Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 265 The guy with a puffy face!
"Yes, you can do your gastroscope."

"okay!"

The lens was inserted from the mouth, and before it got too deep, the entire narrow esophagus was seen, and there was still a lot of blood in it.

After cleaning the lens and then looking down, I saw the lump.

The damaged area of ​​the lump was not large at this time, which made the people in the operating room feel strange.

"The lump didn't bleed much. Could it be that there is a problem under the esophagus? Could it be a gastric ulcer and a large blood transfusion, not an esophageal problem?"

Wu Jiang shook his head and said:
"But why is there a lump in the esophagus? It must be esophageal cancer. Maybe the bleeding point is under the lump, so we can't see it?"

Lin Yi glanced at Wu Jiang:
"You're half right, the bleeding point is indeed below."

The gastroscopy doctor was dumbfounded:

"Then what should I do now, Dr. Lin? Should I continue to probe down? But what if it causes a larger area of ​​bleeding?"

Lin Yi shook his head calmly:

"No need, bring the scalpel, I'm going to make an incision on the chest."

"Ah?! No way, an esophageal cancer is bleeding, do you want to have an operation?"

"Do you want to operate to remove the bleeding esophagus? Do esophagus-cardiac anastomosis directly?"

"Don't make any noise, just do as I say, otherwise this person will die!"

Lin Yi said directly, and the operating room fell silent instantly.

Soon, Lin Yi made an incision with a diameter of [-] cm in the fifth intercostal space.

Just enough to fit the thoracoscope and other instruments.

Everyone looked at Lin Yi's operation and wanted to learn, but they just didn't know what Lin Yi was going to do.

If it was to install an artificial esophagus, then he didn't notify someone to get the equipment.

"Help hold the thoracoscope."

"it is good."

"Probe inward, near the position of the heart, that is, the position of the esophageal mass in the gastroscope."

"Okay." Wu Jiang was Lin Yi's assistant, and his hands were also very flexible.

Lin Yi observed while talking.

At this time, after the chest cavity was opened, everyone discovered that there was a lot of articles in it!

There is blood in the chest cavity!

What's happening here?
Esophageal cancer bleeding, how can it leak into the chest cavity on the heart side?
Moreover, the effusion inside has turned dark, and it looks like blood and inflammatory exudate, and it has been a month or two.

"Explore further!"

"it is good!"

Now the people in the operating room also understood that this patient is probably not a simple esophageal cancer.

But for another reason.

"Stop, don't move!"

When approaching the tumor, Lin Yi asked Wu Jiang to stop.

"tweezers."

Lin Yi used tweezers to gently peel away the surrounding tissue, but everyone found that blood flowed out of it with just a slight movement!
"what's going on?"

Everyone was stunned, only Lin Yi said calmly:

"Rinse the surgical field."

"Tissue forceps."

After rinsing, the vision became clearer again.

Lin Yi carefully exposed the outside of the esophageal tumor.

Esophageal lumps are not only swollen on the inner wall of the esophagus, but also on the outer wall.

The surgical field couldn't see clearly, but when Lin Yi lifted the lump slightly.

At this time, everyone found out!

The culprit of the bleeding turned out to be...

It turned out to be a fishbone! !

Oh my God!
After working for a long time, it turned out to be a fishbone!

Oh, I thought it was esophageal cancer!
"Give me the 15cm hemostat."

Now that the problem has surfaced, it's easy to fix it now.

Firstly, the branches of the thyroid artery and the carotid artery, which are the main blood vessels in the upper esophagus, are clipped.

Then gently clamp out the fishbone that pierced the blood vessel.

As soon as it was pinched out, blood gushed out again.

In less than a few seconds, the entire surgical field was covered.

Fortunately, the upper segment of the artery was clamped, so the problem was not serious.

"Rinse, bring the bipolar electrocoagulation knife."

Wu Jiang moved very quickly, and immediately handed over the electrocoagulation knife after cleaning the surgical field.

"Hey hey hey!"

The electric coagulation knife can seal the wound while cauterizing the blood vessel.

"Okay, stop the bleeding, and then wash the fluid in the chest cavity."

As Lin Yi spoke, he loosened the hemostat clamping the upper artery.

The blood flow resumed, but the place where the fishbone got stuck did not bleed anymore.

The operation was a success!
"Brother Yi... You are simply too powerful, you can even find out the problem!"

Wu Jiang looked at Lin Yi with admiration and asked.

This is also amazing!

Lin Yi looked at Wu Jiang and said with a smile:

"Wu Jiang, you know this man has pneumonia, right?"

