ʻEha Pōhaku Puʻu Koʻikoʻi vs. ʻEha Pohaku ʻAʻai ʻAʻai (Urosepsis)¶

He mea kaulana ** ka hoʻouka ʻana i ka pōhaku ʻāʻī (acute renal colic)** no ka hoʻoulu ʻana i kekahi o nā ʻeha ʻeha loa a ke kanaka e ʻike ai, akā naʻe, ʻo ka pōhaku paʻakikī ma lalo o 5 millimeters (0.2 ʻīniha) e hala ma kāna iho i 80 a 90 pakeneka o nā hihia. Eia nō naʻe, ʻo ka manawa kūpono e paʻa ai ka pōhaku ʻāʻī ** mimi i maʻi ʻia** ma hope o ia i loko o ka pelvis renal (obstructive pyelonephritis / pyonephrosis), e hoʻololi ke kūlana o ke kino mai ka pōhaku ʻeha i waho i kahi ** ʻeha hōʻeha urological hoʻoweliweli **. Ma muli o ka hoʻomau ʻana o ke kīpē i keakea i ke kānana ʻana i ke koko ma ke kaomi kiʻekiʻe, ʻo ka bacteria a me nā endotoxins i hoʻopaʻa ʻia ma luna o ka pōhaku e koi pololei ʻia ma kēlā ʻaoʻao o ka papillae renal i loko o nā veins renal (pyelovenous backflow), e hoʻoulu ai i ka fulminant urosepsis, haʻalulu maʻemaʻe, a make i loko o 6 a 24 hola ke ʻole e hana koke ʻia ka hoʻoheheʻe ʻana i ka ʻoki kino (he stent JJ ureteral a i ʻole percutaneous nephrostomy tube).

ʻO kāu mau kuleana koke i ka wā e ʻeha nui ai ka ʻaoʻao, kua, a i ʻole ka ʻāʻī ʻāʻī e nānā koke no ka ** "Pohaku Infected" pilikia (kekahi renal colic i hui pū ʻia me ke kuni ma luna o 38.0 degere Celsius / 100.4 degere Fahrenheit, haʻalulu aʻe, paʻa ʻole, ʻaʻala ʻala no ka pus-complete , mimi hoʻopiha piha ʻana i ka mimi) (anuria a i ʻole hoʻokahi wale nō kīkī e hana ana), e hōʻoia i ka maʻi ma luna o 50 a hiki i 60 makahiki ʻaʻole he ka ʻeha ʻana o ka ʻōpū aortic aneurysm (AAA), e pale aku i na galani wai i ka wa o ka ma'i eha nui (e hoolele ana i ka capsule kidney paa a hoonui i ka eha a me ka luai ana), a e kelepona koke aku i na lawelawe lapaau pilikia ina he mau hae ulaula.

E hana i kēia i kēia manawa¶

1. E kāhea koke i nā lawelawe lapaʻau kūikawā inā loaʻa ka FEVER, CHILLS, a i ʻole SHOCK ("An Infected Block Kidney"): E kelepona i kāu helu ulia pōpilikia kūloko (911 ma United States a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom, 000 ma Australia) a i ʻole e nānā i kā mākou papa kuhikuhi o helu pilikia inā loaʻa i kekahi kanaka me ka ʻeha koʻikoʻi o ka ʻaoʻao, kua, a i ʻole ka ʻāʻī, ua ulu ʻo ** i ke kuni (38.0 degere Celsius / 100.4 degere Fahrenheit a ʻoi aku paha) a i ʻole ka haʻahaʻa haʻahaʻa o ka wela o ke kino (<36.0 C / 96.8 F), ** ʻūlū hiki ʻole ke hoʻopaʻa ʻia (koʻikoʻi), ** ʻūhū a maule paha i ka wā e kū ana**, ** hiki ke hoʻokuʻu i ka mimi. ʻAʻole hiki i nā lāʻau lapaʻau waha wale ke hoʻōla i ka pus i paʻa ma hope o ka pōhaku; pono e hoʻokahe ʻia ke kīkī i loko o ka haukapila i loko o nā hola.
2. E hele koke i kahi keʻena ulia pōpilikia inā hoʻokahi wale nō kīkiʻi e hana ana (a i ʻole ka hoʻololi ʻana i ke kīpē) a i ʻole ke hāpai ʻia e ka pōhaku: Inā paʻa ka pōhaku i ka ureter o kahi kikini hoʻokahi a i ʻole he kikini i hoʻololi ʻia, ʻaʻohe puʻupaʻa kākoʻo o ke kanaka a komo koke i anuric ʻeha ʻeha ʻeha a me ka hyperkalemia weliweli i ke ola.
3. E hoʻokuʻu i ka ʻeha ʻana o ka Abdominal Aortic Aneurysm (AAA) i kēlā me kēia kanaka ma luna o 50 makahiki: I nā mākua ma luna o 50 (ʻoi aku ka nui o nā kāne, nā mea puhi paka, a i ʻole nā ​​kānaka me ke koko kiʻekiʻe) i ** ʻaʻole i loaʻa i ka pōhaku maʻi ma mua**, kahi haehae a hū paha aneurysm aortic abdominal ʻO ke koko retroperitoneal e kaomi ma luna o nā aʻalolo like ʻole e like me ka pōhaku ʻāʻī hema a ʻākau paha, e hoʻoulu ai i ka ʻeha like ʻole o ka ʻaoʻao a me ka ʻāʻī a me ke koko microscopic i loko o ka mimi. E mālama mau i ka "pōhaku kīkī manawa mua ma mua o 50 makahiki" ma ke ʻano he ulia pōpilikia aortic e koi ana i kahi keʻena ulia pōpilikia CT scan a i ʻole ultrasound.
4. Mai hoʻoikaika i ka nui o ka wai i ka wā o ka maʻi ʻaʻai koʻikoʻi o ka renal: Ua ʻōlelo kekahi moʻolelo moʻolelo i ka poʻe e ʻohi i nā lita o ka wai i ka wā o ka hoʻouka ʻana i ka pōhaku maʻi maʻi e "holo i ka pōhaku." I ka wā o ka ʻākea ureteral, ʻo ka inu ʻana i ka nui o ka wai e hoʻonui i ka hoʻohua ʻana o ka mimi ma luna o ka pōhaku paʻa, e hoʻomāhuahua ana i ka capsule renal e like me ka baluna paʻa (hydronephrosis), ka piʻi ʻana o ka puʻe pelvic renal, hoʻoulu i ka luaʻi nui, a me ka pōʻino o ka haki ʻana o ka puʻupaʻa renal (haʻi kolohe). E inu i ka wai liʻiliʻi inā make wai a ʻaʻole nausea.
5. E hoʻohana i ka ʻauʻau ʻauʻau, ka ʻauʻau, a i ʻole ka pā wela) ma ka ʻaoʻao inā ʻaʻohe maʻi kuni: ʻAʻole like me ka appendicitis (kahi i pāpā ʻia ai ka wela), hōʻike ʻia nā hoʻāʻo hoʻomaʻamaʻa ʻokoʻa e kau ana i kahi ** pā hoʻomaha mahana a i ʻole kahi pākeʻe wela (40 a 42 degere Celsius / 104 a 107.6 degere Fahrenheit ma luna o ka ʻiʻo haʻahaʻa)** hoʻemi nui i ka ʻeha colic renal a me ka nausea i ka wā o ka lawe ʻana.
6. E hoʻokaʻawale i ka mimi a pau ma o ka kānana makaʻala maikaʻi, kānana kope, a i ʻole ka gauze inā mālama ʻia kahi pōhaku paʻakikī ʻole: ʻO ka hopu ʻana i ka pōhaku i hala (e like paha me kahi ʻāpana liʻiliʻi 2 a 5 millimeter ʻeleʻele, melemele, a ʻeleʻele paha o ke one a i ʻole ka ʻiliʻili) hiki i nā urologists ke kālailai i kona haku mele ponoʻī (calcium oxalate, uric acid, strustone)

