Song Luo, the attending physician in the emergency department, is thirty-seven years old. He has a horse face, a thin body, slender lips, and some wrinkles on his forehead. His whole person has a melancholic temperament.

The patient's initial condition has been discussed with his family members, and now he is initially suspected of having an acute abdomen. With Song Luo's many years of clinical experience, he is naturally confident that he can control the condition. Acute abdomen is complex, but it is also the most common disease.

Song Luo had done not only 500 but also 300 cases.

When I saw Tanglou coming, I naturally wanted to take a test.

After all, he was able to score 81 points in the first nine rounds of the emergency training camp, which is already comparable to the best score in history. Song Luo was naturally extremely curious.

Moreover, clinical diagnosis of patients in the ward is part of the teaching of interns and residents.

The superior doctor will ask a question when he is happy, and he will ask a question when he is unhappy. It is normal for the junior doctor to make a fool of himself by asking questions.

This time, asking Tanglou to cooperate with the diagnosis was part of the assessment of the emergency training camp. Naturally, Tanglou was asked to participate in the entire process to assess the capabilities of this young man who had overwhelmed Yang Ming.

"Tanglou, help me diagnose the patient's condition. The first step of communication with the family has been completed. The patient, male, 34 years old, suffered from sudden abdominal pain for 3-4 hours after excessive drinking for 12 hours, and was sent to the hospital by his family. The pain continued to worsen.

. Now you are assisting me with the physical examination. Do you know the process?"

Tanglou nodded and looked at the patient. With the diagnostic skills at his disposal, he naturally would not waste too much time on physical examinations and waste the patient's treatment opportunities.

[Patient: Liu Dishi, male, 34 years old

Symptoms: Lower abdominal pain 3-4 hours later, pain continues to worsen, no radiation

Vital signs: T 37.6 ℃, P 110 times/min, R 22 times/min, BP 140/70 mmHg,

Acute illness appearance, no obvious abnormality on cardiopulmonary auscultation, abdominal distension, no intestinal type stomach type, whole abdominal tenderness

Diagnosis: The patient suffered from a rare spontaneous rupture of the bladder.

Special reminder: The patient's symptoms can easily be misdiagnosed as acute abdomen. If surgical treatment is performed directly based on acute abdomen, a large amount of urine will be found during the operation, which will delay the treatment.

The best treatment method is to perform peritoneal puncture and fluid extraction before surgery, and routine biochemical examination of the fluid is more conducive to early diagnosis and treatment.】

After seeing the diagnosis, Tang Lou was also surprised as to why he kept encountering such rare cases.

There are generally three situations in which bladder rupture occurs:

1. Extraperitoneal rupture often occurs on the anterior wall of the bladder, close to the bladder neck. Urine extravasates into the tissues around the bladder and the retropubic space, reaching the subcutaneous part of the anterior abdominal wall; or along the pelvic fascia to the pelvic floor, or around the ureter

Loose tissue spreads to the kidney area, and urine extravasation is prone to infection, causing serious complications such as cellulitis, suppuration, and tissue necrosis.

2. Intra-abdominal rupture often occurs at the weakest point on the top of the bladder. The rupture is connected to the abdominal cavity, and urine can flow into the abdominal cavity and cause peritonitis.

3. Internal and external rupture of the bladder, caused by multiple ruptures in the bladder wall, often caused by firearm injuries.

This patient's bladder ruptured spontaneously, with no trauma at all. The rupture of the bladder caused urine to fill the abdominal cavity, causing abdominal distension and persistent pain.

If there is no systematic diagnosis technology, naturally we will not think about it, it is too unbelievable.

Tanglou directly stated that the bladder had spontaneous rupture, which was of course unconvincing and too supernatural.

However, if he followed the routine procedure and checked step by step, Tang Lou also knew that it would be impossible to deduce the symptoms of bladder rupture.

"what to do?"

Moreover, this is the last round of assessment. The attending doctor asked himself if he was familiar with the process. Obviously, he had to follow the standardized process and conduct a step-by-step physical examination.

Seeing the patient's painful expression lying on the bed, Tanglou couldn't care less.

Perform palpation directly and skip the useless part.

Seeing Tang Lou's actions, Song Luo's expression changed slightly. This guy actually took action directly? Does he understand the rules?

Abdominal physical examination did not involve palpation at the first step. Song Luo stopped Tang Lou directly and sounded a little angry.

