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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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