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"code": "L05",
"name": "Пилонидальная киста",
"icd_name": "Пилонидальная киста",
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"cause": [
3
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"slug": "l05_pilonidalnaya_kista",
"lead": "врождённая аномалия развития кожи крестцово-копчиковой области, связанная с неполной редукцией рудиментарной каудальной связки. ",
"description": "Для заболевания характерно наличие врождённых первичных свищевых втяжений в межягодичной складке. Нередко из таких втяжений выстоят волосы. ",
"etiology": "<p>Считают, что эпителиальный копчиковый ход является врожденным дефектом развития кожи, обусловленным неполной редукцией мышц и связок хвоста.</p>",
"pathogenesis": "",
"diagnostics": "<p>Местные изменения настолько типичны, что спутать копчиковый ход с другими поражениями этой области почти невозможно. При введении в один из свищей метиленового синего краска выходит из всех остальных ходов и вторичных свищей и не проходит в прямую кишку.</p>",
"treatment": "<p>Радикальное лечение пилонидальной кисты проводится только хирургическим путем, в условиях стационара хирургического или колопроктологического отделения. Существуют две тактики хирургического лечения:</p>\r\n<ol>\r\n<li>В острый период вскрывается и дренируется гнойник. После чего через 1–2 недели проводится радикальная операция – иссечение кисты в пределах здоровых тканей.</li>\r\n<li>В острый период сразу проводится радикальная операция – иссечение кисты единым блоком в пределах здоровых тканей (при этом необходимо сохранить целостность кисты, во избежание инфицирования операционной раны).</li>\r\n</ol>\r\n<p>Операция завершается ушиванием краев раны. Хотя, на усмотрение хирурга, рана может оставаться открытой и долго заживать вторичным натяжением; иногда до 6 месяцев (Прим. автора). При иссечении кисты копчика всегда имеется дефицит тканей, что приводит к чрезмерному натяжению краев раны и негативно сказывается на ее заживлении. Практически всегда послеоперационные раны заживают долго, причиняя значительные неудобства пациенту. При этом частота рецидива достигает 10–40%.</p>\r\n<p>Радикальная операция всегда проводится в условиях наркоза. В послеоперационном периоде пациенты в обязательном порядке получают антибактериальные препараты широкого спектра действия, а также противовоспалительные средства.</p>",
"prevention": "<p>Всем, кто перенес радикальное оперативное вмешательство по поводу эпителиального копчикового хода, желательно соблюдать следующие рекомендации: <br />- в течение трех недель после операции не разрешается сидеть, поднимать тяжести; после снятия швов целесообразно ежедневно принимать гигиенический душ с промыванием межъягодичной складки; <br />- в течение 6 месяцев после операции 2 раза в месяц необходимо производить эпиляцию в зоне операции.</p>",
"clinical_picture": "<p>Эпителиальный копчиковый ход расположен по средней линии в межъягодичной складке, слепо оканчивается в подкожной клетчатке крестцово-копчиковой области, открывается на коже одним или несколькими точечными отверстиями (первичный эпителиальный ход), и представляет собой узкую эпителиальную трубку. Продукты жизнедеятельности эпителия, выстилающего ход, периодически выделяются через точечные отверстия наружу. Закупорка или инфицирование выводных протоков, механическая травма приводят к задержке содержимого в просвете хода и способствуют возникновению воспаления. В результате эпителиальный копчиковый ход расширяется, стенка его разрушается и в воспалительный процесс вовлекается окружающая клетчатка. Развившиеся при этом абсцесс или флегмона крестцово-копчиковой области иногда достигают значительной величины и могут вскрыться наружу в виде гнойного свища, который принято называть вторичным отверстием. <br /><br />В 25-50% случаев внутри эпителиального копчикового хода или возникшей на его месте кисты содержатся волосы, которые могут внедряться в боковые стенки и образовывать дополнительные ходы. Гнойник иногда достигает значительной величины и, как правило, прорывается через кожу, образуя наружное отверстие гнойного свища. <br />Различают неосложненный и осложненный гнойным процессом эпителиальный копчиковый ход.</p>",
"image": null,
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{
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{
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},
{
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},
{
"name": "Боль головная у детей"
