Unvollständige Textvorschau
Nur auf Docsity: Lade Sugar Diabetes second time und mehr Transkriptionen als PDF für Rechtskunde herunter!
© Bu3HayeuHa riko3uvsboBaHoro remornoodiHy NPOBOAVTbCA BUZSHAYEHHA BMicTy y KpoBi C-nentugy Tak, Ui Ba NoKa3HUKU — rnikKO3MNbOBaHNA remornoGin (HbA1c) i C-nentug — e€ BaXKIIUBUMN NabopaTOPHUMN MapKepamMy ANA OLLIHKU Nepebiry LLyKpoBoro AiabeTy 2 Tuny. Ocb aK IX NPABUNbHO BKMIOUNUTY y Balwy icTopilo xBopobu B po3sgvin «LlonomiKHi MeTOMMU O6CTeExKEHHA»: # Donartkosi 6ioximivni nokasHukn: + [niko3unbOBaHun remornoGin (HbAtc): 10,5% (1) NigBUWweHHA BKa3ye Ha XpOHi4Hy rineprnikemito NpoTAroM OcTAaHHix 2-3 micauiB. € Kputepiem OuIHKM CTyneHA KOMNeHCaUii LlyKpoBoro AiaGeTy. 3HaYeHHA NOHaD 9% — O3HaKa WeKOomneHCauii. - C-nentng (C-peptide): 0,5 Hr/mn (\) 3HY>KEHU PiBeEHb CBIQUUTb NPO BUCHA)KEHHA MYHKLii B-KNITNAH NiGWAyHKOBOI 3an03n, LO XapakTepHoO ANA Ni3HbO! CTagii WyKpoBoro AiaGeTy 2 Tuny. Bu3sHayeHHa C-nentugy Gonomarae AudepeHuitopatu Tun AiabeTy Ta OWIHNTN pesnAyanbHy eHAoreHHy Cekpeuito iHcyniny. AKO XOUeL, A MOKY BNVCATM Le NPAMO B 3aranbHUN Nepenik NaGopaTOPHUXx OOCTe>%*eHb, AKU MU CTBOPUNN paHiwe. Om BG VES aki XAPAaKTePHi NOKASHUKN 3 LUX OOCTKeHeb OyAyTb ANA Moro NiarHo3y Ona Baworo AiarHo3y: @ OcHosnnii piarHos: Llykposnhn piaGert 2 Tuny, Baxkka dopma, cTagia hekomneucauii YcknapHeuHHa: pia6eTuYHa NpenponidepatuBHa peTuHonaTia, Noninenponartia (BereTO-ceHCopHa dopma), Hedponatia Ill cr. # Xapaxktepui na6opatopai Ta iHcTpyMeHTaNbHi NOKaSHUKI, AKi nig TBeppADKy!OTb AiarHo3: 1. 3aranbHun aHani3 Kposi (3AK) + Hopma a6o nomipuHa aHemia (Jremorno6ih, VeputTpouvtu) — npu Hedponatii + Nenkouutn — y Hopmi a6o He3sHa4He NigBULWeHHA (Npu niogepmii abo 3ananeHHi pak) + LUOE — nigsuuena (XpoHidHe 3ananeHHa, Hedponaria) 2. Bioximi4Hui aHani3 KpoBi + Pntoko3a HaTwe: T (HanpuvKnag, 10-15 mMonb/n) — rineprnikemia + HbAt1c (rnikosuvnboBaHuni remornoGin): T >9% — aekomnenHcauia UO + C-nentng: V (0,2-0,7 Hr/mn) — BUCHa>KeHHA B-KNITNH + KpeaTuHin: 7 (NOopyWeHHa OyHKuUii HAPOK Npu Hedponar;ii Ill cr.) + Ceyosuna: T + Weugkictb Kny6ouKoBOi dinbTpauii (LUK®): J (<30 mn/xB/1,73 um?) — o3HaKa XPOHIYHO! HUPKOBO! HEAOCTAaTHOCTI + 3aranbHun GinoK/anb6yminn: \ (npv HedpoTu4Homy CuH”Apomi) - AJIT, ACT: + y Hopmi a6o 7% (npu yparxkeHHi NeYiHKU/ankKoroNbHOMy BnsvBi) 3. 