Mbiri yazachipatala

Dzinalo kudwala

Matenda matenda, mtundu II matenda ashuga mellitus, zolimbitsa, subcompensated.

Zaka: zaka 62.

Kukhalapo Kwamuyaya:

Mkhalidwe: Wopuma pantchito

Tsiku lolandila: Seputembara 29, 2005

Tsiku loyang'anira: Seputembara 1, 2005 - Seputembara 9, 2005

1. Madandaulo ofooka, kutopa, chizungulire, ludzu, kuyabwa pakhungu, khungu lowuma, dzanzi la miyendo yake nthawi ndi nthawi.

2. Amadziona wodwala kuyambira Meyi 2005. Matendawa matenda a shuga adapezeka koyamba kwa nthawi ya kuphedwa kwa odwala, pomwe adalandira chithandizo cha infarction ya myocardial, ndipo shuga yake yamwazi idakwezedwa. Kuyambira Meyi 2005, wodwalayo adatengedwa kupita ku dispensary, chithandizo adamulembera (shuga 30 mg). Mankhwala a Hypoglycemic amalolera bwino.

3. Kuphatikiza pa shuga, wodwalayo amadwala matenda a mtima: matenda oopsa kwa zaka 5, mu Meyi 2005 adakumana ndi myocardial infarction.

4. Kubadwa mwana wachiwiri. Anakula ndikukula malinga ndi zaka. Ali mwana, adadwala matenda onse aubwana. Adagwira ntchito yowerengera ndalama, ntchito yokhudzana ndi kupsinjika kwa malingaliro. Panalibe njira zochitira opareshoni. Ndimakonda kuzizira. Pakati pa abale odwala odwala matenda a shuga si. Banja limakhala lopuma. Palibe zizolowezi zoyipa. Kusamba kuyambira wazaka 14, kumachitika pafupipafupi. Moyo wokhala ndi chuma. Amakhala m'nyumba yabwino.

General mkhalidwe wa wodwala: wokwanira.

Msinkhu 168 cm, kulemera 85 kg.

Nkhope: zothandiza

Khungu: khungu labwinobwino, chinyezi cholimbitsa thupi. Turgor yafupika.

Mtundu wa tsitsi: mtundu wachikazi.

Pinki yowoneka bwino ya mucous, chinyezi chokwanira, lilime - loyera.

Minofu yamafuta a subcutaneous: Yotukuka kwambiri.

Minyewa: kukula kwake ndikokhutiritsa, kamvekedwe kamasungidwa.

Mafupa: zopweteka palpation.

Mapeto a zamitsempha: osakulitsidwa.

- mawonekedwe a chifuwa: Normosthenic.

- Chuma: chofanana.

- The m'lifupi mwa malo okhala ndi ochepa.

- Kona ya epigastric ndi yowongoka.

- Mapewa ndi kolala ndizofooka.

- Mtundu wa kupuma pachifuwa.

- Chiwerengero cha mayendedwe azipumira miniti: 18

- Kukhazikika kwa chifuwa: chifuwa ndi chopanikizika, kunjenjemera kwamawu kumodzimodzimodzimodzimodzimodzu, kopanda ululu.

Kuphatikiza kwapadera: Phokoso labwino la pulmonary pazigawo za chifuwa.

M'lifupi mwa minda ya Kraining ndi 8 cm mbali zonse ziwiri.

Kukwera kutsogolo

3 cm pamwamba pa clavicle

3 cm pamwamba pa clavicle

Kutalika kwa Apex

7 khosi lachiberekero vertebra

7 khosi lachiberekero vertebra

Pamodzi ndi mzere wakuthwa

M'mphepete 4 zapamwamba

Pakati - mzere wa clavicular

Pa mzere wa axillary wakutsogolo

Mu mzere wapakatikati wa axillary

Pa mzere wa axillary wam'mbuyo

Pamodzi ndi mzere wa scapular

Pamodzi ndi mzere wamphongo

Pofikira njira X mabere. vertebra

Pofikira njira X mabere. vertebra

Kupumira koyenda kwa m'munsi m'mapapu: kumbuyo kwa mzere wa axillary 1.5 masentimita pakupuma, pa mpweya wotuluka - 1 cm.

Kupuma kwa Vesicular kumveka, phokoso losokonekera kwa mafupa silimapezeka.

Mtima wamtima.

Kuyendera: Mitundu yamtima imasokonekera, nyimbo, mtima kugunda-72 kumenyedwa / mphindi. Kutulutsa kokhutiritsa kokwanira komanso mavuto. HELL.-140/100 mm. Hg Trophic wa minofu ya m'munsi malekezero amadwala chifukwa cha matenda ashuga macroangiopathy.

- chidwi cha apical chikupezeka mu 5thostostal space 1.5-2 masentimita ofananira ndi lamanzere midclavicular mzere (mphamvu yochepa, yochepa).

- Mtanda wa kukomoka kwa mtima: 12-13 cm

Kukula kwa chotupa cha mtima: 6-7 masentimita, malo awiri mbali kumanzere ndi kumanja (chikufanana ndi m'lifupi mwa sternum)

- Kusintha kwa mtima: kwabwinobwino.

4 malo oyambira 1 cm kumanja kwa m'mphepete mwa sternum

4 malo oyenera kumbali yakumanzere kwa sternum

5 malo patsekeke 1.5-2 masentimita ofananira kumanzere kwa midclavicular mzere

Kuchokera pakulimbikitsidwa kwambiri, pitani pakati: (2,5 cm medial)

Mzere wakunja wa 3 malo okhala

Mzere wakunja wa 4 malo okhala

Milomo ndi yotuwa pinki, yonyowa pang'ono, yopanda ming'alu kapena zilonda. Zomwe zimapanga mucous zimakhala zotumbululuka pinki, zonyowa, komanso za m'magazi sizinadziwike. Lilime lake ndi pinki, lonyowa, lokhala ndi duwa loyera, papillae amapangidwa bwino. Zitsamba zotuwa ndizopaka utoto, wopanda magazi komanso zilonda zam'mimba.

Pharynx: nembanemba ya mucous ndiyotuwa pinki, ma toni siopaka michere, amakulitsa pang'ono, zipilala ndi lilime siopindika. Palibe ziwopsezo. Khoma lakumbuyo popanda kusintha kwa pathological.

Tizironda tamadonthono sitikukulitsidwa, osapweteka, khungu lomwe limapezeka m'mbali mwa minyewayo silisinthidwa, kupweteka kutafuna ndi kumeza.

M'mimba ndichabwinobwino, modabwitsa, osati chotupa, palibe zotchingira, kupumira, kuwonekera kwa kupukusa. Khoma lam'mimba limagwira ntchito yopumira, palibe zipsera, palibe peristalsis wowoneka. Ndi kupsinjika ndi kugunda pang'onopang'ono - phokoso lamkokomo, kuwawa, kusokonezeka kwa khoma lam'mimba, kusinthasintha kulibe.

Ndi palpation yapamwamba, kusokonezeka kwa khoma lam'mimba kulibe, zilonda sizidziwika, palibe kuphatikiza. Mafunde a Zizindikiro, Chizindikiro cha Mendel, Zizindikiro za Shchetkin-Blumberg sizabwino.

