This doctor has a system

Chapter 358 429. Pyriform fossa fistula?

The thyroid gland, like a butterfly and also like armor, is located in front of the trachea.

Sometimes the virus infects the thyroid gland, causing internal inflammation of the thyroid gland, which can also cause obvious pain and swelling in the thyroid area. It hurts when touched. It can also radiate to the ears. The pain is more severe when swallowing, and can also cause fever, tachycardia, etc. symptom.

"Have a thyroid function test." The outpatient doctor suggested. "Many patients with viral thyroiditis mistakenly think that it is a cold and sore throat or a bacterial infection in the neck."

Xiao Liu was very active in the examination, but there was nothing he could do about it. The pain was really severe and he felt a little restless.

The results of the five thyroid function tests would not be available until the next day. The doctor thought about it and decided to give Xiao Liu medicine first.

"This is called empiric medication." He said to Xiao Liu, "Let's take it on a trial basis first."

Xiao Liu was a little scared when he heard about the experimental drugs, feeling like he was a guinea pig.

"They are not guinea pigs." The doctor smiled, "They are relatively safe drugs. Even if you don't get sick, you will be fine if you take them for a few days."

He prescribed prednisone to Xiao Liu, taking 6 tablets (30 mg prednisone) a day, divided into three times, 3 tablets (2 mg) each time.

Prednisone is a glucocorticoid and is widely used clinically for many diseases, such as bronchial asthma, immune diseases, etc.

However, this drug generally cannot be used for a long time, otherwise it is easy to develop dependence, and it can also easily lead to high blood sugar, moon face, buffalo hump, and weight gain.

"After using prednisone, your pain will be relieved immediately." The doctor said confidently, "There's no need for you to come to me!"

Xiao Liu left the hospital with peace of mind. After returning home, he took the medicine according to the doctor's instructions, but the effect could not be said to be useless at all, or it could be said to be of no use at all.

"No, it still hurts." He came to the hospital early the next day. At this time, the results of his thyroid gland function also came out, and the results showed that everything was normal.

"Well." The doctor looked a little embarrassed, "It seems there are other reasons."

"You're not good at this level." Xiao Liu complained, "What I said yesterday is that it's useless and you have to be responsible."

"I didn't say that." The doctor said quickly, "I mean you still come to me if it's useless."

"Aren't you here now?"

Xiao Liu just wanted to scold her.

"It's just like seeing a doctor." The doctor reassured, "Some people will be fine with some medicine, and some people may still need to be hospitalized for detailed examination."

"There are still people who die young."

Shut up now, Xiao Liu was speechless to him. But the pain in his neck was getting worse, and he thought about it and decided to be hospitalized.

"Your situation is really uncommon." Bu Zhengyang took the thyroid color ultrasound report and muttered, "The color ultrasound didn't see any abscesses or anything."

Gao Feng also became interested in this patient. He touched Xiao Liu's neck and it did not feel like an abscess. But he couldn't tell what the disease was for the time being.

"If you don't want to do a puncture, let's take a look." Bu Zhengyang suggested, "Under the guidance of color ultrasound, we will give a shot at the most swollen and painful place."

"Does it hurt?" Xiao Liu was scared when he heard about puncture.

"It doesn't hurt, the itching is very comfortable." Bu Zhengyang said.

"seriously?"

"fake."

"Young man, don't be afraid of pain. It will pass if you endure it." Someone said next to him.

It’s not you who’s in pain, Xiao Liu thought to himself, but after careful consideration, he decided to follow the doctor’s advice. There’s nothing he can do, he can’t even go to work if he’s in pain, and he can’t even think about trying to trick his boss in the company’s troubled waters. Money, Xiao Liu's heart hurts a little.

"Strange pain: It's really hard to live with pain. Liu Neng is already a little depressed. Please help him find out the cause of the disease as soon as possible and relieve the pain. You can get 10 skill points by completing the task."

Gao Feng immediately perked up. He was already interested in this patient, but now he was even more excited.

He performed the puncture himself the next day, and the process went smoothly. Xiao Liu felt that he could tolerate the pain, and it was not as severe as usual.

The next step was to wait for pathology, but Gao Feng was not idle. He looked at the anatomy of the neck again, and he had many ideas in his mind.

Two days later, the puncture test results came out: more neutrophils and a small number of lymphocytes were seen in the extracted tissue, but no cancer cells were found.

It looks like cellulitis, a purulent infection caused by bacteria, and the inflammation spreads around.

