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},
"code": "I71",
"name": "Аневризма и расслоение аорты",
"icd_name": "Аневризма и расслоение аорты",
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"age_min": 0,
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"cause": [
3
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"periodicity": 1,
"slug": "i71_anevrizma_i_rassloenie_aorty",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "Расслаивающаяся аневризма аорты – дефект внутренней оболочки аневризматически расширенной аорты, сопровождающийся образованием гематомы, продольно расслаивающей сосудистую стенку с формированием ложного канала. Расслаивающаяся аневризма аорты проявляется внезапной интенсивной болью, мигрирующей по ходу расслоения, подъемом артериального давления, признаками ишемии сердца, головного и спинного мозга, почек, внутреннего кровотечения.",
"etiology": "<p>К факторам, способствующим развитию аневризмы аорты и ее расслоению, относятся: </p>\r\n<ul>\r\n<li>атеросклероз со значительным изменением vasa vasorum (сосудов сосудов) аорты, ишемию стенки аорты; </li>\r\n<li>гипертоническую болезнь и резкие колебания артериального давления; </li>\r\n<li>сифилис; </li>\r\n<li>очаговые некрозы среднего слоя сосуда бактериально-эмболического происхождения при острых инфекционных заболеваниях; </li>\r\n<li>врожденные дефекты развития аорты (коарктация, двойная дуга, гипоплазия, незаращение боталлова протока, синдром Марфана); </li>\r\n<li>физическое и нервно-эмоциональное перенапряжение; </li>\r\n<li>повреждение аорты смежным процессом (спондилит, рак пищевода, пенетрация пептической язвы пищевода, двенадцатиперстной кишки) или инородным телом; </li>\r\n<li>закрытую травму грудной или брюшной полости. </li>\r\n</ul>",
"pathogenesis": "<p>Аорта имеет три наиболее уязвимых сегмента - корень, перешеек и диафрагму. Гемодинамическое напряжение указанных зон и их хроническая травматизация приводят к дегенеративным изменениям средней оболочки сосуда. Длительное повышение артериального давления всегда ведет к той или иной степени дилатации аорты. Известно также, что внутренняя оболочка по своей структуре менее растяжима, чем средняя и наружная оболочки, обладающие большей эластичностью. Именно поэтому при одном из очередных «критических» повышений артериального давления происходит разрыв внутренней оболочки. Однако гидравлический удар о стенку аорты и разрыв внутренней оболочки сами по себе могут привести лишь к развитию внутристеночной гематомы. Дальнейшее расслоение происходит лишь при наличии патологического процесса в средней оболочке аорты. Если расслоение прорывает стенку аорты полностью (все три слоя), то происходит быстрая массивная кровопотеря и гибель больного. </p>",
"diagnostics": "<p>В случае подозрения на появление расслаивающей аневризмы аорты требуется срочная диагностика, основными методами которой являются: </p>\r\n<ul>\r\n<li>рентгенография грудной клетки; </li>\r\n<li>УЗДГ; </li>\r\n<li>ЭхоКГ; </li>\r\n<li>компьютерная томография; </li>\r\n<li>магнитно-резонансная томография; </li>\r\n<li>аортография. </li>\r\n</ul>\r\n<p>Рентгенография грудной клетки позволяет определить признаки расслаивающей аневризмы: расширение аорты, плевральный выпот, отсутствие пульсации, деформацию контуров аорты. </p>\r\n<p>ЭхоКГ (УЗИ сердца) – более информативный и доступный метод, позволяющий обнаружить отслоившийся лоскут, определить истинный и ложный канал, оценить атеросклеротическое поражение, состояние аортального клапана, состояние грудной аорты. </p>\r\n<p>Аортография дает возможность определить место начального разрыва, протяженность и местонахождения расслоения, состояние аортального клапана, ветвей аорты, коронарных артерий. </p>\r\n<p>МРТ дает возможность точно определить локализацию разрыва и направление расслоения, оценить состояние ветвей аорты и клапана. </p>",
