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"code": "K20",
"name": "Эзофагит",
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"lead": "Нарушение здоровья, относящееся к группе болезни пищевода, желудка и двенадцатиперстной кишки",
"description": "Эзофагит - заболевание пищевода, сопровождающееся воспалением его слизистой оболочки, представляет одно из очень распространенных заболеваний пищеварительного тракта. \r\n\r\nРефлюкс-эзофагит представляет собой воспаление слизистой оболочки пищевода, обусловленное забросом желудочного содержимого в пищевод (желудочно-пищеводный рефлюкс). ",
"etiology": "<p>Причины острого эзофагиты: </p>\r\n<ul>\r\n<li>острые инфекционные процессы; </li>\r\n<li>физическое повреждение (ожог, травмирование при введении зонда, повреждение инородными телами); </li>\r\n<li>химический ожог; </li>\r\n<li>аллергическая реакция на пищевые продукты. </li>\r\n</ul>\r\n<p>Причины развития хронических эзофагитов: </p>\r\n<ul>\r\n<li>алиментарный эзофагит (употребление очень горячей, острой пищи, крепкого алкоголя); </li>\r\n<li>профессиональный эзофагит (работа, связанная с вдыханием паров едких химических веществ); </li>\r\n<li>застойный эзофагит (раздражение слизистой остатками скопившейся пищи при разного рода затруднениях эвакуационной функции пищевода); </li>\r\n<li>аллергический эзофагит); </li>\r\n<li>дисметаболический эзофагит (связан с нарушениями обмена – гиповитаминозами, недостаточностью микроэлементов и тканевой гипоксией, продолжительной интоксикацией организма и т. п.).</li>\r\n</ul>\r\n<p>Рефлюкс-эзофагит развивается вследствие гастроэзофагеального рефлюкса (заброса желудочного содержимого в пищевод). Рефлюкс из желудка в пищевод может возникать по следующим причинам: </p>\r\n<ul>\r\n<li>недостаточность кардии (нижнего пищеводного сфинктера); </li>\r\n<li>грыжа пищеводного отверстия диафрагмы; </li>\r\n<li>недостаточная длина пищевода. </li>\r\n</ul>",
"pathogenesis": "<p>Механизм развития эзофагита обусловлен непосредственным раздражающим химическим, термическим, токсическим или пептическим (при недостаточности кардии и рефлюкс-эзофагите) воздействии на слизистую оболочку пищевода, в редких случаях - бактериальным, токсическим или токсико-аллергическим поражением.</p>\r\n<p> </p>",
"diagnostics": "<p>Диагностика эзофагита включает: </p>\r\n<ul>\r\n<li>Рентгенологическое исследование с контрастным веществом. Наблюдаемый заброс контрастного вещества из желудка в пищевод свидетельствует о выраженном рефлюксе.</li>\r\n<li>Эзофагоскопия - эндоскопическое исследование пищевода.</li>\r\n<li>Эзофагоманометрия — фиксирует различные по характеру нарушения моторики пищевода. </li>\r\n<li>Мониторная рН-метрия пищевода - измерение кислотности в просвете пищевода и желудка; содержимое пищевода будет кислым из-за заброса кислого содержимого из желудка.</li>\r\n</ul>",
"treatment": "<p> Консервативное лечение показано больным с неосложненным течением заболевания. Оно включает в себя: </p>\r\n<p>Общие рекомендации: </p>\r\n<ul>\r\n<li>после принятия пищи избегать наклоны вперед и не ложиться в течение 1,5 часов </li>\r\n<li>спать с приподнятым не менее чем на 15 см головным концом кровати, </li>\r\n<li>не носить тесную одежду и тугие пояса, </li>\r\n<li>ограничить потребление продуктов, агрессивно действующих на слизистую оболочку пищевода (жиры, алкоголь, кофе, шоколад, цитрусовые и т.