ВОзвращает список болезней. Можно фильтр/искать

search, age, gender, parent, symptoms, sort_name, sort_by, rand, branches
GET /disease/?format=api&ordering=slug&page=27
HTTP 200 OK
Allow: GET, HEAD, OPTIONS
Content-Type: application/json
Vary: Accept

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            },
            "code": "B18",
            "name": "Хронический вирусный гепатит",
            "icd_name": "Хронический вирусный гепатит",
            "gender": 0,
            "age_min": 0,
            "age_max": 100,
            "cause": [
                3,
                2,
                8,
                9,
                10
            ],
            "periodicity": 4,
            "slug": "b18_hronicheskiy_virusnyy_gepatit",
            "lead": "Клинико-морфологический синдром, который вызывается различными причинами и характеризуется определенной степенью некроза гепатоцитов и воспаления.",
            "description": "Хронический вирусный гепатит — это воспалительный дистрофически-пролиферативный процесс в печени, генетически детерминированный дефицитом клеточного и макрофагеального звеньев иммунитета, длительно протекающий (более 6 месяцев), клинически проявляющийся астеновегетативным и диспептическим синдромами, стойкой гепатоспленомегалией, нарушением функции печени, гиперферментемией и диспротеинемией.",
            "etiology": "<p>Установлена этиологическая связь хронического вирусного гепатита с острыми вирусными гепатитами В, С, D, F и G. При этом ведущее значение в формировании хронического процесса, как правило, принадлежит легко протекающим желтушным, безжелтушным и субклиническим формам острых вирусных гепатитов В, С, D, F и G с затяжным течением. Развитию хронического вирусного гепатита способствуют такие неблагоприятные факторы, как поздняя госпитализация больных с острым гепатитом, неправильное лечение, преждевременная выписка, отягощенный преморбидный фон, наличие сопутствующих и хронических заболеваний, употребление алкоголя, наркотиков, а также суперинфицирование другими гепатотропными вирусами, в частности дельта-вирусами при НВV-инфекции.</p>\r\n<full></full>\r\n<p><br /><br />Хронический гепатит С с большой частотой (до 90 %) формируется из острого вирусного гепатита. Важной особенностью вируса гепатита С является его способность к персистенции в организме и индуцированию хронического гепатита.<br /><br />Хронический гепатит D формируется в результате суперинфекции вирусом дельта-носителей НВV и больных хроническим гепатитом В.<br /><br />Ведущим механизмом поражения печени при хроническом вирусном гепатите является взаимодействие иммунокомпетентных клеток с вируссодержащими гепатоцитами. У больных с хроническим вирусным гепатитом отмечается  иммунного ответа, в результате чего процесс распознавания антигенов на поверхности гепатоцитов и их элиминация нарушается и порой становится невозможной.<br /><br />Хронический вирусный гепатит вследствие недостаточности макрофагальной защиты и формируется в следующих условиях.<br /><br />I. Дефицита Т-системы иммунитета:<br /><br />— снижения уровня Т-лимфоцитов;<br /><br />— дисбаланса иммунорегуляции субпопуляций Т-хелперов и Т-супрессоров;<br /><br />— слабой сенсибилизации к антигенам вирусов.<br /><br />II. Депрессии макрофагов (снижения их функциональной активности).<br /><br />III. Ослабления системы интерфероногенеза.<br /><br />IV. Действия эффекторных клеток на мембраны гепатоцитов с экспрессией вирусных антигенов, а также печеночно-специфического липопротеина.<br /><br />V. Отсутствия эффективного специфического антителогенеза по отношению к антителам вирусов.<br /><br />VI. Активизации процессов перекисного окисления липидов и лизосомных протеаз.<br /><br />VII. Включения печени в аутоиммунный процесс.