Gou is practicing medicine in the clinic

"Jingsheng, why are you thinking of giving the patient a make-up X-ray barium meal?"

Lian Tao is particularly busy today.

One of the patients admitted had an emergency. He led his doctors and department nurses to carry out rescue operations at the scene, and now it is finally over.

The patient's condition has gradually stabilized and his life is no longer in danger.

But no one can guarantee that the patient's condition will not worsen again.

The health of patients over seventy years old cannot be compared with that of young men.

The patient treated by Lian Tao is already 79 years old, only one year shy of turning . Before being hospitalized, my health was relatively strong.

After getting sick this time, the condition progressed rapidly and the physical condition also deteriorated rapidly.

As the body functions of the elderly begin to age, it is difficult for them to return to their original state after falling ill.

Maybe after a serious illness, your physical condition is completely different from before.

Young people have strong physical recovery capabilities. After falling ill, they can return to peak condition after a while.

At 79 years old, he is already an elderly patient.

A sudden worsening of your condition during hospitalization is not a good sign. Fortunately, modern medical technology is advanced, and if you work hard, saving your life shouldn't be a problem.

But after being discharged from the hospital, the old man's health may decline off a cliff.

"Because I suspect that this patient may have gastric cancer, but after gastroscopy, pathological examination, and CT, no problem can be found. I suspect that the lesion may be deep in the stomach wall. It may also be in the upper part of the intestine that is difficult to reach with the gastroscope. Check A barium X-ray meal should be able to find out the problem."

Li Jingsheng expressed his considerations.

"If you just want to check for deep lesions, endoscopic ultrasound should be able to achieve good results. X-ray barium meal check may take two to three days."

Lian Tao felt that it would be easier to have an endoscopic ultrasound examination.

"X-ray barium meal should be more suitable for this patient. Because X-ray barium meal can dynamically observe the contraction and relaxation of the parietal layer, this is especially useful for the diagnosis of patients when no obvious tumors are found in the stomach or upper abdomen. favorable."

As Li Jingsheng's medical skills continue to improve, he now has the ability to 'discuss the truth' with a director of gastroenterology at the level of Lian Tao.

He has unique insights into etiology examination and diagnosis.

"It makes sense! X-ray barium meal does have advantages over other examinations in this regard. You may need to do some explanation work for family members and patients. Because the patient has symptoms of vomiting and even vomiting food, the examination He must be on a liquid diet for two days beforehand. On the third morning, he can be arranged to have a gastric lavage before being sent to the radiology department for examination.

However, based on the patient’s symptoms and early examination results, I think the possibility of small intestinal tumors is very small. "

Lian Tao greeted him in advance.

Inform about preparations before X-ray barium meal.

"I also think that the possibility of high-position small intestinal tumors is very small. Because during palpation examination, although a huge mass was felt, it was relatively fixed. If it is a small intestinal tumor, it is relatively mobile."

When Li Jingsheng checked this barium meal, he mainly wanted to see the condition of the gastric wall.

Especially the activity in the hypertrophic and stiff parts of the gastric mucosa.

……

Three days later, the patient’s air barium double contrast imaging results came out.

No niches or filling defects were found in the stomach and duodenum, and there was no obvious narrowing of the gastric cavity and no obvious retention.

The mucosa of the greater curvature of the gastric antrum becomes thickened and peristalsis slows down.

Barium passes through the pylorus very slowly.

The diagnostic opinion issued by the radiology department was antral gastritis.

Li Jingsheng was full of disappointment with this test result.

I thought that doing a barium X-ray meal would definitely yield great results. Sure enough, the greater the hope, the greater the disappointment.

He frowned deeply as he looked at the test results.

Now, his situation is very passive.

After performing a gastroscopy on the patient and failing to find out the cause, he already felt that the patient and his family were a little disappointed in him. Trust in him has also dropped a lot.

Now it took three days and a lot of trouble to finally complete the supplementary inspection.

However, the cause still could not be found.

What will patients and families think?

The disease that the local hospital failed to detect after two months of testing was indeed not that easy to detect.

Next time you meet this kind of patient, you must not talk too much.

If barium imaging cannot detect it, what if it is replaced by endoscopic ultrasound?

It was only then that Li Jingsheng felt that Lian Tao's level and experience must be much higher than his own. Because Lian Tao suggested that he perform endoscopic ultrasonography on the patient.

But then again, no one dares to say that endoscopic ultrasound is correct before the examination results come out.

There is still a question of probability here.

He frowned, thinking hard about the possible causes of the patient's illness.

