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"code": "K21",
"name": "Гастроэзофагеальный рефлюкс",
"icd_name": "Гастроэзофагеальный рефлюкс",
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"lead": "Нарушение здоровья, относящееся к группе болезни пищевода, желудка и двенадцатиперстной кишки",
"description": "<p>Гастроэзофагеальная рефлюксная болезнь – хроническое рецидивирующее заболевание пищевода, обусловленное забросом агрессивного желудочного или желудочно-кишечного содержимого в просвет пищевода и характеризующееся пищеводными и внепищеводными симптомами.</p>",
"etiology": "<p>Развитию гастроэзофагеальной рефлюксной болезни способствуют следующие причины: </p>\r\n<ul>\r\n<li>Снижение тонуса нижнего пищеводного сфинктера (НПС). </li>\r\n<li>Снижение способности пищевода к самоочищению. </li>\r\n<li>Повреждающие свойства рефлюктанта, то есть содержимого желудка и/или двенадцатиперстной кишки, забрасываемого в пищевод. </li>\r\n<li>Неспособность слизистой оболочки противостоять повреждающему действию рефлюктанта. </li>\r\n<li>Нарушение опорожнения желудка. </li>\r\n<li>Повышение внутрибрюшного давления.</li>\r\n</ul>\r\n<p>На развитие гастроэзофагеальной рефлюксной болезни влияют и особенности образа жизни, такие как стресс, работа, связанная с наклонным положением туловища, ожирение, беременность, курение, факторы питания (жирная пища, шоколад, кофе, фруктовые соки, алкоголь, острая пища), а также приём повышающих периферическую концентрацию дофамина препаратов (фенамин, первитин, прочих производных фенилэтиламина). </p>",
"pathogenesis": "<p> Основным фактором развития гастроэзофагеальной рефлюксной болезни является недостаточность нижнего сфинктера пищевода. У здоровых людей это мышечное циркулярное образование в обычном состоянии держит в сомкнутом состоянии отверстие между пищеводом и желудком и препятствует обратному движению пищевого комка (рефлюксу). </p>\r\n<p>В случае недостаточности сфинктера отверстие открыто и при сокращении желудка происходит обратный заброс его содержимого в пищевод. Агрессивная желудочная среда вызывает раздражение стенок пищевода и патологические нарушения в слизистой вплоть до ее глубокого изъязвления. У здоровых людей рефлюкс может возникать при наклоне туловища, физических упражнениях, ночью.</p>",
"diagnostics": "<p>Диагностика ГЭРБ включает: </p>\r\n<ul>\r\n<li>Суточный внутрипищеводный рН-мониторинг – основной метод исследования, подтверждающий у больного ГЭРБ. В ходе этого исследования определяется количество и длительность рефлюксов в течение суток, а также продолжительность времени, в течение которого уровень рН падает ниже 4. </li>\r\n<li>Тест с ингибитором протонного насоса. Пациенту на 2 недели назначается прием препарата из группы ингибиторов протонной помпы (омез, нексиум) в стандартной дозе. Эффективность терапии является подтверждением заболевания. </li>\r\n</ul>\r\n<p>Помимо этих методов диагностики больному могут назначаться и другие исследования. Обычно они необходимы для оценки состояния пищевода и других органов пищеварительной системы, выявления сопутствующих заболеваний, а также для исключения болезней, с похожей клинической картиной: </p>\r\n<ul>\r\n<li>ЭФГДС (эзофагогастродуоденоскопия) с уреазным тестом; </li>\r\n<li>хромэндоскопия пищевода; </li>\r\n<li>рентгенологические исследования пищевода и желудка с использованием контраста; </li>\r\n<li>ЭКГ и суточное мониторирование ЭКГ; </li>\r\n<li>ультразвуковое исследование органов брюшной полости. </li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Пациентам, страдающим ГЭРБ, рекомендуется: </p>\r\n<ul>\r\n<li>Нормализация массы тела. </li>\r\n<li>Необходимо исключить из своего рациона жирную, жареную, острую пищу, шоколад, кофе, крепкий чай, газированные напитки, цитрусовые, лук, чеснок. </li>\r\n<li>Важно не переедать, принимать пищу малыми порциями, с перерывом в 15-20 минут между блюдами, не есть позже, чем за 3-4 часа до сна. </li>\r\n<li>Исключение нагрузок, связанных с повышением внутрибрюшного давления, а также ношение тесных поясов, ремней и т. п. </li>\r\n<li>Приподнятое положение (15-20 см) головного конца кровати ночью. </li>\r\n</ul>\r\n<p>Медикаментозная терапия ГЭРБ направлена, в основном, на нормализацию кислотности и улучшение моторики. Для лечения