Gou is practicing medicine in the clinic

Chapter 280: After winning the silver medal, Director Yan began to doubt life.
However, because this disease is relatively hidden and extremely difficult to diagnose, the diagnosis cannot be confirmed by the above examinations alone.

At present, the basic locking problem lies in the small intestine segment.

Moreover, the diagnostic results of the secondary auxiliary examination basically concluded that it was malabsorption of the small intestine.

To make a final diagnosis of this disease, at least several tests are needed, and even pathological biopsy of the diseased intestinal mucosa is required.

"Dr. Li, based on the patient's current examination results, it has been determined that there are lesions in multiple segments of the small intestine. The type of diarrhea has also been determined. But considering the long course of the patient's illness, I think it is necessary to do some more examinations. For example, Fecal fat absorption test and carbohydrate absorption test can determine the type and depth of lesions.”

Xiao Linlin's basic knowledge of gastroenterology, acquisition of clinical diagnostic evidence, and necessary procedures for diagnosis are all very solid.

In other words, the experience is a bit lacking and the diagnostic thinking is not flexible enough.

As long as you practice more, you will definitely be able to achieve great results in the future.

"I completely agree with Director Xiao's opinion."

Li Jingsheng had the same idea as hers.

In fact, at this point, a doctor with a slightly higher level will know what to do.

There are many methods for fat absorption test.

The more commonly used one is the fecal fat quantitative test, which is called the gold standard.

Its accuracy is higher than that of triolein breath test and fecal fat qualitative test.

After applying for these two tests, the results came out almost instantly again.

Neither of them were surprised by this.

The patient's 24-hour measurement result was 8.3g, indicating the presence of fat malabsorption.

If he were to seek treatment at Li Jingsheng's clinic, he could tell whether it was steatorrhea just by smelling the smell of the patient's feces.

The stench is unpleasant and ten times out of ten it is steatorrhea.

If it smells sour, it may be malabsorption of sugar.

This patient underwent a D-xylose test and the result was about 0.4g, indicating that the patient had extensive absorptive dysfunction in the small intestine.

It is consistent with the imaging examination results.

At this point, malabsorption syndrome can be diagnosed, and the lesion should be the small intestinal mucosa.

"Dr. Li, is it necessary to take further biopsy of the small intestinal mucosa from this patient?"

Xiao Linlin saw that her ranking had dropped, so she seemed a little anxious.

Li Jingsheng understood what she meant. One or two points would be deducted for each additional inspection he applied for. If he wanted to get a ranking, every point was very important.

A loss of one or two points may directly cause her to fall to No. 3.

This patient has had many tests done.

Although their diagnosis had been on the right track, it still worried her.

"Check it out! This is also the responsibility of the patient. Although it can now be determined that it is a small intestinal lesion and the patient has malabsorption syndrome, the diagnostic significance of small intestinal mucosal biopsy is very important and can identify adult celiac disease, Whipple's disease, and aβ-lipoproteinemia. disease, folate deficiency, etc. The ranking is certainly important, but compared with the patient’s life and health, the latter is definitely more important.”

Li Jingsheng gave his own opinion.

She finally made her choice after hesitating for a few seconds.

A small intestinal mucosal biopsy was requested.

The examination results showed that the patient's small intestinal mucosa became thinner, the villi became shorter and thicker, some fused or even disappeared, the crypts were significantly enlarged, and there was chronic inflammatory cell infiltration.

No other benign and malignant intestinal lesions were found.

After reading the results, the two of them looked at each other and smiled, feeling relieved and confident.

The patient's cause is most likely adult celiac disease, also known as gliadin-sensitive enteropathy.

This disease is relatively rare and difficult to detect. It can easily be misdiagnosed and mistreated as various intestinal diseases.

In the early days, when medical knowledge about this disease had not been popularized in the country, misdiagnosis and mistreatment occurred in many cities, counties, and even provincial hospitals.There are many reports of related deaths.

Even today, this disease still causes headaches for many doctors.

Only some of the top head hospitals in the country have experience in diagnosing and treating such diseases.

"The treatment plan I prescribe to the patient is a trial treatment with a gluten-free diet, and then considering the patient's extreme weight loss, I will strengthen nutrition and supplement electrolytes and vitamins. Do you think there is anything else that needs to be supplemented?"

Xiao Linlin seems to have found her confidence, and has gradually taken a dominant position in conducting examinations and treatments.

She may have pretty good strength to begin with.

"pretty good!"

Li Jingsheng feels that these treatments are completely sufficient.

