SECTION VII.. Genito-Urinary Regions.

GENITO-URINARY REGIONS.

DISEASES OF THE URINARY APPARATUS.

=Symptomatology.= The urinary apparatus comprises the organs of secretion (the kidneys) and those of excretion (the ureters, the bladder, the urethra).

A thorough examination of the urinary apparatus should include, firstly, that of the external organs (the sheath, glans penis and urethra) in the male, and, in the female, the vulva, meatus and urethra; secondly, that of the internal organs (the bladder, ureters and kidneys) in both sexes.

To carry out the external examination, the head must first be fixed and the hind limbs hobbled. If necessary, the animal can be attached to the side of a wall.

External examination comprises inspection and palpation, which is only possible in males. Inspection will reveal at once the existence of malformation, deformity, traumatic lesions, or tumours of the organs.

By palpation the sheath and glans penis can be examined, and cellulitis, abscess formation, calculi in the urethra, obstruction of the extremity of the canal by very fine gravel, as in the case of sheep, etc., can be detected.

The inner margin of the right kidney may also be examined by external palpation, though only in very thin animals. The examination is made from the flank region, behind the last rib, in an upward direction and towards the right (Fig. 227). The kidney, attached under the lumbar region, sometimes extends back beyond the last rib, under the transverse processes of the lumbar vertebræ. On the left the presence of the rumen prevents any examination.

In sheep this examination requires special care.

Examination of the internal urinary organs must be made through the rectum. It should be undertaken slowly and gently. In the male the hand detects the condition of the organs contained within the pelvic cavity, the fulness or emptiness of the bladder, or the existence of calculi within it. More deeply seated can be felt the entire length of the right ureter; its state of dilatation can be felt, and the existence of diverticula of inflammation, if any, can be ascertained. The left ureter cannot readily be examined, on account of the position of the rectum, except as regards the posterior part, close to the bladder and the rumen.

In the abdominal cavity the rectum, or rather the floating colon, turns to the right, in such a way that, in spite of the shortness of the meso-rectum and meso-colon, the hand can be passed as far as the right kidney. It is, then, easy to discover whether this organ is sensitive to pressure, hypertrophied, atrophied, cystic, etc. The paunch interferes with examination on the left side.

In females the ureters and kidneys can be examined in the same way, but the bladder and the canal of the urethra must be reached through the vagina. About 2 or 2¼ inches from the vulva on the floor of the vagina is the entrance to the urethra, covered with a special valve. The meatus becomes visible by separating the lips of the vulva and the vaginal walls. For this purpose a speculum ad hoc can advantageously be used. It is clear that if it is thought desirable to examine the bladder through the rectum, which is not absolutely impossible, the vagina will be interposed between the arm and the urinary organs, and the sensations experienced will, therefore, be much less clearly defined (Fig. 226).

In passing a catheter for the purpose of emptying the bladder the end of the sound should be introduced under the valve of the meatus. By slightly lowering the back end of the sound, the front end is lifted above the cul-de-sac, and the operator at the same time pushes gently forwards. It is then only necessary to lift the hand, and the sound passes readily into the urethra and the bladder.

Examination of the urine and even chemical analysis are of great importance in diagnosing diseases of the urinary tract.

From the clinical point of view very complete analyses are not necessary, but the tests for albumen, sugar, bile pigments and indican are absolutely indispensable; and the same is true of microscopic examination for ascertaining the presence or absence of epithelial cylinders, blood corpuscles, pus corpuscles, etc. It is important also to note the colour and odour and the quantity passed.

These examinations are by no means difficult. Albumen is detected by adding a few drops of acetic acid to the urine, and heating, or by adding nitric acid and Esbach’s liquid. Esbach’s albumenimeter is sufficiently exact to discover the approximate amount of albumen present. Sugar is detected by the use of Fehling’s solution, bile pigments by nitric acid, and indican by adding a few drops of 10 per cent. chloride of calcium solution and hydrochloric acid. Should indican be present a more or less deeply tinted indigo blue circle appears, resulting from its oxidation.

Hippuric acid is precipitated by pure hydrochloric acid.