MTL - Since 1981 Health School-Chapter 449 Doctors from both countries disagree

  Chapter 449 The doctors of the two countries have differences

  Yi Zewen continued to do the physical examination. When he pressed his hand on the abdomen, he found that there was obvious tenderness in the right lower quadrant.

  Here is the McBurney's point, which is the tenderness point of the appendix. The appendix is ​​usually hidden underneath. The tenderness here is obvious. Most of them mean that the appendix below is inflamed, and even invaded the local abdominal wall.

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

  Bowel sounds are slightly more active, but there are no obvious hyperactive bowel sounds. If the bowel sounds sound active or even hyperactive, it may indicate a bowel obstruction.

  So intestinal obstruction can also be ruled out.

  Yi Zewen breathed a sigh of relief when he thought of this. After all, he encountered a patient with intestinal obstruction in the middle of the night and was about to undergo a major operation, so he couldn't sleep well that night.

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

   There is a test that can assist in the diagnosis of appendicitis, called the colon inflation test.

  It is to put the patient in a supine position, use your right hand to compress the left lower abdomen of the patient, and then use your left hand to squeeze the proximal colon. The gas in the colon can be transmitted to the cecum and appendix.

  If the appendix is ​​inflamed, the pain in the right lower quadrant will intensify at this time.

  Yi Zewen's operation is as fierce as a tiger, and his movements are neat and smooth. It takes less than 10 seconds before and after.

   Just when the doctor squeezed Adem's colon with his left hand, Adem couldn't help shouting, "It hurts~~~~"

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

   Adham still has some medical knowledge, and he asked with pain: "Doctor, am I appendicitis?"

  Yi Zewen took off his gloves and replied:

   "The probability is yes, but tests are still needed for evaluation. For example, intestinal obstruction, kidney stones, gallbladder stones, etc. may be ruled out. Diseases are ever-changing. Without tests, there is no evidence, and without evidence, there is no treatment."

   "Doctor, I forgot to tell you. I have had a hernia before, and I haven't had surgery. Do you think this is the problem?"

   Adham suddenly remembered something and added a sentence.

   "Damn, this is a big signal."

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

   After all, he is a newcomer, and the organization tells his international friends every day that he must be careful when he sees a doctor, otherwise he will easily bear diplomatic responsibility and cause disputes between the two countries, so Yi Zewen is very timid.

  He was afraid that if he really made a misdiagnosis, he would be finished, so he prepared to ask carefully.

   "Sir, did you have an indirect or direct hernia before?"

   "I don't know either. It seems to be an indirect hernia. I remember hearing from the doctor. I had a lump here 2 years ago." Adem pointed to his right groin.

   "When it was severe, the yin naan was very swollen, and later it could shrink by itself. The doctor ordered the operation, but after the situation improved, the operation was not performed. It has not swelled up in the past two years."

  You may not know what a hernia is, please explain.

  Our internal organs or tissues leave the normal anatomical position and enter another part through some congenital or acquired weak points, defects or gaps, which is called hernia.

  Ordinary people are accustomed to call it "hernia" or "intestinal gas".

In our groin, there is a potential gap, because the essence passes through here and enters the vaginal cavity. If the intestines and tissues in the abdominal cavity also squeeze into this gap, run to the body surface, and even fall into the vaginal cavity, This is an indirect inguinal hernia.

  The clinical manifestations of an indirect inguinal hernia are mainly a protruding mass in the groin (the inside may be intestinal or other tissues), and there may be a little pain, and there may be no other discomfort.

  If the mass retracts automatically into the abdominal cavity without causing incarceration, it generally does not cause major problems.

  But if the mass is stuck, unable to move, or getting bigger and bigger, it may cause oppressive ischemia, and the pain will aggravate after a long time, and even ischemic necrosis, then it will be troublesome.

