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},
"code": "A07.1",
"name": "Жиардиаз [лямблиоз]",
"icd_name": "Жиардиаз [лямблиоз]",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"2",
"7"
],
"periodicity": 1,
"slug": "a07.1_zhiardiaz_lyamblioz",
"lead": "заболевание, вызываемое простейшими - лямблиями, паразитирующими в тонкой кишке человека",
"description": "<p>Лямблиоз - это <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">инфекция тонкого кишечника, вызываемая одноклеточным простейшим паразитом лямблией.</span></p>",
"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;\">Заражение человека происходит оральным путем. Лямблии попадают в организм, преимущественно, при несоблюдении правил гигиены – грязные руки, употребление некипяченой воды, немытых овощей и фруктов в пищу. Переносчиками лямблий являются мухи, потому одной из эффективных мер профилактики лямблиоза остается истребление этих насекомых в помещении.</span></p>\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;\">После попадания цисты лямблии в организм человека, она превращается в трофозоит (активная форма размножения), начинает размножаться в огромных количествах, заселяя слизистую тонкой кишки (на 10 кв. см может находиться до 1 млн лямблий и более). Параллельно идет обратный процесс: превращение трофозоита в цисту. У цист нет способа прикрепиться к слизистой, поэтому они сразу выходят в толстую кишку и выводятся с фекалиями, длительно сохраняя жизнеспособность во внешней среде.</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;\">Попадая в пищеварительный тракт, цисты лямблий достигают 12-перстной кишки, где превращаются в вегетативные формы. Здесь, а также в проксимальном отделе тощей кишки лямблии прикрепляются к ворсинкам эпителия, вызывая механическое повреждение энтероцитов, раздражение нервных окончаний стенки тонкой кишки, нарушение процесса всасывания. Следствием этих процессов служит развитие воспаления ЖКТ. </span></p>\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;\">Доказано, что в процессе жизнедеятельности лямблии выделяют токсин, обладающий тропностью к нервной ткани, что объясняет угнетающее действие на нервную систему. Вследствие сенсибилизации организма при лямблиозе могут развиваться различные аллергические проявления.</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;\">С учетом причины заболевания и имеющихся симптомов врач может назначить следующие виды обследования:</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;\">общий и биохимический анализы крови;</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;\">общий анализ кала;</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;\">копрограмму;</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;\">ИФА на антиген в кале;</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;\">микроскопическое исследование кала;</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;\">специфические пробы ДНК.</span></li>\r\n</ul>",
"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;\">Лямблиоз требует комплексного поэтапного, часто длительного лечения. В схему терапии могут входить следующие меры:</span></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;\">1. Соблюдение диеты, создающей неблагоприятные условия для размножения лямблий (прежде всего, ограничение потребления углеводов — сладостей, мучного).</span></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;\">2. Этиотропное лечение противопротозойными средствами.</span></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;\">3. Прием желчегонных средств, проведение очистительных тюбажей.</span></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;\">4. Назначение энтеросорбентов, ферментативных препаратов, антигистаминных средств.</span></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;\">5. Устранение кишечного дисбактериоза с помощью пробиотиков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">6. Иммуномодулирующая терапия, прием поливитаминных комплексов.</span></p>",
"prevention": "<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;\">соблюдение личной гигиены (тщательное мытье рук перед едой и приготовлением пищи, после туалета и возвращения с улицы);</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;\">употребление гарантированно безопасной воды и напитков (кипяченая вода, напитки в фабричной упаковке);</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;\">употребление в пищу термически обработанных продуктов, тщательное мытье овощей, фруктов, ягод, зелени и других продуктов, их обработка кипятком перед едой;</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;\">обследование и лечение цистоносителей и больных лямблиозом. Это особенно актуально для членов семьи, где выявлен больной лямблиозом и для детских коллективов.</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;\">Кли­ничес­кая кар­ти­на лям­бли­оза разно­об­разна. Те­чение за­боле­вания за­висит от свой­ств па­рази­та и защитной ре­ак­ции ор­га­низ­ма. В большинс­тве слу­ча­ев ин­фекция протека­ет бес­сим­птом­но. За­боле­вание мо­жет на­чать­ся вне­зап­но или с постепен­но уси­лива­ющи­мися жалобами (при­мер­но 1-3 не­дели пос­ле за­раже­ния). В за­виси­мос­ти от поражён­ной об­ласти же­лудоч­но-кишечно­го трак­та и им­мунно­го ста­туса па­ци­ен­та кар­ти­на сим­пто­мов ме­ня­ет­ся.