Apostematozny pyelonephritis: zvinokonzera, zviratidzo, nechirwere, kurapwa

The chirwere chimwe danho rikwanise pyelonephritis. Kana apostematoznom pyelonephritis kuitika anogumbura pezvakaitwa umo vakawanda duku pus pute (apostemy) vari aumba. The chikuru nzvimbo localization yavo omuti etsvo.

The chikuru chimiro

Kakawanda apostematozny pyelonephritis kachitanga kana ureteral mhingaidzo, kanenge - pamwe node Urinary water drainage.

In itsvo pustules duku yakaumbwa muna zvinotevera tsika imwe glomerular rirambe richibvira loop ari chinouraya tsinga uye itsvo dziri peritubular capillaries -wedzera tusingaoneki. Panguva kwemabhakitiriya clots vari kuumbwa, vakabva kushumira seinokonzera pustules. Vari riri pamusoro pemvura renal cortex, uyewo fibrous Kamudzira akawanda. Kana ukatarira yavo zvakajeka chinoonekwa. Apostemy vane yellowish ruvara, kukura kusvika 2 neMM, unogona kurongwa muzvikwata kana singly.

Kana apostematoznom pyelonephritis itsvo kunowedzera kukura, ane cherry yakatsvuka. Itsvo rinenge riri edema, thickening pamusoro fibrous Kamudzira kunoitika. Renal sectional pustules dzinooneka, unogona kuona vari medulla.

Apostematozny pyelonephritis, bacteremia uye pute of itsvo

The chimiro wechipiri chirwere - nekabhunakeri itsvo. It kunoitika purulent kukuvara necrotic nhengo, itsvo pute. Ari cortex vari aumba foci kuti necrosis. Bacteremia zvingaitika kana gwara hematogenous kupararira chirwere. Muzviitiko zvakadaro kunokonzera pyelonephritis apostematoznogo kuva pustular zvirwere, nekabhunakeri, furunculosis, mastitis, felon. The mashandiro kuti paumbwe nekabhunakeri ndiko:

• Chirwere thrombus anopinda renal tsinga kubva distal mukamuri pus saka bacteremia kunoitika muna rimwe zvikamu zviri arterial ropa rive mapazi kana madiki mapazi arterial.

• Bacteremia kunogona kuitika panguva compression hombe mudziyo intrarenal anogumbura nda kana kubva nevanhu panobva kuzvimba ari vascular pamadziro.

The inonyanya chikonzero kukura nekabhunakeri tupukanana tusingaoneki, zvakadai chena uye anonzi Staphylococcus aureus, Proteus uye E. coli.

Renal nekabhunakeri sectional kuonekwa sezvo woita bulging pamusoro necrotic rinenge riri zvapararira nokuda pustules duku fused, zvichisiya achikanganisa zvakadzama parenchyma.

Chenjera pyelonephritis apostematozny kazhinji rinobatanidza nekabhunakeri itsvo uye apostematozny pyelonephritis. The zvekuchipatara zvinoratidza guru musiyano haina kuchengetwa.

The kunotoda mufananidzo apostematoznogo pyelonephritis

Zviratidzo apostematoznogo pyelonephritis nekabhunakeri zvinoenderana sei kwakakanganiswa aibuda weti kubva itsvo.

Kakawanda, chikuru chimiro pyelonephritis kunoitika nokukurumidza, kazhinji pashure intercurrent chirwere. Anozviratidza chills, fivha (40 madhigirii) pamwe rinorema ziya. Chipatapata hunhu iri hunodzorwa fivha (tembiricha richisimuka anopa nzira pasi). chills Excellent hunogara kusvika awa rimwe, kungangoitika panguva yepamusoro tembiricha vanomutswa. Pashure chill no vangadikitira rinotanga panguva tembiricha kuderera. Zviratidzo izvi mumazuva matatu okutanga akaratidza zvakaneta.

Next, tanga kukura musana marwadzo. Kana itsvo palpation zvakajeka kunorwadza, zvowedzera. Aichinja weti kuitika pazuva rechishanu, pane bacteriuria, proteinuria, leucocyturia.

