Mkhalidwe woyamika subjectivus

Kuban State Medical University

Dipatimenti ya Matenda a Ana

Mbiri yazachipatala: *****, zaka 8

Kuzindikira: Type 1 shuga mellitus, gawo la kuwonongeka, nthawi yayitali 1 chaka

Gulu la 5 maphunziro 8

Tsiku lololeza kuchipatala:Seputembara 7, 2010

Tsiku lobadwa:Novembara 20, 2001

Mayi: ***…………………………, wazaka 37, mayi wapabanja.

Kholo: ***…………………………, wazaka 38, wabizinesi wamba

Dziwani za malo otumizira:

Matenda a shuga, mtundu 1, gawo la kuwonongeka, kutalika kwa matenda - 1 chaka.

Kuzindikira pakuvomerezedwa: Matenda a shuga, mtundu 1, matenda nthawi - 1 chaka.

Wodwalayo amadandaula pakamwa pouma, kukodza pafupipafupi, kuchuluka kudya, malaise, kufooka, kuchepa thupi, kuchepa chidwi.

Mwana wadwala chaka chatha, msungwanayo adavutika ndikumva pakamwa kowuma, kusokonekera pafupipafupi, kusanza, kusanza, kufooka, kuchepa thupi. Mu 2009, adasumira madandaulo awo ndi CRH kumalo komwe amakhala, komwe adatumizidwa ku chipatala cha ana ku Krasnodar kukayesedwa. Kuzindikira kunapangidwa mu Chipatala cha Ana Clinical: mtundu 1 shuga mellitus, kutengera mayeso omwe anachitika, kuchuluka kwa glucose anali 16 mmol / l poyesa magazi, ndipo Lantus ndi Novoropid anathandizidwa. Mwana adachotsedwa ndikuwonetsa kupitiliza chithandizo chamankhwala komanso kutsatira njira yothandizira pakudya. M'masabata awiri apitawa, mkhalidwe wa mwana udakulirakulira, motero adatumizidwa kukayezetsa magazi a CRH kumalo komwe amakhala ku chipatala cha ana a Clasical Hospital ku Krasnodar kuti am'thandize.

Mwana kuyambira mimba yoyamba, woyamba kubadwa. Mimba inali yosasinthika. Kutumiza ndikofunikira. Amamuyika pachifuwa tsiku loyamba, natenga bere mofunitsitsa. Kuyamwitsa kwa chaka chimodzi.

Anakula ndikukula malinga ndi zaka.

M'chaka choyamba cha moyo, nthawi zambiri ankadwala SARS.

BCG "M": 11/29 / 01-0,05 w / c, kuyambira 70 mpaka 2827

V1-18.02.02-DTP, 0,5 V / m, s 497-5

V2-20.03.02-DTP, 0,5 V / m, s 497-2

V3-18.05.02-DTP, 0,5 V / m, s 538-1

R1-21.05.03-DTP, 0,5 V / m, s 577-3

R2-19.12.08- DTP, 0,5 V / m, s244

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

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

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

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

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

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

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

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

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

V1-21.11.02- "Embryovac", 0,5 v / m, s 105

V2-10.12.02- "Embryovac", 0,5 v / m, s 105

V3-19.05.03- "Embryovac", 0,5 v / m, s 10

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

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

V1-25.05.02-ZhKP, 0,5 s / c, s 617

V2-22.03.07-ZhKP, 0,5 s / c, s 932

SPh14.55k 1160 / ikh, 02 2 TE, apamwamba kwambiri

SP 10.47k 060 / vii,

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

Mayi, dzina, wazaka 37 - wathanzi

Abambo - dzina lathunthu, wazaka 38 - wathanzi

Amayi ndi abambo ali athanzi, agogo ali athanzi.

Kutsiliza: mwa mwana, cholowa sichimalemedwa.

Banja la mwanayo limakhala m'nyumba yapadera. Pali anthu asanu m'banjamo. Mwanayo ali ndi chipinda chosiyana, chipindacho chimakhala ndi mpweya wokwanira, chokwanira. Zowongolera masana zimawonedwa. Mwana amaphunzira sukulu.

M'masabata atatu apitawa sindinatuluke m'madambo kupita ku magombe, sindinapezane ndi odwala opatsirana, ndipo kunalibe matenda m'matumbo. Virtual hepatitis sanali kudwala. Kukhalapo kwa chifuwa chachikulu komanso matenda opatsirana pogonana kumakana.

Magazi ndi madzi a m'magazi sanaziike magazi.

Kukhalapo kwa zakudya zosalolerana, mankhwala osokoneza bongo, mankhwala amnyumba, fungo losiyanasiyana, fumbi, sizodziwika.

Kutsiliza: mbiri yakale siyokhala yolemetsa.

Matenda omwe alipo pakadali pano:

Kutentha ndi 36.7 s, chikhalidwe cha wodwalayo chimakhala chokhutiritsa, malo omwe amagona ndiwogwira, mawonekedwe ake pankhope pake amakhala odekha, otanthauza.

Msungwana wazaka 8. Kukula: 134 cm, zizindikiro za kukula zili mkati mwa malo a 97, omwe amafanana ndi chizindikiro pamwamba pa apakati. Kulemera kwa thupi makilogalamu 26, index index yamthupi ndizapakati pa 25 ndi 75 centel, omwe amafanana ndi avareji.

Kutsiliza: Kukula kwa mahomoni.

Khungu komanso mucous nembanemba:

Khungu limakhala lotuwa pinki, loyera, lonyowa, lotentha, lotakasuka limasungidwa. Khungu silinasokere. Dermographism ndi yoyera, yowonjezera, mawonekedwe owoneka ndi -1 miniti, kuchepa kwa mphindi 2.

Mafuta a subcutaneous samapangidwa bwino, amagawanidwa chimodzimodzi. Zisindikizo, subcutaneous emphysema, palibe edema.

Palatine tonsils pinki, osakulitsidwa.

Kukula kwa tsitsi ndi yunifolomu.

Mbale ya msomali sinasinthidwe, ndimtundu wa pinki.

Palpable submandibular, inguinal, axillary lymph node. Pa palpation, yopanda ululu, 0.5x0.5 cm kukula kwake, osakwatira, ozunguliridwa, osaphatikizidwa ndi minofu yowazungulira komanso pakati pa wina ndi mnzake, mafoni.

Mutu ndi wachilendo.

Palibe kuchepa kwa mafupa. Kusintha kwa msana ndikulondola.

Malumikizowo ndi amtundu wanthawi zonse, osapweteka palpation. Kusunthika komwe kumalumikizana ndi kwaulere, kopweteka. Palibe zoletsa kayendedwe.

Minofu imakulitsidwa pang'ono, motsatana. Kutulutsa mawu kumasungidwa. Malingaliro osavulaza.

Kupuma mwaulere kudzera pamphuno, palibe zotulutsa.

Mawu ndi akulu, sonor. Pomwe larynx ndi yolondola, palibe chotupa.

Bokosi la mtundu wa asthenic, lopanda zofooka. Magawo onse a chifuwa amatenganso mbali pakumapumira molingana. BH = 18 pamphindi, kugunda kwamtima = 78 pamphindi.

Mtundu wa kupuma pachifuwa. Mukapuma, simulowerera minofu yothandizira.

Kugwedezeka kwamawu m'zigawo zachifuwa ndizofanana.

Phokoso lodziwika bwino la m'mapapo limamveka ponseponse.

Zothandiza: kupumula- kosayenda, popanda kugudubuza. Phokoso lokangana kwawanthu silimveka.

M'munsi mwa mapapu:

Mzere wakutsogolo wakunja

Mzere wa axillary wapakati

Mzere wowonjezera

Pa palpation yam'tsogolo, carotid, radial, femal, popliteal mitsempha, imamveka kutuluka kwa pulsation.

Pa palpation yamkati mwa 1.5 masentimita kuchokera mzere wa midclavicular mu V malo osungirako malo, kumveka kotsimikizika kwa mphamvu yolimbitsa.

Kugunda kwamphamvu-78 kumenyedwa / mphindi.

