Apostematozny pyelonephritis: ua, cov tsos mob, mob, kev kho mob

Tus kab mob yog ib tug ntawm cov kauj ruam ntawm mob pyelonephritis. Thaum apostematoznom pyelonephritis tshwm sim inflammatory dab nyob rau hauv uas ntau me me rwj kua paug (apostemy) raug tsim. Lub ntsiab qhov chaw ntawm lawv localization yog cov tawv ntoo ntawm ob lub raum.

Lub hom daim ntawv

Feem ntau cov feem ntau apostematozny pyelonephritis pib tsim thaum ureteral rhuav txhua, yam tsawg kawg - nrog lawm urinary outflow.

Nyob rau hauv lub raum me me pustules tsim nyob rau hauv cov nram qab no yam: ib tug glomerular capillary voj nyob rau hauv lub davhlau ya nyob twg cov hlab ntsha thiab lub raum nyob rau hauv peritubular hlab ntsha noog microorganisms. Nyob rau tib lub kab mob txhaws yog tsim, lawv mam li pab raws li ib tug qhov chaw ntawm pustules. Lawv muaj nyob rau ntawm qhov chaw ntawm lub raum cortex, raws li zoo raws li ib tug fibrous capsule nyob rau hauv loj qhov ntau. Thaum saib los ntawm lawv cov kom meej meej pom. Apostemy muaj ib tug yellowish xim, loj li 2 hli, tej zaum yuav teem nyob rau hauv pawg los yog singly.

Thaum apostematoznom pyelonephritis raum nce nyob rau hauv loj, muaj ib tug txiv liab xim. Raum cov ntaub so ntswg yog edema, thooj ntawm cov fibrous capsule tshwm sim. Raum sectional pom pustules, yuav ntes lawv nyob rau hauv lub medulla.

Apostematozny pyelonephritis, mob thiab rwj ntawm lub raum

Qhov thib ob daim ntawv ntawm tus kab mob no - ib tug carbuncle raum. Nws tshwm sim purulent necrotic hloov khoom nruab nrog kev puas tsuaj, raum rwj. Nyob rau hauv lub cortex yog tsim foci ntawm necrosis. Mob tej zaum yuav tshwm sim thaum txoj kev hematogenous kis mob. Nyob rau hauv xws li mob ua pyelonephritis apostematoznogo ua pustular cov kab mob, carbuncle, furunculosis, mastitis, txhaum cai loj. Lub mechanism ntawm tsim ntawm carbuncle yog:

• Kab mob thrombus nkag mus rau hauv lub raum leeg los ntawm cov distal chamber kua paug li mob tshwm sim nyob rau hauv ib tug ntawm cov aav ntawm lub arterial ntshav mov ceg los yog me me arterial ceg.

• Mob tej zaum yuav tshwm sim thaum lub sij hawm compression ntawm ib tug loj txog ntsha intrarenal inflammatory infiltrate los yog los ntawm kev sib cuag nrog rau qhov chaw mob nyob rau hauv lub vascular phab ntsa.

Cov uas keev ua txoj kev loj hlob carbuncle kab mob, xws li dawb thiab Staphylococcus aureus, Proteus thiab E. coli.

Raum carbuncle sectional pom raws li sib npaug su ntawm necrotic ntaub so ntswg, nws yog permeated los ntawm me me pustules fused, tawm hauv npoo tob parenchyma.

Mob pyelonephritis apostematozny feem ntau combines carbuncle raum thiab apostematozny pyelonephritis. Cov kev soj ntsuam txog tus loj sib txawv yog tsis cai.

Cov soj ntsuam daim duab apostematoznogo pyelonephritis

Cov tsos mob apostematoznogo pyelonephritis thiab carbuncle nyob ntawm yuav ua li cas cuam tshuam rau cov ndlwg ntawm cov zis los ntawm lub raum.

Feem ntau cov feem ntau, tus thawj hauv daim ntawv ntawm pyelonephritis tshwm sim mam li nco dheev, feem ntau yog tom qab intercurrent kab mob. Tshwm Sim ua daus no, ua npaws (mus txog 40 degrees) nrog hnyav hws. Muaj num ntau qhov yog yeej los ntawm kev kub taub hau (kub sawv muab txoj kev mus poob). Zoo heev ua daus no yuav kav mus txog rau ib teev, feem ntau yuav tshwm sim ntawm lub ncov ntawm lub kub sawv. Tom qab txias tawm hws pib ntawm ib tug kub poob. Cov tsos mob thaum lub sij hawm thawj peb hnub yog qhia weakly.

