Asaabo mu Ɔbo Ɛyaw a Ɛyɛ Den vs. Asaabo a Ɔyare no Asiw (Urosepsis) .¶

asaabo mu abo a ɛnyɛ den (acute renal colic) agye din sɛ ɛde ɛyaw a emu yɛ den na ɛyɛ yaw sen biara a onipa betumi anya no bi ba, nanso awiei koraa no ɔbo a ɛnyɛ den a ne tenten nnu milimita 5 (nsateakwaa 0.2) no ankasa bɛtwam wɔ nsɛm no mu ɔha biara mu nkyem 80 kosi 90 mu. Nanso, bere pɔtee a asaabo mu ɔbo bi kyere nsu a ɛwɔ ɔyare mmoawa wɔ n’akyi wɔ adwene no akyi berɛmo no mu (obstructive pyelonephritis / pyonephrosis) no, ayaresabea tebea no sesa fi ɔbo a ɛyɛ yaw a wɔde kɔ ayaresabea kɔ nsu mu oprehyɛn a wɔde di dwuma ntɛm a ɛde nkwa to asiane mu. Esiane sɛ asaabo a asiw no kɔ so yi mogya mu wɔ nhyɛso kɛse mu nti, wɔhyɛ mmoawa ne endotoxins a wɔakyere wɔ ɔbo no atifi no fa adwene no ntini no mu tẽẽ kɔ adwene no ntini no mu (pyelovenous backflow), na ɛkanyan fulminant urosepsis, . septic shock a ɛyɛ hu, ne owu wɔ nnɔnhwerew 6 kosi 24 ntam gye sɛ wɔyɛ oprehyɛn a wɔde yi nsu a egye ntɛmpɛ (ureteral JJ stent anaa percutaneous nephrostomy tube) ntɛm ara.

W’asɛyɛde ahorow a ɛwɔ hɔ ntɛm ara bere a ɛyaw a emu yɛ den ba w’afã, akyi, anaa akyi berɛmo mu no ne sɛ wobɛhwehwɛ "Ɔbo a Ɔyare no Mu" ntɛm ara (adwensɔtwaa biara a atiridii a ɛboro digrii Celsius 38.0 / digrii Fahrenheit 100.4 ka ho, awɔw a ɛwosow/a ɛyɛ den, nsu a ɛyɛ mununkum a ɛyɛ huam a ɛyɛ fĩ a wɔde akisikuru ahyɛ mu ma, anaasɛ adwene mu naayɛ), screen for urinary shutoff koraa (anuria anaasɛ ɔwɔ asaabo biako pɛ a ɛyɛ adwuma), hwɛ hu wɔ ɔyarefo biara a wadi boro mfe 50 kosi 60 mu sɛ ɛyaw a ɛba mpofirim wɔ akyi no nyɛ yafunu mu aortic aneurysm a ɛpaapae (AAA) ., kwati sɛ wode ahoɔden bɛtwe nsu galɔn pii bere a ɛyaw a ɛyɛ nnam a ɛyɛ mmerɛw (a ɛma asaabo mu aduru a asiw no yɛ kɛse na ɛma ɛyaw ne ɔfe yɛ kɛse), na sɛ frankaa kɔkɔɔ bi wɔ hɔ a, frɛ nnuruyɛfo a wɔhwɛ ntɛmpɛ so ntɛm ara.

