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"code": "M87",
"name": "Остеонекроз",
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"lead": "Нарушение здоровья, относящееся к группе другие остеопатии",
"description": "Остеонекроз – поражение различных отделов кости множественной этиологии, возникающее в ответ на нарушение в ней кровообращения и приводящее к гибели костного мозга и трабекулярной кости.",
"etiology": "<p>Наиболее распространенные причины остеонекроза следующие:</p>\r\n<ul>\r\n<li>Серьезная травма, которая нарушила нормальное кровоснабжение кости.</li>\r\n<li>Прием кортикостероидных препаратов (преднизолон, метилпреднизолон), особенно в больших дозах и длительными курсами, которые назначаются при хронических заболеваниях.</li>\r\n<li>Злоупотребление алкоголем и табакокурение.</li>\r\n</ul>\r\n<p>Другие, редкие причины остеонекроза:</p>\r\n<ul>\r\n<li>Системная красная волчанка (СКВ).</li>\r\n<li>Декомпрессионная болезнь (дисбарический остеонекроз).</li>\r\n<li>Заболевания крови, такие как серповидноклеточная анемия.</li>\r\n<li>Синдром приобретенного иммунодефицита (СПИД).</li>\r\n<li>Лучевая терапия при онкозаболеваниях.</li>\r\n<li>Прием бифосфонатов, которые связаны с некрозом челюсти. </li>\r\n</ul>",
"pathogenesis": "<p>Остеонекроз связан с гибелью клеток костной ткани (остеоцитов) и костного мозга.</p>\r\n<p>Развитие нетравматического остеонекроза может быть обусловлено эмболией сгустками крови или каплями жира, внутрисосудистым тромбозом и внесосудистой компрессией. После сосудистого эпизода развивается репаративный процесс, направленный на удаление некротизированной кости и костного мозга и замещение их живой тканью. Если зона инфаркта невелика и не подвергается значительной нагрузке, этот процесс может быть успешным. В 80% случаев он оказывается неэффективным и зона инфаркта подвергается компрессии. Так как остеонекроз обычно поражает дистальные участки длинных костей, суставная поверхность становится уплощенной и неровной, что сопровождается усилением болей и приводит к развитию остеоартрита.</p>",
"diagnostics": "<p>На начальном этапе проводится рентгенологическое исследование. Ранние рентгенологические признаки включают локализованные очаги склероза и просветления. Позднее может появиться субхондральный симптом полулуния. Затем развивается коллапс кости и уплощение суставной поверхности с последующим развитием дегенеративных изменений.</p>\r\n<p>МРТ – является более чувствительным и специфичным методом.</p>\r\n<p>Сцинтиграфия костей менее чувствительна и менее специфична, чем МРТ, и в настоящее время выполняется редко.</p>\r\n<p>КТ требуется редко, хотя иногда она может быть полезна для выявления сдавления сустава, который не определяется на обычной рентгенограмме, а иногда не виден даже на МРТ.</p>",
"treatment": "<p>Симптоматическая терапия включает покой, ЛФК, назначение нестероидных противовоспалительных препаратов.</p>\r\n<p>Хирургическое вмешательство направлено также на то, чтобы сохранить кость и не прибегнуть к протезированию. Существует несколько направлений:</p>\r\n<p>Декомпрессия, при которой в повреждённой кости делают отверстие, оно уменьшает давление внутри кости, не позволяет возникновению сдавления. Остеотомия – удаление участка некротизированной костной ткани. Аутотрансплантация – пересадка собственной здоровой костной ткани.</p>\r\n<p>При невозможности применения вышеуказанных методов и восстановления костной ткани прибегают к эндопротезированию суставов.</p>\r\n<p> </p>",
"prevention": "<p>Основными профилактическими мероприятиями являются:</p>\r\n<ul>\r\n<li>Отказ от вредных привычек – курения и употребления алкоголя</li>\r\n<li>Подбор минимальных эффективных доз кортикостероидов</li>\r\n<li>Соблюдение правил гигиены при уходе за ротовой полостью для предупреждения разрушения челюсти</li>\r\n<li>Прекращение приема бисфосфонатов за 2 месяца до инвазивной стоматологической манипуляции. </li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Заболевание может долгое время протекать бессимптомно. Затем постепенно развивается боль, но она может возникнуть и остро. По мере прогрессирования сдавления сустава боль нарастает, усиливается при физической нагрузке.</p>\r\n<p>В развернутой стадии отмечаются боли и ограничение подвижности, при этом пассивные движения ограничиваются в меньшей степени, чем активные. Возможен клинически выраженный синовиальный выпот, особенно в коленном суставе; жидкость при этом имеет невоспалительный характер.</p>",
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"description": "Появление гемоглобина и эритроцитов в моче.",
