Doctor of Healing

Chapter 657 The Unscrupulous Physical Examination

"I read in the medical records that you have an inguinal hernia?" Ji Xiang "finally" remembered that he was a doctor, and asked a medical-related topic.

But Chief Bai expressed his helplessness.

Although inguinal hernia is a medical category, it has nothing to do with postoperative bleeding in patients with internal hemorrhoids.

"Hi, don't mention it. I have a sports hernia. Many people who play basketball have this problem. They say that there is a problem with the core muscles. When I was young, I was thinking about surgery, but I was afraid of pain and I was busy with work, so Just forget about it."

Jixiang and the patient started chatting along the inguinal hernia, and Jixiang even had a physical examination for the hernia.

If it was someone else, Director Bai would go up and kick his ass, telling him to get out.

The purpose of consultation is to solve the postoperative bleeding of internal hemorrhoids, not the inguinal hernia after exercise!
As the name suggests, inguinal hernia after exercise refers to a disease that occurs only after strenuous exercise, and it can basically be repaid, even if it is strangled with a hernia belt, it is a disease that does not matter.

Ji Xiang...

What a digression.

"Hello, Director Bai." Lin Jiuze greeted Director Bai with a harmless expression on his face while holding a notebook in his hand.

When he spoke, the patient's family was shocked.

For five or six minutes, none of them noticed that there was still someone standing here.

"Professor Lin, what do you think?" Director Bai looked forward, not looking at Lin Jiuze at all.

As long as you don't look at him, the feeling of dizziness will be much lighter. Director Bai quickly found a way to deal with Lin Jiuze.

"It's weird, I don't have any opinion for the time being." Lin Jiuze said helplessly, "Doctor Ji Xiang probably doesn't have any opinion either."

Looking at Ji Xiang who was doing a physical examination and explaining the inguinal hernia to the patient, Director Bai thought so too.

"There are not many similar patients at Massachusetts General Hospital."

"I don't know, my profession has nothing to do with this kind of disease."

Director Bai didn't say anything, since he specialized in surgery, it's normal for Lin Jiu not to understand.

Director Bai understood half of what Lin Jiuze wrote in the notebook just now, which was about the same as the guesses of the directors in the office, but Lin Jiuze also wrote about treatment, which was more detailed.

Plus some very rare diseases.

Director Bai's judgment on Lin Jiuze is that his professional level is better than that of the directors of the Second Affiliated Hospital, even though hemorrhoids is not his own specialty.

Especially for the differential diagnosis of those rare diseases, Lin Jiuze's technical level is unquestionable.

It seems that I can only go to Xiehe for consultation, Director Bai has a headache.

He usually doesn't want to use the relationship on the Xiehe side. After all, it's very troublesome to maintain the relationship.

Ji Xiang was doing useless work, Director Bai didn't bother him, but stood patiently at the door and watched.

"Doctor Ji Xiang's consultation is very strange, don't you think Director Bai?" Lin Jiuze spoke suddenly.

"good."

"Your court really values ​​talents." Lin Jiu said something nonsensical.

Director Bai heard a little provocation.

But he still didn't say anything, and didn't look at Lin Jiuze, just pretending that he didn't exist.

A few minutes later, Jixiang and the patient said goodbye with a smile. Although the time was short, the two seemed to have a good relationship, and they were short of beheading chicken heads and burning yellow paper on the spot.

"I'm going to talk about my opinion, don't worry, I will recover soon." Ji Xiang shook hands with the patient and said goodbye with regret.

After leaving the ward, Director Bai looked at Ji Xiang, and said nothing as soon as possible.

"Director Bai, the patient's inguinal hernia is very strange." Ji Xiang said the first sentence after going out.

Director Bai felt a little strange.

He guessed that Jixiang had already had a definite diagnosis, but he didn't explain it clearly. Could it be that Lin Jiuze jumped out by himself and took a blow?

But Lin Jiuze is also a human being, and he doesn't speak at all, as if he really disappeared.

Director Bai couldn't see through Ji Xiang, and didn't know whether his guess was true or not. Ji Xiang said immediately, "I suggest a B-ultrasound."

"I did a B-ultrasound, but didn't you see it?" Director Bai immediately realized that he seemed to have made a mistake after reminding him, "Xiaoji, what position do you want to see?"

"I consider the patient is chronic Budd-Chiari syndrome, and I want to see the location and length of hepatic vein and inferior vena cava obstruction at the top of the diaphragm and the second porta hepatis to determine whether it is a diaphragm type."

"!!!"

"!!!"

Director Bai and Lin Jiuze were both taken aback for a moment.

this diagnosis,
Unconstrained.

Both of them are very smart, and they are also top medical figures. After Ji Xiang said his diagnosis, both Director Bai and Lin Jiuze had an epiphany almost at the same time.

Budd-Chiari syndrome is a posthepatic portal hypertension characterized by inferior vena cava hypertension caused by obstructive lesions of the hepatic vein and its opening above the superior vena cava caused by various reasons.

The disease is divided into acute, subacute and chronic.

Most patients with chronic Budd-Chiari syndrome will show a dyscratic state, or a spider-man state.

However, there are very few patients who have no special physical features to suggest that, in addition to a small amount of peritoneal effusion, there will be hernia and hemorrhoids.

In one sentence, Ji Xiang connected all the things together to form a perfect closed loop.

"Xiaoji, how did you know that?" Director Bai asked with a frown.

"Everyone ignores a small amount of peritoneal effusion, because the amount is small, and it is normal to ignore it, but I don't think so." Ji Xiang said, "In addition, the patient has clinical symptoms of inguinal hernia and continuous bleeding after internal hemorrhoid surgery, so my The initial diagnosis was Budd-Chiari syndrome."

"After the physical examination, it was found that the veins in the patient's lower abdomen were slightly distended, including the patient's jugular veins. Of course, these are my guesses, so let's do an examination first."

Director Bai nodded, he turned around and went to the office with Ji Xiang.

The moment he turned around, Director Bai was a little dizzy, and he immediately overcame his physical discomfort and looked back.

Lin Jiu didn't go with him, but stood in the ward and wrote something in his notebook. As he wrote, he looked up at the patient.

Director Bai confirmed the guess in his heart, turned around and chatted with Ji Xiang while correcting his eye contact.

"Xiao Ji, how high do you estimate the correct diagnosis rate is?" Director Bai asked.

"Eighty percent." Ji Xiang gave a reasonable answer.

"Yes, the operation should be very simple."

"It's very simple. You can do it in the vascular department or the interventional department. It depends on who has done it. Similar cases are rare. Chronic Budd-Chiari syndrome + normal liver function are difficult to diagnose." Ji Xiang said.

Director Bai smiled slightly, and looked sideways at Ji Xiang.

In contrast, Ji Xiang has a kind face, while Lin Jiu looks like a devil.

"I didn't mean that." Ji Xiang saw what he wanted to say from Director Bai's eyes, and quickly explained.

"Hahaha, it's okay, I know you want to say something good for the directors." Director Bai said, "Seek a B-ultrasound consultation. By the way, Xiaoji, if you have any difficulties in the work of the Provincial Department of Self-Care, please call me directly. "

(End of this chapter)