Disadvantaged hernia Code of ICD 10. Standard of medical care patients with disadvantaged hernia. Dorsopathy and back pain

02.10.2020 Information

Included: Occupus hernia

Included:

equaline hernia

Excluded: congenital hernia:

diaphragmal (Q79.0)

Included: Hernia:

lumbar
locked
rakr Trinky
sedalish

Included:

enterocele [Intestinal hernia]
hernia:
- BDA
- interstitial
- intestinal
- intra-abdominal

Excluded: Vaginal Enterocele (N81.5)

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

MKB-10: K40-K46 - Hernia

Chain in classification:

The diagnosis with the code K40-K46 includes 7 clarifying diagnoses (CCM-10 columns):

Contains 6 blocks of diagnoses.

Included: Packing hernia bubonocele :. BDU. straight. bilateral. Indirect. sinking scrotal hernia.

K41 - femoral hernia

Contains 3 diagnoses block.

Included: Occupus hernia.

Contains 3 diagnoses block.

Included: hernia aperture hole (esophageal) (sliding) accumulatory hernia.

Excluded: congenital hernia :. diaphragmal (Q79.0). Food diaphragm orchard (Q40.1).

K45 - Other hernia abdominal cavity

Contains 3 diagnoses block.

Included: hernia :. Abdominal cavity, refined Localization of the NCDR. Lumbar. shutting. Female outdoor genital organs. retroperitoneal. Sedalish.

K46 - Abdominal Neutual Herry

Contains 3 diagnoses block.

Included: Enterocele [intestinal hernia] Epiplocele [loaf of hernia] hernia :. BDU. interstitial. intestinal. intra-painted.

Gryzhi

Note. The hernia with gangrene and obstruction is classified as hernia with gangrene.

Included: Hernia:

acquired
congenital [In addition to the diaphragm or esophageal hole of the diaphragm]
recurrent

Inguinal hernia

Umbilical hernia

Included: Occupus hernia

Hernia Front Abdominal Wall

Diaphragmal hernia

Included:

hernia aperture hole (esophageal) (sliding)
equaline hernia

Excluded: congenital hernia:

diaphragmal (Q79.0)
diaphragm Ecoming Hole (Q40.1)

Other hernias of the abdominal cavity

Included: Hernia:

abdominal cavity refined Localization of the NCDR
lumbar
locked
female outdoor genital organs
rakr Trinky
sedalish

Abdominal uncertain hernia

Included:

enterocele [Intestinal hernia]
epiplocele [Gnug Seal]
hernia:
- BDA
- interstitial
- intestinal
- intra-abdominal

Improved groin hernia code on μb 10

Packing hernia (Code of ICD K40)

Included: Pakhnoy hernia bubonocele. BDU. straight. bilateral. Indirect. sinking scrotal hernia

K40.0 bilateral groin hernia with obstruction without gangrene

K40.1 Double-sided groin hernia with gangrene

note

The following information is beyond the scope of this article, but not write about it would be gross disrespect for site visitors. Information is extremely important, please read it to the end.

In Russia and the CIS countries, 97.5% are constantly suffering from: colds, headaches and chronic fatigue.

An unpleasant smell of mouth, rash on the skin, bags under the eyes, diarrhea or constipation - these symptoms have become so many commonly that people stopped paying attention to it.

Most of the drugs are extremely ineffective, in addition, they cause tremendous harm. Herbal of worms, first of all, you poison yourself!

K40.2 Bilateral Packing hernia without obstruction or gangrene

Bilateral groin hernia BDU

K40.3 One-sided or unspecified groin hernia with obstruction without gangrene

Packing hernia (one-sided). Accuracy\u003e. Infround\u003e. Unaviastrated\u003e without gangrene. Foundation\u003e

K40.4 One-sided or unspecified groin with gangrene

Did you know that 89% of the population of Russia and CIS countries is hypertension? Moreover, most people do not even suspect it. According to statistics, two thirds of the patients dies during the first 5 years of the development of the disease.

If you often increase the pressure, headache, you feel chronic fatigue and, almost, used to bad well-being, do not rush to swallow pills and go to the operating table. Most likely, easy vessel cleaning will help you.

As part of the federal program, when applying to (inclusive), each resident of the Russian Federation and the CIS can clean their vessels for free. Read the details in the official source.

Packing hernia BDU with gangrena

K40.9 one-sided or unspecified grocery hernia without obstruction or gangrene

Packing hernia (one-sided) BDA

Packing hernia cipher CIFR K40

International statistical classification of health problems and problems related to the document used as a leading basis in health care. The ICD is a regulatory document providing unity of methodological approaches and the international comparability of materials. Currently, there is an international classification of diseases of the tenth revision (ICD-10, ICD-10). In Russia, bodies and health care facilities carried out statistical accounting on the ICD-10 in 1999.

Definition and classification of the infringeable groove hernia on the ICD-10

The groove hernia on the ICD-10 has code K40.

Its infringement occurs as a result of the expansion of the hernial gate and falling into the hernial bag of part of the organs. For this disease, the rapid dynamics of development and strengthening symptoms is characterized.

It is important to consult a doctor as quickly as possible, with a delay in treatment there may be a fatal outcome. If medical care is rendered immediately, there will be no problems with treatment, and the person will quickly come to normal.

The groin hernia on the international classification of the tenth reviews has the code of the K40 group, which includes bilateral and unilateral inguinal hernias. They are divided into hernia with gangrene and without gangrene. Each type of disease has its own international code. The infringement of groin hernia is most often with the code K40.3, K40.4, K40.9. But in some cases, the disadvantaged groin hernia on the ICD-10 may have cipher K43.0.

1 Characteristic symptoms

The first sign is a sharp pain in the area of \u200b\u200bthe groin, which can spread to the entire abdominal cavity. The pain syndrome occurs sharply, immediately after a strong voltage.

When examining a paha, you can detect a protrusion. It is slightly scruffus, solid and unfit. When you try to fix it with your hands, the pain is only enhanced. Leather around elastic. In children, this protrusion may be unnoticed.

Another one of the very first symptoms is nausea and vomiting. With progression of disease, vomiting becomes constant. Immediately after infringement, diarrhea may occur, and then constipation and no gases. Periodically arise false uiles to the alarms.

If the bladder suffering occurred, then the patient is experiencing frequent urge to urination. The process occurs painfully. May be caused by pain shock 1-2 degrees (medium and heavy shape). This deteriorates the overall condition of a person. Temperature can rise.

In young children, the infringement of groin hernia is accompanied by anxiety, crying. Older children complain about pain in groin.

The longer the disease develops, the stronger becomes pain and applies to the entire area of \u200b\u200bthe abdomen. Symptoms are developing faster and expressed stronger. The general condition also begins to deteriorate. For example, at the very beginning of the infringement of the patient, in general, it feels good, then in the day his condition has deteriorated sharply. The temperature and constant vomiting appears.

2 causes and risk groups

The reasons for infringement are:

Disadvantaged Pahnaya hernia: the main causes, signs, treatment and forecast

Reasons for the infringement of groin hernia

According to the mechanism of the occurrence of the increasing hernia, two main types are distinguished: calum and elastic.

Caluing infringement provokes the overflow of the intestinal loop, which dropped into the groin canal, the absence of treatment after a few days leads to the sacrifice of the gut tissue.

Elastic infringement provokes a sharp loss of large quantities internal organs In a narrow hernial hole (usually this happens at high intra-abdominal pressure - a strong cough, lifting weights). The fallen organs are pinching the narrow hole, which causes severe pain. The fabrics of the fallen organs during the elastic reinforcement begin to die over 2-5 hours.

Elastic reinforcement is always formed with a narrow hernia hole, here's the time as a caval infringement may occur with a rather wide hole.

In case of fence, the physical overvoltage does not have such a value as with elastic, in this case the decrease in the intestine peristalsis is played a major role, which is often observed in old age. Also, the caval reinforcement can provoke twisting, inflection, a battle, usually such a complication of groin hernia develops with a long time of the current disease.

Various organs may penetrate into the hernial hole, most often, the glands, a thin and thick intestine, the uterus, appendages, etc., falls.

For human health, the integrity is considered the most dangerous state, as this can lead to a leaning of tissues and intestinal obstruction, which, in addition to severe pain, provokes severe intoxication.

Symptoms of infringement of gentle hernia

Pain is the main symptom of plowing hernia. It arises sharply and sharply, most often, after physical overvoltage. Often the patient is experiencing painfulness Not only in the place of infringement, but also throughout the stomach.

After infringement in the first few hours it can disturb diarrhea, then constipation appears and the absence of gases (in some cases, false urges are observed for measurement).

At the beginning of pinching, vomiting may appear, with a long-term process, vomiting almost does not stop.

If the bladder is infrained, there is a frequent and painful urination, a heartbeat impairment, an increase in temperature, a decrease in pressure, increases the risk of severity of the severity and severe severity.

It is worth noting that the symptoms of the infringement of groin hernia can develop rapidly.

First signs

The first sign of infringement is a strong pain in the region of the groove zone, the hernia becomes painful, when changing the position, the convexity does not disappear, the overall well-being will deteriorate, nausea appears, vomiting.

Disadvantaged Patch-Screaming Hernia

With the infringement of the inguinal-scrutiner hernia, the most dangerous state is the acute intestinal obstruction and inflammation of the peritoneum. In this case, median laparotomy is carried out, which leaves the trail almost on the entire stomach.

Disadvantaged gentle hernia in children

When infringement of groin hernia, children are supposed to have two versions of actions, depending on the state of the child.

In the satisfactory condition and the absence of signs of intoxication or ischemia, the intestine is recommended to root the hernial manual methods. If the child is crying, then first of all it needs to soothe, in some cases it is necessary to receive sedatives, the child of the oldest age should be put on the back and raise the pelvis, which will contribute to the management of the authorities.

After the child calms down completely, manual management is carried out: one hand gently presses the inguinal ring, the second - returns the organs into normal position. If the right of the hernia has passed successfully, after two days, an operation to remove hernia is assigned.

If the child's condition is severe, there are signs of toxic poisoning, then urgent surgical help is required, but before this child's condition needs to normalize.

Complications and consequences

Independence on the reasons for the development of the infringement of groin hernia, it is necessary to proceed to treatment, since the consequences may be deplorable: the death of fabrics and organs, which leads to inflammatory processes In the peritoneum and subsequent death.

In the infringement of internal organs in the hernial hole, internal intoxication begins, after leaning the tissues and organs, a toxic shock is developing, which becomes the cause of a long coma or death.

Diagnosis of infringement of gentle hernia

The diagnosis of the disadvantaged groin is usually not difficult for a specialist. During the inspection, hernial jamming in the groin zone (on the left or right side) can also be observed redness and swelling in this place.

The protrusion gives a strong pain when you press, when changing the position of the body, it does not disappear, remains intense. In addition, the specialist may notice the absence of a cough shock (at the stress of hernia does not increase).

With infringement of such organs as a uterine tube or ovary, diagnostics represents a number of difficulties. The pain in this case is new, and the general condition of the woman does not deteriorate. Due to the increased risk of death, surgical intervention is carried out at once, as soon as there is a suspicion of infringement.

Children on the infringement react very violently - they cry out, fell down or silent with legs, in some cases the baby loses consciousness.

Instrumental diagnostics

The disadvantaged hernia is usually diagnosed according to pronounced symptoms, establish intestinal obstruction allows an ultrasound study of the abdominal cavity.

Differential diagnosis

In case of suspected infringement of the groin hernia, a specialist must eliminate other pathological conditions with similar symptoms. Usually the diagnosis of the doctor puts without any problems, due to the bright symptoms of infringement, but in rare cases (when the first infringement of the concomitant pathologies of the abdominal cavity) is quite difficult to recognize the disadvantaged inguinal hernia.

First of all, the doctor should distinguish the infringement of a rather rare pathology - the nepheruble hernia. Usually, such hernia is not tense and the cough push is well transmitted, which is not observed when infringement.

It is also necessary to exclude the development of the stagnant process in the intestines, which most often occurs in old age with non-executable hernias. Symptoms of stagnation appear gradually, primarily constipation arises, increased gas formationThe pain is usually not intense and increases slowly, while when reducing the symptoms are developing with rapid speed.

Also, in the practice of surgeons, there is a so-called false infringement, which occurs during the external abdominal hernias and the symptoms of this state is similar to the infringement, but usually associated with acute diseases internal organs.

Also, an erroneous diagnosis can be delivered with renal or hepatic colic, peritonitis, pancreatic intestinal obstruction, which will lead to an incorrectly selected method of operational treatment.

Only careful and complete examination of the patient will avoid errors.

But with any difficulties in the formulation of an accurate diagnosis, the doctors are inclined to the disadvantaged hernia, because it is believed that for the life and health of the patient, it is less dangerous to carry out an operation (even if it ultimately will be not necessary) than to miss the time, adopting infringement for another disease.

Treatment of infringement of gentle hernia

The main purpose of the operation in the infringement of groin hernia is to eliminate the infringement and its consequences. With such pathology, there is always a high likelihood that the internal organs have already been dead and the surgeon must carefully examine the contents of the hernia bag.

If the leaning of the fabrics did not happen, then the inventive organs of the groin canal are rendered.

At the first signs of dieting tissue, drugs will help drugs.

If there has been a complete death, part of the organ is removed.

With the opening of hernia content, the risk of infection in the abdominal cavity increases, and therefore during operation, antiseptic and aseptic agents are used.

During the operation, men take into account the proximity of the seed cords and the seed-handing duct and the further ability of a man to conceive the surgeon depends on the skill's qualifications.

In women, the decision on plastics of the hernial gate is accepted already in the process of operational intervention.

In childhood, there are its own characteristics of the infringement - the weak pressure of the hernial hole, the high elasticity of the vessels, improved blood flow in the intestine. Therefore, there are no rare cases when the infringement of hernia in children, including newborns, is manually proof. This requires complete peace that contributes to the relaxation of the muscles and remove the spasm of the hernial hole. However, in reducing girls, an urgent surgery is needed, since with a disadvantaged ovary or a royal tube risk of death and infertility in the future.

Boys usually prescribed in the first hours conservative treatment (Trimeperidine, Atropine), if such treatment is not effective, an urgent operation is appointed.

There are no special drugs from the disadvantaged groining hernia, in this case the only treatment method is the operation, the exceptions are children and contraindications to surgery. In such cases, the hernia is trying to fix with their hands, but provided that no more than 2 hours passed after the infringement. Before manipulations, the patient is introduced antispasmodics (atropine), the bladder empties empty, it is mounted, empty the stomach.

Popular treatment

With a disadvantaged grojel ethnoscience Recommends to sit down the patient in a bath with warm water, which will relax muscles and removes spasms, also need to clean the intestine from the content with the help of the enema. In water, you can try to return the fallen bodies into the abdominal cavity.

If a person is worried about a strong vomiting, you can give it to swallow small pieces of ice, and from a strong pain will help to get rid of the ice-drier.

It is worth noting that it is categorically prohibited to give any laxatives.

Operational treatment

Operation to remove hernia is carried out in several ways, the choice of which depends on the type of inclusive hernia.

With infringement fine intestine Herniolipatias are carried out, with an extensive adhesive process in the abdominal cavity, which prevents the return loop to the normal position, with a phlegmon, a spilled peritonitis is made an additional median incision of the anterior abdominal wall.

Before surgery, the patient is preferably emptying the bladder, intestines, stomach, but if these events are delaying the operation, they are missing.

Sources: http://mkb-10.ru/category/832.html, http://gastri.ru/paxovaya-gryzha-mkb-10.html, http://ilive.com.ua/health/ushchemlennaya- Pahovaya-Gryzha_91520i88336.html

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Spinal hernia on the ICD of the 10th revision

This disease is very dangerous and cunning, take care of yourself

The hernia of intervertebral discs is one of the most dangerous pathologies of the musculoskeletal system. This phenomenon is very common, especially among patients of 30-50-year-old age. With the hernia of the spine Code on the ICD 10 put in the medical map of the patient. Why is it necessary? Turning to the hospital, the doctor immediately sees which diagnosis in the patient. The hernia of the intervertebral disc refers to the thirteenth class in which all pathology of bones, muscles, tendons, lesions of synovial shells, osteopathy and hondropathy, dorsopathy and systemic lesions are collected connective tissue. MKB 10 is a reference network developed for the convenience of doctors. Medical information directory has the following goals:

formation of conditions for the purpose of comfortable exchange and comparison of data acquired in various states;
so that the doctors and other medical staff were comfortable to keep information about patients;
comparison of information in one hospital in different periods.

Thanks to the international classification of disease, it is convenient to count death, injuries. Also in the ICC of the 10th revision contains information about the causes of the appearance of the hernia of the spine, the symptoms, the course of the disease and pathogenesis.

Main types of protothes

The disk hernia is a degenerative pathology resulting from the absorption of the intervertebral disc and pressure on the spinal channel, as well as the nerve roots. The following types of hernia are distinguished depending on localization:

Most often there is a disease in the cervical and lumbar department, the pathology is somewhat less often affecting the chest department. The human spine consists of transverse and acute processes, intervertebral discs, rib joint surfaces, intervertebral holes. Each vertex department has a certain amount of vertebrae, between which intervertebral discs are located with the presence of a pulp nucleus inside. Consider the spine departments and the number of segments in each of them

The cervical department consists of Atlanta (1st vertebra), Aksis (2nd vertebra). Then the numbering continues from C3 to C7. There is also a conditional occipital bone, it is denoted by C0. The cervical part is very mobile, so hernia often amazes him.
The breast of the spine has in its composition 12 segments indicated by the letter "T". Between the vertebrae there are discs performing a depreciation function. Intervertebral discs distribute the load on the entire spine. In the ICD 10 it is indicated that in the thoracic hernia is more often formed between the T8-T12 segments.
The lumbar part consists of 5 vertebrae. The vertebrae in this area is denoted by the letter "L". Often the hernia amazes exactly this department. Unlike the cervical, it is more moving, it is more often injured.

Also isolated a sacral department consisting of 5 segments. Less frequently, the disease is found in breast and sacralized department. Each spine is associated with various patient bodies. This should be considered, the knowledge of knowledge will help to make a diagnosis.

How do you draw in the cervical examination on the patient's card? At work which organs affects the disease with this localization?