Yɛ eyi mprempren¶

1. Frɛ nnuruyɛfoɔ a wɔhwɛ ntɛmpɛ so ntɛm ara sɛ asaabo mu ɔboɔ bi ka FEVER, CHILLS, anaa SHOCK ("An Infected Blocked Kidney"): Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma (911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, 000 wɔ Australia) anaa hwɛ yɛn directory of nɔma ahorow a egye ntɛmpɛ sɛ obi a ne ho yɛ no yaw kɛse wɔ n’afã, n’akyi, anaa ne srɛ mu nya atiridiinini (38.0 degrees Celsius / 100.4 degrees Fahrenheit anaa nea ɛboro saa) anaasɛ nipadua mu hyew a ɛba fam wɔ ɔkwan a ɛnteɛ so (<36.0 C / 96.8 F), atiridii a ɛwosow a wontumi nni so (a emu yɛ den), atiridii anaasɛ ɔtotɔ piti bere a ogyina hɔ, adwene mu naayɛ foforo anaa lethargy, anaa ntumi nkɔ nsuo mu koraa. Nnuru a wɔde kum ɔyare mmoawa a wɔnom nkutoo ntumi nsa akisikuru a akɔhyɛ ɔbo akyi no yare; ɛsɛ sɛ wɔyɛ oprehyɛn yi asaabo no mu nsu wɔ ayaresabea wɔ nnɔnhwerew kakraa bi mu.
2. Kɔ ntɛmpɛ dwumadibea ntɛm ara sɛ onipa no wɔ asaabo BAAKO a ɛyɛ adwuma (anaasɛ wɔde asaabo foforo) anaasɛ onyinsɛn a: Sɛ ɔbo bi siw asaabo a ɛyɛ ankonam anaa asaabo a wɔde ama no ureter a, onipa no nni asaabo a ɛboa no zero na ɔhyɛn anuric mu ntɛm ara asaabo mu opira a emu yɛ den ne hyperkalemia a ɛde nkwa to asiane mu.
3. Pow Abdominal Aortic Aneurysm (AAA) a ɛpaapae wɔ obiara a wadi boro mfe 50 mu: Wɔ mpanyimfo a wɔadi boro mfe 50 (titiriw mmarima, sigaretnomfo, anaa nnipa a wɔwɔ mogya mmoroso) a wɔnnyaa asaabo mu ɔbo da, atetew anaasɛ nsu a ɛretu yafunu mu aortic aneurysm a ɛma mogya tu mogya a ɛba akyi berɛmo mu no mia ntini koro no ara pɛpɛɛpɛ sɛnea asaabo mu ɔbo benkum anaa nifa te no, na ɛde ɛyaw a ɛte saa ara mpofirim fi afã kosi akyi berɛmo ne mogya a ɛyɛ ketewaa mpo ba nsu no mu. Bere nyinaa fa "asaabo mu ɔbo a edi kan a ɛboro mfe 50" di dwuma sɛ aortic ntɛmpɛ a ebetumi aba a ɛhwehwɛ sɛ wɔyɛ ntɛmpɛ dwumadibea CT scan anaa ultrasound.
4. NHYƐ nsuo pii nhyɛ bere a adwene mu akisikuru a emu yɛ den no: Atosɛm bi a atrɛw ka kyerɛ nkurɔfo sɛ wɔmfa nsu lita pii nkɔ bere a asaabo mu ɔbo a emu yɛ den retu no na "wɔhohoro ɔbo no mfi mu." Bere a ureteral a ɛyɛ nnam asiw no, nsu pii a wɔnom no ma nsu a ɛba wɔ ɔbo a ayɛ basaa no so no yɛ kɛse, ɛma renal capsule no yɛ kɛse te sɛ balloon a ɛyɛ den (hydronephrosis), ɛma renal pelvic pressure yɛ kɛse, ɛma ɔfe a emu yɛ den, na ɛde asiane ba sɛ renal calyx no bɛpaapae (forniceal rupture). Sɛ sukɔm de wo na ɛnyɛ wo yaw nkutoo a, nom nsu kakraa bi.
5. Fa mpɔtam hɔ ɔhyew a ɛma awerɛkyekye (aguare a ɛyɛ hyew, aguaree, anaa ɔhyew aduru) gu afã no so sɛ atiridii biara nni hɔ a: Nea ɛnte sɛ appendicitis (baabi a wɔabara ɔhyew) no, ayaresabea sɔhwɛ ahorow a wɔanhyɛ da kyerɛ sɛ sɛ wode ɔhyew afiri a ɛyɛ hyew anaa ntama a ɛyɛ hyew (40 kosi 42 digrii Celsius / 104 kosi 107.6 digrii Fahrenheit) si hɔ tẽẽ wɔ akyi/afã ase no ma ureteral smooth muscle spasm no dwo na ɛtew adwene mu yaw a emu yɛ den ne akisikuru a ɛba bere a wɔde rekɔ no so kɛse.
6. Fa fine mesh strainer, kɔfe filter, anaa gauze mu yiyi nsu nyinaa mu sɛ worehwɛ ɔbo a wɔagye atom sɛ ɛnyɛ den so a: Sɛ wokyere ɔbo a atwam no (a ebia ɛte sɛ anhwea anaa abotan a ɛyɛ bruu, kɔkɔɔ, anaa tan a ɛyɛ mmerɛw milimita 2 kosi 5) a, ɛma ntini ho animdefo tumi hwehwɛ ne nnuru pɔtee mu (calcium oxalate, uric acid, . struvite, anaa cystine) na esiw abo a ɛbɛba daakye ano.

