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Iintlungu eziMandundu zeLitye leZintso vs. Izintso eziThintelweyo ezosulelekileyo (Urosepsis)

Emergency numbers differ by country. This page uses 911, the number for the United States and Canada. Many other countries use 112, 999, or another number. Find the number for your country.

I-incomplicated ** i-kidney stone attack (acute renal colic)** idume ngokubangela ezinye zezona ntlungu zibuhlungu kakhulu, ezibuhlungu umntu anokuzifumana, kodwa ilitye elinqabileyo elingaphantsi kweemilimitha ezi-5 (ii-intshi ze-0.2) ekugqibeleni liya kudlula ngokwalo kwi-80 ukuya kwi-90 yeepesenti zamatyala. Nangona kunjalo, umzuzu ochanekileyo ilitye leentso libamba ** umchamo osulelekileyo ** emva kwawo ngaphakathi kwi-pelvis ye-renal (** obstructive pyelonephritis / pyonephrosis ), imeko yeklinikhi iyatshintsha ukusuka kwilitye elibuhlungu elingaphandle kwi--ubomi obusongela ubomi obungxamisekileyo botyando . Ngenxa yokuba intso ethintelekileyo iqhubeka nokucoca igazi kuxinzelelo oluphezulu, iibhaktheriya kunye ne-endotoxins ezibanjwe ngaphezu kwelitye zinyanzeliswa ngokuthe ngqo kwi-renal papillae kwi-renal veins ( pyelovenous backflow **), ibangela i-fulminant ** urosepsis, umothuko we-septic, kunye nokufa ngaphakathi kwe-6 kwiiyure ze-24 ** ngaphandle kokuba i-drainage yotyando olungxamisekileyo (i-ureteral JJ stent okanye i-percutaneous nephrostomy tube) yenziwa ngokukhawuleza.

Uxanduva lwakho olukhawulezileyo xa uqaqanjelwa kakhulu emacaleni, emqolo, okanye emanqeni kufuneka luvavanye ngokukhawuleza "Ilitye elosulelekileyo" likaxakeka (nasiphi na isifo sezintso esikhatshwa ngumkhuhlane ongaphezu kwama-38.0 degrees Celsius / 100.4 degrees Fahrenheit, ukugodola/ukuqaqanjelwa, ukuchama okunuka kakubi okunamafu okufunxa umchamo) ukuvaleka komchamo, ukuvaleka komchamo, ukuchama okanye ukuba nezintso enye kuphela esebenzayo)**, qinisekisa kuso nasiphi na isigulana esingaphezulu kweminyaka engama-50 ukuya kuma-60 ukuba intlungu yephanki ngequbuliso ayiyonto Ukuqhekeka kwe-aortic aneurysm yesisu (AAA), kunqande ukunyanzeliswa kweegaloni zamanzi ngexesha le-spasm esebenzayo (eye iibhaluni i-capsule yezintso evaliweyo kwaye yenza intlungu kunye nokuhlanza), kwaye ubize iinkonzo zonyango eziphuthumayo ngokukhawuleza ukuba kukho naziphi na iiflegi ezibomvu.

