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Kupweteka Kwambiri kwa Impso Kulimbana ndi Impso Yotsekedwa (Urosepsis)

Manambala angozi amasiyana malinga ndi dziko. Tsambali limagwiritsa ntchito 911, nambala ya United States ndi Canada. Mayiko ena ambiri amagwiritsa ntchito 112, 999, kapena nambala ina. Pezani nambala ya dziko lanu.

Vuto losavuta ** la impso (acute renal colic)** limatchuka chifukwa choyambitsa zowawa kwambiri, zowawa kwambiri zomwe munthu amatha kumva, komabe mwala wosavutikira pansi pa 5 millimeters (0.2 mainchesi) pamapeto pake udzadutsa wokha mu 80 mpaka 90 peresenti ya milandu. Komabe, nthawi yeniyeni yomwe mwala wa impso umatchera mkodzo wopatsirana kumbuyo kwake mkati mwa chiuno cha aimpso (obstructive pyelonephritis / pyonephrosis), zochitika zachipatala zimasintha kuchokera ku mwala wopweteka wakunja kupita ku ngozi yowopsa ya opaleshoni yamkodzo. Chifukwa impso yotsekeka imapitilira kusefa magazi pakuthamanga kwambiri, mabakiteriya ndi ma endotoxins omwe amatsekeredwa pamwamba pamwala amakakamizika kudutsa aimpso papillae kulowa mumitsempha yaimpso (pyelovenous backflow), kumayambitsa fulminant **urosepsis, Septic shock, ndi imfa mkati mwa maola 6 mpaka 24 ** pokhapokha ngati madzi opangira opaleshoni mwadzidzidzi (mtsempha wa JJ stent kapena percutaneous nephrostomy chubu) achitidwa mwamsanga.

Udindo wanu wanthawi zonse mukamva kupweteka kwambiri m'mbali, msana, kapena m'chuuno ndikuyang'ana nthawi yomweyo **"Mwala Wopatsirana" (chiwopsezo chilichonse cha aimpso chotsatizana ndi kutentha thupi kopitilira 38.0 digiri Celsius / 100.4 degrees Fahrenheit, kunjenjemera, kuzizira, kununkhira koyipa kwamtambo wamtambo wothira mkodzo) *kutsekeka kwa mkodzo, kukodza kapena kukodza. kapena kukhala ndi impso imodzi yokha yogwira ntchito)**, tsimikizirani kwa wodwala aliyense wazaka zapakati pa 50 mpaka 60 kuti kupweteka kwadzidzidzi m'mbali sikuli kuphulika kwa mtsempha wa m'mimba (AAA), pewani kukakamiza magaloni amadzi panthawi yopweteka kwambiri (yomwe imatulutsa kapsule ya impso yotsekedwa ndikuwonjezera ululu ndi kusanza), ndipo itanani chithandizo chachipatala mwamsanga ngati pali mbendera zofiira.

