Chapter 206 Patients with long-term right lower quadrant pain

In the next few days,

Zhou Mo began to cycle from gastroenterology, outpatient clinic, emergency endoscopy…

Senior Brother Qian Feng is very open, because Zhou Mo is really good at endoscopy.

Every patient, Zhou Mo, can handle it. He doesn’t need to do it himself at all, and he has a good rest.

It’s a pity that this good day will soon be over, because Teacher Zhang Luojia knows that Zhou Mo has learned endoscopy, so Zhou Mo is not required to go to the emergency room.

Senior Brother Qian Feng: “???”

I wipe?

Pull d ruthlessly?

Ten thousand grass and mud horses galloped past.

…

a new day,

Week 5, Monday.

Zhou Mo received a new patient.

76 beds,

The patient, male, 35 years old, named Fang Xiaozhong.

He’s a courier, a rough guy.

I usually deliver couriers every day, which is very busy, but in the past six months, I have been tossed to death by abdominal pain.

“Mr. Fang, you can just call me Doctor Zhou.”

“Hello Doctor Zhou.” Fang Xiaozhong greeted with respect.

“Can you tell me about your condition? Just a little more detail.”

“Good good.”

Soon, Fang Xiaozhong began to talk about his illness.

Since half a year ago, he has experienced repeated severe abdominal pain, mainly in the right lower quadrant.

Right lower quadrant, the first reaction is appendicitis.

Diarrhea may occasionally occur.

When I went to the hospital to see a doctor, the doctor did a consultation, physical examination, and b-ultrasound examination, the first reaction was appendicitis.

Once, twice, he didn’t want to do the operation, it was too painful.

But the third and fourth time, he was shaken and finally decided to have his appendix removed.

That is, 3 months ago, the doctor said that he had repeated abdominal pains, which was a little dangerous. If appendicitis progressed, gangrene, or even peritoneal perforation, it would be troublesome.

In the end, Fang Xiaozhong agreed to have an operation to remove the appendicitis.

result,

After the operation, the abdominal pain persisted.

And the pain is exactly the same.

At this time, Fang Xiaozhong couldn’t help but begin to suspect: the appendicitis the doctor said at the time was fake. There is no problem with the appendix at all, and I was inexplicably cut off the appendix.

Fang Xiaozhong was very angry and asked the hospital for compensation. Finally, he checked the operation records and found that the appendix was cut by mistake. The appendix was fine, and he received compensation.

However, things were still not resolved.

Abdominal pain is still recurring.

Or right lower quadrant.

In addition, it seems that I began to want to spread around the belly button, and the number of times I went to the toilet also increased.

“????”

Fang Xiaozhong was stunned.

But yesterday, because of severe abdominal pain and sweating profusely, he couldn’t bear it, so he called 120 and came to the emergency department.

Well, it’s really miserable to be single, and no one will accompany you when you are sick.

The emergency department is divided into three areas, red area, yellow area, and green area. The red area is basically the one that needs to be rescued immediately, the yellow area is also to be rescued, and the green area can be checked slowly.

He was triaged to the yellow zone by the emergency department.

The doctor in the yellow district first did an electrocardiogram for him, and it was confirmed that it was not a myocardial infarction, so he was relieved.

Then I checked, no hard stomach, not acute peritonitis.

Then the patient’s abdomen was checked. There was tenderness in the entire abdomen, but the tenderness in the right lower quadrant was the most obvious, and the abdominal muscles were still soft overall.

Then again no shock.

On the ECG monitoring, blood pressure, heart rate, blood oxygen saturation, etc. were measured, everything was normal, only the blood pressure was a little higher, but the pain will cause the blood pressure to rise, so there is no ‘major problem’.

Given that the vital signs are still stable,

The emergency doctor arranged him to the yellow zone for observation.

The right lower quadrant is the main lesion, and peptic ulcer, or even perforation, is generally considered.

If the appendix is ​​not removed, appendicitis is the main concern.

Then arrange for abdominal b-ultrasound and chest and abdomen X-ray to do it again,

Blood draw, blood routine check, liver and kidney function, electrolytes, coagulation, two pancreatitis, etc.

soon,

The results of the inspections came out.

There were no obvious abnormalities in the liver, gallbladder, pancreas and spleen.

