi, kukodza kumakulirakulira mpaka 15 patsiku, komwe katatu nthawi usiku, kuyabwa kumawonekera m'chigawo cha inguinal.

· Kwa nthawi yoyamba, matenda adapezeka kuchipatala komwe adakhala pa 10/12/12 malinga ndi momwe wodwala amayendera magazi. Adafika 12 mmol / L.

· Kubwezeretsa matendawa kumadalira kudya glucose m'magazi a 9,7 mmol / L, post-trandial 15.0 mmol / L, 13.6 mmol / L asanagone.

Mavuto a matenda ashuga:

· Matenda osokoneza bongo ophatikizira matenda ophatikizika a genesis (atherosulinotic, hypertensive, diabetes) amatengera madandaulo a wodwalayo omwe akupitiliza kupweteketsa mutu popanda kudziwa kwina, chizungulire, mawu omaliza kuchokera kwa katswiri wamitsempha yamaukwati (kuiwala kukumbukira), zambiri zowunika.

· Matenda a shuga a retinopathy ndi gawo lopanda chidwi potsatira mayeso ochepetsera (kuwona m'maganizo), malingaliro a mayeso a m'maso (OU: Kudzola. Cornea ndiwowonekera. Chithunzi cha fundus ndi pinki. Fundus ndi kuwala kwa pinki, malire ake ndiwopanda malire. Madzi amapukutidwa

· Matenda a shuga a shuga a m'munsi am'munsi amakhazikika pakufufuza koyenera (khungu silizizirira kukhudza), kuwunika kwa dokotala wa opaleshoni ya mtima: Status localis: kulipidwa kwazomwe zikuchitika m'mphepete mwa mtundu waukulu. Zizindikiro za matenda ashuga angiopathy - pulsation pamtunda amasungidwa, kuchepetsedwa, zotsatira Zotsatira zam'munsi: Mapeto: Kudzazidwa kwa magazi kumachepetsedwa kwambiri mu phazi kumanja, kunsi kwa mwendo kumunsi. Ma asymmetry operekera magazi m'miyendo adawululidwa (kumanzere osakwana 40% kumanja) ndi kumapazi (26% mochepera kumanzere kuposa kumanja). Chiyerekezo cha kudzaza magazi kwa phazi / mwendo wotsika kumanja ndi 1.35 (N = 1.4-1.6). Kukaniza kwamitsempha yamagawo kumakulitsidwa m'miyendo ndi kumapazi kumanzere, phazi lamanzere kumanzere, komanso kwabwinobwino mwendo wamanzere.

· Distal diabetesic polyneuropathy imakhazikika pamadandaulo a wodwalayo akumva kupweteka, kugona komanso kutsekemera kwa miyendo, zambiri zowunikira mafunso (Pali kuphwanya kwamvekera kwamtundu wa magolovesi ndi masokosi, kusakhazikika kwachidziwitso kumachepa.

· Mafuta hepatosis amachokera pa data kuchokera pa kupimidwa kwa ultrasound ndikuwunika kwa wodwalayo (chiwindi chimatsutsana ndi 0.5 masentimita kuchokera m'mphepete mwa chipolopolo choyenera).

· Zokhudza: Arterial matenda oopsa a madigiri atatu, chiopsezo 4. Atherosulinosis ya msempha, matumbo, ziwongo. Mkhalidwe pambuyo poti bere lamanzere mu 2005 limapezeka ndi khansa, kenako chemotherapy.

· Mbiri: Kudzala wa IIa II (BMI 30,5).

Nthawi yogona m'chipatala, wodwalayo adayamba kuyenda bwino (monga kudandaula pakamwa, kusungunuka pafupipafupi, kukodza pafupipafupi, kuphatikizapo usiku, kuwonjezeka kwamkodzo, kuyabwa m'chigawo cha inguinal, kupweteka, dzanzi komanso kuzizira kwa mapazi kudatha)

Nthawi yonse yomwe amakhala kuchipatala, wodwalayo adalandira chithandizo chotsatira:

2. Rp. Tab. Amaril 0.001 No. 20

D.S. Mkati, mapiritsi 2 1 r / tsiku. Tisanadye chakudya cham'mawa.

3. Rp. Tab. Metformin 0,5 No.20

D.S. Mkati. Pa 1 t / 2r / s ndi zakudya. M'mawa ndi madzulo.

4. Tab. Captoprili 0.025 No. 10

D.S. Mkati. 1 t 2r / d. Ola limodzi asanadye.

5. Thiogamma 600 mg. + sodium chloride 0,9% 200 ml. kudzera mu mtsempha wa magazi nthawi 1 pa tsiku 10: 10.

6. Rp: Tab. Cardiomagnil 0.075 No. 10

D.S. Mkati piritsi limodzi kamodzi patsiku ku 18,00.

7. Rp: Sol. Pyracetam 20% - 5 ml. D.S. Fotokozerani ma intrales awiri amkati nthawi 1 pa 10:00.

8. Rp. Tab. Sinvastatini 0.01 No.20

D.S. Mkati. 1 t 1 1 / s. Madzulo

9. Maphunziro kusukulu ya matenda ashuga.

Kuneneratu za moyo

· Mwabwino kwambiri ndi moyo chifukwa chodzazindikira matendawa komanso kupezeka kwa zovuta zambiri,

· Zokomera anthu (opuwala mphamvu yogwira ntchito, matendawa sangatanthauzenso moyo).

Kutsatira kudya kwa hypocaloric zakudya (1600 kcal) ndi njira yoletsedwa yamafuta ambiri, kuchepa kwa mafuta m'thupi (zosakwana 300 mg patsiku), kugwiritsa ntchito zakudya zamafuta ambiri Kudya makomedwe mpaka 4-5 patsiku. Kuletsa mchere ndi mowa.

· Kutsatira makonzedwe a mapiritsi ochepetsa shuga,

Kuwongolera shuga m'magazi kamodzi patsiku komanso kanayi pa tsiku katatu pa sabata.