ГЭРБ применяются антисекреторные средства (ингибиторы протонного насоса, блокаторы H2-гистаминовых рецепторов), прокинетики и антациды. </p>\r\n<p>Для нормализации моторики принимают прокинетики - специальные лекарственные препараты, которые усиливают перистальтику желудочно-кишечного тракта. </p>\r\n<p>Хирургические вмешательства при гастроэзофагеальной рефлюксной болезни: эндоскопическая пликация гастроэзофагиального соединения (накладываются швы на кардии), радиочастотная абляция пищевода (повреждение мускульного слоя кардии и гастроэзофагеального соединения, с целью рубцевания и уменьшения рефлюкса), гастрокардиопексия и лапароскопическая фундопликация по Ниссену. </p>",
"prevention": "<p>Профилактикой развития ГЭРБ является ведение здорового образа жизни, исключающего факторы риска, способствующие возникновению заболевания (отказ от курения, злоупотребления алкоголем, жирной и острой пищей, переедания, подъема тяжестей, продолжительного нахождения в наклонном состоянии и др.). Также способствуют профилактике своевременные меры по выявлению нарушений моторики верхних отделов пищеварительного тракта и лечение грыжи диафрагмы.</p>",
"clinical_picture": "<p>Пищеводные (эзофагеальные) проявления ГЭРБ: </p>\r\n<ul>\r\n<li>изжога (чувство жжения за грудиной) – основной симптом; она может принимать разнообразный характер: как возникать несколько раз в течение дня, так и быть постоянной. Отличительная особенность – связь эпизодов изжоги с изменением положения тела (с наклоном вперед, в положении лежа), употреблением провоцирующих продуктов питания или лекарственных препаратов. </li>\r\n<li>отрыжка кислым, горьким, едой (срыгивание) или воздухом; </li>\r\n<li>разнообразные нарушения глотания; </li>\r\n<li>одинофагия (ощущение боли или неприятные ощущения при прохождении пищи по пищеводу, что обычно встречается при выраженном поражении слизистой пищевода); </li>\r\n<li>боли в области желудка или в проекции пищевода; </li>\r\n<li>рвота, упорная икота; </li>\r\n<li>ощущение кома за грудиной. </li>\r\n</ul>\r\n<p>Внепищеводные проявления: </p>\r\n<ul>\r\n<li>легочной синдром [кашель, одышка, эпизоды спонтанной остановки дыхания (апноэ), рефлекторный бронхоспазм, у некоторых пациентов развиваются аспирационная пневмония, бронхиальная астма]; </li>\r\n<li>отоларингологический синдром, так называемая отоларингологическая маска ГЭРБ (грубый лающий кашель, осиплость голоса по утрам, першение, рецидивирующие отит, ринит); </li>\r\n<li>стоматологический синдром (разрушение зубной эмали); </li>\r\n<li>анемический синдром (снижение количества эритроцитов и гемоглобина вследствие микрокровотечений из изъязвлений слизистой оболочки пищевода); </li>\r\n<li>кардиальный синдром (загрудинные боли, имитирующие стенокардию). </li>\r\n</ul>",
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"code": "K27",
"name": "Пептическая язва неуточненной локализации",
"icd_name": "Пептическая язва неуточненной локализации",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 4,
"slug": "k27_pepticheskaya_yazva_neutochnennoy_lokalizacii",
"lead": "Нарушение здоровья, относящееся к группе болезни пищевода, желудка и двенадцатиперстной кишки",
"description": "Пептическая язва - это локальное повреждение слизистой оболочки желудка, пищевода или двенадцатиперстной кишки под воздействием пепсина - фермента желудочного сока и соляной кислоты, активирующей этот фермент. ",
"etiology": "<p>Основными причинами возникновения пептической язвы считаются: </p>\r\n<ul>\r\n<li>заражение бактериями Helicobacter pylori; </li>\r\n<li>острое и хроническое психоэмоциональное перенапряжение; </li>\r\n<li>злоупотребление алкогольными напитками, курение; </li>\r\n<li>алиментарный фактор (систематическое употребление грубой, пряной, чрезмерно горячей или холодной пищи провоцирует желудочную секрецию, избыточную продукцию соляной кислоты); </li>\r\n<li>прием гастротропных лекарственных средств, оказывающих повреждающее воздействие на внутреннюю оболочку органа (нестероидные противовоспалительные лекарственные средства, производные салициловой кислоты, глюкокортикостероидные гормоны); </li>\r\n<li>хронические заболевания органов ЖКТ (цирроз, хронический панкреатит); </li>\r\n<li>давление на слизистую оболочку объемных новообразований, локализующихся в подслизистом слое; острая гипоксия (травмы, массивные ожоги, коматозное состояние); </li>\r\n<li>обширные оперативные вмешательства (продукция соляной кислоты, одного из факторов агрессии, в течение 10 дней после операции возрастает до 4 раз); </li>\r\n<li>выраженный диабетический кетоацидоз; </li>\r\n<li>профессиональные вредности (соли тяжелых металлов, пестициды, пары лакокрасочных материалов, ароматические углеводороды). </li>\r\n</ul>",