The ICB 10 code is set in accordance with the type of damage to cartilage intervertebral discs. With hernia in the cervical spine on the patient's medical card, the M50 code is set. The defeat of intervertebral segments on the international classification of disease is divided into 6 subclasses:

This diagnosis means temporary disability of the patient. With hernia in the cervical department, the patient arises the following symptoms:

headache;
worsening memory;
hypertension;
impairment;
reduction of hearing;
full deafness;
pain in the shoulder muscles and joints;
numbness of face and tingling.

As you can see, the degenerative disease affects the work of the eyes, pituitary glands, brain circulation, forehead, facial nerves, muscles, voice ligaments. In the absence of treatment of hernia, the neck department leads to complete paralysis. The patient remains disabled for life. For diagnosis, pathologists use X-ray, CT or MRI.

Classes with damage to intervertebral discs in breast, lumbar and sacrats

With a chest, lumbar or sacral hernia of the spine in the ICD, a class M51 is assigned. Under it is understood as the defeat of intervertebral discs of other departments with myelopathy (M51.0), radiculopathy (M51.1), Lyumbago due to the displacement of the intervertebral segment (M51.2), as well as clarified (M51.8) and unspecified (M51.9) defeat intervertebral disk. The code in the ICD is also found 10 m51.3. M51.3 is the degeneration of the intervertebral disk, flowing without spinal and neurological symptoms.

This table is usually necessary for doctors, nurses and other medical staff, employees of the Social Insurance Department and representatives of the personnel department. Information can receive any person, it is in the open access.

Symptoms of the disease in the breast, lumbar and sacral division in the form of a table

The spine of man has certain bends, in fact it is not a post, although in many sources you can meet the name "vertebral pillar". Physiological bends are not a sign of a pathological process in the body, there are certain norms and deviations in various pathologies. The hernia of the spine in the thoracic department causes a person to slouch, so the pain is less manifested, therefore, the appearance of kyphosis or lordosis is possible. For the disease does not lead to such complications, the symptoms of pathology should be recognized on time and consult a doctor. Let's consider signs of degenerative disease, depending on the location. In the table, everything is described in detail, even a non-saying person will be able to put a preliminary diagnosis to know what doctor to record.

K40-K46 hernia

acquired hernia
in the birth of hernia (except for daphragm or esophageal hole Daefragma)
recurient hernia

Notification: Hernia with Gangren and obstruction is caught as a hernia with Hangene

hangepid (one-sided) loaf: calling obstruction, disadvantaged, nefriever, stronger

hergezha's Hernia (one-sided) without greasy: calling obstruction, disadvantaged, nefral, stronger

Spinal hernia on μb 10

The code of the intervertebral hernia of the spine on the ICD 10

Spinal hernia Code on MKB 10 gets in strict accordance with the type of damage to cartilage intervertebral discs and the location of their localization. So pathologies that are not involved in the trauma located in the cervical department are made in a separate division and are designated in the official medical records with the M50 code. This designation can be affixed in the diagnosis in a sheet of temporary disability, a sheet of statistical reporting, some types of directions for instrumental control methods.

Located in a chest, lumbar and sacralized department, intervertebral hernia in the ICD 10 is denoted by the M51 code. The designation M51.3 is found, which denotes the pronounced degeneration (nipping the hernia) of the cartilage disk without spinal syndromes and neurological signs. When radiculopathy and severe pain syndrome, during the exacerbation of hernia, it can be denoted by the M52.1 code. The code M52.2 is deciphered as pronounced degeneration (destruction) of a cartilage disc with instability of the position of the vertebrae sitting next to it.

The nodes or intervertebral hernia of the Schimorrich has a code on the ICD - M51.4. In the event that the diagnosis is not specified and additional differential laboratory diagnostics are required in official medical documents, the code M52.9 is affixed.

Special table is used to decrypt such data. It is usually an interest for workers of a medical institution, employees of the social insurance department and representatives of the personnel department. All the necessary information is in public domain and can be studied by any person who has interest in this. If you have any difficulties, you can contact our specialist. He will tell everything about the disease of the spine, which is encrypted as intervertebral hernia in the Code of the ICD 10.

Trubnikov Vladislav Igorevich

Candidate of Medical Sciences

Neurologist doctor, manual therapist, rehabilitologist, reflexology specialist, medical physical culture and therapeutic massage.

Savelyev Mikhail Yuryevich

The doctor manual therapist of the highest category has experience more than 25 years.

Owns methods of Aurikulo and corporate reflexology, pharmacopuncture, hirudotherapy, physiotherapy, physiotherapy, LFC. Perfection applies osteopathy both in adults and in children.

Signs of the dorsal hernia in the lumbar department

Intervertebral hernia is a degenerative disease of the intervertebral disc, characterized by a violation of its integrity and structure

The hernia of the lumbar spine is a fallout or protrusion of an intervertebral disk fragments to the vertebral channel. Code of the disease in the ICD - 10 # 8212; M51 (lesion of intervertebral discs of other departments). It occurs during injuries or osteochondrosis, leads to the compression of nerve structures.

The hernia in the area of \u200b\u200bthe lumbar department occurs with a frequency of 300: 100 thousand population, mainly in men from 30 to 50 years.

Localization of hernia - L5-S1 (mainly) and L4-L5. In rare cases of hernia of the lumbar spine, L3-L4 is found and with severe injuries of the upper lumbar drives.

Systematization (according to the degree of penetration into the vertebral channel):

By the location of hernia in the frontal plane: lateral, median, paramediable hernia.

Main clinical picture

At the very beginning of the disease, patients complain about lower back pain. The root and vertebral syndromes appear much later, in some cases "experience" pain counts for several years.

At this stage, the root compression and the formation of the hernia of the disc: Lambalgia (pain in the lumbar region). Initially - non-permanent and new. Over time, the severity of pain is growing, more often due to the stretching of the rear longitudinal ligament and overvoltage of the ligament and muscles. The patient feels the gain of pain in any muscle tension, cough, sneezing and lifting weights. For Lambalgia, repeated exacerbations are characterized by which for many years.

The hernia of the spine can occur almost on any site of the spine

the stress of the paravertebral muscles prevents the full strain straightening and causes pain;
limiting the mobility of the lumbar department;
smoothing lumbar lordosis (its transition to kyphosis is often observed);

when palpation of the paravertebral muscles and intermediate processes there is soreness;

there is a pronounced change in posture (forced position), to reduce pain;

"Call Symptom." The awakening of an interstilant gap that corresponds to the localization of hernia leads to a shot in the leg;

vegetative manifestations (skin marble, sweating).

With a median and paramediable hernia, scoliosis is observed, open in the sick side (less pulling the rear longitudinal ligament). With lateral hernia (decrease in compression nervous root) Scoop is observed, open in the opposite direction.

Root syndrome (radiculopathy):

paints occur in the innervation zone of one or several roots, spread to the buttock, and below - according to rides, rear (rear-line) surface of the lower leg and hips (Ishialia). According to nature, the pain happens or shooting;
the pain most often arises due to injury, with an unsuccessful turn of the body or when lifting gravity;
changes occur in the innervation zone of the nervous root;
muscles become weak, hypotension is observed, atrophy develops (sometimes becyclation). The patient feels numbness, paresthesia arise;
"Symptom of coughing push." When there is a sneezing (cough, sneezing) in the innervation zone of the siled roof, there is a tight pain or its sharp gain;
there is a loss of proprioceptive reflexes.

the pain occurs even with a slight rise of the leg;
the pain appears in the lower back and in the dermatome of the affected root. The patient can feel numbness or "goosebumps" when picked up straightened legs up;
pain weakens (disappears) when flexing legs in knee jointBut it is enhanced by the re-flexion of the foot.

The hernia of the spine of the lumbar department most often occurs on the background of osteochondrosis

Pathology of horse-tail (acute compression of roots):

the reason: the median hernia of large sizes, pain occurs with a significant physical force and a large load on the spine (sometimes under the manual therapy session). Signs: urine delay (violation of sensitivity in the anogenital region), lower sluggish parapaprex.

Caudogenic mixing chromotype syndrome:

there is pain when walking in the lower limbs (due to the transient compound of the horse-tail). The patient when driving is forced to stop often.

Diagnostic events

When diagnosis, it is important to take into account all the symptoms, "speaking" about the presence of hernia of the lumbar spine. The dorsal hernia is recognized in the following diagnostic methods:

lumbar puncture (moderate protein increase);
x-ray of the spinal column;
MRI and myelography, sometimes - followed by high resolution CT;
electromiography (the ability to retperine reimage neuropathy from the grinding of the root).

Differential diagnosis

It is important when differentiating from lumbar hernia Exclude: tumors and metastases in the spine, Bekhterev's disease, tuberculous spondylitis, metabolic spondylopathy, circulatory disorder in the additional spinal artery of Defraw-Gotteron, diabetic neuropathy.

In time, the diagnosis was diagnosed and the initiated treatment is capable of restoring the intervertebral disk completely. With late circulation all medical eventsUnfortunately, only aimed at reducing the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative dystrophic changes in the spine

Degenerative spinal changes are made up of three main options. This is osteochondrosis, spondylosis, spondyltrosis. Various pattomorphological options can be combined with each other. Degenerative-dystrophic changes of the spine to old age are celebrated by almost all people.

Osteocondritis of the spine

The cipher on the ICD-10: M42 is osteochondrosis of the spine.

Osteochondrosis of the spine is a decrease in the height of the intervertebral disk as a result of dystrophic processes without inflammatory phenomena. As a result, segmental instability is developing (excessive degree of flexion and extension, the sliding of the vertebrae is forwarded when flexing or backward during extension), the physiological curvature of the spine changes. The rapprochement of the vertebrae, and hence the articular processes, their excess friction inevitably lead in the future to local spondyltrosis.

Osteochondrosis of the spine is an x-ray, but not clinical diagnosis. In fact, the osteochondrosis of the spine simply states the fact of aging the body. Call back pain osteochondrosis - illiterately.

Spondylosis

CIFR on the ICD-10: M47 - Spondylosis.

Spondylosis is characterized by the appearance of edge bone expansions (on the upper and lower edge of the vertebrae), which on radiographs have the type of vertical spikes (osteophytes).

Clinically spondylosis will be not significant. It is believed that spondylosis is an adaptive process: edges (osteophytes), fibrosis of disks, ankylosis facetic joints, thickening bundles - all this leads to immobilization of the problem vertebral motor segment, expanding the support surface of the vertebral bodies.

Spondloarthrosis

Cipher on the ICD-10. M47 - Spondillas. Included: arthrosis or osteoarthritis of the spine, degeneration of facade joints.

Spondilotrosis is an arthrosis of intervertebral joints. It is proved that the processes of degeneration in intervertebral and peripheral joints do not differ in principle. That is, essentially spondyltrosis is a type of osteoarthrosis (therefore, drugs of chondroprotective series will be appropriate in treatment).

Spondilitrosis is the most common cause of back pain in older people. Unlike discogenous pain in spondylotrosis, the pain bilateral and localizes paravertebrally; Strengthens with long standing and extension, decreases when walking and seat.

3. Protrusion and hernia disk

The cipher on the ICD-10: M50 is the defeat of the intervertebral discs of the cervical M51 is the defeat of intervertebral disks of other departments.

The protrusion and hernia disk are not a sign of osteochondrosis. Moreover, the less expressed degenerative changes in the spine, the more the disk is active (that is, the more realistic the appearance of hernia). That is why the hernia disk is more common in young people (and even in children) than the elderly.

The sign of osteochondrosis is often considered to be a hernia of Schimor, which has no clinical value (there are no back pain). The hernia of Schimorl is the displacement of the disk fragments to the spongosis of the body of the vertebral body (intracorporeal hernia) as a result of the impairment of the body of the vertebrae during the growth process (that is, in fact, the hernia of the Schimor is a dysplasia).

The intervertebral disk consists of an outer part - this is a fibrous ring (up to 90 layers of collagen fibers); And the inner part is a pentuary pulpidic core. In young people, a pulpous core consists of 90%; In the elderly, a pulp nucleus loses water and elasticity, fragmentation is possible. The protrusion and hernia disk arise both as a result of dystrophic changes of the disc and due to repetitive high loads on the spine (excessive or frequent bends and extensions of the spine, vibration, injury).

As a result of the transformation of vertical forces into the radial pulpseed kernel (or its fragmented parts), shifted to the side, deflection of the dudder the fibrous ring - develops the disk protrusion (from the lat. Protrusum - push, push). Protrusion disappears as soon as the vertical load stops.

Perhaps spontaneous recovery if fibrotization processes apply to the pulp nucleus. Fibrous rebirth occurs and the protrusion becomes impossible. If this does not happen, then as the protrusion of the protrusions, the fibrous ring is increasingly promoted and finally bursts - this is a disk hernia.

The hernia of the disk can develop sharply or slowly (when the fibrous ring breaks in small portions of the fragments of the pulp nucleus). The hernia of the disk in the back and rear-side directions can cause the compression of the spinal root (radiculopathy), the spinal cord (myelopathy) or their vessels.

Most often, the hernia of the disk occurs in the lumbar spine (75%), then the cervical (20%) and the chest spine (5%) goes in frequency.

The cervical department is the most mobile. The frequency of hernia in the cervical spine - 50 cases per 100 thousand population. The most often disk hernia occurs in the C5-C6 or C6-C7 segment.
The lumbar department carries the greatest load by holding the whole body. The frequency of hernia in the lumbar spine - 300 cases per 100 thousand population. The most often disk hernia occurs in the L4-L5 segment (40% of all hernias in the lumbar spine) and in the L5-S1 segment (52%).

The hernia of the disk must have clinical confirmation, asymptomic disk hernias, according to CT and MRI, are found in 30-40% of cases and do not require any treatment. It should be remembered that the detection of the hernia of the disk (especially small sizes) according to CT or MRI does not exclude another cause of the back pain and cannot be the basis of a clinical diagnosis.

The content of the Dorsilla and Back Pain:

Degenerate-dystrophic changes in the spine. Protrusion and disk hernia.

The manifestations of ventral hernia depends on their location, the main feature is the presence of directly hernia education in a particular area. Packing hernia belly is oblique and straight. Kosy groin hernia is a congenital defect, when the vaginal abnurbation process does not overgrow, thanks to which the abdominal message is preserved with a scrotum through a groin canal. With oblique grozier of the abdomen, intestinal loops pass through the inner aperture of the inguinal channel, the channel itself and go through the outer aperture in the scrotum. The hernce bag takes place near the seed cord. Usually such hernia is right-sided (in 7 cases out of 10).
The straight groove hernia of the belly - the acquired pathology, in which the weakness of the outdoor groove ring is formed, and the intestines together with the parietal peritoneum follows from the abdominal cavity directly through the outdoor groove ring, it does not pass next to the seed cord. Often develops from two sides. The straight groin hernia is infringed much less often than obliquely, but more often recurrences after the operation. Inguinal hernias make up 90% of all hernias of the abdomen, while 95-97% of all patients are men after 50 years. About 5% of all men suffer in inguinal hernias. A combined groove hernia is quite rare - with it there are several hernial protrusions that are not interconnected, at the level of the inner and outer ring, the inkhan canal itself.
In the femoral hernia, the intestinal loops overlook the abdominal cavity through the femoral canal to the front of the thigh. In the overwhelming majority of cases, this type of hernia suffer from 30-60 years. The femoral hernia is 5-7% of all ventral hernia. The dimensions of such hernia are usually small, but due to the cramped hernial gates, it is prone to infringement.
With all the above-described types of hernia, patients notice the rounded elastic formation in the groin area, decreasing in the back position and increasing in the standing position. When loading, there is soreness in the area of \u200b\u200bhernia. With oblique groin hernia, intestinal loops can be determined in the scrotum, then in the right of hernia there is a rice of the intestine, during auscultation over the scrotum, the peristalistic is heard, a tympanite is determined at percussion. These types of hernia should be differentiated with lipoms, inguinal lymphadenitis, inflammatory diseases of the testicles (orchitis, epididiment), cryptorchism, abscesses.
Underfloor hernia - moving the hernial bag outward through the umbilical ring. In 95% of cases is diagnosed in early age; Adult women suffer from this disease twice as many than men. In children under 3 years old, it is possible to spontaneously strengthen the umbilical ring with the curable of hernia. In adults, the most frequent causes of the formation of a bustling hernia of belly - pregnancy, obesity, ascites.

Incision hernia without obstruction and gangrene

Incision hernia BDA

Parastomal hernia with impassability without gangrene

disadvantaged without gangrene
unaviables without gangrene
stageless without gangrene

Parastomal hernia with gangrene

Parastomal hernia without obstruction and gangrene

Parastomal hernia BDA

Other or unspecified dooms with obstruction without gangrene

epigastral
graphic (Hyporal)
midline
spielieva line (abdomen)

disability
infringed
nepport
foundation

Other or unspecified front abdominal wall hernias with gangrene

Hernia (K40-K46)

Note. The hernia with gangrene and obstruction is classified as hernia with gangrene.

Included: Hernia:

acquired
congenital [In addition to the diaphragm or esophageal hole of the diaphragm]
recurrent

Included: Occupus hernia

Included:

hernia aperture hole (esophageal) (sliding)
equaline hernia

Excluded: congenital hernia:

diaphragmal (Q79.0)
diaphragm Ecoming Hole (Q40.1)

Included: Hernia:

abdominal cavity refined Localization of the NCDR
lumbar
locked
female outdoor genital organs
rakr Trinky
sedalish

Included:

enterocele [Intestinal hernia]
epiplocele [Gnug Seal]
hernia:
- BDA
- interstitial
- intestinal
- intra-abdominal

Excluded: Vaginal Enterocele (N81.5)

A new revision (ICD-11) is planned to be planned in 2017 2018.

Processing and transferring changes © MKB-10.com

Hernia Front Abdominal Wall (K43)

Incision hernia (postoperative ventral hernia):

irrepressible
disadvantaged without gangrene
unaviables without gangrene
stageless without gangrene

Gangrenous incision hernia

Incision hernia BDA

Parastomal (colostomical) hernia:

irrepressible
disadvantaged without gangrene
unaviables without gangrene
stageless without gangrene

Gangrenous parastonal hernia

Parastomal hernia BDA

epigastral
graphic (Hyporal)
midline
spielieva line (abdomen)
under the Movie-shaped process (subxiphoid)

Any conditions listed in K43.6 without gangrene:

disability
infringed
nepport
foundation

Any options listed in K43.6 with Ganger

Hernia front abdominal wall BDU

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

Light of the new revision of the ICD is planned WHO in 2017 2018.

