Apostematozny pyelonephritis: oonobangela, iimpawu, isifo, unyango

Isifo yenye silungelelanise pyelonephritis ahlekise. Xa apostematoznom pyelonephritis zenzeka iinkqubo ukudumba apho ububomvu ezininzi ezincinane ithumba (apostemy) kwakheka. Eyona ndawo iphambili ye eyendawo yabo amaxolo ye nezintso.

Ifomu yokuqala

Amaninzi apostematozny pyelonephritis uqala ukuphuhlisa xa ureteral isithintelo, ubuncinane - kunye nencindi yayinjalo womchamo.

pustules In kidney encinane abunjwe ngale ndlela ilandelayo: a capillary loop glomerular nasezimpahleni yegazi yesiphelo kunye kwizintso kwi emithanjeni peritubular yande iintsholongwane. E akhiwa egazi ezifanayo yintsholongwane, ke bakhonza njengomthombo pustules. Bona zibekwe phezu neuron kwezintso, kwakunye capsule ezinezikhondo kukuninzi. Xa usibona obonakalayo ngokucacileyo. Apostemy babe umbala tyheli, ubungakanani ukuya kwi-2 mm, zinokulungiswa kumaqela okanye zibangele.

Xa apostematoznom pyelonephritis ukunyuka zezintso ubukhulu, kukho umbala obomvu cherry. Kidney lolwabo na nokudumba, ukuqina leli philisi ezinezikhondo kwenzeka. Sezintso pustules lecandelo ebonakalayo, uyakwazi ukubona nabo Medulla.

Apostematozny pyelonephritis, bacteremia kunye ithumba le kidney

Ifom yesibini isifo - emeraldi zezintso. Oku kwenzeka ubovu umonakalo omzimba necrotic, kidney ithumba. Xa neuron akhiwa nakujoliso olutsha of necrosis. Bacteremia kungenzeka xa ukusasazeka indlela hematogenous kosulelo. Kwiimeko ezinjalo ebangela pyelonephritis apostematoznogo baba izifo pustular, nesmarado, furunculosis, imastitis, felon. Indlela of Ukuqulunqwa emeraldi ngu:

• thrombus bacteria engena kwemithambo sezintso ukusuka kwigumbi ubofu distal ngoko bacteremia kwenzeka kwenye imimandla emithanjeni amasebe igazi okanye amasebe ezincinane lwemithambo.

• Bacteremia ezingenzeka ngethuba ucinezelo inqanawa enkulu intrarenal infiltrate yokukrala okanye adibane umthombo ukudumba eludongeni nemithambo.

Kwala magciwane Uphuhliso nesmarado nobangela eqhelekileyo, ezifana ezimhlophe Staphylococcus aureus, Proteus kunye E. coli.

Sezintso emeraldi somhlathi kubonwa equmbile ahanjiswa kwithishyu necrotic, oko luphokoke pustules ezincinane edidekile, eshiya nesinqumka parenchyma enzulu.

Acute pyelonephritis apostematozny idla ngokudibanisa nesmarado wezintso kwaye apostematozny pyelonephritis. Wabonakala kwezonyango umahluko omkhulu anayenza.

Lo mfanekiso clinical apostematoznogo pyelonephritis

Iimpawu apostematoznogo pyelonephritis kunye nesmarado kuxhomekeke kwindlela ephazamisa ukuhamba umchamo kwizintso.

Amaninzi, ifomu ephambili pyelonephritis lwenzeka ngesiquphe, ngokuqhelekileyo emva usuleleko intercurrent. Ivela Ukugodola, ifiva (ukuya kutsho kuma-40) kunye umbilo enzima. uhlobo ixakekileyo esilawulwa fever (ubushushu ukunyuka unika indlela eya kuwa). Ukugodola abalaseleyo ingahlala ukuya kwiyure enye, ngakumbi ukuba zenzeke kwincopho lobushushu avuke. Emva yokubanda ukubila iqala kwi ukwehla lobushushu. Ezi mpawu ebudeni beentsuku ezintathu zokuqala ivezwe nguvumazonke.