Chitani izi tsopano

  1. Imbani zithandizo zadzidzidzi nthawi yomweyo ngati mwala wa impso uli ndi FEVER, CHILLS, kapena SHOCK ("Impso Yotsekedwa Yopatsirana"): Imbani nambala yanu yadzidzidzi yakudera lanu (911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, 000 ku Australia) kapena onani chikwatu chathu cha manambala angozi ngati wina amene ali ndi ululu waukulu m'mbali, m'mbuyo, kapena m'chuuno ayamba ** kutentha thupi (38.0 digiri Celsius / 100.4 digiri Fahrenheit kapena kupitirira apo) kapena kutentha kwapang'onopang'ono (<36.0 C / 96.8 F)**, kugwedezeka kosalamulirika (kugwedezeka), chizungulire kapena kukomoka, kukomoka kapena kukomoka* kulephera kutuluka mkodzo**. Mankhwala opha tizilombo okha sangathe kuchiza mafinya omwe ali kuseri kwa mwala; impso iyenera kuchitidwa opaleshoni m'chipatala mkati mwa maola.
  2. Pitani kuchipatala nthawi yomweyo ngati munthuyo ali ndi impso IMODZI yokha yomwe ikugwira ntchito (kapena kumuika impso) kapena ali ndi pakati: Ngati mwala watsekereza mkodzo wa impso yokhayokha kapena impso yoikidwa, munthuyo alibe impso zosunga zobwezeretsera ziro ndipo nthawi yomweyo amalowa ** anuric pachimake impso kuvulala** ndi hyperkalemia yowopseza moyo.
  3. Letsani kuphulika kwa Aortic Aortic Aneurysm (AAA) mwa aliyense wazaka zopitilira 50: Kwa akuluakulu opitilira 50 (makamaka amuna, osuta, kapena omwe ali ndi kuthamanga kwa magazi) omwe sanakhalepo ndi mwala wa impso, kung'ambika kapena kutayikira aneurysm ya msempha wa m'mimba retroperitoneal bleed presses pamitsempha yofanana ndi mwala wa impso kumanzere kapena kumanja, zomwe zimapangitsa kuti pakhale kupweteka kwadzidzidzi m'mbali mwa ntchafu komanso ngakhale magazi osawoneka bwino mumkodzo. Nthawi zonse samalirani "mwala wa impso woyamba wazaka 50" ngati vuto ladzidzidzi lomwe likufunika kuti mupite ku dipatimenti yachangu ya CT scan kapena ultrasound.
  4. OSATI kukakamiza kuchucha madzi ochuluka pa nthawi ya chiphuphu chachikulu cha aimpso: Nthano yofala imauza anthu kuti amwe malita a madzi pamwala woopsa wa impso kuti "atulutse mwala." Pamene mkodzo watsekeka, kumwa madzi ochuluka kumawonjezera kupanga mkodzo pamwamba pa mwala wopiringizika, kukweza kapisozi wa aimpso ngati baluni yothina (hydronephrosis), kutsika kwa aimpso kuthamanga kwa chiuno, kuyambitsa kusanza kwambiri, komanso kutha kuphulika kwa aimpso calyx (kuphulika kwa dama). Imwani madzi pang'ono pokhapokha ngati muli ndi ludzu komanso osachita nseru.
  5. Pakani kutentha kotonthoza kwanuko (bafa lofunda, shawa, kapena chotenthetsera) m'mbali mwake ngati KUPANDA kutentha thupi kulibe: Mosiyana ndi appendicitis (kumene kutentha kumaletsedwa), mayesero achipatala mwachisawawa akuwonetsa kuti kuika **pachiyenyere chofunda kapena bulangeti lofunda (madigiri 40 mpaka 42 Celsius / 104 mpaka 107.6) kutsitsimuka kwa msana kumatsitsimutsa msana *kupuma pang'onopang'ono ndipo kwambiri amachepetsa pachimake aimpso colic ululu ndi nseru pa kayendedwe.
  6. Sefa mkodzo wonse kudzera musefa wa mauna abwino, sefa ya khofi, kapena gauze ngati mukuwongolera mwala wotsimikizika kuti ndi wosavuta: Kugwira mwala womwe wadutsa (womwe ungawoneke ngati waung'ono wa 2 mpaka 5 millimeter wokhuthala wa bulauni, wachikasu, kapena wonyezimira wamchenga kapena miyala) kumathandizira akatswiri a urologist kuunika momwe akupangidwira (calcium oxalate, uric cyst, uric acid, uric acid, uric acid, calculi).
flowchart TD
    Start["Mwadzidzidzi, Agonizing Flank / Costovertebral Angle Back Kupweteka Kumadutsa Kumbali Kumayambiriro kwa Groin, Testicle, kapena Labia."] --> CheckSepsis{"1. Yang'anani Impso Yotsekedwa (Urosepsis) Red Flags: Fever (>=38.0 C), Kuzizira/Kuwuma, Mikodzo Yamtambo Wamtambo, Kusokonezeka, Kapena Kugwedezeka?"}
    CheckSepsis -->|Yes| CallEMS["Imbani Ntchito Zadzidzidzi (911 / 112 / 999) Nthawi yomweyo: Kuwonongeka Kwambiri Kwambiri kwa Urological Kufunika"]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. Kodi Woleza Mtima Woposa Zaka 50 Ndi 'Mwala Woyamba', Wodziwika ndi Aortic Aneurysm, Chizungulire, kapena Syncope?"}
    CheckAAA -->|Yes| CallEMS_AAA["Imbani Ntchito Zadzidzidzi Nthawi Yomweyo: Chotsani Kuphulika Kwa M'mimba Mwamtsempha wa Aortic Aneurysm (AAA)"]
    CheckAAA -->|No| CheckRenal{"3. Yang'anani Impso & Kusanza Mbendera Zofiira: Impso Yokha / Kuika Impso, Mimba, Ziro Zotulutsa Mkodzo, Kapena Kusanza Kosasinthika?"}
    CheckRenal -->|Yes| UrgentED["Kuyenda Mwamsanga kupita ku Dipatimenti Yowopsa Yachipatala ya IV Analgesia, Antiemetics, ndi Imaging"]
    CheckRenal -->|No Red Flags| EvalED["Konzani Kuwunika Mwachangu Zachipatala (Zopanda Kusiyanitsa CT / Ultrasound) ndi Kuvuta kwa Mkodzo"]
    CallEMS --> FirstAid["4. Ikani Paketi Yofunda Pamphepete (Ngati Palibe Fever), OSATI Kukakamiza-Madzi Akuchulukira Panthawi Ya Kupweteka Kwambiri, Imani Momasuka."]
    UrgentED --> FirstAid

Kupweteka kwa Renal Colic motsutsana ndi Impso Yotsekedwa (Pyonephrosis ndi Urosepsis)

Chifukwa chiyani mwala wa impso wopanda matenda umasamalidwa bwino ndikuwongolera ululu, pomwe mwala wa impso wokhala ndi matenda amkodzo ndi imodzi mwazadzidzi zadzidzidzi kuchipatala?

Mu mwala wovuta wa impso (renal colic), mkodzo wosabala umabwerera kumbuyo kwa mwala mkati mwa ureter ndi aimpso pelvis (hydronephrosis). Pamene kutambasula kwa fibrous aimpso kapisozi ndi kuphipha kwa ureter kumayambitsa kupweteka kwa 10/10, mkodzowo ndi wosabala.