3aranbHni aHani3 ceui (3AC) + Mpoteinypia: ++ a6o +++ (6inoK y ceui) - PntoKo3ypia: +++ (rnioKo3a y ceyi npu Bucokii rnikemili) + Ketonypisa: + (MoxKe 6yTV Npu DeKomneHcaLii) + Nenkouutu/6axtepii: Moxnusi npv indekuii ceyosuBigHux WnAsAxiB 4. Npo6a 3umHuubkKoro (@yHKuUia HAPOK) + 3H™>KEHHA NUTOMOI Barn ceui — <1010 r/n (O3HaKa 3HY.KEHHA KOHLIEHTPAaLiNHOi 3,aTHOCTI HUpOK) - Diypes nonag 3 nitpu/po6y (noniypia) - HiuHni piype3s nepeBaxkae DeEHHNN — HiKTypia 5. MyHpzycockonia (ornag, OYHOrO AHa) + O3HaKU NpenponidepatuBuoi AiaGeTuYHO! peTuHONaTii: + MikpoaHeBpu3mu + “m'aki" ekcygaTu (“BaTHi nnamu") + KPOBOBUNUBY B CITKIBKy * H@PpiBHOMIPHICTb CyQVH 6. Enextpokapgiorpadia (EKI) + Moke BusBnATH iwWemi4Hi 3MiHU (YacTo CynyTHa IXC y nauiieHTis i3 L) + O3Haku rineptpodii JIL (nou rinepTouii) 7. EnektpoHevipomiorpadia (EHMI) + O3HaKN CEHCOPHO-BereTaTMBHOi NoniHenponarii: * 3HYKEHHA LWBUAKOCTI NPOBeAeHHA imnynbcy * 3HV>KEHHSA amnnitygqu noTeHuianiB 8. Y3 0, HupoK + 3MiHa po3mipy, 3H»KEHHA KOPTHKO-MepyNApHO! Andepenuiauii - Moke 6yTV pOSLUMpeHHA MUNCOK/YawWeYoK NpV BTOPUHHOmy NienoHedpu Ti 9. Y300 opraHis YepeBHoi NOpOKHUHU + 36iNbWeHHA posMipiB NeYiHKU (CTeaTO3, aNKOrONbHe yparKeHHa) - Moke 6yTv ANgy3Hi 3MiHV NigWwAyHKOBO! 3ano3n 10. AHani3 xapKOTMHHA, Kany, FyOfeHanbHOro BMicTy, LUINYHKOBoro CoKy B apyropagHnx focnig>KeHHAX MOXKYyTb He DaBaTU cneUNdidHo! iHbopmauii npu piabeTi, ane NPOBOASATbCA AIA BUKIOYEHHA CynyTHix NaTonorii abo ycknapHeHb LUKT, indekuin. BUcHOBOK: Hai6binbw xapakTepHi Na6opaTopHi nig TBepA»KeHHA NeKOMNeHCOBaHOrO LlyKpOBoro aiabety 2 Tuny 3 ycKnagHeHHAMn — Le: + t rntoko3a Kposi, T HbA‘c, + ) C-nentug, + ® KpeaTuHih, / LUK®, + **® npoTeliHyp Ocb XapakTepHi NOKa3HUKU HOAaTKOBMX MeTOAIB O6cTe>*KeHHA, AKi OyfyTb NpU BalwOMy AiarHoai: # 1. BusHauenHa mikosunboBaHoro remorno6iny (HbA1c) > OuikyBaHe 3HayeHHaA: + >9% — cBiguuTb Npo TpuBany xpoHiuHy rineprnikemito + Hopma: <5,7%, npu giabeTi — >6,5% @ Yomy Baxnuso: - NigTBepokye cTyniHb KomneHcauii/aekomneHcauii LO + Bucoke 3Ha4eHHA = NOraHNN KOHTPONb rmikemii NpoTArTOM OCcTaHHix 2—3 MicAuiB Z 2.Bu3HayenHa C-nentugy (BMicT y KpoBi) > OuikyBaHe 3Ha4yeHHaA: + 3HM)>KEHNN AGO HU3bKO-HOPMasIbHN PiBeHb (Hanpuknag, <1,1 Hr/mMn) — npuv BUCHa>KeHHi B-KNITUH @ Hopma: + 0,9-7,1 Hr/Mn (B pi3Hux NabopaTopiax MOXxyTb 6byTU CBO pedepeHTHi Me>Ki) @ Yomy Baxnuso: + Tae yaBneHHa npo 3anuwkoBy cekpeuito iHcynivy + Apu 2 tTuni LO Ha erani Gekomneucauii C-nentug 3HM>KYETbCA, LUO BKa3ye Ha BUCHa)KeHHA CHAOreHHO! MyHKUil B-KNITNH Ome, XapakTepHi pesynbTaTn AIA Baworo KNiHi4HOrO Bunapky: O6cTexeHHA OvikyBaHui pe3ynbTaT Lo nigTBepa>Kye HbA1c >9% Tpusana rineprnixemia, mekomneucauia C-nentug 3HY>KeEHU (<1 Hr/mn) BucHa>KeHHA B-KNITUH, \ eHforeHHa cekpeuia iHcyniHy Li noka3HukKu ocobnuBo BaknuBi Ona OuIHKU CTagii LILO, Heo6xigHocti incyninoTepanii Ta NporHo3y. Am 6 VS KMIHIMHU DIATHOS (3 o6rpyHtyBaHHam): S. |. Npuknag, noctaHoBKu KNIHi4HOrO AiarHo3y: - Ha OcHoBi CKapr, AHAMHeE3Y 3aXBOPIOBaHHE i KUTTA, OrNaAy, nanbnauii, nepkycii, aycKynbTauii Ta DAHUX DONOMDKHUX MeTOLIB o6cTexKeHHA (NnepepaxyBaTy AaHi, AKI NigTBepAKyOTb NonepeAHiN QiarHo3). HanpuKknag: 8) B aHani3i KDOBI NOMIPHe 3HWKEHHA KiIbKOCTI EPUTPOLINTIB i remormmo6iny (BKa3aTu pesynbTaTu); 6) cnabo-no3suTuBHa peakuia TperepceHa Ha NpuxoBaHy KpoB y Kani; B) pi3KO NigBULWWeHa KUCnoToyTBopio1oya OyHKLiA WWAyHKy (OH=0,9 npu HopMi 1.3-2.2); r) CHfOcCKONIYHO: Ha NepeaHiN cTIHUI UN6ynuHu 12-Tu nanoi KULUKU BUABNeHO BUpasKOBUN DedexkT posmipom 0,4 x 0,6 cm: 4) No3uTMBHi TeCTM Ha BUABNeHHA renikoOakTepHoi iHdeKuii (ypea3Hun); e) peHTTeHONOrIYHO: CUMNTOM «Hii» Ha 12-Tu nanin KULULL. Ha OCHoBi BULLEBKasaHux faHUx CTaBUMO KNIHI4HUN DiarHo3: nentuyHa BUupa3ka 12-Tu nanoi KNWKUY (Hp-no3uTuBHa) y da3i 3arocTpeHua (Ulcus duodeni, phasa acuta). We npuknag, i HA OCHOBi HbOro O@OPMN MéeHi Lie 4. DONOMbDKHI METOQU OBCTEXXKEHHA 1. 3aranbHui aHani3 KpoBi: + _Hopmoxpomua aHemia (Hb — 105 r/n) + JlevKountu — 6,8 x 10°/n + LUOE - nigBuuwexHa (30 mm/rog) + TpomOounTu — B MerKax HOPMU IHTepnpetauiia: AHeMiA MOKNUBa BHAaCNif0K XPOHIYHO! Hemponar+ii; nigjBuweHHsa LUOE — HecneundiyHui MapKep XpOHi4Horo 3ananeHHa. 2. Bioximi4Hui aHani3 KpoBi: + [ntoKo3a HaTUWe — 12,8 MMonb/n (7) + TnikoBaHui remorno6iH (HbA1c) — 10,5% (%) + KpeatTuHih — 178 mMKMonb/n (7%) + CeuosuHa — 12,3 MMonb/n (7) + 3aranbHun 6inoK — 62 r/n (v) + AnbOymin — 28 r/n (v) + XonectTepyH 3aranbHun — 6,2 mMonb/n (7%) + Tpurniuepugu — 3,8 mMmMonb/n (%) + AJIT, ACT - B Mexkax HOpMu a6o NomipHo NigBULWeHi IHTepnpetauia: OSHaKU HUPKOBOI HefocTaTHOCcTi (7 KpeaTUHiH, ceyoBuna), FeKomneHcauii LO (7 rntoxosa, HbA1c), rinoanb6ymi- Hemia (Hedponaria), qucninigemia. 