I Can See Health

  Chapter 719 Seemingly Simple Physical Examination (Second)

   The patient's stomach was so tense and hard, which greatly attracted Lu Chen's attention.

   Abdominal tension often indicates inflammation in the abdominal cavity.

  Inflammation stimulates the peritoneum, causing the abdominal muscles to tighten, so the stomach feels a little tight to the touch.

  Lu Chen muttered to himself, "Could it be that the patient's myocardial infarction caused the tension in the abdomen?"

   This situation is rare!

   At this moment, the ECG of the patient's review also came out.

  Lu Chen took it and read it carefully, but still didn't see the typical myocardial infarction pattern.

   At this time, it has been three or four hours since the patient developed obvious chest pain.

   If it is really acute myocardial infarction, there should be obvious changes in the electrocardiogram.

   However, this pattern is almost the same as before!

   "Could there be another cause for the chest pain?" Lu Chen frowned.

  In his mind, aortic dissection, pulmonary embolism, pneumothorax and other short-term life-threatening "chest pain" diseases flashed across his mind.

   However, they are not very similar!

   And the emergency department also made a preliminary investigation for such diseases.

  Lu Chen's head was spinning fast, thinking about various possibilities.

   At the same time, his hands have not stopped for a moment, and he has been examining the patient's abdomen, hoping to find more useful information.

  Lu Chen percussion on the liver area of ​​the patient.

   is to make a fist with the right hand and lightly hammer the skin on the surface of the patient's liver.

   Just like that, Lu Chen noticed that the patient's brows suddenly became tense, showing a very painful expression.

   A comatose patient suddenly appears in pain, there is only one possibility.

   That is really hurting him!

  Normal people are reluctant to have percussion pain in the liver area, except for some acute inflammatory diseases, such as liver abscess, or cholecystitis.

   The patient's wife saw the patient's painful expression, thought he was awake, and was busy calling his name.

   But no reaction at all.

  …

   Just then, the emergency doctor came back with a newly issued hospital card in his hand.

   He said to the patient's wife: "Now take the hospitalization certificate and go to the CCU ward to be hospitalized!"

   The patient's wife was about to receive the hospitalization certificate, but was stopped by Lu Chen.

   "Wait a minute!" Lu Chen said.

   "Mr. Lu, what's the matter?" The emergency doctor looked at Lu Chen, who was beside him in confusion. Wasn't he the one who asked him to issue a hospitalization certificate just now?

  Lu Chen looked at the patient lying on the hospital bed and said solemnly: "The patient may not be acute myocardial infarction, but most likely a gastrointestinal disease!"

   "Huh?" The emergency doctor was stunned for a moment, not knowing why Lu Chen said that.

   At this time, in order to further verify his idea, Lu Chen placed his left palm on the lower part of the patient's right chest, and used his left thumb to compress the gallbladder area. If the patient has gallbladder inflammation, if he presses so deeply, it is bound to cause severe pain to the patient.

  Because the gallbladder is under Lu Chen's thumb.

   Sure enough!

   When Lu Chen pressed down with his left thumb, the patient's brows furrowed even more, and even twisted into a ball!

  Lu Chen took a long breath and slowly said to the emergency doctor beside him, "It's true that the patient is in shock, but it's not cardiogenic shock, it's septic shock!"

  The emergency doctor saw Lu Chen's physical examination and was amazed, and said loudly, "You mean acute cholecystitis?"

  Lu Chen nodded slightly, "Cholecystitis, cholangitis, these are not ruled out!"

  Cardiogenic shock refers to shock caused by heart disease. If it is myocardial infarction, intervention or thrombolysis should be performed immediately to restore blood supply to the heart muscle, so as to save the shock.

   But if the gallbladder is severely infected and septic shock occurs, the treatment is completely different.

   Inflammation of the gallbladder and bile duct can also cause chest pain. Although it is rare, it is possible!

   Conversely, a myocardial infarction is just as likely to cause abdominal pain rather than chest pain.

   If you get the two wrong and miss the best chance for treatment, the patient may really die.

  …

   "Do you have a bedside ultrasound machine in your emergency department?" Lu Chen turned to the emergency doctor.

   "Yes!" The emergency department nodded immediately.

   "Hurry up and bring it here. I will perform an abdominal ultrasound on the patient to see if it is a liver and gallbladder problem." Lu Chen said.

   The emergency doctor was a little surprised, Mr. Lu did the ultrasound himself?

   Will he also have an abdominal ultrasound of the liver and gallbladder?

  This ultrasound machine is only used by one or two people in the emergency department.

   However, he was only slightly taken aback, now is not the time to doubt these things.

   He immediately instructed Gui Pearson to push the ultrasound machine next door over.

  Lu Chen took advantage of this time to ask the nurse to give the patient a quick refill.

   In fact, whether it is cardiogenic shock or septic shock, it is good to add fluids at this time.

   Only by raising the patient's blood volume and blood pressure can the blood supply and oxygen supply to various organs be guaranteed.

  Otherwise, every organ of the human body will die one by one due to ischemia and hypoxia!

   In order to be safe, Lu Chen performed a detailed physical examination on the patient again, and there were not too many abnormalities in the heart and lungs.

   Pulled another electrocardiogram, but still did not see the typical manifestations of myocardial infarction!

  …

   At this time, Pearson, the emergency department supervisor, came over with an ultrasound machine.

  Lu Chen immediately sat beside the patient's bed and applied couplant to the ultrasound probe.

   All the movements are done in one go.

   Abdominal ultrasound is still very simple. Lu Chen now mainly looks at the gallbladder and bile duct.

  Under Lu Chen's operation, an image of the gallbladder soon appeared on the ultrasound screen.

   "I'm going, the gallbladder is really big!" The emergency doctor can't do an ultrasound, but it can still be identified.

  B-ultrasound showed that the gallbladder was significantly enlarged, the walls of the gallbladder and bile duct were thickened, there were still many stones in the gallbladder, and the bile duct was obviously dilated!

   The result did not surprise Lu Chen, it was really a problem with the gallbladder and bile duct!

  Lu Chen said solemnly: "The patient's gallbladder and bile duct are inflamed, and it is very likely to be acute obstructive suppurative cholangitis."

  Once the stone blocks the common bile duct, the bile cannot be smoothly discharged from the digestive tract, and it is bound to accumulate more and more.

  In the end, the pressure in the bile duct increases, and the bile flows back into the blood. With the bacteria entering the blood, it will produce obvious manifestations of sepsis, and severe cases may have shock!

   "Please ask for hepatobiliary surgery consultation! Operate as soon as possible!" Lu Chen immediately put away the ultrasound equipment and said to the emergency doctor beside him.

  The emergency doctor also knew the urgency of the matter, and immediately ordered the nurse to call the hepatobiliary surgery department for emergency consultation.

   The surgeon came soon, and also confirmed the diagnosis of acute suppurative cholangitis, and rushed to the operating room for decompression and drainage of the bile duct.

   As long as the bile duct is incised to allow the bile to flow out, the condition will be significantly improved, and surgery will be considered later to completely solve the problem of gallstones.

  …

   "Mr. Lu, thank you so much!"

   After the emergency doctor repeatedly thanked him, Lu Chen left the emergency ward.

   The system thanks and the level of upgrade completion have risen again.

  The emergency doctor looked at Lu Chen's distant back and sighed in his heart, thanks to Mr. Lu this time!

   The emergency department was so busy that he didn't have time to perform physical examinations on patients.

   Actually, no matter how busy the doctor is, there is still a need for a necessary physical examination!

   (end of this chapter)