My medical skills add experience

Chapter 492 The Journey of a Famous Doctor, What's wrong with Dr. Du?
I am afraid that this patient has more than simple upper gastrointestinal bleeding, and it is very likely that there is also bleeding in a certain part of the lower gastrointestinal tract.

And the source of major bleeding is most likely in the lower gastrointestinal tract.

When Zhou Can gave this patient the first consultation, hemostasis and pathological diagnosis were combined with two six-level medical techniques, and it was judged that the patient's bleeding source was in the upper gastrointestinal tract, and it was probably the stomach.Now after further diagnosis, it is found that the patient is likely to have multiple sources of bleeding.

This shows that his initial diagnosis was missed.

But even if he misses the diagnosis, he has also gained a lot, groping for the diagnostic technique of a top doctor.

At most, his hemostasis and pathological diagnosis are still at a low level, and there is still a big gap between him and the real top level.

So the diagnosis will be missed.

In any case, it is already very impressive to be able to identify a source of bleeding only through physical examination and the patient's medical history and symptoms.

You know, he is only a resident doctor now!
And it's just a low-level resident doctor, so he's already so good. As long as he studies hard and practices hard, it's only a matter of time before he reaches the top level.

I don't know how much luckier they are than those doctors who have practiced medicine for most of their lives and haven't even passed the director level.

"Okay, I will immediately arrange for the patient to take gastric juice for testing. Dr. Zhou has worked hard, so let's go to dinner! If you have any new diagnostic ideas, please let me know at any time. Since the patient's condition is serious, I will first invite a doctor from the Department of Gastroenterology according to the procedure. Come for a consultation."

Ellie respects and cares for Zhou Canna from the bottom of her heart.

As a doctor, I can best understand the suffering of doctors.

Zhou Can has been busy in the operating room all morning, and now she is still hungry to help her diagnose patients. This is a great kindness.

Ellie asked a gastroenterology doctor to come for a consultation. It is best to find out the cause of the disease. If it cannot be found out, the risk can also be differentiated.Now she is very worried that the patient's condition will suddenly deteriorate, and people will die if they say no.

……

Sitting in the cafeteria eating, Zhou Can was still thinking about the cause of this patient.

The gastric juice is taken out for testing. If the test result is non-bloody, then the lower gastrointestinal tract must be checked.

Considering the patient's hyperthermic reaction and excessive bleeding shock, the possibility of acute hemorrhagic necrotizing enteritis is very high.

When Zhou Can performed an abdominal tenderness examination on the patient, he pressed the patient's lower xiphoid process and around the navel, and the patient had an obvious tenderness response.

Acute hemorrhagic necrotizing enteritis often presents symptoms such as periumbilical and abdominal cramps, bloody and watery stools, and even intestinal mucosa with necrosis and necrosis, and the stools will be particularly fishy.

Among the above symptoms, except for the two symptoms of gastrointestinal bleeding and periumbilical pain, no other symptoms have been found yet.

Therefore, acute hemorrhagic necrotizing enteritis cannot be ruled out, nor can it be fully diagnosed.

At most, the probability of diagnosis is [-]%.

This requires further observation and stool testing.

If the disease is ruled out, what disease would it be?
At this time, Zhou Can deeply realized that when the book is used, he will hate it.

Searching and sifting through the knowledge points of the cases and digestive tract related diseases one by one.

He is already very good, at least a hundred times better than those medical students who have a stomach full of medical knowledge, but when it comes to clinical practice, their minds are blank and they can't use any of them.

This kind of rhetoric is very good, and they get high scores in the exams, but there are not a few doctors who become cowards as soon as they go to the clinic.

Everyone walks this way.

Slowly, there are more actual combats, and with experience, you will know how to apply what you have learned.

After one year of internship, three years of regular training, and nearly two years of resident work, Zhou Can has quite a lot of practical experience.It is completely possible to apply what you have learned.

At this time, he thought of a disease similar to the patient's symptoms.

Ulcerative colitis.

This is a nonspecific inflammatory bowel disease with a slow onset.

The patient's onset is also very slow, and the course of the disease has lasted for more than one month.This is very much in line.

The location of the lesion is also correct.

The lower gastrointestinal tract includes the colon.

Moreover, Zhou Can learned that the patient's anemia symptoms did not change after hemostatic drugs and 1000 ml of blood transfusion were used. He already suspected that the possibility of the patient's small intestine or upper colon bleeding was extremely high.

Ulcerative colitis is often accompanied by symptoms such as diarrhea and abdominal pain, followed by bloody stools, even purulent bloody stools, fever, and weight loss.

Among these symptoms, the patient had four consistent symptoms: abdominal pain, bloody stool, fever, and weight loss.

Slow course is also consistent.

So the likelihood of ulcerative colitis is very high.

Zhou Can has already thought of two possible diseases, and he is not satisfied with that.

A real top doctor is to constantly expand his diagnostic thinking and take into account all possible causes.

The more comprehensive your thinking, the better.

When making a diagnosis, it is very important to test a doctor's knowledge and clinical experience in related fields.

This is also the reason why experts are "single-minded", and few people can bloom in multiple fields at the same time.Because a person's energy and time are really too limited.

Zhou Can has been trained in Gastroenterology and Gastroenterology, and the time is not too short.

This also gave him the opportunity to accumulate more experience in the diagnosis and treatment of digestive diseases and learn more relevant knowledge.

At this time, two new diseases popped up in his mind.

Colonic diverticular disease mostly occurs in the sigmoid colon and cecum, and is often accompanied by fever, elevated white blood cell count, and signs of peritonitis.

The disease manifests as periodic small amounts of bleeding or acute massive bleeding.

Another disorder is Meckel's diverticulum.

The basic symptoms are similar to those of colonic diverticular disease, except that it is more common in the terminal ileum.

The patient had fever and acute massive hemorrhage, both of which were consistent.

However, no signs of peritonitis were found.

These two diseases are possible, but the probability is not very high.

Zhou Can has already thought of four causes, but he is still not satisfied. He is still racking his brains.

"Hey, Xiaolan, you are eating here too!"

A magnetic man's voice sounded, and Zhou Can was awakened from his contemplation.

"Yeah! We're busy this morning. We just had surgery. Have you eaten yet?"

Ma Xiaolan responded with a bright smile.

"I happen to be a little busy today. No, I'm just about to come over to have some food. Can I share a table with you? Doctor Zhou!"

The man who greeted Ma Xiaolan asked Zhou Can with a smile.

"Please sit down! Doctor Du and Xiaolan have known each other for a long time?"

Zhou Can did not expect to meet Du Leng here.

Because he is very busy with work, he often orders meals in the operating room, and seldom comes to the restaurant to eat.The number of encounters with Du Leng is also very few.

In addition, Zhou Can's current status has already thrown Du Leng several blocks away. Even if they meet each other, Zhou Can is still a king.

Du Leng tried not to greet him directly and avoided him.

Why?

Because a doctoral student who graduated from a prestigious overseas university was crushed by an undergraduate student from a domestic 985 university, what a shame!

Don't look at Du Leng, who is usually gentle and elegant, with a modest and gentlemanly demeanor, but he is actually comparable to Yue Buqun in martial arts dramas.Not only is he hypocritical, but he also wants to save face.

What impressed Zhou Can the most was that he went to Xinxiang Maternal and Children's Hospital with Du Leng a few years ago.

Zhou Can rushed out like a peerless dark horse, and Du Cooling fell to the altar.

After the expert consultation, Du Leng began to avoid him intentionally, and began to do basic clinical work in a down-to-earth manner.It is said that he learned the same thing from collecting the patient's excrement and urine, changing the dressing, and inserting the catheter.

As for Du Leng's current strength, Zhou Can really doesn't know.

In terms of surgical talent, Du Leng is not as good as Zhou Can even if he is flying.

"I have known Dr. Du for about three months. Speaking of it, it is also fate. One day I got off work late, and it happened to be raining again, so I couldn't get a taxi. Dr. Du offered to take me back to my residence."

When Ma Xiaolan talked about this matter, she was full of gratitude.

Also a little shy.

Women's touch often happens when they encounter difficulties.

For example, they were robbed by gangsters, entangled by street thieves, or they were sick and needed someone to take care of them. When they were most helpless, a man extended a helping hand, and nine out of ten would leave a deep love in their hearts. impression.

Some wonderful fates often start from such small things.

"Are you two dating now, or just friends?"

Zhou Can asked with a smile after listening.

"As the boss of the surgical team, Dr. Zhou really cares about the team members! Even these personal matters need to be inquired in detail."

Du Leng hurriedly spoke out to rescue Ma Xiaolan.

"Haha, everyone has a heart for gossip. I'm also a layman. It's Dr. Du who thinks too highly of me. Dr. Du has a dazzling education and looks very talented. He must have had a lot of girlfriends. I can get it." Say hello, you can't let Xiaolan down, otherwise everyone in our surgery team will not agree."

Zhou Can said half-jokingly and half-seriously.

The main thing is to remind Ma Xiaolan, don't be played by others and not know.

Du Leng's reputation is not very good.

There were at least ten female doctors and nurses he played with in the hospital.But we must admire Du Leng's ability. So far, none of those female doctors and female nurses have caused any trouble.

I heard that when Du Leng picks a girlfriend, he only needs to be at an upper-middle level for his face, but he pays special attention to his figure.

It can only be said that everyone's hobbies are different.

Ma Xiaolan and him have known each other for three months, and it is not known how far they have developed with Du Leng.

As the boss of the surgical team, Zhou Can can only fulfill his duty of reminder, and he will definitely not interfere with the relationship between the doctors and nurses under him.

"Doctor Zhou, is he complimenting me, or hurting me? Du is not as philandering as you said. I practice the idea of ​​drowning three thousand people and just take a scoop to drink. If one day, I find something that can make my heart beat." Girl, I am willing to be like the love of a white swan, and never leave it for the rest of my life."

Du Leng didn't know whether he was worried that Zhou Can would ruin his relationship, or what.

Quickly express a serious attitude.

It's more like expressing his love view to Ma Xiaolan.

I don't want to be mistaken for a big carrot by her.

He explained in such a hurry to get angry, and it was confirmed that the two were in love.

Judging from Du Leng's caring performance, he probably hasn't been able to win Ma Xiaolan yet.Of course, it is also possible that it has already been won. Maybe it is because I really like Ma Xiaolan, that's why I care so much.

Whether it's a man or a woman, it's easy to become infatuated when you meet someone you like.

One thing falls one thing.

"Hurry up and eat, or the food will be cold!"

Ma Xiaolan smoothed things over for the two of them.

During the meal, Du Leng did a very interesting thing. When he was almost finished eating, he got up quickly, ran to the window to buy a few bottles of yogurt and came over.

One bottle per person.

Zhou Can felt disbelief on his face, what does this guy want to do?Engage in bribery?
"Thank you, Dr. Du, for inviting us to drink yogurt. It's getting late. We have to go back to work in the operating room. Goodbye."

As the leader of the team, Zhou Can must show something.

"You're welcome! Actually, I admire you a lot. It is said that your surgical ability is no worse than that of senior chief physicians in many fields. This is simply a miracle. I believe God must have touched you."

Du Leng didn't seem to be hypocritical and polite at the moment, but spoke in a more serious tone.

"Hehe, Dr. Du admires me, but I don't know that I admire you even more! Overseas students are already good enough, graduates from prestigious overseas schools are definitely one or two out of tens of millions. Also, I never believe in God, I Faith is Yanhuang."

Zhou Can never engages in the practice of worshiping foreigners.

In terms of the mythology system, how can foreign Athena, the Statue of Liberty, God, and Satan compare to the Chinese mythology system?
China's Sanqing, the Jade Emperor, the Star Kings, the Heavenly Kings, the Dragon Kings of the Four Seas, etc., are a very complete mythology system.It has a complete division of labor and clear status and levels.

Du Leng suddenly expressed his admiration for him. What kind of medicine does this guy sell in his gourd?

Is this to take the initiative to shake hands and make peace?
In the past, Du Leng and him were like fire and water.

After coming out of the cafeteria, on the way back to the emergency department, Zhou Can began to think about the possible causes of the patient with gastrointestinal bleeding.
Intestinal malignant histiocytosis.

Another disease that was more consistent with the patient's symptoms was screened out by him.

The disease is often accompanied by fever, gastrointestinal bleeding, and antibiotic treatment is often ineffective.

The patient's condition is highly consistent with this disease.

The best way to diagnose this disease is to give the patient a gastrointestinal barium radiography, or an emergency endoscopy.

It's just that the patient has just gotten out of shock and is still very weak, and there is likely to be a lot of blood in the intestinal tract, so the effect of these two tests will be greatly reduced.

It may be a good way to do a routine bone marrow examination for the patient.

At this time, Zhou Can had already reached the lobby of the emergency department.

"Doctor Zhou, Director Han, please go to the consultation room to discuss your condition."

When the nurse saw Zhou Can, she hurried forward to tell him.

When he came to the consultation room, Zhou Can found that Ai Li, Deputy Director Han, and Director Shang of the Department of Gastroenterology were present with two students.

"Hey, Dr. Zhou hasn't seen him for quite a while."

When Director Shang saw Zhou Can coming in, he immediately stood up and walked over to shake Zhou Can's hand warmly.

Look at Director Shang's attitude, he didn't treat Zhou Can as a resident doctor at all, but elevated him to the level of an old friend at the same level as him.

"Haha, I haven't seen you for a while. Director Shang looks even better."

Zhou Can responded enthusiastically, even flattering the other party.

(End of this chapter)