</span></p>\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;\">На­ибо­лее рас­простра­нен­ны­ми симптомами яв­ля­ют­ся бо­ли в жи­воте (обыч­но пос­ле еды) и ди­арея (различной сте­пени тя­жес­ти). Мо­жет до­мини­ровать ре­ак­ция со сто­роны верхних от­де­лов ЖКТ — тош­но­та, рвота, от­рыжка, взду­тие жи­вота, высыпа­ния на ко­же. Ос­трая ста­дия болез­ни длит­ся око­ло не­дели с частыми ре­циди­вами. Хро­ничес­кий лям­бли­оз не всег­да име­ет ос­трую фа­зу за­боле­вания. Ди­арея воз­ни­ка­ет ред­ко, ча­ще па­ци­ен­ты жа­лу­ют­ся на жид­кий стул, по­вышен­ный ме­те­оризм с запахом се­ры, по­терю ве­са. В слу­чае по­раже­ния жел­чно­го пу­зыря мо­жет воз­никнуть жел­ту­ха. Хро­ничес­кое заболе­вание вы­зыва­ет на­руше­ние всасыва­ния, обез­во­жива­ние, по­терю ве­са, за­дер­жку рос­та у де­тей, в крайних слу­ча­ях, ле­таль­ный ис­ход.</span></p>",
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},
"code": "N97.9",
"name": "Женское бесплодие неуточненное",
"icd_name": "Женское бесплодие неуточненное",
"gender": 2,
"age_min": 20,
"age_max": 45,
"cause": [
"0"
],
"periodicity": 1,
"slug": "n97.9_zhenskoe_besplodie_neutochnennoe",
"lead": "заболевание, характеризующееся невозможностью здоровой половозрелой сексуально активной женщины, не пользующейся контрацепцией, добиться беременности в течение одного года",
"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;\">К самым частым причинам развития данной патологии относятся воспалительные заболевания органов малого таза, чаще всего вызванные инфекциями, передающимися половым путем (гонококком, генитальным герпесом, уреаплазмой, микоплазмой, хламидией, гарднереллой, бледной спирохетой, трихомонадой, цитомегаловирусом). Проникновение возбудителя инфекции в женские родовые пути вызывает развитие хронических и острых воспалительных (часто гнойных) заболеваний.</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;\">Следующей причиной могут стать оперативные вмешательства в области органов малого таза и кишечника, которые также могут привести к появлению спаек в матке и маточных трубах.</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;\">Заболевания половых органов, вызванные различными возбудителями, зачастую протекают субклинически, то есть с малым количеством симптомов и жалоб у больных, поэтому диагноз выставляется на поздних стадиях, когда болезнь приобретает хроническое течение.</span></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 этом случае заболевания трудно поддаются лечению, ведут к возникновению поражений эндометрия, формированию спаечного процесса в матке и маточных трубах, изменяя их анатомическую структуру, и влекут за собой бесплодие.</span></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;\">Причиной хронического инфекционного процесса могут стать бактерии, которые активизируются в случае ослабления организма женщины (к этому ведут хронический стресс, неправильное питание и т.д.). Туберкулезное поражение маточных труб, например, протекает практически бессимптомно, ведет к формированию спаек в маточных трубах и невозможности прохождения по ним яйцеклетки, оперативное лечение в таких случаях малоэффективно.</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;\">К структурным патологиям матки, «ответственным» за развитие бесплодия, относятся миомы, особенно располагающиеся таким образом, что нарушается проходимость устья фаллопиевых (маточных) труб. К этой же группе причин относится изменение состава слизи шейки матки (в результате гормонального дисбаланса или воспаления), полипы эндометрия, дисплазия шейки матки, эндометриоз.</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;\">Систему, контролирующую процесс оплодотворения яйцеклетки, можно ограничить тремя уровнями: гипоталамус – гипофиз - яичники, работающими по принципу обратной связи. Патология любого звена (опухоли головного мозга, локализующиеся в гипофизе, гипоталамусе или сдавливающие эти две структурные области, заболевания яичников опухолевого и неопухолевого характера) ведет к выводу из строя всего каскада гормональных реакций, протекающих в норме. Щитовидная железа, гормоны коры надпочечников, быстрое изменение количества жировой ткани (резкое похудение или, наоборот, набор веса) также влияют на развитие нормального овуляторного цикла.</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;\">Еще одна причина – так называемое иммунологическое бесплодие. Когда иммунная система женщины реагирует на сперму партнера как на чужеродное и опасное для организма явление, начинается выработка антиспермальных антител, препятствующих оплодотворению.</span></p>",
"pathogenesis": "",
