If he had not followed the chief into the surgery and seen the appendix being removed with his own eyes, he would have suspected that it was an ectopic appendix.
He did not know if Boss Zheng in Imperial Capital had ever performed an ectopic appendix before. This kind of surgery was life-threatening. Once he could not find it, the feeling of helplessness on the operating table was enough to make a person collapse.
He found the point of pain. There was only tenderness, no rebound pain or muscle tension.
The percussion was also very standard. However, there was nothing new. He did the same.
Auscultation …
After the physical examination, Zheng Ren put the patient's clothes back on and turned to leave the ward.
"Boss Zheng, you …" Li Yong was a little nervous.
He saw that Zheng Ren's expression was neither sad nor happy, as if victory was in his grasp, but also as if he was at a loss.
"Inject 5ml of methylene blue from the urinary catheter. Aspirate the peritoneal effusion after 30 minutes," Zheng Ren instructed as he walked.
"Huh?" The young doctor was stunned.
"If you can see blue liquid during the aspirate, it proves that it is a bladder rupture. Consider that it may be caused by the rupture of the surgical scar many years ago," Zheng Ren said as he walked.
"…"
"Boss Zheng, this …" The young doctor felt a little incredulous.
"Young man, the medical history and physical examination must be detailed and serious.
The medical record reflects that the patient's medical history was not detailed when he was admitted to the hospital. For example, the patient had a partial cystectomy because of a bladder mass more than 20 years ago. As a result, the important disease was missed and misdiagnosed, "Zheng Ren said very gently.
Although the young doctor was more attentive, because he had worked in a town hospital for a long time, he did not pay attention to too many details. Zheng Ren was just giving him a kind reminder. He did not scold him at all.
"First.
During the second appendectomy, the lesion found during the surgery did not match the diagnosis. The symptoms of appendicitis were not typical, and the amount of fluid extracted was also a little large. Did you consider whether it was caused by other reasons at the time?
As for whether there was a large amount of ascites during the surgery, it is unknown. It is estimated that there was a small amount of urine during the surgery. However, it did not attract the attention of the surgeon, or perhaps you treated the urine as exudate. "
"…" The young doctor's face was covered in sweat.
"Third, after the use of diuretics, the patient's abdominal distension was significantly aggravated. I remember you wrote this in the medical record. If you think one more step, you will think of the truth, "Zheng Ren said with a smile.
"The patient's kidney function is fine. After using diuretics, especially 40 mg of furosemide, 500 to 1000 ml of urine will be excreted. However, the amount of yellowish urine drawn out by the urethral catheter has not increased, which is the biggest problem. "
"In summary, I'm considering bladder rupture. Hurry up and do the methylene blue test. If the blue liquid is extracted from the abdominal puncture, transfer to the urology department for surgery. The surgery isn't that difficult. We just need to stitch it up. "
"Boss Zheng, really?" Li Yong still found it unbelievable. When he saw Zheng Ren's young and inexperienced face, he was slightly confused.
"Hmm? What's true? "Zheng Ren did not understand. He had already explained it so carefully and thoroughly, so why could he not understand?
"I'll go right away." Seeing that Zheng Ren was about to leave, the young doctor mustered up his courage and asked, "Boss Zheng, can … can I leave you a WeChat contact?"
"Hmm?"
"I'll do a laparotomy in half an hour. If there's any blue liquid, I'll report to you." The young doctor suddenly had an idea and found an excuse.
Zheng Ren smiled.
He took out his phone and opened the QR code on WeChat for the young doctor. The two of them added each other on WeChat.
"You guys go ahead. I'll go back and see Old Liu." As he spoke, Zheng Ren left on his own.
The standard of diagnosis and surgery in Xilin Town was indeed the standard of a basic hospital. It was simple and crude. The pain in the lower right abdomen was appendicitis. He did not think about anything else at all.
He did not do the differential diagnosis and did not deal with the abnormal situation during the surgery. After the surgery … Sigh, he used furosemide. The urine output was not much, and there was no problem with his kidney function. He did not even notice such an obvious point.
Forget it, it had nothing to do with him. Zheng Ren walked out of the ward of the General Surgery Department and did not think too much about it.
For such a small medical record, Zheng Ren no longer needed the System panel of the System. First, he went through the medical history, looked at the test results, and the course of the disease. He could basically follow the clues and come to a conclusion.
It was obvious that the bladder had ruptured, and the peritoneal effusion was urine. Zheng Ren finally used the System panel of the System to refer to it and gave the answer with certainty.
As for the surgery, Zheng Ren had no interest in simply suturing the bladder.
Other than opening the abdomen, the difficulty of this surgery was not even comparable to appendicitis. Moreover, it was a little too much to go to the People's Hospital of Xilin Town to snatch the surgery from the Department of Genitourinary Surgery.
Returning to the ward, he gossiped with Liu Xuzhi about Li Yong's wife's condition. Liu Xuzhi's wife came in with a lunch box.
She specially made hot soup and hand-rolled noodles for Zheng Ren. The noodles were especially chewy.
"Boss Zheng, if we go to the Imperial Capital, Old Liu won't be able to support his family. I'm going to find a small noodle house to work," Liu Xuzhi's wife said.
"No, don't worry." Zheng Ren smiled and said, "In the whole country, there are no more than 500 people who can do interventional surgery better than Old Liu."
500 was a very big number.
In fact, Zheng Ren wanted to say 100, but that was just TIPS surgery. Considering all factors, 500 was a relatively standard.
As a doctor, to be able to be ranked in the top 500 in the country, he was at the standard of a professor in a provincial hospital.
Old Liu's wife was actually so worried that Liu Xuzhi almost lost his life for 30,000 yuan.
It was quite ridiculous to say it.
It was a bitter tear.
Zheng Ren saw that Liu Xuzhi and his wife were already prepared to fight to the death, so he did not try to persuade them. If he went to the Imperial Capital, even if his standard was high, he would still have to work hard.
He could live just by lying down … It seemed that he could do it now.
A tenured professor at Massachusetts General Hospital could enjoy life freely with a salary of more than 100,000 US dollars a month.
Tsk tsk, he did not even realize that he would reach this point so quickly.
Seeing that Liu Xuzhi's body was fine, Zheng Ren ate the noodles in big mouthfuls. He was prepared to let Feng Xuhui book a ticket after eating so that he could hurry back to the Imperial Capital.
The matter in Xilin Town was over after Liu Xuzhi was brought back.
After Old Liu recuperated for a few days, he would bring his family to the Imperial Capital. After that, he could carry out a large-scale gastric fundus and left gastric artery embolization surgery.
He would knock on him a few surgeries and see how much Old Liu could master.
Zheng Ren already had some understanding of his talent. It was considered average. The height that Liu Xuzhi could reach in this life would probably not exceed Su Yun's level.
However, as a person, he could not compare to Su Yun. Zheng Ren smiled.
Old Liu probably would not be too bad. After all, he could even touch the threshold of TIPS surgery. He was much stronger than most people.
Before he finished eating, a short, fat, and sturdy man knocked on the door and came in.
When he saw Zheng Ren, he immediately revealed a flattering smile. He stretched out his hands and said, "Boss Zheng, you missed me so much!"
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