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},
"code": "D48.1",
"name": "Опухоль соединительной и других мягких тканей",
"icd_name": "Опухоль соединительной и других мягких тканей",
"gender": 0,
"age_min": 25,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d48.1_opuhol_soedinitelnoy_i_drugih_myagkih_tkaney",
"lead": "доброкачественные и злокачественные новообразования, формирующиеся из мышц, сухожилий, подкожной жировой клетчатки, тканей суставов, жировой прослойки",
"description": "",
"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;\">Окончательно не определено, какие из факторов влияют на развитие доброкачественных либо злокачественных опухолей из соединительной и других мягких тканей. За счет анализа историй болезни миллионов людей с разными типами опухолевых поражений мягких тканей, можно определить некоторые факторы риска, которые способствуют достаточно выраженному повышению риска зарождения и прогрессирования рака. Сюда можно отнести:</span></p>\r\n<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: 7.5pt; font-family: Verdana; color: #212529; 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;\">частые травмы тканей, из-за чего страдает процесс деления клеток;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">рубцовые деформации в определенных зонах провоцируют малигнизацию тканей, что приводит к образованию в соединительной ткани фибросарком;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">генетическую предрасположенность к опухолям, если у близкой родни есть раковые или доброкачественные процессы, риск сходных патологий может быть повышен на 50-70%;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">наличие в организме ВПЧ (вирус папилломы человека);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">туберозный склероз;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">неблагоприятные экологические условия, загрязнение среды;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">воздействие радиации (частое, длительное, даже в низких дозах);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">вредные привычки (алкоголь, курение).</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "",
"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;\">Процесс диагностики проходит поэтапно, по определенному алгоритму. Первым делом врач проведет беседу с пациентом, в ходе которой определит все имеющиеся жалобы, оценит общее состояние, изучит историю семьи и анамнез самого пациента. Это важно для того, чтобы определить все влияющие факторы, возможные особенности опухоли и общее состояние здоровья, которое может повлиять на ход диагностики и лечения.</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;\">Затем необходим осмотр, который включает оценку самого образования, если оно расположено в доступном для осмотра и аккуратного прощупывания месте. Оценить структуру и особенности опухоли важно для того, чтобы предположить ее тип. Доброкачественные опухоли обычно имеют капсулу, они подвижны и безболезненны.</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;\">Далее необходимо выполнение ряда анализов – общих исследований мочи, крови, показателей биохимии и коагулограммы. Кроме того, необходимо рентгенографическое, КТ или МРТ-исследование, а также биопсия тканей с их тщательным изучением в лаборатории. После получения всех результатов анализов и инструментальных тестов, доктор ставит предварительный диагноз.</span></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;\">Для каждого типа опухоли подбирается свой вариант лечения, причем подходы к терапии доброкачественных и злокачественных процессов существенно различаются. Тот или иной метод лечения, который используют в борьбе с онкологией, определяется целым рядом факторов – это пол и возраст пациента, размеры и локализация, тип опухоли, наличие метастазов.</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;\">Доброкачественные процессы обычно требуют динамического наблюдения или удаления без каких-либо дополнительных воздействий. Злокачественные процессы могут лечиться с использованием целого ряда методик:</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;\">применение курса химиопрепаратов (одного или сразу нескольких);</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;\">лучевая терапия (прицельное облучение опухолевой ткани);</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;\">хирургическое удаление опухоли;</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;\">иммунотерапия;</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;\">таргетное лечение;</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;\">гормональное лечение.</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;\">Доброкачественные опухоли чаще всего удаляют радикально, в пределах здоровых тканей с полным иссечением капсулы, сосудистой ножки. В зависимости от локализации и размеров новообразования, иссечение проводится под общим наркозом или местной анестезией. Немедленное вмешательство показано при сдавлении нервов и сосудов, плановое – при бессимптомном течении процесса. Тогда предварительно сдаются анализы, планируется операция, а затем – процесс реабилитации. После операции необходимо примерно 5-7 дней (иногда больше, в зависимости от того, где была опухоль) для возвращения к привычной жизни.