"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;\">Большое значение при диагностике бесплодия уделяется ультразвуковому исследованию органов малого таза, благодаря которому можно выявить множество нарушений строения половых органов. С его помощью диагностируют эндометриоз, нарушения строения яичников, наличие и размеры фолликула и яйцеклетки и другие заболевания. Очень важно не терять данные УЗИ, даже если во время него не выявлено никакой патологии.</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;\">Лапароскопия при диагностике бесплодия представляет собой операцию, во время которой с помощью инструмента, оснащенного оптикой, исследуются органы малого таза. Есть два вида лапароскопии: диагностическая и оперативная.</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;\">Гистеросальпингография (ГСГ) представляет собой рентгенологическое исследование матки и труб, которое позволяет получить объективную информацию об их состоянии, дает возможность оценить проходимость и функциональное состояние маточных труб, рельеф и размеры слизистой матки.</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;\">Гистероскопия представляет собой осмотр стенок полости матки с использованием гистероскопа, при необходимости с последующим проведением как диагностических, так и оперативных манипуляций.</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;\">Ректальная температура (РТ) позволяет объективно оценить функцию яичников на протяжении длительного периода времени. Ее необходимо измерять на протяжении 2-3 циклов непрерывно, в том числе включая дни менструации. Также следует определить, происходит ли у женщины овуляция каждый месяц. Она может отслеживать это в домашних условиях:</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;\">с помощью теста на овуляцию (продается в аптеках и магазинах);</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;\">запись текстуры цервикальной слизи в течение нескольких месяцев;</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;\">запись изменений температуры тела с утра (базальной температуры тела) на протяжении нескольких месяцев.</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;\">Гормональный фон женщины исследуется с помощью комплексной сдачи крови на определение уровня следующих гормонов: тестостерон, пролактин, Т3, Т4, ТТГ, кортизол, эстрадиол, ДГЭА-С. С помощью полученных результатов является возможным определение момента наступления овуляции и пропорциональное соотношение гормонов, которые отвечают за наступление беременности.</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>",
"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;\">Решение вопроса о лечении бесплодия принимается после получения и оценки результатов всех проведенных обследований и установления причин, его вызвавших. Обычно лечение начинают с устранения первостепенной причины бесплодия. Лечебные методики, применяемые при женском бесплодии, направлены на: восстановление репродуктивной функции пациентки консервативными или хирургическими методами; применение вспомогательных репродуктивных технологий в случаях, если естественное зачатие невозможно.</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 эндокринной форме бесплодия проводится коррекция гормональных расстройств и стимуляция яичников. К немедикаментозным видам коррекции относятся нормализация веса (при ожирении) путем диетотерапии и увеличения физической активности, физиотерапия. Основным видом медикаментозного лечения эндокринного бесплодия является гормональная терапия. Процесс созревания фолликула контролируется с помощью ультразвукового мониторинга и динамики содержания гормонов в крови. При правильном подборе и соблюдении гормонального лечения у 70-80% пациенток с этой формой бесплодия наступает беременность.</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 трубно-перитонеальной форме бесплодия целью лечения является восстановление проходимости маточных труб при помощи лапароскопии. Эффективность этого метода в лечении трубно-перитонеального бесплодия составляет 30-40%. При длительно существующей спаечной непроходимости труб или при неэффективности ранее проведенной операции, рекомендуется искусственное оплодотворение. На эмбриологическом этапе возможна криоконсервация эмбрионов для их возможного использования при необходимости повторного ЭКО.</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 случаях маточной формы бесплодия – анатомических дефектах ее развития - проводятся реконструктивно-пластические операции. Вероятность наступления беременности в этих случаях составляет 15-20%. При невозможности хирургической коррекции маточного бесплодия (отсутствие матки, выраженные пороки ее развития) и самостоятельного вынашивания беременности женщиной прибегают к услугам суррогатного материнства, когда подсадка эмбрионов осуществляется в матку прошедшей специальный подбор суррогатной матери.</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;\">Бесплодие, вызванное эндометриозом, лечится с помощью лапароскопической эндокоагуляции, в ходе которой удаляются патологические очаги. Результат лапароскопии закрепляется курсом медикаментозной терапии. Процент наступления беременности составляет 30-40%.