bookpower Chapter 429
Chapter 429
At this time, the patient's grandma information in front of him: obesity, abdominal pain, shortness of breath...
Lin Feng's first reaction:
"Check an electrocardiogram first..."
The electrocardiogram is relatively fast, and it can be consulted at the same time.
Elderly patients with abdominal pain must check the electrocardiogram to exclude cardiac emergencies such as myocardial infarction.
Moreover, Grandma has shortness of breath, so she should be more vigilant about heart disease.
So Lin Feng arranged an electrocardiogram.
Lying in bed,
Electrocardiogram.
Brush brush brush ~~~~
ECG drawings keep appearing.
Lin Feng asked the doctor.
"Grandma, have you had any medical history before? Diabetes, hyperlipidemia, high blood pressure..."
Grandma's weight should be 160 pounds, fat body type, and the probability of high blood lipids is very high.
The husband of the grandmother next to him was thin and replied: "There is high blood lipids... But weight loss can't come down... There is also diabetes, 5 years, but fortunately high blood pressure does not. "
Lin Feng: "Grandma, just now you said that you ate in the middle of the night and started to suffer abdominal pain and vomiting, what did you eat in the middle of the night?" "
Grandma: "Isn't it just after the Mid-Autumn Festival, there are mooncakes, and then I ate a mooncake..."
Lin Feng nodded.
mooncakes,
It may not be clean, so it is possible that Grandma has gastrointestinal problems caused by bacteria and viruses...
"Grandma, did you just take your temperature?"
"Measured, a little low-grade fever, 38.7 degrees..."
Run a fever?
Inflamed?
Measure your blood pressure.
100/50mmHg。
The number of 50, low.
However, Lin Feng looked at the number of 100, so he felt that there should be no big problem.
"Grandma, I'll give you an individual examination... Relax your muscles..."
First of all, cardiopulmonary auscultation:
No problem.
Then bowel sounds:
There is a marked weakening and may be inflamed.
And then
Lin Feng did a physical examination with his hands.
The hand pressed the stomach, slightly hard.
"Grandma, don't resist, relax..."
"Well..."
"Grandma, where does it hurt?"
"Here... (upper left abdomen)..."
Clicked,
Grandma screamed.
Lin Feng: "Does it still hurt?" "
Grandma: "My back, I feel a little pain in the past... It feels like the front is pulling, which makes the back hurt..."
Lin Feng nodded,
The pain in the left upper quadrant radiates to the back.
Left upper abdomen pain, Lin Feng subconsciously thought - pancreatitis.
Among the symptoms of abdominal pain, there are divisions.
Right upper quadrant pain: may be stomach ulcer, pancreatitis or gallstones;
Epigastric pain: may be stomach acid, indigestion, gallstones, gastric ulcer, hernia, pancreatitis;
Left upper quadrant pain: may be duodenal ulcer, gastric ulcer, bile duct obstruction, pancreatitis;
Right abdominal pain: may be inflammation of the urethra, lumbar hernia, constipation, kidney stones;
Abdominal pain: may be early appendicitis, pancreatitis, inflammation of the large intestine, gastric ulcer, umbilical hernia, inflammation of the small intestine, Crohn's disease;
Left-sided abdominal pain: may be constipation, diverticular disease, colorectal inflammation, kidney stones;
Right lower abdominal pain: may be female gynecological diseases (such as pelvic inflammatory disease, endometriosis), constipation, inguinal hernia, appendicitis;
Lower abdominal pain: may be appendicitis, urethral inflammation, pelvic inflammatory disease, diverticular disease, colorectal inflammation;
Left lower quadrant pain: may be inguinal hernia, pelvic inflammatory disease, diverticular disease.
(ps: If book friends have abdominal pain, you can compare this partition.) ）
Of course
This division may not be accurate, because some diseases will be more weird, not 100% must be accurate, to analyze the specific problem.
At this point,
The ECG also pulled up a long chapter.
Lin Feng glanced at the electrocardiogram.
ECG: No abnormalities.
So
The left upper quadrant pain of the patient in front of the patient, Grandma, excludes heart disease:
Possible diseases with a high probability: duodenal ulcer, gastric ulcer, bile duct obstruction, pancreatitis.
Lin Feng: "Grandma, it's okay, get up..."
While getting up, Grandma asked:
"Doctor Lin, what kind of disease am I?"
Lin Feng: "It may be duodenal ulcer, gastric ulcer, bile duct obstruction, pancreatitis..."
Grandma slapped her thigh: "That must be a stomach ulcer, I had a stomach problem last time..."
Lin Feng sweated furiously: "Grandma, last time it was a stomach disease, this time it may not be a stomach disease... It's different..."
Grandma was wary: "Do you want to check me more?" Good pit my money? "
Lin Fengji: "..........................."
The grandmother's husband next to her quickly grabbed the grandmother: "You stop your mouth, talk nonsense... Dr. Lin, what examination, you can mention it, everyone says that Dr. Lin is a good doctor and will not pit our old people..."
Lin Feng nodded: "Don't worry, I won't open the inspection indiscriminately, but the inspection should be carefully checked..."
At last
"Grandma, wait for you to go for a CT, and then draw a blood routine..."
Grandma was unwilling: "Ct is very expensive?" Last time I seemed to spend 400 on this, expensive to die ... Doctor, can't you check stomach disease alone? "
Lin Feng hurriedly said: "You must rule out pancreatitis, if it is really pancreatitis, it is not as simple as infusion, it will be fatal when it is serious... And Grandma, your illness has been five hours, too long, I'm afraid there will be a problem. "
......
Half an hour later,
CT came out the fastest.
Lin Feng took a look!
Abdominal CT: acute pancreatitis!!
· CT teacher: Consider acute severe pancreatitis.
Soon, the blood draw results also came out:
Amylase, 10 times higher!
Lipase: 10 times higher!
"Lipase", mainly derived from the pancreas, is one of the digestive enzymes secreted by the pancreas.
"Amylase": increased lipase, most common in acute pancreatitis, is one of the important diagnostic indicators of acute pancreatitis, 6~12h after the onset of activity began to increase, 24h peak, 48 hours began to decline, 3~5 days after returning to normal.
Both indicators point to acute pancreatitis.
And the indicator value is too high, consider acute severe pancreatitis!
Lin Feng saw this result,
Taken aback,
Suddenly, his face became serious.
"Doctor Lin, what's wrong?"
Grandma's husband asked nervously.
Lin Feng was serious: "Now consider it to be severe pancreatitis, a little serious, it is a sinister acute abdomen!" "
There are more serious Lin Feng did not say.
Severe acute pancreatitis is an acute pancreatitis with systemic and local complications, which belongs to a special type of acute pancreatitis, and is an acute abdomen with many complications and high mortality rate, accounting for 10%~20% of the entire acute pancreatitis.
The fatality rate is 27%!
Lin Feng: "Xiaoru, measure Grandma's blood pressure again..."
One quantity,
The blood pressure results surprised Lin Feng.
·80/45mmHg
(40 minutes ago: 100/50mmHg...) ）
Blood pressure is dropping!
This is already shock blood pressure.
(Blood pressure below 90/60 is called shock blood pressure, but generally only fainting or coma occurs below 70/50.) Some exceptions are special patients with hypotension)
。