Severe Kidney Stone Pain vs. Obstructed Infected Kidney (Urosepsis)¶

Tlhaselo e sa rarahanang ** liphio lejoe la liphio (acute renal colic)** le tumme ka ho baka tse ling tsa bohloko bo matla ka ho fetisisa, bo utloisang bohloko boo motho a ka bo utloang, leha ho le joalo lejoe le sa rarahanang le ka tlas'a limilimithara tse 5 (0.2 inches) le tla qetella le iphetetse ka 80 ho 90 lekholong ea linyeoe. Leha ho le joalo, nako e tobileng eo lejoe la liphio le tšoarang ** moroto o nang le tšoaetso ** ka mor'a eona ka har'a pelvis ea renal (**obstructive pyelonephritis / pyonephrosis **), boemo ba kliniki bo fetoha ho tloha lejoe le bohloko la mokuli ka ntle ho ** ts'ohanyetso ea ts'oaetso ea ho buuoa ka mokokotlo **. Hobane liphio tse thibaneng li tsoela pele ho sefa mali ka khatello e phahameng, libaktheria le li-endotoxin tse koaletsoeng ka holim'a lejoe li qobelloa ka kotloloho ho papillae ea renal ho kena methapong ea renal (pyelovenous backflow), e bakang fulminant **urosepsis, septic shock, le lefu nakong ea lihora tse 6 ho isa ho tse 24 ** ntle le haeba ho etsoa opereishene ea ho buoa ka tšohanyetso (ureteral JJ stent kapa percutaneous nephrostomy tube) e etsoa hang-hang.

Boikarabello ba hau ba hanghang ha bohloko bo matla lephatleng, mokokotlong, kapa mpeng ke ho hlahloba hang-hang bakeng sa "Lejoe le tšoaelitsoeng" (colic leha e le efe ea renal e tsamaeang le feberu e ka holimo ho likhato tse 38.0 tsa Celsius / 100.4 degrees Fahrenheit, ho tsikitlanya, ho tsikitlanya, leru le nkhang hampe ka ho ntša metsi a metsi, ho koala ha moroto) kapa ho ba le phio e le 'ngoe feela e sebetsang)**, netefatsa ho mokuli leha e le ofe ea ka holimo ho lilemo tse 50 ho isa ho tse 60 hore mahlaba a tšohanyetso a lehlakoreng ha se ho phatloha ha aneurysm ea mpeng ea aortic (AAA), qoba matla-ho phunya lilithara tsa metsi nakong ea mahlaba a mahlahahlaha (e leng libalune e koetsoeng ea liphio capsule le ho mpefatsa bohloko le ho hlatsa), le letsetsa litšebeletso tsa bongaka tsa tšohanyetso hang-hang haeba ho na le lifolakha tse khubelu tse teng.

