Auto chess in the operating room

Chapter 110 Tang Lou's Objection

"Tang Lou, have you really seen the patient's cause? Is the patient appendicitis?"

Mar En followed behind curiously. Anyway, he didn't see anything at all. The lower abdomen was rebounding and tender, and there was evidence of the shadow of color Doppler ultrasound. Based on his experience, isn't this the most typical appendicitis, and he underwent a Maxwellian incision? It's fine if you don't have an open stomach.

Tang Lou walked quickly: "It's appendicitis, but it's not appendicitis."

"what?"

Mann was completely dumbfounded.

After returning to the office, I checked the time and it was less than 10 minutes before the consultation.

"Tian Linsheng, help me set up the venue, prepare for the projection, and pour the tea."

Ma En suppressed the puzzlement in his heart, and let's talk about the preparations first.

Tang Lou was studying the medical records on the sidelines. After all, he wanted to draw his own conclusions after the consultation, so he was collecting evidence and formulating his own treatment plan.

After everything was ready, Qingping and Song Yang also came to the office.

Song Yang looked at the four positions prepared, and was a little puzzled: "Doctor Qing, Director Cheng is coming too?"

"No, it's just you and me, Ma En and Tang Lou."

Qingping sat at the host's seat, turned on the computer, and Ma En had already prepared the materials.

"Tanglou?"

Song Yang frowned, naturally he had heard of Tang Lou's name, he was a doctor in a county-level hospital who came to general surgery not long ago, so young, and he was born in a county-level hospital, Song Yang instinctively felt a little uncomfortable untie.

"In this consultation, even Ma En is at most just listening in and putting forward some small ideas. There must be something wrong with Tang Lou."

Song Yang said softly to Qingping, after all, they are all senior attending doctors, Ma En's words, as a senior resident with some experience in appendicitis surgery, Tang Lou, are a bit outrageous.

"Tang Lou still has some research on appendicitis. Of course, it's mainly just participating and listening. Doctor Song, let's start."

Qingping himself only had some small doubts about this case, and basically communicated with Song Yang. As for Tang Lou and Ma En's meeting together, it was mainly to send a signal to the department that Tang Lou was a young man he valued very much.

At the same time, it is also constantly establishing an impression for Ma En that Tang Lou can already be on an equal footing with him, and it will also help promote Tang Lou to carry out laparoscopic appendicitis surgery in the future.

Of course, it would be best if Tang Lou could come up with some valuable ideas and suggestions, but he didn't expect too much.

Song Yang nodded slightly, but he didn't care in his heart. After all, it was simply a fantasy for an attending to believe that a young intern could put forward constructive opinions in department consultations.

In his medical group, even for the simplest cases of appendicitis surgery, senior residents are at least eligible to attend the meeting. As for the interns who can serve tea and water at the side, they are already very content.

"Then let's start."

Qingping and Song Yang were naturally sitting close to the projection screen, one on each side.

Ma En looked at the signs, took a blank notebook and shrank behind Qingping to make an empty space.

Song Yang on the side naturally saw it from the corner of his eye, and smiled slightly, this soy sauce was not concealed.

Just as Song Yang was about to look at the projection screen, Tang Lou took a document and sat down under Qingping, in front of Ma En.

Moreover, on the notebook, there was a piece of handwriting neatly written, and the whole person seemed eager to speak.

Song Yang picked up his cup, took a sip of tea, and couldn't understand.

Is this tenement building really ready to make an opinion?

This kind of consultation between the attending physicians, in fact, the residents and interns are salted fish shouting 666, and they always observe the cups of the dry mouth and tongue that everyone said, and quickly and obediently continue the cup before it is about to dry up. That's it.

"Dr. Song, in this case, the symptoms and the color Doppler ultrasound display clearly showed that it was a typical appendicitis symptom. But when I gave the patient a physical examination and communicated before the operation, I didn't know why. I had a feeling that something was wrong. .But I can't think of a reason."

As Qingping said, he slid the picture onto the color ultrasound:

"Dr. Song, look, there is a finger-like echo with a diameter of 8.5 mm in the patient's right lower abdomen, and there is an echoless dark band around it. We consider it to be an inflammatory appendicitis."

Then Qingping slid the picture to the chest x-ray and electrocardiogram: "The chest x-ray and electrocardiogram were normal. Combined with the patient's right lower quadrant tenderness and rebound tenderness during the physical examination, the initial diagnosis was acute appendicitis. I made a surgical plan. The right lower quadrant McBurney's incision was performed, and a 5cm incision was made."

