Apostematozny pyelonephritis: akpata, mgbaàmà, nchoputa, ọgwụgwọ

The ọrịa bụ otu n'ime nzọụkwụ nke nnukwu pyelonephritis. Mgbe apostematoznom pyelonephritis ime mkpali Filiks nke multiple obere etuto abu (apostemy) ii. Isi ebe bụ nke ha orunótu bụ n'ụgbụgbọ na akụrụ ya.

The isi ụdị

Ọtụtụ mgbe apostematozny pyelonephritis amalite ịzụlite mgbe ureteral mgbochi, ọ dịkarịa ala - na-emebibeghị urinary outflow.

Na akụrụ obere pustules kpụrụ na-esonụ n'ụzọ: a glomerular capillary loop na ọnụ ọbara arịa na akụrụ na peritubular capillaries akpọkọtara microorganisms. N'otu nje egbochi mkpụkọ ii, ha na-eje ozi dị ka isi iyi nke pustules. Ha na-emi odude n'elu gbasara akụrụ cortex, nakwa dị ka a fibrous Capsule na nnukwu quantities. Mgbe anya si ha doro anya na anya. Apostemy nwere a acha agba, Size ruo 2 mm, nwere ike mere ndokwa na iche iche ma ọ singly.

Mgbe apostematoznom pyelonephritis akụrụ na-abawanye na size, nwere a cherry red agba. Akụrụ anụ ahụ bụ edema, ndim nke fibrous Capsule emee. Gbasara akụrụ sectional anya pustules, nwere ike ịchọpụta na ha na medulla.

Apostematozny pyelonephritis, bacteremia na etuto nke akụrụ

The abụọ ụdị ọrịa - a carbuncle akụrụ. Ọ na-adị purulent necrotic ngwa mmebi, akụrụ etuto. Na cortex ii foci nke necrosis. Bacteremia nwere ike ime mgbe ụzọ hematogenous mgbasa nke ọrịa. N'ọnọdụ dị otú ahụ na-akpata pyelonephritis apostematoznogo ibu pustular ọrịa, carbuncle, furunculosis, mastitis, felon. The usoro nke guzobere carbuncle bụ:

• Nje thrombus abatakwa gbasara akụrụ akwara si distal ulo abu otú bacteremia emee na otu nke zones nke ọbara ọbara esenyịn alaka ma ọ bụ nta ọbara alaka.

• Bacteremia nwere ike ime n'oge mkpakọ nke a nnukwu ite intrarenal mkpali infiltrate ma ọ bụ site na kọntaktị na isi iyi nke mbufụt na vaskụla mgbidi.

Ebutekarị development carbuncle microorganisms, dị ka na-acha ọcha na Staphylococcus aureus, Proteus na E. coli.

Gbasara akụrụ carbuncle sectional hụrụ ka ahazi bulging nke necrotic anụ ahụ, ọ na-permeated site obere pustules gwakọtara, na-ahapụ nkpirikpi miri parenchyma.

Nnukwu pyelonephritis apostematozny mgbe agwakọta carbuncle akụrụ na apostematozny pyelonephritis. The adakarị ngosipụta nke nnukwu ọdịiche na-adịghị hụrụ.

The adakarị picture apostematoznogo pyelonephritis

Mgbaàmà apostematoznogo pyelonephritis na carbuncle adabere na otú akwusila eruba mmamịrị si akụrụ.

Ọtụtụ mgbe, isi ụdị pyelonephritis emee mberede, na-emekarị mgbe intercurrent ọrịa. Egosi akpata oyi, fever (ruo 40 degrees) na-arọ ajirija. Ọtụtụ ọdịdị a na-adịkwaghị fever (okpomọkụ ịrị elu na-enye ụzọ na-ada). Magburu onwe akpata oyi nwere ike ịdịru ruo otu awa, yikarịrị ime na ọnụ ọgụgụ kasị elu nke okpomọkụ ịrị elu. Mgbe oyi sweating na-amalite mgbe a okpomọkụ ojuju. Ndị a mgbaàmà n'oge atọ ndị mbụ ụbọchị na-owụt weakly.

