Te mamae o te kowhatu tākihi me nga whatukuhu kua pangia (Urosepsis)¶

Ko te whakaekea kowhatu whatukuhu (acute renal colic) he mea rongonui mo etahi o nga mamae tino kaha, mamae mamae ka pa ki te tangata, engari ko te kohatu uaua i raro iho i te 5 mirimita (0.2 inihi) ka pahemo ake i roto i te 80 ki te 90 paiheneti o nga keehi. Heoi, i te wa tika ka mau te kohatu whatukuhu mii pangia kei muri i roto i te pelvis renal (pyelonephritis / pyonephrosis haumanu), ka huri te ahuatanga haumanu mai i te kohatu mate mamae ki waho ki te whakamate i te ora ohotata urological. Na te mea kei te tarai tonu te whatukuhu kua arai i te toto i te pehanga teitei, ko nga huakita me nga endotoxins e mau ana i runga ake o te kowhatu ka peia tika atu i te papillae renal ki roto i nga uaua renal (pyelovenous backflow), ka puta te fulminant urosepsis, ohorere septic, me te mate i roto i te 6 ki te 24 haora ki te kore e mahia te whakahekenga ohotata (he stent JJ ureteral, ngongo nephrostomy percutaneous ranei) i nga wa tonu.

Ko o kawenga tonu ina pa mai te mamae nui o te taha, tuara, whao ranei, ko te tirotiro tonu mo te "Kohatu Pango" ohorere (tetahi colic renal e haere tahi ana me te kirika i runga ake i te 38.0 nga nekehanga Celsius / 100.4 nga nekehanga Fahrenheit, te wiriwiri, te wiriwiri, te wiriwiri, te hongi kino, te mimi kua whakakiia te mimi, te mimi kua whakakiia ranei) (anuria, kotahi noa iho ranei nga whatukuhu e mahi ana)**, manatokona i roto i tetahi turoro neke atu i te 50 ki te 60 tau ko te mamae ohorere ehara i te te pakaru o te puku aortic aneurysm (AAA), karohia nga karani wai i te wa e kaha ana te mamae o te mamae (e poihau ana i te kapoipu whatukuhu kua aukatia ka nui haere te mamae me te ruaki), ka waea atu ki nga ratonga hauora ohorere mena kei te kitea he haki whero.

