Come on, Dr. Wu

Chapter 156 Clinic Daily
The organs in the human abdominal cavity are strictly arranged.

The spleen is on the left side of the abdomen, and the hepatobiliary appendix is ​​on the right side of the abdomen. If there is general pain, the spleen should be considered on the left side, and the hepatobiliary appendix should be considered on the right side. There are also peritonitis that hurts in circles, or everywhere.

If it is around the umbilicus, that is, in the middle of the abdomen, then you need to consider the intestines and stomach.

For the gastroduodenum, you also need to look toward the umbilicus. There are many large and small intestines around the umbilicus.

"When did it start hurting? Was it here where it first started?"

Some pain will transfer, and if the location of the pain is determined, the diagnosis depends on the duration of the pain.

"The pain started last night and hasn't stopped. I even vomited several times. I tossed and turned and couldn't sleep at all. I couldn't pull it out even if I tried. It just hurts in this area. I thought it was constipation. I have diarrhea at home. Sailu, I have also used it, but it doesn’t work. Doctor, do I have enteritis? The lunch box for work lunch is cold every time I eat it. I must eat it from the box lunch, oops."

enteritis!

It didn't look like it. When Wu Xiaofu touched it, he found a hard mass that was clearly palpable. It didn't look like enteritis, with painful vomiting, swelling and obstruction, but more like intestinal obstruction.

In case of enteritis, there are no symptoms of constipation. Enteritis generally refers to small enteritis or colitis, which is basically caused by bacteria, viruses, fungi or parasites. Although people with enteritis can also have abdominal pain, the nature of the abdominal pain is not like that of constipation. This kind of colic, and because it is mostly a bacterial infection, will definitely be accompanied by diarrhea, loose watery stools, or mucus, pus and bloody stools, so enteritis is also called infectious diarrhea.

"I vomited yesterday when I felt the pain, or later. How many times have I vomited so far? What was it?"

It is not a big deal for the parts in the mouth to have broken skin, but as people are so big, if a tooth is knocked out, there is no possibility of it growing back. The only option is to get a dental implant or a filling, no matter which one it is. They are not very beautiful, and the cost is not small. For students, I am afraid it is not something they can afford.

"Is your mouth numb?"

Intestinal obstruction is actually very easy to diagnose, with pain, vomiting, distension and obstruction, and there are not many diseases with all four symptoms. Combined with physical examination, the basic diagnosis rate is more than 90%, and the nature and frequency of vomiting are very helpful in the diagnosis. Obstruction, in simple terms, means that the intestines are blocked, but how long are people’s intestines and how many types there are? It depends on where the obstruction is and how severe it is.

"What's wrong with you?"

Moreover, the hard lump in the abdomen feels like intestines, and the circulation is not smooth, which is obviously a symptom of obstruction.

"Okay, thank you doctor, we'll go right away."

As for where the obstruction is and how it is caused, we have to look at it again.

Seeing the patient hesitating, Wu Xiaofu also understood something, "Does it smell bad?"

No more questions.

"Pfft!"

"What's going on?"

"I fell down while riding my bicycle."

The next patient comes in.

"Falled?"

"Well! Now the whole mouth is numb and hurts. I always feel like there is a smell of blood when I swallow saliva. Moreover, I feel that my lips are a lot thicker and my face is still intact. Doctor, I won't be disfigured. .”

There are two openings, and you can't pull it out, so you can only spray it from the top.

The little girl's voice was waxy, and she was obviously embarrassed. Not only did she have bruises on her face, but her lips were also chipped. Wu Xiaofu moved closer and motioned for her to open her mouth.

The young man was quite stubborn, and he actually endured it for half a breath. Wu Xiaofu also shook his head.

Wu Xiaofu immediately glanced at Zheng Hua, and Zheng Hua quickly stopped talking.

The patient nodded, no wonder he had to be embarrassed. People sometimes scold people for spewing feces with their mouths full, which means they talk dirty. But after someone gets sick, they really spit feces with their mouths full. Obstruction is generally classified as high obstruction according to the location of the obstruction. With low-level obstruction, things cannot come out from below, so they naturally have to go up.

Now this patient has symptoms of constipation, but it doesn’t look like enteritis.

The young man's face turned pale. At such an old age, he naturally understood what a fracture meant. Normal maintenance was fine, but if there was a fracture, he would need surgery.

"Hiss, it hurts."

The patient nodded quickly, and those who came with him should also be his classmates and golf buddies.

After hearing the question, the girl took off the scarf under the encouraging eyes of her classmates.

I shined a flashlight on it and luckily the tooth was fine.

The first patient went out, and the next patient came in. He looked like a student, wearing a basketball uniform, but at this time there was an obvious wound on his left leg.

It was swollen and bleeding, and when I reached out to touch it, I could feel that the kneecap was incomplete.

