Apostematozny pyelonephritis: zimayambitsa, zizindikiro, matenda, mankhwala

Matendawa ndi imodzi mwa sitepe ya pyelonephritis pachimake. Pamene apostematoznom pyelonephritis zimachitika njira yotupa imene angapo ang'onoang'ono abscess mafinya (apostemy) anapanga. Mbuto ikulu ya kutanthauzira awo ndi khungwa la impso.

Mawonekedwe chachikulu

Nthawi zambiri apostematozny pyelonephritis amayamba kukula pamene ureteral kutsekeka, osachepera - ndi kukhazika mkodzo outflow.

Mu impso pustules yaing'ono anapanga m'njira zotsatirazi: a glomerular capillary kuzungulira ziwiya osachiritsika magazi ndi impso mu capillaries peritubular kudziunjikira tizilombo. Pa yemweyo kuundana bakiteriya anapanga, iwo kutumikira monga gwero la pustules. Iwo zili padziko kotekisi aimpso, komanso kapisozi fibrous lalikulu zedi. Kuwaona zawo kuoneka bwino. Apostemy ndi chikasu mtundu, kukula kwa 2 mm, akhoza anakonza mu magulu kapena singly.

Pamene apostematoznom pyelonephritis impso umachuluka kukula, ali ndi chitumbuwa wofiira mtundu. Impso minofu ndi edema, thickening ya kapisozi fibrous amapezeka. Aimpso yachigawo kuonekera pustules, angazindikire iwo medulla lapansi.

Apostematozny pyelonephritis, bacteremia ndi abscess a impso ndi

Mawonekedwe lachiwiri la matenda - ndi kalabankulo impso. Zimachitika purulent necrotic limba kuwonongeka, impso abscess. Mu kotekisi wa anapanga foci wa necrosis. Bacteremia kumachitika pamene njira hematogenous kufala kwa matenda. Zikatero amachititsa pyelonephritis apostematoznogo kukhala matenda pustular, kalabankulo, furunculosis, mastitis, felon. Limagwirira la mapangidwe kalabankulo ndi:

• Bakiteriya thrombus akulowa mtsempha wamagazi ndi aimpso ku wapotalikira chipinda mafinya kotero bacteremia amapezeka mu imodzi ya mabacteria wa wolumikizira nthambi kotunga magazi kapena nthambi zing'onozing'ono wolumikizira.

• Bacteremia kumachitika pamene psinjika a chotengera lalikulu intrarenal yotupa adzalowerera kapena asanakumane ndi gwero la kutupa mpanda mtima.

Ambiri chifukwa chitukuko kalabankulo tizilombo, monga woyera ndi Staphylococcus aureus, Proteus ndi E. coli.

Aimpso kalabankulo yachigawo amaziona ngati anamaliza oumbidwa minofu necrotic, izo chinamulowerera ndi pustules yaing'ono zinaphatikizidwa, kusiya mphero chozama parenchyma.

Pachimake pyelonephritis apostematozny zambiri Chili kalabankulo impso ndi apostematozny pyelonephritis. Mawonetseredwe matenda a kusiyana kwakukulu si anati.

Chithunzi matenda apostematoznogo pyelonephritis

Zizindikiro apostematoznogo pyelonephritis ndi kalabankulo zimadalira m'mene akusokoneza otaya mkodzo impso ndi.

Nthawi zambiri, mawonekedwe yaikulu ya pyelonephritis umafika mwadzidzidzi, kawirikawiri pambuyo matenda intercurrent. Zikuoneka kuzizira, malungo (mpaka madigiri 40) ndi thukuta lolemera. chikhalidwe lotopetsa chimakhala chogwidwa ndi malungo (nyamuka kutentha amapereka njira kugwa). kuzizira kwambiri ukhoza kwa ola limodzi, m'posavuta pa nsonga ya kuwuka kutentha. Pambuyo tsembwe thukuta akuyamba pa kufooka kutentha. zizindikiro pa masiku atatu yoyamba anafotokoza ofooka.