Mahia tenei inaianei¶

1. Waea atu ki nga ratonga hauora whawhati tata mena kei te haere tahi te kowhatu whatukuhu me te FEVER, CHILLS, SHOCK ranei ("He Kidney I aukatihia kua pangia"): Waea atu ki to nama whawhati tata (911 i te United States me Canada, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom, 000 i Ahitereiria) tirohia to maatau raarangi ingoa tau ohorere Mena ka tupu te tangata e tino mamae ana te taha, te tuara, te hiku ranei ka tupu ** he kirikaa (38.0 nekehanga Celsius / 100.4 nekehanga Fahrenheit teitei ake ranei) he iti rawa te pāmahana o te tinana (<36.0 C / 96.8 F), he wiriwiri kore e taea te whakahaere, ** mangere, he ngenge ranei i te wa e tu ana, rarurarutanga o te mimi hou ranei, **raruraru o te mimi. Kare e taea e nga patu paturopi waha anake te rongoa te nana i mau ki muri o te kohatu; me whakamakuku te whatukuhu ki te hohipera i roto i nga haora.
2. Haere ki te tari whawhati tata mena KOTAHI anake te whatukuhu e mahi ana (he whakawhitinga whatukuhu ranei) kei te hapu ranei: Ki te arai te kohatu i te ureter o te matakihi mokemoke ranei te whatukuhu kua whakawhitia, karekau he whatukuhu tuara o te tangata ka uru tonu ki roto anuric wharanga whatukuhu whakapeka me te hyperkalemia e mate ana ki te ora.
3. Whakakorehia te pakaru o te Abdominal Aortic Aneurysm (AAA) i roto i te tangata neke atu i te 50 tau: I nga pakeke neke atu i te 50 (ina koa nga tane, kaipaipa, te hunga he toto toto teitei) kaore ano nei kare ano kia pangia he kowhatu whatukuhu i mua, he haehae, he turuturu aneurysm aortic puku Ka pehi te toto retroperitoneal ki nga uaua rite tonu ki te kowhatu whatukuhu maui, matau ranei, ka puta te mamae ohorere o te taha-ki-te-papa, tae atu ki te toto moroiti i roto i te mimi. Me mahi tonu he "kohatu whatukuhu tuatahi kua neke ake i te 50 tau" hei mate ohorere aortic e hiahia ana ki te tari ohorere CT scan, ultrasound ranei.
4. Kaua e kaha ki te kapohia te wai nui i te wa o te kowhao o te renal renal spasm: Ko te korero pakiwaitara whanui e kii ana ki nga tangata ki te kohi rita wai i te wa e whakaekehia ana e te kowhatu whatukuhu ki te "whakarewa i te kohatu." I te wa e kaha ana te aukati i te ureteral, te inu nui i te wai ka piki ake te whakaputa mimi ki runga ake i te kowhatu kapo, ka piki te kapopa whatukuhu ano he poihau (hydronephrosis), te pehanga renal pelvic, ka puta te ruaki nui, ka tupono te pakaru o te renal calyx (whawhati moepuku). Hopukia he wai iti ki te matewai ka kore e nausea.
5. Hoatu te whakamahana whakamahana o te rohe (he kaukau mahana, he kaukau, he papa whakamahana ranei) ki te taha ki te kahore he kirikaa: Kare i rite ki te appendicitis (te kore e wera te wera), ka whakaatuhia e nga whakamatautau haumanu matapōkeretia te whakatakoto i te papa whakamahana whakamahana, he paraikete mahana ranei (40 ki te 42 nga nekehanga Celsius / 104 ki te 107.6 nekehanga Fahrenheit e whakangawari tika ana i te tuara o raro) tino whakaiti i te mamae o te renal colic me te nausea i te wa e kawe ana.
6. Tiahia nga mimi katoa ma roto i te tarai mata pai, te kawhe kawhe, te kakano ranei ki te whakahaere i tetahi kohatu tino uaua: Ma te hopu i te kowhatu kua pahemo (he rite te ahua ki te 2 ki te 5 mirimita te ahua o te kirikiri kirikiri, kowhai, kowhai ranei o te kirikiri, kirikiri ranei) ka taea e nga tohunga urologists te tātari i tana hanganga matū tika (calcium oxalate, uric acid, cystinestru) me te aukati.

flowchart TD
    Start["Ohorere ana, Te Peke Whakamamae / Koki Costovertebral Te mamae o muri e whiti ana huri noa i te taha ki te pae, ki te Testicle, ki te Labia ranei"] --> CheckSepsis{"1. Tirohia nga Kidney I pangia (Urosepsis) Nga Kara Whero: Te kirika (>=38.0 C), Te Tio, Te Mimi Kapua, Te Pokarekare, Te Ohooho ranei?"}
    CheckSepsis -->|Yes| CallEMS["Waea atu ki nga Ratonga Ohotata (911 / 112 / 999) Inaianei tonu: E hiahiatia ana te whakahekenga urological i te waa."]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. Kei te Neke atu i te 50 te pakeke o te manawanui me te 'kohatu mo te wa tuatahi', e mohiotia ana ko te Aortic Aneurysm, te mangere, te Syncope ranei?"}
    CheckAAA -->|Yes| CallEMS_AAA["Waea wawetia nga Ratonga Ohotata: Whakakorehia te Ruptured Abdominal Aortic Aneurysm (AAA)"]
    CheckAAA -->|No| CheckRenal{"3. Tirohia nga Kara Whero Kidney & Vomiting: Mokemoke/Transplant Kidney, Haputanga, Kore Putanga Mimi, he Ruaki Karekau ranei?"}
    CheckRenal -->|Yes| UrgentED["Kawea atu ki te Tari Ohotata o te Hohipera mo te IV Analgesia, Antiemetics, me te Atahanga"]
    CheckRenal -->|No Red Flags| EvalED["Whakaritea Te Aromātai Hauora Tere (Kore-Contrast CT / Ultrasound) me te Riri Mimi"]
    CallEMS --> FirstAid["4. Whakanohia te Pokai Mahana ki te taha (Mena Kare he kirika), KAUA e Whakakaha i te wai i te wa o te mokowhiti, me te noho pai."]
    UrgentED --> FirstAid

Ko te Renal Colic kaore i te uaua me te whatukuhu kua pangia (Pyonephrosis me Urosepsis)¶

He aha te take i pai ai te whakahaere i te kowhatu whatukuhu karekau he mate ma te whakahaere mamae me te mataki, engari ko te kowhatu whatukuhu me he mate mimi tetahi o nga mate ohorere tino mate i roto i nga rongoa o te hohipera?

