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},
"code": "A30",
"name": "Лепра ",
"icd_name": "Лепра [болезнь Гансена]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5
],
"periodicity": 1,
"slug": "a30_lepra",
"lead": "Лепра — хроническая антропонозная инфекционная болезнь",
"description": "",
"etiology": "<p>Единственный доказанный источник инфекции при лепре — больной человек. Большинство специалистов допускают как воздушно-капельный, так и контактный (перкутанный) путь передачи лепры. Данные эпидемиологических исследований свидетельствуют о преобладающем значении воздушно-капельного пути передачи: обычно больной может служить источником инфекции при развитии у него обширных поражений слизистой оболочки носоглотки, т.е. в период массивного выделения возбудителя в окружающую среду респираторным путём. В то же время зарегистрированные случаи заражения при хирургических вмешательствах, а также при татуировке подтверждают, что возможны заражение лепрой и проникновение возбудителя через повреждённую кожу.</p>",
"pathogenesis": "<p>Развитие различных морфоклинических типов лепры, вызванной одним и тем же возбудителем, обусловлено особенностями (уровнем) Т-клеточного иммунитета.</p>\r\n<p> </p>",
"diagnostics": "<p>Диагностика лепры основывается на выявлении дерматологических и неврологических симптомов болезни и оценке результатов функциональных и лабораторных исследований. Большое значение придают анамнезу, проживанию в эндемической зоне, контакту с больными лепрой. Поскольку у больного человека длительно (годами) отсутствует субъективное ощущение болезни (отсутствие повышенной температуры, боли и зуда в области высыпаний), для своевременного её выявления обязательно осматривать пациента при хорошем освещении. Необходимо провести неврологическое обследование, чтобы обнаружить утолщённые нервные стволы и кожные нервные веточки (особенно в области высыпаний на коже).</p>\r\n<full></full>\r\n<p>Стандарт диагностики лепры включает:</p>\r\n<p>· осмотр всего кожного покрова, а также слизистых оболочек верхних дыхательных путей;<br />· пальпацию нервных стволов и кожных веточек нервов;<br />· обследование конечностей для обнаружения амиотрофии и контрактур;<br />· постановку функциональных проб в очагах кожных поражений (выявление нарушений различных видов чувствительности кожи, проба на потоотделение, проба с никотиновой кислотой и др.);<br />· бактериоскопическое исследование, позволяющее обнаружить кислотоустойчивые микобактерии в мазках из скарификатов кожи;<br />· патогистологическое исследование кожи, взятой из края очага поражения, с окраской по Цилю–Нильсену для выявления M. leprae.</p>",
"treatment": "<p>Для лечения бактериовыделителей ВОЗ рекомендует следующую помесячную схему комбинированной терапии.</p>\r\n<p>В России из группы препаратов сульфонового ряда производят димоцифон. В качестве препаратов второго ряда для лечения больных лепрой применяют этионамид и протионамид. Для купирования острых лепрозных реакций назначают глюкокортикоиды, НПВС, анальгетики, витамины, средства, улучшающие нервную проводимость и предупреждающие развитие мышечных атрофий, десенсибилизирующие препараты и иммуномодуляторы. Из дополнительных методов лечения по показаниям применяют физиотерапевтические (лечение невритов) и хирургические (остеомиелиты).</p>",
"prevention": "<p>Профилактика при лепре состоит из индивидуальных и общественных (социальных) предохранительных мероприятий. Особенности профилактики при лепре обусловливаются длительным инкубационным периодом, то есть невозможностью применения мер, подобных карантину, а также отсутствием вакцины и быстродействующих лекарств. Важнейшее значение в профилактике лепры имеет проведение оздоровительных и санитарно-гигиенических мероприятий.</p>",
