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},
"code": "K41",
"name": "Бедренная грыжа",
"icd_name": "Бедренная грыжа",
"gender": 0,
"age_min": 45,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "k41_bedrennaya_gryzha",
"lead": "выхождение внутренних органов через естественные либо приобретенные отверстия в мышечно-апоневротическом слое брюшины при сохранении целостности самой брюшины и кожного покрова",
"description": "<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;\">Бедренная грыжа – это заболевание, при котором часть или целый орган брюшной полости выпячивается наружу через бедренный канал.</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;\">Причинами появления грыжи считаются:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">анатомические особенности строения костей таза, пахового канала;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">тяжелые физические нагрузки, профессиональные занятия спортом;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">беременность и тяжелые роды у женщин;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">слабость соединительной ткани;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хронические запоры;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">ожирение;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">обструктивные заболевания легких, сопровождающиеся кашлем;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">оперативные вмешательства в прошлом.</span></li>\r\n</ul>",
"pathogenesis": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Бедренный канал – это патологическое анатомическое образование, через которое грыжа выходит наружу. В норме такой структуры не существует, но при развитии дисбаланса между внутрибрюшним давлением и опорной функцией брюшной стенки, между мышцами и соединительнотканными пучками образуются щели. Через них происходит «выталкивание» внутренних органов.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Одним из ключевых факторов, увеличивающих риск развития проблемы, являются различные аномалии коллагена. Этот белок служит основой для соединительнотканных структур, из которых состоит апоневроз мышц. Из-за молекулярных дефектов в его строении формируются «слабые» места в передней брюшной стенке. При повышении внутрибрюшного давления именно они и превращаются в грыжевые ворота</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </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;\">Для подтверждения и оценки общего состояния организма назначаются следующие дополнительные 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 анализ крови и мочи, биохимический анализ крови. Позволяют исключить воспалительный процесс и выявить сопутствующую патологию.</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;\">ЭКГ, рентгенография органов грудной клетки. Эти тесты нужны для оценки функции легких и сердца перед предстоящей операцией.</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;\">УЗИ патологической зоны и брюшной полости. С помощью этого метода доктор оценивает размеры грыжи, выявляет сопутствующую патологию внутренних органов.</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;\">Рентгеновская компьютерная томография (РКТ). Процедура назначается пациентам с выраженным ожирением и постоянными рецидивами грыж на фоне лечения.</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;\">Магнитно-резонансная томография (МРТ). Показана в трудных диагностических случаях.</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>",
"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;\">Бедренная грыжа – это хирургическая патология, которая не поддается медикаментозному лечению. Наилучшие результаты обеспечивают современные малоинвазивные оперативные вмешательства.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение:</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;\">Консервативное лечение при бедренных грыжах направлено на временное улучшение самочувствия пациента на фоне подготовки к хирургическому вмешательству, во время и после его проведения. Используемые группы медикаментов:</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;\">обезболивающие средства;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">антибиотики (при необходимости);</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;\">нестероидные противовоспалительные препараты.</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> </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;\">Если пациент страдает от сопутствующей патологии внутренних органов, назначается соответствующее медикаментозное сопровождение (слабительные, ферменты, кардиологические средства и другие).</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;\">Хирургическое лечение бедренной грыжи:</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;\">«Золотым стандартом» лечения бедренных грыж остается их оперативное лечение. Суть подобного вмешательства заключается в удалении грыжевого мешка и укреплении брюшной стенки. Для этого могут использоваться как собственные ткани пациента, так и искусственные сетчатые протезы. При развитии необратимого поражения частей внутренних органов, которые находятся в грыжевом мешке, они подлежат удалению.</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;\">Операция грыжесечения может выполняться различными способами. Хирург в каждом конкретном случае выбирает персонифицированную тактику с учетом размеров выпячивания, анатомических особенностей пациента и возможных рисков.</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;\">Наиболее эффективными на сегодняшний день являются малоинвазивные вмешательства с имплантацией сетчатых протезов. Они позволяют достичь хорошего результата без повторного образования грыж у 95-99% пациентов против 85-90% при использовании обычных открытых операций.</span></p>",