Ndi palpation yapadera, palibe kusiyana pakati pa minofu ya rectus abdominis. Kukopa: Kuyenda m'matumbo ndikwabwinobwino.

Pakufufuza, chiwindi sichikukulitsidwa. Mphepete mwa chiwindi chokhala ndi mbali yayitali yodutsa kamtsempha kolimba, m'munsi mwa chiwindi sikutuluka pansi pa chipilala chotsika mtengo. Pa palpation, m'mphepete mwa chiwindi ndi lakuthwa, lopweteka, lofewa, mawonekedwe ake ndi osalala.

Pa palpation, cystic point, epigastric zone, choledo-pancreatic zone, point of the phrenic nerve, acromial point, point of scapular angle, vertebral point is pain.

Momwe kuzindikira: malire a chiwindi

chapamwamba - 6 malo okhala mkati mwa mzere wa midclavicular.

m'munsi - m'mphepete lamanja la chipilala chodula.

Palibe zowawa ndi kupsinjika ndi kukantha.

Kulimira malinga ndi Kurlov:

n pakatikati - 6.5 cm

n m'mbali mwa midclavicular - 9 cm

n m'mphepete mwa mtengo wamanzere - 5 cm

Mpando: Nthawi imodzi m'masiku awiri ndi atatu. Kudzimbidwa nthawi zambiri kumazunza.

Chonde: palibe kuchuluka kowoneka.

- womangidwa kumtunda - 8 nthiti

- malire apansi - 1 cm mkati kuchokera ku chipilala chodula.

Miyeso ya kuzindikira: kutalika - 7.5 cm, m'lifupi - 4.5 cm.

Kuchokera pamachitidwe amtundu, wamanjenje, a endocrine, palibe zopatuka kuzomwe zimachitika.

Kutengera madandaulo, zowunika zamankhwala ndi zasayansi, matenda adapangidwa: mtundu wachiwiri wa matenda a shuga, pang'ono, subcompensated, polyneuropathy.

1.Kusanthula kwapadera kwamkodzo ndi magazi

2. Kuyesedwa kwa magazi kwa BH

3. Phunziro pa glucose yothamanga yamagazi - tsiku lililonse lililonse. Mbiri ya Glycemic

4. X-ray ya chifuwa.

6. Kutalika, kulemera kwa wodwala

7. Kuyang'ana kwa akatswiri opapatiza: ophthalmologist, neuropathologist, dermatologist.

Zambiri kuchokera ku maphunziro a labotale.

Kuyesedwa kwa magazi kozungulira 08/15/05

Maselo ofiira am'magazi 4.6 * 10 12 / L

Hemoglobin 136 g / l

Chizindikiro cha utoto 0.9

Maselo oyera magazi 9.3 * 10 9 / L

Kusanthula kokwanira kwa mkodzo 08/15/05

Kusintha kwa shuga tsiku lililonse

1. pamimba yopanda 7.3 mg /%

2. pambuyo 2 maola 10.0 mmol / l

3. pambuyo maola 4, 7.0 mmol / l

DAC ya syphilis "-" 08/19/05

Palibe kachilombo ka HIV komwe kamapezeka 08.19.05

1. Ophthalmologist kuyambira 08.17.05

Madandaulo: ntchentche zakugonera patsogolo pa maso, mphamvu ya chifunga, zinthu zopanda pake, kuchepa kwa maonedwe.

Kutsiliza: a shuga angioretinopathy.

2. Neurologist pa 08.19.05

Madandaulo: kujambula, kupweteka msana, kumva kugunda kwam'mimba, kutsekemera, kuzizira, nthawi zina kukokana m'mitsempha ya ng'ombe, kutopa kwa miyendo pakulimbitsa thupi, kusamva bwino.

Kutsiliza: distal polyneuropathy

Kulungamitsidwa kwa etiology ndi pathogeneis.

Ndimayanjana ndi chitukuko cha mtundu wachiwiri wa matenda ashuga ndi ntchito yabwino. Kusokonezeka kwa mitsempha, komwe kunathandizidwa ndi pamwezi, kotala, malipoti apachaka ndiudindo wazachuma, chinakhala chinthu chachikulu chomwe chimayambitsa kukula kwa matendawa. Ntchito yofunikira idachitidwanso pogwiritsa ntchito zakudya zopatsa mphamvu zopatsa mphamvu zambiri, maswiti, kuchepa kwa fiber ndi kumangokhala wodwalayo. Chomwe chikuwonetsedwa monga zakudya, kusachita masewera olimbitsa thupi, nkhawa zimagwirizanitsidwa kwambiri ndipo zimapangitsa kuti insulin itulutsidwe ndikukula kwa insulin. Kuperewera kwa insulin mosalekeza ndi zochita zake kwakhala chifukwa chachikulu cha kusokonezeka kwa metabolic ndi chiwonetsero cha matenda a shuga. Kuphwanya carbohydrate metabolism imadziwika ndi mapangidwe owonjezera a sorbitol, omwe amasonkhana kumapeto kwa mitsempha, retina, mandala, omwe amathandizira kuwonongeka kwawo ndi imodzi mwazomwe zimapangidwira kukula kwa polyneuropathy ndi matenda a catarogathy.

Type 2 shuga mellitus, osadalira insulini, subcompensated, odziletsa. Mavuto: angioretinopathy, distal polyneuropathy.

· Chiwerengero cha chakudya cha wodwala patsiku ndi 20 XE

Chakudya cham'mawa 1 (5 XE):Kefir 250 mg

-ophika phala 15-20 g

Zatrak 2 (2 XE):zipatso zouma

Ndimakonda uchi Kitundu

Dzinalo - Himochka Tatyana Ivanovna

M'badwo - zaka 53.

Adilesi: Kiev st. Semashko 21.

Malo ogwirira ntchito: Press Press Publishing House

Tsiku lovomerezedwa ku chipatalachi: 02/06/2007.

Pa kafukufukuyu, wodwalayo amadandaula chifukwa cha ludzu, pakamwa pouma, kuchuluka kwa mkodzo wotulutsidwa, kuyabwa kwa khungu, kuchepa thupi kwakaposachedwa ndi 7 kg, ndi kuchepa kwa maonekedwe owoneka. Wodwalayo akuwonetsa kufooka, kutopa pantchito yakunyumba, chizungulire komanso kupweteka kwa mutu kumayenderana ndi kuwonjezeka kwa kuthamanga kwa magazi kumadwalanso nkhawa.

Wodwalayo adazindikira kuti ali ndi matenda a shuga II mchaka cha 1998, pomwe adayamba kumva ludzu, kuyabwa, kulawa kwazitsulo mkamwa, kuchepa thupi, kuchuluka kwa mkodzo, ndikuwunika kuchipatala adawonetsa kuchuluka kwa glycemia mpaka 6.1 mmol / L. Wothandizira wakuchipatala adapereka malingaliro pazakudya ndikuyambitsa glibenclamide. Mu 2000, kuyesedwa kuchipatala kunawonetsa kuchuluka kwa glycemic kwa 8.2 mmol / L. Glucophage adalembedwa mapiritsi atatu ndi kukonza zakudya. Mu 2003, wodwalayo adagonekedwa kuchipatala cha endocrinology, komwe magawo 8 a insulin ndi iv oyang'anira espolipon adalembedwa. Atayesa komaliza wodwalayo kuchipatala, glycemia idafika 13 mmol / l, motero wodwalayo adagonekedwa kuchipatala pa 02/06/2007 kuchipatala cha endocrinology.

