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

Since solving several patients for the gastroenterology department, Director Xia has clearly realized Zheng Ren's level.

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

"Mr. Zheng, I have a patient on my side. Please help me?" Director Xia said.

As expected, Zheng Ren doesn't care. Just take a look, what big thing can happen.

Moreover, as Zheng Ren progresses his skill tree, he also needs to see more patients and accumulate more clinical experience.

He greeted Zhong Min, who was on duty in the emergency room, and Zheng Ren went to the gastroenterology department.

Emergency consultation requires that you must arrive within five minutes. However, such consultations such as directors who smuggle personal relationships have no time limit and are just favors. Director Xia is not in a hurry, and Zheng Ren does not need to rush over.

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

"Mr. 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 who cannot be diagnosed. I always feel that there is something wrong. Please help me with my palm." Director Xia then pressed Zheng Ren to his desk, pointed to the upper abdomen on the computer and said, "You have a high level of reading films, what is here?"

Zheng Ren watched the film carefully, and Director Xia said: "The patient complained about intermittent colic with the right upper abdomen for 7 months and was admitted to the hospital. He had an attack once a week, each time he had pain for 1-3 days. The patient had no nausea, vomiting, fever or jaundice during pain. The last time he had an attack of abdominal pain was 1 month ago."

"Yes." Zheng Ren slides the mouse pulley with his right hand, and asks while watching it carefully.

"Before admission, there was a B-ultrasound." Director Xia was very skilled in his business. She was also very concerned about this patient with headache. She didn't have to look at the list for assisting examinations. She said casually: "Abdomen ultrasound indicates that there is a fold in the middle and upper part of the gallbladder, no gallbladder stones, and slightly rough in the gallbladder wall. There is no dilation of the bile duct in the liver and outside the liver, and the diameter of the common bile duct is about 3 mm."

"Fold?" Zheng Ren pondered.

The gallbladder folding shown by b-ultrasound is not literally understood, but folding the gallbladder 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 abnormalities. If there are symptoms, it is some manifestations of the digestive system, such as bloating, etc.

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

"After admission, ceftriaxone was given anti-inflammatory treatment, the pain improved significantly after ten days, but stones appeared in the upper abdomen." Director Xia was a little confused and frowned.

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

Out of caution, Director Xia examined an upper abdominal CT before the patient was discharged from the hospital.

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

However, the patient's symptoms did not worsen, but instead he was lively and was discharged from the hospital.

This kind of situation where the patient's private complaints and clinical auxiliary examinations violate each other is not common and should be treated with caution every time.

Zheng Ren looked through the upper abdominal CT films one by one, and no longer asked about Director Xia’s patient’s condition.

Everything you should say is said, nothing else matters.

Director Xia noticed that Zheng Ren looked at the position where the gallbladder was folded for a few more seconds, and then he looked down again.

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

"Hmm?" Director Xia was stunned for a moment.

Is it possible to directly overturn the most primitive diagnosis? Is it necessary to be so direct?

However, Director Xia did not refute, she was going to listen to Zheng Ren's explanation.

But Zheng Ren did not explain, but stood up, smiled, and said, "Make a mrcp."

"Is it necessary?" Director Xia was puzzled.

"Go and take a look at the patient. If I don't make a mistake, this patient should be a rare patient with bigali cysts."

“…”

"The ct movie can only be guessed, and it's clear at a glance when you do a mrcp." Zheng Ren suddenly remembered something and asked, "The patient's family's financial situation is fine."

"It's okay..." Director Xia said.

"If the financial conditions allow... forget it, I will do a 3D reconstruction of MR when doing MRCP. The patient is asymptomatic now, so it is better to do a more careful examination to decide how to do the surgery." Zheng Ren said: "MRCP may have artifacts, and it is impossible to tell whether the two gallbladder ducts are fused or independently transported into the common bile duct.

After the judgment is clear, the harlaftis type of gallbladder malformation belongs to type 1 or type 2 variants, which can determine the patient's surgery method."

Director Xia Dahan.

The purpose of her search for Zheng Ren was to determine why the patient's upper abdominal pain was relieved, but the examination found gallbladder stones.

Unexpectedly, Zheng Ren didn't say anything about this at all, and directly brought out biliary deformities?

Director Xia almost vomited an old blood.

But she was also a little suspicious when she saw what Zheng Ren said seriously.

But the problem is that the biscle malformation of the gallbladder... Director Xia has never seen it even as an old clinical director.

Seeing that Director Xia was not moving, Zheng Ren had no intention of going to see the patient with him. It was a little strange, but then he woke up.

"Director Xia, gallbladder stones have nothing to do with bibasal deformity." Zheng Ren smiled, "The patient does have silt-like stones in the gallbladder. If he stopped ceftriaxone, it would be cured in three or five days."

"Hmm?" Director Xia was confused now.

"The symptoms of reversible cholestasis occur after ceftriaxone. The reason is that the calcium salt of the metabolite of ceftriaxone entering the bile is easily precipitated in the gallbladder, becoming a "stone nucleus" and inducing cholelithiasis." Zheng Ren said, "If you don't believe it, you can look at the instructions for ceftriaxone, which contain complications in this regard."

"Then...what is wrong with this patient?" Director Xia was confused.

"Both gallbladder deformity is quite serious. The gallbladder silt-like stones caused by ceftriaxone can disappear for a period of time after stopping the drug. They are also called drug-induced gallbladder stones."

“Drug-based?”

"For example, birth control pills, ceftriaxone, non-steroidal anti-inflammatory analgesic drugs, intravenous hypertrophic drugs, and Pan Shengding may all cause drug-induced gallstones." Zheng Ren said.

"How did you know?" Director Xia asked.

"Surgery, I once diagnosed gallstones, but after surgery, I found that there was nothing in the gallbladder. Some were fooled; some, the family members refused to give in, and it turned into medical accidents. So I have studied this aspect more."

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

She picked up the phone and said, "Mr. Zheng, wait a moment, I'll ask Director Magneto."
Chapter completed!