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},
"code": "D55",
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"icd_name": "Анемия вследствие ферментных нарушений",
"gender": 0,
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3,
0
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"slug": "d55_anemiya_vsledstvie_fermentnyh_narusheniy",
"lead": "относится к группе гемолитических анемий, развитие которых связано с дефицитом различных ферментов",
"description": "",
"etiology": "<p>Относительно часто встречается анемия вследствие дефицита пируваткиназы. Заболевание наследственное, передается гомозиготно.</p>\r\n<p>Пируваткиназа (а также другие ферменты гликолизного обмена) принимает участие в синтезе АТФ, дефицит этого фермента ведет к снижению содержания АТФ в эритроцитах, а это, в свою очередь, – к нарушению концентрации ионов натрия и калия в эритроцитах (Na+↑; K+↓). В результате такого сдвига возникает функциональная и морфологическая неполноценность красных кровяных клеток.</p>",
"pathogenesis": "",
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"treatment": "<p>Проводится заместительная терапия (ферментативная), используются симптоматические средства. Нередко назначение рибофлавина дает стойкий положительный эффект.</p>",
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"code": "L04",
"name": "Острый лимфаденит",
"icd_name": "Острый лимфаденит",
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"lead": "острое гнойное воспаление лимфатических узлов.",
"description": "Лимфаденит – неспецифическое или специфическое воспалительное поражение лимфоузлов. Лимфаденит характеризуется местной болезненностью и увеличением лимфатических узлов, головной болью, недомоганием, слабостью, повышением температуры тела. \r\n\r\n",
"etiology": "<p>Возбудителями неспецифического лимфаденита обычно выступает гноеродная флора - стафилококки и стрептококки, а также выделяемые ими токсины и продукты тканевого распада, которые проникают в лимфоузлы лимфогенным, гематогенным или контактным путем. Первичным очагом при неспецифическом лимфадените могут являться гнойные раны, панариции, фурункулы, карбункулы, флегмоны, рожистое воспаление, трофические язвы, тромбофлебит, кариес, остеомиелит. Местные воспалительные процессы чаще сопровождаются регионарным лимфаденитом.</p>\r\n<p>Лимфаденит у детей часто бывает связан с воспалительными процессами ЛОР-органов (гриппом, отитом, хроническим тонзиллитом, ангиной), детскими инфекциями (скарлатиной, дифтерией, паротитом), а также кожными заболеваниями (пиодермией, экссудативным диатезом, инфицированной экземой и др.).</p>\r\n<p>Причиной специфического лимфаденита являются возбудители туберкулеза, сифилиса, гонореи, актиномикоза, чумы, сибирской язвы, туляремии и др. инфекций.</p>",
"pathogenesis": "<p>Инфекция поступает в регионарные лимфатические узлы с током лимфы, оттекающей из первичных гнойных очагов. Лимфаденит может возникнуть и без предшествующего лимфангита, причем первичный очаг бывает настолько ничтожен и так быстро заживает, что к моменту возникновения лимфаденита обнаружить место вхождения инфекции уже не всегда удается. В редких случаях возможно попадание инфекции в лимфатические узлы вместе с кровотоком. Лимфаденит иногда возникает и вследствие непосредственного перехода воспалительного процесса с тканей, окружающих узел.<br /> Лимфаденит следует рассматривать как проявление барьерной функции лимфатической системы, ограничивающей дальнейшее распространение инфекции и ее токсинов. Вместе с тем лимфаденит сам по себе может стать исходным пунктом для развития тяжелого гнойного процесса (аденофлегмона, сепсис).</p>",
"diagnostics": "<p>При постановке диагноза лимфаденит, врач проводит сбор анамнеза, и далее основывается на результатах пальпации тех областей, на которые жалуется пациент.</p>\r\n<p>Далее, обязательно назначается общий анализ периферической крови больного, в котором могут быть все признаки воспалительного процесса (в крови будет обнаружено при этом большое количество лейкоцитов, ускорение СОЭ, токсическая зернистость сегментоядерных нейтрофилов).</p>\r\n<p>Для уточнения и подтверждения диагноза лимфаденита назначается ультразвуковое исследование пораженных лимфатических узлов, пункция этих узлов. После пункции делают посев содержимого для того, чтобы определить сам микроорганизм и его чувствительность к препаратам антибактериального действия.</p>",
"treatment": "<p>Катаральный и гиперпластический острый лимфаденит лечится консервативно. Необходимо создание покоя для области поражения, проведение адекватной антибиотикотерапии на основании чувствительности микробной флоры, УВЧ-терапии, витаминотерапии. При гнойном лимфадените показано вскрытие сформировавшегося абсцесса, аденофлегмоны, дренирование и санация очага по принципам ведения гнойных ран. Назначается активная дезинтоксикационная и антибактериальная терапия.</p>",
"prevention": "<p>К профилактическим методам лимфаденита можно отнести здоровый образ жизни и максимальное избегание инфекционных заболеваний.</p>\r\n<p>Так же профилактическими методами лимфаденита являются методы по предупреждению травм различного характера, методы борьбы с раневой инфекцией, и рационализация лечения воспалительных гнойных заболеваний.</p>\r\n<p> </p>",
