#1
|
|||
|
|||
Êðîâü â êàëå
Äîáðûé äåíü.
Æåíùèíà, 58 ëåò, âåñ 56, ðîñò 164. Îáðàòèëàñü ê ïðîêòîëîãó â àâãóñòå 2023 ã. ñ æàëîáàìè íà ïðèñóòñòâèå â êàëå êðîâè òåìíîãî öâåòà è ñ ïåðèîäè÷åñêèìè çàïîðàìè. Áûë îáíàðóæåí ãåìîððîé, íàçíà÷åíî ëå÷åíèå ìóêîôàëüê è äèîôëàí 1 ìåñÿö, ñâå÷è ãåìîðîëü è ìàçü ïðîêòîçàí â òå÷åíèè 10 äíåé. Ëå÷åíèå äàëî óëó÷øåíèå, íî ïðîäîëæàëèñü ïðîáëåìû ñ ëåãêîñòüþ îïîðîæíåíèÿ. Ïðèìåðíî â ôåâðàëå íà÷àëà ñíîâà çàìå÷àòü êðîâü â êàëå ñî ñëèçüþ, ïîÿâèëèñü òðóäíîñòè ñ îïîðîæíåíèåì, ïîâûøåííîå ãàçîîáðàçîâàíèå, ëîæíûå ïîçûâû, ðåçêèå ñõâàòêîîáðàçíûå áîëè âíèçó æèâîòà ïåðåä òàê íàçûâàåìîé äåôåêàöèåé, êîòîðàÿ íå ïðîèñõîäèëà â ïîëíîì îáúåìå.  ïîñëåäíèé ìåñÿö òàêèå ñëó÷àè ñòàëè ó÷àùàòüñÿ. Îáðàòèëàñü ê ñåìåéíîìó âðà÷ó, ïðè îñìîòðå îíà íå îáíàðóæèëà óõóäøåíèÿ ãåìîððîÿ. Âûäàëà íàïðàâëåíèå íà àíàëèçû, ÓÇÈ ÆÊÒ è êîëîíîñêîïèþ. Ðåçóëüòàòû àíàëèçîâ ïðèëàãàþ. Òàêæå åñòü æàëîáû íà ïëîõóþ ïàìÿòü è êðóòèò íîãè âå÷åðîì. Ïîäñêàæèòå, ïîæàëóéñòà, íóæíî ëè äîïîëíèòåëüíî ñäåëàòü êàêèå ëèáî àíàëèçû, ïîêà îæèäàþ î÷åðåäü íà äèàãíîñòèêó. Äèàãíîñòèêà: TSH - ó ìåíÿ 2,67 µIU/ml ëàáîðàòîðíûå íîðìû - 0,27 — 4,20 CRP - ó ìåíÿ < 3,20 mg/l ëàáîðàòîðíûå íîðìû - < 5,00 |
#2
|
||||
|
||||
ðåçóëüòàòîâ êîëîíîñêîïèè íå âèäíî
|
#3
|
|||
|
|||
|
#4
|
|||
|
|||
Èñïðàâèëà ôîðìàò ðåçóëüòàòîâ àíàëèçîâ. Êîëîíîñêîïèÿ áóäåò ñäåëàíà ÷åðåç ìåñÿö. Âîçìîæíû ëè êàêèå-òî äîïîëíèòåëüíûå àíàëèçû èëè äèàãíîñòèêà?
