Ngakhale zaka 10 zapitazo, kukana insulini kwathunthu kapena wachibale kunkawonedwa makamaka kukhala vuto la okalamba.
Tsopano pali milandu yambiri yachipatala yokhudza kupezeka kwa matenda amtunduwu kwa ana ndi achinyamata.
Kwa ophunzira a sukulu zamankhwala pali mndandanda wa mitu yomwe amathandizira paokha. Ambiri mwaiwo ndi mbiri yachipatala yotsatirayi: mtundu wachiwiri wa matenda a shuga, matenda oopsa, matenda oopsa.
Dokotala wamtsogolo ayenera kumvetsetsa bwino momwe kapangidwe ka ntchito komanso zinthu zazikulu zomwe zimayenera kuthandizidwa.
Wodwala
Wodwala: Tirova A.P.
Zaka 65 zakubadwa
Ntchito: yopuma pantchito
Adilesi yakunyumba: st. Pushkin 24
Madandaulo
Panthawi yovomerezeka, wodwalayo amadandaula ndi ludzu lalikulu, pakamwa pouma, amakakamizidwa kumwa mpaka malita 4 a madzi masana.
Zolemba mzimayi zimatopa kwambiri. Anayamba kukodza pafupipafupi. Posachedwa, kuyabwa kwa pakhungu ndi kumverera kwadzuwa m'miyendo.
Kafukufuku wowonjezera adapeza kuti wodwalayo adasiya kugwira ntchito zapakhomo chifukwa cha chizungulire, ndipo kukomoka kudadziwika kangapo. Pazaka zapitazi, kupweteka kumbuyo kwa kupsinjika ndi kufupika kwakanthawi pazolimbitsa thupi kwakhala kosokoneza.
Mbiri yazachipatala
Malinga ndi wodwalayo, zaka 2 zapitazo, pakuwunikira pafupipafupi, kuchuluka kwa glucose (7.7 mmol / l) kwakhazikitsidwa.
Dokotalayo adalimbikitsa kuyesedwa kowonjezereka, kuyesedwa kopatsa mphamvu kwa chakudya.
Mayiyo sananyalanyaze malangizo a dotolo, ndikupitiliza kutsogola moyo wake wam'mbuyo, 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.
Pomupangira mnzake, anathira masamba ake ndi kabichi pamphumi, ndikupukutira msuzi wa mbatata, ndikutenga Aspirin. Pokhudzana ndi ludzu lochulukirapo komanso kukodza kwambiri (makamaka usiku), adapita kuchipatala.
Anamnesis ya moyo wa wodwala
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 ndinapita kusukulu, ndinali ndimagwira pakati. 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 bwinobwino, sizinachotsere mimba. Pa zaka 25, opaleshoni yochotsa appendicitis, palibe ovulala. Mbiri yakubadwa siyiri yolemetsa.
Pano opuma 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 oyenera, osadukiza, samva kuwawa palpation.
Kuyerekeza ndi topographic percussion pathology sikunapezeke (malire a mapapu mkati mwa malire abwinowo). Auscultatory: kupuma kwamaso, kumayenderana paliponse pamagawo onse a m'mapapo.
Kudera la mtima nthawi yakuunika, palibe kusintha, kusunthika kwamtunduwu sikuwonetsedwa.
Kugundika kumagundika pamitsempha yamitsempha, 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 lakhala louma, lokutidwa ndi zokutira yoyera pamizu, 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 za matenda omwe am'chipatala, kafukufuku wambiri akulimbikitsidwa:
- kuyezetsa magazi kwamankhwala: hemoglobin - 130 g / l, maselo ofiira am'magazi - 4 * 1012 / l, chizindikiro cha utoto - 0,8, ESR - 5 mm / h, maselo oyera am'magazi - 5 * 109 / l, str neutrophils - 3%, ogawikana - 75%, ma eosinophils - 3 %, lymphocyte -17%, monocytes - 3%;
- urinalysis: utoto wa mkodzo - udzu, mayankho - zamchere, mapuloteni - ayi, shuga - 4%, maselo oyera am'magazi - ayi, maselo ofiira amwazi - ayi;
- kuyesa kwamwazi wamagazi: mapuloteni onse - 74 g / l, albin - 53%, globulin - 40%, creatinine - 0,8 mmol / lita, urea - 4 mmol / l, cholesterol - 7.2 mmol / l, glucose wamagazi 12 mmol / l.
Analimbikitsa kuwunikira zizindikiro za ma labotale mumphamvu
Zambiri zofufuzira
Zotsatira zofufuza zothandizazi zidapezeka:
- electrocardiography: phokoso la sinus, zizindikiro zamanzere zamitsempha yamagazi;
- chifuwa x-ray: Minda ya m'mapapo ndi yoyera, sinuses yaulere, zizindikiro za hypertrophy zamtima wamanzere.
Kufunsidwa kwa akatswiri monga dotolo wamanjenje, ophthalmologist ndi opaleshoni ya mtima ndikulimbikitsidwa.
Kuyambitsa matenda
Type 2 shuga. Kuopsa kwambiri.
Kulungamitsidwa kwa matenda
Popeza madandaulo a wodwala (ludzu, polyuria, polydipsia), mbiri ya zamankhwala (chakudya chopatsa thanzi), kuyezetsa chidwi (kuchuluka kwa thupi, khungu lowuma), ma labotale ndi zida zothandizira (hyperglycemia, glucosuria), matenda othandizira atha kupangidwa.Choyamba: lembani matenda ashuga a 2 shuga, odziletsa, ochulukirapo.
Concomitant: Matenda oopsa a 2, madigiri awiri, ngozi yayikulu. Chakumbuyo: Kunenepa kwambiri.
Chithandizo
Analimbikitsa kuchipatala kuchipatala cha endocrinological kuti musankhe chithandizo.
Njira ndi yaulere. Zakudya - tebulo nambala 9.
Kusintha kwa moyo - kuchepa thupi, kuwonjezera zolimbitsa thupi.
Mankhwala a Oral hypoglycemic:
- Gliclazide 30 mg 2 pa tsiku, kumwa musanadye, kumwa ndi kapu ya madzi;
- Glimepiride 2 mg kamodzi, m'mawa.
Magazi amawongolera zamagazi mumphamvu, ndi kusachita bwino kwa mankhwala, kusintha kwa insulin.
Matenda a kuthamanga kwa magazi
Lisinopril 8 mg 2 kawiri patsiku, asanadye.
Makanema okhudzana nawo
Zowonjezera pa 2 mtundu wa shuga mu kanema:
Ndikofunikira kukumbukira kuti shuga yachiwiri imatha kuthandizidwa ndikuthandizidwa pakudya. Kuzindikira si chiganizo, koma chifukwa chokhacho choti musamalire thanzi lanu.
