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"lead": "выхождение внутренних органов через естественные либо приобретенные отверстия в мышечно-апоневротическом слое брюшины при сохранении целостности самой брюшины и кожного покрова",
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"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;\">Причинами появления грыжи считаются:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">анатомические особенности строения костей таза, пахового канала;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">тяжелые физические нагрузки, профессиональные занятия спортом;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">беременность и тяжелые роды у женщин;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">слабость соединительной ткани;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хронические запоры;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">ожирение;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">обструктивные заболевания легких, сопровождающиеся кашлем;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">оперативные вмешательства в прошлом.</span></li>\r\n</ul>",
"pathogenesis": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Бедренный канал – это патологическое анатомическое образование, через которое грыжа выходит наружу. В норме такой структуры не существует, но при развитии дисбаланса между внутрибрюшним давлением и опорной функцией брюшной стенки, между мышцами и соединительнотканными пучками образуются щели. Через них происходит «выталкивание» внутренних органов.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Одним из ключевых факторов, увеличивающих риск развития проблемы, являются различные аномалии коллагена. Этот белок служит основой для соединительнотканных структур, из которых состоит апоневроз мышц. Из-за молекулярных дефектов в его строении формируются «слабые» места в передней брюшной стенке. При повышении внутрибрюшного давления именно они и превращаются в грыжевые ворота</span></p>\r\n<p><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;\"> </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;\">Для подтверждения и оценки общего состояния организма назначаются следующие дополнительные 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;\">Общий анализ крови и мочи, биохимический анализ крови. Позволяют исключить воспалительный процесс и выявить сопутствующую патологию.</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;\">ЭКГ, рентгенография органов грудной клетки. Эти тесты нужны для оценки функции легких и сердца перед предстоящей операцией.</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;\">УЗИ патологической зоны и брюшной полости. С помощью этого метода доктор оценивает размеры грыжи, выявляет сопутствующую патологию внутренних органов.</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;\">Рентгеновская компьютерная томография (РКТ). Процедура назначается пациентам с выраженным ожирением и постоянными рецидивами грыж на фоне лечения.</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;\">Магнитно-резонансная томография (МРТ). Показана в трудных диагностических случаях.</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 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;\">Бедренная грыжа – это хирургическая патология, которая не поддается медикаментозному лечению. Наилучшие результаты обеспечивают современные малоинвазивные оперативные вмешательства.</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;\">Консервативное лечение:</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;\">Консервативное лечение при бедренных грыжах направлено на временное улучшение самочувствия пациента на фоне подготовки к хирургическому вмешательству, во время и после его проведения. Используемые группы медикаментов:</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;\">обезболивающие средства;</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;\">антибиотики (при необходимости);</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;\">нестероидные противовоспалительные препараты.</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\"><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;\">Если пациент страдает от сопутствующей патологии внутренних органов, назначается соответствующее медикаментозное сопровождение (слабительные, ферменты, кардиологические средства и другие).</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;\">Хирургическое лечение бедренной грыжи:</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;\">«Золотым стандартом» лечения бедренных грыж остается их оперативное лечение. Суть подобного вмешательства заключается в удалении грыжевого мешка и укреплении брюшной стенки. Для этого могут использоваться как собственные ткани пациента, так и искусственные сетчатые протезы. При развитии необратимого поражения частей внутренних органов, которые находятся в грыжевом мешке, они подлежат удалению.</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;\">Операция грыжесечения может выполняться различными способами. Хирург в каждом конкретном случае выбирает персонифицированную тактику с учетом размеров выпячивания, анатомических особенностей пациента и возможных рисков.</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;\">Наиболее эффективными на сегодняшний день являются малоинвазивные вмешательства с имплантацией сетчатых протезов. Они позволяют достичь хорошего результата без повторного образования грыж у 95-99% пациентов против 85-90% при использовании обычных открытых операций.</span></p>",
"prevention": "<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;\">правильное питание;</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;\">ношение женщинами бандажа во время беременности;</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;\">своевременное лечение болезней ЖКТ;</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 пресса.</span></li>\r\n</ul>\r\n<p> </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;\">На ранних этапах заболевания пациенты жалуются преимущественно на появление эластичного бугорка в области бедра. Характерной особенностью является изменение размеров выпячивания в зависимости от положения тела. При ходьбе и во время физической нагрузки выпуклость увеличивается. В это же время больной может испытывать дискомфорт или болезненные ощущения, которые возникают из-за перерастяжения тканей вследствие повышения внутрибрюшного давления.</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 возникновении осложнений могут появляться следующие проявления:</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;\">выраженные болезненные ощущения;</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;\">покраснение выпячивания, отек, повышение локальной температуры тела;</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;\">тошнота, рвота;</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;\">появление крови в кале, отсутствие дефекации и отхождения газов.</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 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\"><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 появлении указанных признаков грыжа больше не вправляется обратно и называется невправимой. Такая ситуация требует максимально быстрой доставки пациента в хирургическое отделение для проведения оперативного вмешательства.</span></p>",