· Kupewa kwa zovuta (kumwa alpha-lipoic acid, nootropics, mavitamini a B6, antihypertensive mankhwala).

· Kuyang'aniridwa ndi endocrinologist, cardiologist, neurologist, ophthalmologist ndi dokotala wamkulu wagulu lachipatala

Yolembedwa pa Allbest.ru

Zolemba zofananira

Kutengera ndi kufufuzidwa kwakunja, kuyezetsa kwamkati kwamunthu wodwalayo komanso zotsatira za kafukufuku wazamalonda ndi zothandizira, kupezedwa kwamatenda ndi matenda a shuga komanso kutsimikizika kwake. Njira yothandizira. Kuneneratu za moyo.

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mbiri ya zamankhwala 55.0 K, yowonjezera 05.11.2015

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mbiri yakuchipatala 32.1 K, yawonjezereka 04/12/2012

Mbiri yazachipatala: Mtundu wa matenda ashuga a mtundu wachi 2, olimbitsa, ochepa

Dzinalo wodwala: ________
Zaka 65 zakubadwa
Tsiku lobadwa: 04/11/1939
Ntchito komanso malo antchito: penshoni
Amuna: Akazi
Dziko: Chiyukireniya
Malo: ________
Tsiku lolandila: 04/13 / 2004 pa 17.05
Ndani adawatsogolera: SOP monga momwe anakonzera

Zodandaula za odwala
Wodwalayo amadandaula kuti amusokoneza ludzu, pakamwa pouma, kuwonjezeka kwa mkodzo wotulutsa, kuyamwa kwa khungu, kuchepa kwaposachedwa kwamatenda owoneka, kupweteka kwa mwendo kumanja, kupumira, kupweteka, kukanikiza, kupindika kwa zala ndi zala zakumaso, kumva kutentha m'mapazi .
Wodwalayo akuwonetsa kufooka, kutopa nthawi yakunyumba. Kafukufuku wowonjezera adapeza kuti wodwalayo anali ndi nkhawa chifukwa cha chizungulire, kupweteka mutu kumayenderana ndi kuchuluka kwa magazi mpaka 200/130 mm. Hg. Art. Pogwiritsa ntchito masewera olimbitsa thupi, pamakhala kupweteka kumbuyo kwa sternum, ikuwombera kumanzere, tsamba lamanzere lamanzere, lomwe limadutsa ndikugwiritsa ntchito nitroglycerin. Wodwalayo amasokonezeka ndikumveka wobwerezabwereza. Pakafukufukuyu, zidadziwika kuti pali kuchepa kwa kukumbukira: ndizovuta kwa wodwalayo kukumbukira tsiku lobadwa, mayina, mayina amisewu, ndi zina zambiri.

Mbiri yazachipatala
Wodwalayo adazindikira kuti amadwala matenda a shuga mchaka cha 2002, ali ndi zaka makumi asanu ndi atatu ndi chimodzi, pomwe nthawi yoyezetsa magazi kuchipatala adapeza kuchuluka kwa shuga m'magazi. Wochiritsira wa m'deralo adapereka lingaliro pazakudya, adatumizidwa kwa endocrinologist, wopezeka ndi mtundu II matenda a shuga, mankhwala adayikidwa, dzina lomwe wodwalayo sakumbukira. Panthawi yodziwitsa, wodwalayo adanenanso kuti akumva ludzu komanso kukodzanso. Mankhwalawa adachitika mu dipatimenti ya endocrinology ya SOKB, yofunsidwa ndi wamtima, kuwunika kwakhazikitsidwa: CHD. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art. Mankhwalawa atatha, zinthu zinasintha.
Pambuyo pakuchotsa, ndikulimbikitsidwa kuti dokotala wam'deralo azindikire ndikuwonetsetsa kuchuluka kwa shuga 1 nthawi / mwezi. Sindinatsatire malingalirowo, ndinamwa mankhwala mosasamala Kamodzi pachaka amathandizira kupewa. Pakadali pano, adakonzekera zodzitetezera ndikuwongolera.

Anamnesis wamoyo wodwala

Adabadwa pa 04/11/1939, adaleredwa m'banja labwino. Kudyetsa mwachilengedwe. M'banja adakulira ndipo adaleredwa ndi azichimwene awiri. Ali mwana, samadwalanso chimfine. Zambiri pa matenda ena okhudzana ndi ubwana sizinalandiridwe.
Nthawi yakutha msinkhu inali yosasinthika, sipanachedwe kapena kuthamanga kwa kutha. Msambo unakhazikitsidwa kuyambira wazaka 13, wopanda ululu, kusanza kwa zaka 48. Panalibe kuvulala, kuvulala, kugwedezeka. Anamuchita opareshoni ali ndi zaka 13 mpaka 13 chifukwa cha appendicitis. Mwana 3 atabadwa, mwana mmodzi anamwalira adakali aang'ono, kuchuluka kwa mimba sikunatchulidwe. Wodwala ndi wa gulu la anthu wamba. Zida
chitetezo chokwanira. Nyumbayo imasamalidwa bwino, kuyambira 1989, mpaka pano akukhala m'chipinda chachipinda chachitatu, chokhala ndi mpweya wokwanira, chinyezi, chachilendo. Chakudyacho chimakhala chokhazikika, chopatsa thanzi, chopanda masamba. Zovala zikufanana ndi nyengo ya wodwalayo komanso mkhalidwe wa wodwalayo.
Wodwala amakhala ndi maphunziro a sekondale, kuphika. Pakadali pano anapuma pantchito. Amagwira ntchito mchipinda chodyera ku Frunze chomera. Njira zogwiritsira ntchito sizinayambitse kuphwanya zakudya za wodwala. Zowopsa za mafakitale, palibe zovulala.
Makolo adamwalira atakalamba. Sizinali zotheka kudziwa zokhudzana ndi makolo athu. Abale ali ndi thanzi. Ana ndi athanzi. Alibe chidziwitso chokhudza thanzi la abale ena.
Mbiri yokhudza thupi pazakudya, mankhwala osokoneza bongo, inhalation, ma antigen a epidermal sikulemetsa.
Osasuta fodya, samamwa mowa mopitirira muyeso, samamwa mankhwala osokoneza bongo. Matenda amisala, opatsirana pogonana, hepatitis imakana. Kuyika magazi sikunachitike. Sindinalumikizane ndi odwala opatsirana; sindinayende kunja kwa Ukraine kwazaka zitatu zapitazi.

