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},
"code": "J05",
"name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"icd_name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
2,
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],
"periodicity": 1,
"slug": "j05_ostryy_obstruktivnyy_laringit_krup_i_epiglottit",
"lead": "Нарушение здоровья, относящееся к группе острые респираторные инфекции верхних дыхательных путей",
"description": "Острый обструктивный ларингит (круп) - воспаление гортани и тканей подскладочного пространства с сужением просвета гортани. Ранее также использовался термин «стенозирующий ларинготрахеит» \r\n\r\nЭпиглоттит – это остро возникшее бактериальное воспаление надгортанника и окружающих тканей, которое может привести к быстрому жизнеугрожающему нарушению проходимости дыхательных путей. ",
"etiology": "<p>Наиболее часто причинно значимыми возбудителями острого обструктивного ларингита являются респираторные вирусы, причем до 80% случаев крупа обусловлено вирусом парагриппа. </p>\r\n<p>В числе прочих возбудителей болезни: вирусы гриппа А и В, аденовирусы, респираторно-синцитиальный вирус, риновирусы, энтеровирусы, бокавирус, коронавирус, метапневмовирус. В крайне редких случаях круп может быть обусловлен бактериальными возбудителями, например, микоплазмой пневмонии. </p>\r\n<p>Этиологическим фактором эпиглоттита в подавляющем большинстве случаев является гемофильная палочка типа b (>90%). В странах, где введена массовая иммунизация против гемофильной инфекции, у вакцинированных детей встречаются эпиглоттиты другой этиологии. В редких случаях эпиглоттит могут вызывать стрептококки, золотистый стафилококк, менингококк. </p>\r\n<p>Неинфекционные причины крупа и эпиглоттита: </p>\r\n<ul>\r\n<li>термические и химические повреждения вследствие приема горячей пищи или проглатывания препаратов бытовой химии; </li>\r\n<li>травмы, вызываемые слепым касанием пальца при попытке удалить инородное тело из глотки; </li>\r\n<li>отек Квинке; </li>\r\n<li>гемофагоцитарный лимфогистиоцитоз; </li>\r\n<li>острая лейкемия; раздражение при курении наркотиков (марихуана, крэк, кокаин); </li>\r\n<li>реакция на проводимую химиотерапию. </li>\r\n<li>лимфопролиферативные заболевания. </li>\r\n</ul>",
"pathogenesis": "<p>В основе механизма развития крупа лежит: </p>\r\n<ul>\r\n<li>Воспалительный отек с клеточной инфильтрацией голосовых связок и слизистой подскладочного пространства и трахеи и прилегающих тканей. </li>\r\n<li>Гиперсекреция слизистых желез, скопление в просвете дыхательных путей густой мокроты. </li>\r\n</ul>\r\n<p>Патогенез эпиглоттита </p>\r\n<p>При внедрении инфекции очень быстро развивается воспаление надгортанника и поддерживающей его черпаловидно-подгортанной складки. Надгортанник становится отечным и гиперемированным; его обычно твердая структура размягчается. Свисая и отклоняясь кзади, надгортанник закрывает вход в гортань, вызывая тяжелую обструкцию дыхательных путей. </p>\r\n<p>Выброс бактерий и их токсинов в кровь приводит к увеличению проницаемости микрососудов легкого, повышению гидростатического давления в малом круге кровообращения и скоплению жидкости в интерстициальном пространстве. Ухудшаются вентиляционно-перфузионные отношения, развиваются гипоксемия (снижение кислорода в крови), гиперкапния (повышение углекислого газа в крови), ацидоз (снижение рН крови). </p>",
"diagnostics": "<p>Диагноз обструктивного ларингита является клиническим и ставится, как правило, на основании анамнеза и симптомов осиплости голоса, лающего кашля, инспираторного стридора. </p>\r\n<p>Эпиглоттит диагностируется на основании характерных клинических признаков. </p>\r\n<p>Лабораторная диагностика включает общий анализ крови, определение уровня С-реактивного белка, при необходимости – уровень прокальцитонина (маркеры воспаления). </p>",
"treatment": "<p> Консервативное лечение крупа </p>\r\n<ul>\r\n<li>Согласно международному консенсусу, а также рекомендациям Всемирной организации здравоохранения, основу лечения острого обструктивного ларингита составляют ингаляционные и системные глюкокортикостероиды. </li>\r\n<li>При тяжелом крупе или отсутствии кортикостероидов возможно ингаляционное применение эпинефрина. </li>\r\n<li>При снижении сатурации крови кислородом ниже 92% показана оксигенотерапия. Стеноз гортани 3-й степени требует неотложной интубации. </li>\r\n</ul>\r\n<p> Консервативное лечение эпиглоттита </p>\r\n<ul>\r\n<li>Не рекомендуется укладывать ребенка, пациент должен находиться в положении сидя, в т.ч., при транспортировке в стационар. </li>\r\n<li>Рекомендована ранняя интубация для профилактики внезапной асфиксии (удушья). </li>\r\n<li>При эпиглоттите категорически не рекомендуется ингалировать, осуществлять седацию, провоцировать беспокойство. </li>\r\n<li>В обязательном порядке рекомендована антибактериальная терапия. Антибактериальная терапия должна быть продолжена до 7 – 10 дней. Начинают лечение обычно с парентерального (внутривенного) введения антибактериального препарата, после купирования лихорадки и нормализации состояния продолжают лечение пероральными антибиотиками. </li>\r\n<li>При асфиксии и невозможности проведения интубации проводится трахеотомия. </li>\r\n</ul>",
