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Xanuunka Dhagaxa Kelyaha ee Daran

Nambarada deg-degga ahi way ku kala duwan yihiin waddan ahaan. Boggani wuxuu isticmaalaa 911, lambarka Maraykanka iyo Kanada. Wadamo badan oo kale ayaa isticmaala 112, 999, ama nambar kale. U hel lambarka wadankaaga.

Weerarka kelyaha ee kelyaha oo aan dhibsanayn wuxuu caan ku yahay inuu keeno qaar ka mid ah xanuunnada ugu daran, xanuunka daran ee bini'aadamku la kulmi karo, haddana dhagax aan dhib lahayn oo ka hooseeya 5 milimitir (0.2 inji) ayaa ugu dambeyntii iskiis u gudbi doona 80 ilaa 90 boqolkiiba kiisaska. Si kastaba ha ahaatee, daqiiqada saxda ah ee dhagxaan kelyaha ah ay ku dabineyso Kaadi caabuqday gadaasheeda gudaha miskaha kelyaha (** obstructive pyelonephritis / pyonephrosis**), xaalada caafimaad waxay ka beddeshaa dhagax bukaan socod xanuun badan waxayna isu beddeshaa ** xaalad degdeg ah oo qaliinka kaadimareenka ah**. Sababtoo ah kelyaha xannibmay waxay sii wadaan shaandhaynta dhiigga cadaadis sarreeya, bakteeriyada iyo endotoxins ku xayiran dhagaxa ka sarreeya ayaa si toos ah loogu qasbay papillae kelyaha ee xididdada kelyaha septic shoog, iyo dhimasho 6 ilaa 24 saacadood gudahood** ilaa degdeg ah loo sameeyo dareere qalliin degdeg ah (mareenka kaadimareenka JJ stent ama tuubada nephrostomy percutaneous).

Mas'uuliyadahaaga degdega ah marka garbaha, dhabarka, ama gumaarka xanuunka daran uu ku dhaco waa inaad si degdeg ah uga baarto "Dhagaxa caabuqa" degdega ah (xannuun kasta oo kelyaha ah oo ay la socoto qandho ka sarreysa 38.0 darajo Celsius / 100.4 darajo Fahrenheit, qarqaryo/gariir, gariir ur xun, kaadi malax ka buuxsantay, ama kaadida oo shaqaynaysa kaliya)* kelyaha)**, ka xaqiiji bukaan kasta oo da'doodu ka weyn tahay 50 ilaa 60 in xanuunka garabka ee lama filaanka ah aanu ahayn dilaaca aortic aneurysm caloosha (AAA), ka fogow gallon biyo ah oo xoog-ku-jiid ah inta lagu jiro xanuunka firfircoonida (kaas oo buufinaya kaabsal-ka kelyaha ee xannibmay kana sii daraya xanuunka iyo matagga), una wac adeegyada caafimaadka degdegga ah isla markaaba haddii ay jiraan calammo guduudan.