},
{
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},
{
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},
{
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},
{
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{
"name": "Жжение в голове "
},
{
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},
{
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"lead": "Многообразие головной боли очень широкое, может быть длительной и ноющей или резкой и нестерпимой, может охватывать всю голову или ощущаться только в висках",
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{
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{
"name": "мышцы болят"
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{
"name": "Миалгия"
},
{
"name": "ломота"
},
{
"name": "боль в мышцах рук"
},
{
"name": "боль в мышцах ног"
},
{
"name": "боль в мышцах после тренировки"
},
{
"name": "боль в мышцах спины"
},
{
"name": "боль икроножная"
}
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"code": "L04",
"name": "Острый лимфаденит",
"icd_name": "Острый лимфаденит",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3
],
"periodicity": 1,
"slug": "l04_ostryy_limfadenit",
"lead": "острое гнойное воспаление лимфатических узлов.",
"description": "Лимфаденит – неспецифическое или специфическое воспалительное поражение лимфоузлов. Лимфаденит характеризуется местной болезненностью и увеличением лимфатических узлов, головной болью, недомоганием, слабостью, повышением температуры тела. \r\n\r\n",
"etiology": "<p>Возбудителями неспецифического лимфаденита обычно выступает гноеродная флора - стафилококки и стрептококки, а также выделяемые ими токсины и продукты тканевого распада, которые проникают в лимфоузлы лимфогенным, гематогенным или контактным путем. Первичным очагом при неспецифическом лимфадените могут являться гнойные раны, панариции, фурункулы, карбункулы, флегмоны, рожистое воспаление, трофические язвы, тромбофлебит, кариес, остеомиелит. Местные воспалительные процессы чаще сопровождаются регионарным лимфаденитом.</p>\r\n<p>Лимфаденит у детей часто бывает связан с воспалительными процессами ЛОР-органов (гриппом, отитом, хроническим тонзиллитом, ангиной), детскими инфекциями (скарлатиной, дифтерией, паротитом), а также кожными заболеваниями (пиодермией, экссудативным диатезом, инфицированной экземой и др.).</p>\r\n<p>Причиной специфического лимфаденита являются возбудители туберкулеза, сифилиса, гонореи, актиномикоза, чумы, сибирской язвы, туляремии и др. инфекций.</p>",
"pathogenesis": "<p>Инфекция поступает в регионарные лимфатические узлы с током лимфы, оттекающей из первичных гнойных очагов. Лимфаденит может возникнуть и без предшествующего лимфангита, причем первичный очаг бывает настолько ничтожен и так быстро заживает, что к моменту возникновения лимфаденита обнаружить место вхождения инфекции уже не всегда удается. В редких случаях возможно попадание инфекции в лимфатические узлы вместе с кровотоком. Лимфаденит иногда возникает и вследствие непосредственного перехода воспалительного процесса с тканей, окружающих узел.<br /> Лимфаденит следует рассматривать как проявление барьерной функции лимфатической системы, ограничивающей дальнейшее распространение инфекции и ее токсинов. Вместе с тем лимфаденит сам по себе может стать исходным пунктом для развития тяжелого гнойного процесса (аденофлегмона, сепсис).</p>",
"diagnostics": "<p>При постановке диагноза лимфаденит, врач проводит сбор анамнеза, и далее основывается на результатах пальпации тех областей, на которые жалуется пациент.</p>\r\n<p>Далее, обязательно назначается общий анализ периферической крови больного, в котором могут быть все признаки воспалительного процесса (в крови будет обнаружено при этом большое количество лейкоцитов, ускорение СОЭ, токсическая зернистость сегментоядерных нейтрофилов).</p>\r\n<p>Для уточнения и подтверждения диагноза лимфаденита назначается ультразвуковое исследование пораженных лимфатических узлов, пункция этих узлов. После пункции делают посев содержимого для того, чтобы определить сам микроорганизм и его чувствительность к препаратам антибактериального действия.</p>",
"treatment": "<p>Катаральный и гиперпластический острый лимфаденит лечится консервативно. Необходимо создание покоя для области поражения, проведение адекватной антибиотикотерапии на основании чувствительности микробной флоры, УВЧ-терапии, витаминотерапии. При гнойном лимфадените показано вскрытие сформировавшегося абсцесса, аденофлегмоны, дренирование и санация очага по принципам ведения гнойных ран. Назначается активная дезинтоксикационная и антибактериальная терапия.</p>",