</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 иммунологическом бесплодии обычно используется искусственное оплодотворение путем искусственной инсеминации спермой мужа. Этот метод позволяет миновать иммунный барьер цервикального канала и способствует наступлению беременности в 40% случаях иммунного бесплодия. Лечение неустановленных форм бесплодия является наиболее сложной проблемой. Чаще всего в этих случаях прибегают к использованию вспомогательных методов репродуктивных технологий. Кроме того, показаниями к проведению искусственного оплодотворения 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;\">трубная непроходимость или отсутствие маточных труб;</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;\">состояние после проведенной консервативной терапии и лечебной лапароскопии по поводу эндометриоза;</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;\">безуспешное лечение эндокринной формы бесплодия;</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;\">абсолютное мужское бесплодие;</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;\">истощение функции яичников;</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;\">некоторые случаи маточной формы бесплодия;</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;\">сопутствующая патология, при которой невозможна беременность.</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\"> </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\"> </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\"> </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;\">Основными методами искусственного оплодотворения 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;\">метод внутриматочной инсеминации донорской спермой или спермой мужа (ИИСД, ИИСМ);</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;\">метод экстракорпорального оплодотворения (ЭКО);</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;\">внутриклеточная инъекция сперматозоида внутрь яйцеклетки (метод ИКСИ, ИМСИ);</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;\">использование донорской яйцеклетки или донорского эмбриона;</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;\">суррогатное материнство.</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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<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;\">Специфической профилактики бесплодия не существует, но можно предотвратить приводящие к нему заболевания. Для этого нужно соблюдать следующие правила:</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;\">ежегодно посещать гинеколога;</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;\">до планирования беременности использовать презервативы, которые помогут избежать заражения инфекциями и станут профилактикой абортов;</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;\">своевременно лечить воспалительные заболевания и инфекции, передающиеся половым путём;</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;\">соблюдать правила личной гигиены;</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;\">не курить и ограничить употребление алкоголя;</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;\">нормализовать менструальную функцию с помощью препаратов, назначенных врачом;</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;\">контролировать вес тела;</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;\">исключить чрезмерные физические и психоэмоциональные нагрузки;</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;\">вести регулярную половую жизнь.</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;\">При планировании беременности важно правильно питаться и поддерживать нормальный вес (индекс массы тела от 19 до 30)</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;\">Основной признак бесплодия у женщин — это отсутствие беременности при регулярной половой жизни без применения методов контрацепции. Также бесплодие проявляется симптомами тех заболеваний, из-за которых беременность не наступает.</span></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 воспалительных заболеваниях и инфекционных процессах:</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;\">неприятные выделения из половых путей;</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;\">боли в животе;</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;\">зуд и дискомфорт в наружных половых органах;</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;\">повышение температуры тела.</span></li>\r\n</ul>\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 миоме матки и эндометриозе:</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;\">боли внизу живота и при половых актах;</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;\">обильные менструации;</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;\">нарушения менструального цикла — менструации продолжительностью более 7 дней и чаще, чем через 21 день;</span></li>\r\n</ul>\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 гормональной дисфункции и заболеваниях органов, вырабатывающих гормоны:</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;\">нарушения менструального цикла;</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;\">перерывы между менструациями более 35 дней или отсутствие менструаций.</span></li>\r\n</ul>\r\n<p><span id=\"docs-internal-guid-3d8b5225-7fff-d2f3-8ff6-5132e226ade2\"> </span></p>",