flowchart TD
    Start["ʻEha ʻeha ʻeha hope, ʻeha ʻeha o hope / Costovertebral Angle Back a puni ka ʻaoʻao a hiki i ka groin, Testicle, a i ʻole Labia."] --> CheckSepsis{"1. E nānā i nā ʻōpū ʻaʻai ʻia (Urosepsis) Nā Hae ʻulaʻula: ʻO ke kuni (>=38.0 C), ʻO ke ʻano ʻino/kaikaʻi ʻana, ʻAi ʻino ʻino, Piʻoloke, a i ʻole Haʻalulu?"}
    CheckSepsis -->|Yes| CallEMS["Kāhea i nā lawelawe ulia pōpilikia (911 / 112 / 999) koke: Pono ka hoʻopau ʻana i ka Urological Decompression i ka manawa."]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. ʻO ka maʻi ma luna o 50 makahiki me ka 'pōhaku manawa mua', ʻike ʻia ʻo Aortic Aneurysm, Dizziness, a i ʻole Syncope?"}
    CheckAAA -->|Yes| CallEMS_AAA["Kāhea koke i nā lawelawe ulia pōpilikia: E hoʻokuʻu i ka ʻāʻī ʻana o ka ʻōpū aortic aneurysm (AAA)"]
    CheckAAA -->|No| CheckRenal{"3. Nānā Kidney & Vomiting Red Flags: Solitary/Transplant Kidney, Pregnancy, Zero Mimi Output, or Intractable Vomiting?"}
    CheckRenal -->|Yes| UrgentED["E lawe koke aku i kahi Keʻena Hoʻopiʻi Haukapila no IV Analgesia, Antiemetics, a me ke Kiʻi"]
    CheckRenal -->|No Red Flags| EvalED["E hoʻonohonoho i ka loiloi Lapaʻau wikiwiki (Non-Contrast CT / Ultrasound) a me ka ʻāʻī ʻana o ka mimi"]
    CallEMS --> FirstAid["4. E hoopili i ka Puke Pumehana ma ka aoao (ina aole he kuni), mai hooikaika i ka wai i ka wa o ka ma'i ma'i, e noho oluolu."]
    UrgentED --> FirstAid

ʻO ka Colic Renal Paʻakikī ʻole me ke Kidney i hoʻopaʻa ʻia (Pyonephrosis a me Urosepsis)¶

No ke aha e mālama pono ʻia ai ka pōhaku kīkī me ka ʻole o ka maʻi me ka mālama ʻana i ka ʻeha a me ka nānā ʻana, ʻoiai ʻo ka pōhaku puʻupaʻa * me * ka maʻi urinary tract kekahi o nā ulia pōpilikia make loa i ka lāʻau lapaʻau?

I loko o ka pōhaku kīkī paʻakikī (renal colic), hoʻihoʻi ka mimi maʻemaʻe ma hope o ka pōhaku i loko o ka ureter a me ke pelvis renal (hydronephrosis). ʻOiai ʻo ka hoʻolōʻihi ʻana o ka capsule renal fibrous a me ka spasm o ka ureter e hōʻeha i ka ʻeha 10/10, ʻo ka mimi ponoʻī he sterile.

I loko o kahi kiʻi maʻi i hoʻopaʻa ʻia (pyelonephritis a i ʻole pyonephrosis), paʻa nā hua bacteria (e like me Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, a i ʻole Enterococcus) i loko o ka ʻōnaehana hōʻiliʻili paʻa ma luna o ka pōhaku. Lilo maoli ka puʻupaʻa keʻakeʻa i ** abscess paʻa ma lalo o ke kaomi kānana ʻaʻa kiʻekiʻe**:

1. No ke aha ʻaʻole hiki i nā lāʻau ʻokoʻa wale nō ke hiki a hoʻōla paha i kahi puʻupaʻa i keakea ʻia: ʻO ka mua, no ka mea, ua kū ka kānana glomerular i loko o kahi puʻupaʻa paʻa loa, ʻaʻole hiki i nā lāʻau ʻokoʻa a i ʻole nā ​​antibiotics ke kānana i loko o ka mimi paʻa ma luna o ka pōhaku. ʻO ka lua, ʻo ke kaomi intrapelvic kiʻekiʻe (** ma luna o 30 a i 40 mmHg**) wehe i nā waimaka microscopic ma nā kihi o nā calyces renal (pyelovenous and pyelolymphatic backflow), e hoʻokomo pololei i ka bacteria ola a me ka endotoxin bacteria i loko o ke kahe koko pūnaewele me kēlā me kēia puʻuwai.
2. ** Pehea ka wikiwiki o ka make ʻana o ka urosepsis me ka ʻole o ka hoʻokahe ʻana:** Me ka ʻole o ka hoʻohaʻahaʻa ʻana i ka mīkini ulia pōpilikia (retrograde ureteral stenting in the operating room or percutaneous nephrostomy tube placement through the back by interventional radiology), make mai ka obstructive urosepsis ma mua o 20 a 40 pakēneka, a me ka hoʻopaneʻe ʻana o 12 mau hola o ka haʻalulu o ka haʻalulu. make.

