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"lead": "паразитарная инвазия, вызываемая печеночной или гигантской двуусткой и характеризующаяся преимущественным поражением гепатобилиарной системы",
"description": "<p><span id=\"docs-internal-guid-5d5eca18-7fff-ce23-9da2-00ef44a802f4\"><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;\">Фасциолез — внекишечный гельминтоз, обусловленный паразитированием в паренхиме печени и желчных путях печеночной или гигантской фасциолы (сосальщика).</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;\">Возбудителями фасциолеза выступают два вида трематод (сосальщиков): двуустка печеночная и двуустка гигантская. Печеночная фасциола имеет тело плоской листовидной формы, на головном конце которого расположено 2 присоски. Длина взрослого паразита 20-30 мм, ширина 8-12 мм. Гигантская фасциола имеет более крупные размеры: длину 33-76 мм, ширину 5-12 мм.</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;\">Механизм передачи</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;\">Окончательными хозяевами сосальщиков служат травоядные сельскохозяйственные животные, реже – человек. Паразитируя в желчевыводящей системе, гельминты откладывают яйца, которые с испражнениями попадают в окружающую среду и свое дальнейшее развитие проходят в пресной воде. Там вышедшие из яиц личиночные стадии (мирацидии) внедряются в тело брюхоногих моллюсков, являющихся промежуточными хозяевами возбудителя фасциолеза.</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;\">Во внутренних органах моллюсков мирацидии превращаются сначала в спороцисты, а затем в хвостатые церкарии. Через 1-2 месяца церкарии снова выходят в воду, инцистируются, превращаясь в адолескарий, и прикрепляются к поверхности водных растений или водной пленке. В этой стадии личинки становятся инвазионными, т. е способными вызывать фасциолез у животных и человека.</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;\">Инфицирование человека возможно при употреблении в пищу дикорастущих или огородных растений, полив которых осуществлялся водой из пресных водоемов; питье некипяченой воды; во время купания и т. д. В желудочно-кишечном тракте личинки фасциолы высвобождаются из оболочек, через стенку кишечника выходят в брюшную полость, где через капсулу внедряются в паренхиму печени и таким образом попадают в желчные протоки. Возможен гематогенный путь миграции – через кишечные и воротную вены в печеночные протоки.</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;\">Через 3-4 месяца паразитирования в организме окончательного хозяина фасциолы достигают половозрелой стадии и начинают откладывать яйца. В гепатобилиарной системе человека возбудители фасциолеза способны паразитировать 5-10 и более лет.</span></p>\r\n<p><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;\"> </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;\">В патогенезе фасциолеза много общего с другими трематодозами. Миграция личинок фасциол, период их созревания определяют раннюю стадию инвазии. Ведущую роль в патогенезе этой стадии играют аллергические реакции организма больного на продукты обмена паразита и в меньшей мере — механический фактор — повреждение тканей молодыми фасциолами.</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;\">В хронической стадии взрослые особи гельминтов своими присосками и шипиками кутикулы вызывают механические повреждения стенок желчных протоков. Сами гельминты и скопления их яиц нарушают отток желчи, создают условия для присоединения вторичной микробной флоры и развития гнойного ангиохолита. При длительном течении болезни возможно развитие фиброза печени с явлениями портальной гипертензии.</span></p>\r\n<p><span id=\"docs-internal-guid-32c6996c-7fff-7e02-4483-1e3c05aff23c\"> </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;\">Чаще всего фасциолез диагностируется уже в хронической стадии, когда с беспокоящими жалобами больные обращаются к терапевту или гастроэнтерологу. Предположительный диагноз основывается на совокупности эпидемиологических данных и клинических данных. В пользу фасциолеза свидетельствует наличие ранее зафиксированных случаев инвазии на данной территории, групповая заболеваемость, употребление в пищу салатных растений, питье воды из открытых источников или использование ее для мытья посуды, фруктов, овощей и пр.</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;\">Методы выявления возбудителя. В раннем периоде фасциолеза диагноз подтверждается серологическими методами (РИФ, ИФА, РИГА, РСК). В хронической стадии информативно обнаружение яиц фасциол в фекалиях или дуоденальном содержимом. Паразиты могут быть обнаружены с помощью ультразвукового исследования печени и желчного пузыря, КТ печени.</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;\">Биохимия крови. В биохимических пробах печени отмечается повышение активности трансаминаз и щелочной фосфатазы, гипопротеинемия, гипоальбуминемия.</span></li>\r\n</ul>\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;\">Лечение фасциолеза проводится стационарно. В острую фазу назначается щадящая диета, десенсибилизирующие препараты; при развитии миокардита и гепатита показаны глюкокортикостероиды. К противопаразитарной терапии переходят только после стихания острых явлений. В качестве этиотропных препаратов при фасциолезе используются триклабендазол, гексахлорпараксилол, празиквантел. С целью изгнания погибших фасциол из желчных протоков назначаются желчегонные средства.