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},
"code": "J01",
"name": "Острый синусит",
"icd_name": "Острый синусит",
"gender": 0,
"age_min": 0,
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"cause": [
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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},
"code": "A54",
"name": "Гонорея",
"icd_name": "Гонококковая инфекция",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
8,
10
],
"periodicity": 1,
"slug": "a54_gonoreya",
"lead": "инфекционное заболевание, вызываемое грамотрицательным диплококком — гонококком",
"description": "Гонорея это самая распространенная венерическая болезнь, от которой страдают как мужчины, так и женщины. Венерическая инфекция, вызывающая поражение слизистых оболочек органов, выстланных цилиндрическим эпителием: уретры, матки, прямой кишки, глотки, конъюнктивы глаз. Относится к группе инфекций, передаваемых половым путем (ИППП), возбудитель - гонококк.",
"etiology": "<p align=\"justify\">Гонорея является высоко заразной инфекцией, в 99% - имеет половой путь передачи. Заражение гонореей происходит при разных формах половых контактов: вагинальном (обычном и «неполном»), анальном, оральном.</p>\r\n<p align=\"justify\">У женщин после полового акта с больным мужчиной вероятность заражения гонореей составляет 50-80%. Мужчины при половом контакте с женщиной, больной гонореей, заражаются не всегда - в 30-40% случаев. Это обусловлено некоторыми анатомическими и функциональными особенностями мочеполовой системы у мужчин (узкий канал уретры, гонококки могут быть смыты мочой.) Вероятность заражения гонореей мужчины выше, если у женщины менструация, половой акт удлинен и имеет бурное завершение.</p>\r\n<p align=\"justify\">Иногда может встречаться контактный путь инфицирования ребёнка от больной гонореей матери во время родов и бытовой, непрямой – через предметы личной гигиены (постельное бельё, мочалку, полотенце), обычно у девочек.</p>\r\n<p align=\"justify\">Инкубационный (скрытый) период при гонорее может длиться от 1 суток до 2 недель, реже до 1 месяца.</p>\r\n<p> </p>",
"pathogenesis": "<p>Гематогенное распространение гонореи отмечают у 1% заболевших. В патогенезе диссеминирования гонококковой инфекции существенное значение имеет пол больного, обусловливающий характер развивающихся различных синдромов (например, воспаления тазовых органов, артритов, септицемии, менингитов и др.). Женщины более склонны к диссеминированньм поражениям. В то же время заболевание у них часто протекает бессимптомно, а лечение не проводится. Женщины представляют основной резервуар инфекции.</p>",
"diagnostics": "<p align=\"justify\">Для диагностики гонореи недостаточно наличия клинических симптомов у больного, необходимо выявить возбудителя заболевания с помощью лабораторных методов:</p>\r\n<ul>\r\n<li>исследование мазков с материалом под микроскопом;</li>\r\n<li>бакпосев материала на специфические питательные среды для выделения чистой культуры;</li>\r\n<li>ИФА и ПЦР-диагностика.</li>\r\n</ul>\r\n<p align=\"justify\">В микроскопии мазков, окрашенных по Граму и метиленовым синим, гонококки определяются по типичной бобовидной форме и парности, грамнегативности и внутриклеточному положению. Возбудителя гонореи не всегда можно обнаружить этим методом по причине его изменчивости.</p>\r\n<p align=\"justify\">При диагностике бессимптомных форм гонореи, а также у детей и беременных, более подходящим методом является культуральный (его точность 90-100%). Использование селективных сред (кровяной агар) с добавлением антибиотиков позволяет точно выявить даже небольшое количество гонококков и их чувствительность к препаратам.</p>\r\n<p align=\"justify\">Материалом для исследования на гонорею являются гнойные выделения из цервикального канала (у женщин), уретры, нижнего отдела прямой кишки, ротоглотки, конъюнктивы глаз. У девочек и женщин после 60 лет используют только культуральный метод.</p>\r\n<p align=\"justify\">Гонорея часто протекает в виде смешанной инфекции. Поэтому больного с подозрением на гонорею, обследуют дополнительно и на другие ИППП. Проводят определение антител гепатиту В и С, к ВИЧ, серологические реакции на сифилис, общий и биохимический анализ крови и мочи, УЗИ органов малого таза, уретроскопию, у женщин - кольпоскопию, цитологию слизистой цервикального канала.</p>\r\n<p align=\"justify\">Обследования проводят до начала лечения гонореи, повторно через 7-10 дней после лечения, серологические – через 3-6-9 месяцев.</p>\r\n<p align=\"justify\">Необходимость использования «провокаций» для диагностики гонореи врач решает в каждом случае индивидуально.</p>",
