Visceral obstruction

Introduction Stone is the most important manifestation of visceral obstruction. A solid mass formed in the lumen of a catheter or a luminal organ (such as the kidney, ureter, gallbladder, bladder, etc.) in a human or animal body. Mainly found in the gallbladder and bladder, renal pelvis, can also be found in the lumen of the pancreatic duct, salivary ducts, etc., can cause luminal obstruction, affect the discharge of fluids in the affected organs, resulting in pain, bleeding or infection and other symptoms. Stones consist of inorganic salts or organic matter. There is a normal core in the stone, which consists of exfoliated epithelial cells, bacterial agglomerates, parasite eggs or worms, fecal blocks or foreign bodies. The inorganic salts or organic matter are deposited on the core layer. Due to the different organs involved, the composition, shape, texture, and influence on the body of the mechanism of stone formation are different. Common stones include gallstones, bladder stones, ureteral stones, pancreatic duct stones, salivary gland duct stones, appendix feces, stomach stones, foreskin and calculus.

Cause

Both normal intra-urine crystal saturation and crystal polymerization inhibitor activity are in equilibrium. Once the balance is broken due to some factors, whether the former is too saturated or the latter activity is reduced, it can cause intra-urine Crystallization causes urolith formation. The following factors have a significant effect on the cause of urinary stones.

Systemic factor

1 metabolic disorders.

2 diet and nutrition.

3 long bed.

4 living environment.

5 spirit, gender, genetic factors.

2. Local factors of the urinary system:

1 urinary tract infection.

2 urinary tract chronic hard resistance.

3 foreign bodies.

an examination

Related inspection

Renal CT examination of basic embryonic protein

Clinical observations have found that calcium-containing stones are the most common type of stone in urinary stones. It accounts for 70%-80% of all urinary stones. At present, only a few cases of calcium-containing stones can confirm the pathological cause, and the cause of most calcium-containing stones is not fully understood. According to the chemical composition of stones, it can be divided into four types: calcium-containing stones, infected stones, uric acid stones, and cystine stones. Calcium-containing stones can be divided into: simple calcium oxalate, calcium oxalate and calcium phosphate, and calcium oxalate and a small amount of uric acid; the main components of infected stones are magnesium ammonium phosphate and hydroxyapatite; uric acid stone components can be divided into: uric acid The uric acid amine or a small amount of calcium oxalate in addition to the above components; cystine stones can be classified into pure cystine or a small amount of calcium oxalate.

Differential diagnosis

Visceral obstruction caused by various stones should pay attention to phase identification:

(A) gallstones: generally do not produce colic, larger stones are not easy to cause obstruction, long-term no obvious symptoms, and sometimes occasionally feel upset or dull pain after meals, and more related to eating greasy food. Usually have heartburn, belching, abdominal distension and other symptoms of dyspepsia, easily misdiagnosed as "stomach disease" or "hepatitis", smaller stones often move and invade the neck of the gallbladder, severe biliary colic, with nausea and vomiting; When the position of the incarcerated stone changes and the obstruction is lifted, the biliary colic can be relieved. There is no infection in the early stage of the disease, so there is no chills, fever, when accompanied by infection and obstruction, gallbladder can occur purulent, gangrene, and even perforation. Most of the acute attacks are after eating a meal or eating greasy food. When lying down, gallstones can easily slip into the cystic duct and cause obstruction, so some patients can attack at night. If the patient's position changes (such as sitting up or sleeping sideways), the stone loosens, slips back, returns to the gallbladder, and the obstruction is relieved, the pain will be alleviated or disappeared.

(B) common bile duct stones: stones can come from the gallbladder or intrahepatic bile duct, but also in the common bile duct. Small gallstones can fall into the common bile duct through the cystic duct, forming secondary choledocholithiasis, causing obstructive jaundice and cholangitis. About 75% of patients have jaundice, and the depth of jaundice varies with the degree of incarceration of the stone, and there is volatility. If gallstones block the biliary tract infection, abdominal pain, high fever and jaundice triad can occur at the same time.

(C) intrahepatic bile duct stones: in recent years, the number of patients with intrahepatic bile duct stones is less and less, according to our clinical statistics, this stone is mostly yellow-brown, block or sediment-like pigment stones, stones The chemical composition is mainly bilirubin calcium. Bacterial infections, biliary tract mites and bile duct obstruction are closely related to the occurrence of intrahepatic bile duct stones, and may also be caused by biliary stricture or poor bile drainage after surgery. The clinical manifestations may be diversified due to different lesions. When the stones fall into the extrahepatic bile duct and cause biliary obstruction or acute inflammation, suppurative cholangitis such as epigastric cramps, chills, hyperthermia and jaundice may occur. If the stone does not fall into the extrahepatic biliary tract, sometimes it will be complicated by infection. At this time, symptoms such as chills and high fever may occur. In severe cases, toxic shock may occur, but the patient may not have abdominal cramps and jaundice, so it is often misdiagnosed. Sometimes intrahepatic bile duct stones cause long-term obstruction of the intrahepatic bile duct, leading to liver lesions, such as liver tissue necrosis, the formation of abscesses, and finally a part of the liver shrinks and loses normal function.

The symptoms of urinary calculi usually include ureteral stones, kidney stones, renal pelvis stones, renal pelvis stones, and bladder stones. There are three main types of pathological damage and pathophysiological changes caused by urinary calculi.

(1) Direct damage

Urinary stones can cause urinary tract mucosal congestion, edema, ulceration, hemorrhage, and long-term chronic stimulation of stones can sometimes cause urothelial cancer.

(two) obstruction

Upper urinary tract stones often cause obstruction of the urinary flow leading to hydronephrosis and ureteral dilatation, impairing renal tissue and its function. Bladder and urethra stones can cause dysuria or urinary retention. Over time, it can cause bilateral ureteral dilatation, hydronephrosis, and impaired renal function.

(three) infection

The direct damage of urolith to the urothelium is accompanied by infection, especially when the urinary tract obstruction is caused, the infection is more likely to occur, and severe infection can lead to pyelonephritis, renal empyema and periarteritis. Stones, obstruction and infection are mutually causal and promote the development of lesions. Stones cause obstruction, obstruction induces infection, infection leads to stones, aggravates obstruction, and ultimately destroys kidney tissue and impairs renal function.

Clinical observations have found that calcium-containing stones are the most common type of stone in urinary stones. It accounts for 70%-80% of all urinary stones. At present, only a few cases of calcium-containing stones can confirm the pathological cause, and the cause of most calcium-containing stones is not fully understood. According to the chemical composition of stones, it can be divided into four types: calcium-containing stones, infected stones, uric acid stones, and cystine stones. Calcium-containing stones can be divided into: simple calcium oxalate, calcium oxalate and calcium phosphate, and calcium oxalate and a small amount of uric acid; the main components of infected stones are magnesium ammonium phosphate and hydroxyapatite; uric acid stone components can be divided into: uric acid The uric acid amine or a small amount of calcium oxalate in addition to the above components; cystine stones can be classified into pure cystine or a small amount of calcium oxalate.

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