Kenako, anayamba kukula ululu kumbuyo. Pamene impso palpation ndi bwino chowawa, achuluke. Kusintha mkodzo zimachitika pa tsiku lachisanu, pali bacteriuria, proteinuria, leucocyturia.

Kuimira magazi yodziwika ndi leukocytosis, tirigu maselo oyera, kuchuluka erythrocyte sedimentation mlingo, magazi m'thupi.

Ndi ndondomeko mwapang'onopang'ono angathe sepsis, purulent ndi metastatic foci kutupa mu chiwindi, m'mapapo, mu ubongo.

Clinic impso kalabankulo

Ngati mu impso, kumene kalabankulo, maganizo otaya mkodzo, chithunzi matenda ofanana pachimake ndondomeko opatsirana. Kutentha limatuluka digiri 40, yodziwika ndi kuzizira zidzasintha ndi kuthira mphika. Kukula wofooka, kupuma mofulumira akubwera kunyansidwa ndi kusanza, tachycardia.

Mu masiku oyambirira nthawi zambiri kupweteka palibe bacteriuria, leucocyturia, dizuricheskie matenda. Matenda ndi zovuta. Odwala akhoza kupeza chithandizo mu achire, matenda, m'madipatimenti opaleshoni. adokotala akhoza molakwika Kupeza Vuto chibayo, pachimake cholecystitis, tayifodi, ndi zina zotero. masiku ochepa kenako, pamene zizindikiro amayamba kudziwonetsa m'deralo (ululu, chizindikiro Pasternatskogo, mwachikondi), dokotala ikufotokozanso impso.

Apostematozny matenda pyelonephritis

Matenda a matenda zachokera zizindikiro zotsatirazi:

• febrile nthawi kumatenga masiku oposa atatu;
• kuchuluka impso kopweteka palpation;
• Laboratory maphunziro: bacteriuria, leucocyturia, magazi - leukocyte kumanzere kosangalatsa, leukocytosis, CRP, ESR kuchuluka;
• excretory Voiding - yafupika impso ntchito, kuchuluka kumbali akhudzidwa;
• US - okha zoyendayenda, kuwonjezera kukula kwa ziwalo, thickening 2cm parenchyma chake si yunifolomu kachulukidwe; madzi perinephric danga pyelocaliceal dongosolo lomwe lakamba zambiri ureteral kutsekeka;
• MSCT, Kujambula, CT - kuwonjezeka kukula impso, thickening wa parenchyma, heterogeneity ake ndi kubuka purulent suppuration;
• apeza malo amodzi nefrostsintigrafiya - kuwonjezeka kukula impso mu parenchyma m'goli kudzikundikira isotope.

Purulent suppuration minofu momveka bwino ndi kalabankulo. Pa US foci mu parenchyma wa kachulukidwe mkulu kuoneka bwino bwino, komanso dongosolo lawo losanganikirana. Kuoneka bwino pa cipangizo ici ndi Kujambula, CT. Mwauzimu CT ndi kusiyana kuwongola limachititsa kuona kuphwanya pamene inu mulandira kusiyana kwa necrosis.

Mavuto potaya

Mavuto potaya alili angayambe ngati asanaloŵe urology odwala likufa mankhwala mankhwala ndi mankhwala amakono wina - masabata awiri. Zinthu zimenezi akhoza kusalaza anasonyeza apostematoznogo pyelonephritis, koma kuwongolera lofunika sizidzachitika. Thupi kutentha ndi kuchepa amachepetsa ululu, kuzizira kawirikawiri zimachitika, chikhalidwe chawo zochepa kutchulidwa ndi okhalitsa. The chepetse chiwerengero cha leukocytes magazi, koma leukocyte kumanzere kosangalatsa akadali amalimbikira ngati magazi m'thupi ndi kuchuluka ESR. M'mawu ena, matenda kumaonekera monga sepsis flaccid. Izi "kusintha" - chifukwa kuchita wodwala cholakwika. Pofuna kupewa chitukuko cha sepsis kwambiri pamaso pa chiwonongeko impso mtima moto ndikofunikira kugwira ntchito.