But it was a strange inflammation because antibiotics and prednisone didn't work. Prednisone is the most commonly used oral hormone drug. There is almost no inflammation that it cannot suppress. Many patients with autoimmune diseases have severe inflammation, and prednisone can be used to suppress the inflammation.

The prednisone will definitely need to be stopped. Since it is not thyroiditis, but a common bacterial infection, there is a high possibility of using prednisone. Antibiotics are still needed. But I can no longer use the previous antibiotics, I have to change them.

"Could it be lymph node tuberculosis?" Bu Zhengyang asked.

"I'm not considering it at the moment." Gao Feng replied.

If the cervical lymph nodes have tuberculosis, most patients will also have pulmonary tuberculosis. After all, the Mycobacterium tuberculosis is not fixed and will spread. Most of the cases are pulmonary tuberculosis at the beginning because the patient inhales Mycobacterium tuberculosis through the respiratory tract. Pulmonary tuberculosis occurs and the Mycobacterium tuberculosis colonizes. Then it begins to spread to the periphery, and cervical lymph node tuberculosis occurs.

Wu had no obvious symptoms of tuberculosis such as cough, sputum, chest pain, hemoptysis, etc., and there were no obvious abnormalities on chest CT.

"Then what should this be?" Bu Zhengyang had a headache, and he was helpless when he saw Xiao Liu complaining about neck pain every day.

"Could it be a pyriform fossa fistula?" Gao Feng said slowly, "I have also checked some literature in the past two days, and I feel that the patient's current condition is quite consistent with a pyriform fossa fistula."

Pyriform fossa fistula? Bu Zhengyang was a little confused. What is piriform fossa fistula? To be honest, not many doctors even know where the piriform fossa is.

This is really called separated lines like mountains. Everyone may be an expert in their own field. But when it comes to otolaryngology diseases, they are no longer their home base, so it wouldn’t be surprising if they don’t know them.

Pear-shaped fossa, there is a small recess near our throat, shaped like the sunken head of the fruit pear, and also like a dimple, so it is called pear-shaped fossa, one on the left and right.

If the congenital embryo does not develop well and the tube that should be closed is not closed, resulting in the formation of a fistula, then the food or bacteria in the throat will spread through the fistula to the subcutaneous area of ​​the neck. Local bacteria can easily multiply and cause infection, so the neck will Repeated redness, swelling, heat and pain.

"Then what should I do?" Xiao Liu asked. His mental state was much better than before. After intravenous antibiotics, the symptoms of neck pain were greatly relieved, there was no longer fever, and the inflammation indicators also dropped. A lot.

"You can go for hypopharynx imaging and laryngoscopy to see if it is a pyriform fossa fistula."

Bu Zhengyang took the patient to the otolaryngology department, after all, this is their specialty.

"I'm afraid this is not a pyriform fossa fistula, right?" Director Zhou from the Department of Otolaryngology asked about Xiao Liu's condition and said, "The symptoms are not typical, so why would you consider this disease?"

"We, Director Gao, feel like it." Bu Zhengyang said, "So I thought about bringing the patient over to rule it out."

Director Zhou couldn't help laughing, "Director Gao is not an otolaryngologist, so his feeling may not be right."

"Isn't this all speculation." Bu Zhengyang replied. He felt that Director Zhou talked a bit too much.

"Go and find Doctor Hu inside. I'm busy here." Director Zhou didn't want to waste time on this patient. Doctor Hu was his subordinate doctor.

Dr. Hu was very enthusiastic. He had just been working in the provincial hospital for two years and was a newcomer. After hearing Bu Zhengyang's request, he thought for a moment. "Then let's do a pharyngeal angiogram first."

Contrast media is relatively safe and does not harm the body. When swallowing contrast media, if there is a pyriform fossa fistula, some of the contrast media will leak out through the internal fistula opening and flow all the way to the neck.

The radiologist stared at the screen intently, but he couldn't find the fistula.

So Xiao Liu was asked to take another sip of contrast agent.

Still no fistula was found.

Have another drink.

Still no fistula was found.

Have another drink.

No, Dr. Hu from the otolaryngology department was also at the scene. He did not see the fistula. Could it be that it was not a pyriform fossa fistula? ?

"Do you still want to drink? I'm full now." Xiao Liu burped.

Bu Zhengyang went back and reported the situation to Gao Feng.

The result was a bit beyond Gao Feng's expectation, and he pondered for a while.

"Is it possible that the inflammation has not completely dissipated and there is something blocking the fistula tract, so it cannot be seen on the angiogram?"

I don’t know, Bu Zhengyang thought, I know nothing about this pyriform fossa fistula.