Malire a kukwiya kwamtima:

Pakati pakati pa mzere wamanjenje wamanja ndi cholimba kumanja

Chingwe chakumanzere

Malo achitatu odutsa pakati

0,5 masentimita akunja kuchokera kumanzere kwa Midclavicular mzere

Pafupi ndi mzere wamanzere (kuchokera pansi)

Kufupika kwamtima: 10 cm

Kutalika kwa mtima: 12 cm

Kutalika kwa chotupa cham'mimba 5.5 cm

Panthawi yokondwerera, mafunde amakhala omveka bwino.

Lilime yokutidwa zoyera, chonyowa. Nembanemba yamkati yamilomo, masaya, kamkamwa, pharynx ndi mtundu wachilengedwe wa pinki, woyera.

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

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

Khomo lolimba la mawonekedwe olondola, popanda kupunduka, palibe kusintha kwa mucosal.

Khomo lofewa ndilofanana, ndi mafoni.

Palatine toni pamlingo wamabwinja, osagulitsidwa kwa iwo, ochepera.

Mawonekedwe am'mimba ndi ozungulira, pamimba ndimafupa, osatupa.

Ndi palpation yapamwamba, pamimba pake ndiofewa. Zizindikiro Shchetkina-Blumberg-negative.

Chiwindi chimakhazikika m'mphepete mwa chipilala chodula: m'mphepete mwa chiwindi ndi lakuthwa, pansi ndilopanda, losalala, komanso lopweteka.

Kukula kwa chiwindi malinga ndi Kurlov: 9cm-8cm-7cm.

Chikhodzodzo ndulu sichothandiza. Zizindikiro za Ortner, Murphy-negative.

Zikondamoyo sizosatheka. Ululu pa palpation m'dera la Shoffar ndi Desjardins point suwunikidwa.

Ndulu sizimveka.

Mukamayang'ana dera lumbar la hyperemia, kutupa, kutupa. Impso sizithandiza. Malo omwe amawonekera ndi opondaponda alibe kuwawa.

Diuresis yawonjezereka, kukodza sikupweteka, palibe kuchedwa kukodza.

Palibe kukula kobwerera m'mbuyo. Chithokomiro cha chithokomiro sichitha. Makhalidwe oyambilira ogonana amafanana ndi jenda komanso zaka.

Amitundu amakula malinga ndi mtundu wachikazi.

Mwa uchikulire, machitidwe ogonana achikhalidwe amakhala ndi njira:

Ma0 ndiye gawo la ana kukula kwa zofunikira za mabere a mammary.

Kuzindikira ndikudziwikiratu. Luntha limafanana ndi msinkhu wa kakulidwe ndi zaka.

Khalidwe la wodwalayo ndilokwanira. Mtsikanayo ndi wochezeka.

1. Pakamwa pakamwa

4. Chilankhulochi ndi chowala (choyera),

7. Kuchepetsa thupi.

1. Zizindikiro za matenda ashuga

Kulungamitsidwa kwa matenda oyamba:

Kutengera madandaulo a wodwala: kukamwa kowuma, kukoka pafupipafupi, nseru, kupweteka mutu, malaise, kuwonda.

Popeza mbiri yakale ya matendawa: odwala chaka chatha, kuda nkhawa ndikumangokhala pakamwa pakamwa, kukoka pafupipafupi, nseru, kuchepa thupi. Mlingo wa glucose wamagazi panthawi yoyesedwa koyambirira ndi 16 mmol / L.

M'masabata awiri apitawa, zinthu zidayamba kuvuta, chifukwa adatembenukira kuchipatala cha Central District komwe amakhala, komwe adakatumiza kuchipatala cha ana kuchipatala cha Krasnodar kuti akalandire ndikuwathandiza.

Mutha kupanga matenda: mtundu 1 matenda a shuga, kutalika kwa maphunzirowa ndi chaka chimodzi. Gawoli lidzafotokozeredwa nthawi yoyeserera.

3. Kukhazikika kwa enterobiosis (katatu),

4.cal pa mazira a nyongolotsi,

6.BH yamagazi (shuga, bilirubin, ALT, AST, cholesterol),

7. Ultrasound yam'mimba,

8. Kufunsidwa kwa katswiri wa zamitsempha, ophthalmologist kuti adziwe zovuta.

1. mankhwala azakudya (tebulo Na. 9),

2. M'malo mankhwala:

Maphunziro a paraclinical:

Maselo oyera (WBC) -6.16 x 10 / L (N = 5.0-10.0 x 10 / L),

Maselo ofiira a magazi (RBC) -4.53x10 / l (N = 3.5-4.5x10 / l),

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

Voliyumu yapakati pama cell ofiira am'magazi (MCV) ndi 84.1 fl (N = 75-95 fl),

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

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

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

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

Mapeto: pali kuchuluka kwa hemoglobin ya glycosylated, yomwe imawonetsa kuwonongeka kwa matenda ashuga.

Ulesi suyenda,

Mphamvu yapadera yokoka-1020 (N = 1005-1030),

Maselo ofiira a m'magazi-0-1-1 mu ma s,

Bilirubin - sanapezeke

Kutsiliza: glycosuria adapezeka pakuwunika, zomwe zikuwonetsa kukhalapo kwa gawo la matenda a shuga mellitus.

3. kufunafuna enterobiosis (3-fold) -negative.

4. Kalori pa Mazira A Nyongolotsi - Mazira a Nyongolotsi samapezeka.

5. Mwazi pa MPA-negative.

Bilirubin yathunthu ndi 7.11 mmol / L (N = 8.5-20.5 mmol / L)

Triglycerides - 0,86 mmol / L (N = 0.5-3.4 mmol / L)

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

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

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

ALT-29.00 u / l (N = 7-40 u / l)

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

Kutsiliza: kuchuluka kwa glucose kumawonetsa hyperglycemia.

7. Ultrasound yam'mimba chakudya:

Kutsiliza: Kusintha kwa kapangidwe kake m'mimba mwa ziwalo zam'mimba sikunapezeke.

Kutsiliza: mu mitsempha ya mawonekedwe oyang'ana sanazindikiridwe. Palibe zovuta zamitsempha. Panthawi yoyesedwa, palibe zizindikiro za matenda ashuga polyneuropathy.

Diski ya optic ya mitsempha ya kuwala imakhala yotumbululuka pinki, ndipo mizere yake imakhala yomveka bwino.

Zizindikiro zokhala ndi matenda amtundu 1 shuga: polyuria, kumva kukamwa kowuma, glucosuria, kuchepa thupi, amadziwikanso ndi matenda ena angapo, chifukwa chake mtundu 1 wa matenda a shuga umasiyanitsidwa ndi matenda monga matenda a shuga a insipidus, matenda a shuga a impso, omwe amatchedwa " osalakwa "glucosuria, mtundu 2 shuga.

Matenda a shuga amakhalanso akuwonetseredwa ndi polyuria. Koma imadziwika ndi kachulukidwe kachulukidwe ka mkodzo, aglycosuria ndi Normoglycemia, komwe sikogwirizana ndi chithunzi cha matenda a shuga 1.

Matenda a shuga a Renal amaphatikizidwa ndi glucosuria, koma kuchuluka kwa shuga m'magazi sikudutsa kupitirira koyenera, mosiyana ndi mtundu woyamba wa shuga.

Glucosuria ya "wosachimwa" imatha kuchitika chifukwa cha kusakhazikika kwa ma enzymatic machitidwe a impso tubules okha mwa ana a miyezi yoyamba ya moyo, mtundu woyamba wa matenda a shuga umadziwonekeranso pakapita nthawi ya moyo ndipo ndi wokhazikika, wokhalitsa.

Type 2 shuga mellitus imawonetsedwanso ndi polyuria, kuchepa thupi, kumangokhala ndi ludzu, koma mosiyana ndi mtundu wa 1 shuga mellitus, odwala safuna kulandira insulin.

Cholinga chazachipatala:

Kutengera madandaulo a wodwala: kukamwa kowuma, kukoka pafupipafupi, nseru, kupweteka mutu, malaise, kuwonda.