Mbiri ya moyo wa III.

Adabadwa pa Disembala 29, 1953, ndipo adaleredwa mnyumba yabwino. M'banja adakulira ndipo adaleredwa ndi azichimwene awiri. Nthawi yakutha msinkhu inali yosasinthika, sipanachedwe kapena kuthamanga kwa kutha. Kusamba kwakhazikitsidwa kuyambira zaka 17, osapweteka, kusamba kwa zaka 48. Panalibe kuvulala kapena kugwira ntchito. Amadwala matenda opuma maulendo 1-2 pachaka. Mbiri yakubadwa siyiri yolemetsa. Osasuta fodya, samamwa mowa mopitirira muyeso, samamwa mankhwala osokoneza bongo. Matenda amisala, opatsirana pogonana, hepatitis, chifuwa chachikulu amakana. Kuyika magazi sikunachitike. Kunalibe zoopsa pamafakitale. Heredi simalemedwa.

MALO OGULITSIRA.

Palibe ululu komanso kumva moto lirime; kamwa louma ndi vuto. Kulakalaka kumachepa. Kuopa kudya kulibe. Kugwedeza ndikudutsa chakudya kudzera m'mphepete mwaulere. Zowawa pamtima, osati kubwatuka. Kuchepetsa mseru komanso kusanza kulibe. Kukondwerera ayi. Mpando umakhala wokhazikika, wodziyimira pawokha, kamodzi patsiku. Palibe zovuta za chopondapo (kudzimbidwa, kutsegula m'mimba). Zilimbikitso zabodza pamipando sizivutitsa. Chokondweretsa chake ndichopanda, ndi fungo labwino, popanda zodetsa za ntchofu, magazi, mafinya, zotsalira za chakudya chosasokonekera. Kuwotcha, kuyabwa, kupweteka. Palibe magazi ochokera ku rectum.

NSANSI YOLEMBEDWA.

Ululu m'dera lumbar silivutikira. Pafupipafupi, kukodza kwaulere sikuyenda limodzi ndi zowawa, kutentha, ululu. Day diuresis predominates. Mtundu wa mkodzo ndi kuwala wachikaso, wowonekera. Palibe kukonzekera mongodzipereka. Pafupifupi malita 1.5 a mkodzo amatulutsidwa patsiku. Chizindikiro cha Pasternatsky sichabwino.

Mbiri yazachipatala

Malinga ndi wodwalayo, zaka 2 zapitazo, pakuwunikira pafupipafupi, kuchuluka kwa shuga wamagazi (7.7 mmol / l) kwakhazikitsidwa.

Dokotalayo adalimbikitsa kuyesedwa kowonjezereka, kuyesedwa kopatsa mphamvu kwa chakudya.

Mzimayiyo adanyalanyaza malangizo a dotolo, ndikupitiliza kukhala ndi moyo womwewo, pokhudzana ndi kuchuluka kwa chilakolako, adapeza 20 makilogalamu. Pafupifupi mwezi wapitawu, kupuma movutikira ndi kupweteka pachifuwa kunawonekera, anayamba kuwona kuwonjezeka kwa kuthamanga kwa magazi kufika pa 160/90 mm Hg.

Pomupempha mnzake, anathira masamba ake ndi kabichi pamphumi, napukutira msuzi wa mbatata, ndikutenga Aspirin. Pokhudzana ndi ludzu lochulukirapo komanso kukodza kwambiri (makamaka usiku), adapita kuchipatala.

KULIMBIKITSA KWAMBIRI.

Msinkhu - 170 cm, kulemera - 78 kg. Mkhalidwe wokhutiritsa, kuzindikira pang'ono, malo achangu. Nkhope ya bata. Zolimbitsa thupi ndizolondola, ndizofanana ndi zaka komanso jenda. Normostenik. Zakudya zokwanira za wodwala. Khungu ndi ma mucous nembanemba amtundu wabwinobwino, wouma, wogwirizira, wothothoka, osachotsedwa. Misomali, tsitsi silisintha. Ma occipital, posterior cervical, parotid, submandibular, submental, anterior cervical, supraclavicular, subclavian, axillary, elbow, popliteal, ndi inguinal lymph node si palpated. Thupi lamatumbo limapangidwa mokhutira kwa zaka za wodwalayo, minyewa imakhala yopweteka, kamvekedwe kake ndi mphamvu zake ndizokwanira. Mafupa a chigaza, chifuwa, pelvis ndi miyendo sizinasinthidwe, palibe ululu panthawi yolumikizira komanso kukhudzika, umphumphu suphwanyika. Malo omwe mafayilowo amakhala akusinthika kwawoko, mayendedwe ake ali omasuka, palibe chowawa. Chithokomiro cha chithokomiro sichitha. Pamodzi ndi chala chimodzi cha phazi lakumanja pali zilonda zam'mimba.

KUDZIWA MUTU.

Mutu wa mawonekedwe wamba, ubongo ndi nkhope za chigaza ndizofanana. Makatani apamwamba amawonetsedwa mofooka. Kutayika kwa tsitsi lamtundu wamwamuna, kuchepera tsitsi. Kutupa kwa palpebral sikunatalikidwe, ana ndi ofanana ndi mawonekedwe, mawonekedwe a ophunzira pakuwala ndi munthawi yomweyo, yunifolomu. Kusala, kutembenuka kulibe. Mphuno sinapunduke. Milomo ndi yotuwa pinki, yowuma, yopanda ming'alu. Khosi limakhala lofanana, chithokomiro cha chithokomiro sichimatsimikizika.

Kukopa Kwa Mtima

Mitima yamawu imasokonekera. Nyimbo ziwiri, kupuma kwapawiri kumveka. Kugunda kwamtima 96 kumenyedwa / mphindi. Pamalo a I ndi IV okopa chidwi, kamvekedwe kamamveka bwino. Mwachilengedwe, kamvekedwe koyamba ndi kotalikirapo komanso kotsika. Pa II, III, V point of auscultation, kamvekedwe ka II kamamvekedwa bwino, kokwezeka komanso kakafupi.

KUSINTHA KWA MOYO.

Dongosolo: Palibe chotupa m'chigawo cholondola cha hypochondrium ndi epigastric, palibe kukula kwa mitsempha ya khungu ndi anastomoses, ndipo palibe telangiectasia.

CHIPEMBEDZO: Mphepete m'munsi ya chiwindi imakhala yozungulira, yosalala, yodalirika. Imatuluka kuchokera pamphepete mwa zingwe zamtengo wapatali, sizipweteka.

PERCUSSION: Chapamwamba chimatsimikiziridwa ndi

Mphepete m'mphepete mwa kumanja kwa midclavicular mzere m'munsi mwa chipilala chotsika mtengo, motsatira mainline 4 cm pamwamba pa navel. Kukula kwa chiwindi ndi 12 x 10 x 9 cm.