"pathogenesis": "<p>Развитие пептической язвы происходит по 2 основным механизмам: </p>\r\n<ol>\r\n<li>агрессивного действия соляной кислоты на слизистую оболочку, в результате повышенной кислотности. Попадание в двенадцатиперстную кишку кислого желудочного содержимого, приводит к воспалению участков её слизистой, и образование дефекта в виде язвы; </li>\r\n<li>инфекционный фактор (Helicobacter Pylori), бактерия обладающая сродством к эпителию органов пищеварительной системы (желудок, двенадцатиперстная кишка). Инфекции Helicobacter Pylori попадая в пищеварительный тракт, может оставаться в течение многих лет, закрепляясь своими жгутиками к стенке слизистой, не вызывая ни каких клинических проявлений. По мере размножения, происходит выделение бактерией вредных веществ, которые приводят к смерти клеток слизистой двенадцатиперстной кишки, с последующим развитием дефекта. Так же, Helicobacter Pylori повышает кислотность, с помощью выделения аммиака. </li>\r\n</ol>",
"diagnostics": "<p>Обследование включает: </p>\r\n<ul>\r\n<li>Клинический анализ крови. Клинический анализ крови при неосложненном течении язвенной болезни чаще всего остается без существенных изменений. Иногда отмечается незначительное повышение содержания гемоглобина и эритроцитов, но может обнаруживаться и анемия, свидетельствующая о явных или скрытых кровотечениях. Лейкоцитоз и ускорение СОЭ встречаются при осложненных формах язвенной болезни. </li>\r\n<li>Анализ кала на скрытую кровь. </li>\r\n<li>Исследование кислотообразующей функции желудка, которое проводится с помощью внутрижелудочной рН-метрии (в последние годы — с помощью суточного мониторирования внутрижелудочного рН). При язвах двенадцатиперстной кишки и пилорического канала обычно отмечаются повышенные (реже — нормальные) показатели кислотной продукции. </li>\r\n<li>Рентгенологический метод исследования. При рентгенологическом исследовании обнаруживаются рубцово-язвенная деформация луковицы двенадцатиперстной кишки, желудка, нарушения гастродуоденальной моторики. </li>\r\n<li>Эндоскопический метод исследования. Эндоскопическое исследование подтверждает наличие язвенного дефекта, уточняет его локализацию, глубину, форму, размеры, позволяет оценить состояние дна и краев язвы, выявить сопутствующие изменения слизистой оболочки. </li>\r\n<li>Биопсия с последующим гистологическим исследованием полученного материала. Данное исследование дает возможность исключить злокачественный характер язвенного поражения. </li>\r\n<li>Исследования наличия в слизистой оболочке желудка Helicobacter pylori. </li>\r\n<li>Электрогастроэнтерография и антродуоденальная манометрия — позволяют выявить нарушения гастродуоденальной моторики. </li>\r\n</ul>",
"treatment": "<p>Все больные язвенной болезнью, должны обязательно соблюдать режим питания, придерживаться диеты, по возможности исключить нервные стрессы, отказаться от алкогольных напитков и курения. Еда для больных язвенной болезнью должна быть мелко измельчённой (не грубой), тёплой (не горячей и не холодной), не солённой, не жирной и не острой. Больной должен питаться около 5 раз в день, маленькими порциями, общая суточная калорийность, должна составлять около 2000 ккал. Еда должна быть, в варёном виде или приготовленная на пару. </p>\r\n<p>Группы медикаментов, которые используются для лечения язвы: </p>\r\n<ul>\r\n<li>Антибиотики, применяются с целью эрадикации (уничтожения) хеликобактерной инфекции; </li>\r\n<li>Для устранения боли путём снижения секреции соляной кислоты применяются: </li>\r\n</ul>\r\n<ol>\r\n<li>Препараты висмута, обладают как вяжущим механизмом для слизистой желудка, так и бактерицидным действием против Helicobacter Pylori; </li>\r\n<li>Ингибиторы протоновой помпы; </li>\r\n<li>Ингибиторы Н2 – рецепторов. </li>\r\n</ol>\r\n<ul>\r\n<li>Препараты, устраняющие боль, путём образования защитной плёнки на слизистой оболочке (антациды). </li>\r\n</ul>\r\n<p>В ряде экстренных случаев, таких как перфорация язвы, сильное желудочно-кишечное кровотечение, непроходимость пилорического канала, прибегают к оперативному лечению. В данном случае проводят два вида операций: </p>\r\n<ol>\r\n<li>Ваготомия — пересечение нервов, стимулирующих желудочную секрецию и приводящих к рецидивам язвенной болезни. </li>\r\n<li>Резекция желудка — это удаление 2/3 желудка и соединение оставшейся его части с кишечником, зачастую при проведении резекции выполняют также ваготомию. </li>\r\n</ol>",