Kufungidzira ropa hwokuratidza leukocytosis, zviyo ropa masero machena, vakawedzera erythrocyte sedimentation zvazvingava, kupererwa neropa.

Mberi muitiro zvingamuka sepsis, purulent ane metastatic foci kuti kuzvimba chiropa, zvemapapu, uropi.

Clinic itsvo nekabhunakeri

Kana ari itsvo, apo nekabhunakeri, hazvimbotinetsi aibuda weti, chiremba mufananidzo wakafanana chenjera rwarisa muitiro. Tembiricha inokwira kusvika 40 madhigirii, dzinoratidzwa chills hunoshamisa uye kudurura muhari. Kukura simba, kufema unoraramisa, anouya kuda kurutsa uye kurutsa, tachycardia.

Mumazuva okutanga kazhinji hapana marwadzo, hapana bacteriuria, leucocyturia, dizuricheskie nyonganyonga. Chirwere zvakaoma. Varwere vanogona kuwana kurapwa mune kuchirapa, chirwere, kuvhiya madhipatimendi. Chiremba anogona chikanganiso diagnosing nemabayo, rikwanise cholecystitis, sefivha, uye zvakafanana. Papera mazuva mashoma, kana zviratidzo vanotanga kuratidza yomunharaunda (marwadzo, chiratidzo Pasternatskogo, unyoro), chiremba chinoongorora neitsvo.

Apostematozny pyelonephritis kuongorora chirwere

Chirwere chirwere inobva zvinotevera zviratidzi:

• febrile kumwedzi kwapedza mazuva anopfuura matatu;
• yakawedzera itsvo inorwadza kuti palpation;
• Laboratory zvidzidzo: bacteriuria, leucocyturia, ropa - leukocyte wakasiya kusuduruka, leukocytosis, CRP, ESR yemichero;
• excretory Voiding - akaderedza itsvo basa, vakawedzera pamusoro zvakakanganisa rutivi;
• US - zvishoma mufambo, yokukudza zvomukati, thickening kupfuura 2cm parenchyma, ayo asiri yunifomu arambe achirema; emura perinephric nzvimbo pyelocaliceal hurongwa anowedzera ureteral mhingaidzo;
• MSCT, MRI, CT - kuwedzera itsvo kukura, thickening pamusoro parenchyma, ayo heterogeneity uye panomuka ose purulent suppuration;
• simba uye kunofambira mberi nefrostsintigrafiya - yakawedzera itsvo kukura mune parenchyma gogonera kuwanda isotope.

Purulent suppuration rinenge zvakajeka pachena nekabhunakeri. On US foci ari parenchyma mukuru arambe achirema anonyatsooneka kuoneka, uyewo avo yakavhenganiswa marongerwo. Zvakajeka zvinoonekwa ichi mufananidzo uye MRI, CT. Spiral CT pamwe Kusiyana enhancement runoita kuona kukanganisa kana kuti mukagamuchira mumwe Kusiyana necrosis.

Nematambudziko kuongorora

Nematambudziko dzinoongorora murwere nemamiriro anogona kuitika kana asati kupinda urology varwere anozadziswa asingaurayiwi kurapa pamwe nemishonga ano mumwe - kwevhiki mbiri. kurapwa kwakadaro kunogona chechetere kuratidza apostematoznogo pyelonephritis, asi kuvandudzika unokosha hazvizoitiki. tembiricha muviri yadzikira, zvinoderedza marwadzo, chills kashoma kuitika, hunhu hwavo zvishoma raidudzwa uye inogara kwenguva refu. The kwakaderedza nhamba ropa leukocytes, asi leukocyte akasiya kusuduruka achiri anoramba sezvo kupererwa neropa uye kwakawedzera ESR. Nemamwe mashoko, chirwere pachena pacharo somunhu flaccid sepsis. Izvi "kuvandudzika" - chikonzero kuita zvakaipa murwere. Kudzivirira kukura kwazvo sepsis pamberi imwe itsvo murwere pachoto kuparadzwa zvaanofanira ishande.