Wu Xiaofu nodded and bent down to look.

clap clap clap!
I wrote an order to the young man and said, "Let's take a picture. It's probably a fracture."

The calling system calls the next patient.

The girl wrapped a gauze scarf around her face, which made Wu Xiaofu a little strange. She had a good figure, could there be some flaw on her face? Why did you wrap it up with a gauze scarf?

High-level obstruction is better. Basically, what is vomited is the stuff in the stomach and duodenum, such as overnight food. But low-level obstruction is different. After gastrointestinal digestion, things can hardly enter the anus and mix with feces. There is no difference. If this thing is blocked for a long time, it has to go up. Well, the patient said that the vomiting smells a bit smelly, but it is actually fecal matter.

red!
Wu Xiaofu also felt a sinking feeling in his heart. It did not mean that it was a tumor, but there were different types of intestinal obstruction. Generally, when intestinal blood supply disorder occurs, the vomit will be brown or bloody. This is already the last thing doctors want to see. After all, when this happens, it may already be accompanied by intestinal necrosis. Even if it doesn't happen now, we don't dare to delay it.

fracture!

The little girl was even more embarrassed.

"We were playing on the court. When he jumped up and dunked, he couldn't stand firm and fell directly. His knee was broken. At first, we thought it was just a broken knee, but now his knee hurts so much that it's difficult to even walk. , it doesn’t take much effort at all.”

"By the way, in addition to the smell, it's also a little red. Doctor, I can't be sick, can I?"

clap clap clap!
Typing on the computer keyboard, "Don't worry too much. We'll just treat him if he's sick. His family members are here. You can accompany him to do a few tests first, draw blood, and do a color Doppler ultrasound and CT scan of his abdomen. We'll check these first." , look at the specific situation, if it can’t be seen clearly, you may need to have an MRI and an imaging scan later, but those two are too expensive, so we will check these first, and if they don’t work, we will need to do more.”

"The pain started in the first half of the night, and the vomiting started in the second half of the night. I must have vomited two or three times before arriving at the hospital. It was vomiting, okay."

It can be heard that the little girl is very anxious. Also, she is in her prime years. If she really leaves a scar or something, anyone will be worried.

"Don't worry, the wound is just a superficial scratch. After the scabs form, don't damage them and let them fall off naturally. There should be no obvious scars on the face. As for the mouth, no stitches are needed. The wound is not deep, so you can follow Dr. Zheng to disinfect it later, and you should pay attention to your diet and other things later, so as not to irritate the wound."

After hearing Wu Xiaofu's words, the little girl finally felt relieved, "Thank you doctor, thank you doctor."

……

"Doctor, please help us take a look. The CT scan and color Doppler ultrasound say they need to see it as soon as possible. Please help us take a look."

The one who suspected intestinal obstruction came back with an anxious expression. It was obvious that the imaging department said something to them during the color ultrasound and CT scans. Wu Xiaofu took the test results. "The white blood cell count is elevated and inflammation is evident."

"The diameter of the small intestine is widened on B-ultrasound, which shows the liquid, gas and intestinal contents in the dilated intestine, which are anechoic, hypoechoic and medium-strong punctate echoes. This is not enteritis, or you may have had enteritis before, but now you have it. It has been delayed to become intestinal obstruction, and the intestinal blood supply is blocked, so we cannot delay it."

"The CT showed a mass in the obstructed segment of the large intestine, and the abdominal plain film also showed pneumatosis signs, effusion signs, and beak signs. Well, I'm afraid I need surgery."

Operation!

The patient was stunned when he heard this. He originally thought it was just enteritis. Later, he was told it was intestinal obstruction, but he didn't care. In short, it shouldn't be a serious illness, but why did he need surgery?
"Doctor, what does surgery mean? Is it to remove something blocking the intestines?"

From the patient's point of view, intestinal obstruction means that something blocks the intestines, so that the stool cannot come out. Then just take the thing out and it will be fine.

Wu Xiaofu slowly shook his head, "It's not that simple. You have not only intestinal obstruction, but also intestinal strangulation. Long-term blood flow blockage has already caused necrosis in part of the intestines, and this symptom will worsen over time." It worsens with time, so we must operate as soon as possible. Removing the obstruction is only the most basic thing. We also need to remove the necrotic part to ensure intestinal blood supply."

what!
Cut your intestines!
The patient was immediately frightened. Who would be able to accept cutting off a section of such a good thing?

"Doctor, are you kidding me?"

The patient looked at Wu Xiaofu's young face and felt a little doubtful. It was enough to cut out the gallbladder or the appendix, but now he had to cut out the intestines. Then where would he go from here?

"Our doctors don't joke with patients, so don't worry. You came here quite early. There are not many necrotic intestinal sections. After the resection, the remaining parts will be anastomotic, and the normal digestive tract will not be affected in the future." Operation."