"prevention": "<p>К профилактическим методам лимфаденита можно отнести здоровый образ жизни и максимальное избегание инфекционных заболеваний.</p>\r\n<p>Так же профилактическими методами лимфаденита являются методы по предупреждению травм различного характера, методы борьбы с раневой инфекцией, и рационализация лечения воспалительных гнойных заболеваний.</p>\r\n<p> </p>",
"clinical_picture": "<p>Острый лимфаденит может проявлять себя в виде общей и местной симптоматики.</p>\r\n<p>Общие симптомы воспаления:</p>\r\n<ul>\r\n<li>повышение температуры до высоких показателей (вплоть до 40°С);</li>\r\n<li>проявление озноба;</li>\r\n<li>сильная мигрень;</li>\r\n<li>общая сильно выраженная слабость;</li>\r\n<li>боль в мышцах;</li>\r\n<li>плохой сон.</li>\r\n</ul>\r\n<p>Местные проявления острого лимфаденита:</p>\r\n<ul>\r\n<li>увеличенные лимфоузлы;</li>\r\n<li>появление красного отека над лимфоузлами;</li>\r\n<li>возникновение заметной опухоли кожных покровов в области лимфоузлов;</li>\r\n<li>болезненные ощущения, как при прощупывании лимфоузлов, так и в состоянии покоя;</li>\r\n<li>повышение местной температуры кожных покровов;</li>\r\n<li>нарушение двигательной функции той области, где расположены лимфоузлы.</li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 11,
"published": 2,
"parent": null,
"block_rubric": 120,
"standards": []
},
{
"id": 6718,
"symptoms": [
{
"id": 2848,
"synonyms": [
{
"name": "мышечная боль"
},
{
"name": "боль в мышцах"
},
{
"name": "мышцы болят"
},
{
"name": "Миалгия"
},
{
"name": "ломота"
},
{
"name": "боль в мышцах рук"
},
{
"name": "боль в мышцах ног"
},
{
"name": "боль в мышцах после тренировки"
},
{
"name": "боль в мышцах спины"
},
{
"name": "боль икроножная"
}
],
"body_points": [
{
"x": 265,
"y": 3325,
"r": 0
}
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},
"code": "L03",
"name": "Флегмона",
"icd_name": "Флегмона",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"1"
],
"periodicity": 2,
"slug": "l03_flegmona",
"lead": "острый воспалительный процесс, сопровождающийся нагноением и некротизацией ткани, протекающий без четко обозначенных границ",
"description": "<p><span id=\"docs-internal-guid-0bf0319d-7fff-775a-9f50-fd98175de778\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Флегмона - гнойный воспалительный процесс, характеризующийся некрозом тканей и отсутствием капсулы или четких границ поражения.</span></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;\">Непосредственной причиной флегмоны являются патогенные бактерии, проникающие в жировую клетчатку с кровью либо лимфой, а также при травматическом повреждении тканей. Характер воспалительного процесса зависит от вида возбудителя.</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;\">Гнойное воспаление вызывают стафилококковая, стрептококковая, менингококковая либо гонококковая инфекция, а также синегнойная палочка. Гнилостный процесс становится следствием проникновения в организм кишечной палочки, фузобактерии, гнилостного стрептококка, протея. Воспаление, вызываемое анаэробными облигатными бактериями, протекает наиболее тяжело. Это клостридии, бактоерииды, пептококки, которые способны размножаться при отсутствии кислорода.</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;\">Здоровый организм с крепким иммунитетом успешно сопротивляется инфекции. Часто флегмона развивается на фоне иммунодефицита, вызванного хроническим заболеванием, наркотической либо алкогольной интоксикацией. Возбудитель может вызвать воспалительный процесс в здоровой ткани, проникая из очага, расположенного в другой части организма. Часто причиной флегмоны становится наличие незалеченного периостита, карбункула, воспаления миндалин, лимфаденита и т. д</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;\">Основной возбудитель флегмоны – золотистый стафилококк, второй по частоте возбудитель – стрептококк. Возбудители попадают в подкожно жировую клетчатку либо через дефекты кожи (царапины, раны и прочие травмы), либо эндогенным путем – через кровеносную и лимфатическую систему.</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;\">Другой возбудитель, который распространен среди детей младшего возраста – гемофильная палочка.