Anatomy o ka hoʻouka ʻia ʻana o ka pōhaku ʻāʻī: Pehea e ʻike ai ka wahi ʻeha i ka hele ʻana o ka pōhaku ma lalo o ka ureter¶

ʻAʻole ʻeha ka pōhaku puʻupaʻa i ka wā e noho mālie ana i loko o ka puʻupaʻa ākea o ka puʻupaʻa (koe naʻe he pōhaku maʻi staghorn nui). Pahū ka ʻeha i ka manawa e hāʻule ai ka pōhaku i loko o ka ureter muscular ʻiʻo (ʻo ia wale nō 2 a 4 millimeters ka laula) a wili ʻia ma kekahi o nā ** ʻekolu anatomical choke point (narrowings) o ka ʻāpana mimi. I ka neʻe ʻana o ka pōhaku i lalo i ka ʻōpū, hiki ke neʻe ka wahi o ka ʻeha ma ka ** ilioinguinal a me genitofemoral nerves (T11 a i L2)**:

ʻAi ʻAi 1: ʻO ka Ureteropelvic Junction (UPJ, kahi e hui ai ka puʻupuʻu puʻupaʻa me ka piko o ka ureter)¶

• Ma hea ʻoe e manaʻo ai: ʻEha hikiwawe, hohonu, e like me ka pahi ma ka costovertebral angle (CVA), ke kihi ʻano V ma kou kua kahi e hui ai ka iwi ʻaoʻao lalo me ka iwi kuamoʻo.
• Nā hōʻailona pili: Ma muli o ka hui pū ʻana o ka puʻupuʻu puʻupaʻa i nā puʻupuʻu aʻalolo celiac ganglion autonomic me ka ʻōpū, hoʻoulu ʻia ʻo UPJ kiʻekiʻe ** nausea ikaika a me ka luaʻi pinepine ʻana** e hoʻohālike pinepine i kahi ka hoʻouka ʻana o ka maʻi ʻōpū, ka pancreatitis, a i ʻole maʻi ʻōpū.

ʻAi ʻAi 2: Ke ʻaʻa ʻana i nā ʻAha Koko Iliac (Mid-ureter ma ka pelvic brim)¶

• Ma hea ʻoe e manaʻo ai: Hoʻomaka ka ʻeha i mua a i lalo mai ka ʻaoʻao a puni ka ʻaoʻao o ka pūhaka a i ka ** ʻāʻī ʻōpū ʻākau a hema paha** a i lalo i ka ** ʻāʻī ʻāʻī **.
• He pahele hoʻomaʻamaʻa: Ke kū ka pōhaku ma ka ʻaoʻao waena ʻākau ma luna o ka ʻiʻo psoas, hoʻohālikelike ʻo ia ʻo ka appendicitis koʻikoʻi (ma ka ʻaoʻao ʻākau) a i ʻole ** acute diverticulitis** (ma ka ʻaoʻao hema). Eia naʻe, e nānā i ka hana a ka mea maʻi:
• ʻO ka mea maʻi me peritonitis mai ka appendicitis e moe ana ** me ka hau a me ka neʻe ʻole** ma luna o ka moena no ka mea e ʻeha kēlā me kēia neʻe ʻana i ka peritoneum.
• ʻO ka mea maʻi me ka renal colic writh, holo i ke alaloa, wili ma ka papahele, a hoʻololi mau i ke kūlana e hoʻāʻo wale ana e ʻimi i kahi kihi e hoʻomaha ai i ka spasm ureteral kūloko ("ka hōʻailona pacing").

Lae Kuʻi 3: ʻO ka Ureterovesical Junction (UVJ, kahi e komo ai ka lalo o ka ureter i ka paia o ka ʻōpū)¶

• ** ʻO ka puka haiki loa o ka ʻāpana mimi (1 wale nō a 2 millimeters ka laula): ** Ma luna o 60 a 70 pakeneka o nā pōhaku i loaʻa ma ka ʻoihana pilikia CT scans ua paʻa ma ʻaneʻi ma UVJ, mau millimeters wale nō ma mua o ka hāʻule ʻana i loko o ka ʻōpū.
• Ma hea ʻoe e manaʻo ai: No ka mea, ʻo ka lalo o ka ureter e kaʻana like i ka genitofemoral a me nā aʻalolo pudendal (L1, L2, S2-S4) me ka ʻōpū o waho a me ke kumu o ka ʻōpū (trigone), he pōhaku i wili ʻia i ka UVJ ke kumu:
• E ʻeha koʻikoʻi e lele pololei ana i loko o ka ipsilateral testicle a me ka scrotum i loko o nā kāne, a i ʻole i loko o ka labia majora a me ka vulva o nā wahine (e koi ana i ka wehe pono ʻana mai ʻo ka ʻāʻī ʻana o ka testicular a i ʻole ke ʻano ovarian torsion; i loko o ka pōhaku kīkī, manaʻo ka testicle ponoʻī a ʻaʻole pehu ke hoʻopā mālie ʻia, akā ma ka testicular torsion noho kiʻekiʻe ka testicle, pehu, a palupalu maikaʻi).
• ** ʻO nā hōʻailona ʻeha o ka ʻōpū:** Manaʻo koke e pono ʻoe e mimi i kēlā me kēia 3 mau minuke (ka mimi a me ka pinepine), ka ʻeha wela ma ka piko o ka ʻōpū (dysuria), a me ka hoʻoheheʻe ʻana i kekahi mau kulu o ka ** ʻulaʻula, ʻulaʻula, a ʻulaʻula paha ke koko (gross hematuria)**, ʻoiai inā ʻaʻohe maʻi maʻi.
• ** ʻO ka manawa hoʻomaha:** Ke puka hope loa ka pōhaku ma ka UVJ i loko o ka ʻōpū mimi ākea, ʻo ka ʻeha ʻeha 10/10 a me ka ʻeha ʻāʻī ** nalo koke koke **. ʻO ka hele ʻana i ka pōhaku ma hope mai ka ʻōpū ma waho o ka ʻākea ākea (ʻo ia ka 6 a 8 millimeters ka laula) maʻamau ke kumu wale nō i kahi pine pōkole 2-kekona a i ʻole he *clink maʻalahi i loko o ke kīʻaha lua.