Wu Jiang nodded: "I know, I saw it on the chest X-ray."

After finishing speaking, Wu Jiang reacted immediately!

"Oh! I understand! Did you see from the chest X-ray that he was bleeding from a blood vessel punctured by a fishbone, not from esophageal cancer?!"

Lin Yi nodded.

Wu Jiang suddenly realized:
"Oh! Why didn't I expect that? The unprovoked inflammation can be seen. Blood and inflammatory exudate flowed into the chest cavity and caused lung infection. That's why pneumonia was found during the examination!"

"I should have thought of coming here too! Any disease is related, and the patient has no obvious cough symptoms, low-grade fever, and pneumonia. Why didn't I think of it!"

"First of all, pneumonia will definitely not appear for no reason. Since the gastroscope cannot enter the inside and the real cause of the esophageal mass is unknown, then we must look for the cause elsewhere."

"Then this mass cannot be blindly determined to be esophageal cancer!"

"Hey! I was sloppy!"

Wu Jiang clapped his hands, looking like he wished to know sooner.

Other people in the operating room, including the gastroscopy doctor, also looked at Lin Yi with shocked eyes in bewilderment.

Dr. Lin is too awesome, in such a critical situation, he can be so sure that the esophageal bleeding is not caused by esophageal cancer, but something stuck in it.

"Okay, be careful, insert a gastric tube and send the patient to the department. After waking up, let him notify the family members to pay the fee."

"Also, the mass on his esophagus was caused by tissue inflammation after being stuck by a fishbone. Anti-inflammatory treatment should be done in the next few days. A drainage tube should be added to the chest to prevent the exudate from accumulating again."

Lin Yi began to take off his gloves while giving instructions.

"okay, I get it."

After the operation, Lin Yao was finally able to rest for a while.

But not long after, another patient came in.

The door of the consulting room was opened, and there was a young guy in his 20s.

Beside him was a girl about his age.

The girl carefully helped him into the consulting room.

"Why is it uncomfortable?"

Wu Jiang glanced at the young man and said.

I saw the young man's complexion was dull, and his whole face was still a little swollen.

Looking at his face, he felt that the situation was not very good.

"Doctor... I always feel chest tightness, nausea, and diarrhea..."

The young man was supported to sit on a chair and described his condition.

When Wu Jiang heard this, he consciously thought about the diseases of the digestive tract.

"Does your stomach hurt?"

Wu Jiang asked.

"Stomach pain? The stomach feels okay, but I feel uncomfortable all over... and I feel like I can't breathe."

"Can't breathe?"

This made Wu Jiang a little confused about the direction.

Nausea for a while, diarrhea for a while, and breathlessness for a while.

Although the face is indeed sick, but nausea, vomiting, diarrhea, and breathlessness?

Wu Jiang looked at Lin Yi.

Brother Yi, why don't you come and ask.

Lin Yi took the conversation and asked:

"Besides these, are you dizzy?"

"Sometimes a bit later."

Lin Yi turned his gaze to Wu Jiang: "Let's measure your temperature and blood pressure first."

Wu Jiang nodded and began to measure the young man's blood pressure.

The girl who came with the patient was very worried and asked:

"Doctor, what's wrong with him? Nothing will happen, right?"

Seeing that the patient was so young, Wu Jiang thought that generally there would be no serious illness, so he replied:
"Don't worry, we will know the result after we finish the examination. Besides, he is so young, so there are usually no major problems."

After saying this, Wu Jiang saw Lin Yi gesturing towards him.

Wu Jiangdang even realized that he might have said something wrong...

Looking at Lin Yi's eyes, could it be that this patient is very serious?

"Well, family member, let me ask him how long the symptoms have lasted? When did he start feeling nauseous, vomiting and out of breath?"

The girl thought for a while and said:
"Maybe it was half a year ago when I first got nausea and vomiting, right? We went for an inspection at that time. We did a gastroscopy and found nothing wrong."

Wu Jiang was taken aback: "Is there any problem with the gastroscope?"

"Correct."

That's strange, nausea and vomiting, but there is no problem after gastroscopy.

Then it shouldn't be a stomach bug.

Wu Jiang frowned and thought for a while, then looked at Lin Yi again.

There was also a hint of surprise and worry in Lin Yi's eyes.

But when Wu Jiang thought about it carefully, there were many diseases that caused nausea, vomiting and diarrhea, and most of them were gastrointestinal diseases.

Could it be that the young man in front of him has a problem with his intestines instead of his stomach?

