Gou is practicing medicine in the clinic

Chapter 187 All four causes have been ruled out, the final breakthrough
The hospital's hierarchical system is strict, and there may not be any young doctors in the department who dare to walk with Lian Tao.

Chief physicians are amiable, which is an attitude of chief physicians, but it does not mean that any young doctor can be arrogant and impolite in front of chief physicians.

If there are such ignorant young doctors, there is a high probability that they will be marginalized, get worse and worse, and gradually lose popularity.

The doctors and nurses of the Department of Respiratory Medicine noticed that Director Lian seemed to be very polite to this strange young man.

This also added to everyone's guess about the identity of this young man.

"Dear sir, come to my office first to check the patient's information or go to the ward to check the patient's condition first?"

"Let's go to the office to read the information first! Drink some water and resent the alcohol. Otherwise, the patient and family members will think that we are drunk before going to her!"

"Haha, Jingsheng's words are funny! Do you know what it's called?"

"what is it call?"

"Men Sao! Haha..."

Lian Tao laughed so hard that he was obviously in his 40s.

The two have established a very close friendship as if there is no age difference.

After entering the office, it was Lian Tao's exclusive office.

Being able to have one's own separate office in the People's Hospital is not the treatment that ordinary chief physicians can have.

It is also enough to explain Lian Tao's status in the People's Hospital.

Lian Tao turned on the computer, directly logged into his personal doctor account, and called up the patient's medical records, examination reports, etc.

"This is all the information of that patient. Last year, she was diagnosed with nasal polyps because of bilateral nasal mucus, and she had a nasal polyp surgery in another hospital."

To be sick is a great misfortune in itself.

What I fear most is meeting a quack doctor.

If you just prescribe some medicine, it will be better if there is no effect after treatment.

Like this, there are only two possibilities for direct surgery to cut nasal polyps.Either the doctor is trying to complete the department's index tasks, or the doctor is really a quack.

Li Jingsheng checked the patient's detailed information, and the temperature of the physical examination that day was 36.9 degrees, which was normal.

Blood pressure 114/65mmhg.

Pretty normal blood pressure.

血常规结果，白细胞9.2乘以10的9次方每升。血红蛋白150g/L，血小板320乘以10的9次方每升……

Urine routine, urine sediment was negative.

24-hour urinary protein quantification 0.1 to 0.25g.

Liver and kidney function, ALT68U/L, AST44U/L, ALB47g/L...

The examinations done by major hospitals are really detailed.

The advantage is that it can prevent misdiagnosis and missed diagnosis to the greatest extent.

The downside is that patients need to line up here and there, tossing around, and the high cost of examination is also a drawback.

"Her sinus imaging examination is completely normal! This is not rhinitis at all!"

Li Jingsheng was really speechless after watching the film.

Why cut up the nasal polyps for others.

And had two surgeries.

"It's really not rhinitis. The otolaryngologist in our hospital consulted and found bilateral nasal polyps. It's just that there is nothing wrong without surgery. Of course, it would be better to have it cut. But nasal polyps are not the real cause of the patient at all."

Lian Tao said beside him.

The doctor in the compound is still worth learning in the 'master style'.

Lian Tao didn't say anything to belittle the doctors from the other hospital, and he didn't even mean it.

"Tuberculosis can also be ruled out."

Li Jingsheng checked all the way down, and the tuberculosis test was negative.

There are many other examinations that can rule out the possibility of tuberculosis.

"The fungal cultures of the patient's blood, urine, and sputum were all negative. The cause of the disease is really not easy to pinpoint!"

Before Li Jingsheng came, considering the need to use external chest diagnosis medical skills, he deliberately spent 100 health points to upgrade the chest diagnosis to the proficient level.

There are not many places where chest external diagnosis is used.

But it is also good to look at the patient's chest X-ray.

Both internal and external, the advantages of diagnosis are very obvious.

"Brother Lian Tao, what is your diagnosis?"

After reading all the inspection materials, Li Jingsheng asked the other party.

"Somewhat suspicious of an inflammatory granulomatous lesion."

Lian Tao gave a diagnosis opinion.

From the examination results, granuloma should be supported.