With changes and additions to WHO.

Belly hernia - description, reasons.

Short description

The belly hernias are divided into external and inner outer hernia of the belly - a surgical disease in which through various holes in the muscular - aponeurotic layer of abdominal walls and the pelvic floor there is an extinguishing of the insides together with the inner hernia of the abdomen formed inside the abdominal cavity in the abdominal Pockets and folds or penetrate into the chest cavity through natural or purchased holes and diaphragm gaps.

Frequency. Watch at any age. The peaks of morbidity - preschool age And age after 50 years. Men register more often.

The reasons

Ethiology Congenital abdominal wall defects (for example, congenital oblique groove hernias) Expansion of the abdominal wall holes. Existing in the norm, but pathologically advanced holes in the abdominal wall can cause the intelligence of internal organs (for example, the release of the stomach into the chest cavity through the extended esophageal hole of the diaphragm in the hernia of its esophageal opening) thinning and loss of the elasticity of tissues (especially against the background of the total aging of the body or exhaustion ) They lead to the formation of inguinal, umbilical hernia and hernia of the white line of abdominal injury or wound (especially postoperative), when degenerative changes are developing in normal tissues, which often leads to the formation of postoperative ventral hernia. Putting the postoperative wound increases the risk of hernia formation increase in intra-abdominal pressure. Factors contributing to an increase in intra-abdominal pressure: severe physical work, cough with chronic diseases Easy, difficult urination, prolonged constipation, pregnancy, ascites, abdominal tumors, meteorism, obesity.

Basic concepts. The view of the hernia can be installed with an objective study or during surgery full of hernia. The hernia bag and its contents go through the defect in the abdominal wall (for example, a complete groin hernia, when the hernia bag with the contents is in the scrotum [Pakhovo - scrotum hernia]) incomplete hernia. In the abdominal wall there is a defect, but the hernia bag with the contents has not yet been out of the abdominal wall (for example, an incomplete grozha, when the hernia bag with content does not go beyond the outdoor groove rings) patching hernia. The contents of the hernia bag easily moved through the hernia doors from the abdominal cavity in the hernia and the back of the hernia. The contents of the hernia bag can not befilled through the hernia doors in connection with the squeezed hernias or large sizes of hernias - compression of the hernial bag content in the hernial gate. Congenital hernia is associated with developmental anomalies The sliding hernia contains organs, partially not covered with peritoneum (blind gut, bladder ), the hernia bag may be absent Richter hernia - the disadvantaged hernia of the belly. Its feature: infringement of only part of the wall of the intestine (without a mesentery). There is no intestinal obstruction (either it is partial) litter hernia - hernia of an anterior abdominal wall containing a congenital diverticulum of the ileum.

Complications are mainly arising with late treatment for medical assistance and late diagnosis Obstrument intestinal obstruction develops when the intestine of the intestine is exhausted through the abdominal wall defect with the occurrence of a mechanical obstacle to the passage of intestinal content as a result of the compression or intestinal intestine (the so-called cartilage infringement) And the purification of the intestinal loops is developing as a result of the compression of the mesente vessels with a violation of blood flow in the wall of the stricken intestine (the so-called elastic impairment) is isolated necrosis with perforation of the disadvantaged sector of the intestine wall during the hernia Richter.

Kosy groaning hernia passes through a deep inguinal ring in the groin canal. In some cases, it can descend into the scrotum (complete hernia, Pakhovo - scrotal hernia) With congenital inguinal hernias, the vaginal abnormal proceedings remain completely unailed and reported by the abdominal cavity, the groove canal and the scrotum. A partially refused vaginal abnurbation process can cause a waters of the seed cord. Welcome. 80-90% of all types of belly hernia - inguinal. Among patients with inguinal hernias - 90-97% of men aged 50-60 years. In general, 5% of men occur in children to celebrate a significant tendency to infringement. In 75% of cases, the right-sided hernia can be combined with the uncomplication of the egg in the scrotum, its location in the inguinal canal, the development of the water membranes or the vaginal shell of the seed rope. Bilateral unexpectedness of the vaginal abutment process is observed by more than 10% of patients with braid grooves.

Direct groove hernia. The lower left artery and vein serve as an anatomical benchmark for recognition of oblique and straight inguinal hernia. The straight groin hernia comes out of the abdominal cavity of the lateral umbilical fold in the region of the inguinal canal through the hesselbach triangle as a result of thinning and loss of tissue elasticity. Direct grooves. The hernia lies outside the elements of the seed rope (in contrast to the oblique grozha) and, as a rule, it is not descended into the scrotum. The hernia doors are rarely narrow, so the straight groin hernia (in contrast to the oblique), the hernia is less likely, it is not congenital, it is more often observed in old age. The elderly often happens a bilateral recurrence of hernia more often in patients with straight inguinal hernias than with oblique groin hernias. Surgical treatment is aimed at strengthening the rear wall of the inguinal canal.

Combined inguinal hernias refer to complex forms of inguinal hernia. In the patient on one side, 2 or 3 separate hernial bags that are not communicating with each other, with independent hernial holes leading to the abdominal cavity are noted.

The femoral hernia comes through the femoral channel along the femoral fascia prevalence - 5-8% of all hernias of the abdomen. Most patients (80%) - women aged 30-60 are rarely large, prone to infringement. The contents of the hernia bag - the loop of the small intestine, the appearance of hernia is usually associated with large exercise, chronic constipation and pregnancy.

Diagnosis of patient complaints on tumor-like protrusion in the groin area and pain of different intensity (especially with physical stress) An objective examination inspection. Pay attention to the shape and magnitude of the hernial protrusion in the vertical and horizontal positions Palc Palpation. The dimensions of the junk protrusion, the degree of prime, the sizes of the inner opening of the inguinal channel, the shape and the magnitude of the testicles, the symptom of a cough jolly - the arms of the jewelry bag to the tip of the finger introduced into the ink channel, when plowing the patient percussion and auscultation of the area of \u200b\u200bthe hernial protrusion. Are carried out to identify peristaltic noise and tympanic sound (if the bowel loop is located in the hernial bag) Differential diagnosis: Lipoma, groove lymphadenitis, abscess, orchiepididimitis, yablock shells of eggs, varicocele, cryptorchism.

Treatment of the main stages of hernias: access to the inguinal channel Isolation of the hernial bag, opening it with the lumen of the contents of the contents and its right in the abdominal cavity Gnip-bag neck, its removal of the inguinal channel. Features of hernias, with oblique inguinal hernias: Gnigent bags in the level of parietal peritoneum Sunning a deep inguinal ring to normal size. Strengthening the front wall of the inguinal canal with the mandatory stroke of a deep inguinal ring apply among young men with small oblique groove hernias. With sliding, recurrent and large inguinal hernias, the rear wall of the inguinal canal is strengthened. With large nesting wall defects, it is strengthened using various grafts. Strengthening the front wall of the inguinal canal. The method of Girard: the internal oblique and transverse muscles of the abdomen are laid into the groin bond over seed cords, create an aponeurosis duplication with an external braid abdominal muscle. Currently, various modifications of this operation are used - the method of Spakokukotsky, Show Kimbarovsky. Strengthen the rear wall of the inguinal canal. The method of bassini: the edges of the inner oblique and transverse abdominal muscles together with the transverse fascia are laid into the groin bond under seed cords, on top of which the edge of the external muscle dissected before the aponeurosis is sewed. Alloplasty. Apply with complex shapes of inguinal hernia. Use autotransplants of the skin, solid brain shell allotransplants, synthetic materials Feature of hangeal, with direct inguinal hernias - strengthen the rear wall of the inguinal channel after the contents of the hernial bag is right. Use the method of bassini hernutrhess during femoral hernias can be made by the femoral and inguinal methods a femoral way. The poor channel is suitable from its outer hole. Most surgeons apply the method proposed in 1894 by Bassini. Access: In parallel and below the groin bundle over the hernial protrusion. The hernce gate is closed, stitching the inguinal and Lonnaya (Cooper) bundles. A femoral canal interfere with the second seams between the edge of the widespread fascia of the hip and combed fascia. Unfortunately, the Bassini operation leads to deformation of the inguinal channel and in some cases contributes to the occurrence of oblique groin hernia. This disadvantage is deprived of the operation of Ruji groin method according to Ruji. The groin canal is revealed by the cut above and parallel to the groove bundle and (after removing the hernia bag) the herniated gate erect seams connecting the inguinal and cooper bundles with the inner oblique and transverse muscles. Thus, the groin and femoral recurrents are closed simultaneously after surgical treatment - 3-5% Special situations suffering from the intestine of the intestine. With a prescribed diagnosis, laparotomy, the revision of the abdominal cavity and resection of the non-visual segment of the recycle intestine and the large defects of the abdominal wall are performed. To eliminate the defect implanted synthetic prostheses children. The Krasnobeeva method is used: after removing the hernial bag on the legs of the outdoor inguinal channel, 2 seams are applied. At the same time, 2 folds of the aponeurosis of the outer oblique muscle are formed. They are stitched by several additional seams, the hernia Bandage is designed to prevent the exit of the abdominal organs through the hernia. It is used in the presence of contraindications to surgical treatment (associated somatic diseases) or in case of refusal of the patient from the operation Laparoscopic plastic with groin and femoral hernias. Absolute indications: recurrent and bilateral hernias of contraindications: infringement of organs or intestinal infarction within hernia Accessories - intraperitoneal and extra-brute complications: Damage to external iliac vessels, damage to the iliac - inguinal and femoral nerves, the formation of adhesions with an intraperitoneal operation can cause obstruction of the small intestine.

Undermining hernia - the output of the abdominal organs through the abdominal wall defect in the navel area in women is celebrated 2 times more often, in early childhood, in 5% of cases - in older children and adults. As it develops, self-appearances between the ages of 6 and 3 years of the causes of the formation of naughty hernia in adults: an increase in intra-abdominal pressure, ascites, pregnancy plastic umbilical hernia in children: a lexer operation. The umbilical ring is embedded with a brine in adults: MEYO operation: the herniated gate is closed with duplicatura stitched one on top of another aponeurosis leaves. Sapproxo method. Pre-from the rear surface of the vagina, one of the live abdominal muscles peel the peritoneum. Then with separate seams, capturing on one side the edge of the white-line abdomen on one side, and on the other hand, the rearranged part of the vagina's straight muscle, where the peritonean is separated, create a duplication of muscularly - aponeurotic flaps.

The hernia of the white lines of the abdomen can be supper, the octopup and subparticles are more often noted in men (3: 1). In children, there are extremely rare hernias can be multiple plastic by means of a simple embossing of the defect in aponeurosis gives about 10% of relapses. At large hernias use a boat method.

Postoperative ventral hernia is the most frequently observed type of ventral hernia, resulting from complications in healing postoperative wounds predisposing factors: wound infection, hematoma, elderly age, obesity, high pressure in the abdominal cavity in intestinal obstruction, ascite, lightweight complications of the postoperative period, operational treatment is performed after eliminating the reasons that caused their development.

The hernia of the semi-lunged (spectional) line is usually located at its intersection with the Douglas line. Surgical treatment. With small hernias, the gate closes the layer in the overlay of the seams. With big hernias after crosslinking the muscles, you need to create a duplication of the aponeurosis.

ΜБ-10 k40 grozhey hernia k41 femoral hernia k42 bubble hernia front abdominal wall K44 Hernia K45 Diaphragm Hernia K45 Other Bureau cavity Neutic

Standard of medical care patients with disadvantaged hernia

On November 26, 2007, the Ministry of Health approved the protocols for the diagnosis and treatment of the disadvantaged hernia.

The disadvantaged hernia (ICD - 10 K40.3 - to 45.8) - a sudden or gradual compression of hernia contents at its gate.

Infringement is the most frequent and dangerous complication of the hernia. Patients' mortality increases with age, varying between 3.8 and 11%. Necrosis of the damned organs is observed at least in 10% of cases.

Forms of infringement are different. Among them are distinguished:

2) Caluing infringement;

3) clothes infringement;

4) retrograde infringement;

5) Lithra hernia (infringement of the meckel diverticula).

The frequency of occurrence is observed:

1) infrigious inguinal hernias

2) infrained femuric hernias;

3) infrained nuclear bumps;

4) infrained postoperative ventral hernias;

5) infrained hernia of a white abdomen;

6) infrained hernia rare localizations.

With all the types and forms of the disadvantaged hernia, the severity of disorders has a direct dependence on the time factor, which determines the urgent nature of therapeutic and diagnostic measures.

Protocols for the diagnosis of infrainment of hernia in the emergency medical department (OEMP)

Patients enrolled in the OEMP with complaints of abdominal pain, symptoms of acute intestinal obstruction, should be purposefully examined for the presence of hernia protrusions in the places typical.

Based on complaints, anamnesis of a clinical picture and data of an objective examination, patients with infringent hernias should be divided into 4 groups:

1 group - uncomplicated disadvantaged hernia;

2 Group - complicated disadvantaged hernia

With complicated disadvantaged hernia, 2 subgroups are distinguished:

a) the disadvantaged hernia complicated by acute intestinal obstruction;

b) The disadvantaged hernia, complicated by the phlegmon hrying bag.

3 Group - improved thickened hernia;

Uncomplicated disadvantaged hernia;

Criteria for the diagnosis of uncomplicated disadvantaged hernia in the OEMP:

The disadvantaged uncomplicated hernia is recognized by:

Suddenly coming pains in the region of the previously aftered hernia, the nature and intensity of which depends on the type of infringement, the affected organ and the age of the patient;

The impossibility of the right of the earlier hernia;

Increasing in the volume of hernia protrusion;

Voltage and soreness in the field of hernia protrusion;

Lack of transmission of "cough shock";

No symptoms and signs of acute intestinal obstruction with uncomplicated disadvantaged hernia.

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Protocols for preoperative preparation with uncomplicated disadvantaged hernia in the OEMP

Protocols of surgical tactics with uncomplicated disadvantaged hernia.

2. The main tasks of the operation in the treatment of uncomplicated disadvantaged hernia are:

Inspection of the disadvantaged authorities and the corresponding interventions on them;

Plastic hernial gate.

3. The section of sufficient size is carried out in accordance with the localization of hernia. An opening of a hernia bag and fixation of the organ disadvantaged in it. Dissection of the infringerating ring until the junk bag is unacceptable.

4. When spontaneous to the abdominal cavity of the infringent organ, it should be extracted for inspection and evaluating its blood supply. If it fails to find and extract, the wound expansion (Herniolaparotomy) or diagnostic laparoscopy is shown.

5. After dissection of the infringerating ring, an assessment of the state of the disadvantaged organ. The viable intestine quickly takes a normal look, the painting of it becomes a pink, serous shell is brilliant, the peristalsis is distinct, the vessels of the mesentery pulsate. Before the intestine in the abdominal cavity, it is necessary to introduce 100 ml of a 0.25% solution of novocaine into its mesentery.

6. If there are doubts about the viability of the intestine in its mesentery, ml from 0.25% of the novocaine solution should be introduced and to warm up the dubious area with warm tampons moistened with 0.9% NaCl. If doubts in the viability of the intestine remain, the gut must be restected within healthy tissues.

7. Signs of intelligence of the intestine and undisputed testimony to its resection serve:

Dark color of the intestine;

Dull serous sheath;

The absence of intestine peristals;

No pulsation of vessels of her mesentery;

8. Recurches are subject to, except for the disadvantaged area of \u200b\u200bthe intestine, all macroscopically modified part of the pluss of the unchanging part of the leading intestine by the ISM of the unchanged segment of the removal intestine. The exceptions are resection near an ileocecal angle, where limitation of these requirements is allowed with the beneficial visual characteristics of the intestine in the zone of the intended intersection. In this case, control indicators are used to bleed from the wall vessels during its intersection and the state of the mucous membrane. It is also possible to use transyl aluminlation or other objective methods for assessing blood supply. In reducing the intestine, when the level of imposition of anastomosis falls on the most distal department The ileum - MENESME from the blind intestine, should be resorted to the imposition of Ileo-sazeno - or Ileotransversoanastomosis.

9. If there are doubts about the viability of the intestine, especially in its large extent, it is permissible to postpone the solution of the issue of resection using the programmed laparoscopy after 12 hours.

10. In cases of intricate infringement, the intestines should be made. The immersion of the changed area in the intestinal lumen is dangerous and should not be made, since it may be possible to discrepate the immersible seams, and the immersion of an extensive area within the limits of non-modified sections of the intestine can create a mechanical obstacle to the intestine.

11. Restoration of continuity gastrointestinal tract After resection is carried out:

With a large difference in the diameters of the lumen of the crosslinkable sections of the intestine by the anastomosis "side in side";

In the coincidence of the lumen diameters of the crosslies of the intestine, it is possible to apply the anastomosis "end to the end".

12. When infringement of the gland, the testimony for resection is put in the event that it is eaten, has fibrinous raids or hemorrhages.

13. Operational intervention ends with plastic hernia gates depending on the localization of hernia.

Minutes of postoperative management of patients with uncomplicated disadvantaged hernia

2. An intramuscular administration of painkillers (analgin, ketarol) is prescribed to all patients 3 times a day for 3 days after surgery; Wide spectrum antibiotics (cefazoline 1 g x 2 p / day) within 5 days after surgery.

Complicated disadvantaged hernia

Disadvantaged hernia complicated by acute intestinal obstruction

Criteria for diagnosing disadvantaged hernia complicated by intestinal obstruction in the OEMP:

Symptoms of acute intestinal obstruction are joined to local symptoms of infringement:

Grapple-shaped pain in the field of hernia

Thirst, dry mouth,

Tachycardia\u003e 90 wt. in 1 min.

Periodically repeated vomiting;

The delay in the deposition of gases;

During the examination, the bloating is determined, the strengthening of the peristalsis; MB "Slot's noise";

On the survey radiograph, the cables of the cloebeer and the sublictic arches with transverse aperture are determined, perhaps the presence of a "insulated loop";

Under ultrasound examination, extended intestinal loops and "pendulum" peristalistic are determined;

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Survey radiography of chest organs

Review radiography of the abdominal cavity.

Ultrasound abdominal cavity.

Protocols of preoperative preparation of the disadvantaged hernia complicated by intestinal obstruction in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.