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"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;\">На ранних этапах заболевания пациенты жалуются преимущественно на появление эластичного бугорка в области бедра. Характерной особенностью является изменение размеров выпячивания в зависимости от положения тела. При ходьбе и во время физической нагрузки выпуклость увеличивается. В это же время больной может испытывать дискомфорт или болезненные ощущения, которые возникают из-за перерастяжения тканей вследствие повышения внутрибрюшного давления.</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 возникновении осложнений могут появляться следующие проявления:</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;\">выраженные болезненные ощущения;</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;\">покраснение выпячивания, отек, повышение локальной температуры 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;\">тошнота, рвота;</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;\">появление крови в кале, отсутствие дефекации и отхождения газов.</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\"><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 появлении указанных признаков грыжа больше не вправляется обратно и называется невправимой. Такая ситуация требует максимально быстрой доставки пациента в хирургическое отделение для проведения оперативного вмешательства.</span></p>",
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"etiology": "<p>Грыжи возникают вследствие дефекта анатомического строения пупочного кольца и действия факторов, которые вызывают повышение внутрибрюшного давления и растяжение передней брюшной стенки. Существует мнение о возможной роли наследственной предрасположенности в образовании пупочной грыжи у взрослых, что выражается в недоразвитии или отсутствии пупочной фасции, и это действительно выявляется во время операций. Однако пупочная фасция может разрушаться и вторично - из-за давления растущей грыжи. Причины, вызывающие повышение внутрибрюшного давления и растяжение брюшной стенки: беременность, ожирение, асцит различного происхождения, быстро растущие опухоли брюшной полости, упорные запоры. </p>\r\n<p>Образованию пупочной грыжи в детском возрасте способствует плач ребенка, постоянные запоры, газообразование в кишечнике, недоношенность. Иногда появление грыжи совпадает с началом хождения ребенка, особенно в тех случаях, когда он слишком рано принимает вертикальное положение. Склонность к образованию пупочной грыжи имеют дети с врожденным гипотиреозом, болезнью Дауна, болезнью Харлера, лактазной недостаточностью, дисбактериозом кишечника.</p>",
"pathogenesis": "<p>Пупочные грыжи формируются как результат дефекта развития передней брюшной стенки. Обычно самым слабым местом является верхний отдел пупочного кольца, через который проходит только пупочная вена, не имеющая мышечной оболочки. При недоразвитии брюшной фасции она прикрывает изнутри пупочное кольцо лишь частично, образуя дефекты, или же бывает слишком истончена и недостаточно прочна. При этом к возникновению грыжи могут привести все факторы, вызывающие резкое повышение внутрибрюшного давления.</p>\r\n<p> </p>",
"diagnostics": "<p>Диагноз ставится на основании клиники. К дополнительным методам исследования относят:</p>\r\n<ol>\r\n<li>УЗИ – позволяет выявить при больших грыжах содержимое грыжевого мешка и провести дифференциальную диагностику.</li>\r\n<li>Рентгеноконтрастное исследование и обзорная рентгенография практически не используются при неущемленных грыжах у детей, но могут быть применены при диагностических затруднениях у взрослых. Диагностически значимыми считаются обнаружение петель кишечника в проекции грыжевого мешка, нарушение пассажа контраста. </li>\r\n</ol>",
"treatment": "<p>У детей пупочная грыжа может спонтанно регрессировать, что связано с физиологическим укреплением мышц живота. Поэтому до 5-летнего возраста показано наблюдение за пупочной грыжей. В этот период рекомендуется выкладывание детей на животик, назначается тонизирующий массаж передней брюшной стенки, общий массаж, ЛФК, наложение лечебной лейкопластырной повязки на пупок.</p>\r\n<p>Взрослым и детям старше 5 лет с нерегрессировавшей пупочной грыжей показано хирургическое лечение (герниопластика). При пупочной грыже применяются два типа операций – герниопластика местными тканями и с использованием сетчатых имплантов.</p>",
"prevention": "<p> </p>\r\n<p>Мерами профилактики пупочной грыжи служат: предупреждение ситуаций, связанных с натуживанием грудного ребенка (надсадного крика и плача, вздутия живота, запоров и пр.), рациональное кормление, профилактический массаж и гимнастика, направленные на укрепление брюшной стенки, лечение дисбактериоза кишечника, ношение беременными дородового бандажа.</p>\r\n<p> </p>",