Etsa sena hona joale¶

1. ** Letsetsa lits'ebeletso tsa bongaka tsa tšohanyetso hang-hang haeba lejoe la liphio le tsamaea le FEVER, CHILLS, kapa SHOCK ("An Infected Blocked Kidney"):** Letsetsa nomoro ea hau ea tšohanyetso ea lehae (911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, 000 Australia) kapa sheba lenane la rona la dinomoro tsa tshohanyetso haeba motho ea nang le mahlaba a matla lephakong, mokokotlong, kapa a groin a ka ba le** feberu (38.0 degrees Celsius / 100.4 degrees Fahrenheit kapa ho feta) kapa mocheso oa 'mele o tlase ka mokhoa o sa tloaelehang (<36.0 C / 96.8 F)**, ho tsikinyeha ho sa laoleheng (ho tsieleha), ho tsekela kapa ho akheha, ho akheha kapa ho akheha,* ho se kgone ho ntsha moroto**. Lithibela-mafu tse nooang feela li ke ke tsa phekola boladu bo qabeletsoeng ka mor'a lejoe; liphio li tlameha ho ntšoa ka ho buuoa sepetlele ka mor'a lihora tse seng kae.
2. Eya lefapheng la maemo a tshohanyetso hanghang haeba motho a na le phio e LE NNGWE feela e sebetsang (kapa ho fetisetswa liphio) kapa e le moimana: Haeba lejwe le thiba mothapo wa phiyo e le nngwe kapa phiyo e kenngweng, motho o na le lefela la liphio mme hang-hang o kena anuric. kotsi e mpe ea liphio le hyperkalemia e behang bophelo kotsing.
3. Ala ho phatloha ha Abdominal Aortic Aneurysm (AAA) ho mang kapa mang ea ka holimo ho lilemo tse 50: Ho batho ba baholo ba ka holimo ho lilemo tse 50 (haholo-holo banna, batho ba tsubang, kapa batho ba nang le khatello e phahameng ea mali) ba e-s'o ka ba ba le lejoe la liphio pele**, ho taboha kapa ho lutla aneurysm ea aortic ka mpeng retroperitoneal bleed presses methapong e ts'oanang hantle le ea lejoe la liphio le letšehali kapa le letona, e bakang bohloko bo ts'oanang ba tšohanyetso ba lehlakoreng le leng le le leng esita le mali a sa bonahaleng ka har'a moroto. Kamehla tšoara "lejoe la pele la liphio ho feta lilemo tse 50" e le boemo ba tšohanyetso ba aortic bo hlokang lefapha la tšohanyetso la CT scan kapa ultrasound.
4. U SE KE UA qobella metsi a mangata haholo nakong ea lefu le bohloko la renal colic spasm: Tšōmo e atileng e bolella batho hore ba tšele lilithara tsa metsi nakong ea tlhaselo e matla ea majoe a liphio e le hore ba "ntše lejoe ka ntle." Nakong ea tšitiso e matla ea ureteral, ho noa metsi a mangata ho eketsa tlhahiso ea moroto ka holim'a lejoe le koaletsoeng, ho butsoetsa capsule ea renal joalo ka balune e thata (hydronephrosis), ho phunya renal pelvic khatello ea maikutlo, ho etsa hore motho a hlatse haholo, le ho ba kotsing ea ho phatloha ha renal calyx (ho phatloha ha bohlola). Noka metsi a manyane ha feela o nyoriloe mme o sa nyekeloe ke pelo.
5. Tlatsa mofuthu o thobang oa sebaka (bate e futhumetseng, shaoara, kapa phala ea ho futhumatsa) lephakong haeba HA HO feberu e le teng: Ho fapana le appendicitis (moo mocheso o thibetsoeng), liteko tsa bongaka tse sa reroang li bontša hore ho beha *sefuthumatsi se futhumatsang kapa kobo e futhumetseng (likhato tse 40 ho isa ho tse 42 tsa Celsius / 104 ho isa ho tse 104 ho isa ho tse 107.6) ho phomotsa mesifa ea mokokotlo ka ho toba mme e fokotsa haholo bohloko bo bohloko ba renal colic le ho nyekeloa ke pelo nakong ea lipalangoang.
6. Sehla moroto kaofela ka sesefa sa letlooeng, sefeng sa kofi, kapa ka gauze haeba u laola lejoe le thata le netefalitsoeng: Ho tšoara lejoe le fetisitsoeng (le ka shebahalang joaloka limilimithara tse 2 ho isa ho tse 5 tse sootho, tse mosehla, kapa lehlabathe kapa lehlohlojane tse bosootho) ho lumella litsebi tsa methapo ea kutlo ho hlahlobisisa metsoako ea lona ea lik'hemik'hale (calcium oxalate, uric cyst, uric acid, uric acid, kapa uric acid).