ENDOCRINE GLANDS.

Chithokomiro cha chithokomiro sichitha. Zizindikiro za hyperthyroidism ndi hypothyroidism palibe. Zosintha pamaso ndi miyendo zomwe zimadziwika kutiquomegaly palibe. Matenda onenepa (kunenepa kwambiri, kutopa) ayi. Khungu la khungu la matenda a Addison silinapezeke. Zosintha tsitsi zimapangidwa bwino, palibe kutaya tsitsi.

MABODZA A SESES.

Wodwalayo amawona kuwonongeka kwa mawonekedwe. Kumva, kununkhira, kulawa, kukhudza sikusintha.

MABODZA A KUSINTHA KWA PAKATI

Pituitary gland ndi hypothalamus: Kukula kwapakatikati. Amanenanso kuchepa kwa makilogalamu 4 kwa miyezi isanu ndi umodzi. Anorexia ndi bulimia palibe. M ludzu - zakumwa 3-4l zamadzi patsiku. Chithokomiro: chosagwira. Zizindikiro za hyperthyroidism ndi hypothyroidism palibe. Pancreatic zida: Zodandaula za kufooka wamba.Polydipsia - malita 3-4 patsiku. Kuchepetsa bala kuchiritsa m'miyendo.

ANAMNAESIS VITAE.

Wobadwa mu 1940 pa nthawi. Mukukula kwakuthupi ndi kwamaganizidwe sikunatsalira m'mbuyo. Anayamba kuyenda nthawi, kuyankhula pa nthawi. Anayamba kupita kusukulu kuyambira azaka 7. Mikhalidwe yanyumba muubwana ndi unyamata ndizokhutiritsa. Chakudya chimakhala chokhazikika, katatu pa tsiku, kuchuluka kwa chakudya kumakhala kokwanira, mtunduwo ndiwokhutiritsa. Samachita nawo maphunziro akuthupi komanso masewera. Chifuwa chachikulu, mitsempha. Matenda, matenda a Botkin amakana. Palibe zizolowezi zoyipa. Pambuyo pa zaka 58, adazindikira kusinthasintha kwa kuthamanga kwa magazi (120/80 - 130/90) ndi kupweteka kwa paroxysmal kumbuyo kwa sternum, panthawiyi amamwa mankhwalawa Adelfan, Captopril, Izobosida mononitrate ndi Sustak forte. Mu 1999 ndi 2003 anavutika ndi myocardial infaration. Mu 1998, adamugwirira ntchito ya phlegmon phazi. Kuyambira 1997, akhala akukumana ndi kufooka wamba, kuchepa kwa ntchito, komanso kusowa tulo. Kuyambira 1997 - kuwonongeka kwa mawonekedwe.

Mbiri yabanja: bambo anga, azaka 50, adapezeka ndi matenda a shuga 2.

Mbiri ya Epidemiological: kulumikizana ndi odwala omwe alibe, kulumidwa ndi tizilombo, makoswe.

Kuledzera kwachikhalidwe: sikudziwika

Mbiri yam'mbuyo: palibe mawonetsedwe omwe samatsutsana.

Zoyang'anira nyengo ndi nyengo: kukhathamiritsa kwamatenda aliwonse kutengera nyengo sanapezeke.

STATUS PRAESES.

KULIMBIKITSA KWAMBIRI.

Msinkhu - 170 cm, kulemera - 78 kg. Mkhalidwe wokhutiritsa, kuzindikira pang'ono, malo achangu. Nkhope ya bata. Zolimbitsa thupi ndizolondola, ndizofanana ndi zaka komanso jenda. Normostenik. Zakudya zokwanira za wodwala. Khungu ndi ma mucous nembanemba amtundu wabwinobwino, wouma, wogwirizira, wothothoka, osachotsedwa. Misomali, tsitsi silisintha. Ma occipital, posterior cervical, parotid, submandibular, submental, anterior cervical, supraclavicular, subclavian, axillary, elbow, popliteal, ndi inguinal lymph node si palpated. Thupi lamatumbo limapangidwa mokhutira kwa zaka za wodwalayo, minyewa imakhala yopweteka, kamvekedwe kake ndi mphamvu zake ndizokwanira. Mafupa a chigaza, chifuwa, pelvis ndi miyendo sizinasinthidwe, palibe ululu panthawi yolumikizira komanso kukhudzika, umphumphu suphwanyika. Malo omwe mafayilowo amakhala akusinthika kwawoko, mayendedwe ake ali omasuka, palibe chowawa. Chithokomiro cha chithokomiro sichitha. Pamodzi ndi chala chimodzi cha phazi lakumanja pali zilonda zam'mimba.

KUDZIWA MUTU.

Mutu wa mawonekedwe wamba, ubongo ndi nkhope za chigaza ndizofanana. Makatani apamwamba amawonetsedwa mofooka. Kutayika kwa tsitsi lamtundu wamwamuna, kuchepera tsitsi. Kutupa kwa palpebral sikunatalikidwe, ana ndi ofanana ndi mawonekedwe, mawonekedwe a ophunzira pakuwala ndi munthawi yomweyo, yunifolomu. Kusala, kutembenuka kulibe. Mphuno sinapunduke. Milomo ndi yotuwa pinki, yowuma, yopanda ming'alu. Khosi limakhala lofanana, chithokomiro cha chithokomiro sichimatsimikizika.

MABODZA OTHANDIZA

DZIKO LAPANSI:

chokhazikika: Chifuwa ndi Normosthenic, symmetrical, palibe kupindika kwa msana. Fossa ya supra- ndi ya subclavian imatchulidwa chimodzimodzi mbali zonse ziwiri. Mapewa amapindika pachifuwa. Njira ya nthiti ndizabwinobwino.

champhamvu: Mtundu wa kupuma pachifuwa. Kupumira kosasunthika, kupumira, kupumira kwa 20 / min, mbali zonse ziwiri za chifuwa chonse zimagwira nawo ntchito yopumira.

CHITSANZO CHOBWINO BWINO:

Chifuwa chimagwira, kukhulupirika kwa nthiti sikuphwanyidwa. Palibe chowawa palpation. Malo okhala mkati samakulitsidwa. Palibe kuwonjezeka kwamawu akunjenjemera.

Cell PERCUSSION

kuyerekezera kofananira: Phokoso lomveka bwino la m'mapapo limamveka pamwamba paminda yam'mapapo.

Kuzindikira kwapa:

Malire a m'munsi a mapapu olondola ndi omwe amalondola

Mzere wakunja

VI malo okhala pakati

Kumanja midclavicular

VII malo oyambira

Dongosolo lakumunsi la mapapu akumanzere limatsimikiziridwa ndi lamanzere

Kutalika kwa mapapu:

Kukula kwa minda ya Krenig:

KUTHENGA KWA MALO.

Kupumira kwa Vesicular kumveka m'minda yam'mapapo. Kupuma kwa bronchi kumamveka pamwamba pa larynx, trachea ndi bronchi yayikulu. Kupuma kwa bronchovascular sikumveka. Wodzigudubuza, wopanda wowerengeka. Kukula kwa bronchophony sichoncho.