"treatment": "<p>Расслоение аорты требует неотложной медицинской помощи, немедленного лечения. Терапия может заключаться в проведении операции, употреблении лекарственных средств, а также в комбинированном лечении — схема зависит от области аорты, которая подверглась расслоению. </p>\r\n<p>Хирургическое вмешательство - хирурги удаляют как можно большую площадь, подвергшуюся расслоению, а затем реконструируют аорту при помощи синтетической трубки-трансплантата. Если в результате расслоения повреждаются аортальные клапаны, они так же могут быть заменены; </p>\r\n<p>Интенсивная терапия расслаивающейся аневризмы аорты направлена на купирование болевого синдрома (путем введения ненаркотических и наркотических анальгетиков), выведение из шокового состояния, снижение артериального давления. Лекарственные препараты, например, бета-блокаторы и нитропруссид, уменьшают частоту сердечных сокращений и нормализуют низкое кровяное давление, что предотвращает усугубление расслоения. </p>",
"prevention": "<p>Профилактика формирования расслаивающейся аневризмы аорты заключается в контроле за течением сердечно-сосудистых заболеваний. Предупреждение расслоения аорты включает наблюдение кардиолога, мониторинг артериального давления и уровня холестерина крови, периодическое ультразвуковая диагностика сердца и аорты. <br class=\"SCXW45342897\" /> <br class=\"SCXW45342897\" /> </p>",
"clinical_picture": "<p>Для расслаивающейся аневризмы аорты характерно внезапное начало с имитацией симптомов различных сердечно-сосудистых, неврологических, урологических заболеваний. Расслоение аорты проявляется резким нарастанием раздирающей, нестерпимой боли с широкой областью иррадиации (за грудиной, между лопатками и по ходу позвоночника, в эпигастральной области, пояснице), мигрирующей по ходу расслоения. </p>\r\n<p>Отмечается повышение артериального давления с последующим спадом, асимметрия пульса на верхних и нижних конечностях, обильное потоотделение, слабость, синюшность, двигательное беспокойство. Большая часть больных с расслаивающейся аневризмой аорты умирает от развития осложнений. </p>\r\n<p>Неврологическими проявлениями расслаивающейся аневризмы аорты могут служить ишемическое поражение головного или спинного мозга парезы, параличи), периферическая нейропатия, нарушения сознания(обморок, кома). </p>\r\n<p>Расслаивающаяся аневризма восходящей аорты может сопровождаться ишемией миокарда, сдавлением органов средостения (появлением охриплости, дисфагии, одышки, синдрома Горнера, синдрома верхней полой вены), гемоперикарда, тампонады сердца (скопление жидкости между листками околосердечной сумки). </p>\r\n<p>Расслаивающаяся аневризма нисходящей грудной и брюшной части аорты выражается развитием выраженного повышения давления в почечных сосудах и острой почечной недостаточности, острой ишемии органов пищеварения, ишемии кишечника, острой ишемии нижних конечностей. </p>",
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"name": "Эмболия и тромбоз артерий",
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"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "\r\nТромбозы и эмболии артерий – это патология, возникающая при острой закупорке просвета артерий тромбом или эмболом, приводящее к нарушению кровотока в тканях. При этом дальнейшее поступление крови по сосуду прекращается, ткани испытывают гипоксию (кислородное голодание).\r\n",
"etiology": "<p>К причинам возникновения артериальных тромбозов относятся:</p>\r\n<ul>\r\n<li>Сердечно-сосудистые заболевания, облитерирующий атеросклероз, тромбангиит;</li>\r\n<li>Сахарный диабет;</li>\r\n<li>Повреждения стенок артерий при ушибах мягких тканей, вывихах и переломах костей конечностей, компрессия сосудистого пучка опухолью или гематомой;</li>\r\n<li>Предшествующие ангиографические исследования, эндоваскулярные вмешательства, реконструктивные операции на сосудах и другие интервенционные процедуры;</li>\r\n<li>Гематологические заболевания (эритроцитоз);</li>\r\n<li>Инфекционные заболевания (сыпной тиф, сепсис, грипп и т.д.).</li>\r\n</ul>\r\n<p>К причинам возникновения артериальных эмболий относятся:</p>\r\n<ul>\r\n<li>В 92-95% случаев – сердечно-сосудистые заболевания, в первую очередь инфаркт миокарда (особенно в первые 2-3 нед заболевания), осложненный тяжелыми нарушениями ритма сердца, острой или хронической аневризмой левого желудочка;</li>\r\n<li>Внутрипредсердный тромбоз;</li>\r\n<li>Тромбы, образующиеся в аневризмах брюшной аорты и крупных магистральных артерий;</li>\r\n<li>Атероматозные язвы аорты.</li>\r\n</ul>",