To be honest, he may not be as good as Director Xiao on how to treat celiac disease in adults.

What he is good at is diagnosing the cause.

After Xiao Linlin submitted the diagnosis and treatment results, her ranking rose directly from No. 6 to No. 2.

Currently ranked first is Lian Tao.

One point higher than her.

It seems that Xiao Linlin lost points in the diagnosis and treatment of this case, or failed to get full marks in the bonus points.

But the result was far beyond her expectation.

After more than 20 minutes, the dust settled.

Xiao Linlin tied for No. 2 with Professor Mu You from Qiaobang Hospital, Lian Tao from People's Hospital ranked No. 1, and No. 3 was Director Luo Hou from Jiangli Medical University Affiliated Hospital, and Pang Xiangzhi from Yangyuan County Traditional Chinese Medicine Hospital. director.

There is also only one point difference between No.3 and No.2.

It seems that in the field of gastroenterology, there are many great doctors and more experts than imagined.

It must be mentioned here that the Affiliated Hospital of Jiangli Medical University originally started by treating digestive diseases.

In the early years, when the laboratory of Qiao Bang Hospital was not powerful, some tests even had to be sent to them for testing.

Later, Qiaobang Hospital became more and more famous, and after its income increased, the quality of talent recruitment also became higher and higher.

Ultimately, a powerful virtuous cycle is formed.

Later, Qiaobang Hospital had its own first-class laboratory, and almost all the instruments and equipment were replaced with the most advanced imported equipment.Since then, no hospital in Jiangli City can compete with it in the field of biochemical testing.

According to rumors, in order to reverse this unfavorable situation, Jiangli People's Hospital once proposed to cooperate with the Affiliated Hospital of Jiangli Medical University to establish a second super-first-class laboratory.

The result was rejected.

The specific reason is unclear. Some people say that the People's Hospital was too arrogant and made the representatives of the affiliated hospitals feel slighted when discussing cooperation.

Others say that the Medical University Affiliated Hospital has greater ambitions and wants to become the top tertiary hospital in Jiangli City.I am worried that after cooperating with the People's Hospital, I will become a vassal.

In any case, the results of this year's digestive technology competition are enough to wake up the Medical University Hospital.

It also made the arrogant Qiaobang Hospital realize that talents are better than everything.

No matter how powerful the laboratory of Qiao Bang Hospital is, without top talents like Lian Tao, it can still be reduced to a second-rate hospital.

"Dean Jin, the first day of this year's skills competition has turned into a show for your second hospital. You have won another silver medal, congratulations!"

Dean Wang smiled and congratulated.

It’s just that the smile looks like she’s crying.

The first hospital is the big brother in the number one hospital, but now it is being beaten directly by the second one.

The look on his face is definitely unbearable.

"Haha, to be honest, even I didn't expect to achieve this result. It is the result of the all-out efforts of the contestants from our Second Hospital. I also wish the First Hospital to achieve good results in the following competitions."

Dean Jin laughed.

He was very happy with the results of the skills competition on the first day.

The Second Hospital also went from being a bottom tertiary hospital to successfully making it onto this year’s hot search list.

In this era of highly developed self-media, many hot events easily attract public attention and become hot-search news.

Medical care is related to everyone's vital interests. The more than 1000 million citizens of Jiangli City also want to take this opportunity to know which hospital is better.Which hospital specializes in treating which disease?

"Alas, our No. [-] Hospital lacks young talents like Dr. Li Jingsheng!"

Dean Wang looked at Li Jingsheng.

If I had known that this young doctor could become so powerful, I wouldn't have forced him away just because of a doctor's quota.

Now it is extremely difficult to poach people back.

He could only place his hopes on Han Yu next to him.

Whether he could succeed or not, he had no idea at all.

The next digestive surgery competition is mainly about diagnosis and surgical treatment.

Surgery is relatively simpler than internal medicine.

Because most surgical medications are mainly anti-infective, there will also be some other medication requirements, but they are all intuitive.

Internal medicine requires doctors to always pay attention to the effects of medication and then make new judgments.

Sometimes, the diseases that internal medicine has to deal with are more complex and varied.

The digestive surgery department of the Second Hospital is actually part of the general surgery department.

General Surgery is also the strongest department of the Second Hospital.

The game started soon.

"Comrades from the general surgery department, come on. This is the last competition today. I hope you can win the silver medal or even the gold medal in the digestive surgery department. The general surgery department has always been the strongest department in our hospital, and I have confidence in you. "

Vice President Jin encouraged them.

