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},
"code": "E51",
"name": "Недостаточность тиамина",
"icd_name": "Недостаточность тиамина",
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0
],
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"slug": "e51_nedostatochnost_tiamina",
"lead": "Заболевание протекающее с накоплением в крови и тканях пировиноградной кислоты, нарушением водного, углеводного, белкового и жирового обменов, сопровождающееся расстройством функций нервной системы, ослаблением сердечной деятельности.",
"description": "",
"etiology": "<p>Возможные причины развития:</p>\r\n<ul>\r\n<li>недостаточное поступление тиамина в организм с пищей;</li>\r\n<li>заболевания толстого и тонкого кишечника;</li>\r\n<li>аномальная активность щитовидной железы.</li>\r\n</ul>\r\n<p>В группе риска находятся алкоголики, больные малярией и ВИЧ-инфекцией.</p>",
"pathogenesis": "",
"diagnostics": "<p>Специалист назначает анализ крови и мочи. Для уточнения диагноза используют определение транскетолазной реакции.</p>",
"treatment": "<p>Как правило, терапия проводится амбулаторно. Во всех случаях больному назначается диета. Все продукты должны быть богаты витамином В1. Помимо этого, витамин вводится внутрь или принимается перорально.</p>\r\n<p>Пациентов с более тяжелыми формами болезни направляют в стационар. В этом случае микроэлемент вводят в организм парентерально по 1 мг наряду с кокарбоксилазой. Одновременно назначают другие витамины группы В.</p>",
"prevention": "<p>С целью профилактики медики рекомендуют потреблять пищу, богатую микроэлементами, особенно витамином В1.</p>",
"clinical_picture": "<p>К ранним проявлениям заболевания относят:</p>\r\n<ul>\r\n<li>неприятные ощущения в животе;</li>\r\n<li>ухудшение памяти;</li>\r\n<li>проблемы со сном;</li>\r\n<li>плохой аппетит;</li>\r\n<li>уменьшение веса;</li>\r\n<li><a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>;</li>\r\n<li><a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>.</li>\r\n</ul>\r\n<p>Необходимо своевременно обращаться к врачу при возникновении подобной симптоматики. При несвоевременном обращении к специалисту развивается тяжелый дефицит витамина В1. Впоследствии наблюдаются нарушения работы мозга, сердца, нервной системы. Во всех ситуациях изменяются процессы обмена в эритроцитах, а уровень микроэлемента в моче резко снижается.</p>\r\n<p>Наблюдается <a href=\"/symptom/onemenie_kozhi/\" title=\"Перейти на страницу симптома Онемение кожи\">покалывание</a> в пальцах нижних конечностей, жжение в стопах, которое усиливается в ночное время суток, также возникают судороги в мышцах икр и появляются боли в стопах. Во многих случаях развития болезни вибрационная чувствительность пальцев ног снижена.</p>",
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"code": "E52",
"name": "Недостаточность никотиновой кислоты [пеллагра]",
"icd_name": "Недостаточность никотиновой кислоты [пеллагра]",
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"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме. ",
"description": "При выраженном дефиците развивается пеллагра, в менее тяжелых случаях — гиповитаминоз РР, проявляющийся нарушениями функции нервной системы, кишечника, дистрофическими изменениями кожи.",
"etiology": "<p>• Первичная — недостаток в поступающей пище, например, при преобладании в рационе кукурузы, поскольку витамин РР, хотя и содержится в ней, находится в связанном состоянии и не ассимилируется вЖКТ. Кроме того, белки кукурузы бедны триптофаном, используемого в организме для синтеза эндогенноговитамина РР<br />• Вторичная — обусловлена нарушением всасывания или усвоения витамина РР, а также увеличениемпотребности в нём <br />• Длительная <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">диарея</a> <br />• Заболевания печени (чаще всего к недостаточности приводит цирроз)<br />• Алкоголизм<br />• Парентеральное питание без достаточного возмещения витаминов<br />• Злокачественные карциноидные опухоли (увеличивается потребность в триптофане)<br />• Сахарный диабет <br />• Болезнь Хартнапа</p>",
"pathogenesis": "",
"diagnostics": "<p>• Выделение N'-метилникотинамида с мочой менее 4 мг/сут<br />• Снижение содержания никотиновой кислоты<br />• Снижается содержание в крови и моче других витаминов группы В.</p>",
"treatment": "<p>В среднетяжёлых и тяжёлых случаях необходима госпитализация.<br />• Диета. Включение в рацион продуктов, богатых витамином РР (мясо, яйца) и триптофаном (молоко).<br />• Назначение никотиновой кислоты (или никотинамида) от 300 до 1000 мг/сут внутрь в начале лечения привыраженном снижении содержания витамина РР в плазме крови, затем по 300-500 мг.<br />• При заболеваниях ЖКТ никотиновую кислоту (или никоти-намид) вводят парентерально (50-100 мг в/м 2-5раз/сут или 25-100мг <br />• Одновременно назначают по 5 мг тиамина, рибофлавина и пиридоксина.</p>",