"pathogenesis": "<p>Непременными условиями возникновения артериальных тромбозов являются нарушение целостности сосудистой стенки, изменение системы гемостаза и замедление кровотока. Во всех указанных случаях ответной реакцией на повреждения внутренней стенки сосуда является прилипание тромбоцитов, склеивание их между собой и дальнейший рост, что связано с воздействием биологически активных веществ, вырабатываемых в организме. В то же время под действием биологически активных веществ происходит активация свертывающей системы крови и снижение способности растворять тромбы. В результате на поверхности агрегата адсорбируются нити фибрина, образующие сетчатую структуру, которая, задерживая форменные элементы крови, способствует образованию кровяного свертка - тромба.</p>\r\n<p>Эмболия - закупорка просвета кровеносного сосуда эмболом, который обычно представлен частью тромба или бляшки, \"оторвавшейся\" от сосудистой стенки, мигрирующих с током крови по кровеносному руслу. Эти тромбы отрываются от мест прикрепления и, переносясь током крови, застревают в местах анатомических сужений артерий или их разделения на ветви. После закупорки сосуда происходит его рефлекторный спазм ниже эмбола. Сам эмбол стимулирует образование и рост тромба, который иногда достигает очень больших размеров.</p>\r\n<p>Тромбоз и эмболия приводят к полному обескровливанию конечности ниже закупорки. Артериальная ишемия в подавляющем большинстве случаев приводит к гангрене.</p>",
"diagnostics": "<p>Диагностика включает в себя сбор жалоб, анамнеза заболевания и жизни; физикальное обследование.</p>\r\n<p>Лабораторные методы исследования: коагулограмма (обнаруживается повышение свертываемости крови).</p>\r\n<p>Инструментальные методы:</p>\r\n<ol>\r\n<li>Ультразвуковое ангиосканирование аорты и артерий:</li>\r\n</ol>\r\n<ul>\r\n<li>увеличение скорости кровотока в местах препятствия току крови – стеноз (выше уровня тромбоза);</li>\r\n<li>отсутствие кровотока в аорте или артерии на уровне тромбоза (эмболии);</li>\r\n<li>кровоток отсутствует или коллатеральный ниже уровня тромбоза (эмболии);</li>\r\n<li>утолщение стенки артерии, выявление атеросклеротических бляшек.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Ангиография проводится на операционном столе для уточнения воспринимающего сосудистого русла и позволяет определить характер хирургического вмешательства.</li>\r\n</ol>\r\n<ol start=\"3\">\r\n<li>Мультиспиральная компьютерная томография проводится при наличии времени для детальной диагностики и позволяет очень точно выявить характер поражений и определить лечебную тактику.</li>\r\n</ol>",
"treatment": "<p>Тактика лечения зависит от давности начала заболевания, уровня поражения сосуда, степени нарушения артериального кровообращения, от наличия сопутствующих заболеваний. </p>\r\n<p>Консервативную терапию следует проводить в течение 2 – 4 часов при субкомпенсации кровообращения конечности. Если наступает улучшение кровообращения конечности, то следует продолжить консервативную терапию до ликвидации ишемических проявлений конечности. Если за это время улучшения не наступает, следует ставить вопрос о немедленном оперативном лечении.</p>\r\n<p> Немедикаментозное лечение:</p>\r\n<ul>\r\n<li>Режим I, II, III.</li>\r\n<li>Диета №10.</li>\r\n</ul>\r\n<p> Медикаментозное лечение:</p>\r\n<ul>\r\n<li>Назначается тромболитическая терапия, направленная на восстановление кровотока в в сосуде за счет лизиса тромба внутри сосудистого русла.</li>\r\n<li>С целю профилактики восходящего и нисходящего вторичного тромбоза применяется антикоагулянтные препараты прямого действия.</li>\r\n<li>Для улучшения реологических свойств кров применяются антиагрегантные препараты.</li>\r\n<li>Спазмолитическая терапия показана для снижения периферического артериоспазма и улучшения кровотока по пораженной конечности за счет расширения коллатерального кровотока. Для лизиса эмбола или тромба применяют препараты, повышающие фибринолитическую активность крови.</li>\r\n</ul>\r\n<p>Хирургическое лечение острых артериальных эмболии заключается в удалении эмбола и тромботических масс из просвета артерии с помощью катетера.</p>\r\n<p>При тяжелой ишемии, сопровождающейся отеком мышц или мышечной контрактурой с целью декомпрессии и улучшения тканевого кровотока показана фасциотомия (рассечение мышечной фасции (оболочки)).</p>\r\n<p>При остром тромбозе, развившемся на фоне органического поражения артериальной стенки, простое удаление тромба обычно неэффективно, так как быстро наступает повторный тромбоз сосуда. Поэтому должна проводиться реконструктивная операцией.</p>\r\n<p>При развитии гангрены конечности показана ампутация.</p>",
