The system takes me for surgery

Tan Aizhu made a mind map on paper, and said to Liang Yi: "Patient FT3, FT4, blood, urine UFC and T all decreased significantly, but the corresponding thyrotropin, adrenocorticotropic hormone and gonadotropin did not significantly decrease. The increase indicates that the patient has hypogonadism, adrenal cortex, thyroid, and hypogonadism, all of which are secondary, and the root cause of the disease is the hypofunction of the whole pituitary gland. Combined with the MRI of the sellar region, it is considered to be caused by the compression of the normal pituitary tissue by the pituitary tumor.

Liang Yi nodded and said: "Yes, this case is very interesting and should be kept in a collection. In fact, nausea and vomiting can also be seen from MRI. You can see that the patient's appetite loss in the past few months is related to the decrease in pituitary function. Nausea and vomiting, combined with pituitary MRI showed that the sagittal sagittal position of the tumor showed a layered liquid-like level, which was aggravated by pituitary tumor and stroke, which had also caused increased intracranial pressure, which caused nausea and vomiting symptoms."

"That's right, when you put it that way, all the fog has cleared, and all the symptoms have a reasonable explanation." Tan Aizhu said excitedly.

This is like a detective solving a case. After finding out all the clues and connecting them logically, all the clues have been reasonably explained, and the final "murderer" will come out.

Liang Yi smiled and said, "Whether it's a real murderer or a fake murderer, you'll know after taking the medicine."

"Haha... You also have times when you are not confident." Tan Aizhu smiled. Her smile was not pretty, but it was much gentler than when she had a straight face.

"There is a lot of logic in the mouth, and a lot of panic in the heart." Liang Yi laughed at himself.

So Tan Aizhu added prednisone to the patient, the mental state of the patient improved significantly, the appetite increased, and vomiting did not occur again.

One week after admission, he was transferred to the Department of Neurosurgery for "resection of the pituitary tumor through the right nasal sphenoid and evacuation of the hematoma".Postoperative diagnosis: nonfunctioning pituitary macroadenoma with stroke.

The patient recovered and was discharged after follow-up.

Because this case is very special, the emergency department also specially discusses this case again.

Xie Tianmu made a summary like this: "This case started with loss of appetite, nausea, and vomiting, which was mistaken for a digestive system disease, but the patient's vomiting was characterized by early vomiting after eating, and there were no other accompanying symptoms of the digestive system, and there were no relevant auxiliary examinations. Positive findings. Therefore, when the symptoms are not completely consistent with the predicted common manifestations of the disease, the diagnostic thinking should be rearranged, and it cannot be simply attributed to "atypical clinical manifestations."

For the first time, Director Li Zhengping expressed his opinion after Xie Tianmu's speech, "This case really lacks characteristic symptoms, so it is difficult to diagnose at the beginning of the disease. When it is found that the patient has intractable hyponatremia, it brings a new breakthrough for diagnosis. In this way, we can broaden our thinking, consider diagnosis from other than digestive system diseases, and finally find the source of the disease.”

The two directors also praised Tan Aizhu's improvement in diagnostic ability. Xie Tianmu mentioned by the way that the medical level of the entire department has been significantly improved after clarifying the specialization of internal and external departments, and this distribution model will continue in the future.

Everyone learned a lot from this case. Tan Aizhu privately thanked Liang Yi for his help, and he even got a pizza.

Later, this case was communicated in the hospital, and Xie Tianmu was also highly affirmed by the internal medicine system.

Recently, Xie Tianmu, the director of emergency surgery, has been developing a pacemaker quite well. He can arrange two or three such operations a week, which is also a good achievement for the emergency department that has just started the field of extracardiac surgery.

In the operating room, Xie Tianmu performed a pacemaker operation on a middle-aged man in his fifties as usual.

The head nurse in the operating room asked, "Why didn't the young man who did a good job come here?"

"Which one?" Xie Tianmu pretended to be confused.

"Hey, that young doctor who came here for regular training."

"There are so many doctors trained, how can I remember?"

Chen Wenji hurriedly said, "The head nurse is asking Liang Yi."

Xie Tianmu gave him a blank look and blamed him for talking too much.

"That's right, that boy Liang Yi." The head nurse said.

"Liang Yi, he is mainly in charge of internal medicine now. This kid is good at surgery, and he is even better at internal medicine. Recently, he diagnosed a difficult disease by calling Aizhu."

Xie Tianmu asked many emergency nurses about the case. He didn't believe that Tan Aizhu had such a strong diagnostic ability. Later, he found out that it was Liang Yi who called Tan Aizhu to diagnose it.

The head nurse was surprised: "Isn't this from a lower-level hospital? It's even better than Tan Aizhu!"

"Yes, he is very talented in internal medicine, so I plan to train him more."

This Xie Tianmu's speech is very old-fashioned. He didn't say that Liang Yi was bad, but isolated Liang Yi from the operating room in the name of training. If he said it was bad, everyone would think he was bullying Gui Peisheng. With this technique, Liang Yixue can be hidden logically.

The head nurse is also an old fritter. She said with a smile: "It is a good thing to have focused training, but it is best to seek the opinions of young people. If you are interested, you will get twice the result with half the effort. If you are not interested, you will get twice the result with half the effort."

"Our emergency department has always been democratic and open, and we don't play those vain political tricks. We must have asked for his opinion."

Xie Tianmu thought that his speech was impeccable just now, but he didn't expect the head nurse to see through it at a glance, and his tone became a little stiff.

The head nurse immediately noticed such a flaw, so she stopped talking and changed the subject and asked, "When will it end?"

"Half an hour." Xie Tianmu said.

"If only you had the same ability to perform surgery as you do." The head nurse complained.

Xie Tianmu: "How do you say?"

The head nurse said: "You perform the operation for half an hour, but it takes at least an hour longer, and it's the opposite, less than [-] percent."

Everyone suddenly reacted and burst into laughter. This broken car suddenly went on the highway, which caught people off guard.

Xie Tim Mu said: "Sure enough, women are more attractive than men when they get older."

The head nurse said: "That's not true, at this age, you are soft everywhere except hard-talking."

Chen Wenji blushed when he heard that, this kind of classic car is really too blatant, it caught people off guard.

At this moment, Xie Tianmu's cell phone rang.

This is unprecedented. Doctors generally have two mobile phones. One is for external use. It is used to deal with patients and ordinary friends. This mobile phone is in silent mode on the operating table, and the other is for internal use. When I was on the operating table, this phone had an incoming call reminder.

The operating room is a sterile environment, but it is no problem for the nurse to hold the mobile phone close to the surgeon's ear to answer the call.

The head nurse pressed the phone to his ear.

After picking up the phone, Xie Tianmu just nodded his head, said "hmm" a few times, did not speak, his brows were furrowed, and the expression on his face sank.