Yi Zewen continued to do a physical examination, and when he pressed his hand to his abdomen, he was indeed tenderness in the right lower abdomen with obvious tenderness.

This is the McCere's point, that is, the tender point of the appendix, which is usually hidden below the appendix, and the tenderness here is obvious, which mostly means that the appendix below is inflamed, and even violates the local abdominal wall.

Out of a sense of responsibility, Yi Zewen also took out a stethoscope and listened to the bowel sounds.

Bowel sounds are slightly more active, and there are no significantly hyperactive bowel sounds. If bowel sounds active or even hyperactive, it means there may be an intestinal obstruction.

Therefore, intestinal obstruction can also be ruled out.

Yi Zewen breathed a sigh of relief when he thought of this, after all, he had to undergo major surgery when he encountered a patient with intestinal obstruction in the middle of the night, and he didn't sleep well this night.

Originally, Yi Zewen wanted to call the B-ultrasound doctor to do a check-up, but when he thought that the B-ultrasound doctor was a female doctor, he was tired after a busy day, so he wanted to take care of her, so he decided to do a few clinical examinations by himself.

There is a test that can help diagnose appendicitis called a colonic inflation test.

Put the patient in a supine position, press the patient's left lower abdomen with your right hand, and then squeeze the proximal colon with your left hand, so that the gas in the colon can be transmitted to the cecum and appendix.

If there is inflammation of the appendix, the pain in the right lower quadrant will worsen.

Yi Zewen operated like a tiger for a while, and his movements were smooth and smooth, with less than 10 seconds before and after.

Just when the doctor squeezed Adem's colon with his left hand, Adem couldn't help but shout, "Pain and pain~~~~"

Yi Zewen saw that the colon inflation test was positive, and he was almost certain that the appendix was inflamed.

Adem still had some medical knowledge, and asked with pain, "Doctor, am I appendicitis?" ”

Yi Zewen replied while taking off his gloves:

"Most likely, yes, but there is still a need to do an inspection to evaluate. For example, excluding intestinal obstruction, kidney stones, gallstones, etc., diseases are ever-changing, there is no evidence without examination, and there is no treatment without evidence. ”

"Doctor, I forgot to tell you, I have had a hernia before, and I haven't had surgery, do you think it will be this problem?"

Adem suddenly remembered something and added.

"Damn, that's a big signal."

Yi Zewen couldn't help but exclaim, thinking that the patient's abdominal pain was not appendicitis, but a hernia.

After all, it is a newcomer, and the organization talks every day that you must be careful and careful when treating international friends, otherwise it is easy to bear diplomatic responsibilities and cause disputes between the two countries, so Yi Zewen is very timid.

He was afraid that if he really made a misdiagnosis, it would be over, so he was ready to ask carefully.

"Sir, did you have an oblique hernia or a straight hernia?"

"I don't know, it seems to be an oblique hernia, I remember hearing the doctor say it. I had a swollen bag here 2 years ago. Adem pointed to his right groin.

"When it was serious, the naan was swollen badly, and then it could become smaller by itself, and the doctor let the operation be done, but then the situation improved and the operation was not done. It hasn't swollen again in the past two years. ”

You may not understand what a hernia is, so explain it.

When our internal organs or tissues leave their normal anatomical position and enter another part through some congenital or acquired weak spots, defects or gaps, it is called a hernia.

Ordinary people are accustomed to calling it "hernia" or "small intestine gas".

Here in our groin, there is a potential gap, because the jingshu penetrates out from here into the pubic naan, if the intestines and tissues in the abdominal cavity are also squeezed into this gap, run to the body surface, or even fall into the pubic naan, this is the inguinal oblique hernia.

The clinical manifestations of an oblique inguinal hernia are mainly a protruding lump in the groin (which may be the intestine or other tissues), a little tenderness, and there may be no other discomfort.

If the lump retracts into the abdominal cavity on its own without causing incarceration, it is usually not a major problem.

However, if the lump is stuck, unable to move, or grows larger, it may cause compression ischemia, and the pain will worsen over time, and even avascular necrosis, which will be troublesome.

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Ordinary people in Haidong Province like to call this disease "big follicle", which shows that the incidence is still quite high.

There is nothing to say about an oblique inguinal hernia in clinical practice, so if you catch one, you will have surgery, directly repair the weak place, block the exit, and you will naturally not get sick again.

Yi Zewen sweated profusely and carefully examined the patient's right groin area again, and found that except for the tenderness of the right lower quadrant, there was no swollen lump around, and the pubic naan was also in good condition, and there was no sign of swelling.

