bookmarkrole Chapter 423
Chapter 423
Chapter 423
An adult woman with abdominal pain, for all doctors,
The first is to eliminate gynecological problems, the most important of which is “ectopic pregnancy”!
Ectopic pregnancy: The fertilized egg settles in the fallopian tube, grows, and then breaks the fallopian tube, causing hemorrhage…..
It can cause severe abdominal pain in female patients, and even rapid hemorrhagic shock.
result,
The female patient in front of her, with heavy make-up, couldn’t see it.
Lin Feng: “Xiaoru, take her blood pressure…”
The sphygmomanometer is a bit slower than’see’, but it is also very fast.
soon,
The blood pressure came out.
·Blood pressure: 98/72……
·Heart rate: 90……
good.
This means that the female patient did not bleed heavily…
Lin Feng can relax a little now and make a diagnosis slowly.
“How long has the pain been?”
“It started to hurt in the early morning.”
The female patient kept clutching her belly and frowning, but she didn’t have a cold sweat and was obviously able to withstand it.
“Where is the position “Zero Nine Zero”?”
“Here… (holding the right lower abdomen, where is the common place for appendicitis)”
Lin Feng’s first reaction was appendicitis, which is more famous.
Appendicitis has the phenomenon of “metastatic right lower abdominal pain” (I wrote this before, Chapters 352-353).
“Did it start with pain around the belly button?”
“No.” The female patient kept frowning and stooping to answer.
“Are there nausea, vomiting, bloating, etc…”
“nor……”
“Have you had appendicitis before?”
“still none……”
Lin Feng nodded.
“Lie down in bed, I will do a personality check for you…”
Xiaoru helped her and got into bed.
The female patient felt more pain when she lay flat…
Lin Feng put on his gloves and said gently: “It may be a little painful later, bear with it, and then don’t resist…”
The female patient nodded.
massage……
The female patient’s abdomen is still soft, and the pressing is not very painful, so it is not typical intestinal obstruction or peritonitis…
Then I did a “colon inflation test” and it was negative.
High probability rule out appendicitis.
“It’s not appendicitis, so we should consider kidney stones, gallstones, pancreatitis… etc…”
Lin Feng talked about it while investigating.
First tap the liver and gallbladder area, and it is found that the female patient has no response, which can rule out liver and gallbladder problems.
Then tap the kidneys on the left and right sides,
The kidney on the left is okay.
When knocking on the right kidney,
“Ah~~~~”
The female patient screamed in pain.
“There is a problem with the right kidney…”
Lin Feng massaged a few times, and finally felt that 90% of the probability should be kidney stones, ureteral stones causing abdominal pain.
“It’s okay…”
Lin Feng asked the female patient to get up.
“Do you have a boyfriend or husband?”
“No……”
Lin Feng nodded.
“Let me make a list for you. The first is to do a urine test, a blood test, and then do an abdominal B-ultrasound to see if there is any problem with the kidney or ureter…”
Needless to say, blood routine, basic check for inflammation and the like.
As for the urine routine, one is to check for urinary tract infections, to see if there are white blood cells, red blood cells, etc. in the urine (if there are problems with the kidneys and ureters, they can definitely be checked).
Urine, you can also do another “urine pregnancy test”: test whether it is possible to get pregnant!
“Urine pregnancy test”: that is to detect the level of human chorionic gonadotropin (hcg) in the urine. During pregnancy, this hormone will rise. (The pregnancy test stick also uses this method)
However, the patient said that he did not have a boyfriend or husband, so there was no need to do this experiment.
…
after an hour,
The female patient returned to the clinic with the results of the examination.
“Doctor Lin, this is the result…”
Lin Feng took it and looked at them one by one.
·Blood routine: abnormal increase of white blood cells…
·Urine routine: no abnormal increase in white blood cells…
·B-ultrasound: right hydronephrosis, right upper ureter dilation, left ovary, fallopian tube missing, no appendix abnormalities in the appendix area…
Lin Feng frowned.
“What’s the matter? The left fallopian tube is missing?”
Look at the female patient.
The female patient explained: “Have had a left ovary and fallopian tube resection before…”
Lin Feng: “………………”
A little angry.
I am most afraid of such patients who conceal their medical history, because it is easy to cause misdiagnosis.
Lin Feng couldn’t help but solemnly said: “I am your doctor, you should not hide this, if I misdiagnose it, it will be very troublesome…”
The female patient apologized: “Dr. Lin, I’m sorry… Dr. Lin, my illness…”
After an hour of pain, she felt even more pain…
After reading the report, Lin Feng analyzed:
“On the report, we can see that the ureter is dilated. I guess it should be ureteral stones… Normal urine comes out along the kidneys, ureters, bladder, and urethra like this. If there are stones in the lower part of the ureter, the urine will not flow smoothly. Yes, over time it may lead to expansion above the stone…”
“In addition, the report says that there is hydronephrosis, the ureter is blocked, and the urine can’t go down, naturally there is hydronephrosis…”
Lin Feng tried his best to introduce it in an easy-to-understand manner.
The female patient nodded while holding her right abdomen pain.
Lin Feng changed his words: “But what is strange is that there is no obvious leukocytosis in urine routine…”
The female patient was curious: “What’s the problem?”
Lin Feng explained: “There are ureteral stones. Generally, the stones rub against the wall of the tube, causing injury, inflammation, and increasing white blood cells… As a result, there is no abnormal increase in blood white blood cells, so it is strange 0…”
finally,
Lin Feng diagnosed: “I think it is a ureteral stone. Although the stone is not seen on the B-ultrasound for the time being, it may be that the stone is relatively small and can’t be seen clearly… I’ll prescribe some medicine for you first…”
Generally speaking, the abdominal pain caused by urinary tract stones can be relieved by medical treatment, Lin Feng thought.
Lin Feng prescribes medicine,
The female patient took the medicine list, got up and left, limping.
End the diagnosis of this patient.
Lin Feng pressed the number calling machine to call the next patient.
The broadcast sounded: “Please xxx go to the third consultation room…”
While Lin Feng was waiting for the next patient to come in,
When you are bored, review the entire diagnosis process…
Sudden,
Lin Feng thought of something wrong.
·The first point: the pain caused by urinary tract stones, in addition to abdominal pain, the patient should also have waist pain, and it is still relatively painful.
But the percussion pain of the female patient is not serious.
·The second point: If the pain is really caused by ureteral stones, the patient’s abdominal pain will be painful all the way along the ureter, and it will even hurt to the groin and below.
·The third point: The white blood cell problem of urine routine has not increased…Instead, the white blood cell of blood routine has increased! Explain that the inflammation is not in the urinary tract…
“Wait a moment……”
Lin Feng shouted.
The female patient turned her head: “Doctor Lin, what’s the matter?”
Lin Feng: “You lie down 2.3, I will check it for you again…”
The female patient looked surprised, but still obedient, and soon lay on the bed. Lin Feng put on his gloves and began to press.
Starting from the lower right abdomen…
“Does it hurt here? (The appendix continues to go down)”
“No pain……”
“What about here? (groin)”
“It doesn’t hurt…”
Further down…
“Does it hurt?”
“No pain……”
The female patient blushed and looked at Lin Feng, a little watery…
Lin Feng didn’t notice this.
Frown tightly.
This pain method for female patients is not the same as “ureteral stones.”
It’s more like appendicitis…
Lin Feng said: “Why don’t you go and do a CT?” (CT can see things that can’t be seen by b ultrasound)
“OK……”
The female patient blushed, her voice was like a mosquito…
Lin Feng: “???”
With a dazed face, why blush?
…….