საზარდულის ჩაჭედილი თიაქარი

ÀÅÀÃÌÚÏ×É ÌÏÚÅÀÍÉËÉ ÉØÍÀ ÓÔÀÝÉÏÍÀÒÛÉ 03-is mier mZime mdgomareobaSi  07.08.10  02:30  ÜÉÅÉËÉÈ saerTo sisusteze, ÔÊÉÅÉËÆÄ ÌÖÝËÉÓ ÀÒÄÛÉ, Seberilobaze, faRaraTze, ÂÖËÉÓÒÄÅÉÓ ÛÄÂÒÞÍÄÁÀze.

  Anamnesis morbi: avad aris mesame dRea, 3 dRis manZilze ver gadioda kuWSi, eqimisTvis ar miumarTavs, eweoda TviTmkurnalobas safaRaraTo saSualebebiT. guSin daewyo faRaraTi, stacionarSi Semosvlamde kuWSi gavida 20-jer, dasustda, daewyo tkivilebi muclis areSi, aRebina, ris gamoc gadmoyvanili iqna stacionarSi.

Anamnesis vitae: ÀÅÀÃÌÚÏ×ÉÓ ÓÀÝáÏÅÒÄÁÄËÉ ÐÉÒÏÁÄÁÉ ÃÀÌÀÊÌÀÚÏ×ÉËÄÁÄËÉÀ, ÉÃÉÏÓÉÍÊÒÀÆÉÀÓ Ó.ß.Ó.-ÃÌÉ ÖÀÒÚÏ×Ó.

St. praesents: ÀÅÀÃÌÚÏ×ÉÓ ÆÏÂÀÃÉ ÌÃÂÏÌÀÒÄÏÁÀ mZime, ÊÀÍÉ ÃÀ áÉËÖËÉ ËÏÒßÏÅÀÍÉ ÂÀÒÓÉ ×ÄÒÌÊÒÈÀËÉ, ÊÀÍØÅÄÛÀ ÝáÉÌÏÅÀÍÉ ØÓÏÅÉËÉ sustad ÂÀÍÅÉÈÀÒÄÁÖËÉ.

COR- ÔÏÍÄÁÉ moyruebuli, T/A 110\75 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-20.

 ÄÍÀ mSrali ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ, Seberili misi marcxena naxevari,  ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa mTeli muceli, gansakuTrebiT misi marcxena naxevari, aqve aRiniSneba defansi,  ÙÅÉÞËÉ ÍÄÊÍÈÀ ÒÊÀËÓ ÀÒ ÓÝÉËÃÄÁÀ, ÄËÄÍÈÉÓ ÐÄÒÊ. ÓÀÆÙÅÒÄÁÉ ÅÒÝÄËÃÄÁÀ ÌÄÃÉÏÀØÓÉËÀÒÖË áÀÆÆÄ IX- XII ÍÄÊÍÈÀÛÖÀ ÓÉÅÒÝÄÛÉ. ÈÉÒÊÌÄËÄÁÉ ÁÉÌÀÍÖÀËÖÒÉ ÐÀËÐÀÝÉÉÈ ÏÁÒÀÆÝÏÅ-ÓÔÒÀÑÄÓÊÖÓ ÌÄÈÏÃÉÈ ÀÒ ÉÓÉÍãÄÁÀ, ÛÀÒÃÅÀ ÈÀÅÉÓÖ×ÀËÉ. per-rectum- gasinjviT ampula Tavisufalia aRiniSneba mcire raodenobiT ganavlovani masebi.

ÀÅÀÃÌÚÏ×É ÊÏÍÔÀØÔÖÒÉÀ, ÊÉÈáÅÄÁÆÄ ÖáÀËÉÓÏà ÐÀÓÖáÏÁÓ, ÐÀÈ. ÒÄ×ËÄØÓÄÁÉ ÀÒ ÀÙÉÍÉÛÍÄÁÀ.

St. Locus ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ, didi zomis, zomierad Seberili misi marcxena naxevari,  ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa mTeli muceli, gansakuTrebiT misi marcxena naxevari, pacienti uCivis saerTo sisustes, ÔÊÉÅÉËs ÌÖÝËÉÓ ÀÒÄÛÉ, Seberilobas, faRaraTs, ÂÖËÉÓÒÄÅÉÓ ÛÄÂÒÞÍÄÁÀÓ.

