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"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;\">Язвенный проктит является тяжелой формой острого проктита и обычно возникает при высокой интенсивности повреждающего воздействия либо при сочетании нескольких этиологических причин и предрасполагающих условий. Заболевание многофакторное, может возникать вследствие следующих причин:</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;\">Погрешности питания. Язвенный проктит, возникший вследствие нарушений пищевого режима, называется алиментарным. Эта форма воспаления может развиться при злоупотреблении крепкими алкогольными напитками, жирной пищей, копченостями, острыми, пряными и солеными продуктами.</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;\">Хронический запор. Провоцирует застойные язвенные проктиты. Непосредственной причиной развития воспаления в подобных случаях становятся постоянные повреждения нижних отделов толстого кишечника слишком плотными фекальными массами. Нарушения питания и застой кала часто сочетаются между собой или становятся отягчающими факторами, провоцирующими развитие язвенного проктита при других повреждающих воздействиях.</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;\">Механические травмы прямой кишки. Иногда язвенный проктит возникает после механической травмы (анального полового акта, введения в анус твердых или шершавых предметов, повреждения слизистой случайно проглоченными инородными телами), а также после операций по поводу трещины заднего прохода, геморроя и парапроктита.</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;\">Повреждение слизистой раздражающими веществами. Язвенный проктит может развиваться после клизм с использованием веществ, раздражающих и повреждающих стенку кишки: хлоридом калия, борной кислотой, йодом, гипертоническим раствором карловарской или поваренной соли. Дополнительными травмирующими факторами в подобных случаях становятся злоупотребление клизмами, использование слишком горячих или слишком холодных растворов.</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;\">Воздействие паразитов и инфекционных агентов. Иногда заболевание диагностируется на фоне дизентерии либо паразитарных инфекций. Особенно опасен в этом отношении власоглав (возбудитель трихоцефалеза), внедряющийся в стенку кишки. Кроме того, язвенный проктит может обнаруживаться при некоторых специфических инфекциях, например – при гонорейном поражении прямой кишки.</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. Язвенные поражения кишки могут быть следствием чрезмерно интенсивного облучения области малого таза у пациентов с онкологической патологией. Чаще всего тяжелые язвенные проктиты диагностируются у больных раком тела и шейки матки. При злокачественных опухолях других органов малого таза язвы на слизистой оболочке образуются реже.</span></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;\">В числе факторов, способствующих развитию язвенного проктита, специалисты указывают иммунные нарушения, переохлаждение и воспалительные заболевания органов малого таза.</span></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>",
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"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;\">Диагноз язвенный проктит выставляется по результатам консультации проктолога, используются данные опроса, осмотра заднего прохода, ректального исследования, эндоскопию, биопсии и анализов кала. При опросе обращают внимание на факторы, способные спровоцировать развитие язвенного проктита (лучевое лечение, травмы прямой кишки, хронические запоры и пр.), давность появления симптомов и особенности течения заболевания.</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;\">Визуальный осмотр. При осмотре области ануса на начальных стадиях обнаруживают спазм, а в последующем – чрезмерное расслабление сфинктера. При отсутствии заболеваний заднего прохода перианальная зона в первые дни болезни не изменена. В последующем из-за зияния сфинктера у больных язвенным проктитом может выявляться загрязнение кожи калом, кровью, гноем и слизью с развитием мацерации. Ректальное исследование подтверждает наличие отека прямой кишки.</span></li>\r\n<li><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;\">Эндоскопия прямой кишки. Наиболее информативной методикой при язвенном проктите является ректороманоскопия, позволяющая визуально оценить выраженность и распространенность воспаления, количество, размеры и глубину язв. При проведении эндоскопического исследования осуществляют биопсию.</span></li>\r\n<li><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;\">Лабораторные тесты. Для определения причин развития язвенного проктита назначают копрограмму, анализы кала на бакпосев и на яйца глист. При подозрении на специфическую инфекцию (гонорею, сифилис) выполняют ПЦР и ИФА-диагностику, пациента направляют на консультацию к венерологу.</span></li>\r\n</ul>\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;\">Лечение проводится в стационарных условиях. Пациента, страдающего язвенным проктитом, госпитализируют в отделение проктологии. Назначают постельный режим. Исключают из меню продукты, оказывающие раздражающее действие на стенку кишки. Рекомендуют отварное мясо и рыбу, бульон, рисовую и манную кашу на воде, кисели и отвары с обволакивающим действием (из подорожника либо семян льна). Осуществляется:</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;\">Этиотропная терапия. При лучевом язвенном проктите прекращают лучевое лечение. При кишечных инфекциях назначают антибактериальные препараты, при гельминтозах – антигельминтные средства.