"clinical_picture": "<p>Пупочные грыжи у детей В вертикальном положении ребенка и при натуживании в области пупка появляется грыжевое выпячивание округлой или овальной формы, которое, как правило, вправляется самостоятельно при смене положения ребенка в горизонтальное на спине. В этом случае легко пальпируется расширенное пупочное кольцо, являющееся грыжевыми воротами. Ворота могут быть широкими - грыжа легко выходит и вправляется в брюшную полость, не причиняя ребенку никаких беспокойств и не травмируя внутренние органы. Если же грыжевые ворота узкие, ребенок периодически ведет себя беспокойно, плачет. </p>\r\n<p>Пупочные грыжи у взрослых Клинические проявления зависят от следующих факторов:</p>\r\n<p>- величина грыжи;</p>\r\n<p>- размеры грыжевых ворот;</p>\r\n<p>- выраженность спаечного процесса;</p>\r\n<p>- наличие или отсутствие осложнений;</p>\r\n<p>- сопутствующее ожирение. </p>\r\n<p>Размеры грыжи могут варьироваться от 1-2 см в диаметре до 20-30 см и более. Однако даже при очень больших грыжах грыжевые ворота достаточно малы и редко достигают в диаметре более 10 см.</p>\r\n<p>Небольшие пупочные грыжи (при условии, что они вправимы и не ущемлены) не причиняют больным значительных беспокойств. В том случае, когда содержимым грыжи является фиксированный в грыжевых воротах участок большого сальника, который как бы полностью тампонирует грыжу, она протекает бессимптомно и не увеличивается в размерах. Более часто, вследствие узости ворот, выхождение грыжи сопровождается болями, которые могут также зависеть от натяжения большого сальника, припаянного к стенкам грыжевого мешка. </p>\r\n<p>Большие грыжи при относительно узких воротах затрудняют проход содержимого по кишечнику. Типичные проявления: запоры, метеоризм, периодически появляющиеся боли в области грыжи, тошнота, рвота. Особенно сильно выражены эти явления при невправимых грыжах. Состояние пациентов может отягощаться тучностью и отвислым животом, что в сочетании с грыжей причиняет им значительные неудобства при ходьбе, физической нагрузке и сопровождается болями в спине.</p>\r\n<p>Когда больной находится в вертикальном положении и при натуживании в пупочной области появляется характерное выпячивание. Часто через истонченную кожу отчетливо видны контуры кишечных петель и их перистальтика. </p>\r\n<p> </p>",
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"lead": "выхождение внутренних органов через естественные либо приобретенные отверстия в мышечно-апоневротическом слое брюшины при сохранении целостности самой брюшины и кожного покрова",
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"etiology": "<p>Грыжи возникают вследствие действия различных неблагоприятных факторов. Предрасполагающими факторами являются астеническое или гиперстеническое телосложение, резкое снижение или повышение массы тела, молодой или пожилой возраст, увеличение в объеме органов брюшной полости. Также образованию грыж способствуют травмы или атрофия мышц передней брюшной стенки, запоры и <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">вздутие</a> живота, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, затяжные роды, <a href=\"/symptom/ascit/\" title=\"Перейти на страницу симптома Асцит\">асцит</a>, беременность.</p>",
"pathogenesis": "<p>Составными частями грыжи являются грыжевые ворота, грыжевой мешок и грыжевое содержимое. В грыжевом мешке выделяют устье, шейку, тело, дно.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра. Необходимо проведение рентгеноконтрастного исследования, УЗИ, лапароскопии.</p>",
"treatment": "<p>Требуется экстренная операция.</p>",
"prevention": "<p>Прежде всего, профилактика грыжи живота направлена на то, чтобы удалить главную причину возможного заболевания. В большинстве случаев основополагающим фактором её развития являются истощенные стенки живота. Стать слабыми они могут из-за преклонного возраста, травмы, проведенной операции или вследствие анатомического строения.</p>",
"clinical_picture": "<p>При ущемлении грыжи отмечаются внезапное возникновение боли в области грыжи, невправимость грыжи, увеличение в объеме и напряженности грыжи, ее болезненность при пальпации, внезапное исчезновение симптома кашлевого толчка.</p>",
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},
"code": "K46",
"name": "Грыжа брюшной полости",
"icd_name": "Грыжа брюшной полости неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "k46_gryzha_bryushnoy_polosti",
"lead": "выхождение внутренних органов через естественные либо приобретенные отверстия",
"description": "",
"etiology": "<p>Грыжи возникают вследствие действия различных неблагоприятных факторов. Предрасполагающими факторами являются астеническое или гиперстеническое телосложение, резкое снижение или повышение массы тела, молодой или пожилой возраст, увеличение в объеме органов брюшной полости. Также образованию грыж способствуют травмы или атрофия мышц передней брюшной стенки, запоры и <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">вздутие</a> живота, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, затяжные роды, <a href=\"/symptom/ascit/\" title=\"Перейти на страницу симптома Асцит\">асцит</a>, беременность.</p>",
"pathogenesis": "<p>Составными частями грыжи являются грыжевые ворота, грыжевой мешок и грыжевое содержимое. В грыжевом мешке выделяют устье, шейку, тело, дно.</p>\r\n<p>К внутренним грыжам относят диафрагмальные грыжи и грыжи внутреннего ущемления. Диафрагмальные грыжи подразделяются на истинные (грыжевым мешком являются париетальная брюшина и париетальная плевра) и ложные (врожденные, при которых отсутствует грыжевой мешок). Грыжи пищеводного отверстия диафрагмы подразделяются на скользящие и параэзофагеальные. Скользящие грыжи подразделяются на кардиальные, пищеводные, кардиофундальные, желудочные субтотальные и тотальные. Параэзофагеальные грыжи подразделяются на фундальные, антральные, кишечные, желудочно-кишечные, сальниковые.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра. Необходимо проведение рентгеноконтрастного исследования, УЗИ, эзофагоскопии, внутрипищеводной pH-метрии.</p>",
