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"code": "E06",
"name": "Тиреоидит",
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"age_min": 25,
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"slug": "e06_tireoidit",
"lead": "Воспаление неизмененной щитовидной железы.",
"description": "<p>Тиреоидит представляет собой большую категорию новообразований в щитовидной железе, сопровождающихся воспалительными процессами. Наиболее частным видом тиреоидита является хроническое течение.</p>",
"etiology": "<p>Острый гнойный тиреоидит развивается на фоне острого или хронического инфекционного процесса (тонзиллит, пневмония, сепсис и др.).</p>\r\n<p> </p>\r\n<p>Острый негнойный тиреоидит может развиться после травмы, кровоизлияния в щитовидную железу, лучевой терапии.</p>\r\n<p> </p>\r\n<p>Подострый тиреоидит развивается после вирусных инфекций (ОРВИ, Коксаки, инфекционный паротит и др.). Заболевают чаще женщины в возрасте 30-50 лет.</p>\r\n<p> </p>\r\n<p>Аутоиммунный хронический тиреоидит заболевание, в основе которого лежит аутоиммунное поражение щитовидной железы, образуются антитела к различным компонентам щитовидной железы (в норме антитела в организме человека вырабатываются только на чужеродное вещество). Это наиболее часто встречающееся воспалительное заболевание щитовидной железы. Чаще всего аутоиммунный тиреоидит встречается у пациентов от 40 до 50 лет, причем у женщин в десять раз чаще, чем у мужчин. И в последнее время аутоиммунным тиреоидитом страдает все больше пациентов молодого возраста и детей.</p>\r\n<p> Причина хронического фиброзного тиреоидита неизвестна. Есть версия о том, что зоб Риделя это конечная стадия аутоиммунного тиреоидита. Риск развития заболевания имеют люди, у которых наблюдались базедова болезнь или любые формы эндемического зоба.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p>Лабораторная и инструментальная диагностика.</p>",
"treatment": "<p>Острый тиреоидит требует приема антибиотиков, препаратов с витамином C и витаминами группы B, а так же лекарств, которые устраняют симптоматическое проявление болезни. Если имеется абсцесс острого гнойного тиреодита, то неизбежно оперативное вмешательство с целью удаления гнойного накопления. В процессе операции абсцесс вскрывается и из него удаляется весь гной. После этого воспаленное место обрабатывается антибиотиком и закрывается повязкой.</p>\r\n<p>Хронический фиброзный тиреоидит, сопровождающийся возникновением гипотиреоза, требует назначения заместительной терапии препаратами синтетических гормонов щитовидной железы. При обнаружении сдавливания дыхательной трахеи пациенту проводится хирургическая операция.</p>\r\n<p>Подострый тиреоидит лечится длительным приемом препаратов категории «кортикостероиды», лекарств салицилового комплекса при снижении дозы кортикостероидных лекарств. При обнаружении гипертиреоза назначаются медикаменты, которые способны уменьшить количество тиреоидных гормонов в крови больного. При выявлении гипотиреоза назначаются препараты, содержащие тиреоидные гормоны.</p>\r\n<p>Хронический аутоиммунный тиреоидит требует применения препаратов с содержанием тиреоидных гормонов. Если узловой зоб не уменьшается при проведении заместительной терапии в течение 4-х месяцев, то врач может назначить сильные гормональные препараты типа преднизолон, который необходимо принимать не менее 3-х месяцев. Только после этого периода можно снижать ежедневную дозу и постепенно полностью отказываться от препарата. При динамично развивающемся заболевании с болезненными проявлениями и быстрым ростом опухоли требуется незамедлительное хирургическое вмешательство с целью отсечения больной ткани щитовидной железы.</p>",
