Tus kab mob no yog ib theem ntawm kev txhim kho tus mob pyelonephritis. Nrog apostematous pyelonephritis, inflammatory txheej txheem tshwm sim, nyob rau hauv uas muaj ntau yam purulent me abscesses (apostemes) yog tsim. Qhov chaw tseem ceeb ntawm lawv qhov chaw nyob yog lub cortex ntawm lub raum.
Pib daim ntawv
Feem ntau, apostematous pyelonephritis pib tsim nrog kev cuam tshuam ntawm cov ureter, tsawg dua nrog cov zis tsis muaj kev cuam tshuam.
Nyob rau hauv lub raum, pustules me me yog tsim raws li nram no: cov kab mob nyob rau hauv lub capillary loops ntawm lub glomeruli, nyob rau hauv lub davhlau ya nyob twg ntawm lub raum thiab nyob rau hauv lub peritubular capillaries. Hauv qhov no, cov kab mob ntshav txhaws tau tsim, tom qab ntawd lawv ua haujlwm los ntawm pustules. Lawv nyob rau saum npoo ntawm lub raum cortex, thiab nyob rau hauv lub fibrous capsule nyob rau hauv ntau qhov ntau. Ntawm kev ntsuam xyuas, lawv pom meej meej. Apostemes muaj xim daj, txog li 2 hli loj, tuaj yeem npaj ua pawg lossis hu nkauj.
Nrog apostematous pyelonephritis, lub raum loj tuaj, muaj xim cherry. Perirenal cov ntaub so ntswg muaj edema, thickening ntawm lub fibrous capsule tshwm sim. Pustules pom nyob rau ntawm lub raum, koj tuaj yeem pom lawv hauv medulla.
Apostematous pyelonephritis, carbuncle thiab raum abscess
Daim ntawv thib ob ntawm tus kab mob yog carbuncle ntawm lub raum. Muaj ib tug purulent necrotic lesion ntawm lub cev, ib tug abscess ntawm lub raum. Nyob rau hauv lub cortex, foci ntawm necrosis yog tsim. Carbuncle tuaj yeem tshwm sim nrog txoj kev hematogenous ntawm tus kab mob. Nyob rau hauv xws li mob, ua rau apostematous pyelonephritis yog cov kab mob pustular, carbuncle, furunculosis, mastitis, panaritium. Lub mechanism ntawm kev tsim carbuncle yog raws li nram no:
- Ib tus kab mob thrombus nkag mus rau hauv lub raum cov hlab ntsha los ntawm qhov chaw nyob deb ntawm cov kua paug, yog li cov carbuncle tshwm nyob rau hauv ib qho ntawm cov hlab ntshav ntawm cov ceg hlab ntsha lossis hauv cov ceg me me.
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Carbuncle tuaj yeem txhim kho thaum lub nkoj loj hauv lub cev yog compressed los ntawm ib qho inflammatory infiltrate los yog vim yog kev sib cuag nrog ib qho inflammatory focus nyob rau hauv lub hlab ntsha.
Cov kab mob uas muaj kab mob ntau tshaj plaws uas ua rau kev loj hlob ntawm carbuncle yog Staphylococcus aureus, Staphylococcus aureus, Proteus, thiab Escherichia coli.
Nyob rau ntawm lub raum, cov carbuncle pom zoo li lub pob tsawb los ntawm cov ntaub so ntswg necrotic, nws nkag mus los ntawm kev sib koom ua ke me me pustules, wedge-shaped extending tob rau hauv parenchyma.
Tus mob apostematous pyelonephritis feem ntau ua ke carbuncle ntawm lub raum thiab apostematous pyelonephritis. Tsis muaj qhov sib txawv tseem ceeb hauv kev kho mob tshwm simpom.
daim duab kho mob ntawm apostematous pyelonephritis
Cov tsos mob ntawm apostematous pyelonephritis thiab carbuncle nyob ntawm seb qhov tso zis tawm ntawm lub raum tsis zoo li cas.
Feem ntau, thawj hom pyelonephritis tshwm sim tam sim ntawd, feem ntau tom qab kis kab mob sib kis. Txias, kub siab (txog 40 degrees), nchuav hws tshwm. Qhov xwm txheej ntawm qhov kub taub hau predominates (qhov nce hauv qhov kub thiab txias yog hloov los ntawm lub caij nplooj zeeg). Qhov txias txias tuaj yeem kav ntev txog ib teev, feem ntau tshwm sim ntawm qhov kub ntawm qhov nce siab. Tom qab txias, nrog rau qhov kub thiab txias, profuse tawm hws pib. Cov tsos mob no yuav mob me me thaum thawj peb hnub.