"treatment": "<p>Неосложненные скользящие грыжи подлежат консервативной терапии (назначается прием щелочных растворов, антацидов, обволакивающих средств, седативных средств, а также местных анестетиков). Оперативное лечение показано при наличии параэзофагеальных грыж, пептических стриктур, кровотечения, при безуспешности консервативной терапии. Методы оперативного вмешательства: крурорафия, низведение органов.</p>",
"prevention": "",
"clinical_picture": "<p>Скользящие грыжи характеризуются развитием рефлюкс-эзофагита. Больные предъявляют жалобы на жгучие боли за грудиной, усиливающиеся при наклонах туловища, в горизонтальном положении. Возможно появление дисфагии при развитии стриктуры пищевода. При появлении пептического эзофагита возможно появление кровотечения.</p>\r\n<p>Для параэзофагеальных грыж также характерны жалобы на боли за грудиной, развитие дисфагии. Параэзофагеальные грыжи склонны к ущемлению. При развитии ущемления появляются <a href=\"/symptom/kolika/\" title=\"Перейти на страницу симптома Колика\">резкая боль</a>, а также <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> с кровью.</p>",
"image": null,
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},
{
"id": 6683,
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{
"id": 3113,
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{
"name": "копчик болит"
},
{
"name": "копчик стреляет"
},
{
"name": "болит копчик"
},
{
"name": "болит копчик при наклоне"
},
{
"name": "болит низ спины"
},
{
"name": "боль в области копчика"
}
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},
{
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{
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{
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},
{
"name": "Боль в спине"
},
{
"name": "Спина внизу болит"
},
{
"name": "Боль в крестце"
},
{
"name": "Боль в области крестца"
},
{
"name": "Боль в пояснице при беременности"
},
{
"name": "Боль в пояснице справа"
}
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},
"code": "K57",
"name": "Дивертикулярная болезнь кишечника",
"icd_name": "Дивертикулярная болезнь кишечника",
"gender": 0,
"age_min": 40,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "k57_divertikulyarnaya_bolezn_kishechnika",
"lead": "заболевание, при котором образуются множественные выпячивания стенки толстой кишки",
"description": "<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;\">Дивертикулярная болезнь - это хроническое заболевание, которое возникает из-за образования в стенке кишечника мешкообразного выпячивания (дивертикула), и, как следствие, застойного процесса и развития воспаления.</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;\">Наиболее значимый фактор развития дивертикулярной болезни толстого кишечника – диета, бедная растительной клетчаткой. В этой связи отмечается повышенная заболеваемость дивертикулезом в развитых странах, где большинство населения употребляет богатую клетчаткой пищу в значительно меньших количествах.</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;\">Клетчатка входит в состав овощей, фруктов и злаков. Она способствует размягчению стула и более легкому транзиту химуса по кишечнику. При недостатке клетчатки в пищевом рационе развивается склонность к затруднениям опорожнения кишечника, запорам. Частые запоры способствуют повышению давления в кишечнике. В местах, где имеется ослабление кишечной стенки в результате повышения внутрикишечного давления, возникают выпячивания. Со временем, формируются постоянные выпячивания кишечной стенки, которые могут стать очагом размножения бактериальной флоры.</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;\">Когда в рационе мало растительной клетчатки, в кишечнике нарушается пассаж каловых масс и возникают запоры. Давление в просвете кишки повышается и выдавливает слабые участки стенки наружу в виде дивертикулов.</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;\">У образовавшихся дивертикулов нет мышечного слоя, они не могут сокращаться. Поэтому попавшие каловые массы и остатки пищи задерживаются внутри дивертикула.</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;\">Со временем каловые массы твердеют и превращаются в каловый камень — копролит, или фекалит. Этот камень давит на стенку дивертикула, тем самым нарушая её кровоснабжение. В итоге развивается воспаление — острый дивертикулит.</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;\">Развитие воспаления иногда связано с особенностями кишечной флоры. Нередко у пациентов с дивертикулярной болезнью наблюдается рост протеолитических бактерий.</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 продолжающемся воспалении в стенке дивертикула возникает микроперфорация. Через это отверстие бактерии распространяются и поражают ткани, окружающие кишку — развивается так называемый острый околокишечный инфильтрат. При этом другие органы (тонкая кишка, придатки матки, мочевой пузырь) фактически \"приклеиваются\" к инфильтрату, образуя плотную трудноразделимую массу.</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 серьёзном повреждении стенки дивертикула развивается макроперфорация. Она способствует образованию более тяжёлых осложнений — абсцесса и перитонита.</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;\">Кишечное кровотечение при дивертикулёзе вызывают скопившиеся каловые камни. Копролиты сдавливают стенку дивертикула, запуская процесс её разрушения и повреждая мелкие сосуды, расположенные рядом.