"prevention": "<p>Рекомендуется неспецифическая профилактика респираторных вирусных инфекций. </p>\r\n<p>В случае рецидивирования симптомов крупа у детей с гастроэзофагеальным рефлюксом рекомендовано соблюдение противорефлюксного режима с учащенными кормлениями меньшими порциями, а также проведение регулярных курсов противорефлюксной терапии. </p>\r\n<p>К мерам специфической профилактики следует отнести вакцинацию против гриппа, а также вакцинацию против гемофильной и пневмококковой инфекций для предупреждения развития эпиглоттита. </p>",
"clinical_picture": "<p>Обструктивный ларингит (круп) обычно начинается с неспецифических симптомов острой респираторной вирусной инфекции: появляются обильный насморк, першение в горле, кашель. </p>\r\n<p>Чаще протекает на фоне невысокой температуры, редко – на фоне фебрильной лихорадки. </p>\r\n<p>Как правило, симптомам стеноза гортани предшествуют признаки ларингита: осиплость голоса и/или сухой грубый кашель. При прогрессировании воспалительного процесса в гортани осиплость может усиливаться, кашель приобретает лающий характер, появляется шумное дыхание или шумный вдох (стридор). При нарастании степени стеноза гортани развивается инспираторная одышка (затрудненный вдох), которую можно заметить по втяжению яремной ямки на вдохе. </p>\r\n<p>Симптомы обструктивного ларингита обычно развиваются вечером, ночью, нередко в предутренние часы. </p>\r\n<p>I (стадия компенсации) - осиплость, грубый навязчивый кашель, умеренная одышка </p>\r\n<p>II (стадия неполной компенсации) - осиплость, грубый навязчивый кашель, выраженная одышка, возбуждение, дыхание с участием вспомогательной мускулатуры, втяжением податливых мест грудной клетки, раздуванием крыльев носа, цианоз (синюшность) носогубного треугольника, тахикардия </p>\r\n<p>III (стадия декомпенсации) - осиплость, грубый навязчивый кашель, беспокойство, страх, возможна апатия, резкая одышка с выраженным втяжением податливых мест грудной клетки, бледность, акроцианоз </p>\r\n<p>IV (терминальная стадия, асфиксия) - сознание отсутствует, резкая бледность и цианоз, гипотермия, возможны судороги, расширение зрачков, дыхание частое, поверхностное, артериальная гипотензия, нитевидный пульс. Эта стадия предшествует остановке дыхания и сердца. </p>\r\n<p>Эпиглоттит является тяжелой бактериальной инфекцией. </p>\r\n<ul>\r\n<li>заболевание обычно начинается остро с высокой температуры и нарушения общего состояния, </li>\r\n<li>характерны боль в горле, тризм (спазм жевательной мускулатуры), слюнотечение, нарушение глотания, поза «треножника», приоткрытый рот, </li>\r\n<li>быстрое развитие стридора, западение надгортанника в положении на спине. </li>\r\n</ul>\r\n<p>Типичного для крупа лающего кашля не отмечается. </p>",
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{
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{
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{
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{
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{
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{
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"image": null
}
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},
"code": "J04",
"name": "Острый ларингит и трахеит",
"icd_name": "Острый ларингит и трахеит",
"gender": 0,
"age_min": 0,
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"cause": [
2
],
"periodicity": 1,
"slug": "j04_ostryy_laringit_i_traheit",
"lead": "Вирусное заболевание верхних и нижних дыхательных путей",
"description": "Характеризуется затруднением дыхания, особенно вдоха. Возникает у детей, больных ОРВИ, и является ее синдромом. 3 % больных нуждаются в лечении в реанимационном отделении. Летальность при этом заболевании стоит на одном из первых мест в педиатрии.",
"etiology": "<p>Может развиваться при гриппе, ОРВИ, кори преимущественно у детей в возрасте от 6 месяцев до 3 лет. В основе заболевания лежат отек слизистой оболочки гортани, особенно ее подсвязочного пространства, рефлекторный <a href=\"/symptom/sudoroga/\" title=\"Перейти на страницу симптома Судорога\">спазм</a> мышц, <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> гортани.</p>",