Yenza oku ngoku

  1. ** Tsalela iinkonzo zonyango ezingxamisekileyo ngokukhawuleza ukuba ilitye leentso likhatshwa yiFEVER, CHILLS, okanye SHOCK ("I-Infected Blocked Kidney"):** Tsalela umnxeba kwinombolo yakho yexesha likaxakeka (911 eUnited States naseKhanada, 112 kulo lonke elase-European Union, 999 eUnited Kingdom, 000 e-Australia) okanye khangela uluhlu lwethu lweenkcukacha amanani kaxakeka ukuba umntu onecala elibukhali, umqolo, okanye iintlungu ezibuhlungu uvela umkhuhlane (38.0 degrees Celsius / 100.4 degrees Fahrenheit okanye ngaphezulu) okanye ubushushu bomzimba obuphantsi ngokungaqhelekanga (<36.0 C / 96.8 F), ukuqhaqhazela okungalawulekiyo (iingqele), isiyezi okanye isiyezi okanye isiyezi, okanye isiyezi okanye isiqaqa, ukungakwazi ukukhupha umchamo*. Amayeza okubulala iintsholongwane ngomlomo kuphela awakwazi ukunyanga ububovu obuvaleleke emva kwelitye; izintso kufuneka zikhutshwe ngotyando esibhedlele kwiiyure nje ezimbalwa.
  2. Yiya kwisebe likaxakeka ngoko nangoko ukuba umntu unentso ENYE kuphela esebenzayo (okanye uqhaqho-fakelo lwezintso) okanye ukhulelwe: Ukuba ilitye livalele umbhobho we-intso eyedwa okanye intso etshintshiweyo, loo mntu uneziro ezixhasayo kwaye ngoko nangoko angene anuric ukwenzakala okukhulu kwezintso kunye ne-hyperkalemia esongela ubomi.
  3. Lawula ukugqabhuka kweAbdominal Aortic Aneurysm (AAA) kuye nabani na oneminyaka engaphezu kwama-50: Kubantu abadala abangaphezu kweminyaka engama-50 (ingakumbi amadoda, abantu abatshayayo, okanye abantu abanoxinzelelo lwegazi oluphezulu) abangazange babe nelitye lezintso ngaphambili**, ukukrazuka okanye ukuvuza i-aneurysm ye-aorta yesisu ukucinezela ukopha kwe-retroperitoneal kwimithambo-luvo efana kanye nelitye lezintso lasekhohlo okanye lasekunene, elibangela iintlungu ezifanayo zephanki ukuya kwi-groin ngequbuliso kunye negazi elincinci emchameni. Ngalo lonke ixesha phatha "ilitye lokuqala leentso ngaphezu kweminyaka engama-50" njengemeko engxamisekileyo ye-aorta efuna isebe likaxakeka ngokukhawuleza i-CT scan okanye i-ultrasound.
  4. UNGAnyanzeli-ichug izixa ezikhulu zamanzi ngexesha le-renal colic spasm: Intsomi exhaphakileyo ixelela abantu ukuba bachube iilitha zamanzi ngexesha lohlaselo oluqatha lwezintso ukuze "bakhuphe ilitye ngaphandle." Ngexesha lokuvaleka komchamo osebenzayo, ukusela umthamo omkhulu wamanzi kwandisa ukuveliswa komchamo ngaphezu kwelitye elixineneyo, ukuvuthela i-capsule ye-renal efana nebhaluni eqinile (i-hydronephrosis), i-spiking ye-pelvic pressure ye-renal, ibangele ukugabha okukhulu, kunye nomngcipheko wokugqabhuka kwe-renal calyx (ukugqabhuka kobuhenyu). Gcoba amanzi amancinci kuphela xa unxaniwe kwaye awucaphukanga.
  5. Faka ubushushu bendawo obuthuthuzelayo (ibhafu efudumeleyo, ishawari, okanye ipad yokufudumeza) kwiflank ukuba AKUKHO fever: Ngokungafaniyo ne-appendicitis (apho ubushushu buthintelwe), ulingo lwezonyango olungenamkhethe lubonisa ukuba ukubeka *iphedi yokufudumeza efudumeleyo okanye ingubo efudumeleyo (40 ukuya kuma-42 degrees Celsius / 104 ukuya kwi-107.6 ithoba isihlunu esigudileyo) ithoba isihlunu esigudileyo kwaye iyanciphisa kakhulu intlungu ye-renal colic kunye ne-nausea ngexesha lokuthutha.
  6. Gxininisa wonke umchamo ngesihluzo semesh ecolekileyo, isihluzo sekofu, okanye igauze ukuba ulawula ilitye eliqinisekisiweyo elingantsonkothanga: Ukubamba ilitye eligqithisiweyo (elinokubonakala ngathi lincinci i-2 ukuya kwi-5 millimeter egqabhukileyo emdaka, emthubi, okanye ukhozo oluntsundu lwesanti okanye lwegrabile) kuvumela iingcali ze-urologists ukuba zihlalutye ukwakheka kwayo kweekhemikhali (calcium oxalate, i-uric cyst, i-uric acid, ilitye le-uric, okanye i-uric acid, i-uric acid, okanye i-uric acid).
flowchart TD
    Start["Ngequbuliso, iFlank ebuhlungu / iAngle ye-Costovertebral Engasemva Intlungu eRadiya macala onke ukuya kwiGroin, iTesticle, okanye iLabia."] --> CheckSepsis{"1. Qwalasela Izintso Ezithintelweyo (Urosepsis) Iiflegi eziBomvu: Umkhuhlane (>=38.0 C), Ukugodola/Ukuqina, Umchamo omdaka onamafu, ukubhideka, okanye ukothuka?"}
    CheckSepsis -->|Yes| CallEMS["Fowunela iiNkonzo eziNgxamisekileyo (911 / 112 / 999) Ngokukhawuleza: Uxinzelelo lwe-Urological oluBalulekileyo luyafuneka"]
    CheckSepsis -->|No Fever/Chills| CheckAAA{"2. Ngaba isineke ngaphezu kweminyaka eyi-50 'Ngelitye Lokuqala', i-Aortic Aneurysm eyaziwayo, isiyezi, okanye i-Syncope?"}
    CheckAAA -->|Yes| CallEMS_AAA["Fowunela iiNkonzo eziNgxamisekileyo ngoko nangoko: Lawula iAneurysm yeAortic eNxulukileyo yesisu (AAA)"]
    CheckAAA -->|No| CheckRenal{"3. Qwalasela Izintso & Ukugabha Iiflegi eziBomvu: Izintso zodwa/zoTshintsho, Ukukhulelwa, iZero Umchamo ophumayo, okanye ukugabha okuNganyangekiyo?"}
    CheckRenal -->|Yes| UrgentED["Uthutho ngokukhawuleza ukuya kwiSebe likaNgxamiseko eSibhedlele le-IV yokuthomalalisa iintlungu, i-Antiemetics, kunye neMifanekiso"]
    CheckRenal -->|No Red Flags| EvalED["Lungiselela uVavanyo lwezoNyango oluKhawulezayo (I-CT engachasananga / i-Ultrasound) kunye noxinzelelo lwe-Urine"]
    CallEMS --> FirstAid["4. Faka iPakethi efudumeleyo kwiFlanki (Ukuba akukho Fever), UNGAQHELEKILE-Amanzi e-Chug Ngexesha le-Spasm eAcute, kwisikhundla ngokukhululeka."]
    UrgentED --> FirstAid

I-Renal Colic engantsonkothanga xa ithelekiswa nezintso ezithintelweyo (i-Pyonephrosis kunye ne-Urosepsis)

Kutheni ilitye lezintso ngaphandle kosulelo lilawulwa ngokukhuselekileyo ngolawulo lweentlungu kunye nokuqwalaselwa, ngelixa ilitye lezintso *elinosulelo lomgudu womchamo yenye yezona zinto zingxamisekileyo kumayeza esibhedlele?

Kwi- ilitye leentso elingantsonkothanga (i-renal colic), umchamo oyinyumba ubuyela emva kwelitye ngaphakathi kwe-ureter kunye ne-renal pelvis (hydronephrosis). Ngelixa ukolula kwe-fibrous renal capsule kunye ne-spasm ye-ureter kubangela intlungu ebuhlungu ye-10/10, umchamo ngokwawo awunyumba.