Kuphunzira cholinga
Kuyendera kozungulira
Zinthu zofananira ndizokhutiritsa. Kuzindikira ndikudziwikiratu. Udindo wake ndiwothandiza. Maonekedwe a nkhope. Kutalika kwa 175 cm, kulemera 80 kg. Mtundu mtundu wa Normosthenic. Kuyenda, gait - osasinthidwa, kukulitsidwa bwino, molingana. Wodwalayo amalumikizana, okwanira, amalankhula mwachidwi. Kuzindikira kwathunthu, kukumbukira kosamveka, kukumbukira kukumbukira. Nkhope: wamba, wamoyo. Khungu limakhala lotumbululuka. M'malo am'mphepete, mabala, congestive-cyanotic. Hyperkeratosis imadziwika, makamaka kutchulidwa mu malembawo. Khungu turgor limatsitsidwa, zotanuka zimasungidwa. Chinyezi chimakhala chochepa. Palibe zinthu zamatenda zomwe zapezeka. Vuto la appendectomy limatsimikiziridwa pa khoma lakunja lam'mimba m'chigawo cholondola chaac. Kulimbitsa mawonekedwe amtundu wa khungu, kupendekera kwachuma ndi kukulira kwa mitsempha yapamwamba sizinadziwike. Zomwe zimapanga mucous mucous conjunctiva, malembedwe amphuno ndi pinki, oyera, palibe zotulutsa. Sclera wabwinobwino. Tsitsi limakhala lodetsedwa, loyera. Kuphwanya kukula kwa tsitsi mu mawonekedwe a kukula kwambiri pa thupi kapena khola sikunapezeke, tsitsi la mtundu wachikazi. Misomali imakhala yosalala, yonyezimira, yopanda kusinthasintha, kumapeto kwa zala - - kukulitsidwa, kupindika, chikaso chakuda.
Minofu yamafuta osunthika imapangidwa mosamala, imagawidwa mosagwirizana, ndi predominance mumtengo. Ukadaulo, wopanda edema. Minofu ya miyendo ndi thunthu zimakhazikika mokhutira, kamvekedwe ndi mphamvu zake zimachepetsedwa, palibe chowawa. Hypotrophy ya minofu ya malo otalikirana a mapazi, miyendo yam'munsi imadziwika. Palibe madera ena oopsa kwambiri, paresis, ndi ziwalo.
Njira yamafupa imapangidwa moyenera. Palibe kufooka kwa chigaza, chifuwa, mafupa kapena mafupa a tubular. Palibe mapazi athanzi. Kuyimilira ndikulondola. Palpation ulibe zopweteka. Malo omwe mafutawo sanakukulitsidwe, palibe malamulo oletsa kusunthika kokha, kupweteka pakamasuntha, kupindika, kusintha kosinthika, hyperemia ndi kutupa kwa ziwalo zofewa zapafupi
Pophunzira ma lymph node, zotumphukira zamitsempha sizikhala zopanda pake. Mukamayang'ana tinthu tosiyanasiyana ta mammary, kusintha kwa matenda sikunapezeka.
Chithokomiro cha chithokomiro sichitha. Pakufufuza, palibe kusintha kwa khosi.

Kuyesa Mayeso

Mphuno ndiyabwinobwino. Njira yapamwamba yopumira ndiyotheka, palibe kutulutsa kwatsamba. Mphepo yotulutsa mpweya yopanda fungo la pathological.
Chifuwa ndi mawonekedwe a Normosthenic, ma clavicles amapezeka chimodzimodzi. Ma fossa a supraclavicular ndi subclavian ndiwofatsa, pomwe kupuma sikusintha mawonekedwe awo. Tsitsi lamapewa ndilofanana, likuyenda molumikizana mpaka kumenyedwa.
Mtundu wa kupuma kosakaniza. Kupumula kwamankhwala - 16 mphindi. Magawo akumanja ndi kumanzere kwa chifuwa amayenda motsatana. Minofu yothandizira sikugwira nawo ntchito yopumira.
Kudukiza pachifuwa sikupweteka. Chifuwa ndi chotanuka, kunjenjemera kwamawu kumamveka ndi mphamvu yofanana m'malo oyenda. Palibe crunch ndi kukwawa. Palibe zowawa m'mphepete mwa patali.
Ndi kuyerekezera kwapadera m'malo osyanasiyana, phokoso lamkati wam'mapapo limafanana mbali zonse ziwiri, masewera a soneness amasungidwa.
Ndi perographic percussion, malire am'mapapu ali mkati mozungulira, kuyenda konsekonse kwa m'mapapo ndi 6 cm.
Ndi kufananizira kwamapapu ndi kupumira modekha komanso mokakamiza, kupuma kwamtunda wonse padziko lonse lapansi. Palibe phokoso lina la kupuma lomwe linapezeka.