"pathogenesis": "<p>Может развиваться при гриппе, ОРВИ, кори преимущественно у детей в возрасте от 6 месяцев до 3 лет. В основе заболевания лежат отек слизистой оболочки гортани, особенно ее подсвязочного пространства, рефлекторный <a href=\"/symptom/sudoroga/\" title=\"Перейти на страницу симптома Судорога\">спазм</a> мышц, <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> гортани.</p>",
"diagnostics": "",
"treatment": "<p>Выделяются пять основных направлений:</p>\r\n<p> </p>\r\n<p>1) организация помощи с учетом сопусттвующих заболеваний</p>\r\n<p>2) лечение больных с осложненными формами – стенозом гортани в стадии компенсации и неполной компенсации;</p>\r\n<p>3) интенсивная терапия при осложнении стенозом гортани в стадии перехода от неполной компенсации к декомпенсации (проведение ингаляций под тентом);</p>\r\n<p>4) интенсивная терапия больных со стенозом гортани в стадии декомпенсации (продленная интубация и трахеостома);</p>\r\n<p>5) реабилитация детей, перенесших продленную интубацию и трахеотомию.</p>",
"prevention": "",
"clinical_picture": "<p>В клинической картине выделяются три основных симптома: изменение <a href=\"/symptom/sluhovye_gallyucinacii/\" title=\"Перейти на страницу симптома Слуховые галлюцинации\">голоса</a>, грубый лающий <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, стенотическое дыхание. Ларинготрахеит острый может протекать по нескольким клиническим вариантам:</p>\r\n<p> </p>\r\n<p>1) острое начало, когда признаки ларинготрахеита острого проявляются внезапно, в отсутствие других симптомов ОРВИ;</p>\r\n<p>2) острое начало на фоне ОРВИ;</p>\r\n<p>3) постепенное нарастание симптомов ларинготрахеита острого на фоне ОРВИ. Рецидивирующая форма заболевания протекает также по одному из этих вариантов.</p>",
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"parent": null,
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4758,
5046,
5367
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},
{
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{
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{
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},
"code": "J04.2",
"name": "Острый ларинготрахеит",
"icd_name": "Острый ларинготрахеит",
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"age_min": 15,
"age_max": 100,
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"slug": "j04.2_ostryy_laringotraheit",
"lead": "воспаление слизистой оболочки гортани и трахеи",
"description": "<p>Ларинготрахеит — это воспалительное поражение слизистых оболочек гортани и трахеи, которое приводит к появлению отека, спазма верхних дыхательных путей, нарушений голоса и грубого «лающего» кашля. </p>\r\n<p> </p>",
"etiology": "<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 остром ларинготрахеите отмечается выраженная гиперемия слизистой ярко-красного оттенка, скопление в просвете гортани и трахеи большого количества гноевидного экссудата, утолщение слизистой за счет ее пропитывания экссудативной жидкостью. В начальном периоде ларинготрахеита экссудат имеет жидкую консистенцию, по мере развития заболевания он сгущается, на слизистой появляются фибринозные пленки. В случае стрепто- или стафилококковой этиологии ларинготрахеита наблюдается образование желто-зеленых корок, заполняющих просвет дыхательных путей.</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;\">Ларинготрахеит диагностируется на основании жалоб пациента и данных его анамнеза; результатов осмотра, перкуссии и аускультации легких; результатов ларинготрахеоскопии, бактериологических исследований, рентгена и КТ диагностики.</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;\">Диагностировать ларинготрахеит и определить его форму помогает микроларингоскопия, позволяющая при необходимости осуществить забор биопсийного материала. Выявление возбудителя ларинготрахеита проводится путем бактериологического посева мокроты и мазков из зева и носа, микроскопии мокроты и анализа мокроты на КУБ (кислородоустойчивые бактерии), ИФА, РИФ и ПЦР-исследований. При обнаружении туберкулезной этиологии ларинготрахеита необходима консультация фтизиатра. В случаях, когда ларинготрахеит является проявлением сифилиса, пациент обследуется отоларингологом совместно с венерологом.</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;\">В большинстве случаев терапия острого ларинготрахеита осуществляется в амбулаторных условиях. Случаи ложного крупа могут требовать госпитализации в стационар. Пациенту с острым ларинготрахеитом рекомендован прием большого количества теплой жидкости (чай, компот, кисель). В помещении, где находится больной должен быть достаточно увлажненный теплый воздух.