                              D.S. nawlavTa mwvave gauvaloba             07.08.10

avadmyofi umniSvnelod gavida kuWSi Txeli ganavlovani masebiT, subieqturad Tavs uaresad grZnobs, tkivilebma imata, muceli Seibera. mkafiod gamoixata SCotkin-blumbergis simptomi.

                                               ÌÊ. ÄØ.                          Â. Â.07.08.10  10:00  

Aultrasonografiuli kvleva

muclis Rrus organoebis Sard-sasqeso sistemis, gamokvleva

RviZlis sagitaluri zomebi momatebuli. vertikalurad, marjvena laviwSua xazze scildeba neknTa rkals 20-iT. marjvena wilis vertikaluri-iribi zoma 175mm (N<140mm); sisqe 122mm, marcxena wilis kranio-kaudaluri zoma 131mm (N<100mm); sisqe 98 mm, kuTxeebi maxvili, konturebi swori, parenqimis eqostruqtura erTgvarovani, eqogenoba erTgvarovani, eqogamtarianoba SenarCunebuli. kerovani cvlilebebi ar aRiniSneba, Tu ar CavTvliT momatebuli eqogenobis mqone masivs RviZlis centralur (karis) nawilSi.

sisxlZarRvovani suraTi gazlierebuli, karis venis diametri 20mm (N<14mm); RviZlis venebis (sanaTurebamde 2sm-ze) 10-11 mm, doplerografiiT nakadi hepatopetaluri, qvemo Rru vena 25mm (20-25mm),

      RviZlSida da RviZlgareTa sanaRvle gzebi ar aris dilatirebuli. qoledoxusis diametri 4  mm(N<7mm); sanaTuri Tavisufali. 

      naRvlis  buSti     zomebiT  61X31X35mm, SigTavsi   3255 ml,  kedlis sisqe   4mm. lorwovanis  reliefi tlanqi, gasqelebuli. naRveli  arahomogenuri. Seicavs saSualo raodenobi naleqs. naRvlis buStis fuZe ar scildeba RviZlis wina kides.

        muclis aorta diametriT 17 mm, qvemo Rru venis diametri 23  mm. sanaTuri Tavisufali, kedlebi ucvleli.

        pankreasi zomebiT Tavi 21mm, sxeuli 17mm, kudi 24mm, konturebi swori, struqtura erTgvarovani, eqogenoba momatebuli, virsungis sadinari ar aris gaganierebuli.

       elenTa zomebiT 153X69mm, scildeba neknTa rkals 25mm-iT, struqtura erTgvarovani, eqogenoba saSualo.

      RviZlis karis, elenTis karis, paraaortuli, parakavaluri limfuri jirkvlebis koleqtorebi inicirebuli.

    Tirkmelebi normaluri formis da mdebareobis, konturebi swori, vaskularizacia normaluri

        marjvena Tirkmeli zomiT    121X51X69 mm, parenqimis sisqe  14 mm, kortiko-medularuli diferenciacia gamoxatuli,

parenqimis eqogenoba araerTgvarovani. TirkmelSi locirdeba konkrementebi, romelTagan maqsimaluris diametri ar aRemateba 8mm-s..

menj-fialovani sistema dilatirebuli ar aris,

        marcxena Tirkmeli zomiT  125X47X67 mm, parenqimis sisqe  14mm, kortiko-medularuli diferenciacia gamoxatuli,

parenqimis eqogenoba araerTgvarovani. TirkmelSi locirdeba konkrementebi, romelTagan maqsimaluris diametri ar aRemateba 4-5mm-s.

menj-fialovani sistema dilatirebuli ar aris,

orive TirkmelSi locirdeba didi raodenobiT wvrili xazovani struqturis hipereqogenuri CanarTebi akustikuri Crdilis gareSe – kristalebi.

      Sardis buStis forma ucvleli, konturebi da lorwovanis reliefi sada, kedlis sisqe   5 mm.

   muclis RruSi aRiniSneba didi raodenobiT Tavisufali siTxe, aRiniSneba gaZlierebuli meteorizmi, nawlavebi gadavsebulia airebiT (gansakuTrebiT msxvili nawlavi).

