Example 1: Gastroenterology on duty should not only consider diseases of the digestive system, but must not ignore digestive symptoms caused by lesions of other systems. On a recent shift, a patient was admitted with abdominal pain and vomiting, and had a history of gallstone disease with several episodes. He had no history of hypertension, diabetes mellitus or infectious diseases. After admission, he was treated with routine anti-infective rehydration and antispasmodic therapy and was checked for routine blood biochemistry and abdominal ultrasound. The patient’s symptoms were not relieved and he complained of unbearable dry mouth, so he did not care about it. The patient had a cold sweat. The patient was admitted to the hospital for vomiting blood and black stool, and had 2 units of concentrated red blood cells transfused in the local hospital, which was not special in the past. He was admitted with stable vital signs, bowel sounds 8 times/min. Hb8g, and gastroscopy suggesting chronic superficial gastritis barrett’s esophagus. The patient was discharged from the hospital after 4-5 days of admission without further vomiting of blood and black stool. In the evening of the same day, the patient fainted in the toilet, no vomiting of blood, blood pressure 90/60mmHg, heart rate 100 times/minute, but considered to have bleeding, that is, to allocate blood, strengthen rehydration, about 20 minutes the patient vomited coffee-like liquid about 1000ml, transferred to ICU custody, after treatment, no bleeding, re-examination of gastroscopy: gastric sinus ulcer. After about 5 days, the patient suddenly vomited about 800ml of blood again and was treated with emergency intervention. At that time, the interventional team could not see anything for about 2 hours and wanted to give up, but the director felt that it looked like arterial bleeding and was determined to take another look. After that, no more vomiting of blood, Hb also came up, 120g/L. A few days ago, the re-examination of gastroscopy suggests that the body of the stomach ulcer, embolization has been 6 days, but there is still coffee-like things attached. The lesson left by this patient is that there is no history of underlying gastric disease, the bleeding is heavy and frequent, and a vascular problem should be considered. The most common gastrointestinal emergencies are gastrointestinal bleeding and abdominal pain. There was a patient with duodenal ulcer and bleeding who was treated with tolazol, famotidine, lidostat, EACA, soda, bacteriophage, metronidazole, etc., but the patient had cold sweats and chest tightness every night, which could be relieved by oxygen, and the cause was unknown. After 7 days, the patient was found to have a rash all over the body, and was considered to be allergic to mycobacterium, which was discontinued and given anti-allergic treatment, without further attacks. There was another case of duodenal ulcer with hemorrhage, a 40-year-old male with a history of hypertension and cerebral hemorrhage, admitted with blood pressure of 210/110 mmHg, treated with acid suppression, hemostasis (EACA, PAMBA), and sodium nitroprusside 12.5 mg + saline 100 mL IV, 4-6 drops/min, the patient immediately developed profuse sweating, pallor and shock, immediately stopped sodium nitroprusside, the patient’s blood pressure rose again to 180/90 mmHg. The patient’s blood pressure rose to 180/90 mmHg, and he did not dare to take care of it. 2 days later, the patient reported pain under the sword and was given pain relief and acid suppression, and at night he suddenly developed chest tightness, shortness of breath, full of lung rales, and the ECG was urgently checked for inferior wall infarction, and the ST of V1-V6 was shifted down by 1-4 mm. Example 4: A patient was admitted to the hospital for “repeated vomiting for 1 day”. The bedside doctor considered it to be acute gastritis, and the symptoms were slightly relieved by anti-inflammatory treatment after admission. I saw that she had used a lot of painkillers in the past two days, but the effect seemed to be not very satisfactory. I listened to the heart, lungs and bowel sounds, but there was nothing abnormal, and I used Tramadol. It relieved the pain for a while, and then called. I went back and talked to the second line, and he said to ask for a neurological consultation, and once the neurologist came and checked the body, it turned out to be cervical resistance! Meningitis was considered, and lumbar puncture was recommended immediately. The diagnosis of tuberculous meningitis was later confirmed! Consider this case: physical examination must be careful! Do not always limit yourself to the disease of this section, do not encounter any pain with painkillers, must think about why.