</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;\">Поверхностные флегмоны видно невооруженным глазом. Внутренние флегмоны диагностировать сложнее. В диагностике всех видов помогают:</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;\">общий анализ крови;</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;\">общий анализ мочи;</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;\">ультразвуковое исследование;</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;\">рентгенография;</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;\">МРТ, КТ - в тяжелых случаях.</span></li>\r\n</ul>\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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Поскольку воспалительный процесс характеризуется тяжелым течением, пациента госпитализируют сразу после обнаружения у него флегмоны. Лечение проводится в условиях хирургического стационара.</span></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;\">На начальной стадии, до скопления инфильтрата, пациенту назначают местную терапию – согревающие компрессы, соллюкс, УВЧ-процедуры, а также накладывают на пораженное место желтую ртутную мазь.</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 наличии нагноения выполняется хирургическое вскрытие воспалительного очага и удаление гнойного содержимого с последующим дренажом полости. Благодаря выведению гноя снимается напряжение тканей и создаются условия для беспрепятственного отделения экссудата и очистки гнойного очага. Хирургическое лечение флегмоны проводится под общей анестезией.</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;\">Для дальнейшего заживления на рану накладывают мазь с антибиотиком и закрывают повязкой. Препарат подбирают в соответствии с выявленным возбудителем инфекционного воспаления после проверки его резистентности к лекарству. При необходимости применяют обезболивающие средства для внутримышечного введения.</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 анаэробной форме воспаления пациенту вводят противогангренозную сыворотку, чтобы повысить сопротивляемость организма инфекции.</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;\">Во время восстановительного периода больному показан постельный режим и консервативная общеукрепляющая терапия. Введение антибиотиков продолжается до окончания острой фазы воспаления. Одновременно пациенту могут быть назначены иммуномодуляторы, витамины, хлористый кальций, раствор глюкозы.</span></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;\">Профилактикой этого заболевания является предотвращение травм и повреждения кожи, своевременная обработка ран, лечения таких потенциальных источников инфекции как кариес, гнойничковые заболевания кожи и другие.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Формирование гнойного воспалительного очага под кожей сопровождается характерными симптомами флегмоны:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">появлением под кожей плотного инфильтрата, которое сопровождается сильным локальным повышением температуры, резкой болезненностью при пальпации, покраснением и вздутием кожи; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">размягчением инфильтрата спустя некоторое время, сопровождающимся развитием гнилостного процесса с дальнейшим образованием свища либо распространением воспаления на соседние здоровые ткани; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сильным отеком воспаленных тканей; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">посинением кожи над пораженным участком; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">увеличением лимфоузлов, расположенных рядом с пораженным участком; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">повышением температуры, ознобом, головной болью; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общим недомоганием, утомляемостью, слабостью; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">мышечными болями, ощущаемыми при любых движениях; </span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">жаждой.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В случае, если очаг воспаления формируется в глубине мягких тканей, признаки флегмоны напоминают симптомы любого инфекционно-воспалительного процесса. У больного повышается температура тела, появляется озноб, усиливается выделение пота, ощущается слабость, общее недомогание, боли в мышцах, жажда. Симптомы в этом случае появляются быстрее и являются более выраженными, чем при поверхностном воспалении. Возможны появление одышки, понижение артериального давления, посинение конечностей и желтушность кожи.</span></p>\r\n<p> </p>",