Okulandelayo, baqale ukukhula iqolo. Xa kidney Ngokucofa kubuhlungu ngokucacileyo, ukuze nande. Utshintsho komchamo kuthi ngomhla wesihlanu, kukho bacteriuria, proteinuria, leucocyturia.

Ukuba nomfanekiso igazi luphawulwa leukocytosis, ingqolowa iiseli ezimhlophe zegazi, ukunyuka kweqondo neentlenge erythrocyte, igazi.

Ngenkqubo okuqhubekayo inokuphuhlisa nokudumba, ubovu ukuba nakujoliso olutsha kuwenza of ukudumba esibindini, umphunga, ingqondo.

Clinic kidney emeraldi

Ukuba kwizintso, apho nesmarado, musani kuba navuso ithombo umchamo, umfanekiso clinical efanayo etsolo inkqubo ezosulelayo. Le ubushushu degrees 40, luphawulwa kuthibaza amileyo kwaye imbiza eyothi. Ukukhulisa ubuthathaka, ukuphefumla ophilisayo, uyafika isicaphucaphu nokugabha, tachycardia.

Ngemihla beselula badla ntlungu, akukho bacteriuria, leucocyturia, dizuricheskie disorder. Uxilongo kunzima. Izigulane zingafumana ukuba unyango ngamayeza nokunyanga, ezosulelayo, amasebe yotyando. Ugqirha zingaphazama ekufunyanisweni pneumonia, cholecystitis ebukhali, yicesina, nezinto ezinjengezo. kwiintsuku nje ezimbalwa kamva, xa iimpawu ziqala ukubonisa zendawo (iintlungu, uphawu Pasternatskogo, isisa), ugqirha igxininisa nezintso.

Apostematozny pyelonephritis uphethwe

Lokufunyaniswa kwesifo isekelwe zikhombisi zilandelayo:

• ixesha febrile ihlala ngaphezulu kweentsuku ezintathu;
• anda sezintso kubuhlungu Ngokucofa;
• izifundo zeLebhu: bacteriuria, leucocyturia, igazi - leukocyte ngasekhohlo shift, leukocytosis, CRP, ESR ukwanda;
• excretory uchama - kwanciphisa umsebenzi kidney, zanda kwicala achaphazelekayo;
• US - ukuhamba kuphela, ukunyusa ubungakanani amalungu, ukuqina ngaphezu 2cm parenchyma, yayo ingxinano non-uniform; inkqubo engamanzi pyelocaliceal isithuba perinephric esandisa ureteral kokuphazanyiswa;
• MSCT, MRI, CT - ukwanda ubukhulu kidney, ukuqina parenchyma, ukungafani kunye uqhambuko ubovu suppuration;
• obuluqilima kunye static nefrostsintigrafiya - ukwanda ubukhulu kwezintso kwi parenchyma olungalinganiyo abekwe Isotope.

Ubovu suppuration inyama kutyhilwa ngokucacileyo emeraldi. On US nakujoliso olutsha kwi parenchyma of ezixineneyo zibonakala ngokucacileyo, kunye nesakhiwo zazo ezahlukeneyo. Ngokucacileyo kule mfanekiso MRI, CT. CT Ukonakala kunye nophuculo nshita kwenza kube lula ukubona ukuhlukumeza xa ufumana yabonisa necrosis.

Ubunzima ekuhlaziyeni

Ubunzima ekuvavanyeni imeko yomguli kunokwenzeka ukuba ngaphambi kokungena izigulane nomchamo usisisulu unyango zintsholongwane elwa mihla omnye - iiveki ezimbini. unyango olunjalo ezigudileyo ukubonisa apostematoznogo pyelonephritis, kodwa ukuphucuka esisiseko ayisayi kubakho. lobushushu emzimbeni uhle, wehlise iintlungu, kuthibaza kunqabile kwenzeka, ubume babo iqapheleka kancinci nehlala ixesha elide. Imadlana Inani leukocytes igazi, kodwa leukocyte shift ngasekhohlo enyanzelisa kwegazi kunye nokwanda ESR. Ngamanye amazwi, esi sifo kubonakala nje nokudumba iyathamba. Oku "ukuphucula" - isizathu sokwenza umguli engalunganga. Ukuthintela uphuhliso nokudumba kakhulu phambi ngokubhujiswa kidney isigulane Iziko kuyimfuneko ukusebenza.