"Pulmonary Wegener's granulomatosis?"

Li Jingsheng also suspected this disease, but the degree of matching was not very high.

"Yes, I just suspect that the patient has this disease. But this patient only meets the three criteria of fever, pus, and hollow nodules, so there is no way to diagnose it!"

When Lian Tao encountered such a difficult case, even with a wealth of medical knowledge, he was frowning at the moment.

"How about we go to the ward to see the patients! Maybe we can find some breakthroughs."

Li Jingsheng suggested.

The two went to the ward one by one to check the patient's condition.

Li Jingsheng carefully performed a physical examination on the patient and asked about some conditions.

"Is she being treated with prednisone now?"

Li Jingsheng asked just as he saw the nurse coming over to take medicine.

"Yes, at the beginning, the dosage for her was 40mg per day, but now it is reduced to 35mg per day."

Lian Tao answered on behalf of the nurse.

Obviously, the doctor's order was prescribed by him himself, and the dosage of the medicine was also determined by him.

This drug is used for systemic lupus erythematosus, rheumatoid arthritis, rheumatic fever, nephrotic syndrome, chronic active hepatitis, ulcerative colitis, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura and other diseases.

Usually it is administered orally.

After checking the patient's condition, the two returned to the office to continue the discussion.

Li Jingsheng put forward a bold idea at this time.

"Do you think we can start with the problem of right lung space occupation, and it will be easier to make a breakthrough?"

The outer hospital started with the patient's pus and found that the patient had double nasal polyps, and then he was stuck in this endless loop and couldn't get out.

In order to achieve a major breakthrough in this case, it is necessary to change the entry point.

"I started with this problem, but it didn't make any progress."

How could Lian Tao not think of this problem?

"What I mean is, stop prednisone first, and then make a diagnostic breakthrough in the direction of granuloma."

After listening to Li Jingsheng's suggestion, Lian Tao's eyes brightened slightly.

"This proposal is a bit bold, but the idea is very special, a bit eclectic, and it means jumping out of the fog to find out the truth. You can try it."

"Okay, let's try it first."

Li Jingsheng can only wait until the drug is stopped, and then make a further examination for the patient before making a diagnosis.

……

The next day, Li Jingsheng opened for business as usual.

There are quite a lot of patients.

After opening the door, they all rushed to the clinic, wanting to see a doctor first.

Li Jingsheng asked everyone to line up in a civilized manner, and then issued number plates to prevent queue jumping.

"Doctor Li, please show my father, the right hand seems to be broken, can it be treated?"

The one who grabbed the first place was a young and strong guy, 25 years old.

He occupied a seat, and then a family member helped the patient in.

The old man looked hunched over and had a thin body.But there were four family members accompanying him, and with the young man occupying the seat, there were five family members in total.

Needless to say, it must be a family with many children.

There are many children, and it is very difficult to raise them, but as long as the children are filial, there will be many people to take care of them when they are old.

"Help him to sit down, I'll check first."

Li Jingsheng said to his family.

When the family member helped the patient to sit down, he saw that the patient had a painful expression when he sat down.Also, the patient moved slowly when walking just now.

Osteoporosis is common in the elderly, and falls are prone to fractures.

It must have been a hard fall to break his right hand.

Could the hip also be fractured or injured?
"Where is your pain now?"

Li Jingsheng asked the old man.

"Hand, and here!"

Sure enough, the old man pointed to his right hand and buttocks.

Li Jingsheng felt his bones, and his right elbow was displaced, but there was no fracture.

Moreover, this old man's bone quality is much stronger than that of ordinary old people.

Raising so many children must be a lot of work. I have done a lot of work and my body has been well exercised, so even after I get old, my bones are still much stronger than ordinary old people.

This is the conclusion that Li Jingsheng secretly made in his heart.

"Let me check your buttocks."

The old man felt the buttocks again, and found no fractures, joint capsule cracks and other problems.There is soft tissue contusion.

"Go inside and take a radiograph. If there is no particularly serious fracture, I can treat it here. It costs 100 yuan to take a radiograph."

"can!"

The family readily agreed.

The consumption concept of young people is not like that of the older generation. Spending money is really like making paper.

