Chapter 2143: 2069 The Instantly Moving Stone (Alliance Leader Mouse09 Bonus Chapter 1)

Manager Zhou, the patient has left flank pain, urinalysis shows white blood cells, red blood cells +++, and an upright abdominal flat film shows a high-density shadow near the left L2-L3 vertebrae. The on-duty doctor, looking fatigued, instinctively reported the history: "The patient refuses hospitalization; we gave antispasmodic and analgesic treatment."

"Is the effect not good?" Zhou Litao asked.

"So-so, the patient says the pain has eased, but I think he's still in pain. I advised him twice, but he refuses hospitalization for lithotripsy no matter what."

"How's the physical exam?"

"There is clear tenderness on percussion of the left flank, and also quite evident on the right." The on-duty doctor went to the resuscitation room, took out the patient's upright X-ray film, and showed it to Zhou Litao.

The film was placed on the viewbox; a high-density shadow about 1.5 cm in diameter near the left L2-L3 vertebrae was strikingly obvious.

Normally, upright abdominal fluoroscopy and flat abdominal films are commonly used means for diagnosing urinary system stones.

This patient's situation is quite typical, but as Zhou Litao looked at the film, he recalled what the on-duty doctor had just said.

Left flank percussion tenderness is obvious, which is expected.

But there is also percussion tenderness in the right flank; referred pain could explain that. Yet Zhou Litao still felt something was off, and he turned his gaze back to the film on the viewbox.

He carefully examined the upright abdominal flat film; no stone was seen in the right ureter. As for the lower part, near the kidney, the X-ray film cannot show it clearly.

One examination confirming a left ureteral stone, according to normal diagnostic and therapeutic procedure, should not require any further tests.

Otherwise, one would be accused of over-treatment, which nobody can tolerate.

Let's leave it at that; I guess it's because the weather is cold, causing ureteral spasm that prevents pain relief. Zhou Litao took the film down, put it back in its sleeve, but the whole process made him a little hesitant.

He was still thinking about the positive physical signs from the exam.

Early in the morning, during the quietest time of the Emergency Department, Zhou Litao carried the film to the resuscitation room and began taking the history himself.

The patient and his family described the course of the illness.

Nothing noteworthy, except that he went to bed early last night with the window open. As a result, the temperature dropped in the middle of the night, and his left flank and abdomen began to hurt.

At first he thought he had caught a chill, so he got up, closed the window, and went to the bathroom.

He didn't expect the pain to worsen so much that he nearly fainted on the toilet. Only then did he wake his family and have them take him to the Emergency Department of room 912.

Urinary system stones—whether serious or not—are a condition. Although the patient was in severe pain, he had a friend who had undergone extracorporeal lithotripsy and described the experience to him.

A strong sense of fear made him unhesitatingly refuse hospitalization for extracorporeal lithotripsy and other treatments; he stayed only in the Emergency Department for symptomatic treatment and observation of changes.

Actually, it's the same—when others talk about illness, they sound knowledgeable. This belongs to the type of "talking easily while standing, not feeling the back pain," because many things cannot be truly empathized with.

Fear is a normal emotion; as long as it doesn't interfere with normal diagnosis and treatment, it's fine.

Zhou Litao cautiously performed a physical examination on the patient.

He placed his left hand on the patient's left flank and lightly tapped his right hand on the back of his left hand.

"It hurts." The patient furrowed his brows, bared his teeth, and said with a pained expression.

Zhou Litao then had the patient change position and began percussion of the right flank.

His right hand lightly tapped the back of his left hand, but unexpectedly the patient shouted, his body began to tremble a few times, and he arched even more severely.

"Doctor, be gentle, be gentle." The patient's lover watched, heart aching, almost bursting into tears.

"Is it the left side that hurts or the right side?" Zhou Litao asked doubtfully.

"The left side hurts." The patient's voice had changed due to the pain.

"Then I'll tap your right side—what do you feel?"

"My whole belly hurts, I can't bear it…… Doctor, don't tap me—each tap feels deadly." The patient said with a mournful face.

His face was a little pale, deathly pale; Zhou Litao thought it was due to the pain. It didn't look like he was faking, and referred pain probably wouldn't be this severe.

Strange, the patient's subjective feeling is left flank pain, and the upright X-ray confirms that. Yet during the physical exam, it gave Zhou Litao an impression—that the patient had a problem on the right side of the urinary system.

Such a discrepancy between physical exam, subjective symptoms, and clinical findings is not very common.

Zhou Litao covered the patient with his clothes, then asked about family history, past medical history, and a series of other matters, after which he left full of doubts.

There were no noteworthy issues, but Zhou Litao still wanted to check again to see if he had missed something; in the end, the patient almost cried, begging him not to do any more physical exams.

Since encountering a 16-year-old girl with abdominal epilepsy last time, Zhou Litao has made family history a mandatory item to ask about.

Clinical diagnosis and treatment are just like that—growing bit by bit through accumulated experience.

The patient's family and past histories are fine; there is a family history of hypertension, but he himself does not have hypertension.

Zhou Litao pondered hard, quickly made a decision, communicated with the patient and his family, and prepared to do a B-ultrasound to confirm again.

The patient's family agreed, after all the medication had slightly eased the pain, though not very noticeably.

Moreover, when choosing between spending money and undergoing a physical exam, the patient almost unhesitatingly opted to spend money to repeat the same test.

Logically speaking, as long as the stone is lodged in the ureter, the pain won't change much; one also needs to drink plenty of water and do vigorous exercise to let the stone pass.

The pain is somewhat strange, and Zhou Litao's doubts have not been resolved.

Pushed in a wheelchair to the examination, the patient twisted his body, weak and feeble, as if he had only half a life left.

Zhou Litao is used to such patients and cannot really empathize; his mind dwells on the mismatch between physical exam, symptoms, and imaging data.

What kind of strange ailment is this?

If not, let's pull the urology department's Director Yu in for a consultation; Zhou Litao decided to make a big deal out of it. Even if Director Yu is unhappy, we need a clear diagnosis.

Soon, the patient returned, holding a report sheet.

The patient's family felt somewhat confused, even a little unhappy.

"Let me look at the report." Zhou Litao stepped forward and asked for the sheet.

"Doctor, the B-ultrasound says there's a problem on the right side—did you do it wrong?" the family member asked.

Zhou Litao's heart gave a thump.

On the right side? That actually matches the physical exam. But the plain X-ray film and the patient's self-reported symptoms…

He immediately looked at the B-ultrasound report.

Right kidney hydronephrosis; near the proximal ureter of the right kidney, a stone about 2 cm in size was found. Meanwhile, the left kidney and ureter showed no problems at all.

MD! Zhou Litao's hand holding the report began to tremble a little.

Just saying there's a problem, but the clinical examinations contradict each other—what kind of reasoning is this?

Nothing wrong on the left side? Then that high-density shadow beside the left L2-L3 vertebrae, which looks exactly like a stone image—what the heck is that!