Kwi intso enentsholongwane ethintelweyo (obstructive pyelonephritis okanye pyonephrosis), iibhaktheriya (ezifana ne Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, okanye Enterococcus) zivalelwe ngaphakathi kwenkqubo yokuqokelela evaliweyo, ecinezelekileyo ngaphezulu kwelitye. Izintso ezithintelweyo ziba ithumba elivaliweyo phantsi koxinzelelo olukhulu lokuhluzwa komthambo:

  1. Kutheni amayeza okubulala iintsholongwane ewodwa AKWAZI ukufikelela okanye anyange izintso ezithintelekileyo: Okokuqala, ngenxa yokuba ukuhluzwa kweglomerular kuyeka kwizintso ezithinteleke ngokupheleleyo, amayeza okubulala iintsholongwane emithanjeni okanye athathwa ngomlomo awanakuhluza kumchamo omileyo ngaphezulu kwelitye. Okwesibini, uxinzelelo oluphezulu lwe-intrapelvic (** ngaphezu kwe-30 ukuya kwi-40 mmHg ) ivula iinyembezi ezincinci kwiingcebiso ze-renal calyces ( pyelovenous kunye ne-pyelolymphatic backflow **), ukujova ibhaktheriya ephilayo kunye ne-endotoxin yebhaktheriya ngokuthe ngqo kwi-systemic bloodstream kunye nayo yonke intliziyo.
  2. Indlela i-urosepsis ebulala ngayo ngokukhawuleza ngaphandle kwe-drainage: ** Ngaphandle kokutshatyalaliswa komatshini ongxamisekileyo wezintso ( buyisela i-ureter stenting kwigumbi lokusebenza ** okanye ** i-percutaneous nephrostomy tube yokubekwa ngasemva nge-radiology interventional *), ukufa okuvela kwi-obstructive urosepsis kudlula ** i-20 ukuya kwi-40 ekhulwini ngaphaya kwe-20 ukuya kwi-40 ipesenti * ukuxinezeleka *, kunye nokulibaziseka kweeyure ze-2 kunye nokulibaziseka kwe-12 iiyure ukufa.
Uphawu lweklinikhi Ilitye leNdlo elingantsonkothanga I-Pyelonephritis engantsonkothanga kakhulu (Usulelo lwezintso NGAPHANDLE kwelitye elithintelayo) Izintso Ezithintelweyo / I-Pyonephrosis (i-Urosepsis yoTyando oluNgxamisekileyo)
I-Pathology ephantsi Ilitye lekristale leminerali livalela umchamo, libangele uxinzelelo lwasemva olungenazintsholongwane (hydronephrosis) kunye nokuqhawuka okukhulu kwe-ureter peristaltic spasm. Iintsholongwane zinyuka zisuka esinyini ziye kwinyama yezintso, nto leyo ebangela ukudumba kwezintso, kodwa i-ureter ivuleke kakhulu ngoko ke ubovu nomchamo ziphuma ngokukhululekileyo kwisinyi. Ilitye **ithintela i-ureter KUNYE neebhaktheriya ziphindaphindeka kumchamo ovalelekileyo ngaphezu kwelitye **, ukuguqula i-pelvis ye-renal ibe yingxowa yoxinzelelo lobubovu (pyonephrosis).
**Ipateni yeentlungu kunye noBungqongqo ** ** Ngokukhawuleza, amaza e-paroxysmal ebuhlungu be-10/10 ye-flank-to-groin intlungu ** ehlala i-20 kwimizuzu ye-60 ngamaza; isigulana sihamba ngesantya somgangatho, siqengqeleka kwi-stretcher, kwaye asikwazi ukuhlala sizolile. **Ukuqala ngokuthe ngcembe kwi-1 ukuya kwiintsuku ze-2 zokuzinza, ezinzulu, ezibuhlungu ezibuhlungu ** kwi-flank enye / umva (i-costovertebral angle tenderness), edla ngokulandelwa yientsuku zokutshisa isinyi (dysuria). **I-flank enzima, engapheliyo kunye neentlungu zesisu ** (okanye kwizigulane ezikhulileyo / ezinesifo seswekile, i-back back ache ebuhlungu ngokukhawuleza igutyungelwe yi-delirium kunye ne-septic collapse).
**Ubushushu bomzimba kunye nobungqongqo ** Iqondo lobushushu eliqhelekileyo (36.5 ukuya ku-37.3 C / 97.7 ukuya ku-99.1 F). Ifiva yokwenyani ASOZE ibangwe lilitye lezintso elingantsonkothanga. Umkhuhlane ophezulu (38.5 ukuya ku-39.5 C / 101.3 ukuya ku-103.1 F) ngokugodola, isicaphucaphu, kunye nokuhlanza, kodwa uxinzelelo lwegazi ludla ngokuzinza ngokukhawuleza nge-IV fluids kunye ne-antibiotics. Ukutshiza umkhuhlane ophezulu (>38.5 ukuya ku-40.0 C) OKANYE i-hypothermia (<36.0 C) with **violent teeth-chattering rigors, racing heart (>110 bpm), ukuphefumla ngokukhawuleza (> 22 / min), uxinzelelo lwegazi oluphantsi, kunye nokudideka **.
Impendulo kwiiAntibiotics Zodwa Amayeza okubulala iintsholongwane awafuneki ukuba umchamo awunyumba. Ukuphendula ngokuthe ngcembe kwiiyure ezingama-24 ukuya kwezingama-48 ekujoliswe kuko kwi-intravenous okanye kwi-antibiotics yomlomo. Isilele ukuphucula (okanye iba mandundu ngakumbi kwi-septic shock) kunye namayeza okubulala iintsholongwane kuphela kuba ubovu bubotshwe ngokwasemzimbeni emva kwelitye. Ifuna i-stent engxamisekileyo okanye i-nephrostomy tube drainage.

Umthetho weGolide weUrology: Ilitye lezintso UNGAZE libangele umkhuhlane ngokwawo

Ukuba umntu ofunyenwe enesifo sezintso (nokuba ilitye elincinci le-3 millimeter elithunyelwe ekhaya lisuka kwigumbi likaxakeka izolo) uba ngumkhuhlane we-38.0 degrees Celsius (100.4 degrees Fahrenheit) okanye ngaphezulu, ukugodola okungcangcazelayo, ukubila kwe-clammy, okanye isiyezi **, akasenayo i-renal colic elula. Banezintso ezithintelekileyo ezosulelekileyo (obstructive pyelonephritis / urosepsis) kwaye kufuneka babuyele kwisebe likaxakeka esibhedlele ngokukhawuleza ukuze bafumane amayeza okubulala iintsholongwane emithanjeni kunye nokuphuma kwamanzi okungxamisekileyo kwezintso.