</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;\">Контрольное паразитологическое обследование (анализ кала на яйца гельминтов, дуоденальное зондирование с исследованием порций желчи) проводится спустя 3 и 6 месяцев. В случае развития гнойных осложнений требуется назначение антибиотиков и проведение хирургического вмешательства (дренирования абсцесса печени, дренирования желчных протоков и др.).</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;\">Индивидуальная профилактика фасциолеза заключается в недопущении употрeбления сырой воды из водоемов, плохо промытой огородной зелени. Меры общественного контроля включают очистку водоемов, их защиту от фекального загрязнения, ликвидацию промежуточных хозяев фасциолеза – моллюсков, ветеринарное обследование и дегельминтизацию скота, санитарно-просветительскую работу.</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;\">В развитии фасциолеза выделяют инкубационный период, острую (миграционную) и хроническую (связанную с паразитированием взрослых гельминтов) стадии. В зависимости от инвазирующей дозы, инкубационный период может длиться от 1 до 8 недель. В миграционную фазу главным образом выражены общетоксические и аллергические симптомы. Больные фасциолезом жалуются на подъемы температуры, слабость, недомогание, головную боль. Лихорадка может быть субфебрильной или высокой (до 39-40°С), носить ремитирующий или волнообразный характер. На этом фоне появляется крапивница и кожный зуд, отек Квинке, высокая (до 80-85%) эозинофилия в крови. Развиваются диспепсические расстройства: тошнота, рвота, боли в эпигастрии и правом подреберье; происходит увеличение размеров печени, сопровождающееся желтухой. В раннем периоде часто развивается аллергический миокардит, характеризующийся загpyдинными болями, артериальной гипертензией, тахикардией. Через несколько недель клинические проявления острого фасциолеза значительно или полностью стихают.</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;\">Спустя 3-6 месяцев заболевание вступает в хроническую стадию, симптомы которой обусловлены непосредственным поражением печени и желчных путей. Течение хронического фасциолеза сопровождается гепатомегалией, приступообразными болями в правом боку; в периоды обострения – желтухой. Длительная инвазия приводит к развитию диспепсического синдрома, анемии, гепатита, цирроза печени. Вторичное инфицирование чревато возникновением гнойного холецистита и холангита, абсцессов печени, стриктуры желчных путей.</span></p>",
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"periodicity": 0,
"slug": "i48_fibrillyaciya_i_trepetanie_predserdiy",
"lead": "нарушение сердечного ритма, характеризующееся нерегулярным сердцебиением",
"description": "<p>Мерцательная аритмия - это <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">нарушение работы сердца, при котором электрический импульс распределяется по нему неравномерно. Из-за этого сердечные камеры работают несогласованно: в предсердии вместо сокращений возникают подергивания или «мерцания».</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> </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;\">Различают органические и функциональные причины развития фибрилляции предсердий. Группа органических причин обусловлена проблемами с сердечно-сосудистым аппаратом:</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;\">- гипертоническая болезнь;</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;\">- хроническая сердечная недостаточность;</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;\">- приобретенные и врожденные пороки сердца;</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;\">- ишемическая болезнь сердца;</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;\">- перенесенные воспалительные процессы (миокардит, перикардит);</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;\">- другие варианты аритмий;</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;\">- опухоли сердца;</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;\">- последствия операций не сердце.</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;\">Врачи выделяют группу факторов риска, не связанных с сердечной патологией (функциональные причины):</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;\">- эндокринологические заболевания – болезни щитовидной железы, сахарный диабет, ожирение;</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;\">- нехватка некоторых микроэлементом и минералов (калий, магний);</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;\">- хронические соматические патологии (гломерулонефрит, обструктивная болезнь лёгких);</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;\">- заболевания крови (анемия, лейкоз);</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;\">- табакокурение, злоупотребление алкоголем, энергетиками;</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;\">- выраженный стресс, физическое перенапряжение;</span></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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- инфекции (ВИЧ).