This doctor has a system

Chapter 213 211. It's time to eat and drink, comrade cleaning, you have worked hard

"Golden ashes: Please help Gan Liqin to make a clear diagnosis in time and relieve her pain. You can get 15 skill points for completing the task."

"What kind of disease do you think this is?" Gao Fengfa asked.

"I don't know, but it doesn't feel like an ordinary lung infection." Dong Qianqian thought for a while and replied.

患者血常过的结果提示：白细胞数目升高，15.65×10`+9`/L（正常值为3.5-9.5×10`+9`/L），C反应蛋白也明显超出正常值。肝肾功能、电解质、心肌酶均未见明显异常。

Infect?Gao Feng murmured in his heart, but if it was a simple lung infection, why would the week-long anti-infection treatment in the community hospital be ineffective?
"No, use antibiotics first, let's observe while checking and treating." Dong Qianqian suggested.

Gao Feng nodded, that was all he could do for now.

In the next two days, the patient's condition did not decrease, but did not worsen significantly. She coughed up about 2000ml of watery secretions every day.

"Now it's the old cough, I'm just like Koizumi." During the rounds, Gan Liqin held up a disposable cup filled with clear watery secretions for Gao Feng and Dong Qianqian to see, "I can't sleep well at night!"

The old lady was very worried, and the family members hurriedly comforted her.

"Mom, they say water is the source of all things. What does it mean that you keep spitting out water now?" said the patient's son, "It means you are energetic!"

"Shut up!" Gan Liqin glared at him, "If you want to throw up, throw up, I've had enough anyway!"

"The secretions were sent to pathology, but nothing valuable was found." Dong Qianqian reported to Gao Fenghui, "The blood routine and C-reactive protein were also reviewed today, and they were lower than before."

The index has dropped from before, indicating that anti-infective treatment is effective, but the patient's symptoms have not improved, indicating that infection is not the cause of her coughing up a lot of mucus.

"Let's talk to the family and have a bronchoscopy done," Gao Feng told Dong Qianqian.

The patient's son quickly agreed. Although he was a little afraid of risks, he still made up his mind when he saw that his mother's condition was deteriorating day by day.

The bronchoscopy went very smoothly. The anesthesiologist made many plans in advance, but fortunately they were not used.

Under the bronchoscope, the mucous membrane of the airway of Mrs. Gan Liqin was somewhat congested, and the distal airway was filled with clear watery secretions. This was the first time Gao Feng had seen such a situation, and everyone was very surprised by this.

Gao Feng didn't see anything abnormal after washing the watery secretions, which made him a little disappointed.

Secretion cell count, culture, and cytology were all negative, and this result made the diagnosis fall into the fog again.

"I have been working for so long, and I have never seen such a disease." Director Zhao said in amazement, "I don't know what kind of rare disease it is."

"I suggest you search the literature to see if there are any reports in this area." She suggested.

"I've searched all the ones in China, but I didn't find anything similar." Dong Qianqian said, "I seem to be struggling in English."

"I'll do it." Gao Feng said. He has a relatively advantage in this aspect, thanks to his persistent learning of foreign languages. Of course, this foreign language is a serious one, and his medical English level is no longer what it used to be.

Generally speaking, if the daily respiratory secretion is more than 100ml, it is considered as bronchial mucorrhea.Generally seen in tuberculosis, chronic bronchitis and bronchiectasis.

Gao Feng typed the bronchial mucus overflow into the search box, and soon dense feedback results came out.

Damn, this is too much!

Three hours later, Gao Feng yawned. Unfortunately, no useful information was found.

However, he was not obviously disappointed. If it could be retrieved easily, it meant that it was a common disease. Common diseases require literature search.

sleep!Check it out tomorrow.

During the ward rounds the next morning, the patient's mental state was actually better and there was a smile on his face.

Gao Feng was a little strange. After asking, he learned that it was the youngest son who came back from out of town to see her yesterday. It turned out to be the strength of family affection.

"I'm really convinced!" The patient's eldest son complained to Gao Feng, "My brother doesn't come back once a year, and he doesn't take on any obligations. That's all, my mother still cares about him."

Gao Feng felt a little dizzy while reading the literature at night, but he seemed to have luck this time. A German oncologist published a rare case report 2 years ago. The article mentioned that there was a 74-year-old patient. An elderly woman coughed up about 3000ml of clear mucus every day, and was finally confirmed to be adenocarcinoma in situ during a 2-month hospitalization.