flowchart TD
    Start["Hang-hang, Agonizing Flank / Costovertebral Angle Back Pain Radiating Around Side ho Groin, Testicle, kapa Labia"] --> CheckSepsis{"1. Sheba Liphio Tse Thibehileng (Urosepsis) Red Flags: Feberu (>=38.0 C), Chills / Rigors, Cloudy Foul urine, Pherekano, kapa Ho tšoha?"}
    CheckSepsis -->|Yes| CallEMS["Letsetsa Litšebeletso tsa Tšohanyetso (911 / 112 / 999) Hang-hang: Ho Hlokahala ho Tetelleha ha Urological ka Nako e Bohlokoa"]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. Na Mamello Ho Feta Lilemo Tse 50 Ka 'Lejoe la Nako ea Pele', Tse Tsejoang Aortic Aneurysm, Molikoaliko, Kapa Syncope?"}
    CheckAAA -->|Yes| CallEMS_AAA["Letsetsa Litšebeletso tsa Tšohanyetso Hang-hang: Rule Out Ruptured Abdominal Aortic Aneurysm (AAA)"]
    CheckAAA -->|No| CheckRenal{"3. Hlahloba Liphio & Ho Hlatsa Lipampitšana Tse Khubelu: Liphio Tse Bosi / Ho Fetisetsa, Bokhachane, Tsoelo-pele ea Moroto, Kapa Ho Hlatsa ho sa Feleng?"}
    CheckRenal -->|Yes| UrgentED["Tsamaisa Hang-hang ho ea Lefapheng la Tšohanyetso la Sepetlele bakeng sa IV Analgesia, Antiemetics, le Imaging"]
    CheckRenal -->|No Red Flags| EvalED["Rulahanya Tlhahlobo e Potlakileng ea Bongaka (CT / Ultrasound e sa Phapanong) le Ho Eketsa Moroto"]
    CallEMS --> FirstAid["4. Kenya Sephutheloana se Mofuthu ho Flank (Haeba ho se Feberu), U SE KE U QETELA Metsi a Li-Chug Nakong ea Acute Spasm, Boemong bo Phomohileng."]
    UrgentED --> FirstAid

Renal Colic e sa rarahanang le liphio tse nang le tšoaetso e thibetsoeng (Pyonephrosis le Urosepsis)¶

Hobaneng ha lejoe la liphio le se nang tšoaetso le laoloa ka mokhoa o bolokehileng ka taolo ea bohloko le tlhokomeliso, athe lejoe la liphio le nang le tšoaetso ea moroto e le e 'ngoe ea maemo a tšohanyetso a bolaeang ka ho fetisisa meriana ea sepetlele?

Ka ** lejoe le sa rarahanang la liphio (renal colic) **, moroto o nyopa o khutlela morao ka mor'a lejoe ka hare ho ureter le pelvis ea renal (**hydronephrosis **). Le hoja ho otlolloa ha capsule ea fibrous renal le spasm ea ureter ho baka bohloko bo feteletseng ba 10/10, moroto ka booona ha o na likokoana-hloko.

Ho liphio tse nang le tšoaetso tse thibetsoeng (obstructive pyelonephritis kapa pyonephrosis), libaktheria (tse kang Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, kapa Enterococcus) li qabeletsoe ka har'a mokhoa o koetsoeng, o hatelitsoeng ka holim'a lejoe. Liphio tse thibaneng ha e le hantle li fetoha sekoti se koetsoeng tlas'a khatello e phahameng ea arterial filtration:

1. Hobaneng ha lithibela-mafu ka botsona li SA khone ho fihla kapa ho phekola liphio tse nang le tšoaetso e thibaneng: Taba ea pele, hobane glomerular filtration e emisa liphiong tse thibaneng ka ho feletseng, lithibela-mafu tse kenang ka methapong kapa tsa molomo li sitoa ho sefa morotong o emeng ka holim'a lejoe. Ea bobeli, khatello e phahameng ea intrapelvic (** ka holimo ho 30 ho ea ho 40 mmHg ) e bula meokho e nyenyane haholo lintlheng tsa li-calyces tsa renal ( pyelovenous le pyelolymphatic backflow **), ho kenya libaktheria tse phelang le endotoxin ea baktheria ka ho toba maling a tsamaiso ka pelo e 'ngoe le e 'ngoe.
2. Urosepsis e bolaea kapele hakae ntle le ho ntša metsi: Ntle le ho senyeha ha liphio ka tšohanyetso (** khutlisetsa ureter stenting ka kamoreng ea ho buuoa ** kapa ** percutaneous nephrostomy tube placement ka morao ka radiology ea interventional **), lefu le bakoang ke urosepsis e thibelang ho feta ** 20 ho 40 lekholong * khatello ea maikutlo *, le ho lieha ho fokotsa lihora tse 2 ho feta lihora tse 2 le ho lieha ho fokotseha ha lihora tse 2. lefu.

