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},
"code": "C16",
"name": "Рак желудка",
"icd_name": "Рак желудка",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c16_rak_zheludka",
"lead": "злокачественная опухоль, растущая из эпителиальных клеток слизистой (внутренней) оболочки желудка.",
"description": "Опухоль желудка может возникать в различных отделах желудка: в верхнем, где он соединяется с пищеводом, в основной части (теле) желудка или в нижнем, где желудок соединяется с кишечником.",
"etiology": "<p>Факторы риска развития рака желудка:</p>\r\n<ul>\r\n<li>наследственная предрасположенность — если у кого-то в семье выявлен рак желудка, то у всех остальных близких (кровных)родственников вероятность заболеть повышается на 20%;</li>\r\n<li>особенности питания — чрезмерное увлечение копченой, острой, соленой, жареной (пережареной) и консервированной пищей, длительно хранящихся продуктов, содержащих нитраты, заметно повышает вероятность возникновения рака желудка;</li>\r\n<li>длительно существующие болезни желудка: гастриты (с пониженной кислотностью), язвы и полипы желудка;</li>\r\n<li>операции на желудке повышает риск развития рака желудка в 2,5 раза;</li>\r\n<li>наличие в желудке бактерии Helicobacter pylori: в 1994 году Всемирная Организация Здравоохранения (ВОЗ) признала связь между Helicobacter Pylori и раком желудка и занесла эту бактерию в разряд канцерогенов первого класса;<full></full></li>\r\n<li>работа с асбестом и никелем;</li>\r\n<li>дефицит витаминов В12 и С;</li>\r\n<li>первичные и вторичные (например, СПИД) иммунодефицитные состояния;</li>\r\n<li>в 20 раз чаще рак желудка встречается у больных пернициозной (злокачественной) анемией;</li>\r\n<li>некоторые вирусы, в частности, вирус Эпштейн-Барр;</li>\r\n<li>алкоголизм и курение.</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>Основной метод исследования желудка — гастроскопия (ЭГДС). Во время гастроскопии врач оценивает состояние слизистой желудка и выполняет биопсию наиболее подозрительных участков. Гистологическое исследование материала, полученного при биопсии, и позволяет ответить на вопрос: доброкачественная опухоль или злокачественная?</p>\r\n<p>В качестве дополнительных методов для диагностики рака желудка используют:</p>\r\n<ul>\r\n<li>рентгенологическое исследование пищеварительного тракта;</li>\r\n<li>компьютерную томографию;</li>\r\n<li>УЗИ органов брюшной полости и т д.;</li>\r\n<li>общий и биохимический анализ крови позволяют выявить анемию и нарушения белкового обмена в организме пациента.</li>\r\n</ul>",
"treatment": "<p>Успех лечения рака желудка напрямую зависит от размеров и распространенности опухоли на соседние органы и ткани, а также от наличия метастазов.</p>\r\n<p>Основной метод лечения рака желудка— хирургический, заключается в удалении опухоли вместе с желудком (гастрэктомия) или его частью. В ряде случаев помимо желудка удаляют селезенку, часть печени или кишечника. После операции могут быть назначены химиотерапия или лучевая терапия.</p>",
"prevention": "<p>Профилактика рака желудка состоит в ежегодном прохожденннии гастроскопии тем людям, у которых есть атрофический гастрит, язва желудка, полипы желудка, а также лицам, имеющим родственников, страдающих раком желудка.</p>",
"clinical_picture": "<p>Опухоль малых размеров чаще всего существует бессимптомно. Лишь в некоторых случаях у больных раком желудка могут отмечаться следующие симптомы:</p>\r\n<ul>\r\n<li>понижение аппетита;</li>\r\n<li>изменение пищевых пристрастий: например, они чувствуют отвращение к мясу, рыбе и т д.;</li>\r\n<li><a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">повышение температуры</a> (чаще 37-38 градусов);</li>\r\n<li>анемия (снижение гемоглобина).</li>\r\n</ul>\r\n<p>По мере роста раковой опухоли желудка появляются новые симптомы: </p>\r\n<ul>\r\n<li>ощущение тяжести в животе после еды, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\"><a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a></a> и <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\">Рвота</a>\"><a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\">рвота</a></a>, быстрая насыщаемость;</li>\r\n<li><a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">нарушение стула</a> (поносы, запоры);</li>\r\n<li>боли в верхней половине живота, опоясывающие боли, отдающие в спину (при распространении опухоли в поджелудочную железу);</li>\r\n<li>увеличение размеров живота, накопление жидкости в брюшной полости (<a href=\"/symptom/ascit/\" title=\"Перейти на страницу симптома Асцит\">асцит</a>);</li>\r\n<li>похудание; </li>\r\n<li>при разрушении опухолью сосудов возможно развитие желудочно-кишечного кровотечения</li>\r\n</ul>",
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},