</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;\">Обследование пациента с подозрением на дивертикулярную болезнь толстого кишечника осуществляется врачом-проктологом, начинается со сбора жалоб, анамнеза и физикального осмотра. При этом, как правило, выявляются особенности диеты, склонность к запорам, при осмотре может отмечаться болезненность живота и его увеличение. Подтверждение диагноза производят с помощью инструментальных и лабораторных методов диагностики.</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 исследовании крови могут отмечаться общие признаки инфекционного воспаления (лейкоцитоз, нейтрофилия, ускорение СОЭ). При имеющем место внутреннем кровотечении может отмечаться анемия. Признаки воспаления кишечника также могут отмечаться и в копрограмме. Лабораторное подтверждение имеющегося воспалительного процесса при дивертикулярной болезни толстого кишечника может говорить о развитии дивертикулита.</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;\">Основным диагностическим методом выявления дивертикулов в толстом кишечнике является колоноскопия. Кроме того, при колоноскопии возможно выявить источник внутреннего кровотечения и исключить другие заболевания толстого кишечника. Ирригоскопия с контрастным веществом позволяет выявить выпячивания кишечной стенки.</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;\">При легком течении заболевания для облегчения клинических проявлений чаще всего достаточно соблюдения рекомендованной диеты, способствующей снижению давления в толстом кишечнике. Введение в рацион достаточного количества клетчатки обеспечивают облегчение прохождения кишечного содержимого по пищеварительному тракту. Однако, если мер по коррекции диеты недостаточно, необходимо назначение препаратов, способствующих устранению запоров (тримебутин) и обезболивающих спазмолитических средств при выраженной болезненности.</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;\">Развитие дивертикулита требует противовоспалительной и бактерицидной терапии. Для успешного лечения дивертикулита необходимо снятие нагрузки на толстый кишечник, чему способствуют меры по изменению рациона, а также назначается постельный режим. Своевременно назначенный курс антибиотикотерапии, как правило, подавляет развивающуюся инфекцию. Однако, в некоторых случаях консервативное лечение может быть безуспешным либо развитие осложнений требует немедленного хирургического вмешательства.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Абсолютными показаниями к операции являются: перфорация толстой кишки с выходом кишечного содержимого в брюшную полость, перитонит, прогрессирующий абсцесс, полная кишечная непроходимость, массивное кровотечение, высокая вероятность рака кишечника. Кроме того, показанием к оперативному вмешательству является неэффективность консервативного лечения, периодические небольшие внутренние кровотечения, выраженная анемия, свищи, частое рецидивирование дивертикулита. Как правило, производят резекцию пораженного участка кишечника с последующим восстановлением кишечника при помощи реконструктивной операции.</span></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;\">Основные меры профилактики повторного появления дивертикулита:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">соблюдать высокошлаковую диету, которая должна включать не менее 25 г растительной клетчатки в день;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">контролировать качество и частоту дефекации;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">не допускать развитие запоров: пить 2-3 литра воды в день, есть продукты с растительной клетчаткой, принимать слабительные на растительной основе.</span></li>\r\n</ul>",
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},
"code": "K65",
"name": "Перитонит",
"icd_name": "Перитонит",
"gender": 0,
"age_min": 15,
"age_max": 100,
"cause": [
"3"
],
"periodicity": 1,
"slug": "k65_peritonit",
"lead": "воспаление брюшины, которое может привести к нарушению разных функций организма",
"description": "<p><span id=\"docs-internal-guid-55be9941-7fff-462b-011e-2225c5d2f59c\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Перитонит – это воспаление листков брюшины - ткани, которая выстилает внутреннюю поверхность живота (париетальный листок брюшины) и покрывает большую часть органов брюшной полости (висцеральный листок брюшины).</span></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;\">Заболевание возникает при попадании патогенной микрофлоры, желчи, ферментов поджелудочной железы или содержимого кишечника в брюшную полость. Обычно инфекция проникает изнутри, при разрыве или расплавлении органа, с излитием его содержимого. Реже инфекция заносится при ранениях, операциях, травмах. Возбудителями заболевания обычно являются стафилококки, гонококки, кишечная палочка, другие патогенные микроорганизмы.</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;\">Острый перитонит вызывают:</span></p>\r\n<ul>\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;\">аппендицит;</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;\">разрывы кишки;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прободение язвы желудка;</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;\">гнойные процессы в органах малого таза;</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;\">холецистит;</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;\">панкреатит.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">В начале заболевания возникает интоксикация организма. Процесс нагноения стремительно поражает организм токсинами, иммунитет резко ухудшается. Начальная стадия проявляется отеками брюшины, стойким парезом кишечника, понижением артериального давления и расстройством гемодинамики.