I-Anatomy yokuhlaselwa kwamatye ezintso: Indlela intlungu ehlala kuyo ilandelela ngayo uhambo lwelitye ukuhla kwi-ureter

Ilitye lezintso alibi buhlungu xa lihleli ngokuzolileyo ngaphakathi kwi-renal calyx ebanzi yezintso (ngaphandle kokuba lilitye elikhulu losulelo lwe-staghorn). Iintlungu ziqhuma xa ilitye liwela kumxinwa, i-muscular ureter (eyi-2 ukuya kwi-4 millimeters ububanzi* kuphela) kwaye iba ngumjikelo kwelinye lamanqaku amathathue-anatomical choke points (ukuncipha)* kwendlela yomchamo. Njengoko ilitye lisihla lisiya kwisinyi, indawo yentlungu iguquka ngokuqikelelwayo ecaleni kwe-*ilioinguinal kunye ne-genitofemoral nerves (T11 ukuya ku-L2)**:

Inqaku le-Choke 1: I-Ureteropelvic Junction (UPJ, apho i-final funnel idibana nomphezulu we-ureter)

  • ** Apho uziva khona: ** Ubuhlungu ngokukhawuleza, bunzulu, bufana nemela phezulu kwi-**-costovertebral angle (CVA) **, i-V-shaped corner kumqolo wakho apho i-12th rib engezantsi idibana nomqolo.
  • Iimpawu ezinxulumeneyo: Ngenxa yokuba i-capsule yezintso yabelana nge-celiac ganglion i-autonomic nerve fibers kunye nesisu, isithintelo esiphezulu se-UPJ sibangela **ukukhawuleza, ukucaphuka okukhulu kunye nokuhlanza okuphindaphindiweyo ** okuhlala kulingisa ukuhlaselwa kwe-gallbladder, i-pancreatitis, okanye umkhuhlane wesisu.

Inqaku le-Choke 2: Ukuwela iMithambo yeGazi ye-Iliac (I-Mid-ureter kumphetho we-pelvic)

  • Apho uziva khona: Iintlungu ziphuma phambili nasezantsi ukusuka kwiflank ijikeleze icala lesinqe ukuya kwi-ekunene okanye ekhohlo emazantsi esisu sequadrant kwaye ihle iye kwi groin crease.
  • Umgibe wokuxilonga: Xa ilitye liphumla kwi-middle-ureter ekunene phezu kwesihlunu se-psoas, lilinganisa ngokusondeleyo appendicitis ebukhali (kwicala lasekunene) okanye i-acute diverticulitis (kwicala lasekhohlo). Nangona kunjalo, qaphela indlela isigulana esiziphatha ngayo:
  • Isigulana esine peritonitis evela kwi-appendicitis ilele ingumkhenkce kwaye ayishukumi phezu kwebhedi kuba yonke intshukumo ilimaza iperitoneum.
  • Isigulana esine renal colic ** ** siyajijisa, sihamba ngesantya sepaseji, sijija phantsi, kwaye sihlala sitshintsha isikhundla ** sizama ngelize ukufumana i-angle ekhulula i-spasm yangaphakathi ye-ureter ("uphawu lwe-pacing"**).

I-Choke Point 3: I-Ureterovesical Junction (UVJ, apho umzantsi we-ureter ungena kudonga lwesinyi)

  • Owona mnyango umxinwa kumjelo womchamo (kuphela yi-1 ukuya kwi-2 yeemilimitha ububanzi): Ngaphezulu** kwe-60 ukuya kwi-70 yeepesenti yamatye** afunyenwe kwisebe likaxakeka Izikena ze-CT zixingelele kanye apha kwi-UVJ, iimilimitha nje phambi kokuwela esinyini.
  • Apho uziva khona: Ngenxa yokuba umzantsi we-ureter wabelana nge-genitofemoral kunye ne-pudendal nerves (L1, L2, S2-S4)* kunye ne-genitalia yangaphandle kunye ne-bladder base (trigone), ilitye elidityanisiweyo kwi-UVJ ebangela:
  • Iintlungu ezibukhali eziphuma ngokuthe ngqo kwi-ipsilateral testicle kunye ne-scrotum emadodeni, okanye kwi-labia majora kunye ne-vulva kubasetyhini ** (ifuna ukwahlukana okucokisekileyo ku-ukukrala kwamatyhalarha okanye ukukrazuka kwamaqanda**; kwilitye lezintso, isende ngokwalo livakala liqhelekile kwaye alidumbanga xa liphathwa ngobunono, kanti kwi-testicular torsion i-testicle ihlala phezulu, idumbile, kwaye ithenda ngokugqithisileyo).
  • Iimpawu zesinyi ezicaphuka kakhulu: Imvakalelo engxamisekileyo ngesiquphe yokuba kufuneka uchame rhoqo emva kwemizuzu emi-3 (ukungxamiseka kokuchama nokuphindaphindeka), iintlungu ezitshisayo kwincam ye-urethra (dysuria), kunye nokukhupha amathontsi ambalwa**ombala opinki, obomvu, okanye ombala weti womchamo onegazi (i-gross hematuria, nokuba i-hematuria ingekho)
  • Umzuzu wokukhululeka: Nje ukuba ilitye lithe laphumela kwi-UVJ lingene kwisinyi esinamagumbi okuchama, i-10/10 ebuhlungu yeflank kunye neentlungu ze-groin zithi shwaka ngoko nangoko. Ukugqithisa ilitye kamva ukusuka kwisinyi ukuya ngaphandle kwi-urethra ebanzi (eyi-6 ukuya kwi-8 ye-millimeters ububanzi) ngokuqhelekileyo kubangela kuphela i-pinch emfutshane ye-2-second okanye i-Clink * efihlakeleyo kwisitya sendlu yangasese.

Ubungakanani belitye kunye namathuba epaseji yendalo: Ngawaphi amatye adlulayo kwaye ngawaphi abambekayo?

