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"code": "R12",
"name": "Изжога",
"icd_name": "Изжога",
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"cause": [
3,
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"periodicity": 1,
"slug": "r12_izzhoga",
"lead": "ощущение жжения за грудиной по ходу пищевода, обусловленное раздражением рецепторов пищевода при рефлюкс-эзофагите в связи с функциональной недостаточностью кардиального сфинктера",
"description": "",
"etiology": "<p>Вызывается рефлюксом содержимого желудка в пищевод, который возникает в результате повышения давления в брюшной полости. Чаще появляется после еды, при наклоне туловища человека вперед и перенапряжении. Возникает при переедании, заболеваниях желудочно-кишечного тракта, соединительных тканей, после приема лекарственных препаратов, при заболеваниях нервной системы, токсикозе в первой половине беременности.</p>",
"pathogenesis": "<p>Нижний сфинктер расслабляется и пропускает пищу из пищевода в желудок, и в результате воздействия каких-либо факторов повышается внутрибрюшное давление, сфинктер расслабляется и пропускает соляную кислоту и желчь в нижние отделы пищевода, слизистая оболочка раздражается, воспаляется, вызывая изжогу.</p>",
"diagnostics": "<p>Исследование верхней части желудочно-кишечного тракта с помощью эзофагоскопии, определение уровня pH в пищеводе и желудке методом pH-метрии.</p>",
"treatment": "<p>Направлено на основное заболевание. Рекомендуют спать на большом количестве подушек, не курить и не принимать алкогольные напитки, а также щадящую диету и частое, дробное питание, прием препаратов, повышающих сокращение сфинктера нижней части пищевода, вяжущие, обволакивающие препараты.</p>",
"prevention": "<p>Чтобы избежать изжоги:</p>\r\n<ul>\r\n<li>ешьте часто и небольшими порциями;</li>\r\n<li>откажитесь от острых, жареных, жирных блюд, кислых напитков, чеснока, сырого лука, кислых фруктов, ограничьте потребление шоколада, алкоголя, кофе, не пейте крепкий чай;</li>\r\n<li>не наклоняйтесь после еды;</li>\r\n<li>ужинайте как минимум за 2 часа до сна;</li>\r\n<li>поднимите сантиметров на 10 изголовье кровати, подложив что-нибудь под ее ножки – это снизит риск изжоги во сне;</li>\r\n<li>не затягивайтесь туго ремнем, не надевайте тесную одежду, бандажи и корсеты, перетягивающие живот.</li>\r\n</ul>",
"clinical_picture": "<p>Наиболее тесно <a href=\"/symptom/izzhoga/\" title=\"Перейти на страницу симптома Изжога\">изжога</a> коррелирована с целым рядом заболеваний:</p>\r\n<ul>\r\n<li>\r\n<p>хронический гиперацидный гастрит всегда сопровождается стойкой изжогой, которая появляется в результате заброса желудочного сока, содержащего кислоту, в пищевод, раздражая и воспаляя его слизистую оболочку. В некоторых случаях <a href=\"/symptom/izzhoga/\" title=\"Перейти на страницу симптома Изжога\">изжога</a> может быть эквивалентом болевых ощущений, возникающих через полтора-два часа после еды;</p>\r\n</li>\r\n<li>\r\n<p>дуоденит – боли ощущаются постоянно, но особенно усиливаются после еды при «погрешностях» в диете, их верным спутником является <a href=\"/symptom/izzhoga/\" title=\"Перейти на страницу симптома Изжога\">изжога</a>. Однако болевые ощущения постепенно снижаются, а <a href=\"/symptom/izzhoga/\" title=\"Перейти на страницу симптома Изжога\">изжога</a> и <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">вздутие</a> живота остаются и, безусловно, негативно влияют на качество жизни;</p>\r\n</li>\r\n<li>\r\n<p>хронический холецистит характеризуется сочетанием изжоги, и боли в правой верхней части желудка. Как правило, они возникают после приёма блюд из жирных продуктов или тряски во время езды на автотранспорте;</p>\r\n</li>\r\n<li>\r\n<p>язвенная болезнь. <a href=\"/symptom/izzhoga/\" title=\"Перейти на страницу симптома Изжога\">Изжога</a> и <a href=\"/symptom/boli_v_verhney_chasti_zhivota/\" title=\"Перейти на страницу симптома Боли в верхней части живота\">боль в желудке</a> могут указывать и на это заболевание;</p>\r\n</li>\r\n<li>\r\n<p>грыжа