Gou is practicing medicine in the clinic

"I see that your clothes are not bad, your temperament is also very good, and your family background should be very good. When your son gets married, he will naturally get married and start a family, so you don't have to be too anxious. To be honest, I am also thirty. , still not married yet."

Li Jingsheng comforted the patient's father.

The old man's brows furrowed into knots, and his tone was full of anxiety.

I'm afraid I have to worry about my son's life-long events.

"Although you are not married, you have a girlfriend! In terms of career, my son is far behind you. You are only thirty years old and you have already opened such a big clinic. If my son also has such a good career , if we get married two years later, I won’t even urge him."

The old man instinctively looked at Ou Qinglan who was not far away.

"This guy has been stubborn since he was a child. He is thirty-one years old and he has never even had a formal girlfriend."

"Dad, we are here to see a doctor, why are you talking about this!"

The son was unhappy.

Exposing his scars in front of outsiders made him feel uncomfortable.

"If you don't want a girlfriend, don't let anyone tell you."

The old man muttered something, but his voice weakened.

It can be seen that the old couple loves their son very much.

"Let's talk about the diagnosis! If you agree to have a checkup tomorrow evening, then I will arrange for you to go to the People's Hospital. The conditions there are better. If there is any problem, follow-up treatment can be done at It is much more convenient to go to the hospital and get admitted there. Their gastroenterology department beds have always been in short supply. Recently, the number of outpatient surgeries has increased a lot, making it even harder to find a bed.

I think you may need to be hospitalized for your illness. "

Li Jingsheng said it very euphemistically.

If the patient really has gastric cancer, this kind of gastric cancer without obvious tumors will be more difficult to treat.

More malignant.

Gastric atrophy and gastric biochemistry are high risk factors for gastric cancer.

Clinically, it is considered to be a precursor to gastric cancer.

And like liver cirrhosis, kidney failure, and heart failure, once this disease starts, it is difficult to reverse.

It will keep turning forward like a magic wheel, taking the patient into the abyss.

"We are at your disposal."

The patient again took a stand.

"Thank you for your trust. Have you brought your ID? I can sign a service agreement with you today and start making arrangements tomorrow morning. A member of our medical team will contact you later to tell you when to start fasting, what preparations to make before the examination, etc. "

After the two parties reached an agreement, they signed a medical service agreement.

The old man paid the fee.

"The old man is different from ordinary people. He should be an official, right?"

Li Jingsheng chatted casually with his family members.

"Why do you think I am different from ordinary people? I retired from the deputy director level. I have been retired for several years!" Speaking of the past glory, the old man revealed a little bit.

"I heard that these days, the bigger an official becomes, the more dangerous he becomes. Once you have power, it's easy to lose control and be defeated by sugar-coated bullets. You can land safely, which is better than most people."

Li Jingsheng often hears comments from high-end clients who come for medical treatment. They list some high-risk occupations.

Those who work as doctors, electricians who work at heights, and air-conditioning installers...these did not make the list.

"My old Lin has no other good qualities. He is famous for sticking to his principles. Now that he has retired for several years, many people still hate him! Why? Because he did not accept the benefits of these people and did not give them anything. Open the back door and end up being resented by them.”

My wife, who had been silent all this time, interrupted.

"If he had been more flexible back then, he wouldn't have been unable to arrange his son's work."

There was both pride and a hint of complaint in his words.

Her son is still not married at the age of 31, and his career is not successful, or his ability is really not good enough. Either the father was too honest and did not give his son any special care.

Li Jingsheng never interfered in such family matters.

He just smiled and went about his business.

……

In the evening of the next day, Li Jingsheng was in the endoscopy room of the People's Hospital, and the first person to be examined was the patient with suspected gastric cancer.

As the endoscopic probe entered the patient's stomach, Li Jingsheng found that the patient's gastric mucosa was all swollen and stiff.

If you just rely on the previous palpation in the clinic, it does look like hypertrophic gastritis.

After the endoscopy, Li Jingsheng believes that it is difficult to characterize hypertrophic gastritis.

Hypertrophic gastritis often shows huge hypertrophy of the gastric mucosa during endoscopy. But what this patient had was not hypertrophy, but enlargement.

Also, his gastric mucosa is extremely hard.

This is extremely abnormal.

Normal people's stomach walls are soft.

Li Jingsheng has had many cases of gastroscopy and has never seen such hard gastric mucosa.