MABODZA A UTHENGA WABWINO.

KUMVETSA KWA MTIMA:

Kukopa kwamtima sikumatsimikizika, thorax pamalo omwe akuyembekezerera mtima sichinasinthidwe, kutsimikizika kwampikisano sikumatsimikizika, palibe systolic retraction ya disostal dera pamalo opatsa chidwi apical, palibe pathological pulsations.

Kutsitsa kwatsimikizika kumatsimikiziridwa mu danga la V intercostal kumanzere kwa midclavicular pamalo pafupifupi mita 2,5 lalikulu. onani Kuphatikizika, kutsutsa, kukweza, kukweza, kulimbikitsidwa. Kukhudzika mtima sikumveka paliponse, chizindikiro cha "mphaka wa paka" sichikupezeka.

1. Malire a kufooka kwa mtima kutsimikizika ndi:

1. Malire a kutsimikiza kwamtima kwathunthu amatsimikiziridwa ndi:

Kukopa Kwa Mtima

Mitima yamawu imasokonekera. Nyimbo ziwiri, kupuma kwapawiri kumveka. Kugunda kwamtima 96 kumenyedwa / mphindi. Pamalo a I ndi IV okopa chidwi, kamvekedwe kamamveka bwino. Mwachilengedwe, kamvekedwe koyamba ndi kotalikirapo komanso kotsika. Pa II, III, V point of auscultation, kamvekedwe ka II kamamvekedwa bwino, kokwezeka komanso kakafupi.

KUSINTHA KWA ZINSINSI ZABWINO.

Palibe kutumphuka kwa mitsempha ya carotid, kuphipha kowonekera kwamitsempha ya khomo pachifuwa sikunatsimikizike. Kugundika kwamtunduwu ndi kwabwino. Pa zotupa zamapazi, phazi limachepa kwambiri.

KUSINTHA KWA DZIKO LAPANSI.

Kukoka kumakhala chimodzimodzi pamitsempha yama radial yonse: ma frequency 96 kumenyedwa / mphindi., Pafupipafupi, kwathunthu, kwakukulu, kwakukulu, mwachangu, pafupipafupi. Kuperewera kwa ziphuphu - 10. Khoma lamanjenje limasindikizidwa. Kupsinjika kwa magazi 130/90.

MABWINO OGWIRA NTCHITO.

Kuyendera kwamlomo wamkamwa.

Nembanemba yamkamwa ndi pharynx ndi pinki, yoyera, ndi youma. Lilime limanyowa ndi zokutira kuwunika, masamba a kukoma amawatanthauzira bwino. Milomo yamakona popanda ming'alu. Matani samatuluka chifukwa chamakhonde a palatine, lacunae sakhala ozama, osawonongeka.

KULIMBITSA KWA BWINO.

Khoma lakumbuyo lakumbuyo limayenderana, limagwira ntchito yopumira. Kuonekera kwamatumbo, kuwonekera kwa hernial ndi kukula kwa mitsempha yam'mimba sikumatsimikizika. Kutupa kwa m'mimba kumachitika.

SURFACE APPROXIMATE PALPATION OF ANIMAL.

Pa palpation, palibe kusokonezeka ndi kuwawa kwa minofu, minyewa yam'mimba imapangidwira moyenera, palibe kusiyanasiyana kwa abctinis, mphete ya umbilical sikakulitsidwa, ndipo palibe chizindikiro chosinthasintha. Zizindikiro Shchetkina - Blumberg negative.

KUTSITSA CHIYEMBEKEZO CHA ZINYAMA.

Danga la sigmoid limakhazikika m'chigawo chakumanzere mu mawonekedwe a chingwe chosalala, chodontha, chopanda ululu, sichinachite chibwibwi. 3 cm wandiweyani. Cecum imakhazikika m'chigawo cholondola cha leal mwa mawonekedwe a yosalala silinda 3 cm, osakung'ungika. Kusunthika. Zakumapeto sizothandiza. Gawo lokwera m'matumbo limakhazikika m'chigawo cholondola cha chingwe m'njira yopanda chingwe 3 cm mulifupi, zotanuka, zam'manja, osagwedezeka. Gawo lotsika la kolonalo limakhala lachigoba kumanzere kwakumanzere kofanana ndi masentimita 3 mulifupi, kopanda ululu, mafoni, osagwedezeka. Amatsimikiza pambuyo pakupeza kupindika kwam'mimba kwambiri. Danga lozungulira limasunthidwa m'chigawo chakumanzere mu mawonekedwe a cylinder yamitundu yotalika 2 cm, yam'manja, yopanda ululu, osati yopunthwitsa. Kupindika kwam'mimba kwakukulu kumatsimikizika 4 masentimita pamwamba pa navel mu mawonekedwe a kugudubuza kwamphamvu kusasinthika, kopanda zowawa, ndi mafoni. Woyang'anira pachipata amawoneka kuti ndi silinda yopyapyala yokhala ndi zotanuka, yokhala ndi mainchesi pafupifupi 2 cm. Zikondamoyo sizosatheka.

PANGANO LABWINO:

Phokoso lalikulu la tympanic lapezeka. Chizindikiro cha Mendel kulibe. Mafuta aufulu omasuka m'matumbo am'mimba sizipezeka.

UTHENGA WABWINO:

Phokoso la mikangano yolimbirana silikudziwika. Phokoso lanyimbo yamatumbo mwa mawonekedwe akung'ung'udza yapezeka.

KUSINTHA KWA MOYO.

Dongosolo: Palibe chotupa m'chigawo cholondola cha hypochondrium ndi epigastric, palibe kukula kwa mitsempha ya khungu ndi anastomoses, ndipo palibe telangiectasia.

CHIPEMBEDZO: Mphepete m'munsi ya chiwindi imakhala yozungulira, yosalala, yodalirika. Imatuluka kuchokera pamphepete mwa zingwe zamtengo wapatali, sizipweteka.

PERCUSSION: Chapamwamba chimatsimikiziridwa ndi

Mphepete m'mphepete mwa kumanja kwa midclavicular mzere m'munsi mwa chipilala chotsika mtengo, motsatira mainline 4 cm pamwamba pa navel. Kukula kwa chiwindi ndi 12 x 10 x 9 cm.

KUSINTHA KWA WABWINO KWAMBIRI:

Mukamayang'ana gawo la momwe gallbladder ili kumanja kwa hypochondrium mu gawo la kudzoza, mawonekedwe ndi mawonekedwe a malowa sanapezeke. Chikhodzodzo ndulu sichothandiza.

KUSINTHA KWA MTHENGA:

Palipation ndulu mu supine udindo ndipo kudzanja lamanja sizikudziwika.

Sponen percussion.

MABODZA A URINARY.

Ndi palpation yokhala mbali ziwiri zomata komanso zokhazikika, impso sizatsimikizika. Chizindikiro cha Pasternatsky sichabwino mbali zonse ziwiri. Ndi percussion, chikhodzodzo ndi 1.5 masentimita pamwamba pa fupa la pubic. Kung'ung'udza chifukwa cha mitsempha yachilengedwe kulibe. Palibe nocturia 1.6l.

