This Doctor is Great

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Zhou Mo spent a few minutes introducing the patient's condition (eating + drinking - abdominal pain) to Huang Zhichao.

"Mexico, is the patient most likely to have gastrointestinal perforation or acute pancreatitis?"

Huang Zhichao thought for a while, and said judgmentally.

Huang Zhichao has also been here for three weeks, and there is no problem with the routine diagnosis of abdominal pain.

Zhou Mo: "Can you tell me what is the most common cause of gastric perforation?"

Huang Zhichao: "..."

I wipe~~

A series of deadly questions, are you really coming?

Huang Zhichao couldn't help thinking and said:

"Stomach perforation, generally caused by irregular diet, overeating, or frequent consumption of some irritating foods, such as particularly spicy, cold or particularly hard foods, may cause gastrointestinal perforation."

After a pause, Huang Zhichao added.

"In addition to these reasons, long-term heavy drinking, especially drinking some inferior alcohol, is also the main cause of gastrointestinal perforation."

Huang Zhichao was unhurried, unhurried, and spoke in a eloquent manner.

alcoholism,

This is very similar to the patient in front of me.

Zhou Mo nodded in agreement and continued to ask: "That's right, so what is the most common cause of acute pancreatitis?"

Huang Zhichao responded quickly:

"It's a bile duct stone."

"Because the bile duct and the pancreatic duct are next to each other, once the bile duct stones become inflamed or edema, the stones in the bile duct fall into the pancreatic duct."

"And the stones in the bile duct can easily lead to blockage in the pancreatic duct, which can lead to pancreatitis, which is the most common cause."

"Another common cause is alcoholism, and high alcohol consumption is also a major cause of pancreatitis."

Zhou Mo rubbed his hands, then lifted the patient's clothes to reveal a slightly bloated stomach.

Prepare to perform an abdominal examination directly on the patient.

Zhou Mo simply rubbed it and found that although the patient had obvious abdominal pain, he still had upper abdominal pain.

However, the patient's abdominal muscles are still relatively soft, and there is no rigid feeling.

It does not appear to be acute peritonitis.

Because if the patient has acute peritonitis, there will be a lump in the abdomen, and it will feel hard.

"Do you think the patient may have a gastric perforation?"

Zhou Mo straightened up and looked at Huang Zhichao on the side.

Hearing Zhou Mo's words, Huang Zhichao did not rush to answer.

Instead, he pondered for a moment.

After a while, Huang Zhichao shook his head slightly.

"I don't think the patient should have a gastrointestinal perforation."

"If the patient has a gastrointestinal perforation, then the gastric juice and intestinal fluid will leak into the abdominal cavity through the small hole."

"In this case, severe inflammation of the abdominal cavity will occur, resulting in acute peritonitis."

"And acute peritonitis can cause the muscles in the patient's stomach to tense."

"A 'plate belly' appears. "

"However, the patient's stomach looked soft and there was no obvious muscle tension."

Having said that, Huang Zhichao stretched out his hand.

Gently pressing the patient's stomach, a confident smile appeared on his face.

"The patient's stomach is generally soft, and there is no muscle tension, so I don't think there is a possibility of gastrointestinal perforation."

Hearing Huang Zhichao's words, Zhou Mo nodded:

"In theory, it does."

As soon as these words came out, Huang Zhichao raised his head slightly.

"But!" Zhou Mo suddenly changed the conversation.

"?? But?" Huang Zhichao was stunned.

Zhou Mo smiled and said, "Don't forget that there is another possibility."

"For example, after a patient's gastrointestinal perforation, it is wrapped by the surrounding omentum tissue."

"In this case, the gastric juice and intestinal juice will not necessarily be scattered into the peritoneal cavity."

Therefore, Gu Lu

This is one of the difficulties in medicine, and sometimes for some reason, the deduction results are completely opposite.

Huang Zhichao smiled awkwardly like an eggplant beaten by frost.

"Brother Mo, you are right, I neglected this point."

Hearing Zhou Mo's words, Huang Zhichao became more and more admired.

No matter how detailed he understands the knowledge in the book, it is not as good as her Mexican.

Asked some more questions and found nothing.

Zhou Mo began to read the inspection report.

In the emergency department, the emergency department has done several tests.

The first is x-ray, which is one of the ways to diagnose peritonitis. It produced pictures showing widespread bloating of the bowel lumen and signs of intestinal paralysis, such as gas and fluid levels in the small bowel, or scattered steam below the diaphragm.

X-rays were done in the emergency department.

X-ray result: no problem!

Blood count: normal.

The blood amylase content was normal.

If the patient is pancreatitis, then the patient's blood amylase level will be high.

Because amylase is mainly secreted by the pancreas.

When the pancreas is inflamed, the structure of the amylase in the pancreas will be damaged, and naturally all of it will run into the blood, which will lead to an increase in the level of amylase in the patient's blood.

In addition, the troponin test results are also normal.

CT result: no problem with pancreas, no problem with gastrointestinal tract, no problem with appendix...

No problem.

To sum up: pancreatitis (no problem with blood + ct, excluded), gastroenteritis (normal blood routine, etc., temporarily excluded), heart disease (normal electrocardiogram, troponin, etc., excluded)

"This patient is a bit difficult to deal with..." Huang Zhichao looked confused.

"It's not difficult, the emergency department can handle it directly, and we don't need to send us to the gastroenterology department." Zhou Mo smiled.

Zhou Mo also considered a disease.

Aortic dissection.

The patient said that it was as painful as a knife cut, and it was really possible that it was aortic dissection.

First use the left and right hands to rule out the blood pressure.

Soon, the blood pressure was over, and the blood pressure was more than 130, which was considered high blood pressure. In the patient's medical record, it was written that the patient had a history of high blood pressure, so the blood pressure was not high. UU reading www.uukanshu.com

"Mexico, what are you doing?"

Huang Zhichao looked curiously at Zhou Mo taking the patient's blood pressure, and asked shamelessly.

Zhou Mo: "I think it may be aortic dissection."

Huang Zhichao was confused. He had heard of this disease, but he was unfamiliar with it. He didn't realize its danger, which made the Cardiac Surgery Department and the Emergency Department feel terrified.

The patient next to him just blinked his eyes, and didn't look scared.

It's not that he underestimated life and death, but he simply couldn't understand the words of the two doctors.

If there is a myocardial infarction or cerebral thrombosis, he can be shocked.

However, the aorta is layered, and I have never heard of it.

Not at all afraid.

Finally, Zhou Mo finished measuring the blood pressure of the patient's left and right hands, and the left and right were symmetrical, with a gap of 5mmhg.

Zhou Mo also breathed a sigh of relief.

In this way, the possibility of aortic dissection in the patient is not high (and cannot be ruled out.).

Zhou Mo temporarily considered the next possibility.

Stomach!

"I've seen your medical records. I've had stomach problems before? Can you be more specific?"

"Okay, a year ago, I had stomach pains that lasted for more than three months. I couldn't stand it, so I had a gastroscopy. At that time, the doctor said that I had erosive gastritis."

Zhou Mo was surprised: "Erosive gastritis? Didn't the doctor who checked at that time remind you not to drink alcohol?"

Erosive gastritis is a common benign disease characterized by erosive inflammation of the gastric mucosa, mainly manifested as hyperemia, swelling, bleeding, edema and other serious symptoms of the gastric mucosa.

If it is said that the test result is erosive gastritis, then it is absolutely necessary to abstain from alcohol. Because the stimulation of alcohol can be very strong. ,

An embarrassed smile appeared on the patient's face:

"The doctor told me before, but I couldn't hold back."

.