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"code": "L05",
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"lead": "врождённая аномалия развития кожи крестцово-копчиковой области, связанная с неполной редукцией рудиментарной каудальной связки. ",
"description": "Для заболевания характерно наличие врождённых первичных свищевых втяжений в межягодичной складке. Нередко из таких втяжений выстоят волосы. ",
"etiology": "<p>Считают, что эпителиальный копчиковый ход является врожденным дефектом развития кожи, обусловленным неполной редукцией мышц и связок хвоста.</p>",
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"diagnostics": "<p>Местные изменения настолько типичны, что спутать копчиковый ход с другими поражениями этой области почти невозможно. При введении в один из свищей метиленового синего краска выходит из всех остальных ходов и вторичных свищей и не проходит в прямую кишку.</p>",
"treatment": "<p>Радикальное лечение пилонидальной кисты проводится только хирургическим путем, в условиях стационара хирургического или колопроктологического отделения. Существуют две тактики хирургического лечения:</p>\r\n<ol>\r\n<li>В острый период вскрывается и дренируется гнойник. После чего через 1–2 недели проводится радикальная операция – иссечение кисты в пределах здоровых тканей.</li>\r\n<li>В острый период сразу проводится радикальная операция – иссечение кисты единым блоком в пределах здоровых тканей (при этом необходимо сохранить целостность кисты, во избежание инфицирования операционной раны).</li>\r\n</ol>\r\n<p>Операция завершается ушиванием краев раны. Хотя, на усмотрение хирурга, рана может оставаться открытой и долго заживать вторичным натяжением; иногда до 6 месяцев (Прим. автора). При иссечении кисты копчика всегда имеется дефицит тканей, что приводит к чрезмерному натяжению краев раны и негативно сказывается на ее заживлении. Практически всегда послеоперационные раны заживают долго, причиняя значительные неудобства пациенту. При этом частота рецидива достигает 10–40%.</p>\r\n<p>Радикальная операция всегда проводится в условиях наркоза. В послеоперационном периоде пациенты в обязательном порядке получают антибактериальные препараты широкого спектра действия, а также противовоспалительные средства.</p>",
"prevention": "<p>Всем, кто перенес радикальное оперативное вмешательство по поводу эпителиального копчикового хода, желательно соблюдать следующие рекомендации: <br />- в течение трех недель после операции не разрешается сидеть, поднимать тяжести; после снятия швов целесообразно ежедневно принимать гигиенический душ с промыванием межъягодичной складки; <br />- в течение 6 месяцев после операции 2 раза в месяц необходимо производить эпиляцию в зоне операции.</p>",
"clinical_picture": "<p>Эпителиальный копчиковый ход расположен по средней линии в межъягодичной складке, слепо оканчивается в подкожной клетчатке крестцово-копчиковой области, открывается на коже одним или несколькими точечными отверстиями (первичный эпителиальный ход), и представляет собой узкую эпителиальную трубку. Продукты жизнедеятельности эпителия, выстилающего ход, периодически выделяются через точечные отверстия наружу. Закупорка или инфицирование выводных протоков, механическая травма приводят к задержке содержимого в просвете хода и способствуют возникновению воспаления. В результате эпителиальный копчиковый ход расширяется, стенка его разрушается и в воспалительный процесс вовлекается окружающая клетчатка. Развившиеся при этом абсцесс или флегмона крестцово-копчиковой области иногда достигают значительной величины и могут вскрыться наружу в виде гнойного свища, который принято называть вторичным отверстием. <br /><br />В 25-50% случаев внутри эпителиального копчикового хода или возникшей на его месте кисты содержатся волосы, которые могут внедряться в боковые стенки и образовывать дополнительные ходы. Гнойник иногда достигает значительной величины и, как правило, прорывается через кожу, образуя наружное отверстие гнойного свища. <br />Различают неосложненный и осложненный гнойным процессом эпителиальный копчиковый ход.</p>",