NERVO-MENTAL SPHERE.

Kuzindikira kumawonekera, luntha ndilabwinobwino, limapsinjika. Kukumbukira kuli pansi. Malotowa alibe zakuya, Palibe zosokoneza pakulankhula. Kugwirizanitsa mayendedwe ndikwabwinobwino, gait ndi yaulere. Reflexes amasungidwa, kupweteka komanso ziwengo sizipezeka. Maubale kuntchito komanso kunyumba ndizabwinobwino. Amadziwona ngati munthu wochezeka.

ENDOCRINE GLANDS.

Chithokomiro cha chithokomiro sichitha. Zizindikiro za hyperthyroidism ndi hypothyroidism palibe. Zosintha pamaso ndi miyendo zomwe zimadziwika kutiquomegaly palibe. Matenda onenepa (kunenepa kwambiri, kutopa) ayi. Khungu la khungu la matenda a Addison silinapezeke. Zosintha tsitsi zimapangidwa bwino, palibe kutaya tsitsi.

MABODZA A SESES.

Fungo, kukhudza, kumva ndi kukoma sizosweka. Kuwonongeka kwamawonedwe

DIAGNOSIS WA PRELIMINARY.

Kutengera ndi mbiri yachipatala, madandaulo a wodwala, zowunikira poyang'ana, zinapangidwira matenda oyamba: mtundu wachiwiri wa matenda ashuga (kuyambika kwa matendawa ndi zaka 56, wodziwika ndi maphunziro olemba, chithunzi chofatsa kuchipatala, ludzu lakuya, pakamwa kowuma, kufooka kwakukulu, kuchepa thupi mwadzidzidzi, kukodza pafupipafupi, kuwonongeka kwa thanzi, mawonekedwe a dzanzi la miyendo, kuiwala kukumbukira). Wodalira insulini (amatenga insulin). Mawonekedwe owopsa (kuwona kwakachepera, zilonda zam'mimba pamiyendo).

Dongosolo LAPANSI.

1. Chiwerengero chamagazi + formula + IPT
2. Urinalysis
3. Mbiri ya Glycemic.
4. Mbiri ya Glucosuric.
5. Kuyesa kwamwazi wamagazi
6. Urinalysis malinga ndi Nechiporenko.
7. ECG, Reflexometry
8. Fluorography.
9. Kuyang'ana kwamtima ndi kuyesa mchipindacho. wodwala matenda ashuga

KULAMBIRA KWA LABORATORY

1. Kuyesedwa kwa magazi. 01/29/04

1. Kusanthula kwapadera kwamkodzo 01/29/04

1. Kuyesa kwa magazi pa biochemical 29.01.04

1. Fluorography 01/31/04 popanda ma pathologies owoneka.
2. ECG 1.02.04

Mitundu ya sinus. Kuthamanga kwa mtima - 96 kumenyedwa / mphindi. Wamng'ono-wave ciliary arrhythmia, mawonekedwe a tachysystolic. Kusintha kwamakhalidwe azikhalidwe ndi zochitika zaposachedwa. Matenda obwera chifukwa cha kupindika.

1. Kufunsa kwamtima 2.02.04

Kutsiliza: IHD: Angina pectoris 3 kalasi yothandiza komanso kupuma. Postinfarction (1998, 2003) mtima. Aortic atherosulinosis, stenotic coronary atherosulinosis. Postinfarction atrial fibrillation, mawonekedwe a tachysystolic. Kulephera kwa mtima 2.

1. Kusanthula kwa mkodzo malinga ndi Nechiporenko 6.02.04

Maselo ofiira sanapezeke, ma cell oyera - 0.25 * 10 * 6 / l, ma cylinders sanapezeke.

1. Reflexometry 01/29/04

Kukonzanso sikuyitanidwa.

1. Kupima mu ofesi ya odwala matenda ashuga 01/30/04

Matenda a diabetesic phazi, mawonekedwe a neuropathic, ophatikizika ndi trophic ulcer 1 chala chimodzi komanso dzanja lamanja lamanja, kuchiritsa kwadongosolo, microangiopathy.

Zoikika: kukonzekera alpha-lipoic to-you, angioprotectors, kuvala, kusamalira mapazi

1. Mbiri ya Glycemic

1. Mbiri ya Glucosuric 01/30/04

KULIMA KWA DIYIKI YA CLINICAL.

Mukamayang'ana wodwala ndi njira zamankhwala ambiri, zizindikiro zotsatirazi zidadziwika:

madandaulo of kufooka, kuchuluka kutopa, kuchepa kwa ntchito. Wodwalayo amati amachepetsa thupi, akumva ludzu. Pali kuchepa kukumbukira kukumbukira zochitika zenizeni. Pali dzanzi m'm miyendo. Wodwalayo amawona kuwonongeka kwa mawonekedwe.

Matendawa wodwala anayamba zaka 8 zapitazo. Pakadali pano, wodwalayo adamva ludzu lalikulu (amamwa malita atatu amadzimadzi patsiku), pakamwa kowuma, kufooka kwambiri, kukodza mwachangu, komanso kuwonongeka kwa mawonekedwe. Panthawiyi, adokotala. Shuga wokwezeka wapezeka. Ikuwonjezeranso kuwonongeka kwa thanzi, kuchuluka kwa malekezero, kuwonongeka kowonera, kukumbukira kukumbukira.

POPHUNZIRA POPHUNZIRA:

Pa zotupa zamapazi, phazi limachepa kwambiri. Pamodzi ndi chala chimodzi cha phazi lakumanja pali zilonda zam'mimba.

KWA DZANSI ZOTHANDIZA ZOFUNA:

Mbiri ya glycemic ikuwonetsa kuchuluka kwa shuga. Malinga ndi ECG: yaying'ono-wave ciliary arrhythmia, mawonekedwe a tachysystolic. Kusintha kwamakhalidwe azikhalidwe ndi zochitika zaposachedwa. Matenda obwera chifukwa cha kupindika. Malinga ndi kutsiriza kwa mtima: matenda a mtima: mtima wa Angina pectoris 3FK ndikupuma. Postinfarction (1998, 2001) mtima. Aortic atherosulinosis, stenotic coronary atherosulinosis. Postinfarction atrial fibrillation, mawonekedwe a tachysystolic. Kulephera kwa mtima 2.

DIAGNOSIS YOSIYANA

Matendawa a shuga a Mtundu 2 amasiyanitsidwa ndi mtundu wa matenda ashuga 1 ndi matenda ashuga:

Mosiyana ndi matenda a shuga a mtundu wachiwiri, matenda ashuga amtundu 1 amayamba chifukwa cha kuchepa kwa kapangidwe ka insulin ya B-cell chifukwa cha autoimmune ndondomeko ya viral etiology kapena genetic etiology. Matenda a shuga amtunduwu nthawi zambiri amapezeka asanakwanitse zaka 30. Matenda a shuga amtunduwu amadziwika ndi poyambira kwambiri, maphunziro olembetsa, chipatala chotchulidwa, chizolowezi cha ketoacidosis, kuchepa thupi, michereopathies, komanso kuperewera kwa insulin.

