Come on, Dr. Wu

Chapter 367 A Very Difficult Case

Can cupping be used to treat the shoulders and neck?
Stop joking. For people who practice cupping, there is no place that cannot be cupped. Not to mention the shoulders and neck, even putting a circle around the neck is not a problem.

Not only the neck, but also the face and forehead should not be spared.

On the road, if you meet someone with a cup mark on his forehead, don't be surprised, and don't think that he drank too much yesterday and fell asleep on the cup. He just got the mark on his forehead himself. If you have a headache, you can pull out the head; if you have a face pain, you can pull out the face; if you have a cupping, the main purpose is to pull out the cup wherever it hurts.

"Your illness looks like a subdural hematoma to me. We need to do an examination to see the details. However, you have to be mentally prepared. If the hematoma is small, it's okay. We can see if it can be absorbed by itself. But if it's too big, we'll have to use some medication or even surgery. After all, your symptoms are not mild."

What!
hematoma!
The patient was also immediately angry. "I knew that the guy had damaged my tooth. I trusted her so much and kept going to her for extractions. She even said she was a professional. This is what a professional is. I have a hematoma after the extractions. If it weren't for her, I would have had a hematoma."

The sound stopped abruptly, but the anger could not be stopped.

"Doctor, please tell me how much this treatment will cost. I will call her later and ask her to compensate me."

Chao Yuan also shook his head when he heard this. "Go get checked first, and we'll tell you the details after the results come out."

Everyone was amused when looking at this case. It is indeed of great educational significance. Not to mention the issue of cupping, even many doctors may not know where can and cannot be cupped. It is a good opportunity to talk about it. Chao Yuan's treatment was also good. However, this can only be regarded as a simple case, and should be the simplest one among Chao Yuan's five patients.

"Director Wu, look at your favorite student."

So far, they have looked over one by one, and basically everyone else has looked, but Cheng Shi hasn't looked yet. You know, even if Wu Xiaofu didn't say it, Lin Dongping and the others knew that Wu Xiaofu was most optimistic about Cheng Shi, and Cheng Shi's performance really lived up to Wu Xiaofu's training.

Look, from his middle-to-back performance when he first came in, he has now been able to rank among the top three. If he continues like this, it is not impossible for Wu Xiaofu to finally be among the top three and get a place to stay in the hospital.

Therefore, they were also somewhat curious about how Cheng Shi would perform in this assessment.

To be honest, Cheng Shi, a hard-working person, still makes them not very optimistic. He is okay at treating some basic diseases and performing some basic surgeries, but when his professional titles get higher and higher, if he wants to have any outstanding performance, most of the time, it depends on talent and a flash of inspiration.

But Cheng Shi has none of these.

They really didn't understand why Wu Xiaofu was so optimistic about Cheng Shi. Not to mention the future, even in this assessment, with difficult cases and lacking that kind of flash of wisdom, could Cheng Shi really perform well?

Basically impossible.

In their opinion, Wu Xiaofu is just young. When he reaches their age, he will have seen a lot and perhaps he will understand.

However, Wu Xiaofu has such great potential that there is really no need to waste all this time. It just so happens that with the help of Cheng Shi's performance this time, Wu Xiaofu can be alerted earlier. By the same token, when recruiting graduate students in the future, we can also select some with good talents and pass on their skills. There is no need to waste too much energy and time on students with untalented talents like Cheng Shi.

"Well, look, this case is probably more difficult than the one Song Tiantian just had."

Ah!
Hearing this, everyone couldn't help but look over. They had just finished reading Song Tiantian's case, which was difficult enough. Even they might fail. What kind of case did Cheng Shi encounter that Wu Xiaofu said was more difficult than Song Tiantian's.

In Cheng Shi’s clinic.

Sitting next to Cheng Shi was a middle-aged man, who, according to his medical record, was 51 years old. He looked strong, with striking muscles.

"Why did you come here this time?"

Cheng Shi's face was as calm as ever, and there was no sign of nervousness. This was already Cheng Shi's fifth patient, and also the last one. There were still twenty minutes left, which was enough time. However, among the previous four patients, only the third one was more difficult. Cheng Shi gathered the first four patients together.

Knowing these four patients, the difficulty of the cases increases from low to high, there are almost exactly four of them. For these four patients, Cheng Shi believes that his performance is still good. At least the outpatient diagnosis should be correct. As for the third patient, although it is difficult, he also gave an accurate diagnosis and was very confident.

Therefore, the key lies in this fifth patient. If he can handle this patient correctly, his score in this assessment will definitely not be too low.

His eyes fell on the patient in front of him, and Cheng Shi's intuition told him that this patient should be the most difficult of the five patients.

The assessment cannot be so easy. After all, if the most difficult one is only the third patient, then it would be difficult for the eight of them to widen the gap in their scores, and the significance of the assessment would not be achieved. Therefore, we must be careful about this.

Twenty minutes is enough time, don't rush.

Warning himself in his heart, Cheng Shi also began the medical consultation.

The patient was accompanied by his wife. Before the patient could speak, his wife spoke up, pointing at the patient's face and saying, "Doctor, look at his face. It has been like this for a long time, almost two months. We didn't pay much attention to it at first, thinking that he was eating something wrong. It will go away in a few days.

But a month has passed and it's still the same. He still has a low fever, sometimes talks nonsense at night, and has no appetite. Sometimes he feels nauseous and vomits. I was a little scared, so I took him to the hospital. This is our examination. The local doctor said the situation is quite serious and asked us to come to Donghai for treatment.

Doctor, please help me see if our local doctor made a mistake."

