Sometimes there is a thin film between the truth and misunderstanding. If it is pointed out, it will be clear at a glance. The same is true for the diagnosis of disease
.
1 years ago, Lao Zhang almost killed himself due to a misdiagnosis of a disease. Although he is talking about it now, it was a nightmare at that time.
things are like this.
Lao Zhang usually has the habit of exercising after a meal. Although he doesn’t exercise much, he has been persisting for many years.
This time, because his friend called him, he hurriedly ate some food and left.
As soon as he started to move, he felt a little painful, accompanied by slight nausea and vomiting. The parts of the abdominal pain were mainly around the umbilical and upper abdomen.
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In fact, Lao Zhang usually has a faint abdominal pain 2 hours after meals, but it is very mild. Today his abdominal pain is particularly obvious, and it is accompanied by nausea.
friends who were traveling with him were afraid that he would have any major problems, so he advised him to go to the clinic to take a look.
After all, I am old and I am afraid something will happen!
So, he was accompanied by his friend to village clinic .
The doctor in the clinic used seemingly professional knowledge to analyze Lao Wang's characteristics:
1. It usually hurts 2 hours after meals, and is particularly regular. Consider gastric ulcer .
2. I have eaten too fast today, which directly leads to worsening of ulcers.
so he strongly recommended gastroscopy .
What's scary about ulcers? After a while of rest, Lao Zhang's abdominal pain was relieved and he hurriedly took the medicine to nourish his stomach and went home. After
, as for the doctor's gastroscopy , I forgot everything.
The medicine was still effective a few days ago, and three days later he started paroxysmal abdominal pain again.
is like setting a time, almost 2 hours after meals.
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Lao Zhang's abdominal pain recurs like this. After persisting for
for 3 months, Lao Zhang was really upset. The most important thing is that my wife watched him gradually lose weight at a speed visible to the naked eye.
Lao Zhang's wife is also afraid that Lao Zhang will have some serious illness!
Finally, the panicked wife told the child a phone call that the child would soon return home and dragged Lao Zhang to the local county hospital .
The doctor of the county hospital carefully inquired about the medical history and summarized the characteristics of Lao Zhang’s condition:
1. Most of the time when abdominal pain worsens is after meals, especially after taking greasy foods. 2. The time is relatively fixed, and abdominal pain is the most obvious about 2 hours after a meal.
3. Abdominal pain can generally be relieved by itself, without mucus, pus, bloody stool and bloody stool. Remarkable weight loss recently.
4. He has had a history of hyperlipidemia, hyperglycemia, , and hypertension for more than 20 years.
Preliminary diagnosis of gastroenterologists:
Chronic pancreatitis? Gastric ulcer? Tumor? Or ischemic enteropathy ?
has decided on the general idea and start checking immediately.
routine examination:
gastroscopy, colonoscopy , abdominal CT, cancer antigen markers, thyroid hormone examination, rheumatism series and other examinations have begun one after another.
2 days later, all the test results came out.
Although the examination was completed, the doctor was confused when he looked at the examination results!
Gastroscopy: chronic atrophic gastritis.
Colonoscopy: rectal small polyps, pathology: hyperplastic polyps.
full abdomen CT scan: liver cyst , renal cyst .
tumor markers , thyroid hormone , and rheumatism series indicators were not abnormal.After checking
, there was only one abnormal indicator:
stool occult blood (+), and repeated repeated reviews were positive!
"Signs that there is a bleeding spot in the digestive tract, but the location is uncertain," but the doctor said again, "Lao Zhang's vomiting has nothing to do with digestive tract bleeding."
What is the cause of weight loss? Is there a tumor hidden behind the disease or is it caused by diabetes for many years?
The problem is where the tumor is? The blood sugar control has been OK in the past six months.
The causes of the disease appear in the doctor's mind, but they are denied one after another.
image source video screenshot
No imaging and test report supports the diagnosis of chronic pancreatitis. Will it be chronic ischemic enteropathy? In addition, what other diseases can be considered?
Could this disease really exceed the cognitive boundaries of doctors!
, then in the end, I can only check the small intestine, but the small intestine is a tall thing, and the general county-level hospital is not equipped.
There is no way, the doctor can only treat Lao Zhang temporarily with symptomatic treatment.
has been going on for nearly a week. Lao Zhang has spent no money, but the disease has never been clear.
or continue to check? Lao Zhang and his wife were in a dilemma.
Things are unpredictable.
One day, Lao Zhang suddenly disappeared!