Anatomy of a liphio stone attack: Kamoo bohloko bo leng teng bo latelang leeto la lejoe ho theosa le ureter¶

Lejoe la liphio ha le utloe bohloko ha le lutse le khutsitse ka har'a "renal calyx" ea liphio (ntle le haeba e le lejoe le leholo la tšoaetso ea staghorn). Bohloko bo phatloha hang ha lejoe le oela ka har'a moqotetsane, o nang le mesifa ** ureter** (e bophara ba limilimithara tse ** 2 ho ea ho 4 feela **) 'me o oela ho e' ngoe ea lintlha tse tharo tsa "anatomical choke points" (narrowings) ** ea pampiri ea moroto. Ha lejoe le ntse le theohela ka har'a senya, sebaka sa bohloko se fetoha ka mokhoa o sa lebelloang haufi le **ilioinguinal le genitofemoral nerves (T11 ho L2) **:

Choke Point 1: The Ureteropelvic Junction (UPJ, moo lesela la liphio le kopanang le holimo ho ureter)¶

• Moo u ikutloang teng: Ka tšohanyetso, bohloko bo tebileng, bo kang ba thipa bo phahameng ka ** costovertebral angle (CVA) **, sekhutlo se nang le V mokokotlong oa hau moo lehare la 12 le tlase le kopanang le mokokotlo.
• Matšoao a amanang: Hobane capsule ea liphio e arolelana methapo ea celiac ganglion autonomic le mpa, tšitiso e phahameng ea UPJ e baka ** ho nyekeloa ke pelo hang-hang, ho matla le ho hlatsa khafetsa ** hoo hangata ho etsisang tlhaselo ea gallbladder, pancreatitis, kapa feberu ea mala.

Choke Point 2: Ho tšela Lijana tsa Mali tsa Iliac (Bohareng ba ureter molomong oa pelvic)¶

• Moo o e utlwang: Bohloko bo tswela pele le tlase ho tloha lephakong le pota-potileng letheka ho kena karolong e ka tlase ya mpa e ka ho le letona kapa le letshehadi le tlase ho mokotong wa groin.
• Sefi sa ho hlahloba: Ha lejoe le ema ka lehlakoreng le letona la ureter holim'a mesifa ea psoas, le etsisa haufi-ufi appendicitis e matla (ka lehlakoreng le letona) kapa ** acute diverticulitis ** (ka lehlakoreng le letšehali). Leha ho le joalo, hlokomela kamoo mokuli a itšoarang kateng:
• Mokuli ea nang le peritonitis ho tsoa ho appendicitis o robetse a hatsetse a bile a sa sisinyehe betheng hobane motsamao o mong le o mong o utloisa peritoneum bohloko.
• Mokuli ea nang le renal colic ** oa sotha, o tsamaisa phaseje, o sotheha fatše, 'me o lula a fetola boemo ** a leka lefeela ho fumana angle e imollang ka hare ho ureteral spasm ("letšoao la pacing").

Choke Point 3: The Ureterovesical Junction (UVJ, moo bokatlase ba ureter bo kenang leboteng la senya)¶

• Monyako o moqotetsane ka har'a moroto (ka bophara ba limilimithara tse 1 ho isa ho tse 2 feela): Ho feta 60 ho isa ho 70 lekholong ea majoe a fumanoang lefapheng la tšohanyetso la CT scans a khomaretsoe hona mona UVJ, limilimithara feela pele a oela ka senyeng.
• Moo u e utloang: Hobane bokatlase ba ureter bo arola ** genitofemoral le methapo ea pudendal (L1, L2, S2-S4)** le litho tsa botona kapa botšehali tse ka ntle le botlaaseng ba senya (trigone), lejoe le kopantsoeng le UVJ le baka:
• Mahlaba a bohale a hlabang ka kotloloho ka har'a testicle ea ipsilateral le scrotum ho banna, kapa ka har'a litho tsa botona le botšehali ho basali (ho hloka phapang e hlokolosi ho ho thothomela ha testicular kapa ho thothomela ha mahe a mae; ka lejoeng la liphio, testicle ka boeona e ikutloa e tloaelehile ebile e sa ruruhe ha e ts'oaroa hamonate, athe ha testicular torsion testicle e lula holimo, e ruruhile, 'me e bonolo ka mokhoa o tsotehang).
• Matšoao a senyang a senyang haholo: Maikutlo a tšohanyetso a tšohanyetso a hore u lokela ho ntša metsi ka mor'a metsotso e meng le e meng e 3 (**potlako ea ho ntša metsi le makhetlo a mangata **), ho chesa lehlaba ntlheng ea urethra (dysuria), le ho ntša marotholi a **mopinki, o mokhubelu, kapa a 'mala oa tee o nang le mali a mangata (gross hematuria, esita le ha ho se na tšoaetso)
• Nako ea ho imoloha: Hang ha lejoe le qetella le phunyeletse UVJ le kena ka har'a senya se seholo sa moroto, mahlaba a bohloko a 10/10 le groin a nyamela hang hang. Ho fetisa lejoe hamorao ho tloha senya ho tsoa ka har'a moroto o pharaletseng (o bophara ba limilimithara tse 6 ho isa ho tse 8) hangata ho baka pinch e khuts'oane ea metsotsoana e 2 kapa ho penya ka har'a sekotlolo sa ntloana.