</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;\">Этиотропная терапия вирусного ларинготрахеита заключается в назначении противовирусных препаратов (интерферон, ремантадин, умифеновир, протефлазид). При бактериальном и смешанном ларинготрахеите показана системная антибиотикотерапия препаратами широкого спектра действия (цефуроксим, цефтриоксон, амоксициллин, азитромицин). Симптоматическая терапия ларинготрахеита состоит в применении противокашлевых, антигистаминных, муколитических и жаропонижающих препаратов. Хороший эффект у пациентов с ларинготрахеитом оказывают масляные и щелочные ингаляции, электрофорез на область гортани и трахеи.</span></p>",
"treatment": "<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Мероприятия, направленные на укрепление иммунитета.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Отказ от курения (в том числе электронные сигареты и кальян).</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Соблюдение голосового режима.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Лечение неинфекционной патологии ЛОР-органов (полипы, аденоиды, искривление носовой перегородки).</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Использование средств индивидуальной защиты (медицинские маски) при сезонных вспышках заболеваний.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">Консультация врача-профпатолога (при наличии профессиональной вредности).</span></p>\r\n</li>\r\n</ul>",
"prevention": "<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;\">Обычно симптомы ларинготрахеита появляются на фоне уже протекающей вирусной инфекции дыхательных путей: лихорадки, заложенности носа и насморка, болей в горле, дискомфортных ощущений при глотании. Иногда они возникают уже после снижения температуры.</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 остром воспалении у больного появляются следующие признаки ларинготрахеита:</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;\">боль за грудиной во время кашля;</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;\">сухой кашель (иногда «лающий») с более выраженными приступами утром и ночью, после глубокого вдоха;</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;\">дискомфортные ощущения в области гортани (сухость, жжение, щекотание, присутствие инородного тела);</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;\">охриплость и осиплость голоса (иногда до его полного пропадания);</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;\">признаки интоксикации: повышение температуры до 38-39 °С, общая слабость, головная боль и пр.</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;\">Со временем кашель становится влажным и сопровождается отделением небольшого количества вязкой мокроты слизистого характера. По мере прогрессирования воспаления она становится более обильной и жидкой, может содержать примеси гноя. В тяжелых случаях развивается приступ ложного крупа.</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;\">У больных появляются безболезненные и увеличенные лимфоузлы в области шейной группы. При прослушивании выявляется шумное дыхание. В зоне раздвоения трахеи иногда можно услышать сухие и влажные хрипы.</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;\">Острый ларинготрахеит длится несколько недель и заканчивается полным выздоровлением. При неблагоприятных сопутствующих факторах он может принять затяжное течение и перейти в хронический ларинготрахеит, который характеризуется длительным течением с периодами ремиссии и обострениями, чаще возникающими в осенне-зимний период.</span></p>",
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},
"code": "J04.0",
"name": "Острый ларингит",
"icd_name": "Острый ларингит",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0",
"4"
],
"periodicity": 1,
"slug": "j04.0_ostryy_laringit",
"lead": "воспалительный процесс в области слизистой оболочки гортани и связок, имеющий острое или хроническое течение",