</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;\">Раковые поражения крайне сложны в плане радикального лечения. Прогноз наиболее благоприятен при выявлении их на ранних стадиях и при наличии высокодифференцированного типа клеток. В этом случае проводят радикальное хирургическое лечение, эффективное примерно для 80% пациентов. При второй-третьей стадии процесса проводится комплексное лечение, которое включает операцию, а затем облучение и химиотерапию, чтобы добить оставшиеся раковые клетки.</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;\">В поздних стадиях и при наличии метастазов радикально удалить опухоль невозможно. Поэтому назначается паллиативная терапия, направленная на уменьшение размера рака, торможение его роста.</span></p>",
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"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;\">Зачастую впервые опухоль устанавливают при профилактических осмотрах или обследованиях по другим поводам. Ключевые жалобы, с которыми пациенты обращаются к врачу – это:</span></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: 7.5pt; font-family: Verdana; color: #212529; 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;\">появление в толще тканей плотного или эластичного образования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">рост подкожного образования без каких-либо неприятных симптомов, боли или кровотечений;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">неприятные ощущения при давлении опухоли на сосуды, нервы, нарушение функции органа или ткани при неудобном расположении образования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">потеря массы тела, если это раковая опухоль;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">длительный субфебрилитет (повышение температуры в пределах 37,0-37,5°С);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">повышенная утомляемость, слабость, бледность;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">образование на коже эрозий и язвенных дефектов над поверхностью опухолевого образования.</span></p>\r\n</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;\">Если это злокачественный процесс, на поздних стадиях рака возможно метастазирование опухоли в отдаленные органы и ткани. Заподозрить появление метастазов можно по ряду симптомов, возникающих у пациента с первичной опухолью. Это:</span></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: 7.5pt; font-family: Verdana; color: #212529; 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;\">появление болезненности в области спины, конечностей, шеи;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">кровохаркание;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; 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;\">изменение характера стула, появление примеси крови.</span></p>\r\n</li>\r\n</ul>\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;\">Описанные симптомы и любые другие проявления связаны с ростом раковой опухоли в ткани, проникновение ее в лимфатические и кровеносные сосуды, поражение скелета, пищеварительной или дыхательной системы, нервов.</span></p>",
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},
"code": "D50",
"name": "Железодефицитная анемия",
"icd_name": "Железодефицитная анемия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
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"periodicity": 1,
"slug": "d50_zhelezodeficitnaya_anemiya",
"lead": "Нарушение здоровья, относящееся к группе анемии, связанные с питанием",
"description": "<p>Железодефицитная анемия — гематологический синдром, характеризующийся нарушением синтеза гемоглобина вследствие дефицита железа и проявляющийся анемией и сидеропенией. Основными причинами ЖДА являются кровопотери и недостаток богатой железом пищи и питья.</p>",
"etiology": "<ol>\r\n<li>Повышенная потребность организма в железе:</li>\r\n</ol>\r\n<ul>\r\n<li>Подростки в период полового созревания;</li>\r\n<li>Беременные женщины.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Недостаточное поступление железа в организм:</li>\r\n</ol>\r\n<ul>\r\n<li>Искусственное вскармливание детей раннего возраста неадаптированными молочными смесями;</li>\r\n<li>Вскармливание детей раннего возраста коровьим или козьим молоком;</li>\r\n<li>Умышленное недоедание или голодание с целью похудения;</li>\r\n<li>Вегетарианство.</li>\r\n</ul>\r\n<ol start=\"3\">\r\n<li>Нарушение всасывания железа в кишечнике:</li>\r\n</ol>\r\n<ul>\r\n<li>Синдром мальабсорбции;</li>\r\n<li>Дисбактериоз кишечника;</li>\r\n<li>Нарушение минерального обмена (связывание железа в ЖКТ оксалатами, фосфатами, солями кальция).</li>\r\n</ul>\r\n<ol start=\"4\">\r\n<li>Кровотечения – хронические (рецидивирующие) кровопотери.</li>\r\n</ol>\r\n<p>Желудочно-кишечные кровотечения:</p>\r\n<ul>\r\n<li>Кровоточащие эрозии и язвы в пищеводе, желудке или кишечнике;</li>\r\n<li>Геморрой (геморроидальные кровотечения);</li>\r\n<li>Кровоточащие раковые опухоли желудка или кишечника.</li>\r\n</ul>\r\n<p>Маточные кровотечения:</p>\r\n<ul>\r\n<li>Нарушения овариально-менструальной функции у юных девушек и молодых женщин;</li>\r\n<li>Маточные кровотечения у взрослых женщин (при миоме, эндометриозе)</li>\r\n</ul>\r\n<p>Носовые кровотечения.</p>",
