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"description": "Стоматит — воспалительный процесс слизистой оболочки полости рта различной этиологии. Характеризуется покраснением, отечностью слизистой (катаральный стоматит), образованием пузырьков и эрозий (афтозный стоматит), изъязвлений (язвенный стоматит) в полости рта, болезненностью и жжением, особенно при приеме пищи",
"etiology": "<ul>\r\n<li>Вероятные причины и предрасполагающие факторы развития стоматита: </li>\r\n<li>микроорганизмы-возбудители инфекционных заболеваний (бактерии, вирусы, микоплазмы) </li>\r\n<li>некачественное питание </li>\r\n<li>механическое или термическое повреждение полости рта, </li>\r\n<li>обезвоживание организма, вызванное поносом, рвотой, недостаточным потреблением воды, длительным повышением температуры тела, повышенным выделением мочи, большой кровопотерей </li>\r\n<li>недостаточная или избыточная гигиена полости рта </li>\r\n<li>некачественно сделанные или плохо установленные зубные протезы </li>\r\n<li>по статистике 65 % пожилых людей с зубными протезами страдают от стоматита </li>\r\n<li>применение медикаментов, уменьшающих слюноотделение </li>\r\n<li>авитаминоз (витамин А, витамин B, витамин С), нехватка железа или фолиевой кислоты </li>\r\n<li>курение </li>\r\n<li>злокачественные опухоли в области шеи, носа или глотки </li>\r\n<li>гормональные колебания (беременность, переходный возраст и д.р.) </li>\r\n<li>анемия </li>\r\n<li>побочные действия химиотерапии </li>\r\n<li>продромальный период ВИЧ-инфекции </li>\r\n<li>Зубные пасты и очистители для рта, содержащие лаурилсульфат натрия. </li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Ведущее место в патогенезе заболевания слизистой оболочки полости рта отводится инфекционно-аллергическому фактору. Наблюдается изменение реактивности организма, его сенсибилизация, выражающаяся в повышенной чувствительности к протею, стафилококку, стрептококку, кишечной палочке. </p>\r\n<p>Ряд авторов отдают предпочтение в патогенезе заболевания аутоиммунным процессам, когда большое значение имеет перекрестная иммунная реакция. Выражается по следующему принципу: на слизистой оболочке полости рта и кишечника имеются различные микроорганизмы и вырабатывающиеся на их присутствие антитела могут по ошибке атаковать эпителиальные клетки слизистой оболочки из-за сходства их антигенной структуры с таковой некоторых бактерий. </p>\r\n<p>Предполагается аллергическая природа возникновения рецидивирующих афт. В качестве аллергена могут быть пищевые продукты, зубные пасты, пыль, глисты и продукты их жизнедеятельности. </p>\r\n<p>Аутоиммунная теория позволяет связать возникновение патологических элементов с нарушением клеточного и гуморального иммунитета как местного, так и общего. </p>\r\n<p>Не менее важную роль в развитии заболевания играют провоцирующие факторы, в частности — погрешности в диете, функциональные расстройства центральной и вегетативной нервной системы, прием различных лекарственных средств, хронические соматические заболевания, гипо- и авитаминозы, а также очаги фокальной инфекции. </p>\r\n<p> </p>",
"diagnostics": "<p>Клинической картины, субъективных жалоб и внимательного осмотра стоматологом достаточно, чтобы правильно поставить диагноз. Иногда прибегают к лабораторной диагностике: ПЦР-исследование на кандидоз и герпес, бакпосев соскоба или мазка. А при неподдающихся лечению стоматитах показано общее обследование для выявления системных заболеваний, которые и стали основной причиной стоматита.</p>",
"treatment": "<p>Обычно какой-либо специфической терапии не требуется, достаточно ограничиться щадящей диетой и частыми полосканиями полости рта. Можно применять ополаскиватели с антисептическими свойствами: настои трав: ромашки, календулы; разбавленные водно-спиртовые растворы аптечных настоек (календула, эвкалипт ), различные готовые ополаскиватели. </p>\r\n<p>Для снижения болевой симптоматики могут применяться препараты, содержащие местно анестезирующие средства. Частично помогает употребление леденцов, которые увеличивают слюноотделение, благодаря которому улучшается орошение раны слюной и также достигается некоторый антисептический и отвлекающий эффект. Такое же действие оказывает раствор пищевой соды и воды; отвар ромашки; мёд. </p>\r\n<p>Использование антибактериальных препаратов является агрессивным методом лечения стоматитов. Их применяют, если имеется реинфицирование язвочек, чаще всего применяются препараты, в состав которых входит хлогексидина биглюконат. Длительное использование таких препаратов вызывает образование пятен на зубах и пломбах, которые проходят после окончания лечения. </p>\r\n<p>Противовирусные мази оказывают хороший эффект, если стоматит имеет вирусную природу. </p>",