<br /><br />При различных формах хронического вирусного гепатита определяются особенности иммунологического реагирования.<br /><br />Хронический вирусный гепатит с минимальной степенью активности (хронический персистирующий вирусный гепатит) возникает в условиях генетически обусловленного слабого иммунного ответа. Все показатели клеточного звена иммунитета (Т-лимфоциты, Т-хелперы, Т-супрессоры, Т-киллеры и др.) пропорционально снижены, что затрудняет элиминацию вируссодержащих гепатоцитов. В печени воспалительные изменения слабо выражены.<br /><br />Хронический вирусный гепатит с низкой, умеренной и выраженной степенью активности (хронический активный вирусный гепатит со слабой, умеренной и выраженной степенью активности) развивается в условиях резчайшего дисбаланса иммунной регуляции. Наблюдается снижение Т-супрессоров при относительно неизменном уровне Т-хелперов, что приводит к активности В-клеток и выработке большого количества глобулинов. Избыток противовирусных антител способствует усилению цитотоксических реакций и в конечном итоге приводит к иммунокомплексному поражению печени. Липопротеиновые мембраны гепатоцитов приобретают свойства чужеродного антигена, индуцирующего атаку Т-киллеров, что может закончиться лизисом клеток-мишеней, т.е. паренхимы печени.<br /><br />Наиболее часто хронический вирусный гепатит протекает с преобладанием цитолитического синдрома (синдром интоксикации в клинике, повышение активности АлАТ, снижение протромбинового индекса, диспротеинемия). Реже диагностируются холестатический синдром ( кожи, повышение активности щелочной фосфатазы, ГГТП и уровня билирубина в крови, при этом активность АлАТ повышается в меньшей степени) и аутоиммунный (астеновегетативный синдром, артралгии, внепеченочные проявления, диспротеинемия, повышение активности АлАТ, гипергаммаглобулинемия, ЦЦК, наличие разного рода аутоантител).</p>",
            "pathogenesis": "<p>Характер клинической симптоматики при хронических вирусных гепатитах зависит от степени активности воспалительного процесса в печени и длительности течения заболевания.<br /><br />Часто выявляется астеновегетативный синдром. Дети и взрослые обычно жалуются на повышенную \"> и , более выраженную при ходьбе, особенно после тяжелых физических нагрузок; становятся раздражительными, эмоционально лабильными, нередко агрессивными по отношению к близким. В части случаев наблюдаются \">, , , повышенная \">, . Особенностью интоксикации у детей при хроническом вирусном гепатите является ее нерезкая выраженность.<br /><br />Диспептический синдром при хроническом вирусном гепатите возникает как в связи с функциональной неполноценностью печени, так и в связи с весьма частым поражением желчевыводящих путей, гастродуоденальной зоны и поджелудочной железы. Отмечается чувство тяжести в правом подреберье и эпигастральной области,  и , \">,  и непереносимость жирных блюд. Вместе с тем ухудшение аппетита наблюдается лишь у небольшого числа больных.</p>\r\n<full></full>\r\n<p><br /> не относится к числу характерных для хронического вирусного гепатита симптомов. Заболевание, как правило, протекает без нарушений билирубинового обмена. Лишь у отдельных больных может отмечаться субиктеричность или легкая иктеричность склер, однако в особо тяжелых случаях хронического вирусного гепатита с переходом в цирроз становится постоянным симптомом, являясь проявлением печеночно-клеточной недостаточности. Синдром желтухи наблюдается также при редком варианте хронического процесса — хроническом холестатическом гепатите. У этих больных выраженность желтухи варьируется от легкой до интенсивной и может носить застойный характер, при котором цвет кожи со временем приобретает зеленовато-желтый оттенок.