"pathogenesis": "<p>Железодефицитная анемия связана с физиологической ролью железа в организме и его участием в процессах тканевого дыхания. Оно входит в состав гема — соединения, способного обратимо связывать кислород. Гем представляет собой простетическую часть молекулы гемоглобина и миоглобина (белок скелетных мышц, связывающий кислород). В депонировании железа в организме основное значение имеет ферритин и гемосидерин. Транспорт железа в организме осуществляет белок трансферрин.</p>\r\n<p>Организм только в незначительной степени может регулировать поступление железа из пищи и не контролирует его расходование. При отрицательном балансе обмена железа вначале расходуется железо из депо (латентный дефицит железа), затем возникает тканевый дефицит железа, проявляющийся нарушением ферментативной активности и дыхательной функции в тканях, и только позже развивается железодефицитная анемия.</p>",
"diagnostics": "<p>Диагностика ЖДА включает:</p>\r\n<ol>\r\n<li>Клинический анализ крови с подсчетом ретикулоцитов и тромбоцитов – характерно уменьшение содержания гемоглобина и количества эритроцитов, увеличение количества ретикулоцитов.</li>\r\n<li>Биохимические показатели обмена железа – снижение содержания сывороточного железа, повышение лабораторных показателей общей и латентной железосвязывающей способности сыворотки крови;</li>\r\n<li>Биохимические показатели пигментного обмена (билирубина) – уровень билирубина при ЖДА не изменен;</li>\r\n<li>Проба с десфералом;</li>\r\n<li>Эндоскопическое и рентгенологическое обследование ЖКТ – ЭФГДС, рентгенография желудка, ректороманоскопия, ирригоскопия, фиброколоноскопия;</li>\r\n<li>Узи органов брюшной полости;</li>\r\n<li>Анализ кала на скрытую кровь;</li>\r\n<li>Анализ кала на яйца глистов;</li>\r\n<li>Стернальная пункция с анализом костного мозга – миелограмма.</li>\r\n</ol>",
"treatment": "<p>Препараты выбора для лечения ЖДА – пероральные препараты трехвалентного железа. При плохой переносимости или неэффективности пероральных препаратов железа, эрозивном гастродуодените, язве желудка или двенадцатиперстной кишки, синдроме мальабсорбции (нарушении всасывания), анемии 2-3 степени острой постгеморрагической анемии назначают парентеральные препараты железа. При анемии 2-3 степени, неэффективности монотерапии препаратами железа, полидефицитной анемии смешанного генеза назначаются прпараты витамина В12 и фолиевая кислота.</p>",
"prevention": "<p>Основа профилактики ЖДА – здоровый образ жизни и рациональное питание с употреблением продуктов, богатых железом, витаминами и микроэлементами (мясные продукты, печень, рыба, икра, греча, овощи, фрукты). Профилактический прием препаратов железа в группах риска:</p>\r\n<ul>\r\n<li>Юные девушки с нарушением овариально-менструальной функции;</li>\r\n<li>Молодые женщины с гиперменструальным синдромом;</li>\r\n<li>Беременные и кормящие матери;</li>\r\n<li>Дети младшего возраста.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Клиническая картина ЖДА складывается из двух групп симптомов, объединенных в два клинических синдрома:</p>\r\n<p>Синдром сидеропении:</p>\r\n<ol>\r\n<li>Функциональные расстройства ЦНС:</li>\r\n</ol>\r\n<ul>\r\n<li>Астеновегетативный синдром</li>\r\n<li>Ухудшение памяти</li>\r\n<li>Плохая успеваемость</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Эмоционально-личностные изменения – социальная дезадаптация.</li>\r\n<li>Полифагия – извращение вкуса – желание употреблять в пищу несъедобные продукты (мел, известь, глину, землю, сырое мясо, сырое тесто, сырые макаронные изделия, грызть лед).</li>\r\n<li>Патосмия – извращение обоняния – пристрастие к необычным острым запахам (ацетон, бензин, керосин, лаки, краска)</li>\r\n<li>Иммунодефицитное состояние:</li>\r\n</ol>\r\n<ul>\r\n<li>Склонность к инфекционным процессам и простудным заболеваниям;</li>\r\n<li>Хронические очаги инфекции в носоглотке и придаточных пазухах;</li>\r\n<li>Длительный субфебрилитет</li>\r\n</ul>\r\n<ol start=\"6\">\r\n<li>Сидеропеническая миопатия:</li>\r\n</ol>\r\n<ul>\r\n<li>Миастения (мышечная слабость);</li>\r\n<li>Слабость сфинктеров и ночное недержание мочи у подростков.</li>\r\n</ul>\r\n<ol start=\"7\">\r\n<li>Трофические изменения кожи и ее дериватов (волосы, ногти):</li>\r\n</ol>\r\n<ul>\r\n<li>Алебастровый (зелено-желтушный) оттенок кожи;</li>\r\n<li>Сухость кожи;</li>\r\n<li>Шелушение кожи на локтях и голенях;</li>\r\n<li>Гиперкератоз и трещины на пятках;</li>\r\n<li>Ломкость, слоистость, исчерченность ногтей, койлонихии (ложкообразные ногти);</li>\r\n<li>Сухость, ломкость, выпадение волос.