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},
"code": "N97",
"name": "Женское бесплодие",
"icd_name": "Женское бесплодие",
"gender": 2,
"age_min": 14,
"age_max": 50,
"cause": [
0
],
"periodicity": 1,
"slug": "n97_zhenskoe_besplodie",
"lead": "проявляется отсутствием наступления беременности на протяжении 2-х лет и более у женщины, живущей регулярной половой жизнью",
"description": "",
"etiology": "<p>Бесплодность, может быть:</p>\r\n<ul>\r\n<li>\r\n<p>первичной – беременность ни разу не наступала (врожденные гинекологические аномалии) или (осложнения на женских половых органах) до или после менархе (первый цикл);</p>\r\n</li>\r\n<li>\r\n<p>вторичной, после первой успешной беременности, невозможность повторного оплодотворения, может быть абсолютной (неизлечимой) или относительной (излечимой).</p>\r\n</li>\r\n</ul>\r\n<p>В отдельных источниках, посвященных исследованиям физиологии и патофизиологии женской половой сферы, понятие дополняется следующими видами инфертильности.</p>\r\n<ul>\r\n<li>\r\n<p>Физиологическая. Нормой является <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> раннего возраста (до полового созревания), и постклимактерическое <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> (после менопаузы).</p>\r\n</li>\r\n<li>\r\n<p>Добровольная. Иначе называют осознанно выбранное <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> – использование (медикаментозных) препаратов или физических (спираль, другое) средств.</p>\r\n</li>\r\n<li>\r\n<p>Временная. Может быть результатом длительного стресса, ослабления организма после или в период заболевания, некоторые авторы к временному бесплодию относят лактационную аменорею - торможение овуляции в ранний период регулярного грудного кормления.</p>\r\n</li>\r\n<li>\r\n<p>Постоянная. Удаление женских половых органов, полное или частичное, является результатом хирургического вмешательства.</p>\r\n</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>В первую очередь, женщине назначат УЗИ органов малого таза, анализы на инфекции и бактериологические посевы на влагалищную флору, проверят гормональный профиль, выяснят нет ли проблем с иммунологической совместимостью партнеров.</p>\r\n<p>Дополнительные методы исследования: гистеросальпингографию и лапароскопию. Не исключено, что женщине понадобится консультация эндокринолога.</p>\r\n<p> </p>\r\n<p>Медицинские стандарты</p>\r\n<p>По медицинским стандартам, врач обязан поставить диагноз женщине не позднее, чем через шесть месяцев после начала обследования. Кстати, логичнее в первую очередь проверить на <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> партнера-мужчину, это займет меньше времени и обойдется намного дешевле, чем обследование женщины.</p>",
"treatment": "<p>Главная задача лечения бесплодия — устранить повреждения и болезни, которые к нему привели: выровнять гормональный фон, восстановить проходимость маточных труб, удалить опухоли, избавиться от эндометриоза и т.д. Поэтому выполняйте все назначения лечащего врача, не отказывайтесь от операций. После курса лечения естественное зачатие происходит, более чем у 60% женщин.</p>\r\n<p>Возможности медицины</p>\r\n<p>Если, несмотря на все усилия врачей, забеременеть так и не получилось, не отчаивайтесь. Современная медицина дает женщинам шанс забеременеть даже в этом случае. Нужно обратиться в клинику, где используются методы искусственного оплодотворения.</p>\r\n<p>Для женщин, у которых отсутствуют или непроходимы маточные трубы, которые страдают поликистозом, эндометриозом и т.д. разработана методика ЭКО – экстракорпорального оплодотворения. Пациентке назначают препараты, усиливающие рост и созревание яйцеклеток. Затем через боковые своды влагалища специальной иглой вытаскивают полученные яйцеклетки и оплодотворяют их в пробирке сперматозоидами мужа или донора. Полученные эмбрионы на 3-5-ый день переносят в матку, а женщине назначают препараты, способствующие приживлению эмбрионов. Чаще всего в матку переносят не более трех эмбрионов.</p>\r\n<p>В последнее время у женщин до 35 лет применяют методику селекции эмбрионов (т.е. выбирают только один эмбрион, но очень высокого качества). Это позволяет избежать многоплодных беременностей. Данная методика используется только с согласия пациентов.</p>\r\n<p>В тех случаях, когда яйцеклетку получить невозможно, используется методика донации ооцитов. Женщине-донору проводят стимуляцию овуляции и она отдает свои клетки женщине-реципиенту. К сожалению, доноров ооцитов не так много, поэтому ими как правило становятся родственницы или знакомые реципиентки.</p>",
"prevention": "",