Kusanthula kwamtima

Mukafufuza mtima wamtima wamatumbo, zotupa mu msempha, mapangidwe am'mimba, komanso ma epigastric pulsation sanapezeke. Khunyu yolumikizana ya malo a mtima ndi yopweteka. Zomwe zimachitika pakubwezera ndi pakhungu zimayikidwa m'malo V osayikira, kunja kuchokera mzere wa midclavicular ndi 2 cm, osataya, pafupifupi 2 cm mulifupi, osalimbikitsidwa. Kukankhira kwamanja kwamanja sikupezeka. Palibe chizindikiro cha feline purring.
Ndi malingaliro a mtima, malirewo ndi ofanana ndi kukhumudwa kwamtima:
1. Kumanja - 1.5 cm kuchokera kumphepete kumanja kwa sternum.
2. Pamwamba - m'mphepete mwa nthiti ya III.
3. Kumanzere - 1.5 masentimita akunja kuchokera kumanzere pakati pa clavicular.
M'lifupi mwake mtolo ndi 6.5 cm.
Panthawi yosangalatsa mtima ndikupuma modekha komanso kuchedwa kwake, mawu ofooka a mtima, kulira kwa velvet kumveka, phokoso sililondola, kugunda kwa mtima = 78 kumenyedwa / mphindi. Kugawanika komanso kusangalatsa kwamawu amtima, phokoso la ndulu, matani owonjezera sanapezeke. Kung'ung'udza kofowoka, kofewa, kotsimikizika kumatsimikiziridwa. Khalidwe laphokoso silisintha pamene wodwala wasintha mawonekedwe. Palibe phokoso losokonekera lamatama.
The kukoka ndi kuwonekera kupukusika kwa chotupa mitsempha, chizindikiro cha kuvina carotid, capillary kugunda kulibe. Mitsempha ya miyendo siyodzaza. Palibe mitsempha yam'mimba ndi "caput medusae". Kugunda kwa venous sikupezeka. Kugunda kwamankhwala pamitsempha yama radial komweko kumakhala ndi mtengo wofanana, kugunda kumakhala kokhazikika, mafupipafupi ndi 78 pamphindi, palibe kuchepa kwa mafupa, zimachitika kwambiri, sizigwirizana kwenikweni pakudzaza. Mphepo yamkati imayatsidwa pamitsempha yamagetsi, carotid, femoral, popliteal. Pa a.dorsalis pedis siyabwino.
Kuthamanga kwa magazi - 200/130 mm Hg, chimodzimodzi pamanja onse.

Matumbo oyenda

Ngodya za kamwa zimakhala pamalo omwewo, milomo yake ndi yapinki, yopanda zotupa ndi ming'alu. Nembanemba yamkamwa yamkati imakhala yapinki, yoyera, yonyezimira. Mimbulu siyisinthidwa. Chilankhulo sichikuwonjezeka, palibe zolembedwa. Thambo, pharynx, lopanda mawonekedwe. Matani samapitilira pazingwe za palatine.
M'mimba ndi mawonekedwe abwinobwino. Mafuta am'mimbamo samadziwika ndi kusinthasintha. Zizindikiro za vuto la kuthamanga kwa magazi a portal, ngati mutu wa jellyfish komanso kulimbitsa mtima kwa khoma pamimba pakhoma, sizinapezeke. Palibe chizindikiro chosonyeza kukondwerera, ma peristalsis, ma pigment otentha pa phunziroli adapezeka.
Ndi palpation pafupifupi ya hernial protrusions mu navel, inguinal malo, m'malo oyera mzere pamimba. Palibe zowawa. Zizindikiro Shchetkina - Blumberg negative.
Ndi kamvekedwe kakang'ono kotsika, kholamu ya sigmoid imapezeka bwino, 3 cm mulifupi, zotanuka, khomalo limakhala losalala, ngakhale, likuyenda, lopanda ululu, silikugundika. Caecum imakhala moyenera, mainchesi 3 cm, zotanuka, khomalo limakhala losalala, ngakhale, mwapang'onopang'ono, lopanda malo, lopweteka palpation, osagwedezeka. Dambwe likukwera ndi kutsikira, osati palp.
Zikondamoyo sizosatheka. Kukhazikika kwa malowozi kulibe zopweteka.
Ndi mawonekedwe a chiwindi cha Kurlov, kukula kwake ndi 10/9/8 cm, motsatana. Pakhungu la chiwindi, ululu sunapezeke, m'munsi mwa chiwindi simatuluka kuchokera m'mphepete mwa chipilala chodula. Mukamayang'ana dera la ndulu, palibe zomwe zidapezeka. Kukhazikika kwa malo owerengera kulibe zowawa, chizindikiro cha Courvoisier, Musse, Ortner.
Kutalika kwa ndulu ndi 6 masentimita, kutalika ndi 12 cm, m'munsi m'mphepete mulibe paliponse.

Kuphunzira kwamikodzo dongosolo

Impso zakumanzere ndi kumanja pamalo oyimirira komanso osadukiza sizogonyeka. Chizindikiro cha Pasternatsky sichabwino mbali zonse ziwiri. Chikhodzodzo sichikhala chosakhazikika, kamvekedwe ka mawu pamwamba pa pubis popanda kupindika. Kukhazikika kwa mfundo za ureter sikupweteka. Kutumiza sikovuta, kudziyimira payekha, mpaka 2l / tsiku.

Kuwerenga kwamanjenje

Pakufufuzidwa, pali mawonekedwe ena a nkhope, kusalala kwa mafupa amkati kumanzere. Nkhope yafooka, yopanda ntchito. Kuyankhula, phokoso silisokonezedwa. Palibe kupatuka kwa chilankhulo. Ophunzirawo amasunthira molumikizana, momwe kuwala kumayambira komanso malo okhala ndizofanana, zomwe zimafotokozedwanso. Pali kuchepa kwamawonedwe. Kuyesa kwa mgwirizano kumatsimikizika. Mukayang'anidwa mu supine udindo, chizindikiro cha kusokonezeka (Lasegue) ndichabwino, makamaka kutchulidwa kumanja. Palibenso zina zam'mbuyo za pathological zomwe zapezeka, mawonekedwe a tendon opanda mawonekedwe, D = S. Kupweteka ndi ma tactile kumatha kuchepetsedwa pamitunda yotsika kuchokera pamlingo wamabondo. M'madera ena sanasinthe. Palibe kugwedezeka konse kwa zala za manja otambasuka.