Ọzọ, na-amalite na-eto eto azụ mgbu. Mgbe akụrụ palpation bụ n'ụzọ doro anya na-egbu mgbu, nwere ike na-amụba. Mgbanwe mmamịrị ime n'ụbọchị nke ise, e nwere bacteriuria, proteinuria, leucocyturia.

Iji hụ na ọbara e ji leukocytosis, ọka na mkpụrụ ndụ ọbara ọcha, mụbara erythrocyte sedimentation ọnụego, anaemia.

Na-aga n'ihu usoro nwere ike ịzụlite sepsis, purulent enwe metastatic foci nke mbufụt ke imeju, akpa ume, na ụbụrụ.

Clinic akụrụ carbuncle

Ọ bụrụ na akụrụ, ebe a carbuncle, ọ bụghị nsogbu eruba mmamịrị, a na-adakarị picture yiri nnukwu nje usoro. The okpomọkụ adahade 40 degrees, ji akpata oyi pụtara na agbapụtara ite. Na-eto eto ike, na-eku ume quickens, abịa ọgbụgbọ na vomiting, tachycardia.

N'oge mbụ mgbe ọ bụla ihe mgbu, ọ dịghị bacteriuria, leucocyturia, dizuricheskie aghara. Diagnosis siri ike. Ọrịa nwere ike inwe maka ọgwụgwọ na ọgwụgwọ, na-efe efe, ịwa ahụ na Ngalaba. The dọkịta nwere ike na-ezighị Ịchọpụta Otú Nsogbu oyi baa, nnukwu cholecystitis, ọrịa ịba ahụ ọkụ, na dị ka. Naanị a ụbọchị ole na ole mgbe e mesịrị, mgbe mgbaàmà amalite na-egosi obodo (mgbu, mgbaàmà Pasternatskogo, ịdị nro), dọkịta na-elekwasị anya na akụrụ ya.

Apostematozny pyelonephritis nchoputa

Diagnosis nke ọrịa dabeere na-esonụ na-egosi:

• febrile oge dịruru n'ihi na ihe karịrị ụbọchị atọ;
• ụba akụrụ na-egbu mgbu ka palpation;
• Laboratory ọmụmụ: bacteriuria, leucocyturia, ọbara - leukocyte ekpe nnofega, leukocytosis, CRP, ESR abawanye;
• excretory Voiding - belata ọrụ nke akụrụ, mụbara na otụk n'akụkụ;
• US - ejedebeghị agagharị, dịkwuo size of akụkụ, ndim karịa 2cm parenchyma, ya na-abụghị edo njupụta; mmiri mmiri perinephric ohere pyelocaliceal usoro kọwakwuru ureteral mgbochi;
• MSCT, MRI, CT - abawanye na akụrụ size, ndim nke parenchyma, ya heterogeneity na outbreaks nke purulent suppuration;
• ike na static nefrostsintigrafiya - abawanye na akụrụ size na parenchyma mkpumkpu ìgwè isotope.

Purulent suppuration anụ ahụ n'ụzọ doro anya ekpughe carbuncle. On US foci na parenchyma nke elu njupụta bụ doro anya na anya, nakwa dị ka ha mbuaha Ọdịdị. O doro anya na anya na foto a na MRI, CT. Gburugburu CT na iche nkwalite na-eme ka o kwe omume na-ahụ mebiri mgbe ị na-enweta a dị iche na necrosis.

Ihe isi ike na atụle

Ihe isi ike na-adabere na ọrịa na-arịa nwere ike ime ma ọ bụrụ na tupu abanye urology ọrịa n'ịnwụ ogwu mgbochi ọgwụ na oge a na ọgwụ nje maka otu - izu abụọ. Ọgwụgwọ dị otú ahụ nwere ike ire ụtọ na ngosipụta apostematoznogo pyelonephritis, ma a ntoala mma agaghị eme. Ahu okpomọkụ na-ebelata, mbelata mgbu, akpata oyi adịkarịghị ime, ha ọdịdị obere akpọ na-adịgide adịgide. The belatara ọnụ ọgụgụ nke ọbara leukocytes, ma leukocyte ekpe mgbanwe ka nọgidekwara dị ka anaemia ma mụbaa ESR. Na ndị ọzọ okwu, ọrịa na-egosipụta onwe ya dị ka a flaccid sepsis. Nke a "mma" - ihe mere eme na-ezighị ezi ndidi. Iji gbochie mmepe nke oké sepsis na ọnụnọ nke a akụrụ ọrịa n'ekwú mbibi dị mkpa iji rụọ ọrụ.

