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},
"code": "B15",
"name": "Острый гепатит A",
"icd_name": "Острый гепатит A",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"2",
"7",
"9",
"10"
],
"periodicity": 1,
"slug": "b15_ostryy_gepatit_a",
"lead": "Острое вирусное циклически протекающее инфекционное заболевание, характеризующееся поражением гепатоцитов",
"description": "<p>Гепатит А - это <span style=\"background-color: transparent; color: #1c1c1c; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">острое инфекционное заболевание, вызываемое вирусом гепатита А, клинически характеризующееся синдромом общей инфекционной интоксикации, синдромом нарушения пигментного обмена, синдромами энтерита, холестаза, увеличением печени и в некоторых случая селезёнки, сопровождающееся нарушением функции печени, преимущественно доброкачественного течения.</span></p>",
"etiology": "<p>Гепатит А вызывается РНК-содержащим вирусом, относящимся к роду Энтеровирусов семейства Пикорнавирусов.</p>\r\n<p>Гепатит А является антропонозной инфекцией. Чаще болеют дети, молодые люди. Источником распространения заболевания служит больной человек в преджелтушный период или начале желтушного периода. Чаще всего источником инфекции являются лица со стертыми, субклиническими и безжелтушными формами течения болезни. Носительство не выявлено. Механизм передачи инфекции – фекально-оральный. Возбудитель попадает в окружающую среду с фекалиями больного. Заражение происходит при употреблении зараженной воды, пищевых продуктов, через немытые руки, предметы. Возможен и парентеральный путь заражения. Иммунитет стойкий, видоспецифический.</p>",
"pathogenesis": "<p>Вирус гепатита А попадает в кишечник, откуда всасывается в кровь, вследствие чего развивается интоксикация. С током крови вирус попадает в гепатоциты. В гепатоцитах вирус вызывает <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a>, холестаз, а также процессы цитолиза.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра, лабораторно-инструментальных методов исследования. Необходимо провести биохимическое исследование крови с исследованием уровня прямого и непрямого билирубина, АЛТ, холестерина, щелочной фосфатазы. Обязательными являются проведение тимоловой пробы, оценка сулемового титра. Проводят серологическое исследование крови. В моче определяют уровень уробилиногена.</p>\r\n<p> </p>\r\n<p>Дифференциальная диагностика</p>\r\n<p>Проводится с хроническим гепатитом, острыми гепатитами В, С, Д, гастроэнтеритом, а также с надпеченочной или подпеченочной желтухой. В преджелтушном периоде необходимо дифференцировать гепатит А от ОРВИ, аппендицита, глистной интоксикации.</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: #1c1c1c; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Не существует универсального способа лечения гепатита А. Однако практикуются методики лечения гепатита, включающие в себя дезинтоксикационную и симптоматическую терапии. Первая снижает интоксикацию, сопровождающую повреждения печени. Такая терапия включает в себя растворы, которые разбавят кровь, содержащую токсины, выводя их из организма.</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: #1c1c1c; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптоматическая терапия улучшит общее состояние пациента, страдающего болезнью Боткина, устранит симптомы гепатита А. Кроме того, в гепатологической практике используют раствор глюкозы и витаминов, гепатопротекторы (препараты, защищающие клетки печени).</span><span style=\"font-size: 7pt; font-family: Verdana; color: #1c1c1c; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Также лечение включает в себя обязательную диету. Врачи обычно выбирают 5-й стол по Певзнеру. Его используют в период обострения заболевания.</span></p>",
