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"lead": "Нарушение здоровья, относящееся к группе симптомы и признаки, относящиеся к системе пищеварения и брюшной полости",
"description": "Тошнота – это субъективное ощущение человека, возникающее при появлении перистальтической активности желудка в ответ на какой-либо патологический (неприятный) раздражитель. Рвота - акт ускоренного удаления или опорожнения содержимого желудка при достижении этим раздражителем пороговых величин (интенсивности).",
"etiology": "<p>Причины рвоты могут быть следующие:</p>\r\n<ol>\r\n<li>Болезни ЖКТ:</li>\r\n</ol>\r\n<ul>\r\n<li>острые хирургические заболевания: перитонит, аппендицит, острый панкреатит, острая кишечная непроходимость, кровотечения в желудочно-кишечном тракте, острый холецистит;</li>\r\n<li>хронические заболевания: гастрит, язвенная болезнь желудка и двенадцатиперстной кишки, энтероколит, дуоденит, желчекаменная болезнь;</li>\r\n<li>аномалии развития органов ЖКТ: сужение привратника (стеноз), заращение участка желудочно-кишечного тракта (атрезия), дефекты развития поджелудочной железы;</li>\r\n<li>инфекции желудочно-кишечного тракта: вирусные поражения, пищевые токсикоинфекции, гельминтозы,</li>\r\n<li>инородные тела желудка, пищевода, кишечника,</li>\r\n<li>функциональные расстройства, которые сопровождаются нарушением двигательной функции кишечника, желудка.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Заболевания ЦНС:опухоли и травмы головного мозга, инфекции мозга (энцефалит, менингит), повышенное внутричерепное давление.</li>\r\n<li>Болезни сердечно-сосудистой системы:гипертоническая болезнь, сердечная недостаточность, инфаркт миокарда.</li>\r\n<li>Болезни внутреннего уха:болезнь Меньера, лабиринтит</li>\r\n<li>Болезни эндокринной системы:при сахарном диабете – кетоацидоз, тиреотоксикоз, недостаточность функции надпочечников, фенилкетонурия.</li>\r\n<li>Побочное действие лекарственных препаратови проникновение в организм токсических веществ.</li>\r\n<li>Психогенные реакции: страх и тревога, истерика, в качестве выражения некоторых эмоций – привычная рвота.</li>\r\n<li>Рвота и тошнота могут являться результатом «укачивания».</li>\r\n<li>Зачастую рвота появляется у женщин, находящихся в первом триместре беременности, во время токсикоза (гестоза). Рвота и тошнота встречаются при многих заболеваниях. Как правило, тошнота следует перед рвотой, а рвота вызывает у больного чувство облегчения. Но подобное встречается не всегда, поэтому наличие или отсутствие тошноты является одним из главных критериев при диагностике.</li>\r\n</ol>\r\n<p> </p>",
"pathogenesis": "<p>Известно два механизма тошноты и рвоты. Первый связан с поступлением рвотных стимулов непосредственно в рвотный центр. Так, по афферентным вагусным и симпатическим волокнам к рвотному центру поступают импульсы от желудочно-кишечного тракта (ЖКТ) и желчных путей, глотки, брюшины, коронарных артерий, вестибулярного аппарата, из таламуса, гипоталамуса и корковых центров. Двигательные импульсы от рвотного центра идут к диафрагме по диафрагмальным нервам, к межреберным и брюшным мышцам по спинномозговым нервам, а к гортани, глотке, пищеводу и желудку – по блуждающим нервам. Второй механизм связан со стимуляцией хеморецепторной триггерной зоны, из которой импульсы далее идут в рвотный центр и активируют его. Стимуляторами хеморецепторной триггерной зоны являются лекарственные препараты, уремия, гипоксия, диабетический кетоацидоз, эндотоксины грамположительных бактерий, лучевая терапия и др. Хотя медиаторы, которые выделяются в хеморецепторной триггерной зоне и рвотном центре, изучены недостаточно, имеются четкие доказательства, что дофамин играет значительную роль в возникновении рвоты.</p>",