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"clinical_picture": "<p>Острый гнойный тиреоидит: боль в области передней поверхности шеи, отдающая в затылок, нижнюю и верхнюю челюсть, усиливающаяся при движении головы, глотании. Увеличение шейных лимфатических узлов. Повышение температуры тела, озноб.</p>\r\n<p> Острый негнойный тиреоидит: проявления менее выражены, чем при остром гнойном воспалении щитовидной железы.</p>\r\n<p> Подострый тиреоидит: боль в области шеи, отдающая в затылочную область, нижнюю челюсть, уши, височную область, головная боль, слабость, снижение двигательной активности, повышение температуры тела. В начале заболевания (гипертиреоидная, острая стадия) могут наблюдаться симптомы тиреотоксикоза: учащение сердечных сокращений, потливость, похудание, тремор рук. В крови - повышенные уровни гормонов щитовидной железы. При длительном течении могут развиться симптомы гипотиреоза (гипотиреоидная стадия), сонливость, вялость, заторможенность, зябкость, отечность лица, сухость кожи, урежение сердечных сокращений, запоры. Щитовидная железа увеличена (часто только правая доля), плотная, болезненная. В крови - низкое содержание гормонов щитовидной железы. <br />В стадии выздоровления исчезает болезненность щитовидной железы, уровни гормонов щитовидной железы.</p>\r\n<p> Заболевание склонно к рецидивированию (возврату), особенно при повторных вирусных инфекциях, переохлаждении.</p>\r\n<p> Хронический фиброзный тиреоидит: диффузное (распространенное), реже очаговое увеличение щитовидной железы. Железа очень плотная, неподвижная, не смещается при глотании.</p>\r\n<p> Прогрессирование и распространение процесса на всю железу сопровождается развитием гипотиреоза. При больших размерах железы наблюдаются симптомы сдавления органов шеи: осиплость голоса, затруднение глотания, дыхания.</p>\r\n<p> Аутоиммунный хронический тиреоидит: в течение первых лет заболевания жалобы и симптомы, как правило, отсутствуют. В дальнейшем, диффузное, иногда неравномерное увеличение щитовидной железы, плотная, подвижная. При больших размерах железы появляются симптомы сдавления органов шеи. По мере развития заболевания изменения, разрушающие щитовидную железу, приводят к нарушению функции железы - вначале явлениям гипертиреоза вследствие поступления в кровь большого количества ранее выработанных гормонов, в дальнейшем (или минуя гипертиреоидную фазу) - к гипотиреозу. Содержание тиреоидных гормонов в крови снижено. В диагностике большое значение имеют определение титра антитиреоидных антител антител против собственной щитовидной железы.</p>\r\n<p> </p>",
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},
"code": "E11",
"name": "Инсулиннезависимый сахарный диабет",
"icd_name": "Инсулиннезависимый сахарный диабет",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
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"slug": "e11_insulinnezavisimyy_saharnyy_diabet",
"lead": "хроническое заболевание, вызванное абсолютным дефицитом инсулина вследствие недостаточной его выработки поджелудочной железой, приводящее к стойкой гипергликемии и развитию осложнений",
"description": "Диабет 2 типа составляет 85—90 % от всех типов сахарного диабета и наиболее часто развивается у людей старше 40 лет, и, как правило, ассоциирован с ожирением. Заболевание прогрессирует медленно. Для него характерны второстепенные симптомы, кетоацидоз развивается редко. С течением времени развиваются осложнения: микро- и макроангиопатия, нефро- и нейропатия, ретинопатия и другие",
"etiology": "<p>Генетический фактор – имеет полигенный тип наследования, обусловленный множественными генетическими дефектами, вызывающими диабет или предрасположенность к нему. Возможная причина – изменение уровня экспрессии генов, контролирующих секрецию инсулина и его действие на ткани – мишени. Для развития диабета требуется воздействие внешних факторов: возраст после 40 лет, <a href=\"/symptom/ozhirenie/\" title=\"Перейти на страницу симптома Ожирение\">ожирение</a>, употребление высококалорийной пищи с легко усвояемыми углеводами, переедание, <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">Тревожность</a> \">стресс</a>, смена образа жизни.</p>\r\n<p> </p>\r\n<p>Группа абсолютного риска: однояйцовый близнец, партнер которого болен сахарным диабетом (достигает 100 % в течение всей жизни); дети, у которых оба родителя больны сахарным диабетом; дети, у которых один из родителей болен сахарным диабетом, а по линии другого больны родственники; матери, родившие мертвого ребенка, у которого обнаружена гиперплазия островковой ткани поджелудочной железы.</p>\r\n<p> </p>\r\n<p>Группа относительного риска: страдающие ожирением, распространенным атеросклерозом, гипертонической болезнью, хроническим панкреатитом, почечным диабетом, женщины с отягощенным акушерским анамнезом.</p>",