Popeza mbiri yakale ya matendawa: odwala chaka chatha, kuda nkhawa ndikumangokhala pakamwa pakamwa, kukoka pafupipafupi, nseru, kuchepa thupi. Mlingo wa glucose wamagazi panthawi yoyesedwa koyambirira ndi 16 mmol / L.

Kutengera pa kupenda mozama: Mkhalidwe wa mwana wokhazikika, wokhazikika bwino chifukwa cha kuchuluka kwa polyuria, kumva pakamwa, kufooka, kupepuka, kumva mseru, kupweteka mutu.

Kutengera ndi kuchuluka kwa mayeso azachipatala ndi paraclinical: OAK (Seputembara 8, 2010) - kuwonjezeka kwa glycosylated hemoglobin kumadziwika, OAM (Seputembara 8, 2010) - glycosuria adapezeka pakuwunika, magazi a BH - kuchuluka kwa shuga.

Popeza pamwambapa, titha kudziwa za mtundu wa matenda ashuga 1, mtundu wa kuwonongeka, nthawi yayitali 1 chaka.

1. Zakudya za calorie za tsiku ndi tsiku: 1000+ (100 + 8) = 1800 kcal

2. Kuwerengera kwa mapuloteni, mafuta ndi chakudya mu tsiku ndi tsiku:

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

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

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

Pakatikati: mayunitsi 0,5 / kg x 26 = 13

Insulin yokhala nthawi yayitali: Levemir -8: 00 ndi 22: 00-6.5 UNITS

Insulin ya Ultrashort: Novoropid-6.5 IU

5. Rp: "Neuromultivit"

S. mkati, 1 tabu. Kamodzi patsiku

Mkhalidwe wokhwimitsa malire.

Wodwalayo amadandaula pakamwa pouma, kukodza mwachangu, ludzu, kufooka, kutopa, kupweteka kumutu.

Pakufufuza: khungu ndi loyera, louma. Pakamwa pa mucous pamakhala utoto wamphete, lilime limavala zokutira zoyera.

Pa palpation: pamimba ndi zofewa, zopweteka.

Pazosangalatsa: kupuma kwamaso, popanda kupindika. Mitima yamtima imakhala yodziwika bwino, yopanda mawu.

Novoropid: 6.5 magawo / tsiku - kanayi pa tsiku,

Magawo a Levemir-6.5 nthawi ya 8:00 ndi 22:00

4.neuromultivitis 1 tabu / tsiku

Mkhalidwe wokhwimitsa malire.

Wodwalayo amadandaula pakamwa pouma, kukodza mwachangu, ludzu.

Pakufufuza: khungu ndi loyera, louma.

Pazosangalatsa: kupuma kwamaso, popanda kupindika. Mitima yamtima imakhala yodziwika bwino, yopanda mawu.

Novoropid: 6.5 magawo / tsiku - kanayi pa tsiku,

Magawo a Levemir-6.5 nthawi ya 8:00 ndi 22:00

4.neuromultivitis 1 tabu / tsiku

Mkhalidwe wokhwimitsa malire.

Wodwalayo amadandaula pakamwa pouma, kukoka pafupipafupi, ludzu, kufooka, kutopa.

Pakamwa pa mucous pamakhala utoto wamphete, lilime limavala zokutira zoyera.

Novoropid: 6.5 magawo / tsiku - kanayi pa tsiku,

Magawo a Levemir-6.5 nthawi ya 8:00 ndi 22:00

4.neuromultivitis 1 tabu / tsiku

Name, wazaka 8, wokhala ku ***itter, anali kulandira chithandizo ku chipatala cha ana Clinical, komwe adamulandila chithandizo chamankhwala molunjika kuchipatala chachikulu cha Central Clinical, atazindikira kuti ali ndi matenda a shuga 1 nthawi yayitali.

Wodwalayo adadandaula pakamwa kowuma, kukodza pafupipafupi, kuchuluka kwa chilala, malaise, kufooka, kuchepa thupi, kuchepa chidwi.

Kwa nthawi yoyamba, mwana adayamba kuvutitsidwa ndi zomwe zatchulidwazo chaka chapitacho, pomwe adatembenukira kuchipatala cha Central District komwe amakhala, komwe adatumizidwa ku chipatala cha ana ku Krasnodar kuti akafotokozere bwino za matendawo komanso chithandizo china.

Kutengera pa kupenda mozama: Mkhalidwe wa mwana wokhazikika, wokhazikika bwino chifukwa cha kuchuluka kwa polyuria, kumva pakamwa, kufooka, kupepuka, kumva mseru, kupweteka mutu.

Kutengera ndi kuchuluka kwa mayeso azachipatala ndi paraclinical: OAK (Seputembara 8, 2010) - pali kuwonjezeka kwa glycosylated hemoglobin, OAM (Seputembara 8, 2010) - kuwunikaku kunaulula glycosuria, magazi a BCh - kuchuluka kwa glucose.

Kutengera ndi zomwe tafotokozazi, matendawa adapangidwa: mtundu 1 wa matenda a shuga, gawo la kuwonongeka, kutalika kwa matenda 1 chaka.

1. Kutsata zakudya (tebulo nambala 9),

2. Kutsatira ndi regimen ya mankhwala (insulin mankhwala, vitamini mankhwala, enzyme mankhwala),

3. Kukambirana ndi ophthalmologist, neurologist kuti muwone zosintha za kukula kwa zovuta motsutsana ndi maziko azidziwitso akulu,

4. Chithandizo chanthawi zonse (kangapo kawiri pachaka), kuwunikira mphamvu ya matendawa,

5. Sanatorium-resort chithandizo mu gawo la chikhululukiro cha matenda,

6. Zochita zolimbitsa thupi (zofanana ndi zaka komanso kuchuluka kwa matendawa).

Anamnesis morbi.

Amangodzidwalitsa kuyambira mu Marichi 2013, pomwe zodandaula za kufooka, kutsika kwina, mkamwa owuma, ludzu, njala, chilakolako chambiri, kukodza kwamphamvu, kutaya thupi mwadzidzidzi (malinga ndi mwana, makilogalamu 8), osauka kugona usiku ndi kugona tulo masana, kumva kutentha ndi kutentha kwa nkhope. Madandaulo awa adawatengera kwa dotolo wakomweko komwe amakhala, momwe glycemia idaliri 33 mmol / l. Dokotala wa ana adatchulidwa ndi Nursing Unit ku State Pedagogical Institute of the IODKB Endocrinology department kuti akamupime moyenera ndi kumuchiritsa, pomwe adadziwika kuti ndi DS: Type I kishuga. Pakadali pano, kuchuluka kwa shuga m'magazi, ludzu, kukodza pafupipafupi, pakamwa kowuma, nthawi ndi nthawi kumva kwa hypoglycemia, kupweteka mutu, kupuma movutikira, nthawi zambiri pambuyo polimbitsa thupi, kumakhala kosokoneza. Amalandira Humalog pamayunitsi 30 patsiku, magawo a Lantus 18 pa 22.00. Mlingo wa insulin wa tsiku ndi tsiku ndi magawo 48, osakwana 1 unit pa kilogalamu imodzi ya thupi, chifukwa cha zolakwa zakudya. Chithandizo chamtunduwu chimachitika chaka chilichonse. Nthawi ndi nthawi amene akupita ku chithandizo ndi kuumirira, mphamvu, maulitotherapy mpaka m'munsi. Anatumizidwa ku State Health Institution ya IOKB kuti akalandire chithandizo chamankhwala ndikuwunikira kuti ayang'anire kuchuluka kwa shuga, kulandira chithandizo choyenera komanso kupewa zovuta za matenda a shuga.