"code": "C74",
"name": "Рак надпочечника",
"icd_name": "Рак надпочечника",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3
],
"periodicity": 1,
"slug": "c74_rak_nadpochechnika",
"lead": "Нарушение здоровья, относящееся к группе злокачественное новообразование щитовидной железыи других эндокринных желез",
"description": "Рак надпочечников – это злокачественное поражение ткани железы, которая размещается на верхней почечной поверхности. Опухоль надпочечника считается достаточно редким заболеванием и встречается в 5% онкологических больных. Новообразование очень часто метастазирует в такие органы как печень и легкие.",
"etiology": "<p>Причины рака надпочечников наверняка не известны. Считается, что спровоцировать онкопроцесс могут факторы вроде:</p>\r\n<ul>\r\n<li>Употребления канцерогенных веществ, которые в больших количествах встречаются в некоторых напитках и пищевых продуктах;</li>\r\n<li>Нездоровых привычек типа употребления табакаили спиртного;</li>\r\n<li>Возрастных особенностей. Рак подобного характера поражает преимущественно маленьких детей и пациентов старшего возраста;</li>\r\n<li>Предрасположенности семейного характера, наличия генетической склонности к раковым надпочечниковым процессам;</li>\r\n<li>Множественных эндокринных опухолей;</li>\r\n<li>Наличие наследственных патологий вроде синдрома Ли-Фраумени, гиперпластического полипоза, Беквит-Видемана и пр.</li>\r\n</ul>",
"pathogenesis": "<p>Основные теории, объясняющие патогенез опухолей:</p>\r\n<p>Мутационная теория канцерогенеза. Развитие опухолевого роста – следствие мутации. Химические канцерогенные вещества, излучения вызывают мутационный процесс – изменяется геном, изменяется структура клеток, идет малигнизация (озлокачествление).</p>\r\n<p>Эпигеномная теория канцерогенеза. Основой опухолевого процесса при этой теории является деперссия древних генов.</p>\r\n<p>Вирусная теория канцерогенеза. Вирусы длительно могут персистировать в клетках, находясь в латентном состоянии, под действием канцерогенов, физических факторов происходит их активация. Вирус встраивается в клеточный геном, внося дополнительную информацию в клетку, вызывая нарушение генома и нарушение жизнедеятельности клетки.</p>\r\n<p>Трансформированные клетки характеризуются:</p>\r\n<ul>\r\n<li>Нарушением дифференцировки;</li>\r\n<li>Неопределенно долгим делением без признаков старения;</li>\r\n<li>Дефектами апоптоза (генетически запрограммированного разрушения клетки).</li>\r\n</ul>",
"diagnostics": "<p>Для диагностики гормонпродуцирующих опухолей надпочечников значение имеет определение содержания тех или иных гормонов в крови и в моче, а также определение содержания АКТГ (адренкортикотропного гормона) в крови - гормона гипофиза (железы, расположенной в головном мозге, регулирующей работу надпочечников).</p>\r\n<p>Используют визуализирующие методы, которые помогут выявить опухоль:</p>\r\n<p>компьютерную томографию (КТ) органов брюшной полости, надпочечников. Метод позволяет выявить образования размером более 5 мм. сцинтиграфию, которую используют, если есть подозрение на опухоль вне надпочечников. При проведении исследования нужно учитывать возможность ассиметричного накопления изотопа в нормальных надпочечниках. позитронно-эмиссионную томографию (ПЭТ). Этот метод более чувствителен, чем сцинтиграфия, в плане выявления метастатических поражений.</p>",
"treatment": "<p>Основной метод терапии – хирургический. Проводится удаление надпочечника (адреналэктомия) вместе с близрасположенными лимфатическими узлами. При большой раковой опухоли, прорастающей в почку, может встать вопрос об удалении почки.</p>\r\n<p>Для лечения феохромоцитомы также применяется лечение радиоактивным изотопом. При инъекции в вену изотоп проникает в опухоль и вызывает гибель достаточного количества клеток для уменьшения размеров опухоли и даже для уменьшения размера метастазов. При некоторых опухолях хорошие результаты дает химиотерапия.</p>",
"prevention": "<p>Поскольку причины развития опухолей надпочечников до конца не установлены, профилактика сводится к предупреждению рецидивов удаленных опухолей и возможных осложнений. После адреналэктомии необходимы контрольные обследования пациентов эндокринологом 1 раз в 6 мес. с последующей коррекцией терапии в зависимости от самочувствия и результатов исследований.</p>\r\n<p>Пациентам после адреналэктомии по поводу опухолей надпочечников противопоказаны физические и психические нагрузки, употребление снотворных средств и алкоголя.</p>\r\n<p> </p>",
