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},
"code": "R64",
"name": "Кахексия",
"icd_name": "Кахексия",
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3
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"lead": "Крайняя степень истощения организма, для которой характерно резкое исхудание, общая слабость, снижение активности физиологических процессов, расстройства психики",
"description": "Выделяют 2 формы кахексии:\r\nПервичную (экзогенная) — при низком поступлении пищи в организм или в том случае, если ее энергетическая и питательная ценность низки;\r\nВторичную (эндогенная) — является осложнением различных заболеваний.\r\n",
"etiology": "<p><a href=\"/symptom/otkaz_ot_pischi/\" title=\"Перейти на страницу симптома Отказ от пищи\">Голодание</a> или длительное <a href=\"/symptom/snizhenie_appetita/\" title=\"Перейти на страницу симптома Снижение аппетита\">недоедание</a>, поражения пищевода, болезни органов желудочно-кишечного тракта, психогенная <a href=\"/symptom/anoreksiya/\" title=\"Перейти на страницу симптома Анорексия\">анорексия</a>, длительная интоксикация при хронических инфекционных болезнях, амилоидоз, истощающие диффузные заболевания соединительной ткани, тяжелая сердечная недостаточность, злокачественные опухоли, эндокринные заболевания с нарушением обмена энергии, болезни щитовидной железы.</p>",
"pathogenesis": "<p><a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">Кахексия</a> приводит не только к упадку сил, она меняет реакцию на лечение и ухудшает переносимость, что фатально сказывается на продолжительности жизни. При потере за полгода не более 5% массы тела, сопровождающейся патологическим отвращением к пище и признаками воспаления, предполагается прекахексия. О системной воспалительной реакции можно говорить при температуре выше 38 °C или ниже 36 °C, тахикардии от 90 ударов, учащённом дыхании, лейкоцитах выше 12 тысяч или ниже 4 тысяч. Только на стадии прекахексии лечением можно остановить потерю мышечной массы, что изменит ближайшую судьбу больного. При потере более 5% массы со всеми указанными признаками говорят о собственно кахексии. Это же состояние возникает у больного с изначально низким весом при утрате только 2% массы тела. Дальнейшее не просто снижение, а форменное <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">истощение</a> с невозможностью встать с постели или из-за слабости проводить в ней более половины дня, безответное применение противоопухолевой терапии — уже рефрактерная <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">кахексия</a>.</p>",
"diagnostics": "<p>Чаще всего диагноз «<a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">кахексия</a>» можно установить только по внешнему виду пациента, настолько очевидны проявления кахексии при простом визуальном осмотре. Сбор анамнеза помогает уточнить сроки и стадию заболевания, тяжесть поражения организма. Для более точной оценки степени изменений производят стандартные лабораторные обследования: общий и биохимический анализы крови, общий анализ мочи (при необходимости – бакпосев мочи для исключения сепсиса), лабораторные и инструментальные методы обследования для выявления основного заболевания и его тяжести (рентген, УЗИ, МРТ, КТ, гастроскопия). При необходимости к обследованию могут привлечены и другие специалисты – гастроэнтеролог, кардиолог, гинеколог, невропатолог, психиатр, эндокринолог, онколог.</p>",
"treatment": "<p>Направлено на основное заболевание и должно включать мероприятия по восстановлению питания больного и обеспечению тщательного ухода.</p>\r\n<p> </p>\r\n<p>В рацион вводится пища, богатая белками, жирами, витаминами, предпочтительно употреблять легкоусваиваемые продукты. При нарушениях переваривания и всасывания пищи назначают полиферментные препараты. В тяжелых случаях парентерально вводят растворы глюкозы, электролитов, витамины, белковые гидролизаты, аминокислотные смеси. По показаниям применяют анаболические гормоны.</p>",
"prevention": "<p>Профилактика кахексии сводится к своевременному и адекватному лечению заболеваний, на фоне которых может развиться <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">кахексия</a>. При чрезмерном употреблении алкоголя и приеме наркотиков необходимо лечение от этих зависимостей. </p>",
"clinical_picture": "<p>Резко выраженная <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, утрата трудоспособности, <a href=\"/symptom/anormalnaya_poterya_vesa/\" title=\"Перейти на страницу симптома Анормальная потеря веса\">резкое похудание</a>, признаки обезвоживания, могут наблюдаться безбелковые отеки подкожной клетчатки.</p>\r\n<p> </p>\r\n<p>В тяжелых случаях потеря массы достигает 50 % и более. Кожа бледная или землисто-серая, дряблая, морщинистая. Отмечаются трофические изменения волос и ногтей. Развивается стоматит, нередко выпадают зубы, отмечаются упорные запоры. Понижается половая функция, у женщин наступает аменорея. Уменьшается объем циркулирующей крови, АД обычно снижено.</p>",
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"code": "R75",
"name": "Лабораторное обнаружение вируса иммунодефицита человека [ВИЧ]",
"icd_name": "Лабораторное обнаружение вируса иммунодефицита человека [ВИЧ]",
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"slug": "r75_laboratornoe_obnaruzhenie_virusa_immunodeficita_cheloveka_vich",
"lead": "Нарушение здоровья, относящееся к группе отклонения от нормы, выявленные при исследовании крови, при отсутствии установленного диагноза",
"description": "ВИЧ-инфекция представляет собой заболевание, вызываемое вирусом иммунодефицита человека, характеризующееся синдромом приобретенного иммунодефицита, способствующего возникновению вторичных инфекций и злокачественных образований в связи с глубоким угнетением защитных ",
"etiology": "<p>ВИЧ-инфекцию вызывает вирус иммунодефицита человека, относящийся к семейству ретровирусов </p>\r\n<p>ВИЧ – нестойкий вирус. Быстро погибает вне организма носителя, чувствителен к воздействию температуры (снижает инфекционные свойства при температуре 56 °С, погибает через 10 минут при нагревании до 70-80 °С). Хорошо сохраняется в крови и ее препаратах, подготовленных для переливания. Антигенная структура вируса весьма изменчива. </p>\r\n<p>Резервуаром и источником ВИЧ-инфекции является человек: страдающий СПИД и носитель. Вирус содержится в высоких концентрациях в крови, сперме, секрете вагинальных желез и менструальных выделениях. Может выделяться из женского молока, слюны, слезного секрета и ликвора, но эти биологические жидкости представляют меньшую эпидемиологическую опасность. </p>",
"pathogenesis": "<p>ВИЧ поражает клетки крови человека, имеющие на своей поверхности CD4-рецепторы: Т-лимфоциты, макрофаги и дендритные клетки. . Инфицированные вирусом Т-лимфоциты гибнут из-за разрушения вирусом, апоптоза или уничтожения цитотоксическими Т-лимфоцитами. После того, как число CD4+ T-лимфоцитов становится ниже 200 в одном микролитре крови, система клеточного иммунитета перестает защищать организм </p>\r\n<p>Первое время организм компенсирует массовую гибель иммунных клеток, вырабатывая новые, со временем компенсация становится недостаточной, количество лимфоцитов и макрофагов в крови значительно снижается, иммунная система разрушается, организм становится беззащитен как по отношению к экзогенной инфекции, так и к бактериям, населяющим органы и ткани в норме (что ведет к развитию оппортунистических инфекций). Кроме того, нарушается механизм защиты от размножения дефектных бластоцитов - злокачественных клеток. </p>\r\n<p>Заселение вирусом иммунных клеток часто провоцирует различные аутоиммунные состояния, в частности характерны неврологические расстройства в результате аутоиммунного поражения нейроцитов, которые могут развиться даже раньше, чем проявится клиника иммунодефицита. </p>",
"diagnostics": "<p>В настоящее время существуют следующие методы диагностики ВИЧ: косвенные тесты позволяют обнаружить специфические антитела к ВИЧ, которые имеются почти у 100 % ВИЧ-инфицированных; прямые тесты определяют собственно ВИЧ, антигены ВИЧ или нуклеиновые кислоты ВИЧ (вирусная нагрузка). </p>\r\n<p>Вирусную нагрузку(число молекул геномной РНК ВИЧ в мл крови) напрямую связывают со скоростью снижения количества CD4+ лимфоцитов, эта характеристика является важным прогностическим показателем на ранних стадиях заболевания </p>\r\n<p>Для определения антител к ВИЧ, необходимо использовать, по крайней мере, два разных теста: предварительный тест (скрининг-тест) и подтверждающий тест. Большинства современных скрининг-тестов основываются на иммуноферментом анализе (ИФА) или сходных методах; они обладают высокой чувствительностью (до 99 %) и специфичностью (до 99,5 %). </p>\r\n<p>Методы экспресс-анализа основаны на методах реакция агглютинации, ИФА на полимерных мембранах (тест-полоски), иммунологическом фильтрационном анализе и иммунохроматографии. Экспресс-тесты дают результат в течение 15—30 минут. </p>\r\n<p>Подсчёт CD4+ лимфоцитов является критическим параметром в мониторинге ВИЧ-инфекции и позволяет оценивать состояние иммунной системы и склонность к развитию СПИД. </p>",
