Chapter 2069

"President Zhou, the patient has pain in the left waist. There are white blood cells and red blood cells + + + in routine urine. High density shadow can be seen near the left 2-3 lumbar vertebrae on the standing abdominal plain film." The doctor on duty looked tired and instinctively reported the medical history: "the patient did not agree to be hospitalized and was given antispasmodic and analgesic treatment."

"The effect is not good?" Asked Zhou Litao.

"Generally speaking, I complained that the pain was relieved, but I think it should still be in pain. I advised twice and refused to be hospitalized."

"How about physical examination?"

"The percussion pain on the left waist is obvious, and it is also obvious on the right." The doctor on duty went to the rescue room and showed the patient's standing X-ray film to Zhou Litao.

When the film is inserted into the reader, a high-density shadow with a diameter of about 1.5cm near the left 2-3 lumbar vertebrae is so conspicuous.

Generally, standing abdominal dialysis and abdominal plain film are commonly used in the diagnosis of urinary calculi.

The patient's situation is very typical, but Zhou Litao looks at the film and recalls what the doctor on duty just said.

The left percussion pain is obvious, which should be.

But there is also percussion pain in the right waist. It is also possible to conduct the past. But Zhou Litao still felt something was wrong and turned his eyes to the film on the reader.

He carefully looked at the standing abdominal plain film. There was no stone in the right ureter. As for the lower part near the kidney, it is not clear from the X-ray film.

One examination confirmed that it was a left ureteral stone. According to the normal diagnosis and treatment procedures, other examinations should not be done.

Otherwise, who can stand being put on a big hat of excessive medical treatment.

That's it. It's estimated that the cold weather and ureteral spasm can't relieve the pain. Zhou Litao took the film down and put it in the film bag, but there was some hesitation in the whole process.

He was still thinking about the positive signs of the physical examination.

Early in the morning, it was the most leisure time in the emergency department. Zhou Litao came to the emergency room with the film and began to ask about his medical history.

The patient and his family described the course of his illness.

Nothing worth noting is that I went to bed early last night with the windows open. As a result, the temperature dropped in the middle of the night, and the left waist and abdomen began to ache.

At first, I thought it was a cold. I got up, closed the window and went to the bathroom.

Unexpectedly, the pain became more and more severe and almost fainted on the toilet. The patient woke up his family and sent him to the emergency department of 912.

Urinary calculi, say heavy or not, say light or not. Although the patient had severe pain, a friend who had done extracorporeal lithotripsy described the process of extracorporeal lithotripsy to him.

His strong fear made him hesitate to refuse in-hospital extracorporeal lithotripsy and other treatment, and only stayed in the emergency department for symptomatic treatment to observe the changes of his condition.

In fact, it's true that others are right when they say disease. This belongs to the type of standing and talking without low back pain. After all, many things can't feel it.

Fear is a normal emotion, just don't affect the normal diagnosis and treatment.

Zhou Litao carefully examined the patient.

His left hand is pressed on the patient's left waist and his right hand gently taps on the back of his left hand.

"It hurts." The patient frowned, bared his teeth and said painfully.

Zhou Litao then asked the patient to change a position and began to knock on the right waist.

The right hand gently tapped on the back of the left hand. Unexpectedly, the patient shouted, his body began to tremble a few times, and the bow became more powerful.

"Doctor, take it easy, take it easy." The patient's lover pulled his heart and almost cried.

"Do you have pain on your left or right side?" Zhou Litao asked suspiciously.

"The left side hurts." The patient's voice has changed tone because of pain.

"How do you feel when I knock on your right?"

"The whole stomach hurts. I can't stand it... Doctor, don't knock me. It's terrible to knock once." The patient said with a sad face.

His face was a little white and pale. Zhou Litao estimated that it was caused by pain. It doesn't look like a fake, and the conduction pain doesn't seem to be so heavy.

Strangely, the autonomic sensation is left-sided pain, which is also proved by the standing X-ray. However, during physical examination, Zhou Litao was under the illusion that the patient had a problem with the right urinary system.

It is not very common that the physical examination is inconsistent with the symptoms of private prosecution and clinical examination.

Zhou Litao covered the patient's clothes and asked about family history, past history and a series of situations. Only then did he leave full of doubts.

There was nothing worth noting. Zhou Litao wanted to check again to see if he didn't notice. The patient almost cried and begged him not to check his body.

Since the last time I met a girl with abdominal epilepsy for 16 years, Zhou Litao has listed family history as an item that must be asked.

Clinical diagnosis and treatment grow little by little through experience accumulation.

The patient's family history and past history are OK. He has a family history of hypertension, but he has no hypertension.

Zhou Litao thought hard and soon made up his mind to communicate with the patients and their families, and was ready to do a B-ultrasound to confirm.

The patient's family members agree. After all, the pain is slightly relieved after medication, but it is not very obvious.

In addition, when choosing between spending money and physical examination, patients almost did not hesitate to spend money to do the same examination.

Logically speaking, as long as the stone is stuck in the ureter, the pain will not change much. You have to drink a lot of water and exercise violently to let the stone fall out.

The pain was a little strange. Zhou Litao wondered and didn't get an explanation.

The wheelchair pushed the patient for examination. He twisted his body in the wheelchair. He seemed to have only half of his life left.

Zhou Litao is used to such patients, and he is not very sympathetic. All he thought about was that the physical examination was inconsistent with the symptoms and image data.

Is there any strange problem?

If you can't, just pull down Yu, President of Urology, for consultation. Zhou Litao decided to make a mountain out of a molehill. Even if yu Zong is unhappy, a clear diagnosis should be made.

Soon, the patient came back with a report in his hand.

The patient's family members were confused and even unhappy.

"Let me have a look at the report." Zhou Litao came forward and asked for the list.

"Doctor, how can B-ultrasound say that there is a problem on the right side? It's wrong." Asked the patient's family.

Zhou Litao's heart pounded.

Right? That's consistent with the physical examination. But X-rays and patients' self-reported symptoms

He immediately read the B-ultrasound report.

There was hydronephrosis in the right kidney, and a stone about 2cm was found near the proximal end of the right kidney and ureter. The left kidney and ureter had no problem at all.

MD！ Zhou Litao's hands holding the report began to tremble.

Say there is a problem, but the clinical examination is contrary to each other. What's the truth?

Is there no problem on the left? The high-density shadow next to the 2-3 lumbar spine on the left is the image of stones. What is it!