"description": "<p><span id=\"docs-internal-guid-08095f19-7fff-3175-cdfc-842e4de89f35\"><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;\">Острый ларингит – это воспалительный процесс в области слизистой оболочки гортани и связок.</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;\">Острые ларингиты обычно развиваются не как самостоятельная патология, а как одно из проявлений различных инфекций. Признаки острого ларингита типичны для ряда вирусных заболеваний:</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;\">грипп;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">коклюш;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">корь;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">аденовирус;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">некоторые другие возбудители ОРВИ.</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: 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;\">Иногда ларингиты возникают как проявление скарлатины, дифтерии – микробных инфекций.</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;\">Факторы риска для развития острых ларингитов – это переохлаждение как в области шеи, так и системного характера, пыльный воздух, гарь, курение, прием алкоголя, рефлюкс содержимого желудка в пищевод и глотку. Ларингиты чаще возникают при наличии атрофии мышц, изменений в голосовых связках, сухости слизистых, типичных для преклонного возраста.</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;\">Выделяют две формы ларингитов:</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;\">катаральный с поражением слизистого и подслизистого слоя, частично мышц гортани;</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;\">флегмонозный с гнойным воспалением в области слизистой, мышц и связочного аппарата гортани, частично с поражением хрящей.</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<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;\">Патогенез острого ларинготрахеита как синдрома ОРВИ связан с воздействием вирусов на слизистую оболочку дыхательных путей, в результате возникает ее отек и инфильтрация, спазм мышц гортани, скопление густого слизистого или слизисто-гнойного экссудата в просвете дыхательных путей. Это самые важные три звена патогенеза приводят к обструкции просвета гортани. Отек и инфильтрация слизистой оболочки подголосового отдела гортани приводят к его сужению. </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;\">С учетом причины заболевания и имеющихся симптомов врач может назначить следующие виды обследования:</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;\">анализы 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;\">исследование мокроты и смывов верхних дыхательных путей;</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;\">ларингоскопию;</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;\">эндоскопическое исследование</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> </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;\">Лечение ларингита направлено на устранение причины, вызвавшей ларингит.</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;\">Важно в течение недели соблюдать речевой покой (не напрягать голосовые связки), исключить курение, употребление алкогольных напитков, острых блюд. Также не следует находиться в прокуренном помещении, на холодном воздухе, на улице во время смога.</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;\">Назначаются паровые ингаляции при ларингите (15-20 минут через каждые 3 часа), полоскание горла отварами трав, согревающие компрессы на область гортани, горячие ножные ванночки.</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;\">Рекомендуется обильное теплое щелочное питье (молоко, боржоми).</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;\">Применяют противокашлевые препараты, а также физиотерапевтическое лечение (УВЧ, электрофорез на область гортани).</span></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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Антибиотики при ларингите следует принимать строго по назначению врача, если подтверждено бактериальное происхождение болезни.</span></p>",
"prevention": "<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;\">Основными методами профилактики острого ларингита являются: </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;\">своевременное лечение острых и хронических воспалительных процессов в горле;</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;\">бережное отношение к голосовому аппарату;</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;\">избегание резких перепадов температуры;</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;\">отказа от курения и алкоголя;</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;\">укрепление иммунитета.</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>",