пищевого отверстия диафрагмы. В этом случае, боль появляется, когда человек принимает горизонтальное положение или при наклонах. Она локализуется в желудке и может отдавать в область сердца или в спину и сопровождаться изжогой, но болевые ощущения проходят, как только человек принимает вертикальное положение;</p>\r\n</li>\r\n<li>\r\n<p>ГЭРБ также сопровождается болью в верхней части желудка и изжогой;</p>\r\n</li>\r\n<li>\r\n<p>беременность. Спутником этого состояния может стать гастрит с повышенной кислотностью, сопровождающийся всеми характерными симптомами;</p>\r\n</li>\r\n<li>\r\n<p>расстройства пищеварения. Чаще всего беспричинные боли в желудке, сопровождающиеся изжогой, отрыжкой, а иногда тошнотой, - удел молодых. Они могут быть вызваны нарушением сокращения стенок желчного пузыря, кишечника или желудка, а также выработкой излишнего количества кислоты.</p>\r\n</li>\r\n</ul>",
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"lead": "Во время полового возбуждения из полового члена может выделяться предэякулят – бесцветная прозрачная вязкая жидкость, которая вырабатывается железами Литтре и железами Купера (бульбоуретральными железами), и поэтому ее также называют Куперовой жидкостью. Этот секрет необходим не только для того, чтобы поддерживать уретру увлажненной, но также для того, чтобы рН в ней был щелочной – наиболее благоприятный для сперматозоидов.Объем предэякулята может доходить до 4 мл. В среднем в 40% случаев, по данным исследования 2010 года, проведенного врачами из Hull York Medical School при University of Hull, в предэякуляте можно обнаружить живых и активных сперматозоидов.Нормальными также являются выделения, получившие название «смегма» – в переводе с древнегреческого это означает «кожное сало». Это действительно секрет препуциальных сальных желез, находящихся в крайней плоти, смешанный с остатками отмершего эпителия. Он нужен телу мужчины для смазки, чтобы нежная ткань головки не стиралась о крайнюю плоть. В норме в смегме обитают разнообразные бактерии, которых ученые относят к категории комменсалов - так называют организмы, получающие пользу от совместного обитания и при этом не причиняющие организму-партнеру вреда. К таким бактериями относятся: некоторые виды энтерококков, коринебактерии, Mycobacterium smegmatis и др. Под крайней плотью могут обитать более 40 видов микробов.\r\n\r\nПри регулярной гигиене половых органов смегма не накапливается и не доставляет никаких неудобств. В противном случае она откладывается в препуциальном мешке (крайней плоти) и может становиться отличным «пастбищем» для разнообразных микроорганизмов, которые начинают бурно размножаться и, в свою очередь, приводят к воспалению кожи головки пениса и крайней плоти. И вот уже на этом фоне могут развиваться баланит и баланопостит, кондиломы и папилломы (которые в худшем случае трансформируются в рак полового члена)По сути, это воспаление головки пениса. А воспаление крайней плоти называется поститом. Если же воспалительный процесс охватил и то, и другое – говорят о баланопостите. Цепочка баланит-постит-баланопостит часто наблюдается у необрезанных представителей мужского пола.\r\n\r\nВ перечень симптомов баланита, постита и их комбинации входят покраснение в области головки пениса и тканей крайней плоти, неприятный запах и зуд в области половых органов, боль.\r\n\r\nБаланит развивается у каждого 25-го мальчика и у каждого 30-го взрослого необрезанного мужчины. В категорию высокого риска входят мальчики младше 4 лет и мужчины, не проходившие процедуру обрезания (у обрезанных представителей сильного пола баланит развивается на 68% реже). При этом следует помнить, что на фоне баланита в 3,8 раза возрастают риски развития рака полового члена.\r\n\r\nВ группу повышенного риска указанных болезней также входят пациенты с сахарным диабетом и с фимозом (в последнем случае заболевание развивается из-за невозможности проведения полноценных гигиенических процедур и активного развития анаэробных бактерий). Баланит может также развиваться при экземе, грибковых и бактериальных инфекциях, при раздражении из-за использования агрессивных для кожи моющих средств.\r\n\r\nВ свою очередь, на фоне баланопостита увеличивается вероятность развития таких патологий, как фимоз, парафимоз, ксеротический облитерирующих баланит и злокачественные опухоли полового члена.",