"prevention": "<p>• Питание с достаточным содержанием в пищевом рационе продуктов, богатых никотиновой кислотой<br />• При эндогенной форме — своевременная диагностика и лечение заболеваний, нарушающих всасывание иусвоение витамина РР, профилактическое введение препаратов никотиновой кислоты; дополнительноевведение витамина РР лицам с увеличенной в нём потребностью.</p>",
"clinical_picture": "<p>При недостаточности витамина РР возникают нарушения функций кожи, слизистых оболочек, ЖКТ и ЦНС. Характерно наличие трёх Д (дерматит, <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">диарея</a>, <a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">деменция</a>) и поражение слизистых оболочек.<br />• Стадия прегиповитаминоза — неспецифические нарушения (<a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Утомляемость\" href=\"../../../symptom/utomlyaemost/\">утомляемость</a>, <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"../../../symptom/snizhenie_appetita/\">снижение аппетита</a> ит.д.).<br />• Стадии гипо- и авитаминоза<br />• Дерматит. Поражение кожи может быть четырёх типов. Чаще всего оно симметрично и возникает научастках кожи, подвергающихся солнечному облучению или травматизации (давлению)<br />• Остро возникают кожные проявления в виде пеллагрической эритемы с последующим образованиемпузырьков, пузырей, корочек. Часто присоединяется вторичная инфекция <br />• Поражение кожных складок — <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"../../../symptom/pokrasnenie_kozhi/\">покраснение</a>, мацерация, эрозирование и присоединение вторичнойинфекции</p>\r\n<full></full>\r\n<p><br />• Хронические гипертрофические изменения -кожа утолщена, теряет эластичность, становится складчатой. Отмечают выраженную пигментацию на открытых участках тела и в местах, подвергающихся давлению. Очаги поражения имеют чёткую границу и окружены бордюром восстанавливающегося эпителия<br />• Хронические атрофические изменения кожи с потерей эластичности и шелушением. Характерны длядлительно текущих форм пеллагры. <br />• Поражение слизистых оболочек первично затрагивает ротовую полость, хотя возможно вовлечениеслизистых оболочек влагалища и уретры<br />• Для острой недостаточности характерны <a title=\"Перейти на страницу симптома Глоссит\" href=\"../../../symptom/glossit/\">глоссит</a> и стоматит, причём язык приобретает ярко-краснуюокраску. Первоначально в процесс вовлекаются кончик и края языка, а также участки слизистой оболочки, окружающие выходное отверстие стенбнова протока<br />• Постепенно вовлекается вся слизистая оболочка, язык становится болезненным и отёчным, возникаетгиперсаливация<br />• На поздних стадиях заболевания возникает характерная картина лакового языка (ярко-красный язык сгладкой поверхностью вследствие атрофии сосочков)<br />• Возможно появление язв на слизистой оболочке дна полости рта, нижней губы, а также напротив моляров. <br />• <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">Диарея</a> — самый характерный признак нарушения функций пищеварительной системы. Поражение ЖКТвозникает на поздних стадиях заболевания. Характеризуется появлением чувства жжения слизистой оболочкиполости рта, глотки, пищевода; возникает желудочная <a title=\"Перейти на страницу симптома Диспепсия\" href=\"../../../symptom/dispepsiya/\">диспепсия</a> в виде тошноты, реже рвоты, чтообусловлено атрофическими изменениями слизистой оболочки желудка и возникновением ахилии. Возможнадиарея, чередующийся с запорами. О тяжёлом течении свидетельствует <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">диарея</a> с прожилками крови врезультате образования эрозий и язв слизистой оболочки кишечника.<br />• <a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">Деменция</a> — самый яркий признак поражения ЦНС; может сопровождаться органическим психозом и/илиэнцефало-патическим синдромом. На ранних стадиях появляется <a title=\"Перейти на страницу симптома Раздражительность и озлобление\" href=\"../../../symptom/razdrazhitelnost_i_ozloblenie/\">раздражительность</a>, возможны признакиполиневрита<br />• Органический <a title=\"Перейти на страницу симптома Психоз\" href=\"../../../symptom/psihoz/\">психоз</a> проявляется галлюцинаторно-параноидной, аффективной симптоматикой, психомоторным возбуждением<br />• Энцефалопатический синдром, характеризующийся затемнением сознания, гипертонусом мышцконечностей, появлением неконтролируемых сосательного и хватательного рефлексов.<br />• На поздних стадиях нарушаются функции эндокринной системы, возникает гипопротеинемия.</p>",
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