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"etiology": "<p>Возбудитель заболевания Treponema Carateum Herrejin. По морфологическим и антигенным свойствам она сходна с бледной трепонемой. Возбудитель пинты обитает в почве, на растениях, фруктах. Инфицирование происходит при прямом и непрямом контактах с больным человеком. Возбудитель проникает через поврежденную кожу или слизистые оболочки. Доказана передача возбудителя насекомыми (комары, клопы, мошки). Заболеванию особенно подвержены дети. Среди эндогенных факторов следует выделить низкую иммунную реактивность, повышенную потливость кожи и щелочную реакцию ее водно-липидной мантии. Среди экзогенных факторов особенно выделяются скученность населения, микротравмы и мацерация при высокой температуре и влажности тропического климата. </p>",
"pathogenesis": "<p>Проникают трепанемы через поврежденные участки кожи и слизистые оболочки. Затем они локализуются преимущественно в роговом слое эпидермиса, где развивается гиперпигментация, утолщение кожи, межклеточный отек. Также происходит нарушение пигментной функции, так как наблюдается гибель меланоцитов. Поражаются регионарные лимфатические узлы. В поздней стадии развивается очаговая атрофия эпидермиса. </p>",
"diagnostics": "<p>Диагноз пинты основываются на появлении характерных пятен на коже и стадийности их изменений без нарушения общего состояния, за исключением кожного зуда. Диагноз подтверждается обнаружением в соскобах кожи трепонем; в поздних стадиях болезни становится положительной реакция Вассермана. </p>\r\n<p>Применяются серологические реакции, реакции иммунофлюоресценции - обнаруживаются специфические антитела к трепонеме. </p>",
"treatment": "<p>Лечение проводят дюрантным и препаратами пенициллина, типа бициллина, или новыми препаратами – экстенциллнн, ретарпен и др. Детям и взрослым, контактировавшим с больными, проводят профилактическое лечение бициллином.</p>",
"prevention": "<p> </p>\r\n<p>Профилактические мероприятия сводятся к выявлению и лечению больных и лиц, находящихся с ними в тесном контакте. Специфической профилактики не разработано. </p>",
"clinical_picture": "<p>Инкубационный период 7-20 дней. </p>\r\n<p>На месте внедрения трепонемы образуется эритематозная зудящая папула (узелок), размеры которой постепенно увеличиваются до нескольких сантиметров (примерно на 1 см в течение месяца). Вокруг папулы через 6-12 мес появляются мелкие пинтиды, зудящие, многочисленные, различного цвета (голубого, серого, бурого, желтого, фиолетового, красного и др.) разной величины и формы: круглые, овальные, неправильные; они шелушатся и напоминают чешуйчатый лишай или становятся лихеноидными (утолщенным). </p>\r\n<p>В поздней третьей стадии болезни - на коже обилие ахроматичных и пигментированных пятен; появляется утолщение подошв и ладоней, болезненные трещины, пигментные нарушения ногтей. </p>\r\n<p>Физическое состояние больных не нарушается, сохраняется трудоспособность, и заболевание продолжается неопределенно длительное время. </p>",
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"lead": "воспалительное заболевание суставов, обусловленное попаданием инфекции в полость сустава через повреждения на коже или возникающее вследствие наличия острых или хронических заболеваний, вызванных бактериями",
"description": "<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;\">Пиогенный артрит, называемый также септическим артритом или инфекционным артритом, является серьезной болезнью суставов, характеризующейся болью, температурой, ознобом, покраснением и отеком одного или нескольких суставов, а также потерей подвижности пораженных суставов.</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;\">Развитию инфекционного артрита способствуют следующие факторы:</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;\">различные хронические артриты</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;\">системные инфекционные заболевания</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;\">системные заболевания соединительной ткани</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;\">иммунодефицитные состояния (как правило, у пациентов, страдающих иммунодефицитом, развивается полиартрит)</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;\">онкологические заболевания</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;\">внутрисуставные инъекции или хирургические вмешательства на суставах, в ходе которых в ткани сустава может быть занесена инфекция</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;\">сахарный диабет</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</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;\">наличие протезов суставов</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;\">алкоголизм и наркомания (наркозависимые пациенты часто страдают поражением суставов осевого скелета)</span></li>\r\n<li><span id=\"docs-internal-guid-552472a8-7fff-8131-83f0-95ef23c608a6\"><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;\">прием ряда препаратов, в том числе гормональных</span></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>",