Kulungamitsidwa kwa matenda oyamba
Kutengera madandaulo a wodwalayo: ludzu, pakamwa pouma, kutulutsa mkodzo kwambiri, kupweteka kunkhongo chakumanzere, kusinthasintha, kupweteka, kukanikiza.
mbiri yazachipatala: mu 2002 wapezeka ndi mtundu wachiwiri wa matenda osokoneza bongo panthawi yokhazikitsidwa yomwe wodwalayo adamva kuti akumva ludzu komanso kukodzanso, kukhudzika kunatsimikiziridwa mobwerezabwereza ndi chithandizo chamankhwala mu dipatimenti ya endocrinology,
zambiri zofufuzira: khungu limapindika, kuzungulira kumapeto, kupindika, khungu, amachepetsa, makamaka kutchulidwa kwa malembawo, khungu limachepetsedwa, kusintha kwa misomali ndikusintha kwa minyewa, kupindika kwa minyewa ya malo ofikira phazi, miyendo yotsika, kugwedezeka kwamphamvu. pa a.dorsalis pedis sikhala yopanda pake, ululu ndi malingaliro amtopola amachepetsedwa pamunsi pake kuchokera pamlingo wamabondo,
matenda oyambitsidwa atha kupangidwa
1. chachikulu: Type 2 shuga mellitus, zolimbitsa, zophatikiza,
2. zovuta: Matenda a shuga a ziwiya zam'munsi.
Kutengera madandaulo a wodwalayo za: chizungulire, kupweteka kwa mutu kumayendetsedwa ndi kuwonjezeka kwa kuthamanga kwa magazi mpaka 200/130 mm. Hg. Art. mawonekedwe a ululu woyaka kumbuyo kwa sternum panthawi yolimbitsa thupi, ikuwongolera kumanzere, tsamba lamanzere lakumanzere, komwe kumadutsa pogwiritsa ntchito nitroglycerin, kumverera kwa palpitations,
mbiri yazachipatala: mu 2002, adakumana ndi cardiologist, yemwe adapezeka ndi matenda a mtima a ischemic. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art.,
zambiri zofufuzira: kutsimikiza kwakumveka pakuyesa ndi palpation kumatsimikiziridwa mu V malo osungirako malo, kuchokera kunja kuchokera mzere wa midclavicular ndi 2 cm, osataya, pafupifupi 2 masentimita, ndi kuzindikira kwa mtima, malire akumanzere a wachibale wamtima ndi 1.5 cm kuchokera kumanzere mzere wapakati pa clavicular, ndi chidwi chamtima, mawu ofooka a mtima, mawu velvet akumveka, phokoso la ma contract silikhala lolondola, kung'ung'udza kofewa, kofupika, kakhazikikidwe, mawonekedwe a phokoso sasintha pomwe malo a wodwalayo asintha, kusintha kwa iye michen, pano, molimba, wodzala, kuthamanga kwa magazi - 200/130 mamilimita Hg,
Mutha kupanga chithunzithunzi cha matenda oyanjana: CHD. Atherosulinotic mtima. Angina pectoris. Zizindikiro zamitsempha yamagazi. NK IIA Art.

Ndondomeko yowonjezera yoyeserera

1. Kuyesedwa kwa magazi.
2. Kusanthula kwamkodzo kwamatenda.
3. Kuyesa kwamwazi wamagazi.
4. RW No. 371 ya 04/13/04.
5. Kusanthula ndowe za mazira a nyongolotsi.
6. Kuyesedwa kwa magazi kwa shuga.
7. Kusanthula kwa mkodzo kwa shuga.
8. Kusanthula kwa mkodzo malinga ndi Nechiporenko.
9. Kusanthula kwa mkodzo kutayika kwa mapuloteni tsiku ndi tsiku.
10. Kukonzanso.
11. ECG
12. Mbiri ya OGK. Chiwerengero 35
13. Kukambirana ndi dokotala wamaso.
14. Kuyang'ana kwa wamtima.
15. Kuyesa kwa magazi kwa ma elekitirodi.

Zotsatira za labotale ndi maphunziro othandizira

1. Kuyesedwa kwa magazi ku Clinic kuyambira 04/14/04
Hemoglobin - 112 g / l
Maselo ofiira - 3.5 * 1012 / l
Chizindikiro cha utoto - 0,9
ESR - 6 mm / h
Maselo oyera a magazi 4.8 * 10 ^ 9 / L
Neutrophils amaba 2%
Magulu Osagawika 76%
Eosinophils 2%
Malonda 17%
Monocytes 3%
2. Kuyesedwa kwa magazi kuchokera ku 4/32/4
Hemoglobin - 116 g / l
Maselo ofiira - 3.6 * 1012 / l
Chizindikiro cha utoto - 0,9
ESR - 8 mm / h
Maselo oyera a magazi 4.4 * 10 ^ 9 / L
Neutrophils amaba 2%
Magulu Osagawika 70%
Eosinophils 4%
Malonda 21%
Monocytes 3%
Leukocytes 2-3 mu s / sp.
Maselo ofiira a magazi 0-1 mu n / a.
Epithelium - ayi
Palibe mchere
3. Kusanthula kwamkodzo kwamankhwala pa 04/22/04
Mtundu wa mkodzo ndi udzu wachikasu
Ulesi - Wowonekera
Kukongoletsa Mwapadera - 1025
Zomwe zimachitidwazo ndi acidic pang'ono
Mapuloteni - Zotsatira
Glucose - 2%
Ma cell oyera am'magazi 1-2 mu n / a.
Maselo ofiira a magazi 0-1 mu n / a.
Epithelium - ayi
Palibe mchere
4. Kusanthula kwamwazi wamwazi m'mwazi 04/14/04
Mapuloteni onse - 76.3 g / l
Albumin - 54%
Ma Globulins - 46%
Urea 3.7 mmol / L
Magazi a creatinine 0,07 mmol / L
Cholesterol 7.1 mmol / L
VLDL 0.38 mmol / L
CRP - -
Seromucoids - 0,28 mmol / L
5. RW No. 371 ya 04/13/04. - neg.
6. Kusanthula ndowe za mazira a nyongolotsi.
Res.: Palibe mazira omwe adapezeka.
7. Kuyesedwa kwa magazi kwa glucose kuyambira 04/13/04
8˚˚ Magazi a glucose - 7.06 mmol / l
12˚˚ Mafuta a m'magazi - 11.02 mmol / l
18˚˚ Mafuta a m'magazi - 9.2 mmol / l
22˚˚ Magazi a glucose - 8.2 mmol / l
8. Kusanthula kwa mkodzo kwa glucose kuyambira pa 04/14/04
Mlucose mumkodzo - 1.25g.
9. Kusanthula kwa mkodzo malinga ndi Nechiporenko kuyambira 04.15.04
Maselo oyera oyera - 3.01 * 10 ^ 6
Maselo ofiira - 0,9 * 10 ^ 6
10. Urinalysis ya kutaya mapuloteni tsiku ndi tsiku kuchokera pa 4/15/4
Mapuloteni mumkodzo - 0,064 g / tsiku.
11. Kukonzanso.

