Looking at the previous film, the patient’s diagnosis was clear: primary liver cancer.
There was a 3×4cm lesion on the liver, but the gallbladder was intact, not to mention stones, and not even a scratch on the gallbladder wall was visible.
Moreover, what Zhao Wenhua inserted was not one front piece, but two.
The first one is a pre-operative film, and there is no iodized oil in the lesion. The second picture is after embolization. Judging from the date, it should be that the surgery was performed a few days ago.
In the recent film, the inside of the tumor has become necrotic, and the image of the needle track can still be seen. It should be that radiofrequency ablation was performed after embolization.
"It shouldn't be gallstones." Zheng Ren said firmly.
After watching the film, he knew where Zhao Wenhua struggled.
Zhao Wenhua nodded repeatedly, "Boss Zheng, there were no gallbladder stones before the operation. It has only been a few days, so it is impossible for a large number of sand-like gallstones to appear. This is a conventional logical judgment, but it appears to be there on imaging."
As he spoke, he sighed helplessly.
Sometimes there will be errors between images and logical judgment, and most doctors will use objective image judgment as the final basis.
After all, images exist objectively, otherwise what would be the point of performing imaging examinations on patients. The logic of thinking is in many cases limited by the quality and level of the doctor himself.
But at Zhao Wenhua's level, objective images can only be used as one of the reference standards, and he will not rely on any objective images.
The higher the level of a doctor, the more issues he has to consider.
Every problem that cannot be solved logically may cause a very rare situation to occur, causing the patient's condition to further deteriorate, or even lead to the patient's death.
Even if there is a typical imaging diagnosis on the film, it still needs to be understood.
This is why Zhao Wenhua was stunned when he looked at the CT film with a "clear" diagnosis.
Because he could only feel that something was wrong, but could not overturn the diagnosis of gallbladder stones. The two contradict each other, leaving people with no choice.
"What about other laboratory tests?" Zheng Ren said.
Lin Yuan sat aside and was writing medical records. She was a little sleepy, but after hearing what Boss Zheng said, she became energetic.
This was the tone of the superior doctor's words. As the lowest-level doctor in Boss Zheng's medical team, I would definitely run over and hand over the other laboratory tests he needed.
This was true when I was at Harvard, and it was the same when I returned to 912.
However, Lin Yuan was stunned the next second.
She saw Zhao Wenhua, one of the professors in the 912 interventional department, hunched over slightly, ran to the computer, and quickly printed out all the patient's examination reports.
The printer buzzed and spit out pages of A4 paper.
Lin Yuan looked at Zhao Wenhua in surprise and saw that he looked anxious. Every time the printer spit out a report, he had to take it directly into his hands.
As for what!
Although Boss Zheng is usually reluctant to joke, and it is very painful to tap the radial styloid process with hemostatic forceps on the operating table, he is still very kind at ordinary times.
Lin Yuan didn't understand why Professor Zhao Wenhua and Professor Zhao showed such a humble attitude. Simply... more like a little doctor than himself.
"Boss Zheng, look." Zhao Wenhua immediately took the test form in question in his hand and blew air to lower the temperature of the A4 paper left by the printer.
Sure enough, the patient's white blood cells were high, blood and urine amylase were also high, and serum lipase was also elevated.
Low blood calcium, high blood sugar...
Zhao Wenhua has rich experience and has done all the necessary inspections. Zheng Ren has nothing to be picky about.
"Does the patient have a history of diabetes?" Zheng Ren asked.
"No." Zhao Wenhua answered immediately.
There is no history of diabetes, but blood sugar is elevated and blood calcium is reduced. This is one of the typical clinical tests of acute pancreatitis.
Is it a post-operative stress reaction that leads to cholecystitis and acute pancreatitis? Zheng Ren looked through the test results and thought to himself.
Although he thought so, he did not draw a simple or crude conclusion.
The patient's laboratory tests and imaging examinations pointed very clearly to acute gallbladder stones and acute pancreatitis.
But!
There is still no way to explain where so many silt-like stones come from.
If it was the kind of cholecystitis where the gallbladder wall is rough, Zheng Ren would probably give up thinking about it at this time. However, a large number of silt-like stones appeared in the gallbladder from scratch, and within a few days, something was wrong.
And for post-operative patients, even if they don’t eat regularly, their family members take good care of them at this time, and they can eat as soon as possible.
eccentric.
Zhao Wenhua looked at Zheng Ren with great expectation.
"Tell me about the patient's condition." Zheng Ren stood in the position of reading the film, clasping his arms and resting his chin, looking at the film seriously, and said lightly.
Just as the young doctor from Zhao Wenhua's group was about to speak, he was interrupted by Zhao Wenhua.
"That's right, Boss Zheng." Zhao Wenhua began to report the medical history like a junior doctor.
"The patient came to our hospital a week ago and was initially diagnosed with liver cancer. I admitted the patient after I left the outpatient clinic. He underwent interventional embolization + radiofrequency ablation for liver cancer 3 days ago. There is a picture of the patient left after the interventional embolization. image."
Zheng Ren nodded, indicating that he knew.
"The patient recovered fairly well after the operation. He suddenly complained of severe abdominal pain early this morning. An emergency CT scan revealed gallbladder stones and pancreatitis. Please consult him. The same diagnosis was made by the hepatobiliary surgery department. Symptomatic treatment is recommended."
"But I looked at the film and thought there was something wrong." Zhao Wenhua was very cautious. "The patient is not in a very good condition now, and the pain has not been relieved."
"Have you been given painkillers?"
"I held back and didn't give in. There are some things I haven't figured out yet."
Zheng Ren nodded.
If you don't understand, just give analgesics, that's suicidal.
wrong! I just looked at the test report, and it seemed like there was something wrong with it. I just passed it by without paying much attention.
Zheng Ren picked up the test sheet again with confusion and looked at it one by one.
Soon, he discovered the problem. The patient's blood routine has high white blood cells, which can be used as one of the auxiliary diagnostic evidences for cholecystitis and acute pancreatitis.
However, the patient's hemoglobin had dropped to 76g/L, while the preoperative hemoglobin was normal.
"Anemia? Professor Zhao, what did you think about it?" Zheng Ren asked.
Zhao Wenhua shook his head in confusion.
Neither radiofrequency ablation nor interventional embolization surgery will cause anemia.
Not to mention interventional embolization, a needle is inserted into the thigh femoral artery, and then a guidewire and catheter are inserted to perform embolization treatment inside the blood vessel. Bleeding complications are rare because embolization itself is part of the hemostatic treatment.
In the case of radiofrequency ablation, the radiofrequency needle is not thick and penetrates into the liver. When withdrawing after ablation, the radiofrequency needle must be heated to avoid needle path transfer.
While killing tumor cells, the punctured needle path will also be "scalded". Even if there is capillary bleeding, it will be as if it has been burned by electric cautery, and the bleeding will stop.
There was no anemia before the operation, and there was no anemia in the first follow-up examination after the operation. Progressive anemia started to appear early this morning.
This is a particularly dubious point.