</li>\r\n</ul>\r\n<ol start=\"8\">\r\n<li>Трофические изменения слизистых оболочек ЖКТ:</li>\r\n</ol>\r\n<ul>\r\n<li>Хейлоз и заеды в уголках рта;</li>\r\n<li>Гингивит и кровоточивость десен;</li>\r\n<li>Атрофический глоссит (атрофия сосочков языка);</li>\r\n<li>Атрофический эзофагит (сидеропеническая дисфагия – нарушение глотания).</li>\r\n</ul>\r\n<p>Анемический (циркуляторно-гипоксический синдром):</p>\r\n<ol>\r\n<li>Бледность кожи и слизистых;</li>\r\n<li>Гипоксия головного мозга:</li>\r\n</ol>\r\n<ul>\r\n<li>Головные боли;</li>\r\n<li>Астенизация, невротизация;</li>\r\n<li>Слабость, быстрая утомляемость;</li>\r\n<li>Головокружения, обмороки.</li>\r\n</ul>\r\n<ol start=\"3\">\r\n<li>Гиперкинетический кардиальный симптом:</li>\r\n</ol>\r\n<ul>\r\n<li>Тахикардия;</li>\r\n<li>Колебания АД</li>\r\n<li>Функциональные шумы над сердцем и крупными сосудами</li>\r\n</ul>\r\n<ol start=\"4\">\r\n<li>Одышка при физических нагрузках.</li>\r\n</ol>",
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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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},
"code": "D50.9",
"name": "Железодефицитная анемия неуточненная",
"icd_name": "Железодефицитная анемия неуточненная",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d50.9_zhelezodeficitnaya_anemiya_neutochnennaya",
"lead": "патологический синдром, характеризующийся уменьшением количества эритроцитов и гемоглобина крови",
"description": "",
"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;\">Причины железодефицитной анемии (ЖДА)</span></p>\r\n<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: 7.5pt; font-family: Verdana; color: #111111; 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;\">недостаточное поступление железа с пищей: голодание, вегетарианство или обедненная железом и белком диета, соблюдаемая длительное время. У детей на грудном вскармливании причиной может быть железодефицитная анемия матери, ранний перевод на искусственное вскармливание, позднее введение прикорма</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">нарушение всасывания железа: энтерит (воспаление слизистой тонкой кишки, вызванное инфекцией или глистной инвазией), гастриты и язвенная болезнь желудка и двенадцатиперстной кишки; наследственные заболевания (муковисцидоз и целиакия); аутоиммунное поражение слизистой кишечника и возможно желудка (болезнь Крона); состояние после удаления желудка и/или двенадцатиперстной кишки; рак желудка и кишечника</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">хронические кровопотерь. Это самая основная причина. Сюда относятся потери вследствие: язвенной болезни желудка и двенадцатиперстной кишки, неспецифического язвенного колита, болезни Крона, геморроя и анальных трещин, полипоза кишечника, кровотечений из распадающихся опухолей любой локализации и варикознорасширенных вен пищевода; геморрагического васкулита; легочных кровотечений, гемосидероза легких; хронического пиелонефрита, поликистоза и рака почек, мочевого пузыря; потери при гемодиализе; миомы матки, эндометриоза, гиперполименореи, рака шейки матки; носовых кровотечений</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">врожденный недостаток железа в организме (недоношенность, рождение от многоплодной беременности, тяжелая железодефицитная анемия у матери, патологические кровотечения во время беременности и родов, фетоплацентарная недостаточность)</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">алкоголизм (повреждается слизистая желудка и кишечника, затрудняя всасывание железа)</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">применение лекарственных средств: нестероидные противовоспалительные средства (диклофенак, ибупрофен, аспирин) уменьшают вязкость крови и могут способствовать возникновению кровотечений, кроме того эти препараты могут провоцировать возникновение язв желудка и двенадцатиперстной кишки; антациды (альмагель, гастал, ренни) уменьшают продукцию соляной кислоты, которая необходима для эффективного всасывания железа; железосвязывающие препараты (десферал), эти препараты связывают и выводят свободное железо и железо в составе ферритина и трансферрина, и при передозировке могут приводить к железодефицитным состояниям</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">донорство (при донациях чаще 4х раз в год развивается железодефицитное состояние)</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #111111; 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;\">нарушение синтеза трансферрина. Трансферрин – это транспортный белок железа, который синтезируется в печени</span></p>\r\n</li>\r\n</ul>",