Boholo ba lejoe le monyetla oa tsela ea tlhaho: Ke majoe afe a fetang le a khomarelang?¶

Ha lingaka tsa tšohanyetso li etsa ** tekanyo e tlaase ea CT scan ea mpa le pelvis (CT KUB) ** kapa ** renal ultrasound **, tekanyo e le 'ngoe ea bohlokoa ka ho fetisisa (ho nka hore ha ho na tšoaetso kapa liphio tse ikemetseng) ke ** bophara bo fapaneng ba lejoe ka limilimithara **:

Hobaneng ha li-NSAID li otla li-opioid bakeng sa bohloko ba majoe a liphio (le ha li-NSAID li thibetsoe ka thata)¶

Haeba u le lefapheng la maemo a tšohanyetso kapa u se u hlahlobiloe ke ngaka e netefalitseng ** lejoe le sa rarahanang, le sa tsitsang la liphio le nang le ts'ebetso e tloaelehileng ea liphio (serum creatinine e tloaelehileng) **, ho utloisisa hore na ho fokotsa bohloko ho sebetsa joang ho ureter ho thusa ka mokhoa o tsotehang:

1. Ke hobane'ng ha Lithethefatsi tse sa Tšoaneng le ho ruruha (NSAIDs) li lebisa sesosa sa sesosa sa renal colic¶

Ha lejoe le thibela ureter, khatello e ntseng e phahama ka har'a liphio e susumetsa motsoako oa sebaka sa Prostaglandin E2 (PGE2) le prostacyclin. Prostaglandin E2 e etsa lintho tse peli tse etsang hore renal colic e be bohloko:

1. E atolosa li-afferent arterioles tse kenang ho glomeruli ea liphio, e eketsa khatello ea ho sefa moroto ka kotloloho ho phio e seng e koetsoe, e ruruhileng.
2. E etsa hore ho be le mabifi, bohloko **mesifa e boreleli ea lebota la ureter ** ho pota-pota lejoe le ho eketsa ho ruruha ha lerako la ureter (edema).

** li-NSAID ** (tse kang sepetlele intravenous ** ketorolac [Toradol] ** kapa rectal / oral ** diclofenac, ibuprofen, kapa naproxen **) ka ho toba thibela prostaglandin synthesis (**cyclooxygenase inhibition **). Ka ho koala Prostaglandin E2, li-NSAID ** ka nako e le 'ngoe ho theola khatello ka har'a capsule ea liphio e ruruhileng, ho phomola mesifa ea ureteral, ho fokotsa ho ruruha ho pota-pota lejoe, le ho fana ka phomolo e phahameng kapa e lekanang le bohloko ha e bapisoa le intravenous morphine ** ntle le ho baka ho hlatsa kapa ho otsela ho bakoang ke opioid.