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{
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{
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{
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},
"code": "L02",
"name": "Абсцесс кожи, фурункул и карбункул",
"icd_name": "Абсцесс кожи, фурункул и карбункул",
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"cause": [
3
],
"periodicity": 1,
"slug": "l02_abscess_kozhi_furunkul_i_karbunkul",
"lead": "гнойно-некротическое воспалительное заболевание сальной железы и окружающей соединительной ткани, вызываемое гноеродными бактериями",
"description": "Отличительная особенность фурункулов от других видов воспаления кожи в том, что они не могут возникать там, где не растут волосы (ладони, подошвы), а появляются только в тех местах, где имеются волосяные фолликулы. \r\nНаиболее частая локализация: лицо, затылок, задняя поверхность шеи, поясница, паховые области, ягодицы, руки, ноги.",
"etiology": "<p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Эти гнойные заболевания возникают из за нарушения целостности защитных барьеров организма и проникновения в него патогенных агентов (бактерий или вирусов). Бактерии, обычно, являются частью нормальной флоры организма, но при определенных условиях и повышении их количества они могут вызывать <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. Большое количество таких организмов существуют на наших слизистых оболочках: полость рта, носовая полость, слизистая глаз, половых органов, а часть находится в нашем кишечнике, как в толстом, так и тонком. </span></p><p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Это золотистый стафилококк, протей, кишечная палочка.</span></p>",
"pathogenesis": "<p><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Воспалительные изменения кожи могут появится на любом участке тела. Это происходит вследствие нарушения целостности защитного барьера кожи человека — эпителия, при травмах или порезах. Патогенная флора проникает в стерильные условия организма и начинает активно размножаться. Организм ограничивает данный участок от здоровой ткани валом из воспалительных клеток, а когда этого барьера не хватает, возникает капсула, в которой и формируется <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. </span><br></p>",
"diagnostics": "Визуальный осмотр. Микроскопическое исследование отделяемого. Бактериологическое исследование отделяемого.",
"treatment": "Антибактериальная терапия наружная. Антибактериальная терапия системная. Противовоспалительные средства. Физиотерапевтическое лечение.",
"prevention": "<p><br></p>",
"clinical_picture": "<p>Для фурункула свойственно появление на коже болезненной фолликулярной <a href=\"/symptom/pustuly/\" title=\"Перейти на страницу симптома Пустулы\">пустулы</a> на фоне красной эритемы с некрозом в центре (т. н. стержень фурункула). После отторжения некротической ткани происходит заживление путём рубцевания. Наиболее часто фурункул возникает на коже шеи, затылка, лица, спины, бедрах. Появление фурункулов в разных стадиях развития называется фурункулёзом, а гнойно-некротическое <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> кожи и подкожной клетчатки вокруг группы волосяных мешочков и сальных желёз — карбункулом. При нахождении фурункула на лице возможны тяжёлые осложнения (гнойный менингит, <a href=\"/symptom/sistemnoe_vospalenie/\" title=\"Перейти на страницу симптома Системное воспаление\">сепсис</a>).</p>",
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"image_alt": "Фурункул",
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"danger": 28,
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"parent": null,
"block_rubric": 120,
"standards": [
5083
]
},
{
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"lead": "Плотные образования, возвышающиеся над окружающей тканью в полости которых содержится гной. После вскрытия могут оставаться рубцы.",
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},
{
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{
"name": "высыпания на коже"
},
{
"name": "высыпания"
}