"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;\">Острый процесс обычно возникает на фоне простуды или других инфекций, наблюдается першение, сухость, ощущение дискомфорта в области шеи, может возникать ощущение инородного предмета, осиплость, каркающий или лающий кашель, боль при глотании, потеря голоса или его осиплость. Иногда ларингит протекает без температуры, хотя в основном типична слабость и невысокая лихорадка. По тому, как выглядит слизистая, врач может определить форму болезни.</span></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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">По мере прогрессирования болезни кашель становится влажным, отделяется мокрота, голос возвращается. Болезнь проходит примерно через 7-10 дней.</span></p>",
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"code": "J03",
"name": "Острый тонзиллит",
"icd_name": "Острый тонзиллит",
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2,
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"slug": "j03_ostryy_tonzillit",
"lead": "Нарушение здоровья, относящееся к группе острые респираторные инфекции верхних дыхательных путей",
"description": "Острый тонзиллит (ангина) — инфекционное заболевание с местными проявлениями в виде острого воспаления компонентов лимфатического глоточного кольца, чаще всего нёбных миндалин, вызываемое стрептококками или стафилококками, реже другими микроорганизмами, вирусами и грибами.",
"etiology": "<p>Этиология</p>\r\n<p>Наиболее распространенным возбудителем среди бактерий является стрептококк, значительно реже стафилококки, пневмококки, атипичные бактерии.</p>\r\n<p>Любая вирусная инфекция респираторного тракта может привести к развитию тонзиллита (чаще аденовирусы, энтеровирус Коксаки, вирус герпеса). Спирохета Венсана в симбиозе с веретенообразной палочкой (язвенно-плёнчатая ангина). Грибы рода Candida в симбиозе с патологическими кокками.</p>\r\n<p>Способствуют появлению заболевания следующие факторы:</p>\r\n<p>вдыхание загрязненного воздуха на производствах, либо при жизни в крупных мегаполисах; переохлаждения организма; наличие очагов хронических инфекций (фарингит, синусит, аденоиды, отит, кариес); длительный бесконтрольный прием антибактериальных препаратов; нерациональное питание; чрезмерное курение.</p>\r\n<p>Распространение возбудителей заболевания среди взрослого населения происходит воздушно-капельным путем (во время кашля или чихания), очень редко контактно-бытовым.</p>\r\n<p>При контактно-бытовой передаче распространение происходит при пользовании общей посудой, предметами обихода, при несоблюдении правил личной гигиены.</p>",
"pathogenesis": "<p>Входные ворота инфекции (место внедрения возбудителя) - лимфоидная ткань ротоглотки, где формируется первичный очаг воспаления. Предрасполагают к развитию ангины общее и местное переохлаждение, запылённая или загазованная атмосфера, повышенная сухость воздуха, нарушение носового дыхания, гиповитаминозы, снижение иммунитета и т.д. Чаще всего ангина развивается после перенесённого ОРВИ. Возбудители ОРВИ снижают защитные функции эпителиального покрова и способствуют инвазии стрептококков. Патогенное действие стрептококков не ограничивается лишь местным повреждением, приводящим к развитию ангины. Продукты жизнедеятельности стрептококков (в первую очередь токсины), попадая в кровь, вызывают нарушения терморегуляции, токсическое поражение нервной и сердечно-сосудистой систем, а также могут запускать иммунопатологические процессы, приводящие к развитию таких заболеваний, как ревматизм, гломерулонефрит.</p>\r\n<p> </p>",
"diagnostics": "<p>Основным диагностическим приёмом при распознавании является осмотр глотки — фарингоскопия, а также оценка жалоб и анамнеза заболевания. Также для определения вида инфекции проводится забор мазка слизи или гноя, который берётся с миндалин. Биоматериал направляется на разные виды анализов:</p>\r\n<ul>\r\n<li>Посев на питательную среду — заключается в переносе частичек слизи или гноя из миндалин на специальную питательную среду в который микроорганизмы начинают быстро размножаться, образуя колонии (позволяет определить их разновидность, а также чувствительность и резистентностьк антибиотику);</li>\r\n<li>Быстрые антигенные тесты (стрептотест) — это специально разработанные тесты, которые реагируют на частички микроорганизмов определённого типа (часто применяется для выявления бета-гемолитического стрептококка из группы А);</li>\r\n<li>ПЦР анализ — позволяет установить разновидности микроорганизмов, населяющих ротоглотку по фрагментам их ДНК, которые имеются в слизи.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>",