Mwana wochokera kwa ine ndimakhala ndi pakati. Kutumiza ndikofunikira, pamasabata 39. Kubala mwana kunalibe mavuto. Palibe chowopsa pantchito cha bambo, kumbali ya amayi (panthawi yomwe ali ndi pakati sanagwire ntchito). Amasuta zizolowezi zoyipa kuchokera kwa abambo ake kuyambira azaka 18, 1-2 ndudu patsiku. Mimba, mayi anakumana ndi toxosis ya theka loyamba - nseru, kusanza. Panalibe zoopseza zakuchotsa mimba. Kukhalapo kwa matenda opatsirana opatsirana pachaka komanso mankhwala pa nthawi ya pakati kumakanidwa. Zambiri zokhudzana ndi kubereka kwa proreslaxis ya rickets ndi kuchepa kwa magazi sizikupezeka. Zambiri pazakudya zamagetsi ndi zochitika zamasiku onse ayi. Kulemera 3400g (4 corridor), kutalika kwa thupi masentimita 52 (4 corridor), chifuwa kuzungulira 35cm (4 corridor), mutu kuzungulira 34 cm (4 corridor).

FR pobadwa ndi avareji, ogwirizana, mesosomatotype.

Kutsiliza: Pali zinthu zomwe zingayambitse kukula kwa matenda a m'matumbo: toxicosis ya 1 theka la mimba: nseru, kusanza, utsi wachiwiri. Kulemetsa kwakachilengedwe kwachilengedwe (gulu lowopsa).

Palibe deta pa nthawi yamatumbo.

Zambiri zodziteteza:

Katemera molingana ndi kalendala ya katemera wa dziko.

Matenda akale: Chickenpox, SARS 3-4 pachaka.

Resistance index = 4/12 = 0,33, kuchepetsedwa kukana, kuchuluka kwa matenda owopsa pachaka = kanayi.

Mbiri Yabanja: Amayi- Evdokimova Tatyana Mikhailovna, wazaka 26 - mphunzitsi waukazale, palibe zizolowezi zoyipa. Abambo - Mitenkov Maxim Vladimirovich wazaka 28 - injiniya, zizolowezi zoipa - amasuta fodya kuyambira azaka 18 zakubadwa ndudu imodzi patsiku.

Agogo anga aakazi, kumbali ya abambo anga, ali ndi matenda ashuga achi II kuyambira ali ndi zaka 60. Iye ndi abale awo ali ndi matenda monga chifuwa chachikulu, uchidakwa, matenda abwinobwino, kubadwa kwanthawi yayitali, komanso matenda amtima.

Genealogical index J = 0,25 - katundu wochepa.

Kutsiliza: Heredity imalemedwa ndi endocrinological.

Zinthu zakuthupi ndi malo okhala:

Banja la anthu atatu-mwana, amayi, abambo.

Banja limakhala chipinda chocheperako 2. Mwana amapita giredi 8A.

Zakudya zosagwirizana ndi uchi, zomwe zimawonetsedwa ndi totupa kumaso.

PomalizaZotsatira zoopsa izi zidadziwika: toxicosis ya theka la mimba: nseru, kusanza, utsi wachiwiri. Kulemetsa kwakachilengedwe kwachilengedwe (gulu lowopsa). Sars 3-4 pachaka. Resistance index = 4/12 = 0.33, kukana kumachepetsedwa, kufalikira kwamatenda owopsa pachaka = nthawi 4 (kawirikawiri mwana wodwala). Mndandanda wa mibadwo J = 0,25 - kulemera kochepa, cholowa chokhala ndi gawo la endocrinological, zakudya zosagwirizana ndi histamine-liberal mtundu.

Mitundu yambiri ndi mawonekedwe akulu azachipatala a mtundu 1 wa matenda osokoneza bongo omwe amaphatikizidwa ndi matenda ashuga a 1 st, matenda a shuga a polyneuropathy a 2 st, a cataract. Dongosolo ndi mfundo zopangira matenda amtunduwu, kapangidwe ka regimen yothandizira.

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/

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

Chidziwitso chachikulu: Mtundu woyamba wa shuga, wapakatikati, wopindika.

Zovuta: Matenda a shuga a encephalopathy 1 tbsp; matenda a shuga a polyneuropathy 2 tbsp;

Matenda oyamba: ayi.

Madandaulo panthawi yoyang'anira

matenda a shuga a mellitus polyneuropathy encephalopathy

Madandaulo ofooka, chizungulire.

Madandaulopanthawi yolandila

Ndi kafukufuku wogwira, wodwalayo anali ndi nkhawa za ludzu (mpaka malita atatu patsiku), polyuria yolimbitsa thupi (mpaka malita atatu patsiku), pakamwa kowuma, kutaya makilogalamu 20 mu theka la chaka, kufooka, kutopa, kuyabwa kwa khungu, komanso kupezeka kwa hypoglycemia pambuyo otsikira, pafupifupi kawiri pa sabata (kufooka, kutopa, kuzizira, chizungulire, kusachita bwino), kuchepa kwakumaso kowoneka (mawonekedwe a mawanga patsogolo pa maso), kuchepa kwa kukumbukira, kupweteka kwapafupipafupi m'malire am'munsi, kufupika kwa mpweya wosakanikirana pakulimbitsa thupi, kutayika Tsitsi pamutu.

Mbiri yamatenda apanoAnamnesismorbi)

Wodwalayo adazindikira kuti anali ndi matenda osokoneza bongo a 2007, ali ndi zaka 27, pomwe zizindikiro zoyambirira zidayamba: kukodza mwachangu, ludzu lokwanira, kuyabwa kwa khungu ndi kupweteka m'malo otsika, kufupika kwa mpweya wosakanikirana pakulimbitsa thupi. Kuyambika kwa matendawa. Wodwalayo amagwirizanitsa kuyambika kwa chizindikiro choyamba cha matendawa ndi SARS. Mu 2007, mayeso a shuga m'magazi - 2.4 mmol / l - adapangidwa koyamba ku chipatala cha City Clinical No. 1. Pambuyo masiku 4, shuga wamagazi - 22 mol / L. Mu 2012, wodwalayo adasamutsidwa ku City Clinical Hospital No. 2. Ku chipatala, wodwalayo adapezeka ndi matenda amtundu 1 wokhwima kwambiri, kuwonongeka. Glycemia kumayambiriro kwa matendawa 3-13 mmol / l, adatenga Novorapid 4 + 5 + 5U, Levemir 10 + 15U. Mkhalidwe waumoyo wathanzi panthawi yamankhwala. Kukhalapo kwa kulipidwa kwa chakudya cha carbohydrate. Wodwalayo amatsatira chakudyacho No. 9.

Palibe zovuta za shuga.

Adabadwira mumzinda wa Vladivostok mu 1979, kutalika kwa thupi (3100 g, kutalika masentimita 47), adaleredwa m'banja labwino. Ndinapita kusukulu kuyambira ndili ndi zaka 7, ndinamaliza maphunziro 11. Pambuyo pake anaphunzira sekondale.

Matenda aubwana (chifuwa chachikulu, matenda a Botkin, mitsempha. matenda) amakana.

Mbiri yakudziko: osalemedwa.

Mbiri yakunyumba: Malo okhala ndi abwino.

Mbiri ya poizoni: kukana zizolowezi zoipa.

Mbiri yaukadaulo: ntchito yosunthika, zolimbitsa thupi zolimbitsa thupi sizifotokozedwa bwino, zimadya pafupipafupi katatu patsiku ndi zakudya zopepuka, zopatsa mphamvu, zimati nthawi yayitali yogwirira ntchito chifukwa chogwira ntchito.

Matenda akale: chikuku, rubella, CHD - katemera wa Fallot, adachitidwa mu 1989 chifukwa cha matenda oopsa a mtima.

Mbiri yotsatira: osalemedwa.

Mbiri ya zakulera: Mwezi uliwonse kuyambira wazaka 14, kuzungulira kumayambira nthawi yomweyo. Amuna osapweteka, motalika (masiku 4). Kutembenuza kumachitika pafupipafupi masiku 28. Panalibe kutenga pakati.

Zowunikira cholingaMkhalidwemavomerezi)

Mkhalidwe wamba wodwala ndiwokhutiritsa. Kuzindikira ndikudziwikiratu. Udindo wake ndiwothandiza. Zolimbitsa thupi ndi asthenic. Chakudyacho ndi chokhutiritsa. Anthropometry: kutalika kwa 165 masentimita, kulemera kwa 49 makilogalamu, kulemera kwamphamvu kwa thupi 17.9, kuzungulira kwa 62 cm.

