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 constipation 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 common.
TREATMENT—Give 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.
Pyelonephritis
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 peritoneum.
SYMPTOMS—The 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.
TREATMENT—Perform C&S and routine urinalysis. Before the specific pathogen is identified, 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.
Cystitis
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.
SYMPTOMS—Gross hematuria, frequency and urgency of urination, and in most cases, dysuria are common. A C&S often shows E. coli as the offending agent.
TREATMENT—Perform routine urinalysis and C&S. Treat systemically with antibiotics.
Prostatitis
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 tract.
SYMPTONS—They 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.
TREATMENT—Acute 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.
Epididymitis
This inflammation of the epididymis is caused by severe straining, catheterization, prostatitis, or instrumentation.
SYMPTOMS—The 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.
TREATMENT—General measures consist of supporting the scrotum with a scrotal bridge or pillow, sitz baths, rest, sedation, 2-13