This doctor has a system

Chapter 394 459. It’s okay, you’re just too fat
I have tried chemotherapy, radiotherapy, and immunotherapy, but now this situation is really difficult to handle.

"Your dad's left main bronchus has been blocked by a tumor." He said to his family. "If you want to relieve the symptoms of chest tightness, you need to clean this area."

"But I have to tell you up front, this is just treating the symptoms and not the root cause."

"It will definitely grow again after endoscopic treatment."

Hearing this, the family members were very disappointed. Many doctors told him this. They thanked him immediately and turned around and left.

"Suffering from tumors at this age is a matter of life, not a disease." Zhang Zhengye said on the side. He was not willing to spend too much energy on such elderly patients with advanced tumors.

Doctors spend too much energy, which means families have to spend more money.

There are many ways to treat tumors. Rich people can spend millions or even tens of millions, and poor people can also treat tumors for tens of thousands of dollars.

In the advanced stage, no matter how much money is spent, it will not help and cannot prolong the patient's survival period. Even if it can be extended, it is not necessarily a good thing. Prolonging the patient's survival time will greatly reduce the quality of life.

It can only be said that benevolence is in the eye of the beholder.

In this case, the first thing to consider is that the lumbar disc herniation compresses the nerves, causing low back pain, numbness and weakness in both lower limbs.

"Damn it! It can't really be an aortic dissection!" Someone shouted, "Quick! Get a full abdominal augmentation!"

"I think hospice care is better than blind treatment." He said to Gao Feng. In fact, he did the same for his own family.

There was no chest pain, chest tightness, abdominal pain and distension, no blood in urine and dark stools, no dizziness, nausea and vomiting and other discomforts.

"I am from the Department of Respiratory Medicine." Gao Feng replied, "This patient has an obvious abdominal aortic dissection, which cannot be ruled out as a result of aneurysm tear."

The patient was almost frightened to death when he saw the movement, but before he could react, everyone lifted him onto the flat car and pushed him towards the imaging department.

The community staff nearby quickly found a blood pressure monitor, and after measuring it, they found that the blood pressure in the patient's left arm was 180/118mmHg, but not in the right arm.

Gao Feng also stretched his head to take a look, and he noticed something abnormal at just one glance.

"This part doesn't look right." The experienced orthopedic director quickly discovered the abnormality. "The density is a bit higher." He pointed at the L2-3 vertebral body and said.

"That could also be a neurological disease." Gao Feng said, then stood up.

One day ago, the patient's above-mentioned symptoms worsened again, and he felt numbness in both lower limbs, and was too weak to stand up actively. There was no relief after the above-mentioned analgesic regimen. He was originally planning to transfer to another hospital, but today he learned that someone from Peking Union Medical College Hospital had come to him for a free clinic, so he specially treated him here. While waiting.

"Let's measure his blood pressure on both upper limbs again!"

He was treated at a community hospital and was given oral and rectal analgesic treatment and was slightly relieved. However, the pain was recurrent and the pain was slowly tolerated. However, the pain improved after the above-mentioned analgesic treatment.

Gao Feng also came to the scene at this time, and an orthopedic director was watching the film.

It's hard to do things without hair on your lips. Even though Gao Feng looked too young and had no hair on his lips, no one dared to say anything at this time.

Physical examination: Vital signs: blood pressure 187/126mmHg, heart rate about 94 beats/min. The whole abdomen is flat and soft, no masses, no varicose veins, no tenderness, double kidney percussion pain is negative, bowel sounds are acceptable, lumbosacral pain, spine and paravertebral tissue tenderness, double straight leg raising test is negative, strengthen the test Suspicious positive, weakness in both lower limbs, muscle strength level 4, slightly lower skin temperature, numbness below the ankle, decreased sensation, and presence of physiological signs.

The examination results confirmed Gao Feng's judgment that the patient had abdominal aortic dissection, and the current situation was very dangerous.

The scene fell silent for a moment, and the director of orthopedics, who was holding the film in his hand, shook violently. He was frightened.

Hearing this, several directors next to him put their heads over and everyone nodded. Some people said it would be better to do another MRI now, while others said it might be an abdominal aortic aneurysm and it would be best to check the abdomen again. enhanced CT.

"Why is it so lively over there?" Zhang Zhengye noticed that there were many people surrounding the opposite side.

Five days ago, the patient suffered from sudden low back pain for no apparent reason, mainly pain in the lumbosacral region, accompanied by limited waist movement, without numbness or weakness in the limbs.

Zhang Zhengye's mother had cervical cancer, which was already in the advanced stage when it was discovered. The old lady was often in pain and couldn't sleep at night.

The physical signs obviously do not support it. Some experts cherish feathers and dare not draw a decisive conclusion at this time.

Everyone breathed a sigh of relief at this time. This is an aortic dissection. Once it breaks here, it will be fatal. Surgery must be done in time. However, the risks of surgery are also very high and the cost is also very high. I don’t know if the patient can survive. Get through this.

