Sleepless Doctor

In the second picture, there is a staghorn-shaped stone, which is different from the fist-like stone in the previous picture. It has two bifurcations, which are hard and sharp. Zhang Zimo's urethra is inexplicably painful.

Then, a piece of mud-sand-like stones, broken like sand on the seashore.

Pebbles, potatoes, eggs...

One by one, I sent them one by one. Zhang Zimo still has some regrets, if only he could go and see for himself. However, there is an sci, Wang Guiping's goods should not be stingy anymore.

After watching it for an hour, Wang Guiping finished sending out all the weird stones.

"Girl, send that picture of Massachusetts to Director Wang." Wu Mian said.

"Okay." Chu Zhixi took out her mobile phone and started searching.

Zhang Zimo suddenly became energetic, and Mr. Wu also has stock! What kind of weird stone is the picture that Mr. Wu can save? !

Soon, a photo was sent to the group.

If it weren't for the special nature of this group, neither Zhang Zimo nor Wang Guiping on the phone would think this is a urinary tract stone.

What appears in the photo is a "round" egg shell with a light back, and the egg shell seems to be transparent, carved from jade.

At first glance, no one would recognize this as a medical specimen, but at a glance, it looked like a work of art, or the kind that was meticulously carved by master craftsmen.

"Ms. Wu, what is this?" Zhang Zimo asked softly.

"Catheter stones."

"..." Zhang Zi was stunned, the catheter... can he still have stones? !

He works at icu. Almost every patient needs a catheter. Some are temporary temporary catheterization, and some are indwelling for a long time. Why does this kind of stone appear? !

In the WeChat group, Wang Guiping also has the same question.

Chu Zhixi typed like flying on the phone's keyboard with both hands, which was completely different from Wang Guiping's slow motion like an old bull pulling a cart.

[Patient male, 57 years old, from Ansa, due to poor urination for 3 months, worsened with hematuria for 3 days, he was treated at Massachusetts General Hospital. 】

【Inquiry about the medical history, the patient had a long-term indwelling catheter for more than 5 months after the operation before 8 months, and had poor urination after extubation. 】

[Ultrasound performance: The bladder is well filled, and there is a slightly striped hyperechoic band in the cavity, about 5mm×2mm, with uneven ends, accompanied by sound shadows at the back, and it moves with the change of body position. During the movement, its head end looks like Bifurcated. 】

A series of brief introductions to the illness appeared in the WeChat group. Zhang Zimo looked at it carefully and had an estimate in his mind. It may be that the patient has been indwelling the catheter for a long time, causing substances such as oxalic acid to be deposited on the catheter wall.

[An X-ray of the urethra after the bladder was taken, which showed negative. Cystoscopy was performed on the second day. An arc-shaped eggshell-like stone was found in the bladder, about 20mm in length. It is planned to be treated with holmium laser lithotripsy and bladder irrigation. 】

[The patient refused, and the whole stone was taken out after surgery. 】

"Ms. Wu, why would the patient refuse to use the holmium laser to break the stone?" Zhang Zimo asked in surprise.

"The attending doctor Andrew told the patient that this was a rare shell-like stone. The patient was very excited. He refused the minimally invasive gravel, and then naturally discharged from the body. He thought it was a gift from the gods and should be taken out completely. Then as a souvenir."

"..." Zhang Zi was silent.

This hobby is really weird.

[Teacher Wu, Professor Chu, is this a rare shell stone? 】

Wang Guiping sent an information inquiry.

[Crust stones are rare in bladder stones, often because the catheter has been indwelled for more than 4 weeks. Bacteria in the urinary tract grow on the surface of the catheter as a biofilm, and the electrolytes, urinary salt crystals and matrix in the urine persist. The ground deposits agglomerates on the surface of the membrane, and forms in the side hole, cavity, tube body and bulb of the urinary catheter, which is also called urinary catheter encrustation. 】

Chu Zhixi didn't even think about it, and typed a bunch of words within ten seconds to explain the stone.

[I have been looking for a specimen of ureteral encrustation! 】

[It's a urinary catheter. 】

[Sorry, I'm used to it. It is a crusted urinary catheter, Mr. Wu, do you have a real object on that side? 】

[No, this specimen is collected by the patient, there is only one photo. 】

Wang Guiping remained silent on that side, not knowing whether he regretted it or admired the rare and complete urinary catheter encrustation specimen.

[In fact, it's not that rare. 】

Wu Mian typed a line.

【? ? ? 】

Wang Guiping returned three question marks.

[Mainly because the ultrasound image of catheter encrustation is relatively rare, and there is insufficient understanding of this phenomenon. Through careful analysis of the sonographic performance, combined with comprehensive analysis of the clinical history of long-term indwelling catheterization, unnecessary misdiagnosis can be reduced. 】

[Teacher Wu, please talk about it in detail. 】

[The sound image of the urinary catheter crust is arc-shaped strong echo, both ends are not smooth, and the head end can be bifurcated during the movement process, which looks like a foreign body, mainly because it is generated with the shape of the urinary catheter, which is different from the usual The urinary tract stones vary greatly. 】

[To find patients with urinary catheter encrustation, it is recommended that you learn B-ultrasound, or contact the doctor in the B-ultrasound room, and find a doctor with a high level of skill to do slow-diagnosing urinary tract B-ultrasound. Especially patients with long-term indwelling urinary catheters and difficulty in pulling out the catheters are likely to have catheter encrustation. 】

Zhang Zimo looked interesting, but he didn't expect teaching, and finally became teacher Wu giving a lecture to Wang Guiping.

It's really worthy of the name of Teacher Wu, as long as there is a chance, he will talk about some weird things that usually don't pay attention to, but often appear.

For example, this urinary catheter encrustation, according to logical analysis, it should not be uncommon in patients with ICU, but I have never noticed it. Thinking of this, Zhang Zimo secretly wrote down the diagnostic criteria for crusts, and prepared to go back and read the book in detail.

But do you want to learn B-ultrasound by yourself? He felt a little embarrassed.

At that time, I laughed at Peng Peng. He had to change careers at an age, from anesthesia to pain to B-ultrasound~www.wuxiaspot.com~ I didn’t expect that with my curiosity, I would have to learn B-ultrasound to see a broader world.

Wu Mian and Wang Guiping chatted for a while, and ICU’s hospitalization always came to his side, "Mr. Wu, the report of the 2-hour observation by Xue Yuan’s lover is back."

Wu Mian put away his mobile phone and took up the report sheet to review one by one.

After symptomatic treatment, the acute symptoms of Xue Chunhe's lover ketoacidosis have been relieved, the acidosis has been neutralized, and the disordered ions have been corrected. Although it has not returned to the normal value, it is much better than the value checked for the first time when I first came in.

Wu Mian came to the bed and explained the test results in detail with Xue Chunhe's lover, so she was relieved.

After everything was busy, Wu Mian said, "Director Zhang, you are busy, I will go back first."

"Ms. Wu, I will send the report in 4 hours to your phone?"

"Okay." Wu Mian said, "Xue Yuan...it depends on the situation, it is estimated that he will be discharged soon. If it takes a long time, he will be referred and transferred back and treated together with us. Together, let me worry less."