Mu impso zomwe zili ndi kachilombo (obstructive pyelonephritis kapena pyonephrosis), mabakiteriya (monga Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, kapena Enterococcus) amatsekeredwa mkati mwa njira yotsekedwa, yoponderezedwa pamwamba pa miyala. Impso yotsekeka imakhala ** chiphuphu chotsekedwa pansi pa kuthamanga kwambiri kwa mtima kusefera **:

  1. Chifukwa chiyani maantibayotiki okha SINGAfikire kapena kuchiza impso yotsekeka: Choyamba, chifukwa kusefera kwa glomerular kumayima muimpso yotsekeka, maantibayotiki a m'mitsempha kapena amkamwa sangathe kusefa mu mkodzo womwe uli pamwamba pa mwala. Chachiwiri, kuthamanga kwambiri kwa intrapelvic (** pamwamba pa 30 mpaka 40 mmHg **) kumatsegula misozi ya microscopic pansonga za renal calyces (**pyelovenous and pyelolymphatic backflow **), jekeseni mabakiteriya amoyo ndi endotoxin ya bakiteriya mwachindunji m'magazi a systemic ndi mtima uliwonse.
  2. Kuthamanga kwa urosepsis kumapha popanda madzi: Popanda kuwonongeka kwadzidzidzi kwa impso (**kubwezeretsanso ureter stenting m'chipinda chopangira opaleshoni ** kapena ** percutaneous nephrostomy chubu kuika kumbuyo ndi interventional radiology **), imfa kuchokera ku urosepsis yopingasa imaposa ** 20 mpaka 40 peresenti * kupanikizika *, ndi kuchedwa kwa maola 4 ndi kuchedwa kwa maola 12 imfa.
Clinical Mbali Mwala Wa Impso Wosavuta (Wosabala Renal Colic) Pyelonephritis Yosavuta Kwambiri (Kutenga Impso POPANDA Mwala Wotsekereza) Kutsekeka kwa Impso / Pyonephrosis (Opaleshoni ya Urosepsis Emergency)
** Pathology Yoyambira ** Mwala wa mchere wa crystal umatchinga mtsempha wa ureter, zomwe zimapangitsa kuti munthu asabereke (hydronephrosis) komanso kupweteka kwambiri kwa ureter peristaltic spasm. Tizilombo toyambitsa matenda timakwera kuchokera kuchikhodzodzo kupita m'chikhodzodzo, zomwe zimayambitsa kutupa kwa aimpso, koma mtsempha wa ureter uli wotsegula kotero kuti mafinya ndi mkodzo zimatuluka momasuka mu chikhodzodzo. Mwala ** umatchinga ureter NDI mabakiteriya kuchulukirachulukira mu mkodzo wotsekeredwa pamwamba pa mwala **, kutembenuza chiuno cha aimpso kukhala thumba lopanikizika la mafinya (pyonephrosis).
** Chitsanzo cha Ululu ndi Kuvuta ** Mwadzidzidzi, mafunde a paroxysmal opweteka kwambiri a 10/10 m'mbali mwa groin opitilira 20 mpaka 60 mphindi pafunde; wodwala amayenda pansi, amagudubuzika pa machira, ndipo satha kukhala chete. **Kuyamba kwapang'onopang'ono kwa masiku 1 mpaka 2 a ululu wosasunthika, wozama, wosasunthika ** m'mbali / msana umodzi (costovertebral angle tenderness), nthawi zambiri amayamba ndi masiku akuwotcha kwa chikhodzodzo (dysuria). **Kupweteka kwakukulu, kosalekeza m'mbali ndi m'mimba ** (kapena mwa okalamba / odwala matenda a shuga, kupweteka kwa msana kumaphimbidwa ndi delirium ndi kugwa kwa septic).
**Kutentha kwa Thupi ndi Kulimba ** Kutentha kwanthawi zonse (36.5 mpaka 37.3 C / 97.7 mpaka 99.1 F). Kutentha kwenikweni sikumayamba chifukwa cha mwala wovuta wa impso. Kutentha thupi (38.5 mpaka 39.5 C / 101.3 mpaka 103.1 F) ndi kuzizira, nseru, ndi kusanza, koma kuthamanga kwa magazi nthawi zambiri kukhazikika mofulumira ndi madzi a IV ndi maantibayotiki. Kutentha thupi kwambiri (>38.5 mpaka 40.0 C) KAPENA hypothermia (<36.0 C) with violent teeth-chattering rigors, racing heart (>110 bpm), kupuma mwachangu (>22/min), kuthamanga kwa magazi, ndi chisokonezo.
Kuyankha kwa Maantibayotiki Okha Mankhwala opha tizilombo safunikira ngati mkodzo ndi wosabala. Amayankha pang'onopang'ono mkati mwa maola 24 mpaka 48 kwa maantibayotiki am'mitsempha kapena amkamwa. Ikalephera kuwongolera (kapena kuwonjezereka kwambiri ku septic shock) ndi maantibayotiki okha chifukwa mafinya amakhala atakhomerera kumbuyo kwamwala. Imafunika stent kapena nephrostomy chubu drainage mwachangu.

Lamulo Lagolide la Urology: Mwala wa impso SAMAyambitsa kutentha thupi palokha

Ngati wina wapezeka ndi mwala wa impso (ngakhale mwala wawung'ono wamamilimita atatu womwe watumizidwa kunyumba kuchokera kuchipinda chodzidzimutsa dzulo) amayamba ** kutentha thupi kwa 38.0 digiri Celsius (100.4 degrees Fahrenheit) kapena kupitilira apo, kuzizira, kutuluka thukuta, kapena chizungulire **, sakhalanso ndi vuto la aimpso. Ali ndi impso yotsekeka (obstructive pyelonephritis / urosepsis) ndipo amayenera kubwerera ku dipatimenti yodzidzimutsa kuchipatala mwachangu kuti akalowetse maantibayotiki ndi kutulutsa kwadzidzidzi kwa impso.

