Chapter 593 Complicated Gallbladder

"Director Xia, hello." Zheng Ren answered the phone and said.

After treating several patients in the Department of Gastroenterology, Director Xia clearly recognized Zheng Ren's level.

After that, Director Xia encountered a problem, and habitually started looking for Zheng Ren to take a look. With her temper, it is very difficult to do this.

"Mr. Zheng, I have a patient here, could you please help me?" Director Xia said.

Sure enough, Zheng Ren didn't care, just take a look and see what could happen.

Moreover, with the progress of Zheng Ren's skill tree, he also needs to see more patients and accumulate more clinical experience.

After saying hello to Zhong Min who was on duty in the emergency ward, Zheng Ren wandered off to the Department of Gastroenterology.

For emergency consultation, the requirement is to arrive within five minutes. But there is no time limit at all for the consultation where the director smuggles personal relationships, and what is done is favors. Director Xia was not in a hurry, and Zheng Ren didn't need to hurry over.

Arriving at the Department of Gastroenterology, Zheng Ren glanced at the doctor's office. He didn't see Director Xia, so he went straight to the door of the director's office and knocked on the door to enter.

"Boss Zheng, here we come." Director Xia was reading the film on the computer, when he saw Zheng Ren coming in, he stood up and said.

"Director Xia, what's the matter?" Zheng Ren asked.

"There is such a patient. I am not sure about the diagnosis. I always feel that there is something wrong. You can help me take a look." Director Xia then pushed Zheng Ren to the desk, pointed to the upper abdomen CT on the computer and said: "You read the film. The level is high, what is here?"

Zheng Ren watched the film carefully, and Director Xia said on the sidelines: "The patient complained of intermittent colic pain in the upper right abdomen and was admitted to the hospital for 7 months. It occurred once a week, and the pain lasted for 1-3 days each time. The patient had no nausea or vomiting when he was in pain. Fever, jaundice. Last episode of abdominal pain was 1 month ago."

"Hmm." Zheng Ren slid the mouse wheel with his right hand and asked while carefully watching the video frame by frame.

"Before admission, there was a B-ultrasound." Director Xia is very proficient in his business, and she is also very concerned about this headache patient. She doesn't need to read the list for auxiliary examinations, and said casually: "Abdominal ultrasound shows that there are folds in the upper part of the gallbladder, and there are no gallbladder stones." , the gallbladder wall was slightly rough. The extrahepatic and extrahepatic bile ducts were not dilated, and the diameter of the common bile duct was about 3 mm.”

"Fold?" Zheng Ren pondered.

The folding of the gallbladder shown by the B-ultrasound is not literally understood. The gallbladder is folded like origami.

Gallbladder folding, clinically refers to the folding phenomenon of the gallbladder mucosa.

It is more common in patients with chronic cholecystitis, and some of them are congenital dysplasia. If there are symptoms, they are some manifestations of the digestive system. Such as flatulence and so on.

Moreover, the patient's gallbladder wall is slightly rough, which can be diagnosed as cholecystitis.

"After being admitted to the hospital, he was given ceftriaxone anti-inflammatory treatment. Ten days later, the pain improved significantly, but stones appeared on the CT of the upper abdomen." Director Xia was a little puzzled, frowning.

The patient's symptoms improved and he should be discharged from the hospital.

Out of caution, Director Xia checked a CT of the upper abdomen before the patient was discharged.

Unexpectedly, CT showed that the patient's condition did not alleviate, but worsened! The inflammation improved slightly, but stones appeared in the gallbladder.

However, the patient's symptoms did not worsen, but he was alive and kicking, and he was discharged from the hospital clamoring.

It is uncommon that patients' self-reported symptoms and clinical auxiliary examinations contradict each other, and they should be treated with caution every time.

Zheng Ren flipped through the CT images of the upper abdomen frame by frame, and stopped asking Director Xia about the patient's condition.

All that needs to be said has been said, nothing else matters.

Director Xia noticed that Zheng Ren looked at the folded position of the gallbladder for a few more seconds, and then he continued to look.

Five or six minutes later, after watching the film, Zheng Ren said, "Director Xia, the patient should not be diagnosed with cholecystitis."

"Huh?" Director Xia was taken aback.

Does it directly overturn the original diagnosis? Do you need to be so direct?

But Director Xia didn't refute, she was going to listen to Zheng Ren's explanation.

But Zheng Ren didn't explain, but stood up, smiled, and said, "Be an MRCP."

"Is it necessary?" Director Xia was puzzled.

"Go and see the patient. If I'm not mistaken, this patient should be a rare double gallbladder patient."

"..."

"The CT film can only be guessed, but the MRCP will make it clear at a glance." Zheng Ren suddenly remembered something, and asked, "Is the patient's family financially okay?"

"Fortunately..." Director Xia said.

"If economic conditions allow...forget it, I will do 3D MR reconstruction while doing MRCP. The patient is asymptomatic now, so the examination should be done carefully so that we can decide how to do the surgery." Zheng Ren said: "MRCP may have artifacts, It was not possible to determine whether the two cystic ducts merged into the common bile duct or whether they merged into the common bile duct independently.

After the judgment is clear, according to the Harlaftis classification of gallbladder malformation, it belongs to the variant of type 1 or type 2, so as to determine the operation method of the patient. "

Director Xia was sweating profusely.

The purpose of her looking for Zheng Ren was to find out why the patient's upper abdominal pain symptoms had been relieved, but the examination revealed gallbladder stones.

Unexpectedly, Zheng Ren didn't say anything about this at all, and directly pulled out the double gallbladder deformity?

Director Xia almost spit out a mouthful of old blood.

But seeing that what Zheng Ren said was true, she also had some doubts.

But the problem is that the double gallbladder is deformed... Director Xia, even the old clinical director, has never seen it.

Seeing that Director Xia didn't move, Zheng Ren didn't want to see the patient with him at all. It was a little strange, but he came to his senses immediately.

"Director Xia, the gallbladder stones have nothing to do with the deformity of the double gallbladders." Zheng Ren said with a smile, "The patient does have sand-like stones in his gallbladder. Stop ceftriaxone and he will be fine in three to five days."

"Huh?" Director Xia was confused now.

"Reversible cholestasis symptoms occur after the application of ceftriaxone. The reason is that the calcium salt of the metabolite of ceftriaxone that enters the bile is easy to precipitate in the gallbladder and become a "stone nucleus", which induces cholelithiasis. Zheng Ren said, "If you don't believe me, you can read the instructions for ceftriaxone, which has complications in this regard." "

"Then... what's wrong with this patient?" Director Xia was puzzled.

"Double gallbladder deformity, this is more serious. The sand-like stones in the gallbladder caused by ceftriaxone can disappear after a period of time after stopping the drug, and are also called drug-induced gallbladder stones."

"Drug sex?"

"For example, contraceptives, ceftriaxone, non-steroidal anti-inflammatory analgesic drugs, intravenous hypernutrient drugs, and dipyridamole may all cause drug-induced gallstones." Zheng Ren said.

"How do you know?" Director Xia asked.

"The surgeon once diagnosed gallstones, but found nothing in the gallbladder after the operation. Some of them were fooled; some of them became medical malpractice because their family members refused to forgive them. So I have done a lot of research on this aspect. a little."

Director Xia knew that Zheng Ren's level was good, but he didn't expect his level to be so high.

She picked up the phone and said, "Mr. Zheng, wait a minute. I'll ask Director Wang of NMR."