I-pyelonephritis ye-Apostatous: izimbangela, izimpawu, ukuxilongwa, ukwelashwa

Lesi sifo sinye yezinyathelo zokuthuthukiswa kwe-pyelonephritis enamandla. I-apostematous pyelonephritis, izinqubo zokuvuvukala zenzeka, lapho kutholakala khona ama-abscess amancane (apostems) amaningi. Indawo eyinhloko yendawo yabo yendawo i-cortex yezinso.

Ifomu eliyinhloko

Ngokuvamile, i-apostematous pyelonephritis iqala ukukhula ngokuvinjelwa kwe-ureter, kaningi kaningi - ngokungaqhumeki kokuphuma komchamo.

Ezinso, ama-pustules amancane akhiwa ngale ndlela elandelayo: ama-microorganisms ahlala emithonjeni ye-capillary ye-glomeruli, ama-microorganisms ahlala ezikebheni ezibulalayo zezinso nasendaweni ye-capituri ye-peritubular. Ngesikhathi esifanayo, ifomu le-bacterium thrombi, bese likhonza njengomthombo wama-pustules. Zitholakala ebusweni bamagxolo ezinso, kanye nangaphansi kwe-capsule ene-fiber eningi kakhulu. Uma zihlolwe, zibonakala ngokucacile. Ama-Aposts ane umbala ophuzi, ubukhulu bufinyelela ku-2 mm, lungalungiswa ngamaqembu noma nge-singly.

Nge-apostematous pyelonephritis, izinso zanda ngobukhulu, zinombala we-cherry. I-cellulose ye-peripheral inokuvuvukala, ukuqina kwe-capsule ye-fibrous kwenzeka. Uma kutholakala ama-pistules azinso kubonakala, kungenzeka ukuthi uthola kuwo futhi ungqimba oluphakathi.

I-pyelonephritis ye-Apostatous, i-carbuncle ne-abscess yezinso

Ifomu lesibili lesi sifo yi-carbuncle yezinso. Kukhona umonakalo wegciwane lesandulela ngculazi, i-abscess of the kidney. Ku-cortex, i-necrosis iyakhiwa. I-carbuncle ingenzeka ngezindlela ezinamafutha okutheleleka. Ezimweni ezinjalo, izimbangela ze-apostematous pyelonephritis yizifo ze-pustular, carbuncle, furunculosis, mastitis, panaritium. Indlela yokwakhiwa kwe-carbuncle kanje:

• I-thrombus yebhaktheriya ingena emthonjeni we-renal kusuka ekugxilweni okude kakhulu kwe-pus, ngakho-ke kukhona i-carbuncle kwenye yezindawo zokuhlinzeka ngegazi legatsha eliphetheyo noma emagatsheni amancane.

• I-carbuncle ingathuthuka ngokucindezela umkhumbi omkhulu we-intrarenal nge-infiltrate evuvukalayo noma ngenxa yokuxhumana ngokugxila kwesibhakabhaka esodongeni.

Ukuthuthukiswa okuvamile kakhulu kwe-carbuncle kubangelwa ama-microorganisms njenge-staphylococcus emhlophe negolide, i-Proteus ne-E. coli.

Uma kusetshenzwa izinso, i-carbuncle ibonakala njengendlela ehlosiwe yokuphuma kwezingxenyeni ze-necrotic, ibhekwa yi-pustules encane ehlangene ephuma ngaphandle kwe-parenchyma.

I-apostematous pyelonephritis enamandla kakhulu ihlanganisa i-kidney carbuncle ne-apostematous pyelonephritis. Emibonakalweni yomtholampilo, ayikho umehluko omkhulu.

Isithombe somtholampilo we-apostematous pyelonephritis

Izimpawu ze-apostematous pyelonephritis ne-carbuncle zithembele ukuthi ukuphuma komchamo kuphazamiseka kangakanani kusuka ezinso.

Ngokuvamile, ifomu eliyinhloko le-pyelonephritis livela ngokuzumayo, ngokuvamile emva kokutheleleka okufanayo. Kukhona isibindi, umkhuhlane omkhulu (kufika kuma-degrees angu-40), ukuthuthumela okuthulini. Ukushisa komkhuhlane kunomthelela (ukuphakama kokushisa kuthatha indawo yokuwa). I-chill enkulu ingahlala kuze kube ihora elilodwa, ngokuvamile livela phezulu kunomkhuhlane. Ngemuva kokushisa ngehla lokushisa, ukuqubuka okukhulu kuqala. Lezi zimpawu phakathi nezinsuku ezintathu zokuqala zingabonakaliswa kahle.