Anatomy of a kidney stone attack: Momwe ululu umayendera ulendo wamwala kutsika mkodzo

Mwala waimpso supweteka utakhala mwakachetechete mkati mwa impso (pokhapokha ndi mwala waukulu wa matenda a staghorn). Ululu umaphulika pamene mwala ukugwera mu yopapatiza, minofu ** ureter ** (yomwe ndi ** 2 mpaka 4 millimeters mulifupi **) ndipo imakhazikika pa imodzi mwa ** mfundo zitatu za anatomical choke (kuchepa) ** ya mkodzo. Pamene mwala ukusunthira pansi kupita kuchikhodzodzo, malo omwe ululuwo umakhala umasintha modziwikiratu m'mitsempha ya ilioinguinal ndi genitofemoral (T11 mpaka L2):

Choke Point 1: The Ureteropelvic Junction (UPJ, pomwe fupa la impso limakumana pamwamba pa ureter)

  • Kumene mumamva: Mwadzidzidzi, zozama, zowawa ngati mpeni pamwamba pa costovertebral angle (CVA), ngodya yofanana ndi V kumbuyo kwanu komwe nthiti ya 12 yapansi imakumana ndi msana.
  • Zizindikiro zogwirizana: Chifukwa kapisozi wa impso amagawana celiac ganglion autonomic nerve fibers ndi m'mimba, kutsekeka kwakukulu kwa UPJ kumayambitsa **mwamsanga, nseru komanso kusanza mobwerezabwereza ** komwe nthawi zambiri kumatsanzira zilonda zam'mimba, kapamba, kapena chimfine cha m'mimba.

Choke Point 2: Kuwoloka Mitsempha ya Magazi Iliac (Mid-ureter at the pelvic brim)

  • Kumene mumamva: Kupweteka kumatuluka kutsogolo ndi pansi kuchokera kumbali yozungulira mbali ya m'chiuno kupita ku kumanja kapena kumanzere kwapakati pamimba ndi kutsika mu pachifuwa.
  • Msampha wa matenda: Mwala ukaima kumanja pakati pa ureter pamwamba pa minofu ya psoas, umatsanzira kwambiri pachimake appendicitis (kumanja) kapena ** pachimake diverticulitis ** (kumanzere). Komabe, zindikirani momwe wodwalayo amachitira:
  • Wodwala yemwe ali ndi peritonitis kuchokera ku appendicitis amagona ozizira komanso osasuntha pakama chifukwa kuyenda kulikonse kumapweteka peritoneum.
  • Wodwala yemwe ali ndi renal colic amakwinya, akuyenda molowera, kupotokola pansi, ndipo nthawi zonse amasintha malo ** kuyesa pachabe kuti apeze ngodya yomwe imachotsa mkati mwa ureter spasm ("chizindikiro choyenda"**).

Choke Point 3: The Ureterovesical Junction (UVJ, pomwe pansi pa ureter imalowa mchikhodzodzo)

  • Khomo lopapatiza kwambiri panjira ya mkodzo (m'lifupi mamilimita 1 mpaka 2): Miyala yopitilira 60 mpaka 70 peresenti yopezeka pamakakina azadzidzidzi ya CT scan yamamatira pomwepa pa UVJ, mamilimita ochepa chabe isanagwere mchikhodzodzo.
  • Kumene mumamva: Chifukwa pansi pa ureter amagawana genitofemoral ndi pudendal misempha (L1, L2, S2-S4) ndi maliseche akunja ndi chikhodzodzo (trigone), mwala wotsekedwa pa UVJ zimayambitsa:
  • Kupweteka kwakuthwa kumalowa mu machende ndi ma scrotum mwa amuna, kapena ku labia yayikulu ndi maliseche mwa akazi (zomwe zimafuna kusiyanitsa mosamala ndi testicular torsion kapena kuphulika kwa ovarian; m'mwala wa impso, machende amamva bwino komanso osatupa akagwidwa pang'onopang'ono, pamene machende amanjenjemera machende amakhala pamwamba, otupa, komanso ofewa kwambiri).
  • Zizindikiro zachikhodzodzo chowawa kwambiri: Kudzimva mwachangu kwadzidzidzi kuti mukufunika kukodza mphindi zitatu zilizonse (**kukodza mwachangu komanso pafupipafupi ), kuwawa kotentha kumapeto kwa mkodzo (dysuria), ndi kutuluka madontho angapo apinki, ofiira, kapena amtundu wa tiyi wamagazi mkodzo (matenda a hematuria, ngakhale palibe).
  • Mphindi yakupumula: Mwalawu ukangodutsa mu UVJ kulowa mchikhodzodzo chamkodzo, ululu wowawa kwambiri wa 10/10 m'mbali ndi m'chuuno zimachoka nthawi yomweyo. Kudutsa mwala pambuyo pake kuchokera kuchikhodzodzo kudutsa mumkodzo waukulu (womwe ndi 6 mpaka 8 millimeters mulifupi) nthawi zambiri kumapangitsa kuti pang'onopang'ono kwa masekondi 2 kapena * kugwedeza * kosawoneka bwino mu mbale ya chimbudzi.

Kukula kwa miyala ndi kuthekera kwa ndime yachilengedwe: Ndi miyala iti yomwe imadutsa ndi yomwe imakamira?