"prevention": "<p> Профилактикой стоматитов является правильный уход за полостью рта, пропаганда здорового образа жизни и обучение правилам личной гигиены начиная с детского возраста.</p>",
"clinical_picture": "<p>Катаральный стоматит является самой распространенной формой стоматитов. Слизистая оболочка полости рта становится отечной, гиперемированной и болезненной. Пациенты предъявляют жалобы на болезненность во время принятия пищи, увеличение слюноотделения, иногда на кровоточивость и на неприятный запах изо рта. В некоторых случаях при катаральном стоматите слизистая покрыта желтовато-белым налетом. </p>\r\n<p>Язвенный стоматит может являться запущенной формой катарального стоматита или же развиваться как самостоятельное заболевание. При язвенном стоматите поражена вся слизистая оболочка, тогда как при катаральном – только ее верхний слой. На начальном этапе катаральный и язвенный стоматит имеют сходную симптоматику, но через 3-5 дней после начала заболевания повышается температура тела, и увеличиваются регионарные лимфатические узлы. Пациенты предъявляют жалобы на резкую болезненность во время принятия пищи, многие из них отказываются от еды. Нарастают симптомы общей слабости, появляется головная боль. Особенно ярко проявляются симптомы язвенного стоматита у детей и ослабленных больных. </p>\r\n<p>При афтозном стоматите слизистая оболочка полости рта покрывается множественными или единичными афтами – язвами овальной или округлой формы. От здоровой ткани афты отграничены узкой красной каймой, а в центре афтозной язвы имеется серый или желтый налет. Афтозный стоматит начинается с симптомов общего недомогания, после повышения температуры тела слизистая полости рта становится болезненной, далее в областях болезненности появляются афты. </p>\r\n<p>При инфицировании полости рта вирусом простого герпеса диагностируют острый герпетический стоматит. Продромальный период отсутствует, заболевание начинается с резкого подъема температуры до фебрильных значений, общее самочувствие пациентов тоже страдает. При осмотре слизистая полости рта гиперемирована, отечна, иногда имеются очаги кровоточивости десен. Большинство пациентов с герпетическим стоматитом предъявляют жалобы на увеличение слюноотделения и на появление неприятного запаха изо рта. Через несколько дней на слизистой появляются группки мелких пустул и везикул и присоединяются симптомы некротических изменений эпителия. </p>\r\n<p>Язвенно-некротический стоматит или стоматит Венсана клинически характеризуется появлением на слизистой рта язв и эрозий и повышением температуры тела до субфебрильных значений. Пациенты предъявляют жалобы на болезненность и кровоточивость десен, со временем присоединяется гнилостный запах изо рта. Для язвено-некротического стоматита характерно начало процесса с десневого края, далее воспаление переходит на другие участки слизистой оболочки. </p>\r\n<p>Аллергический стоматит может быть любой степени тяжести, начиная от катаральной формы и заканчивая язвено-некротической. По распространению аллергический стоматит может быть локализованным или диффузным. При воздействии на слизистую лекарственными веществами, которые и стали аллергенами, аллергический стоматит обычно носит катаральный или катарально-геморрагический характер. Пациенты предъявляют жалобы на сухость во рту и зуд, прием пищи становится болезненным. Слизистая оболочка полости рта отечна, гиперемирована, при длительно-текущем аллергическом стоматите отмечаются атрофические изменения сосочков языка.</p>",
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"name": "боль в мышцах после тренировки"
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"name": "боль в мышцах спины"
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},
"code": "A33",
"name": "Столбняк новорожденного",
"icd_name": "Столбняк новорожденного",
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5
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"slug": "a33_stolbnyak_novorozhdennogo",
"lead": "Столбняк — острая инфекционная болезнь из группы сапрозоонозов с контактным механизмом передачи возбудителя. ",
"description": "Возбудитель столбняка особо опасен для новорожденных, он может инфицировать малыша через пупочную ранку, что при отсутствии у него антитоксического иммунитета может привести к летальному исходу. ",