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"description": "Флебит – это заболевание вен, при котором происходит воспаление их сосудистых стенок. Преимущественно актуально это заболевание для области нижних конечностей. \r\nТромбофлебит же собой представляет воспаление вены в таком варианте, течение которого сопровождается появлением тромбов. ",
"etiology": "<p>Чаще всего в качестве причин, провоцирующей развитие флебита и тромбофлебита, выделяют: </p>\r\n<ul>\r\n<li>варикозное расширение вен; </li>\r\n<li> избыточный вес; </li>\r\n<li>гиподинамия (состояние, провоцируемое нехваткой двигательной активности); </li>\r\n<li>длительность пребывания в стоячем положении; </li>\r\n<li>запоры в хронической форме течения этого заболевания. </li>\r\n</ul>\r\n<p>Развитие тромбофлебита также возможно и в результате воздействия аллергической реакции, что определяет такую его разновидность, как аллергический флебит, помимо этого возможно развитие заболевания и в качестве осложнения, возникающего после родов – в этом случае речь идет уже о болевом флебите. Не исключаются и такие случаи, при которых тромбофлебит возникает при инфекционном поражении вены или при ее травмировании, что подразумевает под собой нарушение целостности в ее сосудистой стенке. </p>",
"pathogenesis": "<p>Для возникновения тромбофлебита нужно присутствие одного или нескольких факторов из трех (т.н. триада Вирхова): </p>\r\n<ol>\r\n<li>Повреждение стенки вены (может быть как механическим, вследствие травмы, так и химическим – ожог при введении концентрированных препаратов, наркотических веществ) </li>\r\n<li>Нарушение реологических свойств крови (повышение свертываемости, вязкости и т.п.). Это бывает при обезвоживании, некоторых заболеваниях, гормональных, генетических нарушениях. </li>\r\n<li>Замедление кровотока в вене (при сдавлении вены, ограничении движений (например, при ношении гипсовой повязки)). </li>\r\n</ol>\r\n<p>Под действием одного или нескольких факторов происходит образование тромба в просвете сосуда и воспаление его стенки. Пример: при серьезной травме ноги присутствуют все три фактора – механическое повреждение (надрывы стенки вены вследствие удара), повышение свертываемости (вследствие кровопотери), замедление кровотока (отек тканей, наложение гипса). </p>\r\n<p>Обычно при тромбофлебите поверхностных вен поражается одна вена, воспаление также может распространяться и на ее притоки. Известен мигрирующий тромбофлебит – при нем происходит последовательное воспаление нескольких вен на разных участках конечностей. Такой тромбофлебит требует дополнительной диагностики для исключения онкологических процессов или генетических нарушений свертываемости. </p>",
"diagnostics": "<p>Физикальное обследование: </p>\r\n<ul>\r\n<li>Болезненный плотный инфильтрат в виде шнура по ходу подкожной вены. </li>\r\n<li>Над инфильтратом возможна гиперемия кожи с уплотнением подкожной клетчатки. </li>\r\n<li>При ходьбе - умеренная болезненность. </li>\r\n<li> Температура тела субфебрильная. </li>\r\n</ul>\r\n<p>Лабораторные исследования: признаки воспаления (лейкоцитоз, ускоренное СОЭ). </p>\r\n<p>Инструментальные исследования Дуплексное сканирование вен - позволяет определить истинную границу тромба, так как она может не совпадать с границей, определяемой пальпаторно. Тромбированный участок вены становится ригидным, просвет его неоднороден, кровоток не регистрируется. </p>",