2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

3. The presence of pronounced clinical signs General dehydration and endotoxicosis serves as an indication for intensive preoperative preparation with the formulation of the catheter in the main vein and the conduct of infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasberin, cytoflavin 10 ml in dilution by 400 ml of 5% glucose solution. Antibiotics in this case Entered 30 minutes before surgery.

Protocols of surgical tactics in progressive hernia complicated by intestinal obstruction.

2. The main tasks of the operation in the treatment of the disadvantaged hernia complicated by intestinal obstruction are:

Determining the viability of the intestine and determining the indications for its resection;

Establishing the boundaries of resection of the changed intestine and its execution;

Determination of indications and method of drainage of the intestine;

Sanitation and drainage of the abdominal cavity

Plastic hernial gate.

3. The initial stages of the operation to eliminate the disadvantaged hernia, complicated by intestinal obstruction, correspond to the provisions set forth in Schururgical tactics with an uncomplicated disadvantaged hernia.

4. Indication to the drainage of the small intestine is overflowing the content of the leading intestinal loops.

5. The preferred method of draining the small intestine is a nasogasorentestine intubation from a separate median laparotomy access.

6. Operational intervention ends with the drainage of the abdominal cavity and the plastic of the hernial gate, depending on the localization of hernia.

Minutes of postoperative management of patients with infringent hernia complicated by intestinal obstruction

1. Theent nutrition begins with the advent of intestinal peristaltics by introducing glucose-electrolyte mixtures to the intestinal probe.

2. The method of a namogasorentestinal drainage probe is carried out after the restoration of stable peristaltics and an independent chair for 3-4 days. A drainage tube mounted in a small intestine through a gastrostomy or retrograde on the vehicle is removed somewhat later - the windows.

3. The purpose of combating ischemic and reperfusion damage to the small intestine is carried out infusion therapy (intravenous 2-2.5 liters of cryptaloid solutions, reasberin 400 ml, cytooflavin 10.0 ml in dilution by 400 ml of 0.9% sodium chloride solution, Trental 5 0 - 3 times a day, conficilla / day, ascorbic acid 5% 10 ml / day).

4. Calibular therapy B. postoperative period Must include either aminoglycosides II-W, generation cephalosporins III and metronideosol, or fluoroquinolones II of generation and metronideosol.

5. For the prevention of the formation of sharp ulcers, the scicure of therapy should include antisecretory preparations.

6.complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.

Laboratory studies are performed according to the testimony and before discharge. Extract with the uncomplicated passage of the postoperative period is produced by the windows.

Disadvantaged hernia complicated by phlegmon hrying bag

Criteria for the diagnosis of the disadvantaged hernia, complicated by the phlegmon of a junk bag in the OEMP:

The presence of symptoms of severe endotoxicosis;

Herge-up swelling, hot to the touch;

Skin hyperemia and subcutaneous swelling edema propagating far beyond the limits of hernia protrusion;

It is possible to have attachments in the surrounding hernial tissue protrusion.

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Survey radiography of chest organs

Review radiography of the abdominal cavity.

Protocols preoperative preparation of the disadvantaged hernia, complicated by the phlegmon of a hernia bag in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.

2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

3. An intensive preoperative preparation with a catheter is shown to the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasberin, cytooflavin 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour or on the operating table or in OKR.

4. Must with the introduction of a wide range of action (cephalosporins III III and Metronidozol) 30 minutes before operation intravenously.

Protocols of surgical tactics with a disadvantaged hernia complicated by the phlegmon hrying bag.

2. Operative intervention begins with median laparotomy. When reducing the loop of the small intestine, it is carried out with the imposition of anastomosis. The question of the method of completing resection of the colon is solved individually. The ends of the intestine to be removed is sewn tightly. Then the brushless seam is superimposed on the peritoneum around the inner ring of the hernia gate. The intra-painting stage of the operation is temporarily terminated.

3. Hiniotomy is performed. The disadvantaged necrotic part of the intestine is removed through a herniotomic section with simultaneous tightening of the brush seam inside the abdominal cavity. At the same time, special attention is paid to the prevention of the inflammatory purulent-rotary exudate of the hernial bag into the abdominal cavity.

4. Primary plastic of the hernial gate is not performed. In the herniotomic wound, necratetomy is performed followed by its loose rubony and drainage.

5. According to the testimony, the detonation of the small intestine is performed.

6. The operation ends with the drainage of the abdominal cavity.

Protocols postoperative maintenance of patients with a disadvantaged hernia, complicated by the phlegmon of a junk bag.

1. Sea treatment of the herniotomic wound is carried out in accordance with the principles of treatment of purulent wounds. Dressing daily.

2. Severecting therapy includes intravenous administration of 2-2.5 liters of crystalloid solutions, 400 ml reasumber, cytooflavin 10.0 ml in dilution by 400 ml of 0.9% sodium chloride solution, Trental 5.0 - 3 times a day, countercrimal / Day, ascorbic acid 5% 10 ml / day.

3. Intibacterial therapy in the postoperative period should include either aminoglycosides II-w, generation cephalosporins III and metronideosol, or fluoroquinolone II of generation and metronideosol.

4. For the prevention of the formation of sharp ulcers, the trap therapy should include antisecretory drugs.

5. Complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.

Laboratory studies are performed according to the testimony and before discharge.

Imbutable disadvantaged hernia.

Criteria for the diagnosis of undergoing infrained hernia OEMP:

The diagnosis of "disadvantaged hernia, condition after infringement" can be delivered when there is clear indications of the patient himself on the fact of the infringement of the previously aftered hernia, the time of its immediate disposition and the fact of its independent management.

We should also consider the enjoyment of the infringent hernia, the fact of the independent return of which occurred (and recorded in medical documents) in the presence of medical personnel (at a pre-hospital stage - in the presence of ambulance, after hospitalization - in the presence of a duty surgeon Surgeon).

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Survey radiography of chest organs

Review radiography of the abdominal cavity.

Protocols of preoperative preparation of the infringeable inclusive hernia in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.

2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

Protocols of surgical tactics when improving the disadvantaged hernia.

2. If, during dynamic observation, symptoms of deterioration of the overall state of the observed, as well as peritoneal symptomatics - is shown diagnostic laparoscopy.

3. With an independent refueling of the infringent hernia to hospitalization, if the fact of infringement does not cause doubt, and the duration of the infringement is 2 or more hours - the diagnostic laparoscopy is shown.

Protocols for the maintenance of patients when improving the disadvantaged hernia.

Postoperative maintenance of patients after diagnostic laparoscopy is determined by diagnostic finds and a volume of surgical intervention with them.

Infringed postoperative ventral hernia

Criteria for the diagnosis of infrainable postoperative ventral hernia OEMP:

The clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are a wheelchair and elastic infringement.

In case of hidden infringement, there is a gradual principle of the disease. The constantly existing pain in the area of \u200b\u200bhernia absorption increases, acquire a grapple-shaped character, subsequently join the symptoms of acute intestinal obstruction - there is vomiting, the delay of gases, the absence of a chair, the bloating of the abdomen. Herge-up protrusion in the lying position does not decrease, it acquires clear contours.

Elastic reinforcement typically for hernia with a small hernial gate. There is a sudden beginning of pain syndrome due to the introduction of a large segment of the intestines in the hernial bag through a small defect of the front abdominal wall. In the subsequent pain syndrome, symptoms of intestinal obstruction are enhanced.

The main symptoms of the disadvantaged postoperative ventral hernia are:

Pain in the field of hernia dumping;

Sharp pain when palpation of hernia protrusion;

With a long period of infringement, clinical and radiological signs of intestinal obstruction are possible.

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Survey radiography of chest organs

Review radiography of the abdominal cavity.

Protocols for preoperative preparation of the infringent postoperative ventral hernia in the OEMP.

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.

2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

3. With the presence of intestinal obstruction, an intensive preoperative preparation is shown with a catheter formulation to the main vein and infusion therapy (intravenous 1.5 liters of crystalloid solutions, 400 ml reasumber, cytooflavin 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour either on the operating table or in the OKR.

Protocols of surgical tactics in the infringeable postoperative ventral hernia.

1. The treatment of the infrainment postoperative ventral hernia is to perform emergency laparotomy within 2 hours from the moment of entering the hospital.

2. Supports of surgical treatment with a disadvantaged postoperative ventral hernia:

Careful revision of the hernia bag, given its multi-chamber and liquidation of the adhesive process;

Assessment of the viability of the organ stirred in hernia;

With the presence of signs of the unvisability of the disadvantaged organ - its resection.

3. In the infringement of large multi-chamber postoperative ventral hernias of the abdominal wall, the operation is completed by the dissection of all fibrous partitions and the ears of only skin with the subcutaneous tissue.

4. With an extensive hernial defect, more than 10 cm in diameter in order to prevent abdominal compartman-syndrome, it is possible to close the hernial gate with a mesh explant.

Minutes of postoperative maintenance of patients with infringeable postoperative ventral hernia.

1. Treatment of patients with infringent postoperative ventral hernia prior to stabilization of hemodynamics and restoration of independent respiration is carried out in OKH.

2. Therapeutic measures in the postoperative period should be directed to:

Suppression of infection by appointing antibacterial agents;

Fighting intoxication and infringement of metabolic processes;

Treatment of complications from respiratory and cardiovascular systems;

Restoring the function of the gastrointestinal tract.

Disadvantaged hernia complicated by peritonitis

Criteria for the diagnosis of the disadvantaged hernia complicated by peritonitis in the OEMP:

General condition is severe;

Symptoms of heavy endotoxicosis: consciousness confused, dry mouth, tachycardia\u003e 100 ° C. in 1 min., hypotension / mm. Hg;

Periodic vomiting congestive or intestinal content;

During the examination, the bloating is determined, the absence of peristaltics, a positive symptom of Shetkina-Blumberg;

On a survey radiograph, multiple levels of fluid are determined;

Under ultrasound examination, extended intestinal loops are determined;

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Survey radiography of chest organs

Review radiography of the abdominal cavity.

Protocols for preoperative preparation of the disadvantaged hernia complicated by peritonitis in the OEMP

1. Preoperative preparation and diagnostics are carried out in the conditions of OKR.

2. The gastric probe is set and the gastric content is evacuated.

Intensive preoperative preparation with a catheter formulation in a trunk vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml solutions, cytoflavin 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour or on the operating table, or in OKR

3. Be sure to introduce antibiotics of a wide range of action (cephalosporins III of generation and metronideosol) 30 minutes before operation intravenously.

4. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

Protocols of surgical tactics with a disadvantaged hernia complicated by peritonitis.

1. Operation on the complicated disadvantaged hernia is always carried out under anesthesia three-propelled brigade with participation in the operation of the most experienced surgeon on the duty officer or a responsible duty surgeon.

2. Operative intervention begins with median laparotomy.

Attempts to order a disadvantaged hernia are contraindicated.

The diagnosis of improved disadvantaged hernia can be delivered when there are clear indications of the patient himself on the fact of infringement of the previously aftered hernia, the time of its immediate disposition and the fact of its independent return. We should also consider the enjoyment of the infringent hernia, the fact of the independent return of which occurred (and recorded in medical documents) in the presence of medical personnel (at a pre-hospital stage - in the presence of ambulance, after hospitalization - in the presence of a duty surgeon Surgeon).

4 Group - Disadvantaged Postoperative Ventral Hernia

The infringement of postoperative ventral hernia is observed in% of% of cases. The clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are a wheelchair and elastic infringement.

Survey Protocols in the OEMP

Clinical blood test,

Blood group and RH factor

Clinical analysis of urine.

Survey radiography of chest organs

Review radiography of the abdominal cavity.

Ultrasound of the abdominal cavity and hernia protoration - by testimony

Anesthesiologist consultation (according to indications)

With the diagnosed diagnosis, the patient's disadvantaged hernia is immediately sent to the operating.

Protocols of preoperative preparation in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.

2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

3. With the presence of complicated disadvantaged hernia and serious condition, the patient is sent to the separation of surgical resuscitation, where intensive therapy is carried out for 1-2 hours, including the active aspiration of gastric content, infusion therapy, aimed at stabilization of hemodynamics and restoring an introductory and electrolyte balance, and so same antibiotic therapy. After preoperative preparation, the patient is sent to the operating room.

II. Protocols of the anesthesiological implementation of the operation

1. In addition to the infringement of inguinal and femoral hernia with small stages of infringement, with general satisfactory condition, the lack of symptoms of acute intestinal obstruction. Operational intervention can be started under local infiltration anesthesia for visual assessment of the viability of the organ.

2. Meeting of choice is endotracheal anesthesia.

III. Differential surgical tactics protocols

13. With infringent hernias complicated by subfickered obstruction, the detonation of the small intestine is performed using a nasorentestine probe.

14. At the phlegmon of a hernial bag, the operation is performed in 2 stages. The first stage is laparotomy. In the abdominal cavity, resection of the disadvantaged organ with the elimination of the hernial bag and its contents from the abdominal cavity is an acidic seam. The second stage is herniotomy with the removal of the infrained organ outside the abdominal cavity. Plastic of the hernial gate at the phlegmon of a junk bag is not performed.

15. Operational intervention is completed by plastic closure of the hernial gate. The character of plastics is determined by the localization and type of hernia. Plastic of the hernial gate is not performed with gigantic multi-chamber postoperative ventral hernias.

Vi. Protocols postoperative management of patients with uncomplicated flow

1. The overall blood test is assigned a day after the operation and before discharge from the hospital.

2. All patients are administered intramuscular administration of painkillers (analgin, ketarol) versions after surgery; Wide spectrum antibiotics (cefazoline 1 g x 2 p / day) within 5 days after surgery.

3. The seams are removed by the two days before the discharge of patients with treatment in the clinic.

4. Treatment of developing complications is carried out in accordance with their character.

CATAD_TEMA Surgical Diseases - Articles

Standard of medical care patients with disadvantaged hernia

On November 26, 2007, the Ministry of Health approved the protocols for the diagnosis and treatment of the disadvantaged hernia.

Strangulated hernia (ICD - 10 K40.3 - to 45.8) - a sudden or gradual compression of hernia contents at its gate.

Forms of infringement are different. Among them are distinguished:
1) elastic infringement;
2) Caluing infringement;
3) clothes infringement;
4) retrograde infringement;
5) Lithra hernia (infringement of the meckel diverticula).

The frequency of occurrence is observed:
1) infrigious inguinal hernias
2) infrained femuric hernias;
3) infrained nuclear bumps;
4) infrained postoperative ventral hernias;
5) infrained hernia of a white abdomen;
6) infrained hernia rare localizations.

The disadvantaged hernia may be accompanied by acute intestinal obstruction, which proceeds through the mechanism of the strange intestinal obstruction, the severity of which depends on the level of the strategy.
With all the types and forms of the disadvantaged hernia, the severity of disorders has a direct dependence on the time factor, which determines the urgent nature of therapeutic and diagnostic measures.

Protocols for the diagnosis of infrainment of hernia in the emergency medical department (OEMP)

Based on complaints, anamnesis of a clinical picture and data of an objective examination, patients with infringent hernias should be divided into 4 groups:
1 group - uncomplicated disadvantaged hernia;
2 Group - complicated disadvantaged hernia

With complicated disadvantaged hernia, 2 subgroups are distinguished:
a) the disadvantaged hernia complicated by acute intestinal obstruction;
b) The disadvantaged hernia, complicated by the phlegmon hrying bag.
3 Group - improved thickened hernia;

Uncomplicated disadvantaged hernia;

Criteria for the diagnosis of uncomplicated disadvantaged hernia in the OEMP:

The disadvantaged uncomplicated hernia is recognized by:
- suddenly coming pains in the region of the previously aftered hernia, the nature and intensity of which depends on the type of infringement, the affected organ and the age of the patient;
- the impossibility of the right of the previously frightened hernia;
- increasing in the volume of hernial protrusion;
- voltage and soreness in the field of hernia protrusion;
- the absence of a "cough push";

No symptoms and signs of acute intestinal obstruction with uncomplicated disadvantaged hernia.

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

- ECG

Consultation therapeuts

Protocols for preoperative preparation with uncomplicated disadvantaged hernia in the OEMP

Protocols of surgical tactics with uncomplicated disadvantaged hernia.

1. The only method of treating patients with infringent uncomplicated hernia is an urgent operation, which should be started no later than 2 hours from the moment of the patient's admission to the OEMP. There are no contraindications to the operation with a strenuous hernia.
2. The main tasks of the operation in the treatment of uncomplicated disadvantaged hernia are:
- elimination of infringement;
- inspection of the disadvantaged authorities and the corresponding interventions on them;
- Plastic of the hernial gate.
3. The section of sufficient size is carried out in accordance with the localization of hernia. An opening of a hernia bag and fixation of the organ disadvantaged in it. Dissection of the infringerating ring until the junk bag is unacceptable.
4. When spontaneous to the abdominal cavity of the infringent organ, it should be extracted for inspection and evaluating its blood supply. If it fails to find and extract, the wound expansion (Herniolaparotomy) or diagnostic laparoscopy is shown.
5. After dissection of the infringerating ring, an assessment of the state of the disadvantaged organ. The viable intestine quickly takes a normal look, the painting of it becomes a pink, serous shell is brilliant, the peristalsis is distinct, the vessels of the mesentery pulsate. Before the intestine in the abdominal cavity, it is necessary to introduce 100 ml of a 0.25% solution of novocaine into its mesentery.
6. If there are doubtful in the viability of the intestine in its mesentery, 100-120 ml of 0.25% of the novocaine solution should be introduced and to warm up the dubious area with warm tampons moistened with 0.9% NaCl. If doubts in the viability of the intestine remain, the gut must be restected within healthy tissues.
7. Signs of intelligence of the intestine and undisputed testimony to its resection serve:
- dark color of the intestine;
- dull serous shell;
- Drying wall;
- no intestine peristals;
- no pulsation of vessels of her mesentery;
8. Resection is subject to, except for the disadvantaged area of \u200b\u200bthe intestine, all macroscopically modified part of the leading and discharge intestine plus 30 - 40 cm of the unchanged separation of the leading intestine and 15-20 cm of the unchanged segment of the removal intestine. The exceptions are resection near an ileocecal angle, where limitation of these requirements is allowed with the beneficial visual characteristics of the intestine in the zone of the intended intersection. In this case, control indicators are used to bleed from the wall vessels during its intersection and the state of the mucous membrane. It is also possible to use transyl aluminlation or other objective methods for assessing blood supply. When resection of the intestine, when the level of imposition of anastomosis falls on the most distal department of the ileum - less than 15 - 20 cm from the blind intestine, it should be resorted to the imposition of ieoassensto - or an ileotransnetsoanastomosis.
9. If there are doubts about the viability of the intestine, especially in its large extent, it is permissible to postpone the solution of the issue of resection using the programmed laparoscopy after 12 hours.
10. In cases of intricate infringement, the intestines should be made. The immersion of the changed area in the intestinal lumen is dangerous and should not be made, since it may be possible to discrepate the immersible seams, and the immersion of an extensive area within the limits of non-modified sections of the intestine can create a mechanical obstacle to the intestine.
11. Restoration of the continuity of the gastrointestinal tract after resection is carried out:
- with a large difference of the diameters of the lumen of the crosslinkable sections of the intestine by anastomosis "side in side";
- When the diameters of the lumen of the crosslides of the intestine can be used the anastomosis "end to the end".
12. When infringement of the gland, the testimony for resection is put in the event that it is eaten, has fibrinous raids or hemorrhages.
13. Operational intervention ends with plastic hernia gates depending on the localization of hernia.