"etiology": "<p>Кровь в моче может быть вызвано инфекцией, воспалением, опухолью или травмой мочеполовой системы. Наиболее распространенные причины для людей в возрасте до 40 лет имеют камни в почках или инфекции мочевых путей. У людей старше 40 лет – это являются распространенными причинами рака почки, мочевого пузыря и предстательной железы.Причинами крови в моче, являются следующие: почечно-каменные болезни, травмы, пиелонефрит, гломерулонефрит с нефротическим синдромом, опухоли и тому подобные. острый или хронический цистит, рак, дивертикулит, паразитарные инфекции (shistozomatoza) и другие. опухоль захвата камни, травмы и другие. гематологические расстройства (отсутствие одного из факторов свертывания крови, ДВС — синдром, большой потерей белка). прием некоторых лекарственных препаратов (rifampitsin. аспирин, антикоагулянты) и другие. Рецидивирующая и устойчивая гематурия само по себе является симптомом, а не болезнью. Многие люди с гематурией не имеют никаких других жалоб.</p>",
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"diagnostics": "<p>Гематурия может быть оценена с помощью одного или более из следующих тестов:</p>\r\n<ul>\r\n<li>Брюшная рентгенограмма: может быть использована для поиска причин гематурии, таких как камни в почке или мочевом пузыре, особенно если присутствуют тошнота и рвота. Большинство причин гематурии не будут обнаружены с помощью рентгена и, скорее всего, потребуются дополнительные исследования.</li>\r\n<li>МР / КТ урография: оба метода помогут врачу оценить состояние мочевыводящих путей пациента, в том числе мочевой пузырь, мочеточники и почки.</li>\r\n<li>УЗИ брюшной полости: с помощью этого способа диагностики можно «увидеть» почки и мочевой пузырь и определить их аномалии.</li>\r\n<li>Внутривенная пиелограмма: рентгеновское обследование, которое поможет врачу визуализировать почки, мочевой пузырь и мочеточники. Поможет найти патологию в мочеполовой системы и показать, насколько эффективно мочевыделительная система выводит отходы жизнедеятельности.</li>\r\n</ul>",
"treatment": "<ul>\r\n<li>Гематурия является признаком болезни, а не самой болезнью. Таким образом, терапия должна быть направлена на процесс, приведший к гематурии. Причины, вызвавшие бессимптомную (изолированную) гематурию, как правило, не требуют лечения.</li>\r\n<li>Инфекция мочевыводящих путей, возможно, потребует приема препаратов из группы антибиотиков, таких как цефазолин.</li>\r\n<li>Хирургическое вмешательство и установка нефростомы (дренажа или катетера для отведения мочи из почки) могут потребоваться при определенных анатомических аномалиях, например, опухоли полости малого таза.</li>\r\n<li>Пациентам с постоянной микроскопической гематурией следует проходить обследование каждые 6-12 месяцев для контроля признаков или симптомов, свидетельствующих о прогрессирующей почечной болезни.</li>\r\n</ul>",
"prevention": "",
"clinical_picture": "<p>Основной симптом - появление крови в моче.</p>",
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"danger": 51,
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"standards": [
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"lead": "Хемоз — отек конъюнктивы, при котором поверхность глаза в области склер заметно увеличивается, может менять цвет и болеть. Такая патология возникает на фоне множества заболеваний глаза, установить точную причину может только врач, поэтому и самолечение в этом случае недопустимо. Особенно опасны ситуации, при которых хемоз возникает часто и склонен к длительному течению. \r\nПричины отека конъюнктивы могут быть острыми и локальными. Среди наиболее частых причин наблюдается: острое воспаление придаточного глазного аппарата и оболочек глаза, укусы насекомых, появление ячменя на глазу, орбитальный целлюлит (воспаление тканей глаза позади орбитальной перегородки), гонорейный конъюнктивит (опасная для зрения патология, которая развивается при гонореи), нарушение микроциркуляции или застой крови, которые могут быть вызваны воздействием или давлением на глаз опухолей орбитальных областей (зона вокруг глазного яблока). Часто при отеке конъюнктивы диагностируется анемия (малокровие), нефрит (воспаление, которое приводит к изменению парных органов), крапивница (кожное заболевание, преимущественно аллергического происхождения).\r\n\r\nПричинами заболевания может быть патологии глаз, черепно-мозговые травмы, бесконтрольное применение медицинских препаратов.",
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}
]
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