Khungu komanso mucous nembanemba.

Khungu: Khungu limakhala lofiirira, ma mucous nembanemba amaso, mphuno, milomo, ndi pakamwa ndi pinki. Mtundu wabwinobwino wa khungu, turgor yafupika. Kuchuluka thukuta sikunadziwike. Khungu chinyezi ndilabwinobwino. Chingwe, kutulutsa thukuta, kukwapula, kukanda, zithupsa, kuchuluka, kupezeka kwa zolakwika zam'mimba, matenda amiyendo, mabala kulibe. Fungo la acetone kuchokera mkamwa kulibe. Misomaliyo ndi yopyapyala, yocheperako, tsitsi la mtundu wachikazi.

Matenda a minofu: Kukula kwa minofu ndi kamvekedwe kabwino. Pakukhathamira ndi kusuntha, minofu yake imakhala yopweteka, kunjenjemera ndi kunjenjemera kwa minofu imodzi sikunapezeke. Palibe ma parresis ndi ziwalo.

Dongosolo la Osteoarticular: Mukamayang'ana mafupa a chigaza, chifuwa, pelvis, miyendo, makulidwe, zotupa za zovuta zina sizinapezeke. Kugwedezeka ndi kuwonongedwa sizowawa.

Dongosolo la Lymphatic: The occipital, anterior ndi posterior khomo lachiberekero, chibayo, parotid, submandibular, supraclavicular ndi subclavian, axillary, ulnar, inguinal, popliteal lymph node si palpated.

Khungu la chithokomiro: osati kosavomerezeka.

Njira yothandizira.

Chifuwa chimakhala chozungulira, chofanana. Kona ya epigastric ndi yowongoka. Mapewa amapindika zolimba pachifuwa, amasunthira molumikizana mpaka kupumira. Ma fossae a supraclavicular ndi subclavian amawonetsedwa mokhutira, omwe ali pamlingo womwewo, sasintha mawonekedwe awo akapuma.

Mtundu wa kupuma kosakanikirana ndi kuchuluka kwa bere. Kupuma kwamagalamu - 18 pamphindi. Magawo akumanja ndi kumanzere kwa chifuwa amayenda motsatana. Chiwerengero cha zigawo za kudzoza ndi kumaliza ntchito sichinawonongeke. Minofu yothandizira sikugwira nawo ntchito yopumira.

Poyerekeza mapapu

Pamwamba pa magawo onse am'mapapu, phokoso la percussion ndilowonekera bwino.

Kupumira paliponse pamapapo ndi kwamasamba. Crepitus, Wheezing ndi pleural chikwapu phokoso samveka.

Kuyesedwa kwa mtima

Dera lamtima silisintha mosawoneka. Kusunthika kwapang'onopang'ono kumatsimikiziridwa mu V intercostal danga 1 masentimita kuchokera kutsogolo kuchokera kumanzere apakati a clavicular. Kukhudzika mtima panthawi ya mayeso sikumatsimikizika. Zovuta zam'mimba sizikuwoneka.

Kukhumudwa kwa mtima

Kusokonekera komweko kumakhala kolumikizika mkati mwa V malo osanjikiza 1 masentimita kuchokera kutsogolo kuchokera kumanzere apakati pa clavicular, ndi dera la 2 lalikulu. onani, mphamvu zolimbitsa, matalikidwe apakati. Palibe kukopa kwamtima. Chizindikiro cha "katsi purr" sichikupezeka. Kugunda kwa manja onse ndi kwamtambo, kumamenyedwa pamphindi. HELL 110/70.

Malire oyenera a kukhazikika kwa mtima ali pamalo a 4 kutalika kwa 1 cm kuchokera kumphepete kumanja kwa sternum.

Malire akumtunda kwa wachibale wamtima wapendekera m'munsi mwa nthiti ya 3.

Malire akumanzere kwa wachibale wamtima wake ali 1 cm mkati kuchokera kumanzere kwapakati kwamakalata mkati mwa danga la 5.

Pamalo asanu olimbikitsa, ma toni awiri ndi kupumira kwapawiri kumveka. Pa 1st and 4th auscultation point, ndikumveka imamveka bwino, yayitali, yotsika, imatsata kupuma kwakutali, ikugwirizana ndi kusokonekera kwa apical ndikugunda pamitsempha yam'mphepete. Pamalo 2 ndi 3, kamvekedwe ka II kamamvedwa bwino, mokweza, kakafupi, kutalika, kotsatizana ndikapumira pang'ono kuposa kamvekedwe ka mawu, sikakugwirizana ndi kukakamiza kozungulira ndi kugunda kwamitsempha yam'mphepete, kuwonjezeka kwa kamvekedwe ka II pamwamba pa vala ya aortic kumadziwika. Phokoso ndi zida za m'magazi sizimveka. Palibe phokoso losokonekera lamatama.

Matumbo ndi ziwalo zam'mimba.

Kufufuza pakamwa

Masaya a mucous, ofewa komanso olimba, kumbuyo kwa mmero ndi pinki, lonyowa, loyera. Matani samapitilira pazingwe za palatine. Zilonda zamkati sizinasinthidwe, ndimtundu wapinki, musakhe magazi, osadzimitsa. Mano osasinthika. Odor, ming'alu m'makona amkamwa ndi herpes labialis palibe. Lilime ndi pinki, palibe ming'alu, zilonda, kapena kutupa.

M'mimba mwa mawonekedwe olondola, ophatikizira, amathandizira kupuma. Palibe zowonekeratu zam'mimba ndi matumbo zomwe zapezeka. Intaneti wofikira wazimba pakhoma lam'mimba ndi kuzungulira navel sizinatchulidwe. Hernia, kusiyanasiyana kwa minofu ya rectus abdominis sikuwonekera. Khoma lam'mimba lakunja ndilofewa, lowonjezera, lopanda ululu, makina osindikizira am'mimba sanapangidwe bwino, palibe malo a hyperesthesia.

Chiwindi cha chiwindi malinga ndi njira ya Kurlov

Malire a kumtunda kwa chiwindi kufooka pafupi ndi mzere wam'kati mwa clavicular ali pamlingo wa nthiti ya VI (mfundo yoyamba).

Malire a kumtunda pafupi ndi mzere wakutsogolo - wotsimikizika, tsembani mzere kuchokera pamalire omwe apezedwa ndikuwonekera kwa mzere wam'mphepete mwa mzere wa midclavicular kupita kumphepete mwake ndi mzere wakutsogolo wapakati (3 point).

Malire a m'munsi a chiwindi ali kumanja pakati pa clavicular pamalire am'mphepete mwa arch yamtengo wapatali (2 mfundo), pamzere wakutsogolo - pamphepete chakumtunda chapakati komanso chapakati patali pakati pa njira ya xiphoid ndi navel (mfundo 4), kumanzere kwa mtengo wamanzere arch - pamlingo wa nthiti ya VII (5 point).

Kukula koyamba ndi mtunda pakati pa malire am'munsi ndi apansi a chiwindi motsatira mzere wa clavicular - 9 cm (pakati pa 1 ndi 2 point).

Kukula kwachiwiri ndi mtunda pakati pa mfundo yachitatu ndi yachinayi, malo a 3 ndi gawo lolowererapo la perpendicular lobwezeretseka kuchokera ku pointximal to the front midline - 8 cm.

Kukula kachitatu kapena kosapindika kwa chiwindi kumakhala pakati pa mfundo zitatu ndi zisanu. 5 point ikufanana ndi malire am'munsi a chiwindi pamodzi ndi mtengo wamanzere waku mtengo - 7 cm.

Spleen percussion malinga ndi njira ya Obraztsov

Mphepete m'munsi mwa ndulu imatsimikizika m'mphepete mwa chipilala chamtengo kumanzere cha X mpaka pamalo pomwe akuwoneka ngati mkokomo (1 point).