Minutes of postoperative management of patients with uncomplicated disadvantaged hernia

2. An intramuscular administration of painkillers (analgin, ketarol) is prescribed to all patients 3 times a day for 3 days after surgery; Wide spectrum antibiotics (cefazoline 1 g x 2 p / day) within 5 days after surgery.

Complicated disadvantaged hernia

Disadvantaged hernia complicated by acute intestinal obstruction

Criteria for diagnosing disadvantaged hernia complicated by intestinal obstruction in the OEMP:

Symptoms of acute intestinal obstruction are joined to local symptoms of infringement:
- Catching pain in the area of \u200b\u200bhernia
- Thirst, dry mouth,
- Tachycardia\u003e 90 wt. in 1 min.
- periodically repeated vomiting;
- delay of gases;
- during the examination, the bloating is determined, the strengthening of the peristaltics; MB "Slot's noise";
- on the survey radiograph, cubebeer bowls and sublictic arches with transverse aperture are determined, perhaps the presence of a "insulated loop";
- under ultrasound examination, extended intestinal loops and the "pendulum-shaped" peristalistic are determined;

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.
- Abdominal ultrasound.

Consultation therapeuts

Protocols of preoperative preparation of the disadvantaged hernia complicated by intestinal obstruction in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. The presence of pronounced clinical signs of general dehydration and endotoxicosis serves as an indication for intensive preoperative preparation with the formulation of the catheter in the main vein and the conduct of infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasurerin, 10 ml in dilution by 400 ml of 5% glucose solution . Antibiotics in this case are introduced 30 minutes before operation intravenously.

Protocols of surgical tactics in progressive hernia complicated by intestinal obstruction.

1. Operation on the complicated disadvantaged hernia is always carried out under anesthesia three-directional team with participation in the operation of the most experienced surgeon of the duty officer or a responsible duty surgeon no later than 2 hours from the moment the patient's admission to the OEMP.
2. The main tasks of the operation in the treatment of the disadvantaged hernia complicated by intestinal obstruction are:
- elimination of infringement;
- determination of the viability of the intestine and determining the indications for its resection;
- establishing the boundaries of resection of the changed intestine and its execution;
- determination of the testimony and method of drainage of the intestine;
- Sanitation and drainage of the abdominal cavity
- Plastic of the hernial gate.

3. The initial stages of the operation to eliminate the disadvantaged hernia, complicated by intestinal obstruction, correspond to the provisions set out in P.P. 5 - 12 surgical tactics with uncomplicated disadvantaged hernia.
4. Indication to the drainage of the small intestine is overflowing the content of the leading intestinal loops.
5. The preferred method of draining the small intestine is a nasogasorentestine intubation from a separate median laparotomy access.
6. Operational intervention ends with the drainage of the abdominal cavity and the plastic of the hernial gate, depending on the localization of hernia.

Minutes of postoperative management of patients with infringent hernia complicated by intestinal obstruction

1. Theent nutrition begins with the advent of intestinal peristaltics by introducing glucose-electrolyte mixtures to the intestinal probe.
2. The method of a namogasorentestinal drainage probe is carried out after the restoration of stable peristaltics and an independent chair for 3-4 days. The draining tube installed in the small intestine through the gastrostomy or retrograde on the vehicle is removed somewhat later - for 4 to 6 days.
3. The purpose of combating ischemic and reperfusion damage to the small intestine is carried out infusion therapy (intravenous 2-2.5 liters of cryptaloid solutions, 400 ml reasurerin, 10.0 ml in dilution by 400 ml of 0.9% sodium chloride solution, Trental 5, 0 - 3 times a day, conflict - 50,000 cells / day, ascorbic acid 5% 10 ml / day).
4. Aartibacterial therapy in the postoperative period should include either aminoglycosides II-W, generation cephalosporins III and metronideosol, or fluoroquinolones II generation and metronidozol.
5. For the prevention of the formation of sharp ulcers, the scicure of therapy should include antisecretory preparations.
6.complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.
Laboratory studies are performed according to the testimony and before discharge. Extract with the uncomplicated flow of the postoperative period is made for 10-12 days.

Disadvantaged hernia complicated by phlegmon hrying bag

Criteria for the diagnosis of the disadvantaged hernia, complicated by the phlegmon of a junk bag in the OEMP:
- the presence of symptoms of severe endotoxicosis;
- the presence of fever;
- Herge-up swelling, hot to the touch;
- hyperemia of the skin and swelling of subcutaneous fiber, propagating far beyond the limits of hernia protrusion;
- It is possible to have attachments in the surrounding hernial tissue protrusion.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts

Protocols preoperative preparation of the disadvantaged hernia, complicated by the phlegmon of a hernia bag in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. Intensive preoperative preparation with the formulation of the catheter in the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasberin,
4. Must with the introduction of a wide range of action (cephalosporins III III and Metronidozol) 30 minutes before operation intravenously.

Protocols of surgical tactics with a disadvantaged hernia complicated by the phlegmon hrying bag.

1. Operation about the complicated disadvantaged hernia is always carried out under anesthesia three-directional team with participation in the operation of the most experienced surgeon at the duty officer or a responsible duty surgeon no later than 2 hours from the moment of the patient's arrival in the OEMP.
2. Operative intervention begins with median laparotomy. When reducing the loop of the small intestine, it is carried out with the imposition of anastomosis. The question of the method of completing resection of the colon is solved individually. The ends of the intestine to be removed is sewn tightly. Then the brushless seam is superimposed on the peritoneum around the inner ring of the hernia gate. The intra-painting stage of the operation is temporarily terminated.
3. Hiniotomy is performed. The disadvantaged necrotic part of the intestine is removed through a herniotomic section with simultaneous tightening of the brush seam inside the abdominal cavity. At the same time, special attention is paid to the prevention of the inflammatory purulent-rotary exudate of the hernial bag into the abdominal cavity.
4. Primary plastic of the hernial gate is not performed. In the herniotomic wound, necratetomy is performed followed by its loose rubony and drainage.
5. According to the testimony, the detonation of the small intestine is performed.
6. The operation ends with the drainage of the abdominal cavity.

Protocols postoperative maintenance of patients with a disadvantaged hernia, complicated by the phlegmon of a junk bag.

1. Sea treatment of the herniotomic wound is carried out in accordance with the principles of treatment of purulent wounds. Dressing daily.
2. Sequalization therapy includes intravenous administration of 2-2.5 liters of crystalloid solutions, 400 ml reamareine, 10.0 ml in dilution by 400 ml of 0.9% sodium chloride solution, Trental 5.0 - 3 times a day, Contractor - 50000 U / day, ascorbic acid 5% 10 ml / day.
3. Intibacterial therapy in the postoperative period should include either aminoglycosides II-w, generation cephalosporins III and metronideosol, or fluoroquinolone II of generation and metronideosol.
4. For the prevention of the formation of sharp ulcers, the trap therapy should include antisecretory drugs.
5. Complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.
Laboratory studies are performed according to the testimony and before discharge.

Imbutable disadvantaged hernia.

Criteria for the diagnosis of undergoing infrained hernia OEMP:

The diagnosis "disadvantaged hernia, condition after infringement" can be delivered when there is clear indications of the patient himself on the fact of infringement of the previously repeated hernia, the time interval of its email and the fact of its independent return.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts

Protocols of preoperative preparation of the infringeable inclusive hernia in the OEMP

Protocols of surgical tactics when improving the disadvantaged hernia.

1. When the infringement of the infringent hernia and the duration of the infringement of less than 2 hours shows the hospitalization on the surgical department with subsequent dynamic observation within 24 hours.
2. If, during dynamic observation, symptoms of deterioration of the overall state of the observed, as well as peritoneal symptomatics - is shown diagnostic laparoscopy.
3. With an independent refueling of the infringent hernia to hospitalization, if the fact of infringement does not cause doubt, and the duration of the infringement is 2 or more hours - the diagnostic laparoscopy is shown.

Protocols for the maintenance of patients when improving the disadvantaged hernia.

Postoperative maintenance of patients after diagnostic laparoscopy is determined by diagnostic finds and a volume of surgical intervention with them.

Infringed postoperative ventral hernia

Criteria for the diagnosis of infrainable postoperative ventral hernia OEMP:
- The clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are a wheelchair and elastic infringement.
- With a hidden infringement there is a gradual principle of the disease. The constantly existing pain in the area of \u200b\u200bhernia absorption increases, acquire a grapple-shaped character, subsequently join the symptoms of acute intestinal obstruction - there is vomiting, the delay of gases, the absence of a chair, the bloating of the abdomen. Herge-up protrusion in the lying position does not decrease, it acquires clear contours.
- Elastic infringement typically for hernia with a small hernial gate. There is a sudden beginning of pain syndrome due to the introduction of a large segment of the intestines in the hernial bag through a small defect of the front abdominal wall. In the subsequent pain syndrome, symptoms of intestinal obstruction are enhanced.
- The main symptoms of the disadvantaged postoperative ventral hernia are:
- pain in the field of hernia dummy;
- incorrect hernia;
- sharp soreness in palpation of hernia protrusion;
- With a long progress, clinical and radiological signs of intestinal obstruction are possible.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts

Protocols for preoperative preparation of the infringent postoperative ventral hernia in the OEMP.

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. With the presence of intestinal obstruction, an intensive preoperative preparation is shown with a catheter formulation to the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasurerin, 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour or On the operating table, or in the OKR.

Protocols of surgical tactics in the infringeable postoperative ventral hernia.

1. The treatment of the infrainment postoperative ventral hernia is to perform emergency laparotomy within 2 hours from the moment of entering the hospital.
2. Supports of surgical treatment with a disadvantaged postoperative ventral hernia:
- a thorough revision of the hernia bag, given its multi-chamber and liquidation of the adhesive process;
- assessment of the viability of the organ stirred in hernia;
- With the presence of signs of non-viability of the disadvantaged organ - its resection.
3. In the infringement of large multi-chamber postoperative ventral hernias of the abdominal wall, the operation is completed by the dissection of all fibrous partitions and the ears of only skin with the subcutaneous tissue.
4. With an extensive hernial defect, more than 10 cm in diameter in order to prevent abdominal compartman-syndrome, it is possible to close the hernial gate with a mesh explant.

Minutes of postoperative maintenance of patients with infringeable postoperative ventral hernia.

1. Treatment of patients with infringent postoperative ventral hernia prior to stabilization of hemodynamics and restoration of independent respiration is carried out in OKH.
2. Therapeutic measures in the postoperative period should be directed to:
- suppression of infection by appointing antibacterial agents;
- fighting intoxication and violation of metabolic processes;
- treatment of complications from respiratory and cardiovascular systems;
- Restore the function of the gastrointestinal tract.

Disadvantaged hernia complicated by peritonitis

Criteria for the diagnosis of the disadvantaged hernia complicated by peritonitis in the OEMP:
- general condition is severe;
- Symptoms of heavy endotoxicosis: Consciousness confused, dry mouth, tachycardia\u003e 100 ° C. In 1 min., Hypotension 100 - 80/60 - 40 mm. Hg;
- periodic vomiting congestive or intestinal content;
- During the examination, the bloating is determined, the absence of peristaltics, a positive symptom of Shetkina-Blumberg;
- Multiple levels of fluid are determined on the survey radiograph;
- under ultrasound examination, extended intestinal loops are determined;

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts
Inspection of resuscitator

Protocols for preoperative preparation of the disadvantaged hernia complicated by peritonitis in the OEMP

1. Preoperative preparation and diagnostics are carried out in the conditions of OKR.
2. The gastric probe is set and the gastric content is evacuated.
Intensive preoperative preparation with the formulation of the catheter in the main vein and the implementation of infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reastery, 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour or on the operating table, or in OKR.
3. Be sure to introduce antibiotics of a wide range of action (cephalosporins III of generation and metronideosol) 30 minutes before operation intravenously.
4. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

Protocols of surgical tactics with a disadvantaged hernia complicated by peritonitis.
1. Operation on the complicated disadvantaged hernia is always carried out under anesthesia three-propelled brigade with participation in the operation of the most experienced surgeon on the duty officer or a responsible duty surgeon.
2. Operative intervention begins with median laparotomy.

Attempts to order a disadvantaged hernia are contraindicated.

4 Group - Disadvantaged Postoperative Ventral Hernia

The infringement of postoperative ventral hernia is observed in 6 - 13% of cases. The clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are a wheelchair and elastic infringement.
In case of hidden infringement, there is a gradual principle of the disease. The constantly existing pain in the area of \u200b\u200bhernia absorption increases, acquire a grapple-shaped character, subsequently join the symptoms of acute intestinal obstruction - there is vomiting, the delay of gases, the absence of a chair, the bloating of the abdomen. Herge-up protrusion in the lying position does not decrease, it acquires clear contours.
Elastic reinforcement typically for hernia with a small hernial gate. There is a sudden beginning of pain syndrome due to the introduction of a large segment of the intestines in the hernial bag through a small defect of the front abdominal wall. In the subsequent pain syndrome, symptoms of intestinal obstruction are enhanced.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.
- ultrasound of the abdominal cavity and hernia protoration - according to the testimony

Consultation therapeuts
Anesthesiologist consultation (according to indications)

With the diagnosed diagnosis, the patient's disadvantaged hernia is immediately sent to the operating.

Protocols of preoperative preparation in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. With the presence of complicated disadvantaged hernia and serious condition, the patient is sent to the separation of surgical resuscitation, where intensive therapy is carried out for 1-2 hours, including the active aspiration of gastric content, infusion therapy, aimed at stabilization of hemodynamics and restoring an introductory and electrolyte balance, and so same antibiotic therapy. After preoperative preparation, the patient is sent to the operating room.

II. Protocols of the anesthesiological implementation of the operation

III. Differential surgical tactics protocols

13. With infringent hernias complicated by subfickered obstruction, the detonation of the small intestine is performed using a nasorentestine probe.
14. At the phlegmon of a hernial bag, the operation is performed in 2 stages. The first stage is laparotomy. In the abdominal cavity, resection of the disadvantaged organ with the elimination of the hernial bag and its contents from the abdominal cavity is an acidic seam. The second stage is herniotomy with the removal of the infrained organ outside the abdominal cavity. Plastic of the hernial gate at the phlegmon of a junk bag is not performed.
15. Operational intervention is completed by plastic closure of the hernial gate. The character of plastics is determined by the localization and type of hernia. Plastic of the hernial gate is not performed with gigantic multi-chamber postoperative ventral hernias.

Vi. Protocols postoperative management of patients with uncomplicated flow

1. The overall blood test is assigned a day after the operation and before discharge from the hospital.
2. All patients are prescribed intramuscular administration of painkillers (analgin, ketarol) in 1 - 3 and a day after surgery; Wide spectrum antibiotics (cefazoline 1 g x 2 p / day) within 5 days after surgery.
3. The seams are removed by 8 - 10 days, the day before the patient discharge for treatment in the clinic.
4. Treatment of developing complications is carried out in accordance with their character.

Excluded: Lumbar Radiculitis BDU (M54.1)

Lyumbago due to the displacement of the intervertebral disk

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Spinal hernia on μb 10

Trubnikov Vladislav Igorevich

Candidate of Medical Sciences

Physician neurologist, manual therapist, rehabilitol, specialist in reflexotherapy, medical physical education and therapeutic massage.

Savelyev Mikhail Yuryevich

The doctor manual therapist of the highest category has experience more than 25 years.

Owns methods of Aurikulo and corporate reflexology, pharmacopuncture, hirudotherapy, physiotherapy, physiotherapy, LFC. Perfection applies osteopathy both in adults and in children.

Signs of the dorsal hernia in the lumbar department

Intervertebral hernia is a degenerative disease of the intervertebral disc, characterized by a violation of its integrity and structure

The hernia in the area of \u200b\u200bthe lumbar department occurs with a frequency of 300: 100 thousand population, mainly in men from 30 to 50 years.

Localization of hernia - L5-S1 (mainly) and L4-L5. In rare cases of hernia of the lumbar spine, L3-L4 is found and with severe injuries of the upper lumbar drives.

Systematization (according to the degree of penetration into the vertebral channel):

By the location of hernia in the frontal plane: lateral, median, paramediable hernia.

Main clinical picture

At the very beginning of the disease, patients complain about lower back pain. The root and vertebral syndromes appear much later, in some cases "experience" pain counts for several years.

The hernia of the spine can occur almost on any site of the spine

the stress of the paravertebral muscles prevents the full strain straightening and causes pain;
limiting the mobility of the lumbar department;
smoothing lumbar lordosis (its transition to kyphosis is often observed);

when palpation of the paravertebral muscles and intermediate processes there is soreness;
there is a pronounced change in posture (forced position), to reduce pain;
"Call Symptom." The awakening of an interstilant gap that corresponds to the localization of hernia leads to a shot in the leg;
vegetative manifestations (skin marble, sweating).

With a median and paramediable hernia, scoliosis is observed, open in the sick side (less pulling the rear longitudinal ligament). With lateral hernia (reduction of the grinding of the nervous root), scoliosis is observed, open in the opposite direction.

