bookpower Chapter 419
Chapter 419
An adult woman, abdominal pain, for all doctors,
The first is to rule out 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 heavy bleeding.....
It can cause severe abdominal pain in female patients and even rapid hemorrhagic shock.
outcome
The female patient in front of her, with heavy makeup, could not be seen.
Lin Feng: "Xiaoru, take her blood pressure..."
The sphygmomanometer is a little slower than 'seeing', but it's also quite fast.
soon
Blood pressure is out.
Blood pressure: 98/72...
Heart rate: 90...
Not bad.
This means that the female patient did not bleed profusely...
Lin Feng can relax a little at this time and diagnose slowly.
"How long has it been pain?"
"It starts to hurt in the early hours of the morning."
The female patient kept covering her stomach and frowning, but she didn't break out in a cold sweat, and she was obviously able to withstand it.
"Where's the location?"
"Here... (Covering the right lower abdomen, where appendicitis is common)"
Lin Feng's first reaction was appendicitis, which is more famous.
Appendicitis has the phenomenon of "metastatic right lower quadrant pain" (I wrote this earlier, chapters 352-353).
"Was it pain around the navel at first?"
"Nope." The female patient kept frowning and bent over to answer.
"Is there nausea, vomiting, bloating, etc..."
"Nor ..."
"Have you had appendicitis before?"
"Still not..."
Lin Feng nodded.
"Get in bed, I'll give you an individual examination..."
Xiaoru helped her and went to bed.
As soon as the female patient lay flat, it hurt even more...
Lin Feng put on his gloves and said gently: "It may hurt a little later, endure it, and then don't resist..."
The female patient nodded.
Massage......
The female patient's abdomen is still soft, and the pressure is not very painful, so it is not typical intestinal obstruction, peritonitis, etc...
Then a "colonic inflation test" was done, and it was negative.
Appendicitis is most likely excluded.
"It's not appendicitis, then kidney stones, gallstones, pancreatitis should be considered... Wait..."
Lin Feng chanted while investigating.
First tap the hepatobiliary area, and find that the female patient is unresponsive, which can rule out hepatobiliary problems.
And then tap the kidneys on the left and right sides.
The left kidney is fine.
When you tap 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 the 90% probability should be kidney stones and 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.
"Wait a minute, I'll give you a list, the first is to do urine routine, blood routine, and then do an abdominal ultrasound to see what is wrong with the kidney or ureter..."
Needless to say, the basic check for inflammation and the like.
In the urine routine, one is to detect whether there is a urinary tract infection, to see if there are white blood cells, red blood cells, etc. in the urine (if there is a problem with the kidney and ureter, it can definitely be detected).
urine, you can also do another "urine pregnancy test": test whether there is a possibility of pregnancy!
"Urine pregnancy test": This is to measure the level of human chorionic gonadotropin (HCG) in the urine. During pregnancy, this hormone is elevated. (This is also the method of pregnancy test)
However, the patient said that he did not have a boyfriend or husband, so there was no need to do this experiment.
......
An hour later,
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 in white blood cells...
Urinalysis: there is no abnormal increase in white blood cells...
·B ultrasound: right hydronephrosis, right ureter upper segment dilation, left ovary and fallopian tube missing, no appendix abnormalities in the appendix area...
Lin Feng frowned.
"What's going on? Missing left fallopian tube? "
Look at the female patient.
The female patient explained: "I have had a left ovary and salpingectomy surgery before..."
Lin Feng: ".................."
A little angry.
The most afraid is this kind of patient who conceals the medical history, because it is easy to cause misdiagnosis.
Lin Feng couldn't help but say seriously: "I'm your doctor, you shouldn't hide this, in case I misdiagnose, it will be very troublesome..."
The female patient looked apologetic: "Dr. Lin, I'm sorry... Dr. Lin, my illness..."
It hurt for an hour, and she felt even more pain...
After reading the report, Lin Feng analyzed:
"On the report, you can see that the ureters are dilated, and I guess it should be ureteral stones... Normal urine comes out along the kidneys, ureters, bladder, urethra, if there are stones blocking the lower part of the ureter, then the flow of urine is not smooth, and over time it may cause expansion above the stone..."
"In addition, the report says that there is hydronephrosis, the ureter is blocked, and the urine cannot go down, and there is naturally hydronephrosis..."
Lin Feng tried to introduce it as easily as possible.
The female patient nodded while covering the pain in her right abdomen.
Lin Feng's words changed: "But a little strange thing is that the urine routine did not see obvious leukocytosis..."
The female patient was curious: "What's the problem?" "
Lin Feng explained: "There are ureteral stones, generally stones rub against the wall of the tube, causing injury, inflammation, and increased white blood cells... It turned out that there was no abnormal increase in white blood cells in the blood routine, so it was strange. "
At last
Lin Feng diagnosed: "I think it's a ureteral stone, although the ultrasound didn't see the stone for the time being, it may be that the stone is relatively small and I can't see it clearly... I'll give you some medicine first..."
Generally speaking, the abdominal pain caused by urinary tract stones can be relieved by drug treatment.
Lin Feng prescribed medicine,
The female patient took the medicine list, got up and left, and walked with a limp.
End the diagnosis of this one patient.
Lin Feng pressed the call machine and called the next patient.
The radio sounded: "Please xxx to the third consultation room..."
Just as Lin Feng was waiting for the next patient to come in,
When bored, review the whole diagnostic process...
suddenly
Lin Feng thought of something wrong.
The first point: pain caused by urinary tract stones, patients should have abdominal pain in addition to abdominal pain, but also lower back pain, and it is also a relatively painful kind.
But the percussion pain of the female patient is actually not serious.
The second point: if it is really pain caused by ureteral stones, the patient's abdominal pain will hurt all the way down the ureter, and even to the groin and further down.
The third point: the white blood cell problem of urine routine, not increased... On the contrary, the white blood cells of the blood routine are increased! Indicates the place of inflammation, not in the urinary tract system ...
"Wait a minute..."
Lin Feng shouted.
The female patient turned around: "Dr. Lin, what's wrong?" "
Lin Feng: "You lie down, I'll check it for you again..."
The female patient looked surprised, but still obedient, and soon lay down on the bed, Lin Feng put on gloves and began to press.
Start on the right lower abdomen...
"Does it hurt here? (The appendix continues down)"
"It doesn't hurt..."
"What about here? (groin)"
"It doesn't hurt either..."
Further down...
"Does it hurt?"
"It doesn't hurt..."
The female patient blushed shyly, looking at Lin Feng, a little watery...
Lin Feng didn't notice this.
Frowning tightly.
This pain method for female patients is not the same as "ureteral stones".
It's more like appendicitis...
Lin Feng said, "Or, you go for a CT?" (CT can see what ultrasound can't.)
"Okay..."
The female patient had a red face and a voice like a mosquito...
Lin Feng: "???? "
A dazed look, why blush?
......