Auto chess in the operating room

Chapter 247 It Is Really Difficult To Be A Doctor
Tang Lou looked at Wang Airen's past history again:
He complained of repeated epigastric pain and discomfort, belching and other medical history, and usually took Starazol and morphine for symptomatic treatment.

Physical examination: T: 36.2 ℃P: 72 beats/min R: 19 beats/min BP: 158/102 mmHg
Clear mind, low energy, flat abdomen, no distension, no varicose veins in the abdominal wall, scattered tenderness in the whole abdomen, obvious tenderness in the upper abdomen, accompanied by rebound tenderness, suspicious local muscle tension in the upper abdomen, no palpable liver and spleen under the ribs, liver dullness border Existence, bowel sounds not heard, shifting dullness negative.

When checking the auxiliary examination five days ago in Tanglou, Ma Shuya also explained, pointing to the patient's abdominal CT and explained:
"Doctor Tang, look here. There is a small amount of free gas in the front edge of the left lobe of the patient's lung. It is preliminarily speculated that the patient's hollow viscera is perforated, and he has peritonitis in the middle and upper abdomen, peripancreatic and splenic flexure of the colon, and left paracolic groove area. fluid. Pancreatitis cannot be ruled out."

Tang Lou nodded, and added: "The scan can be enhanced for further examination, whether there is a possibility of necrotizing pancreatitis."

Ma Shuya agreed very much: "What Dr. Tang said is correct at all. We will also conduct an enhanced scan later. You can see the film from three days ago later."

Ma Shuya pointed to the CT of the abdomen five days ago, and told Tang Lou the conclusion of the first examination: "Doctor Tang, you can see the patient's right hepatic duct and pancreatic duct area with strip-shaped high-density shadows, and there are sand-like stones in it. Row. In addition, it can be seen that cholecystitis, the patient's bilateral renal pelvis is mildly dilated and hydrops, the possibility of bilateral renal cysts, and small stones in the left kidney. It was also found at the same time, suggesting coronary artery calcification."

Looking at this chest CT, Tang Lou is also frowning. There are many complications. This kind of case is really rare, and a paper can be published alone.

It can also be seen from this that the uniqueness of Zijingang Hospital basically treats difficult and miscellaneous diseases in the whole province. Such complicated cases are very rare in the No. [-] Hospital of Hecheng City.

Ma Shuya took out the patient's chest CT scan from five days ago: "Doctor Tang, look, from this film, we can see that the patient meets the symptoms of chronic bronchitis and emphysema in both lungs. At that time, Dr. Pan, the chief physician of our department, A senior attending physician who studies the liver, biliary and pancreas suggested considering pneumonia in the left lingual lobe, right middle lobe and both lower lungs."

Ma Shuya then pointed to the upper and middle lobes of the patient's right lung: "Doctor Tang, these areas have calcified nodules."

Tang Lou nodded solemnly, and at the same time looked at the patient's heart image, which was also slightly larger than usual, obviously due to coronary artery calcification, and at the same time, the aorta was slightly dilated and circuitous, and calcium plaques formed on the wall.

唐楼又看向了下面的血常规指标：C反应蛋白7.7mg/L↑，超敏C反应蛋白>5mg/L↑，白细胞12.37*10^9/L↑，中性粒细胞百分比94.80%↑。

"Based on the examination on the first day, Dr. Pan made a preliminary diagnosis that the patient suffered from cavity organ perforation and acute pancreatitis. He was given a fasting gastric tube, established an intravenous channel for fluid replenishment, cefoperazone, sulbactam (domestic), and replacement therapy. Nitrazole dual anti-infection, omeprazole to protect the stomach, rehydration and other treatments. Traditional Chinese medicine enema."

Since he had never seen the patient himself, Tang Lou could only make inferences based on the case data. Obviously, Dr. Pan's diagnosis was very reasonable and comprehensive.