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

   Clinically, there is nothing to say when you encounter an indirect inguinal hernia. If you catch one, you will be operated on, and the weak place will be repaired directly, and the exit will be blocked. Naturally, you will not get sick again.

Yi Zewen carefully checked the patient's right groin area again, sweating profusely, and found that except for the tenderness of the McBurney's point in the right lower abdomen, there was no swollen mass around, and the yin pan was also in good condition without any signs of swelling. .

   "It's not like the abdominal pain caused by an indirect inguinal hernia attack," Yi Zewen said to himself.

  So he said to Aunt Hei in a firm tone: "I think the possibility of acute appendicitis is the highest. We'd better perform surgery immediately."

  Generally speaking, if appendicitis is diagnosed, unless there are contraindications, surgery can be considered. Even if you don't have surgery for the time being, you will still have surgery for appendicitis in the future.

  Acute appendicitis is to be operated on if one is caught, and the appendix will be removed, so that there will be no future troubles.

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

  The attitude of the family members was very cooperative. Anyway, appendicitis is not a serious illness, and Adem and his wife both breathed a sigh of relief.

  Chen Qi had just finished playing cards at this time, because he was worried about Yi Zewen facing "international friends" alone, so he planned to come and see for himself.

  He came to Africa because of a medical accident, so there will inevitably be shadows in his heart.

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

   "Xiao Yi, how is the situation?"

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

   "Dean Chen, no problem, a small appendicitis, a small operation is enough. Oh yes, this patient said that he had a hernia before."

  Appendicitis? hernia?

   Chen Qi's heart skipped a beat. Although these two diseases have typical symptoms, they are very easy to distinguish.

   But the problem is that if the disease is atypical, these two diseases are very easy to cause misdiagnosis, which is not uncommon in clinical practice, and it would be fun to make a mistake.

  So Chen Qi decided to check again by himself.

  Ms. Adham was dissatisfied when she saw a young doctor coming up and wanted to touch his stomach.

   "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 said anything, Yi Zewen ran over immediately:

"Ma'am, I misunderstood, this is the best surgeon in our country, he is also the double director of the International Medical Association, and the vice president of our China-Serbia Friendship Hospital. He can treat Mr. Adem, you absolutely You can rest assured."

   Adham and his wife were a little stunned for a while, thinking about such a young vice president?

  But both of them have the city, so they quickly smiled and said: "It turns out to be Dean Chen, so I will trouble you."

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

  Hehehe, the atmosphere on the scene 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 clicks on the Maishi point.

  Adham cried again.

  Chen Qi carefully inspected some groins and genitals. These places are normal and there is no abnormal protrusion. It seems that the possibility of hernia can also be ruled out.

   Just when Chen Qi thought it was a minor illness, he unconsciously pressed a circle around the Mai's point again.

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

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

  Chen Qi's eyebrows trembled, and his mood suddenly became a little excited, and he pressed his fingers repeatedly to compare the two places at the Mai's point and the inner ring mouth.

   "Sir, which of these two places do you think hurts more?"

   "A little lower, it hurts more."

  Chen Qi said to Yi Zewen at this time: "Something is wrong, it may not be appendicitis, there is something wrong with the pain point."

"What's the problem?"

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

   In this country, those who can wear a suit are obviously people of certain status. The person who asked the question was the black uncle who took the lead.

  Seeing the person coming, Mrs. Adham rushed forward, grabbed the black uncle, and said anxiously:

   "Pieter, my brother, you are finally here. Your brother-in-law has a severe stomachache. The doctor from Huaguo said it was appendicitis, but the doctor from Chen thinks there is something else wrong. Please help your brother-in-law take a look."

  The middle-aged man named Piet comforted Aunt Hei, and then walked up to Chen Qi.

   "Hello, Dr. Chen, let me introduce myself. I am Piet, a surgeon from Freetown National Hospital. I used to work in Newcastle Hospital in England. The patient is also my brother-in-law. Nice to meet you."