flowchart TD
    Start["Mpofirim, Ayɛ yaw Flank / Costovertebral Angle Akyi Ɛyaw a Ɛhyerɛn Twa Afã Kosi Groin, Testicle, anaa Labia"] --> CheckSepsis{"1. Hwɛ Asaabo a Ɛyare no Asiw (Urosepsis) Frɛko Kɔkɔɔ: Atiridii (>=38.0 C), Atiridii/Atirimɔdensɛm, Nsu a Ɛyɛ Fɛ a Mununkum wom, Adwennwen, Anaasɛ Ahodwiriw?"}
    CheckSepsis -->|Yes| CallEMS["Frɛ Emergency Services (911 / 112 / 999) Ntɛm ara: Bere a ɛho hia sɛ wɔtew Urological Decompression so"]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. So Ɔyarefo a Wadi Bɛboro Mfe 50 Wɔ ‘Ɔbo a Edi Kan’, Aortic Aneurysm a Wonim, Atiridiinini, Anaasɛ Syncope?"}
    CheckAAA -->|Yes| CallEMS_AAA["Frɛ Nnwuma a Ɛho Hia Ntɛmntɛm: Yi Yafunu mu Aortic Aneurysm a Apaapae (AAA) no fi hɔ ."]
    CheckAAA -->|No| CheckRenal{"3. Hwɛ Asaabo & Ɔfe Red Flags: Solitary/Transplant Asaabo, Nyinsɛn, Zero Urine Output, anaasɛ Ɔfe a Wontumi Nsa?"}
    CheckRenal -->|Yes| UrgentED["Fa Kɔ Ayaresabea Dwumadibea a Ɛhwɛ Ntɛmntɛm so Ntɛm ara a Ɛhwɛ IV Analgesia, Antiemetic, ne Mfoninitwa"]
    CheckRenal -->|No Red Flags| EvalED["Yɛ Aduruyɛ mu Nhwehwɛmu a Wɔyɛ Ntɛmntɛm (Non-Contrast CT / Ultrasound) ne Nsu a Wɔde Yɛ Adwuma ho nhyehyɛe"]
    CallEMS --> FirstAid["4. Fa Warm Pack gu Flank (Sɛ Atiridii biara nni hɔ a), MMFA Nhyɛ Nsuo Nsuo Bere a Acute Spasm, Fa Si hɔ a Ɛyɛ Ahotɔ"]
    UrgentED --> FirstAid

--- .

Renal Colic a Ɛnyɛ Den ne Asaabo a Ɛyare a Ɛsiw (Pyonephrosis ne Urosepsis) .¶

Dɛn nti na wɔde ɛyaw ano aduru ne hwɛ di asaabo mu ɔbo a enni ɔyare mmoawa ho dwuma dwoodwoo, bere a asaabo mu ɔbo a ɛwɔ nsu mu yare no yɛ ntɛmpɛ a edi awu sen biara wɔ ayaresabea nnuruyɛ mu no mu biako?

Wɔ asaabo mu ɔbo a ɛnyɛ den (renal colic) mu no, nsu a ɛnyɛ den no san kɔ ɔbo a ɛwɔ ureter ne renal pelvis mu no akyi (hydronephrosis). Bere a adwene no mu ntini a ɛyɛ nhama a ɛtrɛw ne nsu a ɛkɔ nsu mu no ma ɛyɛ yaw kɛse 10/10 no, nsu no ankasa yɛ nea enni mmoawa.

Wɔ asaabo a ɔyare no asiw mu (pyelonephritis a esiw kwan anaa pyonephrosis) mu no, mmoawa (te sɛ Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, anaa Enterococcus) akɔhyɛ ɔbo no atifi nhyehyɛe a wɔato mu a wɔde nhyɛso ahyɛ mu no mu. Asaabo a asiw no titiriw bɛyɛ akuru a wɔato mu wɔ ntini a ɛtwetwe nhyɛso kɛse ase:

1. Nea enti a nnuru a ekum ɔyare mmoawa nkutoo NTUMI nkɔ anaa ɛsa asaabo a ɔyare no asiw no: Nea edi kan no, esiane sɛ glomerular filtration gyae wɔ asaabo a asiw kwan koraa mu nti, nnuru a wɔde fa ntini mu anaa wɔnom no ntumi nkɔ nsu a ɛyɛ mmerɛw a ɛwɔ ɔbo no atifi no mu. Nea ɛto so abien no, nhyɛso a ɛkɔ soro wɔ akyi berɛmo mu (boro 30 kosi 40 mmHg) bue nusu nketenkete wɔ adwene no mu ntini no ano (pyelovenous ne pyelolymphatic backflow), na ɛde mmoawa a wɔte ase ne mmoawa endotoxin gu mogya a ɛwɔ nipadua no mu no mu tẽẽ bere biara a koma bɔ biara.
2. Sɛnea urosepsis kum ntɛmntɛm a nsuo ntumi nkɔ mu: Sɛ wɔamfa mfiri amfa mfiri asɛe asaabo no ntɛm ara (retrograde ureteral stenting wɔ oprehyɛn dan mu anaa percutaneous nephrostomy tube a wɔde fa akyi denam interventional radiology so), nnipa a wowuwu wɔ obstructive urosepsis mu no boro ɔha biara mu nkyem 20 kosi 40, na ɛtwentwɛn decompression ase sɛ ɛboro nnɔnhwerew 12 kosi 24 a, asiane a ɛwɔ hɔ sɛ septic shock ne owu bɛba no mmɔho abiɛsa.