"treatment": "<p>Основным диагностическим приёмом при распознавании является осмотр глотки — фарингоскопия, а также оценка жалоб и анамнеза заболевания. Также для определения вида инфекции проводится забор мазка слизи или гноя, который берётся с миндалин. Биоматериал направляется на разные виды анализов:</p>\r\n<ul>\r\n<li>Посев на питательную среду — заключается в переносе частичек слизи или гноя из миндалин на специальную питательную среду в который микроорганизмы начинают быстро размножаться, образуя колонии (позволяет определить их разновидность, а также чувствительность и резистентностьк антибиотику);</li>\r\n<li>Быстрые антигенные тесты (стрептотест) — это специально разработанные тесты, которые реагируют на частички микроорганизмов определённого типа (часто применяется для выявления бета-гемолитического стрептококка из группы А);</li>\r\n<li>ПЦР анализ — позволяет установить разновидности микроорганизмов, населяющих ротоглотку по фрагментам их ДНК, которые имеются в слизи.</li>\r\n</ul>",
"prevention": "<p>Специфическая профилактика не разработана. Для предупреждения распространения инфекции большое значение имеет своевременная изоляция больных ангиной. Индивидуальная профилактика заключается в повышении общей резистентности организма (закаливании), устранении раздражающих факторов (пыли, дыма, чрезмерной сухости воздуха), своевременной санации очагов хронической инфекции (при синусите, кариесе зубов), ликвидации причин, затрудняющих свободное дыхание через нос (искривление перегородки носа, аденоиды.</p>\r\n<p>Ангина может быть контагиозной (особенно при скарлатине), поэтому больного надо поместить в отдельную комнату, часто проветривать её и проводить влажную уборку, не пускать к нему детей и пожилых людей. Для больного выделяют специальную посуду, которую после каждого использования кипятят или обдают кипятком.</p>\r\n<p> </p>",
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"code": "J02",
"name": "Острый фарингит",
"icd_name": "Острый фарингит",
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2
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"lead": "Острое воспаление задней стенки глотки. Чаще всего острый фарингит развивается на фоне острых респираторных вирусных заболеваний",
"description": "",
"etiology": "<p>Вирусы Коксаки группы A, Эпштейна-Барра, простого герпеса, аденовирус, респираторные синцитиальные вирусы, вирусы парагриппа и гриппа; бактерии – гемолитические стрептококки группы А, гонококки, дифтерийная палочка, микоплазмы и хламидии.</p>",
"pathogenesis": "<p>Микроорганизмы проникают через микроповреждения в слизистой оболочке глотки (возможно проникновение в неповрежденную слизистую) и вызывают местную воспалительную реакцию, как правило, экссудативного характера.</p>",
"diagnostics": "<p>На первом этапе проводится анализ жалоб и анамнеза заболевания. Врач тщательно расспрашивает больного о всех симптомах, в частности, симптоме «пустого глотка».</p>\r\n<p>При осмотре горла отмечается <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">гиперемия</a> (<a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">покраснение</a>) задней стенки глотки, а также увеличение лимфоидной ткани глотки. На слизистой оболочке глотки отмечается образование так называемых гранул, стекание слизи и появление налета. Иногда отмечается изъязвление слизистой оболочки глотки.</p>\r\n<p>В некоторых случаях для определения патогенного возбудителя острого фарингита с задней стенки глотки берут мазок. После идентификации микроорганизма проверяется их чувствительность к антибиотикам.</p>",
"treatment": "<p>При бактериальной инфекции используют антибиотики, при вирусной инфекции – противовирусные препараты. Если причиной острого фарингита является неинфекционный агент, то стараются достичь полного устранения его влияния на организм.</p>",
"prevention": "<p>Профилактика острого фарингита сводится к соблюдению следующих рекомендаций:</p>\r\n<p>· своевременное и адекватное лечение острых респираторных вирусных заболеваний;</p>\r\n<p>· сбалансированное и рациональное питание;</p>\r\n<p>· отказ от вредных привычек;</p>\r\n<p>· применение индивидуальных средств защиты на производствах с загрязненным воздухом;</p>\r\n<p>· своевременное лечение воспалительных заболеваний носа, носоглотки, околоносовых пазух и зубов. </p>",
"clinical_picture": "<p>Отек, <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">покраснение</a> слизистой оболочки миндалин, появление слизистого или гнойного секрета на ее поверхности, чувство саднения в горле, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>. Повышается температура, как правило, до небольших значений. Тяжелым проявлением может быть перитонзиллярный <a href=\"/symptom/abscess/\" title=\"Перейти на страницу симптома абсцесс\">абсцесс</a>, который проявляется лихорадкой, болью при глотании, асимметрией миндалин и осиплостью <a href=\"/symptom/sluhovye_gallyucinacii/\" title=\"Перейти на страницу симптома Слуховые галлюцинации\">голоса</a>.</p>",