Root syndrome (radiculopathy):

paints occur in the innervation zone of one or several roots, spread to the buttock, and below - according to rides, rear (rear-line) surface of the lower leg and hips (Ishialia). According to nature, the pain happens or shooting;
the pain most often arises due to injury, with an unsuccessful turn of the body or when lifting gravity;
changes occur in the innervation zone of the nervous root;
muscles become weak, hypotension is observed, atrophy develops (sometimes becyclation). The patient feels numbness, paresthesia arise;
"Symptom of coughing push." When there is a sneezing (cough, sneezing) in the innervation zone of the siled roof, there is a tight pain or its sharp gain;
there is a loss of proprioceptive reflexes.

the pain occurs even with a slight rise of the leg;
the pain appears in the lower back and in the dermatome of the affected root. The patient can feel numbness or "goosebumps" when picked up straightened legs up;
the pain is weakening (disappearing) when flexing the legs in the knee joint, but it is enhanced by the rear flexion of the foot.

The hernia of the spine of the lumbar department most often occurs on the background of osteochondrosis

Pathology of horse-tail (acute compression of roots):

the reason: the median hernia of large sizes, pain occurs with a significant physical force and a large load on the spine (sometimes under the manual therapy session). Signs: urine delay (violation of sensitivity in the anogenital region), lower sluggish parapaprex.

Caudogenic mixing chromotype syndrome:

there is pain when walking in the lower limbs (due to the transient compound of the horse-tail). The patient when driving is forced to stop often.

Diagnostic events

lumbar puncture (moderate protein increase);
x-ray of the spinal column;
MRI and myelography, sometimes - followed by high resolution CT;
electromiography (the ability to retperine reimage neuropathy from the grinding of the root).

Differential diagnosis

It is important when differentiating from the lumbar hernia to exclude: tumors and metastases in the spine, Bekhterev's disease, tuberculous spondylitis, metabolic spondylopathy, circulatory disruption in the additional spinal artery of dererage-Gotteron, diabetic neuropathy.

In time, the diagnosis was diagnosed and the initiated treatment is capable of restoring the intervertebral disk completely. With late appeal, all therapeutic measures, unfortunately, are directed only to reduce the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative dystrophic changes in the spine

Osteocondritis of the spine

The cipher on the ICD-10: M42 is osteochondrosis of the spine.

Spondylosis

CIFR on the ICD-10: M47 - Spondylosis.

Spondylosis is characterized by the appearance of edge bone expansions (on the upper and lower edge of the vertebrae), which on radiographs have the type of vertical spikes (osteophytes).

Clinically spondylosis will be not significant. It is believed that spondylosis is an adaptive process: edges (osteophytes), fibrosis of disks, ankylosis of the facet joints, thickening of bundles - all this leads to immobilization of the problem vertebral segment, expanding the support surface of the vertebral bodies.

Spondloarthrosis

Cipher on the ICD-10. M47 - Spondillas. Included: arthrosis or osteoarthritis of the spine, degeneration of facade joints.

3. Protrusion and hernia disk

Cipher on μb-10: m50 -; M51 is the defeat of intervertebral disks of other departments.

Most often, the hernia of the disk occurs in the lumbar spine (75%), then the cervical (20%) and the chest spine (5%) goes in frequency.

The cervical department is the most mobile. The frequency of hernia in the cervical spine - 50 cases per 100 thousand population. The most often disk hernia occurs in the C5-C6 or C6-C7 segment.
The lumbar department carries the greatest load by holding the whole body. The frequency of hernia in the lumbar spine - 300 cases per 100 thousand population. The most often disk hernia occurs in the L4-L5 segment (40% of all hernias in the lumbar spine) and in the L5-S1 segment (52%).

Spinal hernia on the ICD of the 10th revision

This disease is very dangerous and cunning, take care of yourself

The hernia of intervertebral discs is one of the most dangerous pathologies of the musculoskeletal system. This phenomenon is very common, especially among patients of 30-50-year-old age. With the hernia of the spine Code on the ICD 10 put in the medical map of the patient. Why is it necessary? Turning to the hospital, the doctor immediately sees which diagnosis in the patient. The hernia of the intervertebral disk refers to the thirteenth class, in which all the pathology of bones, muscles, tendons, lesions of synovial shells, osteopathy and hondropathy, dorsopathy and systemic lesions of the connective tissue are collected. MKB 10 is a reference network developed for the convenience of doctors. Medical information directory has the following goals:

formation of conditions for the purpose of comfortable exchange and comparison of data acquired in various states;
so that the doctors and other medical staff were comfortable to keep information about patients;
comparison of information in one hospital in different periods.

Main types of protothes

The cervical department consists of Atlanta (1st vertebra), Aksis (2nd vertebra). Then the numbering continues from C3 to C7. There is also a conditional occipital bone, it is denoted by C0. The cervical part is very mobile, so hernia often amazes him.
The breast of the spine has in its composition 12 segments indicated by the letter "T". Between the vertebrae there are discs performing a depreciation function. Intervertebral discs distribute the load on the entire spine. In the ICD 10 it is indicated that in the thoracic hernia is more often formed between the T8-T12 segments.
The lumbar part consists of 5 vertebrae. The vertebrae in this area is denoted by the letter "L". Often the hernia amazes exactly this department. Unlike the cervical, it is more moving, it is more often injured.

How do you draw in the cervical examination on the patient's card? At work which organs affects the disease with this localization?

This diagnosis means temporary disability of the patient. With hernia in the cervical department, the patient arises the following symptoms:

headache;
worsening memory;
hypertension;
impairment;
reduction of hearing;
full deafness;
pain in the shoulder muscles and joints;
numbness of face and tingling.

Classes with damage to intervertebral discs in breast, lumbar and sacrats

This table is usually necessary for doctors, nurses and other medical staff, employees of the Social Insurance Department and representatives of the personnel department. Information can receive any person, it is in the open access.

Symptoms of the disease in the breast, lumbar and sacral division in the form of a table

The hernia of the spine in the sacral division most often occurs between the L5-S1 segments. At the same time, there is a pain that gives the buttocks, the lower limbs, the lumbar department, numbness in the foot, the absence of reflexes, the change in the sensitivity, the feeling of "goosebumps", tingling, "coughing push" (with the coughing or sneezing of the patient, is striking sharp pain).

How are SFORL nodes in official documents mean?

International Classification of Disease Indicates Hernia Schimor Code M51.4. Schorla nodes are to pry the cartilage tissue of the closure plates in the spongy bone of the segment. This disease disrupts the density of the cartilage of the intervertebral disc and mineral exchange. As a result, a decrease in the density of the vertebrae, the elasticity of intervertebral ligaments can occur. There is a deterioration in the depreciation properties, the growing of fibrous tissue at the location of the Schymno nodes and the formation of intervertebral pathology.

The hernia of the intervertebral disc

The hernia of the intervertebral disk is the morphofunctional state of the spine, in which the intervertebral disc goes beyond the fibrous ring. It is a sign of pronounced degenerative-dystrophic changes in the spine, may be a consequence of spinal spinal injury.

Many it is believed that the disk loss of less than 6 millimeters is a protrusion, while loss of 6 millimeters and more hernias.

The disk hernia itself cannot be considered as a separate independent disease and, rather, is the consequence of osteochondrosis, injuries. Consider the same hernia disc within various syndromes, which differ depending on the localization, involvement in the process of roots or the substance itself of the spinal cord.

More often than other localizations are the localization of intervertebral hernia at the LV-SI segment level. It is at this level that the transition of one mobile spine to another fixed and the load on intervertebral segments is the greatest.

Information for doctors. In ICD 10, there are several ciphers under which it is customary to encode discogenous spinal lesions. Under the M50.0 code, the lesion of cervical intervertebral disks is encrypted. Under the code M51.1, the localization of hernia in the lumbar, thoracic departments is encrypted. The third digit zero means the presence of myelopathy, 1 - radiculopathy, 2 is another refined lesion, 3 - other degeneration of disks.

Symptoms

Symptoms of the disease depends on the localization of the process, the size of the hernia, its localization directly in the intervertebral segment. Thus, the hernia of the disc, which dropped out the kepent, cannot lead to the infringement of the root, nor to squeeze the spinal cord and proceeds asymptomatic. Whereas hernia, pinching spinal cord root can lead to radiculopathy. Then the symptoms of hernia will be weak in the leg or hand, a violation of sensitivity in it, convulsions, limiting the limb movements. In the later stages of radiculopathy, muscle hypotrophy develops.

Large hernias can lead to a spinal cord. In the case of localization in the lumbar-sacral division, patient may develop pelvic disorders, caudogenic chromium syndrome. Also, the compression of the spinal cord threatens the development of myelopathy, in which it is broken nervous, suffering the ways of conducting nerve impulses from the head to the spinal cord.

Disability in hernias is determined in patients with pronounced violations of functions. Thus, the disability can be assigned to a person with radiculopathy, patients after a neurosurgical surgery, with myelopathy.

Diagnostics

Diagnose the hernia can only be diagnosed when conducting a highly solid neurovalizing study. Such studies are MSCT or MRI. At the same time, it should be noted that MRI as a whole, especially the latest generations (3 Tesla and more) on the devices of the last generations (3 Tesla and more). MSCT does not always determine the presence of hernia with localization in the cervical department.

It is impossible to determine the hernia of the disk with "hands", with the help of an ordinary x-ray study. One can only assume the likely presence of the lesion of the intervertebral disc.

Neurological examination allows you to identify signs of tension of spinal roots, reveal the reflex muscle spasm. Also, the loss of reflexes, a change in the sensitivity of the root type, the decrease in the strength of the muscles of the limbs suggests the idea of \u200b\u200bthe presence of radiculopathy.

Video from the author

Treatment

All treatment of hernias of intervertebral discs can be divided into several stages - conservative treatment, blockade, neurosurgical treatment.

At the first stage, a standard for vertebrogenic pain syndromes is a drug treatment. Used non-steroidal anti-inflammatory drugs, muscle relaxants central action, Group V. Vitamins are often treated with vazoactive drugs (for example, Trental). With a protracted pain syndrome with evidence-effectiveness, the use of anticonvulsants, such as pregabalin, Gabapentin, is considered.

In the presence of a radiculopathy, additional neuroprotective therapy (tioktic acid preparations) can be used. Also additionally uses such drugs such as prozerne contributing to the improvement of the nervous pulse.

Sometimes, especially in cases of moderately pronounced pain, protracted characteristics of the process, emotional changes in the patient are resorted to antidepressant therapy. Many drugs are used as an antidepressant, the choice is carried out on the basis of the financial capabilities of the patient, the availability of somatic pathology and other criteria.

In addition to drug treatment, manual impacts, physiotherapy, LFC, common-profile recommendations are used. Massage in a light pace as an additional means of removing muscle spasm and pain can be assigned to almost all patients, subject to the lack of direct contraindications to the massage. The question is less unequivocal, the question of manual therapy.

Manual therapy can be appointed only in a small number of cases. Contrary to popular belief, the manual therapy is unable to "correct" the intervertebral hernia and save the patient from the ailment. I myself love very manual therapy, resorting to various manual techniques with very many situations, but it is impossible to remove the hernia. In order to understand why it simply should be closely familiar with the process pathogenesis. Fingers to the place of localization of hernia do not get there, "to improve" the intervertebral disc will not be released, too, as well as "to shave" a fibrous ring. But once again to shift the hanieu, causing additional compression of the roots or directly spinal cord. Therefore, in the threat of such a process, during the localization of hernia at the cervical level, manual therapy is contraindicated.

From physiotherapeutic influences, in the absence of contraindications, DDTs are most often used, electrophoresis with various drugs, magnetotherapy. Currency treatment must, at least 5-10 procedures.

LFC classes are better held after consulting an instructor on the exercise. Specific exercises during the localization of the process at a certain level are shown in the section Rehabilitation, a subsection of the LFC. To strengthen the muscular corset, removal of spasm, the prevention of exacerbations is recommended regular (and perfect - daily) execution.

With the ineffectiveness of all of the above treatment methods, they switch to the next stage - the blockade method. Blocages are mainly divided into the following types: paravertebral, epidural, blockadic joints. Paralertebral is the simplest of all blockades - in fact, are intramuscular introduction into the long muscles of the back of drugs. The doctor finds the most painful points and introduces various drugswhich reduce pain.

The blockade of faceted joints is rarely used for disk hernias. They are directed to reduce pain in spondyloarthrosis of the arcotted intervertebral joints. Epidural blockades are a way of delivery. medicinal substance In the epidural spinal cord space and have a pronounced anti-inflammatory and painkillers. The blockade course usually consists of three procedures, the most commonly used drugs such as Kenalog, Diprosspan in combination with local anesthetics, vitamin B12.

In case of insufficient effectiveness of the above treatments, severe muscle hypotrophy under radiculopathic conditions, pelvic disorders, manifestations of myelopathy, and in the threat of the development of caudal interspersed chromium syndrome, neurosurgical intervention is shown. Laminectomy intervention is usually used with the removal of the disc hernia, the strengthening of the hernia can be carried out with transficuous fixation. The patient after surgery is not recommended to sit for 3-6 months, due to the high load on the vertebrae in the sitting position.

Also, all patients show the observance of general-rated events. These include: restriction of raised gravity, work in the tilt. When using elevators, public transport is recommended to be leaning back to the wall to reduce possible loads due to acceleration. It is necessary to sleep on a solid bed, preventing uncomfortable provisions.

The code of the intervertebral hernia of the spine on the ICD 10

Spinal hernia Code on MKB 10 gets in strict accordance with the type of damage to cartilage intervertebral discs and the location of their localization. So pathologies that are not involved in the trauma located in the cervical department are made in a separate division and are designated in the official medical records with the M50 code. This designation can be affixed in the "Diagnosis" field in a sheet of temporary disability, a sheet of statistical reporting, some types of directions on the instrumental control methods.

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Description and Treatment of Hernia Disc MKB 10

The most severe and dangerous diseases of the musculoskeletal system include the hernia of the intervertebral disc. According to the international classification of illness 10 reviews (ICD-10), they have the M51 code. The disease is diagnosed with each 3 of 1000 people. The flutters of men are usually diagnosed with the hernia of the ICC10 disk. Children's hernia are associated with congenital spinal pathology.

Description

When hernia is formed, the disks of the spine fall (prolapse) or protruded (protrusion), and the nerve endings of the spinal cord root occur. In the first place is the hernia, which are formed when moving the mobile spine to the stationary. The next frequency comes the hernia L3-4 disks. The hernia of the intervertebral disk of the upper lumbar spine is most rare. Usually they arise in patients who have suffered severe injuries.

Determine the presence of hernia in a patient, according to the results of neurological examination, it is impossible.

And, since the symptoms of the intervertebral hernia of the disk of the lumbar separation depend on the location of the localization, the size and stage of the disease, the only correct way to form a diagnosis is MRI or MSCT.

Symptoms of the disease

At the initial stage of the disease, while the intervertebral hernia of the disk has small sizes, the root of the root does not occur, and the patient does not experience severe pain. Usually, at this stage, pain is stupid and appears periodically:

In some cases, in the initial stage of the hernia, the disk is accompanied by the attacks of Lumbago. As hernia grows, the root of the spinal cord and the lesion of the intervertebral disks is observed. This leads to the manifestation of vertebral and root syndromes. If there is no sharp breakthrough of the hernia of the disk of the lumbar department, then there are several years between the initial stage of the disease and the emergence of syndromes.

With a vertebral syndrome, the mobility of the lumbar spine is limited, with the paravertebral muscles all the time are tense, because of which the patient is experiencing severe pain and cannot straighten the back. In a patient, with such syndrome, scoliosis is often observed, and in some cases kyphosis. Patients are experiencing severe sweating, and the skin has a marble shade. When tapping at the place of localization of hernia, the patient is experiencing a sharp shooting pain in the leg.

In the root syndrome, the shooting and noving pain gives to the buttock and the thigh, and in some cases in the shin. As the disease develops, the patient is experiencing numbness of the limbs, strong weakness of muscles, which, without proper treatment, goes into atrophy. Usually pain occurs with a sharp movement of the body, fall. One of the symptoms of the root syndrome of the lumbar department is a sudden strong pain that occurs during sneezing or cough.

Patients with intervertebral hernias of the lumbar department are painful when picked up the leg even on a small height, while the pain decreases or passes when the legs bended in the knee and becomes stronger when flexing the foot.

Sometimes even quite large hernias may not cause pain. If the loss occurred in front, then the root of the root does not occur. However, even the small hernia of the disk when pinching the spinal cord root can cause severe pain. In the median hernia, the disk can occur with chairs, incontinence or urine delay, impotence.

Methods of treatment

Depending on the stage of the disease and the size of the hernia, the treatment is carried out by a conservative or operational method. The operational treatment of the hernia of the intervertebral disk is resorted only in the inefficiency of conservative, strong muscular weakness, or in emergency cases during acute compression of the spinal cord root.

The traditional methods of treating the hernia disk include:

pulling of the spine;
novocaine or lidocaine blockade;
reception of anti-inflammatory drugs and vitamins;
physiotherapy;
massage.

With intervertebral hernia, the disk of the lumbar department does not recommend manual therapy.

How to cure joints and forever get rid of back pain - Home Method

Have you ever tried to get rid of joint pain yourself? Judging by what you read this article - the victory was not on your side. And of course you do not know what: it is:

with pain and creak bending legs and hands, turn, bend.
wake up in the morning with a feeling of fragmentation in the back, neck or limbs
to any change of weather to suffer from what turns and turns the joints
forget what free movement is and every minute there's another attack of pain!

Intervertebral hernia

Intervertebral hernia (the hernia of the intervertebral disk, the Code of ICD 10 M51.2) is the terminal stage of the spinal osteochondrosis, which is a degenerative-dystrophic disease. Recently, the frequency of occurrence of this pathological state is becoming higher.

The intervertebral hernia is called such a disease in which the intervertebral disc from the dust or knutrice is made from the spinal column due to the instability of the ligament and other fixing structures.

The symptoms of the intervertebral hernia are primarily determined by the presence of the grinding of nerve roots as a result of the seats of the intervertebral disc and reduce the gaps between the vertebrae. Therefore, the main clinical manifestations Intervertebral hernia are the following:

Pains that can be permanent or periodic, and they are enhanced by changing the position of the human body (sloping to the side, for example)
Symptoms of irritation of nervous roots, which are manifested by increased sensitivity, pain along the nerve, feeling of tingling and crawling goosebumps
Chronic squeezing of the nervous root can lead to atrophy of the skin and muscles in the zone of its innervation, since the nervous tissue is inherent in the trophic function
Violation of motor activity and sensitivity with the loss of certain innervation zones with a loss of its self-service ability.