Next, there was the information from three days ago and the supplementary abdominal contrast-enhanced CT. Ma Yashu told Tanglou Doctor Pan’s secondary diagnosis:

1. Considering acute pancreatitis, peritonitis in the middle and upper abdomen, and scattered effusion in the abdomen and pelvis, it is hoped that it will be combined with clinical analysis.

2. Small cysts in the liver

3. Small cysts in both kidneys and parapelvic cysts.

4. Reflex changes in both lower lungs. (Compared with the CT scan five days ago: no definite free air shadow was found in the abdominal cavity in this scan, the peritonitis was worse than before, and the reflex changes in both lower lungs were increased than before. (Reexamination of liver function was completely normal)
After Ma Yashu finished speaking, she handed Muzi's latest ward inspection information to Tanglou in a depressed tone:
"Doctor Tang, according to the treatment plan formulated according to the previous diagnosis, the overall pain level of the patient today is significantly relieved compared with when he was admitted to the hospital, but he still feels pain. The pain is mainly above the abdomen and below the xiphoid process. The pain is persistent and aggravated by paroxysms."

"Obviously, we still overlooked something, and we still haven't found out the key cause of the patient's disease."

Ma Yashu sighed, apparently there was no progress.

Tang Lou couldn't do anything with just relying on these materials, and he didn't have any good suggestions for a while.

Seeing Tang Lou's condition, Ma Shuya was not surprised. She got up and handed a few fruits to Tang Lou: "Doctor Tang, even Doctor Pan has been studying this patient's condition for four or five days, and he is still at a loss. , You didn't find anything, and it's normal."

"Perhaps in Hecheng No. [-] Hospital, your department does not have this feeling, but in Zijingang Hospital, although it has the best doctors and the most advanced equipment in the province, it also treats various difficult problems that cannot be solved in the province. Miscellaneous diseases, so the situation of this patient is very common."

Ma Yashu took a sip of tea, and then smiled sadly: "Sometimes, I really feel that being a doctor is boring. The patient came with high expectations, but after more than ten rounds of diagnosis and examination, we still couldn't come up with any constructive suggestions. What do you think is going to support us?"

Muzi on the side seemed to have seen this side of Ma Shuya for the first time. After all, he had just started his internship and had not yet realized this, but he also felt a little sad.

Secretly hid on his bed, closed his eyes, not daring to disturb.

After all, even Dr. Pan, Dr. Ma, and Dr. Tang couldn't solve the difficult and complicated diseases, so she only added trouble.

It’s really hard to be a doctor!

Seeing Ma Shuya's frustration, Tanglou didn't know how to comfort him. He thought for a while: "Doctor Ma, how about we go to the ward to see the patient now, or maybe we can gain something."

"Alright."

Ma Shuya thought he was going out for a walk, and didn't expect anything.

The two soon arrived at the ward. The patient Wang Airen had already fallen asleep, and the patient's daughter was also lying on the folding chair beside her with her eyes closed.

It's been a rough few days.

"Doctor Tang, why don't we go in and ask again tomorrow morning."

Ma Yashu walked to the door, thought for a while, and decided not to go in and disturb her. One reason is that she doesn't want to wake up the family and the patient. The second reason is that if the patient really asks, she can't give the patient anything but disappointment.

Tang Lou stood at the door, and sent a diagnosis:

[Patient: Wang Airen, female, 75 years old

Symptoms: Consciousness, poor spirits, flat stomach
Diagnosis: 1. Acute pancreatitis, 2. Biliary ascaris, 3. Peritonitis, 4. Small cysts in both kidneys, 5. Pelvic abscess, 6. Rectal perforation caused by enema...

Special reminder: Ascariasis in the biliary tract is very hidden, and color Doppler ultrasound is needed to check the biliary tract for confirmation. At the same time, rectal imaging should be performed, and attention should be paid to the secondary damage caused by enema during treatment. 】

Seeing Tanglou still staring at Wang Airen in the ward, Ma Shuya reminded him in a low voice: "Doctor Tang?"

Tang Lou's eyes quickly recovered, and he looked at Ma Shuya: "Well, let's go back."

(End of this chapter)