Gou is practicing medicine in the clinic

Chapter 277: The symptoms are severe, and the biopsy result is a minor illness.Harvest of iron head
This patient is so sick but dare not enter the hospital, which is also a true portrayal of most ordinary people.

It shows that there are still many areas for improvement and improvement in medical security.

Li Jingsheng continued to look down.

The patient reported that he had been experiencing chest and abdominal pain more than a month ago. The doctor confirmed on the spot that it was actually pain under the xiphoid process.Persistent dull pain occurs after eating, accompanied by abdominal distension and loss of appetite.

No fever or diarrhea symptoms.

The patient began to lose weight continuously, losing approximately 5 kilograms within a month.

But he did not go to the hospital for treatment.

Losing so much weight in one month is considered a sudden loss of weight in a short period of time.When this happens, you need to be highly vigilant and go to the hospital for an examination immediately to find out the cause.

But the patient did not go to the hospital.

One is afraid of spending money, and the other may feel that he is too old. If it is really a serious illness, he will not be treated.

Four hours before admission, the patient suddenly felt nauseated and then vomited dark red liquid four times, each time about 150 ml.

Also accompanied by symptoms of dizziness and palpitation.

But there was no cough or phlegm.

It’s scary to think about it. Vomiting so much blood at one time, the patient didn’t rush to the hospital for treatment until four hours later.

I really don’t know if it’s ignorance or fearlessness.

The patient's temperature was 36.5 degrees, pulse 80 beats/min, and respirations 21 beats/min.

Blood pressure 120/80mmhg.

Clear consciousness but poor energy.

The skin and mucous membranes were not yellowish, and the superficial lymph nodes were not touched or swollen.

The eyeballs were normal except for the conjunctiva which was slightly pale.

It's strange that he's not pale after vomiting so much blood.

The patient's throat was not congested, his neck was soft, and his heart and lungs were normal.

The abdomen was flat and soft, with slight tenderness under the xiphoid process, and bowel sounds were active, about seven or eight times per minute.

Digital rectal examination revealed no abnormalities.

The blood routine results showed that hemoglobin was 69g/L, red blood cells were 2.6 times ten to the ninth power per liter, white blood cells were 6.6 times ten to the ninth power per liter, platelets were 155 times ten to the ninth power per liter, and erythrocyte sedimentation rate 10MM/H.

Urine routine was normal.

Fecal occult blood test was positive.

This indicates that the patient has gastrointestinal bleeding and has been bleeding for some time.

Generally, it takes at least several hours after upper gastrointestinal bleeding to detect positive occult blood in the stool.

The patient may have started bleeding a little and not paid any attention to it.

Later, I vomited a lot of blood again and again, so I thought of seeking medical treatment.

In addition to the above inspections, the organizer did not provide other inspection data.

You should have to wait for the contestants to apply on their own.

Li Jingsheng couldn't help but think that this case was under treatment. What if the patient had not had the examination items requested by the contestants?
The organizer may send a direct message to the applying doctor like last time.

As long as the doctor's answer makes sense, the organizer will arrange it immediately.

"Director Xiao, I suspect that the lesion is probably in the upper gastrointestinal tract. The patient's vomited blood was dark red, large in amount, and he continued to vomit blood within four hours. I estimate that the possibility of esophageal and pharyngeal bleeding is extremely small. It should be stomach bleeding. The highest, so I suggest you apply for a gastroscopy immediately."

In this emergency case, timeliness is very important.

If the receiving doctor is slow to make a diagnosis, the patient may die without waiting for the final test results.

When encountering an extraordinary illness, extraordinary measures should be taken.

This is Li Jingsheng's method of diagnosing and treating such acute and severe cases.

If the patient's bleeding is not detected and stopped in time, there is a high probability that he will suffer from excessive blood loss and then go into shock.

"it is good!"

Xiao Linlin now has great trust in him, and she herself is not incompetent.

She also has her own analysis and insights into the diagnosis of diseases in the digestive tract.

It's just that the level of clinical diagnosis may not be as good as that of Li Jingsheng.

After all, Li Jingsheng's gastrointestinal diagnosis has reached Dacheng, which is equivalent to the level of a top deputy chief physician in a large hospital.

"Wow, it seems you were right again, the results came out immediately."

She said happily.

Li Jingsheng leaned over to check the results.

Gastroscopy showed nodular bulges in the gastric antral mucosa, with shallow ulcers scattered on the surface, poor mobility, and prone to bleeding when touched.The duodenal bulb was normal.

After reading the results of the gastroscopy, he was stunned.

To be honest, it was a bit unexpected.

What I originally imagined was that serious, large lesions, or even cancerous lesions, would be discovered directly in the stomach.

The feeling now is that his expectations were too high, and the test results were much lighter than he expected.

"No, whether the patient lost ten pounds in a month, or the patient's fecal occult blood test was positive, he vomited blood, and continued pain, these are all symptoms that appear to be caused by cancer."

This test result was like a punch to cotton, making him feel a little uncomfortable.

"Apply for pathology biopsy!"

Li Jingsheng frowned and spat out a few words.

In fact, you shouldn't talk to Xiao Linlin with this expression and tone.

Because after all, she is the chief physician and the head of the Department of Gastroenterology, and her status is much higher than that of Li Jingsheng.

Fortunately, she didn't care.

And we also know that it is normal for Li Jingsheng to show such a focused expression when he encounters problems in diagnosing difficult cases.