ʻO ka nui o ka pōhaku a me ka hiki ke hele maoli: ʻO wai ka pōhaku i hala a ʻo wai ka mea paʻa?¶

Ke hana nā kauka ulia pōpilikia i kahi haʻahaʻa haʻahaʻa non-contrast CT scan o ka ʻōpū a me ke pelvis (CT KUB) a i ʻole kahi ** ultrasound renal**, ʻo ke ana nui loa (me ka manaʻo ʻaʻole he maʻi a i ʻole ka puʻupaʻa hoʻokahi) ʻo ia ka ke anawaena transverse o ka pōhaku i millimeters:

No ke aha i hahau ai nā NSAID i nā opioids no ka ʻeha pōhaku ʻāʻī (a i ka wā i pāpā ʻia ai nā NSAID)¶

Inā ʻoe i loko o ke keʻena ulia pōpilikia a i ʻole ua loiloi ʻia e ke kauka nāna i hōʻoia i kahi ** ʻaʻole paʻakikī, ʻo ka pōhaku maʻemaʻe me ka hana maʻamau maʻamau (normal serum creatinine)**, ʻo ka hoʻomaopopo ʻana i ke ʻano o ka hana ʻana o nā mea hōʻeha ʻeha ma ka ureter he mea kōkua nui ia:

1. No ke aha i hoʻopaʻa ai nā Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) i ke kumu kumu o ka colic renal¶

Ke paʻa ka pōhaku i ka ureter, hoʻoulu ka piʻi ʻana o ke kaomi i loko o ka puʻupaʻa i ka synthesis kūloko o Prostaglandin E2 (PGE2) a me prostacyclin. Hana ʻo Prostaglandin E2 i ʻelua mau mea e hōʻeha ai i ka colic renal:

1. Hoʻonui ia i nā arteriole afferent e komo ana i loko o ka glomeruli o ka puʻupaʻa, **hoʻonui i ke kaomi kānana mimi pololei i loko o ka puʻupaʻa i hoʻopaʻa mua ʻia, pehu **.
2. Hoʻoulu ia i ka ʻeha ʻeha ** nā ʻiʻo maʻemaʻe o ka pā ureter ** a puni ka pōhaku a hoʻonui i ka pehu ʻana o ka pā ureteral kūloko (edema).

NSAID (e like me ka halemai intravenous ketorolac [Toradol] a i ʻole rectal/oral diclofenac, ibuprofen, a i ʻole naproxen) hoʻopaʻa pololei i ka prostaglandin synthesis (cyclooxygenase inhibition). Ma ka pani ʻana i ka Prostaglandin E2, nā NSAID ** i ka manawa like e hoʻohaʻahaʻa i ke kaomi ʻana i loko o ka ʻāʻī o ke kīpē pehu, e hoʻomaha i nā ʻiʻo o ka ʻōpū, e hoʻemi i ka pehu ʻana a puni ka pōhaku, a hāʻawi i kahi hōʻoluʻolu maikaʻi a i ʻole like me ka morphine intravenous** me ka ʻole o ka luaʻi a me ka hiamoe ʻole o ka opioid.