"clinical_picture": "<p>Для лепры характерны крайне длительный и неопределённый инкубационный период (от нескольких месяцев до 20 лет и более; в среднем 3–7 лет), большое разнообразие клинических симптомов, отсутствие чётких признаков течения.</p>\r\n<p>В качестве продромальных при лепре иногда выступают признаки периферической вегетативной недостаточности и симптомы рефлекторно-сосудистых расстройств (мраморность кожи, <a href=\"/symptom/cianoz/\" title=\"Перейти на страницу симптома Цианоз\">цианоз</a>, отёки кистей и стоп, нарушения пото- и салоотделения), а также <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">ломота</a>, парестезии, кровотечения из носа.</p>\r\n<p>В начале развития манифестных форм заболевания, как правило, отмечают диффузные изменения окраски кожного покрова, одиночные или множественные пятнистые <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a>, варьирующие по локализации, форме, размерам и окраске (эритематозные, гипопигментные, гиперпигментные, синюшные, с буроватым оттенком), усиливающиеся парестезии. В более поздних стадиях болезни возникают ограниченные или разлитые кожные инфильтраты, <a href=\"/symptom/papuly/\" title=\"Перейти на страницу симптома Папулы\">папулы</a>, бугорки, узлы, <a href=\"/symptom/nasmork/\" title=\"Перейти на страницу симптома Насморк\">ринит</a> и <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> на слизистых оболочках верхних дыхательных путей, лепрозный пемфигус, выпадение бровей и ресниц (мадароз), амиотрофия, ломкость ногтей, ихтиозиформные признаки, язвы и другие трофические расстройства, грубые нарушения поверхностных видов чувствительности.</p>\r\n<p>Поражения периферической нервной системы раньше или позже обнаруживаются при всех формах лепры. Особенность лепрозных невритов — их восходящий характер и островковый (рамускулярный) тип расстройства чувствительности, что обусловлено разрушением нервных окончаний в очагах высыпаний, поражением кожных веточек нервов и отдельных нервных стволов. Чаще всего именно поражение периферической нервной системы приводит к инвалидности (отсутствие кожных видов чувствительности, амиотрофия, контрактуры, параличи, нейротрофические язвы, остеомиелит, мутиляции, лагофтальм).</p>",
"image": "http://api.symptomd.ru/storage/46b6f408f2f79ecea92d7911bf1a60d3_z3CibJ6.png",
"image_alt": "Лепра",
"standard_type": 1,
"danger": 72,
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"parent": null,
"block_rubric": 4,
"standards": [
4846
]
},
{
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},
"code": "A30",
"name": "Лепра ",
"icd_name": "Лепра [болезнь Гансена]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
5
],
"periodicity": 1,
"slug": "a30_lepra",
"lead": "Лепра — хроническая антропонозная инфекционная болезнь",
"description": "",
"etiology": "<p>Единственный доказанный источник инфекции при лепре — больной человек. Большинство специалистов допускают как воздушно-капельный, так и контактный (перкутанный) путь передачи лепры. Данные эпидемиологических исследований свидетельствуют о преобладающем значении воздушно-капельного пути передачи: обычно больной может служить источником инфекции при развитии у него обширных поражений слизистой оболочки носоглотки, т.е. в период массивного выделения возбудителя в окружающую среду респираторным путём. В то же время зарегистрированные случаи заражения при хирургических вмешательствах, а также при татуировке подтверждают, что возможны заражение лепрой и проникновение возбудителя через повреждённую кожу.</p>",
"pathogenesis": "<p>Развитие различных морфоклинических типов лепры, вызванной одним и тем же возбудителем, обусловлено особенностями (уровнем) Т-клеточного иммунитета.</p>\r\n<p> </p>",
"diagnostics": "<p>Диагностика лепры основывается на выявлении дерматологических и неврологических симптомов болезни и оценке результатов функциональных и лабораторных исследований. Большое значение придают анамнезу, проживанию в эндемической зоне, контакту с больными лепрой. Поскольку у больного человека длительно (годами) отсутствует субъективное ощущение болезни (отсутствие повышенной температуры, боли и зуда в области высыпаний), для своевременного её выявления обязательно осматривать пациента при хорошем освещении. Необходимо провести неврологическое обследование, чтобы обнаружить утолщённые нервные стволы и кожные нервные веточки (особенно в области высыпаний на коже).