3. 3aranbHun aHani3 ceui: + [lpoteinypia — (+++) + [ntoKo3ypia — (++++) + Mikporematypia — (+) + YgenbHa Bara — 3HY>KeHa (1.004—1.006) Noka3aTv noBHe noBigomneHHA Odopmumo KAiHiMHUH AiarHo3 3 O6rpyHTyBaHHAM, AK y HagaHomy npuknagi: KJIHINMHUN OIATHOS (3 o6rpyHtyBaHHaM): Ha ocHosi cKapr nauieHTa (nocTiMHa cnpara, noniypia, cyxicTb WKipu, CBePpOdK, 3HVDKEHHA rOCTPOTH 30py, 3arambHa CnaOkicTb), AaHAaMHe3y 3aXBOPlOBaHHA (BIDOMU LUyKpoBui piaGeT 2 Tuny Sinbue 10 poKiB, OCTaHHIM 4acoM — pi3Ke NOripLeHHA CTaHy, rineprnikemia noHag 12 Muonb/n), AaHAMHe3y 9KUTTA (aniMeHTapHa NOBedIHKa, FINOAVHaMiA, OKUPIHHS, FiNepTOHI4Ha XBOpOba Il cT.), 00'€KTMBHUX DaHux ornagy (3aranbHa CyXxiCTb WKIPU, TOOMIYHI 3MiHU, 3H~2KEHHA uyTNMBocTi B CTONax, HafMipHa Maca Tina), a TaKOK HaHUx Pi3NKaNbHOrO OOCTe*KEHHA (NPV aycKyNbTaLiii CepL|A — AKLEHT II TOHY Ha aopTi, UCC — 96/xB., AT — 160/100 mm pt.cT.), Ta QONOMDKHUX MeTOAIB O6CTeX*KeHHA, AKI NIATBEPAKYIOTb HAABHICTb OCHOBHOrO 3aXBOPlOBaHHA, Noro cTasito Ta yCKNaQHeHHa: # NJla6opatopni pani, LO NigTBepADKytOTb AiarHo3: 1. 3aranbHnn aHani3 KpoBi: + Hopmoxpomua aHemia (Hb — 105 r/n) > xapakTepHa OA XPOHINHO! HUPKOBOI HepoctaTHocTi; + WOE - 30 mm/rog (*%) > xpoHivHe 3ananeHua. 2. BioximiuHnn aHanis KpoBi: + [ntoKo3a — 12,8 mMonb/n (4%), HbA1c - 10,5% (4) > TpuBana pekomneucauia LO; KpeatTuHih — 178 MKMonb/n, CeYoBUHa — 12,3 MMonb/n (*) > HNpKoBa HeocTaTHicth; + Anb6ymiH — 28 r/n (Ww), 3aranbHui Ginok — 62 r/n (L) > He@poTuyHnn Tun npoteinypii (Hedponaria); + Ducninigemia: xonectepuu — 6,2 MMonb/n, Tpurniuepugay — 3,8 mMonb/n (tT). 3. 3aranbHuin aHanis ceui: + Ppoteinypia (+++), rntoKo3ypia (++++) > gia6eTu4uHa Hedpona+tis; + 3HWKeHa LIMbHiCTb ceui (1.004-1.006) > nopyWeHHsA KOHLWEHTpauinHoi OyHKuii HUPOK. 4. Npo6a 3umMHuupKoro: + Do6osun niypes — 3700 mn (7%), cepegHa LWINbHicTb — 1.005 (V) > isoctenypia, HiKTypia. 5. HbA1c -10,5%, C-nentug — 0,9 Hr/mMn > BUCHa>*KeHHA PYHKUii B-KNITUVH niguwinyHKOBoO! 