The barium becomes slow when passing through the pylorus. Could it be invasive gastric cancer?

Among the patient's symptoms, there was obvious stomach pain, and the lesion was most likely to be in the stomach.

In the absence of obvious ulcers in the stomach, the probability of cancer pain is high.

Nowadays, when performing endoscopic ultrasound on patients, it must be considered that there is no barium retention in the stomach.

Although the patient had gastric lavage immediately after the air barium double contrast imaging to empty the barium. However, out of caution, before endoscopic ultrasonography, you definitely need to do another X-ray to make sure there is no residual barium in the stomach before endoscopic ultrasonography can be performed.

Moreover, the patient took drug treatment for more than a month, but no obvious effect was achieved.

This shows that the patient's condition is of little significance for medical treatment.

Surgery should be considered for treatment.

He couldn't help but once again focused his diagnosis on invasive gastric cancer.

First of all, the patient's lesions were extremely hidden. Apart from the distension and stiffness of the stomach wall, after so many examinations, there was almost no discovery.

Secondly, although the patient's X-ray barium meal angiography failed to detect the cause, it was of great significance to the diagnosis.

It dispelled some of Li Jingsheng's doubts and made his diagnosis direction clearer.

It also led to a major breakthrough in his diagnosis.

It can target invasive gastric cancer, a type of disease that is difficult to diagnose.

But there are still some doubts that have not been clarified.

He forced himself to think calmly. The diagnosis of this disease should not be made too hastily.

The more anxious you are, the easier it is to lose your sense of proportion.

Before asking the patient to have another endoscopic ultrasound examination, Li Jingsheng decided to visit the radiologist.

Doctors in the radiology department have high and low standards, and some of them are more powerful than the chief physician of the specialty. Before the film comes out, they can give a rough diagnosis.

And it's almost the same.

Those with low standards are basically those doctors who are just dawdling or new doctors.

Li Jingsheng believed that the diagnosis given by the radiologist was antral gastritis, which was definitely a wrong diagnosis.

He didn't know whether the other person was a dabbler or a novice doctor.

After asking Lian Tao to find out, the doctor He Min who made the report was already off work.

That's the only good thing about doctors in the medical technology department. They never have to work overtime.

Not to mention that after get off work, the patient's condition was still on his mind, and he was called back to the hospital for rescue after a phone call.

Doctors in the medical technology department go to work on time and leave work on time.

The workload is relatively concentrated, there is no need to work overtime, and there is no need to take care of patients after get off work. Those with better wages can earn around 20,000 yuan, which is considered to be the upper-middle level among doctors.

Li Jingsheng asked for Dr. He Min's phone number and called him.

"Is this Dr. He?"

"I am! Who are you? What's the matter?"

You can hear the sound of playing games on the other end. It seems that Dr. He chose to relax after get off work.

"Hello, my name is Li Jingsheng, and I am a friend of Director Lian Tao of the Department of Gastroenterology. I would like to ask you about a patient. There is a patient named Lin who underwent an X-ray barium meal examination..."

Li Jingsheng explained the situation.

"Oh, hello, hello! There's nothing wrong with that patient after checking. It's probably not the gastric cancer you suspect. I feel like there's a high possibility of antral gastritis."

Dr. He became much more enthusiastic after hearing Li Jingsheng introduce himself.

This is basically the case between doctors.

If everyone has the opportunity to get to know each other, they will try their best to build a good relationship. This is also a human resource.

"The cause of this patient's disease is indeed difficult to diagnose. To bother you so late, I would like to ask, after the patient completed the barium angiography, did the barium empty out quickly?"

"Well...his barium discharge was very slow at that time."

Dr. He said after recalling carefully.

"Then is there any narrowing of his stomach cavity?"

"There is no obvious narrowing of the gastric cavity, but I feel that there is a slight narrowing of the upper part of his stomach. This phenomenon is often encountered when examining other patients. Generally, if it is not serious, we will consider it as a result when issuing a report. normal."

"Okay, thank you for providing me with this valuable inspection information. I won't disturb you anymore. Goodbye."

"goodbye!"

The two ended their chat.

Li Jingsheng asked about some information he wanted to know.

These contents will not appear on the report, but are very meaningful for the patient's diagnosis.

The barium empties very slowly and then there is some constriction of the upper stomach.

It should be of a progressive nature.

Like the mouth of a sack slowly tightening.

This is often called a leather sack stomach.

It's just that this patient is less obvious and may still be in the early stages of the disease. As the disease progresses, it will gradually worsen.