</span></p>\r\n<p><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;\"> </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;\">Хронические заболевания сердечно-сосудистой системы, а также состояния, характеризующиеся повышенной активностью РААС, вызывают структурное ремоделирование стенок предсердий и желудочков. Процессы ремоделирования камер сердца приводят к неоднородности проведения потенциала действия и к диссоциации сокращения мышечных пучков. </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;\">Желудочки производят неритмичные сокращения, в итоге кровь задерживается в предсердиях, их объем увеличивается. Уменьшение наполнения желудочков, их частое сокращение, а также отсутствие эффективного сокращения предсердий могут приводить к снижению сердечного выброса и выраженным гемодинамическим расстройствам.</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;\">Из-за того, что кровоток в предсердиях замедляется из-за нарушения их механической систолы, а также из-за турбулентного перемешивания крови образуются тромбы.</span></p>\r\n<p><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;\"> </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 начинается со сбора жалоб и тщательного осмотра. Пациенту проводят аускультацию (выслушивание), оценивая сердечную деятельность, анализируют характер пульсовой волны.</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;\">Для фибрилляции предсердий рекомендуют следующие диагностические мероприятия:</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;\">1. Клинические и биохимические анализы крови и мочи для установления первопричины мерцания.</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;\">2. Электрокардиография (ЭКГ). Также проводят нагрузочную ЭКГ (тредмил-тест), провоцирующую аритмию в диагностических целях.</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;\">3. Холтеровское исследование ЭКГ. Строка ритма фиксируется в течение 24 часов, благодаря чему можно выявить факторы, способные вызывать приступ.</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;\">4. Эхокардиография (УЗИ сердца). Метод подтверждает диагноз «мерцательная аритмия», определяет мелкие тромбы в предсердиях.</span></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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">5. Велоэргометрия – исследование, в ходе которого используется дополнительная физическая нагрузка (так называемый «велосипед»).</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;\">Терапевтическое лечение предполагает предупреждение пароксизма или устранение уже начавшегося. Для этого применяется один из классов антиаритмических препаратов. К ним относятся блокаторы натриевых каналов, блокаторы кальциевых каналов, бета-адреноблокаторы. Фибрилляция предсердий сопровождается образованием тромбов. Это требует приема средств, способствующих разжижению крови и растворению тромбов, – препараты-антикоагулянты.</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 неэффективности консервативного лечения, а также при угрожающих жизни формах мерцания предсердий специалисты рекомендуют хирургическое лечение. Применяют следующие варианты:</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;\">1. Электрическая кардиоверсия. Проводят с помощью аппарата кардиовертера-дефибриллятора и специальных седативных препаратов.</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;\">2. Фармакологическая кардиоверсия. Менее болезненная процедура. Метод основан на внутривенном введении в кровяное русло антиаритмических препаратов.</span></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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">3. Катетерная радиочастотная абляция. Процедура актуальна при пароксизмальной форме заболевания. Суть операции заключается в обнаружении аритмогенных зон с последующей их нейтрализацией с помощью абляционного электрода.</span></p>\r\n<p><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;\"> </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;\">Профилактические мероприятия заключаются в следующем:</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;\">- здоровое питание с ограничением животных жиров;</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;\">- активный образ жизни с дозированными физическими нагрузками;</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;\">- борьба с избыточным весом;</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;\">- устранение стрессового фактора;</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;\">- отказ от вредных привычек (табакокурение, злоупотребление алкоголем);</span></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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- профилактический регулярный осмотр у врача-кардиолога и выполнение ЭКГ.</span></p>",
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},
"code": "N60.2",
"name": "Фиброаденоз молочной железы",
"icd_name": "Фиброаденоз молочной железы",
"gender": 0,
"age_min": 15,
"age_max": 60,
"cause": [
"0"
],
"periodicity": 1,
"slug": "n60.2_fibroadenoz_molochnoy_zhelezy",
