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"code": "E46",
"name": "Белково-энергетическая недостаточность неуточненная",
"icd_name": "Белково-энергетическая недостаточность неуточненная",
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3,
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"slug": "e46_belkovo-energeticheskaya_nedostatochnost_neutochnennaya",
"lead": "Состояние питания, при котором дисбаланс энергии, белков и других питательных веществ ведет к измеримым нежелательным эффектам на ткани, функции и клинические исходы.",
"description": "При недостаточном поступлении белков и энергии уменьшаются безжировая масса тела и количество жировой ткани, причем одно из этих изменений может быть более выраженным.",
"etiology": "<p>Белково-энергетическая недостаточность может быть первичной или вторичной. Первичная белково-энергетическая недостаточность обусловлена неадекватным поступлением питательных веществ, а вторичная белково-энергетическая недостаточность является следствием различных расстройств или приема лекарственных препаратов, которые препятствуют использованию питательных веществ.</p>",
"pathogenesis": "",
"diagnostics": "",
"treatment": "<p>При легкой и умеренной белково-энергетической недостаточности следует устранить возможные причины этого состояния. Суточный приход белков и энергии увеличивают (в соответствии с идеальным весом) для ликвидации их дефицита. Всем больным назначают поливитамины. Проводят также лечение и профилактику дефицита минеральных веществ (в том числе микроэлементов) для предупреждения угрожающих жизни гипокалиемии, гипомагниемии, гипофосфатемии и т. д. Если больной способен принимать пищу и глотать, достаточно самостоятельного питания. При снижении аппетита или в отсутствие зубов дополнительно назначают жидкие питательные смеси для самостоятельного или зондового питания.</p>\r\n<full></full>\r\n<p>При тяжелой белково-энергетической недостаточности требуется более срочное вмешательство. Лечение таких больных затруднено по нескольким причинам:</p>\r\n<ul>\r\n<li>Заболевания, вызвавшие белково-энергетическую недостаточность, протекают тяжело, их труднее лечить. Иногда азотистый баланс можно восстановить только после излечения инфекции и устранения лихорадки.</li>\r\n<li>Белково-энергетическая недостаточность сама по себе может препятствовать излечению вызвавшего ее тяжелого заболевания. В таких случаях необходимо как можно раньше начать зондовое или парентеральное питание.</li>\r\n<li>Поступление пищи через ЖКТ способствует поносу из-за атрофии слизистой и дефицита ферментов кишечника и поджелудочной железы. При этом может быть показано полное парентеральное питание.</li>\r\n<li>Следует устранить сопутствующий дефицит других компонентов пищи (витаминов, незаменимых минеральных веществ, микроэлементов).</li>\r\n</ul>\r\n<p>У взрослых восстановление питательного статуса наступает медленно и не всегда полностью; у детей выздоровление происходит в течение 3-4 мес. Во всех случаях необходимы образовательные и реабилитационные программы, а также меры психологической и социальной поддержки.</p>",
"prevention": "",
"clinical_picture": "<p>Легкая и умеренная белково-энергетическая недостаточность. У детей отсутствует прибавка веса и роста. У взрослых отмечается снижение веса, хотя при отеках или ожирении оно может быть не столь заметным. Уменьшаются толщина кожной складки над трехглавой мышцей плеча и мышечная масса в области плеча.</p>\r\n<p>В отсутствие болезней почек чувствительным показателем белковой недостаточности служит отношение суточной экскреции креатинина к росту (показатель измеряют еженедельно). Снижаются уровни альбумина, трансферрина и транстиретина (преальбумина) в крови. Уровень Т3 снижается, а реверсивного Т3 - повышается. Замедляется метаболизм. Возможны лимфопения и нарушение толерантности к глюкозе . Размеры сердца уменьшены .</p>\r\n<p>Тяжелая белково-энергетическая недостаточность. Тяжелая белково- энергетическая недостаточность сопровождается более выраженными изменениями клинических и лабораторных показателей. При физикальном исследовании обнаруживают западение межреберий, атрофию височных мышц и атрофию мышц конечностей. Подкожная клетчатка атрофирована или отсутствует. Характерны <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>, быстрая <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>, чувство холода, депигментация кожи и депигментация волос, заострившиеся черты лица; кожа сухая, покрыта трещинами. В запущенных случаях образуются пролежни, кожа изъязвляется. АД снижено, также как и температура тела, пульс ослаблен. Нарушаются функции всех органов и систем.</p>",
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"code": "O44",
"name": "Предлежание плаценты",