п.), </li>\r\n<li>отказаться от курения. </li>\r\n</ul>\r\n<p>Медикаментозная терапия: </p>\r\n<ul>\r\n<li>Приём антацидов и производных альгиновой кислоты - препараты снижающие кислотность посредством её нейтрализации. </li>\r\n<li>Антисекреторные препараты - препараты, снижающие кислотность посредством подавления её образования. </li>\r\n<li>Прокинетики - препараты, которые увеличивают тонус нижнего пищеводного сфинктера. </li>\r\n<li>Антибиотикотерапия - применяется для подавления инфекционного процесса. </li>\r\n</ul>\r\n<p>Физиотерапевтическое лечение: </p>\r\n<ul>\r\n<li>при рефлюкс-эзофагите хороший результат дает амплипульстерапия; </li>\r\n<li>снижение болевого синдрома электрофорезом; </li>\r\n<li>грязелечение и бальнеотерапия. </li>\r\n</ul>\r\n<p>При тяжелом течении рефлюкс-эзофагита со стриктурами, язвами и стенозом физиотерапия противопоказана. Операции при стенозе пищевода заключаются в эндоскопическом рассечении стриктур, расширении или бужировании пищевода. По показаниям проводится резекция и пластика пищевода. </p>",
"prevention": "<p>Профилактика эзофагитов подразумевает избегание причин его развития – ожогов горячей пищей, химическими веществами, повреждений инородными телами и т. п. </p>\r\n<p>Профилактика хронического эзофагита – регулярное диспансерное обследование у гастроэнтеролога и при необходимости – лечение. Больным хроническим эзофагитом в качестве профилактики обострений показано санаторно-курортное лечение.</p>",
"clinical_picture": "<p>Острый поверхностный эзофагит проявляется болями при глотании, ощущением саднения за грудиной, иногда дисфагией. При геморрагическом эзофагите могут быть кровавая рвота и мелена. При псевдомембранозном эзофагите в рвотных массах обнаруживают пленки фибрина. Особенно тяжело, с картиной септической интоксикации, протекают абсцесс и флегмона пищевода. </p>\r\n<p>Подострые и хронические эзофагиты проявляются изжогой, чувством жжения, саднения за грудиной, в редких случаях — болью, дисфагией. При рефлюкс-эзофагите основными симптомами являются изжога и срыгивание, усиливающиеся при наклоне туловища и в горизонтальном положении больного. Нередко наблюдаются загрудинные боли при глотании.</p>",
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"code": "O15",
"name": "Эклампсия",
"icd_name": "Эклампсия",
"gender": 2,
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"lead": "Нарушение здоровья, относящееся к группе отеки, протеинурия и гипертензивные расстройства во время беременности, родов и в послеродовом периоде",
"description": " Эклампсия – поздняя форма гестоза, характеризующаяся резким подъемом артериального давления, несущего угрозу жизни матери и плода. ",
"etiology": "<p>К предрасполагающим факторам развития эклампсии относятся: </p>\r\n<ul>\r\n<li>гипертонические состояния; </li>\r\n<li>наличие аналогичных приступов в предыдущие беременности; </li>\r\n<li>хронические заболевания внутренних органов (тяжелые поражения почек, патологии сердца и сосудов, сахарный диабет, тяжелая форма ожирения); </li>\r\n<li>первые роды в раннем (до 18 лет) или позднем (после 35 лет) возрасте; </li>\r\n<li>многоплодие; </li>\r\n<li>плохой маточный кровоток; </li>\r\n<li>нарушения в плаценте; </li>\r\n<li>эклампсия у ближайших родственниц. </li>\r\n</ul>",
"pathogenesis": "<p>Определяющим в развитии эклампсии является повреждение клеток головного мозга вследствие критической гипертензии (подъема артериального давления), спазма сосудов, повышения проницаемости гемато-энцефалического барьера, снижения объема мозгового кровотока, нарушения калиево-кальциевого баланса. </p>\r\n<p>Из-за того, что локальные вазоконстрикторы вызывают спазм сосудов и уменьшают плацентарный кровоток, происходит снижение кровоснабжения плода, задержка его развития и задержка циркуляции вазоконстрикторов в сосудистой системе беременной. Выработка вазоактивных субстанций направлена на увеличение артериального давления матери для улучшения кровотока в плаценте и у плода. Последнее, как следствие, сопровождается развитием артериальной гипертензии. В то время как артериальная гипертензия является наиболее видимым признаком заболевания, на самом деле происходит генерализованное повреждение внутренней стенки сосудов печени и почек (снижение почечного кровотока, приводящее к ишемическому повреждению клубочков с развитием протеинурии (потеря белка с мочей), задержки воды и как следствие развитию отёков). </p>",