Kumanzere Kumanja
PI tibia 1.2 1.4 0.8 - 1.2
PI phazi 1.0 1.5 1.0

12. ECG
Kutsiliza: Mkhalidwe wabwinobwino wa axis yamagetsi pamtima.
Atria fibrillation, mawonekedwe a tachysystolic. Mlingo wamtima 90 / min. Hypertrophy ya kumanzere kwamitsempha yamagazi yam'mimba yokhala ndi zochuluka. Kusintha kwa myocardium.
14. Mbiri ya OGK. Chiwerengero 35
Pathology OGK sapezeka.
15. Kukambirana ndi oculist.
Vis OD - 0,8
OS - 0,8
Cholinga: koyamba kugundika ndi mandala.
Momwe zimakhalira: HD ndi yapinki, maonekedwe ake ndiwowonekera, mitsempha ndiyosungunuka, magazi okhaokha.
Kutsiliza: Matenda a shuga a retinal angiopathy. Poyamba zovuta za maso onse awiri.
16. Kufunsidwa kwa wamtima.
Kutsiliza: matenda a mtima. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art.
17. Kuyesa kwa magazi kwa ma elekitirodi.
Potaziyamu - 6.1 mmol / L
Sodium - 160 mmol / L
Calcium - 2.3 mmol / L
Chlorides - 107 mmol / L

Itsenko-Cushing's a shuga Mellitus
Hyperglycemia ndi episodic mwachilengedwe, mtundu wa metabolism wa carbohydrate umachitika pamene matenda oyambitsawo achiritsidwa. Hyperglycemia imalimbikira, imakwera, imapezeka pamimba yopanda kanthu, nthawi zambiri imayendera limodzi ndi glucosuria

Matenda a shuga
Glucosuria sizimatengera kuchuluka kwa chakudya chamagulu omwe amaperekedwa, sikuyenda ndi hyperglycemia kapena kuphwanya kwamphamvu thupi. Palibe angio ndi neuropathies. Glucosuria zimatengera kuchuluka kwa chakudya chamagulu omwe amaperekedwa, limodzi ndi hyperglycemia kapena kuphwanya kwamphamvu thupi.

Matenda a shuga a insipidus
Polyuria sichikuphatikizidwa ndi glucosuria, kuchuluka kwa mkodzo ndi hyperglycemia Polyuria sikuphatikizidwa ndi glucosuria, kuchuluka kwa mkodzo ndi hyperglycemia

Kulungamitsidwa kwazindikiritso womaliza
Kutengera madandaulo a wodwalayo: ludzu, pakamwa pouma, kutulutsa mkodzo kwambiri, kupweteka kunkhongo chakumanzere, kusinthasintha, kupweteka, kukanikiza.
mbiri yazachipatala: mu 2002 wapezeka ndi mtundu wachiwiri wa matenda osokoneza bongo panthawi yokhazikitsidwa yomwe wodwalayo adamva kuti akumva ludzu komanso kukodzanso, kukhudzika kunatsimikiziridwa mobwerezabwereza ndi chithandizo chamankhwala mu dipatimenti ya endocrinology,
zambiri zofufuzira: khungu limapindika, kuzungulira kumapeto, kupindika, khungu, amachepetsa, makamaka kutchulidwa kwa malembawo, khungu limachepetsedwa, kusintha kwa misomali ndikusintha kwa minyewa, kupindika kwa minyewa ya malo ofikira phazi, miyendo yotsika, kugwedezeka kwamphamvu. pa a.dorsalis pedis sikhala yopanda pake, ululu ndi malingaliro amtopola amachepetsedwa pamunsi pake kuchokera pamlingo wamabondo,
zasayansi ndi njira zofufuzira: kuwonjezeka kwa shuga m'magawo 7.5 - 11.02 mmol / l, otchulidwa munthawi yamasana, kupezeka kwa shuga mumkodzo wa 1.25 g,
kufunsa kwa okhudzana ndi izi: Mapeto a dokotala wa matenda am'mimba - matenda a shuga a mtima. Mphamvu yoyamba ya maso onse awiri,
kusiyanitsa matenda
Mutha kudziwa kuti:
• Yoyambirira: Type 2 shuga mellitus, zolimbitsa, zophatikiza,
• Mavuto: A shuga angiopathy a ziwiya zamagawo am'munsi. A shuga angiopathy a retina. Poyamba zovuta za maso onse awiri.
Kutengera madandaulo a wodwalayo za: chizungulire, kupweteka kwa mutu kumayendetsedwa ndi kuwonjezeka kwa kuthamanga kwa magazi mpaka 200/130 mm. Hg. Art. mawonekedwe a ululu woyaka kumbuyo kwa sternum panthawi yolimbitsa thupi, ikuwongolera kumanzere, tsamba lamanzere lakumanzere, komwe kumadutsa pogwiritsa ntchito nitroglycerin, kumverera kwa palpitations,
mbiri yazachipatala: mu 2002, adakumana ndi cardiologist, yemwe adapezeka ndi matenda a mtima a ischemic. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art.,
zambiri zofufuzira: kutsimikiza kwakumveka pakuyesa ndi palpation kumatsimikiziridwa mu V malo osungirako malo, kuchokera kunja kuchokera mzere wa midclavicular ndi 2 cm, osataya, pafupifupi 2 masentimita, ndi kuzindikira kwa mtima, malire akumanzere a wachibale wamtima ndi 1.5 cm kuchokera kumanzere mzere wapakati pa clavicular, ndi chidwi chamtima, mawu ofooka a mtima, mawu velvet akumveka, phokoso la ma contract silikhala lolondola, kung'ung'udza kofewa, kofupika, kakhazikikidwe, mawonekedwe a phokoso sasintha pomwe malo a wodwalayo asintha, kusintha kwa iye michen, pano, molimba, wodzala, kuthamanga kwa magazi - 200/130 mamilimita Hg,
Dongosolo la njira zasayansi yothandizira:
Mapeto a ECG - malo abwinobwino azitsulo zamagetsi amtima. Atria fibrillation, mawonekedwe a tachysystolic. Mlingo wamtima 90 / min. Hypertrophy ya kumanzere kwamitsempha yamagazi yam'mimba yokhala ndi zochuluka. Kusintha kwakasinthasintha
Kufunsa kwamtima: kumapeto - IHD. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art.,
mutha kudziwa nthendayi yomwe ilipo: CHD. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art.