"clinical_picture": "<p>Острый лимфаденит может проявлять себя в виде общей и местной симптоматики.</p>\r\n<p>Общие симптомы воспаления:</p>\r\n<ul>\r\n<li>повышение температуры до высоких показателей (вплоть до 40°С);</li>\r\n<li>проявление озноба;</li>\r\n<li>сильная мигрень;</li>\r\n<li>общая сильно выраженная слабость;</li>\r\n<li>боль в мышцах;</li>\r\n<li>плохой сон.</li>\r\n</ul>\r\n<p>Местные проявления острого лимфаденита:</p>\r\n<ul>\r\n<li>увеличенные лимфоузлы;</li>\r\n<li>появление красного отека над лимфоузлами;</li>\r\n<li>возникновение заметной опухоли кожных покровов в области лимфоузлов;</li>\r\n<li>болезненные ощущения, как при прощупывании лимфоузлов, так и в состоянии покоя;</li>\r\n<li>повышение местной температуры кожных покровов;</li>\r\n<li>нарушение двигательной функции той области, где расположены лимфоузлы.</li>\r\n</ul>",
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"image_alt": null,
"standard_type": 1,
"danger": 11,
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{
"id": 6720,
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{
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"name": "Дрожь"
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{
"name": "Холод"
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{
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"code": "L05",
"name": "Пилонидальная киста",
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"lead": "врождённая аномалия развития кожи крестцово-копчиковой области, связанная с неполной редукцией рудиментарной каудальной связки. ",
"description": "Для заболевания характерно наличие врождённых первичных свищевых втяжений в межягодичной складке. Нередко из таких втяжений выстоят волосы. ",
"etiology": "<p>Считают, что эпителиальный копчиковый ход является врожденным дефектом развития кожи, обусловленным неполной редукцией мышц и связок хвоста.</p>",
"pathogenesis": "",
"diagnostics": "<p>Местные изменения настолько типичны, что спутать копчиковый ход с другими поражениями этой области почти невозможно. При введении в один из свищей метиленового синего краска выходит из всех остальных ходов и вторичных свищей и не проходит в прямую кишку.</p>",
"treatment": "<p>Радикальное лечение пилонидальной кисты проводится только хирургическим путем, в условиях стационара хирургического или колопроктологического отделения. Существуют две тактики хирургического лечения:</p>\r\n<ol>\r\n<li>В острый период вскрывается и дренируется гнойник. После чего через 1–2 недели проводится радикальная операция – иссечение кисты в пределах здоровых тканей.</li>\r\n<li>В острый период сразу проводится радикальная операция – иссечение кисты единым блоком в пределах здоровых тканей (при этом необходимо сохранить целостность кисты, во избежание инфицирования операционной раны).</li>\r\n</ol>\r\n<p>Операция завершается ушиванием краев раны. Хотя, на усмотрение хирурга, рана может оставаться открытой и долго заживать вторичным натяжением; иногда до 6 месяцев (Прим. автора). При иссечении кисты копчика всегда имеется дефицит тканей, что приводит к чрезмерному натяжению краев раны и негативно сказывается на ее заживлении. Практически всегда послеоперационные раны заживают долго, причиняя значительные неудобства пациенту. При этом частота рецидива достигает 10–40%.</p>\r\n<p>Радикальная операция всегда проводится в условиях наркоза. В послеоперационном периоде пациенты в обязательном порядке получают антибактериальные препараты широкого спектра действия, а также противовоспалительные средства.</p>",
"prevention": "<p>Всем, кто перенес радикальное оперативное вмешательство по поводу эпителиального копчикового хода, желательно соблюдать следующие рекомендации: <br />- в течение трех недель после операции не разрешается сидеть, поднимать тяжести; после снятия швов целесообразно ежедневно принимать гигиенический душ с промыванием межъягодичной складки; <br />- в течение 6 месяцев после операции 2 раза в месяц необходимо производить эпиляцию в зоне операции.</p>",
"clinical_picture": "<p>Эпителиальный копчиковый ход расположен по средней линии в межъягодичной складке, слепо оканчивается в подкожной клетчатке крестцово-копчиковой области, открывается на коже одним или несколькими точечными отверстиями (первичный эпителиальный ход), и представляет собой узкую эпителиальную трубку. Продукты жизнедеятельности эпителия, выстилающего ход, периодически выделяются через точечные отверстия наружу. Закупорка или инфицирование выводных протоков, механическая травма приводят к задержке содержимого в просвете хода и способствуют возникновению воспаления. В результате эпителиальный копчиковый ход расширяется, стенка его разрушается и в воспалительный процесс вовлекается окружающая клетчатка. Развившиеся при этом абсцесс или флегмона крестцово-копчиковой области иногда достигают значительной величины и могут вскрыться наружу в виде гнойного свища, который принято называть вторичным отверстием. <br /><br />В 25-50% случаев внутри эпителиального копчикового хода или возникшей на его месте кисты содержатся волосы, которые могут внедряться в боковые стенки и образовывать дополнительные ходы. Гнойник иногда достигает значительной величины и, как правило, прорывается через кожу, образуя наружное отверстие гнойного свища. <br />Различают неосложненный и осложненный гнойным процессом эпителиальный копчиковый ход.</p>",
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{
"name": "Височная боль"
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{
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{
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"name": "Остеопороз при болезнях, классифицированных в других рубриках",
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"standard_type": 3,
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"published": 1,
"parent": null,
"block_rubric": 143,
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}
]
}