Gou is practicing medicine in the clinic

Let’s first look at the pathogenesis of pseudoaneurysm to understand why it is dangerous.

It is due to an abnormality in the blood vessel wall that a rupture appears in the aortic wall, and blood slowly overflows from the rupture.However, due to the presence of soft tissue or other tissues at the ruptured blood vessel, a closed false lumen is formed.

At this time, blood fills the false cavity to form a false tumor-like structure.

In most cases, this false lumen is only surrounded by a thin layer of tissue surrounding the blood vessels.

The risk of rupture is extremely high.

If you don’t have enough experience when taking X-rays, you may even be prone to misdiagnosis and mistreatment.

The risk of a pseudoaneurysm is similar to that of aortic dissection.

When the pseudotumor ruptures, the patient's blood will drain out in a short period of time and eventually he will die.

Even if it does not rupture, some false cavities can continue to grow, which is equally dangerous.

In general, it is somewhat different from aortic dissection.

In aortic dissection, only the inner wall of the blood vessel is damaged, but not the outer wall.

A pseudoaneurysm is a complete rupture of the blood vessel wall.

Clinically, both diseases have a high mortality rate.

However, as long as a pseudoaneurysm is discovered in time and treated, it can generally be turned around.

Li Jingsheng did not ask what kind of treatment Director Zhang gave the patient.

The treatment plan is the 'responsibility' of the attending physician.

Whether people grow rice or corn is their freedom.

Endoluminal isolation is generally more common.

Open surgery and interventional surgery can solve the problem.Regarding which treatment method to use, the attending doctor will recommend the best treatment plan based on the patient's actual situation and the techniques he is good at.

……

In the afternoon, Li Jingsheng continued his consultation.

Each patient is effectively treated under his diagnosis and treatment, and he feels very accomplished.

At this time, five young men and girls walked to Li Jingsheng's consulting table with an old man in their arms.

"Dr. Li, this is our teacher. He accidentally slipped and fell and injured his right shoulder. At that time, we checked at Qiaobang Hospital and found that it was subglenoid dislocation of the shoulder. Then we performed reduction treatment there. Now. It has been almost two months, and my teacher still cannot move his right hand. I would like you to take a look at it."

The old man is only 65 or [-] years old, so he is not particularly old.

His right hand hangs by his side in an unusual posture.

Li Jingsheng is an expert in manual bone setting and reduction.

Looking at the old man's condition, he immediately realized that the old man's shoulder joint had either failed to be restored successfully or had suffered from joint disease.

The level of Qiaobang Hospital is not bad, the quality of medical treatment is very strict, and shoulder joint reduction is a simple operation.

Logically speaking, nothing should go wrong.

"Are you all students of this teacher?"

"Yes! We are all students of Mr. He. Mr. He has devoted his whole life to education. He has no children or marriage, so we are his children."

Li Jingsheng didn't quite believe this.

No matter how busy a teacher is with teaching, it does not affect starting a family and starting a career.

I have never heard of a teacher who is too busy to get married.

But the world is so vast that there are no wonders.Maybe there are some education geeks who, in order to help students achieve better results and get high scores, will choose to sacrifice a lot of personal time to help students learn and do some tutoring.

To have five students accompany the old man to the hospital for treatment when he is sick, this teacher must have a great side.

Only by being sincere can you win the respect and love of these students.

Only then will you be willing to repay the teacher's kindness.

"I think you must be a good teacher who is highly respected. Can this right hand grasp objects now?"

"I can hold some light things, but I can't use the strength. I can't lift or bend them. Every time I move this arm, I feel special pain. It's like being tied by an invisible rope. It's hard to move. very inconvenient."

The old man's thinking is clear and his language is very organized.

"Have you gone to Qiaobang Hospital for a review?"

"I went for a follow-up checkup a month ago, and they said that my recovery was pretty good."

"Let's take a picture first to see what's going on! I charge 100 yuan to take a picture here. Do you think it's okay?"

Li Jingsheng decided to take a picture of the patient first to see the condition.

Since the reexamination a month ago showed no problems, it stands to reason that the patient's condition should continue to improve.

How could this happen?

After Li Jingsheng took a X-ray of the patient, he found that the bone position of the patient's right shoulder joint was normal.But judging from the film, there seems to be a problem with the surrounding soft tissue.

"The shoulder joint has been cured, but there seems to be an abnormality in the soft tissue around your shoulder. Let me feel the bones for you."

After Li Jingsheng felt the bones of the old man, he found that the results were consistent with the X-ray examination.

The patient's right shoulder joint has indeed been successfully reduced, but there are some lumps around the patient's shoulder joint.

And to the touch, the soft tissue feels very stretched.

It feels more like a muscle in spasm.

Hard as stone.

This shows that the soft tissue has formed a large amount of fibrous tissue.

As for those hard lumps, Li Jingsheng didn't feel like tumors when he touched them.

Logically speaking, there are no nodules in this area.