APTT - ðåçóëüòàò 28,4 sek íîðìû 24,0 — 37,0 INR- ðåçóëüòàò 0,98 íîðìû 0,8 - 1,2 GGT - ðåçóëüòàò 22 IU/L íîðìû 9 — 36 |
#5
|
||||
|
||||
â àíàëèçàõ íè÷åãî îñîáåííîãî, êðîìå ïîâûøåííîãî õîëåñòåðèíà, íî îòíîøåíèå ê ñðîâè â êàëå çäåñü íåò.Íå äóìàþ, ÷òî íóæíûå äî ïðîâåäåíèÿ êîëîíîñêîïèè äðóãèå àíàëèçû
|
#6
|
||||
|
||||
õð. êðîâîïîòåðÿ ìîæåò âåñòè ê äåôèöèòû æåëåçà, îí áûâàåò, äàæå åñëè ãåìîãëîáèí ó âåðõíåé ãðàíèöû íîðìû; æä ìîæåò ñíèæàòü ïàìÿòü è âûçûâàòü ñèìïòîìû áåñïîêîéíûõ íîã; íóæåí î÷íûé ñïåöèàëèñò, êîòîðûé çíàåò î íåàíåìè÷åñêîì æä
âðîäå òàêèõ Guidelines of the Polish Society of Gynecologists and Obstetricians on the diagnosis and treatment of iron deficiency and iron deficiency with anemia Piotr Sieroszewski1 , Dorota Bomba-Opon2 , Wojciech Cnota3 , Agnieszka Drosdzol-Cop4 , Marek Gogacz5 , Mariusz Grzesiak6, Hubert Huras7 , Artur Jakimiuk8, Piotr Kaczmarek6 , Sebastian Kwiatkowski9 , Radzislaw Mierzynski10 , Wlodzimierz Sawicki11 , Agnieszka Seremak Mrozikiewicz12 , Rafal Stojko4 , Miroslaw Wielgos13 , Ewa Wender-Ozegowska14 , Mariusz Zimmer15 , Marta Konieczna16 11st Department of Gynaecology and Obstetrics, Medical University of Lodz, Poland 21st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland 3Chair and Department of Gynaecology and Obstetrics in Ruda Slaska, Medical University of Silesia in Katowice, Poland 4Chair and Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia in Katowice, Poland 52nd Department of Gynecology, Medical University of Lublin, Poland 6Department of Perinatology, Obstetrics and Gynaecology, Polish Mother’s Memorial Hospital Research Institute in Lodz, Poland 7Collegium Medicum, Jagiellonian University, Cracow, Poland 8Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of the Interior and Administration (MSWiA), Warsaw, Poland 9Departament of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland 10Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland 11Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Poland 12Department of Perinatology and Women’s Diseases, Poznan University of Medical Sciences, Poznan, Poland 131st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland 14Department of Reproduction, Chair of Obstertics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, Poland 15 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Poland 16Pathology of Pregnancy Department Medical Univeristy of Lodz, Poland Ginekologia Polska 2023, vol. 94, no. 5, 415–422 www. journals.viamedica.pl/ginekologia_polska
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
|
|||
|
|||
Öèòàòà:
Íóæíî ëè â ìî¸ì ñëó÷àå ïðèíèìàòü ñòàòèíû èëè ïîïðîáîâàòü îòêàçàòüñÿ îò âñåõ ïðîäóêòîâ ñîäåðæàùèõ õîëåñòåðèí è ïåðåñäàòü àíàëèçû? |
