Gou is practicing medicine in the clinic

Chapter 334 Transverse intestinal tumors, the doctor’s choice
Taking over the control handle of the colonoscope, he did not hesitate anymore and decisively consumed 941 points of health, upgrading the insertion technique from a master to a proficient one.

The implantation level has also reached a new level from the deputy chief physician level to the real director level.

Because Xiao Linlin often performs colonoscopy on patients, and because women are naturally ingenious, her implantation skills have reached the Dacheng level.

However, women's rational thinking, courage, and practical ability are inherently weaker than men.

Therefore, although she and Li Jingsheng were both highly skilled in colonoscopy, they gradually became accustomed to asking Li Jingsheng to come over for help.

Perhaps for women, even if they live to be 80 years old, they still lack a sense of security and can't help but rely on men when they encounter difficulties.

This habit has been developed for millions of years since the birth of human beings.

Men's bodies are much stronger, and they are the absolute main force in facing various dangers and resisting beasts.They can't help but protect their women and children, it's their nature.

Li Jingsheng's current colonoscopy technology has surpassed hers.

Especially in terms of skills, he is already much better than her.

Spending more than 900 points of health accumulated in an instant made him feel very sad.Because he wanted to save his health to upgrade his diagnostic skills and prescriptions.

But in the past few months, either bone-setting techniques or surgical skills have been greatly improved.

There is no extra health left to upgrade diagnosis and prescription skills.

As a result, he became more and more popular at the Second Hospital, but he often encountered difficult cases that he could not solve in his own clinic.

In this regard, he is very helpless.

In the operating room, facing the expectant eyes of the chief physician, the silent dedication and full support of the team of doctors and nurses behind him, and the lesions on the patient, he had no choice at all.

I can only grit my teeth and rush forward with all my strength.

As a result, his status in orthopedic surgery and cardiothoracic surgery is getting higher and higher, and he can solve more and more problems.

His status in the surgical team is also rising rapidly.

He left the third and second assistants far behind, and then surpassed the first assistant, becoming the most capable one under the chief physician.

When encountering difficult separations that other doctors could not handle, Li Jingsheng was able to successfully separate the lesions.

Some parts were extremely difficult to cut, but Li Jingsheng was able to cut them quickly after getting in there.

Now, the same goes for colonoscopy.

It was very difficult for Xiao Linlin to do it. After he took over, he could always complete the colonoscopy successfully every time.

It is precisely because he is very reliable and asking him to come over can solve the problem. Xiao Linlin invites him again and again.

At this moment, the electronic colonoscope probe has been lubricated with the help of the nurse.

Squeeze open the patient's sphincter and enter the rectum.

"Be careful, the intestinal wall looks very thin."

Xiao Linlin reminded nervously at the side.

Many people think that colonoscopy can examine the entire intestinal segment. In fact, this is impossible.It is already difficult to find the ileum segment.

Mainly check the rectum and the entire colon.

The areas where tumors are most likely to occur are also in these two sections.

I believe many ordinary people are familiar with rectal cancer and colon cancer.

Li Jingsheng controlled the colonoscope and moved forward little by little.

On the night before the colonoscopy, the doctor will ask the patient to fast and drink nothing.

It is unrealistic to empty the intestines simply by fasting food and water.At this time, the doctor will give the patient something good - a laxative.

Some patients may have weak intestinal peristalsis function, or they may eat "hard" foods, which will lead to unsatisfactory intestinal emptying and ultimately lead to colonoscopy failure.

The remedy is often an enema.

The process is not as painful as imagined and is completely within the tolerance of the human body.

You can refer to the feeling of diarrhea, which may be more comfortable than diarrhea.

Under the lens, I saw that the intestinal wall was relatively clean for the time being, and no feces or the like was found.

The gastroenterology prep was well done.

As the colonoscope advances, it goes around the bend, gradually enters the sigmoid colon, and then all the way into the descending colon.

"Her intestinal function is very weak!"

Li Jingsheng found that after his implantation surgery was upgraded to a proficient level, he could control the colonoscope to pass through the border with great ease.