I roto i te kohatu whatukuhu (renal colic), ka hoki te mimi parakore ki muri o te kohatu i roto i te ureter me te pelvis renal (hydronephrosis). Ahakoa te toronga o te kapopa whatukuhu me te mokowhiti o te ureter ka mamae te mamae 10/10, ko te mimi ano he horomata.

I roto i te te whatukuhu kua pangia (pyelonephritis or pyonephrosis ranei), ka mau nga huakita (pēnei i te Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, Enterococcus ranei) ki roto i te punaha kohi katia, pehia ki runga ake o te kohatu. Ko te whatukuhu kua araia ka huri hei whana kati i raro i te pehanga filtration arterial teitei:

1. He aha te mea KAORE e taea e te patu paturopi anake te toro atu, te rongoa ranei i te whatukuhu kua pangia: Tuatahi, na te mea ka mutu te tātari glomerular i roto i te whatukuhu kua tino arai, kaore e taea e nga patu paturopi a-roto, waha ranei te tarai ki roto i te mimi i runga ake o te kohatu. Tuarua, ko te pehanga intrapelvic teitei (i runga ake i te 30 ki te 40 mmHg) ka whakatuwhera i nga roimata moroiti ki nga pito o nga kopa renal (pyelovenous me te pyelolymphatic backflow), ka werohia nga huakita ora me te endotoxin huakita tika ki roto i te rerenga toto nahanaha me nga ngakau katoa.
2. Ka pehea te tere o te mate o te urosepsis ki te kore he whakaheke wai: Ki te kore he whakahekenga miihini ohorere o te whatukuhu (retrograde ureteral stenting i roto i te rūma mahi ranei percutaneous nephrostomy tube te tuunga ki muri na roto i te radiology interventional), te mate mai i te urosepsis aukati kua neke ake 20 ki te 40 ōrau, me te whakaroa i te 12 haora o te mate ohorere o te 12 haora o te tere tere. mate.

Anatomy o te whakaeke kowhatu whatukuhu: Me pehea te waahi mamae e whai ana i te haerenga o te kohatu ki raro i te ureter¶

Karekau te kowhatu whatukuhu e mamae i te wa e noho ata ana i roto i te kowhatu whatukuhu whanui o te whatukuhu (mehemea he kowhatu mate staghorn nui). Ka pahū te mamae i te wa ka taka te kohatu ki roto i te whaiti, te uaua ureter (he 2 ki te 4 mimimita noa te whanui) ka piri ki tetahi o nga e toru nga tohu kowaowao tinana (whakaiti) o te mimi. I te wa e neke haere ana te kohatu ki raro ki te pukupuku, ka huri te waahi o te mamae ki te ** ilioinguinal me te genitofemoral nerves (T11 ki L2)**:

Koowaowao 1: Ko te Ureteropelvic Junction (UPJ, kei reira te kohanga whatukuhu e tutaki ai ki runga o te ureter)¶

• Kei hea koe: He mamae ohorere, he hohonu, he rite ki te naihi i runga i te koki costovertebral (CVA), te kokonga ahua-V i to tuara e tutaki ai te riu 12 o raro ki te tuara.
• Nga tohu e pa ana: Na te mea kei te noho tahi te kapopa whatukuhu ki nga muka nerve autonomic celiac ganglion ki te puku, ka puta te arai UPJ teitei ** te nausea tonu, te kaha o te nausea me te ruaki tonu** e rite tonu ana ki te te whakaeke i te gallbladder, te pancreatitis, rewharewha puku ranei.

