The emergency bedside B-ultrasound came soon, and no obvious problems were found. The appendix, gallbladder, kidney and ureter were all good.
Liver, gallbladder, pancreas, spleen and kidney also look normal!
Considering that the girl has no history of overeating, and the pain is not mainly on the left, it should not be acute pancreatitis.
Is it appendicitis?
Acute attack?
Appendicitis can''t be seen by B-ultrasound, unless it''s a long-term chronic inflammation that doesn''t heal and has formed a serious abdominal inflammatory mass.
Chen Cang continued to inquire about the disease history in detail.
"Do you feel metastatic abdominal pain, that is, from the upper abdomen, and then gradually transferred to the navel and to the right lower abdomen?"
The girl seemed to have a problem with Chen Cang. She was in a bad mood when she spoke.
Chen Cang was helpless.
Seeing this, the mother suddenly said, "Nini, talk well and cooperate with the doctor. Can the doctor treat you badly?"
The girl shook her head: "there is no such situation."
Chen Cang thought about it: "go and have an abdominal CT to see if there is any possibility of appendicitis!"
The girl gave Chen Cang a white look and sneered: "can you do this and that for a while? You cheat my family''s money!"
Parents quickly apologized: "sorry, doctor, in fact, we have long wanted to have a physical examination of our children. Let''s take it as an examination!"
Fortunately, with the active cooperation of parents, the examination can continue.
The girl was reluctant anyway, but she was pulled by her parents for abdominal CT.
The CT was completed and no major abnormalities were found.
It is not acute appendicitis, and there are no bile duct stones, cholecystitis, cholangitis, pancreatitis, intestinal obstruction, gastrointestinal perforation and so on.
Now I''m confused about the cause of abdominal pain.
There are so many reasons for this severe abdominal pain. Now the only doubt may be the problem of the digestive tract.
Such as gastric ulcer and duodenal ulcer. This peptic ulcer is a common cause of abdominal pain.
But... If you want to do gastroscope, Chen Cang is very worried about the girl''s lack of cooperation.
And now it''s really impossible to diagnose what''s going on.
At this time, the girl''s father''s phone rang, got up, went out to make a phone call, and then came back, hurriedly sent the test sheet and image data to each other, and asked Chen Cang some professional questions.
After Chen Cang explained, the man took the phone and went out.
After a few minutes, the man came over and said, "doctor... Can you help us check a gastroscope and enteroscope?"
"Well, my child has abdominal pain these days. I also consulted my friend who is a doctor in the capital. He is an expert in gastroenterology. He suggested that I have a gastroscope and enteroscope to see if there are any changes."
It is quite convenient to make an appointment for gastroscope in the emergency department. The gastroscope room number must be arranged in the gastroscope department, but the emergency department will be more convenient, but the charge will also be more expensive.
Chen Cang looked at the girl like this and suggested that she go to the digestive department for in-hospital examination, which can also be reimbursed.
As a result, the girl''s parents quickly refused.
The other party doesn''t seem to care about the money, so he wants to diagnose it as soon as possible.
Gastroscope was hard. At first, the girl resisted. Later, in view of her parents'' obscenity, she reluctantly agreed to do it.
The gastroscope results came out. There was a little superficial gastritis. There were no other major problems, but this was certainly not the cause of abdominal pain.
If the gastroscope girl can barely accept it, the reaction of enteroscope will be violent!
When the girl''s mother thought of colonoscopy, she quickly discussed it with her father.
They suddenly decided to do it!
However, before that, the girl''s mother found a gastroscope room to give to the female doctor who was going to do the colonoscopy. She said a few whispers and secretly stuffed some red envelopes. I hope she can see if it is damaged when she did the colonoscopy!
The colonoscopy came out and there was still no obvious abnormality.
No enteritis, no colonic lesions, and no tumors.
Although there was no difference, the girl''s mother was obviously a little angry
It seems that the reason for being angry is not because of abdominal pain, but because of the report of the female doctor.
"Your girl may have, but... There is no guarantee. After all, there are still many damages caused by various reasons, so don''t worry too much."
After the examination, the girl''s parents were angry.
But at this time, the girl suddenly had abdominal pain again!
Cover your stomach and yell.
In the observation room, Chen Cang also lost his clue.
It can be said that all the inspections that can be done have been basically done.
But now there is no abnormality at all, which is too unscientific!