"lead": "доброкачественное образование железистой природы с преобладанием соединительной ткани",
"description": "<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;\">Фиброаденоз молочной железы - это доброкачественное заболевание, которое проявляет себя болями в молочной железе из-за разрастания железистой и соединительной ткани.</span></p>\r\n<p><span id=\"docs-internal-guid-bd7abaf8-7fff-ffa7-a5f6-11f860e24e3b\"> </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;\">Фиброаденома имеет гормональную природу. Работа молочных желез зависит от гормонального фона, и нарушения функции эндокринной системы могут стать причиной развития болезни. Есть несколько причин фиброаденомы молочной железы:</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;\">наследственная предрасположенность; </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;\">заболевания эндокринной системы: сахарный диабет, гипертиреоз, аденомы гипофиза и пр.; </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;\">хронические воспалительные заболевания органов 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;\">перенесенные аборты и выкидыши; </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;\">отсутствие беременностей в репродуктивном возрасте; </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;\">прием гормональных средств; </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;\">длительное грудное вскармливание или отказ от лактации; </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;\">раннее наступление менструаций; </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;\">поздний климакс; </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;\">травмы груди; </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;\">стрессы; </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;\">вредные привычки и др. </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\"> </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\"> </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>\r\n<p><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;\"> </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;\">Основная роль в образовании узловой мастопатии принадлежит эстрогенам. Они вызывают следующие изменения в тканях груди:</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;\">усиление пролиферации эпителия;</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;\">активный рост протоков;</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;\">увеличение активности фибробластов;</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;\">разрастание соединительной ткани.</span></li>\r\n</ul>\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;\">Но не у всех женщин с относительной гиперэстрогенией наблюдается фиброаденома. Поэтому считается, что для начала роста узлов необходимо достаточное количество рецепторов к эстрогенам</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;\">Диагностика фиброаденомы молочной железы начинается с осмотра. Врач проводит визуальную оценку состояния молочных желез, пальпацию, а также задает вопросы и анализирует жалобы пациентки. После этого специалист направит на дополнительные инструментальные исследования:</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;\">УЗИ молочных желез. Позволит определить размеры, очертания, структуру, а также наличие или отсутствие кровоснабжения образования. Также поможет оценить состояние лимфоузлов. </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;\">Аспирационная биопсия. Необходима для забора участка тканей и дальнейшего цитологического исследования в лаборатории. </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;\">Лабораторные анализы. Позволяют определить уровень половых гормонов, пролактина. </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;\">Маммография. Назначается женщинам старше 35 лет в качестве альтернативы УЗИ. </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;\">КТ и МРТ при наличии показаний. </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>\r\n<p><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;\"> </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;\">Тактика лечения определяется полученными в результате диагностики данными, типом опухоли, индивидуальными особенностями пациентки. </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;\">Фиброаденомы молочных желез не подлежат медикаментозному лечению, поэтому есть только один способ — удаление. Исключение составляют только образования, не достигшие 1 см, а также незрелые фиброаденомы. Отложить операцию можно в подростковом возрасте, периоде менопаузы, но только при отсутствии рисков злокачественности образования. При этом важно наблюдать состояние молочных желез, дважды в год посещать врача и проходить инструментальные исследования (УЗИ или маммографию). Также при выборе выжидающей позиции врач может порекомендовать прием гормональных, растительных, общеукрепляющих и других средств.