"diagnostics": "<p> </p>\r\n<p>Диагностика включает в себя:</p>\r\n<ul>\r\n<li>Выяснение анамнеза заболевания</li>\r\n<li>Осмотр пациента с определением признаков инфекционной болезни, отравления, степени обезвоживания, признаки заболеваний желудочно-кишечного тракта. Также врач обязательно проводит осмотр рвотных масс, чтобы определить, какая пища содержится в них: переваренная или нет.</li>\r\n<li>Лабораторные методы исследования: анализы крови и мочи. Проводятся для выявления сопутствующих заболеваний.</li>\r\n<li>Инструментальные методы исследования:\r\n<ul>\r\n<li>УЗИ (ультразвуковое исследование) брюшной. Проводится для выявления заболеваний пищеварительного тракта, приводящих к возникновению рвоты;</li>\r\n<li>Нейросонография (ультразвуковое исследование головного мозга);</li>\r\n<li>Фиброгастродуоденоскопия (ФГДС) — исследование желудка с помощью специального оптического прибора (эндоскопа). Проводится для выявления заболеваний пищеварительного тракта, приводящих к возникновению рвоты.</li>\r\n<li>Рентгенографическое исследование органов брюшной полости с контрастированием (использованием специального вещества, на фоне которого дефекты желудочно-кишечного тракта видны более четко) барием для исключения непроходимости желудочно-кишечного тракта.</li>\r\n</ul>\r\n</li>\r\n</ul>",
"treatment": "<p>Лечение рвоты начинают с коррекции водно-электролитных нарушений (инфузионной терапии). Одновременно уточняют причину рвоты и, если позволяет состояние больного, проводят этиологическое лечение. В тех случаях, когда причина тошноты и рвоты неизвестна или когда этиологическое лечение невозможно, используют противорвотные средства. При выборе противорвотного средства учитывают его эффективность, причину рвоты, индивидуальные особенности больного и побочные эффекты.</p>\r\n<ul>\r\n<li>Антихолинергические средства эффективны при тошноте и рвоте, вызванной укачиванием. Эти препараты назначают перед поездками на автомобиле, морском транспорте, а также при вестибулярных расстройствах (например, при синдроме Меньера). При тошноте и рвоте другого генеза эти средства малоэффективны.</li>\r\n<li>Нейролептики эффективны в лечении тошноты и рвоты, которые обусловлены лекарственными средствами, лучевой терапией и при гастроэнтерите.</li>\r\n<li>Н1-блокаторыэффективны при тошноте и рвоте, обусловленных вестибулярными нарушениями, при укачивании, а также при беременности, уремии и в послеоперационном периоде.</li>\r\n<li>Блокаторы серотониновых рецепторов. Данная группа препаратов используется в лечении больных, получающих химио- и лучевую терапию.</li>\r\n<li>Блокаторы дофаминовых рецепторов – нормализуют моторику пищевода, повышают тонус нижнего пищеводного сфинктера, улучшают эвакуацию из желудка за счет повышения тонуса тела и антрального отдела. Одновременно происходит расслабление проксимальных отделов тонкой кишки, что предотвращает заброс содержимого двенадцатиперстной кишки в желудок и ускоряет продвижение пищевого комка по тонкой кишке. Применяется в комплексном лечении многих заболеваний, сопровождающихся моторно-эвакуаторными расстройствами верхних отделов ЖКТ и проявляющихся симптомами диспепсии, включая тошноту и рвоту.</li>\r\n</ul>\r\n<p>Примером патогенетической терапии является лечение тошноты, вызванной отравлением, при этом рекомендуют прием внутрь адсорбирующих веществ.</p>",
"prevention": "<p>Профилактика развития тошноты направлена на устранение причин, которые могут привести к ее возникновению.</p>\r\n<p>Массаж, медитация, йога и другие методы релаксации помогают предотвратить вызванную стрессом тошноту. Лекарства против тошноты, принятые перед поездкой, предотвращают болезнь движения.</p>\r\n<p>Пища должна быть свежей и должным образом приготовленной. Следует избегать переедания, плотно облегающей одежды, напряженной деятельности сразу после еды. Рвоты, связанной с эмоциональным расстройством, можно избежать посредством психотерапии.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Рвоте может предшествовать тошнота. Чувство тошноты, а затем и рвота сопровождаются:</p>\r\n<ul>\r\n<li>бледностью кожных покровов;</li>\r\n<li>болью в животе;</li>\r\n<li>повышенным потоотделением;</li>\r\n<li>увеличением выделения слюны;</li>\r\n<li>учащенным сердцебиением;</li>\r\n<li>общей слабостью;</li>\r\n<li>иногда головокружением.</li>\r\n</ul>\r\n<p> </p>",
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