"It's not like abdominal pain caused by an onset of an oblique inguinal hernia," Yi Zewen muttered to himself.

So he said to Aunt Hei in an affirmative tone: "I think acute appendicitis is still the most likely, and we had better have surgery immediately." ”

In general, surgery can be considered for confirmed appendicitis unless contraindicated. Even if you don't have surgery for a while, it is inevitable that you will have surgery for appendicitis in the future.

Acute appendicitis is to catch one and operate on it, kill the appendix, and never suffer from it.

"Okay, okay, everything is up to you, doctor!"

The attitude of the family was very cooperative, anyway, appendicitis was not a serious illness, and Adem and his wife were both relieved.

Chen Qi had just finished playing cards at this time, and because he was not worried that Yi Zewen would face "international friends" alone, he was ready to take a look in person.

He came to Africa because of medical malpractice, and there will inevitably be a shadow in his heart.

If this causes any more trouble in Africa, it will be a proper international dispute, and Chen Qi feels that he will definitely be assigned to the Antarctic Great Wall Station.

"Xiao Yi, how's the situation?"

Yi Zewen was just writing a doctor's order, and when he saw Chen Qi coming, he shook his hair, and said with a relaxed expression:

"Dean Chen, no problem, a small appendicitis, just do a minor operation. Oh yes, the patient said he had a hernia. ”

Appendicitis? Hernia?

Chen Qi's heart suddenly sudden, although these two diseases have typical symptoms, it is very easy to distinguish them.

But the problem is that if it is atypical, these two diseases are very easy to cause misdiagnosis, which is not uncommon in clinical practice, and it is fun to get it wrong.

So Chen Qi decided to check it again for himself.

When Mrs. Adem saw a young doctor coming, and she was about to touch her belly, she was not satisfied.

"This little doctor, my husband has already been diagnosed with appendicitis, please don't repeat the examination, it will aggravate my husband's discomfort."

Before Chen Qi could say anything, Yi Zewen immediately ran over:

"Madam, misunderstanding, this is the best surgeon in our country, a double director of the International Medical Association, and the vice president of our China-Cyprus Friendship Hospital, he can treat Mr. Adem, you can definitely rest assured."

Ademu and his wife were a little stunned for a while, thinking to themselves, such a young vice dean?

However, both of them had a city government, so they hurriedly smiled and said, "It turned out to be Dean Chen, so I'll trouble you." ”

Chen Qi also smiled, "It's okay, I'm often misunderstood, I'm used to it." ”

Hehehe, the atmosphere at the scene has eased a lot.

Chen Qi is not looking for a needle in a haystack like Yi Zewen, his goal is very clear, and he directly pressed it to the Mai point at once.

Adem cried out in pain again.

Chen Qi carefully inspected some groins and pubic naan, and these places were very normal, with no abnormal bulges, and it seemed that the possibility of hernia could also be ruled out.

Just when Chen Qi thought it was a minor illness, his hand unconsciously pressed around the Mai dot again.

When he pressed to the mouth of the inner ring (2 cm above the midpoint of the inguinal ligament), suddenly Adem cried out:

"Ah, doctor, it hurts here, it hurts, ......"

Chen Qi's eyebrows twitched, and his emotions suddenly became a little excited, and he repeatedly pressed his fingers to the two places at the mouth of the inner ring to make comparisons.

"Sir, where do you feel more pain in these two places?"

"A little below, a little more painful below."

Chen Qi said to Yi Zewen at this time: "Something is wrong, it is not necessarily appendicitis, there is a problem with the pain point." ”

"What's the problem?"

At this time, the door of the rescue room was pushed open, and several black uncles in suits came in from inside.

In this country, people who can wear suits are obviously people with a certain status, and it is a black uncle who takes the lead when asking questions.

Seeing the coming, Mrs. Adem pounced at once, grabbed the black uncle, and said anxiously:

"Piette, my brother, you are finally here, your brother-in-law has a terrible stomachache, this Huaguo doctor said that it is appendicitis, but this doctor Chen thinks there is other problems, you hurry up and help your brother-in-law take a look."

The middle-aged man named Piette comforted Aunt Hei for a moment, and then walked up to Chen Qi.

"Hello Dr. Chan, I would like to introduce myself, I am Surgeon Piette at Freetown National Hospital, I used to work at Newster Hospital in England, and the patient is also my brother-in-law. Nice to meet you. ”

Chen Qi thought to himself, what kind of hospital is this? Haven't heard of it. However, he also smiled and shook his hand: "Good evening, Dr. Piette." ”

"Can I diagnose my brother-in-law?"