"icd_name": "Предлежание плаценты",
"gender": 2,
"age_min": 20,
"age_max": 50,
"cause": [
0
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"periodicity": 1,
"slug": "o44_predlezhanie_placenty",
"lead": "Предлежание плаценты — расположение плаценты в нижнем сегменте матки в области внутреннего зева или на 3 см выше (по данным УЗИ). ",
"description": "Предлежание плаценты — расположение плаценты в нижнем сегменте матки в области внутреннего зева или на 3 см выше (по данным УЗИ). При предлежании плацента находится на пути рождающегося плода",
"etiology": "<p>Среди причин предлежания плаценты выделяют два фактора: маточный и плодовый.</p>\r\n<p>Маточный фактор связан с дистрофическими изменениями слизистой оболочки матки, в результате чего происходит нарушение условия плацентации. К дистрофическим изменениям слизистой оболочки матки приводит хронический эндометрит; значительное количество родов и абортов в анамнезе, особенно при развитии послеродовых или послеоперационных эндометритов; наличие рубцов на матке после кесарева сечения или консервативной миомэктомии, курение.</p>\r\n<p>К плодовым факторам, способствующим предлежанию плаценты, относят снижение протеолитических свойств плодного яйца, когда прикрепление в верхних отделах матки невозможна. </p>",
"pathogenesis": "",
"diagnostics": "<p>К клиническим признакам предлежания плаценты относят:<br />· кровяные выделения из половых путей яркого цвета при безболезненной матке;<br />· высокое стояние предлежащей части плода;<br />· неправильные положения или тазовые предлежания плода.</p>\r\n<p>При предлежании плаценты влагалищное исследование проводить нежелательно, так как может произойти отслойка плаценты, усиливающая <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a>. При отсутствии возможности УЗИ влагалищное исследование осуществляют крайне осторожно. При исследовании пальпируют губчатую ткань между предлежащей частью и пальцами акушера.</p>\r\n<p>Влагалищное исследование проводят при развёрнутой операционной, позволяющей экстренно произвести кесарево сечение вслучае появления обильных кровяных выделений.</p>\r\n<p> </p>",
"treatment": "<p>В III триместре беременности при наличии предлежания плаценты и отсутствии кровяных выделений вопрос огоспитализации решают индивидуально. Если пациентка живет недалеко от родильного дома и может за 5–10 минут доехать до него, то возможно наблюдение ее врачами женской консультации до 32–33 нед. Если местожительство беременной значительно удалено от лечебного учреждения, она должна быть госпитализирована раньше.</p>\r\n<p>Беременность можно пролонгировать до 37–38 нед, после чего при любом варианте предлежания плаценты с целью профилактики массивного кровотечения в плановом порядке производят кесарево сечение. Рекомендован постельный режим.</p>",
"prevention": "<p>Поскольку предлежание плаценты чаще возникает у многорожавших женщин с внутриматочными вмешательствами в анамнезе, снижение числа абортов, необоснованных консервативных миомэктомий, частоты кесарева сечения за счёт рационального ведения родов будут способствовать снижению частоты неправильного прикрепления плаценты.</p>",
"clinical_picture": "<p>Главный симптом предлежания плаценты — <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a> из половых путей, возникающее внезапно среди полного здоровья, чаще в конце II–III триместра или с появлением первых схваток. Соответственно кровопотере возможны симптомы геморрагического шока. Чем больше степень предлежания плаценты, тем раньше происходит <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a>. Вытекающая из половых путей кровь яркоалого цвета. <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">Кровотечение</a> не сопровождается болевыми ощущениями; нередко рецидивирует, приводя к анемии беременных. На фоне анемии даже небольшая <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровопотеря</a> может способствовать развитию геморрагического шока.</p>\r\n<p>Общее состояние беременной при предлежании плаценты зависит от величины кровопотери. При этом необходимо учитывать кровь, скапливающуюся во влагалище (до 500 мл). Состояние плода зависит от тяжести анемии или геморрагического шока при кровопотере. При обильном кровотечении развивается острая гипоксия плода.</p>\r\n<p>При предлежании плаценты возникают следующие осложнения беременности:<br />· угроза прерывания;<br />· железодефицитная анемия;<br />· неправильное положение и тазовое предлежание плода в силу наличия препятствия вставлению головки в малый таз;<br />· хроническая гипоксия и задержка развития плода за счёт плацентации в нижнем сегменте и относительно низкого кровотока в этом отделе матки.</p>",
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