Ntxiv mus, qhov mob hauv qab pib hnyav zuj zus. Ntawm palpation, lub raum yog qhov mob kom meej meej, tejzaum nws loj tuaj. Hloov cov zis tshwm sim rau hnub thib tsib, bacteriuria, proteinuria, leukocyturia tshwm sim.
Cov duab ntshav yog tus yam ntxwv ntawm leukocytosis, granularity hauv leukocytes, nce ESR, anemia.
Nrog cov txheej txheem nce ntxiv, sepsis tuaj yeem txhim kho, uas muaj metastatic foci ntawm purulent o hauv daim siab, ntsws, thiab hlwb.
Kidney carbuncle tsev kho mob
Yog tias qhov tso zis ntawm cov zis tsis cuam tshuam rau hauv lub raum qhov chaw carbuncle tsim, daim duab kho mob zoo ib yam li cov txheej txheem sib kis. Qhov kub nce mus txog 40 degrees, qhov txias txias thiab hws hnyav yog yam ntxwv. Tsis muaj zog nce, ua pa nrawm, xeev siab thiab ntuav, tachycardia teeb tsa.
Nyob hauv thawjhnub feem ntau tsis muaj qhov mob nyob rau hauv lub nraub qaum, bacteriuria, leukocyturia, dysuric mob tsis pom. Kev kuaj mob nyuaj. Cov neeg mob tuaj yeem tau txais kev kho mob hauv chaw kho mob, kis kab mob, kev phais. Tus kws kho mob yuav ua yuam kev kuaj mob ntsws, mob cholecystitis, typhoid fever, thiab lwm yam. Tsuas yog ob peb hnub tom qab ntawd, thaum cov tsos mob hauv zos pib tshwm sim (mob qis dua, Pasternatsky cov tsos mob, mob ntawm palpation), tus kws kho mob tsom rau lub raum.
YApostematous pyelonephritis, kuaj mob
Kev kuaj tus kab mob yog ua raws li cov ntsuas hauv qab no:
- lub sijhawm febrile kav ntev dua peb hnub;
- mob raum loj rau palpation;
- kuaj kuaj: bacteriuria, leukocyturia, hauv cov ntshav - hloov mus rau sab laug ntawm leukocyte mis, leukocytosis, C-reactive protein, nce ESR;
- excretory urogram - txo qis hauv lub raum ua haujlwm, nce rau ntawm qhov cuam tshuam;
- Ultrasound - txwv kev txav mus los, nce qhov loj ntawm cov kabmob, thickening ntawm parenchyma los ntawm ntau tshaj 2 cm, nws qhov sib txawv ntom ntom; Cov kua dej nyob rau hauv qhov chaw perinephric, pelvicalyceal system nthuav nrog kev cuam tshuam ntawm cov ureter;
- MSCT, MRI, CT - nce qhov loj ntawm lub raum, thickening ntawm parenchyma, nws heterogeneity, manifestation ntawm foci ntawm purulent kev puas tsuaj;
- dynamic thiab zoo li qub nephroscintigraphy - nce qhov loj ntawm lub raum, tsis sib xws ntawm cov isotope hauv parenchyma.
Purulent cov ntaub so ntswg puaspom meej dua nrog carbuncle. Ntawm ultrasound nyob rau hauv lub parenchyma, foci ntawm nce ceev yog pom meej meej, nrog rau lawv cov qauv sib xyaw. Daim duab no pom meej meej ntawm MRI, CT. Contrast-enhanced helical CT ua rau nws tuaj yeem pom qhov txawv txav thaum qhov sib txawv nkag mus rau necrosis foci.
Kev ntsuas qhov nyuaj
Nyuaj rau kev ntsuas tus neeg mob tus mob yuav tshwm sim yog tias, ua ntej nkag mus rau hauv urology, tus neeg mob tau txais kev kho cov kab mob nrog cov tshuaj tua kab mob niaj hnub no rau ib mus rau ob lub lis piam. Cov kev kho mob zoo li no tuaj yeem ua rau pom qhov tshwm sim ntawm apostematous pyelonephritis, tab sis yuav tsis muaj kev txhim kho hauv qhov xwm txheej. Lub cev kub poob qis, qhov mob ntawm lub cev poob qis, ua daus no tsis tshua muaj tshwm sim, lawv tus cwj pwm tsis tshua meej thiab ntev. Tus naj npawb ntawm leukocytes hauv cov ntshav txo qis, tab sis kev hloov pauv mus rau sab laug ntawm leukocyte mis tseem khaws cia, zoo li yog ntshav ntshav thiab nce ESR. Nyob rau hauv lwm yam lus, tus kab mob manifests nws tus kheej raws li ib tug sluggish sepsis. Qhov "kev txhim kho" no yog qhov ua rau kev tswj tsis raug. Txhawm rau tiv thaiv kev loj hlob ntawm sepsis hnyav, yog tias muaj kev tsom mus rau kev puas tsuaj hauv lub raum, tus neeg mob yuav tsum tau ua haujlwm rau.