"Isn't this a leathery bag-shaped stomach one of the typical characteristics of invasive gastric cancer? The gastric mucosa is swollen and stiff. Over time, the mucosal ruffles will disappear. When the time comes, the barium meal will be more clear.

It's still early stages, so only the first symptoms are showing. "

After careful review, Li Jingsheng basically determined that the patient had invasive gastric cancer.

Now that we have this initial diagnosis result, it will be much more reasonable for the patient to have an additional endoscopic ultrasound.

This time he did not talk directly to the patient, but to the patient's parents.

Take them to the hallway.

"Uncle, aunt, the results of your son's examination have come out. Although the doctor from the medical technology department wrote the report as gastritis, based on my experience, your son's disease is likely to be early gastric cancer."

Li Jingsheng said directly.

"cancer!"

When the patient's mother heard that it was early-stage gastric cancer, it was like a bolt from the blue. She covered her head and leaned against the wall.

The old man also had a pale face and didn't speak for a long time.

Although they had already made some preparations when their son's condition did not improve after more than a month of treatment. But when it comes to doctors, it's still hard for them to accept it.

"Don't be anxious, don't be anxious. This is just my personal preliminary diagnosis result. To get the final diagnosis, further examination is needed. And even if it is really gastric cancer, various signs indicate that it should be early-stage gastric cancer. As long as it is scientific and reasonable Treatment, the possibility of a cure is very high.

If I were diagnosed with late-stage gastric cancer, I wouldn't be able to talk to you in such a relaxed tone. "

Li Jingsheng was worried that the old couple would be frightened and fell ill, so he quickly offered comfort.

The diagnosis results must be communicated to family members.

Sooner or later, there is no way to escape this. They also have to face reality.

"Dr. Li, for a baby like me, many experts have looked at it, but they haven't found out the disease. Your medical skills are superb, but you must save my baby!"

After the patient's mother recovered, she held Li Jingsheng's arm tightly and begged him with tears in her eyes.

"Auntie, cancer is not a terminal disease. It is much easier to cure early-stage cancer. Don't worry too much and take good care of yourself. Since you have come to me, I will definitely go all out and find ways to give you a healthy son. .”

Li Jingsheng feels that there should be great hope for the treatment of this patient.

Early gastric cancer has a high cure rate.

Cancer causes patient death mainly due to three factors. One is recurrence, the other is metastasis, and the other is complications.

For example, liver cancer can cause loss of liver function and lead to a series of complications.

Abnormal coagulation, loss of bile function, loss of synthesis of various digestive enzymes, etc., can lead to the end of the patient's life.

Not to mention recurrence and metastasis.

Some cancer patients actively fight cancer and undergo surgery to remove the tumor, and then undergo chemotherapy to consolidate the curative effect.

As a result, after some time, a recurrence was detected.

The patient's condition took a turn for the worse.

Perhaps this patient did not die of recurrence but was frightened to death.

Sometimes, courage is also important.

Two days later, the patient’s endoscopic ultrasound results came back.

Li Jingsheng specially invited a surgeon for consultation.

The final diagnosis was invasive gastric cancer.

Still in the first phase.

Later analysis showed that because the patient's gastric cancer was still in its early stages, only some parts of the mucosa were stiff.

At the same time, barium retention in the stomach is not obvious.

This is one of the factors that makes diagnosis difficult.

The patient was diagnosed and received surgical treatment at the People's Hospital.

Li Jingsheng's research in the field of cancer did not stop because of this, but became more diligent.

I worked hard to learn all kinds of new and old technologies in tumor treatment, and deeply analyzed the cases of treatment failure and success.

Ms. Huang's father has advanced gastric cancer and is being actively treated under Li Jingsheng's arrangement.

Currently the main treatment is chemotherapy.

I plan to do three to four rounds of chemotherapy first to see the effect before making further plans.

Conquering tumors can be divided into several steps.

The first step, in Chinese medicine terms, is to overcome evil spirits.

Surgery, radiotherapy, and chemotherapy are all the first steps in dealing with cancer. And it is an effective method.

Because tumors grow to a certain extent in the body, it does not take just one or two days.

Three feet frozen, not a cold day.

They have established a deep base in the human body. If you want to deal with them at this time, you must launch a ferocious attack like a storm. Clean it up with thunder.

After clearing the tumor, the next step is to consider the second step, which is to help the patient rebuild the immune system and bone marrow hematopoietic function.

In traditional Chinese medicine, it can be called strengthening.

During this period, Li Jingsheng has only reached the second step through deep learning.

There must be two or three steps later. (End of chapter)