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"code": "N84",
"name": "Полип женских половых органов",
"icd_name": "Полип женских половых органов",
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"lead": "Нарушение здоровья, относящееся к группе невоспалительные болезни женских половых органов",
"description": "Полипы женских половых органов – это доброкачественная опухоль, которая имеет ворсинчатую или грушевидную форму, и прикрепляется к слизистой или на широком плотном основании, или посредством узенькой длинной ножки или стебля.",
"etiology": "<p>Причины развития полипов эндометрия и полипов шейки матки одинаковы. Они заключаются в следующих факторах:</p>\r\n<ul>\r\n<li>Гормональные нарушения, в том числе и нейроэндокринные синдромы (особенно следует выделить синдром поликистозных яичников)</li>\r\n<li>Хронические воспалительные заболевания женских половых органов;</li>\r\n<li>Последствие перенесенных травм шейки матки</li>\r\n<li>Ожирение</li>\r\n<li>Сахарный диабет</li>\r\n<li>Заболевания печени и желчевыводящих путей, где происходят метаболические превращения гормонов.</li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Основная причина возникновения полипов - нарушение гормонального баланса, при котором вырабатывается большое количество эстрогенов - гормонов, стимулирующих увеличение внутренних стенок матки (эндометрия). Из-за высокой концентрации эстрогенов в крови, внутренние стенки матки наращивают слои и выросты, называемые полипами эндометрия.</p>\r\n<p>Развитие полипов может прогрессировать по причине других заболеваний: страдает щитовидная железа, имеются хронические эндометриты, аднекситы, пониженный иммунитета. Спустя какое-то время после перенесенного аборта либо диагностического выскабливания также могут образоваться полипы.</p>",
"diagnostics": "<p>Физикальное обследование:</p>\r\n<ol>\r\n<li>осмотр наружных половых органов;</li>\r\n<li>осмотр влагалища и шейки матки на зеркалах. При осмотре шейки матки на зеркалах обнаруживаются образование, имеющие четкие контуры, чаще грушевидной формы, с гладкой поверхностью, ярко-розового цвета, которое прикрепляется к слизистой цервикального канала и может выступать за пределы наружного зева шейки матки. вагинальное исследование.</li>\r\n</ol>\r\n<p>Лабораторные исследования: решающим методом диагностики полипов является гистологическое исследование материала. Инструментальные исследования:</p>\r\n<ol>\r\n<li>УЗИ позволяет врачу увидеть утолщение эндометрия (внутреннего слоя матки), а также наличие выростов в полости матки (полипов). Современная ультразвуковая аппаратура с высокой разрешающей способностью позволяет диагностировать полипы небольших размеров, не выходящие за пределы наружного зева. Они выглядят, как включения повышенной или средней эхогенности в цервикальном канале.</li>\r\n<li>Гистероскопия - в полости матки определяются разрастания различной величины и формы. </li>\r\n</ol>\r\n<p>Дополнительные методы:</p>\r\n<ol>\r\n<li>Кольпоскопия;</li>\r\n<li>Мазок на онкоцитологию.</li>\r\n</ol>\r\n<p> </p>",
"treatment": "<p>Любой полип подлежит удалению. Полноценное удаление полипа эндометрия и цервикального канала возможно только при использовании гистероскопии. Одиночные полипы на ножке удаляются щипцами или ножницами, введенными через операционный канал гистероскопа. После удаления полипа необходима контрольная гистероскопия, чтобы убедиться, что ножка полипа иссечена полностью. При множественных полипах и сочетании с гиперпластическими процессами эндометрия должно быть проведено раздельное диагностическое выскабливание под контролем гистероскопии. Весь полученный операционный материал подлежит гистологическому исследованию.</p>\r\n<p> </p>",
"prevention": "<p>Профилактика полипов заключается в своевременном лечении воспалительных гинекологических заболеваний и общих обменных нарушений. Также следует избегать абортов и случайных половых связей.</p>\r\n<p>Элементарная забота женщины о своем здоровье – правильное питание, избегание стрессов, вредного воздействия окружающей среды, воздействия электромагнитного излучения, отсутствие абортов.</p>\r\n<p> </p>",