"clinical_picture": "<p>Важным признаком, указывающим на <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> у женщины, является невозможность забеременеть, в течение 2 лет и более, при наличии благоприятных условий для зачатия, а именно:</p>\r\n<ul>\r\n<li>\r\n<p>регулярные половые контакты;</p>\r\n</li>\r\n<li>\r\n<p>половой партнер с хорошей спермограммой;</p>\r\n</li>\r\n<li>\r\n<p>полный, длительный отказ от средств контрацепции;</p>\r\n</li>\r\n<li>\r\n<p>возраст женщины от 20 до 45 лет.</p>\r\n</li>\r\n</ul>\r\n<p><a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">Бесплодие</a> не имеет патогномоничного (ведущего) признака, часто протекает бессимптомно, или имеет косвенные симптомы. Признаки бесплодия устанавливают при сборе анамнеза, осмотра, физикальных, лабораторных, инструментальных исследований.</p>\r\n<p>Анамнез. Устанавливают явные симптомы, связанные с нарушением регулярных циклов: длительные, короткие, болезненные, обильные, с посторонними выделениями. Предположить <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> можно на основании, установления косвенных симптомов, характерных, инфекционным, неинфекционным и хирургическим заболеваниям.</p>",
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"parent": null,
"block_rubric": 156,
"standards": []
},
{
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"lead": "заболевание невоспалительной этиологии, в основе которого лежит скопление слизи внутри желчного пузыря из-за нарушения оттока его содержимого",
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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;\">Киста в желчном пузыре образуется при состояниях, связанных с нарушением оттока желчи из полости пузыря. В результате застоя желчи и постепенного всасывания её слизистой оболочкой происходит разрушение клеток, на ткани появляются рубцы, структура органа становится рыхлой. При этом наружная оболочка желчного пузыря не страдает, остается плотной. Со временем наблюдается увеличение размеров пораженного участка – появление кисты, внутри которой находятся жидкость и слизь.</span></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;\">Таким образом, основным фактором, провоцирующим развитие кисты в желчном пузыре, является застой желчи, который может быть связан со следующими состояниями:</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;\">врожденными дефектами желчного пузыря или пороками развития желудочно-кишечного тракта;</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;\">желчнокаменной болезнью – проток может быть перекрыт конкрементом;</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;\">беременностью – нарушение оттока желчи в данном случае связано с давлением растущей матки на желчный пузырь (так возникает киста желчного пузыря у женщин);</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;\">паразитарной инвазией – отток жидкости может быть заблокирован глистами;</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;\">полипом желчного пузыря;</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;\">хроническими воспалительными процессами в желчном пузыре или близлежащих органах (почке, поджелудочной железе, печени, желудке).</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "",
"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;\">При наличии кисты желчного пузыря довольно часто жалобы пациента скудные. Консультация гастроэнтеролога позволяет предположить данное заболевание, в случае значительного увеличения пузыря врач может его пропальпировать через переднюю брюшную стенку. Результаты лабораторных анализов при этой патологии в большинстве случаев не изменены.</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;\">Основная роль в диагностике кисты желчного пузыря принадлежит инструментальным методикам. УЗИ брюшной полости позволяет оценить размеры кисты, состояние стенок желчного пузыря, визуализировать конкременты. При проведении обзорной рентгенографии органов брюшной полости выявляется округлая тень желчного пузыря, рентгенконтрастные конкременты. При выполнении ретроградной холангиопанкреатографии желчный пузырь не контрастируется при заполнении протоковой системы.</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 детальной оценки состояния желчного пузыря, его стенок, выявления причины формирования кисты может быть проведена магнитно-резонансная томография органов брюшной полости, КТ желчевыводящих путей. При выполнении данных методов обследования определяется увеличенный желчный пузырь, неоднородность его содержимого, могут быть обнаружены конкременты непосредственно в пузыре либо в желчевыводящих путях, рубцовые стриктуры, опухоли, сдавливающие пузырный проток.</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;\">Высокоинформативный метод выявления кисты желчного пузыря – диагностическая лапароскопия. Врач-эндоскопист при проведении процедуры видит желчный пузырь, степень изменения его стенок, через которые просвечивает белесоватое содержимое. В ходе лапароскопии может быть сразу проведена холецистэктомия.</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;\">Тактика лечения кисты желчного пузыря зависит от ее размеров, причины формирования, наличия или отсутствия осложнений. При небольших размерах образования возможно консервативное лечение на фоне обязательного контроля размеров желчного пузыря. При наличии крупной кисты желчного пузыря, а также отсутствии эффекта от консервативной терапии проводится хирургическое лечение. Методом выбора является лапароскопическая холецистэктомия, возможно удаление желчного пузыря из мини-доступа или путем открытой холецистэктомии (в настоящее время такое оперативное вмешательство применяется редко, в основном при наличии осложнений). При удалении кисты желчного пузыря обязательно производится бактериологическое исследование ее содержимого, но в большинстве случаев бактериального воспаления нет.