Pamene madokotala odzidzimutsa amachita ** mlingo wochepa wosagwirizana ndi CT scan wa mimba ndi pelvis (CT KUB) ** kapena ** renal ultrasound **, muyeso umodzi wofunika kwambiri (poganiza kuti palibe matenda kapena impso yokhayokha) ndi ** m'mimba mwake mwala mu millimeters **:

Stone Diameter pa CT Mwayi Wongodutsa Modzidzimutsa Popanda Opaleshoni Avereji ya Nthawi Yodutsa Mchikhodzodzo Standard Clinical Management (Ngati Palibe Fever, Infection, kapena Impso Yokha)
1 mpaka 4 mamilimita (0.04 mpaka 0.16 mu) ** 80 mpaka 90 peresenti ** amadutsa mwachibadwa paokha. 5 mpaka masiku 14 (miyala yaying'ono ya 2 mm pa UVJ nthawi zambiri imadutsa mkati mwa maola 48). Kuyang'anitsitsa odwala kunja, kupweteka kwapakamwa kwa NSAID (ngati ntchito ya impso ili yabwinobwino), kumwa madzi abwinobwino pakati pa spasms, ndi kusefukira kwa mkodzo.
5 mpaka 7 mamilimita (0.20 mpaka 0.28 mu) 50 mpaka 60 peresenti amadutsa mwachilengedwe. Masiku 14 mpaka 28* Mayesero akunja a Medical Expulsive Therapy (MET) pogwiritsa ntchito oral alpha-1 blocker (**tamsulosin / Flomax 0.4 mg tsiku **), yomwe imatulutsa minofu yosalala ya m'munsi mwa ureter kuti ikulitse chitseko ndi kuchepetsa kupweteka kwa colic, kuphatikizapo kutsata kwapafupi ndi urologist mkati mwa 1 mpaka masabata a 2.
8 mpaka 9 mamilimita (0.31 mpaka 0.35 mkati) 20 mpaka 30 peresenti amadutsa mwachibadwa; chiopsezo chachikulu cha kukhudzidwa kosatha komanso kuwonongeka kwa impso (hydronephrosis). Zokayikitsa kudutsa mkati mwa masabata a 4 popanda kuchitapo kanthu. Kutumiza urology mwachangu kuti muchotse mwala wotsimikizika: Ureteroscopy yokhala ndi holmium/thulium laser lithotripsy (kudutsa kamera yaying'ono mmwamba mkodzo kuti isungunuke mwala ndi laser) kapena Extracorporeal Shock Wave Lithotripsy (ESWL).
mamilimita 10 (1 centimeter / 0.4 mu) kapena Kukulirapo Osakwana 10 peresenti amatha kudutsa mumkodzo wopapatiza. Imafunika kuchotsedwa mwadongosolo. Zokonzekera kapena mwachangu ureteroscopic laser lithotripsy kapena Percutaneous Nephrolithotomy (PCNL) (kuchotsa makiyi kumbuyo kwa miyala ikuluikulu ya impso>20 mm kapena miyala ya staghorn struvite).

Kodi mungakhale ndi mwala wa impso ngati muli magazi a ZERO mumkodzo wanu?

Inde. Ngakhale kuti magazi ochulukirapo (wowoneka pinki/ofiira) kapena magazi osawoneka bwino mumkodzo (hematuria) amapezeka mu 80 mpaka 85 peresenti ya milandu ya miyala ya impso, 15 mpaka 20 peresenti ya odwala omwe ali ndi mwala wotsimikizika wa mkodzo amakhala ndi mkodzo wopanda mkodzo ndi ziro maselo ofiira amagazi mumkodzo wawo, makamaka ngati palibe mkodzo ndi mkodzo womwe umatulutsa magazi. ureter wovulalayo ukhoza kuyenda kudutsa mwala kulowa mchikhodzodzo.

Chifukwa chiyani ma NSAID amamenya opioid chifukwa cha ululu wa miyala ya impso wosabala (komanso pamene NSAID ndi zoletsedwa)

Ngati muli mu dipatimenti yodzidzimutsa kapena mwayesedwa kale ndi dokotala yemwe adatsimikizira ** mwala wosavuta, wosabala impso ndi ntchito ya impso (yachibadwa serum creatinine) **, kumvetsetsa momwe zowawa zimagwirira ntchito pa ureter ndizothandiza kwambiri:

1. Chifukwa chiyani Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) amalimbana ndi zomwe zimayambitsa aimpso colic

Mwala ukatsekereza ureter, kukwera kwamphamvu mkati mwa impso kumapangitsa kaphatikizidwe kameneko ka Prostaglandin E2 (PGE2) ndi prostacyclin. Prostaglandin E2 imachita zinthu ziwiri zomwe zimapangitsa kuti aimpso colic ikhale yowawa:

  1. Imafewetsa ma afferent arterioles kulowa mu glomeruli ya impso, kuchulukitsa kusefera kwa mkodzo kupita ku impso yotsekeka kale, yotupa.
  2. Zimayambitsa zachiwawa, zopweteka ** zosalala za minofu ya khoma la ureter ** kuzungulira mwala ndikuwonjezera kutupa kwa khoma la ureter (edema).

NSAID (monga chipatala intravenous ketorolac [Toradol] kapena rectal/oral diclofenac, ibuprofen, kapena naproxen) imalepheretsa mwachindunji prostaglandin synthesis (**cyclooxygenase inhibition **). Potseka Prostaglandin E2, NSAIDs panthawi yomweyo kuchepetsa kupanikizika mkati mwa kapisozi yotupa ya impso, kupumula minofu ya ureter, kuchepetsa kutupa mozungulira mwala, ndikupereka mpumulo wopambana kapena wofanana wa ululu poyerekeza ndi mtsempha wa morphine popanda kuyambitsa kusanza kapena kugona chifukwa cha opioid.