2. Ha li-NSAID li thibetsoe ka thata ho mokuli oa majoe a liphio¶

Hobane li-NSAID li fokotsa phallo ea mali ho li-filters tsa liphio tse thibetsoeng, ** le ka mohla u se ke ua nka ibuprofen, naproxen, ketorolac, kapa diclofenac ** haeba ho na le maemo a latelang a sebetsang:

• Ha u so etse liteko tsa mali sepetlele kapa nalane e netefatsang tšebetso e tloaelehileng ea liphio, kapa u na le lemala a liphio tse matla (creatinine e phahameng) kapa lefu la liphio le sa foleng (CKD Stage 3, 4, kapa 5).
• U na le phio e le 'ngoe feela e sebetsang (phio e le 'ngoe) kapa transplant ea liphio: Ho noa NSAID ha liphio tsa hau feela li koetsoe ke lejoe ho koala phepelo ea eona e setseng ea mali a arteriolar 'me ho baka kapele ho hloleha hoa renal.
• U moimana (li-NSAID li ka senya nts'etsopele ea liphio tsa lesea 'me tsa koala pele ho nako ea fetal ductus arteriosus).
• O na le lefu la peptic ulcer, ho tsoa madi ka mpeng, kapa ho felloa ke metsi haholo/urosepsis.
• Maemong ao kaofela, lingaka tsa sepetlele li sebelisa intravenous acetaminophen (paracetamol) le titrated **intravenous opioids ** (kapa ultrasound-guided erector spinae nerve blocks / intravenous lidocaine protocols) ho e-na le li-NSAID.

Mohato ka mohato tlhokomelo ea prehospital le thibelo ea nako e telele ea majoe¶

Mohato oa 1: Tsamaiso e sireletsehileng ea lapeng le ea lipalangoang nakong ea ketsahalo e mahlonoko¶

1. Sheba thempereichara ka thermometer hang-hang: Pele u phekola lejoe leha e le lefe le belaelloang la liphio lapeng, lekanya mocheso oa 'mele. Haeba mocheso o le 38.0 degrees Celsius (100.4 degrees Fahrenheit) kapa holimo (kapa ka tlase ho 36.0 C / 96.8 F), kapa haeba motho a tšoeroe ke mohatsela o sisimosang, emisa tlhokomelo eohle ea lapeng 'me u ee ka kotloloho lefapheng la tšohanyetso kapa letsetsa 911 / 112 / 999.
2. Beha mocheso o sebetsang ka ntle lephakong le mokokotlong o ka tlase: Beha letlapa le futhumatsang, botlolo ea metsi a futhumetseng e thatetsoeng ka thaole, kapa pakete ea mocheso oa lik'hemik'hale tse futhumetseng ka 40 ho isa ho 42 degrees Celsius (104 ho 107.6 degrees Fahrenheit) holim'a lepheko le bohloko le mokokotlong o ka tlase nakong ea sepalangoang.
3. Qoba ho ntša metsi ka mokhoa o qobelloang nakong ea tlhōrō ea bohloko bo matla: Ha u ntse u emetse hore leqhubu la bohloko le kokobele kapa u ee kamoreng ea tšohanyetso, u se ke ua hula likhalase tsa metsi. Hang ha spasm e matla ea colic e se e laoloa 'me ho nyekeloa ke pelo ho rarollotsoe, qalella ho noa metsi a tloaelehileng, a tsitsitseng (** 2.0 ho ea ho 2.5 litha ka letsatsi **) ho thusa ho isa lejoe ho ea tlaase.
4. Bokella le ho hlohlora lerotholi le leng le le leng la moroto: Ntšela ka har'a moroto, komiki, kapa katiba e hloekileng ea polasetiki 'me u e tšele ka sefeneng sa lejoe la bongaka kapa sefe ea kofi ea pampiri e tšoeu. Hang ha kristale ea lejoe le thata e tšoaroa, e lumelle hore e omelle moeeng ka botlolong ea lipilisi e hloekileng (le ka mohla u se ke ua e phuthela ka pampiri ea ntloana e metsi, e qhibilihang kapa e khomarelang kristale) 'me u e tlise ho ngaka ea hau bakeng sa ** Fourier-transform infrared spectroscopy (FTIR) kapa X-ray diffraction stone analysis **.