Abdominal B-ultrasound, gynecological color ultrasound, abdominal CT, gastroscope and enteroscope were all done, but the problem of abdominal pain was not found.
There are only so many things in the stomach, and the whole digestive tract is so long. Gastroscope can see part of the digestive tract and enteroscope can see part of it.
Is it... The invisible part in the middle except the problem?
That is, the digestive tract, jejunum and ileum. I can''t see. Is there a problem here?
A capsule endoscope?
Chen Cang now also wants to know who is the evil doer.
I haven''t seen this strange abdominal pain for a long time!
But looking at the girl''s state at this time, Chen Cang felt choked!
Capsule endoscopy can see the whole digestive tract, that is, let the patient swallow a camera the size of a capsule. The camera will walk around the gastrointestinal tract, take pictures constantly, transmit data to the computer, and finally pull it out through defecation.
If there is a problem with the small intestine (jejunum, ileum), capsule endoscopy is helpful.
But this check is very expensive!
The endoscopy room of the second provincial hospital can do it, but it costs thousands. Inpatients can be reimbursed, but this kind of emergency... Is choking.
At this time, Chen Cang suddenly turned around and found that the corners of the girl''s mouth twitched and her eyes were dull!
！
Chen Cang was frightened!
This is... What''s the matter?
However, this situation came and went in a hurry, and soon passed.
This signal shocked Chen Cang.
Suddenly thought of a possibility!
He looked at the girl and the woman: "excuse me... Does the family have epilepsy?"
As soon as the words came out, the two quickly shook their heads: "no, no epilepsy..."
Chen Cang continued to ask, "does she have any history of trauma? The head."
The girl''s father suddenly realized: "yes! This, yes. In July, she fell down on her car during the summer vacation and hit her head. At that time, she was dizzy for several days. She did cranial MRI and CT and said it was nothing. It might be a slight concussion."
Chen Cang hurriedly said, "I think your girl''s performance may be epilepsy!"
The woman was startled at this remark!
Epilepsy is not a good disease!
That''s madness!
To put it bluntly, it used to be a disease despised and laughed at in the countryside.
Who''s crazy? It''s hard to find a partner!
So the woman was quite frightened: "doctor... Are you kidding? How can epilepsy cause stomachache? Isn''t it convulsion and foaming all over?"
Chen Cang shook his head: "I just doubt now, because there is an epilepsy, the main manifestation is abdominal pain!"
"When seizures occur, they may be accompanied by autonomic seizures, which is also called diencephalic epilepsy in medicine. The specific types can be headache, abdominal pain, limb pain, syncope or cardiovascular seizures."
"So, so many tests have been done. Now I suggest that we do an EEG to find out the reason."
The girl''s parents are very reasonable. As soon as they hear it, they quickly promise!
Typical epilepsy is really convulsions, disturbance of consciousness and foaming at the mouth. Everyone knows it.
However, atypical epilepsy may show abdominal pain, because the abnormal discharge of the brain may be related to the neurological disorder of the abdomen, leading to abdominal pain.
Although such examples are rare, there have been!
Otherwise it wouldn''t be written in the textbook.
So when Chen Cang saw that the girl had an absence attack, he suddenly thought of this possibility.
Very rare cases have greatly increased Chen Cang''s interest.
The parents took their children directly to the EEG room and temporarily pulled an EEG.
Compared with ECG, EEG is slow, but Chen Cang estimates that epilepsy can be found.
Because the girl has had several attacks today, and there was a small attack just now.
Soon, the EEG results came out!
Chen Cang looks at the waveform diagram and is not very good at interpreting
The doctor who examined said, "Dr. Chen, do you see? These three second spike slow wave syndromes are symmetrical and synchronous on both sides... This is the EEG manifestation of typical small seizures!"
Hearing this, Chen Cang was immediately happy!
Finally found the reason!
EEG examination plays a decisive role in the diagnosis of epilepsy.
And now, the truth has come out.
Li Yan of the examination department was surprised: "this is the first time I have seen such a patient!"
Now that the reason has been found, Chen Cang calls the neurology department and asks for consultation.
After hearing this special medical record, Zhang Lingyun hurried down.
"Xiao Chen, I''ve seen such a patient in school for so many years! Unexpectedly, I met again!" Zhang Lingyun was a little excited.
It was diagnosed as epilepsy. The girl''s parents were still in charge of learning. They hurriedly asked for leave and went through the hospitalization formalities in the Department of Neurology.
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