2. Pamene NSAID ZOLETSEDWA KWAMBIRI mu wodwala mwala wa impso

Chifukwa NSAID zimachepetsa kutuluka kwa magazi mu zosefera za impso yotsekeka, ** musatenge ibuprofen, naproxen, ketorolac, kapena diclofenac ** ngati pali zina mwa zotsatirazi:

  • **Simunayezetse magazi m'chipatala kapena mbiri yotsimikizira kugwira ntchito kwa impso **, kapena muli ndi kuvulala kwa impso ( creatinine yokwera) kapena matenda a impso (CKD Stage 3, 4, kapena 5).
  • Muli ndi impso imodzi yokha yomwe ikugwira ntchito (impso yokhayokha) kapena kuika impso: Kumwa NSAID pamene impso yanu yokhayo yatsekedwa ndi mwala imatseka magazi ake otsala a arteriolar ndikuyambitsa nthawi yomweyo kulephera kwaimpso.
  • Muli ndi pakati (NSAIDs zingawononge kukula kwa impso za mwana wosabadwayo ndi kutseka msanga wa fetal ductus arteriosus).
  • Muli ndi matenda a zilonda zam'mimba, magazi m'mimba, kapena kutaya kwambiri madzi m'thupi/urosepsis.
  • Pazochitika zonsezi, madokotala achipatala amagwiritsa ntchito intravenous acetaminophen (paracetamol) ndi titrated **intravenous opioids ** (kapena ultrasound-guided erector spinae nerve blocks / intravenous lidocaine protocols) m'malo mwa NSAIDs.

Pang'onopang'ono chisamaliro cha prehospital ndi kupewa mwala kwanthawi yayitali

Khwerero 1: Kuwongolera kotetezedwa kunyumba ndi mayendedwe panthawi yovuta kwambiri

  1. Yang'anani kutentha ndi thermometer nthawi yomweyo: Musanachize mwala uliwonse wa impso kunyumba, yesani kutentha kwa thupi. Ngati kutentha kuli 38.0 degrees Celsius (100.4 degrees Fahrenheit) kapena kupitirira apo (kapena pansi pa 36.0 C / 96.8 F), kapena ngati munthuyo akunjenjemera, siyani chisamaliro chonse chapakhomo ndipo pitani kuchipatala kapena imbani 911 / 112 / 999.
  2. Pakani kutentha kwakunja ku mbali ndi kumunsi kumbuyo: Ikani chotenthetsera chotenthetsera, botolo la madzi ofunda litakulungidwa mu chopukutira, kapena paketi yotenthetsera ya mankhwala otenthetsera pa 40 mpaka 42 digiri Celsius (104 mpaka 107.6 digiri Fahrenheit) pamwamba pa mbali zowawa ndi msana pamene mukuyenda.
  3. Pewani kuthira madzi mokakamiza panthawi ya ululu wowawa kwambiri: Pamene mukuyembekezera kuti funde la ululu lichepetse kapena kupita kuchipinda chodzidzimutsa, musamange magalasi amadzi. Kupweteka koopsa kwa colic kukawongoleredwa ndipo nseru yathetsedwa, yambiranso kumwa madzi okhazikika (2.0 mpaka 2.5 malita patsiku) kuti athandizire kunyamula mwala kupita pansi.
  4. Sonkhanitsani ndikusefa dontho lililonse la mkodzo: Kodzerani mumkodzo, kapu, kapena chipewa chapulasitiki choyera ndikuchithira kudzera musefa wamwala wamankhwala kapena sefa ya khofi yamapepala oyera. Mwala wolimba ukagwidwa, lolani kuti muwume mu botolo loyera lamapiritsi (osakulunga mu pepala lachimbudzi lonyowa, lomwe limasungunuka kapena kumamatira ku kristalo) ndikubweretsa kwa dokotala wanu ** Fourier-transform infrared spectroscopy (FTIR) kapena X-ray diffraction stone analysis **.

Khwerero 2: Zakudya zozikidwa ndi umboni kuti mupewe mwala wachiwiri wa impso

Popanda kusintha kodziletsa, ** 50 peresenti ya omwe adayambitsa miyala ya impso yoyamba adzadwala mwala wina mkati mwa zaka 5 mpaka 10 **:

  • Imwani madzi okwanira kuti mutulutse pafupifupi malita 2.5 (85 fluid ounces) a mkodzo wachikasu wotumbululuka maola 24 aliwonse: Chizolowezi chimodzichi chimadula mwala kubwerezabwereza pakati pa mitundu yonse ya miyala.
  • Onjezani citrate yachilengedwe (ndimu weniweni kapena madzi a mandimu) kumadzi anu atsiku ndi tsiku: Citrate mumkodzo amamanga kashiamu wamkodzo ndipo mwachibadwa amatchinga makristalo a calcium oxalate ndi calcium phosphate kuti asamamatirane.
  • OSATI KULETSA kashiamu m'zakudya (kudya mkaka wamba / calcium NDI chakudya), koma chepetsani mchere wambiri wa sodium (mchere): Chodabwitsa n'chakuti, kudya zakudya zopanda calcium * kumawonjezera * calcium oxalate aimpso chifukwa cha calcium m'matumbo anu amamangiriza ku oxalate kuchokera ku chakudya (sipinachi, rhubarb, amondi, njuchi, beets m'malo mwa chokoleti). Zakudya zambiri sodium (mchere) zimakakamiza impso kutaya calcium yambiri mumkodzo (hypercalciuria).