Of course, Li Jingsheng likes such a family.

The old man was helped into the medical laboratory to take an X-ray, but no fracture was found.The examination results of the hip joint were consistent with his palpation of the bone, and no fracture was found.

The old man's luck is quite good.

After getting outside, let the old man sit down.

"Siying, get the plaster and come over to help."

"Ok!"

She also just arrived not long ago, and she was going to help Dr. Gao sell health medicines, but now she needs her help in the diagnosis and treatment, so she is naturally happy.

Can take the opportunity to learn a lot of knowledge.

Moreover, she was very curious about bone-setting techniques, so she just took the opportunity to increase her knowledge.

Li Jingsheng negotiated the cost of treatment with his family members, and one of the daughters who got along well rushed to scan the QR code to pay without saying a word.

Treatment can begin.

Ask family members to support the elderly to prevent them from falling.

Did not dare to use anesthetics.

Blocking the brachial plexus has certain risks. For such an old man, if he is injured by a fall, it will be bad if something goes wrong.

Fortunately, Li Jingsheng's bone-setting technique is quite good now.

Grab the old man's arm and swing it lightly a few times, then put it down and pull.

Accompanied by the old man's cries of pain, the displaced elbow joint has been successfully reset by him.

Carefully fix the plaster cast, let the children sit beside him and observe for half an hour, and make sure that the blood supply of the hand is not blocked because the bandage on the cast is too tight, and then the patient is allowed to leave.

If the plaster is cast too tightly, the blood vessels are compressed, causing ischemia at the end of the hand.

As long as it takes more than half an hour, necrosis is easy to occur.

That would be a big accident.

When everyone saw that Li Jingsheng easily helped the old man who had broken his right hand, everyone took a good look at his medical skills, and their trust rose to a new level.

After dealing with the old man who broke his hand, he went on to diagnose and treat other patients.

Han Siying watched and studied from the side and acted as an assistant.

When a new patient joins the queue, she will go over and issue a number plate to the patient.

In one morning, a total of 21 patients were diagnosed.

No difficult cases were encountered.

It was almost twelve o'clock at noon.

After dealing with the patients in his hands, Li Jingsheng could finally get up and go to the toilet.

Tang Ping was busy infusing patients.

Xiao Gao is working hard to sell medicine.

"Siying, I've read and annotated the medical records you wrote yesterday. You can read them when you have time. Also, it's best for your female classmate to go to a big hospital for an examination. I'm afraid What a serious illness."

Li Jingsheng said to Han Siying.

"She refuses to go! And she plans to come to you today, so you can take a look for her then, okay?"

Han Siying begged.

"This is of course no problem."

Li Jingsheng readily agreed.

At ten o'clock in the morning, when he was consulting a patient, the phone message rang several times.

I was busy and didn't have time to watch it.

After opening it, it was discovered that it was a message from Lian Tao.

It is the result of further examination of the patient.

After Li Jingsheng checked it, he fell into thinking.

The patient's condition seemed complicated, but if it was divided into several blocks to diagnose and analyze one by one, it would not be so complicated.

The first block, the upper airway.

No abnormalities were seen in the sinuses, and the nasal mucosa was also normal. The nasal polyps had been surgically removed.Therefore, the upper respiratory tract should be normal, and there is no change due to disease.

The second block, the lungs.

No nodular signs were found in the imaging examination, no infection was found in multiple sputum specimen examinations, and the evidence of tumor was not sufficient.

Therefore, lung cancer can basically be ruled out.

The third block, kidney.

There were no abnormalities such as hematuria, proteinuria, or impaired renal function.

In the fourth block, anti-neutrophil cytoplasmic antibody is negative, and immune function diseases can basically be ruled out.

After checking this step, the possibility of pulmonary Wegener's granulomatosis can basically be overturned.

What disease is this patient?
Li Jingsheng used to think that his calli diagnosis had reached a small success, and he was already very strong.

Now I try to challenge such a difficult and difficult case, and I feel that my level is far from enough.

Naturally, it is not so easy to find out the cause of the disease that can cause headaches for top respiratory specialists like Director Yang and Lian Tao.

Li Jingsheng's current chest diagnosis is at the proficient level, at least at the attending level, so he has some experience in diagnosis.

When he was thinking hard, he couldn't help thinking of a possibility. Could the patient's cause be caused by infection?

The lungs are an organ that is relatively invaded by viruses, fungi, and bacteria.

For example, Mycobacterium tuberculosis can cause changes in the lungs, and early tuberculosis imaging is no different from lung cancer.

This patient had multiple tests for fungal infection, all of which were negative.

During the rounds last night, the patient mentioned a symptom that was ignored by everyone.

She had forehead pain symptoms when she had a fever and purulent nasal discharge.

It's not serious, and it doesn't last long.

Headache, fever, runny nose, isn't this a symptom of a cold?

Of course, this patient is definitely not a cold.

No patient is known to have cold symptoms lasting up to three months.

What causes a cold?virus!
Li Jingsheng felt that it should be possible to check the patient's lung biopsy specimen.

"Brother Lian Tao, can you take a sample of the patient's lungs to check for viral and bacterial infections?"

"Is it a sample of the lung lesion?"

Lian Tao responded to his message almost instantly.

It seems that Lian Tao has fallen into a state of madness in order to break through this case.

"Judging from the film, there should be nodules in the lungs, and it should be more accurate to take samples from these parts. I think the disease of sarcoidosis can be ruled out now."

Tumors and granulomas were excluded.

This should have dealt quite a blow to Lian Tao.

"Okay, I'll send you a message when I have the result."

After Lian Tao replied to the message, he was silent.

It should be arranged for the patient to take a lung lesion sample for biopsy.

At this time, the fast food ordered by the clinic arrived.

Li Jingsheng hurried to eat while he was not busy at the meeting.

Even while eating, he was still deducing the cause of this patient repeatedly.

CT showed a hollow mass in the lower right lung, not granuloma, not lung cancer, and not tuberculosis. What kind of disease could it be?

Now it means that the focus of the disease is placed in the open, but there is no way to find out what the specific disease is.

Medicine is so confusing.

After dinner, Li Jingsheng instructed Han Siying to revise some problematic parts in the medical records.

At this time, a young girl pushed the door and walked in.

Dressed more plainly than Han Siying.

And with a sick look on his face.

Mentality also looks a little bad.Very haggard.

"Siying, I'm here again!"

She forced a smile and waved hello.

"This is my boss, Dr. Li Jingsheng." Han Siying hurriedly introduced her. "Boss, this is the female classmate I mentioned yesterday."

"Hello!"

The girl greeted Li Jingsheng.

"Hello! Since you are Siying's classmate, you are an acquaintance. Please sit down."

Li Jingsheng poured her a glass of water himself.

After she got up to take it, she said thank you, but she still looked a little restrained.

"I basically know about your situation. It's mainly diarrhea, right?"

"Yes, it's diarrhea now, and I still have a little fever, which is a low-grade fever."

She nodded.

"Come on, lie down on the bed inside, and I'll check your abdomen."

Li Jingsheng said to her.

The best way is palpation and instrumental examination.

"Siying, you also come to help."

When Li Jingsheng examines a female patient, he must call a female doctor or nurse by his side.

After the girl lay down, Li Jingsheng checked her abdomen.

A surgical scar is seen on her lower abdomen.

"Is this a scar from having a baby?"

"No. I had stones when I was a child. At that time, the medical conditions in my hometown were not good, so I had to be operated on."

"Urinary stones?"

"Correct!"

Li Jingsheng must ask clearly.

Because it's about diagnosis.

History is very important in clinical diagnosis.Just like some thieves who were caught in prison for stealing and sentenced, this means they have a criminal record.

Even if it is released after the transformation, it is still possible to return to the old business.

When a theft occurs in the surrounding area, the police must first investigate these criminals.

The same is true for doctors. When investigating the cause, you need to check the medical history first.

Some diseases are prone to repeated attacks.

There are also diseases that may leave some complications and sequelae after being cured.

"Does it hurt?"

"No pain!"

Li Jingsheng continued to press her abdomen.

"Ouch, it hurts, it hurts!"

There was an obvious tenderness reaction at the pressed position this time.

(End of this chapter)