</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;\">Способов удаления фиброаденомы молочных желез существует несколько:</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;\">лазерное удаление; </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;\">криоабляция; </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;\">вакуумная аспирационная биопсия; </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;\">радиоволновое удаление. </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>\r\n<p><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;\"> </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;\">Специфических мер для профилактики возникновения фиброаденом молочной железы не существует. Однако регулярное самообследование и осмотр онкологом или маммологом не реже 1 раза в год позволяют своевременно выявить новообразование</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;\">Самый частый возраст выявления приходится на 20-30-летний рубеж. В большинстве случае образование выявляется самой женщиной или при обследовании. Клинически фиброаденома растет медленно и протекает бессимптомно.</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;\">Признаки фиброаденомы:</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;\">преимущественная локализация снаружи ареолярной области, в верхненаружном квадранте;</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;\">при крупных размерах она легко визуализиаруется как подкожное образование груди;</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;\">при пальпации узел плотный, безболезненный, легко подвижен и четко отграничен от окружающих тканей;</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;\">образование преимущественно имеет размеры от 1 до 5 см;</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;\">выделения из сосков не наблюдаются;</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;\">увеличение подмышечных лимфоузлов не характерно.</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\"> </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 беременности и лактации образование может быстро увеличиваться в размерах. После климакса фиброаденома регрессирует и претерпевает гиалиновое перерождение с последующим кальцинозом.</span></p>",
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"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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"lead": "Частичный или полный отказ от приема пищи. Проявляется снижением общего аппетита (не хочется ничего), изменением аппетита (нарушаются вкусовые потребности в отношении какой либо группы продуктов), полным отсутствием аппетита (анорексия).",
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"icd_name": "Фиброз печени",
"gender": 0,
"age_min": 30,
"age_max": 100,
"cause": [
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"slug": "k74.0_fibroz_pecheni",
"lead": "разрастание соединительной ткани в печени, которое происходит при повреждении гепатоцитов (печеночных клеток) вирусами гепатитов В, С, и D, алкоголем, токсическими веществами и другими факторами",
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"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;\">Основным пусковым фактором фиброзного перерождения печени признаны вирусные гепатиты В и С, которыми в России болеют более 5 млн. человек. Риск развития ФП у конкретного человека зависит от длительности существования гепатита, наличия и эффективности терапии, особенностей иммунной системы организма. Среди других причин фиброза печени выделяют 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;\">Гепатотоксины. Одним из самых распространенных факторов неинфекционного фиброза является алкогольный гепатит, вызванный хроническим повреждением печени этанолом и продуктами его распада. Токсическое влияние оказывают некоторые лекарства: цитостатики, блокаторы калиевых каналов.</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;\">Аутоиммунный гепатит. Заболевание выступает типичной причиной фиброза и цирроза у молодых женщин. Патология имеет наследственную предрасположенность и быстропрогрессирующий характер, повреждение паренхимы органа обусловлено специфическими аутоантителами.</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;\">Инфекции. Помимо вирусов гепатита, фиброз печени провоцируют вирус Эпштейна-Барр, бруцеллы, эхинококки. У пациентов с ВИЧ болезнь развивается на фоне осложненной цитомегаловирусной инфекции, диссеминированного криптококкоза, криптоспоридиоза.</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;\">Врожденные заболевания. Поражение печени происходит при болезни Вильсона-Коновалова, синдромах накопления гликогена, нарушениях липидного обмена (болезнь Гоше). Причиной разрастания соединительной ткани выступают фруктоземия, галактоземия, тирозинемия.</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;\">Нарушения печеночного кровотока. Причиной фиброза становится длительная гипоксия и застой крови на фоне синдрома Бадда-Киари, тромбоза портальной вены, веноокклюзионной болезни печени. Соединительнотканное перерождение паренхимы бывает при хронической сердечной недостаточности.</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>",
