Chapter 593： Complex gallbladder

"Director Xia, hello." Zheng Ren called the phone and said.

Since the resolution of several patients in the Department of Gastroenterology, Director Xia clearly recognized the level of Zheng Ren.

After that, Director Xia encountered difficulties and habitually began to look for Zheng Ren to take a look. With her temper, it is very difficult to do this.

"Zheng Zong, I have a patient on this side, can you help me with a look?" Director Xia said.

Sure enough, Zheng Ren does not care. If you look at it, you can have a big deal.

Moreover, with the progress of the skill tree, Zheng Ren also needs to see more patients and accumulate clinical experience.

Zhong Min, who was on duty in the emergency room, said hello. Zheng Ren slid to Dada to go to the Department of Gastroenterology.

Emergency consultation, the request must be within five minutes. However, there is no time limit for such a consultation with a director to take a personal relationship. It is a human condition. Director Xia’s words are not in a hurry, and Zheng Ren does not have to rush to rush.

When he came to the Department of Gastroenterology, Zheng Ren glanced at the doctor's office. When he didn't see Director Xia, he went straight to the front of the director's office and knocked on the door.

"Zheng Zong, come." Director Xia is reading the film on the computer, see Zheng Ren come in, stand up and say.

"Director Xia, what is it?" Zheng Ren asked.

"There is such a patient, I can't diagnose it. I always feel that there is a problem. You can help with a palm." Xia then pressed Zheng Ren to his desk and pointed to the upper abdomen on the computer. CT said: "You read the film. The level is high, what is it here?"

Zheng Ren carefully watched the film, Director Xia said on the side: "The patient complained of intermittent cramps in the right upper quadrant and was admitted to the hospital for 7 months. One episode per week, each pain 1-3 days. The patient had no nausea or vomiting during pain, no Fever, jaundice. The most recent episode of abdominal pain was before January."

"Yeah." Zheng Ren swung his mouse wheel with his right hand, and looked at it while watching a frame.

"Before admission, there is a B-ultrasound." Director Xia's business is very skilled, this headache patient she is also particularly attentive, auxiliary examination without looking at the list, casually said: "Abdominal ultrasound tips in the upper part of the gallbladder fold, no gallstones The gallbladder wall is slightly rough. There is no expansion of the bile duct inside and outside the liver, and the diameter of the common bile duct is about 3 mm."

"Folding?" Zheng Ren Shen Shen.

The gallbladder fold displayed by B-ultrasound is not literally understood, and the gallbladder is folded like an origami.

Gallbladder folding, clinically refers to the folding phenomenon of the gallbladder mucosa.

More common in patients with chronic cholecystitis, some are congenital dysplasia. Symptoms are the performance of some digestive systems. Such as flatulence and so on.

Moreover, the patient's gallbladder wall is slightly rough and can be diagnosed as cholecystitis.

"After admission, ceftriaxone was given anti-inflammatory treatment. After ten days, the pain improved significantly, but the upper abdomen CT showed stones." Director Xia had some doubts and his brow was wrinkled.

The patient's symptoms have improved and should be discharged.

Out of caution, Director Xia examined a CT of the upper abdomen before the patient was discharged from the hospital.

I did not expect CT to show that the patient's condition has not been alleviated, but it has worsened! The inflammation has improved slightly, and stones have appeared in the gallbladder.

However, the patient's symptoms did not aggravate, but instead of being alive and kicking, he was discharged from the hospital.

This kind of patient's self-reported symptoms and clinical auxiliary examinations are mutually unrelated, and they are treated with caution every time.

Zheng Ren looked at the upper abdominal CT film with one frame and no longer asked about the situation of the director Xia.

All that is said is that the other is not important.

Director Xia noticed that Zheng Ren had watched the gallbladder for a few more seconds, and then he looked at it again.

After five or six minutes, Zheng Ren watched the film and said: "Director Xia, patients should not be diagnosed with cholecystitis."

“Hmm?” Director Xia stunned.

Directly overturn the most original diagnosis? Do not need to be so direct?

However, Director Xia did not refute, she is ready to listen to Zheng Ren's explanation.

However, Zheng Ren did not explain, but stood up and smiled and said: "Be a MRCP."

“Is it necessary?” Director Xia wondered.

"Go to the patient, if I didn't make a mistake, this patient should be a rare double gallbladder patient."

"..."

"The CT film can only be guessed. It is clear at a glance." Zheng Ren suddenly remembered something and asked: "The patient's family economy is fine."

"Fortunately..." Director Xia said.

"If the economic conditions allow ... forget it, when doing MRCP, do a three-dimensional reconstruction of MR. The patient has no symptoms now, and the examination is still done carefully, so that the surgery can be done." Zheng Rendao: "MRCP may have artifacts, It is impossible to judge whether the two cystic ducts are merged and merged into the common bile duct.

After the judgment is clear, according to the classification of gallbladder malformation, it is a variant of type 1 or type 2, which is good for determining the surgical procedure of the patient. ”

Director Xia sweats.

The purpose of her search for Zheng Ren is to judge why the symptoms of upper abdominal pain have been relieved, but the examination found gallstones.

I did not expect that Zheng Ren did not say anything about this aspect, directly pulling out the double gallbladder deformity?

Director Xia almost didn't spit out a bit of old blood.

But she saw Zheng Ren’s ignorance and some doubts.

However, the problem lies in double gallbladder malformation... Even the director of Xia has not seen the old clinical director.

Zheng Ren saw that Director Xia did not move. He didn't want to see the patient's meaning with himself. It was a bit strange, but he immediately realized.

"Director Xia, gallstones, and double gallbladder deformity have nothing to do with." Zheng Ren smiled. "The patient's gallbladder does have sediment-like stones, and the ceftriaxone is stopped. It will be good in three or five days."

"Hmm?" Director Xia was confused.

"The symptoms of reversible cholestasis after ceftriaxone application occur because the ceftriaxone metabolite calcium salt that enters the bile is easily precipitated in the gallbladder and becomes a "calculus nucleus", which induces cholelithiasis. "Zheng Ren said, "If you don't believe, you can look at the instructions of ceftriaxone, which has complications in this regard. ”

"That... what is the problem with this patient?" Director Xia was confused.

"Double gallbladder malformation, this is more serious. The cholecystoid-like stones caused by ceftriaxone can disappear after a period of withdrawal, and are called drug-induced gallstones."

"Pharmaceutical?"

"For example, contraceptives, ceftriaxone, non-steroidal anti-inflammatory analgesic drugs, intravenous high-nutrition drugs, and dipyridamole may cause drug-induced gallstones." Zheng Rendao.

"How do you know?" Director Xia asked.

"Surgery, there have been diagnosed gallstones. After the surgery, I found that there is nothing in the gallbladder. Some of them have been fooled. Some family members have become medical accidents because of their refusal. So I have studied this. a little more."

Director Xia knows that Zheng Ren’s level is good, but he did not expect the level to be so high.

She picked up the phone and said: "Zheng Zong, wait a moment, I will ask the Director of Nuclear Magnetics."