2. I ka wā i pāpā ʻia ai nā NSAID i loko o ka mea maʻi maʻi pōhaku kīkī¶

Ma muli o ka ho'ēmi 'ana o ka NSAID i ke kahe o ke koko i loko o nā kānana o ka pu'upa'a ke'ake'a, 'a'ole loa e lawe i ka ibuprofen, naproxen, ketorolac, a i 'ole diclofenac inā pili kekahi o kēia mau 'ano:

• ** ʻAʻole i loaʻa iā ʻoe nā hoʻāʻo koko o ka haukapila a i ʻole kahi moʻolelo e hōʻoia ana i ka hana maʻamau maʻamau**, a i ʻole ʻoe he ** ʻeha kīkī nui (elevated creatinine)** a i ʻole ka maʻi kīkī mau (CKD Stage 3, 4, a i ʻole 5).
• ** Hoʻokahi wale nō ʻākena e hana ana ʻoe (kekini hoʻokahi) a i ʻole ka hoʻololi ʻana i ke kinikini:** ʻO ka lawe ʻana i kahi NSAID i ka wā i paʻa ʻia ai kāu puʻupaʻa e ka pōhaku e pani ai i ke koena o ke koko afferent arteriolar a hoʻopale koke i ka acute renal failure.
• Ua hāpai ʻoe (Hiki i nā NSAID ke hoʻopōʻino i ka ulu ʻana o ka pēpē pēpē a pani koke i ka fetal ductus arteriosus).
• ** Loaʻa iā ʻoe ka maʻi ʻeha peptic, kahe koko ʻōpū, a i ʻole dehydration koʻikoʻi/urosepsis.**
• Ma ia mau hihia a pau, hoʻohana nā kauka o ka haukapila i intravenous acetaminophen (paracetamol) a titrated intravenous opioids (a i ʻole ultrasound-guided erector spinae nerve blocks / intravenous lidocaine protocols) ma kahi o nā NSAID.

ʻO ka mālama prehospital step-by-step a me ka pale pōhaku lōʻihi¶

KaʻAnuʻu Hana 1: Mālama i ka home a me ka hoʻokele kaʻa i ka wā o kahi hanana koʻikoʻi¶

1. E nānā koke i ka wela me ka ana wela: Ma mua o ka mālama ʻana i nā pōhaku ʻākea i manaʻo ʻia ma ka home, e ana i ka wela o ke kino. Inā he 38.0 degere Celsius (100.4 degere Fahrenheit) a ʻoi aku paha (a i ʻole ma lalo o 36.0 C / 96.8 F), a i ʻole e haʻalulu ke kanaka, ** hoʻōki i ka mālama home a hele pololei i ke keʻena pilikia a i ʻole kelepona 911 / 112 / 999**.
2. E hoʻopili i ka wela o waho ma ka ʻaoʻao a me ke kua i lalo: E kau i kahi pā mehana, ka hue wai mehana i ʻōwili ʻia i ke kāwele, a i ʻole ka pūʻulu wela kemika ma 40 a 42 degere Celsius (104 a 107.6 degere Fahrenheit) ma luna o ka ʻaoʻao ʻeha a me ke kua i lalo i ka wā o ka lawe ʻana.
3. E hōʻalo i ka hoʻomaʻemaʻe ʻia i ka wā o ka ʻeha nui: I ka wā e kali ana i ka emi ʻana o ka nalu ʻeha a i ʻole e hele ana i ka lumi ulia pōpilikia, mai ʻohi i nā aniani wai. Ke hoʻomalu ʻia ka spasm acute colic a hoʻopau ʻia ka nausea, e hoʻomaka hou i ka inu wai maʻamau (2.0 a 2.5 lita i kēlā me kēia lā) e kōkua i ka lawe ʻana i ka pōhaku i lalo.
4. E hōʻiliʻili a kānana i kēlā me kēia kulu o ka mimi: E mimi i loko o kahi mimi plastik maʻemaʻe, kīʻaha, a i ʻole pāpale a ninini ʻia ma o kahi kānana pōhaku lāʻau a i ʻole kānana kope kope pepa keʻokeʻo. Ke hopu ʻia kahi aniani pōhaku paʻa, e maloʻo i ka ea i loko o kahi ʻōmole pila maʻemaʻe (ʻaʻole e uhi iā ia i loko o ka pepa toilet pulu, e hoʻoheheʻe a pili paha i ke aniani) a lawe mai i kāu kauka no Fourier-transform infrared spectroscopy (FTIR) a i ʻole X-ray diffraction stone analysis.