"clinical_picture": "<p>Длительное время полипы женских половых органов протекают бессимптомно. Однако позже появляются определенные клинические признаки, которые не зависят от локализации полипа. К ним относятся следующие симптомы: межменструальные влагалищные кровотечения, мажущие кровянистые выделения из влагалища во время и после полового сношения (полип механически травмируется во время полового акта), обильные менструальные кровотечения, обильные слизистые выделения из влагалища, боли и дискомфорт во время полового акта. При нарушении кровообращения в полипе могут появиться резкие боли внизу живота.</p>",
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"lead": "Зрачковый рефлекс заключается в содружественном и равном сужении зрачков при освещении одного из глаз, обеспечивая при этом уменьшение светового потока, падающего на сетчатку. Сужение зрачка выявляется при исключительно низкой интенсивности освещения и пропорционально интенсивности и продолжительности стимула.\r\nПричинами нарушений зрачковых реакций являются:\r\nПоражения зрительного нерва. Слепой глаз не отвечает на прямой свет при его изолированном освещении и при этом нет содружественного сокращения сфинктера другого глаза, но слепой глаз отвечает содружественной реакцией, если его III нерв интактен и если другой глаз и его зрительный нерв не повреждены.\r\nПоражения глазодвигательного нерва. При повреждении III нерва прямая и содружественная реакция на свет отсутствует на поражённой стороне из-за паралича сфинктера зрачка, но прямая и содружественная реакция остаются сохранными на противоположной стороне.\r\nДругими причинами являются:\r\nСиндром Эди.\r\nНеобходимо отметить особый тип зрачковых нарушений, когда имеется паралич зрачковых рефлексов с отсутствием реакций на свет, но сохраненной реакцией на конвергенцию. Эта патология описана при различных состояниях: нейросифилис, синдром Эди, сахарный диабет, пинеалома, патологическая регенерация после поражения глазодвигательного нерва, энцефалиты, рассеянный склероз, офтальмический герпес, травма глаза, дистрофическая миотония, пандизавтономия (семейная вегетативная дисфункциия синдром Райли-Дея), синдром Фишера, I тип НМСН (болезнь Шарко-Мари-Тута).",
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"code": "N96",
"name": "Привычный выкидыш",
"icd_name": "Привычный выкидыш",
"gender": 2,
"age_min": 15,
"age_max": 49,
"cause": [
3
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"periodicity": 1,
"slug": "n96_privychnyy_vykidysh",
"lead": "Нарушение здоровья, относящееся к группе невоспалительные болезни женских половых органов",
"description": "Привычный выкидыш — это самопроизвольное прерывание беременности (при сроке до 22 недель беременности), повторяющееся при каждой последующей беременности. ",
"etiology": "<p>Причины привычного выкидыша включают в себя: </p>\r\n<ul>\r\n<li>дефекты анатомического строения матки; </li>\r\n<li>недоразвитие плодного яйца; </li>\r\n<li>воспалительные заболевания и опухоли матки; </li>\r\n<li>эндокринные заболевания; </li>\r\n<li>генетическую детерминацию; </li>\r\n<li>хронические инфекции и интоксикации; </li>\r\n<li>вирусные инфекции, перенесенные в первые недели беременности; </li>\r\n<li>гиповитаминозы; применение противоопухолевых, гормональных, противозачаточных препаратов; </li>\r\n<li>неблагоприятные факторы внешней среды. </li>\r\n</ul>",
"pathogenesis": "<p>Механизм привычного выкидыша различен. В ряде случаев сначала возникают сокращения матки, вызывающие отслойку плодного яйца. В других случаях сокращениям матки предшествует гибель плодного яйца (при токсикозах, острых и хронических инфекционных болезнях беременной и др.). Иногда отслойка и гибель плодного яйца и сокращения матки происходят одновременно. </p>",