|
#8
|
||||
|
||||
íåðåäêî óðîâåíü õîëåñòåðèíà íå çàâèñèò îò âåñà òåëà, áîëåå íàñêëåäñòâåííûå ôàêòîðû âëèÿþò íà åãî óðîâåíü.Äèåòà ìîæåò ñíèçèòü óðîâåíü õîëåñòåðèíà íà 10-15%, ñ äèåòû ñòîèò íà÷èíàòü , íî åñëè åñòü ñåìåéíàÿ èñòîðèÿ çàáîëåâàíèé èøåìè÷åñêèõ ñåðäöàü àòåðîñêëåðîçàü ìåòàáîëè÷åñêîãî ñèíäðîìà(+ îæèðåíèåü ïîâûøåíèå ñàõàðà â êðîâè...) äèåòû îáû÷íî íåäîñòàòî÷î
Äëÿ ïðîâåðêè íà ñêðûòûé æåëåçîäåôèöèò ìîæíî ñëåä.ðàç ïðîâåðèòü ôåððèòèí. .Ñïàçìû â íîãàõ áûâàþò ïðè äåôèöèòå ìàãíèÿü îñîáåííî ó áåðåìåííûõ è ëþäåé ñòðàøåãî âîçðàñòà .Àíàëèç êðîâè íà ìàãíèé íå îòðàæàåò åãî íåäîñòàòîê è îáû÷íî áåñïîëåçåí.Âðà÷è èíîãäà íàçíà÷àþò ìàãíèé ïàöèåíòàì(îñîáåííî ÷àñòî áåðåìåííûì æåíùèíàì ïðè ñïàçìàõ â íîãàõíà íåñê.ìåñÿöåâ (åñëè åñòü ïîëîæ.ðåçóëüòàò- íå ñðàçó |
#9
|
|||
|
|||
Öèòàòà:
çà æåëåçîäèôèöèò ïîíÿëà, ïîïðîáóþ ïîïðîñèòü äîêòîðà î íàïðàâëåíèè íà äîïîëíèòåëüíûå àíàëèçû. |
#10
|
||||
|
||||
Öèòàòà:
Ëó÷øå îáñëåäîâàòüñÿ ó î÷íûõ âðà÷åé, êîòîðûå âèäÿò Âàøó ïðåäûäóøóùóþ è íàñòîÿùóþ èñòîðèþ, ìîãóò îïðîñèòü è îñìîòðåòü Âàñ,îöåíèòü íåâðîëîãè÷åñêèé è ïñèõîèëîãè÷åñêèé ñòàòóñ, à íå ëå÷èòü îòäåëüíûå ñèìòîìû... |
#11
|
||||
|
||||
çàòðóäíåíèå ãëîòàíèÿ âñåãî òâåðäîãî (äèñôàãèÿ) òîæå ìîæåò áûòü ñèìòîìîì æä, âñÿ ñèìïòîìàòèêà çäåñü https://forums.rusmedserv.com/showpo...62&postcount=2
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
|
|||
|
|||
Öèòàòà:
Ðåçóëüòàò Íîðìû HGB - hemoglobina 14,8 g/dl 12,0 — 16,0 HCT - hematokryt 43,4 % 36,0 — 47,0 RBC - erytrocyty ↑ 5,28 ×106/µl 4,0 — 5,2 MCV - średnia objętość krwinki 82,2 fl 81,0 — 99,0 MCH - średnia waga HGB 28,0 pg 27,0 — 34,0 MCHC - średnie stężenie HGB 34,1 g/dl 31,0 — 37,0 RDW-CV - zmienność objęt. RBC 12,9 % 12,4 — 15,1 WBC - leukocyty 5,7 ×103/µl 4,0 — 10,0 LYMPH - limfocyty 2,35 ×103/µl 0,80 — 4,50 LYMPH% - udział procentowy 41,2 % 20,0 — 48,0 MONO - monocyty 0,46 ×103/µl 0,10 — 1,00 MONO% - udział procentowy 8,1 % 3,0 — 12,0 NEUT - neutrocyty 2,58 ×103/µl 1,50 — 7,00 NEUT% - udział procentowy 45,3 % 45,0 — 70,0 EOS - eozynocyty 0,27 ×103/µl 0,00 — 0,50 EOS% - udział procentowy 4,7 % 0,4 — 7,0 BASO - bazocyty 0,03 ×103/µl 0,00 — 0,10 BASO% - udział procentowy 0,5 % 0,0 — 1,0 IG - niedojrzałe granulocyty 0,01 ×103/µl 0,00 — 0,09 IG% - udział procentowy 0,2 % 0,0 — 0,6 PLT - płytki krwi 207 ×103/µl 140 — 400 MPV - średnia objętość płytek 10,4 fl 9,4 — 12,5 NRBC - erytroblasty 0,00 10´3/µl 0,00 — 0,02 NRBC% - udział procentowy 0,00 % 0,00 — 0,03 Ðåçóëüòàò Íîðìû Żelazo 88 ug/dl 50,00 — 170,00 TIBC 271 ug/dl 250 — 440 UIBC 183 ug/dl 70 — 310 Wsp.wysycenia transferyny 32,4 % 15,0 — 35,0 |
#13
|
|||
|
|||
Öèòàòà:
|
#14
|
||||
|
||||
íå âèæó ôåððèòèíà
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
|
|||
|
|||