Koowaowao 2: Te whakawhiti i nga Iliac Blood Vessels (I waenganui-ureter i te pelvic brim)¶

• Kei hea koe: Ka puta te mamae ki mua me te whakararo mai i te kaokao huri noa i te taha o te hope ki roto ki te tika, maui ranei o raro o te puku ka heke iho ki roto i te ** riu maa**.
• Mahanga tātaritanga: Ina okioki tetahi kohatu i te taha matau o waenganui-ureter i runga i te uaua psoas, ka tino rite appendicitis whakapeka (i te taha matau) ranei diverticulitis whakapeka (kei te taha maui). Engari, tirohia te whanonga o te manawanui:
• Ko te tangata manawanui e peritonitis mai i te appendicitis e takoto ana kua toka me te kore neke i runga i te moenga na te mea ka mamae nga nekehanga katoa i te peritoneum.
• Ko te tangata manawanui e renal colic ka wiri, ka hikoi i te aroa, ka kopikopiko i runga i te papa, ka huri haere tonu i te tuunga ka ngana noa ki te kimi i tetahi koki hei whakamaarama i te momi o roto ("te tohu pacing").

Koowaowao 3: Ko te Ureterovesical Junction (UVJ, kei te uru te raro o te ureter ki te pakitara o te ngongo)¶

• Ko te kuaha whaiti rawa atu i roto i te mimi (1 ki te 2 mirimita anake te whanui): Neke atu i te 60 ki te 70 ōrau o ngā kōhatu i kitea i te tari ohorere CT scans kei konei tonu i te UVJ, he mitamano noa i mua i te topa ki roto i te puku.
• Kei hea koe: Na te mea kei te taha o raro o te ureter nga genitofemoral me te pudendal nerves (L1, L2, S2-S4) ki te taihemahema o waho me te take o te ngongo (trigone), he kohatu kua piri ki te UVJ:
• Te mamae koi e toro tika ana ki roto i te ipsilateral testicle me te scrotum i roto i nga tane, ki roto ranei i te labia majora me te vulva o nga wahine (e hiahia ana kia ata wehea mai i teticular torsion or ovarian torsion; i roto i te kowhatu whatukuhu, ko te testicle ake he ahua noa me te kore e pupuhi ina pa marietia, engari i roto i te testicular torsion ka noho teitei te testicle, te pupuhi, me te tino ngawari).
• Ko nga tohu o te puku pukuriri: Ko te ahua ohorere e hiahia ana koe ki te mimi ia 3 meneti (te mimi me te auau), te mamae o te wera i te pito o te urethra (dysuria), me te tuku i etahi pata o te mawhero, whero, mimi toto ranei te tae tea (he mate nui), ahakoa karekau he mate.
• Te taima whakamama: Kia puta te kohatu i roto i te UVJ ki roto i te mimi e waatea ana, ko te mamae mamae 10/10 o te taha me te hiku ** ka ngaro tata tonu**. Ko te tuku i te kohatu i muri mai i te pukupuku ki waho i roto i te urethra whanui (e 6 ki te 8 mitamano te whanui) ka puta he paku poto 2-hekona, he paoro ngawari ranei i roto i te peihana wharepaku.

Te rahi o te kowhatu me te tuuponotanga o te huarahi taiao: Ko wai nga kohatu ka paahi, ko wai ka mau?¶

Ina mahia e nga taote ohorere he ** iti- horopeta kore-rerenga CT scan o te puku me te papa (CT KUB)** ranei te ultrasound renal, ko te inenga tino nui (mehemea kaore he mate, he whatukuhu mokemoke ranei) ko te te whanui whakawhiti o te kohatu i roto i te mitamanita:

He aha te take i whiua ai e nga NSAID nga opioids mo te mamae o te kowhatu whatukuhu (me te wa e tino aukatia ana nga NSAID)¶

Mena kei roto koe i te tari whawhati tata, kua arotakehia ranei koe e te taote nana i whakapumau he kohatu whatukuhu kore uaua me te mahi o te whatukuhu noa (te hangahanga toto noa), he tino awhina te mohio ki te mahi a te hunga whakaora mamae i runga i te ureter:

1. He aha te take a Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) i aro ki te take pakiaka o te mate renal colic¶