The most reliable causes of the development of intervertebral hernia are finally not established. Allocate a number of predisposing factors that increase the likelihood of developing this disease. These include the following:

Connective dysplasia, which causes the inferiority of the fixing device

Humidated heredity

Obesity

Age - the older man, the worse the condition of the connective tissue

Traumatic spine damage and some other factors.

Thus, the main mechanism for the development of intervertebral hernia is to exceed the compensatory-adaptive mechanisms of the locking apparatus above the load that the spine is experiencing.

Diagnostic search with suspected intervertebral hernia includes the following studies:

X-ray study that allows you to see the protrusion between certain vertebrae
Computed tomography (MRI, PET, YMRR)
Electronomyography, which allows you to estimate the degree of involvement of a nervous root in the pathological process.

Absence timely treatment Intervertebral hernia can lead to the development of certain complications, which are reflected on the quality of the patient's life. These include the following:

Pares and paralysis
Chronic pain syndrome
Implanting urine and feces and some others who are associated with the squeezing of nerve roots responsible for the innervation of internal organs.

The treatment of intervertebral hernia can be both operational and conservative. However, given that this is the last stage of osteochondrosis, conservative therapy has low efficiency. The operation pursues the goal to restore the normal anatomical structure and strengthen the spine to prevent the repeated protrusion of the intervertebral disk.

Physiotherapeutic treatment has a certain efficiency. These techniques allow you to improve microcirculation in the connective tissue, which is somewhat strengthening the vertebral pole.

The risk group includes the following categories of patients:

With burdened heredity
With excess body
Engaged professional activitieswhich is associated with severe physical labor (for example, weightlifters, movers).

Preventive measures are aimed at eliminating predisposing factors. If the patient is in a higher risk group, it is necessary to undergo prophylactic inspections of the neurologist, including the mandatory passage of the X-ray or tomographic study of the spine. In addition, it is recommended to adhere to the following recommendations:

Apply dosage physical exertion
Eliminate overeating and hypodynamine.

Avoiding excessive physical exertion
Wearing a special orthopedic corset
Regular observation at the neurologist
Power has practically no restrictions, in addition to using high-calorie food, since overweight leads to the progression of the disease.

Spin hurt
Hurts loins
hurts the loin nims
pain in the lower back
pain in the upper spins
pain in the lumbar region
pain in the lower back is intensified with inclons, lifting and twisting of the body.
Pain in the bottom of the back

550 m.
Chkalovskaya

850 m.
Kursk

1.15 km.
Taganskaya

To favorites

Manual therapist, neurologist. Experience - 22 years
- Diseases:
- 1.
- 2. Cervicalgia
- 3. Chorea
- 4. Tremor
- 5.
- 6. Toxic encephalopathy
- 7.
- 8.
- 9.
- 10.
- 11. Siringomyelia
- 12.
- 13.
- 14.
- 15. Multiple sclerosis
- 16. Radiculopathy
- 17. Radiculitis
- 18.
- 19.
- 20.
- 21.
- 22. Loosity of a trigeminal nerve
- 23.
- 24.
- 25.
- 26. Disease muscle lesions
- 27. Lesions of facial nerve
- 28.
- 29. Brain lesions
- 30. Defeat of a trigeminal nerve
- 31. Defeat of intervertebral discs of the cervical
- 32. Primary muscle lesions
- 33. Parkinsonism with disease
- 34. Paraplegy and tetraplegia
- 35. Osteochondrosis of the cervical department
- 36. Neurasthenia
- 37.
- 38. Hereditary ataxia
- 39. Violations of speech
- 40.
- 41.
- 42.
- 43.
- 44. Mononeuropathy in disease
- 45.
- 46.
- 47. Miosit
- 48. Migraine
- 49. Miasthenia
- 50. Malgy
- Show all diseases
- 1.
- 2.
- 3.
Treatment of the following diseases: neurosis, panic attacks, diseases of the vegetative nervous system (vegetative-vascular dystonia, migraine), pain syndromes for diseases of the peripheral nervous system (radiculites, neuritis), neck pain, lower back disease, vascular diseases of the nervous system (headaches, dizziness, state after stroke).
- 550 m.
- Chkalovskaya
- 850 m.
- Kursk
- 950 m.
- Avtozavodskaya
To favorites
- Neurologist, manual therapist.
- - Diseases:
  - 1. Extrapyramidal and motor disorders
  - 2. Shain-Shoulder Syndrome
  - 3. Cervicalgia
  - 4. Chorea
  - 5. Tremor
  - 6. Transient ischemic attack
  - 7. Toxic encephalopathy
  - 8. Spinal muscle atrophy and related syndromes
  - 9. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
  - 10. Somance, stupor and coma
  - 11. System atrophy affecting mainly CNS
  - 12. Siringomyelia
  - 13. Compression of nervous roots and plexuses in disease
  - 14. Forestative [autonomous] nervous system
  - 15. Eggs of the vegetative (autonomous) nervous system
  - 16. Multiple sclerosis
  - 17. Radiculopathy
  - 18. Radiculitis
  - 19. Lumbar-sacral plexopathy
  - 20. The consequences of cerebrovascular diseases
  - 21. The consequences of inflammatory diseases of the central nervous system
  - 22. Defeats of cranial nerves in disease
  - 23. Loosity of a trigeminal nerve
  - 24. Defeats of nerve roots and plexuses
  - 25. Lesions of the nervous system during diseases
  - 26. Lesions of neuromuscular synapses and muscles
  - 27. Disease muscle lesions
  - 28. Lesions of facial nerve
  - 29. Defeat other cranial nerves
  - 30. Brain lesions
  - 31. Defeat of a trigeminal nerve
  - 32. Defeat of intervertebral discs of the cervical
  - 33. Primary muscle lesions
  - 34. Parkinsonism with disease
  - 35. Paraplegy and tetraplegia
  - 36. Osteochondrosis of the cervical department
  - 37. Neurasthenia
  - 38. Hereditary and idiopathic neuropathy
  - 39. Hereditary ataxia
  - 40. Violations of speech
  - 41. Mobility and mobility disorders
  - 42. Disorders of smell and taste sensitivity
  - 43. Disorders of the nervous system, after medical procedures
  - 44. Skin disorders
  - 45. Mononeuropathy in disease
  - 46. Mononeuropathy of the lower limb
  - 47. Mononeuropathy of the upper limb
  - 48. Miosit
  - 49. Migraine
  - 50. Miasthenia
  - Show all diseases
  - 1. Consultation, primary neurologist
  - 2. Re-consulting neurologist
  - 3. Consultation, primary reception of the manual therapist
  - 4. Repeating a manual therapist
  - 5. Therapeutic blockade
  - 6. {!LANG-c0ef066e5c6c0a241843800ce6fb40f1!}
  - 7. {!LANG-5cd5406789dc190b096e2212cbd53c38!}
  - 8. {!LANG-ab4266ccf98daa552e3a37df3c94f2d1!}
  - 9. {!LANG-2fd5660843279755dcb6a8ced924caed!}
  - 10. {!LANG-530df3476e56eb06a166d66705cafa01!}
  - 11. {!LANG-f938c6402810061ee44035b06b0aa737!}
  - 12. {!LANG-497ec6792690a7efc743aa308b99aced!}
  - 13. {!LANG-49ad29dbb1b03b79e0ec1bc19f74a16c!}
  - 14. {!LANG-14c10f79059b18ed65f042376e898032!}
  - 15. {!LANG-a8c226dcfae258c773570d9e6512fe3c!}
  - 16. {!LANG-bf519315673eef69a9f09d22f1ce3fac!}
  - 17. {!LANG-44b24668ca196f6bbee001eaaa18b6f1!}
  - 18. {!LANG-2a0a7eedfefbc3342cd417ccfd5b3b79!}
  - 19. {!LANG-65ea6f439adad8567783e59cc10eb0a9!}
  - 20. {!LANG-1f757717c26f923d2f52d21414e5b949!}
  - 21. {!LANG-b9f4fc7c1740f327344262651ed048c0!}
  - 22. {!LANG-283daf7df1e243ea46a56233e49c568f!}
  - 23. {!LANG-c0cdf6069e2fb72b323bc0874e731bbf!}
  - 24. {!LANG-7535120ee546fce84b3193ce0b745ddf!}
  - 25. {!LANG-4f76eb76bb10fabd43e09f0cc8a5c047!}
  - 26. {!LANG-d9d5f2c4f83253ebe76b2530ef84aec2!}
  {!LANG-2871af0ebfe0491547f95899eb3711f8!}
  - {!LANG-3ad52c88062bd6777389f106089e7f4b!}
  - {!LANG-2e34790c4f0a140b5b9679f552516652!}
  - {!LANG-5b1a82a08cf0156fef30c7b297bb344c!}
  - {!LANG-b4781d1df6048ba0436d859575125aa8!}
  - {!LANG-c4b4c54b35babd2cbe88823a997c88b8!}
  - {!LANG-a795a4f0ea93cb6dd24143cf03c61561!}
  To favorites
  - {!LANG-8e40ada380e3b9a3402f52235a88d315!}
  - - Diseases:
    - 1. Extrapyramidal and motor disorders
    - 2. Shain-Shoulder Syndrome
    - 3. Chorea
    - 4. Tremor
    - 5. Transient ischemic attack
    - 6. Toxic encephalopathy
    - 7. Spinal muscle atrophy and related syndromes
    - 8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
    - 9. Somance, stupor and coma
    - 10. System atrophy affecting mainly CNS
    - 11. Siringomyelia
    - 12. Compression of nervous roots and plexuses in disease
    - 13. {!LANG-d8e34859af83abdc9f9b28f57e6e3bc7!}
    - 14. Forestative [autonomous] nervous system
    - 15. Eggs of the vegetative (autonomous) nervous system
    - 16. Multiple sclerosis
    - 17. Radiculitis
    - 18. The consequences of cerebrovascular diseases
    - 19. The consequences of inflammatory diseases of the central nervous system
    - 20. Defeats of cranial nerves in disease
    - 21. Loosity of a trigeminal nerve
    - 22. Defeats of nerve roots and plexuses
    - 23. Lesions of the nervous system during diseases
    - 24. Lesions of neuromuscular synapses and muscles
    - 25. Disease muscle lesions
    - 26. Lesions of facial nerve
    - 27. Defeat other cranial nerves
    - 28. Brain lesions
    - 29. Defeat of a trigeminal nerve
    - 30. Primary muscle lesions
    - 31. Parkinsonism with disease
    - 32. Paraplegy and tetraplegia
    - 33. Osteochondrosis of the cervical department
    - 34. Neurasthenia
    - 35. Hereditary and idiopathic neuropathy
    - 36. Hereditary ataxia
    - 37. Violations of speech
    - 38. Mobility and mobility disorders
    - 39. Disorders of smell and taste sensitivity
    - 40. Disorders of the nervous system, after medical procedures
    - 41. Skin disorders
    - 42. Mononeuropathy in disease
    - 43. Mononeuropathy of the lower limb
    - 44. Mononeuropathy of the upper limb
    - 45. Miosit
    - 46. Migraine
    - 47. Miasthenia
    - 48. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
    - 49. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
    - 50.
    - Show all diseases
    - 1. Consultation, primary neurologist
    - 2. Re-consulting neurologist
    - {!LANG-3ad52c88062bd6777389f106089e7f4b!}
    - {!LANG-2e34790c4f0a140b5b9679f552516652!}
    - {!LANG-5b1a82a08cf0156fef30c7b297bb344c!}
    - {!LANG-b4781d1df6048ba0436d859575125aa8!}
    - {!LANG-c4b4c54b35babd2cbe88823a997c88b8!}
    - {!LANG-a795a4f0ea93cb6dd24143cf03c61561!}
    To favorites
    - {!LANG-ec8aac0ed89483ca66021aca41701521!}
    - - Diseases:
      - 1. Extrapyramidal and motor disorders
      - 2. Shain-Shoulder Syndrome
      - 3. Chorea
      - 4. Tremor
      - 5. Transient ischemic attack
      - 6. Toxic encephalopathy
      - 7. Spinal muscle atrophy and related syndromes
      - 8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
      - 9. Somance, stupor and coma
      - 10. System atrophy affecting mainly CNS
      - 11. Siringomyelia
      - 12. Compression of nervous roots and plexuses in disease
      - 13. {!LANG-d8e34859af83abdc9f9b28f57e6e3bc7!}
      - 14. Forestative [autonomous] nervous system
      - 15. Eggs of the vegetative (autonomous) nervous system
      - 16. Multiple sclerosis
      - 17. Radiculitis
      - 18. The consequences of cerebrovascular diseases
      - 19. The consequences of inflammatory diseases of the central nervous system
      - 20. Defeats of cranial nerves in disease
      - 21. Loosity of a trigeminal nerve
      - 22. Defeats of nerve roots and plexuses
      - 23. Lesions of the nervous system during diseases
      - 24. Lesions of neuromuscular synapses and muscles
      - 25. Disease muscle lesions
      - 26. Lesions of facial nerve
      - 27. Defeat other cranial nerves
      - 28. Brain lesions
      - 29. Defeat of a trigeminal nerve
      - 30. Primary muscle lesions
      - 31. Parkinsonism with disease
      - 32. Paraplegy and tetraplegia
      - 33. Osteochondrosis of the cervical department
      - 34. Neurasthenia
      - 35. Hereditary and idiopathic neuropathy
      - 36. Hereditary ataxia
      - 37. Violations of speech
      - 38. Mobility and mobility disorders
      - 39. Disorders of smell and taste sensitivity
      - 40. Disorders of the nervous system, after medical procedures
      - 41. Skin disorders
      - 42. Mononeuropathy in disease
      - 43. Mononeuropathy of the lower limb
      - 44. Mononeuropathy of the upper limb
      - 45. Miosit
      - 46. Migraine
      - 47. Miasthenia
      - 48. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
      - 49. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
      - 50. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
      - Show all diseases
      - 1. Consultation, primary neurologist
      - 2. Re-consulting neurologist
      - 3. {!LANG-67367a5f9dd95ff036986a396d72fe9f!}
      - 4. {!LANG-6f2c713c14b1be3bdbbfe12636713f66!}
      {!LANG-8f62cec98a75331f4ad8177a1d189753!}
      - {!LANG-4a12f4d1fa39129871ce0df64c9b9fea!}
      - {!LANG-6ad054fd643b28deb75492869a7bb7b1!}
      - {!LANG-3554d3891bc7d56466f3b5425cd79826!}
      - {!LANG-a462a254beffa1ece09c7a2af87f197f!}
      - {!LANG-3554d3891bc7d56466f3b5425cd79826!}
      - {!LANG-2f267dcbdc889c400437abd633cd8b51!}
      To favorites
      - {!LANG-e1fd494035648ced60bb43d848f012dd!}
      - Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Shain-Shoulder Syndrome
        3. Chorea
        4. Tremor
        5. Transient ischemic attack
        6. Toxic encephalopathy
        7. Spinal muscle atrophy and related syndromes
        8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        9. Somance, stupor and coma
        10. System atrophy affecting mainly CNS
        11. Siringomyelia
        12. Compression of nervous roots and plexuses in disease
        13. {!LANG-d8e34859af83abdc9f9b28f57e6e3bc7!}
        14. Forestative [autonomous] nervous system
        15. Eggs of the vegetative (autonomous) nervous system
        16. Multiple sclerosis
        17. Radiculitis
        18. The consequences of cerebrovascular diseases
        19. The consequences of inflammatory diseases of the central nervous system
        20. Defeats of cranial nerves in disease
        21. Loosity of a trigeminal nerve
        22. Defeats of nerve roots and plexuses
        23. Lesions of the nervous system during diseases
        24. Lesions of neuromuscular synapses and muscles
        25. Disease muscle lesions
        26. Lesions of facial nerve
        27. Defeat other cranial nerves
        28. Brain lesions
        29. Defeat of a trigeminal nerve
        30. Primary muscle lesions
        31. Parkinsonism with disease
        32. Paraplegy and tetraplegia
        33. Osteochondrosis of the cervical department
        34. Neurasthenia
        35. Hereditary and idiopathic neuropathy
        36. Hereditary ataxia
        37. Violations of speech
        38. Mobility and mobility disorders
        39. Disorders of smell and taste sensitivity
        40. Disorders of the nervous system, after medical procedures
        41. Skin disorders
        42. Mononeuropathy in disease
        43. Mononeuropathy of the lower limb
        44. Mononeuropathy of the upper limb
        45. Miosit
        46. Migraine
        47. Miasthenia
        48. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
        49. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
        50. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        
        {!LANG-d5046c274da376eae8ed70e451185c37!}
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-3eb34c1de9a9b6994408a456c0677ae5!}
        
        {!LANG-bd63eaf066adbce4ab0dcafcc79906b0!}
        {!LANG-f5edf152fb741600a1bbd8b21c0baabb!}
        
        {!LANG-8e35d8ac6d3355dc50b2e1865bb44352!}
        {!LANG-fd48db3174ca37e7d532ada390efc592!}
        
        To favorites
        Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Chorea
        3. Tremor
        4. Transient ischemic attack
        5. Toxic encephalopathy
        6. Spinal muscle atrophy and related syndromes
        7. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        8. Somance, stupor and coma
        9. System atrophy affecting mainly CNS
        10. Siringomyelia
        11. Compression of nervous roots and plexuses in disease
        12. Forestative [autonomous] nervous system
        13. Eggs of the vegetative (autonomous) nervous system
        14. Multiple sclerosis
        15. Radiculitis
        16. The consequences of cerebrovascular diseases
        17. The consequences of inflammatory diseases of the central nervous system
        18. Defeats of cranial nerves in disease
        19. Loosity of a trigeminal nerve
        20. Defeats of nerve roots and plexuses
        21. Lesions of the nervous system during diseases
        22. Lesions of neuromuscular synapses and muscles
        23. Disease muscle lesions
        24. Lesions of facial nerve
        25. Defeat other cranial nerves
        26. Brain lesions
        27. Defeat of a trigeminal nerve
        28. Primary muscle lesions
        29. Parkinsonism with disease
        30. Paraplegy and tetraplegia
        31. Osteochondrosis of the cervical department
        32. Neurasthenia
        33. Hereditary and idiopathic neuropathy
        34. Hereditary ataxia
        35. Violations of speech
        36. Mobility and mobility disorders
        37. Disorders of smell and taste sensitivity
        38. Disorders of the nervous system, after medical procedures
        39. Skin disorders
        40. Mononeuropathy in disease
        41. Mononeuropathy of the lower limb
        42. Mononeuropathy of the upper limb
        43. Miosit
        44. Migraine
        45. Miasthenia
        46. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
        47. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
        48. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
        49. {!LANG-ea966445154ad8b4d28f593f3d83d329!}
        50. {!LANG-2566e00bfb982959c99dbcedc8c8667c!}
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        
        {!LANG-21b4ee481a546add1f666b3addcfe3a3!}
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-3eb34c1de9a9b6994408a456c0677ae5!}
        