differential kuongorora chirwere

Panoongororwa apostematoznogo pyelonephritis, chirwere anofanira kusiyaniswa nevamwe zvirwere. With chenjera pfungwa nomuviri zvemwana asati uye cholecystitis pamwe subdiaphragmatic pute, rikwanise appendicitis, rikwanise cholangitis, rikwanise adnexitis uye rikwanise pleurisy.

itsvo Kurbunkul kusiyaniswa nokungoti chinoda kugadziriswa itsvo chikofu, bundu parenchyma, pamwe chakasimba zvirwere abdominal mhango.

Chii chinosiyanisa apestomatozny pyelonephritis uye renal nekabhunakeri?

• Pyuria. Bacteriuria.
• Low musana marwadzo.
• Renal dysfunction.
• Thickening kuti parenchyma. Change wayo arambe achirema.
• Chinorwadza palpation pamwe nokuwedzera neitsvo.
• Pakuwedzera renal chiuno hurongwa.

The Ultrasound, MRI, CT kubvumira kusiyanisa apostematozny pyelonephritis-siyana chakasimba zvirwere peritoneum.

mabatiro

Treatment apostematoznogo pyelonephritis nekabhunakeri kuitwa chete nokuda kuvhiyiwa. Kakawanda, kuvhiyiwa rinoitwa pamusoro zvashata hwaro. Rokutanga pfupi preoperative gadziriro, pamwe nekupinda nemukoti anokotsirisa runogara hapana maawa anopfuura maviri. Kudzidziswa zvinosanganisira:

• Chiuno catheterization, intravenous kwokubatsira mushonga unorwisa.
• Kuisira shuga uye electrolytes.
• Kudzikamiswa kuti BP.
• Maererano yechipupuriro - cardiotonic.

Chinangwa chikuru kuvhiyiwa - kudzivirira sepsis. Kuponesa upenyu.

chinangwa A yechipiri - ruponeso neitsvo.

Nokuti yokutindivadza kushandisa endotracheal yokutindivadza.

Panguva oparesheni kugutsikana fenzi kubudisa abscesses uye chiuno kuti chirimwa kuona microflora kumwe Kutsunga aikanganiswa nemishonga. Results achasimbisa ari purulent pyelonephritis uye kuona mimwe mishonga nzira.

The postoperative kumwedzi

Ndavhiyiwa, murwere anogamuchira kurapwa kunobva chinovhiringidza pamusoro renal nerevane intokikatsii. The murwere basa:

• 10% shuga mhinduro - 500 Rine mamiririta, 10 U jekiseni nomutsinga;
• mhinduro 9% yavaibvisa chloride - 1000 Rine mamiririta;
• gemodez - 400 Rine mamiririta;
• cocarboxylase - 200 MG;
• Vhitamini B6 - 2 Rine mamiririta;
• vhitamini C - 500 MG;
• Korglikon mhinduro kubva 0,06% kusvika 1.0 Rine mamiririta;
• 15% mannitol mhinduro uye 50 Rine mamiririta;
• Lasix 60 MG;
• Fresh -oma (chizvarwa) plasma - 250 Rine mamiririta;
• Clexane kana Fragmin, vakapiwa parameters ose coagulation;
• ndokurongedza masero matsvuku kuti kupererwa neropa ropa (HB asingasviki 70).

Kana akashandisa purulent kudhaka extracorporal detoxification (plasmapheresis, hemosorbtion, plazmasorbtsiya).

Zvaida inorwisa mabhakitiriya kurapa pamwe nemishonga maviri navanopinda chakarondedzera chiito.

zvikuru ano nzira (MRI, CT, Ultrasound) anoshandiswa mune tinyatsonzwisisa yacho parenchyma. Izvi zvinoita kuti zvakanaka kuongorora mamiriro ezvinhu uye sarudza kwazvo kukodzera Vhoriyamu kwema.