Hadda samee tan

  1. ** Isla markiiba wac adeegyada caafimaadka degdegga ah haddii dhagax kelyaha ay la socdaan XUMO, QARQAAR, ama NAXDIN ("Kida Xiran oo Xanuunsan"):** Wac lambarka degdegga ah ee degaankaaga (911 gudaha Maraykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Ingiriiska, 000 gudaha Australia) ama hubi buuggayaga nambarada degdega ah Haddii qof qaba lafaha, dhabarka, ama gumaarka xanuun daran uu ku dhaco ** qandho (38.0 darajo Celsius / 100.4 darajo Fahrenheit ama ka sareeya) ama heerkulka jidhka oo aan caadi ahayn (<36.0 C / 96.8 F) *, ** gariir aan la xakamayn karin kaadida oo aan awoodin. Antibiyootikada afka oo keliya ma daweyn karto malaxda ku xayiran dhagax gadaashiisa; kelyaha waa in si qalliin ah isbitaalka loogu shubaa saacado gudahood.
  2. ** Isla markiiba u tag qaybta gargaarka degdegga ah haddii uu qofku leeyahay HAL kelyood oo shaqaynaysa (ama kelyaha beddelka) ama uur leedahay:** Haddii dhagax uu xannibo kaadi-mareenka ** kelli kali ah** ama ** kelyaha la tallaalay**, qofku wuxuu leeyahay eber kayd ah oo isla markiiba galaya anuric dhaawac degdeg ah kelyaha iyo hyperkalemia nafta halis gelisa.
  3. ** Meesha ka saar dilaaca caloosha Aortic Aneurysm (AAA) qof kasta oo ka weyn da'da 50:** Dadka qaangaarka ah ee ka weyn 50 (gaar ahaan ragga, sigaarka, ama dadka qaba dhiig karka) kuwaas oo aan ** waligood dhagxaan kelyo ah ka hor**, dillaac ama dareere aneurysm aortic caloosha Dhiigbaxa retroperitoneal wuxuu ku cadaadiyaa dareemayaasha saxda ah ee dhagxaan kelyaha ee bidix ama midig, taasoo keenaysa xanuun lama filaan ah oo isku mid ah gumaarka iyo xitaa dhiig yar oo kaadida ah. Had iyo jeer u daaweyso "dhagaxa kelyaha markii ugu horeysay ee ka weyn da'da 50" sida xaalad degdeg ah oo xididada ah oo u baahan waaxda degdega ah ee CT scan ama ultrasound.
  4. Ha ku qasbin xaddi badan oo biyo ah inta lagu jiro xanuunka caloosha ee kelyaha ee degdega ah: Khuraafaad baahsan ayaa dadka u sheegta inay ceshadaan litir biyo ah inta lagu jiro weerarka degdega ah ee dhagxaan kelyaha si ay "dhagaxa uga soo saaraan." Inta lagu jiro xannibaadda kaadi-mareenka ee firfircoon, ** cabidda xaddi badan oo biyo ah waxay kordhisaa wax soo saarka kaadida ee ka sarreeya dhagxaanta isku xiran, oo ku buufinta kaabsal kelyaha sida buufin adag (hydronephrosis), cadaadiska miskaha kelyaha oo soo booda, kicinta matag daran, iyo khatarta dillaaca calyx kelyaha (dillaaca sinada)**. Qaado qadar yar oo biyo ah kaliya haddii aad harraadsan tahay oo aanad lallabo lahayn.
  5. ** Codso diirimaad ku raaxaysata deegaanka (qubeyska diiran, qubeyska, ama suufka kululaynta) dhinaca dabada haddii AANAN qandho jirin:** Si ka duwan xanuunka loo yaqaan 'appendicitis' (meesha kulaylku ka mamnuuc yahay), tijaabooyin caafimaad oo kala soocday ayaa muujinaya in dhigista ** suuf diiran oo diiran ama buste diiran (40 ilaa 42 darajo Celsius / 104 ilaa 107.6 darajo Celsius) spasm oo si weyn u yareeya xanuunka calool xanuunka ba'an ee kelyaha iyo lallabbo inta lagu jiro gaadiidka.
  6. Kaadi oo dhan ku miir miiraha mesh, filter kafeega, ama faashad haddii aad maaraynayso dhagax aan dhib lahayn: Qabashada dhagaxa la soo dhaafay (kaas oo u ekaan kara 2 ilaa 5 milimitir oo yar oo bunni ah, huruud ah, ama taan ciid ah ama quruurux ah) waxay u ogolaataa dhakhaatiirta urologists in ay falanqeeyaan sida saxda ah ee ay ka kooban tahay kiimikada (kaalshiyam oxalate, uric acid ama cystte structures) mustaqbalka.
flowchart TD
    Start["Si lama filaan ah, Xagalka Dhabarka ee Xanuunka Xanuunka badan ee Dhabarka dhabarka ee Costovertebral"] --> CheckSepsis{"1. Iska hubi Kelyaha Xanuunsan (Urosepsis) Calaamadaha Cas: Qandho (>= 38.0 C), Qandho/qaraar, Kaadi Darruur leh, Jahwareer, ama Naxdin?"}
    CheckSepsis -->|Yes| CallEMS["Wac Adeegyada Degdegga ah (911/112/999) Isla markiiba: Waqti- Halis ah Ka-baxa Kaadigoodu ayaa loo baahan yahay"]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. Bukaanka ka weyn 50 jir ma qaba 'dhagax-waqtiga kowaad', la yaqaan aortic aneurysm, dawakhaad, ama syncope?"}
    CheckAAA -->|Yes| CallEMS_AAA["Isla markiiba wac Adeegyada Degdegga ah: Meesha ka saara Aneurysm Aortic Aortic Aortic (AAA) ee dillaacay"]
    CheckAAA -->|No| CheckRenal{"3. Hubi kelyaha & Calamada gaduudan ee matagaya: Kelyaha Kelida ah/Trantay, Uurka, Kaadi Soo Baxa Eber, Ama Matag Aan La Kabayn?"}
    CheckRenal -->|Yes| UrgentED["Isla markiiba u qaado Waaxda Gurmadka Degdegga ah ee Cisbitaalka ee IV Xannuunka, Dawaynta Dhiig-baxa, iyo Sawirka"]
    CheckRenal -->|No Red Flags| EvalED["Diyaarso Qiimaynta Caafimaad ee Degdega ah (CT / Ultrasound-ka aan isbarbar dhigin) iyo Cadaadiska Kaadi"]
    CallEMS --> FirstAid["4. Ku codso baakad diirran dhinaca garabka (haddii aysan qandho lahayn), ha ku qasbin biyaha inta lagu jiro maro ba'an, u dhig si raaxo leh"]
    UrgentED --> FirstAid

Colic kelyaha oo aan dhibsanayn iyo kelyaha caabuqay ee xannibmay (Pyonephrosis iyo Urosepsis)

Waa maxay sababta dhagaxa kelyaha oo aan caabuq lahayn si badbaado leh loogu maareeyo xakamaynta xanuunka iyo fiirsashada, halka dhagaxa kelyaha * oo leh * caabuqa kaadi mareenka uu yahay mid ka mid ah xaaladaha degdegga ah ee ugu dhimashada badan ee daawada isbitaalka?

Dhagaxa kelyaha ee aan dhibsanayn (xanuunka kelyaha), kaadida nadiifka ah waxay dib ugu soo noqotaa dhagxaanta ku dhex jira kaadi mareenka iyo miskaha kelyaha (hydronephrosis). Iyada oo kala-baxa kaabsal kelyaha faybarka leh iyo bararka kaadi mareenka ay sababaan 10/10 xanuun daran, kaadida lafteedu waa madhalays.