<br /><br />Геморрагический синдром отмечается у половины больных. Он характеризуется кожными кровоизлияниями в виде синяков, носовыми кровотечениями, петехиальными высыпаниями. Синяки чаще обнаруживаются на конечностях и на туловище. Носовые кровотечения весьма непродолжительны и спонтанно прекращаются. Петехиальные сыпи необильные и локализуются на коже лица, шеи, туловища, реже — конечностях. Геморрагические проявления обусловлены снижением синтеза протромбина и других факторов свертывания крови, в частности тромбоцитопенией.<br /><br />Сосудистые проявления (так называемые внепеченочные знаки) встречаются у 70 % больных. К ним относятся телеангиэктазии (сосудистые звездочки), капилляриты и пальмарная . Размер сосудистых звездочек колеблется от 1 до 10 мм в диаметре. Количество и величина их тем больше, чем тяжелее поражение печени. Капилляриты, или расширение капилляров, чаще выявляются на щеках и в межлопаточной области и реже на всей грудной клетке. Помимо капилляритов, порой диагностируется усиленный сосудистый рисунок (расширение вен) на груди.<br /><br />Механизм возникновения сосудистых знаков связывают с обменными нарушениями в печени и циркуляцией избыточного количества биологически активных веществ (кининов, простогландинов и др.) вследствие недостаточной инактивации их в печени. Активные гуморальные факторы вызывают периферическую вазодилатацию и открытие артериовенозных шунтов. Пальмарная  (печеночные ладони) наиболее характерна для больных с умеренной и выраженной степенью активности хронического вирусного гепатита. Она выражается симметричным мелкопятнистым (иногда точечным) покраснением ладоней и подошв, более значительным в области тенара и гипотенара. Появление пальмарной эритемы связано с микроциркуляторными нарушениями.<br /><br /> — главный симптом заболевания. Она может быть единственным клиническим признаком хронического вирусного гепатита. Печень пальпируется из-под реберного края в пределах от 0,5 до 8 см, а верхняя граница перкуторно определяется в VI—IV межреберьях.<br /><br />Консистенция органа варьируется от плотноэластической до плотной в зависимости от степени активности хронического вирусного гепатита и стадии процесса (обострение или ремиссия). У многих больных отмечается чувствительность и даже болезненность печени, особенно в периоде обострения заболевания, а также при наличии воспалительных изменений со стороны желчевыводящих путей. Поверхность органа обычно гладкая, край закругленный или острый. В большинстве случаев отмечается равномерное увеличение правой и левой долей печени.<br /><br /> типична для хронического вирусного гепатита, но не столь постоянна, как . Поэтому отчетливый гепатолиенальный синдром наблюдается не у всех больных, с большей закономерностью проявляясь при умеренно выраженной степени активности хронического вирусного гепатита. Селезенка может выступать из подреберья на 0,5—5 см и больше, имеет плотноэластическую или плотную консистенцию с ровной поверхностью. В период обострения хронического вирусного гепатита гепатолиенальный синдром обнаруживается наиболее часто.<br /><br />Хронический гепатит В большей частью имеет клинически сглаженное малосимптомное течение. Диагноз нередко первично устанавливают на основании результатов лабораторных исследований (повышение уровня АлАТ, определение маркеров НВV) и биопсии печени.<br /><br />Отличительной особенностью хронического гепатита С является торпидное, латентное или малосимптомное течение; большей частью в течение длительного времени инфекционный процесс остается нераспознанным. Заболевание постепенно прогрессирует с дальнейшим бурным развитием цирроза печени и/или первичной гепатокарциномы.