"treatment": "<p>Необходимо применять эластические компрессионные бинты, чулки, колготки как дополнение к медикаментозному лечению больных. Все пациенты с ТГВ должны носить эластические компрессионные чулки для снижения риска развития посттромботического синдрома. </p>\r\n<p>Системная консервативная терапия осуществляется с применением нестероидных противовоспалительных фармпрепаратов в комбинации со средствами, уменьшающими проницаемость венозной стенки. </p>\r\n<p>Антикоагулянтную терапию рекомендуется проводить при симультантном тромбозе глубоких вен или при развитии восходящего тромбофлебита у пациентов с ограничением показаний для оперативного лечения, при возникновении посттромбофлебитического синдрома. </p>\r\n<p>В первоначальные несколько дней заболевания рекомендуется локальное применение холода, эластичная компрессия больной конечности (эластичное бинтование), нанесение мазей, в составе которых содержатся нестероидное противовоспалительное средство и гепарин (категорически недопустимо применение мазевых компрессов, которые ограничивают теплоотдачу и могут способствовать прогрессированию заболевания). </p>\r\n<p> </p>",
"prevention": "<p>Чтобы избежать появления тромбофлебита нужно вести здоровый образ жизни. Необходимо своевременное лечение варикозной болезни. Следует избегать травм, обезвоживания. Несколько повышает риск развития тромбофлебита прием гормональных контрацептивов. При появлении первых симптомов нужно срочно обратиться к врачу – это позволит эффективно лечить заболевание и избежать осложнений. <br class=\"SCXW95579271\" /> <br class=\"SCXW95579271\" /> <br class=\"SCXW95579271\" /> <br class=\"SCXW95579271\" /> </p>",
"clinical_picture": "<p>Тромбофлебит поверхностных вен нижних конечностей </p>\r\n<ul>\r\n<li>Начинается с варикоза, отчего симптоматику патологии невозможно спутать с каким-либо другим заболеванием. </li>\r\n<li>Помимо болевых ощущений, которые зачастую возникают именно в том месте, где произошло уплотнение стенок с образованием кровяных сгустков, у больного отмечается повышенная температура тела. К числу сопутствующей симптоматики относят увеличение лимфоузлов. </li>\r\n<li>Пораженные вены можно обнаружить при пальпации. Как правило, кожные покровы в этих местах приобретают красный оттенок, а при ощупывании места можно обнаружить характерное уплотнение, причем при визуальном рассмотрении нередко отмечается припухлость. При пальпации больного мучают сильные боли. </li>\r\n</ul>\r\n<p>Флебит и тромбофлебит глубоких сосудов нижних конечностей </p>\r\n<ul>\r\n<li>Характеризуются болевыми ощущениями, в особенности при опускании ноги. В этот же момент больной часто ощущает распирание, что может сопровождаться повышением температуры кожных покровов в месте поражения. </li>\r\n<li>Вследствие развития патологии человек замечает у себя набухание и изменение оттенка кожных покровов на синий. Уже на вторые сутки от начала заболевания ноги больного «покрываются» соответствующей венозной и сосудистой сеткой, которая не только портит внешний вид, но и доставляет дискомфорт. </li>\r\n<li>Так, при ходьбе и в статичном положении человек страдает от болевого синдрома, в то время, когда при сжимании с передней и задней стороны наступает нестерпимая боль. При этом также отмечается, что сжимания со сторон не доставляет неудобств. </li>\r\n</ul>\r\n<p>Бедренной вены </p>\r\n<ul>\r\n<li>Проявляется набуханием и покраснением поверхности с внутренней стороны бедра; </li>\r\n<li>здесь же отмечается боль и разбухание подкожных вен; </li>\r\n<li>поражения общей бедренной вены сопровождается распуханием венозной системы, набуханием, покраснением, повышением температуры тела, лихорадкой, а также острой болью. </li>\r\n</ul>\r\n<p>Тромбофлебит подвздошно-бедренного участка магистральной вены </p>\r\n<ul>\r\n<li>характеризуется болевыми ощущениями в области поясницы и крестца, нередко присутствует боль с одной стороны живота; </li>\r\n<li>причем болевой синдром может быть ярко выраженным при полном перекрытии сосуда, и слабо выражен в случае частичного перекрытия. </li>\r\n</ul>\r\n<p>Глубоких вен </p>\r\n<ul>\r\n<li>Также проявляется в зависимости от локализации и расположения тромба. Более того, представленные поражения проявляются лишь незначительными болевыми ощущениями и малой отечностью, что затрудняет диагностирование заболевания. </li>\r\n<li>При отсутствии своевременного лечения глубокие тромбозы открываются, что провоцирует развитие тромбоэмболии легочных артерий. </li>\r\n<li>Опасность тромбоэмболии заключена в ее стремительном течении и размером тромба. Если отрывается тромб больших размеров, смертельный исход наступает в течение получаса. </li>\r\n</ul>",
