Apostematozny pyelonephritis: haddasawa, cututtuka, ganewar asali, magani

A cuta ne daya daga cikin mataki na m pyelonephritis. Lokacin da apostematoznom pyelonephritis faruwa kumburi tafiyar matakai a cikin abin da mahara kananan ƙurji ruɓaɓɓen jini (apostemy) suna kafa. Babban wuri na sarrafawa ne haushi da kodan.

A farko fom

Mafi sau da yawa apostematozny pyelonephritis fara ci gaba a lokacin da ureteral toshewa, akalla - tare da m urinary outflow.

A koda kananan pustules kafa a cikin wadannan iri: a glomerular capillary madauki a cikin m jini da kuma koda a peritubular capillaries tara kwayoyin. A daidai wannan kwayan clots aka kafa, suka sa'an nan ku bauta a matsayin tushen pustules. Suna located a farfajiya na koda bawo, kazalika da fibrous kwantena a cikin manyan yawa. Lokacin da kyan gani, daga su a fili a bayyane. Apostemy da yellowish launi, size har zuwa 2 mm, za a iya shirya a kungiyoyin ko singly.

Lokacin da apostematoznom pyelonephritis koda ƙaruwa a size, yana da wani ceri ja launi. Koda nama ne edema, thickening na fibrous kwantena faruwa. Koda bangaranci a bayyane pustules, za a iya gane su a cikin medulla.

Apostematozny pyelonephritis, bacteremia da ƙurji na koda

Na biyu nau'i na cutar - a carbuncle koda. Yana auku surkin jini necrotic Gabar lalacewa, koda ƙurji. A bawo suna kafa foci na necrosis. Bacteremia na iya faruwa a lokacin da hanya hematogenous baza kamuwa da cuta. A irin haka ne ya sa pyelonephritis apostematoznogo zama pustular cututtuka, carbuncle, furunculosis, mastitis, felon. Ginshikai na samuwar carbuncle ne:

• Kwayan thrombus shiga koda jijiya daga distal jam'iyya ruɓaɓɓen jini haka bacteremia faruwa a daya daga cikin bangarori na jijiya jinin samar rassan ko karami jijiya rassan.

• Bacteremia na iya faruwa a lokacin da matsawa da wani babban jirgin ruwa da intrarenal kumburi infiltrate ko daga lamba tare da tushen kumburi a cikin jijiyoyin bugun gini bango.

Mafi na kowa hanyar raya carbuncle kwayoyin, kamar fari da kuma staphylococcus aureus, Proteus da E. coli.

Koda carbuncle bangaranci gani a matsayin taso bulging na necrotic nama, shi ne Ribar da kananan pustules Fused, da barin sandan zurfi parenchyma.

M pyelonephritis apostematozny sau da yawa hadawa carbuncle koda da kuma apostematozny pyelonephritis. The asibiti manifestations na babban bambanci ba ya lura.

The asibiti hoto apostematoznogo pyelonephritis

Alamun apostematoznogo pyelonephritis da carbuncle dogara kan yadda disrupted da ya kwarara daga fitsari daga koda.

Mafi sau da yawa, da farko nau'i na pyelonephritis auku ba zato ba tsammani, yawanci bayan intercurrent kamuwa da cuta. Bayyana jin sanyi, zazzabi (har zuwa 40 digiri) da nauyi gumi. M yanayi ne da ya mamaye da zazzabi (zazzabi Yunƙurin bada hanya zuwa fada). Excellent jin sanyi iya wuce har zuwa sa'a daya, mafi kusantar su zamanto a ganiya zazzabi Yunƙurin. Bayan sanyi sweating farawa a zazzabi ƙi. Wadannan cututtuka a lokacin farko da kwanaki uku suna bayyana weakly.

Next, fara girma ciwon baya. Lokacin koda palpation ne a fili m, na iya ƙara. Canje-canje a cikin fitsari faru ne a rana ta biyar, akwai bacteriuria, proteinuria, leucocyturia.

Don hoto da jini halin da leukocytosis, hatsi a cikin farin jini Kwayoyin, ta ƙara erythrocyte sedimentation kudi, anemia.

Tare da m tsari na iya ci gaba sepsis, surkin jini da ciwon metastatic foci na kumburi a cikin hanta, huhu, kwakwalwa.

Clinic koda carbuncle

Idan a cikin koda, inda wani carbuncle, ba a gaji da damuwa da ya kwarara daga fitsari, wani asibiti hoto kama m dauke da kwayar cutar tsari. A zafin jiki yakan zuwa 40 digiri, halin da jin sanyi mai ban mamaki da kuma zuba tukunya. Girma rauni, numfashi rãyar, zo tashin zuciya da kuma amai da tachycardia.

A farkon zamanin sau da yawa ba ciwo, babu wani bacteriuria, leucocyturia, dizuricheskie cuta. Ganewar asali ne wuya. Marasa lafiya na iya samun magani a warkewa, dauke da kwayar cutar, m sassan. Likita na iya kuskure diagnosing ciwon huhu, m cholecystitis, typhoid zazzabi, da kuma kama. Kawai 'yan kwanaki daga baya, lokacin da cututtuka fara nuna gida (zafi, alama Pasternatskogo, tausayi), likita mayar da hankali a kan kodan.