</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;\">Местная терапия. Используют теплые клизмы с настоем ромашки, рыбьим жиром, маслом облепихи, протарголом или колларголом. Применяют местные средства с обезболивающим, противовоспалительным и регенерирующим действием: свечи с прополисом, свечи с метилурацилом.</span></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;\">В процессе лечения язвенного проктита назначают повторные эндоскопические исследования для контроля за состоянием слизистой оболочки. В остром периоде хирургическое вмешательство показано только при перфорации кишки. При возникновении рубцовых стриктур в отдаленном периоде осуществляют соответствующую терапию (физиотерапевтические процедуры, введение гормонов, расширение бужами Гегара), при неэффективности консервативных мероприятий рубцовую ткань иссекают.</span></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>",
"prevention": "<p><span id=\"docs-internal-guid-105b0809-7fff-8d5e-a3d2-90e74a26eba0\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Профилактика заключается в рациональном питании, своевременном опорожнении кишечника, предупреждении травм и повреждений слизистой, элиминации паразитов.</span></span></p>",
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"etiology": "<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;\">Псевдополипоз ободочной кишки характеризуется появлением бляшек различного размера и формы, выступающих над поверхностью стенки в просвет кишечника. Причиной образования таких бляшек становятся повреждения слизистой при воспалительных заболеваниях кишечника (неспецифическом язвенном колите, болезни Крона) и некоторых инфекционных поражениях ЖКТ (чаще всего при дизентерии). При болезни Крона псевдополипоз ободочной кишки выявляется гораздо реже, чем при неспецифическом язвенном колите, что обусловлено различиями в течении и преимущественной локализации воспалительного процесса при этих двух заболеваниях.</span></p>",
"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;\">Узлы при псевдополипозе ободочной кишки могут представлять собой сохранившиеся участки нормальной слизистой оболочки, окруженные язвами и очагами поверхностного некроза. Такие выросты также могут образовываться в результате разрастания железистого эпителия при восстановлении слизистой. Под разрастаниями иногда обнаруживаются островки соединительной ткани. В некоторых случаях псевдополипоз ободочной кишки возникает в результате образования избыточных грануляций. В формировании узлов могут играть роль не только изъязвления слизистой, но и растяжения стенки кишечника при перистальтических движениях, травмы воспаленной слизистой твердыми каловыми массами и т. д.</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;\">Количество и размеры псевдополипов при псевдополипозе ободочной кишки существенно варьируют. У одних больных выявляются единичные узлы, у других – множественные образования, покрывающие значительную часть слизистой оболочки сигмовидной кишки. Средний диаметр узла при псевдополипозе ободочной кишки составляет 5-10 миллиметров, при этом отдельные псевдополипы могут достигать 5 и более сантиметров. С учетом внешнего вида узлов различают обычные псевдополипы, образования в форме шапочки и глубокий кистозно-полипозный колит.</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;\">Псевдополипоз ободочной кишки диагностируется на основании эндоскопических исследований. В процессе ректороманоскопии или колоноскопии врач изучает состояние слизистой, выявляет изъязвления и другие изменения, характерные для неспецифического язвенного колита и других заболеваний, способных спровоцировать псевдополипоз ободочной кишки. Эндоскопист оценивает количество, размер и форму псевдополипов, берет образцы ткани узлов и соседних участков слизистой оболочки для морфологического исследования.</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 процессе изучения морфологической структуры образований, возникающих у больных псевдополипозом ободочной кишки, определяется неизмененный эпителий, разрастания эпителия или грануляционная ткань. При исследовании слизистой оболочки, пораженной язвенным колитом выявляются расширенные капилляры, кровоизлияния, язвы и крипт-абсцессы. Подслизистый слой обычно изменен незначительно. Слизистая оболочка кишечника у пациентов с болезнью Крона грубая, бугристая, по внешнему виду напоминает «булыжную мостовую».</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;\">Ирригоскопия при псевдополипозе ободочной кишки малоинформативна, поскольку позволяет обнаруживать только достаточно крупные псевдополипы и при этом не дает возможности оценивать форму узлов, состояние и общий вид слизистой оболочки. Компьютерная томография обеспечивает более точные результаты, но, как и контрастная рентгенография, не предоставляет врачу достаточно информации для дифференцировки псевдополипоза ободочной кишки и других заболеваний, сопровождающихся появлением дефектов наполнения на рентгенограммах. Обе методики применяют только при недоступности эндоскопических исследований или наличии противопоказаний к проведению ректороманоскопии и колоноскопии.</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;\">Тактику лечения псевдополипоза ободочной кишки определяют в зависимости от вида и степени тяжести основной патологии. При неспецифическом язвенном колите рекомендуют полноценное сбалансированное питание, в периоды обострения назначают иммуносупрессоры, глюкокортикоидные средства и препараты 5-аминосалициловой кислоты. При псевдополипозе ободочной кишки с выраженными нарушениями водно-электролитного обмена проводят инфузионную терапию. По показаниям применяют антибиотики. При неэффективности консервативной терапии, дисплазии слизистой оболочки, ярко выраженных внекишечных проявлениях и осложнениях неспецифического язвенного колита (мегаколоне, перфорации сигмовидной кишки, кишечном кровотечении, озлокачествлении участка измененной слизистой оболочки) осуществляют хирургические вмешательства.