The case is not long.
Just a few words.
But you can see a lot of information.
Doctors sometimes read only a few medical records.
The first is to find the cause according to the symptoms, and the second is to push the symptoms according to the cause.
At this time, the patient''s symptoms do not seem to be very difficult. His legs are short.
In terms of symptoms, patients have sudden dizziness and weakness, which should be the performance of low blood volume, as well as the stimulating symptoms of abdominal bleeding such as sudden abdominal pain and abdominal distention!
Physical signs: pulse speed, low blood pressure and obvious peritoneal irritation, which should indicate intraperitoneal lesions.
Blood routine examination showed that hemoglobin decreased progressively in the early stage of onset, while MCV and MCH did not change significantly. On the contrary, FIB continued to be low and D-dimer increased significantly. These seemingly messy test reports can obviously draw a conclusion, which is completely in line with the performance of acute blood loss!
So Chen Cang said directly, "consider acute hemorrhagic diseases!"
Chen Cang''s diagnosis was almost given directly with the case.
Several directors glanced frequently, full of appreciation.
Although this diagnosis is not difficult, it... Needs a certain level of blood to get acute bleeding so quickly.
Chen Cang basically blurted out, which can see the other party''s solid foundation!
Huang Qiuying couldn''t help nodding: "yes, since it is a hemorrhagic disease with lower abdominal pain, physical examination and imaging found solid tumors in the pelvic cavity, and the patient has a gynecological history, so I first consider gynecological related diseases.
Gynecological diseases can lead to bleeding diseases are so few!
The first is pregnancy related diseases: such as ectopic pregnancy, trophoblastic tumor, etc;
Secondly, ovarian or fallopian tube tumor rupture;
The last is the rupture of ovarian endometriosis cyst. "
Chen Cang nodded: "after menopause for many years, pregnancy related diseases can be ruled out, and endometriosis cyst is unlikely!"
Thinking of this, Chen Cang suddenly asked, "did the patient fall?"
Cui Jisheng nodded: "yes, but... It just slipped to the ground."
Gently sliding on the ground is not the same angle of thinking as a heavy fall.
Huang Qiuying said: "before the diagnosis of bleeding caused by gynecological diseases is established, it is still necessary to exclude bleeding caused by other systems and other causes."
As director of general surgery, he Zhiqian said, "we have discussed before that surgical abdominal bleeding diseases are generally seen in organ injury."
"However, the injury of parenchymal organs such as liver, spleen and pancreas, hollow organs such as stomach, intestine, gallbladder and bile duct, and vascular injury such as abdominal aorta and inferior vena cava. Generally, these injuries are secondary to severe closed injury or penetrating injury, and the injury of pelvic blood vessels is mostly secondary to penetrating injury, pelvic or lower limb fracture.
Therefore, the patient only falls to the ground slowly after slight activity, and there is no obvious fracture. Generally, it will not lead to the injury of the above organs and tissues. "
He Zhiqian''s remarks directly denied the possibility of organ damage.
Next, Urology, hematology, endocrinology and interventional departments began to discuss again.
Maybe many people don''t understand what consultation is?
This is consultation, giving an inferential diagnosis, and then each department makes a diagnosis.
This is the advantage of division.
Every doctor is proficient in a field!
They are very good at diseases in their field.
Constantly reduce the possibility of patients.
An acute intraperitoneal hemorrhage seems common, but now it is impossible to give a clear diagnosis.
In fact, this is medicine.
As Sir William Osler, one of the founders of Johns Hopkins Medical School, said: "medicine is an uncertain science!"
At this time, the discussion became anxious again.
Urology rejected the possibility of bladder injury, and temporarily did not consider urology related diseases.
The Department of Hematology''s inference is concentrated on vascular injury. After long term diabetes and other chronic diseases secondary to vascular disease, it is easy to cause bleeding.
It was the end of another round of discussion.
The crowd was silent again.
Generally speaking, consultation is actually step-by-step.
If something is diagnosed, it''s easy to say.
But
If this is the case today, we can''t find the cause after a long discussion.
Consultation will not be wasted!
The consultation will gradually become a push pot meeting.
After all, the diagnosis of such a difficult patient is not clear, let alone treatment.
In fact, it can only be said that the patient''s condition is OK.
If it is really critical, the first step may be laparotomy.
Sometimes, imaging examination is limited.
There must be some bleeding, but the amount of bleeding is not very large.
At this moment, the office fell into silence again.
Huang Qiuying was also decisive: "inform the operating room and prepare for laparotomy!"
There is no point in dragging on now.
At this time, Chen Cang also kept thinking about all kinds of possibilities.
The routine diagnosis has been thought over completely, but... It doesn''t accord with the patient''s symptoms.
No wonder everyone consulted and discussed for an hour without results.
At this time, Chen Cang suddenly said, "can I go and see the patient?"
Huang Qiuying turned around and looked at Chen Cang. Only then did she think that Chen Cang had not commented since he came.
Everyone also thinks that Chen Cang... Won''t come for a show?!
However, no one will force Chen Cang. After all, he is just a learning doctor.
He is not responsible for giving or not giving.
But
To tell the truth, these directors certainly don''t believe Chen Cang can give the results.
Huang Qiuying was stunned when she saw that Chen Cang was serious. It didn''t seem like a pose. "OK!"
While talking, Huang Qiuying personally took Chen Cang to the ward.
An old woman in her sixties was lying in bed, covering her stomach and groaning bitterly.
Seeing Huang Qiuying coming, she was about to speak when she suddenly saw Chen Cang!
Suddenly, the old lady blushed: "Professor Chen!"
Cui Jisheng, the old lady''s husband, couldn''t help but say, "wife, don''t worry, Professor Chen must be able to make a clear diagnosis!"
The old lady nodded and suddenly felt that her stomach didn''t hurt so much: "yes, yes! I believe Professor Chen!"
Chen Cang also sighed. The pressure is huge!
Only love and trust can be lived up to!
The directors around looked different.
If Chen Cangzhen makes a clear diagnosis, he is really capable.
But... To tell you the truth, the disease really needs to be so simple, and it won''t be up to now.
This kind of bleeding is absolutely rare!
Sure enough, after Chen Cang''s palpation, he also fell into an impasse and couldn''t get an accurate answer for a long time!
However, Chen Cang''s eyes are not perspective after all.
There is no way to see the situation in the abdominal cavity.
The patient''s pelvic hematoma seems to be an unsolved mystery.
Time goes by!
Chen Cang also racked his brains to think!
What are the symptoms of acute abdomen?
His mind is like a search engine, constantly bringing in, thinking and speculating.
Chen Cang suddenly thought of something and hurriedly said, "do a color Doppler ultrasound of the veins of the upper and lower limbs!"
Huang Qiuying frowned: "what''s the meaning of the upper and lower limbs?"
After hearing Chen Cang''s words, the doctor of the intervention Department couldn''t help jumping his eyelids!
"Yes, let''s do a color Doppler ultrasound!"
Huang Qiuying didn''t stop the intervention doctor when he heard it happen.
Gynecology itself has ultrasound, and soon the results came out!
Color Doppler ultrasound of the upper and lower limbs also showed thrombosis of the right femoral and popliteal veins!
People who saw the results were a little confused.
But Chen Cang was scared and sweating!