My medical skills are a billion points

Can any of you tell me, which diseases are considered by this patient, and what diseases are the most suspected? "

Since these students believe in him, Xiao Chu must try his best to impart clinical knowledge and experience to these interns.

Since these interns call him a teacher, he must fulfill his responsibility as a teacher!

The provincial hospital is a large tertiary hospital.

The doctors practicing here have at least a bachelor's degree, and some are postgraduates.

For advanced doctors, because they have certain clinical experience, their academic qualifications are extended to junior colleges.

It can be said that the theoretical knowledge of these students is not too bad. Of course, what they lack is mainly clinical experience and hands-on ability.

Of course, there are also some undergraduates who only focus on the study of theoretical knowledge for the postgraduate entrance examination, but don't pay attention to it during clinical practice.

Xiao Chu didn't notice it before.

Since the number of interns following him increased, he found that some students only came to check the wards after work, and they just had to order them.

For the rest of the time, I don't know where to go.

There is no emphasis on clinical practical skills at all.

However, there are still some undergraduate interns who are very dedicated to studying, and a few doctors who are studying at the scene.

Seeing Xiao Chu asked them questions.

These interns and fellow doctors looked at each other, and the trainee doctor Wang Panpan stood up first and said:

"Mr. Xiao, this patient has no previous medical history, and today the epigastric pain suddenly broke out, and it was after drinking. I think the pain may be caused by gastroduodenal ulcer. After all, he has a history of frequent drinking."

Xiao Chu nodded.

I agree with the answer of this trainee doctor.

But he glanced again, and the circle of study doctors standing around asked again: "Do you have any other considerations?"

After a patient comes to the hospital, a simple symptom of abdominal pain can be caused by various diseases.

Therefore, like the patient with upper abdominal pain just now, it is impossible to only consider gastroduodenal ulcer.

At this time, a male trainee doctor wearing glasses adjusted his glasses and said, "Mr. Xiao, it is one thing to consider this patient's gastroduodenal ulcer, but I also consider whether he has acute cholecystitis or gallbladder disease." possibility of gallstones.

After all, after drinking alcohol, it is easy to induce cholecystitis, or stimulate the onset of symptoms of gallbladder stones. "

When other study doctors saw someone speaking, they stood up and expressed their views one after another.

"I think this patient may also have stomach cramps."

"This patient may not rule out acute appendicitis. We all know that the typical symptom of acute appendicitis is metastatic right lower quadrant pain.

At the beginning, the patient's main symptom was epigastric pain, and then after a few hours, fixed right lower quadrant pain would appear.

Now this patient has epigastric pain, which occurred only one hour ago, so the possibility of acute appendicitis cannot be ruled out. "

"There is also this patient, the possibility of gastric perforation cannot be ruled out. After all, he often drinks alcohol, which is easy to cause damage to the gastric mucosa. He is now suffering from severe upper abdominal pain, and there is still tenderness in the upper abdomen, so the possibility of gastric perforation is not ruled out. .”

"Mr. Xiao, there is also intestinal obstruction, which cannot be ruled out."

This is considered by a trainee doctor.

After all, I have worked in the hospital for several years, so I think about it quite a bit more than interns.

Everyone chattered about several diseases.

But repeat, repeat the past, nothing more than gastroduodenal ulcer, stomach cramps, gastric perforation, cholecystitis and acute appendicitis and the like.

At the end, no one stood up and said anything.

Xiao Chu made the final conclusion.

"You consider the patient's symptoms as simple upper abdominal pain, and the diseases you consider are relatively comprehensive.

But there is only one very typical and relatively common acute disease, which none of you have thought of. "

Chapter 235 Am I mild or severe?

So many people chattered and discussed many diseases.

However, in Xiao Chu's eyes, there was still no comprehensive discussion.

All the study doctors looked at me and I looked at you, and they all saw doubts and incomprehensions in the eyes of both sides.

They couldn't figure out which disease was missing.

Xiao Chu paused for a moment, looked at everyone's reactions, and then continued: "Although this disease is not very common, it can be seen clinically, and it is acute pancreatitis."

After Xiao Chu's reminder, all the doctors who studied suddenly realized.

They discussed so many diseases that they forgot the more typical acute pancreatitis.

However, a trainee doctor immediately stood up and asked doubtfully: "Mr. Xiao, I also considered acute pancreatitis just now, but the symptoms of acute pancreatitis are mainly pain in the left upper abdomen, accompanied by vomiting and nausea.

But this patient only had pain in the middle and upper abdomen, and no nausea or vomiting, so he didn't think about it. "

"Ms. Xiao, what do you mean, is this patient considering acute pancreatitis?"

Xiao Chu glanced at the trainee doctor and said: "As doctors, we must consider the problem comprehensively. The same symptom may be caused by different diseases.

If you don't consider it comprehensively and miss one of them, it may cause missed diagnosis and cause incalculable losses to patients. You must keep this in mind. "

Just then, the patient came back with the results of the examination report.

Now the patient is no longer in such pain and can straighten his waist.

But the pain still exists, but it is less than when it came.

He handed the report to Xiao Chu, and asked eagerly: "Doctor, all my examination reports are out, can you show me what is wrong?"

"Although you gave me an injection just now, the pain has been relieved a lot, but I still have a faint pain in my stomach, which is very uncomfortable."

Xiao Chu took all the report checklists, glanced at them quickly, and then handed all the report sheets to a group of interns in front of him.

