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},
"code": "K74",
"name": "Фиброз и цирроз печени",
"icd_name": "Фиброз и цирроз печени",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "k74_fibroz_i_cirroz_pecheni",
"lead": "Нарушение здоровья, относящееся к группе болезни печени",
"description": "Фиброз печени — это диффузное (обширное) заболевание печени, при котором происходит постепенная замена ее ткани на грубую рубцовую соединительную (процесс фиброза). Цирроз печени – последняя стадия фиброза с развитием печеночной недостаточности.",
"etiology": "<p>К причинам, вызывающим развитие фиброза печени относят:</p>\r\n<ul>\r\n<li>Вирусные гепатиты B, C, D;</li>\r\n<li>Нарушения обмена веществ (дефицит альфа-1-антитрипсина, болезнь Вильсона-Коновалова, гемохроматоз, галактоземия и т.д.);</li>\r\n<li>Врожденный фиброз печени;</li>\r\n<li>Паразитарные инвазии (эхинококкоз);</li>\r\n<li>Бактериальные инфекции (бруцеллез);</li>\r\n<li>Нарушения печеночного кровотока (сердечная недостаточность, сдавление печеночных вен по каким-либо причинам);</li>\r\n<li>Злоупотребление алкоголем;</li>\r\n<li>Амилоидоза, когда нарушения наблюдаются в белковом обмене;</li>\r\n<li>Токсические и лекарственные вещества (соли тяжелых металлов, цитостатики (метотрексат), метилдофа, изониазид и т.д.).</li>\r\n</ul>",
"pathogenesis": "<p>В основе развития фиброза и цирроза печени лежит разрушение печеночных клеток, приводящий к сдавлению печеночных долек, диффузному образованию соединительнотканных перегородок и возникновению узлов регенерации (узлов печеночной ткани, пытающейся восстановить нормальную структуру).</p>\r\n<p>Ведущее место в патогенезе цирроза принадлежит коллагену 1 и 3 типов, откладывающемуся в печеночных дольках. Стенка печеночных сосудов становится непроницаемой для белков, просвет сосудов уменьшается. Ограниченные соединительнотканными перегородками печеночные клетки регенерируют, образуя сферические дольки, значительно нарушающие кровоток. Желчные протоки облитерируются (зарастают), нарушая отток желчи. Вследствие этого образуются коллатерали (обходные пути), соединяющие портальную вену с конечными отделами печеночных вен, минуя ткань печени.</p>\r\n<p> </p>",
"diagnostics": "<p>Лабораторные методы исследования.</p>\r\n<ul>\r\n<li>Клинический анализ крови (для выявления возможной анемии (малокровия), лейкоцитоза (повышения лейкоцитов (белых клеток крови, клеток иммунной системы) в крови при воспалительных заболеваниях).</li>\r\n<li>Биохимический анализ крови (для контроля функции печени, поджелудочной железы, содержания важных микроэлементов (калий, кальций, натрий) в крови).</li>\r\n<li>Биохимические маркеры (показатели) фиброза печени;</li>\r\n<li>Коагулограмма — оценка состояния свертывающей (препятствующей возникновению кровотечения) системы крови: у больных фиброзом свертываемость будет в норме либо слегка снижена. Исследование необходимо для того, чтобы исключить диагноз цирроза.</li>\r\n<li>Антимитохондриальные антитела (показатели, характерные для аутоиммунной (заболевание, при котором иммунная система организма начинает атаковать собственные клетки печени) природы фиброза печени). Исследование необходимо для того, чтобы исключить диагноз цирроза.</li>\r\n<li>Антигладкомышечные антитела (показатели, выявляемые при повреждении гладких мышц организма, характерные для аутоиммунной природы фиброза печени). Исследование необходимо для того, чтобы исключить диагноз цирроза.</li>\r\n<li>Антинуклеарные антитела (показатели, характерные для разрушения структуры ядер клеток, при их аутоиммунном повреждении). Исследование необходимо для того, чтобы исключить диагноз цирроза.</li>\r\n<li>Общий анализ мочи (для контроля состояния мочевыводящих путей и органов мочеполовой системы).</li>\r\n<li>Анализ крови на присутствие вирусных гепатитов.</li>\r\n<li>Копрограмма – анализ кала (можно обнаружить непереваренные фрагменты пищи, жира, грубые пищевые волокна).