Xa oogqirha bexakeka benza i-*-dose ephantsi ye-CT scan yesisu kunye ne-pelvis (CT KUB) ** okanye ** i-renal ultrasound **, umlinganiselo owodwa obaluleke kakhulu (ucinga ukuba akukho ntsholongwane okanye intso eyodwa ikhona) yi ** idayamitha eguquguqukayo yelitye kwiimilimitha **:

I-Stone Diameter kwi-CT Ukubakho kokuPasa okuzenzekelayo ngaphandle kotyando Ixesha eliphakathi lokudlula kwiSinyi Ulawulo lweKlinikhi oluMgangatho (Ukuba akukho Fever, Usulelo, okanye Izintso eziZodwa)
1 ukuya 4 millimeters (0.04 ukuya 0.16 ku) ** I-80 ukuya kwi-90 ipesenti ** idlula ngokwemvelo ngokwayo. 5 ukuya kwiintsuku ezili-14 (amatye ama-2 mm amancinci kwi-UVJ ahlala edlula kwiiyure ezingama-48). Ukuqwalaselwa kwezigulane zangaphandle, i-analgesia yomlomo ye-NSAID (ukuba umsebenzi wezintso uqhelekile), ukungenisa okuqhelekileyo kwamanzi phakathi kwe-spasms, kunye noxinzelelo lomchamo.
5 ukuya kwi-7 millimeters (0.20 ukuya ku-0.28 ngaphakathi) ** i-50 ukuya kwi-60 ipesenti ** idlula ngokwemvelo. Iintsuku ezili-14 ukuya kwezingama-28 Ulingo lwangaphandle lwe-** I-Medical Expulsive Therapy (MET) ** usebenzisa i-alpha-1 blocker yomlomo (**tamsulosin / Flomax 0.4 mg imihla ngemihla **), ekhulula i-muscle epholileyo ye-ureter ephantsi yokwandisa umnyango kunye nokunciphisa i-colic spasms, kunye nokulandelelana ngokusondeleyo kunye ne-urologist ngaphakathi kwe-1 kwiiveki ze-2.
8 ukuya kwi-9 millimeters (0.31 ukuya ku-0.35 ngaphakathi) ** i-20 ukuya kwi-30 ipesenti ** iphumelele ngokwemvelo; umngcipheko ophezulu wokuchaphazeleka ngokusisigxina kunye nomonakalo wezintso oqhubekayo (i-hydronephrosis). Akunakwenzeka ukuba kudlule kwiiveki ezi-4 ngaphandle kokungenelela. Ukuthunyelwa kwe-urology engxamisekileyo ukuze kususwe amatye aqinisekileyo: Ureteroscopy ene-holmium/thulium laser lithotripsy (ukudlulisa ikhamera encinci kumlambo womchamo ukuze ilitye libe ngumphunga ngelaser) okanye Extracorporeal Shock Wave Lithotripsy (ESWL).
Iimilimitha ezili-10 (isentimitha eyi-1 / 0.4 ngaphakathi) okanye Enkulu **Ngaphantsi kweepesenti ze-10 ** inokudlula kwi-ureter emxinwa. Ifuna ukususwa ngokwenkqubo. Okucwangcisiweyo okanye okungxamisekileyo ureteroscopic laser lithotripsy okanye Percutaneous Nephrolithotomy (PCNL) (ukukhutshwa komngxuma wesitshixo ngasemva kumatye ezintso ezinkulu>20 mm okanye staghorn struvite stones).

Ngaba unokuba nelitye lezintso ukuba kukho igazi elingu-ZERO kumchamo wakho?

Ewe. Ngelixa i-gross (i-pink ebonakalayo / ebomvu) okanye igazi elincinci kumchamo (**hematuria **) likhona kwi-80 ukuya kwi-85 yepesenti yeemeko zamatye ezintso, ** i-15 ukuya kwi-20 ekhulwini yezigulane ezinelitye eliqinisekisiweyo le-urethra zine-dipstick engalunganga yomchamo kunye ne-zero iiseli zegazi ezibomvu kumchamo wabo **, ngokukodwa xa kungekho mchamo obomvu kunye neeseli ezibomvu zegazi. i-ureter eyenzakeleyo inokuqengqeleka idlule ilitye ingene esinyini.

Kutheni ii-NSAID zibethe i-opioids ngenxa yeentlungu zamatye ezintso (kwaye xa ii-NSAID zithintelwe ngokungqongqo)

Ukuba ukwisebe elingxamisekileyo okanye sele sele uhlolwe ngugqirha oye waqinisekisa ** intsonko enzima, ilitye eliyinyumba elingenazintso kunye nomsebenzi oqhelekileyo wezintso (i-serum creatinine eqhelekileyo) **, ukuqonda indlela iintlungu ezisebenza ngayo kwi-ureter kunceda ngokuphawulekayo:

1. Kutheni i-Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) ijolise kwingcambu ye-renal colic

Xa ilitye livimba i-ureter, ukunyuka kwengcinezelo ngaphakathi kwintso ivuselela i-synthesis yendawo ye-Prostaglandin E2 (PGE2) ** kunye ne- prostacyclin **. I-Prostaglandin E2 yenza izinto ezimbini ezenza i-renal colic ibuhlungu:

  1. Yandisa i-afferent arterioles engena kwi-glomeruli yezintso, inyusa uxinzelelo lokuhluza umchamo ngqo kwizintso esele zivaliwe, edumbile.
  2. Ibangela ubundlobongela, ubuhlungu ** i-spasms ye-muscle egudileyo yodonga lwe-ureter ** malunga nelitye kunye nokwandisa ukuvuvukala kwendawo ye-ureter (i-edema).