"Consultation?" Gao Feng was obviously also interested.

Considering the weakened muscle strength and low skin temperature of both lower limbs, it is difficult for neurological compression lesions to occur.

"It looks okay. It shouldn't be such a serious symptom." Everyone was talking about it.

Seeing him going, Zhang Zhengye shook his head. Young people are energetic and love to join in the fun. Of course, this is also a good thing.

"It should be a surgical disease." Li Youliang said, "The patient suffered from low back pain and weakness in both lower limbs."

The ambulance arrived quickly and the panicked patient was transported away.

"That's the surgery area over there," Li Youliang said. When he saw his boss stretching his head to look, he immediately got up and went over.

Normally, Zhang Zhengye would recommend such patients to go to the Department of Palliative Medicine, which mainly provides symptomatic treatment to alleviate the patient's pain as much as possible.

The patient had undergone a CT scan of the entire lumbar spine, and the results showed degenerative disease of the lumbar spine and L4/5 intervertebral disc bulging.

"There is a special patient. The surgeon over there is conducting consultations." He came back soon.

The patient, a 55-year-old male, freelancer, mainly complained of low back pain and limited activity for 5 days, which worsened with numbness and fatigue in both lower limbs for 1 day.

"You are?" he asked hesitantly.

Past history: High blood pressure for more than 5 years, failure to take medication regularly, and a habit of smoking and drinking for 10+ years.

Later, he did some ideological work for his family and took his mother to the palliative medicine department. Only then did he realize that painkillers and the company of relatives are the best medicine for patients with advanced tumors.

Could it be lumbar disc herniation and neuropathy? Intervertebral disc compresses blood vessels? Iliac vascular disease? Vertebral dislocation?

"This is abdominal aortic dissection!"

Gao Feng felt that he lived a very transparent life, which may be related to the fact that he had seen too many life and death in the hospital. The old doctor's heart is cold.

"You're back?" Zhang Zhengye asked, "Have you figured out what happened?" He was a little curious when he saw the excitement over there.

"It's an aortic dissection." Gao Feng mentioned casually.

"The student just now seemed to be Academician Bao's student." Someone recognized him shortly after Gao Feng left. "He was there when Academician Bao celebrated his last birthday."

"My name is Gao Feng." Someone continued, "The youngest Yangtze River scholar, he is awesome."

"No wonder!" The director of the Department of Orthopedics slapped his thigh hard and said, "How could any young doctor be so good?"

He was stunned for a moment, but he just saw something was wrong, and they just said it was an aortic dissection.

At first, he thought the other party was crazy, but now he realized that his level was not up to par.

After returning to the hospital, he took the film to the imaging department.

"Old Bian, look at this movie."

Director Bian of the Imaging Department picked up the film and briefly looked at it, then raised his head and gave the other party a puzzled look.

"My lumbar disc has prolapsed, what's wrong?"

"No, what's your level?" The director of orthopedics was disappointed. "Ah?" Director Bian was stunned for a moment, and then took a closer look.

"There should be a problem with the L2-3 vertebral body. This is the location of the abdominal aorta. We need to check it with enhanced CT," he said.

"What are you looking for with contrast-enhanced CT?" the director of the Department of Orthopedics said dissatisfied, "Can't you tell at a glance that this is abdominal aortic dissection?!"

"I thought you were so good at watching movies, but you're almost as good at watching movies as I am!"

He glanced at Director Bian with disgust, turned around and left.

Director Bian of the Imaging Department felt baffled.

"You're sick!"

Gao Feng was sitting in the clinic at the moment. Director Ma had something to do today, so he asked him to come and take care of him for a long time.

The first patient was a 35-year-old middle-aged man. The patient complained of coughing and dyspnea for more than 10 days, and occasional spasms of the limbs. No chills, fever, dizziness, pain, chest tightness, chest pain, abdominal pain, bloating, Diarrhea and other discomforts.

Since the onset of the illness, he has become conscious, has poor energy, diet, and sleep, and has decreased physical strength. His bowel movements are normal.

The patient complained mainly of respiratory symptoms, but it did not seem to be caused by an upper respiratory disease. Common clinical causes seemed to be unexplainable, and it was difficult for Gao Feng to make a judgment at the moment.

After further questioning about the medical history, it was found that I had similar symptoms 3 years ago, which were sometimes mild and sometimes severe, and the diagnosis was unclear. He has a history of hypertension for more than 5 years, and denies a history of infectious diseases such as hepatitis and tuberculosis, a history of poisoning, and a history of cholecystectomy.

Physical examination revealed: there was no congestion in the pharynx, no enlargement of the bilateral tonsils, no edema in the uvula, no obvious abnormalities in the posterior pharyngeal wall, no congestion and swelling in the epiglottis, and the glottis was not visible.

Although no obvious abnormalities were heard in the heart and lungs, Gao Feng still prescribed chest CT and cardiac color ultrasound examinations for the patient.

This is called killing mistakes rather than letting them go. Many diseases have unclear early signs and can easily be missed with a stethoscope. Imaging examinations can undoubtedly reduce this probability.

The patient was very positive about the examination and went out with the order.

The second patient was a middle-aged woman with a worried expression, holding a CT bag in her hand.

"Doctor, please take a look at this chest CT scan." The patient handed over the bag in his hand. "I thought there were no symptoms. Why is it so scary on the report?"

Gao Feng took it and took a look, and soon discovered the problem.

"This area does not look good. The probability of malignancy is very high. It is very likely to be lung adenocarcinoma." He said to the patient, "Hurry up and get hospitalized for evaluation. If there is no metastasis, perform surgical removal as soon as possible."

A ground-glass nodule with a diameter of 1.2 cm was seen in the upper lobe of the patient's right lung, with spiculation and vacuole signs, which is a sign of malignancy.

After careful questioning, we learned that the patient had a history of dyeing his hair for more than 20 years, and his father also died of lung cancer.

"Then why are you hesitating?" Gao Feng asked, "Go to the hospital immediately."

"Then should I be admitted to the Department of Respiratory Medicine or the Department of Thoracic Surgery?" the patient hesitated.

Before coming here, she had consulted many people's opinions. Some said she should conduct a puncture to confirm the diagnosis first, while some doctors suggested cutting it off directly.

"What they said makes sense." Gao Feng thought about it and said, "But I think it would be better to just cut it off."

Some tumors just look typical and grow according to the description in the book. This is undoubtedly an unfortunate blessing.

"Because the probability of malignancy is very, very high, and there is a small probability that tumor cells may migrate along the needle track during puncture." Gao Feng explained to the patient, "It is safest to cut it off directly."

"But what if it's not a tumor?" The patient struggled. "Then I was stabbed in vain."

It's not the main thing. The key thing is that a piece of lung is missing.

Gao Feng couldn't accept what she said. Although the imaging was very similar, he still couldn't guarantee it with the patient.

The world is full of surprises, and sometimes coincidences will happen.

There are also patients who were sent to pathology after surgery, but no tumor cells were found. This situation is very embarrassing. It is best if the patient understands it. If he does not understand, he will inevitably fall into a quarrel.

Therefore, in this case, if you choose surgical resection directly, you must make an agreement with the patient in advance. Not only must you sign it, but you must also record it to avoid turning your back and denying it later.

"Let's do this, you write me a guarantee that it is a tumor." The eldest sister said to Gao Feng, "If it is not, you and the hospital must bear corresponding responsibilities."

"In this case, I will listen to you and go to the thoracic surgery department for surgery."

Wrong day! Why don't you go to heaven?
Gao Feng just frowned, and Li Youliang on the side quit.

"Sister, do you want to sign up for a neurology department?" he asked.

"Okay, why should I register as a neurologist?" the eldest sister asked in confusion.

"Look at your brain." Li Youliang said to her with a sincere expression, "How else could you say such ridiculous things."

I even wrote you a letter of guarantee, why don’t you go to heaven?

The eldest sister was very angry, grabbed the CT and turned around to leave.

"You have such a bad attitude! I won't do the surgery! You are so angry!"

Gao Feng and Li Youliang looked at each other, really confused about the eldest sister's brain circuit.

It’s because you have something growing on your lungs, it’s not that we are sick. Whether you do something or not, and how many years longer or shorter you live have nothing to do with us.

Around noon, another patient came in, also a middle-aged woman, and her daughter came with her.

"Doctor, please show it to my mother quickly." The patient's daughter was very anxious, "We did a CT scan for physical examination, and they said there was something occupying the space!"

The doctor at the physical examination hospital said it was very serious, saying that cancer could not be ruled out and asked him to come to the big hospital and have a look.

Another person was looking at chest CT, and the lungs were still occupying space. Gao Feng felt nervous.

He picked it up and looked at it, and soon he breathed a sigh of relief.

"It's okay, you're just too fat."

"This place is the greater omentum." He said to the patient and his family. "In medicine, it is also called Morgani's hernia, which is related to being too fat."

Morgani's hernia is also called congenital parasternal hernia. It mostly affects adult women and obese people. It is more common on the right side. The organ that herniates into is more commonly the omentum and sometimes the colon.

The disease is often asymptomatic or has mild upper abdominal discomfort or pain, and intestinal obstruction is rarely seen.

Many patients are discovered during CT. If the imaging doctor is inexperienced, it is easy to determine that it is a lung mass, causing anxiety and worry in the patient.

The patient and his family members looked much better after hearing his explanation. They thanked him and left the clinic.

"Nier, I'm still not at ease." The patient said to her daughter, "This doctor is too young, and he doesn't read the films very carefully."

The doctors at the last hospital were looking at it in their hands for a long time with solemn expressions.

Gao Feng's reading speed was too fast, which made him look unprofessional. In addition, he was too young, so the patient still had doubts.

(End of this chapter)