Tom ntej no, pib loj hlob rov qab mob. Thaum raum palpation yog kom meej meej heev, tej zaum yuav ua rau kom. Cov kev hloov nyob rau hauv cov zis tshwm sim nyob rau hauv lub thib tsib hnub, muaj yog bacteriuria, proteinuria, leucocyturia.

Yuav kom daim duab cov ntshav yus leukocytosis, grain nyob rau hauv cov ntshav dawb, muaj zog erythrocyte sedimentation tus nqi, anemia.

Nrog hnyav txheej txheem yuav tsim sepsis, purulent muaj metastatic foci ntawm o nyob rau hauv lub siab, mob ntsws, lub hlwb.

Clinic lub raum carbuncle

Yog hais tias nyob rau hauv lub raum, qhov chaw uas ib tug carbuncle, tsis ntxhov lub khiav ntawm cov zis, ib tug soj ntsuam daim duab zoo ib yam li mob kis txheej txheem. Qhov kub ntawm lub nce mus 40 degrees, yus muaj los ntawm ua daus no stunning thiab pouring lub lauj kaub. Loj hlob muaj zog, ua tsis taus pa quickens, los xeev siab thiab ntuav, tachycardia.

Nyob rau hauv thaum ntxov hnub feem ntau tsis muaj mob, muaj yog tsis muaj bacteriuria, leucocyturia, dizuricheskie teeb meem. Mob yog ib qhov nyuaj. Cov neeg mob yuav tau txais kev kho mob nyob rau hauv kho, mob, phais departments. Tus kws kho mob tej zaum yuav yuam diagnosing mob ntsws, mob cholecystitis, typhoid kub taub hau, thiab cov zoo li. Tsuas yog ib tug ob peb hnub tom qab ntawd, thaum cov tsos mob pib qhia hauv zos (mob, cov tsos mob Pasternatskogo, rhiab), tus kws kho mob qhia txog kev ntawm ob lub raum.

Apostematozny pyelonephritis mob

Mob ntawm tus kab mob no yog raws li nyob rau hauv cov nram no ntsuas:

• febrile lub sij hawm ntev tshaj peb hnub;
• nce lub raum mob heev rau palpation;
• Kuaj kev tshawb fawb: bacteriuria, leucocyturia, ntshav - leukocyte tshuav haujlwm, leukocytosis, CRP, ESR nce;
• excretory Voiding - txo raum muaj nuj nqi, muaj nyob rau hauv lub cov sab;
• US - tas muaj, ua rau kom qhov luaj li cas ntawm cov kabmob, thooj ntau tshaj 2cm parenchyma, nws uas tsis yog niaj hnub zoo li ceev; kua perinephric chaw pyelocaliceal system expands ureteral rhuav txhua;
• MSCT, MRI, CT - nce nyob rau hauv lub raum loj, thooj ntawm parenchyma, nws heterogeneity thiab kab mob ntawm purulent suppuration;
• dynamic thiab zoo li qub nefrostsintigrafiya - nce nyob rau hauv lub raum loj nyob rau hauv lub parenchyma sis tsis ncaj txuam nrog isotope.

Purulent suppuration cov ntaub so ntswg kom meej meej qhia los ntawm carbuncle. Nyob rau US foci nyob rau hauv lub parenchyma ntawm kev kub ceev yog kom meej meej pom, raws li zoo raws li lawv mixed qauv. Kom meej meej pom nyob rau daim duab no thiab MRI, i. Muab Kauv CT nrog zoo li ua rau nws tau mus pom ua txhaum thaum uas koj tau txais ib tug sib piv rau necrosis.

Teeb meem nyob rau hauv kev ntsuag

Teeb meem nyob rau hauv nrug muaj feem luj tus neeg mob tus mob yuav tshwm sim yog tias ua ntej yuav nkag mus kawm rau hauv lub urology cov neeg mob niaj tshuaj tua kab mob uas niaj hnub tshuaj tua kab mob rau ib tug - ob lub lim piam. Tej kev kho mob yuav smooth zaub apostematoznogo pyelonephritis, tab sis ib tug yuav tsum muaj kev txhim kho yuav tsis tshwm sim. Lub cev kub yog tsis, decreases mob, ua daus no tsis tshua tshwm sim, lawv qhov tsawg pronounced thiab kav ntev. Lub txo tus naj npawb ntawm cov ntshav leukocytes, tab sis leukocyte tshuav haujlwm tseem tsawv li anemia thiab muaj zog ESR. Nyob rau hauv lwm yam lus, cov kab mob manifests nws tus kheej raws li ib tug flaccid sepsis. Qhov no "kev txhim kho" - yog vim li cas rau koj ua tus tsis ncaj ncees lawm neeg mob. Yuav kom tiv thaiv cov kev loj hlob ntawm kev mob loj sepsis nyob rau hauv lub xub ntiag ntawm ib lub raum neeg mob hearth kev puas tsuaj yog tsim nyog los ua hauj lwm.