ßÉÍÀÓÀÏÐÄÒÀÝÉÏ ÄÐÉÊÒÉÆÉ ÏÐÄÒÀÔÏÒÉÓ ÃÀÓÊÅÍÀ

ÅÉÍÀÉÃÀÍ ÀÅÀÃÌÚÏ×Ó ÃÀÄÓÅÀ mwvave muclis diagnozi, saxezea peritonealuri movlenebi, ÓÀàÉÒÏà ÌÉÌÀÜÍÉÀ ÂÀÊÄÈÃÄÓ ÓÀÓßÒÀ×Ï ÏÐÄÒÀÝÉÀ laparotomia, ნათესავებს ÀÄáÓÍÀÈ ÌÃÂÏÌÀÒÄÏÁÉÓ ÓÉÌÞÉÌÄ ÃÀ ÌÏÓÀËÏÃÍÄËÉ ÂÀÒÈÖËÄÁÄÁÉ ÃÀ ÛÄÃÄÂÄÁÉ, ÈÀÍáÌÏÁÀ ÏÐÄÒÀÝÉÀÆÄ ÌÉÙÄÁÖËÉÀ, ÏÐÄÒÀÝÉÀ ÂÀÊÄÈÃÄÁÀ ÆÏÂÀÃÉ ÂÀÖÔÊÉÅÀÊÒÄÁÉÈ, operaciis taqtika dadgindeba saoperacio magidasTan, ÀÅÀÃÌÚÏ×É ÌÆÀÃÃÄÁÀ ÏÐÄÒÀÝÉÉÓÀÈÅÉÓ.

                                               ÌÊ. ÄØ.                          Â. Â.

07.08.10  23:30  

ÏÐÄÒÀÝÉÉÓ ÏØÌÉ №

  Sua-Sua laparotomia, sigmeqtomia, kolostomia, muclis Rrus sanacia drenireba.

zogadi, endotraqealuri narkozis qveS gakeTda Sua-Sua laparotomia daTvalierda muclis Rru, reviziiT dadginda, rom aris swori nawlavis Cr. დოლიქოსიგმა, სიგმური კოლინჯი gaSavebuli, გადავსებულია სითხითა და აირებით, განავლოვანი ქვებით. სწორი ნაწლავის პროქსიმალურ ნაწილში იმყოფება სიმსივნური წარმონაქმნი ზომით 18X20X15sm, irgvliv myofi qsovilebi, maT Soris sigmuri kolinjis proqsimaluri nawili, mlivi nawlavis maryuJi qmnian erT mTlian konglomerats, uZravad intimurad mixorcebuls mcire menjis ukana kedelze. sigmuri kolinjis centraluri nawili ( 30sm) gaSavebuli, seroza ar brwyinavs, peristaltika ar aRiniSneba, jorjlis sisxlZarRvebi ar pulsireben, muclis RruSi aris ganavlovani sunis, serozul-hemoragiuli gamonadeni.

 gakeTda sigmuri kolinjis jorjlis mobilizacia, swori nawlavis simsivnuri warmonaqmnidan 3sm-mde da proqsimalurad mTlianad daswvrivi kolinjis sigmaSi gadasvlis ubnamde, sigmaSi gadaidevna msxvili nawlavis zeda sarTulidan nawlavis SigTavsi da gakeTda sigmis rezeqcia. swori nawlavis proqsimaluri nawili daixura sam sarTuliani nakerebiT. daswvrivi kolinjis distaluri bolo momzadda stomirebisTvis da gamotanili iqna muclis wina kedelze  muclis Rru amoirecxa, amomSralda, duglasis fosoSi Caidga polieTilenis drenaJi, romlis Semdgomac muceli daixura yrud. aseptiuri naxvevi.

preparati: sigmuri kolinji.

                                ÏÐÄÒÀÔÏÒÉ:                        Â. Â.

                               ÀÓÉÓÔÄÍÔÉ:                             e.g. 

                               ÀÍÄÓÈÄÆÉÏËÏÂÉ:                 Ì. á. 

                                 ÓÀÏÐÄÒÀÝÉÏ ÃÀ                  m. f.

                                                                07.08.10                      11:00-1400    

07.08.10                19:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba ukiduresad mZimea, kani ruxi, xiluli lorwovani garsi fermkrTali, imyofeba dopminze. T/A 60\20 P-110 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-34.