"prevention": "<p>Меры профилактики гепатита А просты и доступны каждому:</p>\r\n<ul>\r\n<li>Строгое выполнение правил личной гигиены. Мыть руки перед едой, после посещения туалета, при возвращении с работы, прогулки и т.п.</li>\r\n<li>Овощи, ягоды, фрукты, зелень мыть под сильной струей водопроводной воды, ополаскивать кипяченой водой.</li>\r\n<li>Употреблять для питья только кипяченую воду.</li>\r\n<li>Не купаться в водоемах.</li>\r\n<li>Содержать в чистоте помещения, где находятся люди: дома, на работе, объектах общественного питания, торговли, коммунальных, промышленных помещений.</li>\r\n<li>На сегодняшний день самым эффективным методом профилактики вирусного гепатита А является вакцинация.</li>\r\n</ul>\r\n<p>Для проведения прививок используется высокоэффективная и безопасная вакцина. Вакцина вводится двукратно и формирует защиту от заболевания на срок до 20 лет.</p>",
"clinical_picture": "<p>Различают типичное и атипичное течение заболевания. При типичном течении заболевание развивается циклично с постепенной сменой периодов заболевания.</p>\r\n<p>Выделяют четыре периода в течении заболевания: инкубационный, продромальный, период разгара и период реконвалесценции. К атипичным формам относятся субклиническая, стертая и безжелтушная. По степени тяжести выделяют легкую, среднетяжелую и тяжелую формы заболевания. По течению заболевания различают острую и затяжную формы.</p>\r\n<p>Инкубационный период длится от 10 до 45 дней с момента попадания возбудителя в организм человека. Обычно инкубационный период продолжается от 15 до 30 дней. Длительность этого периода зависит от возможностей организма противостоять инфекции. При нормальном иммунитете, а также при приеме противовирусных препаратов инкубационный период удлиняется. В этот период заболевания клинические выраженные симптомы отсутствуют, хотя при лабораторных методах исследования выявляются патологические признаки. В крови определяется наличие вируса, уровень печеночных ферментов (АЛТ, АСТ, щелочной фосфатазы) повышен.</p>\r\n<p>Продромальный период длится около 3–5 дней, иногда длится до 7 дней или укорачивается до 1–2 дней. Заболевание начинается остро. Температура поднимается до 38–39 °С, нарастает интоксикация. У больных нарастают <a title=\"Перейти на страницу симптома Слабость\" href=\"/admin/icd/symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Утомляемость\" href=\"/admin/icd/symptom/utomlyaemost/\">недомогание</a>, отмечаются <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"/admin/icd/symptom/snizhenie_appetita/\">потеря аппетита</a>, <a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/golovnaya_bol/\">Головная боль</a>\"><a title=\"Перейти на страницу симптома Мигрень\" href=\"/admin/icd/symptom/migren/\">головная боль</a>, <a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/toshnota/\">Тошнота</a>\"><a title=\"Перейти на страницу симптома Тошнота\" href=\"/admin/icd/symptom/toshnota/\">тошнота</a>, <a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/rvota/\">Тошнота</a>\">Рвота\"><a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/toshnota/\">Тошнота</a>\">рвота. В продромальный период характерно появление болей в правом подреберье, эпигастральной области. Характер боли может быть различным. Боль может быть тупой, давящей, сжимающей. Возможны и острые приступообразные боли, как при аппендиците, остром холецистите, печеночной колике. Отмечаются и диспепсические расстройства в виде поноса или запора, метеоризма, тошноты. Кроме того, в продромальный период гепатита А возможны катаральные явления в виде насморка, гиперемии зева, кашля. Через 2–3 дня отмечается нормализация температуры, но симптомы интоксикации сохраняются. Возможны усиление болей в животе, учащение рвоты. При объективном обследовании выявляется <a title=\"Перейти на страницу симптома Увеличение печени\" href=\"/admin/icd/symptom/uvelichenie_pecheni/\">гепатомегалия</a>, печень болезненна при пальпации, возможно выявление спленомегалии. В конце продромального периода моча приобретает темный оттенок (цвет пива), возможно частичное обесцвечивание кала. При лабораторном исследовании выявляются повышение содержания печеночных ферментов в крови (АЛТ, АСТ, щелочной фосфатазы), увеличение показателей тимоловой пробы, отмечается диспротеинемия. Кроме того, имеет место повышение уровня прямого билирубина. В моче повышен уровень уробилина.