Ina kapohia e te kohatu te ureter, ka piki te pehanga o roto i te whatukuhu ka whakaihiihi i te whakahiatotanga o Prostaglandin E2 (PGE2) me prostacyclin. Ko te Prostaglandin E2 e rua nga mea e whakapouri ana i te colic renal:

1. Ka whakanuia e ia nga uaua afferent ka uru ki roto i te glomeruli o te whatukuhu, ka whakanui ake te pehanga filtration mimi ki roto i te whatukuhu kua aukatia, kua tetere.
2. Ka puta te kaha, te mamae ** nga uaua maeneene o te pakitara ureter ** huri noa i te kohatu me te whakanui ake i te pupuhi o te pakitara ureteral rohe (edema).

** NSAIDs** (pērā i te hōhipera intravenous ketorolac [Toradol] ranei rectal/oral diclofenac, ibuprofen, naproxen ranei) ka aukati tika i te whakahiato prostaglandin (cyclooxygenase inhibition). Ma te kati i te Prostaglandin E2, NSAIDs i te wa ano ka whakaiti i te pehanga i roto i te kapene whatukuhu tetere, te whakamaarama i nga uaua o te ureteral, te whakaheke i te pupuhi huri noa i te kohatu, me te whakarato i te mamae pai ake, te rite ranei ki te morphine i roto i te toto me te kore e puta te ruaki, te moe moe ranei.

2. Ina KAUPAPA KAUPAPA NSAID i roto i te manawanui kohatu whatukuhu¶

Na te mea ka whakaitihia e nga NSAID te rere toto ki roto i nga whiriwhiringa o te whatukuhu kua arai, kaua rawa e tango i te ibuprofen, te naproxen, te ketorolac, te diclofenac ranei mena ka pa tetahi o enei tikanga:

• KORE ano koe kia whakamatauria toto i te hohipera, he hitori ranei e whakapumau ana i te mahi o te whatukuhu noa, kei a koe he ** wharanga whatukuhu whakapeka (creatinine teitei)** ranei he mate whatukuhu roa (CKD Stage 3, 4, 5 ranei).
• ** KOTAHI anake to whatukuhu e mahi ana (te whatukuhu mokemoke) he whakawhitinga whatukuhu ranei:** Ma te tango i te NSAID ka aukatihia to whatukuhu anake e te kohatu ka kati te toenga o te toto afferent afferent, ka heke tere ** te mate renal acute**.
• Kei te hapu koe (Ka taea e nga NSAID te whakararu i te whakawhanaketanga o te whatukuhu o te kopu me te kati moata i te ductus arteriosus fetal).
• He mate whewhe peptic koe, toto gastrointestinal, te matewai nui ranei/urosepsis.
• I roto i era take katoa, ka whakamahia e nga taote hōhipera ** acetaminophen (paracetamol)** me te titrated ** opioids intravenous** (ranei i te ultrasound-guided erector spinae nerve blocks / intravenous lidocaine protocols) hei utu mo nga NSAID.

Te tiaki i mua i te hohipera me te aukati kohatu mo te wa roa¶

Hipanga 1: Te noho haumaru ki te kainga me te whakahaere waka i te wa o te wahanga whakapeka¶

1. Tirohia te pāmahana me te inemahana i nga wa tonu: I mua i te rongoa i nga kowhatu whatukuhu e whakapaetia ana i te kainga, inehia te pāmahana tinana. Mena he 38.0 nga nekehanga Celsius (100.4 nga nekehanga Fahrenheit) teitei ake ranei ** (i raro ranei i te 36.0 C / 96.8 F), mena ka wiriwiri te tangata, ** whakamutua nga tiaki kaainga katoa ka haere tika ki te tari whawhati tata, waea atu ranei ki 911 / 112 / 999.
2. Hoatu te wera o waho ki te kaokao me te tuara o raro: Whakanohoia he papa whakamahana mahana, he ipu wai mahana kua takai ki te tauera, he putea wera matū mahana ranei kei 40 ki te 42 nga nekehanga Celsius (104 ki te 107.6 nekehanga Fahrenheit) ki runga i te taha mamae me te tuara o muri i te wa e kawe ana.
3. Kati te whakamakuku i te wa o te mamae nui: I a koe e tatari ana kia heke te ngaru mamae, e haere ana ranei ki te rūma ohorere, kaua e inumia he karaihe wai. I te wa e whakahaeretia ana te mate o te kowha, ka mutu te whakapairuaki, haere tonu ki te inu wai (2.0 ki te 2.5 rita ia ra) hei awhina i te kawe i te kohatu ki raro.
4. Kohikohia ka werohia nga pata katoa o te mimi: Mimi ki roto i te mimi kirihou parakore, kapu, potae ranei ka ringihia ma te tarai kohatu rongoa, he tātari kawhe pepa ma. Kia mau mai he karaihe kohatu maro, tukua kia maroke i roto i te pounamu pire ma (kaua rawa e takai ki te pepa wharepaku maku, ka memeha, ka piri ranei ki te karaihe) ka kawe atu ki to rata mo Fourier-transform infrared spectroscopy (FTIR) or X-ray diffraction stone analysis.