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"name": "Избыточная крайняя плоть, фимоз и парафимоз",
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"lead": "Нарушение здоровья, относящееся к группе болезни мужских половых органов",
"description": "Избыточная крайняя плоть имеет врожденный характер и проявляется увеличением размеров, что приводит к различным осложнениям. Фимозом называется сужение удлиненной крайней плоти. Это состояние является, как правило, врожденным.\r\nПарафимозом называется состояние ущемления головки пениса крайней плотью.\r\n",
"etiology": "<p>Фимоз может иметь различные причины происхождения. Помимо врожденного состояния, сужение крайней плоти может возникать в результате следующих состояний:</p>\r\n<ul>\r\n<li>Возрастная атрофия</li>\r\n<li>Склеродермия</li>\r\n<li>Рубцовые сужения после травм, в том числе и после оперативных вмешательств;</li>\r\n<li>Хронический воспалительный процесс головки полового члена и т.д.</li>\r\n</ul>\r\n<p>Следует учитывать, что фимоз может быть и физиологическим состоянием. У мальчиков оно должно проходить до возраста 3-4 лет.</p>\r\n<p>Парафимоз возникает в результате наличия фимоза, который приводит к развитию этого осложнения, когда взрослые пытаются самостоятельно отодвинуть крайнюю плоть. У взрослых мужчин такое состояние развивается в результате рубцовых или воспалительных сужений крайней плоти. </p>",
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"diagnostics": "<p>Диагностика не составляет каких-либо трудностей, и постановка диагноза возможна уже при осмотре.</p>",
"treatment": "<p>Лечение фимоза оперативное. Его задача заключается в том, чтобы иссечь лишнюю крайнюю плоть. Операция выполняется под обезболиванием. Чем раньше она проведена, тем эффективнее ее результат оказывается.</p>\r\n<p>В случае парафимоза необходимо требуется охладить головку полового члена в течение нескольких минут. Это приведет к уменьшению отечности и, соответственно, к уменьшению размеров. После этого врач пытается вправить головку пениса обратно. Если же попытка оказывается неудачной, то проводится оперативное лечение. Оно включает в себя два этапа:</p>\r\n<ul>\r\n<li>Рассечение кольца, которое вызвало ущемление. Рассечение производится со стороны тыльной поверхности</li>\r\n<li>После того, как исчезнет отек, необходимо иссечь крайнюю плоть.</li>\r\n</ul>\r\n<p>Избыточная крайняя плоть требует ее иссечения, которое выполняется под адекватным обезболиванием. </p>",
"prevention": "",
"clinical_picture": "<p>Фимоз проявляется определенными клиническими симптомами, которые для каждой степени различны.</p>\r\n<ul>\r\n<li>Для первой степени характерно легкое обнажение головки полового члена, однако во время полового акта могут быть определенные затруднения</li>\r\n<li>Вторая степень характеризуется затрудненным обнажением головки полового члена в спокойном состоянии и затруднением ее обнажения во время эрекции</li>\r\n<li>В третьей степени головка полового члена практически не обнажается, но проблем еще с мочеиспусканием нет</li>\r\n<li>Четвертая степень проявляется полным закрытием головки полового члена и наличием затрудненного мочеиспускания, при этом моча скапливается в препуциальном мешке, который может воспаляться.</li>\r\n</ul>\r\n<p>Симптомами парафимоза являются следующие:</p>\r\n<ul>\r\n<li>Отечность головки полового члена</li>\r\n<li>Она синеет</li>\r\n<li>Затем появляются очаги некротизированной ткани.</li>\r\n</ul>\r\n<p>Избыточная крайняя плоть может причинять определенный дискомфорт во время полового акта. Постепенно могут появиться затруднениями с мочеиспусканием. </p>",
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