"Lung adenocarcinoma in situ?" Dong Qianqian was very surprised.

Lung adenocarcinoma in situ, also known as bronchioloalveolar carcinoma, is a small adenocarcinoma that grows locally without mucus. Cancer cells mainly grow along the alveolar walls and do not aggregate in the alveolar walls. There are a large number of diffusely distributed cells in the tumor. alveolar space.

It is usually judged as lung adenocarcinoma in situ or minimally invasive adenocarcinoma based on the pathological examination of the patient's lung tumor.

The patient's chest CT showed suspicious blurred shadows in the upper lobe of the left lung, and massive consolidation in the lower lobe of the right lung.

"Let's do a puncture in the upper lobe of the left lung." Gao Feng suggested. In fact, he mentioned it before, but the family members felt that this was an invasive operation and were reluctant to do it.

"Is there no way to diagnose without this puncture?" The patient's son asked, "Is there a way to get the best of both worlds? It can not only clarify the cause, but also avoid pain."

"You're still thinking about beauty!" Dong Qianqian laughed.

Gan Liqin was indeed a bit timid, and she couldn't help shivering while lying on the CT machine. Dong Qianqian, who accompanied him, hurriedly comforted her, and it took a lot of effort for the old lady to get better.

"I can't move for a while!" The puncture doctor confessed that he wanted to give up when he saw this situation just now. The patient kept shaking but the needle couldn't be inserted.

five days later.
"It's lung adenocarcinoma in situ." Dong Qianqian reported to Gao Fenghui, "I've already asked for genetic testing."

Once the cause is clarified, the next step is easy. There are several methods that can reduce the airway secretion of bronchial mucus overflow, thereby improving respiratory symptoms.

After continuous pumping of 25ug/h of octreotide, the respiratory secretion of Ganliqin decreased from 2000ml to 200ml/day, and the symptoms of chest tightness were also significantly relieved.

The results of genetic testing were also reassuring, suggesting that there was an EGFR exon 19 deletion mutation, which indicated that the patient could be treated with oral targeted drugs.

Seeing that his mother's condition is getting better and better, the patient's son is not happy, "Doctor, how long will it take for this targeted drug to become resistant? What should we do after the drug is resistant?"

"About half a year, and it may last for several years if it gets better." Dong Qianqian replied patiently, "If you are resistant to the drug, you should come to the hospital in time to see if you can change the drug or receive chemotherapy."

If early lung cancer can be surgically removed, the prognosis is relatively good, but if it has reached the advanced stage, the survival period will be short, mostly about half a year to a year.

For this patient, Dong Qianqian actually has relatively low expectations, but many things cannot be said directly to the patient or family members, which will easily cause excessive ideological pressure on them.

"You should eat and drink when you go back." She confessed, "It's okay to take her around to see what the old man has wishes."

The family members originally wanted to ask about other precautions, but when they heard that they should eat and drink, they immediately lost the courage to open their mouths.

It's time to eat and drink, and there is a note about wool.

"You have completed the task of catching gold from dust, and you have obtained 5 skill points."

Gao Feng shook his head. He only has 5 skill points. It seems that the system is very dissatisfied with his performance this time. In fact, he himself feels a little bit down, but he is not very dissatisfied. At least he has 5 skill points.
-
"Gao Feng, aren't you busy right now?" Vice President Guo asked at the door of Room 1 of the bronchoscopy room. He was a bit fat, but he looked very funny wearing a blue surgical gown of S size. .

Gao Feng, who was working in the bronchoscopy room, was stunned for a moment. Are your two eyes just for display?I'm obviously very busy.

"I called you, but you didn't answer." Vice President Guo looked into the room again, "How long do you want? Everyone is waiting for you over there."

"Wait for me?" Gao Feng said while operating, "What's the matter? No one notified me in advance."

It turned out that Gu Xueshi, who was driven into the sky by a car, was transferred out of the intensive care unit today. The condition is very good, and the family members are ready to thank the saviors.

"I'm busy." Gao Feng didn't like to go, and he didn't like standing or sitting on such occasions.

"Ouch, that's not possible." Vice President Guo became anxious, "Secretary Gu is very impressed by you and even brought you a gift."

"Didn't the hospital emphasize that we can't accept gifts and red envelopes from patients and their families?" Gao Feng said casually, "I don't do anything that violates the principles."