KaʻAnuʻu Hana 2: Nā ʻanuʻu meaʻai e pili ana i nā hōʻike e pale aku ai i ka lua o ka pōhaku ʻekena¶

Me ka ʻole o ka hoʻololi pale ʻana, 50 pākēneka o ka poʻe hana pōhaku ʻāʻī i ka manawa mua e loaʻa i kekahi pōhaku hou i loko o 5 a 10 mau makahiki:

• E inu i ka wai e lawa ai ka 2.5 lita (85 auneke wai) o ka mimi melemele haikea i kēlā me kēia 24 hola: ʻO kēia maʻamau hoʻokahi e ʻoki i ka hoʻi hou ʻana o ka pōhaku i ka hapalua ma nā ʻano pōhaku āpau.
• Hoʻohui i ka citrate maoli (lemona maoli a i ʻole ka wai lime) i kāu wai i kēlā me kēia lā: Hoʻopaʻa ka Citrate i loko o ka mimi i ka calcium mimi a hoʻopaʻa maoli i ka calcium oxalate a me ka calcium phosphate crystals mai ka hui pū ʻana.
• ** Mai kaohi i ka calcium meaʻai (ʻai maʻamau i ka waiu/calcium ME ME nā meaʻai), akā e ʻoki ʻoe i ka sodium kiʻekiʻe (paʻakai): ** ʻO ka mea ʻē aʻe, ʻo ka meaʻai haʻahaʻa-calcium * hoʻonui i nā pōhaku o ka calcium oxalate no ka mea e hoʻopili ai ka calcium meaʻai i loko o kou ʻōpū i ka oxalate mai ka meaʻai (spinach, rhubarb, almonds, beets, mimi ma mua o ka lau). ʻO ka meaʻai kiʻekiʻe sodium (paʻakai) ke koi nei i nā puʻupaʻa e hoʻolei i ka calcium nui i loko o ka mimi (hypercalciuria).

ʻO ka hoʻomaopopo ʻana i nā ʻano kemika 4 o nā pōhaku kīkī a me nā pilikia kūikawā¶

Ke hopu ʻia ka pōhaku kīkī i loko o kahi kānana a wehe ʻia paha i ka wā o ka ureteroscopy, ʻike ka ʻimi noiʻi ʻana i ka mea o nā **ʻohana mineral ʻehā nui i kumu i ka pōhaku, aia kēlā me kēia me nā manaʻo noʻonoʻo kūʻokoʻa.

ʻO nā pōhaku kīʻaha i ka wā hāpai a me nā mea maʻi me kahi Indwelling Ureteral Stent¶

1. Renal colic i ka wā hāpai (Hoʻomalu i ka makuahine a me ke keiki hānai)¶

Ma kahi o 1 i loko o 200 a i 1,500 mau maʻi hāpai e hoʻomohala ana i ka pōhaku ʻokiʻoki, ʻo ka mea maʻamau i ka makahiki ʻelua a me ke kolu o ka trimester (ke hoʻomaha ka progesterone i ka ʻiʻo maʻemaʻe o ka ureteral a hoʻopaʻa ka ʻōpū nui i nā ureter, ʻoi aku ma ka ʻaoʻao ʻākau).

• No ke aha e pono ai i nā poʻe maʻi hāpai me ka colic renal e loiloi koke i ka haukapila:
• ʻO ka ʻeha colic renal ʻaʻole i mālama ʻia a me ka pyelonephritis obstructive i ka hāpai ʻana, hiki ke hoʻoulu ʻia ** ka hana mua ʻana a me ka hānau mua ʻana **, maternal urosepsis, a me ka preeclampsia-like hypertension.
• Kiʻi diagnostic me ka ʻole o ka radiation: ʻAʻole hoʻohana nā keʻena pilikia i nā CT scan maʻamau ma ke ʻano he hoʻāʻo mua i ka wā hāpai; akā, hoʻohana lākou i ka Renal and Pelvic Ultrasound (ke ana ʻana i nā jet ureteral a me ka hoʻokaʻawale ʻana i ka hydronephrosis physiological o ka hāpai ʻana mai ka pōhaku) a ukali ʻia inā pono e ** non-contrast Magnetic Resonance Urography (MRU)** a i ʻole nā ​​protocol ultra-low-dose.
• Ka palekana no ka lāʻau lapaʻau: Nā NSAID (ibuprofen, ketorolac, naproxen) ua pāpā loa ʻia i ka hāpai ʻana. Hoʻomalu ʻia ka ʻeha me ka acetaminophen intravenous a me nā opioid titrated, a inā loaʻa ke kuni, urosepsis, a i ʻole ka ʻeha refractory, waiho ka urologists no ka mea, ua hoʻololi ʻia ka ʻeha i loko o ka ʻōpū i kēlā me kēia pule. ka calcium encrutation ma nā stents) a ma hope o ka hānau ʻana.