** kelyaha caabuqa xannibay (obstructive pyelonephritis ama pyonephrosis), bakteeriyada (sida Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas,ama Enterococcus) waxay ku xayiran yihiin meel xiran, nidaamka ururinta cadaadiska ee ka sarreeya dhagaxa. Kelyaha xannibmay asal ahaan waxay noqonayaan ** naas-nuujinaya cadaadiska sifaynta halbowlayaasha sare:

  1. Waa maxay sababta antibiyootiga kaligeed eysan u gaari karin ama u daweyn karin kelyaha caabuqsan ee xannibmay: Marka hore, sababtoo ah sifeynta glomerular waxay ku istaagtaa kelyaha gebi ahaanba xannibmay, antibiyootiga faleebada ama afka ma shaandhayn karto kaadida fadhida ee ka sarreysa dhagaxa. Marka labaad, cadaadiska sare ee intrapelvic (** ka sarreeya 30 ilaa 40 mmHg *) waxay furaysaa ilmada yar yar ee talooyinka calyces kelyaha ( pyelovenous iyo pyelolymphatic dib-u-socodka ***), oo si toos ah bakteeriyada nool iyo endotoxin bakteeriyada si toos ah ugu geliso nidaamka dhiigga ee garaaca wadnaha kasta.
  2. Sida ugu dhakhsaha badan ee urosepsis u disho biyo la'aan naxdin iyo geeri.
Muuqaalka Caafimaadka Dhagax kelyaha oo aan dhibsanayn (Sterile Colic kelyaha) Pyelonephritis Ba'an Oo Aan Dhibsanayn Kelyaha Qabsoomay/Pyonephrosis (Qaliinka degdega ah ee Urosepsis)
Pathology-ga hoose Dhagaxa macdanta macdanta ah ayaa xannibaya kaadi mareenka, taasoo keenta cadaadis dhabarka oo nadiif ah (hydronephrosis) iyo bararka kaadi mareenka ee xooggan. Bakteeriyadu waxay ka soo baxdaa kaadiheysta oo soo gasho nudaha kelyaha, taasoo keenta caabuq kelyaha, laakin kaadi mareenku wuu ballaaran yahay sidaas darteed malaxda iyo kaadidu waxay si xor ah ugu shubmaan kaadiheysta. Dhagax ** wuxuu xannibaa kaadi mareenka, bakteeriyaduna waxay ku tarmeysaa kaadida ku xayiran ee ka sarreysa dhagaxa**, taasoo miskaha kelyaha u beddeleysa bac malax cadaadis ah (pyonephrosis).
Habka xanuunka iyo darnaanta ** Si lama filaan ah, mowjado paroxysmal ah oo xanuun daran 10/10 gar-ilaa-gumaar *** waara 20 ilaa 60 daqiiqo hirkiiba; Bukaanka ** sagxadda ayuu ku socdaa, ku rogrogaa barellada, mana fadhiisan karo meel**. ** Tartiib tartiib u bilaabma 1 ilaa 2 maalmood oo joogto ah, qoto dheer, xanuun xanuun leh oo caajis ah ** hal garab/dhabar (damqasho xagasha costovertebral), oo inta badan ay ka horeyso maalmo gubasho kaadiheysta (dysuria). Xanuun daran, garab iyo calool xanuun oo aan joogsanayn (ama dadka da'da ah ama bukaanada qaba xanuunka macaanka, dhabar xanuunka oo dagdag ah oo ay hadheeyeen delirium iyo septic burburka).
** Heerkulka Jirka iyo Cadaadiska** ** Heerkulka caadiga ah (36.5 ilaa 37.3 C / 97.7 ilaa 99.1 F). ** xumad sare (38.5 ilaa 39.5 C / 101.3 ilaa 103.1 F)** oo leh qarqaryo, lallabbo, iyo matag, laakiin dhiig karka sida caadiga ah si dhakhso ah ayuu u xasiliyaa dareeraha IV iyo antibiyootiga. ** qandho sare oo qandho ah (> 38.5 ilaa 40.0 C) AMA hypothermia (<36.0 C)** with violent teeth-chattering rigors, racing heart (>110 bpm), neefsasho degdeg ah (> 22/min), cadaadis dhiig oo hooseeya, iyo jahawareer.
** Ka-jawaabista Antibiyootikada Kalidaa ah** Antibiyootiga looma baahna haddii kaadidu ay madhalays tahay. Wuxuu si joogto ah uga jawaabaa 24 ilaa 48 saacadood gudahood si loo beegsado antibiyootiga xididada ama afka. **Ku guul darreysato inay horumariso (ama si firfircoon uga sii darto shoog septic) iyadoo la isticmaalayo antibiyootiko oo keliya *** sababtoo ah malax jir ahaan ayaa ku daboolan dhagaxa gadaashiisa. **Waxay u baahan tahay dheecaan degdeg ah stent ama tuubada nephrostomy.

Xeerka Dahabka ah ee Kaadi-mareenka: Dhagax kelyaha WELIGU ma keeno qandho kaligiis ah

Haddii qof laga helay dhagxaan kelyaha ah (xitaa dhagax 3 milimitir ah oo guriga looga soo diray qolka degdega ah shalay) uu yeesho ** qandho ah 38.0 darajo Celsius (100.4 darajo Fahrenheit) ama ka sareeya, qarqaryo, dhidid badan, ama dawakhaad *, hadda ma qabaan calool xanuun fudud. Waxay leeyihiin ** kelyo caabuqsan oo xannibmay (obstructive pyelonephritis / urosepsis) waana inay isla markiiba ku soo laabtaan qaybta degdegga ah ee cisbitaalka si ay u helaan antibiyootiga xididdada dhiigga iyo dareeraha degdegga ah ee kelyaha.