"It's really possible," he said.

"Then let's do an electronic laryngoscope first and see if we can find the fistula within the pyriform fossa under direct vision," Gao Feng said.

"Director Yingming, I didn't expect this." Bu Zhengyang said quickly, "I will take the patient there now."

When Bu Zhengyang took Xiao Liu to the otolaryngology department again, he heard Director Zhou talking nonsense there.

"Hey, today's young people just can't recognize themselves."

"I'm not talking about Gao Feng. Has he seen pyriform fossa fistula before?"

"You are not a professional in the Department of Otolaryngology, so what are you doing here?"

"Xiao Hu, you need to strengthen your professional studies in the future, but don't imitate him, and just show off your hair if you have some achievements!"

"Director, you are raising your tail." Doctor Hu corrected him in a low voice.

"It's all the same." Director Zhou said, "You have to remember it."

"How can I achieve what others have achieved?" Dr. Hu touched his nose awkwardly, "He has published several articles in Nature and The Lancet, is a multi-millionaire, and is now the director of the department. .”

Who am I?

"Ahem!" Bu Zhengyang coughed a few times.

As soon as Director Zhou looked up and saw him, he immediately shut his mouth. He was scared.

I guess you know the truth, otherwise I would go back and read your book, Bu Zhengyang thought to himself.

"Director Zhou, let's do an electronic laryngoscope on this patient. Director Gao still thinks it's a pyriform fossa fistula."

"I'll be a little busy right now." Director Zhou still wanted to shirk.

"Director Gao asked you to do it by name." Bu Zhengyang's tone was a bit bossy, "You are hurt! Hurry up."

Why should he command me? Director Zhou is very reluctant, so I won’t do it.

"Okay." Director Zhou said.

There was no way, he couldn't afford to offend this Gao Feng.

"Let me go, it's really a pyriform fossa fistula!" Dr. Hu screamed strangely, "He is so special, why is the position of his mouth different from others."

Under the electronic laryngoscope, the fistula within the pyriform fossa was clearly seen.

"Our Director Gao feels that we haven't made any mistakes yet." Bu Zhengyang looked at Director Zhou and said, "Director Zhou, you still need to strengthen your professional study in the future. This patient was almost missed in your hands."

What else can Director Zhou say? He will be extremely embarrassed. He just needs to let these two people go.

"That's too much. You don't respect old comrades at all." As soon as Bu Zhengyang left, Director Zhou complained, "If there is anything to be proud of, it must be blind."

Doctor Hu remained silent.

"What do you mean?" Director Zhou glanced at him dissatisfied, "You actually agreed with me!"

No wink!

"I don't want to agree with you." Doctor Hu said, "You are really an old fool. Why do you offend others when you have nothing to do?"

"What are you talking about?" Director Zhou was shocked. This kid's wings were stiff.

"What is my status in the hospital? Why can't you understand it clearly?" Dr. Hu said speechlessly, "If I say something in front of the hospital director, can your old arms and legs bear it?"

"Hmph!" Director Zhou snorted coldly, but he didn't dare to refute. His old arms and legs really couldn't stand the torture. In fact, there is no need for the dean to take action. Director Zhou can't stand it if the director of the department puts on his shoes.

"Follow me and study hard from now on." Dr. Hu said, "From now on, we will do our own thing. I will treat you as the superior doctor, and you will treat me as my teacher."

Director Zhou looked at him in shock, then turned around and started pulling things on the desk.

"Director Zhou, what are you looking for? Teacher Hu can help you look for it," Dr. Hu said enthusiastically.

Then he saw Director Zhou walking towards him with a stethoscope and a fierce expression.

"What are you going to do?" Dr. Hu panicked, "It is illegal to beat a colleague in the hospital!"

"Wang Liang, what are you doing with the money in your hand now?" Yue Penghui asked.

"Why are you asking this?" Wang Liang was very wary, "I'll let you know first whether I want to borrow money or not."

Borrowing money hurts feelings. The relationship between him and Yue Penghui is so deep that they cannot be hurt in the slightest.

"I have hundreds of thousands in my hands. Do you think we should make some investments or something?" Yue Penghui said, "I see several of our colleagues trading stocks there, but I don't know if they are reliable or not?"

"Are you crazy?" Wang Liang looked at him as if he were a fool, "It's only been a few good days, and you actually want to trade in stocks?"

Is that something ordinary people can touch? If you're lucky, you won't be able to recognize it, but if you're unlucky and brave enough, you can jump off the building with a little leverage.

(End of this chapter)