"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;\">Как правило, возбудитель артрита попадает в сустав с током крови или лимфы. В зависимости от того, какой именно возбудитель вызвал заболевание, различают бактериальный, вирусный, грибковый и паразитарный артриты.</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;\">Если возбудитель попадает в сустав извне, то такой артрит называется первичным. Если очаг воспаления находится в самом организме, то есть инфекция попадает из других органов и тканей, то артрит называется вторичным.</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;\">Также инфекционный артрит может развиться в результате травмы сустава и попадания возбудителей воспаления в рану. </span></p>",
"diagnostics": "<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;\">При подозрении на развитие инфекционного артрита пациента направляют на рентген или УЗИ суставов. Также необходимо сделать анализ крови, иммунограмму, исследовать внутрисуставную жидкость, для анализа берутся мазки из половых путей. При подозрении на туберкулезную природу артрита проводится исследование для выявления очагов туберкулеза.</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;\">Основные принципы лечения инфекционных артритов:</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;\">подавление инфекции, вызвавшей поражение суставов;</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;\">дезинтоксикационная терапия – выведение из организма токсических продуктов воспаления;</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;\">предупреждение рецидивов заболевания и дальнейшего разрушения суставов.</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\"><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;\">Разные клинические формы инфекционного артрита требуют разного подхода к лечению. Так, острые гнойные и другие, протекающие тяжело артриты, лечатся только стационарно. При хроническом течении возможно амбулаторное лечение или его сочетание со стационарным во время обострения. На этом этапе основными методами лечения инфекционного артрита являются хирургическое и медикаментозное в сочетании с иммобилизацией (созданием неподвижности) пораженных суставов.</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;\">В дальнейшем, на стадии восстановления присоединяются немедикаментозные методики: лечебная гимнастика, массаж, физиотерапевтические процедуры, курсы рефлексотерапии.</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;\">Хирургическое лечение острых гнойных артритов</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;\">При нагноительном процессе в суставах проводят следующие хирургические манипуляции и операции:</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;\">артроцентез - пункция сустава (прокол иглой со шприцем) с последующим удалением гнойного экссудата, промыванием (лаважем) суставной полости дезинфицирующим раствором и введением антибиотиков;</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;\">лечебная артроскопия – та же самая процедура, но проводится при помощи эндоскопической аппаратуры (артроскопа); во время артроскопии можно удалить не только гной, но и кусочки некротизированной ткани, секвестры костей;</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;\">артротомия с проточно-аспирационным дренированием – проводится при большом скоплении гноя и деструкции сустава; полость сустава раскрывается традиционным хирургическим способом, после чего проводится удаление гноя,регулярное промывание суставной полости дезинфицирующими растворами с введение в нее антибиотиков.</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><span id=\"docs-internal-guid-aa0d875c-7fff-a70d-1da2-4fa91cfb01c1\"><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;\">Инфекционный артрит можно предупредить, занимаясь закаливанием, спортом без тяжелых физических нагрузок, правильно питаясь и вовремя пролечивая все инфекции.