While waiting for the takeaway, Zhou Yewu began to continue thinking about Xie Xiaohui's condition.

He feels that a patient with acute abdominal pain in childbearing age should routinely consider and exclude gynecological emergencies such as ectopic pregnancy, corpus luteal rupture, ovarian cyst pedicle torsion, fallopian tube torsion and other gynecological emergencies!

These considerations are not wrong, but the probability seems to be somewhat low in terms of the knots, symptoms and existing tests!

"Does it really take a posterior dome puncture, or is it possible to consider tumors? Is it okay to do a pathology?" Zhou Yewu sat in front of the computer and began to talk to himself at Xie Xiaohui's electronic case.

When Sun Jun listened carefully, especially in pathology, he smiled when he heard it.

A patient with abdominal pain can think in the direction of the tumor. This is actually not a wild idea, but a jumping thinking. It seems illogical, but it cannot be completely ruled out!

This may be considered a kind of talent for being a doctor.

When most people hear about abdominal pain, they will go to the emergency room to consider it. As for acute abdominal disease, a doctor can tell a lot, but it is said that they should consider chronic diseases and then tumor rupture and bleeding. This can be said to be the talent of being a doctor!

Women say that this kind of thing has the third feeling, which is called self-consciousness!

But in the medical field, this is a naked talent.

Many experienced doctors can easily ignore these diseases that seem unrelated to each other.

Zhou Yewu slid his mouse, and his expression gradually became solemn with the test sheets.

Seeing the end, my eyes became dull and desperate.

Xie Xiaohui has tenderness in the lower abdomen and occasionally has obvious rebound pain. It is necessary to consider gynecological acute diseases and surgical acute abdominal diseases.

The previous diagnosis began to be screened in Zhou Yewu's mind over and over again!

Ectopic pregnancy, gastrointestinal bleeding, corpus luteal rupture, acute appendicitis...

Everything changes quickly like a slide.

Cough gynecological ultrasound shows a small amount of pelvic effusion, and the blood HCG is normal, which basically excludes pregnancy, especially ectopic pregnancy.

What is HCG?

In fact, it is human chorionic gonadotropin!

A glycoprotein secreted by the trophoblast cells of the placenta. After the fertilized egg moves into the uterine cavity, a mature woman forms an embryo. During the development and growth of the fetus, the placental fusion trophoblast cells produce a large amount of HCG, which can be excreted into the urine through the blood circulation of pregnant women.

When pregnancy is 1 to 2.5 weeks, the HCG levels in the serum and urine can rise rapidly, reaching a peak in the 8th week of pregnancy, and dropping to moderate levels until the fourth month of pregnancy, and maintaining until the end of pregnancy.

Many women test whether they are pregnant. The most accurate method is actually blood HCG, which is much more accurate than any pregnancy test stick.

Now Xie Xiaohui's HCG is normal, so ectopic pregnancy is unlikely.

Unless you are less than a week pregnant? Is it the first time you had sex seven days ago?

Zhou Yewu suddenly felt that this song might have to be pondered.

However, during his internship, he had never encountered pregnant patients with normal hematuria and HCG, unless there was an error in the test.

As for the possibility of corpus luteum rupture, check the gynecological color ultrasound... Let's take a look...

"Oh, it's really difficult. Is this a test for my case analysis? But there are too few clues." Zhou Yewu felt a headache when he looked at these test tests.

He forced himself to go to see all the examination sheets issued by the emergency department.

Tumor pedicle twisting? Is this possible?

He didn't know why he was so stupid that he took the tumor into consideration again.

Actually, there is really no reason for this!

But Zhou Yewu just had a intuition, and a voice in his mind told him if it was possible to consider tumor pedicle twisting?

...

He suddenly thought of teratoma!

Mature cystic teratoma of ovarian uterogenesis originates from primitive germ cells. It is the most common type of germ cell tumor. It consists of multigerm tissue and is a benign ovarian tumor. It can occur at any age, and is more common in the age of 20 to 40!

Girls are precocious now, and they may also appear at the age of 16.

Generally, they are unilateral or bilateral, and are prone to complications such as tumor pedicle torsion and infection.

If it is really a teratoma torsion, then surgery should be treated as soon as it is confirmed, so it is very important for its early diagnosis!

Generally speaking, transabdominal and transY channel ultrasound examination has high sensitivity and specificity for mature ovarian cystic teratomas. If it really doesn't work, pelvic CT will be performed.

However, considering that Xie Xiaohui is still a student's problem in the emergency department, she did not have an ultrasound of Y.

"Is there any possibility of teratoma? You said, Brother Jun." Zhou Yewu clicked on the B-ultrasound of the attachment area of ​​the emergency room, and was about to look at the content for the last time...

Sun Jun pushed the chair and sat next to Zhou Yewu: "It's hard to say, but even if it's a teratoma, it's not easy to see your B-ultrasound without Y. Anyway, I don't have this level."

"Because the patient's tumor is a single homogeneous component and fat, fat shows high signal under ultrasound and is difficult to distinguish between the intestinal tract."

Sun Jun said so, but he couldn't help but stare at the computer screen.

Zhou Yewu was thinking about what Sun Jun said, but in fact what he said was not false at all!

If you really have ovarian cystic teratoma, it will mostly have strong echoes inside, similar to intestinal echoes, and are not easy to identify when mixed in the intestinal tract, and are easy to confuse. It is not easy to detect transabdominal ultrasound, but more than it is found during transY ultrasound examination!

The blood flow characteristics of ovarian cystic teratoma are less blood flow or no blood flow signals, and it is extremely difficult to display blood flow signals inside and on the capsule. According to this feature, it can be distinguished from other mixed masses!

Zhou Yewu shook his head and said to himself: "I can see this ultrasound."

Moreover, the instruments in the ultrasound department seem to have some problems, and the key points are always very vague.

In fact, when exams, you should pay special attention to some ovarian teratomas with higher positions, or even teratomas in the extraperitoneal space. The ovarian teratomas in this area can cause the iliac blood vessels to shift forward or backward, which is most likely to miss diagnosis.

...

"What do you mean, Dr. Zhou, have you made your tumor?" Sun Jun said jokingly.

Zhou Yewu sighed, and a feeling of helplessness appeared in his eyes.

If I can understand it, I will just become the director!

And you can also be the director of the ultrasound department! 4

"Give some advice, otherwise the fried rice we ordered will be almost here." Sun Jun still wanted to hear Zhou Yewu's opinions and opinions.

In fact, he also treated Zhou Yewu as a medical heir to see him.

Tianfeng's future still requires talents like Zhou Yewu.

Zhou Yewu thought about it and thought about it for a while. Finally, he vomited out his own opinion: "I suggest that a senior doctor in obstetrics and gynecology department consult with a specialist, and then perform a Y-lane posterior fornix puncture. If blood is not coagulated, combined with the patient's sexual life, he will be diagnosed with corpus luteal rupture."

"Otherwise, the diagnosis highly considers acute atypical appendicitis, and then improves the abdominal CT scan to further clarify the diagnosis, which can also exclude atypical gastrointestinal perforation."
Chapter completed!