"treatment": "<p>До настоящего времени не разработано лечения ВИЧ-инфекции, которое могло бы устранить вирус иммунодефицита человека из организма. Современная высокоактивная антиретровирусная терапия замедляет прогрессирование ВИЧ-инфекции и её переход в стадию СПИД, позволяя ВИЧ-инфицированному человеку жить полноценной жизнью. </p>\r\n<p>На сегодняшний день преимущественным этиотропным лечением является назначение препаратов, снижающих репродуктивные способности вируса. Антиретровирусную терапию следует начинать у пациентов с ВИЧ-инфекцией независимо от клинической стадии заболевания, при любом количестве клеток СД4, в том числе всем ВИЧ-инфицированным беременным женщинам. </p>\r\n<p>Лечение ВИЧ-инфицированных включает общеукрепляющие и поддерживающие организм средства (витамины и биологически активные вещества) и методики физиотерапевтической профилактики вторичных заболеваний. </p>",
"prevention": "<p>В настоящее время Всемирная организация здравоохранения проводит общие профилактические мероприятия по снижению заболеваемости ВИЧ-инфекцией по четырем основным направлениям: </p>\r\n<p>просвещение в вопросах безопасности половых отношений, распространение презервативов, лечение заболеваний, передающихся половым путем, пропагандирование культуры половых взаимоотношений; </p>\r\n<p>контроль над изготовлением препаратов из донорской крови; </p>\r\n<p>ведение беременности ВИЧ-инфицированных женщин, обеспечение их медицинской помощи и предоставление им средств химиопрофилактики (в последнем триместре беременности и в родах женщины получают антиретровирусные препараты, которые также на первые три месяца жизни назначаются новорожденным детям); </p>\r\n<p>организация психологической и социальной помощи и поддержки ВИЧ-инфицированных граждан, консультирование. </p>\r\n<p>В настоящее время в мировой практике особое внимание уделяют таким эпидемиологически важным в отношении заболеваемости ВИЧ-инфекцией факторам, как наркомания, беспорядочная половая жизнь. В качестве профилактической меры во многих странах производится бесплатная раздача одноразовых шприцов, метадоновая заместительная терапия. В качестве меры, способствующей снижению половой неграмотности, в учебные программы вводятся обучающие половой гигиене курсы. </p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период, время от момента заражения ВИЧ до появления симптоматики, называют серологическим окном. Сывороточные реакции на вирус иммунодефицита отрицательны: специфические антитела ещё не определяются. Средняя продолжительность инкубации составляет 12 недель; сроки могут сокращаться до 14 дней при сопутствующих ЗППП, туберкулёзе, общей астении, либо увеличиваться до 10-20 лет. В течение всего периода пациент опасен как источник ВИЧ-инфекции. </p>\r\n<p>Стадия первичных проявлений характеризуется проявлением реакции организма на активную репликацию вируса в виде клиники острой инфекции и иммунной реакции (выработка специфических антител). Вторая стадия может протекать бессимптомно, единственным признаком развивающейся ВИЧ-инфекции будет положительная серологическая диагностика на антитела к вирусу. </p>\r\n<p>Клинические проявления второй стадии протекают по типу острой ВИЧ-инфекции. Начало острое, отмечается у 50-90% пациентов спустя три месяца после момента заражения, зачастую предшествуя формированию ВИЧ-антител. Острая инфекция без вторичных патологий имеет довольно разнообразное течение: могут отмечаться лихорадка, разнообразные полиморфные высыпания на кожных покровах и видимых слизистых оболочках, увеличение лимфатических узлов, боль в горле, увеличение селезенки, диарея. </p>\r\n<p>Острая ВИЧ-инфекция обычно длится от нескольких дней до нескольких месяцев, в среднем 2-3 недели, после чего в подавляющем большинстве случаев переходит в латентную стадию. </p>\r\n<p>Латентная стадия характеризуется постепенным нарастанием иммунодефицита. Гибель иммунных клеток на этой стадии компенсируется их повышенным производством. В это время диагностировать ВИЧ можно с помощью серологических реакций (в крови присутствуют антитела к ВИЧ). Клиническим признаком может быть увеличение нескольких лимфатических узлов из разных, не связанных между собой групп, исключая паховые лимфоузлы. При этом других патологических изменений со стороны увеличенных лимфоузлов (болезненность, изменения окружающих тканей) не отмечается. Латентная стадия может продолжаться от 2-3 лет, до 20 и более. В среднем она длиться 6-7 лет.</p>",
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}
]
}