Etiopathogenesis
Ichi ndi matenda a polyetiological.
Gawani:
1. Insulin - wodwala matenda a shuga - kuperewera kwathunthu kwa insulin - mtundu 1.
2. Insulin ndi shuga yodziimira payekha. Zimachitika ndi kuperewera kwa insulin. M'magazi a odwala oterewa, insulin ndi yachilendo kapena yokwezeka. Amatha kukhala onenepa komanso onenepa.
Insulin - wodwala matenda a shuga - ndimatenda a autoimmune. Maziko a kakulidwe kake ndi:
1. Wokhulupirika mu 6 - chromosome yoyanjana ndi HLA - D3, D4. Kulemala uku ndikubadwa.
2. Ma virus a mumps, chikuku, Coxsackie, zinthu zopsinjika kwambiri, mankhwala ena. Ma virus ambiri amafanana ndi maselo a beta. Kuteteza thupi kwathunthu kumalimbana ndi ma virus. Zikakhala kuti zili ndi vuto, kumalizidwa kumalowa ndi ma lymphocyte. B lymphocyte amatulutsa ma cytotoxic antibodies. maselo a beta amafa, ndipo vuto la kupanga insulini limayamba - matenda a shuga.
Insell-Independent shuga mellitus ali ndi vuto lakubadwa, koma amawoneka osachita chifukwa cha zinthu zakunja.
1. Chovuta m'maselo a beta okha komanso zotumphukira. Katemera wa insulini amatha kukhala woyambira komanso woyambitsa (wokhala ndi shuga m'magazi a 6.5 mmol / l).
2. Kuzindikira kwa zotumphukira zimakhala kuti insulini ithe.
3. Kusintha kapangidwe ka insulin.
Matenda a shuga a insulin omwe amadzimirawa amakhudzidwa ndi kunenepa kwambiri. Poterepa, maselo amafunikira insulini yambiri, ndipo ma cell ake mu ma cell siokwanira.

Chithandizo
1. Zakudya nambala 9.
Kuwerengedwa kwa zakudya kumachitika pozindikira zomwe zimachitika, jenda, zizindikiro zolemetsa komanso kuchuluka kwa mphamvu (ya mtundu winawake wa zochitika). Norm: 30 kcal / kg ya kulemera kwakuthupi. Kulemera kwakuthupi kwa wodwalayo ndi 55 kg. Kuwerengera: 75x30 = 2250 kcal / tsiku.
Pafupipafupi zakudya - 5-6 pa tsiku. Gawoli lotsatira tsiku lililonse likulimbikitsidwa:

Chakudya Chambiri ku%
Chakudya cham'mawa choyamba maola 8%
Chakudya chamasana 12 h. 10%
Chakudya 14 h. 20-30%
Zosakhazikika 17 maola 10%
Kudya kwa maola 19 20%
Chakudya chachiwiri maola 21% 10%
2. Makina oyenda.
3. Kuchuluka kwa thupi. katundu.
4. Diabeteson MR 30mg, 1 piritsi 1r / d m'mawa mphindi 30 asanadye.
5. Piritsi la Aspirin 325 ½ mkati mwa 1 r / d mu 19˚˚.
6. Nitrogranulong 0,005, piritsi limodzi mkati 3 r / d.
7. Piritsi ya 25aptop ya 25mg inside mkati mwa 2p / d.
8. Sol. Vit B6 5% - 2.0 ml intramuscularly 1 r / d tsiku lililonse.
9. Mildronate 5.0ml kudzera m'mitsempha 1r / d.
10. Piracetam 5.0 ml kudzera m'mitsempha, 1 r / d.
11. Furosemide 2.0 ml kudzera m'mitsempha tsiku lililonse.
12. Asparkam piritsi 1 mkati 3 r / d.
13. Eufilin 0.15 usiku.

20.04.04
Wodwalayo amadandaula za ludzu, pakamwa pakatha kudya, polyuria, thukuta, kufooka, kupweteka kwa mwendo kwamuyaya, popanda kutulutsa kwina, kulimbitsa kwambiri, kuwuka ndi kudutsa popanda chifukwa.
Moyenera: mkhalidwe wa wodwalayo uli pafupi kwambiri komanso wokwanira. Khungu limakhala lotuwa. Palibe chotupa. BH = 18 / mphindi. M'mapapu, kupuma kwamisempha, popanda kugudubuza. Ps = 82 / min, kudzaza kokhutiritsa ndi kusokonezeka, kosakhazikika. HELL = 180/100 mmHg Panthawi yokonda mtima, mafunde ofooka, velvet akumveka, phokoso sililondola, kugunda kwa mtima = 82 kumenyedwa / mphindi. Kung'ung'udza kofowoka, kofewa, kotsimikizika kumatsimikiziridwa. Lilime ndi loyera, osati lopindika. Mimba pamimba yake ndi yofewa, yopweteka. Mpando ndi wabwinobwino. Diuresis pafupifupi 2l., Independent.
Nthawi yoikidwiratu: pitilizani chithandizo chamankhwala malinga ndi mndandanda wa omwe akusankhidwa.