This also shows that the progression time of the patient's disease is by no means a day or two, but may have lasted for several months or even years.

He frowned, thinking about the patient's previous treatment in the hospital.

The hospital where the patient was at that time was a head hospital in a prefecture-level city.

Even though his father has retired, he still has a little influence. If my son is seriously ill and his life is at stake, he will definitely try his best to find the best hospital.

The medical skills of local hospitals should be pretty good.

Medication is also very symptomatic.

When the cause of the disease could not be determined, the attending doctor gave the patient two main drugs: teprenone and metoclopramide.

They are all symptomatic treatments.

Teprenone can promote the synthesis and secretion of regenerative defense factors, high molecular glycoproteins, and phospholipids in the gastric mucosa and gastric mucus. It can increase bicarbonate in gastric mucus and improve prostaglandin biosynthetic ability in gastric mucosa.

It is extremely effective in treating ulcers, especially ulcers of the digestive tract.

Clinical applications are also very extensive.

Metoclopramide, many people may have never heard of it.

Its other name is metoclopramide, which many patients should have heard of or even taken.

Its function is to stop vomiting.

It can inhibit the emetic chemoreceptor zone in the brain oblongata and has a strong anti-emetic effect. It can also promote gastric peristalsis and speed up the emptying of gastric contents.

Both of these drugs are empiric drugs for symptomatic treatment.

However, after the patient took the medicine, there was no effect.

This can only show that the medicine that seems to be symptomatic is actually not symptomatic.

If the medicine is not suitable for the symptoms, no matter how much you take, it will be in vain and will do more harm than good.

The patient did not find ulcers during gastroscopy, which also proves that the use of teprenone is wrong from another aspect.

So, what exactly is the patient’s disease?

Li Jingsheng couldn't help but focus his diagnosis on hypertrophic gastritis again.

There are two main syndromes of this disease. One is hypertrophic hyperacid secretion gastric disease, which is very rare in the world. Another common disease is giant gastric mucosal hypertrophy.

Both diseases share a common feature: their proteins are lost from the gastric cavity.

Especially when the disease develops to an advanced stage, protein loss is severe, resulting in low protein, which can cause edema. Li Jingsheng checked the patient's lower limbs, face and other parts and found no edema.

It means that the patient probably does not have hypertrophic gastritis.

He couldn't help but adjust his direction and look for other diagnostic breakthrough points.

Could there be something wrong with the specimen taken under gastroscopy?

The patient's gastroscopic specimen biopsy results at the local hospital were normal. It may also be that the width of the gastroscopic biopsy forceps was limited and could not reach the lesion at all.

This kind of thing has happened in more than one case among the difficult and complicated diseases that Li Jingsheng has diagnosed.

Some lesions are extremely hidden and grow in deeper areas.

It may even be deep within the muscle layer.

In order not to damage the patient's body when taking the specimen, a few tissue cells on the surface are usually taken.

In addition, the width of the gastroscopic biopsy forceps is only about five millimeters, so it cannot obtain tissue cells from the lesion deep in the stomach.

Also, teprenone mainly treats damaged mucosa.

This patient's medication was ineffective, which indirectly showed that he did not suffer mucosal damage.

His main symptoms were difficulty swallowing and persistent pain in the upper abdomen, which were significantly different from the common symptoms of gastritis and gastric ulcer.

If gastroscopy cannot detect it, can other examination methods be considered?

Take people's money and eliminate disasters with them.

Li Jingsheng collected 3,000 yuan in medical service fees from patients, so he naturally had to provide high-quality services to match.

Does this patient have diseases such as pseudolymphoma, malignant lymphoma, or pancreatic tumors?

The patient had already had a CT scan at the local hospital, but the results were normal.

The patient's CT examination results showed that there were no abnormalities in the liver, spleen, gallbladder, and pancreas.

Gastroscopy biopsy was also normal.

Is there any better way to check next?

The results of MRI are similar to those of CT.

PET/CT examination is a type of examination that specifically targets tumors throughout the body and costs about 10,000 yuan.

The patient has already had a CT scan, and if he checks this again, it is estimated that the results will not change much.

On the contrary, it will delay the treatment time by more than two days and increase the financial burden on the patient.

Ten thousand yuan is neither too much nor too little.

If it is three thousand yuan a month, it is equivalent to more than three months' salary.

Li Jingsheng pondered quietly.

