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Abstract: Acute gastroenteritis belongs to a common clinical type of gastroenteritis with mostly acute onset. The patient in this case was a 27-year-old male who came to our hospital with persistent dull pain in the abdomen after consuming crayfish, and was clearly diagnosed with acute gastroenteritis. After admission, he was treated with levofloxacin hydrochloride sodium chloride injection and ceftazidime for injection for 3 days, and the routine blood test was repeated, and the indicators dropped back to the normal range, the abdominal pain disappeared, and the condition was stable.
Basic information】Male, 27 years old
Disease Type】Gastroenteritis (acute gastroenteritis)
Hospital】The First Hospital of China Medical University
Time of consultation】July 2016
Treatment plan】Medication (levofloxacin hydrochloride sodium chloride injection, ceftazidime for injection)
Treatment period】3 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] The abdominal pain disappeared and the condition was stable.
I. Initial consultation
After consuming crayfish one day ago, the patient developed abdominal pain, which was persistent and dull, with no obvious relief, no diarrhea, nausea, vomiting, no fever and chills. Outpatient physical examination showed a flat, symmetrical abdomen with no abdominal wall veins showing, no gastrointestinal pattern or peristaltic waves, soft abdomen, median lower abdominal pressure pain, no rebound pain, no abdominal mass; liver and spleen were not palpated under the ribs, Murphy’s sign was negative; abdominal percussion showed a drum sound, the upper border of the liver was between the fifth ribs in the right midclavicular line, no percussion pain in the liver and kidney area, no mobile turbid sounds; intestinal sounds were active, 6 times/min. A routine blood test was performed and the leukocytes were 18.2×10^9/L. Combined with the physical examination, a preliminary diagnosis of acute gastroenteritis was made and the patient was admitted to the hospital. Since the onset of the disease, the patient had poor appetite, could sleep, and had no significant abnormalities in urine.
II. Treatment history
The patient was given antibiotic treatment, and levofloxacin hydrochloride sodium chloride injection and ceftazidime for injection were used after admission to control the symptoms of bacterial infection, during which changes in the condition were noted. On the second day of admission, the patient’s abdominal pain disappeared, liquid diet was available, and there was no abnormality in urine and stool. Routine blood examination showed that: leukocytes 12.7×10^9/L, neutrophil ratio 76.3%, red blood cells 4.69×10^12/L, hemoglobin 125g/L, platelets 192×10^9/L. There were still signs of inflammation, and anti-inflammatory drugs were continued to be given intravenously for symptomatic treatment. On the third day of admission, the routine blood test was repeated and the indexes dropped back to the normal range, and the patient was discharged after stopping the anti-inflammatory drugs.
Treatment effect
Before admission, the patient had persistent dull pain in the abdomen that could not be relieved, and the values of leukocytes and neutrophils were significantly elevated in routine blood tests. After 3 days of treatment with levofloxacin hydrochloride sodium chloride injection and ceftazidime for injection, the patient’s abdominal pain disappeared and the routine blood test was repeated: leukocyte 9×10^9/L and neutrophil ratio 61.2%, which were within the normal range. The patient was discharged from the hospital with no other symptoms. The patient was advised to take more rest, drink more water and take enough calories.
IV. Notes
After the patient’s condition improved, I was sincerely happy for the patient. At the time of discharge, I did not forget to emphasize to the patient that the following points should be noted in life.
1. Take more rest after discharge, establish regular rest and rest habits, and avoid staying up late. Restrict heavy physical labor as well as strenuous exercise in the early stage and avoid solitary exertion.
2, the recovery period diet is appropriate to eat warm, easy to digest food, such as rice porridge, egg custard, etc., avoid cold drinks, ice-cream and other cold food, so as not to cause gastrointestinal stimulation, causing discomfort.
3.After discharge from the hospital, patients should observe their own changes, such as the number of bowel movements, body temperature, stool shape and other changes, and seek medical advice if there is any discomfort.
V. Personal insight
The patient in this case has persistent dull pain in the present abdomen as the main symptom, which is more common in digestive system diseases and easily confused with the following diseases in diagnosis.
1, acute appendicitis: the patient has a history of right lower abdominal pain or metastatic right lower abdominal pain with gastrointestinal symptoms, blood routine suggests elevated blood leukocytes, ultrasound: swollen appendix visible in the right lower abdomen, physical examination: right lower abdominal pressure pain, rebound pain, so the diagnosis is basically clear.
2, urinary stones: Patients with urinary stones usually have no obvious positive signs in the right lower abdomen, urine routine shows occult blood and red blood cells, ultrasound shows dilated right renal pelvis, but this patient does not have the above-mentioned performance, so the diagnosis can be basically excluded.
3, upper gastrointestinal perforation: patients often have a history of previous gastric disease, sudden onset of epigastric pain, physical examination suggests total peritonitis, the upper abdomen is heavy, abdominal plain film can be seen under the diaphragm free gas gas gas. In this patient, the physical signs were not consistent with the signs of upper gastrointestinal perforation, and no subdiaphragmatic free gas was seen in the abdominal plain film, so the diagnosis was basically excluded.
Therefore, patients with persistent dull pain in the abdomen should go to the hospital in a timely manner, as in this case, and be treated under medical supervision to avoid more serious consequences.