Anatomy ee weerarka dhagxaan kelyaha: Sidee meesha xanuunku ula socotaa socodka dhagaxa ee hoosta kaadimareenka

Dhagaxa kelyuhu ma dhaawacmaan marka uu si deggan u fadhiyo gudaha calyx-ga kelyaha ee ballaaran ee kelyaha (haddii aysan ahayn dhagxaan caabuq staghorn ah oo wayn). Xanuunku wuxuu qarxiyaa marka uu dhagaxu u dhaco cidhiidhi, muruq ureter (kaas oo kaliya 2 ilaa 4 millimitir ballaciisu yahay) wuxuuna noqdaa mid la jeexjeexo mid ka mid ah saddexda dhibcood ee matagaga anatomical (cidhiidhi) ee marinka kaadi mareenka. Marka dhagaxu hoos ugu sii socdo dhinaca kaadiheysta, meesha xanuunku wuxuu u wareegayaa si la saadaalin karo ** ilioinguinal iyo dareemayaasha genitofemoral (T11 ilaa L2):

Dhibicda Choke 1: Isgoysyada Ureteropelvic (UPJ, halkaas oo dhuunta kelyaha ay ku kulmaan dusha sare ee kaadi mareenka)

  • Halka aad ka dareento: Xanuun degdeg ah, qoto dheer, midi u eg oo sarreeya ** xagasha costovertebral (CVA)**, geeska V-qaabeeya ee dhabarkaaga halkaasoo feeraha 12aad ee hoose ay la kulmaan lafdhabarta.
  • Calamadaha isku xidhan: Sababtoo ah kaabsal kelyuhu waxay la wadaagaan caloosha, xannibaadda sare ee UPJ waxay kicisaa ** isla markiiba, lallabo daran iyo matag soo noqnoqda ** kaas oo si joogto ah u ekaysiiya xanuunka xameetida, pankreatit, ama hargab caloosha.

Dhibicda Choke 2: Ka gudubka marinnada Dhiigga Iliac (Mid-ureter at the pelvic miskaha)

  • Halka aad ka dareento: Xanuunku wuxuu ka soo ifbaxaya hore iyo hoos ka soo baxa garbaha ku wareegsan dhinaca dhexda ilaa *midig ama bidix afar geesoodka hoose ee caloosha
  • Dabin ogaanshaha: Marka dhagaxu ku hakado midigta dhexe ee kaadi-mareenka ee muruqa psoas, wuxuu si dhow ula mid yahay xanuunka loo yaqaan 'appendicitis' (dhinaca midig) ama ** diverticulitis daran ** (dhanka bidix). Si kastaba ha ahaatee, u fiirso sida bukaanku u dhaqmo:
  • Bukaanka qaba peritonitis oo ka yimi xanuunka loo yaqaan 'appendicitis' wuxuu ku jiifaa sariirta ** barafaysan oo aan dhaqdhaqaaq lahayn** sababtoo ah dhaqdhaqaaq kastaa wuxuu dhaawacayaa peritoneum-ka.
  • Bukaanka qaba ** colic kelyaha *** waa uu fooraraa, kor u qaada dariiqa, dhulka ayuu maroojiyaa, oo si joogto ah u beddelaa booska *** isku dayaya macno la'aan si uu u helo xagal ka nafisa qulqulka kaadi mareenka gudaha (**"calaamadaha socodka"

Dhibicda Choke 3: Isgoysyada Ureterovesical (UVJ, halka hoose ee kaadi mareenka uu galo gidaarka kaadiheysta)

  • Albaabka ugu cidhiidhsan ee kaadi mareenka (kaliya 1 ilaa 2 milimitir ballac): In ka badan ** 60 ilaa 70 boqolkiiba dhagxaanta** ee laga helo CT scans ee waaxda xaaladaha degdega ah ayaa halkan ku dheggan UVJ, kaliya milimitir ka hor intaysan ku dhicin kaadi haysta.
  • Halka aad ka dareento: Sababtoo ah hoosta kaadi mareenku waxay wadaagaan ** genitofemoral iyo neerfayaasha pudendal (L1, L2, S2-S4)** oo leh xubinta taranka ee dibadda iyo saldhigga kaadiheysta (trigone), dhagax la jeexjeexay UVJ wuxuu keenaa:
  • ** Xanuun daran oo si toos ah uga soo baxaya xiniinyaha ipsilateral iyo xiniinyaha ragga, ama gudaha faruuryaha waaweyn iyo siilka dumarkadildilaaca xiniinyaha ama dildilaaca ugxansidaha; Dhagxaan kelyaha, xiniinyaha laftiisa ayaa dareema wax caadi ah oo aan bararin marka si tartiib ah loo taabto, halka jeexjeexa xiniinyaha ay xiniinyaha fadhiistaan mid sare, barar iyo jilicsanaan).
  • Calaamadaha kaadiheysta xanaaqa daran:** Dareen degdeg ah oo aad u baahan tahay inaad kaadido 3dii daqiiqoba (** degdegga kaadida iyo soo noqnoqda**), xanuunka gubanaya caarada kaadi mareenka (dysuria), iyo gudbinta dhowr dhibcood oo ah * casaan, casaan, ama midab shaah leh oo kaadi dhiig ah (hematuria guud, xitaa marka ma jirto)***
  • Xilliga nasinta: Marka dhagaxu ugu dambeyntii ka soo baxo UVJ ee kaadiheysta qolka qolka, xanuunka 10/10 ee garbaha iyo gumaarka ** isla markiiba wuu baabi'iyaa. Ka gudbidda dhagaxa ka dib kaadiheysta oo ka soo baxda kaadi mareenka ballaaran (kaas oo ah 6 ilaa 8 milimitir ballac ah) waxay badanaa keentaa kaliya qanjaruufo 2-ilbiriqsi gaaban ah ama * qallafsanaan* khafiif ah oo ku jira saxanka musqusha.