"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;\">При фиброзе печени происходит интенсивное разрастание волокнистой соединительной ткани, которая постепенно замещает паренхиму органа, выполняющую физиологические функции. Патологические процессы наблюдаются одновременно во всех компонентах стромы: наружной печеночной капсуле, периваскулярной соединительной ткани, портальных трактах. Значимым изменениям подвергается внеклеточный матрикс, который содержит звездчатые клетки и эндотелиоциты.</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;\">Фиброзное перерождение проявляется возрастанием числа коллагена 1 и 3 типов во внеклеточном матриксе, что результирует склерозом синусоидов, формированием артериовенозных шунтов. Процессы образования соединительной ткани усиливаются на фоне оксидантного стресса, накопления провоспалительных цитокинов, факторов роста. В дальнейшем прогрессирует септальный и перисинусоидальный фиброз, возникают глубокие необратимые нарушения кровотока.</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;\">Во время врачебного осмотра обнаружить заболевание можно лишь на последних стадиях развития процесса. Гораздо более информативны клинические исследования:</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;\">ОАК\u2028 – общий анализ крови, который показывает пониженный уровень гемоглобина и эритроцитов при повышенном СОЭ; </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;\">ОАМ\u2028 – общий анализ, который выявляет наличие белка, цилиндров и билирубина; </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;\">крови – биохимический анализ\u2028, обнаруживающий рост всех показателей, относящихся к печени; </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 печени\u2028 – выявляет увеличение размеров органа и появление фибротических образований; </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;\">эластометрия\u2028 – для оценки структуры печени и эластичности ее тканей; </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;\">томография\u2028 – для определения количества фиброзных очагов, из локализации и качественных показателей.</span></li>\r\n</ul>\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;\">Для точной диагностики фиброза печени может понадобиться биопсия Она проводится под контролем ультразвукового оборудования при помощи введения специальной трепанационной иглы. При наличии противопоказаний к процедуре возможна постановка диагноза на основе данных эластометрии.</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;\">Основу медицинской помощи составляет антифибротическая терапия, которая должна влиять на все звенья патогенеза болезни. Терапию необходимо начинать как можно раньше, желательно еще до начала клинических проявлений, поскольку ранние стадии фиброза печени являются потенциально обратимыми. Антифибротитческое лечение включает следующие направления:</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;\">Устранение этиологического фактора. По возможности назначаются препараты для коррекции хронической вирусной инфекции, подавления аутоиммунных реакций, эрадикации паразитарных и грибковых возбудителей. Рекомендуется строго исключить употребление алкоголя, максимально ограничить прием потенциально гепатотоксических лекарств.</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;\">Лечение хронического воспаления. С этой целью применяются глюкокортикоиды, нестероидные противовоспалительные средства из группы селективных ингибиторов ЦОГ-2, антагонисты цитокиновых рецепторов. Важным медикаментом патогенетического действия признана урсодезоксихолевая кислота.</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;\">Подавление фиброгенеза. Для угнетения активности звездчатых клеток печени, которые отвечают за развитие фиброза, применяются антиоксиданты, цитокины, антагонисты эндотелин-рецепторов. Схема лечения усиливается гепатопротекторами синтетического и растительного происхождения.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Профилактика заключается в предупреждении и лечении заболеваний, вызывающих фиброз печени.</span></p>\r\n<p><span id=\"docs-internal-guid-2bd56c1f-7fff-9b5d-f1d7-6529eda5f7d2\"> </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;\">Клинические проявления обусловлены основным заболеванием, которое вызывает склеротические процессы в печени. У большинства пациентов начальные стадии фиброза протекают бессимптомно, поскольку здоровые гепатоциты выполняют свои функции, процессы обмена веществ не страдают. Признаки болезни развиваются при обострении основной патологии, появлении портальной гипертензии, переходе фиброза в цирроз.</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;\">Начальные симптомы включают беспричинную слабость, повышенную утомляемость, ухудшение аппетита. Периодически появляется тупая боль в правом подреберье, которую пациенты связывают с употреблением алкоголя, перееданием, приемом жирной пищи. Прогрессирование заболевания проявляется желтушной окраской кожи и слизистых, зудом, расстройствами пищеварения. Возможно повышение температуры тела, появление носовых и желудочно-кишечных кровотечений.</span></p>",
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"code": "K74.2",
"name": "Фиброз печени в сочетании со склерозом печени",
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"image": null,
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"standard_type": 3,
"danger": 1,
"published": 1,
"parent": 6700,
"block_rubric": 117,
"standards": []
}
]
}