This is basically the case for most doctors when they encounter a problem.

"The biopsy results came out, indicating mild chronic inflammation of the gastric antrum mucosa." Xiao Linlin was also slightly disappointed when she saw the gastroscopy results.

It’s not that I hope the patient will get seriously ill, but that it is seriously inconsistent with the actual symptoms.

Now that she saw the pathology biopsy results, she breathed a sigh of relief.

It seems that the possibility of gastric cancer is basically ruled out.

After Li Jingsheng heard this, his brows were still furrowed.

He studied the patient's blood routine and other test data again, frowning slightly and staring at the big screen, looking very focused.

"Would you like a chest X-ray?"

Xiao Linlin couldn't help but feel anxious when she saw that other contestants were working hard on diagnosis.

She finally got her rating to No. 2, and she really hoped to keep it there.

Even if I get a bronze medal and go back, that would be great!

"Don't rush to check the chest X-ray. There is no problem with the patient's lungs and no obvious abnormalities in the heart. I estimate that the possibility of liver problems is also very small. With so much blood vomiting, it must be upper gastrointestinal bleeding. It continues after every meal The location of the pain is also suggested to be in the gastric antrum. In some cases, there may be headaches and foot injuries, but in this case the symptoms all point to the upper gastrointestinal tract, so I think the stomach should be checked again."

Li Jingsheng became more determined as he spoke, and his eyes became persistent.

"But the results of the gastroscopy and biopsy showed that it was just antral gastritis! Should we check again?"

Xiao Linlin found that she seemed weak when facing these actual cases.

We rely on Li Jingsheng in many aspects.

This kind of dependence made her feel ashamed, and she made up her mind that after this skills competition was over, she must study hard in medical skills when she went back, so that she would not be so weak when she participated in the skills competition again in three years.

"Don't worry, let me think again."

Li Jingsheng calmly thought over and over again in his mind, ruling out various cases that fit the patient's symptoms.

"The amount of bleeding in the patient was so large. If it was just mild gastritis, it could not have been caused. I think the lesion tissue taken by biopsy may only be superficial mucosa, so there is a possibility of misdiagnosis or missed diagnosis."

After thinking about it, Li Jingsheng could only think of this possibility.

"Apply for another endoscopic ultrasound, and then apply for biopsy of tissue specimens deep in the gastric lesion."

Li Jingsheng said to Xiao Linlin.

"Do you...do you want to think about this again? I have just checked the gastroscopy and pathological biopsy, and no major problems were found. If I check again, I guess the results will be similar. The equipment and laboratory tests of Qiaobang Hospital are all out of date. Famous precision.”

Xiao Linlin did not agree this time.

She even thought that Li Jingsheng might have successfully applied for endoscopic ultrasonography in the previous case, so he wanted to rely on this examination to succeed this time.

Although endoscopic ultrasonography is more accurate than ordinary endoscopy, it can detect sonographic images of five or even nine layers of the gastric wall structure.

Ordinary endoscopes can only examine the superficial layer.

This is also an important breakthrough in medical progress.

"Director Xiao, please believe me again. This is an emergency patient and cannot be delayed. The earlier we apply for this examination, the higher the score will be. Even if it fails, the most 4 points will be deducted."

Li Jingsheng could only persuade her with kind words.

Women are generally not as decisive as men when it comes to making decisions on some matters.

"All right!"

She finally agreed.

Because Li Jingsheng's eyes are particularly sincere and full of confidence.

If she refuses, it will be a blow to Li Jingsheng, and their cooperation will probably be interrupted.

Xiao Linlin's idea was simple. No. 2 originally rushed up with the help of Li Jingsheng. If he lost it, it would be okay.

After no longer suffering from the disease, she decisively applied for endoscopic ultrasonography and deep gastric antrum pathological tissue biopsy.

"Oumaga..."

She had just finished applying, she was so excited that she clenched her fists and let out a scream of excitement.

This move immediately attracted the attention of many people.

Including the participating doctors and nurses from other hospitals, they all looked at her in amazement.

"Director Xiao, pay attention to the impact and control your emotions!"

Vice President Jin really didn't expect that at 45 or [-] years old, she would still be as unstable as a little girl.

How does this work?
She is the leader of the Gastroenterology Department of the Second Hospital and is at the helm.

Must be steady.

Vice President Jin even thought about talking to her after the competition was over.

"Sorry, sorry, I'll be careful next time."

She apologized repeatedly, but she couldn't suppress the excitement and smile on her face.

Seeing her expression, Vice President Jin's eyes brightened slightly. It seemed like he had achieved something again!
good thing.

"Dr. Li, you are my god!"

She said to Li Jingsheng.

"Ahem... Well, Director Xiao, please pay attention to the impact. I'm not a star, let alone your boyfriend."

Li Jingsheng didn't dare to accept her words.

"Haha, a slip of the tongue. No, it must be oral euphoria. Please check the results of the second examination quickly."

She thought of business and quickly asked Li Jingsheng to check.

The results of the second examination showed that the patient actually had gastric cancer.

This means that Li Jingsheng's inference just now is correct.

The patient's first gastroscopy and pathological biopsy only detected the superficial layer.

"Looking at the results, as well as the depth of infiltration of the lesions, surgical resection should be able to cure it. However, it may require adjuvant radiotherapy and chemotherapy."

After Li Jingsheng saw it, his face showed relief.

This disease was almost impossible to detect.

(End of this chapter)