 ÄÍÀ mSrali ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are, drenaJi

fvunqcionirebs, gamoiyofa serozul-hemoragiuli siTxe, misma raodenobam 2 sT-is ganmavlobaSi Seadgina 40,ml. diurezi bolo ori saaTis manZilze ar aRiniSneba.

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

                                  ÌÊ. ÄØ.                          Â. გ.

07.08.10                21:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba ukiduresad mZimea, kani ruxi, xiluli lorwovani garsi fermkrTali, imyofeba dopminze. T/A 80\45 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-34.

ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are, drenaJi fvunqcionirebs, gamoiyofa serozul-hemoragiuli siTxe, misma raodenobam 2 sT-is ganmavlobaSi Seadgina 40,ml. diurezi bolo ori saaTis manZilze Seadgina 40mll.

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

                                  ÌÊ. ÄØ.                          Â. გ.

07.08.10                23:30                                                                        Cursus morbi

pacientis zogadi mdgomareoba ukiduresad mZimea, kani ruxi, xiluli lorwovani garsi fermkrTali, imyofeba dopminze. T/A 90\55 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-34.

pacienti aRgznebulia, cdilobs amoiglijos zondi, drenaJi, kaTeterebi, araadeqvaturia.

 ÄÍÀ mSrali ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are. diurezi bolo ori saaTis manZilze Seadgina 60mll.

gakeTda aseptiuri Sexveva, stoma funqcionirebs, gamoiyofa mcire raodenobiT Txeli ganavali.

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

                                  ÌÊ. ÄØ.                          Â. გ.

08.08.10                02:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba ukiduresad mZimea, kani ruxi, xiluli lorwovani garsi fermkrTali, imyofeba dopminze. T/A 90\55 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-34. pacienti aRgznebulia, cdilobs amoiglijos zondi, drenaJi, kaTeterebi, araadeqvaturia. ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are. diurezi bolo ori saaTis manZilze Seadgina 60mll. gakeTda aseptiuri Sexveva, stoma funqcionirebs, gamoiyofa mcire raodenobiT Txeli ganavali.

 ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

Zlieri tkivilebis gamo pacients gaukeTda Sol. Morphini 1% 1,0 i/m

                                  ÌÊ. ÄØ.                          Â. გ.

                eqTani             n. maWaraSvili

08.08.10                10:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba SedarebiT dastabilurda, kani ruxi, xiluli lorwovani garsi fermkrTali, wneva uWiravs vazopresorebis gamoyenebios gareSe. T/A 90\55 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-34. pacienti aRgznebulia, cdilobs amoiglijos zondi, drenaJi, kaTeterebi, araadeqvaturia.

ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are. diurezma dRis ganmavlobaSi Seadgina 600mll.

gakeTda aseptiuri Sexveva, gakeTda aseptiuri Sexveva. gasuli dRe-Ramis manZilze, drenaJidan gamoiyo serozuli siTxe 250mll-is raodenobiT. stoma funqcionirebs, gamoiyofa mcire raodenobiT Txeli ganavali.

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

pacients gaukeTda Sol. Diazepeqsi  2,0 i/m

                                  ÌÊ. ÄØ.                          Â. გ.

                eqTani             m. foladiSvili

09.08.10                10:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba stabiluria, wneva uWiravs vazopresorebis gamoyenebios gareSe. T/A 100/65 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-28. ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are. diurezma dRis ganmavlobaSi Seadgina 600mll.

gakeTda aseptiuri Sexveva, gakeTda aseptiuri Sexveva. gasuli dRe-Ramis manZilze, drenaJidan gamoiyo serozuli siTxe 200mll-is raodenobiT. stomaze moixsna morgvi. stoma funqcionirebs, gamoiyofa mcire raodenobiT Txeli ganavali.

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

pacients gaukeTda Sol. Diazepeqsi  2,0 i/m

                                  ÌÊ. ÄØ.                          Â. გ.

                eqTani             m. foladiSvili

.

10.08.10                10:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba stabiluria, wneva uWiravs vazopresorebis gamoyenebios gareSe. T/A 100/65 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-28.

ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa naoperaciebi are. gakeTda aseptiuri Sexveva. gasuli dRe-Ramis manZilze, drenaJidan gamoiyo serozuli siTxe 250mll-is raodenobiT. diurezma dRis ganmavlobaSi Seadgina 600mll.

gakeTda aseptiuri Sexveva. stoma funqcionirebs, gamoiyofa didi raodenobiT Txeli ganavali. ganavlismimRebi Seicvala 7-jer.

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

pacients gaukeTda Sol. Diazepeqsi  2,0 i/m

                                  ÌÊ. ÄØ.                          Â. გ.

                eqTani             m. l.

10.08.10  11:00                              plazmis gadasxmis kursusi   

ეტიკეტის №3062

plazma: 250,0

10.08.10                10:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba stabiluria, wneva uWiravs vazopresorebis gamoyenebios gareSe. T/A 100/65 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-28.

ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ, ÐÀËÐÀÝÉÉÈ rbili, umtkivneulo, diurezma dRis ganmavlobaSi Seadgina 900mll.

gakeTda aseptiuri Sexveva. gasuli dRe-Ramis manZilze, drenaJidan gamoiyo serozuli siTxe 150mll-is raodenobiT. stoma funqcionirebs, gamoiyofa didi raodenobiT Txeli ganavali. ganavlismimRebi Seicvala 7-jer.

gadaiketa nazogastraluri zondi da mieca sakvebi (Cai, fafa).

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

pacients gaukeTda Sol. Diazepeqsi  2,0 i/m

                                  ÌÊ. ÄØ.                          Â. გ.

11.08.10                10:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba stabiluria, T/A 100/65 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-28.

ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ, ÐÀËÐÀÝÉÉÈ rbili, umtkivneulo, diurezma dRe-Ramis ganmavlobaSi Seadgina 1000mll. gakeTda aseptiuri Sexveva. gasuli dRe-Ramis manZilze, drenaJidan gamoiyo serozuli siTxe 150mll-is raodenobiT. stoma funqcionirebs, gamoiyo guSindelTan SedarebiT mcire raodenobiT Txeli ganavali da airebi.

nazogastraluri zondi gadaketilia pacienti iRebs sakvebs (Cai, fafa).

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

                                  ÌÊ. ÄØ.                          Â. გ.

12.08.10                10:00                                                                        Cursus morbi

pacientis zogadi mdgomareoba stabiluria, T/A 100/65 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-28.

ÄÍÀ sveli, ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ,   ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ, ÐÀËÐÀÝÉÉÈ rbili, umtkivneulo, diurezma dRe-Ramis ganmavlobaSi Seadgina 1000mll.

gakeTda aseptiuri Sexveva. gasuli dRe-Ramis manZilze, drenaJidan gamoiyo serozuli siTxe 150mll-is raodenobiT. stoma funqcionirebs, gamoiyo guSindelTan SedarebiT mcire raodenobiT Txeli ganavali da airebi.

nazogastraluri zondi gadaketilia pacienti iRebs sakvebs (Cai, fafa).

  ÌÊÖÒÍÀËÏÁÀ ÂÒÞÄËÃÄÁÀ ÃÀÍÉÛÍÖËÄÁÉÓ ÌÉáÄÃÅÉÈ, ÀÅÀÃÌÚÏ×É ÉÌÚÏ×ÄÁÀ ÃÉÍÀÌÉÖÒÉ ÃÀÊÅÉÒÅÄÁÉÓ ØÅÄÛ.

                                  ÌÊ. ÄØ.                          Â. გ.

Ä Ð É Ê Ò É Æ É

ÀÅÀÃÌÚÏ×É ÌÏÚÅÀÍÉËÉ ÉØÍÀ ÓÔÀÝÉÏÍÀÒÛÉ 03-is mier mZime mdgomareobaSi  07.08.10  02:30  ÜÉÅÉËÉÈ saerTo sisusteze, ÔÊÉÅÉËÆÄ ÌÖÝËÉÓ ÀÒÄÛÉ, Seberilobaze, faRaraTze, ÂÖËÉÓÒÄÅÉÓ ÛÄÂÒÞÍÄÁÀze.

avad aris mesame dRea, 3 dRis manZilze ver gadioda kuWSi, eqimisTvis ar miumarTavs, eweoda TviTmkurnalobas safaRaraTo saSualebebiT. guSin daewyo faRaraTi, stacionarSi Semosvlamde kuWSi gavida 20-jer, dasustda, daewyo tkivilebi muclis areSi, aRebina, ris gamoc gadmoyvanili iqna stacionarSi.