Khona-ke ubuhlungu obuncane emuva buqala ukwanda. Ezingweni zezinyobala ngokusobala zihlaziyekile, mhlawumbe zanda. Izinguquko kumchamo zenzeka ngosuku lwesihlanu, i-bacteriuria, i-proteinuria, ne-leukocyturia.

Isithombe segazi sibonakala nge-leukocytosis, i-granularity ku-leukocytes, ukwanda kwe-ESR, i-anemia.

Ngenkambiso eqhubekayo, i-sepsis ingahlakulela, enesifo esiphezulu se-inflammation esiswini esibhedlela, emaphashini nasebuchosheni.

Umtholampilo we-kidney carbuncle

Uma ukuphuma komchamo kungaphazanyiswa ezinso, lapho i-carbuncle iqala khona, isithombe somtholampilo sifana nenqubo eguquguqukayo. Ukushisa kuphakama kuya kuma-degrees angu-40, okubhekene nezikhukhula ezinamandla nokuphefumula okukhulu. Kukhona ubuthakathaka obandayo, ukuphefumula kuba yinto evame kakhulu, isicashu kanye nokuhlanza, i-tachycardia ivela.

Ezinsukwini zakuqala kaningi alukho ubuhlungu emhlane ongezansi, akukho bacteriuria, i-leukocyturia, izifo ze-dysuric. Ukuthola ukuhlolwa kunzima. Iziguli zingathola ukwelashwa eminyangweni yokwelashwa, ephathekayo, ehlinzayo. Udokotela angakwazi ukuhlola i-pneumonia, i-cholecystitis ephawulekayo, umkhuhlane we-typhoid nokunye okunjalo. Ezinsukwini ezimbalwa kuphela kamuva, lapho izimpawu zendawo ziqala ukuvela (ubuhlungu engemuva ongemuva, uphawu lwePasternatsky, ububele besilwane), udokotela ugxila ezintsheni.

I-pyelonephritis ye-Apostatous, ixilongwa

Ukuxilongwa kwalesi sifo kusekelwe ezinkomba ezilandelayo:

• Inkathi ye-Febrile ihlala izinsuku ezingaphezu kwezintathu;
• Izinso ezibuhlungu ezinwetshiwe ngesikhathi sokulunywa;
• Ukuhlola i-Laboratory: i-bacteriuria, i-leukocyturia, egazini - kwesokunxele kwesifomula se-leukocyte, i-leukocytosis, i-pro-protein esebenzayo, i-ESR eyanda;
• I-urrogram e-excretory - umsebenzi wezinso wehlile, ukwanda kusuka ohlangothini oluthintekile;
• Ukuvimbela ukuhamba kwe-ultrasound, ukwandisa ngobukhulu bezitho, ukuqina okungaphezu kuka-2 cm we-parenchyma, ubuningi bayo obungafani; I-fluy in the space paranephric, uhlelo lwe-cup-and-pelvic olunezithiyo ezithintekayo;
• I-MSCT, i-MRI, i-RKT - ukwanda ngobukhulu bezinso, ukuqina kwe-parenchyma, i-heterogeneity yayo, ukubonakaliswa kwe-foci yokuphazanyiswa okuhlanzekile;
• I-nephroscintigraphy ene-Dynamic ne-Static - ukwanda ngobukhulu bezinso, ku-parenchyma, ukuqoqwa okungalingani kwe-isotopu.

Izicubu ezivuthiwe zichazwe ngokucacile ku-carbuncles. I-ultrasound ku-parenchyma foci yokunyuka kwabantu kubonakala ngokucacile, kanye nesakhiwo sabo esixubekile. Lesi sithombe sibonakala ngokucacile ku-MRI, i-RKT. I-Spiral CT ne-contrast ephakeme yenza kube lula ukubona ukuphazanyiswa lapho kufika ukungafani phakathi kwe-necrosis.

Izinkinga ekuhloleni

Izinkinga ekuhloleni isimo sesiguli zingasuka uma, ngaphambi kokungeniswa kwe-urology, isiguli sathola ukwelashwa kwama-antibiotic ngama-antibiotic yanamuhla kumasonto amabili kuya kwamabili. Ukwelashwa okunjalo kungabonakalisa ukubonakaliswa kwe-apostematous pyelonephritis, noma kunjalo, ukuthuthukiswa kwamakhadikhadi wesimo akukhona. Ukushisa komzimba kunciphisa, ubuhlungu be-syndrome buyancipha, kunezinhlobo ezingavamile ukuphola, uhlamvu lwazo alubi kakhulu futhi luhlala isikhathi eside. Egazini, inani lama-leukocyte liyancipha, kodwa ukushiya ngakwesokunxele kwefomula ye-leukocyte kusalokhu kugcinwa, njengoba kunesifo se-anemia nokwandisa i-ESR. Ngamanye amazwi, lesi sifo sibonakala njenge-sepsis enobucayi. Lokhu "ukuthuthukiswa" kuyimbangela yokuphathwa kweziguli ezingafanele. Ukuvimbela ukuthuthukiswa kwe-sepsis eqinile, uma kunokugxila ekubhujisweni kwezinso, isiguli kumele sisebenze.