</span></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;\">Проявления инфекционного артрита могут различаться, в зависимости от того, какой возбудитель стал причиной заболевания. Однако можно выделить ряд симптомов, общих для всех форм инфекционного артрита:</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;\">сильная боль в суставе в покое или во время движения; сустав болезненный даже при прикосновении</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;\">нарушение функции сустава, вынужденное положение конечности</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;\">изменение контуров сустава</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;\">отечность, покраснение и повышение температуры кожи в районе сустава</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;\">общее плохое самочувствие, повышение температуры тела</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;\">тошнота и рвота</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;\">слабость, повышенное потоотделение</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> </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;\">Если инфекционный артрит вызван гонококками, то могут быть и кожные проявления в виде высыпаний на коже и слизистых. Золотистый стафилококк является причиной такой формы артрита, при которой разрушение хрящей происходит очень быстро, буквально в течение 2-3 дней.</span></p>",
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"etiology": "<p>Чаще всего на пораженных участках кожи выявляются такие микроорганизмы, как Streptococcus haemolyticus, Staphylococcus aureus, S. albus. Эти кокки выделяют различные экзотоксины и ферменты, которые определяют клиническое отличие различных пиодермий.Пиодермия развивается под влиянием различных экзогенных и эндогенных факторов.</p>\r\n<p>Экзогенные факторы</p>\r\n<ul>\r\n<li>Травматизация кожи.</li>\r\n<li>Загрязнение кожи, несоблюдение гигиенических норм, чрезмерное обезжиривание кожи.</li>\r\n<li>Нарушение секреторной функции кожи.</li>\r\n</ul>\r\n<p>Эндогенные факторы</p>\r\n<ul>\r\n<li>Фокальная инфекция.</li>\r\n<li>Заболевания желудочно-кишечного тракта.</li>\r\n<li>Нарушения обмена веществ.</li>\r\n<li>Заболевания эндокринной системы.</li>\r\n<li>Неврозы, психическая травма.</li>\r\n<li>Хроническая интоксикация.</li>\r\n<li>Иммунный дефицит, ВИЧ-инфекция.</li>\r\n</ul>",
"pathogenesis": "<p><span id=\"docs-internal-guid-aca276b1-7fff-925e-dd63-afdf2c6451d4\"><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;\">Процесс формирования язвы при гангренозной пиодермии проходит три стадии. На стадии иммунных реакций происходит накопление специфических для определённого вида антигена антител. При этом иммунные лимфоциты и антитела класса Е из крови переходят в ткани кожи, сенсибилизируя её. На второй (патохимической) стадии заболевания повторное попадание чужеродного антигена вызывает активацию протеолитических ферментов клеток и тканей с нарушением их функций. Эпидермальные клетки начинают вырабатывать биологически активные вещества, провоцирующие воспаление. На третьей (патофизиологической) стадии возникает специфический ответ кожи на внедрение патологического антигена в виде дегрануляции клеток, разрушения сосудов, нарушения трофики и локальной деструкции ткани. Глубина деструкции зависит от количества патогенного антигена и степени устойчивости иммунной системы.</span></span></p>",
"diagnostics": "<p>Клинический диагноз ставится дерматологом на основании анамнеза, специфической симптоматики и консультаций узких специалистов, поскольку гангренозная пиодермия является междисциплинарным заболеванием. Гистология очага поражения не показательна, но в сложных случаях полезна. Выявляется тромбоз сосудов, гранулематозные инфильтраты, островки деструкции в эпидермисе и дерме. Дополнительно проводят электрофорез сывороточного белка, исключают микотическую природу язвы, берут кровь на RW.</p>",
"treatment": "<p><span id=\"docs-internal-guid-86eb6e11-7fff-fefe-229c-1391e5ce073a\"><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;\">Терапию гангренозной пиодермии начинают с коррекции соматической патологии у профильных специалистов, поскольку кожный патологический процесс без этого плохо поддаётся терапии. Целью дерматологического лечения является снятие воспалительных проявлений, болезненных ощущений, восстановление кожных покровов. Для этого проводят курсы гормонотерапии и антибиотикотерапии. В тяжёлых случаях подключают цитостатики, иммуносупрессоры, калия иодид, внутривенно вводят иммуноглобулин. Показан плазмаферез. Наружно при гангренозной пиодермии очищают поверхность дефекта кожи с помощью вибрационно-турбулентных ванн, антисептических растворов. Применяют влажно-высыхающие повязки с растворами серебра, гормональные препараты. С учётом патергии стараются избегать хирургических манипуляций.