(Thanks to my friend Chensi for his encouragement, thanks to the painting of the falling wind leaves, the blood hell demon dragon, the old guy little carpenter, the silent little guard, and the book friend 20171213215219169 monthly pass encouragement)

"You all saw the inspection process just now, right?" asked Liu Banxia.

Everyone nodded in unison.

"So what is the answer you gave?" Liu Banxia asked again.

"It's appendicitis, and the patient has rebound tenderness at McT's point. Xu Yinuo hurriedly said.

"Probably not. Although Mr. Liu also swept the appendix just now, and later swept the gallbladder and kidneys, is it cholecystitis?" Huang Bo, who was in the same group as her, expressed his objections.

"What do you think? Don't worry, because I don't even know what the patient is sick with. Liu Banxia said.

When he said this, he was dumbfounded by these people, how could it be? How could Mr. Liu not know what kind of disease the patient had? Just kidding.

"I really don't know, it's no good to lie to you. Liu Banxia shrugged his shoulders.

"Because in the process of examining the patient just now, two completely different indications were given. The abdominal muscles were slightly tense, and there was rebound tenderness at the McCerez point, which may be appendicitis, but the appendix was found to be intact during the B-ultrasound examination. ”

"I scanned my kidneys and gallbladder again, and although I found some stones, there was no stuckness in the kidney stones. What about the gallbladder part? I did a percussion and the patient didn't respond. ”

"Have you ever seen acute appendicitis with an intact appendix? Have you ever seen acute cholecystitis with pain in the right lower abdomen? Anyway, I haven't seen it yet, let's discuss it. ”

"As a friendly reminder to you, the patient will do an urgent CT, so the results will come out quickly. If any of you have reasonable judgment at this time, I will definitely give it a compliment. ”

"And if patients with acute abdominal pain are not treated in time, the mortality rate is also very high. Then today I and you will all have a human life on our backs. Therefore be hasty and careful. ”

It is this simple sentence that puts a lot of pressure on these people. The originally relaxed face also tensed.

They are not Chu Ding, and they also know that what Liu Banxia said is completely correct. If you really can't tell the cause of acute abdominal pain, the only thing you can do is open or laparoscopic exploration.

But if you do that, it's also dangerous.

Surgery is inherently dangerous, and such operations have brought harm to patients. If the cause is still not found after exploration, medical disputes may be filed.

"Mr. Liu, is the pressure on them too much? Xu Hui, who came over, asked.

"There's no pressure and there's no motivation, I'm just helping them shorten the time it takes to get into the groove. You heard it just now, do you have any opinions?" asked Liu Banxia.

Xu Hui shook his head, "I can't judge it either, let's wait for the CT results to come out and see." At present, the most likely pain is cholecystitis, but there is a deviation in the nerve conduction process. ”

"Like many people with acute appendicitis, the pain starts around the navel and then slowly moves to the McNus point. Nerve interlacing in the abdominal wall, although rare, should also occur. ”

"But even if there is a deviation in conduction, if there is acute cholecystitis, the deviation is too far, right?" Liu Banxia said with a wry smile.

"Now I don't think there should be any problem with either the appendix or the gallbladder, and the only thing that can be done is other organs. I wonder if it's a problem with the colon?"

"Let's look at the CT results first. Didn't you see any suspicious lesions when you scanned it just now, so you really have to do a barium swallow or gastrointestinal endoscopy. However, in general, if the CT scan does not detect it, it is a headache. Xu Hui said.

Liu Banxia nodded, although the instrument examination is more precise, but not all diseases can be detected. Because the instrument inspection has accuracy requirements, it can't be checked beyond the range he can inspect.

What can be done is to do more different inspections and corroborate each other.

At this time, it will often cause patients to misunderstand, thinking that the patient is being slaughtered as a pig, and one more examination will give the hospital more income.

"How are you discussing?" Liu Banxia came to the intern's side again.

The answer he got was the same as what he had discussed with Xu Hui just now, and he could only wait for the CT to come out before making a judgment, and the data he currently had was not enough to support a judgment.

However, the patient's abdominal pain and fever can also prove that there is inflammation in the patient's abdominal cavity.

Qu Feng, who was not far away, also filmed the discussion they had just had with each other, and the specific situation was not clear, but she knew that now Liu Banxia and they were encountering a problem, that is, an incurable disease.

The waiting time is a bit painful, and the patient's condition is still unknown. But this unknown is accompanied by a dangerous unknown.

The CT results came out, and it only showed that the patient's gallbladder was in some condition. For the rest of the organs, no problems were found.

"How are you feeling now?" Liu Banxia asked the patient who had been transferred back again.

