People often ask me what to do if " has a stomachache ". If I ask where the abdominal pain is specifically, I will be asked impatiently. They tell you that your stomach hurts, but you still ask if your stomach doesn't hurt. The atmosphere was very awkward, so I could only explain that in medicine, the area below the chest and above the legs is called the abdomen. For this purpose, I specially wrote 
Abdominal Nine Zones Diagram
Let’s take a look at the old man who came to see a doctor with “stomach pain” and what issues he should consider in the end. This is a 70-year-old female who suffered from upper abdominal pain for 3 days and occasional nausea and vomiting. She reported no fever. For such a seemingly simple patient, it seems reasonable to just give him some stomach medicine and go home. However, we are generally very cautious when it comes to elderly people with symptoms that last for three days.
After arriving, it is normal to do an electrocardiogram first. That is to rule out myocardial infarction first. This must be checked for upper abdominal pain in the elderly. The second is a simple blood test to check , blood routine, , C-reactive protein (inflammation indicator), biochemistry (liver, kidney, pancreas, and other indicators), mainly to see if there is obvious inflammation and whether there are abnormalities in liver, gallbladder, pancreas and other indicators. Thirdly, a B-ultrasound examination of the liver, gallbladder, pancreas, spleen and kidney will be performed. Basically this is the most routine test for upper abdominal pain. The result was a bit surprising.
Blood routine + C-reactive protein
Biochemistry + Myocardial enzymes
B ultrasound
Because the test showed that white blood cells were as high as 43.7 × /l, this is generally a blood picture only seen in severe infection or leukemia ; the biochemical results also indicate liver and kidney Damage, elevated myocardial enzymes, actually multi-organ damage; B-ultrasound showed a thickening of the right ureter . Seeing this result, on the one hand, first observe the anti-inflammatory treatment, and also check the urine routine to see if it is a urinary tract infection, and manually divide the blood to rule out leukemia. The result was that there were a large number of red and white blood cells in the urine, suggesting urinary tract infection . No immature cells were seen in the blood slice. Severe urinary tract infection was temporarily considered, but leukemia was not considered.
Urine routine
Artificial blood slices
Urinary tract infection is usually very common, usually urinary tract irritation symptoms such as frequent urination, urgency and pain, or upper urinary tract symptoms such as low back pain, fever, etc. This old man mainly suffered from upper abdominal pain and vomiting. It's rare, and it's also rare for such a severe infection to occur without obvious fever. Of course, sometimes it's the elderly who have poor immunity and can't react with body temperature. Generally speaking, most severe urinary tract infections have urinary tract obstruction, but the B-ultrasound only found a section of duct wall thickening and no obstruction, so an abdominal ct examination was arranged.
The right ureter is dilated as shown by the arrow, but the left ureter is not obvious
The dilated ureter is very clear compared with the left side
The high-density shadow shown in the transaction is ureteral stones
ct report
In order to identify the pathogenic bacteria, blood and urine bacterial cultures were done , the blood culture was negative, and the urine culture found bacteria, which was Escherichia coli , which is also a very common urinary tract infection bacteria. The drug sensitivity test showed sensitive antibiotics, so that the medication would be more targeted and the diagnosis would be clear. .
Urine culture result
This case is not clinically complex, but judging from the performance at the time of treatment, it is unexpected. This is also a true portrayal of the great uncertainty in medicine. We can also see that abdominal ultrasound often has limitations and misses many problems due to the influence of intestinal gas and personal skills. This is why we often do CT after B-ultrasound. But because B-ultrasound is cheap and has no radiation, it is often better to do a B-ultrasound first.
For this kind of severe urinary tract infection with obstruction, in addition to strengthening the anti-infection, the obstruction must also be relieved. As the saying goes, "running water does not rot the household hinges, but does not cause beetles". Once the obstruction is relieved, anti-inflammation will be simple, otherwise the anti-inflammatory effect will be very poor. . This is the principle not only for urinary tract obstruction, but also for bile duct obstruction , intestinal obstruction , appendicitis if there is fecal stone obstruction, surgery is also the first choice.Therefore, we invited the urology department for consultation and placed a ureteral stent. During acute inflammation , the adhesion of the stones is difficult to remove. The obstruction and inflammation should be removed first. After the inflammation improves, the stones and stent can be removed at an elective time. After treatment, the patient recovered quickly, and it can be seen from the indicators that he has recovered well.
There are many causes of upper abdominal pain. In addition to common stomach problems, the heart, pancreas, gallbladder, appendix, intestines, urinary tract, gynecology, etc. can all cause it. Therefore, upper abdominal pain cannot be equated with For "stomach pain", if the pain lasts for more than 6 hours or is relatively severe, you should seek medical treatment in time to find out the cause.
I am Dr. Wang Mingxuan. Everyone is welcome to follow me and learn various clinical cases together. Everyone is welcome to forward and comment. #Beijing Toutiao# # Domain See Beijing# #Health2022# #Abdominal Pain# # stomachache#