Hipanga 2: Ko nga huarahi kai e pa ana ki nga taunakitanga hei aukati i te rua o nga kowhatu whatukuhu¶

Ki te kore he huringa arai, 50 paiheneti o te hunga katahi ano ka pa ki te kowhatu whatukuhu i roto i te 5 ki te 10 tau:

• Inumia te wai kia nui te 2.5 rita (85 hekere wai) o te mimi kowhai kowhai ia 24 haora: Ma tenei tikanga kotahi ka tapahia te hokinga mai o te kohatu ki te haurua puta noa i nga momo kohatu katoa.
• Taapirihia te citrate maori (he rēmana tūturu, he wai kotakota ranei) ki to wai o ia ra: Ka herea te citrate i roto i te mimi ki te konupūmā mimi me te aukati i te konupūmā oxalate me te konupūmā phosphate tioata kei piri tahi.
• Kaua e rāhuitia te konupūmā kai (kai miraka / konupūmā MĀ te kai), engari KAUA kia whakaitihia te konutai nui (tote): Ko te tikanga, ko te kai iti-konupora ka whakanui ake te konupūmā oxalate kōhatu whatukuhu na te mea ka herea te konupūmā kai i roto i to whea ki te oxalate mai i te kai (koki, rhubarb, aramona, beets, tiakarete, kaua e uru ki roto i to tii. Ko te kai nui ** konutai (tote)** ka kaha nga whatukuhu ki te maka i te taikaha o te konupūmā ki roto i te mimi (hypercalciuria).

Te mohio ki nga momo matū e 4 o nga kowhatu whatukuhu me nga ohorere motuhake¶

Ina mau te kowhatu whatukuhu i roto i te riaka, ka tangohia ranei i te wa o te ureteroscopy, ka kitea e te tātaritanga taiwhanga ko wai o nga wha whanau kohuke nui i puta te kohatu, kei ia tangata nga whakaaro ohorere motuhake:

Ko nga kowhatu whatukuhu i te wa e hapu ana me nga turoro me te Indwelling Ureteral Stent¶

1. Renal colic i te wa e hapu ana (Te tiaki i te whaea me te kopu)¶

Tata ki te 1 i roto i te 200 ki te 1,500 nga turoro e hapu ana ka whanake he kowhatu whatukuhu whakapeka, i te nuinga o te waa i te waa tuarua me te tuatoru tuatoru (i te wa e whakangawari ana te progesterone i nga uaua maeneene o te ureteral me te nui o te kōpū ka kopaki i nga ureter, ina koa ki te taha matau).

• He aha nga turoro e hapu ana me te renal colic e hiahia ana ki te arotake wawe i te hohipera:
• Ko te mamae nui o te renal colic me te pyelonephritis arai i te wa e hapu ana ka taea e ** te whanau o mua me te whanautanga o mua**, te urosepsis o te whaea, me te whakaheke toto-preeclampsia.
• Whakaahua taatai ​​me te kore iraruke: Kaore nga tari ohorere e whakamahi i nga matawai CT paerewa hei whakamatautau tuatahi i te wa e hapu ana; engari, ka whakamahi ratou i te Renal and Pelvic Ultrasound (te ine i nga jet ureteral me te wehewehe i te hydronephrosis whaiaroaro o te haputanga mai i te kowhatu) ka peehia mena ka hiahiatia e kore-rereketanga Magnetic Resonance Urography (MRU) ranei nga tikanga ultra-iti-horopeta.
• Haumarutanga mo te rongoa: Ko nga NSAID (ibuprofen, ketorolac, naproxen) ka tino aukatihia i te wa e hapu ana. Ka whakahaerehia te mamae ma te haumaru me te acetaminophen me nga opioid kua whakahekehia, a, ki te puta te kirikaa, te urosepsis, te mamae kino ranei, ka tukuna e nga tohunga urologists he **rewharewharewharewharewhareiti i ia wiki (6 wiki ureteral) konupūmā encrutation on stents) tae noa ki muri i te whanautanga.