</li>\r\n<li>Анализ кала на яйца глист (круглые черви аскариды, острицы) и организмы царства простейших (амебы, лямблии).</li>\r\n</ul>\r\n<p>Инструментальные методы исследования.</p>\r\n<ul>\r\n<li>УЗИ органов брюшной полости – позволяет обнаружить очаги рубцовой ткани в печени.</li>\r\n<li>Эзофагогастродуоденоскопия — выявление варикозно расширенных вен пищевода.</li>\r\n<li>Компьютерная томография (КТ) органов брюшной полости для более детальной оценки состояния печени, выявления характерных узлов в ткани печени при циррозе печени.</li>\r\n<li>Биопсия печени — микроскопическое исследование ткани печени, полученной при помощи тонкой иглы под контролем УЗИ</li>\r\n<li>Эластография – исследование ткани печени, выполняемое с помощью специального аппарата для определения степени фиброза печени. Является альтернативой биопсии печени.</li>\r\n</ul>",
"treatment": "<p>Немедикаментозное лечение:</p>\r\n<p>Режим: </p>\r\n<ul>\r\n<li>запрет на курение;</li>\r\n<li>ограничение физической нагрузки у пациентов с декомпенсированным заболеванием печени и при наличии варикозного расширения вен ЖКТ.</li>\r\n</ul>\r\n<p>Диета:</p>\r\n<ul>\r\n<li>Запрет на потребление алкоголя;</li>\r\n<li>Принципы рационального питания;</li>\r\n<li>Потребление кофе без сахара и молока до 2-3 чашек в сутки (при удовлетворительной переносимости);</li>\r\n<li>Ограничение поваренной соли.</li>\r\n</ul>\r\n<p>Медикаментозное лечение предусматривает:</p>\r\n<ol>\r\n<li>Ревизию всей терапии, получаемой пациентом, с отменой гепатотоксичных препаратов;</li>\r\n<li>Этиотропную терапию (например, противовирусную терапию при вирусной этиологии ЦП или абстиненцию при алкогольной этиологии, что во многих случаях способствует замедлению прогрессирования и даже регрессу заболевания).</li>\r\n<li>Препараты, используемые для лечения и коррекции нарушений гепатобиллиарной системы (печень, желчный пузырь и желчевыводящие пути):</li>\r\n</ol>\r\n<p> </p>\r\n<ul>\r\n<li>Гепатопротекторы (препараты, сохраняющие активность клеток печени).</li>\r\n<li>Глюкокортикостероиды (гормональные препараты), цитостатики (препараты, снижающие образование рубцовой ткани в печени), если имеется аутоиммунный (заболевание, при котором иммунная система организма начинает атаковать собственные клетки печени) компонент возникновения фиброза.</li>\r\n<li>Желчегонные средства (усиливающие выведение желчи), если нет камней в желчном пузыре и желчевыводящих путях.</li>\r\n<li>Иммунномодуляторы (препараты, стимулирующие собственную иммунную системы на борьбу против заболевания).</li>\r\n<li>Противоспалительные препараты – снимающие воспаление ткани печени.</li>\r\n<li>Антиоксиданты (препараты, снижающие и/или устраняющие повреждающее действие токсических (отравляющих) веществ и продуктов обмена в организме).</li>\r\n</ul>",
"prevention": "<p>Профилактика включает:</p>\r\n<ul>\r\n<li>Ограничение физических и психоэмоциональных нагрузок при наличии гепатитов (воспалений печени).</li>\r\n<li>Профилактика вирусных гепатитов и их своевременное и полноценное лечение.</li>\r\n<li>Снижение или исключение влияния вредных производственных и бытовых факторов, токсичных (отравляющих) для печени лекарственных препаратов.</li>\r\n<li>Рациональное и сбалансированное питание (отказ от слишком горячей, копченой, жареной и консервированной пищи).</li>\r\n<li>Умеренные физические нагрузки, здоровый образ жизни.</li>\r\n<li>Отказ от алкоголя, курения и наркотических препаратов.</li>\r\n<li>Регулярное (не реже одного раза в год) эндоскопическое исследование (ззофагогастродуоденоскопия) — диагностическая процедура, во время которой врач осматривает и оценивает состояние внутренней поверхности пищевода, желудка и двенадцатиперстной кишки при помощи специально оптического инструмента (эндоскопа).</li>\r\n<li>Своевременное и адекватное лечение заболеваний желудочно-кишечного тракта.