"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;\">По своей роли в обеспечении нормального функционирования всех биологических систем железо является важнейшим элементом. От уровня железа зависит поступление кислорода к клеткам, протекание окислительно-восстановительных процессов, антиоксидантная защита, функционирование иммунной и нервной систем и пр. В среднем содержание железа в организме находится на уровне 3-4 г. Более 60% железа (>2 г) входит в состав гемоглобина, 9% - в состав миоглобина, 1% - в состав ферментов (гемовых и негемовых). Остальное железо в виде ферритина и гемосидерина находится в тканевом депо – главным образом, в печени, мышцах, костном мозге, селезенке, почках, легких, сердце. Примерно 30 мг железа непрерывно циркулирует в плазме, будучи частично связанным основным железосвязывающим белком плазмы – трансферрином.</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;\">При развитии отрицательного баланса железа мобилизуются и расходуются запасы микроэлемента, содержащиеся в тканевых депо. На первых порах этого бывает достаточно для поддержания адекватного уровня Hb, Ht, сывороточного железа. По мере истощения тканевых резервов компенсаторно увеличивается эритроидная активность костного мозга. При полном истощении эндогенного тканевого железа его концентрация начинает снижаться в крови, нарушается морфология эритроцитов, уменьшается синтез гема в гемоглобине и железосодержащих ферментов. Страдает кислородтранспортная функция крови, что сопровождается тканевой гипоксией и дистрофическими процессами во внутренних органах (атрофический гастрит, миокардиодистрофия и др.).</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 диагностики ЖДА достаточно много информации может предоставить общий анализ крови.</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;\">Снижение гемоглобина ниже нормы указывает на анемию.</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;\">Гематокрит отражает объем, который занимают клетки крови в кровяном русле. При ЖДА он, как правило, снижен.</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;\">Эритроцитарные индексы показывают размер и форму эритроцитов: средний объем эритроцитов (MCV) и среднее содержание гемоглобина в эритроците (MCH) при ЖДА обычно снижены.</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;\">Анализы, подтверждающие, что анемия действительно вызвана дефицитом железа:</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;\">Уровень железа в сыворотке при ЖДА снижен.</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;\">Железосвязывающая способность сыворотки – количество железа, которое может переносить кровь. При ЖДА этот показатель чаще всего повышен.</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;\">Трансферрин – белок, в составе которого железо переносится по организму. При ЖДА его уровень может быть повышен.</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;\">Ферритин – белок, в составе которого железо запасается в организме. Снижение его уровня является достоверным показателем истощения запасов железа в организме.</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;\">Дополнительные исследования:</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;\">эндоскопия желудочно-кишечного тракта (при анемии нередко необходимо проверить желудок на наличие язвы или грыжи пищеводного отверстия диафрагмы, для этого используется специальный зонд, который позволяет увидеть возможный источник кровотечения);</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;\">фиброколоноскопия.</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>",
"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;\">К основным принципам терапии железодефицитной анемии относятся устранение этиологических факторов, коррекция рациона питания, восполнение железодефицита в организме. Этиотропное лечение назначается и проводится специалистами гастроэнтерологами, гинекологами, проктологами и др.; патогенетическое – гематологами. При железодефицитных состояниях показано полноценное питание с обязательным включением в рацион продуктов, содержащих гемовое железо (телятины, говядины, баранины, мяса кролика, печени, языка). Следует помнить, что усилению ферросорбции в ЖКТ способствуют аскорбиновая, лимонная, янтарная кислота. Ингибируют всасывание железа оксалаты и полифенолы (кофе, чай, соевый протеин, молоко, шоколад), кальций, пищевые волокна и др. вещества.</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;\">Вместе с тем, даже сбалансированная диета не в состоянии устранить уже развившийся недостаток железа, поэтому больным с гипохромной анемией показана заместительная терапия ферропрепаратами. Препараты железа назначаются курсом не менее 1,5-2-х месяцев, а после нормализации уровня Hb проводится поддерживающая терапия в течение 4-6 недель половинной дозой препарата. Для фармакологической коррекции анемии используются препараты двухвалентного и трехвалентного железа. При наличии витальных показаний прибегают к гемотрансфузионной терапии.</span></p>",