** ii-NSAID ** (ezifana ne-intravenous esibhedlele ** ketorolac [Toradol] ** okanye i-rectal / ngomlomo ** diclofenac, ibuprofen, okanye i-naproxen ) ivimba ngokuthe ngqo i-prostaglandin synthesis ( cyclooxygenase inhibition **). Ngokuvala i-Prostaglandin E2, ii-NSAID **ngaxeshanye ukuthoba uxinzelelo ngaphakathi kwi-capsule yezintso ezidumbileyo, ukuphumza i-ureteral muscle spasms, ukuncipha ukudumba malunga nelitye, kunye nokubonelela ngentlungu ephezulu okanye elinganayo xa kuthelekiswa ne-intravenous morphine ** ngaphandle kokubangela ukugabha okubangelwa yi-opioid okanye ukozela.

2. Xa ii-NSAID ZIKHUSELEKILEYO kwisigulane se- kidney stone

Ngenxa yokuba ii-NSAID zinciphisa ukuhamba kwegazi kwizihluzo zezintso ezivaliweyo, ** ungaze uthathe ibuprofen, i-naproxen, i-ketorolac, okanye i-diclofenac ** ukuba kukho naziphi na iimeko ezilandelayo ezisebenzayo:

  • **AWUKE ube novavanyo lwegazi esibhedlele okanye imbali eqinisekisa ukusebenza kwezintso okuqhelekileyo *, okanye une-acute kidney injury (i-creatinine ephakamileyo) okanye isifo sezintso esingapheliyo (CKD Stage 3, 4, or 5).
  • Unentso ENYE kuphela esebenzayo (izintso ezizimeleyo) okanye uqhaqho-fakelo lwezintso: Ukuthatha i-NSAID xa intso yakho ekuphela kwayo ivalwe lilitye kuvala unikezelo lwegazi olushiyekileyo lwe-afferent arteriolar kwaye lugalele kwangoko acute renal failure.
  • Ukhulelwe (ii-NSAID zisenokwenzakalisa ukukhula kwezintso zomntwana kwaye zivale phambi kwexesha i-fetal ductus arteriosus).
  • Unesilonda se-peptic esisebenzayo, ukopha emathunjini, okanye ukuphelelwa ngamandla kwamanzi emzimbeni/urosepsis.
  • Kuzo zonke ezo meko, oogqirha basesibhedlele basebenzisa ** i-acetaminophen ye-intravenous (paracetamol) ** kunye ne-titrated ** i-opioids ye-intravenous ** (okanye i-ultrasound-guided erector spinae nerve blocks / i-intravenous lidocaine protocols) endaweni ye-NSAID.

Inyathelo ngenyathelo lokhathalelo lwe-prehospital kunye nokuthintela amatye ixesha elide

Inyathelo 1: Ukhuseleko lwekhaya kunye nolawulo lwezothutho ngexesha lesiganeko esinzima

  1. Jonga iqondo lobushushu ngethemometha ngokukhawuleza: Phambi kokuba unyange naliphi na ilitye elikrokrelekayo kwizintso ekhaya, jonga ubushushu bomzimba. Ukuba iqondo lobushushu li38.0 ngokukaCelsius (100.4 degrees Fahrenheit) okanye lingaphezulu (okanye lingaphantsi kwe-36.0 C / 96.8 F), okanye ukuba umntu uqhaqhazelis’ amazinyo, yeka ukukhathalelwa ekhaya uze uye ngqo kwisebe likaxakeka okanye utsalele umnxeba ku-911/112/999.
  2. Faka ubushushu obusebenzayo bangaphandle kwiflanki kunye nomqolo osezantsi: Beka i-pad yokufudumeza efudumeleyo, ibhotile yamanzi ashushu ebhijelwe ngetawuli, okanye ipakethe yobushushu bekhemikhali efudumeleyo kwi-40 ukuya kwi-42 degrees Celsius (104 ukuya kwi-107.6 degrees Fahrenheit)* phezu kweflank ebuhlungu kunye nomqolo ophantsi ngexesha lokuthutha.
  3. Kuphephe ukuntywiliswa kwamanzi ngenkani ngexesha leentlungu ezibukhali: Ngelixa ulinde ukuba iliza lentlungu lidambe okanye usiya kwigumbi likaxakeka, musa ukugoba iiglasi zamanzi. Nje ukuba i-acute colic spasm ilawulwe kwaye isicaphucaphu kusonjululwe, phinda uqalise ukutya okuqhelekileyo, okuzinzileyo (2.0 ukuya kwi-2.5 ilitha ngosuku) ukunceda ukuthwala ilitye lijonge ezantsi.
  4. Qokelela kwaye uhluze ithontsi ngalinye lomchamo: Chamela kwiplastiki ecocekileyo yokuchama, ikomityi, okanye umnqwazi kwaye uwugalele ngesihluzo samatye okanye isihluzo sekofu esimhlophe sephepha. Emva kokuba i-crystal yamatye enzima ibanjwe, mayibe i-air-dry kwibhotile yepilisi ecocekileyo (ungaze uyifake kwiphepha langasese elimanzi, elinyibilikayo okanye linamathele kwi-crystal) kwaye uyizise kugqirha wakho ** I-Fourier-transform infrared spectroscopy (FTIR) okanye i-X-ray diffraction stone analysis **.

Inyathelo lesi-2: Amanyathelo asekelwe kubungqina bokutya okuthintela ilitye lengtso yesibini

Ngaphandle kweenguqu zokukhusela, ** i-50 ipesenti ye-first-time kidney stoneers iya kuhlupheka elinye ilitye phakathi kwe-5 kwiminyaka eyi-10 **:

  • Sela amanzi aneleyo ukuze uvelise ubuncinane iilitha ezi-2.5 (ii-ounces ezingama-85 zolwelo) zomchamo omthubi oluthuthu rhoqo kwiiyure ezingama-24: Lo mkhwa uwodwa usika ukuphindaphinda kwamatye ngesiqingatha kuzo zonke iindidi zamatye.
  • Yongeza i-citrate yendalo (ilamuni yokwenyani okanye ijusi yekalika) kumanzi akho emihla ngemihla: I-Citrate kumchamo ibophelela kwi-calcium yomchamo kwaye ivimba ngokwendalo iikristale ze-calcium oxalate kunye ne-calcium phosphate ukuba zinganamatheli.
  • ** UNGAKUthinteli i-calcium yokutya (ukutya ubisi oluqhelekileyo / i-calcium kunye nokutya), kodwa YEHLISA i-sodium ephezulu (ityuwa): ** Ngokumangalisayo, ukutya okune-calcium ephantsi * kwandisa * i-calcium oxalate yezintso zamatye ngenxa yokuba i-calcium oxalate emathunjini akho ibophelela kwi-oxalate ekutyeni (isipinatshi, i-rhubarb, i-almonds, i-beet, i-beet, i-tool ephuma kwi-umchamo kwi-tea yakho. Ukutya okuphezulu i-sodium (ityuwa) kunyanzelisa izintso ukuba zikhuphe i-calcium engaphezulu kumchamo (hypercalciuria).