ÀÅÀÃÌÚÏ×ÉÓ ÆÏÂÀÃÉ ÌÃÂÏÌÀÒÄÏÁÀ mZime, ÊÀÍÉ ÃÀ áÉËÖËÉ ËÏÒßÏÅÀÍÉ ÂÀÒÓÉ ×ÄÒÌÊÒÈÀËÉ, ÊÀÍØÅÄÛÀ ÝáÉÌÏÅÀÍÉ ØÓÏÅÉËÉ sustad ÂÀÍÅÉÈÀÒÄÁÖËÉ.

COR- ÔÏÍÄÁÉ moyruebuli, T/A 110\75 P-100 susti ÀÅÓÄÁÉÓÀ ÃÀ ÃÀàÉÌÖËÏÁÉÓ, ariTmuli, Pulmo- ÛÄÓÖÓÔÄÁÖËÉ ÅÄÆÉÊÖËÖÒÉ ÓÖÍÈØÅÀ, ÐÄÒÊÖÔÏÒÖËÀà ×ÉËÔÅÉÓ ÍÀÈÄËÉ áÌÉÀÍÏÁÀ R-20.

 ÄÍÀ mSrali ÛÄËÄÓÉËÉ moTeTro-moyviTalo ÍÀÃÄÁÉÈ, ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ, Seberili misi marcxena naxevari,  ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa mTeli muceli, gansakuTrebiT misi marcxena naxevari, aqve aRiniSneba defansi,  ÙÅÉÞËÉ ÍÄÊÍÈÀ ÒÊÀËÓ ÀÒ ÓÝÉËÃÄÁÀ, ÄËÄÍÈÉÓ ÐÄÒÊ. ÓÀÆÙÅÒÄÁÉ ÅÒÝÄËÃÄÁÀ ÌÄÃÉÏÀØÓÉËÀÒÖË áÀÆÆÄ IX- XII ÍÄÊÍÈÀÛÖÀ ÓÉÅÒÝÄÛÉ. ÈÉÒÊÌÄËÄÁÉ ÁÉÌÀÍÖÀËÖÒÉ ÐÀËÐÀÝÉÉÈ ÏÁÒÀÆÝÏÅ-ÓÔÒÀÑÄÓÊÖÓ ÌÄÈÏÃÉÈ ÀÒ ÉÓÉÍãÄÁÀ, ÛÀÒÃÅÀ ÈÀÅÉÓÖ×ÀËÉ. per-rectum- gasinjviT ampula Tavisufalia aRiniSneba mcire raodenobiT ganavlovani masebi.

ÀÅÀÃÌÚÏ×É ÊÏÍÔÀØÔÖÒÉÀ, ÊÉÈáÅÄÁÆÄ ÖáÀËÉÓÏà ÐÀÓÖáÏÁÓ, ÐÀÈ. ÒÄ×ËÄØÓÄÁÉ ÀÒ ÀÙÉÍÉÛÍÄÁÀ.

St. Locus ÌÖÝÄËÉ ÏÅÀËÖÒÉ ×ÏÒÌÉÓ, didi zomis, zomierad Seberili misi marcxena naxevari,  ÓÖÍÈØÅÉÓ ÀØÔÛÉ ÌÏÍÀßÉËÄÏÁÓ dazogviT, ÐÀËÐÀÝÉÉÈ ÌÔÊÉÅÍÄÖËÉa mTeli muceli, gansakuTrebiT misi marcxena naxevari, pacienti uCivis saerTo sisustes, ÔÊÉÅÉËs ÌÖÝËÉÓ ÀÒÄÛÉ, Seberilobas, faRaraTs, ÂÖËÉÓÒÄÅÉÓ ÛÄÂÒÞÍÄÁÀÓ.

avadmyofi umniSvnelod gavida kuWSi Txeli ganavlovani masebiT, subieqturad Tavs uaresad grZnobs, tkivilebma imata, muceli Seibera. mkafiod gamoixata SCotkin-blumbergis simptomi.