Puncturing the patient's intestines is a common mistake for novices.

In his case, it almost doesn't exist.

"Weak intestinal peristalsis is generally caused by many reasons. The most common one is a problem in the upper end of the intestine, which leads to poorer peristalsis function toward the end of the intestine. It can be understood that, for example, there is a large tumor in the ileum Or intestinal polyps, when the intestinal fluid flows to this part, it is blocked to a certain extent, but the intestine is not completely blocked, and it can pass by the tumor.

In this case, the intestinal fluid slows down as it passes through the tumor.

The further it goes down the intestines, the slower and slower it goes. "

Xiao Linlin shared practical clinical experience with Li Jingsheng.

"Understood. It's like the back wave pushing the front wave! The lack of thrust from the back wave will cause the thrust transmitted to the front wave to become weaker and weaker. Is that what you mean?"

Li Jingsheng asked with a smile.

"Yes, that's what I mean, you are very smart."

She nodded with a smile.

At this time, the colonoscopy seemed to have encountered a problem.

"Why is there still feces here? I'm afraid it's blocked in front."

Li Jingsheng began to carefully control the colonoscope and continued to move forward.

As a rule of thumb, there are likely to be larger intestinal polyps or even tumors in the front.

It is also possible that intestinal volvulus has occurred.

The patient is currently under general anesthesia.

Under normal circumstances, if you are just doing a regular colonoscopy, you don’t actually need anesthesia.

Generally, only painless colonoscopy requires general anesthesia, and the requirements for preoperative evaluation are much higher.

There are two types of people who choose painless colonoscopy. One is afraid of pain and chooses general anesthesia.Another method is that the doctor predicts that there may be intestinal polyps or other things in the patient's body, and they can be easily removed during the colonoscopy.

This patient falls into the latter category.

"It seems like bleeding was detected."

Li Jingsheng's heart tightened and his expression became more serious.

Xiao Linlin stared at the screen.

A mountain-shaped tumor came into view.

"This tumor grows horizontally and is extremely proliferative. It is rapidly expanding in this direction. There is an ulcer point on the tumor and it is still bleeding."

Li Jingsheng reported what he had discovered.

Xiao Linlin had seen it from the side.

"It hasn't turned evil yet, has it?"

She was a little undecided and asked Li Jingsheng for his opinion.

"I feel that malignant transformation has not occurred yet, but the probability of malignant transformation of this kind of tumor is extremely high. Under normal circumstances, it may take three to five years, or even longer, for an intestinal tumor to become malignant. But this tumor is too aggressive. The devil’s true nature is revealed, and if surgery is not performed in time, it will definitely turn malignant in a short period of time.”

As Li Jingsheng's clinical experience becomes more and more abundant, he can accurately predict various types of tumors.

Not to mention very accurate, at least it is close to ten.

He is particularly good at bone tumors.

Basically, just by touching it, you can know the nature of the tumor.

The bone-touching technique is working hard to move towards the next level, and it is currently only at the proficiency level.

In fact, he is not the only one who can tell the general nature of a tumor by touching it through the skin.Many experts with rich clinical experience also have this ability.

Especially experts in thyroid and breast medicine, because they often encounter patients with thyroid tumors, nodules, breast hyperplasia and nodules, they can basically determine what type they are by just touching them.

"It should be too late for surgery now. Although the boundary is not clear, it feels that the depth of its infiltration in the intestine is very shallow. It should only have infiltrated into the mucosa and submucosa, and has not yet reached the muscle layer. Surgery should be able to clean it up. Very thorough.”

The intestines are divided into four layers.

The two innermost layers are the mucosa and submucosa.

Lymph and blood vessels are densely distributed in the submucosa.

For this tumor to grow so fast, it must receive a lot of nutrients.

It is the nutrients absorbed from the submucosa that cause it to accelerate its proliferation, expand crazily to both ends, and infiltrate deeper into the intestines.

If this colonoscopy had not been done this time, the tumor would have become malignant in a short time.

Many intestinal tumors are already in the middle and late stages once discovered, and often spread and metastasize.