The team members did not bother him. After working together for a long time, everyone already knew his diagnosis and treatment habits.

Lian Tao didn't come over because he had something to do.

For now, there are only Li Jingsheng, anesthesiologist Yani, and nurse Meng Luo, while general surgeon Lin Xiaoran is here to make soy sauce.

He joined Li Jingsheng's team originally to improve his medical skills and make continuous progress.

"Dr. Lin, do you think this patient's CT scan and gastroscopy biopsy show no abnormalities? What other tests can be done to clarify the cause?"

"This...I'm really not very good at this field. I'm mainly good at diagnosis and treatment in the field of general surgery."

Lin Xiaoran didn't dare to answer randomly.

"He did a CT scan but failed to detect the problem. That's because CT is only sensitive to space-occupying lesions in solid organs and is often insensitive to the examination of cavity organs, especially the gastrointestinal tract.

I was wondering, when he did the gastroscopy biopsy, would the depth of the specimen taken be not deep enough?

Some hidden lesions are likely to be hidden deep under the mucosal layer, muscular layer, serosal layer, etc.

If the lesion is really in the muscular layer or serosal layer, and it cannot be detected, it will definitely be a disaster for him if it continues.

I am going to use one of the cheapest and oldest examination methods, X-ray, to examine him. "

Li Jingsheng originally wanted to discuss it with Lin Xiaoran.

But in this field, the two of them are not at the same level at all, so he can only make the decision himself.

There is definitely a gap in the level of doctors because of their different areas of expertise.

If Lian Tao were here, he would definitely be able to have a discussion at the same level as Li Jingsheng. Even in many aspects, Lian Tao's knowledge and experience exceeded Li Jingsheng's by a lot.

"X-ray examination? This, this... its examination accuracy should be far inferior to that of CT, right?"

Lin Xiaoran said in shock.

"That's not necessarily the case. Every examination method has its meaning. When examining bones, the clarity of X-rays should be the king of all examinations. Ultrasound examination, the oldest, also has some advantages that cannot be replaced by CT and MRI. .”

Li Jingsheng looked determined.

A ruler is longer and an inch is shorter.

With the continuous development of science and technology, inspection methods are becoming more and more abundant. PET/CT, MRI, CT, genetic testing, etc., these were slowly developed later.

They are becoming more and more advanced.

However, X-ray and Doppler ultrasound examination methods still have their advantages.

There is no rubbish examination method, it mainly depends on how the doctor uses it.

Sometimes, a very ancient examination method, if used well by doctors, can turn from decay into magic and exert examination effects that exceed those of PET/CT and MRI.

"Mr. Lin, the gastroscopy has been completed. The examination results are consistent with your examination at the local hospital. The gastric mucosa was swollen and stiff."

"Then what exactly is my disease?"

The patient's face suddenly showed disappointment.

I spent a lot of money on the inspection, but this is the result.

The greater the hope, the greater the disappointment.

"The cause of your illness is currently unclear. I suggest you take an additional X-ray examination, which may be able to detect your lesions."

"Are you sure you can find out?"

The patient's trust in Li Jingsheng has been significantly reduced, and his heart is full of disappointment and loss.

"I don't dare to give you a guarantee. No doctor can give you a guarantee on this kind of thing. But I think it's worth trying. Maybe we can get good results. The cost won't be too expensive. If you are willing, I will give it to you now. Think of ways to make arrangements and try to find out the cause of the disease today."

"Okay then! That's all it can do."

The patient agreed.

Li Jingsheng walked out of the endoscopy room and tried to arrange an X-ray examination for the patient.

In fact, this is not an ordinary X-ray examination, but an X-ray barium meal imaging.

For some intestinal fistulas or hidden lesions in the digestive tract that are difficult to find, this method is often used to check.

"Young man, have you checked the gastroscopy and still got no results?"

The patient's old father asked Li Jingsheng.

He apparently learned about the test results from his son.

"Sorry, gastroscopy is not omnipotent. I suspect that your son's lesions may be deep in the stomach wall. Therefore, it is recommended to do an additional X-ray barium meal examination."

"Well, since everything has been done, we believe in you, please help make arrangements for my son as soon as possible!"

The old man's words were quite polite.

But his attitude towards Li Jingsheng has obviously changed a little.

Li Jingsheng asked Lian Tao for help, and finally arranged an X-ray barium meal examination for the patient. Next, just wait to see the test results. (End of chapter)