matenda masiyanidwe

Kudziwa apostematoznogo pyelonephritis, matenda ayenera kusiyanitsidwa ndi matenda ena. Ndi kapamba pachimake ndi cholecystitis ndi abscess subdiaphragmatic, pachimake appendicitis, pachimake cholangitis, pachimake adnexitis ndi pachimake pleurisy.

impso Kurbunkul kusiyanitsidwa ndi zamafinya zinangoti impso chotupa yosavuta, chotupa parenchyma, ndi matenda wokonda zinthu zonse m'mimba.

Kodi n'chiyani chimasiyanitsa apestomatozny pyelonephritis ndi kalabankulo aimpso?

• Pyuria. Bacteriuria.
• Low kupweteka kwa msana.
• Aimpso kukanika.
• Thickening wa parenchyma. Kusintha kachulukidwe ake.
• Kupweteka palpation ndi kuwonjezeka mu impso.
• Yowonjezera aimpso mafupa a chiuno dongosolo.

The ultrasound, Kujambula, CT kulola kusiyanitsa apostematozny pyelonephritis matenda osiyanasiyana wokonda peritoneum lapansi.

chithandizo

Chithandizo apostematoznogo pyelonephritis ndi kalabankulo ikuchitika yekha ndi opaleshoni. Nthawi zambiri, opaleshoni amachitidwa pa maziko mwadzidzidzi. Kuyambirira kochepa preoperative lokonzekera, ndi nawo Anesthetist kumatenga palibe maola oposa awiri. Maphunziro zikuphatikizapo:

• Mafupa a chiuno catheterization, utsogoleli mtsempha wa mankhwala opha tizilombo toyambitsa.
• Kuika shuga ndi electrolytes.
• Olimba a kuthamanga magazi.
• Malinga ndi umboni - cardiotonic.

Cholinga cha opaleshoni - kuteteza sepsis. Adzapulumuke.

Cholinga sekondale - chipulumutso cha impso.

Pakuti ochititsa dzanzi ntchito mankhwala ochititsa dzanzi endotracheal.

Pa mpanda ntchito zili kubala abscesses ndi mafupa a chiuno kuti mbewu kudziwa microflora kwa mtima kowonjezereka kwa kudziwa mankhwala. Zotsatira adzatsimikizira ndi purulent pyelonephritis ndi kudziwa mankhwala njira zina.

Nthawi postoperative

Pambuyo pa opaleshoni, wodwalayo amalandira chithandizo zochokera chopinga wa ntchito aimpso ndi intokikatsii. Wodwala akapatsidwa:

• 10% shuga njira - 500 ml, 10 U insulin m'nsinga;
• njira ya sodium kolorayidi 9% - 1000 ml ya;
• gemodez - 400 ml ya;
• cocarboxylase - 200 mg;
• Vitamini B6 - 2 ml;
• vitamini C - 500 mg;
• Korglikon njira ya 0,06% kwa 1.0 ml ya;
• 15% mannitol njira ndi 50 ml ya;
• Lasix kuti 60 mg;
• Mwatsopano mazira (mbadwa) plasma - 250 ml ya;
• Clexane kapena Fragmin, anapatsidwa magawo a coagulation;
• maselo ofiira okhaokha magazi kwa magazi m'thupi (HB zosakwana 70).

Pamene ntchito purulent kuledzera extracorporal detoxification (plasmapheresis, hemosorbtion, plazmasorbtsiya).

Amafuna mankhwala mankhwala ndi mankhwala awiri a sipekitiramu lonse kanthu.

ndi njira zamakono kwambiri (Kujambula, CT, ultrasound) amagwiritsidwa ntchito mu ziyenera a parenchyma lapansi. Izi zimathandiza kuti bwino ganizilani zinthu ndi kusankha buku zoyenerera za wotuluka.