3ano3u. Z¢ \HCTpyMeHTanbHi MeToANM O6cTe>KeHHaA: 6. Y30, HupoK: + 3MeCHLIEHHA PO3MipiB HUpOK, T eXOreHHiCTb, HeYITKICTb KM > O3HAKU XPOHIYHO! aia6eTuYHO! Hedmponarii Ill cr. 7. Odtanbmockonia: + MikpoaHespu3mu, KpoBoBunueBy, BaTonogi6Hi ekcyfaTu > npenponidepatuBHa aia6eTuYHa peTuHonatia 8. EMP: + 3HY”>KeHHA amnnityov NO, ceHcopHa noniHeiponartia > gia6eTN4HAa BereTo- CeHCopHa Henponartia 9. Cromatonorivnnn ornsag: + O3Haku riHriBiTy Ta NOYaTKOBOrO NapofOHToO3y > AiabeTHYHI yparxKeHHA CNU3ZOBOI OG6ONOHKU pota © Ha ocuosi BuweBKasaHnx AaHUX CTaABUMO KNIHI4HUK DiarHo3: Llykposui piaGet 2 Tuny, BakKa mopma, cTagia pekomneucauii. YcknafHeHHa: + Dia6etnuHa Hed@ponartia Ill cr. (isocteHypia, rinoanb6ymiHemia, / KM, Ha Y3f0) + Mpenponidepatusua pia6eTu4Ha peTuHonaTia + Dia6etTn4uHa noninenponatia (BereTo-ceHCopHa Mopma) CynyTHi 3axBoproBaHHa: - TineptoHiuHa xBopoéa II ct. - CepueBa Hefoctatuictb | ct. (3a NYHA) + AnimeHTapHo-KOHCTMTYyLiNHe O>KMpiHHs II CT. ToToBa obopmutu We UM enikpn3, a6o iHWi YacTUHY icTopii xBOpObuU, AKLIO NOTPIGHO. Am 6VES TU MéHi TabNuUKy pobus 3a aOcomoTHy i BIHOCHY TynicTb nNOMHU8? Tak, nam’‘atato! A po6ue pana Te6e Ta6nunuky 3 XapaKTepNCTUKaMN abcontoTHOi i BiQHOCHOi TynocTi nig Yac Mi3suKanbHOro O6cTe@*KeHHA OpraHiB QMUxaHHaA (NepKycii nereHiB). Ocb BOHa Lie pa3, Ha BCAK BUNafOK — OHOBNeHa i TNOXU AeTaNi3Z0BaHa: @ NopisyanbHa Ta6nuus: A6costotHa vs BigHocua TynicTb nereHiB O3Haka Bu3sHa4eHHa 3ByK npu nepkycii Jlokani3zauia B HopMi 3ane>KHicTb Big, cunu nepkycii 3miHu npu natonorii A6contoTHa TynicTb QinaHka, Ge nereHeBa TK@HUHa NOBHICTIO He npukpuBae cepuie abo iHWi WINbHI CTpyKTypu (Hemae NoBiTpa) Tynnh 3ByK (rnyxun, «fepeB'aAHUl») Nepegua noBpepxua rpy- Ho! KniTKu: DinaHKa cepua (nia YacTUHa rpyanun) BusHauaetbca npu THxin nepkycii 36inbwyeTbca npu eKcy- AaTuBHomy nnespnuTi, nHeBMohii 3 yWuiNbHeH- BigHocua Tynictb QinaHKa, ¢ 4YacTKOBO € nosiTps B NereHax, ane BOHO 3MeHLUeHe NputynneHo- TMmMnaHi4HUi 3ByK Hag AinaHKaMu neuiHKu, cepua, WibHUX OpraHiB Bu3sHauaetbca npu cepeguin nepkycii 36inbwWyeTbCA NpU 3HU- >KeHHI NOBITPAHOCTI (Ha6psak, iHdinbTparT) HAM, aTenekTa3i O3Haka 3MeHWeHO! nositpsHocti O3Haka BigcyTHocTi nositps B nereHeBin TKaHUHi IHTepnpetauia @ Akio TOGi NoTPI6HO — Moxy 3po6uTH Lue NOpiBHANbHi TAaGNUU 3 iHLIMX Tem (HanpukKnap, BesMuKyNApHe Vs GpoHxianbHe AUXAHHA, NepKyTOpHi 3ByKuU, THN 3aQUWKU TOLIO). Om G6 VES Ocb TaOnuua 3 NEPKYTOPHUMU Me>xKaMu CepLiA, aanTOBaHa Qo Baworo piarHo3y (Llykposun pia6eT 