</p>\r\n<p>После продромального начального периода наступает желтушный период, длящийся около 7–10 дней. Вначале появляется желтушное окрашивание склер, мягкого и твердого нёба, лица, а затем и туловища. Нарастание желтухи происходит в течение 2–3 дней, иногда <a title=\"Перейти на страницу симптома Желтуха\" href=\"/admin/icd/symptom/zheltuha/\">желтуха</a> развивается за 1 день. При появлении желтушного окрашивания кожи общее состояние пациента улучшается, температура тела снижается.</p>\r\n<p>При объективном обследовании отмечается <a title=\"Перейти на страницу симптома Увеличение печени\" href=\"/admin/icd/symptom/uvelichenie_pecheni/\">гепатомегалия</a>, край печени при пальпации плотный, закругленный, болезненный. Выявляется и <a title=\"Перейти на страницу симптома Увеличение слезенки\" href=\"/admin/icd/symptom/uvelichenie_slezenki/\">спленомегалия</a>. Становится возможной пальпация селезенки, край которой плотный, несколько болезненный. Моча становится очень темной, а кал – абсолютно бесцветным (глинистого цвета).</p>\r\n<p>Отмечаются патологические симптомы и со стороны сердечно-сосудистой системы: <a title=\"Перейти на страницу симптома Брадикардия\" href=\"/admin/icd/symptom/bradikardiya/\">брадикардия</a>, снижение артериального давления, тоны сердца несколько ослаблены, возможно появление функционального систолического шума на верхушке, акцента II тона на легочной артерии, могут отмечаться нарушения ритма. При лабораторном исследовании в крови выявляется повышение содержания билирубина (преимущественно прямой фракции), уровень печеночных ферментов повышен (АЛТ, АСТ, щелочной фосфатазы). Могут появляться и гематологические сдвиги в крови (умеренная лейкопения, относительная нейтропения, моноцитоз, лимфоцитоз). Через 7–10 дней <a title=\"Перейти на страницу симптома Желтуха\" href=\"/admin/icd/symptom/zheltuha/\">желтуха</a> исчезает, моча приобретает нормальный цвет, кал окрашивается, увеличивается диурез. С уменьшением желтушного окрашивания кожи уменьшается и интоксикация, появляется аппетит, исчезают головные боли.</p>",
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},
"code": "B15",
"name": "Острый гепатит A",
"icd_name": "Острый гепатит A",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"2",
"7",
"9",
"10"
],
"periodicity": 1,
"slug": "b15_ostryy_gepatit_a",
"lead": "Острое вирусное циклически протекающее инфекционное заболевание, характеризующееся поражением гепатоцитов",
"description": "<p>Гепатит А - это <span style=\"background-color: transparent; color: #1c1c1c; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">острое инфекционное заболевание, вызываемое вирусом гепатита А, клинически характеризующееся синдромом общей инфекционной интоксикации, синдромом нарушения пигментного обмена, синдромами энтерита, холестаза, увеличением печени и в некоторых случая селезёнки, сопровождающееся нарушением функции печени, преимущественно доброкачественного течения.</span></p>",
"etiology": "<p>Гепатит А вызывается РНК-содержащим вирусом, относящимся к роду Энтеровирусов семейства Пикорнавирусов.</p>\r\n<p>Гепатит А является антропонозной инфекцией. Чаще болеют дети, молодые люди. Источником распространения заболевания служит больной человек в преджелтушный период или начале желтушного периода. Чаще всего источником инфекции являются лица со стертыми, субклиническими и безжелтушными формами течения болезни. Носительство не выявлено. Механизм передачи инфекции – фекально-оральный. Возбудитель попадает в окружающую среду с фекалиями больного. Заражение происходит при употреблении зараженной воды, пищевых продуктов, через немытые руки, предметы. Возможен и парентеральный путь заражения. Иммунитет стойкий, видоспецифический.</p>",