ÅÉÍÀÉÃÀÍ ÀÅÀÃÌÚÏ×Ó ÃÀÄÓÅÀ mwvave muclis diagnozi, saxezea peritonealuri movlenebi, ÓÀàÉÒÏà CaiTvala ÂÀÊÄÈebuliyo ÓÀÓßÒÀ×Ï ÏÐÄÒÀÝÉÀ laparotomia, ნათესავებს ÀÄáÓÍÀÈ ÌÃÂÏÌÀÒÄÏÁÉÓ ÓÉÌÞÉÌÄ ÃÀ ÌÏÓÀËÏÃÍÄËÉ ÂÀÒÈÖËÄÁÄÁÉ ÃÀ ÛÄÃÄÂÄÁÉ, ÈÀÍáÌÏÁÀ ÏÐÄÒÀÝÉÀÆÄ ÌÉÙÄÁÖËÉ iqna, ÏÐÄÒÀÝÉÀ ÂÀÊÄÈÃÀ ÆÏÂÀÃÉ ÂÀÖÔÊÉÅÀÊÒÄÁÉÈ: Sua-Sua laparotomia, sigmeqtomia, kolostomia, muclis Rrus sanacia drenireba.

zogadi, endotraqealuri narkozis qveS gakeTda Sua-Sua laparotomia daTvalierda muclis Rru, reviziiT dadginda, rom aris swori nawlavis Cr. დოლიქოსიგმა, სიგმური კოლინჯი gaSavebuli, გადავსებულია სითხითა და აირებით, განავლოვანი ქვებით. სწორი ნაწლავის პროქსიმალურ ნაწილში იმყოფება სიმსივნური წარმონაქმნი ზომით 18X20X15sm, irgvliv myofi qsovilebi, maT Soris sigmuri kolinjis proqsimaluri nawili, mlivi nawlavis maryuJi qmnian erT mTlian konglomerats, uZravad intimurad mixorcebuls mcire menjis ukana kedelze. sigmuri kolinjis centraluri nawili ( 30sm) gaSavebuli, seroza ar brwyinavs, peristaltika ar aRiniSneba, jorjlis sisxlZarRvebi ar pulsireben, muclis RruSi aris ganavlovani sunis, serozul-hemoragiuli gamonadeni.

 gakeTda sigmuri kolinjis jorjlis mobilizacia, swori nawlavis simsivnuri warmonaqmnidan 3sm-mde da proqsimalurad mTlianad daswvrivi kolinjis sigmaSi gadasvlis ubnamde, sigmaSi gadaidevna msxvili nawlavis zeda sarTulidan nawlavis SigTavsi da gakeTda sigmis rezeqcia. swori nawlavis proqsimaluri nawili daixura sam sarTuliani nakerebiT. daswvrivi kolinjis distaluri bolo momzadda stomirebisTvis da gamotanili iqna muclis wina kedelze  muclis Rru amoirecxa, amomSralda, duglasis fosoSi Caidga polieTilenis drenaJi, romlis Semdgomac muceli daixura yrud. aseptiuri naxvevi.

  postoperaciuli periodi mimdinareobda mZimed, mkurnaloba tardeboda antimikrobuli, tkivilgamayuCebeli, kristaloidebis, sisxlis Semcvlelebisa da plazmis intravenuri transfuziiT. stoma funqcionirebda, Sardi gamoiyofoda, operaciidan meoTxe dRe pacients mieca  sakvebi, amoRebuli iqna nazogastraluri zondi, drenaJi muclis Rrudan, meSvide-merve dRes pacients kanze moexsna nakerebis nawili, miuxedavad TiTqosda dadebiTi dinamikisa, pacientis mdgomareoba rCeboda mainc mZime, ZiriTadi daavadebidan gamomdinare, wina planze wamovida Tavis tvinis sisxlis mimoqcevis moSlis suraTi, pacients periodulad ewyeboda aRgzneba, (motoruli), ebindeboda goneba, ewyeboda paTologiuri sunTqva (Ceinstoqsis tipis), 12.08.10 03:00   erT-erTi aseTi Setevis dros, daiwyo wnevam vardna,  paTologiuri sunTqva, sveli xixinebiTa da didi raodenobiT naxveliT, intensiurma Terapiam Sedegi ver gamoiRo, pacienti kidev ufro damZimda, gaaCera sunTqva da guliscema, Catarebuli reanimaciuli RonisZiebebi uSedego, pacienti gardaicvala 04:00.

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