<br /><br />Существуют печеночные и внепеченочные проявления хронической HCV инфекции:<br /><br />— эндокринные — гипертиреоз, гипотиреоз, тиреоидит Хашимото, сахарный диабет;<br /><br />— гематологические — смешанная криоглобулинемия, идиопатическая тромбоцитопения, неходжкинская В-лимфома, макроглобулинемия Вальденстрема, апластическая анемия;<br /><br />— поражение слюнных желез и глаз — лимфоцитарный сиалоаденит, язвы роговицы, увеит;<br /><br />— кожные — кожный некротизирующий васкулит, поздняя кожная порфирия, красный плоский лишай, мультиформная , узловатая , лейкоплакия, крапивница;<br /><br />— нейромышечные и суставные — миопатический синдром, периферическая полинейропатия, синдром Гийена—Барре, артриты, артралгии;<br /><br />— почечные — гломерулонефрит;<br /><br />— аутоиммунные и другие — узелковый периартериит, интерстициальный легочный фиброз, легочный васкулит, гипертрофическая кардиомиопатия, CRST-синдром, антифосфолипидный синдром, аутоиммунный гепатит 1 и 2 типа, синдром Бехчета, дерматомиозит.<br /><br />Хронический гепатит D является основной формой болезни при НДV/НВV-суперинфекции и может протекать от клинически бессимптомной формы до манифестной, нередко быстрым прогрессирующим течением.<br /><br />Вирусоносители в подавляющем большинстве случаев оказываются больными хроническим вирусным гепатитом, причем нередко в фазе репликации.<br /><br />Клиническая симптоматика хронического вирусного гепатита во многом зависит от репликативной активности вирусов и выраженности воспалительного процесса в печени.</p>",
            "diagnostics": "<p style=\"padding-bottom: 19px;\" align=\"justify\">Диагноз хронического вирусного гепатита устанавливается при длительно текущем (свыше 6 месяцев) инфекционном процессе, вызванном вирусами гепатита В, С, D, F, G; наличии гепатоспленомегалии, астенического, диспепсического и геморрагического синдромов.</p>\r\n<p style=\"padding-bottom: 19px;\" align=\"justify\">С целью верификации формы заболевания проводится определение маркеров вирусных гепатитов методом ИФА, обнаружение РНК вирусов с помощью ПЦР-диагностики. Из биохимических показателей функции печени наибольший интерес представляет исследование АлАт и АсАТ, щелочной фосфатазы (ЩФ), гамма-глутамилтранспептидазы (ГГТ), лецитинаминопептидазы (ЛАП), сывороточной холинэстеразы (ХЭ), лактатдегидрогеназы (ЛДГ), билирубина, холестерина и др., позволяющих судить о степени повреждения паренхимы печени при хроническом вирусном гепатите. С целью оценки состояния гемостаза производится исследование коагулограммы, определение количества тромбоцитов.</p>\r\n<p style=\"padding-bottom: 19px;\" align=\"justify\">УЗИ печени позволяет увидеть изменения печеночной паренхимы (, , склерозирование и пр.). С помощью реогепатографии изучается информация о состоянии внутрипеченочной гемодинамики. Проведение гепатосцинтиграфиипоказано при признаках цирроза печени.</p>\r\n<p style=\"padding-bottom: 19px;\" align=\"justify\">Биопсия печени и морфологическое исследование биоптата выполняется на заключительном этапе обследования для оценки активности хронического вирусного гепатита.</p>",
            "treatment": "<p style=\"padding-bottom: 19px;\" align=\"justify\">В стадии ремиссии хронического вирусного гепатита необходимо придерживаться диеты и щадящего режима, проводить профилактические курсы приема поливитаминов, гепатопротекторов, желчегонных средств. Обострение хронического вирусного гепатита требует стационарного лечения.</p><p style=\"padding-bottom: 19px;\" align=\"justify\">Основу базисной терапии хронического вирусного гепатита составляет диетический стол № 5; назначение препаратов, нормализующих кишечную микрофлору; ферментов; гепатопротектор. Целесообразен прием настоев и отваров, обладающих противовирусным (календула, зверобой), спазмолитическим и слабым желчегонным и действием (спорыш, мята).</p><p style=\"padding-bottom: 19px;\" align=\"justify\">При цитолитическом синдроме необходимы внутривенные инфузии белковых препаратов и свежезамороженной плазмы, проведение плазмафереза. Купирование холестатического синдрома проводится с помощью адсорбентов, препаратов ненасыщенных жирных кислот. При аутоиммунном синдроме назначаются иммунодепрессанты, глюкокортикоиды, делагил, проводится гемосорбция.</p><p style=\"padding-bottom: 19px;\" align=\"justify\">Этиотропная терапия хронического вирусного гепатита требует назначения противовирусных препаратов.</p>",