Apostematozny pyelonephritis ganewar asali

Ganewar asali da cutar dogara ne a kan wadannan Manuniya:

• febrile zamani yana for fiye da kwana uku.
• ƙara koda mai raɗaɗi ga palpation.
• Laboratory nazarin: bacteriuria, leucocyturia, jini - leukocyte bar motsi, leukocytosis, CRP, ESR karuwa.
• excretory Voiding - rage koda aiki, ya karu a kan ya shafa gefe.
• Amurka - iyakance motsi, kara girman gabobin, thickening fiye 2cm parenchyma, wadanda ba uniform yawa. ruwa perinephric sarari pyelocaliceal tsarin yana faɗaɗa ureteral toshewa.
• MSCT, MRI, CT - karuwa a koda size, thickening na parenchyma, ta heterogeneity da kuma annobar cutar da surkin jini suppuration.
• tsauri, kuma a tsaye nefrostsintigrafiya - karuwa a koda size a cikin parenchyma m jari isotope.

Surkin jini suppuration nama a fili saukar da carbuncle. A Amurka foci a parenchyma na high yawa ne a fili bayyane, kazalika da su gauraye tsarin. A bayyane yake a bayyane a kan wannan hoto da kuma MRI, CT. Karkace CT tare da bambanci enhancement sa ya yiwu don ganin take hakkin lokacin da ka karɓi bambanci ga necrosis.

Matsalolin a kimantawa

Matsalolin a kimantawa da haƙuri da yanayin iya faruwa idan kafin shigar da urology marasa lafiya jurewa kwayoyin far da zamani maganin rigakafi daya - makonni biyu. Irin wannan jiyya iya santsi nuni apostematoznogo pyelonephritis, amma a muhimman hakkokin kyautata ba za ta auku. Jiki zafin jiki na raguwa, yana raguwa zafi, jin sanyi da wuya faruwa, da yanayi kasa pronounced kuma zaunanniya. A rage yawan jini leukocytes, amma leukocyte bar motsi har yanzu ta ci gaba kamar yadda anemia, kuma Ya ƙãra ESR. A wasu kalmomin, cutar bayyana kanta a matsayin flaccid sepsis. Wannan "kyautata" - dalilin yin ba daidai ba haƙuri. Don hana ci gaban mai tsanani sepsis a gaban wani koda haƙuri hearth halaka wajibi ne ta yi aiki.

bambanci ganewar asali

A gano apostematoznogo pyelonephritis, cutar dole ne a bambanta daga sauran cututtuka. Tare da m pancreatitis da cholecystitis da subdiaphragmatic ƙurji, m appendicitis, m cholangitis, m adnexitis kuma m pleurisy.

koda Kurbunkul bambanta da sauki festering koda mafitsara, da ƙari parenchyma, tare da m cututtuka na kogon ciki.

Abin da banbanta tsakanin apestomatozny pyelonephritis kuma koda carbuncle?

• Pyuria. Bacteriuria.
• Low ciwon baya.
• Koda tabarbarewa.
• Mai kauri parenchyma. Canza a yawa.
• M palpation tare da karuwa a cikin kodan.
• The fadada daga cikin na koda kafafuwa tsarin.

A duban dan tayi, MRI, CT damar rarrabe apostematozny pyelonephritis na daban-daban m cututtuka na peritoneum.

magani

Jiyya apostematoznogo pyelonephritis da carbuncle za'ayi na musamman ta hanyar tiyata. Mafi sau da yawa, da aiki da aka yi a kan gaggawa akai. Na farko short preoperative shiri, tare da sa hannu Anesthetist yana ba fiye da sa'o'i biyu. A horo hada da:

• Kafafuwa catheterization, igiyar jini gwamnati na wani kwayoyin.
• Transfussion na glucose da kuma Wutan.
• Karfafawa na jini.
• Bisa ga shaidar - cardiotonic.

Babban manufar da aiki - su hana sepsis. Ceton rayuka.

A sakandare haƙiƙa - ceton kodan.

Domin maganin sa barci yin amfani da maganin sa barci endotracheal.

A lokacin aiki ciki shinge nuna abscesses da kafafuwa a yi amfanin gona domin sanin microflora domin kara tabbatar da dalilin da ji na ƙwarai to maganin rigakafi. Results zai tabbatar da surkin jini pyelonephritis kuma domin sanin karin magani dabarun.

A postoperative zamani

Bayan tiyata, da mãsu haƙuri sami wani magani bisa hanawa na koda aiki da intokikatsii. A haƙuri da ake sa:

• 10% glucose bayani - 500 ml, 10 U insulin intravenously.
• bayani na 9% sodium chloride - 1000 ml.
• gemodez - 400 ml.
• cocarboxylase - 200 MG.
• Vitamin B6 - 2 ml.
• bitamin C - 500 MG.
• Korglikon bayani daga 0.06% zuwa 1.0 ml.
• 15% mannitol bayani da kuma 50 ml.
• Lasix zuwa 60 MG.
• Fresh daskararre ( 'yan qasar) jini - 250 ml.
• Clexane ko Fragmin, ba da sigogi na coagulation.
• cushe ja jini Kwayoyin ga anemia (HB kasa da 70).

Lokacin amfani surkin jini maye extracorporal detoxification (plasmapheresis, hemosorbtion, plazmasorbtsiya).

Ake bukata kwayoyin far da biyu maganin rigakafi na fadi bakan na mataki.

mafi fasaha ta zamani (MRI, CT, duban dan tayi) ana amfani da kima na parenchyma. Wannan ya sa ya yiwu su yadda ya kamata a kimanta halin da ake ciki da kuma zabi mafi dace girma na ma'amaloli.