After thinking for a while, there was no result. Wu Jiang felt that he really said something wrong just now.

Maybe this guy is really an intractable terminal disease!
"Blood pressure 150/106 mmhg, body temperature 37.4 ℃."

After 1 minute, the blood pressure and body temperature came out.

High blood pressure and low body temperature.

After hearing the result, Lin Yi asked again:

"The dyspnea also started half a year ago?"

The young man nodded:

"Yes, I go to work during the day and occasionally take out food at night.

It started almost half a year ago. When I delivered food at night, I walked from the gate into the community to deliver food to people. I felt very tired and dizzy when I ran, which was uncomfortable.

I don't know the reason, and the feeling of nausea and vomiting has become more and more serious in the past six months.

Also, the color is very dark when you urinate. "

Dyspnea on exertion plus dark urine?

"How deep is it? Deep yellow or brown or blood red?"

"It's between brown and blood red. In fact, the urine color has always been a bit dark before. Yesterday it was between brown and blood red..."

Upon hearing such dark urine color, Wu Jiang next to him also became nervous.

Dark urine is not a good thing.

"You lie there and I'll check you up." Lin Yi said as he began to put on his gloves.

The girl quickly helped the boy to the hospital bed in the consulting room.

Lin Yi lifted the clothes on the patient's chest, began to auscultate with a stethoscope, and then palpated on the chest and abdomen.

Although Lin Yi already knew what was going on with this guy.

But the patient and other doctors didn't know, so Lin Yi could only complete the examination as soon as possible to give the diagnosis.

In addition to the examination of the chest and abdomen, Lin Yi also looked at the patient's face, including the pupils, cheeks, and limbs.

Afterwards, Lin Yi helped the patient up again and said:
"I see that you have tenderness in your lower right abdomen. That location is the kidney. Have you ever had pain in your lower right abdomen before?"

The guy nodded: "Yes, it hurts before, but I didn't pay much attention to it. It doesn't hurt after I bear it."

Lin Yi sighed and continued:
"If you have any problems, you should come to the hospital early, early examination and early treatment, you know?"

"Also, I see that you have an anemic face. Have you felt weak in the past six months? Or have you experienced any other inexplicable bleeding?"

The boy nodded repeatedly and said:
"Yes, yes, yes! I don't know if it's anemia. Anyway, I feel dizzy and out of breath after a trot. I have to sit or lie down to rest to feel better."

"And the last time I cut my toenails, I accidentally cut the flesh with the scissors. It was a very small wound. It might not have hurt at all before, but last time it not only bleeds, but also hasn't healed for two days."

"I...doctor...what's the matter with me? Have I got some kind of cancer? "

Wu Jiang did not dare to answer abruptly, but turned his gaze to Lin Yi.

After a moment of silence, Lin Yi said:
"Well, we can't give you a definite answer at the moment. You have to go for an examination to be sure. First of all, you are a little anemic, so blood routine red blood cell platelets and some other infectious diseases need to be checked."

"In addition, I see that your whole face and limbs are a little swollen, which is edema. In addition, you also have dark urine. My initial guess is that it is related to the kidneys."

"So electrolytes, thyroid function, liver and kidney function, and urine tests are also required. Also, you have exertional dyspnea, so a chest CT also needs to be done."

"Then there is an abdominal color ultrasound to see if there is any problem with the various organs in the abdomen. I won't prescribe other gastroscopic gastrointestinal examinations for you. Let's wait until the results of these examinations come out."

"Don't worry, I didn't prescribe any extra inspections. All the inspections that are currently underway are mandatory. After these results come out, we will decide what to do next. It would be best if there are no major inspections."

"Then...then how much will it cost to do these checks?"

The patient looked at Lin Yi with embarrassment.

Lin Yi looked up at him and the girl next to him and said:
"Maybe seven or eight hundred, at most nine hundred."

"Okay, then...then I'll go check it out first."

After speaking, the patient was helped out of the consulting room by the girl.

Wu Jiang immediately asked:

"How about Lin Yi, what kind of disease do you suspect?
Hyperthyroidism or kidney problem?
At first I thought it was a minor illness, but the more I asked, the more difficult it became. "

I saw Lin Yi said solemnly:
"I observed it. His skin was dry, slightly edematous, he had anemic face, and he also had some problems with blood clotting. In addition to digestive symptoms, he also had chest tightness and respiratory symptoms."

"It also tastes a little strong in my mouth when I talk."

"And the most important point, dark urine, and the color is between tea-colored and hematuria."

(End of this chapter)