"Director Xia, I'm back." Zheng Ren knocked on the door and came in. Director Xia was studying double gall bladder deformity.
"Mr. Zheng, come and tell me about the double gallbladder malformation." Director Xia waved calmly without showing any airs.
She wanted to stand up to make way for Zheng Ren, but Zheng Ren smiled and pushed her down on the chair.
"Director Xia, you don't dare to do this. You sit down, you sit down, it's not difficult, I just say a few words." Zheng Ren bent over, holding the mouse in his right hand, and began to move the MR three-dimensional reconstruction he had just done.
Both MRI and CT can perform three-dimensional reconstruction, but clinicians basically only know about CT three-dimensional reconstruction, and few people know that MRI can also perform reconstruction.
The resolution of CT can reach 0.5mm, but although the MRI of Haicheng City No. 1 Hospital is 3.0, the resolution is only 6.0mm. The resulting three-dimensional reconstruction looks like a mosaic, which looks very awkward.
Zheng Ren was simply trying to save trouble and save some money for the patients.
The gold standard for diagnosing double gallbladder malformations is ERCP. However, because ERCP is an invasive examination and costs a lot, the current consensus is to use mrcp for diagnosis.
As for the three-dimensional imaging, Zheng Ren did it easily, so as not to bother the patient and avoid any uncertainty, which was difficult for Director Xia.
Although Director Xia did not intentionally misdiagnose... almost no one would intentionally misdiagnose, and the patient seemed to be relatively cooperative, but Zheng Ren still subconsciously nipped all hidden dangers in the bud.
"Director Xia, look here, the patient has a cystic duct in both gallbladders." Zheng Ren used the mouse to outline the area he wanted to talk about, and then simply explained: "Bilateral gallbladder malformations are divided into type 1 and type 2. Harlaftis type 2 refers to Bigallbladders have 2 or more cystic ducts independently connected to the common bile duct, and type 2 can be further subdivided into h-shaped and trabecular variants.”
"This patient belongs to the more common harlaftis type 2, which means it can be treated surgically."
"The patient has no pain symptoms now. I guess it is unlikely that the patient's family will agree to the operation. But you can tell the patient and the patient's family that I can perform this operation."
Director Xia glanced at Zheng Ren lightly, not surprised or saying anything.
"In 1997, gigot reported a case of double gallbladder malformation. At that time, the surgeon only removed one gallbladder, leaving the other one. 27 months after the operation, the patient's other gallbladder was complicated by gallstones and acute cholecystitis. There was no other way but to The remaining gallbladder was removed.”
"If surgery is required, I recommend removing both gallbladders."
"Of course, this is just my opinion. I think the patient still needs to walk a few more places and get a good consultation." Zheng Ren slightly hesitated, wanting to say something, but finally held back.
"Mr. Zheng, your back wave really slapped me on the beach." Director Xia sighed.
"Look at what you said." Zheng Ren smiled and said, "No way."
Director Xia picked up the instructions for Rocefen (Ceftriaxone) from the table, waved it, and said: "Mr. Zheng, I can memorize the instructions. This skill... I am not good at it."
Zheng Ren smiled and said nothing.
"Mr. Zheng, how did you know?" In fact, Director Xia didn't believe that Zheng Ren could memorize the drug instructions.
There are at least hundreds of commonly used drugs in clinical practice.
For various drugs, the better the drug, the more detailed the side effects are.
If you read the instructions, this medicine cannot be used at all.
But the more this kind of medicine, the better the effect. It's not like the shabby medicines produced by Pheasant Pharmaceutical Factory, which can cure almost all diseases according to the instructions.
Therefore, it was very strange for Director Xia that Zheng Ren could know this.
How good is this memory
"Director Xia, my medical certificate is in general surgery." Zheng Ren said: "Have you heard of the medical accident at Liaozhou People's Hospital a few years ago?"
Liaozhou is a county under Haicheng. A few years ago, they performed an emergency cholecystectomy on a patient for diagnosing cholecystitis and cholelithiasis.
It happened that the family members of the patient were quite serious and insisted on seeing the stone, saying that it was a relic and that they wanted to keep it as a souvenir.
A red envelope was also given before the operation, and the surgeon confidently said that the stone must be kept for the patient’s family. It's just a gallbladder removal, and no one thinks there are any risks.
But after cutting out the gallbladder, the surgeon was stupid.
There are no stones in the gallbladder at all.
This matter ended up causing a big fuss. The chief surgeon insisted that there was gallstones on the pre-operative B-ultrasound and there would be no problem in performing the surgery on his own. But the stone was not taken out after the operation, and he refused to let go.
In the end, the family members held up banners and the commotion became louder and louder.
Later, the chief surgeon was suspended and the hospital lost a lot of money.
Zheng Ren resolutely refused to accept the red envelope, which was directly related to this incident.
Thinking about it makes me feel terrible. The preoperative auxiliary examination confirmed that there was a stone, but the stone was not big.
But during the operation, the stone disappeared like a ghost.
How do you explain this to the patient's family when encountering this situation? If you don't take the money, be tougher. If you take money, you will be embarrassed.
After this incident, Zheng Ren read a lot of information and understood the causes and consequences of gallstones before the big pig's hooves got into his body.
So when he encountered it today, he directly judged it to be intravenous ceftriaxone. The crystalline substance left behind by gallbladder metabolism will disappear soon as long as the intravenous injection is stopped.
It seemed like a trivial matter to Zheng Ren, but to Director Xia, it was magical.
Director Xia thought of the medical dispute and immediately realized that the surgeon in charge at the time had also encountered the same situation as himself.
If it weren't for Zheng Ren, and if he met a difficult family member, he wouldn't be able to explain where gallstones came from.
Fortunately, I seemed to be lucky and met this young Mr. Zheng.
For clinical doctors, luck is very important.
Director Xia nodded, understanding what Zheng Ren meant. Zheng Ren didn't say anything further. After all, the rabbit dies and the fox grieves, and everything harms its own kind.
Zheng Ren and Director Xia would feel a little uncomfortable talking about the surgeon behind their backs.
After chatting for a few more words, Director Xia felt reassured, and Zheng Ren said goodbye and left.
Can surgery be done
Of course it can be done.
But Zheng Ren knew that for this rare disease, it would be difficult for his family to choose to have surgery in Haicheng. I can only provide my opinions to Director Xia, and then she will explain it to the patient's family.
The size of the temple is directly related to the incense of the Bodhisattva.
And since I am too young, it is difficult for patients and their families to have a sense of trust.
If it were the imperial capital or the magical capital, Zheng Ren might have directly explained the situation to the patient's family and performed the operation.
Zheng Ren is quite confident about this.
Not in a hurry, Zheng Ren slowly returned to the emergency ward, looked around at the patients, and then continued to sit down and read a book.