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Anatomy of a kidney stone attack: Sɛnea ɛyaw beae di ɔbo no akwantu a ɛkɔ fam wɔ ureter no akyi¶

Asaabo mu ɔbo nyɛ yaw bere a ɔte asaabo no adwene mu ntini a ɛtrɛw no mu komm (gye sɛ ɛyɛ ɔbo kɛse bi a ɛde ɔyare mmoawa ba staghorn). Ɛyaw pae bere a ɔbo no kɔ ureter a ɛyɛ teateaa a ɛyɛ ntini (a ne tɛtrɛtɛ yɛ milimita 2 kosi 4 pɛ) no mu na ɛyɛ mmerɛw wɔ anatomical choke points abiɛsa (narrowings) a ɛwɔ urinary tract no mu biako so no. Bere a ɔbo no kɔ fam kɔ akisikuru no mu no, beae a ɛyaw no wɔ no sesa sɛnea wɔhyɛɛ nkɔm wɔ ilioinguinal ne genitofemoral ntini (T11 kosi L2) no so:

Choke Point 1: Ureteropelvic Junction (UPJ, baabi a asaabo no mu ntini no hyia asaabo no atifi) .¶

• Baabi a wote nka: Ɛyaw a ɛba mpofirim, emu dɔ, te sɛ sekan a ɛkorɔn wɔ costovertebral angle (CVA), ntwea a ɛte sɛ V wɔ w’akyi baabi a mpampam a ɛto so 12 a ɛwɔ ase no hyia akyi berɛmo no.
• Nsɛnkyerɛnne a ɛbata ho: Esiane sɛ asaabo no mu ntini no ne yafunu no kyɛ celiac ganglion autonomic nerve fibers nti, UPJ akwanside a ɛkɔ soro no kanyan ntɛm ara, akisikuru a emu yɛ den ne ɔfe mpɛn pii a ɛtaa suasua a akisikuru ntua, dwensɔtwaa mu yare, anaa yafunu mu atiridii.

Choke Point 2: Iliac Mogya Ntini a Wɔtwa (Mid-ureter wɔ pelvic brim) .¶

• Baabi a wote nka: Ɛyaw no hyerɛn kɔ anim ne fam fi afã a atwa asen no afã ho ahyia no mu kɔ yafunu no ase nifa anaa benkum na ɛkɔ fam kɔ asen no mu.
• Diagnostic trap: Sɛ ɔbo bi gyina nifa mfinimfini ureter wɔ psoas ntini no so a, ɛsuasua ** yiye .appendicitis a emu yɛ den** (wɔ nifa so) anaa acute diverticulitis (wɔ benkum so). Nanso, hyɛ sɛnea ɔyarefo no yɛ n’ade no nsow:
• Ɔyarefo a ɔwɔ peritonitis a efi appendicitis da nwini na onhinhim wɔ mpa no so efisɛ biribiara a ɔkeka ne ho no yɛ peritoneum no yaw.
• Ɔyarefo a ɔwɔ renal colic ho twitwiw, ɔnam ɔkwan no so, twitwiw ne ho wɔ fam, na ɔsesa ne gyinabea bere nyinaa bɔ mmɔden kwa sɛ obenya anim a ɛbɛma ureteral spasm a ɛwɔ mu no afi hɔ ("the pacing sign").

Choke Point 3: Ureterovesical Junction (UVJ, baabi a ureter no ase hyɛn akisikuru no fasu mu) .¶

• Ɔpon a ɛyɛ teateaa sen biara wɔ nsu a ɛkɔ nsu mu (ne tɛtrɛtɛ yɛ milimita 1 kosi 2 pɛ): Aboɔ** bɛboro **ɔha biara mu nkyem 60 kosi 70 a wohu wɔ dwumadibea a wɔhwɛ ntɛmpɛ so CT scan mu no abata UVJ ha yi ara, milimita kakraa bi ansa na ahwe ase wɔ akisikuru no mu.
• Baabi a wote nka: Esiane sɛ ureter no ase ne akyi genitalia ne bladder base (trigone) kyɛ genitofemoral ne pudendal nerves (L1, L2, S2-S4) nti, ɔbo bi a wɔde abɔ UVJ no ma:
• Ɛyaw a ano yɛ den a ɛhyerɛn kɔ ipsilateral testicle ne scrotum mu tẽẽ wɔ mmarima mu, anaasɛ ɛkɔ labia majora ne vulva mu wɔ mmea mu (ɛhwehwɛ sɛ wɔde ahwɛyiye kyerɛ nsonsonoe a ɛda testicular torsion anaasɛ ovarian torsion deɛ; wɔ asaabo mu ɔbo mu no, sɛ wɔde wɔn nsa ka asaabo no ankasa a, ɛte sɛ nea ɛteɛ na ɛnyɛ nea ɛho ahonhon, bere a wɔ asaabo mu torsion mu no, awotwaa no tra soro, ɛho ahonhon, na ɛyɛ mmerɛw fɛfɛɛfɛ).
• Akisikuru ho sɛnkyerɛnne a ɛhyɛ abufuw kɛse: Nkate a egye ntɛmpɛ mpofirim sɛ ɛsɛ sɛ wototo wo ho simma 3 biara (nsuo a egye ntɛmpɛ na ɛtaa ba), ɛyaw a ɛhyew wɔ urethra no ano (dysuria), ne pink, red, anaa tii kɔla mogya nsu (gross hematuria) kakraa bi a wobɛfa mu, bere mpo a ɔyare mmoawa biara nni hɔ.
• Bere a ahotɔ wom: Sɛ awiei koraa no ɔbo no fa UVJ no mu kɔ nsu a ɛyɛ kɛse no mu pɛ a, ɛkame ayɛ sɛ ɛyaw a ɛyɛ yaw 10/10 afã ne akyi berɛmo no yera ntɛm ara. Sɛ wɔde ɔbo no fi akisikuru no mu akyiri yi fa nsu a ɛtrɛw (a ne tɛtrɛtɛ yɛ milimita 6 kosi 8) no mu a, ɛtaa ma wɔde sikɔne 2 twitwiw bere tiaa bi pɛ anaasɛ ɛbɔ anifere kwan so wɔ tiafi kuruwa no mu.

