Chapter 480: Female patient who concealed her history of natural childbirth

She is very thin.

It is not pathologically thin, but this kind of thinness is still unhealthy. The chopstick-like legs seem to be unable to support the body at any time. If you look closely at the arms and other parts, the outline of the bones is even revealed, which makes the handsome appearance She inevitably reveals her paleness and frailty.

If it was just like this, it wouldn't be enough for Xu Qiu to pay attention.

There are too many chopstick legs and skinny bones born under deformed aesthetics.

But this patient's abdomen was uncoordinatedly bulging, or... bulging.

Although the bulge is not large, for a woman with this kind of figure, a small belly should not appear.

Xu Qiu couldn't help but have several guesses in her mind.

But it's not easy to judge right now.

"Doctor, my girlfriend has been having stomachaches lately, and she has no appetite for anything she eats. She vomits everything she eats." The young man in his twenties started talking hurriedly as soon as he entered the consulting room.

He seemed to be afraid of being misunderstood, so he immediately explained: "It's definitely not pregnant, we took a pregnancy test!"

Xu Qiu nodded, "Early pregnancy test strips also have false positives. They are not used as clinical indicators for diagnosis. To confirm, you still need to check human chorionic gonadotropin, which is commonly known as HCG..."

"I know, I know. We have been preparing for pregnancy these days and have a certain understanding of this knowledge. If we are really pregnant, we will be so happy!" At this point, the young man looked worried.

It has been almost half a year without safety measures, and there is still no sign of pregnancy...

"Preparing for pregnancy? Have you ever been pregnant before?" Xu Qiu asked casually.

"No, we have been together since junior high school, and we only started living together after graduating from college. How could we have been pregnant?"

Xu Qiu listened to half of the man's words. When the disease occurs, the accompanying family members only play a supporting role. The real cause and true situation must be obtained from the patient's mouth.

He looked at the female patient.

The other party frowned, curled up, and let out a painful groan from time to time.

"When did it start?"

"Have you been eating normally recently?"

"Which part hurts the most, what does the pain feel like, whether it's cutting with a sharp knife, grinding with a dull knife, or it's like being crumpled into a ball..."

Xu Qiu asked about the specific medical history, and of course "whether the menstrual period is normal" for female patients, etc.

Abdominal pain, vomiting, these symptoms are not characteristic. There are more than a dozen organs in the human abdominal cavity, as well as the uterus, ovaries, etc. that are unique to women. If inflammation, ischemia, thrombosis, obstruction or even tumors occur, the symptoms can be vomiting and pain. .

At this moment, the man suddenly remembered something and said, "Doctor, my wife was found to have gallbladder stones before. Could this be the problem?"

Xu Qiu looked stern.

A medical history of gallbladder stones is critical and can sometimes even save a life.

If it is clear that you have gallbladder stones, but severe pain occurs, it is likely to be cholecystitis, cholangitis, etc., especially cholangitis. Once the bile duct is completely blocked, bile cannot be discharged, which will cause the pressure in the gallbladder cavity to increase. The higher it is, the final ischemic necrosis.

In severe cases, it can cause systemic shock and death.

"Family members, please go out first. I will do some examinations on the patient." Xu Qiu stood up and said.

The accompanying boyfriend immediately became wary: "You are a male doctor..."

Without waiting for Xu Qiu and Shi Lian to explain, the female patient endured the pain and uttered a few words: "It's okay, Dr. Xu has good medical ethics, and there is a female doctor here."

"Okay, okay, you are always so kind, then I will wait outside and call me if you need anything."

There were only three people left in the consulting room.

Shi Lian made the examination bed, the female patient lay down, and pulled up her clothes with Shi Lian's help.

Xu Qiugang put on his gloves and was slightly startled when he saw the patient's belly.

My guess was correct...

He pressed every part of the patient's abdomen one by one, placed his left hand flat on the lower part of the right chest, and pressed the junction of the outer edge of the right rectus abdominis and the right costal arch with his thumb.

"Take a deep breath."

With the cooperation of the patient, Xu Qiu would push his thumb down every time he inhaled.

"It hurts, it hurts!" The female patient immediately broke out in sweat.

"Murphy's sign is positive?" Shi Lian's expression changed.

The part Xu Qiu pressed was the gallbladder. The sensitivity to diseases such as acute cholecystitis was 97%, but the specificity was not high.

That is, when a patient develops acute cholecystitis or even more severe gallbladder perforation, there is more than 97% chance that Murphy's sign will be positive; however, when Murphy's sign is positive, it does not necessarily mean that it is a gallbladder disease. There may also be other acute abdominal diseases.

Specific circumstances require a combination of specialist examinations, imaging reports, etc.

Xu Qiu shook his head: "The patient's entire abdomen is tense. It's not Murphy's sign, it's just a sign of acute peritonitis."

To put it simply, it hurts no matter where I press it.

The inspection continues.

Suddenly, Xu Qiu suddenly said: "Was it a normal delivery before?"

Shi Lian Shui Lingling's eyes widened. She thought the teacher had asked the wrong person. This patient was obviously preparing for pregnancy and had no history of childbirth before!

But not only did she fail to respond, the female patient on the examination bed also subconsciously blurted out: "Yes."

"???"

At this moment, the expressions of Shi Lian and the female patient changed at the same time.

The patient's back was immediately soaked with sweat, and the severe pain in her abdomen was temporarily ignored. She sat up in horror, "You... Doctor Xu, how do you know?!"

Xu Qiu's expression remained unchanged as he glanced at her abdomen.

Although it was not very typical, he could still see that the female patient's rectus abdominis was separated, and the abdomen was layered, with upper muscles and lower fat.

This cannot be explained by simply being "fat" or having a small belly. Basically, only pregnancy can cause this kind of separation and layered abdomen.

Moreover, it was a normal birth.

Healthy rectus abdominis are tight and elastic, like Shi Lian's belly, which is flat and elastic. The rectus abdominis on both sides can be understood as two parallel, straight chopsticks.

Rectus abdominis separation means that the abdominal muscles are squeezed by the fetus, causing the elastic fibers to break and be damaged, and the two chopsticks are bent to both sides. In severe cases, it is even similar to an "O" shape.

The abdominal organs and intestinal tract that were originally held by the rectus abdominis naturally protrude from the middle of the separated rectus abdominis, which looks almost like a small belly.

The rectus abdominis separation of this female patient is not very obvious,

and doctors from other departments certainly cannot see it.

Even if it was sent to the gynecology department, perhaps only an old director like Kong Huixia who had worked in clinical practice for decades could find it.

However, in front of Xu Qiu, it was actually difficult to hide whether she had ever been pregnant or given birth. The patient on the bed must have a history of normal delivery, and it happened in the past two years.