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Обычно клинические симптомы начинают проявлять себя через 6 – 8 лет после возникновения фиброза печени.</p>\r\n<p>На ранних стадиях фиброза нет клинических проявлений, и чрезмерное накопление соединительной ткани выявляется только при гистологическом исследовании.</p>\r\n<p>Начальные симптомы заболевания:</p>\r\n<ul>\r\n<li>повышенная утомляемость;</li>\r\n<li>снижение работоспособности;</li>\r\n<li>снижение способности переносить физические и психологические нагрузки.</li>\r\n</ul>\r\n<p>В дальнейшем, при прогрессировании заболевания, появляются:</p>\r\n<ul>\r\n<li>сонливость, слабость, повышенная утомляемость (при выраженной сонливости, равно как и при раздражительности и агрессивном поведении, необходимо исключать печёночную энцефалопатию);</li>\r\n<li>кожный зуд, желтушность склер и слизистых оболочек, уздечки языка, потемнение мочи (как правило, свидетельствует о печеночной недостаточности);</li>\r\n<li>увеличение живота в объёме за счёт скопившейся жидкости (может скапливаться более 10 – 15 литров), при большом её количестве создаётся картина «напряжённого асцита», выбухание пупка;</li>\r\n<li>расширение вен передней брюшной стенки в виде «головы медузы»;</li>\r\n<li>кровоточивость дёсен, носовые кровотечения, петехиальные кровоизлияния, синячки в местах инъекций вследствие нарушения синтеза факторов свёртывания крови в печени и снижении тромбоцитов при увеличенной селезенке;</li>\r\n<li>рвота с примесью крови, мелена, ректальные кровотечения из варикозно расширенных вен;</li>\r\n<li>лихорадка (при присоединении инфекций);</li>\r\n<li>затруднение дыхания при выраженном асците (вследствие повышенного внутрибрюшного давления и ограниченной подвижности диафрагмы, гидроторакса);</li>\r\n<li>снижение либидо, отсутствие менструаций.</li>\r\n</ul>",
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},
"code": "L02",
"name": "Абсцесс кожи, фурункул и карбункул",
"icd_name": "Абсцесс кожи, фурункул и карбункул",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "l02_abscess_kozhi_furunkul_i_karbunkul",
"lead": "гнойно-некротическое воспалительное заболевание сальной железы и окружающей соединительной ткани, вызываемое гноеродными бактериями",
"description": "Отличительная особенность фурункулов от других видов воспаления кожи в том, что они не могут возникать там, где не растут волосы (ладони, подошвы), а появляются только в тех местах, где имеются волосяные фолликулы. \r\nНаиболее частая локализация: лицо, затылок, задняя поверхность шеи, поясница, паховые области, ягодицы, руки, ноги.",
"etiology": "<p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Эти гнойные заболевания возникают из за нарушения целостности защитных барьеров организма и проникновения в него патогенных агентов (бактерий или вирусов). Бактерии, обычно, являются частью нормальной флоры организма, но при определенных условиях и повышении их количества они могут вызывать <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. Большое количество таких организмов существуют на наших слизистых оболочках: полость рта, носовая полость, слизистая глаз, половых органов, а часть находится в нашем кишечнике, как в толстом, так и тонком. </span></p><p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Это золотистый стафилококк, протей, кишечная палочка.</span></p>",
"pathogenesis": "<p><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Воспалительные изменения кожи могут появится на любом участке тела. Это происходит вследствие нарушения целостности защитного барьера кожи человека — эпителия, при травмах или порезах. Патогенная флора проникает в стерильные условия организма и начинает активно размножаться. Организм ограничивает данный участок от здоровой ткани валом из воспалительных клеток, а когда этого барьера не хватает, возникает капсула, в которой и формируется <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. </span><br></p>",