Cabbirka dhagaxa iyo suurtogalnimada marinka dabiiciga ah: dhagxaan kee baa dhaafa yaase ku dheggan?

Marka takhaatiirta deg-degga ahi ay sameeyaan qiimo-hooseeya oo aan ka soo horjeedin CT scan ee caloosha iyo miskaha (CT KUB) ama ** ultrasound kelyaha**, cabbirka kaliya ee ugu muhiimsan (malaha infekshanka ama kelyaha keligiis ma joogo) waa ** dhexroorka wareejinta dhagaxa ee millimeters**:

Dhexroorka Dhagaxa ee CT Suurtagalnimada Gudbinta Kediska ah ee Qalliin la'aan Celceliska Waqtiga Loo Gudbo Kaadi-haystaha Maareynta Caadiga ah ee Kiliinikada (Haddii aysan jirin Qandho, Caabuqa, ama Kelyo Keli ah)
1 ilaa 4 millimitir (0.04 ilaa 0.16 inji) ** 80 ilaa 90 boqolkiiba *** si dabiici ah iskood ayay u gudbaan. ** 5 ilaa 14 maalmood *** (dhagaxaan 2 mm ka yar ee UVJ badanaa waxay ku gudbaan 48 saacadood gudahood). U fiirsashada bukaan-socodka, xanuunka afka ee NSAID-da (haddii shaqada kelyuhu caadi tahay), qaadashada dareeraha caadiga ah ee u dhexeeya bararka, iyo cadaadiska kaadida.
5 ilaa 7 millimitir (0.20 ilaa 0.28 inji) ** 50 ilaa 60 boqolkiiba ** si dabiici ah ayey u gudbaan. 14 ilaa 28 maalmood Tijaabada bukaan-socod ee ** Daaweynta Expulsive Expulsive Therapy (MET)** iyadoo la adeegsanayo alfa-1 blocker (**tamsulosin / Flomax 0.4 mg maalin kasta ***), kaas oo dejinaya muruqa siman ee kaadi mareenka hoose si uu u balaadhiyo albaabka oo uu u yareeyo xiidmaha, iyo la socodka dhow ee dhakhtarka kaadi mareenka 1 ilaa 2 toddobaad gudahood.
8 ilaa 9 millimitir (0.31 ilaa 0.35 inji) ** 20 ilaa 30 boqolkiiba ** si dabiici ah ayey u gudbaan; Khatar sare oo saameyn joogto ah iyo dhaawaca kelyaha ee sii socda (hydronephrosis). Ma dhici karto inay ku dhaafto 4 toddobaad gudahood iyada oo aan la faragelin. U gudbinta kaadi mareenka degdega ah ee ka saarista dhagaxa ah: Ureteroscopy oo leh holmium/thulium laser lithotripsy (kor u qaadida kamarad yar oo kor u qaadaysa kaadimareenka si ay dhagaxa ugu soo saarto laysarka) ama ** Extracorporeal Shock Wave Lithotripsy (ESWL)**.
** 10 milimitir (1 sentimitir / 0.4 inji) ama ka weyn** In ka yar 10 boqolkiiba waxay mari kartaa kaadi-mareenka cidhiidhiga ah. Wuxuu u baahan yahay habraac ka saarid. Qorshaysan ama degdeg ah ** ureteroscopic laser lithotripsy ** ama ** Percutaneous Nephrolithotomy (PCNL)** (daloolada furaha ee dhabarka laga soo saaro dhagxaan kelyaha waaweyn>20 mm ama ** staghorn struvite stones**).

Ma yeelan kartaa dhagax kelyo haddii uu jiro dhiig ZERO ee kaadidaada?

***Haa Ka soo baxa kaadi mareenka dhaawacmay ayaa ku soo daaci kara dhagaxa kaadiheysta.

Waa maxay sababta NSAIDs ay ugu garaacday opioids xanuunka dhagxaan kelyaha ee nadiifka ah (iyo marka NSAIDs si adag loo mamnuucay)

Haddii aad ku jirto qaybta gargaarka degdegga ah ama uu hore u qiimeeyay takhtar kaas oo xaqiijiyay ** aan dhibsanayn, dhagxaan kelyaha oo nadiif ah oo leh shaqo caadi ah oo kelyaha ah (serum creatinine) **, fahamka sida xanuun-yareyaasha uga shaqeeyaan kaadi-mareenka waa mid waxtar leh:

1. Waa maxay sababta daawooyinka aan dawooyinka lahayn ee ka-hortagga caabuqa (NSAIDs) ay bartilmaameedsadaan sababta asalka u ah colic kelyaha

Marka dhagax uu xiro kaadi-mareenka, cadaadiska kor u kaca ee gudaha kelyaha wuxuu kiciyaa isku-dhafka maxalliga ah ee Prostaglandin E2 (PGE2) iyo prostacyclin. Prostaglandin E2 waxay qabataa laba shay oo ka dhigaya calool xanuun kelyaha:

  1. Waxay balaadhisaa xididada afferent arterioles ee gala glomeruli ee kelyaha, ** kordhinta cadaadiska kaadida si toos ah ugu xidhma, kelyaha bararsan**.
  2. Waxay kicisaa rabshado, xanuun badan muruqa jilicsan ee gidaarka kaadi mareenka agagaarka dhagaxa waxayna kordhisaa bararka derbiga kaadi mareenka ee maxaliga ah ( bararka).