"pathogenesis": "<p>Вирус гепатита А попадает в кишечник, откуда всасывается в кровь, вследствие чего развивается интоксикация. С током крови вирус попадает в гепатоциты. В гепатоцитах вирус вызывает <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a>, холестаз, а также процессы цитолиза.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра, лабораторно-инструментальных методов исследования. Необходимо провести биохимическое исследование крови с исследованием уровня прямого и непрямого билирубина, АЛТ, холестерина, щелочной фосфатазы. Обязательными являются проведение тимоловой пробы, оценка сулемового титра. Проводят серологическое исследование крови. В моче определяют уровень уробилиногена.</p>\r\n<p> </p>\r\n<p>Дифференциальная диагностика</p>\r\n<p>Проводится с хроническим гепатитом, острыми гепатитами В, С, Д, гастроэнтеритом, а также с надпеченочной или подпеченочной желтухой. В преджелтушном периоде необходимо дифференцировать гепатит А от ОРВИ, аппендицита, глистной интоксикации.</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: #1c1c1c; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Не существует универсального способа лечения гепатита А. Однако практикуются методики лечения гепатита, включающие в себя дезинтоксикационную и симптоматическую терапии. Первая снижает интоксикацию, сопровождающую повреждения печени. Такая терапия включает в себя растворы, которые разбавят кровь, содержащую токсины, выводя их из организма.</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: #1c1c1c; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптоматическая терапия улучшит общее состояние пациента, страдающего болезнью Боткина, устранит симптомы гепатита А. Кроме того, в гепатологической практике используют раствор глюкозы и витаминов, гепатопротекторы (препараты, защищающие клетки печени).</span><span style=\"font-size: 7pt; font-family: Verdana; color: #1c1c1c; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Также лечение включает в себя обязательную диету. Врачи обычно выбирают 5-й стол по Певзнеру. Его используют в период обострения заболевания.</span></p>",
"prevention": "<p>Меры профилактики гепатита А просты и доступны каждому:</p>\r\n<ul>\r\n<li>Строгое выполнение правил личной гигиены. Мыть руки перед едой, после посещения туалета, при возвращении с работы, прогулки и т.п.</li>\r\n<li>Овощи, ягоды, фрукты, зелень мыть под сильной струей водопроводной воды, ополаскивать кипяченой водой.</li>\r\n<li>Употреблять для питья только кипяченую воду.</li>\r\n<li>Не купаться в водоемах.</li>\r\n<li>Содержать в чистоте помещения, где находятся люди: дома, на работе, объектах общественного питания, торговли, коммунальных, промышленных помещений.</li>\r\n<li>На сегодняшний день самым эффективным методом профилактики вирусного гепатита А является вакцинация.</li>\r\n</ul>\r\n<p>Для проведения прививок используется высокоэффективная и безопасная вакцина. Вакцина вводится двукратно и формирует защиту от заболевания на срок до 20 лет.</p>",
"clinical_picture": "<p>Различают типичное и атипичное течение заболевания. При типичном течении заболевание развивается циклично с постепенной сменой периодов заболевания.</p>\r\n<p>Выделяют четыре периода в течении заболевания: инкубационный, продромальный, период разгара и период реконвалесценции. К атипичным формам относятся субклиническая, стертая и безжелтушная. По степени тяжести выделяют легкую, среднетяжелую и тяжелую формы заболевания. По течению заболевания различают острую и затяжную формы.</p>\r\n<p>Инкубационный период длится от 10 до 45 дней с момента попадания возбудителя в организм человека. Обычно инкубационный период продолжается от 15 до 30 дней. Длительность этого периода зависит от возможностей организма противостоять инфекции. При нормальном иммунитете, а также при приеме противовирусных препаратов инкубационный период удлиняется. В этот период заболевания клинические выраженные симптомы отсутствуют, хотя при лабораторных методах исследования выявляются патологические признаки. В крови определяется наличие вируса, уровень печеночных ферментов (АЛТ, АСТ, щелочной фосфатазы) повышен.