Matenda a shuga a insipidus amayamba chifukwa cha kuperewera kwa vasopressin kwathunthu kapena kwina ndipo amadziwika ndi mkodzo wa polydipsia ndi polyuria wokhala ndi kachulukidwe kakang'ono kwambiri. Kuphatikiza apo, matendawa adakhudzana ndi kusowa kwa kuchuluka kwa mkodzo mkati mwa kuyesedwa ndi kudya kouma, kusokonekera kwamphamvu kwa plasma, kusokonekera kwa pituitrin komanso chotsika chapakati pa matenda a ADH mu plasma.

DIAGNOSIS YA CLINICAL

Wodwalayo watero mtundu 2 shuga (Izi zanenedwa kwa ife ndi mbiri yakale - kuyambika kwa matendawa ku 56, kudziwikiratu zamtundu, mawonetsedwe azachipatala: ludzu lakuya, mkamwa wowuma, kufooka kwambiri, kuchepa thupi mwadzidzidzi, kuyamwa mwachangu, kuyimitsidwa kwamaso, thanzi labwinobwino, kuzindikira za malekezero, kuiwala kukumbukira, kufunsa ziwalo ndi machitidwe: zodandaula za kufooka, kuchuluka kwa kutopa, kuchepa kwa ntchito, kuchepa thupi, ludzu, zosowa zasayansi: hyperglycemia), zopindika (Izi ndi zomwe mbiri ya glycemic imatiuza: shuga wokwanira panthawi ya chithandizo.), katundu wapano(zowonongeka, zilonda zam'mimba m'miyendo).

Kuphatikiza apo, wodwalayo ali ndi zovuta:

Matenda a shuga a retinopathy, gawo lodziwikiratu: (zowonongeka.)

Diabetesic phazi matenda, neuropathic mawonekedwe (zowerengera) - zilonda zam'mimba za chala 1 ndi miyendo ya kumapazi.)

Mashuga a macroangiopathy (Aortic atherosulinosis, stenosing coronary atherosulinosis),

komanso matenda ophatikizika:

CHD: Angina pectoris vol 3 FC ndikupuma. Postinfarction (1998, 2001) mtima. Aortic atherosulinosis, stenotic coronary atherosulinosis. Postinfarction atrial fibrillation, mawonekedwe a tachysystolic. Type 2 kulephera kwa mtima

KULENGA KWAULERE

1. Mtundu wamawadi
2. Zakudya nambala 9
3. Mankhwala a insulin: Humodar B15 - 22 mayunitsi. m'mawa, 18 magawo. madzulo.
4. Pancreatin 1 tabu. 3p / tsiku (cholimbikitsa ntchito zachinsinsi za kapamba)
5. Captopril 1/2 tabu. 2p / tsiku (lochiritsa)
6. Isosorbide 1 tabu. 2p / tsiku (lopeza vuto la angina)
7. Aspicard 1/2 tabu. 1p / tsiku (analgesia, mpumulo wa njira za rep.)
8. Sol. Acidi lipoici 1% 2.0 v / m
9. Trental 1 tabu. 2 r / tsiku (angioprotector)
10. Zipande za phazi lamanja

D.S. 1 tabu. 3 r / tsiku

D.S. 1/2 tabu 2 r / tsiku

1. Rp. Tab. Isosorbidi mononitratis 0.02 N. 40

D.S. 1 tabu. 2 r / tsiku mutadya

D.S. Pa ½ tsamba 1r / tsiku

1. Rp: Sol. Acidi lipoici 1% 2.0

D.t.d.N.10 mu ampull.

1. Mu / mamililita 2 ml 1r / tsiku
2. Rp. Tab. Trentali 0.4 N20

D.S. 1 tabu 2 r / tsiku

1. Rp. Insulini "Humodar B15" 10ml (1ml = 40ED)

1. 22 iliyonse - m'mawa, 18 magawo. - madzulo subcutaneally.
2. The zikuchokera chakudya nambala 9

Mtengo wamagetsi 2400 kcal. Zakudya zamkati 5-6 nthawi / tsiku.

Chakudya cham'mawa choyamba 25%, kachiwiri 8-10%, nkhomaliro 30-35%, chakudya chamadzulo 5-8%, chakudya chamadzulo choyamba 20%, chakudya chachiwiri 5%.

Chiwerengero cha zinthu patsiku: mkate wakuda 150 g, mkate wa tirigu 100 g, mbatata 150 g, masamba 500 g, batala 20 g, kanyumba tchizi 100 g, kirimu wowawasa 30 g, kefir 200 g, zipatso (kupatula mphesa) 200 g, dzira 2 ma PC., mafuta a masamba 20 g, ufa 40 g.

3.02.04 Mkhalidwe wokhutiritsa, chikumbumtima chodziwikiratu, kufooka wamba, kudya kwakanthawi, 1.6ct, khungu lowuma, mtundu wabwinobwino, kupuma kwamitsempha, kupumira kwa 18 / mphindi, popanda kugudubuzika, kumveka kwamtima, kopanda phokoso, AT 120/75, Ps 96 kumenyedwa / mphindi , Kuchuluka kwamtima kwa 106, kukoka kwamphamvu 0, Ps pa onse aa. dorsalis pedis yayamba kufooka, lilime ndi lonyowa, osati lophimba, m'mimba ndilofewa, lopweteka palpation, chiwindi chimakulitsidwa ndi 1 cm, kupweteka m'miyendo, t = 36.6 * C. Mlingo wa insulin sunasinthike. Glycemia control - m'mawa - 6.1, masana - 14.1, madzulo - 11.8 mmol / l. Mphamvu yakuwongolera ndiyabwino.

10.02.04 Ali m'malo okhutira, kuzindikira bwino, kupweteka kwa mutu m'dera lamutu wawung'ono, chakudya chokwanira, nocturia 1,2 l, khungu louma, mtundu wabwinobwino, kupuma kwamaso, 18 min / h, popanda kugwedeza, mawu amtima ndi ophatikizika, palibe phokoso, AT 140/90, Ps 94 kumenyedwa / mphindi, kugunda kwa mtima 104, kukoka kwa 10, lilime lonyowa, osati kotetezedwa, pamimba yofewa, yopweteka palpation, chiwindi chikuwonjezeka ndi 1 cm, kupweteka kwamiyendo kumachepa, t = 36.7 * C. Mlingo wa insulin sunasinthike. Glycemia control - m'mawa - 6.2, masana - 9,0, madzulo - 7.3 mmol / l. Mphamvu yakuwongolera ndiyabwino.

Anamnesis ya moyo wa wodwala

Matenda a shuga amawopa mankhwalawa, ngati moto!

Muyenera kungolemba ...

Wobadwa pa Julayi 15, 1952, mwana woyamba kubadwa m'banjamo.

Mimba za amayi zinali zabwinobwino. Adali kuyamwitsa.

Zikhalidwe zamtundu wa anthu zimadziwika kuti ndizokhutiritsa (nyumba yapadera ndi zinthu zonse). Talandira katemera kutengera zaka. Ndili ndi zaka 7 ndapita kusukulu, ndinali ndi magwiridwe antchito apakati. Amadwala nthomba ndi chikuku.

