Ko da shekaru 10 da suka gabata, juriya ko rashin juriya na insulin shine mafi mahimmanci matsalar tsofaffi.
Yanzu akwai wasu maganganu na asibiti game da bayyanar wannan cutar a cikin yara da matasa.
Ga ɗaliban makarantun likitanci akwai jerin batutuwa waɗanda suke yin aikin mai zaman kansu na tilas. Mafi na kowa sune tarihin tarihin likita: type 2 diabetes mellitus, hauhawar jini, ciwo mai jijiyoyin zuciya.
Likita nan gaba yakamata ya fahimci tsarin irin wannan aiki da kuma manyan abubuwanda yakamata a kula dasu.
Mai haƙuri
Marasa lafiya: Tirova A.P.
Shekaru 65 da haihuwa
Aiki: yayi ritaya
Adireshin gida: st. Pushkin 24
Gunaguni
A lokacin shiga, mara lafiya ta koka da tsananin ƙishirwa, bushe bakin, an tilasta mata ta sha har zuwa lita 4 na ruwa a lokacin.
Matar bayanin kula ta kara gajiya. Ta fara yin urin more sau da yawa. Kwanan nan, itching fata da kuma jin numbness a cikin wata gabar jiki sun bayyana.
Additionalarin binciken ya gano cewa mara lafiyar ya daina yin aikin gida na yau da kullun saboda tsananin wahala, kuma an lura da rauni sau da yawa. A cikin shekarar da ta gabata, jin zafi a baya na tsananin zafin jiki da gazawar numfashi yayin motsa jiki suna ta da damuwa.
Tarihin likita
Dangane da mai haƙuri, shekaru 2 da suka gabata, yayin gudanar da gwaje-gwaje na yau da kullun, an sami ƙara yawan matakan glucose na jini (7.7 mmol / l).
Likita ya ba da shawarar ƙarin gwaji, gwajin haƙuri da ƙwayar cuta.
Matar ta yi watsi da shawarar likita, ta ci gaba da jagorancin rayuwarta ta baya, dangane da karuwar ci, ta sami kilo 20 cikin nauyi. Kimanin wata daya da suka wuce, gajeriyar numfashi da ciwon kirji ya bayyana, ya fara lura da karuwar hawan jini zuwa 160/90 mm Hg.
A kan shawarar da wata maƙwabta ta yi, sai ta shafa ganyen kabeji da zuma a goshinta, ta sha wani ɗan dankalin turawa, ta dauko Asfirin. Dangane da yawan ƙishirwa da yawan urination (galibi da daddare), ta nemi taimakon likita.
Anamnesis na rayuwar haƙuri
An haifeshi a ranar 15 ga Yuli, 1952, ɗan fari na ɗaya a cikin iyali.Haihuwar mahaifa tayi al'ada. Ta kasance tana shayarwa.
An lura da yanayin zamantakewa a matsayin mai gamsarwa (gidan mai zaman kansa tare da duk abubuwan jin daɗi). Samun alurar riga kafi gwargwadon shekaru. A shekaru 7 Na je makaranta, yana da matsakaiciyar cika. Tana da ƙwayoyin huwa da gudawa.
Lokacin haila bai zama da matsala ba, farkon haila ya kasance shekara 13, yana yin kullun, mara jin zafi. Menopause a shekara 49. Yana da 'ya'ya maza biyu da suka girma, masu juna biyu da kuma haihuwa sun ci gaba kamar yadda aka saba, babu masu zubar da ciki. Lokacin da yake da shekaru 25, wani aiki don cire appendicitis, babu raunin da ya faru. Tarihin rashin lafiyan ba a ɗaukar nauyi.
A halin yanzu ya yi ritaya. Mai haƙuri yana zaune a cikin yanayin zamantakewa mai gamsarwa, ya yi aiki na shekaru 30 a matsayin mai siyarwa a cikin shagon kayan kiwo. Yawancin abinci na yau da kullun, carbohydrates yana cin nasara a cikin abincin.
Iyaye sun mutu cikin tsufa, mahaifina ya sha wahala daga ciwon sukari na 2, ya sha magungunan rage sukari. Ba a cinye barasa da kwayoyi, yana lalata fakitin sigari ɗaya kowace rana. Ban je ƙasar waje ba, ban kasance cikin masu haɗarin cutar da marasa lafiya ba. Tarihi na tarin fuka da hepatitis an hana su.
Janar dubawa
Halin matsakaici mai zurfi. Matsayi na sane a bayyane (GCG = maki 15), mai aiki, wadatacce, akwai zuwa lambar sadarwa mai amfani. Height 165 cm, nauyi 105 kg. Jiki na hypersthenic.
Fatar ta kodadde ruwan hoda, mai tsabta, bushe. Gangar jikin mucous na gani mai ruwan hoda, mai laushi.
Turgor taushi mai taushi mai gamsarwa ne, ba a faɗi cututtukan microcirculatory ba. Hanyoyin haɗin gwiwa ba su da nakasa, motsi cikakke, babu kumburi. Ba zazzabi ba. Ba a kara girman mahaɗan jini ba. Ciwon glandon kwayar cuta bashi da matsala.