"diagnostics": "Визуальный осмотр. Микроскопическое исследование отделяемого. Бактериологическое исследование отделяемого.",
"treatment": "Антибактериальная терапия наружная. Антибактериальная терапия системная. Противовоспалительные средства. Физиотерапевтическое лечение.",
"prevention": "<p><br></p>",
"clinical_picture": "<p>Для фурункула свойственно появление на коже болезненной фолликулярной <a href=\"/symptom/pustuly/\" title=\"Перейти на страницу симптома Пустулы\">пустулы</a> на фоне красной эритемы с некрозом в центре (т. н. стержень фурункула). После отторжения некротической ткани происходит заживление путём рубцевания. Наиболее часто фурункул возникает на коже шеи, затылка, лица, спины, бедрах. Появление фурункулов в разных стадиях развития называется фурункулёзом, а гнойно-некротическое <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> кожи и подкожной клетчатки вокруг группы волосяных мешочков и сальных желёз — карбункулом. При нахождении фурункула на лице возможны тяжёлые осложнения (гнойный менингит, <a href=\"/symptom/sistemnoe_vospalenie/\" title=\"Перейти на страницу симптома Системное воспаление\">сепсис</a>).</p>",
"image": "http://api.symptomd.ru/storage/f08415fb54c17612609474c7a617f37f_Z1mzc9I.png",
"image_alt": "Фурункул",
"standard_type": 1,
"danger": 28,
"published": 1,
"parent": null,
"block_rubric": 120,
"standards": [
5083
]
},
{
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{
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{
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{
"name": "Мигрень "
},
{
"name": "Боль в голове при наклоне"
},
{
"name": "Боль головная у детей"
},
{
"name": "Боль при повороте головы"
},
{
"name": "Височная боль"
},
{
"name": "Колющая боль в голове"
},
{
"name": "Покалывание в голове"
},
{
"name": "Жжение в голове "
},
{
"name": "Боль в лобной части головы "
},
{
"name": "Прострелы в голове"
}
],
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"name": "Головная боль ",
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"age_min": 1,
"age_max": 100,
"slug": "golovnaya_bol",
"lead": "Многообразие головной боли очень широкое, может быть длительной и ноющей или резкой и нестерпимой, может охватывать всю голову или ощущаться только в висках",
"image": null,
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},
{
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"synonyms": [
{
"name": "мышечная боль"
},
{
"name": "боль в мышцах"
},
{
"name": "мышцы болят"
},
{
"name": "Миалгия"
},
{
"name": "ломота"
},
{
"name": "боль в мышцах рук"
},
{
"name": "боль в мышцах ног"
},
{
"name": "боль в мышцах после тренировки"
},
{
"name": "боль в мышцах спины"
},
{
"name": "боль икроножная"
}
],
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},
"code": "L04",
"name": "Острый лимфаденит",
"icd_name": "Острый лимфаденит",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3
],
"periodicity": 1,
"slug": "l04_ostryy_limfadenit",
"lead": "острое гнойное воспаление лимфатических узлов.",
"description": "Лимфаденит – неспецифическое или специфическое воспалительное поражение лимфоузлов. Лимфаденит характеризуется местной болезненностью и увеличением лимфатических узлов, головной болью, недомоганием, слабостью, повышением температуры тела. \r\n\r\n",
"etiology": "<p>Возбудителями неспецифического лимфаденита обычно выступает гноеродная флора - стафилококки и стрептококки, а также выделяемые ими токсины и продукты тканевого распада, которые проникают в лимфоузлы лимфогенным, гематогенным или контактным путем. Первичным очагом при неспецифическом лимфадените могут являться гнойные раны, панариции, фурункулы, карбункулы, флегмоны, рожистое воспаление, трофические язвы, тромбофлебит, кариес, остеомиелит. Местные воспалительные процессы чаще сопровождаются регионарным лимфаденитом.</p>\r\n<p>Лимфаденит у детей часто бывает связан с воспалительными процессами ЛОР-органов (гриппом, отитом, хроническим тонзиллитом, ангиной), детскими инфекциями (скарлатиной, дифтерией, паротитом), а также кожными заболеваниями (пиодермией, экссудативным диатезом, инфицированной экземой и др.).</p>\r\n<p>Причиной специфического лимфаденита являются возбудители туберкулеза, сифилиса, гонореи, актиномикоза, чумы, сибирской язвы, туляремии и др. инфекций.</p>",