"etiology": "<p>Возбудителем столбняка у новорожденного является особый микроб (столбнячная палочка), которой для размножения и роста необходимо отсутствие кислорода. Микробы крайне устойчивы во внешней среде, в виде особых спор они сохраняются в почвах, воде или на поверхности грязных предметов годами. Опасна не сама бактерия, а вырабатываемый ею в условиях размножения в организме токсин. Он относится к сильнейшим нейротропным ядам, что дает сильнейшие проявления со стороны нервной системы.</p>\r\n<p>Учитывая то, что иммунная защита к столбнячному токсину развивается только после вакцинирования, а это делают с 3-ех месяцев, новорожденные не защищены от него. Им опасно попадание возбудителя в область пупочной ранки, так как в области ранки нет кислорода, бацилла активно размножается, токсин проникает в кровь и поражает все отделы нервной системы. Это приводит к гипертонусу всех групп мышц и формированию судорог. Особенно опасно для новорожденных поражение мозга, что может привести к летальному исходу. </p>\r\n<p>Период инкубации у новорожденного крохи короткий, от 2 до 14 дней, область входных ворот инфекции - это пуповина, особенно опасен столбняк для детей, рожденных вне условий стационара с неполноценной обработкой остатка пупочного канатика и несоблюдением правил обработки ран.</p>",
"pathogenesis": "<p>Попадая в организм через повреждения наружного покрова, споры возбудителя остаются в месте входных ворот. При наличии анаэробных условий (некротические ткани, сгустки крови, ишемия, инородные тела, флора, потребляющая кислород) и отсутствии достаточного уровня иммунной защиты споры прорастают в вегетативные формы. После этого начинается интенсивная выработка столбнячного экзотоксина. Токсин гематогенным, лимфогенным и периневральным путями распространяется по организму и прочно фиксируется в нервной ткани. Он избирательно блокирует тормозящее действие вставочных нейронов на мотонейроны прежде всего в двигательных клетках передних рогов спинного мозга. Импульсы, спонтанно возникающие в мотонейронах, беспрепятственно проводятся к поперечнополосатым мышцам, обусловливая их тоническое напряжение.</p>\r\n<p>Постоянное мышечное напряжение сочетается с нарушением микроциркуляции. Возникает порочный круг: метаболический ацидоз и нарушения микроциркуляции ведут к развитию судорог, а судорожный синдром в свою очередь усугубляет метаболический ацидоз и нарушения микроциркуляции. Если больной не умирает на «пике» судорожного приступа от остановки дыхания или сердечной деятельности, то при дальнейшем течении болезни причинами смерти могут быть прямое действие токсина на дыхательный и сосудодвигательный центры в сочетании с глубокими метаболическими нарушениями, а также гнойно-септические осложнения.</p>",
"diagnostics": "<p>Диагноз столбняка в ранние сроки устанавливают, если выявляют <a href=\"/symptom/trizm/\" title=\"Перейти на страницу симптома Тризм\">тризм</a>, сардоническую улыбку и дисфагию. Позднее появляется ригидность мышц затылка; гипертонус распространяется на другие мышцы туловища, присоединяются тетанические судороги, характерная особенность которых — сохранение гипертонуса мышц после приступа. Отличительная черта болезни — ясное сознание, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a>, <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a> и гиперсаливация.</p>\r\n<p>Лабораторная диагностика столбняка имеет второстепенное значение. При появлении клинических симптомов болезни токсин в крови невозможно обнаружить даже самыми чувствительными методами. Выявление антитоксических антител не имеет диагностического значения, поскольку оно свидетельствует лишь о прививках в анамнезе. При столбняке нарастания титров антител не происходит, так как даже летальные дозы экзотоксина не вызывают иммунного ответа.</p>\r\n<p>В отдельных случаях применяют бактериологические методы (микроскопия мазков-отпечатков, гистологическое исследование тканей, иссекаемых при хирургической обработке ран, посевы раневого отделяемого на питательные среды в анаэробных условиях), позволяющие обнаружить возбудитель в месте расположения входных ворот инфекции. Выделить культуру возбудителя из раны удаётся не более чем у 30% больных.</p>",