</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;\">Терапия псевдополипоза ободочной кишки при болезни Крона также предусматривает использование глюкокортикоидов, иммуносупрессоров, препаратов 5-аминосалициловой кислоты и антибиотиков. Дополнительно назначают блокаторы фактора некроза опухоли, блокаторы интегриновых рецепторов, витамин D и гипербарическую оксигенацию. При осложнениях проводят операции. Неспецифический язвенный колит и болезнь Крона являются хроническими заболеваниями с рецидивирующим течением. Пациентам необходимы регулярные осмотры и поддерживающая терапия в период ремиссии.</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;\">При псевдополипозе ободочной кишки, обусловленном дизентерией и другими кишечными инфекциями, назначают специальную диету, проводят этиотропную терапию с использованием противомикробных препаратов, осуществляют дезинтоксикационные мероприятия. Прогноз при данной патологии определяется типом и особенностями течения основного заболевания. Больные с псевдополипозом ободочной кишки находятся под наблюдением врача-проктолога и гастроэнтеролога.</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 основе профилактики – предупреждение травмирования и развития воспалительных процессов в ободочной кишке. Конкретными мероприятиями являются:</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;\">аккуратное выполнение всех манипуляций на ободочной кишке, чтобы предотвратить травмирование ее слизистой оболочки; </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;\">своевременное выявление и лечение неспецифического язвенного колита, болезни Крона и дизентерии – заболеваний, на фоне которых чаще всего и возникает псевдополипоз ободочной кишки, а также других предрасполагающих болезней; </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;\">предупреждение возникновения запоров и формирования каловых камней – для этого следует в первую очередь отрегулировать питание.</span></li>\r\n</ul>",
"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;\">Специфическая симптоматика псевдополипоза ободочной кишки отсутствует. Пациенты предъявляют жалобы, характерные для основного заболевания. При неспецифическом язвенном колите наблюдаются поносы. Возможен кашицеобразный стул с примесями слизи, крови и гноя. Больных псевдополипозом ободочной кишки беспокоят частые ложные позывы и боли в левой половине живота. Отмечаются слабость, нарушения аппетита и потеря веса. Выраженность гипертермии зависит от тяжести патологии, температура тела может колебаться от 37 до 39 градусов. Иногда выявляются внекишечные симптомы: боли в суставах, анкилозирующий спондилит (болезнь Бехтерева), афтозный стоматит, увеит, узловатая эритема и пр.</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;\">Для псевдополипоза ободочной кишки при болезни Крона также характерны боли в животе, расстройства стула, потеря аппетита, снижение массы тела, слабость и гипертермия различной степени выраженности. Обнаруживаются те же внекишечные проявления, что и при неспецифическом язвенном колите. Отличительными особенностями псевдополипоза ободочной кишки при болезни Крона являются склонность к образованию рубцовых сужений просвета кишечника, более высокая частота развития осложнений (кишечной непроходимости, кишечного кровотечения, перфорации толстой кишки) и нарушения со стороны печени и почек. При дизентерийном псевдополипозе ободочной кишки наблюдаются острое начало, общие симптомы интоксикации и выраженные кишечные расстройства (многократный понос, урчание, схваткообразные боли, патологические примеси в кале).</span></p>",
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},
"code": "K56.2",
"name": "Заворот кишок",
"icd_name": "Заворот кишок",
"gender": 0,
"age_min": 40,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "k56.2_zavorot_kishok",
"lead": "один из видов кишечной непроходимости, при котором происходит закручивание одного из отделов кишечника вокруг своей оси или вокруг оси брыжейки",
"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;\">Чтобы произошел поворот, должны возникнуть нетипичные, форс-мажорные обстоятельства. Это могут быть внутренние и внешние причины:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">физические: травма живота, удар об воду, резкий поворот тела, вынужденная непривычная поза, сдавление, сотрясение, подъем тяжестей;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">пищевые:</span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> переедание, особенно после длительного голодания, употребление незнакомой экзотической пищи, большое количество трудноперевариваемой клетчатки в рационе, продолжительный голод;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">органические: спаечные процессы, пупочная грыжа, новообразования, нарушение иннервации кишечника вследствие поражения центральной нервной системы, беременность;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">химические: отравление свинцом или лекарственными препаратами.</span></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;\">При анализе данных о пациентах были выявлены факторы, увеличивающие вероятность возникновения перекручивания кишок:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">возраст старше 55 лет (заворот сигмовидной кишки часто возникает у пациентов старше 60 лет, ободочной и слепой кишки – после 50 лет);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">регулярные запоры или поносы;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">малоподвижный образ жизни;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">тяжелый физический труд;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">фанатичная приверженность различным системам голодания для похудения, нерегулярное питание;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">переедание, особенно перед сном.</span></li>\r\n</ul>",