"clinical_picture": "<p>Альдостеромы проявляются тремя группами симптомов: сердечно-сосудистыми, почечными и нервно-мышечными. Отмечаются стойкое повышение артериального давления, не поддающееся гипотензивной терапии, головные боли, одышка, перебои в сердце, гипертрофия, а затем дистрофия миокарда. Стойкая гипертензия приводит к изменениям глазного дна.</p>\r\n<p>При резком выбросе альдостерона может развиваться криз, проявляющийся рвотой, сильнейшей головной болью, резкой миопатией, поверхностными дыхательными движениями, нарушением зрения, возможно - развитием вялого паралича или приступа тетании.</p>\r\n<p>Почечные симптомы альдостеромы развиваются при резко выраженном снижении уровня калия в крови: появляются жажда, повышенное образование мочи, преобладание ночного диуреза, щелочная реакция мочи.</p>\r\n<p>Нервно-мышечные проявления альдостеромы: мышечная слабость различной степени выраженности, парестезии (онемение) и судороги - обусловлены сниженным уровнем калия в крови, развитием внутриклеточного ацидоза и дистрофией мышечной и нервной ткани.</p>\r\n<p>У 6-10 % пациентов с данным видом опухолей надпочечников встречается бессимптомное течение альдостеромы.</p>\r\n<p>Клиника кортикостеромы соответствует проявлениям гиперкортицизма (синдрома Иценко-Кушинга). Развивается ожирение по кушингоидному типу, гипертензия, головная боль, повышенная мышечная слабость и утомляемость, стероидный диабет, половая дисфункция. На животе, молочных железах, внутренних поверхностях бедер отмечается появление стрий (растяжек) и петехиальных кровоизлияний. У мужчин развиваются признаки феминизации – увеличение грудных желез (гинекомастия), гипоплазия (уменьшение) яичек, снижение потенции; у женщин, напротив, признаки вирилизации – мужской тип оволосения, понижение тембра голоса, гипертрофия клитора.</p>\r\n<p>Развивающийся остеопороз может стать причиной компрессионного перелома тел позвонков. У четверти пациентов с данной опухолью надпочечников выявляется пиелонефрит и мочекаменная болезнь. Нередко отмечается нарушение психических функций: депрессия или возбуждение.</p>\r\n<p>Проявления кортикоэстеромы у девочек связаны с ускорением физического и полового развития (увеличением наружных половых органов и молочных желез, оволосением лобка, ускорением роста и преждевременным созреванием скелета, влагалищными кровотечениями), у мальчиков – с задержкой полового развития. У взрослых мужчин развиваются признаки феминизации – двустороннее увеличение грудных желез, атрофия полового члена и яичек, отсутствие роста волос на лице, высокий тембр голоса, распределение жировых отложений на теле по женскому типу, снижение уровня активных спермотозоидов, снижение или утрата потенции.</p>\r\n<p>У женщин эта опухоль надпочечников симптоматически никак себя не проявляет и сопровождается только увеличением концентрации в крови эстрогенов.</p>\r\n<p>Андростеромы, характеризующиеся избыточной продукцией андрогенов опухолевыми клетками (тестостерона, андростендиона, дегидроэпиандростерона и др.), вызывают развитие анаболического и вирильного синдромов. При андростероме у детей отмечается ускоренное физическое и половое развитие – быстрый рост и мышечное развитие, огрубение тембра голоса, появление угревой сыпи на туловище и лице. При развитии андростеромы у женщин появляются признаки вирилизации – прекращение менструаций, гирсутизм (повышенное оволосенение), снижение тембра голоса, гипотрофия матки и молочных желез, гипертрофия клитора, уменьшение подкожно-жирового слоя, повышение либидо. У мужчин проявления вирилизма выражены меньше, поэтому эти опухоли надпочечников часто являются случайными находками.</p>\r\n<p>Развитие феохромоцитомы сопровождается опасными гемодинамическими нарушениями и может протекать в трех формах: пароксизмальной, постоянной и смешанной. Течение наиболее частой пароксизмальной формы (от 35 до 85%) проявляется внезапной, чрезмерно высокой артериальной гипертензией (до 300 и выше мм рт. ст.) с головокружением, головной болью, мраморностью или бледностью кожных покровов, сердцебиением, потливостью, загрудинными болями, рвотой, дрожью, чувством паники, полиурией, подъемом температуры тела. Приступ пароксизма провоцируется физическим напряжением, пальпацией опухоли, обильной едой, алкоголем, мочеиспусканием, стрессовыми ситуациями (травмами, операцией, родами и др.).</p>\r\n<p>Пароксизмальный криз может длиться до нескольких часов, повторяемость кризов – от 1 в течение нескольких месяцев до нескольких в день. Криз прекращается быстро и внезапно, артериальное давление приходит к исходной величине, бледность сменяется покраснением кожных покровов, наблюдаются обильное потоотделение и секреция слюны. При постоянной форме феохромоцитомы отмечается стойко повышенное артериальное давление. При смешанной форме данной опухоли надпочечников феохромоцитомные кризы развиваются на фоне постоянной артериальной гипертензии.</p>\r\n<p> </p>\r\n<p> </p>",
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