"Mr. Zhou, the patient has pain in the left side of the waist. The urine routine shows white blood cells and red blood cells +++. A plain abdominal X-ray shows high-density shadows near the 2-3 lumbar vertebrae on the left side." 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?" Zhou Litao asked.
"It's average. I reported that the pain has eased, but I think it still hurts. I tried to persuade him twice, but I refused to be hospitalized no matter what."
"How about the physical examination?"
"The left side of the waist has obvious percussion pain, and the right side is also quite obvious." The doctor on duty went to the emergency room and took out the patient's standing X-ray to show to Zhou Litao.
When the film was inserted into the reader, a high-density shadow with a diameter of about 1.5cm was so conspicuous near the 2-3 lumbar vertebrae on the left side.
Under normal circumstances, standing abdominal X-ray and abdominal plain X-ray are the most commonly used methods for diagnosing urinary tract stones.
This patient's situation is very typical, but when Zhou Litao watched the film, he recalled in his mind what the doctor on duty just said.
The pain on percussion on the left side is obvious, which is what it should be.
However, there is also percussion pain in the right waist, and it is possible that it was transmitted. But Zhou Litao still felt that something was wrong, and turned his attention to the film on the reader.
He carefully looked at the standing abdominal X-ray and found no stones in the right ureter. As for the lower part, close to the kidney, it cannot be seen clearly on X-rays.
After an examination, it is confirmed that it is a left ureteral stone. According to normal diagnosis and treatment procedures, no other examinations should be performed.
Otherwise, who can bear the label of excessive medical treatment
That's it, it's probably due to the cold weather and ureteral spasm, causing the pain to be unrelieved. Zhou Litao took off the film and put it into the film bag, but he hesitated a little during the whole process.
He was still thinking about the positive signs on the physical examination.
Early in the morning, the most leisurely time in the emergency department, Zhou Litao carried the film to the emergency room and began to inquire about the medical history.
The patient and his family described the illness.
Nothing worth noting, except that I went to bed early last night with the windows open. As a result, when the temperature dropped in the middle of the night, my left waist and abdomen began to hurt.
At first, I thought I had caught a cold, so I got up, closed the window, and went to the bathroom.
Unexpectedly, the pain got worse and worse, and I almost fainted on the toilet. The patient then woke up his family and sent him to the 912 emergency department.
Urinary tract stones are a serious or minor disease. Although the patient was in severe pain, he had a friend who had undergone extracorporeal lithotripsy and described to him the process of extracorporeal lithotripsy.
His strong sense of fear made him refuse in-hospital extracorporeal lithotripsy and other treatments without hesitation, and he only stayed in the emergency department for symptomatic treatment and observed changes in his condition.
In fact, when others talk about diseases, they always talk clearly. This all falls into the category of standing and talking without pain in the back. After all, there are many things that cannot be empathized with.
Fear is a normal emotion, as long as it does not affect normal diagnosis and treatment.
Zhou Litao carefully examined the patient.
His left hand pressed on the left side of the patient's waist, and his right hand gently tapped on the back of his left hand.
"It hurts." The patient frowned, gritted his teeth, and said in pain.
Zhou Litao then asked the patient to change his position and start tapping on the right waist.
The right hand gently tapped on the back of the left hand. Unexpectedly, the patient yelled, and his body began to tremble a few times, and his bow became more severe.
"Doctor, be gentle, be gentle." The patient's lover felt his heart tightening and almost cried.
"Do you have pain on the left side or the right side?" Zhou Litao asked doubtfully.
"It hurts on the left side." The patient's voice had changed its tone because of the pain.
"Then if I knock on your right side, how do you feel?"
"My whole stomach hurts, I can't stand it... Doctor, please stop knocking me, knocking me once is really fatal." The patient said with a sad face.
His face was a little pale, Zhou Litao probably thought it was caused by pain. It doesn't look like he's faking it, and the pain transmitted doesn't seem to be that severe.
Strangely, I felt pain on my left side, and the standing X-ray also proved this. However, during the physical examination, Zhou Litao was given the illusion that the patient had a problem with the right urinary tract.
This discrepancy between physical examination, self-reported symptoms, and clinical examination is not very common.
Zhou Litao covered the patient's clothes and asked about a series of information such as family history, past history, etc., and then left full of doubts.
There was nothing noteworthy. Zhou Litao wanted to check again to see if there was anything he had not noticed. In the end, the patient almost cried and begged him not to do the physical examination.
Since the last time he met a girl with abdominal epilepsy for 16 years, Zhou Litao has listed family history as a must-ask item.
This is how clinical diagnosis and treatment grow little by little through the accumulation of experience.
The patient's family history and past medical history were all correct. There was a family history of hypertension, but he did not have hypertension.
Zhou Litao thought hard and quickly made up his mind to communicate with the patient and his family and prepare to do a B-ultrasound to confirm.
The patient's family agreed. After all, the pain was slightly relieved after taking the medicine, but it was not obvious.
Furthermore, when given the choice between spending money and getting a physical examination, the patient almost without hesitation chose to spend money and get another 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 vigorously to let the stone fall out.
The pain was a bit weird, and Zhou Litao's doubts never got an explanation.
The patient was pushed in a wheelchair for examination. He was twisting his body in the wheelchair, weak and weak, as if he only had half a life left.
Zhou Litao is used to seeing this kind of patients and is not very empathetic. All he was thinking about was the inconsistency between physical examination, symptoms and imaging data.
Is this something strange
If that doesn't work, just bring Mr. Yu from the Department of Urology down for consultation. Zhou Litao decided to make a fuss out of a molehill. Even if Mr. Yu is unhappy, a clear diagnosis must be made.
Soon, the patient came back with a report sheet in his hand.
The patient's family members were a little confused and even a little unhappy.
"Let me take a look at the report sheet." Zhou Litao stepped forward and asked for the report sheet.
"Doctor, how does the B-ultrasound say there is a problem on the right side? Is it wrong?" the patient's family asked.
Zhou Litao's heart skipped a beat.
The right side? That is consistent with the physical examination. But X-rays and patients’ self-reported symptoms…
He immediately looked at the B-ultrasound report.
There was hydronephrosis in the right kidney, near the proximal end of the ureter, and a stone of about 2cm was found. However, there were no problems with the left kidney and ureter.
MD! Zhou Litao's hand holding the report began to tremble a little.
It is said that there is a problem, but the clinical examination is inconsistent with each other. What is the reason
Is the left side okay? What the hell is that high-density shadow next to the 2-3 lumbar vertebrae on the left side, which looks like a stone!