</span></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;\">Основные методы профилактики:</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;\">гигиенический уход за кожей;</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;\">своевременная обработка порезов и ожогов;</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 хронических инфекций;</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;\">регулярные обследования у дерматолога при хронических кожных заболеваниях;</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;\">контроль уровня сахара в крови при диабете.</span></li>\r\n</ul>\r\n<p> </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>",
"clinical_picture": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гангренозная пиодермия встречается обычно у взрослых, дети болеют редко. Очаги поражения часто локализуются на нижних конечностях, но могут развиться и на других участках.</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гангренозная пиодермия начинается с образования фурункулоподобных инфильтратов или пустул. Последние быстро некротизируются и эксцентрически увеличиваются в размерах. Язвы имеют отечный воспалительный ободок шириной 1-1,5 см, подрытые края, гнойное, кровянисто-гнойное неровное дно и участки некроза тканей. В отделяемом язвы обнаруживают различную кокковую и бактериальную флору. В пределах валикообразной инфильтрации имеются множественные мелкие пустулы и очаги некроза. Очаги серпигинируют во всех или в одном каком-либо направлении, одновременно рубцуясь в другом. Гангренозная пиодермия субъективно проявляется сильной болью. У половины больных наблюдается одиночный очаг. Общее состояние остается удовлетворительным, но у некоторых больных отмечаются преходящая лихорадка и недомогание. </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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Системные признаки: лихорадка, общее недомогание и артралгия. Язвы сливаются, формируя большие язвы, часто с обширным рубцеванием, далее развивается патергия. Характерно рецидивирующее течение заболевания.</span></p>\r\n<p><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;\"> </span></p>",
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"lead": "гнойно-деструктивное заболевание почек, представляющее собой некроз почечной ткани на завершающей стадии острого воспалительного процесса мочевыводящих путей",
"description": "<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;\">Пионефроз - заболевание, возникающее вследствие активного специфического или неспецифического вторичного пиелонефрита, для которого характерны гнойно-деструктивный процесс в почке, гнойное расплавление почечной паренхимы и практически полное угнетение её функций.</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;\">Выделяют следующие причины развития пионефроза:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #444444; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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 мочевыводящих путей патогенными микроорганизмами — пионефроз возникает на заключительных этапах пиелонефрита, цистита, туберкулеза почек и ряда других почечных инфекционных заболеваний в случае неверно назначенного антибактериального лечения или несоблюдения пациентом назначений врача;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #444444; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">мочекаменная болезнь — образовавшиеся камни препятствуют свободному отхождению мочи, ухудшают гемодинамику, что влечет за собой значительное угнетение иммунитета и увеличение вероятности инфицирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #444444; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">постановка мочевого катетера — заболевание может развиться в результате использования нестерильного катетера или травмирования мочевыводящих путей при его постановке;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #444444; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">врожденные и приобретенные патологии мочевыводящей системы (удвоение мочеточников и почки, опущение почки и другие).</span></p>\r\n</li>\r\n</ul>",