Nthawi yofala inali yosasangalatsa, msambo woyamba anali ndi zaka 13, mwezi uliwonse, wopanda ululu. Kusamba kwa zaka 49. Ali ndi ana amuna akulu awiri, kubereka komanso kubereka zimachitika nthawi zonse, palibe amene amachotsa mimbayo. Pa zaka 25, opaleshoni yochotsa appendicitis, palibe ovulala. Mbiri yakubadwa siyiri yolemetsa.

Panopa apuma pantchito. Wodwalayo amakhala m'malo okhalitsa, wogwira ntchito kwa zaka 30 wogulitsa mu makeke ogulitsa. Zakudya zopanda zakudya, zopatsa mphamvu zimapezeka m'zakudya.

Makolo anamwalira ali okalamba, bambo anga anali ndi matenda a shuga a mtundu wachiwiri, kumwa mapiritsi ochepetsa shuga. Mowa komanso mankhwala osokoneza bongo samatha, kusuta paketi imodzi ya ndudu patsiku. Sindinapite kudziko lina, sindinkakumana ndi odwala opatsirana. Mbiri yakale ya chifuwa chachikulu ndi ma hepatitis a virus amakanidwa.

Kuyendera kozungulira

Mkhalidwe wokhwimitsa malire. Mulingo wodziwa zinthu umamveka bwino (GCG = 15 point), yogwira, yokwanira, yopezeka ndi kulumikizana kopindulitsa. Kutalika kwa 165 cm, kulemera kwa 105 kg. Hypersthenic physique.

Khungu limakhala lofiirira, loyera, louma. Zowoneka bwino za mucous ndi pinki, zonyowa.

Zofewa minofu turgor ndizokhutiritsa, zovuta zam'mimba sizitchulidwa. Malo omwe mafupa ake ali osaduka, kuyenda kwathunthu, palibe chotupa. Osati malungo. Ma lymph sanakulidwe. Chithokomiro cha chithokomiro sichitha.

Kupumira mwapang'onopang'ono kudzera mumayendedwe a ndege zachilengedwe, NPV = 16 rpm, minyewa yothandizira siyikhudzidwa. Chifuwa chimagwirizanitsidwa ndi kupuma, imakhala ndi mawonekedwe olondola, osadukiza, samva kuwawa palpation.

Kuyerekeza ndi topographic percussion pathology sikunapezeke (malire a mapapu mkati mwa malire abwinowo). Auscultatory: kupumula kwamasamba, mosanjikiza mochitika m'minda yonse yam'mapapo.

Kudera la mtima pakuyesa, palibe kusintha, kusunthika kwampweya sikuwonetsedwa.

Mimbayo imakhala paliponse pamitsempha yamafinya, yofanana, kudzaza bwino, kugunda kwamtima = 72 rpm, kuthamanga kwa magazi 150/90 mm Hg Ndi kuzindikira, malire a kupanda chiyembekezo kwathunthu komanso a mtima ali mkati mwa malire. Zopatsa chidwi: Kuveka kwamtima kwaphwanyidwa, phokoso ndilolondola, phokoso lakumiseche silimveka.

Lilime ndi louma, lophimba ndi zokutira yoyera ku muzu, chinthu chamezetsa sichinaphwanyidwe, thambo lilibe mawonekedwe. M'mimba mumachulukitsa voliyumu chifukwa cha mafuta onunkhira, amatenga nawo mbali popumira. Palibe chizindikiro cha matenda oopsa a portal.

Ndi palpation zapamwamba za hernial protrusions ndi zowawa sizinadziwike.

Zizindikiro Shchetkina - Blumberg negative. Kutsekeka kwakuya kwambiri kumakhala kovuta chifukwa cha mafuta ochulukirapo a subcutaneous.

Malinga ndi Kurlov, chiwindi sichikukulitsidwa, m'mphepete mwa chipilala chodula, palpation mu ndulu ilibe vuto. Zizindikiro za Ortner ndi Georgiaievsky sizabwino. Impso sizigwiritsidwa ntchito, kukodza ndi kwaulere, diuresis imachulukitsidwa. Mkhalidwe wamanjenje wopanda mawonekedwe.

Kusanthula kwa deta ndi maphunziro apadera

Kuti mutsimikizire matenda omwe am'chipatala, kafukufuku wambiri akulimbikitsidwa:

• kuyezetsa magazi kwamankhwala: hemoglobin - 130 g / l, erythrocyte - 4 * 1012 / l, chizindikiro cha utoto - 0,8, ESR - 5 mm / h, maselo oyera am'magazi - 5 * 109 / l, stab neutrophils - 3%, maukosi osokoneza bongo - 75%, ma eosinophils - 3 %, lymphocyte -17%, ma monocytes - 3%,
• urinalysis: utoto wa mkodzo - udzu, momwe - alkaline, mapuloteni - ayi, shuga - 4%, maselo oyera - ayi, maselo ofiira amwazi - ayi
• kuyesa kwamwazi wamagazi: mapuloteni onse - 74 g / l, albin - 53%, globulin - 40%, creatinine - 0,08 mmol / lita, urea - 4 mmol / l, cholesterol - 7.2 mmol / l, glucose wamagazi 12 mmol / l.

Analimbikitsa kuyang'anira magawo a ma labotale mumphamvu

Zambiri zofufuzira

Zotsatirazi zomwe zatsatiridwa pophunzira zinapezeka:

• electrocardiography: phokoso la sinus, zizindikiro za kumanzere kwamitsempha yamagazi,
• chifuwa x-ray: Minda ya m'mapapo ndi yoyera, sinuses yaulere, zizindikiro za hypertrophy zamtima wamanzere.

Kufunsidwa kwa akatswiri monga katswiri wa zamitsempha, ophthalmologist ndi opaleshoni ya mtima akulimbikitsidwa.

Kulungamitsidwa kwa matenda

Popeza madandaulo a wodwala (ludzu, polyuria, polydipsia), mbiri ya zamankhwala (chakudya chopatsa thanzi), mayeso owunika (kuchuluka kwa thupi, khungu lowuma), ma labotale ndi zida zothandizira (hyperglycemia, glucosuria), matenda othandizira amatha kupangidwa.

Choyamba: lembani matenda ashuga a 2 shuga, ochepa, okhathamira.

Concomitant: Matenda oopsa a 2, madigiri awiri, ngozi yayikulu. Chakumbuyo: Kunenepa kwambiri.

Kulimbikitsidwa kuchipatala kuchipatala cha endocrinological posankha chithandizo.

Njira ndi yaulere. Zakudya - tebulo nambala 9.

Kusintha kwa moyo - kuchepa thupi, kuwonjezera zolimbitsa thupi.

Mankhwala a Oral hypoglycemic:

• Gliclazide 30 mg 2 kawiri pa tsiku, kumwa musanadye, kumwa ndi kapu ya madzi,
• Glimepiride 2 mg kamodzi, m'mawa.

Magazi amawongolera zamagazi mumphamvu, komanso osagwiritsa ntchito mankhwalawa, kusintha kwa insulin.