Mphepete yam'mphepete mwa ndulu imatsimikizika pamzerewu kulowera kwa malo oyamba kupita kumalo komwe kumachitika phokoso losakhazikika (2nd point).

Kutalika kwa ndulu ndi gawo lolumikiza mfundo za 1 ndi 2 - 6 cm.

Danga lam'mphepete limatsimikizika ndi njira ya kuzungulira kuchokera kufumbi kupita kumalo opondera kuloza kuchokera kumveka omveka kupita kumodzi, malinga ndi perpendicular, yomwe imagawa kutalika kwa ndulu pakati, mpaka phokoso lowoneka bwino (lachitatu). Mfundo yachinayi imatsimikizika kuzungulira kuyambira pansi mpaka pamwamba, koma mpaka kumunsi kwa perpendicular, komwe kumagawa kutalika kwa nduluyo pakati, mpaka kumveka kulira. Gawo lolumikiza mfundo za 3 ndi 4 - mainchesi a ndulu - 4 cm.

Kuyeserera kwa kapamba

Kukhazikika kwa kapamba

kapamba sikuchitika.

Palibe zotupa ndi zotupa za khungu pamwamba pa impso.

Impso sizithandiza. Kugwedezeka kwambiri kwa impso ndi ureters sikupweteka.

Chizindikiro cha kumenya sichabwino. Kuchotsa kumakhala kwaulere, kopweteka, mwachangu. Diuresis ndi yokwanira.

Kuzindikira ndikudziwikiratu. Nzeru ndizabwinobwino. Wodwalayo amayankha mafunso molondola. Munthawi yake. Kuwonongeka kwa mawu sikunadziwike. Pfupifupi, kuwonongeka kwa kukumbukira kumadziwika. Maimidwe amkati a nkhope, kusalala kwa khola la nasolabial, kupatuka kwa lilime pambali apo. Ana amasuntha mosinthana, momwe kuwala kumayambira komanso malo okhala pang'onopang'ono. Kusunthaku ndikugwirizana, kumakhala ndi chidaliro. Tendon amawunikira popanda mawonekedwe. Kupweteka ndi ma tactile kumachepetsedwa zala zakumalo, m'malo ena sasinthidwa. Palibe kunjenjemera konse konse kwa zala.

Nyanja: khungu limakhala lotentha, khungu limakhala labwinobwino. Palibe kusintha kwa ma trogic m'malo otetezedwa, zimakhala ndi zala, zotupa kumbuyo kwa manja, mapazi, miyendo. Kutumphuka kwa ziwiya zamagawo akumunsi ndizabwinobwino.

Ukazi wamtundu wachikazi. Kuwonongeka kwa tsitsi kumutu kumadziwika. Tizilombo ta mammaries timachepa kukula.

Poyambirira: Matenda a shuga a mtundu 1 amakhala olimba, kuwonongeka.

Mavuto: Matenda a shuga a matenda ashuga a 1 ;;

1. Kuyesedwa kwa magazi.

2. Kusanthula mkodzo pafupipafupi.

3. Acetone mu mkodzo.

4. Kusintha kwatsiku ndi tsiku m'magazi a magazi.

5. Bilirubin, kuyesa kwa chiwindi.

6. Magazi a creatinine.

7. Mlingo wa potaziyamu m'magazi.

8. Ultrasound ya chithokomiro.

10. Kukambirana ndi ophthalmologist: kufufuza kwa fundus.

Anamnesis matenda

Amadzidwalitsa okha kuyambira mu 1986 (zaka 36), pomwe madandaulo otsatirawa adawonekera: kuchuluka kwa ludzu (mpaka malita 8 patsiku), kukodza pafupipafupi, kufooka, kuchepa thupi kwambiri (kupitirira miyezi 4 wodwalayo adataya makilogalamu 13). Viral kapena matenda ena akulu izi zisanachitike. Ndidapempha thandizo mu Okutobala 1986, fungo lokhazikika la mkamwa mwanga litatuluka. Kuchipatala.Mlingo wa glycemia ndi 18 mmol / l; glucose ndi matupi a ketone mumkodzo adapezeka. Wodwala adapezeka ndi mtundu wa matenda a shuga a mellitus, mankhwala a insulin adalembedwa. Pakatha milungu itatu, wodwalayo adachotsedwa mu ntchito yolipira. Mu 1988, adagonekedwanso m'chipatala ndi zizindikiro zakubwezeretseka (ludzu lalikulu m'mawa, njala, thukuta madzulo ndi usiku). Mulingo wa glucose sukumbukira. Wodwalayo adasintha mlingo wa insulin. Kugonekedwa kwa chipatala kumeneku, mu February 2005 wodwalayo adayamba kuwona zodabwitsika (pakamwa pouma, ludzu, polyuria, kufooka), adapita kwa adotolo, adagonekedwa m'chipatala.

ANAMNESIS WA MOYO

Anakula ndikukhazikika. Ndinapita kusukulu kuyambira ndili ndi zaka 7. Anamaliza maphunziro 8 ndi masukulu ophunzitsa ntchito. Pambuyo pake adagwira ntchito yoyendetsa.

Munthawi zonse za moyo, chakudya chinali chokwanira komanso zofunikira. Osasuta. Mowa sutha.

Amakhala m'nyumba yabwino. Mikhalidwe yanyumba ndiyokhutiritsa. Malamulo a ukhondo waumwini amawonedwa pafupipafupi.

Amakhala m'malo otetezeka m'malo a chilengedwe komanso ukhondo. Sindinalumikizane ndi odwala opatsirana. Sindinapite kunja kwa dera la Smolensk. Kuthiridwa magazi ndi katemera sizinachitike.

Palibe mbiri yamatenda oyambitsidwa.

Pafupipafupi, ma ARVI akudwala (1 nthawi yazaka 1.5). Ali mwana, adadwala matumbu, rubella ndi nkhuku. Kuchokera pa zolemba: opaleshoni. Palibe mbiri ya chifuwa chachikulu komanso matenda opatsirana pogonana.

ZOFUNA ZOFUNA

Kulemera thupi makilogalamu 78

Kuthamanga kwa mtima = 76 kumenyedwa mphindi.

HELL = 120/80 mm. Hg. Art.

Panthawi yoyang'aniridwa, mkhalidwe wa wodwalayo ndiwokhutiritsa. Chidziwitso chowonekeratu, zochitika zogwira mtima, kuyankha mokwanira kwa ena. Amayankha mafunso mofunitsitsa, ochezeka. Mawuwo ndi olondola, chiwonetserochi ndichachidziwikire, matchulidwe ake ndi olondola. Ntchito zamagalimoto ndi zamaganizidwe ndizoyenera zaka.

Mkhalidwe wa pakhungu ndi mucous nembanemba

Khungu limakhala loyera, lopaka khungu. Zowoneka bwino za mucous ndi pinki, zoyera, zonyowa. Conjunctiva wamaso ndi wotuwa pinki. Mtundu wa sclera sunasinthidwe. Chinyezi cha pakhungu chimakhala chochepa, zotanuka ndizochepa. Makulidwe akhungu la khungu m'malo opezekanso chimodzimodzi. Zizindikiro za Endothelial "-".

Maukonde a venous sanakulitsidwe

Amapangidwa mosamala, ndikugawidwa moyenerera padziko lonse la thupi.

Turgor minofu yosungidwa. Palibe edemas zoonekeratu.

BONE - MUSCLE SYSTEM

Chifuwa chofiyira chopindika. Kutalika kwa malo oyambira m'magawo azofanana ndizofanana. Normostenic mtundu wa thupi. Chifuwa chimakhala choyimira, popanda kupindika.

Malingaliro ali ofanana. Mawonekedwe a zala zakumtunda komanso zam'munsi popanda kusintha kwatsoka, mapazi osadukiza sanawonekere.

Maulalo osasinthika, mawonekedwe abwinobwino, bb. Kuyenda kokhazikika ndi kolumikizana molumikizana kwathunthu. Zilonda zofewa m'malumikizidwe sizisinthidwa.