Differential Diagnosis
Thaum kuaj pom tus kab mob apostematous pyelonephritis, nws yog ib qho tsim nyog yuav tau cais tus kab mob no los ntawm lwm cov kab mob sib kis. Nrog mob pancreatitis thiab cholecystitis, subphrenic abscess, mob plab hnyuv, mob cholangitis, mob adnexitis thiab mob pleurisy.
raum curbuncle sib txawv ntawm lub raum festering yooj yim, nrog cov qogparenchyma, nrog rau mob mob plab kab noj hniav.
Dab tsi qhov txawv ntawm apestomatous pyelonephritis thiab lub raum carbuncle?
- Leukocyturia. Bacteriuria.
- mob plab.
- Impaired raum ua haujlwm.
- Thickening ntawm parenchyma. Hloov ntawm nws qhov ntom.
- mob palpation nrog raum o.
- Kev nthuav dav ntawm lub plab pelvicalyceal.
US, MRI, CT cov ntaub ntawv tso cai rau peb kom paub qhov txawv ntawm apostematous pyelonephritis los ntawm ntau yam kab mob ntawm lub peritoneum.
Kev kho mob
Kev kho mob ntawm apostematous pyelonephritis thiab carbuncle yog nqa tawm tsuas yog los ntawm kev phais. Feem ntau, kev ua haujlwm yog ua thaum muaj xwm txheej ceev. Kev npaj ua ntej lub sij hawm luv luv nrog kev koom tes ntawm tus kws tshuaj loog-resuscitator kav tsis pub dhau ob teev. Kev npaj suav nrog:
- Catheterization ntawm lub plab mog, tso quav tso tshuaj tua kab mob.
- Kev hloov ntshav qabzib thiab electrolytes.
- Txhim kho ntshav siab.
- Raws li kev qhia - cardiotonic.
Lub hom phiaj tseem ceeb ntawm kev ua haujlwm yog txhawm rau tiv thaiv kab mob sepsis. Txuag txoj sia.
Lub hom phiaj thib ob yog cawm lub raum.
Ib qho tshuaj loog endotracheal yog siv los kho qhov mob.
Thaum lub sijhawm ua haujlwm, cov ntsiab lus ntawm abscesses thiab pelvis raug coj los ua kab lis kev cai rau kev txiav txim siab ntawm microflora txhawm rau txiav txim siab ntxiv rau cov tshuaj tua kab mob. Cov txiaj ntsig yuav paub meej tias muaj cov kab mob pyelonephritis, nrog rau kev txiav txim siab txog kev kho mob ntxiv.
Postoperativelub sij hawm
Tom qab ua haujlwm, tus neeg mob tau txais kev kho mob suav nrog kev cuam tshuam ntawm lub raum ua haujlwm thiab qaug cawv. Tus neeg mob raug xaiv:
- 10% qabzib tov - 500 ml, nrog 10 units ntawm insulin IV;
- daws 9% sodium chloride - 1000 ml;
- Hemodez - 400 ml;
- cocarboxylase - mus txog 200 mg;
- vitamin B6 - mus txog 2 ml;
- vitamin C - txog 500 mg;
- Korglicon tov 0.06% rau 1.0 ml;
- mannitol tov 15% rau 50 ml;
- Lasix txog 60 mg;
- frozen (native) plasma - 250 ml;
- Clexane lossis Fragmin, suav rau hauv tus account coagulation tsis;
- erythrocyte mass rau anemia (Hb tsawg dua 70).
Rau purulent intoxication, siv cov tshuaj detoxification extracorporeal (plasmapheresis, hemosorption, plasmasorption).
Kev kho kab mob tua kab mob nrog ob hom tshuaj tua kab mob dav dav yog xav tau.
Thaum ntsuas lub xeev ntawm parenchyma, cov txheej txheem niaj hnub no yog siv (MRI, CT, ultrasound). Qhov no ua rau nws ua tau kom raug ntsuas qhov xwm txheej thiab xaiv qhov ntim txaus ntawm kev ua haujlwm.