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"id": 53,
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{
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"name": "лечебная физкультура и спортивная медицина",
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"slug": "lechebnaya_fizkultura_i_sportivnaya_medicina",
"lead": "Область медицины, включающая в себя лечение 412 заболеваний. В 579 клиниках России оказывается помощь по этому направлению медицины.",
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},
{
"id": 47,
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"lead": "Область медицины, включающая в себя лечение 908 заболеваний. В 1399 клиниках России оказывается помощь по этому направлению медицины.",
"image": null
}
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},
"code": "Q56",
"name": "Неопределенность пола и псевдогермафродитизм",
"icd_name": "Неопределенность пола и псевдогермафродитизм",
"gender": 0,
"age_min": 0,
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"cause": [
3,
0
],
"periodicity": 4,
"slug": "q56_neopredelennost_pola_i_psevdogermafroditizm",
"lead": "патологическое состояние, при котором половые железы и хромосомный набор не соответствует некоторым (или даже большинству) внутренних и наружных половых органов",
"description": "",
"etiology": "<p>Мужской псевдогермафродитизм наблюдается при различных эндокринных расстройствах (дефектах синтеза тестостерона, его метаболизма и эффектов на клетки-мишени).</p>\r\n<p>Этиология женского псевдогермафродитизма до конца не изучена. Установлена связь с гиперплазией коры надпочечников, при которой наблюдается нарушение синтеза кортизола и его прогестероновых предшественников. Имеет значение и прием лекарственных средств, содержащих андрогены и прогестины. Также существуют данные, свидетельствующие в пользу наличия наследственной передачи аутосомно-рецессивным путем.</p>",
"pathogenesis": "<p>В результате ослабления воздействия тестостерона на клетки-мишени ведущую роль в развитии половых органов берут на себя эстрогены, вырабатываемые в надпочечниках. Таким образом, фенотип становится женским.</p>\r\n<p>При женском псевдогермафродитизме отмечается <a href=\"/symptom/povyshennaya_chuvstvitelnost/\" title=\"Перейти на страницу симптома Повышенная чувствительность\">повышенная чувствительность</a> XX-плода к воздействию андрогенов во время критического периода эмбрионального развития (8-я неделя внутриутробного развития). Все это приводит к развитию разной степени выраженности губомошоночного сращения, формированию урогенитального синуса и увеличению клитора.</p>",
"diagnostics": "<p>Основана на осмотре гениталий, вторичных половых признаках, кариотипировании, исследовании уровня эстрогенов, андрогенов, лапаротомии, макроскопическом и гистологическом исследовании гонад.</p>",
"treatment": "<p>Показаны хирургическое лечение, проведение пластики, а также гормональная коррекция в направлении избранного пола. Выбор пола основывается не только на степени выраженности женских или мужских половых органов, но и на психологическом ощущении своего пола.</p>",
"prevention": "",
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4647,
5092,
5289
]
},
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},
"code": "Q56",
"name": "Неопределенность пола и псевдогермафродитизм",
"icd_name": "Неопределенность пола и псевдогермафродитизм",
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"slug": "q56_neopredelennost_pola_i_psevdogermafroditizm",
"lead": "патологическое состояние, при котором половые железы и хромосомный набор не соответствует некоторым (или даже большинству) внутренних и наружных половых органов",
"description": "",
"etiology": "<p>Мужской псевдогермафродитизм наблюдается при различных эндокринных расстройствах (дефектах синтеза тестостерона, его метаболизма и эффектов на клетки-мишени).</p>\r\n<p>Этиология женского псевдогермафродитизма до конца не изучена. Установлена связь с гиперплазией коры надпочечников, при которой наблюдается нарушение синтеза кортизола и его прогестероновых предшественников. Имеет значение и прием лекарственных средств, содержащих андрогены и прогестины. Также существуют данные, свидетельствующие в пользу наличия наследственной передачи аутосомно-рецессивным путем.</p>",
"pathogenesis": "<p>В результате ослабления воздействия тестостерона на клетки-мишени ведущую роль в развитии половых органов берут на себя эстрогены, вырабатываемые в надпочечниках. Таким образом, фенотип становится женским.</p>\r\n<p>При женском псевдогермафродитизме отмечается <a href=\"/symptom/povyshennaya_chuvstvitelnost/\" title=\"Перейти на страницу симптома Повышенная чувствительность\">повышенная чувствительность</a> XX-плода к воздействию андрогенов во время критического периода эмбрионального развития (8-я неделя внутриутробного развития). Все это приводит к развитию разной степени выраженности губомошоночного сращения, формированию урогенитального синуса и увеличению клитора.</p>",
"diagnostics": "<p>Основана на осмотре гениталий, вторичных половых признаках, кариотипировании, исследовании уровня эстрогенов, андрогенов, лапаротомии, макроскопическом и гистологическом исследовании гонад.</p>",
"treatment": "<p>Показаны хирургическое лечение, проведение пластики, а также гормональная коррекция в направлении избранного пола. Выбор пола основывается не только на степени выраженности женских или мужских половых органов, но и на психологическом ощущении своего пола.</p>",
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4647,
5092,
5289
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