2. Tiaki ohorere mo nga turoro kua whai Indwelling Ureteral Stent ("JJ Stent")¶

Mēnā he rua-J (JJ) ureteral stent tetahi tūroro i tukuna ki roto i to ureter e te tohunga urologist (ki te karo i te kohatu, te whakaora ranei i muri i te laser lithotripsy), whakamarama he aha te mea noa me te ohorere:

• Ko nga tohu stent noa e tumanakohia ana: He mimi mawhero, he whero ranei i muri i te hikoi, ka mamae te kaokao inaa mimi (na te pehanga o te ngongo ngongo e piki ake ana te ngongo stent), me te tere o te ngongo ngongo ki raro o te stent (he rongoa ki te tamsulosin me te oxybutynin/solifena kua tohua).
• Ko nga mahi ohorere stent haki-whero e hiahia ana kia toro wawe te tari tari whawhati tata:
• Ko te kirika hou (>=38.0 C / 100.4 F) he makariri ranei (he tohu kua kapi te stent, kua purua ranei ki te kiriata koiora me te nana).
• Te hokinga mai o te mamae 10/10 nui o te taha ka kore e mutu i muri i te mimi (e tohu ana kua heke te stent ki waho o te tuunga, kua honoa ranei e te toto, te kongakonga kohatu ranei).
• Mimi mātotoru, whero pouri kei roto i nga katote toto nui, kaore ranei e kaha ki te mimi (te pupuri mimi whakapeka).
• Ka neke, ka kumea ranei te aho stent tarewa: Ko etahi stent rangitahi he aho angiangi nylon tether e puta ana i te urethra kia ngawari te tango tari; Kaua rawa e toia te aho stent e koe ake ki te kore e tino tohutohuhia kia tangohia i taua wa i whakaritea e to kairoro.

Pātai auau¶

Kua tirohia nga puna¶

• European Association of Urology (EAU): EAU Guidelines on Urolithiasis (2024 Update): Acute Renal Colic Management, Medical Expulsive Therapy, and Emergency Decompression of the Obstructed Infected Kidney.
• American Urological Association (AUA) and Endourological Society (United States): Whakahaere Hauora o Kidney Stones me te Haparaparatanga o nga Kohatu: AUA/Endourological Society Aratohu.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Renal and Ureteric Stones: Aromatawai me te Whakahaere (NG118).
• Te Whakatairanga Sepsis Surviving (SSC) me te Infectious Diseases Society of America (IDSA): Nga Aratohu o te Ao mo te Whakahaere i te Urosepsis me te Mana Whakanuia i te Pyelonephritis Obstructive.
• Pathan SA, Mitra B, Straney LD, et al. (Te Lancet): Te tuku analgesia haumaru me te whai hua mo te whakahaeretanga o te renal colic i roto i te tari whawhati tata: he matapo-rua, roopu-maha, he whakamatautau whakahaere matapōkeretia (e whakaatu ana i te pai ake o nga NSAID i runga i te morphine mo te colic renal acute).

Nga kaiarahi e pa ana¶

• Te whakamohiotanga o te sepsis me te ru septic me te awhina tuatahi ohorere
• Te wehenga aortic me te ruptured aneurysm aortic abdominal
• Ko te pupuri i te mimi whakapeka me te tiaki ohotata i te noho
• Te torsion testicular, te torsion ovarian, me te mamae pelvic
• Ko te rhabdomyolysis mahi, te whara o te whatukuhu, me te mimi pouri
• Ko nga nama ohorere ma te whenua