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"slug": "i88_nespecificheskiy_limfadenit",
"lead": "воспаление лимфатических узлов, причиной которого является инфекция",
"description": "<p><span id=\"docs-internal-guid-bea401e1-7fff-e7dd-1f79-b01cba079e4d\"><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;\">Неспецифический лимфаденит - это заболевание, которое проявляется увеличением и воспалением лимфатических желез.</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;\">В большинстве случаев воспаление лимфатических узлов возникает как следствие той или иной болезни организма. </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;\">Причиной неспецифического являются патологические процессы, развивающиеся на фоне попадания в организм вирусов и инфекции. Пародонтиты, абсцессы, запущенные кариозные процессы, ангина, простудные заболевания, токсоплазмоз, очаги нагноения и даже аллергические реакции – «благоприятный» фон для возникновения неспецифического лимфаденита. Воспаление лимфоузлов под мышкой в большинстве случаев также относится к данному типу.</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;\">Возбудителями лимфаденита являются гноеродные микроорганизмы, проникающие в лимфатические узлы по лимфатическим сосудам из очагов острого или хронического гнойного воспаления (флегмоны, панариции и т.д), с током лимфы, крови или путём непосредственного контакта. </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;\">Инфекция поступает в регионарные лимфатические узлы с током лимфы, оттекающей из первичных гнойных очагов. Лимфаденит может возникнуть и без предшествующего лимфангита, причем первичный очаг бывает настолько ничтожен и так быстро заживает, что к моменту возникновения лимфаденита обнаружить место вхождения инфекции уже не всегда удается. В редких случаях возможно попадание инфекции в лимфатические узлы вместе с кровотоком. Лимфаденит иногда возникает и вследствие непосредственного перехода воспалительного процесса с тканей, окружающих узел.</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 лимфаденита лица, шеи, подмышечных впадин проводится путем сбора анамнеза и совокупности клинических проявлений. Труднее разобраться с тяжелыми формами заболевания, на фоне которого уже возникли осложнения.</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;\">Врачу необходимо определить первопричину, источник появления лимфаденита, подобрать соответствующее лечение.</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;\">Также для диагностики используют:</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;\">пункцию;</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;\">сдачу проб Манту и Пирке на туберкулезную палочку;</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;\">рентген грудной клетки;</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;\">пальпацию увеличенных лимфоузлов;</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;\">КТ и МРТ пораженных сегментов.</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;\">Обычно к исследованию заболевания подключаются также инфекционисты, венерологи, фтизиатры. Специалисты могут назначить:</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;\">общий анализ крови;</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;\">анализ на ВИЧ;</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;\">осмотр ЛОРа;</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;\">УЗИ лимфоузлов и органов брюшной полости.</span></li>\r\n</ul>",
"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 лимфаденита при его катаральной или гиперпластической форме проводится консервативными методами. Для этого подключают:</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;\">соблюдение покоя пациента;</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;\">терапию антибиотиками;</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;\">УВЧ;</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;\">электрофорез;</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;\">гальванизацию;</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;\">покой пораженного участка тела;</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;\">прием витаминов.