"Hello, Director Xia." Zheng Ren answered the phone and said.
After treating several patients in the Department of Gastroenterology, Director Xia clearly recognized Zheng Ren's level.
After that, when Director Xia encountered a problem, he habitually started looking for Zheng Ren to give him a slap. With her temper, it would be difficult to do this.
"Mr. Zheng, I have a patient here. Could you please come and help me?" Director Xia said.
As expected, Zheng Ren didn't care. Just take a look and see what big things could happen.
Moreover, as Zheng Ren progresses in his 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 strolled to the Department of Gastroenterology.
For emergency consultation, the requirement is that you must arrive within five minutes. But for consultations like this where the director has a personal relationship, there is no time limit at all, and it is based on human relationships. Director Xia was not in a hurry, so there was no need for Zheng Ren to rush over in a hurry.
When he arrived at the Department of Gastroenterology, Zheng Ren glanced at the doctor's office. He didn't see Director Xia, so he went straight to the door of the director's office, knocked on the door, and entered.
"Mr. Zheng, here we come." Director Xia was reading the film on the computer. When he saw Zheng Ren come in, he stood up and said.
"Director Xia, what's going on?" Zheng Ren asked.
"There is a patient like this. I am not sure about the diagnosis. I always feel that there is something wrong. Please help me take a look." Director Xia then pushed Zheng Ren to the desk, pointed to the upper abdominal CT scan on the computer and said, "Read the scan." The level is high, 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 abdomen for 7 months and was admitted to the hospital. The attack occurred once a week, and the pain lasted for 1-3 days each time. The patient had no nausea or vomiting when in pain. Fever and jaundice. The last abdominal pain episode was one month ago.”
"Hmm." Zheng Ren asked as he slid the mouse wheel with his right hand and carefully watched the film frame by frame.
"Before admission, there was a B-ultrasound." Director Xia was very skilled in her business, and she was particularly attentive to this patient with a headache. She did not need to read the order for the auxiliary examination, and said casually: "Abdominal ultrasound showed folding in the middle and upper part of the gallbladder, and no gallbladder stones. , the gallbladder wall is slightly rough. There is no dilation of the intrahepatic and intrahepatic bile ducts, and the diameter of the common bile duct is about 3 mm."
"Folding?" Zheng Ren pondered.
The folding of the gallbladder shown by B-ultrasound is not taken literally, it is like folding the gallbladder up like origami.
Gallbladder folding refers to the folding phenomenon of gallbladder mucosa clinically.
It is more common in patients with chronic cholecystitis, and some are congenital developmental abnormalities. If there are symptoms, they are some manifestations of the digestive system. Such as flatulence, etc.
Moreover, the patient's gallbladder wall is slightly rough, which can be diagnosed as cholecystitis.
"After being admitted to the hospital, we were given anti-inflammatory treatment with ceftriaxone. Ten days later, the pain improved significantly, but stones appeared on the CT scan of the upper abdomen." Director Xia was a little confused and frowned.
Originally, the patient's symptoms improved and he should be discharged from the hospital.
Out of caution, Director Xia performed an upper abdominal CT scan before the patient was discharged.
Unexpectedly, the CT scan showed that the patient's condition did not improve, but worsened! The inflammation improved slightly, but stones appeared in the gallbladder.
However, the patient's symptoms did not worsen. Instead, he was active and clamoring to be discharged from the hospital.
This kind of conflict between the patient's self-reported symptoms and the clinical auxiliary examination is not common, and must be treated with caution every time.
Zheng Ren flipped through the CT films of the upper abdomen frame by frame and stopped asking Director Xia about the patient's condition.
All that needs to be said is said, nothing else matters.
Director Xia noticed that Zheng Ren looked at the folded gallbladder for a few seconds, and then he continued to look at it.
Five or six minutes later, Zheng Ren finished watching the film and said, "Director Xia, the patient should not be diagnosed with cholecystitis."
"Huh?" Director Xia was stunned for a moment.
Directly overturn the original diagnosis? Is it so direct
However, Director Xia did not refute, she was ready to listen to Zheng Ren's explanation.
But Zheng Ren didn't explain. Instead, he stood up, smiled, and said, "Let's be an mrcp."
"Is it necessary?" Director Xia wondered.
"Go and take a look at the patient. If I'm not wrong, this patient should be a rare patient with double gallbladders."
“…”
"CT films can only make guesses, but an MRCP will make it clear." Zheng Ren suddenly remembered something and asked, "Is the patient's family financially okay?"
"Fortunately..." Director Xia said.
"If financial conditions permit... forget it, I will do a three-dimensional MRI reconstruction while doing mrcp. The patient has no symptoms now, so the examination should be done more carefully to decide how to perform the surgery." Zheng Rendao: "mrcp may have artifacts, so we can't Determine whether the two cystic ducts merge into the common bile duct or merge into the common bile duct independently.
After the diagnosis is clear, the gallbladder malformation is classified as a variant of type 1 or type 2 according to the Harlaftis classification, so it is best to decide on the surgical procedure for the patient. "
Director Xia sweated profusely.
The purpose of her visit to Zheng Ren was to determine why the patient's upper abdominal pain symptoms were relieved, but the examination revealed gallbladder stones.
Unexpectedly, Zheng Ren didn't say anything about this at all, but just pulled out the double gallbladder deformity
Director Xia almost spit out a mouthful of old blood.
But when she saw that what Zheng Ren said was true, she also had some doubts.
But the problem is that double gallbladder malformation... Director Xia has never seen it before even though he is an old clinical director.
Zheng Ren felt a little strange when he saw that Director Xia didn't move and had no intention of seeing the patient with him, but he soon woke up.
“Mr.
"Huh?" Director Xia was confused now.
"Reversible cholestasis symptoms occur after the use of ceftriaxone. The reason is that the calcium salt of ceftriaxone metabolite that enters the bile easily precipitates in the gallbladder, becoming a stone core and inducing cholelithiasis." Zheng Ren said, "If you don't believe it, , you can read the instructions for ceftriaxone, which lists complications in this regard.”
"Then... what is wrong with this patient?" Director Xia was confused.
"Double gallbladder deformity, this is more serious. The silt-like stones in the gallbladder caused by ceftriaxone will disappear after a period of time after stopping the drug, and they are also called drug-induced gallbladder stones."
"Drug sex?"
"For example, birth control pills, ceftriaxone, non-steroidal anti-inflammatory analgesics, intravenous hypertrophic drugs, and dipyridamole may all cause drug-induced gallstones." Zheng Rendao.
"How did you know?" Director Xia asked.
"Surgery, there have been times when gallstones were diagnosed, but after the operation, it was found that there was nothing in the gallbladder. In some cases, they were fooled; in other cases, the family members refused to forgive, and it turned into a medical accident. So I researched in this area A little more."
Director Xia knew that Zheng Ren was good at it, but he didn't expect it to be so high.
She picked up the phone and said, "Mr. Zheng, wait a moment. I'll ask Director Wang of NMR."