"diagnostics": "<p>У 5%-15% женщин с привычным абортом определяется клинически значимое повышение титра антифосфолипидных антител. </p>\r\n<p>При планировании следующей беременности супругам необходимо: </p>\r\n<ul>\r\n<li>сделать спермограмму; </li>\r\n<li>пройти гинекологическое УЗИ; </li>\r\n<li>сделать гистероскопию; </li>\r\n<li>исследовать анализы крови на гормоны (определение уровня прогестерона), а также на наличие вирусных и половых инфекций; </li>\r\n<li>исследовать иммунный статус; </li>\r\n<li>исследовать кариотип (выявление носительства хромосомных аномалий, в том числе унаследованные тромбофилии); </li>\r\n<li>исследовать свертывающую систему крови (определение АчТВ, антитромбин 3, Д-димер, агрегация тромбоцитов, МНО, протромбиновое время – признаки гиперкоагуляции). </li>\r\n</ul>\r\n<p>При необходимости может быть назначен ряд дополнительных исследований. </p>",
"treatment": "<p>При несостоятельности шейки и внутреннего маточного зева применяют пластические операции с целью устранения деформации, разрывов и т. п. При несостоятельности шейки функционального характера используют операции, сущность которых заключается в суживании области внутреннего зева при помощи швов из найлоновой тесьмы. Швы удаляют на 36—38-й неделе беременности, наступившей после наложения швов. </p>\r\n<p>У женщин, страдающих привычным выкидышем на почве инфантилизма, недостаточности функции яичников, воспалительных заболеваний половых органов, следует проводить лечение до наступления беременности. В подобных случаях рекомендуется курс лечения эстрогенами и прогестероном в соответствии с индивидуальным менструальным циклом (не менее 3 циклов) в сочетании с влагалищно-крестцовой диатермией и воротником по Щербаку (15 процедур, чередуя их через день). </p>\r\n<p>Лечение во время беременности женщин, страдающих привычным выкидышем, должно носить выраженный профилактический характер (режим питания, труда и отдыха, пребывание на свежем воздухе, психотерапия и пр.). При наступлении беременности рекомендуется назначать прогестерон внутримышечно в течение 10 дней в начале 2, 4, 7-го месяцев беременности. </p>\r\n<p>При угрозе прерывания беременности — немедленная госпитализация и лечение, как и при первичном самопроизвольном аборте. После исчезновения симптомов угрожающего выкидыша беременная должна оставаться в стационаре еще 10—15 дней, затем ее выписывают для амбулаторного наблюдения. </p>\r\n<p>При гормональной терапии угрожающего выкидыша большое значение имеет определение экскреции прегнандиола и эстрогенов, позволяющее проводить более рациональное лечение. При пониженном количестве прегнандиола целесообразно назначение прогестерона; если же экскреция прегнандиола в пределах нормы, прогестерон противопоказан, так как при этом опасность наступления выкидыша увеличивается. При низком уровне экскреции прегнандиола и эстрогенов ряд авторов указывает на хорошие результаты от применения диэтилстильбэстрола. </p>\r\n<p> </p>",
"prevention": "<p>Главные принципы профилактики: </p>\r\n<ol>\r\n<li>Выявление женщин, входящих в группу риска развития невынашивания беременности. </li>\r\n<li>Целенаправленное обследование супружеской пары до беременности и рациональная их подготовка. </li>\r\n<li>Систематический контроль над возможным возникновением инфекционных осложнений и адекватная противовоспалительная, антибактериальная и иммунотерапия. </li>\r\n<li>Своевременное диагностирование шеечной недостаточности посредством мануальной оценки и проведения ультразвукового исследования с помощью трансвагинального датчика до 24 недель беременности, а при многоплодии — до 26-27 недель. </li>\r\n<li>Проведение рациональной терапии сопутствующих экстрагенитальных заболеваний. </li>\r\n<li>Профилактика и своевременное лечение нарушений тромбофилического генеза и плацентарной недостаточности с ранних сроков беременности. </li>\r\n</ol>\r\n<p> </p>",
"clinical_picture": "<p>Чаще всего выкидыш происходит в первые 2 месяца беременности, а при истмико-цервикальной недостаточности — после 14-й недели беременности. Появляются схваткообразные боли в нижних отделах живота и/или в поясничной области и кровянистые выделения или кровотечение из половых путей. Через некоторое время все эти симптомы выкидыша могут полностью прекратиться, после чего возобновиться снова. При привычном невынашивании характерно прерывание трех и более беременностей в сроке до 22 недель. <br class=\"SCXW70246934\" /> </p>",
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