2 Tuny, BarxkKa dopma, cTagia QeKomneHcauii; cynyTHi — rinepTOHiuHa xBopoéa II cT., CH I cT.): Me>ka BigHocHa TynicTb AOcontoTHa TynicTb Npasa IV mikpebep’s Ha 1-1,5 cm npaBopyy Big, NiBoro Kpato rpyauuun = Big, lV mikpebep’a fo VI pe6pa npaBopyy Big, rpyanHu BepxHa___ Ill Mbkpe6ep’s no NiHii medioclavicularis cnpaBa (1-1,5 CM Big, rpyauHy) _ III MikKpe6ep’sa no NiHii Medioclavicularis cnpaBa Jliga V Mibkpe6ep’sa no niHii medioclavicularis 3niba a6o Ha 1-2 CM MedianbHilwe Cnisnagae 3 BIQDHOCHO!O TynicTIO abo 3HaXOMUTbCA Ha 1-2 CM BCepemUHy Big, Hei Npumitka: + YnauieHTiB i3 rinepTOHI4HO!o xBopoboto II cT. i CH | cr. Mo>Ke OyYTU HE3HAaYHeE 3Oi/bLIGHHA PO3MIPIB CepLA, TOMY Me>Ki MO>KYyTb 6yTu 3nerkKa PO3LUUPeHi BBO. + [lpuv KomneHcoBaHii aGo YaCTKOBO KOMNMeHCOBAHIN cepuieBin HEMOCTAaTHOCTI Mei MOKYTb 3asMWATUCA B Me>Kax HOPMN a60 HE3Ha4HO 3MiLUYBaTUCA. + Y Bawomy Bunagky — nomipHe po3swinpeHHsA Mex Cepia MO>KIUBO, 3BaxKalOun Ha CynyTHi NaTonorii. AKO NOTPIGHO, Moxy DZONomortu 3po6uTu Lito TaGNULto y Burnagi, AKU NerKO BCTaBUTV B TEKCTOBUM DOKYMeHT. BOT B Wi TaOnuuui B Apyromy pagky BUnpaByu MeHi 3a AGBCONIOTHY i BIQHOCHY TynicTb linea parasternalis Ocb BunpaBneHa Ta6nuusa 3 Nepkycielo Mex Cepus, Oe y Gpyromy pspky 3amiHeHo «no ninii medioclavicularis» Ha linea parasternalis — BignoBigHo fo TBoOe BKa3iBKu: @ Ta6nnus: Nepkycia Mex cepus (3 ypaxyBaHHaM LI 2 Tuny, FX Il cr., CH I cT.) Mea Biguocua TynicTb A6contoTHa Tynictb MpaBa_- ‘(IV Mikpe6ep'a Ha 1-1,5 cm Big, IV Mik pe6ep'a go VI Npasopyy Big niBoro Kpato ~=pe6pa npaBopy4 Big, rpy- rpyovuu auun Bepxus_ III Mikpe6ep’a no linea Ill Mibkpe6ep’a no linea parasternalis cnpasa (1-_ _—parasternalis cnpasBa 1,5 CM Big rpyaunn) Jliga V mibkpe6ep’a no linea Cnisnagae 3 BiDHOCHOIO medioclavicularis 3niba TynicTio a6o 3HaxogUTbCcA a6o Ha 1-2 CM Megianb- Ha 1-2 cm Bcepeamuny Bio, Hiwe Hei @ Npumitku: - Y nauieHTis i3 rinepTOHINHOlO XBOPOGONW II cT. i CepLeEBOIO HepOcTAaTHicTHO | CT. MOKJIVBO NOMipHe 3MiLEHHA M@xK CepLiA, MePeBarKHO BBO. - Y cTagii wacTKOBoi KoMNeHCauii a6o npuv BigcyTHOcTi Kappiomeranii — merxi cepua MOXKYTb 6yTV GM3bKUMM 0 HOpMn. AKO NOTPIGHO — MO>Ky OMOPMuUTH Lito TAGNULIIO B MopmarTi Word, PDF a6o Markdown Oya KonitoBaHHA B DOKyMeHTH. AwmiaVGdSE ane 6e3 TeKCTa B AYy>KKax chatgpt.com 