Mohato oa 2: Mehato ea lijo e thehiloeng bopaking ho thibela lejoe la bobeli la liphio¶

Ntle le liphetoho tse thibelang, ** karolo ea 50 lekholong ea batho ba pele ba nang le majoe a liphio ba tla ba le lejoe le leng nakong ea lilemo tse 5 ho isa ho tse 10 **:

• Noa metsi a lekaneng ho hlahisa bonyane lilithara tse 2.5 (li-ounces tse 85) tsa moroto o mosehla o mosehla lihora tse ling le tse ling tse 24: Tloaelo ena e fokotsa ho hlaha ha majoe ka halofo ho mefuta eohle ea majoe.
• Eketsa citrate ea tlhaho (sirilamunu ea sebele kapa lero la lime) metsing a hao a letsatsi le letsatsi: Citrate ka har'a moroto e tlama k'halsiamo ea moroto 'me ka tlhaho e thibela likristale tsa calcium oxalate le calcium phosphate ho khomarelana.
• U se ke ua thibela khalsiamo ea lijo (eja lebese le tloaelehileng / calcium LE lijo), empa u fokotse sodium e ngata (letsoai): Ho makatsang ke hore, lijo tse nang le calcium e tlase e eketsa calcium oxalate liphio majoe hobane calcium ea lijo ka maleng a hao e tlama ho oxalate ho tsoa lijong (spinach, rhubarb, almonds, beet, makhasi a chokolete ho e-na le ho monya tsokolate ea hau). Lijo tse phahameng sodium (letsoai) li qobella liphio hore li lahlele calcium e ngata ka har'a moroto (hypercalciuria).

Ho utloisisa mefuta e 4 ea lik'hemik'hale tsa majoe a liphio le maemo a tšohanyetso a khethehileng¶

Ha lejoe la liphio le tšoaroa ka strainer kapa le tlosoa nakong ea ureteroscopy, tlhahlobo ea laboratori e bontša hore na ke efe ho **malapa a mane a maholo a liminerale ** a bakileng lejoe, le leng le le leng le na le lintlha tse ikhethang tsa tšohanyetso:

Majoe a liphio nakong ea kemaro le ho bakuli ba nang le Ureter Stent¶

1. Renal colic nakong ea bokhachane (Ho sireletsa 'mè le lesea)¶

Hoo e ka bang ** 1 ho bakuli ba 200 ho isa ho ba 1,500 ba moimana ** o hlahisa lejoe le matla la liphio, hangata nakong ea ** li-trimester tsa bobeli le tsa boraro ** (ha progesterone e phomotsa mesifa e boreleli ea ureteral le popelo e atolohang e hatella ureters, haholo-holo ka lehlakoreng le letona).

• Hobaneng bakuli ba baimana ba nang le renal colic ba hloka tlhahlobo ea sepetlele hanghang:
• Bohloko bo matla ba renal colic bo sa alaoeng le pyelonephritis e thibelang nakong ea bokhachane e ka baka ** pelehi ea pelehi le ho beleha pele ho nako **, urosepsis ea bakhachane, le khatello ea mali e kang preeclampsia.
• ** Litšoantšo tsa tlhahlobo ntle le mahlaseli: ** Mafapha a maemo a tšohanyetso ha ho mohla a sebelisang lisebelisoa tse tloaelehileng tsa CT e le teko ea pele nakong ea bokhachane; ho e-na le hoo, ba sebelisa ** Renal le Pelvic Ultrasound ** (ho lekanya li-jets tsa ureteral le ho khetholla physiological hydronephrosis ea bokhachane ho tloha lejoeng) e lateloa ha ho hlokahala ** e sa bapisoang le Magnetic Resonance Urography (MRU) ** kapa li-protocol tsa ultra-low-dose.
• ** Tšireletseho ea meriana: ** ** li-NSAID (ibuprofen, ketorolac, naproxen) li hanyetsanoa ka ho feletseng nakong ea bokhachane.** Bohloko bo laoloa ka mokhoa o sireletsehileng ka intravenous acetaminophen le li-opioids tse nang le titrated, 'me haeba feberu, urosepsis, kapa bohloko bo sa tloaelehang bo hlaha, litsebi tsa urology li beha nako ea nakoana ** ho fetola ka hare ho 6 ka libeke tse ling le tse ling tse 4 tsa bokhachane. e potlakisa k'halsiamo e kenngoeng ka li-stents) ho fihlela ka mor'a ho pepa.

