A manual of the practice of medicine / by Frederick Taylor.

  • Taylor, Frederick, Sir.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the practice of medicine / by Frederick Taylor. Source: Wellcome Collection.

    788/1016 (page 772)
    Morbid Anatomy—An acute or chronic form may be distin- guished. In acute pyelitis, the mucous membrane is swollen, its vessels injected, and the surface covered with muco-pus; there are often small spots of haemorrhage, and sometimes the inflam- mation takes on a diphtheritic form/patches of membrane adher- ing to the surface here and there. In calculous pyelitis, there may be ulceration of the surface from the presence of the stone; and such ulceration may, as already indicated, lead to perfora- tion and perinephritis. Chronic pyelitis, in which the membrane has a white or ash-gray colour, is often the result of long-con- tinued obstruction; and accordingly there is at the same time dilatation of the pelvis, infundibula, and calices, with flattening of the pyramids, and more or less atrophy of the renal structure, \s a result of the pyelitis, pus and urine may accumulate to such an extent as to form a perceptible tumour (pyonephrosis); and the fluid so retained may from time to time, through a change in the obstructing conditions (e.g., shifting of a calculus), be discharged into the bladder, so that the renal tumour subsides, and the urine suddenly contains a quantity of pus. Sometimes a pyonephrosis will open like perinephric abscess in various directions, such as into the loin, the iliac fossa, the bowel, the peritoneum, or the chest. In the renal pelvis there may be, besides pus and urine, blood, calculi, or other foreign bodies which have set up the mischief ; and the urinary salts may be deposited, namely, urates in acid urine, and phosphates if the urine is alkaline or ammoniacal, as it often is. The kidney is the subject of consecutive nephritis, either suppurative or inter- stitial, with more or less dilatation and atrophy. In some old cases the organ is so atrophied as to consist of little else than its capsule, and septa forming cavities which contain putty-like masses, the result of the inspissation of pus and the deposit of amorphous phosphates. Symptoms.—In most cases the symptoms of pyelitis are com- bined with those of the lesions which have caused it. There is frequently some dull, aching pain in the loins, increased on pressure. The results of the inflammation generally show them- selves in the urine. In early stages, there are some mucus a few pus cells, epithelial cells from the pelvis and infundibula, and perhaps blood. The cells of the pelvic and infundibular epi- thelium are mostly conical, pyriform, tailed, or fusiform m shape. The urine is acid, and contains a mere trace of albumen. In later stages, the urine contains pus in notable quantities. Pyuria— When such urine is passed it is turbid, and as it settles the pus forms a very pale yellow creamy deposit at the bottom of the glass, and mixes with the urine only just at the line of junction. The nature of this deposit can be determined bv chemical tests, and by the microscope. The usual chemical test is this:—The supernatant liquid is poured off, and some liquor potassae or liquor ammonia? is added