diagnosis umehluko

Ekuchongeni apostematoznogo pyelonephritis, esi sifo kufuneka ingafani kwezinye izifo. Nge pancreatitis acute kunye cholecystitis kunye ithumba subdiaphragmatic, appendicitis etsolo, cholangitis etsolo, adnexitis etsolo kunye unepleurisy oyingozi.

sezintso Kurbunkul umahluko nge elula cyst iyabhiqiza kidney, ithumba parenchyma, kunye nezifo nokoyika esiswini.

Yintoni umahluko apestomatozny pyelonephritis kunye nesmarado sezintso?

• Pyuria. Bacteriuria.
• ubuhlungu Low umva.
• kwekhono kwezintso.
• Ukuqina parenchyma. Tshintsha kwi mninzi yayo.
• Ngokucofa Ebuhlungu nge ukwanda nezintso.
• Ukwandiswa kwenkqubo isinqe sezintso.

I-ultrasound, MRI, CT ukuvumela ukwahlula apostematozny pyelonephritis zizifo ezahlukahlukeneyo yayiyazi loo peritoneum.

unyango

Unyango apostematoznogo pyelonephritis kunye nesmarado kwenziwa kuphela uqhaqho. Amaninzi, umsebenzi lwenziwa qho ngexesha likaxakeka. Zokuqala ukulungiselela elifutshane ipreoperative, kunye nokuthatha inxaxheba imizwa awutsali ngaphezu kweeyure ezimbini. Uqeqesho ibandakanya:

• Isinqe catheterization, ulawulo efakwa we olwa nawo.
• Ezinye glucose kunye electrolytes.
• Nokuzinziswa wegazi.
• Ngokutsho ubungqina - cardiotonic.

Eyona njongo iphambili yalo msebenzi - ukuthintela nokudumba. Igcina ubomi.

Injongo zamabanga - usindiso nezintso.

Kuba zomzimba usebenzisa Ukubulawa endotracheal.

Ngexesha kocingo isiqulatho ukusebenza ukuvelisa amathumba kunye isinqe ukwenza isityalo ukumisela microflora ngokuzimisela ubukhali antibiotics phambili. Iziphumo ziya kuqinisekisa pyelonephritis ubovu kunye ukumisela isicwangciso olunye unyango.

Ithuba postoperative

Emva kotyando, isigulana ufumana unyango olusekelwe inhibition umsebenzi kwezintso kunye intokikatsii. Isigulane sinikeziwe;

• 10% glucose isisombululo - 500 ml, 10 U insulin butofelwe;
• nesisombululo 9% sodium chloride - 1000 ml;
• gemodez - 400 ml;
• cocarboxylase - 200 mg;
• Vitamin B6 - 2 ml;
• vitamin C - 500 mg;
• Korglikon nesisombululo 0,06% ukuya 1.0 ml;
• 15% solution mannitol 50 ml;
• Lasix 60 mg;
• Fresh kungahlala (lweenkobe) plasma - 250 ml;
• Clexane okanye Fragmin, banikwe parameters of coagulation;
• wapakisha iiseli ezibomvu igazi kwegazi (HB ngaphantsi kwama-70).

Xa ubovu kusetyenziswa ukunxila ezigulela extracorporal (plasmapheresis, hemosorbtion, plazmasorbtsiya).

Kufuneka unyango zintsholongwane elwa ezimbini emininzi ebanzi amanyathelo.

Eyona ndlela mihla (MRI, CT, ultrasound) zisetyenziswa kohlolo parenchyma. Oku kwenza kube lula ukuba kuhlolwe kakuhle le meko kwaye khetha umthamo efanelekileyo imicimbi.