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Abo kɛseɛ ne abɔdeɛ mu kwan a ɛbɛtumi aba: Aboɔ bɛn na ɛtwam na ɛhe na ɛkyere?¶

Sɛ nnuruyɛfo a wɔhwɛ ntɛmpɛ so yɛ low-dose non-contrast CT scan of the yafunu ne akyi berɛmo (CT KUB) anaa renal ultrasound a, susudua biako pɛ a ɛho hia sen biara (sɛ yɛfa no sɛ ɔyare mmoawa biara nni hɔ anaasɛ asaabo a ɛyɛ ankonam nni hɔ) ne ɔbo no ntwemu a ɛtrɛw wɔ milimita mu:

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Nea enti a NSAIDs di opioid so nkonim ma asaabo mu ɔbo a ɛnyɛ yaw (ne bere a wɔabara NSAIDs katee) .¶

Sɛ wowɔ dwumadibea a wɔhwɛ ntɛmpɛ so anaasɛ oduruyɛfo bi a osii so dua dedaw sɛ wowɔ asaabo mu ɔbo a ɛnyɛ den, a ɛnyɛ den a asaabo no yɛ adwuma sɛnea ɛsɛ (serum creatinine a ɛyɛ daa) a, sɛnea nnuru a wɔde kum ɛyaw yɛ adwuma wɔ ureter no so ntease a wobɛte ase no boa ma ɛyɛ nwonwa:

1. Nea enti a Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) de wɔn ani si nea ɛde adwene mu yare ba no ntini so¶

Sɛ ɔbo siw asaabo no kwan a, nhyɛso a ɛkɔ soro wɔ asaabo no mu no kanyan Prostaglandin E2 (PGE2) ne prostacyclin a wɔyɛ wɔ mpɔtam hɔ no. Prostaglandin E2 yɛ nneɛma abien a ɛma adwene mu akisikuru yɛ yaw:

1. Ɛtrɛw afferent arterioles a ɛkɔ asaabo no glomeruli mu no mu, ɛma nsu a wɔde yi nsu mu nhyɛso kɔ soro tẽẽ kɔ asaabo a asiw dedaw a ahonhon no mu.
2. Ɛkanyan basabasayɛ, yaw ntini a ɛyɛ mmerɛw a ɛyɛ mmerɛw wɔ ureter fasu no ho twa ɔbo no ho hyia na ɛma mpɔtam hɔ ureteral fasu a ɛho ahonhon (edema).

NSAIDs (te sɛ ayaresabea ketorolac [Toradol] anaa akyi berɛmo/ano diclofenac, ibuprofen, anaa naproxen) siw prostaglandin a wɔyɛ no kwan tẽẽ (cyclooxygenase inhibition). Ɛdenam Prostaglandin E2 a ɛto mu so no, NSAIDs tew nhyɛso a ɛwɔ asaabo a ɛho ahonhon no mu bere koro mu, ɛma ureteral muscle spasms no brɛ ase, ɛtew ɔfe a atwa ɔbo no ho ahyia no so, na ɛma ɛyaw ano brɛ ase a ɛkorɔn anaasɛ ɛyɛ pɛ sɛ wɔde toto morphine a wɔde fa ntini mu ho a ɛmma opioid a ɛma ɔfe anaasɛ ɔtɔ.