</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;\">Ухудшение работы печени вызывает снижение качества выработки белка. Возрастает содержание а-аминоуксусной кислоты и аммония в крови. Клетки надпочечников изменяются, легкие отекают, ухудшается сердечно-сосудистая деятельность. Перестраивается работа нервной системы, возникают адинамия, гиперкалиемия, гипокалиемия и другие заболевания, связанные с пониженной концентрацией ионов калия в крови.</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;\">На последних стадиях перитонита в канальцах почек накапливается нерастворимый белок, что приводит к развитию острой почечной недостаточности. Нарушается метаболизм, организм накапливает промежуточные продукты обмена веществ.</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;\">Врач проводит осмотр пациента, пальпацию брюшной полости, определяет характер боли. При необходимости проводится вагинальное или ректальное исследование.</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;\">Дополнительно пациентам могут быть назначены следующие анализы при перитоните:</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;\">исследование мочи и 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;\">рентгенография;</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;\">УЗИ органов брюшной полости;</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;\">диагностическая лапаротомия.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Пациента с признаками заболевания немедленно госпитализируют в стационар и начинают готовить к операции. Самолечение недопустимо и может привести к смертельному исходу.</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;\">Запрещено самостоятельно пить анальгетики, принимать горячие ванны, прикладывать тепло для снятия боли, так как эти меры могут размыть симптомы, что затруднит диагностику и может стоить пациенту жизни.</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;\">Лечение в данном случае только оперативное. Целью операции при перитоните является выявление и купирование источника развития заболевания (удаление аппендикса, ушивание кишечника, желудка и так далее).</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;\">После этого проводится многократное промывание брюшной полости антисептическими растворами для окончательного устранения инфекции. Затем необходимо обеспечить дренирование малого таза и брюшной полости. </span><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;\">Через установленные во время операции дренажные трубки брюшную полость промывают растворами антисептиков для профилактики осложнений. До операции и после ее окончания показано проведение консервативного лечения.</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;\">Профилактика строится на раннем выявлении и качественном лечении основного заболевания. Постоперационного перитонит предупреждается качественной санацией брюшной полости, гемостазом и тщательным проведением абдоминальных операций.</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;\">Клиническая картина зависит от фазы заболевания. </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;\">Первые признаки и симптомы перитонита следующие:</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 в животе, которые усиливаются при движении и дыхании, пациенту комфортнее всего лежать на спине или в позе 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;\">раздражительность, общая слабость, ухудшение состояния;</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<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;\">частое дыхание, тахикардия;</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;\">тошнота, рвота.</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\"><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 наступлении второй стадии заболевания состояние пациента ухудшается. Появляются признаки сильной интоксикации, боли усиливаются, возникает анемия и вздутие живота. Давление снижается, пульс по-прежнему повышен, начинается неукротимая рвота.</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;\">Во время третьей стадии внутренние резервы организма полностью истощаются. Кожа бледная, температура снижается ниже нормы, у пациента наблюдается помутнение сознания, он перестает реагировать на внешние раздражители. Для этой стадии почти неизбежен летальный исход.</span></p>",
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"code": "K70",
"name": "Алкогольная болезнь печени",
"icd_name": "Алкогольная болезнь печени",
"gender": 0,
"age_min": 0,
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0
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"periodicity": 1,
"slug": "k70_alkogolnaya_bolezn_pecheni",
"lead": "Нарушение здоровья, относящееся к группе болезни печени",
"description": "Алкогольная болезнь печени — это различные нарушения структуры и функции печени, развивающееся вследствие длительного приема алкоголя. При алкогольной болезни происходит гибель ткани печени и постепенная замена ее на грубую фиброзную (рубцовую) ткань.",
"etiology": "<p>Факторы, способствующие развитию алкогольной болезни печени:</p>\r\n<ul>\r\n<li>высокие дозы употребляемого алкоголя, частота и продолжительность его употребления;</li>\r\n<li>женский пол (активность алкогольдегидрогеназы у женщин, как правило, ниже);</li>\r\n<li>генетическая предрасположенность к развитию алкогольной болезни печени. Она проявляется различиями в активности ферментов (алкогольдегидрогеназы и ацетальдегиддегидрогеназы), которые участвуют в метаболизме алкоголя в организме, а также недостаточностью системы цитохрома P-450 2E1печени.;</li>\r\n<li>сопутствующие или перенесенные болезни печени;</li>\r\n</ul>\r\n<p>нарушения обмена веществ (метаболический синдром, ожирение, вредные пищевые привычки нарушение диеты), эндокринные расстройства.</p>",