</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 своевременной диагностике и эффективном лечении прогноз при кисте желчного пузыря благоприятный. Бессимптомное течение заболевания может привести к значительному истончению стенок пузыря, его разрыву и развитию перитонита, поэтому при любых жалобах на боли в правом подреберье или диспепсические явления обязательно должна быть проведена консультация гастроэнтеролога и соответствующее обследование.</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;\">Специфической профилактики кисты желчного пузыря не существует. Важную роль играет здоровый образ жизни с рациональным питанием, своевременное лечение желчнокаменной болезни, а также регулярное наблюдение у специалиста при ЖКБ и других заболеваниях желчевыводящих путей.</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;\">Клинические симптомы кисты в желчном пузыре могут варьироваться. Если патология обусловлена рубцовыми стриктурами и внешним сдавлением пузырного протока, симптоматика чаще всего отсутствует до того момента, как пузырь достигнет значительных размеров.</span></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;\">Однако преимущественно формирование кисты желчного пузыря обусловлено желчнокаменной болезнью и печеночной коликой.</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;\">Незначительное увеличение желчного пузыря обычно не сопровождается существенным дискомфортом. Однако киста в желчном пузыре больших размеров проявляется более выраженной симптоматикой: болью в области правого подреберья, иррадиирущей в спину или правую лопатку. Как правило, боли отличаются тупым или ноющим характером, могут усиливаться, когда больной изменяет положение тела.</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;\">Кроме того, у пациентов с кистой желчного пузыря нарушаются пищеварительные процессы – их мучают тошнота, рвота, отрыжка с горьким вкусом. Неприятные симптомы усиливаются при приеме пищи, особенно жирной и жареной.</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;\">Отсутствие своевременного грамотного лечения грозит значительным истончением стенок желчного пузыря, в них могут формироваться микроперфорации, в результате чего содержимое кистозного образования попадает в брюшную полость.</span></p>\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;\">Наиболее тяжелое осложнение кисты желчного пузыря – её разрыв, при котором высока вероятность обильного кровотечения и развития перитонита.</span></p>",
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"lead": "заболевание, характеризующееся образованием камней в желчном пузыре и желчных протоках",
"description": "<p>Желчекаменная болезнь - это хроническое заболевание желчевыводящих путей, характеризующееся нарушением обмена веществ в организме и образованием камней.<span style=\"color: #444444; font-family: Inter, sans-serif; font-size: 16px; text-align: justify;\"><br /></span></p>",
"etiology": "<p>Желчнокаменная болезнь относится к весьма распространенным заболеваниям людей старше 40–50 лет. Женщины болеют приблизительно в 3 раза чаще мужчин. В большинстве своем камни образуются в желчном пузыре, реже – в общем желчном протоке и очень редко – в других протоках.</p>\r\n<p>В развитии холелитиаза имеют значение воспалительные процессы в желчевыводящей системе, изменение pH пузырной желчи, гидролиз конъюгатов билирубина и фосфолипидов, повышение концентрации кальция в желчи и повышение всасывания желчнокислых солей, заброс панкреатического сока в желчный пузырь с развитием воспаления и образованием желчных камней, выделение перенасыщенной холестерином желчи самой печенью. В развитии холестериновых камней большую роль играют характер питания (употребление высококалорийной, богатой углеводами и жирами пищи), малоподвижный образ жизни. Желчные камни нередко образуются при гемолизе, когда в желчь поступает большое количество желчных пигментов.</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;\">Желчь, синтезируемая клетками печени, по правому и левому долевым протокам попадает в общий печёночный проток. Далее через пузырный проток она временно откладывается в желчном пузыре. Во время приёма пищи желчный пузырь сокращается, и желчь по общему желчному протоку через большой дуоденальный сосок попадает в двенадцатиперстную кишку, где и связывается с пищей. Основная роль желчи - расщепление жиров.</span></p>\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;\">По различным причинам, чаще всего из просвета двенадцатиперстной кишки, в желчный пузырь попадают патогенные микроорганизмы, формируя «бактериальное ядро» будущего желчного камня. В связи с наличием в просвете желчного пузыря хронического инфекционного воспаления нарушается его сократительная функция. Желчь застаивается, способствуя увеличению числа конкрементов и их размеров. </span></p>",