2. Bere a wɔabara NSAIDs KƐSE wɔ ɔyarefo a ɔwɔ asaabo mu abo mu no¶

Esiane sɛ NSAIDs brɛ mogya a ɛkɔ asaabo a asiw no mu nsu a wɔde yiyi mu no ase nti, nnom ibuprofen, naproxen, ketorolac, anaa diclofenac da sɛ tebea horow a edidi so yi mu biara fa ho a:

• WONNYAA ayaresabea mogya mu nhwehwɛmu anaa abakɔsɛm a ɛkyerɛ sɛ asaabo yɛ adwuma sɛnea ɛsɛ, anaasɛ wowɔ asaabo mu opira a emu yɛ den (creatinine a ɛkɔ soro) anaa asaabo mu yare a enni sabea (CKD Stage 3, 4, anaa 5).
• Wowɔ asaabo BAKO a ɛyɛ adwuma (solitary kidney) anaasɛ asaabo a wɔde si ananmu: NSAID a wobɛnom bere a ɔbo asiw w’asaabo biako pɛ no ano no to ne afferent arteriolar mogya a aka no mu na ɛma acute renal failure ntɛmntɛm ntɛm ara.
• Woanyinsɛn (NSAIDs betumi apira awotwaa no asaabo nkɔso na ato awotwaa no ductus arteriosus no mu ntɛm).
• Wowɔ active peptic ulcer yare, . mogya a ɛba yafunu mu, anaasɛ nsu a ɛtɔ kɛse/urosepsis.
• Wɔ saa nsɛm no nyinaa mu no, ayaresabea nnuruyɛfo de acetaminophen a wɔde fa ntini mu (paracetamol) ne titrated opioids a wɔde fa ntini mu (anaasɛ ultrasound-guided erector spinae nerve blocks / intravenous lidocaine protocols) di dwuma sen NSAIDs.

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Ɔhwɛ a wɔyɛ no anammɔn biara ansa na wɔakɔ ayaresabea ne abo a wɔde siw ano bere tenten¶

Anamɔn 1: Ofie ne kar ho nhyehyɛe a ahobammɔ wom bere a tebea a emu yɛ den bi rekɔ so no¶

1. Fa thermometer hwɛ ɔhyew ntɛm ara: Ansa na wobɛsa asaabo mu ɔbo biara a wosusuw sɛ ɛwɔ fie no, susuw nipadua mu hyew. Sɛ ɔhyew yɛ 38.0 degrees Celsius (100.4 degrees Fahrenheit) anaa nea ɛboro saa (anaasɛ ɛba fam 36.0 C / 96.8 F), anaasɛ sɛ onipa no wɔ awɔw a ɛwosow a, gyae ofie hwɛ nyinaa na kɔ dwumadibea a wɔhwɛ ntɛmpɛ so tẽẽ anaa frɛ 911 / 112 / 999.
2. Fa abɔnten ɔhyew a ɛyɛ nnam gu akyi ne akyi: Fa ɔhyew aduru a ɛyɛ hyew, nsu a ɛyɛ hyew toa a wɔde mpopaho abɔ mu, anaa nnuru a ɛyɛ hyew a ɛyɛ hyew a ɛwɔ 40 kosi 42 degrees Celsius (104 kosi 107.6 degrees Fahrenheit) gu akyi a ɛyɛ yaw no so ne akyi bere a wode rekɔ no.
3. Kwati nsu a wɔhyɛ wo ma wo bere a ɛyaw a emu yɛ den no dɔɔso: Bere a woretwɛn sɛ ɛyaw asorɔkye no bɛbrɛ ase anaasɛ worekɔ baabi a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu no, nnom nsu nkuruwa. Sɛ wodi acute colic spasm no so na akisikuru no ano aduru wie a, san fi ase nom nsu a ɛfata, a ɛkɔ so daa (lita 2.0 kosi 2.5 da biara) na aboa ma wɔde ɔbo no akɔ fam.
4. Boaboa nsuo biara ano na yiyi mu: To nsuo gu plastic nsuo dan, kuruwa, anaa kyɛw a ɛho tew mu na hwie fa aduruyɛ aboɔ a wɔde yiyi nsuo anaa krataa fitaa kɔfe afiri mu. Sɛ wɔkyere ɔboɔ a ɛyɛ den ahwehwɛ wie a, ma mframa nwo wɔ pill toa a ɛho tew mu (mfa tiafi krataa a ɛyɛ nsuo nkyekyere no da, a ɛpete anaa ɛbata ahwehwɛ no ho) na fa kɔ wo duruyɛfoɔ nkyɛn ma Fourier-transform infrared spectroscopy (FTIR) anaa X-ray diffraction stone analysis.