Minofu ya m'munsi yam'munsi imapangidwa mosiyanasiyana. Kutulutsa mawu kumveka bwino. Kulimbitsa minofu kumafanana ndi jenda komanso zaka. Paresis ndi ziwalo sizinapezeke. Minofu b / w.

NJIRA YOKAMBIRANA.

Kupumira m'mphuno ndi kwaulere, palibe ululu womwe umawerengeka ndi zolakwika. Mphuno ndi yachilendo. Mawu ndi a mwana. Osatulutsa mphuno. The mucous nembanemba mkamwa wamkati ndi pinki. Lilime ndi loyera, lonyowa, la papillae silopanda tanthauzo, kulibe ming'alu. Matani a Palatine samakulitsidwa, palibe zolembedwa. Khoma lakumbuyo kwa pharynx silopanda chinyengo, popanda zomata.

Chifuwa chimakhala ndi mawonekedwe a cheni wopindika, wopingasa, mbali zake zonse ziwiri amagwiranso ntchito mothandizidwa ndi kupuma. Palibe kutupa ndi kufutukula kwa malo okwera mtengo. Kutalika kwa malo oyambira m'magawo azofanana ndizofanana. Minofu yothandizira sikugwira nawo ntchito yopumira. Epigastric angle of the straight. Magawo a mapewa amapezeka symmetrically. Kupuma kwamimba .. NPV = 18, pulse = 76, chiyerekezo cha NPV ndi kugunda kwa mtima = 1: 4.2. Kupuma kwa Vesicular. Palibenso dyspnea pakupuma.

Pesi b / w, zotanuka. Kugwedezeka kwamawu ndikubwinobwino, kumachitidwa chimodzimodzi pamagawo ofanana pachifuwa.

Ndi kuyerekezera kofananira kudera lonse la mapapu, kumveka bwino kwamapapu kumamveka. Ndi mawonekedwe a topographic:

M'malire ochepa

• l. Medioclavicularis 6th nthiti
• l. axillaris media 8th nthiti 9th nthiti
• l. scapularis 9th nthiti 10th nthiti
• l. paravertebralis spinous process Th 11

Kuyenda kwa m'munsi m'mapapu

• l. axillaris media 3 cm 3 cm

Kupuma kwamaso, kulibe kulira kwachiwiri. Bronchophony m'malo oyesa sinasinthidwe.

NJIRA YA CARDIOVASCULAR.

Malo amtima sasinthidwa. Mtima umatha kulibe. Chikhumbo chamtima sichimadziwika. Pulsations ya carotid mitsempha yotupa yamchiberekero ya khomo pachibelekeropo, kutupira ndi kutulutsira kwa malo oyanjana sikumawonedwa. Tsambalo silinafotokozedwe.

Mapa 76 / min., Synchronous, yemweyo pamanja onse, mwaphokoso, kudzazidwa kwabwino komanso kusokonezeka, osati kuthamanga, yunifolomu. Kukoka kwa capillary sikupezeka.

Kutsitsa kwaphokoso kumalongosoledwa m'gawo lachisanu mkati mwa 1.5cm kuchokera mzere wa midclavicular, osataya, 1 cm lalikulu, 1 mm kukwera, kwamphamvu.

MALO A CARDIAC STUPIDITY.

Malire Ogwirizana

m'mphepete lamanja lamanja la sternum m'mphepete mwa sternum

lamanzere 1.5 cm mkati kuchokera pafupi ndi parter wamanzere

midclavicular mzere wolipa

lakuthwa 3 nthiti 4th

Mawu amitima akumveka bwino. Palibe phokoso.

The mucous nembanemba mkamwa wamkati ndi pinki chonyowa. Lilime ndi loyera, lonyowa, papillae silakulitsidwa, palibe ming'alu. Palibe mano oopsa. Chitsamba sichinasinthidwe, musakhe magazi. Khoma lakumbuyo kwa pharynx, khansa yolimba komanso yofewa sikuti ili yopanda mafupa, osapakidwa, palibe zilonda. Matani a Palatine satuluka m'mphepete mwa zipilala za palatine, sikuti amakhala opanda mafupa. Kugwedeza sikuphwanyidwa. Njira yodutsa chakudya kudzera mummero imakhala yaulere, yopweteka. Mimba ndi yozungulira, yozungulira, yofanana. Peristalsis m'diso sawoneka. Tsambalo la venous silifotokozedwa. Zovuta za rectus abdominis ndi hernias sizinapezeke. Minofu yakhoma yam'mimba khoma symmetrically imathandizira kupuma. Mpando umaperekedwa, 1 nthawi patsiku, kuchita defecation b / b.

Ndi pakamwa mopepuka, pamimba pamakhala zofewa, zopweteka. Kamvekedwe ka minofu khoma lamkati lam'mimba ndi kochepa. Maumwini achilendo omwe sanapezeka. Kupsinjika ndi kusiyana mu minofu ya khomo lakunja kwam'mimba sikunapezeke. Chiwindi mmbali mwa chipilala chodula, ndulu sizikukulitsidwa.

Ndi njira yayikulu yotsatsira topographic palpation malinga ndi Obraztsov - Strazhesko:

- m'chigawo chakumanzere, kholamu ya sigmoid imakhazikika ngati chingwe chosalala, chopindika, chopweteka, chingwe cholimba d = pafupifupi. 2 cm, osagwedezeka.

- m'chigawo cholondola chakumalo, cecum imakutidwa ndi chingwe chosalala, chowoneka bwino, chosapweteka, chosagwedezeka, chingwe chosunthidwa d = pafupifupi. 2 cm

- Colon yopingasa imakhala yolimba ndi 1.5 cm pamwamba pa msomali mu mawonekedwe osalala, otanuka, osapweteka, osagwedezeka, osunthika mozungulira silinda d = pafupifupi. 2 cm

- m'chigawo chakumanja, kolonayo ikutchulidwa kuti yosalala, yodontha, yosavulaza silinda d = pafupifupi. 1.5 masentimita, kusunthika pang'ono, osagwedezeka.

- m'chigawo chakumanzere, kolona yotsikirako imatanthauzidwa ngati cylinder dyl yosalala, yopanda zowawa, yopanda ululu d = pafupifupi. 1.5 masentimita, kusunthika pang'ono, osagwedezeka.

- dera lamatumbo laling'ono ndilopweteka palpation.

Chiwindi pakhungu: 0,5 cm. Mphepete yake m'munsi ndiyolimba - zotanuka, zopanda ululu, zosalala, ngakhale.

Ndi kuzindikira: kukula kwa chiwindi malinga ndi Kurlov:

- kumanja kwa midclavicular mzere 11 cm.

- m'ma 9 cm.

- m'mphepete mwa arc (kumanzere), kukula kwake ndi 6.5 cm.

Zizindikiro za Kerr, Ortner, kugunda kwa oblique, squirsky, Murphy, Jonas, Boas, Mussi - Georgiaievsky, Courvoisier - ndizosalimbikitsa panthawi yoyang'anira.

Zikondamoyo sizosatheka. Zizindikiro za Kach, Boas, Mendel, Mayo - Robson, Yonas - zikuwonetsa.

M'mimba pa palpation. Pa 2 cm pamwamba pa msomali, kupindika kwam'mimba kwakukulu kumakhala kolimba ngati khola losalala, lofewa, lotanuka, loonda.

Ndulu sizimveka. Miyeso ya Percussion ndi 4: 6 cm.

Palpation ya mesenteric l / y kudera la Stenberg ilibe zopweteka.

Khungu m'dera lumbar la mtundu wamba, Hyperemia sichinawonedwe. Edema yowoneka pankhope, miyendo yam'munsi, kumbuyo kwakumbuyo sikuwonetsedwa. Palibe kukonda nkhope. Mimba imakhala yozungulira, yozungulira, siyimatuluka m'mphepete mwa zingwe zamtengo wapatali. Chikhodzodzo sichitha kupitirira m'mimba.

Palpation kudera lumbar, oblium ndi malekezero otsika sanawululire edema. Impso m'malo a supine ndi oyimirira sizigonyeka, palpation yopweteka. Chikhodzodzo sichimveka. Zowawa ndi zowonda m'mimba zimapweteka.