</p>\r\n<p>Продромальный период длится около 3–5 дней, иногда длится до 7 дней или укорачивается до 1–2 дней. Заболевание начинается остро. Температура поднимается до 38–39 °С, нарастает интоксикация. У больных нарастают <a title=\"Перейти на страницу симптома Слабость\" href=\"/admin/icd/symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Утомляемость\" href=\"/admin/icd/symptom/utomlyaemost/\">недомогание</a>, отмечаются <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"/admin/icd/symptom/snizhenie_appetita/\">потеря аппетита</a>, <a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/golovnaya_bol/\">Головная боль</a>\"><a title=\"Перейти на страницу симптома Мигрень\" href=\"/admin/icd/symptom/migren/\">головная боль</a>, <a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/toshnota/\">Тошнота</a>\"><a title=\"Перейти на страницу симптома Тошнота\" href=\"/admin/icd/symptom/toshnota/\">тошнота</a>, <a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/rvota/\">Тошнота</a>\">Рвота\"><a title=\"Перейти на страницу симптома <a href=\" href=\"/admin/icd/symptom/toshnota/\">Тошнота</a>\">рвота. В продромальный период характерно появление болей в правом подреберье, эпигастральной области. Характер боли может быть различным. Боль может быть тупой, давящей, сжимающей. Возможны и острые приступообразные боли, как при аппендиците, остром холецистите, печеночной колике. Отмечаются и диспепсические расстройства в виде поноса или запора, метеоризма, тошноты. Кроме того, в продромальный период гепатита А возможны катаральные явления в виде насморка, гиперемии зева, кашля. Через 2–3 дня отмечается нормализация температуры, но симптомы интоксикации сохраняются. Возможны усиление болей в животе, учащение рвоты. При объективном обследовании выявляется <a title=\"Перейти на страницу симптома Увеличение печени\" href=\"/admin/icd/symptom/uvelichenie_pecheni/\">гепатомегалия</a>, печень болезненна при пальпации, возможно выявление спленомегалии. В конце продромального периода моча приобретает темный оттенок (цвет пива), возможно частичное обесцвечивание кала. При лабораторном исследовании выявляются повышение содержания печеночных ферментов в крови (АЛТ, АСТ, щелочной фосфатазы), увеличение показателей тимоловой пробы, отмечается диспротеинемия. Кроме того, имеет место повышение уровня прямого билирубина. В моче повышен уровень уробилина.</p>\r\n<p>После продромального начального периода наступает желтушный период, длящийся около 7–10 дней. Вначале появляется желтушное окрашивание склер, мягкого и твердого нёба, лица, а затем и туловища. Нарастание желтухи происходит в течение 2–3 дней, иногда <a title=\"Перейти на страницу симптома Желтуха\" href=\"/admin/icd/symptom/zheltuha/\">желтуха</a> развивается за 1 день. При появлении желтушного окрашивания кожи общее состояние пациента улучшается, температура тела снижается.</p>\r\n<p>При объективном обследовании отмечается <a title=\"Перейти на страницу симптома Увеличение печени\" href=\"/admin/icd/symptom/uvelichenie_pecheni/\">гепатомегалия</a>, край печени при пальпации плотный, закругленный, болезненный. Выявляется и <a title=\"Перейти на страницу симптома Увеличение слезенки\" href=\"/admin/icd/symptom/uvelichenie_slezenki/\">спленомегалия</a>. Становится возможной пальпация селезенки, край которой плотный, несколько болезненный. Моча становится очень темной, а кал – абсолютно бесцветным (глинистого цвета).</p>\r\n<p>Отмечаются патологические симптомы и со стороны сердечно-сосудистой системы: <a title=\"Перейти на страницу симптома Брадикардия\" href=\"/admin/icd/symptom/bradikardiya/\">брадикардия</a>, снижение артериального давления, тоны сердца несколько ослаблены, возможно появление функционального систолического шума на верхушке, акцента II тона на легочной артерии, могут отмечаться нарушения ритма. При лабораторном исследовании в крови выявляется повышение содержания билирубина (преимущественно прямой фракции), уровень печеночных ферментов повышен (АЛТ, АСТ, щелочной фосфатазы). Могут появляться и гематологические сдвиги в крови (умеренная лейкопения, относительная нейтропения, моноцитоз, лимфоцитоз). Через 7–10 дней <a title=\"Перейти на страницу симптома Желтуха\" href=\"/admin/icd/symptom/zheltuha/\">желтуха</a> исчезает, моча приобретает нормальный цвет, кал окрашивается, увеличивается диурез. С уменьшением желтушного окрашивания кожи уменьшается и интоксикация, появляется аппетит, исчезают головные боли.</p>",
"image": "http://api.symptomd.ru/storage/904a9679cdb44d7cccf84e3eb1d53767_qX6U4W6.png",
"image_alt": "Острый гепатит A",
"standard_type": 1,
"danger": 76,
"published": 1,
"parent": null,
"block_rubric": 12,
"standards": [
4731,
4958,
4959,
5007,
5011,
5072
]
}
]
}