Anamɔn 2: Aduan ho anammɔn a egyina adanse so a wɔde besiw asaabo mu ɔbo a ɛto so abien ano¶

Sɛ nsakrae ansiw ano a, wɔn a wɔyɛ asaabo mu abo nea edi kan no mu ɔha biara mu nkyem 50 benya ɔbo foforo wɔ mfe 5 kosi 10 ntam:

• Nom nsuo a ɛdɔɔso a anyɛ yie koraa no, wobɛtumi ayɛ lita 2.5 (85 fluid ounces) a ɛyɛ kɔkɔɔ a ɛyɛ mmerɛw nnɔnhwerew 24 biara: Saa su baako yi twa aboɔ a ɛsan ba no mu mmienu wɔ aboɔ ahodoɔ nyinaa mu.
• Fa abɔdeɛ mu citrate (lemon anaa lime nsuo ankasa) ka wo da biara da nsuo ho: Citrate a ɛwɔ nsuo mu no kyekyere calcium a ɛwɔ nsuo mu na ɛfiri awosu mu siw calcium oxalate ne calcium phosphate ahwehwɛ no kwan sɛ ɛbɛbata ho.
• MMFA aduane mu calcium ano hye (di nufusu/calcium a ɛfata NE aduane), nanso TWƐ sodium (nkyene) pii so: Nea ɛyɛ nwonwa no, aduan a calcium kakraa bi nnim ma calcium oxalate asaabo mu aboɔ yɛ kɛseɛ ɛfiri sɛ aduane mu calcium a ɛwɔ wo dwensɔtwaa mu no kyekyere oxalate a ɛfiri aduane mu (spinach, rhubarb, almonds, beets, chocolate, tii) enti efi wo nsu mu sen sɛ ɛbɛkɔ wo nsu mu. Aduan a ɛdɔɔso sodium (nkyene) hyɛ asaabo no ma ɛtow calcium a ɛboro so gu nsu mu (hypercalciuria).

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Nnuru ahorow 4 a ɛwɔ asaabo mu abo ne tebea titiriw a egye ntɛmpɛ mu ntease¶

Sɛ wɔkyere asaabo mu ɔbo wɔ afiri a wɔde yiyi mu anaasɛ woyi fi hɔ bere a wɔreyɛ ureteroscopy a, aduruyɛdan mu nhwehwɛmu kyerɛ aboɔden abo mmusua atitiriw anan no mu nea ɛde ɔbo no bae, na emu biara kura ntɛmpɛ ho nsusuwii soronko:

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Asaabo mu abo bere a wɔyem ne ayarefo a wɔwɔ Indwelling Ureteral Stent¶

1. Renal colic bere a nyinsɛn (Ɛbɔ ɛna ne akokoaa nyinaa ho ban) .¶

Bɛyɛ ayarefo a wɔyem 200 kosi 1,500 biara mu 1 nya asaabo mu ɔbo a emu yɛ den, mpɛn pii no wɔ bere a ɛto so abiɛsa ne abiɛsa mu (bere a progesterone ma ureteral smooth muscle no dwo na awotwaa a ɛreyɛ kɛse no mia ureters no, titiriw wɔ nifa so no).

• Nea enti a ayarefo a wɔyem a wɔwɔ renal colic hia sɛ wɔyɛ ayaresabea nhwehwɛmu ntɛm ara:
• Adwene mu ɛyaw a emu yɛ den a wɔansa ne pyelonephritis a esiw kwan wɔ nyinsɛn mu no betumi akanyan awo a ɛba ntɛm ne awo a ɛba ntɛm, ɛnanom urosepsis, ne mogya mmoroso a ɛte sɛ preeclampsia.
• Diagnostic imaging a radiation nka ho: Dwumadibea ahorow a wɔhwɛ ntɛmpɛ so mfa CT scan a wɔahyɛ da ayɛ nni dwuma da sɛ sɔhwɛ a edi kan wɔ nyinsɛn mu; mmom no, wɔde Renal ne Pelvic Ultrasound (a wɔsusu ureteral jets na wɔkyerɛ nsonsonoeɛ a ɛda nipadua mu hydronephrosis a ɛba nyinsɛn mu ne ɔboɔ ntam) di dwuma a sɛ ɛhia a, wɔde non-contrast Magnetic Resonance Urography (MRU) anaasɛ ultra-low-dose protocols di akyi.
• Nnuru ahobanbɔ: Wɔbara NSAIDs (ibuprofen, ketorolac, naproxen) katee wɔ nyinsɛn mu. Wɔde acetaminophen a wɔde fa ntini mu ne opioids a wɔahyɛ no titrated di ɛyaw ano dwoodwoo, na sɛ atiridiinini, urosepsis, anaa ɛyaw a ɛnyɛ den ba a, ntini ho animdefo de bere tiaa mu internal ureteral JJ stent gu hɔ. (wɔsesa no adapɛn 4 kosi 6 biara efisɛ nyinsɛn ma calcium a ɛwɔ stent so no yɛ ntɛmntɛm) kosi awo akyi.

