When doctors have a simulated operating room

The patient was very tired.

"Is it here?" Chen Fang pressed the position of the pancreas with his hand.

The old man frowned the whole time and his expression never changed: "It hurts, it hurts a lot."

"What about here?"

"Ouch... It hurts a lot!"

Chen Fang was a little confused. Why does it hurt everywhere?

There should be an obvious tender point, right?

Could it be peritonitis?

As a result, when he looked up, Chen Fang saw Zhang Yi standing behind them from the corner of his eyes.

Good guy!

What's the difference between this and the teacher standing in front of you and watching you write the answers during the exam! !

Unconsciously, Chen Fang got nervous!

No!

Can't be nervous!

Zhang Yi just stood there without saying anything.

He must have wanted to see how he would deal with this patient with abdominal pain.

It's okay.

Zhang Yi is not as scary as Kang Yanming.

Just focus on diagnosis and treatment.

Chen Fang silently encouraged himself in his heart.

After taking a deep breath, Chen Fang raised his head calmly and listened to the old man's heart sounds with a stethoscope.

"Did you have any heart disease before?"

The family member shook his head: "This... No? We don't know either. We haven't checked this disease before. What? Could it be that my dad's stomachache is related to heart disease?"

"Well, myocardial infarction may also cause abdominal pain."

"Ah?" The two family members and the old man lying on the bed were all scared by this.

The risk of elderly people suffering from senile heart disease is already high.

After Chen Fang said this, the patient and the family members' hearts almost jumped to their throats.

Especially the old man lying on the bed.

It might have been in a state of moderate pain just now, but now, for some reason, the pain suddenly became more severe.

"Hiss... Ouch... Ouch... Why is it so painful..." The old man couldn't help complaining.

At this time, this wave of severe pain directly made the old man's forehead sweat.

The family members also became anxious and said that they should give him some painkillers first.

Chen Fang frowned, and the knowledge points about abdominal pain in his mind flashed one by one like a slide...

Severe pain?

If it is this level of severe pain, then the first thing to consider is stones or the process of stone removal.

"Uncle, have you been in this kind of severe pain these two days?"

The uncle nodded with difficulty: "Yes... When I first started to feel pain two days ago, it was intermittent, and it got better after a while, so I didn't take it seriously. As a result, the next day, after I got up and went to the toilet, the pain started again... It hurts again and again... I can't stand it, doctor, please prescribe me some painkillers... I'm old, I really don't want to suffer!"

The uncle wanted to take painkillers to get rid of it in one go.

But painkillers can't be taken randomly.

Chen Fang didn't say anything, walked to the bedside and did an experiment.

Murphy's sign test.

Murphy's sign test is also called gallbladder tenderness test.

Most patients with abdominal pain have to do a simple abdominal palpation when they come to the hospital.

That is, the doctor puts the palm of his left hand on the patient's right ribs and the thumb on the gallbladder point.

Press down with your thumb to press the gallbladder position, light to moderate pressure, and let the patient take a deep breath at the same time.

If the patient's pain increases when inhaling, it means that Murphy's sign is positive.

Basically, it can be judged that the patient may have acute cholecystitis.

(Even if it is not cholecystitis, it may be other bile duct diseases)

Sure enough.

The old man couldn't stand the pain halfway through inhaling.

He broke out in big drops of cold sweat and shouted that he couldn't stand it and was dying of pain.

Chen Fang stopped in time.

As soon as he loosened his hand, the old man immediately breathed a sigh of relief.

"Oh my, doctor, what's wrong with me? It can't be cancer..." The old man was a little worried.

At his age, he is afraid of these serious diseases.

Chen Fang smiled and shook his head: "Uncle, don't think too much. I suspect it's cholecystitis or bile duct stones."

After thinking for a while, Chen Fang asked again: "Uncle, have you eaten anything that irritates your stomach these days? Do you drink alcohol normally?"

"No, I don't eat anything random, just ordinary home-cooked meals, but... I like to drink..."

Speaking of drinking, the family members also complained.

"Oh, he loves to drink. He wants to drink a glass every two or three days. We can't persuade him!"

"That's right. He didn't drink for the past two days. I thought he had changed. I didn't expect that he didn't drink because of stomachache!"

After absorbing the information given by the family, Chen Fang nodded secretly.

His thoughts gradually became clear.

The patient has a history of drinking and a positive Murphy's sign.

In addition to cholecystitis, pancreatitis cannot be ruled out.

After thinking for a few seconds, Chen Fang looked up and glanced at Zhang Yi's expression.

... Well, no expression.

After swallowing silently, Chen Fang started to write out the checklist. He typed on the keyboard, observed Zhang Yi's expression, and reminded the family members:

"Let's do this. Generally, for patients like the old man who have obvious severe pain and a history of drinking, we need to check if they have pancreatitis.

I'll first write a blood routine + CPR, plus an amylase test to see if it's pancreatitis.

Then, if the abdominal pain is obvious and tender, and Murphy's sign is positive, cholecystitis cannot be ruled out.

Pains like his are very severe, which is also common in the process of stone excretion in clinical practice, which means that he may have stones in his body now, and these stones are moving and excreting.

So we need to do another abdominal CT to see if there is inflammation in the gallbladder or stones in it.

Hey, just these few tests, you go do them first, and come to me when the results are out."

After he finished speaking, the checklists came out.

After Chen Fang handed the list to the family members, he glanced at Zhang Yi's expression again.

This time, Zhang Yi was not expressionless.

Instead, his eyebrows were gentle, with a hint of satisfaction.

Chen Fang breathed a sigh of relief!!!

The diagnostic idea this time was indeed correct!!!

"Okay, thank you, doctor!" The family took the list and took the old man out for examination.

Only after the man left did Zhang Yi speak: "Not bad, Chen Fang, this time you found the right way."

The old man did have a stone.

The cause of the abdominal pain was not myocardial infarction, but the stone in the bile duct fell off.

Severe pain occurred during the movement.

After hearing what Zhang Yi said, Chen Fang's heart finally fell to the ground!

After a long sigh of relief, he said indignantly: "Hey... That's right! I have been reading books and cases since I went back these days! I don't believe that I can't handle a small abdominal pain!"

Seeing that Chen Fang is also a motivated and hardworking person, Zhang Yi is very satisfied.

It is a rare opportunity to work in Union Hospital.

Zhang Yi brought him here, and naturally hoped that he could do well.

Otherwise, he would not be able to stay in PUMC.

Seeing that the matter was settled, Zhang Yi hurried off work.

…

The next morning.

After checking the room, Zhang Yi took the stack of test papers to the large classroom in the science and education building.