Hello, Director Xia. Zheng Ren answered the phone and said.

Since treating several patients to the Department of Gastroenterology, Director Xia has clearly recognized Zheng Ren's level.

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

"Mr. Zheng, I have a patient here, could you please come and take a look?" said Director Xia.

Sure enough, Zheng Ren doesn't care, take a look, what big deal can be.

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

After saying hello to Zhong Min, who was on duty in the emergency ward, Zheng Ren went to the gastroenterology department.

Emergency consultation is required to be within five minutes. But like this kind of consultation of the director's private relationship, there is no time limit at all, and it is a human favor. Director Xia's words are not in a hurry, and Zheng Ren has no need to rush over.

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

"Mr. Zheng, here. Director Xia was reading the film on the computer, and when he saw Zheng Ren coming in, he stood up and said.

"Director Xia, what's the matter?" Zheng Ren asked.

"There is such a patient, I am not sure of the diagnosis, I always feel that there is a problem, you help me to take a look. Director Xia then pressed Zheng Ren to his desk, pointed to the upper abdominal CT on the computer and said, "You have a high level of reading, what is here?"

Zheng Ren watched the film carefully, and Director Xia said on the side: "The patient complained of intermittent colic in the right upper quadrant and was admitted to the hospital for 7 months. Pain occurs 1 time a week for 1-3 days each time. The patient has no nausea, vomiting, fever, or jaundice in pain. The last 1 episode of abdominal pain was before 1 month. ”

"Hmm. Zheng Ren slid the mouse wheel with his right hand, and asked while watching carefully frame by frame.

"Before I was admitted to the hospital, I had a B-ultrasound. Director Xia's business is very skilled, and she is also very concerned about this headache patient, and she doesn't need to look at the list for auxiliary examinations, so she said casually: "Abdominal ultrasound shows that the middle and upper part of the gallbladder is folded, there are no gallstones, and the gallbladder wall is slightly rough." The intrahepatic and extrahepatic bile ducts are not dilated, and the common bile duct is about 3 mm in diameter. ”

"Fold?" Zheng Ren mused.

The gallbladder folded shown by ultrasound is not taken literally, it is like origami folding the gallbladder.

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

It is more common in patients with chronic cholecystitis, and some are congenital developmental abnormalities. If there are symptoms, it is a manifestation of some digestive system. Such as flatulence, etc.

In addition, the patient's gallbladder wall is slightly rough, which can be diagnosed as cholecystitis.

"After being admitted to the hospital, ceftriaxone was given anti-inflammatory treatment, and the pain improved significantly after 10 days, but the upper abdominal CT showed stones. Director Xia was a little puzzled and frowned.

Originally, the patient's symptoms improved and he should have been able to be discharged.

Out of an abundance of caution, Director Xia performed an upper abdominal CT before the patient was discharged.

Unexpectedly, the CT scan showed that the patient's condition did not reduce, but worsened! The inflammation improved slightly, but stones appeared in the gallbladder.

However, the patient's symptoms did not worsen, but he was lively and noisy and discharged from the hospital.

This kind of patient-reported symptoms are contrary to clinical auxiliary examinations, which is uncommon, and should be treated with caution every time.

Zheng Ren flipped through the CT films of the upper abdomen frame by frame, and no longer asked Director Xia about the patient's condition.

Everything that needs to be said has been said, and nothing else matters.

Director Xia noticed that Zheng Ren looked at the position of the bladder folded for a few more seconds, and then he looked at it again.

Five or six minutes later, Zheng Ren finished watching the film and said, "Director Xia, patients should not be diagnosed with cholecystitis. ”

"Huh?" Director Xia was stunned for a moment.

Is it possible to directly overturn the most primitive diagnosis?

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

But Zheng Ren didn't explain, but stood up, smiled, and said, "Be an MRCP." ”

"Is it necessary?" Director Xia wondered.

"One look at the patient, if I'm not mistaken, this patient should be a rare double gallbladder patient. ”

“……”

"CT films can only be guessed, and doing an MRCP is clear at a glance. Zheng Ren suddenly remembered something and asked, "Is there no problem with the patient's family's finances?" ”

"It's okay......," Director Xia said.

"If the economy allows...... Forget it, when you do MRCP, you can do an MR 3D reconstruction by the way. The patient is now asymptomatic, and the examination should be done carefully to decide how to do the surgery. Zheng Ren said: "MRCP may have artifacts, and it is impossible to tell whether the two cystic ducts are fused and merged into the common bile duct or independently.

Once the diagnosis is clear, the Harlaftis classification of the gallbladder malformation, which is a variant of type 1 or type 2, can determine the surgical procedure for the patient. ”

Director Xia Khan.

She approached Jeong-in to determine why the patient's epigastric pain had eased, but the examination revealed gallstones.

I didn't expect Zheng Ren to say anything about this at all, and directly pulled out the double gallbladder malformation?

Director Xia almost didn't vomit out a mouthful of old blood.

But when she saw that what Zheng Ren said was serious, she was also a little suspicious.

But the problem is that the double gallbladder is malformed...... Director Xia, even if he is an old clinical director, has never seen it.

Zheng Ren saw that Director Xia didn't move, and he didn't want to see the patient with him at all, which was a little strange, but then he woke up.

"Director Xia, gallbladder stones have nothing to do with double gallbladder malformations. Zheng Ren said with a smile, "The patient did have sediment-like stones in his gallbladder, and he stopped ceftriaxone, and he was fine after three or five days." ”

"Huh?" Director Xia was confused at this moment.

"Reversible cholestasis symptoms occur after the application of ceftriaxone, because the calcium salts of ceftriaxone metabolites that enter the bile are easy to precipitate in the gallbladder and become "stone nuclei", inducing cholelithiasis. Zheng Ren said, "If you don't believe it, you can take a look at the instructions for ceftriaxone, which has complications in this regard." ”

"That'...... What is wrong with this patient?" Director Xia was puzzled.

"Double gallbladder malformation, this one is more serious. The gallbladder sediment-like stones caused by ceftriaxone can disappear after a period of time after stopping the drug, and are also called drug-induced gallstones. ”

"Drug-based?"

"For example, contraceptive pills, ceftriaxone, non-steroidal anti-inflammatory analgesics, intravenous hypertrophic drugs, and dipyridine may cause drug-induced gallstones. Zheng Rendao.

"How do you know?" asked Director Xia.

"Surgery, I once diagnosed gallstones, but after surgery, I found that there was nothing in the gallbladder. Some of them are fooled, and some of them become medical accidents if their families do not give up. So I'm looking a little bit more into that. ”

Director Xia knew that Zheng Ren's level was good, but he didn't expect the level to be so high.

She picked up the phone and said, "Mr. Zheng, wait a minute, I'll ask Director Wang of NMR." ”

Sogou reading website: