Chief Zhou, the patient has pain on the left side of her waist. White blood cells and red blood cells are present in the urine routine. High density shadows can be seen near the left two to three lumbar vertebrae on the upright abdominal plain film. " The doctor on duty looked tired and instinctively reported the patient's history. "The patient doesn't agree to be hospitalized. Give him antispasmodic and analgesic treatment."
"The effect isn't good?" Zhou Litao asked.
"It's alright. The self-reported pain has eased, but I think it's still hurting. I tried to persuade him twice, but he refused to stay in the hospital. "
"How was the physical examination?"
"The percussion pain on the left side of the waist is obvious, and so is the right side." The doctor on duty went to the resuscitation room and showed Zhou Litao the patient's X-ray.
The radiographic films were inserted into the radiographic film viewer. A high-density shadow of about 1.5 cm in diameter near the left 2-3 lumbar vertebrae was very conspicuous.
Under normal circumstances, peritoneal dialysis and abdominal plain film were the more common means of diagnosis of urinary calculi.
This patient's situation was very typical, but when Zhou Litao looked at the scan, he recalled what the doctor on duty had just said.
The pain on the left side was obvious, as it should be.
However, the right side of his waist also had a knocking pain. It was possible that it was transmitted over. However, Zhou Litao still felt that something was wrong. He turned his gaze to the film on the film viewer.
He carefully looked at the upright abdominal plain film and did not see any stones in the right ureter. As for the lower part near the kidney, it was not something that could be seen clearly on the X-ray.
One examination confirmed that it was a left ureteral calculus. According to normal diagnosis and treatment procedures, no other examinations should be done.
Otherwise, who would be able to bear being accused of overtreatment?
So be it. It was probably because of the cold weather that the ureter was convulsing, causing the pain to be unable to be relieved. Zhou Litao removed the films and put them into the bag. He was a little hesitant during the whole process.
He was still thinking about the positive signs from the physical examination.
Early in the morning, it was the most leisurely time in the Emergency Department. Zhou Litao brought the scans to the resuscitation room and started asking about the patient's medical history.
The patient and the patient's family members described the course of the disease.
There was nothing noteworthy. It was just that he slept early last night and left the window open. In the end, the temperature dropped in the middle of the night, and the left side of his waist started to hurt.
At first, she thought she had caught a cold, so she closed the window and went to the bathroom.
Unexpectedly, the pain was getting worse and worse, and she almost fainted on the toilet bowl. Only then did the patient wake up his family and send him to the emergency department of the 912.
Urolithiasis was a disease that was neither serious nor light. Although the patient was in great pain, he had a friend who had done extracorporeal lithotripsy. He had described the process of extracorporeal lithotripsy to him.
The strong sense of fear made him refuse to be hospitalized for extracorporeal lithotripsy and other treatments without hesitation. He only stayed in the Emergency Department to receive symptomatic treatment and observe the changes in his condition.
Actually, it was true. When other people talked about diseases, they were all clear and logical. After all, there were a lot of things that could not be understood by others.
Fear was a normal emotion, as long as it did not affect normal diagnosis and treatment.
Zhou Litao carefully performed a physical examination on the patient.
His left hand pressed on the patient's left waist, and his right hand gently tapped the back of his left hand.
"It hurts," the patient said with a pained expression, frowning and gritting his teeth.
Zhou Litao then asked the patient to change his position and began to percussion on the right side of the waist.
His right hand tapped the back of his left hand lightly. Unexpectedly, the patient screamed, and his body began to tremble. His back arched even more.
"Doctor, be gentle, be gentle." The patient's wife felt her heart clench and almost cried.
"Does your left side hurt or your right?" Zhou Litao asked doubtfully.
"My left side hurts." The patient's voice had changed because of the pain.
"Then how do you feel if I tap your right side?"
"My entire stomach hurts. I can't stand it … Doctor, don't knock me anymore. It's really killing me once," the patient said with a sad face.
His face was a little pale. Zhou Litao guessed that it was caused by the pain. It did not seem like he was faking it, and the transmitted pain did not seem to be so severe.
It was strange that the patient felt pain on his left side. The X-ray in the upright position also proved this. However, during the physical examination, Zhou Litao had an illusion that the patient had a problem with the right urinary tract.
It was not very common for this kind of physical examination to not match the symptoms and clinical examination.
Zhou Litao covered the patient's clothes and asked about his family history, past history, and a series of other information before leaving with a stomach full of doubts.
There was nothing worth paying attention to. Zhou Litao wanted to check again to see if he had missed anything. In the end, the patient almost cried and begged him not to do a physical examination.
Ever since the last time he met the girl with abdominal epilepsy for 16 years, Zhou Litao had made family history a must be asked.
Clinical diagnosis and treatment were like this through the accumulation of experience and growth bit by bit.
There were no problems with the patient's family history and past history. There was a family history of high blood pressure, but he did not have high blood pressure.
Zhou Litao thought hard and quickly made up his mind. He communicated with the patient and the patient's family and prepared to do a B-scan to confirm.
The patient's family agreed. After all, the pain was slightly relieved after using the medicine, but it was not very obvious.
Moreover, between the two options of spending money and a physical examination, the patient almost did not hesitate to choose to spend money for another examination.
Logically speaking, as long as the stone was stuck in the ureter, the pain would not change much. He still had to drink a lot of water and exercise vigorously to let the stone fall out.
The pain was a little strange. Zhou Litao's doubts had not been explained.
The wheelchair pushed the patient to the examination. He twisted his body in the wheelchair and looked weak, as if he only had half a life left.
Zhou Litao was used to seeing such patients, but he could not empathize. His mind was filled with the fact that the physical examination did not match the symptoms and imaging data.
Was it some strange disease?
If it did not work, he would pull Chief Yu from the Department of Genitourinary Surgery down for a consultation. Zhou Litao decided to make a big deal out of it. Even if Chief Yu was unhappy, he had to make a clear diagnosis.
Soon, the patient came back with a report in his hand.
The patient's family was a little confused and even a little unhappy.
"Let me take a look at the report." Zhou Litao went forward and asked for the report.
"Doctor, why did the ultrasound say that there was a problem on the right side? Did it wrong? "the patient's family asked.
Zhou Litao's heart skipped a beat.
The right side? That was consistent with a physical examination. But the X-ray and the patient's self-described symptoms …
He immediately looked at the ultrasound report.
The right kidney was hydronephrosis, and a stone about 2 cm was found near the ureter in the right kidney. However, there was no problem with the left kidney and ureter at all.
MD！ Zhou Litao's hands began to tremble as he held the report.
He said that there was a problem, but the clinical examination contradicted each other. What was the reason?
Was there no problem on the left side? Then what was the high-density image beside the left 2-3 lumbar vertebrae? It looked like the image of a stone!
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