"prevention": "<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;\">В целях профилактики железодефицитной анемии необходим ежегодный контроль параметров клинического анализа крови, полноценное питание с достаточным содержанием железа, своевременная ликвидация источников кровопотери в организме. Лицам групп риска может быть показан профилактический прием железосодержащих препаратов.</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;\">Анемический синдром - происходит из-за снижения уровня эритроцитов и гемоглобина крови, снижая насыщения клеток и тканей кислородом. Признаки анемического синдрома сложно распознаваемые, но помогают заподозрить наличие анемии и в комплексе с данными других обследований поставить диагноз. Это общая слабость, высокая утомляемость и снижение работоспособности, головокружение, шум в ушах и мелькание «мушек» перед глазами, периодическое учащенное сердцебиение, одышка при незначительной физической нагрузке, обморочные состояния. При осмотре выявляются бледность кожного покрова и видимых слизистых, небольшие отеки голеней, стоп, лица (преимущественно области вокруг глаз), тахикардия, различные варианты аритмии, умеренные шумы в сердце, приглушенность сердечных тонов.</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;\">Сидеропенический синдром - вызван дефицитом железа в тканях, что вызывает снижение активности многих ферментов (белковые субстанции, регулирующие многие жизненные функции), проявляется многочисленными симптомами:</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;\">изменение вкуса (желание употреблять в пищу необычные продукты: песок, мел, глину, зубной порошок, лед, а также сырой фарш, непропеченное тесто, сухие крупы)</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;\">склонность к употреблению острой, соленой, пряной пищи</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;\">извращение обоняния (привлекают запахи бензина, ацетона, запах лаков, красок, извести)</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;\">снижение мышечной силы и атрофия</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">сухость, шелушение кожа</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">ломкость и выпадение волос</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">тусклость, поперечная исчерченность, ложкообразная вогнутость ногтей</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">долго не заживают мелкие травмы, ссадины</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;\">сухость и трещины в углах рта у 10-15% больных</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;\">чувство распирания языка, покраснение и атрофия, частые пародонтозы и кариес</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;\">сухость слизистой пищевода, что вызывает боли при глотании и затруднение при глотании твердой пищи, развитие атрофического гастрита и энтерита</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;\">неотложные позывы к мочеиспусканию, невозможность удержать мочу при кашле, смехе, чихании, эпизоды ночного недержания мочи</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;\">симптом «синих склер» характеризуется голубоватой окраской склер</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;\">длительное повышение температуры тела до субфебрильных цифр (37.0-37.9°С) без видимых причин</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;\">частые ОРВИ</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>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 25,
"published": 1,
"parent": 6181,
"block_rubric": 39,
"standards": []
},
{
"id": 6182,
"symptoms": [
{
"id": 2563,
"synonyms": [
{
"name": "Сердцебиение"
},
{
"name": " Аритмия"
}
],
"body_points": [
{
"x": 630,
"y": 2939,
"r": 393
}
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},
"code": "D51",
"name": "Витамин-B12-дефицитная анемия",
"icd_name": "Витамин-B12-дефицитная анемия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "d51_vitamin-b12-deficitnaya_anemiya",
"lead": "образование в костном мозге мега лобластов, внутрикостное мозговое разрушение эритроцитов, изменение нервной системы в виде фуникулярного миелоза",
"description": "",
"etiology": "<p>Одним из важнейших моментов биологического действия витамина В12 является активизация им фолиевой кислоты, витамин В12 способствует образованию производных фолиевой кислоты – фолатов, которые непосредственно необходимы для костномозгового кроветворения. При дефиците витамина В12 и фолатов нарушается синтез ДНК, что в свою очередь приводит к нарушению деления клеток, увеличению их размеров и качественной неполноценности. Наиболее значительно страдают клетки эритробластического ростка: вместо эритробластов в костном мозге обнаруживаются крупные клетки эмбрионального кроветворения – мегалобласты, они не способны «созреть» до полноценного эритроцита, т. е. не могут переносить гемоглобин и кислород. Средний срок жизни мегалоцитов приблизительно в 3 раза меньше, чем у «нормальных» эритроцитов. При недостатке второго кофермента витамина В12 – внутреннего фактора – имеет место другой механизм развития анемии – происходит нарушение жирового обмена с накоплением метилмалоновой кислоты, токсичной для нервной системы. Вследствие этого возникает фуникулерный миелоз – нарушение кроветворения в костном мозге и развитие анемии. В12-дефицитная анемия развивается и в результате нарушения всасывания витамина в желудочно-кишечном тракте вследствие атрофического гастрита или в результате врожденной недостаточности железистого аппарата желудка, при этом в желудочном соке отсутствует гастромукопротеин, принимающий непосредственное участие в расщеплении и всасывании В12 и его коферментов.</p>",
