Abdominal pain Hide the arcane truth in simple disease

Abdominal pain Hide the arcane truth in simple disease
Suffer from abdominal pain, as one of the gi medicine and most common symptom, its cause of disease is complicated and changeable. How to misdiagnose, not leak and examine? Digesting a physician not only possess the sturdy basic trainings, should but also be good at analyzing the condition, sum up and summarize.
Cholecystitis " Hide " Volvulus
Subsidiary south district of Beijing Tongren Hospital of Capital University of Medical Sciences Zhu ChangYu
A middle aged woman comes to examine at night, suffer from abdominal pain for one day on the main suit, aggravate disconnectedly, it is sick and vomiting not to have, without abdominal distension, diarrhoea, there are no shiver with cold, generates heat, jaundice. It is angry to arrange, defecate once day, take shape yellow softly and relieve oneself. Diabetes has been for many years previously, the medicine is maintained.
Check the body: Blood pressure 110/70mmhg, 110 times fen of heart rate. The spirit is clear, however, not yet it is dyed, does not reach spider's mole of liver palm that the skin sclera of whole body has been yellow for spirit, heart and lungs ( -),The whole belly is flat and soft, do not reach shape of intestines and peristaltic wave. The tenderness of upper abdomen, the right upper abdomen is. Not yet the skin has been jumped and ached tensely and instead. Solicit murphy' s to lay not reaching liver spleen rib (+) ,Some Maxwell do not reach tenderness. By drum sound,mobility voiced sound (-) ,Gurgling sound can, reach the angry over water sound, does not reach the metal sound of the lofty tone.
Check: The blood elephant is a bit high. There is not anaemia. Biochemistry is checked: Liver work is a bit high,frank gallbladder, among normal in gallbladder. Blood glucose is on the high side ' More than about 10) . There are a few acetone bodies in urine examination, the urine candy is a bit high. Upper abdomen ct: But and gallbladder calculus, gallbladder wall are increased thick. Liver, pancreas, spleen, a pair of kidney were not reached unusually, the abdominal cavity has not accumulated the liquid yet.
Diagnose: Suffer from abdominal pain and wait to check, cholecystitis, gallbladder calculus, 2 type diabetes.
Treat: Training hold a consultation, leave view, the intersection of heart and electricity, monitor, prohibit drinking water, fluid infusion, resist inflammation, solve convulsion, protect liver, control blood glucose.
Handed over to the next shift the next morning, the physical sign of the life was steady, the blood pressure, heart rate were basically normal. Suffer from abdominal pain and relatively obviously relieve. Come down with shock, abdominal distension, a large number of abdominal cavity light courage and uprightness and accumulate the liquid at noon. Originally consider for diabetic ketone disease and acidosis, but blood glucose is basically normal at this moment. Give the physical sign of a steady life of fluid infusion. Patients have few urine. Consider the abdominal cavity accumulates the liquid to break for the bladder, do the radiography, has not seen radiography pharmaceutical enter abdominal cavity. Bladder wash by water test ' -). The department of general surgery walks and cuts open the belly to ascertain the skill, prove volvulus, intestines necrosis. Excision of intestines of walking, intestines anastomosis. Several future trouble person in Japan fully recovers and leaves hospital.
Lesson: The limitation, choose the belly ct between ct and X-ray and because consider ct can find out about abdominal cavity's situation in an all-round way because of suffering from abdominal pain. Find gallbladder calculus under checking in ct, assume this causes the reason to suffer from abdominal pain, thus has concealed volvulus that has already existed. Employing spasmolytic, antibiotic, and under the situation of a large number of fluid infusion, abdominal pain appearing because of volvulus, fungus group shift, humoral and lose and is relieved to a great extent, thus has missed defining the opportunity diagnosed as soon as possible.
There are many abdominal pain reasons The thinking should be widened
Gi medicine of kind hospital of East China Sea of Jiangsu Province Liu ZhenQing
Abdominal pain is a clinical common symptom, its many ends of cause of disease, therapeutic method and prognosis differ significantly. Generally speaking, are inquired the medical history, pain property and followed symptom in detail, check body carefully, can mostly obtain diagnosing tentatively, the auxiliary examination of more pointed choice is verified, can make a definite diagnosis of. There is or typical symptom sometimes, diagnose it really has difficulty in.

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