"pathogenesis": "<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;\">Перекрут петель кишки вокруг брыжейки вызывает сдавливание сосудов и нервов, из-за чего нарушается питание и иннервация кишечника. Перистальтика сначала усиливается, а затем возникает парез приводящего отдела кишечника - развивается механическая кишечная непроходимость.</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;\">Подтвердить или опровергнуть кишечную непроходимость по причине заворота кишечника можно при помощи:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">рентген контрастного исследования с барием;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">ультразвуковой диагностики;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">эндоскопии;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">лапароскопии;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">лабораторной диагностики.</span></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;\">Специализированных лабораторных тестов нет, но общий анализ и биохимия крови могут показать глубину интоксикации и воспалительного процесса. </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;\">В начале диагностического поиска пациент может находиться в отделении гастроэнтерологии, однако после постановки диагноза он должен быть переведен в отделение абдоминальной хирургии. Консервативную терапию и подготовку к операции начинают с введения назогастрального зонда для разгрузки кишечника, выведения застойного содержимого и газов. Целью инфузионной терапии является восстановление жидкостного баланса, водно-электролитного равновесия крови, уровня белка. Антибактериальная терапия обязательна, если подозревается перитонит или сепсис – её начинают немедленно после госпитализации больного в стационар, если же данные осложнения исключены – за два часа до операции.</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;\">Заворот тонкого кишечника лечится исключительно оперативным путем. Во время операции хирург должен попытаться расправить перекрут петель, при наличии некроза кишок производится сегментарная резекция тонкой кишки, наложение анастомоза тонкой кишки в тонкую или толстую. Если же во время операции выявляется перитонит – накладывается илеостома, через три месяца производится реконструктивная операция. Операция при завороте слепой кишки преследует своей целью проведение гемиколэктомии с наложением межкишечного анастомоза либо илеостомы (при наличии воспалительного экссудата в брюшной полости). У ослабленных больных может быть проведена чрескожная тифлостомия – она позволит улучшить состояние кишечника, стабилизировать пациента.</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;\">Терапию заворота сигмовидной кишки предпочтительно начинать с ректороманоскопии или колоноскопии, во время которых в сигмовидную кишку вводят гибкую трубку для разгрузки кишечника. При необходимости после декомпрессии производится радикальная операция, показаниями к которой являются острый заворот сигмовидной кишки, отсутствие эффекта от консервативной терапии. После операции необходимо продолжить массивную антибактериальную и инфузионную терапию, осуществлять наблюдение за пациентом для раннего выявления осложнений: присоединение инфекции, несостоятельность швов на кишке, образование межкишечных абсцессов и свищей, развитие генерализованной инфекции.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-5394b655-7fff-aecf-39ae-5fc830ccf9b1\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для профилактики требуется контроль назначения и приема психотропных и слабительных средств, препаратов, усиливающих или замедляющих перистальтику кишечника. Количество грубых пищевых волокон в рационе должно быть достаточным, но не избыточным. После оперативных вмешательств в обязательном порядке должна проводиться профилактика образования спаек.</span></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;\">Симптомы по степени их появления и нарастания:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">острая, схваткообразная боль в животе;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">в течение суток боль становится постоянной и труднопереносимой, может дойти до состояния шока;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">асимметрия контуров живота, вздутие;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">тошнота, многократная рвота (может быть с желчью, а в тяжелых случаях с запахом или примесью кала);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">слабость, бледность, низкое артериальное давление, учащенный пульс;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">головная боль, головокружение, возможно спутанное сознание (и другие признаки интоксикации);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">обезвоживание (сухие и потрескавшиеся губы, вязкая слюна, тусклая кожа);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">отсутствие дефекации.</span></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;\">Патология развивается быстро и состояние больного стремительно ухудшается. Летальный исход возможен в течение 2–3 суток, если не будет оказана экстренная медицинская помощь.</span></p>",
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