            "prevention": "<p style=\"padding-bottom: 19px;\" align=\"justify\">Пациенты с хроническим вирусным гепатитом находятся на пожизненном диспансерном учете у инфекциониста-гепатолога. Неблагоприятное течение хронические вирусные гепатиты приобретают при отягощенном фоне: одновременном инфицировании несколькими вирусами, злоупотреблении алкоголя, наркотической зависимости, ВИЧ-инфекции. Исходом хронических вирусных гепатитов служит цирроз и рак печени.</p><p style=\"padding-bottom: 19px;\" align=\"justify\">Профилактика хронизации инфекционного процесса заключается в выявлении малосимптомных форм вирусного гепатита, проведении адекватного лечения и контроле за реконвалесцентами. Пациенты, перенесшие вирусные гепатиты, должны придерживаться рекомендуемой врачом диеты и образа жизни</p>",
            "clinical_picture": "<p>Нередко хронический гепатит протекает бессимптомно несколько лет, постепенное перерождение печени приводит к ухудшению самочувствия: появляются диспептические нарушения, , , боли в правом подреберье, иногда возникает , селезенка увеличена, нередко имеет место анемия (так как печень принимает участие в кроветворении).</p>",
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            },
            "code": "B19",
            "name": "Вирусный гепатит неуточненный",
            "icd_name": "Вирусный гепатит неуточненный",
            "gender": 0,
            "age_min": 0,
            "age_max": 84,
            "cause": [
                2,
                7,
                9,
                10
            ],
            "periodicity": 4,
            "slug": "b19_virusnyy_gepatit_neutochnennyy",
            "lead": "Нарушение здоровья, относящееся к группе вирусный гепатит",
            "description": "Вирусные гепатиты – группа инфекционных заболеваний, вызываемых первично-гепатотропными вирусами, характеризующихся преимущественным поражением печени.",
            "etiology": "<p>Гепатит может быть вызван многими причинами, но наиболее часто гепатит вызывается вирусами. На данный момент известно большое количество вирусов, способных вызвать вирусный гепатит: вирус гепатита A, вирус гепатита B, вирус гепатита C, вирус гепатита D, вирус гепатита E, вирус гепатита F и вирус гепатита G, вирусы гепатитов TTV и SEN, цитомегаловирус, вирус Эпштейна — Барр, ВИЧ и другие. Некоторые вирусы, вызывающие вирусный гепатит, недостаточно изучены.</p>\r\n<p>Известны также вирусы гепатитов животных:</p>\r\n<ul>\r\n<li>собак (аденовирус),</li>\r\n<li>мышей (коронавирус),</li>\r\n<li>уток (энтеровирус) и, вероятно,</li>\r\n<li>обезьян (пегивирус).</li>\r\n</ul>\r\n<p>Кроме того, гепатит может вызываться такими вирусами, как вирус желтой лихорадки, герпесвирусы, вирус краснухи, вирусы Коксаки, вирус лихорадки Ласса, вирусы лихорадок Марбург-Эбола и другими.</p>",
