"Boss Zheng, please take a look at the test report." The young doctor attentively flipped the iron medical record clip to the place where the test unit was pasted and handed it to Zheng Ren. Then, he reported the medical history.
"Five days ago, the patient came to our hospital with abdominal pain for four hours and was diagnosed with acute appendicitis. An emergency appendectomy was performed.
During the operation, it was found that the symptoms of appendicitis were not typical, and the appendix was removed successfully. After the surgery, the patient still felt abdominal pain, and a few hours later, abdominal distension appeared. Because it was bearable, it was not taken seriously, and no special treatment was given. After that, the abdominal distension gradually worsened, and the abdominal pain gradually subsided.
"Wait a minute. I saw that 20 ml of pale yellow exudate was aspirated during the surgery. Did you follow the surgery?" Zheng Ren did not look at the test results directly. Instead, he searched for the surgery record.
Zheng Ren glanced at it and saw a sentence that puzzled him.
"Boss Zheng, I'll follow you into the surgery." The junior doctor said, "When the peritoneum was cut open during the operation, there was indeed a small amount of light yellow oozing out. I used an aspirator to suck it clean. There are no abscesses, and the ooze is clear and not turbid. "
He felt that Zheng Ren was making a mountain out of a molehill. It was just a small ooze, probably caused by appendicitis.
Although there was a lot of fluid, it was estimated to be only 20ml. It did not seem to be a big deal.
This was not the main point. The main condition was the intestinal obstruction and a large amount of peritoneal effusion.
However, before he could report it, Boss Zheng interrupted him.
"Okay, let me think about it. You can continue," Zheng Ren said casually as he flipped through the medical records.
"Subsequent plain film examination of the abdomen showed intestinal obstruction. According to intestinal obstruction, he was given fasting, continuous gastrointestinal decompression, fluid replacement, and other treatments. Three days after the surgery, the patient was ventilated and defecated, but the abdominal distension persistently increased, and the abdomen was obviously swollen. After the chief consultation, it is recommended that the patient's family be transferred to Chengdu Provincial Hospital to continue diagnosis and treatment. "
"Physical examination of the patient: clear consciousness, poor spirit, stable vital signs. Left lower abdomen tenderness positive, no rebound pain, Murphy
The symptoms were negative. The liver and spleen were not palpated under the ribs. There was no mass in the whole abdomen. There was no tenderness in the ureter. There was no percussion pain in the area of liver and kidney. The percussion sound in the abdomen was turbid.
Times/min. "
The young doctor was a little proud. He had put in a lot of effort to casually say these things.
It was hard to find a clinician as serious as him.
His body trembled. Boss Zheng had no choice but to bow down and cry to bring him to the Imperial Capital?
It was said that the coward Liu Xuzhi from the radiology department had been invited by Boss Zheng many times to work in the Imperial Capital. Not only was he going to work, he was also authorized!
That was an establishment of the Imperial Capital.
If Liu Xuzhi could go, why couldn't he?
After reporting the medical history, the junior doctor thought proudly.
"Past history … Li Yong, has your wife had hepatitis B and tuberculosis before?" Zheng Ren asked.
"No."
The young doctor was a little puzzled. The history was not important. It was all in the past. What was there to ask?
Is there any relationship between hepatitis B and appendicitis?
Even if it was a tuberculous intestinal obstruction … how many times had that happened? Boss Zheng was nitpicking. Was it just because he had reported his medical history well?
"Have you performed any surgeries?" Zheng Ren asked.
The junior doctor looked at Li Yong with a dumbfounded expression.
"No …" Li Yong hesitated.
"Think about it again. Cesarean sections and the like are all counted." Zheng Ren looked at the medical record that said almost nothing about the past history and felt a little helpless.
The medical record was too crude. It was eighteen streets worse than Chang Yue's.
'Then I'll do it myself,' Zheng Ren asked.
"I've never had a cesarean section … I heard from my wife that before we got married … she had an operation about 20 years ago. There was a tumor on her bladder. After it was removed, it was diagnosed as a benign mass." Li Yong found what Zheng Ren needed in the dust of his memory.
It was like this when asking the patient's family about the medical history. First, the patient's family did not care about many things and felt that it had nothing to do with the current condition. Second, they had completely forgotten. This was a kind of memory deviation.
Only by finding clues and getting to the bottom of it could it be possible to ask about the medical history clearly.
Seeing a doctor was like solving a case. It was really not easy.
"Bladder?" Zheng Ren pondered. "Let me take a look at the radiographic films."
The junior doctor answered crisply and inserted the upright abdominal radiographic films into the radiographic film viewer.
The radiographic films were very simple. There was a small liquid level. Just by looking at the radiographic films, there was no problem diagnosing intestinal obstruction.
However, intestinal obstruction … Peritoneal effusion …
There was no definite connection between the two diseases.
Zheng Ren went back and looked through the medical advice again. There was a large amount of peritoneal effusion. The General Surgery Department of Xilin Town People's Hospital used conventional diuretic methods.
However, the urine volume recorded in the course of the disease was very little.
"Is the urine volume recorded in the course of the disease correct?" Zheng Ren asked.
Sometimes, some doctors would ignore this point and casually write a random value.
"Boss Zheng, I'm very serious about my work." The junior doctor's face was a little red. He felt very wronged when he read the medical history just now.
This was clearly the patient's family's fault. He had asked but they did not say anything. Why did Boss Zheng say it as soon as he asked?
Li Yong, this old man, was making things difficult for him!
"Yes, I can tell," Zheng Ren said warmly.
The junior doctor's face looked a little better.
"But you don't have enough clinical experience."
"…"
"After using 40mg of furosemide, the urine volume did not increase. There is no problem with kidney function. What are you thinking about?" Zheng Ren asked.
"…" The junior doctor was stunned for a moment. "I noticed this, so I suggested that the patient's family bring the patient to Chengdu Provincial Hospital."
Zheng Ren already had a guess. He smiled and said, "Let's go and take a look at the patient."
The junior doctor and Li Yong were both dripping with sweat. However, seeing the patient and doing a physical examination were normal diagnostic procedures. The specific diagnosis should be out after seeing the patient.
If Boss Zheng could understand it …
If he could not understand it … the possibility was also very high.
The junior doctor led Zheng Ren to the ward in front and heard Zheng Ren ask, "Where's your chief?"
"There's a lunch meeting at noon. He went out to eat."
"Do you want to drink again?" Zheng Ren asked.
"I think so." The junior doctor had no choice. His chief liked this. He would drink when he was on vacation. On a normal working day, if there were no surgeries in the afternoon, he would also be willing to drink a few mouthfuls. This was quite ironic.
However, in a town hospital, everyone was about the same.
When they arrived at the ward, the junior doctor stood respectfully to the side and watched Boss Zheng do a physical examination.
He took a look first. His abdomen was swollen.
Yes, this was the most basic visual diagnosis. Although he did not say it, after looking at it for nearly two seconds, he was probably already thinking about the relevant condition in his heart.
He did palpation three to five times a day. The patient's pain had actually shifted to the left lower abdomen.
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