"pathogenesis": "<p>Ключевую роль в поражении печени алкоголем играет этанол и его более токсичное производное – ацетальдегид. Можно выделить несколько механизмов поражения.</p>\r\n<p>Во-первых, алкоголь способствует повышенному образованию жирных кислот и уменьшает их окисление. Это приводит к накоплению избытка жира в клетках печени (гепатоцитах), то есть к развитию ее жировой дистрофии.</p>\r\n<p>Второй механизм поражения печени связан с окислением алкоголя ферментами, в частности алкогольдегидрогеназой. В результате в избытке образуются свободные кислородные радикалы (оксидативный стресс) и ацетальдегид, оказывающие повреждающее действие на ее клетки.</p>\r\n<p>Третий механизм обусловлен повышением проницаемости кишечной стенки под влиянием алкогольных напитков. Вследствие этого липополисахариды (продукты жизнедеятельности грамотрицательной флоры кишечника) через кровь проникают в печень, где стимулируют выработку клетками Купфера провоспалительных цитокинов – биологически активных веществ, вызывающих воспаление.</p>\r\n<p>Четвертый механизм связан с активацией свободными радикалами иммунной системы и иммуноопосредованным воспалением, и поражением печени.</p>\r\n<p>Следствием воспаления является разрушение гепатоцитов (цитолиз), их гибель (некроз) и разрастание соединительной ткани (фиброз). Прогрессирующий фиброз приводит к нарушению нормального долькового строения печени – циррозу, а в дальнейшем к первичному раку – гепатоцеллюлярной карциноме.</p>",
"diagnostics": "<p>В диагностике алкогольной болезни печени значительную роль играет сбор анамнеза и выявление продолжительного злоупотребления пациентом алкоголя. </p>\r\n<p>При лабораторных исследованиях в общем анализе крови отмечается макроцитоз (сказывается токсическое влияние алкоголя на костный мозг), лейкоцитоз, ускорение СОЭ. Может отмечаться мегабластическая (В12 или фолиеводефицитная) и железодефицитная анемия. Пониженное количество тромбоцитов связано с угнетением функций костного мозга, а также выявляется как симптомом гиперспленизма (увеличение селезенки) при повышении давления в системе полой вены при циррозе.</p>\r\n<p>При биохимическом исследовании крови отмечают повышение активности печеночных ферментов (АСТ и АЛТ). Также отмечают высокое содержание билирубина. Иммунологический анализ выявляет повышение уровня иммуноглобулина А. При употреблении алкоголя в среднесуточной дозе более 60 г чистого этанола в сыворотке крови отмечают повышение обедненного углеводами трансферрина. Иногда может отмечаться повышение количества сывороточного железа. Также у пациентов отмечается нарушение жирового обмена – в крови повышается содержание триглицеридов.</p>\r\n<p>К инструментальным методикам, помогающим диагностировать алкогольную болезнь, относят УЗИ органов брюшной полости и печени, доплерографию, КТ, МРТ печени, радионуклеиновое исследование и биопсию ткани печени.</p>\r\n<p>При проведении УЗИ печени хорошо видны признаки изменений размеров и формы, жирового перерождения печени (характерная гиперэхогенность тканей печени). Ультразвуковая доплерография выявляет портальную гипертензию и повышение давления в системе печеночной вены. Компьютерная и магнитно-резонансная томография хорошо визуализирует ткань печени и ее сосудистую систему. При радионуклеидном сканировании выявляются диффузные изменения в печеночных дольках. Для окончательного подтверждения алкогольной болезни проводят биопсию печени для гистологического анализа.</p>\r\n<p> </p>",
"treatment": "<p>Немедикаментозные методы лечения</p>\r\n<ul>\r\n<li>Отказ от алкоголя. Основным методом терапии алкогольной болезни печени является полный отказ от алкоголя. На любой стадии эта мера способствует благоприятному течению заболевания. Признаки стеатоза могут исчезать при воздержании от приема алкоголя в течение 2-4 недель.</li>\r\n</ul>\r\n<ul>\r\n<li>Диетотерапия. Важно придерживаться пищевого рациона, содержащего достаточные количества белка и калорий, так как у людей, злоупотребляющих алкоголем, часто развивается дефицит белков, витаминов и микроэлементов (особенно калия, магния и фосфора). </li>\r\n</ul>\r\n<p>Назначаются витамины (В 6 , В 12 , С, К, Е) в составе мультивитаминных препаратов.</p>\r\n<p>При анорексии применяется зондовое или парентеральное питание. </p>\r\n<p>Медикаментозные методы лечения</p>\r\n<ul>\r\n<li>Дезинтоксикационная терапия. Проведение дезинтоксикационных мероприятий необходимо при всех стадиях алкогольной болезни печени. Курс обычно составляет 5 дней.</li>\r\n<li>Кортикостероиды. Применение этих препаратов оправдано у пациентов с тяжелой формой острого алкогольного гепатита при отсутствии инфекционных осложнений и желудочно-кишечных кровотечений.</li>\r\n</ul>\r\n<ul>\r\n<li>Урсодеоксихолевая кислота - оказывает стабилизирующее действие на мембраны гепатоцитов: на фоне терапии отмечается улучшение лабораторных показателей (AсАТ, АлАТ, ГГТП, билирубина).</li>\r\n</ul>\r\n<ul>\r\n<li>Эссенциальные фосфолипиды. Механизм действия этих препаратов заключается в восстановлении структуры клеточных мембран, нормализации молекулярного транспорта, деления и дифференцировки клеток, стимуляции активности различных ферментных систем, антиоксидантных и антифибротических эффектах.