"pathogenesis": "<p>Инфекция поступает в регионарные лимфатические узлы с током лимфы, оттекающей из первичных гнойных очагов. Лимфаденит может возникнуть и без предшествующего лимфангита, причем первичный очаг бывает настолько ничтожен и так быстро заживает, что к моменту возникновения лимфаденита обнаружить место вхождения инфекции уже не всегда удается. В редких случаях возможно попадание инфекции в лимфатические узлы вместе с кровотоком. Лимфаденит иногда возникает и вследствие непосредственного перехода воспалительного процесса с тканей, окружающих узел.<br /> Лимфаденит следует рассматривать как проявление барьерной функции лимфатической системы, ограничивающей дальнейшее распространение инфекции и ее токсинов. Вместе с тем лимфаденит сам по себе может стать исходным пунктом для развития тяжелого гнойного процесса (аденофлегмона, сепсис).</p>",
"diagnostics": "<p>При постановке диагноза лимфаденит, врач проводит сбор анамнеза, и далее основывается на результатах пальпации тех областей, на которые жалуется пациент.</p>\r\n<p>Далее, обязательно назначается общий анализ периферической крови больного, в котором могут быть все признаки воспалительного процесса (в крови будет обнаружено при этом большое количество лейкоцитов, ускорение СОЭ, токсическая зернистость сегментоядерных нейтрофилов).</p>\r\n<p>Для уточнения и подтверждения диагноза лимфаденита назначается ультразвуковое исследование пораженных лимфатических узлов, пункция этих узлов. После пункции делают посев содержимого для того, чтобы определить сам микроорганизм и его чувствительность к препаратам антибактериального действия.</p>",
"treatment": "<p>Катаральный и гиперпластический острый лимфаденит лечится консервативно. Необходимо создание покоя для области поражения, проведение адекватной антибиотикотерапии на основании чувствительности микробной флоры, УВЧ-терапии, витаминотерапии. При гнойном лимфадените показано вскрытие сформировавшегося абсцесса, аденофлегмоны, дренирование и санация очага по принципам ведения гнойных ран. Назначается активная дезинтоксикационная и антибактериальная терапия.</p>",
"prevention": "<p>К профилактическим методам лимфаденита можно отнести здоровый образ жизни и максимальное избегание инфекционных заболеваний.</p>\r\n<p>Так же профилактическими методами лимфаденита являются методы по предупреждению травм различного характера, методы борьбы с раневой инфекцией, и рационализация лечения воспалительных гнойных заболеваний.</p>\r\n<p> </p>",
"clinical_picture": "<p>Острый лимфаденит может проявлять себя в виде общей и местной симптоматики.</p>\r\n<p>Общие симптомы воспаления:</p>\r\n<ul>\r\n<li>повышение температуры до высоких показателей (вплоть до 40°С);</li>\r\n<li>проявление озноба;</li>\r\n<li>сильная мигрень;</li>\r\n<li>общая сильно выраженная слабость;</li>\r\n<li>боль в мышцах;</li>\r\n<li>плохой сон.</li>\r\n</ul>\r\n<p>Местные проявления острого лимфаденита:</p>\r\n<ul>\r\n<li>увеличенные лимфоузлы;</li>\r\n<li>появление красного отека над лимфоузлами;</li>\r\n<li>возникновение заметной опухоли кожных покровов в области лимфоузлов;</li>\r\n<li>болезненные ощущения, как при прощупывании лимфоузлов, так и в состоянии покоя;</li>\r\n<li>повышение местной температуры кожных покровов;</li>\r\n<li>нарушение двигательной функции той области, где расположены лимфоузлы.</li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 11,
"published": 2,
"parent": null,
"block_rubric": 120,
"standards": []
}
]
}