He can also understand the patient's emotions, but the explanation must be accurate and try to dispel the patient's doubts. After all, this disease cannot be delayed. The longer it is delayed, the more necrotic intestinal segments will be, and the more disadvantageous it will be for the patient.

"Doctor, can I make a call first and make an appointment?"

Wu Xiaofu nodded, "Let's fight here!"

here!

The patient had some doubts. He actually wanted to call a relative who was a doctor. Although that relative worked in a small hospital, he was also a doctor and must know more about intestinal obstruction than he did. He could not trust the slightly younger relative. Wu Xiaofu, after all, has a hairless mouth and is weak in his work. Now he has to cut off a section of intestines, so they have to be careful.

The impact of the information even made the patient forget about the pain.

Seeing Wu Xiaofu's insistence, the patients and their families had no choice but to start making phone calls.

"Hey, Xiaoyu, there is such a thing. Your brother came to the hospital with a stomachache. After a checkup, it was intestinal obstruction. The doctor said that he had to cut off the intestines. We don't understand. I want you to give me some advice. This is cutting out the intestines. Ah, can you not cut it?"

Cut the intestines!
The person on the other side of the phone was also stunned. Most of the intestinal obstructions did not need to be cut. Where did this brother go? It couldn't be that he went to a private hospital and was praised for his performance.

"Sister-in-law, where did you and my brother go to see this?"

"It's just the attached courtyard."

First attached courtyard!

Oh, that's okay.

"What have we checked? If the intestinal obstruction is severe, the intestines need to be cut. The First Affiliated Hospital should not lie to you."

Wu Xiaofu glanced at the patient's wife and motioned for her to take the phone.

"Hello, I am Dr. Wu from the emergency department of the First Affiliated Hospital. The patient has undergone color ultrasound, plain abdominal X-ray and CT scan. It has been confirmed that he has intestinal strangulation, intestinal necrosis, and poor intestinal blood supply. There is no way to delay it. You are their relative. Well, you can talk to them about the situation."

There was a sudden change of people, and the people on the other side were also shocked.

Intestinal strangulation! Intestinal necrosis! That's no problem.

"Brother, sister-in-law, in your case, you need to have surgery as soon as possible. You can't delay it, or you will die."

What! dead!

The patient was also shocked. It was so serious, and it was said by his family, so why delay?

"Doctor, do it, we agree to do it, do it quickly."

Wu Xiaofu looked at Zheng Hua and said, "Call the Gastrointestinal Surgery Department and ask them to consult and explain the situation."

Gastrointestinal Surgery!

The patients were also stunned. It was not Wu Xiaofu who co-authored the book. They thought Wu Xiaofu was trying to get them to practice.

Wu Xiaofu said that emergency surgery does not compete with all surgeries, such as intestinal obstruction surgery. Unless there is no other way, emergency surgery generally does not compete with gastrointestinal surgery or anorectal surgery. After all, this surgery Full of flavor, it has a great impact on both the visual and taste senses.

Well, it’s okay not to rob.

In fact, the gastrointestinal surgery department in the hospital is not very popular. According to the statistics of caring people, the gastrointestinal surgery department in the hospital is the hospital's E. coli culture dish. The medical staff of the gastrointestinal surgery department may smell the raging E. coli bacteria in their breaths on weekdays. Well, as you can imagine, this environment is even worse than that of the anorectal department.

The young man who fell while playing basketball also came back at this time.

"Doctor, this is a film. It says there is indeed a fracture. It really needs surgery. Can it be treated conservatively?"

Wu Xiaofu took a look at the film and found that his left patella was comminutedly fractured.

"Conservative treatment is not feasible. How old are you? You don't want to play basketball in the future? What's more, this doesn't mean you can't play basketball. If you don't have surgery, you will have problems walking in the future. Call your parents as soon as possible."

The young man was also a little frustrated, but who gave up on this matter? He could only go out and call his parents.

"Doctor, I have a stomachache."

Well, this is pain in the right abdomen, in the right rib area, tenderness and rebound pain.

The first case of cholecystitis occurred today.

"It's probably cholecystitis. Let's take a picture first."

For emergency doctors, if they want to admit patients for surgery, outpatient service is the only way. Whoever accepts the patient will do it, or if emergency surgery is needed, let the person who prepares the surgery do it.

In one day of outpatient service, Wu Xiaofu directly received six more gallbladder appendices for himself. As expected, he could have them done at any time this week.

"get off work!"

When Zhu Yun's voice appeared, Wu Xiaofu took the water cup and ran away. He was not active after get off work and had ideological problems.

Jingle Bell!
"Senior brother."

"Xiao Fu, you haven't left yet, come here."

(End of this chapter)