2. Tlhokomelo ea tšohanyetso bakeng sa bakuli ba seng ba ntse ba e-na le Indwelling Ureteral Stent ("JJ Stent").¶

Haeba mokuli a sa tsoa ba le double-J (JJ) ureteral stent e kentsoeng ka har'a ureter ke ngaka ea urologist (ho feta lejoe kapa ho folisa ka mor'a laser lithotripsy), hlakisa hore na ke eng e tloaelehileng khahlanong le tšohanyetso:

• Matšoao a tloaelehileng a ho tsubella: Moroto o mopinki o bobebe kapa o bokhubelu ka mor'a ho tsamaea, ho opeloa ka lehlakoreng ka ho khetheha ha u ntša metsi (ho bakoang ke khatello ea senya e khutlelang ka har'a stent tube), le ho potlaka ha senya / khafetsa karolong e ka tlaase ea stent (e phekoloang ka tamsulosin le oxylifecinine).
• Maemo a tshohanyetso a stent a hlokang ho etela lefapha la tshohanyetso hanghang:
• Letadi le lecha (>=38.0 C / 100.4 F) kapa mohatsela (lipontšo tsa hore stent e kentsoe kapa e kentsoe biofilm le boladu).
• **Ho khutla ha bohloko bo sa khaotseng, bo matla ba 10/10 flank ** bo sa khaotseng ka mor'a ho ntša metsi (lipontšo tsa hore stent e tlohile sebakeng kapa e kenngoa ka leqeba la mali kapa sekhechana sa lejoe).
• Moroto o motenya, o mokgubedu o lefifi o nang le maqeba a maholo a madi kapa ho se kgone ho rota (ho tshoaroa ha moroto ho hlobaetsang).
• Khoele e leketlileng ea stent ea tsamaea kapa ea huloa: Li-stenti tse ling tsa nakoana li na le khoele e tšesaane ea nylon e tsoang ka har'a urethra hore ho be bonolo ho tlosa ofisi; ** le ka mohla u se ke ua hula khoele e stent uena ** ntle le haeba u laetsoe ka ho hlaka hore u e tlose ka nako eo e reriloeng ke ngaka ea hau ea urologist.

Lipotso tse botsoang khafetsa¶

Mehloli e hlahlobiloe¶

• ** European Association of Urology (EAU): ** * EAU Guidelines on Urolithiasis (2024 Update): Acute Renal Colic Management, Medical Expulsive Therapy, le Emergency Decompression of the Obstructed Infected Kidney *.
• American Urological Association (AUA) le Endourological Society (United States): Medical Management of Kidney Stones le Surgery Management of Stones: AUA/Endourological Society Guideline.
• Setsi sa Sechaba sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE, United Kingdom): Renal le Ureteric Stones: Tlhahlobo le Tsamaiso (NG118).
• ** Letšolo la Ho Pholoha ha Sepsis (SSC) le Mokhatlo oa Mafu a tšoaetsanoang oa Amerika (IDSA):** Litaelo tsa Machaba tsa Tsamaiso ea Urosepsis le Taolo e Potlakileng ea Mohloli ho Obstructive Pyelonephritis.
• Pathan SA, Mitra B, Straney LD, et al. ( The Lancet ): *Ho fana ka analgesia e sireletsehileng le e sebetsang bakeng sa tsamaiso ea renal colic lefapheng la tšohanyetso: teko e laoloang ka makhetlo a mabeli, e nang le lihlopha tse ngata (e bontšang bophahamo ba li-NSAID ho feta morphine bakeng sa acute renal colic).

Litataiso tse amanang¶

• Tlhokomelo ea sepsis le septic shock le thuso ea pele ea tšohanyetso
• Aortic dissection le ho phatloha ha aneurysm ea mpeng ea aorta
• Tlhokomelo e matla ea moroto le tlhokomelo ea tšohanyetso e koetsoeng ea catheter ea kahare
• Testicular torsion, torsion ea mahe a bomme, le bohloko bo matla ba pelvic
• Exertional rhabdomyolysis, kotsi e mpe ea liphio, le moroto o lefifi
• Linomoro tsa maemo a tshohanyetso ho ea ka linaha