esi nchoputa

Na-akọwapụta apostematoznogo pyelonephritis, ọrịa ga-ọdịiche dị n'etiti ndị ọzọ na-efe efe. Na nnukwu pancreatitis na cholecystitis na subdiaphragmatic etuto, nnukwu appendicitis, nnukwu cholangitis, nnukwu adnexitis na nnukwu pleurisy.

akụrụ Kurbunkul ọdịiche dị na a mfe aba aba akụrụ ahu otutu, akpụ parenchyma, na nnukwu ọrịa nke abdominal uji eze.

Gịnị dị iche apestomatozny pyelonephritis na gbasara akụrụ carbuncle?

• Pyuria. Bacteriuria.
• Ala azụ mgbu.
• Gbasara akụrụ dysfunction.
• Ndim nke parenchyma. Gbanwee ya njupụta.
• Na-egbu mgbu palpation na-abawanye na akụrụ ya.
• Mmụba nke gbasara akụrụ pelvis usoro.

The ultrasound, MRI, CT ekwe ịmata apostematozny pyelonephritis nke dị iche iche nnukwu ọrịa nke peritoneum.

ọgwụgwọ

Ọgwụgwọ apostematoznogo pyelonephritis na carbuncle rụrụ nanị site n'ịwa ahụ. Ọtụtụ mgbe, na-arụ ọrụ a rụrụ na ihe mberede ndabere. Preliminary obere preoperative nkwadebe, na òkè nkụnwụ dịruru ọ dịghị ihe karịrị awa abụọ. Ọzụzụ na-agụnye:

• Pelvis catheterization, igba ogwu n'akwara ochichi nke ọgwụ nje.
• Transfusion nke glucose na electrolytes.
• Stabilization nke ọbara mgbali.
• Dị ka ihe-àmà - cardiotonic.

Isi nzube nke na-arụ ọrụ - iji gbochie sepsis. -Azọpụta ndụ.

A abụọ ebumnobi - nzọpụta nke na akụrụ ya.

N'ihi ná Nkụnwụ iji endotracheal ná Nkụnwụ.

N'oge ọrụ content ngere emepụta ahụ etuto na pelvis mee akuku iji chọpụta microflora maka inwekwu mkpebi siri ike nke uche na ọgwụ nje. Results ga-egosi na purulent pyelonephritis na-ekpebi n'ihu ọgwụgwọ atụmatụ.

The postoperative oge

Mgbe ịwa ahụ, onye ọrịa na-enweta a ọgwụgwọ dabeere na mgbochi nke gbasara akụrụ ọrụ na intokikatsii. Onye ọrịa na-kenyere:

• 10% glucose ngwọta - 500 ml, 10 U insulin intravenously;
• ngwọta nke 9% sodium chloride - 1000 ml;
• gemodez - 400 ml;
• cocarboxylase - 200 mg;
• Vitamin B6 - 2 ml;
• vitamin C - 500 mg;
• Korglikon ngwọta nke 0,06% na 1.0 ml;
• 15% mannitol ngwọta na 50 ml;
• Lasix 60 mg;
• Fresh friji (nwaafo) plasma - 250 ml;
• Clexane ma ọ bụ Fragmin, nyere afọ nke coagulation;
• juru n'ọnụ mkpụrụ ndụ ọbara uhie nke anaemia (HB erughị 70).

Mgbe e ji purulent mmenaanya extracorporal detoxification (plasmapheresis, hemosorbtion, plazmasorbtsiya).

Chọrọ ogwu mgbochi ọgwụ na abụọ ọgwụ nje nke a dịgasị iche iche nke edinam.

ndị kasị oge a usoro (MRI, CT, ultrasound) na-eji na ntule nke parenchyma. Nke a na-eme ka o kwe omume na n'ụzọ kwesịrị ekwesị na-amata ọnọdụ na họrọ kasị kwesị ekwesị olu nke azụmahịa.