</li>\r\n</ul>\r\n<ul>\r\n<li>Лечение контрактуры Дюпюитрена. Лечение заболевания на начальных стадиях может быть консервативным (физиотерапия); на поздних стадиях проводится хирургическое лечение.</li>\r\n</ul>\r\n<ul>\r\n<li>Лечение цирроза печени. При возникновении цирроза печени основная задача лечения заключается в профилактике и лечении его осложнений (кровотечений из варикозно-расширенных вен пищевода, асцита , печеночной энцефалопатии).</li>\r\n</ul>\r\n<ul>\r\n<li>Лечение осложнений алкогольной болезни печени. Осложнения диагностируются у пациентов с алкогольным гепатитом и циррозом печени и являются результатом развития портальной гипертензии . Лечение асцита , спонтанного бактериального перитонита, гепаторенального синдрома, печеночной энцефалопатиии кровотечений из варикозно-расширенных вен проводится медикаментозными и хирургическими методами. </li>\r\n</ul>\r\n<p>Хирургическое лечение</p>\r\n<p>Трансплантация печени выполняется пациентам, находящимся в терминальной стадии алкогольной болезни печени. Основным условием для выполнения трансплантации печени является не менее чем 6-месячная абстиненция от алкоголя. Операция позволяет добиться 5-летней выживаемости у 50% пациентов с острым алкогольным гепатитом.</p>\r\n<p> </p>",
"prevention": "<p>Профилактика алкогольная болезнь печени</p>\r\n<ul>\r\n<li>Отказ от приема алкоголя.</li>\r\n<li>Своевременное полноценное лечение всех стадий алкогольной болезни — снижает риск перехода в более тяжелую стадию и развития осложнений.</li>\r\n<li>Рациональное и сбалансированное питание (отказ от слишком горячей, копченой, жареной и консервированной пищи).</li>\r\n</ul>",
"clinical_picture": "<p>Заболевание развивается постепенно и незаметно для больного. Проходит обычно около пяти лет с момента возникновения повреждения печени до появления первых симптомов. По мере ухудшения состояния печени нарастает количество и выраженность симптомов. Все проявления алкогольной болезни печени представлены несколькими синдромами (устойчивая совокупность симптомов, объединенных единым развитием).</p>\r\n<p>Астенический синдром:</p>\r\n<ul>\r\n<li>повышенная утомляемость;</li>\r\n<li>слабость;</li>\r\n<li>сонливость днем;</li>\r\n<li>снижение аппетита;</li>\r\n<li>подавленное настроение.</li>\r\n</ul>\r\n<p>Диспептические проявления (расстройства пищеварения):</p>\r\n<ul>\r\n<li>снижение аппетита;</li>\r\n<li>тошнота и рвота;</li>\r\n<li>вздутие живота;</li>\r\n<li>боль в околопупочной области;</li>\r\n<li>урчание в животе.</li>\r\n</ul>\r\n<p>Системные проявления алкогольной интоксикации(влияния алкоголя на различные органы):</p>\r\n<ul>\r\n<li>Периферическая полинейропатия (повреждение нервов, соединяющих органы и конечности человека с головным и спинным мозгом). Проявляется нарушениями чувствительности и ограничением движений;</li>\r\n<li>Мышечная атрофия (слабость в мышцах конечностей за счет их истончения и уменьшения объема);</li>\r\n<li>Тахикардия (учащенное сердцебиение) и одышка (учащенное дыхание) вследствие поражения сердечно-сосудистой системы.</li>\r\n<li>Кахексия(истощение), снижение массы тела.</li>\r\n<li>Артериальная гипотония— снижение систолического (первая цифра при измерении) артериального давления ниже 100 миллиметров ртутного столба.</li>\r\n<li>Синдром «малых» печеночных признаков (синдром печеночно-клеточной недостаточности):</li>\r\n</ul>\r\n<p>Ø Телеангиоэктазии (сосудистые «звездочки» на лице и теле).<br />Ø Покраснение кожи ладоней и стоп;<br />Ø У мужчин наблюдается отложение жира на бедрах и на животе, тонкие конечности; скудное оволосение в подмышечной области и на лобке; гинекомастия (образование и увеличение молочных желез у мужчины); атрофия яичек (уменьшение объема ткани яичек, расстройство их функции); импотенция (расстройство половой и эректильной функции у мужчин, невозможность совершить нормальный половой акт).<strong> </strong></p>\r\n<ul>\r\n<li>Гипертрофия (увеличение) околоушных слюнных желез.</li>\r\n<li>Расширенная капиллярная сеть на лице (красное лицо).</li>\r\n<li>Склонность к образованию «синяков».</li>\r\n<li>Контрактура Дюпюитрена (безболезненный подкожный тяж – уплотнение тканей в виде жгута) — искривление и укорочение сухожилий ладони, приводящее к ограничению функции ладони и ее сгибательной деформации.</li>\r\n<li>Желтушная окраска кожи, слизистых оболочек полости рта и склер (белых оболочек глазного яблока).</li>\r\n<li>Лейконихии (мелкие белые полоски на ногтях).</li>\r\n<li>Симптомы « барабанных палочек» (увеличение размеров кончиков пальцев рук, отчего их внешний вид похож на барабанные палочки) и « часовых стекол» (увеличение размеров и округлое изменение ногтевых пластин).</li>\r\n<li>Синдром портальной гипертензии(повышения давления в системе воротной вены – сосуда, приносящего кровь в печень от органов брюшной полости):\r\n<ul>\r\n<li>увеличение селезенки;</li>\r\n<li>асцит (свободная жидкость в брюшной полости);</li>\r\n<li>варикозное (деформационное) расширение вен пищевода (несущих кровь от пищевода к сердцу);</li>\r\n<li>расширение параумбиликальных (находящихся в области пупка) вен – симптом « головы медузы» (характерный венозный рисунок на животе в виде расходящихся в разные от пупка стороны синих вен);</li>\r\n<li>варикозное расширение верхних прямокишечных вен (выносящих кровь от верхней части прямой кишки).</li>\r\n</ul>\r\n</li>\r\n</ul>\r\n<p>Состояние пациента значительно улучшается после прекращения приема алкоголя. Периоды резкого ухудшения состояния связаны с продолжающимся употреблением алкоголя, приводящим к развитию эпизодов острого алкогольного гепатита (воспаления печени).</p>\r\n<p> </p>",
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