Pregnancy with urolithiasis
Introduction
Introduction to pregnancy complicated with urolithiasis Pregnancy with urolithiasis is rare. Improper handling can endanger the safety of mother and child. Urinary calculi regardless of whether the stone is located in nephritis, ureter, or bladder, the effect on pregnancy is whether there is a urinary tract infection and renal parenchymal damage. Urolithiasis is one of the common diseases of the urinary system, which is more common in the reproductive age. The incidence of urinary calculi during pregnancy is 0.03% to 0.3%. basic knowledge The proportion of illness: 0.005% Susceptible population: pregnant women Mode of infection: non-infectious Complications: urinary tract obstruction
Cause
Pregnancy with urolithiasis
(1) Causes of the disease
The cause of urolithiasis is not fully understood. It is currently believed that the formation of urolithiasis is mainly due to metabolic disorders such as hypercalcemia, hypercalciuria, endocrine disorders, etc.; secondly, it may be related to urinary tract infections, pregnant women due to endocrine hormones and Urinary tract compression caused by urinary system smooth muscle relaxation, ureteral peristalsis slowed, and urinary stasis, poor urination, and often accompanied by urinary tract infection, it is reasonable to say that urinary stone formation, but in fact urinary tract during pregnancy Rarely, this may be due to intrauterine fetal development during pregnancy, increased calcium requirements and increased protective colloids in the urine, thus effectively preventing the formation of urinary calculi.
(two) pathogenesis
The pathological changes of uroliths are mainly caused by the trauma caused by stones on the tissues and the obstruction of urine drainage and concurrent infections. There may be epithelial shedding, tissue ulcers and fibrous tissue hyperplasia at the stones. Long-term stone trauma can make the renal pelvis wall thicker. Interstitial fibrosis and leukocyte infiltration, general urinary stones cause obstruction of urine drainage and stagnant water in the proximal urinary tract, especially hydronephrosis, but obstruction is often not complete, kidney is found in hydronephrosis The small sputum becomes blunt and has different degrees of small sputum enlargement. When the disease is further developed, the renal cortex can be atrophied and damaged. The enlarged renal pelvis can make the renal cortex become thin, such as stone hydronephrosis and infection. Become a purulent calculus hydronephrosis, accelerate the damage of the renal parenchyma, infection can still cause peri-renal inflammation and peri-renal abscess.
Prevention
Pregnancy with urolithiasis prevention
Pay attention to drinking more water to avoid urinating urine can wash the urinary tract to avoid the formation of stones. At the same time, lower urinary infarction and infection must be eliminated. Such as surgical treatment of prostate enlargement and urethral stricture, radical urinary tract infections, especially those bacteria that break down urea, to avoid bladder foreign body, reduce stone occurrence.
Complication
Pregnancy with complications of urolithiasis Complications, urinary tract obstruction
Urinary closure is a rare and extremely serious complication caused by obstruction of the urinary tract on both sides of the urinary tract, or by the obstruction of the only functional renal urinary tract.
Symptom
Pregnancy with urolithiasis symptoms Common symptoms Pus blunt pain, hematuria, pain, renal pelvis, urinary urgency, frequent urination, discharge of stones, chills
Symptom
The symptoms of urinary stones depend on the size, shape, location and presence or absence of infection and the degree of obstruction.
(1) Asymptomatic: stones with smooth surface or stones that are fixed in the renal pelvis or lower renal pelvis without moving and without infection may not cause symptoms.
(2) Pain: When the kidney stone moves, it can cause low back pain, which is persistent or paroxysmal. The nature is dull pain, dull pain, pain or cramping. When the movement causes the stone to move and is invaded in the ureter, the pain can be along. The ureter is radiated to the bladder, external genitalia, and inside the thigh.
(3) hematuria: a common symptom of urolithiasis, due to stone movement damage to the renal pelvis and ureter caused by hematuria, most patients have macroscopic or microscopic hematuria, but 20% to 25% of patients have no hematuria.
(4) Symptoms of urinary tract infection: urinary tract infection may occur frequent urination, urgency, dysuria and pyuria, etc. In acute infection, there may be symptoms such as elevated body temperature and chills.