"diagnostics": "<p>Основным способом диагностики желчнокаменной болезни является ультразвуковое исследование. При этом в просвете желчного пузыря определяются плотные эхоструктуры, перемещающиеся при изменении положения тела. Информативность метода составляет 96–98 %. Одним из важнейших методов диагностики является рентгенологическое исследование. Иногда желчные камни можно видеть на обзорной рентгенограмме. Во многих случаях камни обнаруживаются при холецистографии или холеграфии. Перспективным методом является ретроградная холангиография при помощи специального фиброскопа.</p>",
"treatment": "<p>Консервативное лечение проводят при отсутствии серьезных осложнений. Оно направлено на устранение нарушений моторной функции желчевыводящих путей, улучшение оттока желчи и уменьшение воспалительного процесса в билиарной системе.</p>\r\n<p>В период желчной колики назначают антиспастические средства. При длительном болевом синдроме и особенно при лихорадке показано назначение антибактериальных препаратов. Большое значение в лечении желчнокаменной болезни имеет диета (диета № 5) с исключением острых, жирных, соленых блюд. Лечение на курортах с минеральными водами, занятия лечебной физкультурой, физиопроцедуры дают благоприятный результат при умеренно выраженном болевом синдроме.</p>\r\n<p>Абсолютные показания к экстренному хирургическому лечению: местный или разлитой перитонит, угроза перфорации при деструктивной форме острого холецистита, эмпиема или водянка желчного пузыря, илеус на почве желчных камней.</p>",
"prevention": "<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">не практиковать длительное лечебное голодание; </span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">пить достаточно жидкости, не менее 1.5л в день;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">чтобы не спровоцировать движение камней, избегать работ, связанных с продолжительным пребыванием в наклонном положении;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">соблюдать диету, нормализовать массу тела;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">увеличить физическую нагрузку; </span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">питаться чаще, каждые 3-4 часа, чтобы вызывать регулярные опорожнения пузыря от накопившейся желчи;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">женщинам стоит ограничить поступление эстрогенов, данный гормон способствует образованию камней или их увеличению;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">полезно включать в ежедневный рацион небольшое количество (1-2ч.л.) растительного масла, лучше оливкового. Подсолнечное усваивается только на 80%, в то время как оливковое полностью. Поступление растительного жира стимулирует активность пузыря с желчью, в результате чего он получает возможность хотя бы раз в сутки опорожниться, предупреждая застойные явления и образование камней;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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 рацион питания стоит включить магний. Микроэлемент стимулирует моторику кишечника и выработку желчи, выводит холестерин. Кроме того, для выработки желчных ферментов необходимо достаточное поступление;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">отказаться от употребления кофе. Напиток стимулирует сокращение пузыря, что может вызвать закупорку протока и последующий приступ.</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<p>Клиническая картина зависит от локализации камней. Различают холецистолитиаз и холедохолитиаз. Остроболевая форма характеризуется возникающими с различными интервалами приступами типичной желчной колики. Боль локализуется в правом подреберье и эпигастрии, иррадиирует в спину справа, правое надплечье и правую руку. Во время болевого приступа определяются местная болезненность в правом подреберье и положительные желчнопузырные симптомы Кера и Мерфи, а также зоны гиперестезии Захарьина – Геда у правой реберной дуги и справа от IX–XI грудных позвонков. Иногда удается прощупать желчный пузырь (симптом Курвуазье). Наблюдаются симптомы раздражения брюшины. Нередки <a title=\"Перейти на страницу симптома Тошнота\" href=\"/symptom/toshnota/\">тошнота</a>, <a title=\"Перейти на страницу симптома Рвота\" href=\"/symptom/rvota/\">рвота</a>, <a title=\"Перейти на страницу симптома Метеоризм\" href=\"/symptom/meteorizm/\">метеоризм</a> и задержка стула. Присоединение инфекции проявляется повышением температуры тела и нейтрофильным лейкоцитозом. При торпидно-болевой форме наблюдаются длительные тупые боли, обычно в правом подреберье, усиливающиеся в связи с погрешностью в диете. При диспепсической форме преобладают диспепсии: плохая переносимость жирных блюд (билиарная <a title=\"Перейти на страницу симптома Диспепсия\" href=\"/symptom/dispepsiya/\">диспепсия</a>), иногда желчный <a title=\"Перейти на страницу симптома Диарея\" href=\"/symptom/diareya/\">понос</a>. Нередко на первый план выступает дискинезия кишечника с метеоризмом. Во многих случаях холелитиаз протекает бессимптомно.</p>",
"image": "http://api.symptomd.ru/storage/b1bd5b1229bf0053897f64f14c966f02_TxlG97P.png",
"image_alt": "Желчекаменная болезнь",
"standard_type": 0,
"danger": 31,
"published": 1,
"parent": null,
"block_rubric": 118,
"standards": []
}
]
}
