radiate from side to side in the lower back. The
pain often worsens when the patient is in a supine
position and is relieved by sitting and leaning
forward. Nausea and vomiting as well as con-
stipation are common. Bowel sounds may be
diminished, and the abdomen is usually distended.
The upper abdomen is tender with muscle
guarding and rebound tenderness. Fever,
tachycardia, shock, pallor, profuse sweating
with cool, clammy skin, and jaundice are
TREATMENTGive the patient nothing by
mouth. Place on complete bed rest. Meperidine
may be administered for pain. DO NOT give
morphine. Place the patient on fluid and antibiotic
therapy, and provide nasogastric suction.
DISEASES OF THE
GENITOURINARY (GU) TRACT
The following are some of the more commonly
encountered diseases of the GU tract.
This acute diffuse, often bilateral pyogenic
infection of the kidneys normally occurs via the
ascending route, but may be spread through the
bloodstream during bacteremia. It is sometimes
precipitated by tumors or obstruction. Diabetes
increases the likelihood of infection. Mixed
infections are common after instrumentation or
from fecal flora obtained from the skin of the
SYMPTOMSThe symptoms may at times
be absent or obscured by associated disease. The
patient usually experiences chills, fever, flank
pain, nausea, and vomiting. The patient may
complain of urgency and frequency of urination,
and the urine may contain pus or blood.
Sometimes there is abdominal rigidity, or in the
absence of rigidity, a tender enlarged kidney may
be palpated. Costovertebral tenderness on the
affected side is common.
TREATMENTPerform C&S and routine
urinalysis. Before the specific pathogen is identi-
fied, start broad-spectrum antibiotic therapy.
When the specific organism is identified, treat
with the appropriate drug. Force fluids to
maintain urinary output of 2 to 3 liters per day.
Treat symptomatically for pain.
This is a bladder infection resulting from
pathogens entering the bladder via the ureter.
Infection may result from trauma, stones, or
inadequate emptying of the bladder.
SYMPTOMSGross hematuria, frequency
and urgency of urination, and in most cases,
dysuria are common. A C&S often shows E. coli
as the offending agent.
TREATMENTPerform routine urinalysis
and C&S. Treat systemically with antibiotics.
Prostatitis is an infection of the prostate gland.
Bacteria often reach the gland via the bloodstream
or the urethra. It is commonly associated with
urethritis or active infection of the lower GU
SYMPTONSThey include perineal pain,
urethral discharge (copious amounts produced by
palpation), fever, dysuria, and urgency and
frequency of urination. Palpation of the prostate
shows the gland to be enlarged, tender, and
boggy. Chronic prostatitis may serve as a source
of recurrent lower GU tract infection.
TREATMENTAcute prostatitis should be
treated with sulfas, tetracycline, erythromycin, or
ampicillin until C&S indicates the antibiotic of
choice. Do not massage the prostate. Chronic
prostatitis should be treated with long-term
antimicrobial therapy. Follow up with weekly
prostate massage to promote drainage.
This inflammation of the epididymis is
caused by severe straining, catheterization, pros-
tatitis, or instrumentation.
SYMPTOMSThe disease is characterized by
severe pain in the scrotum and rapid unilateral
enlargement of the scrotum, with a marked
tenderness over the spermatic cord that is
relieved by lifting the testes. Pyuria, bacteriuria,
and leukocytosis are usually present.
TREATMENTGeneral measures consist
of supporting the scrotum with a scrotal
bridge or pillow, sitz baths, rest, sedation,