  Chen Qi thought, what kind of hospital is this? never heard of that. However, he also smiled and shook hands heavily: "Good evening, Dr. Piet."

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

  Chen Qi shrugged and made a gesture of please.

  I saw that Piet conducted a comprehensive abdominal examination. From a professional point of view, Chen Qi felt that he did it rigorously and seriously, and he should be praised.

  When he pressed the Max point, he found that there was obvious tenderness and rebound pain. This symptom is so typical that it is exactly the same as the textbook.

  Pieter chuckled, the meaning behind it was self-evident, but of course he didn't show it.

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

  Chen Qi has a good impression of this serious Piet. After all, these days, there are not many doctors who can do a complete visual examination as written in the textbook, so I kindly reminded him.

   "You can check the inner ring mouth."

  Pieter was a little skeptical, and pressed his hand to the inner ring, and asked, "Brother-in-law, does it hurt here?"

  It may be a change in body position, or it may be a psychological factor. Patient Adam suddenly changed his words:

   "Here, it hurts, but it doesn't hurt very much, it still hurts more here," he still clicked on the Mai's point.

  Pieter looked at Chen Qi and said seriously: "Doctor Chen, do you have B-ultrasound or X-ray equipment? I want to do an examination to make a clearer diagnosis."

  Chen Qi nodded. It is really difficult to make a diagnosis based on just a few pain points. Since the "foreign aid" invited by others has different opinions, it should be checked further.

   "Zhang Xing, go and call the doctors in the examination room, B-ultrasound room, and X-ray room immediately, and ask them to be on duty within 10 minutes."

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

  At this time, Yi Zewen had already noticed that there seemed to be some differences of opinion between the dean of his family and the black doctor on the diagnosis.

  He turned his attention to the patient and thought about it carefully for a long time. He thought that this Dean Chen was about to overturn. Why should such a simple diagnosis of appendicitis be so complicated?

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

  The blood test results came out, and there was nothing abnormal.

  B-ultrasound showed that the appendix was slightly enlarged, but because of gas interference, it was not clear whether there was perforation or not. At least no gallbladder stones, no kidney stones.

   Chest X-ray was completely normal. There was no free gas shadow under the diaphragm on the abdominal plain film, which meant that the abdominal pain was not caused by gastrointestinal perforation.

  Pieter put down the report card in his hand, smiled and looked at Chen Qi:

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

  Chen Qi still shook his head, facing international friends, he could only patiently explain:

"The tenderness of the inner ring mouth is obvious. I don't think this should be paid attention to. For example, the clinical manifestations of the inner ring mouth incarceration and appendicitis are very similar, but they can still be identified. For example, from the beginning of the disease to the present, the patient has not really metastatic right lower quadrant pain."

  Piet disagrees:

   "Metastatic abdominal pain, those are typical symptoms of appendicitis. It is not typical because the situation you mentioned does not occur, so there is no way to convince me based on this."

  Many Hua Guo 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, can the level be the same as you Mongolian doctors.

"There is another one. The patient had a history of hernia. What if the intestinal tube protrudes from the inner ring mouth into the inguinal canal and does not protrude from the outer ring mouth? In this way, we can't see the raised point on the surface. Misdiagnosis is often because we are too dogmatic. It must be written in the book."

   Chen Qi's words actually imply that Piet's thinking is too rigid. Whoever gets sick must follow the textbook?

"Besides, the abdominal tenderness points are also different. For example, in acute appendicitis, the McBurney's point is the most obvious abdominal tenderness point, but when the intestinal ring is incarcerated, the abdominal tenderness is most obvious at the inner ring, which is lower than the McBurney's point. This is because the intestine is only 6-8cm and folded back, so the pain is worse at the inner ring, and it is combined with discomfort in the inguinal canal."

  As soon as Chen Qi finished speaking, the surgeons at the scene nodded slightly again, apparently feeling that the dean's deduction made sense.

  But Piet was obviously impatient.

  (end of this chapter)