Song Yang looked at the materials that Ma En had sorted out, and then at the color ultrasound and pictures on the projection.

"Because I didn't go for a physical examination in person, based on the available information, I agree with Dr. Qing's initial diagnosis, which is also a very typical symptom of appendicitis. In fact, I am curious, why does Dr. Qing feel that something is not right? "

As a senior attending doctor, Song Yang has naturally experienced too many appendicitis operations: "The symptoms of patients so far are actually clear and specific enough. Compared with some inexplicable causes of acute abdomen, or suspected acute appendicitis, it is much clearer. .Moreover, for appendicitis surgery, McBurney's incision and traditional laparotomy, even for some minor cases, with Dr. Qing's experience and response, I think further investigation during the operation is the best solution."

Regarding Song Yang's judgment, Qingping naturally thought about it. If he came to perform the surgery, there would be no problem, and there was no need to be entangled. However, this operation was prepared for Tang Lou, so he needed to be more cautious in the early stage.

Qingping looked at Tang Lou and thought for a while: "If the Mai's incision is fixed, it is not impossible to wait for further exploration during the operation. However, this operation is not my main operation, but I still hope that we can brainstorm before the operation. Explain why I feel something is wrong. That is the path and timing of the metastatic pain reported by the patient, which is a bit weird."

Qingping stood up, and then recalled the location of the pain and the path and time point of the change of pain transfer that the patient pointed out during the physical examination.

After moving his fingers a few times, Qingping sat down and looked at Song Yang: "Is there something slightly wrong? But if it follows the path described by the patient, it is actually somewhat contradictory to the shadow on the lower right abdomen shown by the color Doppler ultrasound. But the color Doppler ultrasound and the final location of the pain are consistent."

Song Yang has rich experience. Naturally, when Qingping described the trajectory, he also frowned. According to this trajectory, it doesn't look like appendix disease, it seems that something is slowly flowing from the upper abdomen to the lower abdomen, but obviously The appendix does not move freely in the abdominal cavity like this.

The metastatic abdominal pain of appendicitis is not due to the movement of the appendix itself, but because the pain at the initial stage of the onset is due to the strong peristalsis of the wall of the appendix in order to remove fecal stones or foreign bodies and to relieve the obstruction of the lumen, which reflexively causes visceral nerve dysfunction.

Therefore, the visceral nerve cannot accurately identify the exact location of the pain at the first time.

When the inflammation spreads to the serosa and mesentery of the appendix, the right lower abdominal wall peritoneum innervated by the receptor nerves is stimulated, and the location of the pain is determined, thus creating the illusion of classic appendicitis pain transfer.

But the scope of this metastatic pain is not like the long-distance "flowing feeling" described by the patient recalled by Qingping.

Song Yang took a sip of tea, and Ma En who was at the side quickly got up and came over to continue.

Song Yang touched his chin, suddenly thought of a possibility, and suddenly realized: "Doctor Qing, the preoperative physical examination is naturally important, but don't ignore the deviations in the description of the patients themselves. After all, they are not professional. One statement deviates from the facts. It is still necessary to make a comprehensive diagnosis based on color Doppler ultrasound, rebound pain and our experience."

Qingping took a deep breath, and looked at the color Doppler ultrasound and other information. What Song Yang said was indeed reasonable. In many cases, the patient's self-report would indeed mislead the doctor.

"I suggest performing McBurney's incision and laparotomy. In case there are some minor problems, even if it is an ectopic appendix. Our experience is enough to deal with it. Continued investigation will delay the operation time. The patient's operation indications are clear, Dr. Qing Don't hesitate."

"And I suggest that this operation should not be performed by a subordinate doctor, just in case Doctor Qing will perform the operation himself."

Song Yang glanced at Tang Lou meaningfully, and came to his conclusion.

Qingping nodded: "Dr. Song is right, maybe I'm sensitive, so let's order the Maishi incision. Ma En, do you have any other opinions?"

Song Yang was ready to get up and leave. After all, Qingping said that asking Ma En and Tang Lou to raise their opinions was nothing more than a scene. After all, the two big bosses had made a final decision. How dare this resident doctor and fellow doctor raise objections?That would be too ignorant of the rules.

Sure enough, Ma En shook his head: "No objection, no objection, I agree with Dr. Song's point of view, and my judgment is also typical acute appendicitis. There is nothing controversial."

"Tanglou?" Qingping naturally wanted to finish the procedure.

And Song Yang had already stood up, ready to leave.

"I think this patient should have had a laparoscopic appendectomy!"

The tenement building is loud and loud, I am absolutely sure!
(End of this chapter)