The general surgery department is very strong, with a total of seven contestants coming this time.

The team was personally led by Director Bi of the General Surgery Department.

It can also be seen from this point that Director Bi is determined to win this skills competition.

Prepare to pick up a few gold medals and go back.

"All contestants from the digestive surgery department are asked to read the question. This patient has only been admitted to the hospital for a short period of time. After the diagnosis is made, the contestants will operate on him. Those with high diagnosis scores will have priority for surgery."

As soon as the host finished speaking, the patient's information was displayed on the big screen.

The patient, a 23-year-old female, developed abdominal pain after meals, and then metastatic pain, which was fixed in the right lower abdominal area.Due to unbearable pain, I came to see a doctor one after another...

This case is the first case in the digestive surgery competition.

Diagnosis should not be difficult.

The patient's body temperature is normal, and basic signs such as blood pressure and heart rate are normal.He was pale on admission.

This should be due to the severe pain causing the paleness of the face.

Abdominal pain first, then fixed pain in the right lower quadrant. Isn’t this the most typical symptom of appendicitis?
Doctors from the general surgery department have begun to quickly make diagnoses and request some examinations.

Li Jingsheng found it interesting that apart from the routine blood test results, no other test results were given.

If you want to get it, you definitely need to apply for it from participating doctors.

Routine blood tests showed that the patient's white blood cell count was significantly elevated.

The diagnosis of appendicitis is more clear-cut.

Appendicitis usually also causes elevated white blood cells.

Because he was not a contestant, he could not answer questions or apply for inspection items. He could only wait quietly for the final results to come out.

"Dr. Li, do you think it's appendicitis?"

Xiao Linlin's face still showed the joy of having just won the second prize.

This time I fought alone and won the silver medal, but I did not live up to my mission.

After three days, you can return home.

She and Li Jingsheng also formed an indissoluble bond because of this game.

The two became visibly closer.

"It's hard to say. I think the possibility of appendicitis exists, but it should be small. Unfortunately, there is too little effective information given, so there is no way to make a further diagnosis."

Li Jingsheng has participated in many rounds of competitions and has some understanding of the organizer's examiners.

The examiners are very cunning, and the questions they ask are often confusing, which can easily lead to misdiagnosis and misjudgment by participating doctors.

With the symptoms of this case, a doctor with a little experience could preliminarily diagnose it as appendicitis, which is too simple.

As time passed, the ranking list gradually appeared on the screen.

Not surprisingly, People's Hospital and Qiaobang Hospital tied for first place.

And the number of players with perfect scores is still increasing.

After 10 minutes, the question answering game was basically over.The doctor who made the diagnosis quickly gave the result within five to six minutes and was successfully listed.

Slower, 10 minutes is completely enough.

Doctors usually treat a patient in just one or two minutes.

It's not an exaggeration.

Many doctors need to see fifty or sixty patients a day, or even more than 100, and do not have much time to spend on the same patient.

Unless you encounter a patient who is difficult to diagnose, it may take a long time or even consult a superior doctor.

Many patients complained that after spending tens of dollars to register a director number, they were dismissed after saying no more than ten sentences.

this is normal phenomenon.

At present, small hospitals are deserted, and larger hospitals are generally facing shortages of medical resources and even cash runs.

Doctors have to deal with so many patients a day, so they can only speed up and improve efficiency.

"The ranking of our second hospital has come out, and it's ranked seventeenth. And it's not Director Yan of the Department of Gastroenterology, but the doctor below him, Liu Miao."

Xiao Linlin said worriedly.

To be honest, the doctors at the Second Hospital were very disappointed when they saw this result.

Especially after winning a gold medal at the beginning, everyone's expectations for general surgery are very high.

Because the weaker department of gastroenterology has already won the silver medal, there is no reason why the strongest department of general surgery cannot win the gold medal.

The fact is, three gastrointestinal surgeons in the Department of General Surgery have let everyone down.

There was a Waterloo fall.

Is this what is often said about arrogant soldiers being defeated?
"Director Yan, you must not let your guard down at the critical moment!"

Vice President Jin was furious, but he did not dare to say harsh words.

I can only say a gentle reminder that it doesn't hurt.

"Ahem...I thought it was acute appendicitis just now, so I misdiagnosed it."

Director Yan is close to 52 years old and is considered a relatively young chief physician.

There must be strength.

It’s just that I may not have adjusted my mentality well this time.

Perhaps seeing that a little guy like Li Jingsheng had successfully won two gold medals, he was overconfident in his own ability, so he failed in the first round.