Even cutting out that section of intestine may not be a cure.

The most it can do is extend the life cycle.

"This can only be transferred to the digestive surgery department for elective surgery. Being able to find out is a blessing among misfortunes."

Xiao Linlin was happy for the patient.

Doctors are the ones who want their patients to get well the most.

Most doctors especially like to see patients walk out of the hospital healthy and happy.

This is the greatest reward for a doctor.

"Director Xiao!"

"Call Sister Xiao!"

Xiao Linlin was in a good mood at the moment because she had successfully detected the patient's disease.

"Sister Xiao! I think the colonoscopy is not over yet, we have to continue the investigation."

Li Jing said angrily.She rolled her eyes at him charmingly, making the nurse next to her snicker.

I never thought that Director Xiao, who usually looked aloof and serious, would be so kind and easy-going to this young orthopedic surgeon.

The hierarchical relationship between the director and the attending physician could not be seen at all between the two. What could be seen was the casualness of brother and sister.

"Hasn't it been found out? You just saw the patient's intestinal condition. Many places are as thin as paper. What if it breaks?" Xiao Linlin, like most department directors, is thinking about stability. .

She will never take risks easily and create complications.

The disease has been diagnosed. If the investigation continues, who can bear the responsibility if something happens?

"Based on my feeling, she may have more than one intestinal lesion. I'll be careful and I won't break it. If I'm not sure, I'll stop the investigation in time."

Li Jingsheng told his reasons.

"Why do you think there are still lesions? Based on my clinical experience, if a tumor is found in one place and there is no cancer in the early stage, tumors will generally not appear in other places."

Xiao Linlin still did not agree easily.

Tumors are very interesting.

From mutation to taking root, it needs to go through a long and risky process.

When a mutated malignant tumor cell successfully takes root somewhere in the human body and begins to proliferate quietly, it is as if the human body has acquired an alternative kind of immunity.

Other normal cells are less likely to mutate into tumors.

It is somewhat similar to the meaning that one mountain cannot accommodate two tigers.

But it is not absolute. There are also unfortunate patients who are diagnosed with multiple cancers at the same time.

According to the doctor's clinical experience, for example, it was now discovered that this female patient had a large tumor at the junction of her descending colon and transverse colon.So under normal circumstances, the patient's other intestines are safe.

No more tumors will appear.

"It's just a feeling! I have also done some colonoscopies, and it is not uncommon to find feces in the intestines during the examination. But this patient's situation made me feel very unusual. The tumor found was indeed very unusual. It is large, but it grows horizontally, so it is impossible to block too much feces in the intestines. Also, the blood streaks just discovered can be bright red or darkened in color.

So I suspect there is still a diseased intestinal segment on it. "

Li Jingsheng's medical talent gradually emerged.

He has careful thinking, meticulous observation, and is good at thinking. Now based on clues, he has made a different diagnosis from Director Xiao.

"Be careful! Keep checking!"

After hearing this, she agreed.

This is also the responsibility of the patient.

It is a sign of trust that the patient entrusts them with this colonoscopy.

Doctors tend to do their best.

Even the kind of doctor who lies down and goes about his business will do his best when examining his patients.At most, they are lazy at work and like to be lazy and fishy.

When you encounter dirty and tiring work, push it if you can.

This does not mean that the lying doctor was negligent in the treatment process.

There are doctors like that, who are often kicked out quickly, or those with some connections are directly transferred to the administrative department.

After all, in the process of diagnosing and treating patients, accidents can easily occur if you neglect your duties.

If something goes wrong, who will resist?

The superior doctor is not that stupid, and the department director is even less likely to take over.

Moving people away is the ideal solution.

Li Jingsheng continued to control the colonoscope to explore deeper.

At this moment, the probe has entered the transverse colon segment, and dangers occur frequently.Xiao Linlin and the nurse beside her were seen sweating coldly.

The patient's intestinal condition is very bad, and it is not just a problem of weak peristalsis.

Li Jingsheng found that when a patient has a large lesion in a certain organ, it often means that the organ has problems in many aspects.

