Dispepsia

miRebulia “klinikuri praqtikis erovnuli ministris 2010 wlis 24 seqtembris Sefasebisa da danergvis erovnuli sabWos" klinikuri mdgomareobis marTvis saxelmwifo akne kanis cximovani jirkvlebis anTebiTi daavadebaa, qronikuli dermatozia da xasiaTdeba Ria da/an daxuruli komedonebiT, papulebiT, pustulebiTa da kvanZovani gamonayariT. akne viTardeba tipur agdilebze – sxeulis im nawilebze, romelTa kani didi raodenobiT Seicavs cximovan jirkvlebs. esenia: saxe, kiseri, gulmkerdi, zurgis zeda nawili, mxrebi. aknesTvis damaxasiaTebel dazianebasTan (TeTrTaviani, SavTaviani komedonebi da anTebiTi kerebi) erTad aRiniSneba nawiburebi da hiperpigmentacia. hiperpigmentacia ufro metad vlindeba muqi feris kanis mqoneTa Soris. aknes dros ganviTarebuli gamonayaris tipebi:  TeTri (anu daxuruli) komedonebi (araanTebiTi folikulebi, romelTa Sesavali Seicavs keratinul sacobebs da dafarulia Txeli epidermuli membraniT)  Savi (anu Ria) komedonebi (araanTebiTi folikulebi, romelTa Sesavali Seicavs keratinul sacobebs da Savi Seferiloba aqvs)  papulebi  pustulebi  kvanZebi da/an kistebi simZimis mixedviT ganarCeven daavadebis Semdeg formebs:  msubuqi akne – komedonebi < 20, araanTebiTi papulebi < 15 an  saSualo simZimis Aakne – 15-50 papula da pustula komedonebiT, iSviaTi kistebi. totaluri dazianebebis ricxvi 30-125;  mZime akne – pirveladi anTebiTi kvanZebi da kistebi, aseve komedonebi, papulebi da pustulebi, totaluri dazianebebis ricxvi >125. 3. instrumentul-laboratoriuli gamokvlevebi da pacientis Sefaseba anamnezis detalurad SegrovebiT iwyeba. daavadebis diagnostika kanis daTvalierebiT xdeba. fizikuri gasinjvisas ganisazRvreba dazianebebis lokalizacia, tipi (anTebiTi, araanTebiTi), zoma (mcire <5 mm – papulebi an pustulebi, didi zomis >5 mm – kvanZebi), daavadebis Sedegebi: nawiburebi (atrofiuli, gavrcelebuli, hipertrofuli, keloidi), hiperpigmentacia, anTebis Semdgomi eriTema. kvlevebis Catareba, Cveulebriv, saWiro ara aris. maTi Catarebis saWiroeba sxva Tanmxlebi niSnebis arsebobis SemTxvevaSi dgeba.  mikrobiologiuri kvleva rutinulad ar tardeba; mikrobiologiuri kvlevis Catareba esaWiroebaT pacientebs, romelTac aqvT aknes magvari gram-uaryofiTi floriT gamowveuli folikuliti;  androgenebis donis gansazRvra sisxlSi rutinulad ar tardeba. kvlevis Catareba marTebulia, rodesac pacients aknesTan erTad androgenebis siWarbis sxva niSnebic aqvs.  pacientebi msubuqi da saSualo simZimis akneTi, rodesac eqvsTviani konservatuli Terapiis Semdeg efeqti ar vlindeba;  pacientebi, romelTa daavadeba refraqtorulia mkurnalobis mimarT, gansakuTrebiT mZime aknes da nawiburebis SemTxvevaSi;  pacientebi sistemuri izotretinoiniT kursis daniSvnisas - am SemTxvevaSi mkurnalobis meTods irCevs dermatologi, magram gamomdinare izotretinoiniT mkurnalobis dawyebabmde erTi TviT adre, fertiluri asakis qalebisaTvis aucilebelia kontraceptivebis daniSvna, am periodiT pacienti meTvalyureobisaTvis kvlav ubrundeba pjd-s.  