The doctor at the county hospital panicked:
Lao Zhang wouldn't be unable to think about it and committed suicide. Recently, several people jumped off the building, so it's not!
is fine, but it was just a false alarm: it turned out that my wife went out privately and took Lao Zhang to a so-called "miracle doctor" who helped people get rid of evil.
It’s okay, Lao Zhang quickly returned to the hospital.
The doctor didn't say much about going out to "seek medical treatment". After all, even mental comfort is a good thing, as long as the disease is cured. The result of
is still ineffective in the end. Both the real doctor and the "jianghu doctor" are helpless until the disease is diagnosed clearly!
was finally helpless, and the doctor in the county hospital still asked Lao Zhang to be transferred to the hospital.
The doctor suggested that he go to the superior hospital for a small entanglement examination.
The dusty Lao Zhang family came to a provincial hospital.
The experts from the Provincial Hospital conducted a detailed examination of Lao Zhang again. At this time, the doctor found a strange sign:
Lao Wang had a cord-shaped mass in the lower left abdomen and a volatility mass with unclear boundaries around the umbilical. If you use stethoscope and auscultation, you will hear a whirring sound of water.
is due to weight loss or abdominal aortic aneurysm ?
So, the experts focused on Lao Wang's belly.
Finally, a small intestine was performed. The results showed that
staged multiple stenosis, the intestinal tract above the stenosis segment was slightly dilated, and the remaining stomach and colon mucosa were normal.
Vascular Doppler ultrasound suggests: There are obvious calcifications in many places in the aorta, especially the abdominal aorta, and there is obvious stenosis at the beginning of the abdominal cavity, and the blood flow rate is significantly increased here.
Doctor analysis: Crohn's disease ?
obvious manifestations of Crohn's disease: elevated blood sedimentation, increased C-reactive protein, low fever, diarrhea, pus, bloody stool , etc.
But Lao Wang did not meet any symptoms. Slight stool occult blood is positive, which cannot explain any problem.
Crohn's disease is ruled out!
ischemic enteropathy? Finally all the questions are directed towards this disease.
After general discussion, a three-dimensional reconstruction examination of small intestine CT was conducted, showing that:
abdominal aorta showed calcification throughout the whole cycle of the perivascular circumference, and the starting part of the superior mesenteric artery and the inferior mesenteric artery were significantly narrowed; the ileum showed obvious stage stenosis, and there was obvious collateral circulation between the superior mesenteric artery.
The supervisor of the doctor injected a small amount of drug papaverine into Lao Zhang's superior mesenteric artery under DSA.
The result miracle happened: The abdominal pain that had tortured Lao Zhang for so long disappeared instantly!
finally revealed the truth, and the final diagnosis was:
ischemic enteropathy!
Finally, after active treatment, Lao Wang was happily discharged from the hospital.
Popular knowledge of this article: ischemic enteropathy
1. What is ischemic enteropathy?
ischemic enteropathy is divided into acute mesenteric ischemia, chronic mesenteric ischemia and ischemic colitis .
ischemic enteropathy is caused by long-term or acute ischemia and hypoxia in the colon wall, which causes a large accumulation of harmful factors. The onset site is mainly the segment where the colon splenic flexor is the key site.
2. What are the symptoms of typical ischemic enteropathy?
Typical symptoms are postprandial abdominal pain, fear of food and weight loss.
mainly manifests as repeated abdominal pain related to eating. Abdominal pain can be persistent dull pain.
The degree of abdominal pain is different and the positioning is unclear. The onset site is mainly related to the intestinal segment of ischemia, which is mainly manifested as perium or the lower left abdomen, and there are many cases of illness about half an hour after meals. It reaches its peak in about 2 hours, and then as the food goes down, the abdominal pain will be relieved.
The characteristics of ischemic bowel disease are: squat or lying position can relieve abdominal pain in some patients.
What are the other characteristics of ischemic intestinal disease:
The typical symptoms are abdominal pain. It is mostly located in the lower left abdomen, and acute ischemic bowel disease can manifest as sudden colic. The severity varies, it worsens after eating, and abdominal pain is often accompanied by stool.
Patients with acute attacks can discharge bright red or dark red bloody stool mixed with feces within 24 hours, which are often accompanied by anorexia, nausea, and vomiting.
Why are the elderly prone to ischemic enteropathy?
The elderly have underlying diseases such as hypertension, diabetes, and hyperlipidemia. These diseases will lead to stenosis of the mesenteric artery, especially after fatigue, which makes the symptoms of ischemic more obvious, and it is easy to have symptoms of acute ischemic and abdominal pain. But once the intestinal burden is reduced, such as when the stool is empty, the abdominal pain will be significantly relieved.
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