"In terms of diagnosis, I think Li Jingsheng is very good. You can use collective operations! Please help Director Xiao and Dr. Li!"

Dean Jin suddenly felt a black line on his forehead when he heard that Director Yan had not missed the diagnosis but directly misdiagnosed it.

Misdiagnosing the first question is basically giving yourself a red card and being eliminated directly.

"It's okay, I'll be more careful next time."

Director Yan was unwilling to ask Li Jingsheng and Xiao Linlin for help.

Some chief doctors are not ashamed to ask questions and can put down their posture, while some chief doctors hold their heads high until they die.

If you want to ask Li Jingsheng and Director Xiao for help, you should say hello before the game starts.

Xiao Linlin was similar to Director Yan at the beginning, both were thin-skinned and couldn't let go of their figure.

Fortunately, she decided to ask Li Jingsheng for help.

Finally, he successfully won the silver medal.

The game was still going on, Director Yan held his breath.

The person who answers the first question correctly and has the highest score will be lucky enough to be qualified for surgery.

The staff at the scene had already invited him to the operating room to preside over the operation.

This digestive surgery skill competition is a bit interesting.

It seems that its competition rules are comprehensive evaluation, and the best will have an advantage everywhere.

If you make a good diagnosis, you can get priority for surgery.

The higher the questions in the exam, the less difficult the surgery will be.

The first case turned out not to be appendicitis, but intestinal strangulation.

It's really unexpected.

The painful location of intestinal strangulation is not fixed, it mainly depends on where the strangulated intestinal segment is found.

It also causes an increase in white blood cells.

If the site of strangulation happens to be in the right lower abdominal area, it will be a bit difficult to distinguish between male and female.

Director Yan fell into the trap, and he was not unfair at all.

"These examiners are so treacherous."

Li Jingsheng once again recognized the true colors of the examiners.

They worked hard to deliberately dig holes for the contestants to fall into.

"Let me reiterate the rules of the competition. For example, the person who answered the first question correctly is Director Wu Shengwang of the People's Hospital, and the score ranks first. He has grabbed the qualification for surgery. Then he will jump out. The remaining contestants can participate in the second question. For the answer defense, those with the top three scores for the first question will not have their points deducted. Starting from No. 4, one point will be deducted. Your previous answer scores will be cleared and the scores will be recalculated."

This is the examiners trying their best to have some fun.

Equivalent to the rush to answer each question, only No. 1 can successfully land.The rest, even No. 2 and No. 3, need to continue to answer questions, but no points will be deducted.

As for the latter, one point will be deducted for everything.

This means that before the competition even starts, they are already one point behind the top three.

And probably so on.

When answering the third question, a total of two points will be deducted.

Doing this will allow truly capable people to stand out to the greatest extent possible.

Those without strength can only widen the gap with the top few, and ultimately miss out on medals.

"Please look at the second question next."

The patient, a 27-year-old male, was unfortunately involved in a car accident while driving a van to deliver goods.There were trauma to the upper abdomen and lower back.After admission, she developed abdominal pain, severe pain in her lower back, and vomiting of blood and bile. At the same time, the patient developed genital abnormalities and erections.

There is tenderness in the upper abdomen, rebound tenderness and muscle tension.

The body temperature is normal, the blood pressure is slightly low, and the heart rate is fast.

The information given is still very limited.

There are no abdominal films or examination results such as abdominal puncture or lavage.

Director Yan has no intention of asking Director Xiao and Li Jingsheng for help. Anyway, he is stubborn and has a tough temper.

The second round of diagnostic rankings came out soon.

This time, the Second Hospital was really miserable, and the whole army was completely wiped out.

Among the top fifty, there was actually no sign of any of the three contestants from the Second Hospital.

Isn't this just a joke? Two people participated in a competition, but they couldn't make it into the top three, so they were nicknamed "Knockout Lang".

Dean Jin was dumbfounded, and Director Bi of the General Surgery Department was equally dumbfounded.

"Lao Yan, what happened? The car overturned again!"

Director Bi saw Dean Jin's face turned even longer than a donkey's face, and quickly asked Director Yan.

"Damn it, I really carried it to grandma's house today and got another misdiagnosis."

Director Yan also looked ugly.

Who would have thought that this year's skills competition would be so difficult!

The first diagnosed case fell into the pit, and the second time it fell into it again.

This is really the best time to carry it home.

But then again, it is true that the strength is not as strong as imagined.

(End of this chapter)