Chapter 1685

"Boss Zheng, look at the eye test sheet." The little doctor politely turned the iron medical record clip to the pasted test sheet, handed it to Zheng Ren, and then reported the medical history.

"The patient was treated in our hospital for abdominal pain 4 hours 5 days ago. He was diagnosed as acute appendicitis and underwent appendectomy in an emergency.

During the operation, it was found that the manifestations of appendicitis were atypical, and the appendix was removed smoothly. After the operation, the patient still felt abdominal pain, and abdominal distension occurred a few hours later. Because it was tolerable, it was not paid attention to, and there was no special treatment. After that, the abdominal distention gradually increased and the abdominal pain gradually decreased. "

"Wait a minute. During the operation, I said 20ml of light yellow exudate was sucked out. Did you follow the operation?" Zheng Ren did not directly look at the test sheet, but found the operation records.

At a glance, Zheng Ren saw a sentence that made him have questions.

"Boss Zheng, I followed the operation." The little doctor said, "when I cut the peritoneum during the operation, a small amount of light yellow exudate came out. I sucked it clean with an aspirator. There is no pus moss, and the exudate is relatively clear and not turbid."

He felt that Zheng Ren made a fuss, just a little exudation, which may be caused by appendicitis exudation.

Although there are many exudates, it is estimated that there is only 20ml, which seems to be nothing to be surprised about.

This is not the point. The main condition is the later intestinal obstruction and a large amount of peritoneal effusion.

But before the report, boss Zheng interrupted his words.

"Well, I'll think about it again. You go on." Zheng Ren said casually while looking through the medical records.

"The subsequent abdominal plain film examination showed intestinal obstruction. According to the intestinal obstruction, the patients were given diet prohibition, continuous gastrointestinal decompression, fluid replacement, etc. three days after operation, the patients had ventilation and defecation, but the abdominal distention was continuously aggravated, and there was obvious abdominal distention. After consultation with the director, it was suggested that the patient's family members should be transferred to the provincial hospital for further diagnosis and treatment."

"The patient has clear consciousness, poor spirit and stable vital signs. The tenderness of the left lower abdomen is positive, there is no rebound pain, Murphy sign is negative, the liver and spleen are not touched under the ribs, the whole abdomen is not touched, there is no tenderness at each ureter tenderness point, there is no percussion pain in the liver and kidney area, the abdominal percussion is voiced, the mobility voiced sound is positive, and the bowel sound is normal, about 4 times / min."

The little doctor was a little proud. He said these things casually, but he made great efforts.

It's hard to find a clinician as serious as yourself.

When the tiger body shook, boss Zheng bowed before he could accept it, crying and shouting to take him to the imperial capital?

It is said that Liu Xuzhi, the counsellor of the radiology department, was invited by boss Zheng many times to work in the imperial capital. Not even going to work, but also the establishment!

That's the establishment of the imperial capital.

Liu Xuzhi can go. What can't he do?

After reporting the medical history, the little doctor thought of it with some pride.

"Past history... Li Yong, have your loved ones ever had hepatitis B or tuberculosis?" Zheng Ren asked.

"No."

The little doctor was puzzled that the past history was not important. It's all in the past. There's nothing to ask.

What is the relationship between hepatitis B tuberculosis and appendicitis?

Even tuberculous intestinal obstruction... It's much more common. Boss Zheng is picking a bone in the egg because he has reported his medical history well?

"Have you had any surgery?" Zheng Ren continued to ask.

The little doctor looked at Li Yong with a confused face.

"No..." Li Yong hesitated.

"Think again, caesarean section and so on." Zheng Ren looked at the past history that had hardly said anything in the medical record, and was a little helpless.

The medical record is too rough, 18 blocks worse than Chang Yue.

Then do it yourself, Zheng Ren asked.

"I haven't had a caesarean section... I heard my wife say that before marriage... I had an operation about 20 years ago. There was a tumor on the bladder. Later, after resection, it was diagnosed as a benign mass." Li Yong found what Zheng Ren needed in the dust of memory.

This is the case when asking the patient's family members about the medical history. First, the patient's family members don't care and feel that it has nothing to do with the current condition. The second is simply forgetting that this belongs to some kind of memory deviation.

Only by finding clues and getting to the bottom of the matter can it be possible to ask about the medical history.

Seeing a doctor is like solving a case. It's really not easy.

"Bladder?" Zheng Ren pondered, "let me have a look at the film."

The little doctor answered clearly and inserted the standing abdominal flat film into the film reader.

The film is very simple. There is a small liquid level. Just looking at the film, there is no problem in diagnosing intestinal obstruction.

But intestinal obstruction... Peritoneal effusion

There is no necessary connection between the two diseases.

Zheng Ren went back and looked through the doctor's advice again. There was a large amount of peritoneal effusion. The general surgery of Xilin Town People's hospital used conventional diuretic methods.

However, the amount of urine recorded in the course of disease is very small.

"Is the recorded urine volume correct?" Zheng Ren asked.

Sometimes, some doctors ignore this and write a value casually.

"Boss Zheng, I work very hard." The little doctor's face was a little red. He felt very wronged in the past period of history.

This is clearly the fault of the patient's family. They asked themselves, but they didn't say anything. Why did boss Zheng say it when he asked?

Li Yong, an old man, gives himself eye medicine!

"Well, I can see." Zheng Renwen said.

The little doctor's face is a little better.

"But clinical experience is not rich enough."

“……”

"40 mg of furosemide was used. There was not much urine. There was no problem with renal function. What would you consider?" Zheng Ren asked.

"..." the little doctor was stunned, "I noticed this, so I suggest the patient's family take the patient to the provincial hospital."

Zheng Ren had guessed. He smiled and said, "go and have a look at the patient."

Both the little doctor and Li Yong are exposed, but seeing the patient and physical examination are normal diagnosis and treatment processes. The specific diagnosis should come out after seeing the patient.

If boss Zheng could understand.

If you don't understand... This possibility is also great.

The little doctor led Zheng Ren to the ward in front and heard Zheng Ren ask, "where's your director?"

"There's a lunch at noon. I went out for dinner."

"Another drink?" Zheng Ren asked.

"Probably." The little doctor can't help it. His director likes it. He drinks when he is on holiday. On normal working days, without surgery in the afternoon, he is willing to drink two mouthfuls, which is very disgusting.

But the town level hospital, on this virtue, everyone is almost the same.

When he came to the ward, the little doctor stood aside respectfully and watched boss Zheng check his body.

He took a first look and his abdomen swelled.

Well, this is the most basic visual examination. Although he didn't say it, he watched it for nearly two seconds. I'm afraid he has begun to think about the relevant condition in his heart.

Palpation, I do it three or five times a day, and the position of the patient's pain is transferred to the left lower abdomen.