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{
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{
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{
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{
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"name": "Мигрень "
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"name": "Височная боль"
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"name": "Колющая боль в голове"
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},
"code": "J01",
"name": "Острый синусит",
"icd_name": "Острый синусит",
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2
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"lead": "Воспалительное заболевание околоносовых пазух бактериальной, вирусной, грибковой или аллергической природы. \r\n",
"description": "Острое воспаление придаточных пазух носа. Различают гайморит (воспаление слизистой оболочки верхнечелюстной (гайморовой) пазухи), фронтит (воспаление лобной пазухи), этмоидит (воспаление решетчатого лабиринта) и сфеноидит (воспаление клиновидной пазухи).",
"etiology": "<p>Основными возбудителями при остром синусите являются Streptococcus pneumoniae и Haemophilus influenzae, которые высеваются более чем в 50% случаев заболевания. Реже встречаются M. catarralis, Str. pyogenes, Staph. aureus, анаэробы, вирусы. Синусит, развившийся на фоне респираторных инфекций верхних дыхательных путей, традиционно относят к внебольничным формам заболевания. Кроме того, в последнее время выделяют нозокомиальный (внутрибольничный) синусит, возникающий после длительной тампонады полости носа, назогастрального зондирования или назотрахеальной интубации. При этой форме основные возбудители – анаэробы, группа энтеробактерий, реже золотистый стафилококк и грибы.<br></p><p><br>Острое <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> околоносовых пазух может развиться на фоне различных состояний, по происхождению выделяют следующие типы<br></p><p> Травматические<br> Вирусные (развиваются после ОРВИ);<br> Бактериальные;<br> Грибковые (чаще как суперинфекция);<br> Смешанные;<br> Аллергические<br> Медикаментозные</p>",
"pathogenesis": "<p>При остром\r\n воспалении преобладают экссудативные процессы. Первоначально, на ранних\r\n стадиях воспаления <a href=\"/symptom/vypot/\" title=\"Перейти на страницу симптома Выпот\">экссудат</a> серозный, затем слизисто–серозный, а с \r\nприсоединении бактериальной инфекции становится гнойным, содержащим \r\nбольшое количество лейкоцитов и детрита. При этом повышается \r\nпроницаемость капилляров и развивается отек слизистой оболочки.<br><br>Существует\r\n два вида синусита: острый (начинается внезапно) и хронический \r\n(длительный). Синусит часто является результатом вирусной инфекции. \r\nБольшинство синусовых инфекций проходит самостоятельно, но иногда они \r\nперетекают в бактериальную инфекцию – отек, <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> и выделение \r\nслизи, вызванные простудой, могут привести к блокировке носовых проходов\r\n и способствовать росту бактерий.<br><br>Острый синусит, и вирусный и \r\nбактериальный, может продлиться 8 недель и дольше. Хронический синусит \r\nможет привести к постоянным изменениям в мембранах слизистой оболочки, в\r\n результате которых пациент становиться более склонными к развитию \r\nсинусовых инфекций.<br></p>",
"diagnostics": "<p>Жалобы. В анамнезе присутствуют хронический отит и/или ренит. Показательна рентгенография черепа в двух проекциях.</p>",
"treatment": "<p>Консервативное. Применяются антибиотики, сосудосуживающие препараты.</p>",
"prevention": "<p><br></p>",
"clinical_picture": "<p>Температура тела повышена. Характерны <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, давящая боль в области корня носа и переносицы, нередко отмечают отек внутренних отделов верхнего и нижнего века, гиперемию конъюнктивы на соответствующей стороне. Выделения вначале серозные, а затем гнойные. Гнойное <a href=\"/symptom/vypot/\" title=\"Перейти на страницу симптома Выпот\">отделяемое</a> в среднем носовом ходе – признак поражения передних решетчатых клеток, в верхнем носовом ходе – воспаления задних. Резко снижено обоняние, затруднено носовое дыхание. Средняя раковина в большинстве случаев увеличена, гиперемирована. При затрудненном оттоке гноя воспалительный процесс может распространяться на глазничную клетчатку.</p>",
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4758,
4780,
5046,
5233
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