I really don't want to be a doctor

Chapter 146 Merkel Chamber? ?

How could the appendix be gone?
Yu Wenxing frowned, flipped through the medical records,
Although this patient could not be definitively diagnosed as appendicitis before surgery,
But as a result, the patient had repeated abdominal pain in the right lower quadrant, and the McBurney's point tenderness was written in the physical examination. This patient's diagnosis of chronic appendicitis can basically be established.

"Have you cut your appendix before?"

Yu Wenxing asked.

"No, there is no scar on the patient's abdomen at all."

Li Xiaojun also frowned.

"Maybe it's because the stitching is so good that it doesn't come out."

Yu Wenxing pursed his lips,
"Can't tell?" Li Xiaojun frowned, "It's possible."

But his brows did not relax, and he was silent for two seconds before he asked, "Then what diagnosis do you think this patient is considering now?"

"Ha ha."

Yu Wenxing smiled,

I'm here to help you stand,
You are here to test me!
"What do you say are the differential diagnoses for right lower quadrant pain?"

Yu Wenxing asked back.

Li Xiaojun thought for a while, "The pain in the lower right abdomen can be caused by many other diseases besides appendicitis, such as acute gastritis, acute cholecystitis, acute pancreatitis, acute hepatitis, ureteral stones, etc. Abnormality found."

"Far from enough."

Yu Wenxing shook his head, "Patients with appendicitis and abdominal pain must first rule out fatal rare diseases, such as acute coronary syndrome and aortic dissection."

"This patient doesn't look like it."

"What do you mean it doesn't look like it?"

Yu Wenxing's voice turned cold,
Is this what a doctor should say?
It doesn't look like it doesn't look like it?
"Eh, no abnormalities were seen in the electrocardiogram, and an abdominal CT was also done. Besides, it's a rare disease, and the possibility is too small."

Li Xiaojun quickly explained.

Hearing that there are auxiliary examinations, Yu Wenxing nodded, "There are also relatively rare intestinal tuberculosis, mesenteric lymphangitis, intestinal obstruction, intestinal tumors, intussusception, and right lower quadrant pain may occur."

"The intestines have been probed from the surface, and no abnormalities have been found so far."

"There are even rarer ones, such as lower right pneumonia, right pleurisy"

"I also had a chest X-ray on this one, but I didn't find it."

"There are also rarer ones, such as Henoch-Schonlein purpura abdominal type, such as ischemic enteropathy."

Li Xiaojun was speechless,
At this moment, Yu Wenxing doesn't look like an intern!

What the hell is a director at all!
This foundation,
It's too deep.

"Excluded?"

Seeing that Li Xiaojun was silent, Yu Wenxing asked.

"Allergic purpura has not been ruled out, but the family members have not provided such past medical history; also, ischemic enteropathy is an exclusive diagnosis after all, and the diagnosis is made now."

Li Xiaojun means that it is too early to make a diagnosis like this.

"Of course I know, it's just identification."

Yu Wenxing smiled, "Do you think there is any differential diagnosis?"

"It should be gone."

Li Xiaojun thought about it, so many differential diagnoses are already very detailed.

"There are more, and there are many! If a woman has to consider ectopic pregnancy, corpus luteum rupture, salpingitis, and ovarian cyst torsion."

"This patient is a man!"

"How do you know he's a man?"

"I"

Li Xiaojun is about to vomit blood,
I can't even tell the difference between men and women?
"Then what if it's a woman disguised as a man?"

Yu Wenxing asked.

"I saw his little brother when I was preparing the skin, it should be a man."

Tang Ling wanted to stick out her tongue to pretend to be cute, but she had no choice but to wear a mask, so she put her drool on the mask when she stuck out her tongue.

"Hey, just kidding."

Yu Wenxing was still thinking, "There are still some relatively rare diseases, such as ketoacidosis!"

"Ketoacidosis???"

Li Xiaojun almost fainted,
The differential diagnosis mentioned above by Yu Wenxing,

Although he did not expect,

But as soon as he said it, he knew it.

but.
Ketoacidosis? ? ?
Isn't this a complication of diabetes?
Can cause abdominal pain.

"Yes, ketoacidosis can also cause abdominal pain, but I just checked the patient's blood sugar, and it's not high."

Yu Wenxing denied the diagnosis again. "besides."

"Yu Wenxing, wait a minute." If it wasn't for wearing gloves, Li Xiaojun would have raised his hand to ask a question.

He really felt that he was no different from a primary school student at the moment.

And what Yu Wenxing said,

Probably linear geometry.

"?"

"Why does ketoacidosis cause abdominal pain?"

Li Xiaojun thought about all the knowledge in his mind, but he didn't think of the reason.

"During ketoacidosis, the hydrogen ions in the body increase, which can stimulate the end of the stomach and intestinal mucosa and cause abdominal pain. This is one of them; second, acidosis is accompanied by hypokalemia, which can cause paralytic ileus , causing abdominal pain;
Third, the history of diabetes is often complicated by autonomic dysfunction, gastrointestinal motility imbalance, stress stimulation of Oddi sphincter contraction, resulting in increased pressure in the gallbladder, causing abdominal pain,

Fourth, during ketoacidosis, the blood volume is insufficient, and the body tissue ischemia and hypoxia are obvious, resulting in low perfusion of the microcirculation, toxic substances stimulate the peritoneum, and cause abdominal pain. "

After Yu Wenxing finished speaking, he thought for a moment, "That's about it."

Li Xiaojun was completely dizzy!He sighed helplessly, "Now that the diagnosis has been ruled out, just tell me what disease you are considering now!"

"If it is an organic disease, almost all possibilities have been ruled out, so there is only one possibility left."

What Yu Wenxing said just now are all organic diseases,
After all, the diagnosis of non-organic diseases is mostly a diagnosis made when there is no other way.
There are not so many people who have mental disorders that lead to psychogenic diseases.

"What is possible?"

Li Xiaojun finally stopped being dizzy, and his spirit suddenly collapsed.

"The Merkel Lounge."

"The Melk Chamber??"

Li Xiaojun felt that he was a fool.

He really doesn't understand at all.

He even began to doubt whether he was a general surgeon, or whether the disease was a disease of general surgery.

"Of course, this disease is rare."

Yu Wenxing smiled,

But in the bottom of my heart,
He has almost made the diagnosis,
This patient is this disease!
breathing room,

It can probably be understood as an extra room outside the normal organs.

Meckel's breath is a rare disease with a very low incidence, but it is a little longer in a certain place above the ileocecal.

Because the appendix is ​​under the ileocecal part,
Therefore, if there is inflammation in the ventricles, it is extremely difficult to distinguish the manifestation from appendicitis.

Especially in traditional laparotomy, because the field of view is too narrow, people don't pay attention to this problem. When they see the appendix, they cut it directly regardless of whether there is any problem with the appendix.

And after cutting,
Postoperative antibiotics,

Maybe the inflammation in the ventricles will be controlled, and the pain will really be relieved.

Everyone also said that the patient had appendicitis.

Therefore,
this patient,

Yu Wenxing thought about it, it might be like this.

(End of this chapter)