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"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Панкреатическая стеаторея - это синдром, развивающийся при выделении с калом более 7 г нейтрального жира за сутки из каждых 100 г, принятых с пищей.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Различают патологические варианты синдрома и физиологическую алиментарную форму стеатореи, спровоцированную перееданием жирной пищи. При пищевых причинах расстройства пищеварения появление специфических симптомов обусловлено относительной недостаточностью панкреатических ферментов, которые не успевают расщепить большие количества жира. Намного чаще встречаются патологические формы ПС, в развитии которых играют роль 4 основные причины:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Уменьшение объема панкреатической паренхимы. Главный этиологический фактор стеатореи у взрослых — панкреатиты различного генеза. При хроническом воспалении ткань поджелудочной железы (ПЖ), секретирующая панкреатические ферменты, постепенно подвергается склерозу и фиброзу. Вторая по распространенности причина — сахарный диабет с образованием антител к клеткам ПЖ.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение оттока панкреатического секрета. Такое состояние связано с недостаточностью гормональных веществ, которые стимулируют выделение пищеварительных ферментов в тонкую кишку. Характерно для энтеропатий, болезни Крона, синдрома короткого кишечника. Реже наблюдаются механические препятствия — опухоли или кисты.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диссинхрония пищеварительного процесса. У больных нарушается согласованная эвакуация содержимого желудка и выделение панкреатических ферментов. Наиболее часто диссинхрония возникает в послеоперационном периоде: в 30-50% - при стволовой ваготомии с пилоропластикой, в 50-70% - при ваготомии с антрумэктомией.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врожденные аномалии. Недостаточность внешнесекреторной функции бывает связана с гипоплазией или дисплазией панкреатической железы. Очень редкая причина заболевания — изолированный генетически обусловленный дефицит синтеза панкреатической липазы. Такие формы болезни встречаются у детей и молодых людей.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В норме при попадании кислого химуса желудка в двенадцатиперстную кишку начинают выделяться активные вещества, стимулирующие продукцию панкреатических энзимов. За расщепление жиров отвечает липаза. Сначала жиры эмульгируются под действием желчи, а затем крупные молекулы распадаются до глицерина и жирных кислот. Низкомолекулярные вещества быстро всасываются в кровь.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При панкреатической стеаторее жиры не расщепляются и не могут абсорбироваться в кишечнике, поэтому они выводятся из организма вместе с калом. Непереваренные жиры гидролизуются бактериями толстой кишки и усиливают активность секреторной функции колоноцитов. Выраженные клинические признаки развиваются, если функционирует не более 10% клеток поджелудочной железы.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Первичный метод исследования, рекомендованный при подозрении на панкреатическую недостаточность — копрограмма. В анализе обнаруживают мелкие капли жира, мышечные волокна и другие непереваренные пищевые фрагменты. Такие данные позволяют установить предварительный диагноз стеатореи, после чего врач-гастроэнтеролог назначает детальное обследование больного. Основные методы диагностики:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Зондовые тесты. Наиболее надежным для установления внешнесекреторной панкреатической недостаточности является секретин-панкреозиминовый тест. О патологии свидетельствует снижение уровня липазы в панкреатическом соке после внутривенного введения стимулирующих гормоноподобных веществ. Реже выполняется пищевая проба Лунда.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Беззондовые тесты. Для выявления хронического панкреатита как основной причины стеатореи измеряется концентрация фекальной эластазы в кале. Для установления количества липидов, которые содержатся в каловых массах, используется метод Ван де Камера — диагноз подтверждается при выделении ежесуточно более 5 г жира.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ поджелудочной железы. Ультразвуковой метод применяется для визуализации очагов воспаления или фиброза в паренхиме поджелудочной железы. С помощью эхографии исследуют печень, желчный пузырь и протоки, чтобы исключить билиарные причины стеатореи. При недостаточной информативности сонографии производится КТ органов брюшной полости.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Радиоизотопные методы. Применяют для топической диагностики нарушения переваривания и всасывания жиров. В организм человека вводят меченые липиды, количество которых через определенный промежуток времени измеряется в кале, крови и моче. Для заболевания характерно повышение уровня радиоактивных изотопов в каловых массах.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение стеатореи начинают с подбора специальной диеты. Чтобы улучшить пищеварение, требуется ограничение количества жиров до 40-60 г в день, а при тяжелой секреторной недостаточности — до 30 г. Рекомендуется частое дробное питание, которое предполагает 5 приемов пищи с интервалами 2,5-3 часа. Диетотерапия дополняется медикаментозным лечением, которое включает ряд препаратов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ферменты. Заместительная терапия проводится при стойких диспепсических жалобах или при потере с испражнениями более 15 г жиров в сутки. Для компенсации пищеварения принимается липаза, при необходимости схему лечения усиливают другими панкреатическими ферментами.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамины. Используются при тяжелых гиповитаминозах с клиническими проявлениями. Чаще всего назначается комплекс жирорастворимых витаминов: А, Д, Е. При наличии анемии эффективны цианокобаламин и фолиевая кислота.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вспомогательные лекарства. Препараты желудочного сока показаны при сопутствующих гипоацидных гастритах, которые сопровождаются диссинхронией процессов пищеварения. Для улучшения работы ЖКТ применяют кишечные антисептики и пробиотики.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактические мероприятия включают раннее выявление и лечение гастроэнтерологических болезней, диспансерное наблюдение за страдающими панкреатической стеатореей для предотвращения осложнений.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные признаки ПС — обильный стул (полифекалия) и «жирный» кал. Испражнения приобретают оранжевый или желтоватый цвет, имеют зловонный запах. Характерен сальный блеск кала и трудно смываемые следы на стенках унитаза. Частота дефекации увеличивается до 3-4 раз в течение суток, при этом каждый раз выделяется довольно большая порция кала. Иногда в выделяемых каловых массах можно увидеть непереваренные фрагменты пищи.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обострение панкреатической стеатореи наступает после употребления пищи с большим количеством животных жиров. Пациенты жалуются на спастические боли без четкой локализации, урчание в животе. Определяется сильное вздутие живота. Частота стула иногда возрастает до 5-6 раз за сутки. После дефекации урчание и дискомфорт в животе уменьшаются, но полностью не исчезают.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие клинические симптомы присоединяются позже. Они связаны с дефицитом микро- и макронутриентов. Вследствие нехватки железа развиваются глосситы, истончаются и деформируются ногтевые пластины. Дефицит кальция проявляется судорогами икроножных мышц, болями в костях и суставах. Гиповитаминоз жирорастворимого витамина А вызывает ухудшение сумеречного зрения, чрезмерное утолщение и огрубение кожи.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При длительной декомпенсированной панкреатической стеаторее происходит потеря веса вплоть до кахексии. В связи с нехваткой липидов нарушается синтез половых гормонов. У женщин сбои гормонального фона приводят к задержке менструаций или аменорее, у мужчин — к снижению полового влечения, импотенции. При дефиците витамина Е беспокоит слабость в мышцах.</span></p>",
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}
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}