"Tanglou, are you sure?"

In the judging room, the directors who were watching Tanglou's performance were also puzzled.

"Xiao Tang, what is going on? This step is wrong! How can you just come up and palpate directly?"

"A normal abdominal physical examination must first expose the entire abdominal range, which starts from Hengge and goes down to the pelvis. The front and sides are the abdominal wall, and the back is the spine and psoas muscles."

Niu Bolin explained with some dissatisfaction, also for the players in the back row to listen to,

"The next step is to inspect the skin first, and observe whether there are rashes, spots, abdominal hernias, incision scars, the shape of the abdomen, gastrointestinal patterns and peristaltic waves, and abdominal pulsations. After completing this step,

Only after some causes have been ruled out can we start palpation!”

"Xiao Tang didn't explain it very clearly in the previous level. He had such a solid theory, yet he made such a low-level mistake. If he continues like this, I think he will fail this round!"

Calmly said with some anger, naturally the greater the expectations, the greater the disappointment!

In the emergency department diagnosis room, Tang Lou was stopped by Song Luo and wanted to tell the reason directly, but it was too unbelievable after all.

After thinking about it, since I couldn't skip steps, I could only follow the process and sighed.

He completed the inspection from the beginning and then started palpation, but he moved very quickly and did not waste time on unnecessary things.

"...the patient has abdominal distension..."

After finishing it, Tang Lou directly performed percussion, especially strengthening his tone to guide the attending physician. If Song Luo still couldn't think of it, then Tang Lou directly said that preoperative puncture and fluid extraction were needed:

"...The patient has shifting dullness in the abdomen, and it is suspected that the abdominal cavity is filled with fluid..."

Naturally, Song Luo could not understand the implication of Tanglou's story. He preconceived the suspicion of acute abdomen, and naturally he did not think of the rare spontaneous rupture of the bladder.

After all, acute abdomen is a clinical syndrome, not a single disease.

Internal medicine, gynecology, neurological and systemic diseases can all cause acute abdomen.

The diagnosis of acute abdomen is inherently difficult, as the patient's onset is acute and painful, with varying degrees of severity and varied pain.

Song Luo obviously only followed the conventional classification and judged based on experience. So far, Tanglou's physical examination results could not determine a specific category, so the most conservative way was to press the painful area to investigate.

For another reason, he also hopes to create a relaxed atmosphere by discussing the symptoms in Tanglou, thereby infecting patients and their families.

Song Luo continued to ask very relaxedly: "The patient was initially diagnosed as acute abdomen. Can you summarize the diseases corresponding to abdominal pain in different parts of acute abdomen?"

Song Luo raised this question quite well.

The directors in the review room were also very satisfied. After all, it is very classic to infer the possible specific inflammation through the pain at the pressed site.

Song Luo raised this question with the intention of guiding Tanglou to discover specific symptoms.

Tanglou's face looked a little ugly. He naturally knew Song Luo's intention. Generally speaking, it was indeed the most reasonable. However, in this special situation of the patient, it was of no use and would only waste time.

"Dr. Song, I feel that the compression of abdominal pain, that is, the nine-segment disease map of the abdomen, is not omnipotent. Of course it can be a preliminary diagnosis, but patients have different anatomy and cannot be too rigid. We should continue to auscultate."

Naturally, Tanglou aims to target the symptom of hydroabdominal fluid and guides the patient to perform puncture and fluid extraction first.

"Xiao Tang, since you know the disease map of the nine abdominal divisions, you should understand that although patients have different anatomy and cannot be applied too rigidly, it is still very practical for beginners like you. So, I hope you will still follow this

Press to one side."

Song Luo's tone was a little serious. As a senior doctor, he naturally had his considerations. It was not good for an intern to be too ambitious.

Where are there so many rare cases?

Ninety percent of the cases in the operating room can be diagnosed through the most conventional methods.

This is Song Luo’s experience over the years, and the most classic is the most practical!

The nine-district disease map of the abdomen is based on the experience summarized by countless ancestors and can basically deal with 90% of common acute abdominal diseases.

Therefore, Song Luo believes that abdominal pain screening is currently the most effective preliminary diagnosis. The first city hospital is not a county hospital. It has a strict hierarchy and the authority of the superior doctor is unquestionable.
Chapter completed!