2. Signs
In the onset of renal colic, deep press of the kidney can stimulate and aggravate colic and make percussion difficult, and there may be muscle spasm and protective muscle tension on the affected side of the stone. The sputum can cause pain and tenderness. Calculous hydronephrosis may be found in the abdomen, but an enlarged uterus can limit abdominal percussion.
Examine
Pregnancy with urolithiasis
Urine routine examination
Red blood cells, pus cells and epithelial cells can be seen, and pathogenic bacteria can be found in the middle urine culture.
2. Renal function test
Urea nitrogen, creatinine, and uric acid were measured to understand renal function status and repeated examinations for monitoring and comparison.
3. Blood test
In addition to blood routine examination of red, white blood cell count, determination of serum calcium and inorganic phosphorus, as well as the ratio of serum protein, albumin and globulin, will help to diagnose the cause of stones.
4. X-ray inspection
The urinary tract X-ray examination has important diagnostic significance, but the shadow in the plain film must be different from other shadows such as gallstones and mesenteric lymph node calcification, so it can be taken on the lateral position and the supine deep inhalation and deep exhalation. If it is a kidney stone, the shadow changes with the movement of the kidney, and the relative position of the kidney is unchanged. The venous pyelography can show the position of the stone and the whole urinary tract. Because the X-ray has certain influence on the fetus, the pregnancy The inspection should be avoided during the period.
5. Cystoscopy
Such as bladder area pain, sudden interruption of urinary flow and hematuria as the main symptoms, bladder stones should be considered, the diagnosis of bladder stones can be based on X-ray examination and cystoscopy.
6. Ultrasound examination
When the diameter of the urinary stone reaches 0.5cm or more, the high-resolution ultrasonic diagnostic apparatus can see dense glare spots or strong light groups in the urinary tract or in the kidney. This is a characteristic of the presence of stones. The larger the stones, the more light and the sound. The clearer the shadow, when the stone is accompanied by water, it can have the characteristics of the sonogram of water. Although the ultrasound can detect the stone, but the sensitivity is poor, it is not difficult to make a diagnosis on the stone that can be detected by ultrasound. At the same time, X-ray film examination and various pyelography can get more information, so the examination of the stones can only assist in the diagnosis, but for the light-transparent stones, the X-ray film can not be displayed, and the contrast film can not be Blood clots, when the tumor is identified, ultrasound examination is helpful for the differential diagnosis of stones.
Diagnosis
Diagnosis and diagnosis of pregnancy complicated with urolithiasis
diagnosis
According to the medical history and typical clinical manifestations, such as low back pain or renal colic, hematuria and discharge of stones are not difficult to diagnose, but it is also necessary to determine the location, size, number and function of kidneys on both sides of the stone, with or without concurrent infection, as far as possible To explore the cause of the stone, it is necessary to combine the various auxiliary examinations.
Differential diagnosis
Urinary stones must be identified with the following diseases:
Acute appendicitis
Early appendicitis complicated with acute appendicitis is easier to diagnose, but in pregnancy, acute appendicitis symptoms and signs are very atypical, easily confused with pain caused by urolithiasis, by carefully observing the progress of the disease, continuously doing white blood cell count, urine Road X-ray film inspection can be identified.
2. Cholelithiasis
The biliary colic caused by gallstones is sometimes confused with the gluten-induced colic, but the onset of biliary colic is mostly within a few hours after a full meal or a high-fat meal, or in the abdomen under vibration. The upper abdomen or right upper abdomen is often radiated to the right scapula or right shoulder, but the diagnosis can be confirmed by X-ray examination.
3. Pancreatitis
Urinary calculi sometimes have to be differentiated from the acute onset of pancreatitis. The most common symptoms of acute pancreatitis are upper abdominal pain, nausea and vomiting, but acute pancreatitis is often difficult to diagnose. Therefore, patients with acute upper abdominal pain should be considered acute. The possibility of pancreatitis, early determination of serum or other body fluid amylase content, is helpful for diagnosis, if necessary, abdominal X-ray film examination can help differential diagnosis.