</p>\r\n<full></full>\r\n<p>Стандарт диагностики лепры включает:</p>\r\n<p>· осмотр всего кожного покрова, а также слизистых оболочек верхних дыхательных путей;<br />· пальпацию нервных стволов и кожных веточек нервов;<br />· обследование конечностей для обнаружения амиотрофии и контрактур;<br />· постановку функциональных проб в очагах кожных поражений (выявление нарушений различных видов чувствительности кожи, проба на потоотделение, проба с никотиновой кислотой и др.);<br />· бактериоскопическое исследование, позволяющее обнаружить кислотоустойчивые микобактерии в мазках из скарификатов кожи;<br />· патогистологическое исследование кожи, взятой из края очага поражения, с окраской по Цилю–Нильсену для выявления M. leprae.</p>",
"treatment": "<p>Для лечения бактериовыделителей ВОЗ рекомендует следующую помесячную схему комбинированной терапии.</p>\r\n<p>В России из группы препаратов сульфонового ряда производят димоцифон. В качестве препаратов второго ряда для лечения больных лепрой применяют этионамид и протионамид. Для купирования острых лепрозных реакций назначают глюкокортикоиды, НПВС, анальгетики, витамины, средства, улучшающие нервную проводимость и предупреждающие развитие мышечных атрофий, десенсибилизирующие препараты и иммуномодуляторы. Из дополнительных методов лечения по показаниям применяют физиотерапевтические (лечение невритов) и хирургические (остеомиелиты).</p>",
"prevention": "<p>Профилактика при лепре состоит из индивидуальных и общественных (социальных) предохранительных мероприятий. Особенности профилактики при лепре обусловливаются длительным инкубационным периодом, то есть невозможностью применения мер, подобных карантину, а также отсутствием вакцины и быстродействующих лекарств. Важнейшее значение в профилактике лепры имеет проведение оздоровительных и санитарно-гигиенических мероприятий.</p>",
"clinical_picture": "<p>Для лепры характерны крайне длительный и неопределённый инкубационный период (от нескольких месяцев до 20 лет и более; в среднем 3–7 лет), большое разнообразие клинических симптомов, отсутствие чётких признаков течения.</p>\r\n<p>В качестве продромальных при лепре иногда выступают признаки периферической вегетативной недостаточности и симптомы рефлекторно-сосудистых расстройств (мраморность кожи, <a href=\"/symptom/cianoz/\" title=\"Перейти на страницу симптома Цианоз\">цианоз</a>, отёки кистей и стоп, нарушения пото- и салоотделения), а также <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">ломота</a>, парестезии, кровотечения из носа.</p>\r\n<p>В начале развития манифестных форм заболевания, как правило, отмечают диффузные изменения окраски кожного покрова, одиночные или множественные пятнистые <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a>, варьирующие по локализации, форме, размерам и окраске (эритематозные, гипопигментные, гиперпигментные, синюшные, с буроватым оттенком), усиливающиеся парестезии. В более поздних стадиях болезни возникают ограниченные или разлитые кожные инфильтраты, <a href=\"/symptom/papuly/\" title=\"Перейти на страницу симптома Папулы\">папулы</a>, бугорки, узлы, <a href=\"/symptom/nasmork/\" title=\"Перейти на страницу симптома Насморк\">ринит</a> и <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> на слизистых оболочках верхних дыхательных путей, лепрозный пемфигус, выпадение бровей и ресниц (мадароз), амиотрофия, ломкость ногтей, ихтиозиформные признаки, язвы и другие трофические расстройства, грубые нарушения поверхностных видов чувствительности.</p>\r\n<p>Поражения периферической нервной системы раньше или позже обнаруживаются при всех формах лепры. Особенность лепрозных невритов — их восходящий характер и островковый (рамускулярный) тип расстройства чувствительности, что обусловлено разрушением нервных окончаний в очагах высыпаний, поражением кожных веточек нервов и отдельных нервных стволов. Чаще всего именно поражение периферической нервной системы приводит к инвалидности (отсутствие кожных видов чувствительности, амиотрофия, контрактуры, параличи, нейротрофические язвы, остеомиелит, мутиляции, лагофтальм).</p>",