2. Ka mālama ulia pōpilikia no nā maʻi i loaʻa i ka Indwelling Ureteral Stent ("JJ Stent")¶

Inā loaʻa i kahi maʻi he double-J (JJ) ureteral stent i hoʻokomo ʻia i loko o ko lākou ureter e kekahi urologist (e kāʻalo i ka pōhaku a hoʻōla paha ma hope o ka lithotripsy laser), e wehewehe i ka mea maʻamau me kahi pilikia.

• ** Nā hōʻailona stent maʻamau i manaʻo ʻia:** Mimi ʻulaʻula ʻulaʻula a ʻulaʻula paha ma hope o ka hele ʻana, e ʻeha ana ma ka ʻaoʻao i ka wā e mimi ana (ma muli o ke kaomi ʻana o ka ʻōpū i ka puʻu stent ʻaʻa), a me ka wikiwiki o ka ʻōpū ma lalo o ka stent (mālama ʻia me ka tamsulosin a me ka oxybutynin/solifena i kuhikuhi ʻia).
• Hula ʻulaʻula stent ulia pōpilikia e koi ana i ka mākaʻikaʻi koke o ke keʻena pilikia:
• ** ʻO ke kuni hou (>=38.0 C / 100.4 F) a i ʻole ke anu** (e hōʻailona ana ua hoʻopili ʻia ka stent me ka biofilm a me ka pus).
• **E hoʻi mai i ka ʻeha ʻeha 10/10 koʻikoʻi ma hope o ka mimi ʻana (e hōʻailona ana ua neʻe ka stent mai kahi kūlana a i hoʻopili ʻia me kahi ʻāpana koko a i ʻole ʻāpana pōhaku).
• Mimi ʻulaʻula mānoanoa a me ka ʻulaʻula e loaʻa ana nā ʻaʻa koko nui a i ʻole ** hiki ʻole ke mimi (ka paʻa ʻana o ka mimi)**.
• Ke neʻe a huki ʻia ke kaula stent e lele ana: He kaula kaula nylon lahilahi e puka ana i waho o ka urethra no ka wehe ʻana i ke keʻena; ʻaʻole ʻoe e huki iā ʻoe iho i kahi kaula stent ke ʻole i kuhikuhi pololei ʻia e wehe iā ia i kēlā manawa i hoʻonohonoho ʻia e kāu urologist.

Nīnau pinepine¶

Nānā ʻia nā kumu¶

• Ahui ʻEuropean o Urology (EAU): EAU alakaʻi no Urolithiasis (2024 Update): Acute Renal Colic Management, Medical Expulsive Therapy, and Emergency Decompression of the Obstructed Infected Kidney.
• Ahahui Urological ʻAmelika (AUA) a me Endourological Society (United States): Hoʻoponopono Lapaʻau o nā Pōhaku Kidney a me Hoʻoponopono Hoʻopalekana Pohaku: AUA/Endourological Society Guideline.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Renal and Ureteric Stones: Assessment and Management (NG118).
• Ke ola nei i ka Sepsis Campaign (SSC) a me ka Infectious Diseases Society of America (IDSA): Nā Kūlana Kūikawā no ka Hoʻoponopono ʻana i ka Urosepsis a me ka Mana Kūmole Kūlohelohe i ka Pyelonephritis Obstructive.
• Pathan SA, Mitra B, Straney LD, a me al. (The Lancet): Ke hāʻawi nei i ka analgesia palekana a maikaʻi hoʻi no ka mālama ʻana i ka colic renal i loko o ke keʻena pilikia: kahi hoʻāʻo ʻelua makapō, multigroup, randomized controlled trial (e hōʻike ana i ke kiʻekiʻe o nā NSAID ma mua o ka morphine no ka colic renal acute).

Nā alakaʻi pili¶

• ʻO ka ʻike ʻana i ka Sepsis a me ka haʻalulu septic a me ke kōkua mua pilikia
• ʻO ka ʻoki ʻana a me ka ʻeha o ka ʻōpū aortic aneurysm
• ʻO ka mālama ʻana i ka mimi nui a me ka mālama ʻana i ka catheter e noho ana
• ʻO ka ʻeha o ke kino, ka ʻeha o ka ʻōpū, a me ka ʻeha pelvic
• ʻO ka rhabdomyolysis hoʻoikaika, ʻeha ʻeha ʻeha, a me ka mimi ʻeleʻele
• Nā helu pilikia ma ka ʻāina