"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;\">Инфекционный агент вызывает развитие воспалительного процесса в почечной ткани. Усиливается приток крови, повышается проницаемость почечных сосудов, формируется отек. Появляются гнойные полости в паренхиме. Дальнейшее развитие воспаления приводит к формированию рубцов, расширению лоханок, нарушению притока крови и оттока постоянно продуцирующейся мочи, что ухудшает течение болезни. При пионефрозе почка доступна для пальпации, бугристая, увеличенная в размерах.</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;\">Если на данном этапе проводится хирургическое удаление органа, то на разрезе обнаруживаются полости с толстыми стенками, заполненные густым, зловонным гноем. Иногда в процессе течения пионефроза собственная ткань почки замещается плотной жировой. Жировая дистрофия — реакция нефральных структур на ухудшение кровоснабжения и кислородное голодание тканей. Пионефроз чаще развивается как односторонний процесс, но при выраженном иммунодефиците может носить двусторонний характер.</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;\">При возникновении признаков заболевания необходимо обратиться к хирургу или урологу для прохождения обследования. Физикальная диагностика пионефроза складывается из сбора жалоб, проведения пальпации почек и мочевого пузыря. При нагноении орган болезненен, увеличен в размерах, имеет неоднородную поверхность и ограниченную подвижность в забрюшинном пространстве. </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;\">Из методов диагностики используются:</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;\">Общий анализ мочи. С помощью исследования диагностируется воспалительный процесс в почках, признаками которого является мутность мочи со значительным осадком, большое содержание лейкоцитов, выраженная протеинурия, бактериурия, специфические белковые цилиндры, слизь.</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;\">Общий анализ крови. Показывает наличие воспаления и активацию иммунитета в организме, для которых характерны высокий уровень лейкоцитов, увеличенная скорость оседания эритроцитов.</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;\">Биохимический анализ крови. Выявляет повышенный уровень мочевины, креатинина, электролитов — индикаторов снижения способности почек фильтровать кровь от токсинов.</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;\">Посев мочи. Исследование позволяет идентифицировать микроорганизм, вызвавший инфекцию. При выборе схемы лечения это помогает назначить адекватную антибактериальную терапию, направленную на конкретного возбудителя.</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;\">Рентгенодиагностика. При обзорной урографии на рентгенограмме видна тень увеличенной почки с четкими контурами. Часто обнаруживаются камни в почечной лоханке или мочеточнике, создающие механическую преграду для оттока гноя. Дополнительно используется ангиография почечных сосудов, оценивающая уровень кровоснабжения органа. КТ почек также определяет очаг, но позволяет отличить полость, заполненную гноем, от опухоли или кисты.</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 почек. Помогает локализовать воспалительный очаг, определить его форму, оценить качество уродинамики в лоханках и мочеточниках.</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;\">Радиоизотопная ренография. Нефросцинтиграфия, назначается для оценки функции почек и степени почечной недостаточности.</span></li>\r\n</ul>\r\n<p> </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;\">Лечение патологии оперативное — нефрэктомия или нефроуретерэктомия, если нагноение возникло из-за сужения просвета нижнего отдела мочеточника. Способствует скорейшему заживлению, уменьшению риска осложнений удаление не только самой почки, но и околопочечной жировой клетчатки. В тяжелых случаях ткань органа и гнойные очаги удаляются малоинвазивными способами внутри капсулы. Подготовка к плановой нефрэктомии проходит в течение 1-1,5 недель в условиях стационара. Необходима комплексная оценка состояния пациента, консультации терапевта, нефролога, кардиолога, анестезиолога.</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;\">Больным с напряженной закрытой формой пионефроза проводится экстренное оперативное вмешательство для предупреждения развития перитонита и сепсиса. У пациентов с тяжелыми сопутствующими заболеваниями, нарушением работы второй здоровой почки или двусторонним пионефрозом первый этап операции заключается в наложении нефростомы, позволяющей дренировать гнойный очаг. Дополнительно назначается интенсивная антибактериальная, детоксикационная терапия, выполняется плазмаферез. При стабилизации состояния становится возможна радикальная операция.