Ukuqonda iintlobo ze-4 zeekhemikhali zamatye ezintso kunye neemeko eziphuthumayo ezikhethekileyo

Xa ilitye lezintso libanjwe kwisihlunu okanye lisuswe ngexesha le-ureteroscopy, uhlalutyo lwebhubhoratri lubonisa ukuba yeyiphi kwiintsapho ezine eziphambili zeminerali ** ezibangele ilitye, nganye ithwele imiba engxamisekileyo eyahlukileyo:

Uhlobo lweMichiza yelitye Ukuphindaphinda kunye nokubonakala kweX-Ray Unobangela wengcambu kunye nomchamo pH IiNgqwalaselo ezingundoqo zeklinikhi kunye nezoNgxamiseko
1. Amatye eCalcium (iCalcium Oxalate [75%] kunye neCalcium Phosphate [5%]) I-80% yawo onke amatye. Amhlophe qhwa (radiopaque) kwi-X-reyi eqhelekileyo kunye ne-CT scan. Umthamo ophantsi womchamo, i-sodium ephezulu yokutya, i-hypercalciuria, i-hyperoxaluria (isifo se-Crohn, i-gastric bypass, ukutya okuphezulu kwe-oxalate), i-citrate ephantsi yomchamo, okanye i-hyperparathyroidism. Amatye aqinileyo, abukhali, amatye ("i-mulberry" okanye "iimvulophu" iikristale) ezibangela i-spasm enzima ye-ureter kunye ne-hematuria; ithintelwe ngokutya okuphezulu kwamanzi, ityuwa ephantsi, i-calcium yexesha eliqhelekileyo lokutya, kunye ne-potassium citrate.
2. Amatye e-Uric Acid (iGout / Amatye aneAcidic Urine) ** i-10% yawo onke amatye.** **Engabonakaliyo (i-radiolucent) kwi-X-ray yesisu esicacileyo **, nangona ibonakala ngokucacileyo kwi-CT scan kunye ne-ultrasound. Ngokuzingileyo umchamo oneasidi (pH ngaphantsi kwe-5.5) udityaniswe negawuthi, i-metabolic syndrome/ukutyeba kakhulu, urhudo olungapheliyo (ilahleko yebicarbonate), i-purine ephezulu/inyama yokutya, okanye i-chemotherapy tumor lysis. Ekuphela kwelitye lezintso ezinokuthi zinyibilike ngokupheleleyo ngeyeza ngaphandle kotyando: Ukunika ngomlomo potassium citrate okanye sodium bicarbonate ukunyusa umchamo pH ukuya 6.5 ukuya 7.0 inyibilika amatye uric acid ecocekileyo kanye ngaphakathi kwizintso kunye ureter (ngaphandle kokuba usulelo okanye i-high-grade crisis ikhona).
3. Amatye eStruvite (iMagnesium Ammonium Phosphate / "Amatye Osulelo") 5% ukuya kwi-10% yamatye. I-radiopaque ephakathi; ikhule ngokukhawuleza ibe yi-branching enkulu "iStaghorn Calculi" igcwalise i-pelvis yonke yezintso. Ibangelwa 100% yintsholongwane engapheliyo yomchamo ophezulu kunye neebhaktheriya ezivelisa urease (Proteus mirabilis, Klebsiella, Pseudomonas, Providencia), eyahlula i-urea ibe yi-ammonia kwaye ijike umchamo ngamandla ** alkaline (pH> 7.2)**. I-high-risk urosepsis time bomb: Ngenxa yokuba iibhaktheriya eziphilayo zihlala nzulu ngaphakathi kwi-porous layers yelitye le-struvite, i-antibiotics ayinakuze icolise umchamo de ilitye le-staghorn lisuswe ngotyando nge-Percutaneous Nephrolithotomy (PCNL). Amatye e-staghorn angaphathwanga atshabalalisa intso (xanthogranulomatous pyelonephritis).
4. Cystine Stones (Hereditary Cystinuria) I-1% ukuya kwi-2% yamatye. I-radiopaque epholileyo (imbonakalo ye-"ground-glass"); iikristale ezinehexagonal kumchamo. I-autosomal recessive genetic defect kwi-renal tubular reabsorption ye-amino acid ** i-cystine , iqala ku- ebuntwaneni okanye ebusheni **. Amatye aqine kakhulu amelana ne-thotripsy-wave; zifuna ubomi bonke ultra-high hydration (3.5 ukuya 4 ilitha/ngosuku kuquka ukuvuka ebusuku ukusela amanzi), alkalinization umchamo ngaphezu pH 7.5, kunye neziyobisi thiol-binding.

Amatye ezintso ngexesha lokukhulelwa kunye nakwizigulane ezine-Inwelling Ureter Stent

1. I-Renal colic ngexesha lokukhulelwa (Ukukhusela umama kunye nomntwana)

Ngokumalunga ** i-1 kwi-200 ukuya kwi-1,500 izigulane ezikhulelweyo ** ivelisa ilitye elibukhali lezintso, ngokuqhelekileyo ngexesha le- ** yesibini neyesithathu yesithathu ** (xa i-progesterone ikhulula i-ureteral muscle smooth kunye ne-uterus eyandisiweyo icinezela i-ureters, ngakumbi kwicala lasekunene).