29.04.04
Wodwalayo amadandaula za ludzu, pakamwa youma atatha kudya, polyuria, kufooka, kupweteka m'miyendo kunachepa, popanda kutuluka kwachidziwikire, kukula mwamphamvu, kuwuka ndi kudutsa popanda chifukwa. Zowongolera kusintha kwathanzi.
Moyenera: mkhalidwewo ndiwokhutiritsa. Khungu limakhala lofiirira, loyera. BH = 16 / mphindi. M'mapapu, kupuma kwamisempha, popanda kugudubuza. Ps = 76 / min, kudzaza kokhutiritsa ndi kusokonezeka, kusakhazikika, kulibe kufooka. HELL = 160/100 mm Hg Ndi chisangalalo chamtima, mafunde ofooka akumveka, phokoso la mtima silolondola, kugunda kwa mtima = 76 bpm. Kung'ung'udza kofowoka, kofewa, kotsimikizika kumatsimikiziridwa. Chilankhulochi ndi choyera. Mimba pamimba yake ndi yofewa, yopweteka. Mpando ndi wabwinobwino 2p / d. Diuresis pafupifupi 2l., Independent.
Nthawi yoikidwiratu: pitilizani chithandizo chamankhwala malinga ndi mndandanda wa omwe akusankhidwa.
Kuletsa: piracetam, furosemide.

02.05.04
Wodwalayo amadandaula pakamwa pouma atatha kudya, kufooka, polyuria.
Moyenera: mkhalidwewo ndiwokhutiritsa. Khungu limakhala lofiirira, loyera. BH = 16 / mphindi. M'mapapu, kupuma kwa vesicular, pamtunda wonse. Ps = 80 / mphindi, osasamba, opanda kufooka. HELL = 160/100 mm Hg Ndi chisangalalo cha mtima, mafunde ofooka akumveka, phokoso la mtima silolondola, kugunda kwa mtima = 80 kumenyedwa / mphindi. Kung'ung'udza kofowoka, kofewa, kotsimikizika kumatsimikiziridwa; pakusintha mawonekedwe a thupi, sasintha mawonekedwe ake. Chilankhulo sichikhala ndi msonkho. Mimba pamimba yake ndi yofewa, yopweteka. Mpando ndi wabwinobwino 2p / d. Diuresis pafupifupi 2l., Independent.
Amaikidwe: konzekerani kutulutsa 03.04.04.
Kuletsa: Sol. Vit B6 5%, Mildronate.

Mavuto
Wodwala Karpenko Aleksandra Nikolaevna adagonekedwa m'chipatala ku dipatimenti yachipatala ya Specialocrin Hospital kuyambira 04/13/04 mpaka 05/03/04. Adalandiridwa munjira yoyenererana ndi madandaulo osokoneza iye, mkamwa owuma, kupindika, pakhungu, posachedwa kutsika kwamaso, ululu kumiyendo yakumanja, kusinthasintha, kupweteka, kukanikiza, kupindika kwa zala ndi zala zakumaso, kumva kutentha kumapazi . Kafukufuku wachitika. Zowonetsera zasayansi zimaphunziridwa: kusanthula kwamkodzo kwamankhwala kuchokera pa 04/22/04 - shuga - 2%, kuyesa magazi kwa shuga kuchokera pa 04/13/04 - 8˚˚ shuga wamagazi - 7.06 mmol / l, 12˚˚ shuga wamagazi - 11.02 mmol / l, 18˚˚ glucose wamagazi - 9,2 mmol / l, 22˚˚ glucose wamagazi - 8.2 mmol / l, ECG - mawonekedwe abwinobwino azitsulo zamagetsi amtima, atroperment fibrillation, mawonekedwe a tachysystolic. Mlingo wamtima 90 / min, lamitsempha yamagazi yam'mitsempha yamapositi yokhala ndi zochuluka kwambiri, imayambitsa kusintha kwa myocardium. Adakumana ndi katswiri wamaso. Kutsiliza: Matenda a shuga a retinal angiopathy. Poyamba zovuta za maso onse awiri. Adafunsidwa ndi dokotala wamtima. Kutsiliza: matenda a mtima. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Zizindikiro zamitsempha yamagazi. NK IIA Art. Dziwa ndi chachikulu - Type 2 shuga mellitus, zolimbitsa, zophatikiza,
mavuto - a shuga angiopathy a ziwiya am'munsi malekezero. A shuga angiopathy a retina. Magawo oyamba ovuta a maso onse awiri, ofanana - matenda a mtima. Atherosulinotic mtima. Angina pectoris. Atria fibrillation, mawonekedwe a tachysystolic. Kuchitiridwa chithandizo. Wodwalayo ali wokhutitsidwa adathamangitsidwa kunyumba. Yalimbikitsa: pitilizani chithandizo chamankhwala omwe mumalandira pakulipika, kotheka thupi. katundu, kudziwunikira kwa shuga, magazi ndi mankhwala othandizira odwala nthawi 1 pachaka.

Mndandanda wazidziwitso

Balabolkin M.I. Endocrinology: Zolemba. chilolezo. .M M: Mankhwala, 1989. 416 mas. (Textbook. Lit. for subordinates and interns).
Potemkin V.V. Endocrinology. --- M: Mankhwala, 1986. 432 p., Ill.
Medvedev V.V., Volchek Yu.Z. Matenda Othandizira Kwachipatala: Buku Lamadokotala / Ed. V.A. Yakovleva. --- St. Petersburg: Hippocrates, 1995.-- 208 p.
Mashkovsky M.D. Mankhwala M'magawo awiri. Gawo 1., Gawo 2 --- M: Mankhwala, 1993.