</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;\">Профилактика пионефроза направлена на предупреждение развития воспалительных заболеваний мочеполовой системы: следует избегать переохлаждения, вовремя и в полном объеме лечить возникшие очаги инфекции в организме. Адекватная терапия строится на применении антибактериальных препаратов узкого спектра после лабораторного определения конкретного возбудителя.</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 симптомы зависят от проходимости мочевыделительных путей. Наслаивание симптомов пионефроза на проявления основного заболевания представляет дополнительную диагностическую сложность. Общее состояние больных в первые 24 часа заболевания удовлетворительное. Отмечается постоянная боль в пояснице средней интенсивности с иррадиацией во внутреннюю часть бедра или половые органы. Температура тела нормальная или повышена до 37-38°С.</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 развитии нагноения наступает острая фаза заболевания с усилением боли, изменением ее характера на приступообразный. Температура тела повышается до 40-41°С, появляются симптомы общей интоксикации: озноб, головная боль, слабость, рефлекторная тошнота и рвота. При двустороннем характере процесса развиваются симптомы почечной недостаточности и общего истощения организма. Снижаются функции иммунной системы, что часто приводит к присоединению вторичной инфекции — гриппа, пневмонии, стоматита.</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;\">Основной симптом открытой формы пионефроза — выделение мутной мочи, содержащей продукты распада и воспаления тканей (пиурия). Содержание гноя на общий объем мочи может достигать 10%. Степень пиурии и клиническая симптоматика зависят от формы пионефроза. При закрытом характере течения боли в поясничной области большей интенсивности, иногда по типу почечной колики. Моча прозрачная, но при переходе закрытой формы в открытую становится мутной. Вскрытие капсулы гнойного фокуса приводит к улучшению самочувствия, снижению температуры тела. Открытая форма, при которой в течение всего заболевания сохраняется нормальный отток гноя, лихорадка и общая интоксикация организма выражены слабее или вовсе отсутствуют.</span></p>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 40,
"published": 1,
"parent": 6878,
"block_rubric": 148,
"standards": []
},
{
"id": 6634,
"symptoms": [
{
"id": 2641,
"synonyms": [
{
"name": "Акроцианоз"
},
{
"name": "синюха"
},
{
"name": "посинение кожи"
},
{
"name": "синяя кожа"
},
{
"name": "Синюшность кожи"
}
],
"body_points": [
{
"x": -440,
"y": 5392,
"r": 155
},
{
"x": 59,
"y": 8868,
"r": 160
},
{
"x": 916,
"y": 8868,
"r": 161
},
{
"x": 1369,
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{
"x": 464,
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}
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"etiology": "<p>Чаще эмпиемы плевры являются вторичными по своему происхождению и развиваются при непосредственном переходе гнойного процесса с легкого, средостения, перикарда, грудной стенки, поддиафрагмального пространства. </p>\r\n<p>Чаще всего эмпиема плевры возникает при острых или хронических инфекционных легочных процессах: пневмонии, бронхоэктазах, абсцессе легкого, гангрене легкого, туберкулезе, нагноившейся кисте легкого и др. В ряде случаев эмпиемой плевры осложняется течение спонтанного пневмоторакса, экссудативного плеврита, медиастинита, перикардита, остеомиелита ребер и позвоночника, поддиафрагмального абсцесса, абсцесса печени, острого панкреатита. Метастатические эмпиемы плевры обусловлены распространением инфекции гематогенным или лимфогенным путем из отдаленных гнойных очагов (например, при остром аппендиците, ангине, сепсисе и др.). </p>\r\n<p>Посттравматический гнойный плеврит, как правило, связан с травмами легкого, ранениями грудной клетки, разрывом пищевода. Послеоперационная эмпиема плевры может возникать после резекции легких, пищевода, кардиохирургических и других операций на органах грудной полости. </p>",