It just didn’t attract the patients’ attention.

The medical idea that prevention is better than cure is correct.

When the body sends out some alarm, its cry for help cannot be ignored.Instead, we should pay attention to it and find ways to correct it in time.

This will ensure that your body is always functioning healthily.

Kind of like a machine that starts with just one screw loose.If you don't take care of it, when this screw falls off, the crisis will further increase.

Next, it is very likely that a major obstacle will occur, or even a direct shutdown.

People are the same.

Even with myocardial infarction and cerebral infarction, which are considered the most dangerous by doctors, the body will still send out various distress signals before the onset of the disease.

I saw that the entire colon was checked, but no problem was found.

Not even an ulcer was found.

"Brother, are you convinced this time? I have done many colonoscopies. As long as a tumor is found in one place, tumors rarely appear in other places. It is not like polyps, which grow randomly everywhere."

Xiao Linlin watched Li Jingsheng finish the transverse colon examination with great difficulty.

She admired Li Jingsheng's colonoscopy skills in her heart.

I almost watched Li Jingsheng grow up with my own eyes.

When he had a colonoscopy for the first time, Li Jingsheng seemed quite unfamiliar, but he was very talented in the operation.

Tech-savvy.

Little did she know that at that time, Li Jingsheng already had proficiency in the implantation technique.

Implantation has a wide range of clinical applications.

Especially after the rapid development of minimally invasive, interventional, and endoscopic medical techniques, implantation surgery has almost become the most important medical technique besides basic surgery.

"I'm really not convinced. I want to check further."

Li Jingsheng is nothing but a tough guy.

"You're crazy! Further ahead is the ileum," she exclaimed.

"The lesions may occur in the ileum."

Li Jingsheng said firmly.

"You, you have a gambler's mentality, which is extremely undesirable. I don't agree. Colonoscopy is enough after the colonoscopy. Just quit."

Xiao Linlin gave the order.

Here, she has absolute power.

Li Jingsheng was just a guest she invited.

Li Jingsheng could not refuse her order.

But he wasn't willing to let it go, so he was dilly-dallying.

"Teacher Tang, please help me press the patient's upper abdomen."

He doesn't give up.

The judgment should not be wrong.

I just found some fecal liquid in the transverse colon, indicating that it came down from above.

Look at the color, it must have come from the ileum.

But feces alone will definitely not convince Xiao Linlin.

When she and Li Jingsheng are getting along, she can ask him to call her sister.But faced with such high-risk clinical operations, she would become ruthless and extremely harsh.

Because this is related to the patient's life safety and must not be trivial.

Nurse Tang looked at Xiao Linlin.

"Press! Be careful, otherwise my brother will not give up."

Xiao Linlin agreed.

It seemed that he also knew what kind of situation Li Jingsheng wanted to wait for.

"Forget it, let me press it for you!"

Xiao Linlin walked over and pressed the patient's abdomen herself.The purpose of this is to promote intestinal peristalsis. If there are bleeding points or blood in the ileum, it will move downward.

Li Jingsheng stared at the screen closely.

"The blood is bloodshot. Sister Xiao, look, it's bloodshot."

He saw a trace of bright red blood flowing down the intestine into the transverse colon, and was clearly captured by the probe of the electronic colonoscope.

"Did your probe break the patient's intestines?"

Xiao Linlin asked nervously.

"I didn't even move. You gave me the order not to let me continue to investigate. Do I dare to move?"

Li Jingsheng looked aggrieved.

She stared at the blood and frowned.

The intestines were not punctured, so where did this blood come from?
It must have come from the ileum. Could it be that Li Jingsheng's judgment was correct and there were really lesions in the front?

She hesitated.

The patient's bowels were in terrible condition, and every step forward increased the risk significantly.

At this point, she faced a choice.

Either allow Li Jingsheng to continue investigating, or play a trick and call it a day.

Anyway, the problem has been identified and the patient has been given a good explanation.

And even after checking the end of the colon, no problem was found, which is worthy of the patient's trust.

(End of this chapter)