What the hell is it?
It has now been basically determined that the patient's right shoulder joint cannot move normally, which is related to soft tissue lesions.

"Were you able to move your right shoulder normally before you fell?" "Yes. I am an old teacher and I often have to raise my hand to write on the blackboard. Due to occupational diseases, I suffered from frozen shoulder. I saw it later The doctor told me to exercise more. My arms have been moving all the time and the activities are normal. Only after the fall this time, it was particularly difficult for me to lift my right hand."

The old man explained.

As he spoke, he moved his left hand, and it was indeed normal.

It seems that his left hand is very flexible.

When Li Jingsheng heard this, an idea flashed and he thought of a possibility.

"Did you do rehabilitation training soon after the treatment on your right shoulder?"

"Yes! How do you know?"

The old man nodded and admitted calmly.

Li Jingsheng smiled bitterly, "You shouldn't be in a hurry to do this rehabilitation training! The recovery speed of the elderly is slower than that of the young people, because the fixation time after manual reset is shorter. At this time, you should take a good rest instead of rushing to recover all the muscles. Motor function. Just now I felt some lumps in the soft tissue at the injured shoulder joint.

I was a little curious at first, what are these little bumps?It doesn't look like a tumor, nor can it be a nodule.

Now I kind of know what they are.

They are most likely the result of extensive scarring of the soft tissue caused by your rehabilitation. "

Li Jingsheng didn't even know what to say.

I don’t know whether the doctor at Qiaobang Hospital didn’t explain it clearly, or the old man was too stubborn and acted in his own way.

If you want to speed, you can't reach it.

Sometimes being too hasty is not a good thing.

"This, this... could it be that my exercise has turned out to be a bad thing? Young man, please tell me carefully."

"Exercise is not a bad thing, but when your right shoulder joint was injured, the soft tissue has been damaged. In this case, it will take a long time to recover slowly. As a result, you haven't waited for it to be fully repaired, and you are in a hurry. Exercise is equivalent to rubbing salt on a wound. Not only does it fail to promote recovery, it actually adds more damage to the damaged tissue that has been repaired to a certain extent.

This results in the formation of a large amount of fibrous tissue and scarring.

Once they form, the more you exercise and the more they form, the more restricted your right hand will be. "

Li Jingsheng explained the basic pathological mechanism.

The old man felt regret after hearing this.

Patting his thigh, "Oh, if I had known better, I shouldn't have been in a hurry to exercise. When I was discharged from the hospital, the nurse told me, but I didn't listen to her. How can this happen now?"

"Let's rest for a while first! Don't irritate the damaged soft tissues anymore. Scar hyperplasia is very scary. The more you irritate it, the harder it will grow."

Li Jingsheng is also helpless with scar hyperplasia.

Over time, it may degrade on its own.

This time will be relatively long, it may take two to three years, or even longer.

If you have a scarred constitution, it will be even more miserable.

After seeing off the old teacher, a young female patient sat next to Li Jingsheng's examination table.

The strong smell of perfume hit my nostrils.

Wearing short shorts, a fashionable navel-baring outfit, and wavy hair, this woman is not only young, but also dressed very hotly.

"Doctor, I feel a severe sore throat. It may be that I drank too much wine and ate a lot of barbecue and spicy food the night before. I bought anti-inflammatory medicine at the drugstore and took it, but it didn't seem to have any effect."

The woman was breathing heavily when she spoke.

It feels like the nostrils are blocked.

"Let me take your temperature and see."

Li Jingsheng took the ear temperature of this hot girl.

The earrings on her ears were as big as half an adult's hand.Looks wild.

37.1 degrees, low fever.

I have a little fever.

I just received a patient with a sore throat and no fever this morning.

Now another one.

Fortunately, this one has fever symptoms, so it should be easier to diagnose.

"Did you take the anti-inflammatory medicine yesterday?"

"Well! I felt a sore throat when I got up last night. Because I am a host, if my voice is hoarse, it will affect my work. So I quickly bought anti-inflammatory medicine and took it with Panda. But it didn't have any effect. .My throat has always been very uncomfortable. Now it hurts so much when I eat anything.”

I didn't expect that the woman was actually a host.

No wonder she dresses so fashionably.

"Let me look at your throat and open your mouth!"

Li Jingsheng looked at her throat and found that the tonsils were not red or swollen.

Heck, sore throat is one of the most diagnosed symptoms. Today I encountered two cases in a row, both of which showed that the tonsils were fine.

What is wrong with this patient?
The patient has low-grade fever, indicating that the body should have an inflammatory response.

"Have you always been breathing so heavily?"

Li Jingsheng asked her.

"Oh my god, if my breathing has been so heavy, when I speak with the microphone, all the audience will hear is my breathing! Before I had a sore throat, my breathing had been normal."

The woman covered her forehead with her left hand.

The tonsils are fine, but the patient is breathing heavily, which is a sign of dyspnea.

Could it be bronchitis or tracheitis?

Li Jingsheng further investigated the cause of the disease. (End of chapter)