"pathogenesis": "<p>Первая стадия протекает с образованием в плевральной полости серозного выпота. Своевременно начатая антибактериальная терапия позволяет подавить экссудативные процессы и способствует спонтанной резорбции жидкости. В случае неадекватно подобранной противомикробной терапии в плевральном экссудате начинается рост и размножение гноеродной флоры, что приводит к переходу плеврита в следующую стадию - фибринозно-гнойную. </p>\r\n<p>В этой фазе эмпиемы плевры вследствие увеличения количества бактерий, детрита (продукт распада тканей), лейкоцитов экссудат становится мутным, приобретая гнойный характер. На поверхности висцеральной и париетальной плевры образуется фибринозный налет, возникают рыхлые, а затем плотные спайки между листками плевры. Сращения образуют ограниченные внутриплевральные осумкования, содержащие скопление густого гноя. </p>\r\n<p>В стадии фиброзной организации происходит образование плотных плевральных спаек, которые, как панцирь, сковывают поджатое легкое. Со временем нефункционирующая легочная ткань подвергается фиброзным изменениям с развитием цирроза легкого. </p>",
"diagnostics": "<p> Лабораторные методы исследования крови и мочи. </p>\r\n<p>Общеклинические анализы крови и мочи, биохимические анализы крови направлены на выявление признаков интоксикации и гнойного воспаления, органной недостаточности. </p>\r\n<p> Лабораторное исследование мокроты. </p>\r\n<p>Бактериоскопическое исследование мокроты позволяет ориентировочно судить об этиологии деструкции </p>\r\n<p>Обзорная рентгенография органов грудной клетки. </p>\r\n<p>Она позволяет установить локализацию патологического процесса, определить степень отграничения экссудата (свободный или осумкованный), а также относительно точно определить его объем. </p>\r\n<p>Компьютерная томография органов грудной клетки. </p>\r\n<p>Позволяет убедительно уставить характер поражения легкого, которое стало причиной эмпиемы плевры, определить локализацию осумкований (для последующего выбора способа дренирования), определить наличие свища культи бронха </p>\r\n<p>Ультразвуковое исследование плевральных полостей. </p>\r\n<p>Необходимо для определения точки для безопасного и адекватного дренирования плевральной полости в случае наличия осумкований. </p>\r\n<p>Диагностическая пункция плевральной полости. </p>\r\n<p>Является окончательная методом верификация диагноза. Получение гнойного содержимого плевральной полости позволяет считать предположительный диагноз эмпиемы плевры абсолютно достоверным. </p>\r\n<p> Фибробронхоскопия. </p>\r\n<p>Преследует несколько целей: определить дренирующий бронх, если причиной эмпиемы является абсцесс легкого; исключить центральный рак легкого, нередко вызывающий канцероматоз плевры (раковый плеврит), трансформирующийся в эмпиему плевры при инфицировании экссудата; исследовать промывные воды бронхов для установления микробиологического агента и подбора рациональной антибактериальной терапии; провести санацию трахеобронхиального дерева при наличии деструктивного процесса в легких. </p>",
"treatment": "<p>При установлении диагноза эмпиемы плевры требуется госпитализация пациента в специализированное торакальное хирургическое отделение. </p>\r\n<p>В лечении эмпиемы плевры используются как консервативные, так и оперативные методы, которые применяются параллельно друг другу, начиная с самого раннего этапа лечения. </p>\r\n<p>Большое значение придается раннему и эффективному опорожнению плевральной полости от гнойного содержимого. Это достигается с помощью дренирования плевральной полости, вакуум-аспирации гноя, плеврального лаважа, введения антибиотиков и протеолитических ферментов, лечебных бронхоскопий. Эвакуация гнойного экссудата способствует уменьшению интоксикации, расправлению легкого, спаиванию листков плевры и ликвидации полости эмпиемы плевры. </p>\r\n<p>Одновременно с местным введением противомикробных средств назначается массивная системная антибиотикотерапия. Проводится дезинтоксикационная, иммунокорригирующая терапия, витаминотерапия, переливание белковых препаратов (плазмы крови, альбумина, гидролизатов), растворов глюкозы, электролитов. </p>\r\n<p>В период рассасывания экссудата назначаются процедуры, предотвращающие образование плевральных сращений - дыхательная гимнастика, ЛФК, ультразвук, классический, перкуторный и вибрационный массажгрудной клетки. </p>\r\n<p>При формировании хронической эмпиемы плевры показано хирургическое лечение. При этом может выполняться торакостомия (открытое дренирование), плеврэктомия с декортикацией легкого, интраплевральная торакопластика, закрытие бронхоплеврального свища, различные варианты резекции легкого. </p>",
"prevention": "<p>Профилактика эмпиемы плевры заключается в своевременной антибиотикотерапии легочных и внелегочных инфекционных процессов, соблюдении тщательной асептики при хирургических вмешательствах на грудной полости, достижении быстрого расправления легкого в послеоперационном периоде, повышении общей резистентности организма.</p>",
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