"pathogenesis": "",
"diagnostics": "<p>В периферической крови определяется резкое снижение количества эритроцитов (до 0,8×1012), цветовой показатель остается высоким – 1,2–1,5. Клетки красной крови неодинаковы по величине (анизоцитоз), преобладают крупные эритроциты – макроциты, у многих эритроцитов отмечается форма в виде овала, ракетки, полумесяца и иного (пойкилоцитоз).</p>\r\n<p>В пунктате костного мозга количество клеток красного ростка резко увеличено, в 3–4 раза больше клеток лейкоцитарного ростка (в норме – обратное соотношение). В плазме крови отмечается увеличение содержания свободного билирубина и железа (до 30–45 ммоль/л).</p>",
"treatment": "<p>Назначается витамин В12. Лечение начинают введением 100–300 мкг витамина подкожно или внутримышечно 1 раз в день. На 2–3-и сутки терапии эритропоэз полностью нормализуется, а на 5–6-е сутки вновь образованные полноценные эритроциты начинают поступать в кровяное русло в необходимом количестве, самочувствие больных постепенно нормализуется. После восстановления картины крови переходят на поддерживающую терапию – введение витамина В12 в дозе 50–100 мкг, которую проводят в течение всей жизни больного. При нарушениях нервной системы на первом этапе применяют нейротропные препараты.</p>\r\n<p>Прогноз</p>\r\n<p> </p>\r\n<p>При адекватной терапии благоприятный. Без лечения заболевание прогрессирует и может привести к смерти больного.</p>",
"prevention": "",
"clinical_picture": "<p>Заболевание начинается незаметно, постепенно прогрессирует <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, появляются <a href=\"/symptom/narushenie_serdechnogo_ritma/\" title=\"Перейти на страницу симптома Нарушение сердечного ритма\">сердцебиение</a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> и <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>, особенно при физической нагрузке, резких движениях, снижается трудоспособность, ухудшается аппетит, возможно подташнивание. Нередко первая жалоба, с которой больные обращаются к врачу, – это жжение языка, его причиной является характерный для данного заболевания атрофический <a href=\"/symptom/glossit/\" title=\"Перейти на страницу симптома Глоссит\">глоссит</a>. Как следствие дистрофических изменений в нервной системе возникают кожные анестезии и парестезии, в тяжелых случаях нередко отмечается нарушение походки (спастический парапарез), могут наблюдаться расстройства функций мочевого пузыря и прямой кишки, нарушается сон, появляется эмоциональная неустойчивость, <a href=\"/symptom/depressiya/\" title=\"Перейти на страницу симптома Депрессия\">депрессия</a>. При осмотре больного обращают внимание на бледность кожных покровов и слизистых оболочек (обычно с желтоватым оттенком вследствие повышенного распада мегалоцитов и образования из освобождающегося гемоглобина билирубина), одутловатость лица; очень характерен ярко-красный блестящий гладкий язык (из-за резкой атрофии сосочков) – «полированный» язык. Очень характерен атрофический гастрит. Нередко при поколачивании по плоским и некоторым трубчатым костям отмечается болезненность – признак гиперплазии костного мозга. Частым симптомом В12-дефицитной анемии является <a href=\"/symptom/povyshennaya_temperatura_37-38/\" title=\"Перейти на страницу симптома Повышенная температура 37-38°\">субфебрильная температура</a>.</p>",
"image": "http://api.symptomd.ru/storage/c8681ce032a8688dfbbd7b25b883eb80_PyNlj4z.png",
"image_alt": "Витамин-B12-дефицитная анемия",
"standard_type": 3,
"danger": 71,
"published": 1,
"parent": null,
"block_rubric": 39,
"standards": [
5253,
5277
]
},
{
"id": 9431,
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{
"id": 57,
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{
"name": "отек глаза"
}
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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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},
"code": "D51.9",
"name": "Витамин-B12-дефицитная анемия неуточненная",
"icd_name": "Витамин-B12-дефицитная анемия неуточненная",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d51.9_vitamin-b12-deficitnaya_anemiya_neutochnennaya",
"lead": "заболевание, вызванное нарушением процесса кроветворения в связи с дефицитом витамина В12",
"description": "",