Bugawa ta hanyar numfashi ta hanyar hanyoyin jirgin sama na dabi'a, NPV = 16 rpm, tsokoki na taimako ba su shiga ba. Kirji yana da hannu a cikin maimaituwa, yana da tsari daidai, ba ya nakasa, ba shi da ciwo a kan bugun jini.
Ba a gano daidaituwa ba da kuma yanayin cutar sankarau (iyaka na huhu a cikin iyakoki na yau da kullun). Auscultatory: vesicular numfashi, symmetrically da za'ayi a kan dukkan huhu filin.
A fannin zuciya yayin jarrabawa, babu canje-canje, yanayin motsa apical ba'a hango shi ba.
An buga bugun jini a kan jijiyoyin bugun gini, ƙwanƙwasawa, cika kyau, bugun zuciya = 72 rpm, hawan jini 150/90 mm Hg Tare da hasashe, iyakancewar rashin lafiyar zuciya da tazarar dangi suna a cikin iyakance ta al'ada. Auscultatory: sautunan zuciya suna muffled, kari kuwa daidai ne, ba a jin kararrakin jijiyoyin cuta.
Harshen bushewa, an rufe shi da farin rufewa a tushe, aikin hadiye bai karye ba, sama ba shi da fasali. Abun ciki yana ƙaruwa da yawa saboda yawan kitse, yana ɗaukar cikin aiki na numfashi. Babu alamun hauhawar jini.
Tare da palpation na waje na herni protrusions da tashin hankali ba a lura.
Alamar Shchetkina - Blumberg korau. Jin zurfin palpation yana da wahala saboda yawan kitse mai ƙyalƙyali.
A cewar Kurlov, hanta ba ta faɗaɗawa, a gefen farashin tsada, buguwa a cikin ƙwayar cuta ba ta jin ciwo. Kwayar cutar cututtukan Ortner da Georgievsky ba su da kyau. Kodan ba palpable, urination kyauta ne, diuresis yana ƙaruwa. Matsayi na kwakwalwa ba tare da fasali ba.
Nazarin bayanai da bincike na musamman
Don tabbatar da ganewar asali na asibiti, da yawa ana ba da shawarar karatu:
- asibiti gwajin jini: haemoglobin - 130 g / l, ƙwayoyin jini - 4 * 1012 / l, mai nuna launi - 0.8, ESR - 5 mm / h, farin jinin sel - 5 * 109 / l, stabroprop - 3%, rarrabe - 75%, eosinophils - 3 %, lymphocytes -17%, monocytes - 3%;
- urinalysis: launi fitsari - bambaro, amsawa - alkaline, furotin - a'a, glucose - 4%, farin jini - ba, ƙwayoyin ja - ba;
- gwajin jini na biochemical: jimlar furotin - 74 g / l, albumin - 53%, globulin - 40%, creatinine - 0.08 mmol / lita, urea - 4 mmol / l, cholesterol - 7.2 mmol / l, glucose na jini 12 mmol / l.
Nagari na sa ido kan alamomin gwaji a cikin kuzari
Kayan bincike na kayan aiki
An samo bayanan bincike na kayan aiki mai zuwa:
- karafarini: karar sinus, alamun alamun hauhawar jini ventricular hagu;
- x-ray: Filin huhun mara tsabta, sinusi kyauta ne, alamun hauhawar jini na hagu.
Ana ba da shawarar yin shawarwari na ƙwararrun likita kamar ƙwararren mahaifa, likitan fata da kuma tiyata.
Farkon ganewar asali
Type 2 ciwon sukari. Matsakaici mai ƙarfi.
Tabbatar da cutar
Ganin kokewar mai haƙuri (ƙishirwa, polyuria, polydipsia), tarihin likita (yawan abinci mai narkewa na carbohydrates), jarrabawar haƙiƙa (ƙara yawan jikin mutum, fata bushe), dakin gwaje-gwaje da sigogi na kayan aiki (hyperglycemia, glucosuria), ana iya yin binciken asibiti.Primary: type 2 ciwon sukari mellitus, matsakaici, ƙididdigewa.
Mai yarda: hauhawar jini 2 matakai, digiri 2, babban haɗari. Bayan Fage: Kiba mai gina jiki.
Jiyya
An ba da shawarar asibiti na asibiti a cikin asibitin endocrinological don zaɓar maganin rashin lafiya.
Yanayin kyauta. Abincin - lambar tebur 9.
Canza salon rayuwa - asarar nauyi, ƙara yawan aiki na jiki.
Oral hypoglycemic kwayoyi:
- Gliclazide 30 MG sau 2 a rana, ana ɗauka kafin abinci, sha tare da gilashin ruwa;
- Glimepiride 2 mg sau ɗaya, da safe.
Gudanar da glucose na jini a cikin abubuwa masu motsi, tare da rashin tasirin magani, sauyawa zuwa insulin.
Normalization na jini
Lisinopril 8 MG 2 sau a rana, kafin abinci.
Bidiyo masu alaƙa
Onari akan nau'in ciwon sukari na 2 a cikin bidiyon:
Yana da mahimmanci a tuna cewa za a iya magance nau'in ciwon sukari na 2 da kyau tare da sauye-sauyen abinci da salon rayuwa. Bayyanar cututtuka ba magana ba ce, amma kawai uzuri ne don kula da lafiyar ku.