** NSAIDs** (sida xididada cisbitaalka ** ketorolac [Toradol]** ama malawadka/ afka diclofenac, ibuprofen, ama naproxen) waxay si toos ah u xidhaan prostaglandin synthesis (** xannibaadda cyclooxygenase**). Adigoo xiraya Prostaglandin E2, NSAIDs ** isla mar ahaantaana hoos u dhiga cadaadiska gudaha kaabsulka kelyaha ee barara, naso murqaha kaadi mareenka, yareyso bararka agagaarka dhagaxa, oo bixi xanuun ka sarreeya ama la mid ah marka la barbar dhigo morphine xididka ** iyada oo aan sababin matag ama hurdo uu opioid-ku keeno.

2. Marka NSAID-yada ay si adag uga mamnuuceen bukaanka dhagxaan kelyaha

Sababtoo ah NSAID-yadu waxay yareeyaan qulqulka dhiigga ee filtarrada kelyaha xanniban, ** waligaa ha qaadan ibuprofen, naproxen, ketorolac, ama diclofenac ** haddii mid ka mid ah shuruudahan soo socda lagu dabaqo:

  • Weli ma aadan samayn baaritaan dhiig isbitaal ama taariikh xaqiijinaysa shaqada kelyaha ee caadiga ah, ama aad qabto dhaawac kelyo ah oo ba'an (creatinine sare leh) ama cudur kelyaha daba-dheeraada (CKD Stage 3, 4, or 5).
  • Waxaad leedahay hal kelyood oo shaqaynaysa (keli keli ah) ama kelyo beddelasho: Qaadashada NSAID marka kelyahaaga kaliya uu xannibo dhagax ayaa xidhaysa qulqulka dhiigga halbowlaha afferent ee soo hadhay waxayna soo dedejisaa ** degdeg ah kelyaha
  • **Waxaad uur leedahay *** (NSAIDs waxay dhaawici karaan korriinka kelyaha uurjiifka ah waxayna si degdeg ah u xiri karaan xuubka uurjiifka arteriosus).
  • Waxaad qabtaa cudurka boogaha peptic ee firfircoon, dhiigbaxa caloosha, ama fuuqbax daran/urosepsis.
  • Dhammaan kiisaskaas, takhaatiirta isbitaalku waxay adeegsadaan ** xididada acetaminophen (paracetamol)** iyo titrated ** xididada opioids** (ama xuubka xuubka xuubka laf dhabarta dareemaha xididada xididada xididada xididada xididada xididada lidocaine) halkii NSAID-yada.

Tallaabo-tallaabo ah daryeelka isbitaalka ka hor iyo ka-hortagga dhagaxa muddada-dheer

Tallaabada 1: Badbaadada guriga iyo maamulka gaadiidka inta lagu jiro xaalad degdeg ah

  1. ** Isla markiiba heerkulka ku hubi heerkulbeeg:** Kahor intaadan guriga ku daawayn dhagxaan kellida ah ee looga shakisan yahay, cabbir heerkulka jidhka. Haddii heerkulku yahay 38.0 darajo Celsius (100.4 darajo Fahrenheit) ama ka sarreeya (ama ka hooseeya 36.0 C / 96.8 F), ama haddii qofku qabo qarqaryo, ** jooji dhammaan daryeelka guriga oo si toos ah u aad waaxda gurmadka ama wac 911/112/999**.
  2. ** Dabool kulaylka dibadeed ee fir fircoon ee garbaha iyo dhabarka hoose:** Dhig suuf diiran oo diirran, dhalada biyo diirran oo lagu duuduubay tuwaal, ama xirmo kulayl kiimiko ah oo diirran 40 ilaa 42 darajo Celsius (104 ilaa 107.6 darajo Fahrenheit) dulsaar xanuunka dhabarka iyo dhabarka hoose inta lagu jiro gaadiidka.
  3. Ka fogow fuuq-baxa khasabka ah inta lagu jiro xanuunka ba'an ee ugu sarreeya: Markaad sugayso mawjada xanuunku inay degto ama u safrayso qolka gargaarka degdegga ah, ha ku dhufan koobabka biyaha. Marka la xakameeyo qanjidhada ba'an ee calool-xanuunka oo lallabbo la xaliyo, dib u bilow qaadashada caadiga ah, qaadashada dareeraha joogtada ah (2.0 ilaa 2.5 litir maalintii) si ay gacan uga geysato qaadista dhagaxa hoos.
  4. Ururi oo miir dhibic kasta oo kaadi ah: Ku kaadi kaadida caaga ah ee nadiifka ah, koob, ama koofiyad oo ku shub shaandhaynta dhagaxa caafimaadka ama filter kafeega cad cad. Marka la qabto crystal dhagax adag, ha ku qallajiso dhalo kaniini nadiif ah (waligaa ha ku duubin warqad musqusha qoyan, taas oo milla ama ku dheggaada crystal) oo u keen dhakhtarkaaga Fourier-transform infrared spectroscopy (FTIR) ama falanqaynta dhagxaanta raajada.