"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;\">Нехватка витамина В12 может быть связана со следующими причинами или их комбинацией:</span></p>\r\n<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: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">нарушение всасывания витамина в кишечнике: гастрит, сопряженный с инфицированием Хеликобактер Пилори, болезнь Крона, перенесенные операции на кишечнике, полипоз слизистой желудка, рак, кишечные свищи и пр.;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">врожденные нарушения обменных процессов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">хроническая интоксикация оксидом азота, используемого в качестве седации в анестезиологии.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">незначительные нарушения всасывания, например, снижение доступности В12 в пище при хроническом панкреатите, умеренном атрофическом гастрите, приеме метформина, лекарств для снижения выработки соляной кислоты и пр.;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">скудный рацион, вегетарианство;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">хронический алкоголизм.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "",
"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;\">Лечение В12-дефицитной анемии назначается после комплексного обследования. Врач направит на следующие лабораторные гематологические и иные исследования:</span></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: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">общий анализ крови;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">биохимические и иммунологические исследования: определение уровня В12 в плазме, оценка уровня гомоцистеина в сыворотке или плазме крови, определение антител к париетальным клеткам желудка и др.;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">аспирационная или трепанобиопсия костного мозга.</span></p>\r\n</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;\">Также может потребоваться гастроскопия для выявления атрофического гастрита.</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;\">Диагноз устанавливает врач на основании жалоб, проявлений болезни, параметров лабораторных исследований.</span></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;\">Обычно назначают внутримышечное введение больших доз препарата витамина В12 курсом до 2 месяцев. Затем переходят на поддерживающую терапию со снижением дозировки (ее продолжительность зависит от выраженности дефицита и вызвавшей его причины, в редких случаях она может быть пожизненной). Прием таблеток возможен, если установлено, что дефицит кобаламина вызван его недостаточным поступлением с пищей, и не выявлено других патологических причин.</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;\">В тяжелых случаях требуется переливание крови.</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;\">Также предписывается диета, обогащенная продуктами с высоким содержанием витамина В12, фолатов и железа.</span></p>",
"prevention": "<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;\">Первичная профилактика заключается в рациональном питании, своевременной диагностике и лечении глистных инвазий, назначении витамина В12 при состояниях, ведущих к развитию его дефицита (например, после резекции кишечника, субтотальной резекции желудка).</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;\">На начальной стадии развития симптомы могут быть стертыми или не беспокоить вовсе. По мере развития синдрома могут появляться следующие признаки:</span></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: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">снижение веса, не связанное с объективными причинами;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">жжение языка и изменение вкусовых ощущений;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">увеличение размеров языка, сглаживание сосочков, краснота слизистых;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">чередование запоров и диареи;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">тошнота;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">покалывания в руках и ногах, онемения;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">нарушение походки;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">нарушения мочеиспускания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">снижение полового влечения;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">снижение тонуса мышц;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">нарушения зрения;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">бледность, желтушность кожных покровов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">поседение волос;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">учащенное сердцебиение;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">одышка;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #6d6e71; 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;\">витилиго (пятна на коже) и др.</span></p>\r\n</li>\r\n</ul>\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;\">Стоит отметить, что нередки нарушения со стороны психоэмоциональной и познавательной сфер: ухудшение памяти, внимания и мышления, переменчивость настроения, плаксивость, раздражительность, депрессивные тенденции. У пожилого человека может развиться слабоумие. Тяжесть психоневрологических симптомов не зависит от выраженности анемии, а определяется тем, насколько долго она протекает и как быстро человек получит медицинскую помощь.</span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": 6182,
"block_rubric": 39,
"standards": []
}
]
}