</span></li>\r\n</ul>\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;\">Дополнительно применяют препараты и мази с хорошим противовоспалительным эффектом, работающие на местном уровне.</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;\">Особое внимание уделяется лечению лимфаденита антибиотиками. Перед этим необходимо провести тест на чувствительность микроорганизмов к разным видам антибиотиков. Выбирают те препараты, к которым особо чувствительны возбудители.</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 речь идет о гнойном лимфадените, то потребуется вскрыть гнойники, удалить их содержимое и провести санацию пораженных участков.</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 выявлении туберкулезной палочки пациента отправляют на лечение в условиях стационара. Это поможет постоянно наблюдать больного, контролировать его лечение и защитить других людей от потенциального заражения.</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;\">Для лечения хронической формы болезни нужно найти и вылечить основную причину, по которой страдают лимфоузлы. Только это поможет полностью избавиться от недуга, и больше никогда не вспоминать о нем.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-0d2a2836-7fff-7685-e6f5-3c22d46e2a1d\"><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;\">Профилактика лимфаденитов требует предупреждения микротравм, инфицирования ран и ссадин, потертостей кожи. Также необходимо своевременное лечение очагов инфекции (ангины, кариеса зубов), вскрытие гнойных образований (панацириев, фурункулов).</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;\">Клинические признаки заболевания зависят от формы и типа лимфаденита. Он бывает острый или хронический, региональный (поражение лимфоузлов одной анатомической группы) и генерализированный (вовлечение нескольких групп лимфоузлов), серозный, гнойный, гангренозный, геморрагический, флегмонозный.</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 норме лимфатические узлы не пальпируются или прощупываются в виде эластических, не большого размера, не спаянных с соседними тканями и друг с другом образований, кожа над узлами нормального цвета, прощупывание безболезненно.</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;\">Самые частые признаки неспецифического лимфаденита:</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: 6.5pt; font-family: Verdana; color: #363636; 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;\">Увеличение размеров пораженных лимфатических структур</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #363636; 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;\">Появляются выраженные болезненные ощущения при пальпации пораженного участка и при движениях</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #363636; 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;\">Воспаленные узлы спаиваются между собой и с соседними тканями в один плотный конгломерат</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #363636; 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;\">Кожа над больными узлами краснеет, становится горячей на ощупь, блестит, выглядит натянутой</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #363636; 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;\">Появляются симптомы интоксикации организма – лихорадка, слабость, головная боль, отсутствие аппетита, чувство разбитости, боль в мышцах</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #363636; 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;\">Сопровождается признаками основного заболевания.</span></p>\r\n</li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 1,
"published": 1,
"parent": null,
"block_rubric": 98,
"standards": []
},
{
"id": 6576,
"symptoms": [
{
"id": 2758,
"synonyms": [
{
"name": "лимфаденопатия"
},
{
"name": "увеличение лимфоузлов"
},
{
"name": "лимфоузел воспаление"
},
{
"name": "лимфоузлы набухли"
},
{
"name": "увеличились лимфоузлы"
}
],
"body_points": [
{
"x": 273,
"y": 1533,
"r": 100
},
{
"x": 654,
"y": 1510,
"r": 100
},
{
"x": -202,
"y": 2724,
"r": 100
},
{
"x": 1178,
"y": 2748,
"r": 100
},
{
"x": 273,
"y": 5081,
"r": 100
},
{
"x": 654,
"y": 5081,
"r": 100
}
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