        {!LANG-bd63eaf066adbce4ab0dcafcc79906b0!}
        {!LANG-f5edf152fb741600a1bbd8b21c0baabb!}
        
        {!LANG-8e35d8ac6d3355dc50b2e1865bb44352!}
        {!LANG-fd48db3174ca37e7d532ada390efc592!}
        
        To favorites
        {!LANG-b4104ce73b7d0a7b27f07e05ce602c5c!}
        Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Cervicalgia
        3. Chorea
        4. Tremor
        5. Transient ischemic attack
        6. Toxic encephalopathy
        7. Spinal muscle atrophy and related syndromes
        8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        9. Somance, stupor and coma
        10. System atrophy affecting mainly CNS
        11. Siringomyelia
        12. Compression of nervous roots and plexuses in disease
        13. Forestative [autonomous] nervous system
        14. Eggs of the vegetative (autonomous) nervous system
        15. Multiple sclerosis
        16. Radiculopathy
        17. Radiculitis
        18. Lumbar-sacral plexopathy
        19. The consequences of cerebrovascular diseases
        20. The consequences of inflammatory diseases of the central nervous system
        21. Defeats of cranial nerves in disease
        22. Loosity of a trigeminal nerve
        23. Defeats of nerve roots and plexuses
        24. Lesions of the nervous system during diseases
        25. Lesions of neuromuscular synapses and muscles
        26. Disease muscle lesions
        27. Lesions of facial nerve
        28. Defeat other cranial nerves
        29. Brain lesions
        30. Defeat of a trigeminal nerve
        31. Defeat of intervertebral discs of the cervical
        32. Primary muscle lesions
        33. Parkinsonism with disease
        34. Paraplegy and tetraplegia
        35. Osteochondrosis of the cervical department
        36. Neurasthenia
        37. Hereditary and idiopathic neuropathy
        38. Hereditary ataxia
        39. Violations of speech
        40. Mobility and mobility disorders
        41. Disorders of smell and taste sensitivity
        42. Disorders of the nervous system, after medical procedures
        43. Skin disorders
        44. Mononeuropathy in disease
        45. Mononeuropathy of the lower limb
        46. Mononeuropathy of the upper limb
        47. Miosit
        48. Migraine
        49. Miasthenia
        50. Malgy
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        3. Consultation, primary reception of the manual therapist
        
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-3eb34c1de9a9b6994408a456c0677ae5!}
        
        {!LANG-bd63eaf066adbce4ab0dcafcc79906b0!}
        {!LANG-f5edf152fb741600a1bbd8b21c0baabb!}
        
        {!LANG-8e35d8ac6d3355dc50b2e1865bb44352!}
        {!LANG-fd48db3174ca37e7d532ada390efc592!}
        
        To favorites
        {!LANG-b7f3eb17285f75262c124980362fcf3a!}
        Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Chorea
        3. Tremor
        4. Transient ischemic attack
        5. Toxic encephalopathy
        6. Spinal muscle atrophy and related syndromes
        7. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        8. Somance, stupor and coma
        9. System atrophy affecting mainly CNS
        10. Siringomyelia
        11. Compression of nervous roots and plexuses in disease
        12. Forestative [autonomous] nervous system
        13. Eggs of the vegetative (autonomous) nervous system
        14. Multiple sclerosis
        15. Radiculitis
        16. The consequences of cerebrovascular diseases
        17. The consequences of inflammatory diseases of the central nervous system
        18. Defeats of cranial nerves in disease
        19. Loosity of a trigeminal nerve
        20. Defeats of nerve roots and plexuses
        21. Lesions of the nervous system during diseases
        22. Lesions of neuromuscular synapses and muscles
        23. Disease muscle lesions
        24. Lesions of facial nerve
        25. Defeat other cranial nerves
        26. Brain lesions
        27. Defeat of a trigeminal nerve
        28. Primary muscle lesions
        29. Parkinsonism with disease
        30. Paraplegy and tetraplegia
        31. Osteochondrosis of the cervical department
        32. Neurasthenia
        33. Hereditary and idiopathic neuropathy
        34. Hereditary ataxia
        35. Violations of speech
        36. Mobility and mobility disorders
        37. Disorders of smell and taste sensitivity
        38. Disorders of the nervous system, after medical procedures
        39. Skin disorders
        40. Mononeuropathy in disease
        41. Mononeuropathy of the lower limb
        42. Mononeuropathy of the upper limb
        43. Miosit
        44. Migraine
        45. Miasthenia
        46. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
        47. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
        48. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
        49. {!LANG-ea966445154ad8b4d28f593f3d83d329!}
        50. {!LANG-2566e00bfb982959c99dbcedc8c8667c!}
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        
        {!LANG-012897f7bfa3c1a1fe0313279e03d246!}
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-3eb34c1de9a9b6994408a456c0677ae5!}
        
        {!LANG-bd63eaf066adbce4ab0dcafcc79906b0!}
        {!LANG-f5edf152fb741600a1bbd8b21c0baabb!}
        
        {!LANG-8e35d8ac6d3355dc50b2e1865bb44352!}
        {!LANG-fd48db3174ca37e7d532ada390efc592!}
        
        To favorites
        {!LANG-7dd3a1b9b7d42587f8ceb676f26f6336!}
        Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Chorea
        3. Tremor
        4. Transient ischemic attack
        5. Toxic encephalopathy
        6. Spinal muscle atrophy and related syndromes
        7. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        8. Somance, stupor and coma
        9. System atrophy affecting mainly CNS
        10. Siringomyelia
        11. Compression of nervous roots and plexuses in disease
        12. Forestative [autonomous] nervous system
        13. Eggs of the vegetative (autonomous) nervous system
        14. Multiple sclerosis
        15. Radiculitis
        16. The consequences of cerebrovascular diseases
        17. The consequences of inflammatory diseases of the central nervous system
        18. Defeats of cranial nerves in disease
        19. Loosity of a trigeminal nerve
        20. Defeats of nerve roots and plexuses
        21. Lesions of the nervous system during diseases
        22. Lesions of neuromuscular synapses and muscles
        23. Disease muscle lesions
        24. Lesions of facial nerve
        25. Defeat other cranial nerves
        26. Brain lesions
        27. Defeat of a trigeminal nerve
        28. Primary muscle lesions
        29. Parkinsonism with disease
        30. Paraplegy and tetraplegia
        31. Osteochondrosis of the cervical department
        32. Neurasthenia
        33. Hereditary and idiopathic neuropathy
        34. Hereditary ataxia
        35. Violations of speech
        36. Mobility and mobility disorders
        37. Disorders of smell and taste sensitivity
        38. Disorders of the nervous system, after medical procedures
        39. Skin disorders
        40. Mononeuropathy in disease
        41. Mononeuropathy of the lower limb
        42. Mononeuropathy of the upper limb
        43. Miosit
        44. Migraine
        45. Miasthenia
        46. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
        47. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
        48. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
        49. {!LANG-ea966445154ad8b4d28f593f3d83d329!}
        50. {!LANG-2566e00bfb982959c99dbcedc8c8667c!}
        Show all diseases
        
        1. Re-consulting neurologist
        2. Consultation, primary neurologist
        
        {!LANG-393b546ae05a51070e60a5939bd4c04d!}
        {!LANG-dcd24ca4e344bf630e007b26c36e6687!}
        {!LANG-f76171497edb76e362a3eb463ccf7b5c!}
        
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-3eb34c1de9a9b6994408a456c0677ae5!}
        
        {!LANG-c9da007d12870619c047ba6718abdc38!}
        {!LANG-1f79bb59adc2b431de64d8abeaa65a92!}
        
        To favorites
        {!LANG-e6866ee6e81437bdfbf1c20ad13d98e4!}
        Diseases:
        
        1. {!LANG-2e4b5d1ebfb66fd662e1e2a68779a957!}
        2. Extrapyramidal and motor disorders
        3. Chorea
        4. Tremor
        5. Transient ischemic attack
        6. Toxic encephalopathy
        7. Spinal muscle atrophy and related syndromes
        8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        9. Somance, stupor and coma
        10. System atrophy affecting mainly CNS
        11. Siringomyelia
        12. Compression of nervous roots and plexuses in disease
        13. Forestative [autonomous] nervous system
        14. Eggs of the vegetative (autonomous) nervous system
        15. Multiple sclerosis
        16. Radiculitis
        17. The consequences of cerebrovascular diseases
        18. The consequences of inflammatory diseases of the central nervous system
        19. Defeats of cranial nerves in disease
        20. Loosity of a trigeminal nerve
        21. Defeats of nerve roots and plexuses
        22. Lesions of the nervous system during diseases
        23. Lesions of neuromuscular synapses and muscles
        24. Disease muscle lesions
        25. Lesions of facial nerve
        26. Defeat other cranial nerves
        27. Brain lesions
        28. Defeat of a trigeminal nerve
        29. Primary muscle lesions
        30. Parkinsonism with disease
        31. Paraplegy and tetraplegia
        32. {!LANG-11d178018cbc317dcdb3acb6751fdea1!}
        33. Osteochondrosis of the cervical department
        34. Neurasthenia
        35. Hereditary and idiopathic neuropathy
        36. Hereditary ataxia
        37. Violations of speech
        38. Mobility and mobility disorders
        39. Disorders of smell and taste sensitivity
        40. Disorders of the nervous system, after medical procedures
        41. Skin disorders
        42. Mononeuropathy in disease
        43. Mononeuropathy of the lower limb
        44. Mononeuropathy of the upper limb
        45. Miosit
        46. Migraine
        47. Miasthenia
        48. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
        49. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
        50. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        3.
        4.
        
        {!LANG-f6371be4bc9c1b7fe9eef818370e3c49!}
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-b2a13905da3f7f0294b3a672eb4a4b27!}
        
        {!LANG-103e14bc64616c1c1b8cd541f73e990a!}
        {!LANG-c912f9aff2b50d78d3ed763e554748e2!}
        
        {!LANG-64f27afe8ef140ec1479a629a09fbf8c!}
        {!LANG-ff5fabce0d735f1c8944968c39831306!}
        
        To favorites
        {!LANG-37718e6dc668b7ff364fb300509b49d2!}
        Diseases:
        
        1. {!LANG-2e4b5d1ebfb66fd662e1e2a68779a957!}
        2. Extrapyramidal and motor disorders
        3. Chorea
        4. Tremor
        5. Transient ischemic attack
        6. Toxic encephalopathy
        7. Spinal muscle atrophy and related syndromes
        8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        9. Somance, stupor and coma
        10. System atrophy affecting mainly CNS
        11. Siringomyelia
        12. Compression of nervous roots and plexuses in disease
        13. Forestative [autonomous] nervous system
        14. Eggs of the vegetative (autonomous) nervous system
        15. Multiple sclerosis
        16. Radiculitis
        17. The consequences of cerebrovascular diseases
        18. The consequences of inflammatory diseases of the central nervous system
        19. Defeats of cranial nerves in disease
        20. Loosity of a trigeminal nerve
        21. Defeats of nerve roots and plexuses
        22. Lesions of the nervous system during diseases
        23. Lesions of neuromuscular synapses and muscles
        24. Disease muscle lesions
        25. Lesions of facial nerve
        26. Defeat other cranial nerves
        27. Brain lesions
        28. Defeat of a trigeminal nerve
        29. Primary muscle lesions
        30. Parkinsonism with disease
        31. Paraplegy and tetraplegia
        32. {!LANG-11d178018cbc317dcdb3acb6751fdea1!}
        33. Osteochondrosis of the cervical department
        34. Neurasthenia
        35. Hereditary and idiopathic neuropathy
        36. Hereditary ataxia
        37. Violations of speech
        38. Mobility and mobility disorders
        39. Disorders of smell and taste sensitivity
        40. Disorders of the nervous system, after medical procedures
        41. Skin disorders
        42. Mononeuropathy in disease
        43. Mononeuropathy of the lower limb
        44. Mononeuropathy of the upper limb
        45. Miosit
        46. Migraine
        47. Miasthenia
        48. {!LANG-1785b1f847aed1ba080b68d3fff460e8!}
        49. {!LANG-d8e5d7c603ea977c8c4cdc12949c9df3!}
        50. {!LANG-541f1cd49c655b77da65a39ff95cbaf0!}
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        3. {!LANG-07cc58fb829ae749662d11fec198161a!}
        4. {!LANG-00aa407a1c5ac1fced5653b7d9d9d989!}
        
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-b2a13905da3f7f0294b3a672eb4a4b27!}
        
        {!LANG-103e14bc64616c1c1b8cd541f73e990a!}
        {!LANG-c912f9aff2b50d78d3ed763e554748e2!}
        
        {!LANG-64f27afe8ef140ec1479a629a09fbf8c!}
        {!LANG-ff5fabce0d735f1c8944968c39831306!}
        
        To favorites
        {!LANG-b6d1f1b97e0acced438ea80f343467be!}
        Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Cervicalgia
        3. Chorea
        4. Tremor
        5. Transient ischemic attack
        6. Toxic encephalopathy
        7. Spinal muscle atrophy and related syndromes
        8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        9. Somance, stupor and coma
        10. System atrophy affecting mainly CNS
        11. Siringomyelia
        12. Compression of nervous roots and plexuses in disease
        13. Forestative [autonomous] nervous system
        14. Eggs of the vegetative (autonomous) nervous system
        15. Multiple sclerosis
        16. Radiculopathy
        17. Radiculitis
        18. Lumbar-sacral plexopathy
        19. The consequences of cerebrovascular diseases
        20. The consequences of inflammatory diseases of the central nervous system
        21. Defeats of cranial nerves in disease
        22. Loosity of a trigeminal nerve
        23. Defeats of nerve roots and plexuses
        24. Lesions of the nervous system during diseases
        25. Lesions of neuromuscular synapses and muscles
        26. Disease muscle lesions
        27. Lesions of facial nerve
        28. Defeat other cranial nerves
        29. Brain lesions
        30. Defeat of a trigeminal nerve
        31. Defeat of intervertebral discs of the cervical
        32. Primary muscle lesions
        33. Parkinsonism with disease
        34. Paraplegy and tetraplegia
        35. Osteochondrosis of the cervical department
        36. Neurasthenia
        37. Hereditary and idiopathic neuropathy
        38. Hereditary ataxia
        39. Violations of speech
        40. Mobility and mobility disorders
        41. Disorders of smell and taste sensitivity
        42. Disorders of the nervous system, after medical procedures
        43. Skin disorders
        44. Mononeuropathy in disease
        45. Mononeuropathy of the lower limb
        46. Mononeuropathy of the upper limb
        47. Miosit
        48. Migraine
        49. Miasthenia
        50. Malgy
        Show all diseases
        
        1. Consultation, primary neurologist
        2. Re-consulting neurologist
        3. Consultation, primary reception of the manual therapist
        4. {!LANG-c0ef066e5c6c0a241843800ce6fb40f1!}
        
        {!LANG-982f632a7a2fe7e8d3ea66b121b47282!}
        {!LANG-1ea7740076b4043b89f6535355db7a4a!}
        {!LANG-b2a13905da3f7f0294b3a672eb4a4b27!}
        
        {!LANG-103e14bc64616c1c1b8cd541f73e990a!}
        {!LANG-c912f9aff2b50d78d3ed763e554748e2!}
        
        {!LANG-64f27afe8ef140ec1479a629a09fbf8c!}
        {!LANG-ff5fabce0d735f1c8944968c39831306!}
        
        To favorites
        {!LANG-c8e4d73c5db7dc5530c6eaad787663b2!}
        Diseases:
        
        1. Extrapyramidal and motor disorders
        2. Cervicalgia
        3. Chorea
        4. Tremor
        5. Transient ischemic attack
        6. Toxic encephalopathy
        7. Spinal muscle atrophy and related syndromes
        8. Vascular brain syndromes with cerebrovascular diseases (I60-i67 *)
        9. Somance, stupor and coma
        10. System atrophy affecting mainly CNS
        11. Siringomyelia
        12. Compression of nervous roots and plexuses in disease
        13. Forestative [autonomous] nervous system
        14. Eggs of the vegetative (autonomous) nervous system
        15. Multiple sclerosis
        16. Radiculopathy
        17. Radiculitis
        18. Lumbar-sacral plexopathy
        19. The consequences of cerebrovascular diseases
        20. The consequences of inflammatory diseases of the central nervous system
        21. Defeats of cranial nerves in disease
        22. Loosity of a trigeminal nerve
        23. Defeats of nerve roots and plexuses
        24. Lesions of the nervous system during diseases
        25. Lesions of neuromuscular synapses and muscles
        26. Disease muscle lesions
        27. Lesions of facial nerve
        28. Defeat other cranial nerves
        29. Brain lesions
        30. Defeat of a trigeminal nerve
        31. Defeat of intervertebral discs of the cervical
        32. Primary muscle lesions
        33. Parkinsonism with disease
        34. Paraplegy and tetraplegia
        35. Osteochondrosis of the cervical department
        36. Neurasthenia
        37. Hereditary and idiopathic neuropathy
        38. Hereditary ataxia
        39. Violations of speech
        40. Mobility and mobility disorders
        41. Disorders of smell and taste sensitivity
        42. Disorders of the nervous system, after medical procedures
        43. Skin disorders
        44. Mononeuropathy in disease
        45. Mononeuropathy of the lower limb
        46. Mononeuropathy of the upper limb
        47. Miosit
        48. Migraine
        49. Miasthenia
        50. Malgy
        Show all diseases
        
        1. Consultation, primary reception of the manual therapist
        2. {!LANG-c0ef066e5c6c0a241843800ce6fb40f1!}
        3. Consultation, primary neurologist
        4. Re-consulting neurologist
        
        {!LANG-3c7a48a106bf9c73c5ec786405049fcc!} {!LANG-4be70acdd16bf43fdd9858a520a31763!}{!LANG-94a6c68f642d39a8f2c77aa48a81c744!}