Chizindikiro cha Pasternatsky sichabwino mbali zonse ziwiri. Chikhodzodzo sichimapitilira chiberekero. Kukhalapo kwa madzimadzi aulere pamimba pamimba sikunawonekere.

Kutupa kulibe vuto, 4-5 patsiku. Mtundu wa mkodzo ndi udzu wachikasu.

Plandial gland: kutalika 175 cm, kofanana ndi zaka komanso jenda. Palibe zochulukitsa kapena zochulukirapo. Mafuta amchere am'madzi am'madzi amapangidwira pang'ono, ndikugawidwa chimodzimodzi.

Chithokomiro: sichikukulitsidwa.

Matenda a parathyroid: mawonekedwe a tendon ndi khungu amakhala odziletsa.

Thandi: lilmph osakulitsidwa

Adrenal gland: minofu ndi mafupa amapangika molingana ndi zaka komanso jenda. Khungu limakhala lakhungu. PZhK imagawidwa wogawana. HELL = 12080. Palibenso mchere. Palibe zodandaula kuchokera m'matumbo am'mimba.

Pancreas Wodwala amadandaula za kuchuluka kwa chakudya, pakamwa pouma, ludzu (makamaka m'mawa ndi masana) mpaka malita atatu patsiku, kuchepa thupi kwa miyezi itatu ndi 5 kg. Kukodza mwachangu, kukodza usiku (1 nthawi).

Gonads: Mitundu yakunja imapangidwa molondola.

Epiphysis: palibe chizindikiro cha kupanga kwamphamvu mu chigaza. Mutu, kudzimbidwa, bradycardia - ayi.

Mutha kutsitsa buku lathunthu la mbiri yakale ya zamankhwala pano.

ZOPHUNZITSIRA ZA MTIMA

Nthawi yolandila:

Wodwalayo amadandaula zakuwonjezeka kwa kudya, limodzi ndi palpitations, pakamwa kowuma, ludzu (makamaka m'mawa ndi masana) mpaka malita atatu patsiku, kuchepa thupi kwa miyezi itatu ndi 5 kg. Kukodza mwachangu, kukodza usiku (1 nthawi). Kuda nkhawa ndi kufooka komwe kukukula kuyambira mu Disembala - mwezi, kukokana, kupweteka m'mapazi, matako, dera lakuchepera, kukumbukira kukumbukira.

ANAMNESIS WA KUDwala

Amadziona wodwala kuyambira mu June 1996 (zaka 36), pomwe madandaulo otsatirawa adawoneka: kuchuluka kwa ludzu (mpaka malita 8 patsiku), kukodza pafupipafupi, kufooka, kuchepa thupi kwambiri (kupitirira miyezi 4 wodwalayo adataya makilogalamu 13). Kunali zowawa m'miyendo. Izi zisanachitike, sindinawone kachilombo kapena matenda ena akulu. Ndinapita ku chipatalako mu Okutobala 1996, pomwe kunanunkha fungo la acetone mkamwa mwanga. Kuchipatala. Mlingo wa glycemia ndi 18 mmol / l; glucose ndi matupi a ketone mumkodzo adapezeka. Wodwalayo adapezeka kuti ali ndi matenda a shuga a mtundu I, chithandizo cha mankhwala a insulin - - mayunitsi 54 / tsiku. Pakatha milungu itatu, wodwalayo adachotsedwa mu ntchito yolipira. Atatulutsa, tsiku lililonse adazindikira zochitika za hypoglycemic (nthawi zambiri usiku), limodzi ndi thukuta, kufooka, kunjenjemera, komanso kumva mwamphamvu njala. Mlingo wa insulin sunachepe. Pambuyo pa miyezi isanu ndi umodzi, pafupipafupi zoterezi zimachepa. Mu 1997, adagonekedwanso m'chipatala ndi zizindikiro zakubwezeretsa (ludzu lakuya ndi polyuria m'mawa, njala, thukuta madzulo ndi usiku), yowonjezereka ndi zowawa m'miyendo. Glycemia sakumbukira. Wodwalayo adasintha (amachepetsa) mlingo wa insulin. Pambuyo pachipatala ichi, mikhalidwe ya hypoglycemic imawonedwa kangapo. Kuwunikira kwa glycemia kunachitika nthawi 1 pamwezi pachipatalachi. Ndidasunga chakudyacho, koma mlingo wa insulin sunasinthe malingana ndi kuchuluka kwa chakudya. Zipatala zotsatira - chaka chilichonse. Mu 1999, adaphunzira kusukulu ya odwala matenda ashuga, koma samasunga diary, sawerengera kuchuluka kwa mkate mu chakudya. M'chaka chomwechi adalandila gulu lolumala la III chifukwa cha matenda enieni. Kugonekedwa kwa chipatala kumeneku, mu Disembala 2000, wodwalayo adayamba kuwona zodabwitsazi (pakamwa pouma, ludzu, polyuria, kufooka), adapita kwa adotolo, adagonekedwa m'chipatala.

Mbiri ya zakulera:

Mwezi uliwonse kuyambira zaka 14, kuzungulira kwake kudakhazikitsidwa nthawi yomweyo. Zowawa kwambiri, zochulukirapo, zazitali (masiku 5). Kutembenuza kumachitika pafupipafupi masiku 26. 6 pakati oyembekezera 3 (78, 82, 85 zaka)

Amakanitsitsa chifuwa chachikulu, matenda opatsirana mwakugonana, kulumikizana ndi odwala opatsirana. Mu 1982, anali ndi matenda otupa chiwindi.

Sindinawone ziwonetsero zilizonse za mankhwalawa, zakudya, mankhwala.

Mbiri ya Kuika Magazi: Panalibe kuthiridwa magazi.

Khungu komanso mucous nembanemba

Khungu limakhala lotumbululuka, chinyezi wamba. Khungu ndi zotanuka, lonyowa, minofu turgor kusungidwa. Mafuta a subcutaneous samawonetsedwa bwino, makulidwe a khola pa navel ndi cm 1. The hairline, symmetrical, ikufanana pansi. Ma strip alopecia ndi necrobiosis mawanga pamiyendo amawonedwa. Misomali m'manja ndi miyendo ndi yopyapyala, imvi, ya utoto, yoyera. Diso la mucous ndi pinki, lonyowa, loyera. Sclera sinasinthe. Lilime limachulukana pang'ono kukula, m'mphepete mwa izi ndiye malembedwe a mano.

Njira yothandizira

Mawonekedwe a mphuno sasinthidwa, khosi silinapunduke. Kupumira pamphuno ndi kwaulere, palibe zotulutsa. Kukula kwamawu, aphonia, palibe chifuwa. Mpweya wopumira, kupuma kwamphamvu - 17 / mphindi, mtundu wa kupuma kwamkati. Chifuwa ndi mawonekedwe owumbika, ofanana. Pakufufuza, palibe kusintha kwa chifuwa. Maonekedwe a chifuwa ndi Normosthenic. Onsewa ndi theka amaphatikizidwa pakupuma. Mapewa ndi ma clavicles amamangiriridwa pachifuwa, ma symmetrical. Phokoso la supra- ndi subclavian limatchulidwa mwapang'onopang'ono.

Kukhazikika kwa chifuwacho ndikwabwinobwino, palibe madera achilonda omwe adadziwika, kunjenjemera kwa mawu m'malo omwe ali omwewo.

Kuphatikiza kwapadera: Pazonse zamapapu, kamvekedwe ka mawu ndi omveka.

Topographic percussion: malire a mapapu amatsimikizika pamlingo wokhazikika, kutalika kwa mapapu akutsogolo ndi 3.5 cm kuchokera ku clavicle kumanja ndi kumanzere. Kumbuyo - pamlingo wazingwe wozungulira wotuluka kudzera mu kupindika kwamkati mwa VII khomo lachiberekero la m'mimba. Minda ya Krenig: kumanja - 5 cm, kumanzere - 5.5 cm.