"image": "http://api.symptomd.ru/storage/46b6f408f2f79ecea92d7911bf1a60d3_z3CibJ6.png",
"image_alt": "Лепра",
"standard_type": 1,
"danger": 72,
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"parent": null,
"block_rubric": 4,
"standards": [
4846
]
},
{
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},
"code": "E02",
"name": "Йододифицитный гипотиреоз",
"icd_name": "Субклинический гипотиреоз вследствие йодной недостаточности",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "e02_yododificitnyy_gipotireoz",
"lead": "специфическое состояние организма, связанное с реакцией на низкий уровень концентрации гормонов щитовидной железы из-за недостатка йода",
"description": "",
"etiology": "<p>Гипотиреоз в России встречается приблизительно с частотой 19 на 1000 у женщин и 1 на 1000 у мужчин. Несмотря на распространённость, гипотиреоз очень часто выявляется с опозданием.</p>\r\n<p>Это обусловлено тем, что симптомы расстройства имеют постепенное начало и стёртые неспецифические формы. Многие врачи расценивают их как результат переутомления или следствие других заболеваний, либо беременности, и не направляют пациента на анализ уровня тиреотропных гормонов в крови. Гормоны щитовидной железы регулируют энергетический обмен в организме, поэтому все обменные процессы при гипотиреозе несколько замедляются .</p>\r\n<p>Дефицит йода, избыток тиоционатов присутствующих в капусте, брюкве, репе, турнепсе, маниоке, избыток ионов кальция и лития блокирующих захват йода</p>",
"pathogenesis": "",
"diagnostics": "<p>Дифференциальная диагностика строится на основании клинических исследований пациента, в частности, уровней тиреоидных гормонов в течение некоторого времени. Определяют тироксин (Т4-норма для детей старше 2 мес 50-140 нмоль/л)и трийодтиронин (T3- 1,50-3,85 ммоль/л). При гипотиреозе их уровень снижается пропорционально тяжести заболевания, уровень ТТГ резко повышен. Определённые изменения уровней тиреоидных гормонов возможны под действием неблагоприятных экологических условий, под влиянием факторов профессиональной деятельности (химические вещества, радиация).</p>",
"treatment": "<p>Основная цель лечения йододефицитных заболеваний на ранних стадиях (в том числе заболеваний ЩЖ) - обеспечить адекватное поступление йода в организм и тем самым прервать цепь патологических реакций организма, направленных на компенсацию хронического йодного дефицита. В случае развития выраженных изменений (многоузловой эутиреоидный или токсический зоб и другие последствия йодного дефицита) целями лечения являются профилактика прогрессирования имеющейся патологии и лечение осложнений.</p>",
"prevention": "<p>Основным методом массовой профилактики ЙДЗ на территории РФ, соответствующим общепринятым международным стандартам, является употребление йодированной соли. Индивидуальная йодная профилактика и лечение в группах повышенного риска ЙДЗ проводится на фоне массовой йодной профилактики.</p>",
"clinical_picture": "<p>Жалобы часто скудны и неспецифичны, тяжесть состояния больных обычно не соответствует их жалобам: <a href=\"/symptom/vyalost/\" title=\"Перейти на страницу симптома Вялость\">вялость</a>, медлительность, <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">снижение работоспособности</a> и быстрая <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>, <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>, снижение памяти, многие часто жалуются на <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>, одутловатость лица и отечность конечностей, грубый голос, ломкость ногтей, <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>, увеличение массы тела, ощущение зябкости, отмечаются парестезии, запоры, другие симптомы. Выраженность симптомов гипотиреоза во многом зависит от причины заболевания, степени тиреоидной недостаточности, индивидуальных особенностей пациента.</p>",
"image": "http://api.symptomd.ru/storage/3b4d7e6d313c765ddfda064e044b47ca_2SJYa4f.png",
"image_alt": "Щитовидная железа",
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"danger": 16,