Kumvetsetsa mitundu 4 yamankhwala a miyala ya impso ndi zoopsa zapadera

Mwala wa impso ukagwidwa mu strainer kapena kuchotsedwa panthawi ya ureteroscopy, kusanthula kwa labotale kumawonetsa kuti ndi iti mwa **mabanja anayi akuluakulu amchere ** omwe adayambitsa mwalawo, aliyense ali ndi malingaliro apadera:

Mtundu wa Stone Chemical Frequency & X-ray Kuwonekera Muzu ndi Mkodzo pH Zofunika Zachipatala ndi Zadzidzidzi
1. Miyala ya Calcium (Calcium Oxalate [75%] ndi Calcium Phosphate [5%]) 80% ya miyala yonse. Yoyera yowala (radiopaque) pa X-ray yokhazikika ndi CT scan. Mkodzo wochepa kwambiri, zakudya zambiri za sodium, hypercalciuria, hyperoxaluria (matenda a Crohn, gastric bypass, high oxalate diet), kuchepa kwa mkodzo citrate, kapena hyperparathyroidism. Miyala yolimba, yakuthwa, yokhotakhota ("mabulosi" kapena "envelopu" makhiristo) omwe amayambitsa kupweteka kwambiri kwa ureter ndi hematuria; kupewedwa ndi kumwa madzi ambiri, mchere wochepa, kashiamu wanthawi zonse wa chakudya, ndi potaziyamu citrate.
2. Miyala ya Uric Acid (Gout / Acidic Urine Stones) 10% mwa miyala yonse. Yosaoneka (radiolucent) pa X-ray yam'mimba yopanda kanthu, ngakhale imawonekera bwino pa CT scan ndi ultrasound. Mosalekeza mkodzo wa asidi (pH pansi pa 5.5) kuphatikizapo gout, metabolic syndrome/kunenepa kwambiri, kutsegula m'mimba kosatha (kutayika kwa bicarbonate), kudya kwambiri purine/nyama, kapena chemotherapy tumor lysis. Mwala wa impso wokhawo womwe ungathe kusungunuka kwathunthu ndi mankhwala popanda opaleshoni: Kupereka oral potassium citrate kapena sodium bicarbonate kukweza mkodzo pH ku 6.5 mpaka 7.0 kumasungunula miyala ya uric acid yoyera mkati mwa impso ndi ureter (ngati palibe matenda kapena vuto lapamwamba liripo).
3. Miyala ya Struvite (Magnesium Ammonium Phosphate / "Miyala Yopatsirana") 5% mpaka 10% ya miyala. Moderapo radiopaque; imakula mwachangu kukhala nthambi yayikulu "Staghorn Calculi" kudzaza chiuno chonse cha impso. Zoyambitsa 100% ndi matenda osatha a m'mikodzo omwe amakhala ndi mabakiteriya omwe amapanga urease (Proteus mirabilis, Klebsiella, Pseudomonas, Providencia), omwe amagawa urea kukhala ammonia ndikutembenuza mkodzo mwamphamvu alkaline (pH> 7.2). Bomba lanthawi ya urosepsis loopsa kwambiri: Chifukwa mabakiteriya amoyo amakhala mkati mwa minyewa ya mwala wa struvite, maantibayotiki sangathe kuwononga mkodzo mpaka mwala wonse wa staghorn utachotsedwa opaleshoni kudzera Percutaneous Nephrolithotomy (PCNL). Miyala ya staghorn yosasamalidwa imawononga impso (xanthogranulomatous pyelonephritis).
4. Cystine Stones (Hereditary Cystinuria) 1% mpaka 2% ya miyala. Mawonekedwe a "ground-glass") makristalo a hexagonal mu mkodzo. Autosomal recessive genetic defect mu aimpso tubular reabsorption of the amino acid cystine, kuyambira ubwana kapena unyamata. Miyala yolimba kwambiri yolimbana ndi shock-wave lithotripsy; zimafunika moyo wonse wa ultra-high hydration (3.5 mpaka 4 malita/tsiku kuphatikizapo kudzuka usiku kumwa madzi), alkalination mkodzo pamwamba pH 7.5, ndi thiol-binding mankhwala.

Impso miyala pa nthawi ya mimba komanso odwala okhala ndi Ureter Stent

1. Renal colic pa nthawi ya mimba (Kuteteza amayi ndi mwana wosabadwayo)

Pafupifupi ** 1 mwa 200 mpaka 1,500 odwala omwe ali ndi pakati ** amayamba kukhala ndi mwala wopweteka wa impso, makamaka pa ** yachiwiri ndi yachitatu trimester ** (pamene progesterone imatsitsimula minofu yosalala ya ureter ndipo chiberekero chokulitsa chimakanikiza ureters, makamaka kumanja).

  • Chifukwa chiyani odwala omwe ali ndi pakati omwe ali ndi aimpso colic amafunikira kuunika kuchipatala mwachangu:
  • Kupweteka koopsa kwa aimpso kosachiritsika komanso kutsekeka kwa pyelonephritis pamimba kumatha kuyambitsa **kubereka msanga komanso kubereka msanga **, urosepsis wa amayi, komanso matenda oopsa a preeclampsia.
  • Kuyerekeza kwachidziwitso popanda ma radiation: Madipatimenti azadzidzidzi sagwiritsa ntchito makina ojambulira a CT ngati mayeso oyamba apakati; m'malo mwake, amagwiritsa ntchito ** Renal ndi Pelvic Ultrasound ** (kuyeza jets ureral ndi kusiyanitsa physiological hydronephrosis mimba kuchokera mwala) kutsatiridwa ngati pakufunika ** osagwirizana ndi Magnetic Resonance Urography (MRU) ** kapena ultra-low-dose protocols.
  • chitetezo chamankhwala: NSAIDs (ibuprofen, ketorolac, naproxen) amatsutsana kwambiri pa nthawi yomwe ali ndi pakati. Ululu umalamuliridwa bwino ndi acetaminophen ndi opioid ya m'mitsempha, ndipo ngati malungo, urosepsis, kapena kupweteka kwapweteka kumachitika, akatswiri a urologist amaika kanthaŵi kochepa **kusintha kwa chiberekero * 4 masabata * imathandizira kuyika kwa calcium pama stents) mpaka mutabereka.