Tallaabada 2: Tallaabooyin cunto caddayn ku salaysan si looga hortago dhagxaan kelyaha labaad

Iyadoo aan la helin isbeddello ka hortag ah, ** 50 boqolkiiba dadkii hore ee dhagxaan kelyaha markii ugu horeysay waxay la kulmi doonaan dhagax kale 5 ilaa 10 sano gudahood ***:

  • ** Cab biyo kugu filan si aad u soo saarto ugu yaraan 2.5 litir (85 wiqiyadood oo dareere ah) oo kaadi jaale ah oo cirro leh 24-kii saacba
  • Ku dar citrate dabiici ah (liin ama casiir liin dhab ah) biyahaaga maalinlaha ah: Citrate kaadida ku jirta waxay ku xidhaa kaalshiyamka kaadi mareenka waxayna si dabiici ah u xannibaysaa kalsiyum oxalate iyo kalsiyum phosphate crystals inay isku dhegaan.
  • ** Ha xaddidin kalsiyumka cuntada (cun caanaha caadiga ah / kalsiyumka cuntada), laakiin ha iska yareynin sodium sare (milix):** Si ka duwan, cunto yar oo kalsiyum * waxay kordhisaa * dhagxaan kelyaha oxalate calcium sababtoo ah kalsiyumka cuntada ee xiidmahaaga waxay isku xirtaa inay ka soo baxdo cuntada (spinach, rhubarb, almonds, beets) aad ka nuugi lahayd shukulaatada. kaadida. Cunto badan sodium (milix) waxay kelyaha ku qasabtaa inay kaadida ku shubaan kalsiyum xad dhaaf ah (** hypercalciuria**).

Fahamka 4-ta nooc ee kiimikaad ee dhagxaan kelyaha iyo xaaladaha degdegga ah ee gaarka ah

Marka dhagax kelyaha lagu qabto miiraha ama laga saaro inta lagu jiro ureteroscopy, shaybaadhka shaybaadhka ayaa tilmaamaya mid ka mid ah ** afar qoys oo macdanta ugu waaweyn ah** sababay dhagaxa, mid kastaa wuxuu sitaa tixgelin gaar ah oo degdeg ah:

Nooca Kiimikada Dhagaxa Soo noqnoqda & Muuqaalka raajada Sababta xididka & kaadida pH Tixgelinta Kiliinikada ee Muhiimka ah iyo Xaaladda Degdegga ah
1. Dhagxaanta Kaalshiyamka ah (Kaalshiyam Oxalate [75%) iyo Kaalshiyam Fosfate [5%) 80% dhammaan dhagxaanta. Cad dhalaalaysa (radiopaque) ee raajo iyo CT-ga caadiga ah. Mugga kaadida oo hooseeya, soodhiyam cunto oo sarreeya, hypercalciuria, hyperoxaluria (Crohn disease, gastric bypass, diet oxalate high), citrate kaadi yar, ama hyperparathyroidism. Dhagxaan adag, fiiqan, jeexan ("mulberry" ama "bakhshad" kiristaalo) kuwaas oo keena barar daran oo kaadi mareenka iyo hematuria; lagaga hortagayo qaadashada dareeraha badan, milix yar, wakhtiga cuntada ee calcium, iyo potassium citrate.
2. Dhagaxyada Uric Acid (Gout / Dhagaxa Kaadi Aysiidhka ah) ** 10% dhammaan dhagxaanta.** ** Lama arki karo (radiolucent) ee raajada caloosha ee cad**, inkastoo si cad looga arki karo CT scan iyo ultrasound. Si joogto ah ** kaadi acidic ah (pH ka hooseeya 5.5)** oo ay weheliso gout, dheef-shiid kiimikaad xanuunka/ buurnida, shuban dabadheeraad ah (luminta bicarbonate), cunista hilibka purine/hilibka oo sarreeya, ama lysis burada kiimoterabiga. Dhagaxa kelyaha kaliya ee si buuxda ugu milmi kara dawo qaliin la'aan ah: Siinta afka potassium citrate ama sodium bicarbonate si kor loogu qaado pH kaadida ilaa 6.5 ilaa 7.0 waxa ay milantaa dhagxaanta uric acid ee saafiga ah gudaha kelyaha iyo kaadi mareenka (haddii aanay jirin caabuq ama dhibaato heer sare ahi aanay jirin).
3. Dhagaxyada Struvite (Magnesium Ammonium Phosphate / "Dhagaxa caabuqa") ** 5% ilaa 10% dhagxaanta.** Shucaac shucaac ah oo dhexdhexaad ah; si degdeg ah u koraan una koraan laamo weyn "Staghorn Calculi" buuxinaya dhammaan miskaha kelyaha. Waxaa keenay ** 100% caabuqa kaadi mareenka sare ee daba dheeraada oo ay weheliso bakteeriyada urease-ka soo saarta** ** Bamka waqtiga urosepsis ee khatarta sare leh:** Sababtoo ah bakteeriyada nool waxay ku nooshahay gudaha lakabyada jeexan ee dhagaxa struvite, antibiyootiga marnaba ma nadiifin karaan kaadida ilaa dhagxaanta staghorn oo dhan qalliin laga saaro ** Percutaneous Nephrolithotomy (PCNL)**. Dhagxaanta staghorn ee aan la daweynin waxay burburiyaan kelyaha (xanthogranulomatous pyelonephritis).
4. Dhagxaanta Cystin (Cystinuria ee la iska dhaxlo) 1% ilaa 2% ee dhagxaanta. Shucaac shucaac ah oo daciif ah kiristaalo lix geesood ah oo kaadida. Autosomal recessive genetic cilad ku jirta dib u nuugista tubbada kelyaha ee amino acid cystine, laga bilaabo ** caruurnimada ama qaan-gaarka**. Dhagxaan aad u adag oo u adkeysanaya lithotripsy-shoog; Waxay u baahan tahay fuuq-bax aad u sarreeya (3.5 ilaa 4 litir/maalintii oo ay ku jiraan habeenkii si aad u cabto biyo), alkalinization kaadida ee ka sarreeya pH 7.5, iyo daawooyinka thiol-ku-xidha.