            "pathogenesis": "<p>Вирусы гепатита попадают в организм разными путями: гепатит А и Е — через загрязненные пищевые продукты и воду; гепатит В — через небезопасную кровь и другие жидкости организма; гепатит С — в основном, через зараженную кровь и гепатит D — в качестве дополнительной инфекции при наличии гепатита В.</p>\r\n<p>Вирусы обладают тропностью к ткани печени, при этом они вызывают острое ее воспаление, повреждение и разрушение печеночных клеток (гепатоцитов), воспалительный отек и снижение функциональной деятельности органа. Недостаточность желчеобразующая функции печени является первопричиной повышенного накопления билирубина в крови (билирубинемии) и, как следствие, желтухи. Поскольку в тканях печени нет болевых рецепторных зон, болевой синдром редко выражен и связан с увеличением печени, растяжении ее хорошо иннервированной капсулы и воспалительными процессами в желчном пузыре.</p>\r\n<p>Хроническое воспаление, как правило, развивается вследствие нелеченного или недостаточно леченного острого гепатита. Нередко хронический гепатит постепенно переходит в цирроз печени.</p>",
            "diagnostics": "<p><strong></strong></p>\r\n<p>Диагностика гепатитов осуществляется на основании анамнеза, клинических данных, данных физикального осмотра, функциональных и лабораторных исследований.</p>\r\n<p> </p>\r\n<p>Лабораторные исследования включают: </p>\r\n<ul>\r\n<li>Биохимический анализ крови (повышение уровня печеночно-клеточных ферментов – АЛТ, АСТ; повышение общего билирубина, изменение соотношения прямой и непрямой фракций билирубина);</li>\r\n<li>Общий анализ мочи – появление в моче билирубина, накопление уробилина;</li>\r\n<li>Коагулограмма – оценка свертывающей системы крови;</li>\r\n<li>Тимоловая и сулемовая пробы;</li>\r\n<li>ПЦР-диагностика крови – выявление генома (РНК или ДНК) вируса;</li>\r\n<li>ИФА – выявление в сыворотке крови специфических антител (иммуноглобулинов класса М)</li>\r\n</ul>\r\n<p> </p>\r\n<p>Инструментальные методы диагностики включают:</p>\r\n<ul>\r\n<li>УЗИ органов брюшной полости – отмечают увеличение печени и изменение ее звуковой проницаемости и, кроме этого, отмечают увеличение селезенки и, возможно, расширение полой вены;</li>\r\n<li>Реогепатография(исследование печеночного кровотока), </li>\r\n<li>Гепатохолецистосцинтиография(радиоизотопное исследование желчевыводящих путей), </li>\r\n<li>Пункционная биопсия печени.</li>\r\n</ul>\r\n<p> </p>",
            "treatment": "<p>Лечение острого гепатита обязательно проводится в стационаре.</p>\r\n<p>Назначается:</p>\r\n<p>прописывается диета №5, полупостельный режим (при тяжелом течении – постельный);</p>\r\n<p> </p>\r\n<p>Этиотропная терапия</p>\r\n<ul>\r\n<li>Интерферон-а</li>\r\n<li>Индукторы интерферона</li>\r\n<li>Ламивудин</li>\r\n</ul>\r\n<p>Патогенетическая и посиндромная терапия:</p>\r\n<ul>\r\n<li>Интенсивная дезинтоксикационная инфузионная терапия, при необходимости экстракорпоральная детоксикация;</li>\r\n<li>Желчегонные препараты или тюбажи по Демьянову;</li>\r\n<li>Ферментные препараты;</li>\r\n<li>Гепатопротективные препараты;</li>\r\n<li>Глюкокортикоиды;</li>\r\n<li>Ингибиторы протеолиза;</li>\r\n<li>Поливитамины, витамино-минеральные комплексы, фитотерапия.</li>\r\n</ul>\r\n<p>Хорошие результаты по улучшению общего состояния при выраженной гипоксии дает кислородотерапия, оксигенобаротерапия. Если присутствуют признаки геморрагического диатеза, назначают витамин К внутривенно.</p>",
            "prevention": "<p>Первичная профилактика вирусных гепатитов – соблюдение гигиенических предписаний, осуществление санитарно-эпидемических мер, санитарный надзор над предприятиями, могущими стать очагом распространения инфекции, вакцинация. Профилактикой других форм гепатитов является избегание действия гепатотравмирующих факторов – алкоголя, лекарственных средств, токсических веществ.</p>\r\n<p>Вторичная профилактика хронического гепатита заключается в соблюдении диеты, режима, врачебных рекомендаций, регулярном прохождении обследования, контроле клинических показателей крови. Больным рекомендовано регулярное санаторно-курортное лечение, водолечение.</p>\r\n<p> </p>\r\n<p> </p>",
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