"treatment": "<p align=\"justify\">Недопустимо самостоятельное лечение гонореи, оно опасно переходом заболевания в хроническую форму, и развитием необратимых поражений организма. Обследованию и лечению подлежат все половые партнёры больных с симптомами гонореи, имевшие с ними половой контакт за последние 14 дней, или последний половой партнёр, если контакт произошел ранее этого срока. При отсутствии клинических симптомов у больного с гонореей обследуют и лечат всех половых партнёров за последние 2 месяца. На период лечения гонореи исключается алкоголь, половые отношения, в период диспансерного наблюдения разрешаются половые контакты с использованием презерватива.</p>\r\n<p align=\"justify\">Современная венерология имеет на вооружении эффективные антибактериальные препараты, позволяющие успешно бороться с гонореей. При лечении гонореи учитывается давность заболевания, симптомы, место поражения, отсутствие или наличие осложнений, сопутствующей инфекции. При остром восходящем типе гонореи необходима госпитализация, постельный режим, лечебные мероприятия. В случае возникновения гнойных абсцессов (сальпингита, пельвиоперитонита) проводят экстренное оперативное вмешательство – лапароскопию или лапаротомию. Основное место в лечении гонореи отводится антибиотикотерапии, при этом учитывается устойчивость некоторых штаммов гонококков к антибиотикам (например, пенициллинам). При неэффективности применяемого антибиотика назначается другой препарат, с учётом чувствительности к нему возбудителя гонореи.</p>",
"prevention": "<p align=\"justify\">Профилактика гонореи, как и других ЗППП, включает в себя:</p>\r\n<ul>\r\n<li>личную профилактику (исключение случайных половых связей, использование презервативов, соблюдение правил личной гигиены);</li>\r\n<li>своевременное выявление и лечение больных гонореей, особенно в группах риска;</li>\r\n<li>профосмотры (у работников детских учреждений, медицинского персонала, работников сферы питания);</li>\r\n<li>обязательное обследование беременных женщин и ведение беременности.</li>\r\n</ul>\r\n<p align=\"justify\">С целью профилактики гонореи, новорождённым сразу после рождения в глаза закапывают раствор сульфацила натрия.</p>",
"clinical_picture": "<p align=\"justify\">Исходя из длительности заболевания, различают свежую гонорею (с момента заражения < 2 месяцев) и хроническую гонорею (с момента заражения > 2 месяцев).</p>\r\n<p align=\"justify\">Свежая гонорея может протекать в острой, подострой, малосимптомной (торпидной) формах. Существует гонококконосительство, которое субъективно не проявляется, хотя возбудитель гонореи присутствует в организме.</p>\r\n<p align=\"justify\">В настоящее время гонорея не всегда имеет типичные клинические симптомы, так как часто выявляется смешанная инфекция (с трихомонадами, хламидиями), которая может менять симптоматику, удлинять инкубационный период, затруднять диагностику и лечение болезни. Встречается много малосимптомных и бессимптомных случаев гонореи.</p>\r\n<p align=\"justify\">Классические проявления острой формы гонореи у женщин:</p>\r\n<ul>\r\n<li>гнойные и серозно-гнойные влагалищные выделения;</li>\r\n<li><a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">гиперемия</a>, отек и изъязвление слизистых оболочек;</li>\r\n<li>частое и <a href=\"/symptom/boleznennoe_mocheispuskanie/\" title=\"Перейти на страницу симптома Болезненное мочеиспускание\">болезненное мочеиспускание</a>, жжение, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>;</li>\r\n<li>межменструальные кровотечения;</li>\r\n<li>боли внизу живота.</li>\r\n</ul>\r\n<p align=\"justify\">В более половины случаев гонорея у женщин протекает либо вяло, малосимптомно, либо совсем не проявляется. В этом случае позднее обращение к врачу опасно развитием восходящего воспалительного процесса: гонорея поражает матку, маточные трубы, яичники, брюшину. Может ухудшаться общее состояние, повышаться температура (до 39° С), наблюдается <a href=\"/symptom/narushenie_menstrualnogo_cikla/\" title=\"Перейти на страницу симптома Нарушение менструального цикла\">нарушение менструального цикла</a>, <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">диарея</a>, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>.</p>\r\n<p align=\"justify\">У девочек гонорея имеет острое течение, проявляется отеком и гиперемией слизистой вульвы и преддверия влагалища, жжением и зудом гениталий, появлением гнойных выделений, болями при мочеиспускании.</p>\r\n<p align=\"justify\">Гонорея у мужчин протекает в основном в виде острого уретрита:</p>\r\n<ul>\r\n<li><a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>, жжение, отечность уретры;</li>\r\n<li>обильные гнойные, серозно-гнойные выделения;</li>\r\n<li>учащенное болезненное, иногда затруднённое мочеиспускание.</li>\r\n</ul>\r\n<p align=\"justify\">При восходящем типе гонореи поражаются яички, простата, семенные пузырьки, повышается температура, возникает <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, болезненная дефекация.</p>\r\n<p align=\"justify\">Гонококковый фарингит может проявляться покраснением и болью в горле, повышением температуры тела, но чаще протекает бессимптомно. При гонококковом проктите могут наблюдаться выделения из прямой кишки, болезненность в области анального отверстия, особенно при дефекации; хотя обычно симптомы мало выражены.</p>\r\n<p align=\"justify\">Хроническая гонорея имеет затяжное течение с периодическими обострениями, проявляется спаечными процессами в малом тазу, снижением полового влечения у мужчин, нарушениями менструального цикла и репродуктивной функции у женщин.</p>",
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