Dhagxaanta kelyaha xilliga uurka iyo bukaanka qaba xuubka kaadi mareenka ee Indwelling

1. Calool-jilicda kelyaha xilliga uurka (Ilaalinta hooyada iyo uurjiifka labadaba)

Qiyaastii 1 200 ilaa 1,500 bukaan ah oo uur leh waxa ku dhaca dhagxaan kelyaha oo degdeg ah, inta badan inta lagu jiro saddex biloodlaha labaad iyo saddexaad (marka progesterone nasiyo muruqa siman ee kaadi mareenka iyo ilmo-galeenka weynaana uu cadaadiyo kaadi mareenka, gaar ahaan dhinaca midig).

  • Waa maxay sababta bukaanada uurka leh ee qaba calool-xanuunka kelyaha ay ugu baahan yihiin qiimayn degdeg ah:
  • Calool-xannuun daran oo kelyaha ah oo aan la daweyn iyo pyelonephritis-ka xanniba ee uurka waxay kicin karaan ** foosha kahor iyo dhalmada dhicis ah**, urosepsis hooyada, iyo dhiig-karka preeclampsia-sida.
  • ** Sawirka ogaanshaha aan lahayn shucaaca halkii, waxay isticmaalaan ** kelyaha iyo miskaha Ultrasound ** (cabbirka jets kaadi mareenka iyo kala soocida hydronephrosis physiological ee uurka ee dhagaxa) oo ay ku xigto ** non-contrast Magnetic Resonance Urography (MRU)** ama borotokollada ultra-hooseeya.
  • ** Badbaadada daawada: ** ** NSAIDs (ibuprofen, ketorolac, naproxen) si adag ayaa looga hortegay uurka. ku dhejinta stent) ilaa dhalmada ka dib.

2. Daryeelka degdega ah ee bukaanada horay u haystay stent Uretral ("JJ Stent")

Haddii bukaan uu dhawaan lahaa **double-J (JJ) stent kaadi mareenka ** uu geliyo gudaha kaadimareenka urologist (si uu u dhaafo dhagax ama u bogsado ka dib lithotripsy laysarka), cadee waxa caadiga ah iyo xaalad degdeg ah:

  • Calaamadaha stent ee caadiga ah ee la filayo: Kaadi casaan khafiif ah ama casaan guduudan ka dib markaad socoto, oo ku xanuunaysa garbaha gaar ahaan markaad kaadinayso (sabato cadaadiska kaadiheysta oo dib u soo celinaya tuubada stent godka), iyo degdega kaadiheysta khafiifka ah / soo noqnoqda ee gariiradda hoose ee stent (oo lagu daaweeyay tamsulosin iyo oxybutynin).
  • ** Xaaladaha degdega ah ee stent calan-cas oo u baahan booqasho waax degdeg ah oo degdeg ah:**
  • ** Qandho cusub (>=38.0 C / 100.4 F) ama qarqaryo** (calaamadaha stent-ku waxa ay noqdeen kuwo la isku duubay ama lagu xidhay biofilm iyo malax).
  • Soo laabashada joogtada ah, xanuun daran 10/10 ee garbaha oo aan joogsan kaadida ka dib (calaamadaha stent-ka ayaa ka guuray booska ama ku xirmay xinjir dhiig ama jajab dhagax ah).
  • Kaadi qaro weyn, madaw oo cas oo ay ku jiraan xinjiro dhiig oo waaweyn ama ** la'aanta kaadidakaadida oo degdeg ah)**.
  • ** Xadhiga stent ee laalaado wuu dhaqaaqaa ama waa la jiidaa:** Xarigyada ku meel gaadhka ah qaarkood waxay leeyihiin xadhig fiilada nylon dhuuban oo ka soo baxa kaadi mareenka si fudud xafiiska looga saaro; Weligaa ha soo jiidin xadhkaha stent laftaadu ilaa si cad loogu amro inaad ka saarto dhakhtarkaaga kaadi mareenka.

Qaado koorsada gargaarka degdegga ah ee shahaadaysan

Aqoonsiga urosepsis, kala soocida xaaladaha degdega ah ee xididada caloosha iyo xanuunka garabka, iyo maaraynta shoogga waa xirfado nolol badbaadin ah. Tixgeli inaad iska diiwaan geliso koorsada gargaarka koowaad ee shahaadeysan ee Laanqeyrta Cas, St John Ambulance, ama bixiye maxalli ah oo la aqoonsan yahay.

Su'aalaha soo noqnoqda

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.

Ilaha la hubiyay

  • Ururka Yurub ee Urology (EAU): * Tilmaamaha EAU ee Urolithiasis (Cusbooneysii 2024): Maareynta Calool-Ba'an ee Kelyaha, Daaweynta Ka-saarista Caafimaadka, iyo Naafaynta Degdegga ah ee Kelyaha Xanuunsan ee xannibay*.
  • Ururka Urological American (AUA) iyo Endurological Society (Mareykanka): Maareynta Caafimaadka ee Dhagxaanta Kelyaha iyo Maareynta Qalliinka ee Dhagxaanta: AUA/Hagaha Bulshada Endourological.
  • Machadka Qaranka ee Caafimaadka iyo Wanaajinta Daryeelka (NICE, United Kingdom): Dhagaxa Kelyaha iyo Kaadi-mareenka: Qiimaynta iyo Maareynta (NG118).
  • ** Ololaha Sebsis-ka Badbaadinta (SSC) iyo Bulshada Cudurada Faafa ee Ameerika (IDSA):** * Tilmaamaha Caalamiga ah ee Maareynta Urosepsis iyo Xakamaynta Ilaha Degdegga ah ee Pyelonephritis-ka xanniba*.
  • ** Pathan SA, Mitra B, Straney LD, iyo al. (* Lancet*):**

Tilmaamaha la xidhiidha