"pathogenesis": "<p>В поджелудочной железе нарушается секреция инсулина в виде качественных, кинетических, количественных изменений (снижение количества и дисфункции β-клеток).</p>\r\n<p> </p>\r\n<p>В периферических тканях, которые резистентны к инсулину (печень, жировая и мышечная ткань), происходит нарушение транспорта и метаболизма глюкозы.</p>\r\n<p> </p>\r\n<p>В печени повышается продукция глюкозы вследствие глюконеогенеза в связи с дефицитом инсулина и избытка глюкагона. Наблюдается нарушение чувствительности печени к инсулину, повышение свободных жирных кислот и лактата, отсутствие снижения продукции глюкозы печенью в связи с сокращением ранней фазы секреции инсулина и недостаточным снижением секреции глюкагона, отсутствие снижения продукции глюкозы ночью.</p>",
"diagnostics": "<p>На основании клиники (симптомов диабета), лабораторных данных (уровень глюкозы в плазме натощак > 7,0 ммоль/л не менее чем в двух исследованиях в разные дни, уровень глюкозы в плазме или капиллярной крови через 2 ч после приема глюкозы в дозе 75 г (детям 1,75 г/кг массы тела, но не больше 75 г), 7,8–11,1 ммоль/л. В норме уровень глюкозы в крови составляет 3,3–5,5 г/л).</p>",
"treatment": "<p>Диетотерапия – ограничение или устранение из диеты легкоусвояемых углеводов (сладостей, меда, шоколада), обеспечение организма физиологическими количествами белков, жиров, углеводов, витаминов. Рекомендуются продукты, богатые клетчаткой, при артериальной гипертонии ограничить употребление соли.</p>\r\n<p> </p>\r\n<p>Суточный калораж рассчитывается с учетом должной массы тела. При компенсированном сахарном диабете 60 % суточного калоража должно покрываться углеводами, 24 % – жирами, 16 % – белками. Режим распределения суточного калоража: завтрак – 25 % суточной калорийности, второй завтрак – 10–15 % суточной калорийности, обед – 25–30 % суточной калорийности, полдник – 5–10 % суточной калорийности, ужин – 20–25 % суточной калорийности, второй ужин – 5–10 % суточной калорийности.</p>\r\n<p> </p>\r\n<p>1 хлебная единица = 12 г углеводов = 48–50 ккал.</p>\r\n<p> </p>\r\n<p>Физические нагрузки должны быть индивидуальными с учетом возраста больного, рекомендуются регулярные прогулки по 30 мин вместо езды на машине, подъем по лестнице, плавание по 1 ч 3 раза в неделю. Однако нужно помнить, что интенсивные физические нагрузки вызывают острое гипогликемическое состояние. При гликемии выше 13–15 ммоль/л физические нагрузки не рекомендуются.</p>\r\n<p> </p>\r\n<p>Пероральные сахароснижающие препараты: препараты сульфонилмочевины, бигуаниды, тиазолидиндионы, меглитиниды и производные фенилаланина, ингибиторы L-глюкозидазы.</p>\r\n<p> </p>\r\n<p>Инсулинотерапия назначается при неэффективности диеты и пероральных сахароснижающих препаратов. Дозы инсулина рассчитывает врач-эндокринолог.</p>",
"prevention": "",
"clinical_picture": "<p>Начало заболевания постепенное, без ярких симптомов нарушения обменных процессов, поэтому диагностируется случайно при обращении к врачу по поводу кожного зуда, зуда половых органов, фурункулеза, грибковых заболеваний (чаще после 40 лет) у лиц, страдающих ожирением. Жалобы на жажду, полиурию, полидипсию, <a href=\"/symptom//\" title=\"Перейти на страницу симптома Снижение массы тела\">снижение массы тела</a> отсутствуют или выражены слабо. </p>",
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"image_alt": "Поджелудочная железа",
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"parent": null,
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4753,
4833,
5096,
5359,
5403,
5423
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}
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3,
0
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}
]
}
