Hello, Chief Xia, "Zheng Ren answered the phone and said.
Ever since he had helped the gastroenterology department with a few patients, Department Chief Xia had recognized Zheng Ren's capabilities.
After that, when Chief Xia encountered a problem, she habitually began to look for Zheng Ren to take a look. Given her temper, it was very difficult for her to do this.
"Chief Zheng, I have a patient here. Can you help me take a look?" Chief Xia said.
As expected, Zheng Ren did not care. He just wanted to take a look. What could be the big deal?
Moreover, as his skill tree progressed, he would also need to see more patients and accumulate more clinical experience.
After greeting Zhong Min, who was on duty in the emergency ward, he made his way to the gastroenterology department.
The emergency consultation required him to arrive within five minutes. However, there was no time limit at all for this kind of consultation where the chief used his personal connections. What he relied on was a favor. Chief Xia's words were not urgent, so there was no need for Zheng Ren to rush over.
When he arrived at the gastroenterology department, he glanced at the doctor's office but did not see Chief Xia, so he went straight to the chief's office and knocked on the door.
"Chief Zheng, you're here." Chief Xia was reading films on the computer. When she saw Zheng Ren enter, she stood up and greeted him.
"Chief Xia, what is it?" Zheng Ren asked.
"There's such a patient. I can't make a diagnosis. I always feel that there's a problem. Can you help me take a look?" Chief Xia then pressed him to the desk and pointed at the CT scan of the upper abdomen on the computer. "You're good at reading scans. What's this?"
As Zheng Ren studied the scans carefully, Chief Xia said, "The patient complained of intermittent right upper abdominal colic and was admitted to the hospital for seven months. It flares up once a week, and each time it hurts for 1-3 days. The patient had no nausea, vomiting, fever or jaundice when in pain.
The first episode of abdominal pain.
A month ago. "
"Okay." Zheng Ren slid the mouse wheel with his right hand and looked at the films carefully as he asked.
"Before admission, there will be an ultrasound." Department Chief Xia was very familiar with the work. She was also very attentive to this patient who had a headache. She did not need to look at the list to assist in the examination. She said casually, "The abdominal ultrasound shows that there is a fold in the upper part of the gallbladder. There are no gallstones and the gallbladder wall is slightly rough. No dilatation of intrahepatic and extrahepatic bile ducts. The diameter of the common bile duct is approximately
mm。”
"Folding?" Zheng Ren muttered.
The fold of the gallbladder shown on the ultrasound was not literal. It was folded like origami.
Gallbladder folding refers to the folding of the mucosa of the gallbladder.
It was more common in patients with chronic cholecystitis, and some of them were congenital developmental abnormalities. If there were any symptoms, it would be some symptoms of the digestive system. For example, flatulence.
Moreover, the patient's gallbladder wall was slightly rough, which could be diagnosed as cholecystitis.
"After admission, he was given anti-inflammatory treatment with ceftriaxone. Ten days later, the pain improved significantly, but a CT scan of the upper abdomen revealed calculus." Department Chief Xia was a little confused and frowned.
Initially, the patient's symptoms had improved and he should have been discharged.
Out of caution, Chief Xia performed an upper abdominal CT scan before the patient was discharged.
Unexpectedly, the CT scan showed that the patient's condition had not improved but had worsened! The inflammation improved slightly, but gallstones appeared in the gallbladder.
However, the patient's symptoms did not worsen. Instead, he was alive and kicking, clamoring to be discharged.
It was not common for a patient's self-reported symptoms to contradict the clinical examination. It had to be treated with caution every time.
He flipped through the CT scans of the upper abdomen frame by frame and stopped asking Chief Xia about the patient's condition.
Everything that needed to be said had been said. Nothing else was important.
Chief Xia noticed that Zheng Ren looked at the folded gallbladder for a few more seconds before continuing.
Five or six minutes later, Zheng Ren finished looking at the scans and said, "Chief Xia, the patient should not have been diagnosed with cholecystitis."
"Huh?" Chief Xia was stunned.
Was he going to overturn the original diagnosis? Was there a need to be so direct?
However, Chief Xia did not refute. She was ready to listen to Zheng Ren's explanation.
However, Zheng Ren did not explain. Instead, he stood up, smiled, and said, "Let's do an MRCP."
"Is it necessary?" Chief Xia was puzzled.
"Let's take a look at the patient. If I'm not wrong, this patient should be a rare double gallbladder patient."
"…"
"The CT scan can only be guessed. It'll be clear at a glance if we do an MRCP." Zheng Ren suddenly thought of something and asked, "The patient's family has no financial problems, right?"
"It's fine …" Chief Xia said.
"If the financial conditions allow it … Forget it, we'll do a three-dimensional reconstruction of the MR while doing the MRCP. The patient has no symptoms now. It's better to do a careful examination so that we can decide how to perform the surgery, "Zheng Ren said. "The MRCP may have artifacts. It's impossible to determine whether the two cystic ducts merged into the common bile duct after fusion or independently.
After making a clear judgment, based on the gallbladder deformity
Classification, belonging to
Type or
Type variation, so that we can determine the surgical method for the patient. "
Chief Xia was sweating.
The purpose of looking for Zheng Ren was to determine why the patient's upper abdominal pain symptoms had eased, but the examination revealed gallbladder stones.
She did not expect Zheng Ren to directly pull out the double gallbladder deformity without saying anything about this at all?
Chief Xia almost vomited a mouthful of blood.
However, when she saw that Zheng Ren was serious, she also had some doubts.
However, the problem was that the double gallbladder deformity … Even Chief Xia, an old clinical chief, had never seen it before.
Zheng Ren saw that Chief Xia did not move and had no intention of seeing the patient with him at all. He was a little strange but immediately came to a realization.
"Chief Xia, gallbladder stones have nothing to do with the double gallbladder deformity," Zheng Ren said with a smile. "There are indeed silt-like stones in the patient's gallbladder. If you stop using ceftriaxone, it'll be fine in three to five days."
"Huh?" Chief Xia was confused.
"After using ceftriaxone, reversible cholestasis symptoms occur. The reason is that the calcium salt metabolite of ceftriaxone that enters the bile easily precipitates in the gallbladder, forming a 'stone nucleus' and inducing cholelithiasis," Zheng Ren said. "If you don't believe me, you can look at the instructions for ceftriaxone. There are complications in this area."
"Then … What exactly is wrong with this patient?" Chief 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 the drug is stopped. It's also known as drug-induced gallbladder stones. "
"Drug-induced gallbladder stones?"
"For example, contraceptives, ceftriaxone, non-steroidal anti-inflammatory and analgesic drugs, intravenous high-nutrition drugs, and dipyridamole can all cause drug-induced gallstones," Zheng Ren said.
"How do you know?" Chief Xia asked.
"In the surgery department, there was once a diagnosis of gallstones. In the end, after the surgery, there was nothing in the gallbladder. Some, it was fooled; some, the family refused to let it go, and it became a medical accident. That's why I did more research in this area. "
Chief Xia knew that Zheng Ren's standard was not bad, but she did not expect it to be so high.
She picked up the phone and said, "Chief Zheng, wait a moment. I'll ask Chief MRI Wang."
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