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antibiotics, analgesics, and sometimes infil- tration of the spermatic cord with procaine hydrochloride. Renal Calculi Renal calculi are concentrations of mineral salts and crystals commonly called stones. Many theories and factors have been advanced as causes of calculi. Among these are excessive intake of milk (calcium), previous infection, sulfonamide therapy, metabolic disease, dehydra- tion, or exposure to intensely hot climates. Also chronic pyelonephritis often predisposes to calculi. SYMPTOMS—Excruciating intermittent pain that originates in the flank or kidney area and radiates across the abdomen and along the course of the ureters is common. Frequently the pain radiates into the genitalia and along the inner aspects of the thighs. Chills, fever, and frequency and urgency of urination, despite pain, is common. Hematuria is usally present. Vomiting, diaphoresis, and shock may occur. Screening the urine may produce crystalline substances. Anuria indicates renal failure and leads to uremia. TREATMENT—Many solitary calculi, unac- companied by obstruction or infection, require no specific therapy. Force fluids and restrict the intake of calcium. Antibiotics, Demerol®, or morphine are indicated. Do not give anti- spasmodic. Bed rest and supportive treatment are indicated. Stones that are obstructive must be surgically removed. Hospitalize as soon as possible. Uremia Uremia is a toxic condition produced by renal failure and retention of waste products in the circulatory system. SYMPTOMS—At first, weakness, anorexia, nausea, and vomiting, headache, vertigo, and dimness of vision may occur. Later there is extreme restlessness, insomnia, twitching, urinous odor to the breath, perspiration, waxy pallor, edema, coma, and convulsions. TREATMENT—Fluid replacement to equal the amount of urinary output plus the amount of insensible fluid loss should be effected. Specific therapy is aimed at treating the underlying cause, such as congestive heart failure, infection, or obstruction. Hospitalize immediately. Testicular Torsion This condition is the result of twisting the testes. It may occur spontaneously as the result of emotional stress or as the result of strenuous activity or exercise. SYMPTOMS—There is a sudden onset of intense pain, and the pain is aggravated by elevating the scrotum. This is the essential diagnostic difference between testicular torsion and epididymitis. The twisted testicle is normally higher and closer to the external ring. The patient demonstrates nausea, vomiting, pallor, and syncope. The color of the scrotum on the affected side is pink and swelling is rapid. TREATMENT—This is an emergency! Im- mediate surgical correction is essential to avoid gangrene due to vascular occlusion. Administer meperidine or morphine for intense pain. Genitourinary Trauma This condition is normally caused by penetrating and perforating wounds, blunt crushing injuries, surgery, or irradiation. The kidney is most often injured by blunt external force to the flank or abdomen. Rupture of the bladder occurs when the bladder is over distended and external force is applied. Injuries to the urethra are caused by pelvic fractures. Crushing or avulsion is the main cause of injury to the genitalia. TREATMENT—In all cases of serious GU trauma, the patient should be hospitalized as soon as possible, since in most cases, surgical correc- tion will normally be required. In all injuries, gangrene and tetanus are serious possibilities. In case of avulsions, retain the avulsed tissue and refrigerate it immediately. Treat for shock, give analgesics, and force fluids. DISEASES OF THE CIRCULATORY SYSTEM Rheumatic Fever This acute, infectious, noncontagious systemic disease is most commonly found in children and 2-14


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