X-rays of the chest and abdomen were also undetectable and did not support gastrointestinal perforation.

B-ultrasound also did not find cholecystitis, hepatitis, liver abscess and so on.

Both pancreatitis and pancreatitis are normal.

Blood routine, that is, the white blood cell count is a little high.

Emergency doctor: “…………”

I’m so hard jpg

then,

Send it to a gastroenterologist.

It was accepted by Zhou Mo.

…

before the bed,

“Is everything normal?”

While listening to the patient’s statement, Zhou Mo opened the patient’s various examination results.

read it again,

Sure enough, there is no exception.

Can’t see any problem.

However, there must be a special reason for the patient’s repeated abdominal pain for six months.

“Why don’t you do a colonoscopy…”

Zhou Mo said.

At this time, colonoscopy is undoubtedly the most direct and intuitive.

The problem can be found with the greatest probability.

Of course, you can also do CT to see if there is any tumor or the like.

At the same time, keep a stool routine to see if there is anything. Of course, this possibility is very small, because the patient Fang Xiaozhong has been to the hospital too many times, and the stool has been left many times, but no reason has been found.

However, most hospitals will not use each other’s inspections (which will involve accountability issues), so they still need to re-examine.

“Doctor, that’s all for my condition.”

“Okay, did you bring your appendicitis and surgery last time? At present, it cannot be ruled out that the surgery was unsuccessful, resulting in the pain of adhesion or something.”

“There are some.”

He quickly took out a stack of documents from his schoolbag and gave it to Zhou Mo.

“In addition, I’m going to give you a colonoscopy, so it’s best for you to fast today, and then take laxatives to clear your bowels… The specific nurse will explain to you later…”

“Enteroscopy?”

“Yes, there’s a pipe poking through your steel door…”

“…”

The patient Fang Xiaozhong suddenly felt the chrysanthemum tighten.

…

The next day, in the afternoon,

Zhou Mo took the patient Fang Xiaozhong to the endoscopy center and gave him a colonoscopy.

Zhou Mo can do the surgery himself this time, and he doesn’t need the help of colleagues from the Endoscopy Center.

“Zhou Mo, will you be able to do endoscopy?”

“Is it ripe?”

“Do you want to help?”

Several doctors gathered around curiously.

Zhou Mo naturally refused their help.

soon,

The patient Fang Xiaozhong put on a good posture, and then felt the chrysanthemum tighten, and felt that he was not pure.

Once the colonoscope is in, it passes through the **** (up) and then into the sigmoid colon. (Both in the lower left abdomen.)

very slow,

Zhou Mo looked carefully and found nothing special.

Then (up) through the descending colon (left abdomen), but also not found.

Then (to the left) through the transverse colon (upper abdomen), still not found.

Then (down) through the ascending colon (right abdomen),

(Digestive System Diagram)

This time,

Problem found.

Ascending colon mucosa, severe inflammation!

And some ulcers formed!

And the location, not in the location of the appendix surgery.

The colonoscope continued to advance and came to the ileocecal area.

A more serious ulcer appeared in front of Zhou Mo.

Zhou Mo thought about it, took a little bit, and sent it for a biopsy.

Colonoscopy done,

“I’m going to ~www.readmtl.com~ so soon?”

“It’s very fast.”

“Zhou Mo, did you grow up eating Shennong 9+9? How come you are so familiar with colonoscopy?”

Under the ‘shocked’ eyes of many doctors in the gastroscope center,

Zhou Mo took Fang Xiaozhong away from the endoscopy center, leaving a handsome back.

on the way,

Zhou Mo thought about the illness of the patient Fang Xiaozhong.

“Crohn’s disease?”

Crohn’s disease (written earlier) is a chronic intestinal inflammation that can occur from the oral cavity, anus, and the entire digestive tract. The most common predisposing sites are the ileocecal and small intestine. Its main clinical The performance is abdominal pain, abdominal mass, fistula formation, intestinal obstruction.

Although Zhou Mo couldn’t see the location of the small intestine, but the ileocecal area was so serious, maybe there was also the small intestine.

Just got back to the ward,

Zhou Mo checked the test results.

A new result came out:

ppd test – strong positive!

.

This doctor is amazing https://