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"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;\">Импетиго возникает вследствие инфицирования стрептококками и стафилококками. Заражение происходит через кожные покровы и слизистые.</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;\">Повышают риск развития заболевания:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">микротравмы (ссадины, царапины, укусы и др.);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">несвоевременная обработка ран;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">мацерация кожи;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">несоблюдение правил личной гигиены;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">тактильный контакт с носителем инфекции;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общие предметы быта;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">анемия;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сниженный иммунитет;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">высокая влажность климата;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сахарный диабет, атеросклероз.</span></li>\r\n</ul>\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;\">Группы риска развития импетиго:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">климатические условия: повышенная влажность и температура воздуха;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">снижение защитного барьера организма, в том числе при беременности, при наличии сопутствующих соматических патологий;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">наличие кожных заболеваний, сопровождающихся зудом (ветрянка, экзема, педикулез и др.);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">нарушенный обмен веществ;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">нарушение целостности кожных покровов (ссадины, царапины, порезы, микротрещины, эрозии);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">люди с повышенным потоотделением.</span></li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">На коже постоянно находится большое количество стафилококков и стрептококков. Это - представители так называемой транзиторной флоры, способные заражать кожу, даже не размножаясь на её поверхности. Латентность их существования обусловлена защитной функцией кожи. При нарушении целостности кожных покровов в результате травмы, мацерации (разбухания дермы при длительном контакте с жидкостью), дисфункции потовых и сальных желёз, изменения нормальной кислотности кожи открываются входные ворота для проникновения инфекции. Усугубляется этот момент нарушением правил личной гигиены, снижением иммунитета.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Затем в дерме развивается воспаление, направленное на уничтожение инфекционного антигена с восстановлением дефекта кожи. Воспаление начинается на участке соединительной ткани – гистионе, состоит из фаз альтерации, экссудации, пролиферации. Альтерация - выброс в кожу из повреждённых клеток медиаторов воспаления. Медиаторы включают фагоцитоз, увеличивают проницаемость стенки сосудов, начинают за счёт бактерицидных свойств обеззараживать участок воспаления. Кроме того, они вызывают вторичную альтерацию (гистолиз), подключают к воспалению иммунные механизмы, регулируют пролиферацию за счёт работы макрофагов. Причём весь этот процесс действует по принципу обратной связи. Фаза экссудации наступает почти мгновенно вслед за альтерацией, включает в себя ряд процессов: изменяет вязкость крови, повышает проницаемость капилляров, вызывая миграцию составных частей крови в очаг воспаления с образованием экссудата, воспалительного клеточного инфильтрата. Пролиферация завершает процесс. В результате последовательного осуществления всех фаз воспаления кожа восстанавливается полностью или рубцуется (в зависимости от величины и глубины первоначального дефекта).</span></p>\r\n<p> </p>",
"diagnostics": "<div style=\"text-align: start;\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Диагноз ставит дерматолог на основании анамнеза, клинических проявлений. При наличии сомнений в диагнозе проводят дерматоскопию. Дополнительно применяют специфические методы исследования: окрашивание мазков экссудата по Граму (видны кокки под микроскопом), посев отделяемого булл на флору и антибиотикограмму.</span></p>\r\n</div>",
