"Hurry up! Isn't it ethical to chat with the doctor here? If we are on good terms, we can chat in the pub after get off work. What are you talking about here?" Zheng Ren threw away the moral shackles on the patient's family.
They were startled for a moment and then calmed down.
The patient had severe stomach pain and was feeling uncomfortable during the CT scan. Because of this, one CT was not enough and two more CT scans were required, which aroused their dissatisfaction.
This noise is unintentional and sporadic.
After being yelled at twice, the anger and courage disappeared, and the whole person calmed down.
In addition, Zhou Litao had a good temper and kept explaining, so they quickly went into the room with the emergency surgery doctor to make an order.
Zhou Litao wiped his sweat, winked at Zheng Ren, and wanted to take Zheng Ren into the host's duty room.
But Zheng Ren didn't go. He walked directly to the door of the emergency surgery clinic and kept urging.
The doctor wrote orders on the fly, and the patient's family members trotted away.
Seeing the patient's family disappear, Su Yun walked into the emergency surgery clinic, gave a thumbs up and praised: "Boss, your acting is good, very impressive."
Zheng Ren smiled and said, "Let's go to Mr. Zhou's duty room and talk."
If the patient's family members turn around and come back, I'm afraid things will become even bigger.
Zheng Ren has rich experience in dealing with such minor frictions that are not considered medical disputes.
After all, he is the chief resident of the emergency department, so he has seen a lot of these little disturbances.
Arriving at Zhou Litao's duty room, Zheng Ren completely relaxed and sat on the chair with a smile.
"Mr. Zhou, go up and confront him." Su Yun sat directly on the bed and said with a smile.
"How dare you." Zhou Litao said with a frown. He knew that Su Yun was joking, but the joke was not funny at all.
Everyone is a doctor and knows the awkwardness of the topic just now, so they consciously say something new.
"Mr. Zhou, what's the patient's condition?" Su Yun asked: "Free liver is usually discovered in childhood. How did the patient delay it until now?"
"When the patient came, I asked about the medical history. It was said that he had intermittent abdominal pain since he was five or six years old, but it got better after a while." Zhou Litao said, "The family didn't care about it, thinking it was because the little girl was weak."
"Later, the patient got used to it. Every time he had pain, he would feel better if he lay on his right side."
"On the right side, this is the rhythm of retracting the liver based on body position."
"Absolutely. Every time I have a stomachache, I will find a lump. I can still move it if I push it with my hands." Zhou Litao said.
This... Zheng Ren was a little helpless. The patient was really arrogant. He found such a big mass on his stomach, but he still didn't come to the hospital for examination
No, it should be...
Zheng Ren thought that Su Yun had already asked: "Has the patient never come to the hospital for examination?"
"It was said that I had been checked twice. After the abdominal pain subsided, I checked again when I remembered it. Nothing happened. In the end, the patient gradually forgot about it."
Forgot
Forgot!
"The patient's pain lasted for a long time, and it didn't get better even when he was lying on his right side. The mass in his upper abdomen was particularly large. Coupled with nausea and vomiting, the pain was severe, so he got scared and called 120 ambulance to bring him to the hospital."
"After I came here, I felt it. There was no tenderness in the patient's abdomen, and I could feel a mass moving from right to left."
"What were you thinking about at that time?" Su Yun asked.
"If I don't do an examination, what can I consider?" Zhou Litao smiled, "But I have still considered the accessory spleen and liver malformation."
"Is the intestinal obstruction serious?" Zheng Ren asked.
"I listened and could still hear bowel sounds, but they were slightly weaker, about once per minute." Zhou Litao's physical examination was very detailed and beyond reproach.
"Okay, then just watch the film and send it directly to the surgery." Zheng Ren said with a smile: "Free liver in adults is really rare. Terrier and Auvray first reported it in 1897. Since then, there has been no decent summary. There are even few case reports.”
"Well, as long as it's mainly children, those under 5 years old." Su Yun added.
Zhou Litao knew that the two people in front of him sounded very reasonable, but this was also the first time he saw them.
What is ability
That's the thing.
If you can remember things in books after reading them, you have a good memory. But in clinical practice, it can be used, as if it has been seen in countless cases, this is a great skill!
There are some things and some people that you can't accept.
Zheng Ren called Dr. Liang, who said that the examination was almost completed and the left side posture film had been uploaded.
Turn on the computer and call up the patient's imaging data. It can be seen that the colon passes from the retrohepatic space into the space between the liver and the diaphragm.
The image is quite typical, and the distance of the liver dissociation is about 10cm to the left compared with the supine position film.
This is the origin of the palpable mass reported by the patient and the origin of intestinal obstruction.
There is no complete blockage, no strangulation, or necrosis. The patient's condition is in a controllable stage.
After watching the film, the film of the right lateral decubitus position was uploaded.
After changing the body position, you can see that the position of the liver has moved significantly and returned directly to its original position.
However, the intestines were compressed, and there were some artifacts in the film. It was probably due to intestinal obstruction. The patient had obvious pain and restlessness when lying on his right side.
"Okay, let's send him to the surgery department to prepare for emergency surgery." Zheng Ren turned off the imaging data.
"For liver and gallbladder?"
Zheng Ren glanced at Su Yun and said with a smile: "Brother Yun said, send the liver and gallbladder, and ask the gastrointestinal tract to come on stage together. First the gastrointestinal tract will reset the intestines, and then the liver and gallbladder will fix the liver."
"Don't let me take the blame." Su Yun said, "It's all what you said. I never do anything that makes people miserable."
This disease is actually very simple, but everyone has never seen it before and is a little vague about it.
It is caused by developmental abnormalities such as excessive length, weakness, or absence of liver ligaments that prevent the liver from being fixed. When the patient is upright, the liver moves downwards, the hepatophrenic space widens, and the colon becomes embedded in it, causing obstruction. Subsequently, a series of clinical symptoms such as increased pain, nausea, and vomiting occur.
"Mr. Zhou, let the surgeon accompany you." Zheng Ren warned, "Don't let anything happen on the way."
"Okay." Zhou Litao stepped out of the shift system, called out the surgeon who was doing the physical examination, and gave a few instructions.
Subsequently, Zhou Litao walked into the surgical emergency room to deal with the patients who were undergoing examination before.
Zheng Ren followed Zhou Litao out with a smile. He glanced towards the surgical clinic and paused immediately.
"Boss?" Su Yun followed behind, but unexpectedly he stopped suddenly and almost bumped into Zheng Ren's back.
Zheng Ren didn't say anything, and hurried back to Zhou Litao's duty room, grabbed a piece of white clothes and put it on.
"Why are you so hysterical?" Su Yun asked him standing at the door.
"Ask Mr. Zhou to prepare nitroglycerin, and keep your voice down so as not to put more pressure on the patient." Zheng Ren said seriously.