"treatment": "<p>Важен лечебно-охранительный режим, помогающий уменьшить частоту судорожных приступов. Пациентов размещают в отдельных палатах, максимально изолируя от внешних раздражителей, способных провоцировать судороги.</p>\r\n<p>Возможности этиотропного лечения весьма ограничены. Проводят хирургическую обработку ран, чтобы удалить нежизнеспособные ткани, инородные тела, вскрыть карманы, создать отток раневого отделяемого, что предотвращает дальнейшую выработку токсина возбудителем.</p>\r\n<p>Для нейтрализации циркулирующего экзотоксина вводят внутримышечно однократно 50–100 тыс. МЕ противостолбнячной очищенной концентрированной сыворотки или, что предпочтительнее, 900 МЕ противостолбнячного иммуноглобулина. На фиксированный в тканях токсин не удаётся воздействовать никакими средствами.</p>\r\n<p>При среднетяжёлом и тяжёлом течении столбняка необходимо назначать миорелаксанты, поэтому больных сразу переводят на искусственную вентиляцию легких.</p>\r\n<p>При тяжёлом течении болезни для борьбы с гиповолемией показана инфузионная терапия (кристаллоиды) под контролем гематокрита, параметров гемодинамики, таких, как центральное венозное давление, давление заклинивания лёгочных капилляров, сердечный выброс, общее периферическое сопротивление сосудов. Показано назначение средств, улучшающих микроциркуляцию (пентоксифиллин, никотиновая кислота) и уменьшающих метаболический ацидоз (раствор натрия гидрокарбоната в расчётных дозах). Эффективно использование гипербарической оксигенации, иммуноглобулинов — иммуноглобулина человека нормального (пентаглобин) и метаболических средств (большие дозы водорастворимых витаминов, триметазидин, мельдоний, анаболические стероиды). При длительной ИВЛ на первый план выходят вопросы ухода за больным.</p>",
"prevention": "<p>Основа профилактики столбняка у новорожденных – роды в условиях стационара и полноценная надлежащая обработка пупочной ранки. Важно также своевременное вакцинирование женщины, планирующей беременность. При ней женщина передает младенцу антитоксический иммунитет, защищающий его от столбняка после рождения.</p>\r\n<p> </p>",
"clinical_picture": "<p>Зачастую столбняк у малышей может начинаться нетипично, и первые его проявления могут быть не сильно выраженными, типичными для многих других проблем в здоровье. Многие родители в начальном этапе отмечают <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">беспокойство</a> детей, плохое сосание груди или отказ от него, формирование запоров, напряжение передней стенки живота. Ребенок может начинать пронзительно кричать, что наталкивает родителей на мысль о том, что у малыша что-либо болит. При этом нет видимых причин боли и о патологии никто не догадывается.</p>\r\n<p>Первый признак заболевания у новорожденных – изменение мышечного тонуса в области мышц лица, особенно жевательной группы. Это приводит к нарушению сосания, его существенному затруднению, а затем присоединяется подрагивание всем телом и конечностями. Также формируется <a href=\"/symptom/sudoroga/\" title=\"Перейти на страницу симптома Судорога\">спазм</a> мышц лица – уголки растягиваются вниз, формируя полулунную форму рта, лоб морщинится, губы вытягиваются в хоботок. Это придает лицу специфическое выражение. Постепенно происходит присоединение судорог на всем теле, сгибаются предплечья в области локтевых суставов, кисти в запястьях, пальчики формируют неразжимаемые кулачки. Ноги при этом неестественно для крохи вытягиваются. Изначально судороги длятся не более нескольких секунд, постепенно частота и длительность их нарастает, при тяжелых приступах они беспрерывны, возникают на фоне незначительных раздражителей (прикосновения, шум, свет). Тонус даже вне судорог резко повышен. Нарушается дыхание ребенка, оно поверхностное учащенное до 100 вздохов в минуту, присоединяются судороги диафрагмы. При приступе ребенок кричит и его дыхание останавливается на 20-40 секунд. Личико бледнеет, затем краснеет и синеет, вены на шее вздуваются. Может урежаться частота сердца и наступает <a href=\"/symptom/obmorok/\" title=\"Перейти на страницу симптома Обморок\">потеря сознания</a>. После приступа цвет лица медленно нормализуется, в легких могут прослушиваться <a href=\"/symptom/hripy/\" title=\"Перейти на страницу симптома Хрипы\">хрипы</a>, что говорит об отеке.</p>\r\n<p>В период судорог родничок выбухает, сильно напряжен, после окончания приступа резко западает. Голос может снижаться, при судорогах полностью исчезает. Присоединяется невозможность глотания, что приводит к нарушению поступления пищи и истощению. Спазмы мышц брюшной полости дают запоры, повышается температура.</p>",
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