"prevention": "<p>Меры профилактики развития язвенной болезни: </p>\r\n<ul>\r\n<li>своевременное выявление и лечение хеликобактерной инфекции; </li>\r\n<li>нормализация режима и характера питания; </li>\r\n<li>отказ от курения и злоупотребления алкоголем; </li>\r\n<li>контроль за принимаемыми лекарственными средствами; </li>\r\n<li>гармоничная психологическая обстановка, избегание стрессовых ситуаций. </li>\r\n</ul>",
"clinical_picture": "<p>У детей и лиц пожилого возраста течение язвенной болезни иногда практически бессимптомное либо с незначительными проявлениями. Такое течение чревато развитием тяжелых осложнений, таких как перфорация стенки ДПК с последующим перитонитом, скрытое кровотечение и анемия. Типичная клиническая картина язвенной болезни – это характерный болевой синдром. </p>\r\n<p>Боль чаще всего умеренная, тупая. Выраженность боли зависит от тяжести заболевания. Локализация, как правило, в эпигастрии, за грудиной. Иногда боль может быть разлитой в верхней половине живота. Возникает зачастую ночью (в 1-2 часа) и после продолжительных периодов без приема пищи, когда желудок пуст. После приема пищи, молока, антацидных препаратов наступает облегчение. Но чаще всего боль возобновляется после эвакуации содержимого желудка. </p>\r\n<p>Боль может возникать по несколько раз в день на протяжении нескольких дней (недель), после чего самостоятельно проходить. Однако с течением времени без должной терапии рецидивы учащаются, и интенсивность болевого синдрома увеличивается. Характерна сезонность рецидивов: обострения чаще возникают весной и осенью. </p>\r\n<p>Основные осложнения язвы – это пенетрация, перфорация, кровотечение и сужение просвета кишки. </p>\r\n<p>Язвенное кровотечение возникает, когда патологический процесс затрагивает сосуды желудочной стенки. Кровотечение может быть скрытым и проявляться только нарастающей анемией, а может быть выраженным, кровь может обнаруживаться в рвоте и проявляться при дефекации (черный или с кровавыми прожилками кал). </p>\r\n<p>Перфорация язвы приводит к проникновению содержимого пищеварительного тракта в брюшную полость и воспалению брюшины – перитониту. При прободении обычно возникает резкая режуще-колющая боль в эпигастрии, которая быстро становится разлитой, усиливается при смене положения тела, глубоком дыхании. Определяются симптомы раздражения брюшины (Щеткина-Блюмберга) – при надавливании на брюшную стенку, а потом резком отпускании боль усиливается. Перитонит сопровождается лихорадкой. </p>\r\n<p>Пенетрация язвы – это глубокий дефект, поражающий стенку пищеварительного тракта с проникновением в смежные органы Проявляется интенсивной болью колющего характера, которая может локализоваться в правом или левом подреберье, иррадиировать в спину в зависимости от месторасположения пенетрации. брПри изменении положения боль усиливается. </p>\r\n<p>Стеноз возникает при выраженном отеке изъязвленной слизистой или формировании рубца. При сужении просвета возникает непроходимость (полная или частичная). Зачастую она характеризуется многократной рвотой. В рвотных массах может определяется пища, принятая задолго до приступа. Также из симптоматики характерна тяжесть в желудке (переполнение), отсутствие стула, вздутие живота. Регулярная рвота способствует снижению массы тела и обменным нарушениям, связанным с недостаточностью питательных веществ.</p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 77,
"published": 2,
"parent": null,
"block_rubric": 111,
"standards": []
},
{
"id": 7323,
"symptoms": [],
"alternative_names": [],
"complications": [],
"medicine_branches": [],
"who": [
{
"id": 13013,
"gender": 2,
"diseased": 45605,
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