2. Ɔhwɛ a egye ntɛmpɛ ma ayarefo a wɔwɔ Indwelling Ureteral Stent ("JJ Stent") dedaw .¶

Sɛ nnansa yi ara na ɔyarefo bi nyaa double-J (JJ) ureteral stent a urologist de guu wɔn ureter mu (sɛnea ɛbɛyɛ a obetwa ɔbo bi ho anaasɛ ɔbɛsa yare wɔ laser lithotripsy akyi) a, ma nea ɛyɛ daa ne nea egye ntɛmpɛ mu nna hɔ:

• Stent ho sɛnkyerɛnne a ɛte saa a wɔhwɛ kwan: Nsu a ɛyɛ pink anaa kɔkɔɔ a ɛnyɛ den bere a woanantew akyi, ɛyɛ yaw wɔ afã pɔtee bere a wɔreto nsu (a ɛnam akisikuru nhyɛso a ɛsan kɔ soro wɔ stent afiri a ɛwɔ tokuru no mu nti), ne akisikuru a ɛyɛ ntɛm/mpɛn a ɛba wɔ stent no ase coil no mu a ɛnyɛ den (a wɔde tamsulosin ne oxybutynin/solifenacin a wɔakyerɛw ama no sa).
• Red-flag stent ntɛmpɛ a ɛhwehwɛ sɛ wɔkɔ dwumadibea a wɔhwɛ ntɛmpɛ so ntɛm ara:
• Atiridii foforo (>=38.0 C / 100.4 F) anaasɛ awɔw (ɛkyerɛ sɛ stent no ayɛ nea ɛkata so anaasɛ biofilm ne akisikuru ahyɛ mu).
• Ɛyaw a emu yɛ den a ɛyɛ 10/10 akyi a ɛsan ba a ennyae bere a woatow nsu awie (ɛkyerɛ sɛ stent no atu afi ne gyinabea anaasɛ mogya a ɛtɔ anaa ɔbo asinasin ahyɛ mu).
• Nsuo a ɛyɛ den na ɛyɛ kɔkɔɔ tuntum a mogya a ɛtɔ gu mu kɛse anaa nsuo a ɛntumi nkɔ (acute urinary a ɛkɔ nipadua no mu) na ɛyɛ.
• Stent hama a ɛsensɛn hɔ no tu anaasɛ ɛtwe: Bere tiaa mu stent ahorow bi wɔ nylon tether hama a ɛyɛ tratraa a efi urethra no mu ma ɛyɛ mmerɛw sɛ wobeyi afi hɔ wɔ adwumayɛbea; w’ankasa ntwe stent hama da gye sɛ wo urologist kyerɛ no pefee sɛ yi fi hɔ wɔ saa bere a wɔahyɛ no mu.

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Nsɛm a wɔtaa bisa¶

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Sources a wɔhwɛɛ mu¶

• Europa Fekuo a Ɛhwɛ Nsuo mu Ntini Ho Nsɛm So (EAU): EAU Akwankyerɛ a ɛfa Nsuo mu Ntini Ho (2024 Nsakraeɛ): Acute Renal Colic Management, Medical Expulsive Therapy, ne Emergency Decompression of the Obstructed Infected Kidney.
• Amerika Urological Association (AUA) ne Endourological Society (United States): Aduruyɛ mu Asaabo mu Aboɔ a Wɔde Di Dwuma ne Oprehyɛn a Wɔde Hwɛ Aboɔ so: AUA/Endourological Society Akwankyerɛ.
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom): Adwene ne Nsuo mu Aboɔ: Nhwehwɛmu ne Dwumadie (NG118).
• Surviving Sepsis Campaign (SSC) ne Infectious Diseases Society of America (IDSA): Amanaman ntam Akwankyerɛ a ɛfa Urosepsis ho dwumadie ne Source Control a Egye Ntɛmntɛm wɔ Obstructive Pyelonephritis mu.
• Pathan S. A., Mitra B., Straney L. D., ne afoforo. (The Lancet): Ɛyaw ano aduru a ahobammɔ wom na etu mpɔn a wɔde ma de di adwene mu akisikuru ho dwuma wɔ dwumadibea a wɔhwɛ ntɛmpɛ so: sɔhwɛ a wɔde anifurae abien, akuw pii, a wɔanhyɛ da ahwɛ so (a ɛkyerɛ sɛ NSAIDs korɔn sen morphine ma adwene mu akisikuru a emu yɛ den).

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Akwankyerɛ ahorow a ɛfa ho¶

• Sepsis ne septic shock a wohu ne mmoa a edi kan a wɔde ma ntɛm
• Aortic dissection ne yafunu mu aortic aneurysm a apaapae
• Nsu a wɔde siw nsu mu denneennen ne indwelling catheter a wɔde hwɛ ntɛmpɛ a wɔasiw ano
• Testicular torsion, ovarian torsion, ne ɛyaw a emu yɛ den wɔ akyi berɛmo mu
• Rhabdomyolysis a wɔde mmɔdenbɔ yɛ, asaabo mu opira a emu yɛ den, ne nsu a ɛyɛ tumm
• Nnɔmba a egye ntɛmpɛ sɛnea ɔman biara te