Chen Qi shrugged his shoulders and made a gesture of please.

I saw that Piette had a comprehensive examination of his abdomen, and from a professional point of view, Chen Qi felt that he had done a good job and was very serious, and should be praised.

When he pressed the McSs point, he noticed that there was a noticeable tenderness and rebound tenderness, which was so typical that it was exactly like a textbook.

Piette chuckled, the meaning was self-evident, and of course he didn't show it.

"Dr. Chen, I think there is no problem with my brother-in-law's condition and the diagnosis is appendicitis."

Chen Qi has a good impression of this serious Piette, after all, there are not many doctors who can do a complete visual touch and percussion physical examination as written in the textbook these years, so he kindly reminded him.

"You can check the inner ring."

Piette was a little suspicious, pressed his hand to the inner ring again, and asked, "Brother-in-law, does it hurt here?" ”

It may be a change in body position, or it may be a psychological factor, the patient Adem suddenly changed his words:

"Here, it hurts, but it doesn't hurt very much, or it hurts more here," he pointed to where he still counted.

Piette looked at Chen Qi and said seriously, "Doctor Chen, do you have B-ultrasound or X-ray equipment?" I would like to have a test to make a better diagnosis. ”

Chen Qi nodded, it is indeed difficult to say that it is necessary to diagnose the diagnosis just by relying on a few pain points, since the "foreign aid" invited by others has different opinions, then it should be checked further.

"Zhang Xing, you immediately go and call the doctors in the laboratory, B-ultrasound room, and X-ray room, and let them arrive at their posts within 10 minutes."

"Okay Dean, I'll call right away."

At this time, Yi Zewen had already seen that there seemed to be a little difference in the diagnosis between his own dean and the black doctor.

He set his eyes on the patient, and thought carefully for a long time, thinking that this Dean Chen was probably about to overturn, why should such a simple diagnosis of appendicitis be so complicated?

The doctors of the entire "China-Cyprus Friendship Hospital" only serve one patient, and the examination process is very fast.

The results of the blood draw also came out, and there was nothing too abnormal.

B ultrasound showed that the appendix was mildly enlarged, but due to gas interference, it was not very clear whether there was a perforation. At least no gallstones were seen, no kidney stones.

Chest x-ray is completely normal. Plain abdominal x-rays do not show discrete air shadows downstream of the diaphragm, which means that abdominal pain is not caused by a perforation of the gastrointestinal tract.

Piette put down the report sheet in his hand and looked at Chen Qi with a chuckle:

"Dr. Chen, it's basically clear now, and it seems that only appendicitis can explain my brother-in-law's abdominal pain, what do you think?"

Chen Qi still shook his head, and in the face of international friends, he could only patiently explain:

"The tenderness of the inner ring orifice is obvious, which I don't think should be paid attention to, for example, the clinical manifestations of intestinal annular incarceration and appendicitis are very similar, but they can still be identified. For example, from the onset of the disease, the patient has not had real metastatic right lower quadrant pain. ”

Piette disagreed:

"Metastatic abdominal pain, that's all typical appendicitis symptoms, and atypical is that you don't have the situation you said, so there's no way to convince me based on that."

Many Huaguo doctors next to him nodded slightly, obviously agreeing with the black doctor's diagnosis.

Chen Qi didn't care about everyone's attitude, and thought to himself what is called an international double director, and the level can be the same as that of you Mongolian doctors.

"Another one, the patient has a history of hernia, what if the intestinal tube protrudes from the inner ring into the inguinal canal and does not protrude from the outer ring? In this way, we can't see the bump point on the surface, and the misdiagnosis is often that we are too dogmatic and must be written in the book. ”

Chen Qi's words are actually alluding to Piet's thinking being too one-sided, and whoever is sick must be according to the textbook?

For example, in acute appendicitis, the abdominal tenderness point is most obvious at the McNus point, and when the intestinal annular mouth is incarcerated, the abdominal tenderness point is the most obvious at the inner annular orifice, which is lower than the McCereal point. This is because the intestinal tube is only 6-8 cm and folds and compresses, so the pain is worse at the inner ring orifice, and it is combined with discomfort in the groin. ”

As soon as Chen Qi's voice fell, the surgeons on the scene nodded slightly, obviously thinking that their dean's inference was reasonable.

But Piette was clearly getting impatient.