If it's an ordinary person, Vice President Guo went to whip him in the morning, you're talking about principles now!But in Gao Feng's case, he could only coax him, "Oh, you can go, old secretary Gu is so old, he is waiting for you there, you can't bear it if you don't go."

"Respecting the old and loving the young is an excellent tradition of our Chinese nation"

The head nurse of the endoscopy room hurried over at this moment. Seeing Vice President Guo with a large beer belly exposed, she hurriedly sent someone to get a new set of surgical gowns.

"No need." Vice President Guo waved his hand, what kind of surgical gown is he wearing at the moment.

"Okay then." Gao Feng has also completed the main operations for this meeting. The trainees below are completely fine, and Director Pan is in Room 2, so don't panic if anything happens.

"Then let's go quickly." Vice President Guo pulled him and walked out the door. Old Secretary Gu had already arrived for a while, so he didn't dare to let people wait too long.

"Thank you so much!" Old secretary Gu blushed, his son's situation was good and he was in a good mood, and he was always kind to everyone recently.

"This is Professor Gao who saved your life." He said to his son Gu Xueshi, "When you recover, you must thank him."

Gu Xueshi smiled and nodded to Gao Feng, "Thank you, Doctor Gao. I will come to thank you when I am discharged from the hospital."

"No, no." Gao Feng waved his hand, "This is what we should do."

"This is a little bit of our thoughts." Secretary Gu took out a small box, and inside was a milky white safety button. The texture looked better than the other one.

He was about to say no, but the other party had already put it on for him, "I asked for two dollars for the one that has been opened."

"It's too expensive." Gao Feng was a little embarrassed, but everyone had hung it on his neck, and it seemed inappropriate to take it off at this occasion.

Dean Qin and Vice Dean Guo at the side were envious, and it was not uncommon to get a Ping An deduction, but it depended on who gave it to them.

Although the old secretary Gu has retired, he still has a huge influence in the province. When Dean Qin's brother was transferred here, he visited him specially.

It's a pity that Gao Feng did not enter politics, and Vice President Guo felt sorry for him.

"Who gave it to you?" Li Ma took the safety buckle on the dining table and looked it over carefully, "This one looks even better than the last one."

"It's a gift from the patient's family." Gao Feng responded casually. He was busy peeling the prawns that Li Ma fried today.

"Aren't you not allowed to accept gifts from patients?" Father Li said, "It seems that there is something wrong with it."

"The patient's status is quite special. The old man insisted on giving it to me, so he put it on my neck in front of the hospital leaders." Gao Feng explained, "I dare not refuse."

"Special status?" Dad Li was curious, what kind of big shot?He found that his son-in-law was always in contact with these powerful people.

"The former secretary is now retired."

"Gu XX?!!"

"Yes." Gao Feng replied, "His youngest son was in a car accident and was hospitalized in our hospital. I happened to help."

Father Li's expression was quite complicated, "I also had an encounter with Secretary Gu before."

"How can you, a small staff member, have anything to do with such a big shot?" Mama Li curled her lips, "Stop bragging about it."

"Who blew it up." Father Li was displeased. "5 years ago in the winter, Old Secretary Gu visited our place. I was in charge of cleaning the reception hall, and the floor was polished."

"The old man even shook my hand specifically, saying that I have worked hard."

"People probably thought you were cleaning." Mama Li laughed.

"Crap, does my temperament look like a cleaning?" Father Li retorted.

5 years ago, in winter, there was light snow in the sky
"Ouch!" Secretary Gu almost sat down on the ground, but the secretary next to him quickly grabbed him.

"It's too bright here." Secretary Gu laughed.

The dean was taken aback, "Why didn't you wipe the floor dry after mopping it? It's so slippery that you can't leave!"

"Didn't you say come at 10 o'clock?" Father Li felt a little aggrieved.

How did I know that the dean was more wronged than him.

"Comrade Cleaning, you've worked hard in such a cold day." Secretary Gu came up to shake Father Li's hand.

"Not hard, not hard."

This was the only intersection between Father Li and Old Secretary Gu.

Early in the morning, Section Chief Mo Yunchang of the political engineering department of the court hurried to the dean's office. He was quite puzzled. The political engineering department has nothing important recently. The dean suddenly asked him to come. Could it be because of some special circumstances? Bar?

But he wasn't very worried, and the tone didn't sound like a bad thing.

(End of this chapter)