Chapter 2329: Differential Diagnosis
As the parents answered the doctor’s questions, the doctor carried on with the child’s physical examination swiftly.
After clearing the foreign objects from the child’s mouth to keep the airway open, the nurse took the child’s temperature and blood pressure and reported to the doctor. The temperature wasn’t high, but the blood pressure was low.
Since the child’s main symptoms were in the digestive tract, the doctor, with stethoscope earbuds on, didn’t rush to listen to the heart and lungs but quickly focused on the intestines. Then, he palpated the child’s abdomen with his hands.
The child’s mother stood on tiptoe behind the doctor, watching anxiously.
"Has the child had any bowel movements?"
The child’s mother, redirected by the doctor asking for the medical history, answered, "Not today." Then asked the doctor, "What illness does my son have?"
Acute abdominal syndrome in infants requires careful differentiation, just like in adults. It is the trickiest to discern because the human abdominal cavity contains the most organs.
The child’s current symptoms mainly include vomiting, no bowel movements, no fever, which doesn’t quite resemble acute food poisoning. The breathing is normal, ruling out foreign body aspiration. The child’s crying and fussing have diminished, indicating a deterioration of the child’s condition to a more severe stage. According to the family’s information, the onset was judged to be within the past 48 hours.
What were the results of the abdominal examination by the doctor?
Xie Wanying, along with Student Wei, watched as Duan Sanbao’s hands palpated the child’s abdomen.
A good doctor will never press hard during palpation. Duan Sanbao’s fingers lightly pressed on the child’s abdomen, as the internal organs are soft and deep within the abdominal cavity, requiring exploratory touch to detect any abnormal signs.
To avoid causing pain to internal organs, some doctors develop various techniques. Duan Sanbao’s current hand gesture seemed a bit like pushing. The internal organs are indeed anchored by ligaments and, when palpated by the doctor, resemble a ship anchored at sea. The pushing helps the doctor feel whether the object inside the abdominal cavity is space, skin, a peritoneal ligament, or a moving organ.
Push and probe, probe and find an abnormal object. Probing further reveals the extent of this abnormal object, resembling a sausage.
A sausage-like mass located in the right lower abdomen?
"It’s likely an intussusception," Wei Shangquan spoke first.
"What did he say?" The child’s mother asked anxiously, pulling on Xie Wanying’s white coat.
Acute intussusception is a very common acute abdominal condition during infancy, typically occurring in children under one year old, most commonly between four to ten months, rarely seen over two years old. This is mainly due to the underdevelopment of the infant’s digestive system. Additionally, four-month-olds are usually starting various complementary foods, and some infants have poorer digestive adaptability, resulting in illness.
"Are you saying his grandmother fed him something inappropriate, causing this?" The child’s mother remarked unhappily, as if she had anticipated it.
The child’s grandmother, seated outside the consultation room, stood up, her face full of unease.
"That’s not the case," Xie Wanying denied.
She wasn’t speaking up for the child’s grandmother on purpose; the doctor only speaks scientifically.
If it is indeed intussusception, first, it’s crucial to explain what it is.
Intussusception refers to one section of the intestine sliding into another, forming a loop.
To describe it more vividly, think of connecting several rubber tubes of varying diameters end-to-end.