  • Kutheni izigulane ezikhulelweyo ezine-renal colic zifuna ukuxilongwa kwangoko esibhedlele:
  • Intlungu engapheliyo ye-renal colic enganyangwayo kunye ne-pyelonephritis ephazamisayo ekukhulelweni inokubangela ** ukubeletha kwangaphambili kunye nokunikezelwa kwangaphambi kwexesha **, i-urosepsis yomama, kunye ne-preeclampsia-like hypertension.
  • Umfanekiso wokuxilonga ngaphandle kwemitha: Amasebe kaxakeka akaze asebenzise ii-CT scans eziqhelekileyo njengovavanyo lokuqala lokukhulelwa; endaweni yoko, basebenzisa ** I-Renal kunye ne-Pelvic Ultrasound ** (ukulinganisa iijethi ze-ureter kunye nokwahlula i-physiological hydronephrosis yokukhulelwa kwilitye) ilandelwa ukuba ifunwa ngu ** non-contrast Magnetic Resonance Urography (MRU) ** okanye i-ultra-low-dose protocols.
  • Ukhuseleko lwamayeza: Ii-NSAID (ibuprofen, ketorolac, naproxen) zichasene ngokungqongqo ekukhulelweni. Iintlungu zilawulwa ngokukhuselekileyo nge-acetaminophen ene-intravenous kunye ne-opioids ene-titrated, kwaye ukuba i-fever, i-urosepsis, okanye intlungu e-refractory iyenzeka, i-urologists ibeka i-urologists yesikhashana ngenxa yokukhulelwa kwe-urete ye-6 kwiveki nganye inyusa i-calcium encrustation kwi-stents) de kube semva kokuziswa.

2. Ukhathalelo olungxamisekileyo kwizigulane esele zine-Indwelling Ureteral Stent ("JJ Stent")

Ukuba isigulana kutshanje sine- **double-J (JJ) i-ureter stent ** ifakwe ngaphakathi kwi-ureter yi-urologist (ukudlula ilitye okanye ukuphilisa emva kwe-laser lithotripsy), cacisa ukuba yintoni eqhelekileyo xa ithelekiswa nemeko kaxakeka:

  • Iimpawu eziqhelekileyo ezilindelekileyo zokungarhaleli: Umchamo opinki ongephi okanye obomvu emva kokuhamba, ukuqaqamba kwiflank ngokukodwa xa uchama (okubangelwa kuxinzelelo lwesinyi ukuphinda ukhuphe umbhobho we-stent ongenanto), kunye nokungxamiseka okuncinci kwesinyi/i-frequency kwicoil esezantsi ye-stent (iphathwa nge-tamsulosin/so oxylifecinine) emiselweyo.
  • Iimeko ezingxamisekileyo ezifuna utyelelo lwesebe olungxamisekileyo olukhawulezileyo:
  • Ifiva entsha (>=38.0 C / 100.4 F) okanye iingqele (imiqondiso yokuba i-stent ibotshelelwe okanye ifakwe i-biofilm kunye nobovu).
  • **Ukubuyiswa kweentlungu eziqhubekayo, ezinzima ze-10/10 zeflank ** ezingayekiyo emva kokuchama (iimpawu ze-stent ziye zafuduka ngaphandle kwendawo okanye zixhunywe ngehlwili legazi okanye iqhekeza lelitye).
  • Umchamo omkhulu, omnyama obomvu onamahlwili amakhulu egazi okanye ukungakwazi ukuchama (ukugcinwa komchamo obukhali).
  • Umtya ojingayo ojingayo uyashukuma okanye uyatsalwa: Ezinye iziteyinti zethutyana zinentambo ebhityileyo yenayiloni eqhina ephuma kumchamo ukuze ususwe lula iofisi; **ungaze utsale umtya we-stent ngokwakho ** ngaphandle kokuba uyalelwe ngokucacileyo ukuba uwususe ngelo xesha licwangcisiweyo ngugqirha wakho we-urologist.

Thatha ikhosi yoncedo lokuqala eqinisekisiweyo

Ukuqaphela i-urosepsis, ukwahlula iimeko ezingxamisekileyo ze-aorta yesisu kwintlungu ye-flank, kunye nokulawula ukothuka zizakhono zokusindisa ubomi. Cinga ngokubhalisa kwikhosi yoncedo lokuqala eqinisekisiweyo kunye noMnqamlezo oBomvu, iSt John Ambulance, okanye umboneleli wengingqi ovunyiweyo.

Imibuzo edla ngokubuzwa

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.

Imithombo ijongiwe

  • ** I-European Association of Urology (EAU): ** * Izikhokelo ze-EAU kwi-Urolithiasis (Uhlaziyo lwe-2024): Ulawulo lwe-Acute Renal Colic, i-Medical Expulsive Therapy, kunye noKunyanzeliswa okuNgxamisekileyo kwiNtsonko eNcinyiweyo *.
  • ** I-American Urological Association (AUA) kunye ne-Endourological Society (eUnited States): ** * ULawulo lwezoNyango lweZintso zaMatye * kunye * noLawulo loTyando lwaMatye: i-AUA / Endourological Society Guideline *.
  • Iziko leSizwe lezeMpilo kunye neNkathalo eGqwesileyo (NICE, eUnited Kingdom): I-Renal kunye ne-Ureteric Stones: Uvavanyo kunye noLawulo (NG118).
  • Iphulo lokusinda kwi-Sepsis (SSC) kunye ne-Infectious Diseases Society of America (IDSA): *Izikhokelo zamazwe ngamazwe zoLawulo lwe-Urosepsis kunye noLawulo loMthombo oluKhawuleza kwi-Obstructive Pyelonephritis *.
  • *Pathan SA, Mitra B, Straney LD, et al. ( I-Lancet *): ** * Ukuhambisa i-analgesia ekhuselekileyo nesebenzayo yokulawula i-renal colic kwisebe eliphuthumayo: i-double blind-blind, multigroup, isilingo esilawulwa ngokungahleliwe * (ebonisa ukuphakama kwe-NSAIDs ngaphezu kwe-morphine ye-acute renal colic).

Izikhokelo ezinxulumeneyo