SerCeulia Terapiis gaumjobesebuli reJimi;  damTavrebulia sistemuri izotretinoiniT mkurnalobis kursi;  laboratoriuli kvlevebi (garkveuli periodulobiT) sistemuri  saxezea daavadebis gamo fsiqikis sxvadasxva saxis dazianeba. mkurnalobis mizania pacientis zogadi mdgomareobis gaumjobeseba, gamonayaris kontroli, diskomfortis da fsiqosocialuri stresis Semcireba, nawiburebis prevencia. mkurnalobis saxe (adgilorivi, sistemuri) daavadebis simZimiTa da dazianebis lokalizaciiT ganisazRvreba (ix. sqema 1, 2, 3). ZiriTadi samkurnalo saSualebebis dozirebis reJimi da gverdiTi movlenebi ix. cxrilSi. mikrokomedonebis maturacia 8 kviramde grZeldeba da aqedan gamomdinare, efeqtis misaRebd mkurnalobis xangrZlivoba am periodze naklebi ar unda iyos. mkurnaloba diagnostikis Semdgom rac SeiZleba male unda daiwyos da yovel 2-3 TveSi Sefasdes da gadaixedos. sqema 1. msubuqi aknes mkurnalobis algoriTmi sqema 2. saSualo simZimis aknes mkurnalobis algoriTmi sqema 3. mZime aknes mkurnalobis algoriTmi (Tretinoin)
(Adapalene)
SedarebiT naklebad); fotosensitiuroba adgilobrivi (Tazarotene)
ukunaCvenebia orsulobis da ZuZuTi kvebis dros adgilobrivi iritacia; SeiZleba gamoiwvios (Benzoyl peroxide)
(Metronidazole)
(Clindamycin)
(Erythromycin)
(Azelaic acid)
asakamde, radgan SesaZlebelia gamoiwvios (Tetracycline)
(Doxycycline)
minociklini*
(Minocycline)
(Erythromycin)
(Isotretinoin)
hipertrigliceridemia; depresia; Zvlis tvinis *aRniSnuli saSualebebi saqarTveloSi registrirebuli ara aris. mkurnalobis efeqturobis Sefaseba da gegmis gadaxedva yovel 2-3 TveSi unda moxdes.  sistemuri retinoidebiT mkurnalobis dros mkurnalobis dawyebamde da Semdgom garkveuli periodulobiT unda Catardes sisxlis saerTo analizi, Sratis trigliceridebis, qolesterinis, RviZlis funqciuri testebi. zogadad janmrTeli, asimptomuri pirebisTvis, romelTac diabetis an dislipidemiis ojxuri anamnezi ar aqvT, laboratoriuli kvlevebis Catareba SesaZlebelia TveSi erTxel; sxva SemTxvevaSi ki yovelkvireulad an or kviraSi erTxel, manam, sanam maCveneblebi rekomendebul zRvars ar miuaxlovdeba. mkurnalobis Sewyvetis Cvenebaa mZime hipertrigliceridemia (mag. >800 mg/dl an 9 mmol/l - mwvave panreatitis ganviTarebis riskis gamo) an sxva gamoxatuli laboratoriuli cvlilebebi. izotretinoiniT mkurnalobis Sewyvetis Sedegad hipertrigliceridemiis TandaTan mowesrigebis miuxedavad, mainc saWiroa Semdgomi meTvalyureoba.  spironolaqtoniT mkurnalobis SemTxvevaSi, Terapiis dawyebamde da Semdgom, periodulad unda ganisazRvros sisxlSi eleqtrolitebis done.  minocikliniT xangrZlivad sistemuri mkurnalobis (1 welze meti) SemTxvevaSi rekomendebulia antinuklearuli antisxeulebis da RviZlis transaminazebis gansazRvra. 6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli implementaciisaTvis saWiro adamianuri resursebi ojaxis eqimi – pacientis Sefaseba, daavadebis diagnostika, medikamenturi mkurnalobis Sesaxeb gadawyvetilebis miReba, referalis saWiroebis Sefaseba, mimdinare meTvalyureoba; zogadi praqtikis eqTani – pacientis ganaTleba; registratori – mimdinare meTvalyureobisTvis pacientebis gamoZaxebis uzrunvelyofa; menejeri/administratori – gaidlainisa da protokolis implementaciis xelSewyoba; implementaciaze meTvalyureoba; auditis Catareba da Sedegebis analizi.

Source: http://gpmc.ge/wp-content/uploads/2013/03/89.2.pdf