differential mob

Nyob rau hauv paub apostematoznogo pyelonephritis, tus kab mob yuav tsum tau txawv los ntawm lwm yam kab mob. Nrog mob pancreatitis thiab cholecystitis nrog subdiaphragmatic rwj, mob hnyuv tws, mob cholangitis, mob adnexitis thiab mob pleurisy.

raum Kurbunkul txawv nrog ib tug yooj yim festering raum cyst, mob parenchyma, nrog mob cov kab mob ntawm lub plab kab noj hniav.

Yuav ua li cas nyias txawv nyias apestomatozny pyelonephritis thiab raum carbuncle?

• Pyuria. Bacteriuria.
• Tsis tshua muaj mob nraub qaum.
• Raum tsis ua hauj lwm.
• Thooj ntawm parenchyma. Hloov nyob rau hauv nws cov ceev.
• Mob palpation nrog ib qho kev nce nyob rau hauv lub ob lub raum.
• Qhov kev nthuav ntawm lub raum plab mog system.

Lub ultrasound, MRI, CT cia kom paub qhov txawv apostematozny pyelonephritis ntawm ntau yam mob cov kab mob ntawm lub peritoneum.

kev kho mob

Kev kho mob apostematoznogo pyelonephritis thiab carbuncle nqa tawm heev dua lwm yam los ntawm kev phais. Feem ntau cov feem ntau, lub lag luam yog ua rau ib tug thaum muaj xwm ceev hauv paus. Yam ua ntej luv luv preoperative npaj, nrog kev koom tes Anesthetist kav tsis muaj ntau tshaj li ob teev. Txoj kev kawm muaj xws li:

• Plab mog hnab cug zis, tso dej thawj coj ntawm ib tug tshuaj tua kab mob.
• Ntshav ntawm piam thaj thiab electrolytes.
• Stabilization ntawm cov ntshav siab.
• Raws li cov lus tim khawv - cardiotonic.

Lub hom phiaj tseem ceeb ntawm lub lag luam - mus tiv thaiv kom txhob sepsis. Txuag lub neej.

Ib tug thib ob lub hom phiaj - txoj kev cawm seej ntawm ob lub raum.

Rau tshuaj loog siv endotracheal tshuaj loog.

Thaum lub sij hawm lub lag luam cov ntsiab lus laj kab ua paug thiab lub plab mog rau ua qoob loo los mus txiav txim microflora rau ntxiv kev txiav txim ntawm kev mloog tau tshuaj tua kab mob. Tau yuav paub meej tias cov purulent pyelonephritis thiab los mus txiav txim ntxiv kev kho mob zoo.

Lub postoperative lub sij hawm

Tom qab qhov phais, tus neeg mob tau txais kev kho mob raws li inhibition ntawm lub raum muaj nuj nqi thiab intokikatsii. Tus neeg mob yog muab:

• 10% zib tov - 500 ml, 10 U insulin intravenously;
• tov ntawm 9% sodium chloride - 1000 ml;
• gemodez - 400 ml;
• cocarboxylase - 200 mg;
• Vitamin B6 - 2 ml;
• vitamin C - 500 mg;
• Korglikon tshuaj ntawm 0,06% mus rau 1.0 ml;
• 15% mannitol tov thiab 50 ml;
• Lasix mus rau 60 mg;
• Tshiab khov (haiv neeg) ntshav - 250 ml;
• Clexane los yog Fragmin, muab qhov tsis muaj coagulation;
• ntim ntshav liab rau anemia (HB tsawg tshaj li 70).

Thaum siv purulent qaug cawv extracorporal detoxification (plasmapheresis, hemosorbtion, plazmasorbtsiya).

Yuav tsum tau tshuaj tua kab mob nrog ob tug tshuaj tua kab mob los ntawm ib tug dav spectrum ntawm kev txiav txim.

lub feem ntau niaj hnub hom kev kawm (MRI, CT, ultrasound) yog siv nyob rau hauv qhov kev soj ntsuam ntawm lub parenchyma. Qhov no ua rau nws ua tau rau kom ntsuam xyuas qhov teeb meem no thiab xaiv tsim nyog tshaj volume ntawm muas.