Ukuxilongwa okuhlukile

Ekutholeni i-apostematous pyelonephritis, kubalulekile ukuhlukanisa lesi sifo kwezinye izifo ezithathelwanayo. Nge-pancreatitis ejulile ne-cholecystitis, nge-abscess encane, i-appendicitis ephawulekayo, i-cholangitis enamandla, i-adnexitis ejulile ne-pleurisy ejulile.

Amaqabunga e-Kurbunkul ahlukanisa nokuhlukana okulula kwezinso zezinso, ene-tumor parenchyma, enezifo ezinzima zesisu esiswini.

Yini eyenza sikwazi ukuhlukanisa phakathi kwe-pyelonephritis yezihlubuki kanye ne-carbuncle yezinso?

• I-Leukocyturia. Bacteriuria.
• Ubuhlungu ehlane elingezansi.
• Umsebenzi ongasebenzi ngokweqile.
• Ukuqiniswa kwe-parenchyma. Izinguquko ngobuningi bayo.
• I-palpation ebuhlungu enezinso ezikhulisiwe.
• Ukwandiswa kwesistimu ye-cup-and-pelvis.

Idatha ye-ultrasound, i-MRI, i-RKT yenza kube lula ukuhlukanisa i-apostematous pyelonephritis ezifo ezihlukahlukene eziyingozi ze-peritoneum.

Ukwelapha

Ukwelashwa kwe-apostematous pyelonephritis ne-carbuncle kwenziwa kuphela ngokuhlinzwa. Ngokuvamile, ukuhlinzwa kwenziwa esiphuthumayo. Ukulungiswa kokuqala kwesikhathi esifushane sokulungiselela nokubamba iqhaza kwe-anesthesiologist-resuscitator akupheli amahora amabili. Ukuqeqeshwa kuhlanganisa:

• I-catheterization ye-pelvis, i-antibiotic e-intravenous.
• Ukuthuthwa kwe-glucose nama-electrolytes.
• Ukuqiniswa kwengcindezi yegazi.
• Ngokusho kobufakazi - i-cardiotonic.

Umgomo oyinhloko wokusebenza ukuvimbela i-sepsis. Insindiso yokuphila.

Umgomo wesibili ukugcina izinso.

I-anesthesia yokugcina i-endotracheal isetshenziselwa i-anesthesia.

Ngesikhathi sokusebenza, okuqukethwe kwe-abscesses ne-pelvis kuqoqwe, ukuze kwenziwe isiko ekunqumeni i-microflora ukuze kuqinisekiswe ukuzwela kwemithi elwa namagciwane. Imiphumela izoqinisekisa i-purulent pyelonephritis, futhi inqume izindlela zokwelapha ezengeziwe.

Isikhathi se-Postoperative

Ngemva kokuhlinzwa, isiguli sithola ukwelashwa ngenxa yokucindezelwa kwezinso zezinso kanye ne-inkikatsii. Isiguli sinikezwa:

• Isixazululo se-10% seglucose - 500 ml, enezinhlamvu eziyi-10 ze-insulin ngaphakathi;
• Isixazululo se-9% i-chloride ye-sodium - 1000 ml;
• I-Hemodez - i-400ml;
• I-Kokarboksilaza - kufika ku-200 mg;
• I-Vitamin B6 - kufika ku-2 ml;
• I-Vitamin C - kufika ku-500 mg;
• 0.06% kuya ku-1.0 ml isisombululo seKorglikon;
• Isixazululo samannitol 15% kuya ku-50 ml;
• I-Lasix kuya ku-60 mg;
• I-plasma esanda efriziwe (ezalwa) - 250 ml;
• Cexane noma i-fragmine, ngokucabangela izinhlamvu ze-coagulogram;
• Isisindo se-Erythrocyte enesifo semvelo (Hb ngaphansi kuka-70).

Lapho ukuphuza ngokweqile kusetshenziselwa ukuxilongwa okungekho emthethweni (i-plasmapheresis, i-hemosorption, i-plasmasorption).

Ukwelashwa kwama-antibiotiki ngama-antibiotics amabili wezinga elibanzi kakhulu lemiphumela kuyimpoqo.

Ekuhloleni isimo se-parenchyma, izindlela zanamuhla (MRI, RVT, ultrasound) zisetshenziswa. Lokhu kwenza kube lula ukuhlola kahle isimo bese ukhetha imiqulu efanelekile yokusebenza.