If I hadn't followed the director for surgery and saw the appendix being cut out with my own eyes, I would have suspected it was an ectopic appendix.
I don’t know if Boss Zheng of the Imperial Capital has ever had an ectopic appendix. This kind of surgery is life-threatening. Once you can't find it, the feeling of helplessness on the operating table is enough to make you collapse.
I found the pain point, only tenderness, no rebound pain or muscle tension.
Percussion is also very standard. But it’s nothing new, I do it myself.
auscultation…
After the physical examination, Zheng Ren restored the patient's clothes and left 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 he was sure of victory, but also seemed confused.
"Inject 5ml of Meilan into the urinary catheter and drain the abdominal fluid 30 minutes later." Zheng Ren gave the doctor's instructions as he walked.
"Ah?" The little doctor was startled.
"If you can see blue liquid when removing ascites, it proves that the bladder is ruptured. 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 incredible.
“Young man, the medical history and physical examination must be detailed and careful.
The medical records reflect that the patient's medical history collection, especially the past medical history, was incomplete when he was admitted. For example, the patient had omitted a partial cystectomy for a bladder mass more than 20 years ago, which resulted in missed diagnosis and mistreatment of important diseases. "Zheng Ren said very gently.
Although this little doctor was caring, he didn't pay attention to too many details because he had worked in a town-level hospital for a long time. Zheng Ren just reminded him kindly and didn't scold him at all.
"During the first appendectomy, the lesions found during the operation were not consistent with the diagnosis. The inflammation in the appendix was atypical, and the amount of fluid removed was a bit large. Did you consider whether it was caused by other reasons
No further exploration was done. It is unknown whether there was a large amount of ascites at the time of the operation. It is estimated that there was a small amount of urine during the operation. However, the surgeon did not pay attention to it, or perhaps you regarded the urine as leakage at the time. "
"..." The little doctor was sweating profusely.
"Third, the patient's abdominal distension significantly worsened after taking diuretic drugs. I remember you wrote this sentence in the medical record. As long as you think about it one more step, you will realize the truth." Zheng Ren said with a smile.
"The patient's kidney function is fine. After taking diuretics, especially 40mg of furosemide, 500-1000ml of urine will be excreted. However, the light yellow urine produced by the urinary catheter has not increased. This is the biggest problem."
"To sum up, I think the bladder is ruptured. Take the time to do the Melan test. If blue fluid is extracted through abdominal puncture, I will transfer to the urology department for surgery. The surgery is not too difficult, just suture it and you're done."
"Boss Zheng, is it true?" Li Yong still found it unbelievable. When he saw Zheng Ren's still green face, he felt a little confused.
"Huh? What's true?" Zheng Ren didn't understand. He said it so carefully and thoroughly, why couldn't he understand it
"I'll go right away." Seeing that Zheng Ren was about to leave, the young doctor mustered up the courage to ask: "Boss Zheng, I...can I leave you a WeChat message?"
"Um?"
"I'll do a abdominal puncture in half an hour. If blue liquid appears, I'll report it to you." The young doctor had an idea and found a reason.
Zheng Ren smiled.
He took out his mobile phone and opened the WeChat QR code for the little doctor, and the two of them added WeChat.
"You guys are busy, I'll go back and see Lao Liu." With that said, Zheng Ren left on his own.
The level of diagnosis, treatment and surgery in Xilin Town is indeed that of a grassroots hospital. Simple and crude, pain in the lower right abdomen is appendicitis, and there is no need to think about anything else.
Differential diagnosis is not made, and abnormal conditions seen during surgery are not dealt with. After the operation... Alas, after taking furosemide, the urine output was not large and the kidney function was fine. I didn't notice such obvious points.
Forget it, it had nothing to do with him. Zheng Ren walked out of the general surgery ward and stopped thinking about it.
For such a small medical record, Zheng Ren no longer uses the big pig's hooves system panel. First, go through the medical history, read the laboratory test sheets and disease course records, and then you can basically follow the clues to get the conclusion.
It was obvious that the bladder was ruptured and the fluid in the abdominal cavity was urine. Zheng Ren finally used the system panel of Big Pig Trotter to refer to it and gave a definite answer.
As for surgery, Zheng Ren had no interest in simply suturing the bladder.
In addition to requiring an open abdomen, the difficulty of this operation is not even comparable to that of appendicitis. Moreover, it was a bit excessive to go to Xilin Town People's Hospital to get a urological surgery.
Returning to the ward, I gossiped with Liu Xuzhi about Li Yong's lover's condition. Liu Xuzhi's lover came in with a lunch box.
She specially made hand-made noodles with hot soup for Zheng Ren. The noodles were particularly chewy.
"Boss Zheng, if old Liu can't support his family in the imperial capital, I'm going to find a small noodle shop to work in." Liu Xuzhi's lover said.
"No, don't worry." Zheng Ren said with a smile: "Across the country, there are no more than 500 people who can perform interventional surgeries better than Lao Liu."
500, that's a big number.
In fact, Zheng Ren wanted to say 100, but that was just TIPS surgery. All things considered, 500 is relatively standard.
As a doctor, he can be ranked among the top 500 doctors in the country, and he is at the level of a professor in a provincial hospital.
But Lao Liu's wife was so worried that Liu Xuzhi almost died for 30,000 yuan.
It sounds ridiculous.
A handful of bitter tears.
Seeing that Liu Xuzhi and his wife were already preparing for a last-ditch battle, Zheng Ren didn't persuade them much. When you go to the imperial capital, even if your level is high, you still have to work hard.
I can survive lying down... It seems that I can do it now.
A tenured professor at Massachusetts General Hospital can enjoy life comfortably with a monthly salary of more than 100,000 US dollars.
Tsk, tsk, I didn’t even notice that I had reached this point so quickly.
Seeing that there was nothing wrong with Liu Xuzhi's health, Zheng Ren ate a big meal and asked Feng Xuhui to book a ticket after the meal, so that he could return to the imperial capital as soon as possible.
Xilin Town brought Liu Xuzhi back and the matter was over.
After Lao Liu rested for a few days and took his family to the Imperial Capital, he could then carry out large-scale fundus and left gastric artery embolization surgeries.
Perform a few surgeries on his own to see how much Lao Liu can master.
Zheng Ren already knew about his talent. It's average, and the height Liu Xuzhi can reach in this life will probably not exceed Su Yunyan's level.
But as a human being, you can't compare with Su Yun, Zheng Ren smiled.
Lao Liu probably won't be too bad. After all, he can figure out the threshold for TIPS surgery, which is much better than most people.
Before finishing the noodles, a short, fat, strong man knocked on the door and came in.
When he saw Zheng Ren, he immediately showed a flattering smile, stretched out his hands and said, "Boss Zheng, you miss me so much!"