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"code": "E46",
"name": "Белково-энергетическая недостаточность неуточненная",
"icd_name": "Белково-энергетическая недостаточность неуточненная",
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"lead": "Состояние питания, при котором дисбаланс энергии, белков и других питательных веществ ведет к измеримым нежелательным эффектам на ткани, функции и клинические исходы.",
"description": "При недостаточном поступлении белков и энергии уменьшаются безжировая масса тела и количество жировой ткани, причем одно из этих изменений может быть более выраженным.",
"etiology": "<p>Белково-энергетическая недостаточность может быть первичной или вторичной. Первичная белково-энергетическая недостаточность обусловлена неадекватным поступлением питательных веществ, а вторичная белково-энергетическая недостаточность является следствием различных расстройств или приема лекарственных препаратов, которые препятствуют использованию питательных веществ.</p>",
"pathogenesis": "",
"diagnostics": "",
"treatment": "<p>При легкой и умеренной белково-энергетической недостаточности следует устранить возможные причины этого состояния. Суточный приход белков и энергии увеличивают (в соответствии с идеальным весом) для ликвидации их дефицита. Всем больным назначают поливитамины. Проводят также лечение и профилактику дефицита минеральных веществ (в том числе микроэлементов) для предупреждения угрожающих жизни гипокалиемии, гипомагниемии, гипофосфатемии и т. д. Если больной способен принимать пищу и глотать, достаточно самостоятельного питания. При снижении аппетита или в отсутствие зубов дополнительно назначают жидкие питательные смеси для самостоятельного или зондового питания.</p>\r\n<full></full>\r\n<p>При тяжелой белково-энергетической недостаточности требуется более срочное вмешательство. Лечение таких больных затруднено по нескольким причинам:</p>\r\n<ul>\r\n<li>Заболевания, вызвавшие белково-энергетическую недостаточность, протекают тяжело, их труднее лечить. Иногда азотистый баланс можно восстановить только после излечения инфекции и устранения лихорадки.</li>\r\n<li>Белково-энергетическая недостаточность сама по себе может препятствовать излечению вызвавшего ее тяжелого заболевания. В таких случаях необходимо как можно раньше начать зондовое или парентеральное питание.</li>\r\n<li>Поступление пищи через ЖКТ способствует поносу из-за атрофии слизистой и дефицита ферментов кишечника и поджелудочной железы. При этом может быть показано полное парентеральное питание.</li>\r\n<li>Следует устранить сопутствующий дефицит других компонентов пищи (витаминов, незаменимых минеральных веществ, микроэлементов).</li>\r\n</ul>\r\n<p>У взрослых восстановление питательного статуса наступает медленно и не всегда полностью; у детей выздоровление происходит в течение 3-4 мес. Во всех случаях необходимы образовательные и реабилитационные программы, а также меры психологической и социальной поддержки.</p>",
"prevention": "",
"clinical_picture": "<p>Легкая и умеренная белково-энергетическая недостаточность. У детей отсутствует прибавка веса и роста. У взрослых отмечается снижение веса, хотя при отеках или ожирении оно может быть не столь заметным. Уменьшаются толщина кожной складки над трехглавой мышцей плеча и мышечная масса в области плеча.</p>\r\n<p>В отсутствие болезней почек чувствительным показателем белковой недостаточности служит отношение суточной экскреции креатинина к росту (показатель измеряют еженедельно). Снижаются уровни альбумина, трансферрина и транстиретина (преальбумина) в крови. Уровень Т3 снижается, а реверсивного Т3 - повышается. Замедляется метаболизм. Возможны лимфопения и нарушение толерантности к глюкозе . Размеры сердца уменьшены .</p>\r\n<p>Тяжелая белково-энергетическая недостаточность. Тяжелая белково- энергетическая недостаточность сопровождается более выраженными изменениями клинических и лабораторных показателей. При физикальном исследовании обнаруживают западение межреберий, атрофию височных мышц и атрофию мышц конечностей. Подкожная клетчатка атрофирована или отсутствует. Характерны <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>, быстрая <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>, чувство холода, депигментация кожи и депигментация волос, заострившиеся черты лица; кожа сухая, покрыта трещинами. В запущенных случаях образуются пролежни, кожа изъязвляется. АД снижено, также как и температура тела, пульс ослаблен. Нарушаются функции всех органов и систем.</p>",
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"code": "N49",
"name": "Воспалительные болезни мужских половых органов, не классифицированные в других рубриках",
"icd_name": "Воспалительные болезни мужских половых органов, не классифицированные в других рубриках",
"gender": 1,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "n49_vospalitelnye_bolezni_muzhskih_polovyh_organov_ne_klassificirovannye_v_drugih_rubrikah",
"lead": "",
"description": "",
"etiology": "",
"pathogenesis": "",
"diagnostics": "",
"treatment": "",
"prevention": "",
"clinical_picture": "",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 1,
"parent": null,
"block_rubric": 153,
"standards": [
5124,
5373
]
}
]
}