2. Chisamaliro chadzidzidzi kwa odwala omwe ali kale ndi Indwelling Ureteral Stent ("JJ Stent").

Ngati wodwala posachedwapa ali ndi **double-J (JJ) ureter stent ** atayikidwa mkati mwa ureter ndi katswiri wa urologist (kudutsa mwala kapena kuchiritsa pambuyo pa laser lithotripsy), fotokozani zomwe ziri zachilendo motsutsana ndi ngozi:

  • Zizindikiro zomwe zimayembekezereka: Mkodzo wocheperako kapena wofiyira mukamayenda, kupweteka m'mbali makamaka pokodza (zomwe zimachitika chifukwa cha kuthamanga kwa chikhodzodzo kupita ku chubu cha stent), komanso kufulumira kwa chikhodzodzo kumunsi kwa stent (kuthandizidwa ndi tamsulosin/so oxylifecinine).
  • Red-flag stent emergencies requiring an immediate emergency department visit:
  • New fever (>=38.0 C / 100.4 F) or chills (signals the stent has become encrusted or plugged with biofilm and pus).
  • Return of constant, severe 10/10 flank pain that does not stop after urinating (signals the stent has migrated out of position or plugged with a blood clot or stone fragment).
  • Thick, dark red urine containing large blood clots or inability to urinate (pachimake mkodzo posungira).
  • Chingwe cholendewera chimasuntha kapena kukokedwa: Zopangira zina zosakhalitsa zimakhala ndi chingwe chopyapyala cha nayiloni chotuluka mkodzo kuti chichotsedwe mosavuta; ** musadzikoke nokha chingwe chokhazikika ** pokhapokha mutalangizidwa kuti muchotse pa nthawi yokonzedwa ndi dokotala wanu wa urologist.

Tengani maphunziro ovomerezeka a chithandizo choyamba

Recognizing urosepsis, differentiating abdominal aortic emergencies from flank pain, and managing shock are life-saving skills. Consider enrolling in a certified first aid course with the Red Cross, St John Ambulance, or an accredited local provider.

Mafunso omwe amafunsidwa pafupipafupi

Why is having a fever or shaking chills with a kidney stone such a dangerous medical emergency?

An uncomplicated kidney stone never causes a fever. If you have a fever (38.0 degrees Celsius / 100.4 degrees Fahrenheit or higher) or shaking chills alongside kidney stone pain, it means bacteria are trapped inside the blocked urine behind the stone (obstructive pyelonephritis or pyonephrosis). Because the ureter is corked shut by the stone, antibiotics cannot drain the pus, and high filtration pressure inside the kidney forces bacteria directly into your bloodstream, causing fatal septic shock (urosepsis) within hours unless a urologist places an emergency ureteral stent or nephrostomy tube to drain the kidney.

Should I chug gallons of water right in the middle of a severe kidney stone pain attack to flush it out?

No. While drinking 2.5 liters of water a day is great for preventing stones and helping a stone pass between attacks, force-chugging large volumes of water during an active, severe renal colic spasm is counterproductive and dangerous. When the ureter is acutely blocked, flooding the body with water increases urine pressure behind the stone, stretches the swollen kidney capsule tighter (increasing pain and vomiting), and can even cause the kidney's collecting system to tear open (forniceal rupture).

Why do doctors worry about an abdominal aortic aneurysm (AAA) when an older adult gets sudden "kidney stone" pain?

When an abdominal aortic aneurysm (a ballooned, weakened wall of the body's main artery) begins leaking or rupturing into the retroperitoneal space at the back of the abdomen, the pooling blood presses against the exact same lumbar and ureteral nerves as a kidney stone, causing sudden, severe flank pain radiating to the groin and even blood in the urine. In any adult over age 50 (especially someone who has never had a kidney stone before), sudden flank or back pain must be evaluated immediately in an emergency department to rule out a rupturing aorta.

Why did my excruciating back and flank pain suddenly turn into bladder burning and pain in my testicle or labia?

As a kidney stone travels downward from the kidney to the bottom of the ureter right where it enters the bladder wall (the ureterovesical junction, or UVJ), it irritates the genitofemoral and pudendal nerves as well as the sensitive trigone base of the bladder. Because those same nerves supply the scrotum/testicle in men and the labia in women, your brain feels referred pain in the groin and genitals along with a constant urge to urinate right before the stone drops into the bladder.

Magwero afufuzidwa

  • 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): Medical Management of Kidney Stones and Surgical Management of Stones: AUA/Endourological Society Guideline.
  • National Institute for Health and Care Excellence (NICE, United Kingdom): Renal and Ureteric Stones: Assessment and Management (NG118).
  • Surviving Sepsis Campaign (SSC) and Infectious Diseases Society of America (IDSA): International Guidelines for Management of Urosepsis and Urgent Source Control in Obstructive Pyelonephritis.
  • Pathan SA, Mitra B, Straney LD, et al. (The Lancet): Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial (demonstrating superiority of NSAIDs over morphine for acute renal colic).

Maupangiri ogwirizana