"It still hurts, and then I'm still a little nauseous, I don't know if it hurts. The patient said with difficulty.

"Do you have nausea now?" did you start to hurt?" asked Liu Banxia with a frown.

"I just had a CT scan, and it hurt yesterday. The patient said.

Now the patient's face has become much worse, and under the long-term pain and torture, the taste is not so easy to bear.

Liu Banxia's heart "chuckled" suddenly, because he thought of a very bad possibility, that is, the patient was indeed a gallbladder perforation caused by cholecystitis.

Because the perforation is very small, neither ultrasound nor CT can be seen. If the leaking bile moves and flows to the location of the appendix, does it explain the symptoms of right lower quadrant pain?

The pain in the other place has always reminded him that today's case is not simple.

Now the patient has increased the feeling of nausea, which is now very consistent with the indication of acute cholecystitis. And the blood test results showed that the white blood cells were slightly higher.

In order to finally determine whether it was acute cholecystitis, Liu Banxia stood on the patient's right side and used his left thumb to compress the abdominal wall at the junction of the outer edge of the right rectus abdominis muscle and the right costal arch.

"Come, take a deep breath. Liu Banxia said.

According to Liu Banxia's instructions, the patient took a deep breath, and then Liu Banxia and the others were a little dumbfounded.

The test that Liu Banxia did just now is called Murphy's sign, just like the rebound pain of the McLacer's point, which is the first weight of appendicitis, the Murphy sign test is a rapid examination for acute cholecystitis.

Pain can be caused by touching the thumb pressed hard when the gallbladder, which is inflamed during inhalation, moves downward. It is a severe pain, and the inhalation will definitely be interrupted by the severe pain, which is a positive Murphy sign.

And what about the patient just now, he inhaled and inhaled smoothly, inhaled and exhaled in one breath, and there was no response.

This turns back to the fact that the indications are not so clear. The only basis that can support acute cholecystitis is speculation. But there are many grounds to disprove this speculation, is Murphy's sign negative?

"Doctor Xu, I thought about it just now, is it possible that a perforated gallbladder will not bring too much inflammation to the gallbladder?

"It's an idea, but it's not so certain. Xu Hui frowned and thought for a while and said.

"If there is a perforation, even if it is a very small hole, the inflammation will be very strong. Unless it is a perforation caused by an external cause, such as a puncture wound. ”

"And this patient has been in pain for a long time, right? How much bile would have to leak out if there was a hole leaking for such a long time? ”

"It's strange how come all the conclusions are contradictory? Now I also tend that the cause is not the gallbladder. But the rest of the possibilities, I can't think of yet. ”

"Did you do anything yesterday before the pain? Just the pain after eating?" Liu Banxia asked the patient again.

"I didn't do anything, I just had a square dance with everyone after dinner. It didn't hurt at first when I got home, but it hurt after resting on the sofa for a while. The patient said, and the expression on his face became worse.

Liu Banxia closed his eyes and took a deep breath, he needed to calm down his mood and combine the information provided by the patient to judge.

From the CT scan, it can be seen that the only suspicious organ in the abdominal cavity is the gallbladder. However, after the examination just now, the indication for cholecystitis is negative. Even the gallbladder perforation he boldly suspected, is not in line with the current patient's condition.

If the pain is not caused by the internal organs of the abdominal cavity, what is the cause of it?

"Doctor, it hurts up there, too. Liu Banxia was still thinking about it, and the patient shouted.

Liu Banxia hurriedly pressed it, and this time the patient's pain was obvious. I did the Murphy sign again, and heckly it turned positive.

"Doctor Xu, have you been sluggish for such a long time?" Liu Banxia looked at Xu Hui.

Xu Hui shook his head, "I haven't encountered it in my medical experience. Do you want to find someone else for a consultation?"

Liu Banxia did not speak, but re-examined the patient's abdomen. In the current situation, the patient has a pain response after compression on the right side of the abdomen. This also means that the patient's condition has changed and become more severe.

Thinking about it, Liu Banxia's head flashed.

"Brother Xu, do you think it is possible that it is primary omentitis? With the spread of inflammation, it causes the spread of the pain area? Because the patient's pain point is not metastasizing, but spreading. Liu Banxia said.

"And now the patient's abdominal muscles are as tense as they were when they were present, and they don't stiffen too much. Such a divergent pain seems to be the only one that meets this. ”

Xu Hui was stunned for a moment, "Damn, it really may be that there is something wrong with the omentum." If it's really a large omentum, the instrument can't detect it at all. ”

Hearing Liu Banxia and Xu Hui say this, Liang Xiaolin and their group were all invigorated. Although this is just Liu Banxia's bold guess now, it seems to be very reliable.