"published": 1,
"parent": null,
"block_rubric": 45,
"standards": [
5097
]
},
{
"id": 6217,
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{
"id": 3014,
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{
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},
"code": "E02",
"name": "Йододифицитный гипотиреоз",
"icd_name": "Субклинический гипотиреоз вследствие йодной недостаточности",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "e02_yododificitnyy_gipotireoz",
"lead": "специфическое состояние организма, связанное с реакцией на низкий уровень концентрации гормонов щитовидной железы из-за недостатка йода",
"description": "",
"etiology": "<p>Гипотиреоз в России встречается приблизительно с частотой 19 на 1000 у женщин и 1 на 1000 у мужчин. Несмотря на распространённость, гипотиреоз очень часто выявляется с опозданием.</p>\r\n<p>Это обусловлено тем, что симптомы расстройства имеют постепенное начало и стёртые неспецифические формы. Многие врачи расценивают их как результат переутомления или следствие других заболеваний, либо беременности, и не направляют пациента на анализ уровня тиреотропных гормонов в крови. Гормоны щитовидной железы регулируют энергетический обмен в организме, поэтому все обменные процессы при гипотиреозе несколько замедляются .</p>\r\n<p>Дефицит йода, избыток тиоционатов присутствующих в капусте, брюкве, репе, турнепсе, маниоке, избыток ионов кальция и лития блокирующих захват йода</p>",
"pathogenesis": "",
"diagnostics": "<p>Дифференциальная диагностика строится на основании клинических исследований пациента, в частности, уровней тиреоидных гормонов в течение некоторого времени. Определяют тироксин (Т4-норма для детей старше 2 мес 50-140 нмоль/л)и трийодтиронин (T3- 1,50-3,85 ммоль/л). При гипотиреозе их уровень снижается пропорционально тяжести заболевания, уровень ТТГ резко повышен. Определённые изменения уровней тиреоидных гормонов возможны под действием неблагоприятных экологических условий, под влиянием факторов профессиональной деятельности (химические вещества, радиация).</p>",
"treatment": "<p>Основная цель лечения йододефицитных заболеваний на ранних стадиях (в том числе заболеваний ЩЖ) - обеспечить адекватное поступление йода в организм и тем самым прервать цепь патологических реакций организма, направленных на компенсацию хронического йодного дефицита. В случае развития выраженных изменений (многоузловой эутиреоидный или токсический зоб и другие последствия йодного дефицита) целями лечения являются профилактика прогрессирования имеющейся патологии и лечение осложнений.</p>",
"prevention": "<p>Основным методом массовой профилактики ЙДЗ на территории РФ, соответствующим общепринятым международным стандартам, является употребление йодированной соли. Индивидуальная йодная профилактика и лечение в группах повышенного риска ЙДЗ проводится на фоне массовой йодной профилактики.</p>",
"clinical_picture": "<p>Жалобы часто скудны и неспецифичны, тяжесть состояния больных обычно не соответствует их жалобам: <a href=\"/symptom/vyalost/\" title=\"Перейти на страницу симптома Вялость\">вялость</a>, медлительность, <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">снижение работоспособности</a> и быстрая <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>, <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>, снижение памяти, многие часто жалуются на <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>, одутловатость лица и отечность конечностей, грубый голос, ломкость ногтей, <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>, увеличение массы тела, ощущение зябкости, отмечаются парестезии, запоры, другие симптомы. Выраженность симптомов гипотиреоза во многом зависит от причины заболевания, степени тиреоидной недостаточности, индивидуальных особенностей пациента.</p>",
"image": "http://api.symptomd.ru/storage/3b4d7e6d313c765ddfda064e044b47ca_2SJYa4f.png",
"image_alt": "Щитовидная железа",
"standard_type": 1,
"danger": 16,
"published": 1,
"parent": null,
"block_rubric": 45,
"standards": [
5097
]
}
]
}