"The test results are all out. Let's see what kind of disease this patient has?"

Then Xiao Chu turned her head and said to the patient: "The nurse has arranged a bed for you, you go to your ward and lie on the bed first, and I will give you an infusion treatment in a while. I will tell you about your detailed condition in a while."

When the patient couple heard the words, they went to the ward.

All the interns and fellow doctors passed the inspection reports to each other.

They all stared wide-eyed, looking at Xiao Chu with admiration!

Because the patient's color ultrasound report suggested that the pancreas was edema, acute pancreatitis was considered.

Blood and urine amylase is the standard for prompting acute pancreatitis, and this test is more than three times higher than the normal value.

These examination data can already confirm the diagnosis, and this patient is acute pancreatitis.

Sure enough, it was exactly as Xiao Chu expected.

"It's Mr. Xiao who is amazing. You can tell at a glance what kind of disease this patient is."

"We have been discussing here for so long, and we haven't talked about it."

"This patient really has acute pancreatitis. No wonder Mr. Xiao dared to give this patient an intramuscular injection of pethidine for pain relief. If he was not sure, he would definitely not use an analgesic."

"In the future, I will only take Teacher Xiao's class. Teacher Xiao explained it in such detail. I feel that I have improved a lot both in theoretical knowledge and clinical experience."

……

For the praise and admiration of these trainee doctors and interns, Xiao Chu just smiled.

Medical students will only admire those highly skilled doctors.

When he was an intern at school, he also had this idea.

But for the patient with acute pancreatitis just now, diagnosing the disease is only the first step.

Targeted treatment is needed in the follow-up to make the patient recover before he can become a qualified doctor.

Soon, Xiao Chu brought a group of trainee doctors and interns to the ward where the patient was.

He first explained in detail the occurrence of the disease, as well as the principles of diagnosis and follow-up treatment to the patient and their family members.

Xiao Chu's explanation was very detailed and easy to understand, so both the patient and his family could understand it.

However, these interns probably know how acute pancreatitis is caused.

However, the specific pathogenesis, pathophysiological changes, and specific treatment options are not necessarily clear.

Xiao Chu gave a detailed explanation to the interns on this acute pancreatitis patient.

"Acute pancreatitis is a variety of causes that lead to pancreatic enzymes, which are activated in the pancreas and cause an inflammatory reaction in which pancreatic tissue digests itself, edema, hemorrhage, and even necrosis."

"Symptoms are usually characterized by acute epigastric pain, nausea, vomiting, fever, and elevated blood and urine amylase."

"Clinically and pathologically, acute pancreatitis is usually divided into two types: edema type and hemorrhagic necrosis type."

Xiao Chu paused, looked at the people who were listening carefully, and continued:

"Although this patient has acute edematous pancreatitis, he should not take it lightly. You must know that the root cause of his pancreatitis is hyperlipidemia."

"You can see how high his triglycerides are, it's 20.65.

The triglycerides of normal people do not exceed 1.8. This patient has pancreatitis because of high blood lipids. "

As Xiao Chu said, he patted the patient's belly lightly.

"You are too fat. You must pay attention to losing weight in the future. Your blood lipids are so high now that it will have a great impact on your pancreas. It is best not to eat greasy barbecued food in the future, or you will easily relapse."

The patient has already received an infusion, and the pain in the upper abdomen is much less than when he came.

Hearing Xiao Chu's persuasion, he hurriedly said: "Doctor, I will definitely listen to you, and I must make up my mind to lose weight in the future. This time, my stomach hurts and I must lose weight."

Xiao Chu pointed to the patient's waist again, and continued to explain:

"If the patient's waist or umbilicus appears blue and purple, it is called purple blue sign.

This is a typical manifestation of acute hemorrhagic necrotizing pancreatitis. "

"If around the patient's waist, a purple-blue sign is found on the skin.

Then consider acute necrotizing pancreatitis, which is severe pancreatitis, and patients are usually life-threatening.

Severe pancreatitis has a high mortality rate, and surgical treatment is required if necessary. "

Hearing what Xiao Chu said, the patient was immediately startled.

The man hurriedly asked, "Am I light or heavy?"

Seeing the nervous look of the man, Xiao Chu explained:

"This is a mild case of yours. You only need medication and diet control to recover."

Hearing what Xiao Chu said, the man felt relieved.

Xiao Chu explained the whole pathogenesis of acute pancreatitis to the interns in detail.

Pathophysiological changes, as well as diagnostic auxiliary examinations and treatments, and finally reminded them.

"If you go to the clinic in the future and meet this kind of pancreatitis patient, after you leave the hospital, you must tell the patient,

Even if he is cured this time, he must always pay attention to eating and drinking in the future, and he must not eat greasy food and drink alcohol. "

"Once you drink alcohol, the chance of pancreatitis recurrence is very high. You must keep this in mind!"

Chapter 236

All the students nodded.

"Mr. Xiao, we remember!"

In the end, Xiao Chu reminded everyone again.

"A few days ago, I was treated for acute pancreatitis caused by gallstones, which is called biliary pancreatitis.

You must learn the differential diagnosis of acute pancreatitis caused by hyperlipidemia. "

Xiao Chu is explaining the clinical knowledge of common diseases to a group of students,

A nurse came running over.

"Director Xiao, a manic patient was brought in by the ambulance. He bit and beat him again. Hurry over and have a look."