"diagnostics": "<p>Эклампсия является острым, внезапно развивающимся состоянием, поэтому традиционные методы обследования беременных (гинекологический осмотр, УЗИ, допплерометрия маточно-плацентарного кровотока) не имеют диагностической значимости. В диагностике эклампсии основываются на наблюдении типичных проявлений, которые позволяют отличить данную форму гестоза от других поражений мозга — аневризмы, эпилепсии, опухолей, а также уремической и диабетической комы. </p>\r\n<p>Типичным для эклампсии является ее связь с беременностью, возникновение во второй половине гестации (после 22-ой недели) либо в первые послеродовые сутки, предшествующий тяжелый гестоз с критической артериальной гипертензией и кратковременная симптоматика преэклампсии. В случае эклампсии отсутствует характерная для эпилепсии аура — т. е. малые симптомы-предвестники. С целью исключения отека легких выполняется рентгенография грудной клетки; для оценки состояния головного мозга — КТ, ЯМРТ. </p>",
"treatment": "<p>Этиопатогенетическим методом лечения остается досрочное родоразрешение. До и после родоразрешения также применяются следующие методы лечения: </p>\r\n<ul>\r\n<li>Обеспечение строжайшего покоя, устранение зрительных, слуховых, тактильных и болевых ощущений. </li>\r\n<li>Устранение сосудистого спазма, ведущего к артериальной гипертензии. </li>\r\n<li>Дегидратационная терапия, способствующая усилению диуреза и предупреждающая отек мозга. </li>\r\n<li>Оксигенотерапия — вдыхание кислорода, при необходимости проводится искусственная вентиляция легких (ИВЛ). </li>\r\n</ul>\r\n<p>Предупредить повторение Предупреждение крайней формы гестоза — эклампсии - требует профилактики развития поздних токсикозов в процессе ведения беременности, своевременное выявление и коррекцию водянки, нефропатии и преэклампсии.приступов эклампсии позволяет назначение седативных или наркотических средств.</p>",
"prevention": "<p>Предупреждение крайней формы гестоза — эклампсии - требует профилактики развития поздних токсикозов в процессе ведения беременности, своевременное выявление и коррекцию водянки, нефропатии и преэклампсии.</p>",
"clinical_picture": "<p>Самый характерный признак эклампсии — судороги с потерей сознания, не связанные с какой-либо другой церебральной патологией (например, эпилепсией или кровоизлиянием в головной мозг). Обычно судорожному припадку предшествуют следующие симптомы: головная боль, боль в подложечной области, а также нефропатия. Судорожный припадок развивается в определенной последовательности: </p>\r\n<ol>\r\n<li>Возникают мелкие фибриллярные сокращения мышц лица, переходящие на верхние конечности (15-25 с). </li>\r\n<li>Развиваются тонические судороги мышц всей скелетной мускулатуры, нарушается или полностью отсутствует дыхание, больная теряет сознание, зрачки расширены, отмечается прогрессирующий цианоз (синюшность) кожных покровов и видимых слизистых оболочек. (10-20 с). </li>\r\n<li>Развиваются клонические судороги мышц туловища, верхних и нижних конечностей. В эту стадию у больной появляется нерегулярное, хриплое дыхание, изо рта выделяется пена, нередко окрашенная кровью из-за прикусывания языка. (1-1,5 мин). </li>\r\n<li>После сокращения клонических судорог больная впадает в эклампсическую кому. </li>\r\n<li>Во время припадка могут возникать асфиксия, прикусывание языка, ушибы и переломы. После окончания судорог возможно развитие аспирационной пневмонии и печеночно-почечной недостаточности. Больная может умереть во время судорожного припадка или после его окончания от кровоизлияния в мозг, асфиксии, отека легких. Плод нередко погибает от острой гипоксии. </li>\r\n</ol>",
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