This Doctor is Great

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

"Brother Mo, is the patient most likely suffering from gastrointestinal perforation or acute pancreatitis?"

Huang Zhichao thought about it and said decisively.

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

Zhou Mo: "Tell me what is the most common cause of gastric perforation?"

Huang Zhichao: "..."

I wipe~~

The life-threatening serial question, is it true?

Huang Zhichao couldn't help thinking and said:

"Gastric perforation is generally caused by irregular eating, overeating, or frequent consumption of some irritating foods, such as extremely spicy, cold or extremely hard foods, which may lead to gastrointestinal perforation."

After a pause, Huang Zhichao added.

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

Huang Zhichao was unhurried, calm and unhurried, and spoke eloquently.

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 quickly replied:

"It's gallstones."

"Because the bile duct and the pancreatic duct are close together, once the bile duct stones become inflamed or edematous, the stones in the bile duct will fall into the pancreatic duct."

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

"Another common cause is alcohol abuse, and heavy alcohol consumption is also a leading cause of pancreatitis."

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

Prepare to do an abdominal physical examination directly on the patient.

Zhou Mo rubbed briefly, and found that although the patient had obvious abdominal pain, it was still an upper abdominal pain.

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

It seems that it should not be acute peritonitis.

Because if the patient has acute peritonitis, the abdomen will feel like a lump, which feels hard.

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

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

Hearing Zhou Mo's words, Huang Zhichao didn't 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 gastrointestinal perforation."

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

"In this way, severe inflammation of the abdominal cavity will be triggered, and acute peritonitis will occur."

"In acute peritonitis, the muscles in the patient's stomach become tense."

"A "plate belly" appears. "

"But the patient's stomach looks very soft, and there is no obvious muscle tension."

As he spoke, 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 think the possibility of gastrointestinal perforation is unlikely."

Hearing Huang Zhichao's words, Zhou Mo nodded:

"In theory, it is."

As soon as this remark came out, Huang Zhichao raised his head slightly.

"But!" Zhou Mo suddenly changed the topic.

"?? 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, they are wrapped by the surrounding omentum tissue."

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

so,

This is one of the difficulties in medicine. Sometimes for some reason, the derivation results are completely opposite.

Huang Zhichao smiled awkwardly like an eggplant beaten by frost.

"Brother Mo, you are right, I was negligent on this point."

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

No matter how detailed he understands the knowledge in the books, he is still not as good as her brother Mo.

Asked some more questions, found nothing.

Zhou Mo began to read the inspection report.

In the emergency department, several tests were done in the emergency department.

The first is X-rays, which are one of the ways to diagnose peritonitis. It produced pictures showing widespread distension of the bowel lumen with signs of intestinal paralysis such as gas and fluid levels in the small bowel, or scattered vapor visible beneath the septum.

The emergency department did an X-ray on the patient.

X-ray results: no problem!

Blood routine: normal.

Wherein blood amylase content is normal.

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

Because amylase is mainly secreted by the pancreas.

When the pancreas is inflamed, the structure will be destroyed. The amylase in the pancreas will naturally run into the blood, which will lead to an increase in the amylase content in the patient's blood.

In addition, there are also troponin test results, and the value is normal.

CT results: no problem with the pancreas, no problem with the gastrointestinal tract, no problem with the appendix...

No problem.

In summary: pancreatitis (no problem with blood + CT, ruled out), gastroenteritis (normal blood routine, ruled out temporarily), heart disease (normal ECG, troponin, etc., ruled out)

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

"It's not difficult to do. The emergency department can handle it directly, and there is no need to send us to the gastroenterology department." Zhou Mo laughed.

Zhou Mo also considered another illness.

Aortic dissection.

The patient said that it hurts like being cut by a knife, and it may really be aortic dissection.

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

Soon, the blood pressure was over, and the blood pressure was more than 130, which was considered high blood pressure. It was written in the patient's past medical records that the patient had a history of high blood pressure, so this blood pressure was not considered high.

"Brother Mo, what are you doing?"

Huang Zhichao looked curiously at Zhou Mo taking the patient's blood pressure, and asked without shame.

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

Huang Zhichao was confused. He had heard about this disease, but he was not familiar with it. He didn't realize its danger.

The patient next to him just blinked his eyes, showing no sign of fear.

It's not that he's indifferent to life and death, it's just that he doesn't understand what the two doctors are saying.

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

However, aortic layering has never been heard of.

Not scared at all.

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

Zhou Mo also breathed a sigh of relief.

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

Zhou Mo temporarily considered the next possibility.

Stomach trouble!

"I've seen your medical records. I've had stomach problems before? Can you tell me more about it?"

"Okay, a year ago I had a stomachache, which lasted for about three months. I couldn't bear it, and then I went for a gastroscopy. At that time, the doctor said that I had a little 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 severe symptoms such as hyperemia, swelling, bleeding, and edema of the gastric mucosa.

If it is said that the test result is erosive gastritis, then alcohol must be strictly prohibited. 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 didn't hold back."

.