"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 неосложнённых форм импетиго проводят в амбулаторных условиях. Терапия преследует две цели: устранить причину патологии и улучшить общее самочувствие пациента. Обычно для купирования процесса достаточно наружных средств: очаг поражения обрабатывают 2% камфорным спиртом, пузыри после вскрытия – фукорцином, мазями с антибиотиком. Фоново назначают витаминотерапию, иммуностимуляторы, натрия дезоксирибонуклеат. Запрещаются все водные процедуры. Курс лечения - 10 дней. Если заболевание продолжает распространяться, подключают антибиотики по индивидуальным схемам: внутрь или в/м в инъекциях. Назначается диета с отсутствием сахаросодержащих продуктов, так как глюкоза является благоприятной питательной средой для распространения микробов. </span></p>\r\n<p><span id=\"docs-internal-guid-570d5c20-7fff-75ea-920d-673d17a07c7f\"> </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;\">Для исключения повторного инфицирования важно знать и соблюдать основные меры профилактики. Загрязнения кожи – один из основных факторов, повышающих риск заражения. Поэтому соблюдение правил личной и трудовой гигиены – основное профилактическое мероприятие. Важно также укреплять иммунитет, вести активный образ жизни, правильно питаться, поддерживать баланс витаминов и минералов в организме. </span></p>",
"clinical_picture": "<p>Различают импетиго стафилококковое, стрептококковое и стрептостафилококковое. <br /> <br />Стрептококковое импетиго начинается с образования мало возвышающихся, склонных к периферическому росту фликтен - полостных элементов типа пузырей размером от 2 до 10 мм и более в диаметре. рассеяны или скучены группами, окружены узким ободком гиперемии. Содержимое фликтен сначала прозрачное, затем мутнеет и быстро ссыхается в светло-желтые корки, отпадающие через 5-7 дней, после чего остается депигментация. <br /> <br />К разновидностям стрептококкового импетиго относится простой лишай лица или сухая пиодермия - очаги мелкопластинчатого шелушения с незначительным покраснением кожи. <br /> <br />Другая разновидность стрептококкового импетиго - стрептококковые заеды, которые чаще встречаются у детей. Начинаются они с появления в углу рта пузыря с вялой тонкой покрышкой, на его месте быстро образуется щелевидная эрозия, после удаления которой, обнаруживается красная влажная легко кровоточащая поверхность с трещиной в центре. Спустя 1-2 часа заеда вновь покрывается коркой. Процесс может сопровождаться небольшой болезненностью при открывании рта. Процесс часто распространяется на слизистую оболочку полости рта. Иногда импетиго возникает изолированно во рту, где на месте быстро вскрывающихся фликтен образуются болезненные , покрывающиеся гнойным налетом. <br /> <br />Разновидностью пузырного импетиго является и поверхностный панариций, при котором фликтена возникает на ногтевом валике дугообразно вокруг ногтя на месте заусениц при травмах (например, во время маникюра), уколе иглой и т.д. При травмировании такая фликтена вскрывается и образуется мокнущая эрозия в большим количеством стрептококков в отделяемом. <br /> <br />Стафилококковое импетиго (фолликулит) <br />Фолликулит - это воспалительное поражение волосяного мешочка, вызванное стафилококками. Фолликулит может быть поверхностным или глубоким. Поверхностный фолликулит характеризуется образованием множественных небольших (1-2 мм, отдельные могут достигать 5 мм) гнойничков, пронизанных в центре волосом и окруженных узкой розовой каймой. На 3-4 день их содержимое подсыхает, появляются желтые , после отпадения которых, на коже не остается следов. <br /> <br />При глубоком фолликулите на коже образуются болезненные узелки красного цвета величиной 5 мм и больше в диаметре, иногда с гнойничком посредине. Через несколько дней узелок рассасывается или нагнаивается, а затем вскрывается. После заживления такого узелка часто остается рубчик. <br /> <br />Смешанное (стрептостафилококковое) импетиго <br />При сочетании стрептококковой и стафилококковой инфекции развивается смешанное (вульгарное) импетиго, при котором содержимое фликтен бывает гнойным, а корки - массивными. При снятии корок обнажается влажная эрозированная поверхность. <br />Располагается вульгарное импетиго обычно на лице и других открытых участках кожи. К заболеванию склонные дети, подростки и молодые женщины. Без лечения рядом с бывшими высыпаниями или на отдаленных участках кожи возникают новые фликтены, процесс нередко принимает распространенный характер. Имеет значение перенос инфекции на новые участки через руки и белье. <br /> <br />Осложнения импетиго <br />Чаще всего заболевание заканчивается без последствий, но могут быть и осложнения. Одними из самых неприятных осложнений являются осложнения на почки (нефриты) и на сердце (миокардиты). <br /> <br />Стафилококковое импетиго может осложниться распространенными гнойными процессами - абсцессами и флегмонами.</p>",
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5314
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