When the patient's family member was speaking, she glanced at her husband carefully. She didn't mention any specific illness. There was no report in the examination bag, which should have been taken away by the patient's family member. Combined with the patient's family member's demeanor just now, it's possible that some serious illness was found during the examination, but the patient has not been told yet.

However, Cheng Shi took a look at the patient. Apart from a gloomy face, the patient did not have any other expression, so he probably was not completely ignorant.

Shaking his head, Cheng Shi had seen many patients like this.

Many family members think that not telling the patient is for the patient's own good, but it really cannot be concealed. Once the patient has a serious illness, the attitude of the patient's family members will change, the doctor's attitude will also be different, and there will be clues in the treatment and examination. The patient is not a fool, so how can he not have guesses?

However, as long as the patient's family members don't say anything, the patient will just cooperate. After all, the patient's family members are worried about the patient, and the patient is also worried about the patient's family members.

Place the NMR slide on the developing lamp.

After just one glance, Cheng Shi frowned. He lacked talent, but he made up for it with hard work. Among the eight interns, Cheng Shi definitely dared to say that he read the most films. Before he went to graduate school, Cheng Shi started to go to the hospital from time to time to learn how to read films. Teachers would never reject such students who love to learn.

Cheng Shi also has a clear plan for his future.

From the very beginning, he was in general surgery. Therefore, from undergraduate to master's and doctoral levels, Cheng Shi tried his best to learn how to read films in his spare time almost every day, as well as whenever films appeared. So even if his current film reading ability is not as good as that of some directors, his level should be no worse than that of some attending physicians.

And this difference may just be experience.

But there is no other way, he can only make up for it with time. As soon as the movie in front of him came into view, many movies he had seen before appeared in Cheng Shi's mind. There were many similarities, and the problems of the movie were also obvious.

Magnetic resonance imaging showed significant irregular thickening of the patient's gallbladder wall.

Thickening?

Why does it thicken?
Inflammatory stimulation? Tumor infiltration? Or what?
That would be fine, but the liver hilum also showed stenosis, and the degree of stenosis was not mild. This is worth thinking about, as this situation rarely occurs due to inflammatory stimulation.

The patient also underwent MRCP, which showed significant dilatation of the intrahepatic bile ducts.

Looking back at the MRI, Cheng Shi's mood became heavier. In addition to the film, there was also a blood test. The tumor marker was placed at the bottom, but Cheng Shi was not used to it and pulled it out directly from the bottom.

CA19-9 is greater than 1200.

All the signs matched. Gallbladder cancer? This answer popped up in Cheng Shi's mind.

Cheng Shi tried to find another disease to see if it could be identified as gallbladder cancer, but after searching every disease in his mind, Cheng Shi couldn't convince himself.

Infiltration of the liver hilum.

What else could it be besides a tumor?
But there is one thing, it is too simple.

This case was too simple. Although gallbladder cancer was very serious, he would not be responsible for the surgery. Even if it was serious, so what? With these tests in hand, it was not difficult to confirm gallbladder cancer during the outpatient diagnosis. In fact, the simplicity of this case could be ranked in the top three among the five cases.

This does not conform to Cheng Shi's judgment.

There must be some problems.

Cheng Shi glanced at the time. There were still fifteen minutes left. He was not in a hurry at all. In that case, he would just ask more questions and check more.

"Come, lie down on the bed and I'll take a look at you."

Cheng Shi asked the patient to lie on the bed while examining him, "Does it hurt here? In addition to the symptoms I just mentioned, are there any other discomforts?"

"pain!"

Cheng Shi looked at the patient's slightly painful expression, and then looked at the position of his hand. The tenderness and rebound pain in the upper and middle abdomen were very obvious. Not only in the upper and middle abdomen, but also to the right and left, there was pain, and there was even radiating pain to the chest and back.

Cheng Shi looked at the X-ray again and found no stones. The pain was not so typical.

The doubts in my heart deepened.

“There is nothing else.”

Cheng Shi nodded. The location of the patient's gallbladder and the physical signs were quite obvious, but no lump was felt. He looked at the film and shook his head again.

There is infiltration of the liver portal, dilation of the bile duct, and perhaps invasion. At this level, if it is gallbladder cancer, you should be able to feel something.

The doubts in my heart grew deeper.

I think of some differential diagnoses of gallbladder cancer, such as cholecystitis, gallstones, liver cancer, gastric cancer, biliary ascariasis...

"Didn't you do a color ultrasound?"

"No, I went there and had an MRI. The other one was also a backup."

Upon hearing this, Cheng Shi shook his head. This is how some hospitals do examinations. They just do whatever is most expensive. According to normal procedures, they should do a color ultrasound first, and then see if there are any problems before doing other examinations.

It doesn't mean that the more expensive the MRI is, the better the results will be.

You know, color ultrasound, CT, and plain films all have their own advantages, and they can see things that other examinations cannot see. For example, the imaging and blood flow signals of color ultrasound are very distinctive. Now if there is a color ultrasound result, Cheng Shi may be able to make a better identification.

But with doubts in his mind, Cheng Shi was even more reluctant to make a decisive diagnosis of gallbladder cancer.

If you are not sure and the inspection is not sufficient, then keep asking.

In the past, doctors treated patients without medical examination lists, but their misdiagnosis rate was just a little higher. Now, Cheng Shi at least has some examination evidence, and asking more questions may yield more results.

If there are no other symptoms, then just ask about the main symptoms.

"What causes a stomach ache?"

"How does it hurt, husband? How does it hurt?"

This time, the patient's wife did not rush to speak, but looked at the patient and asked.

The patient frowned and said, "At the beginning, it was a piercing pain, and I felt like I was throbbing with pain."

Ah!
Regarding this kind of pain, Cheng Shi actually wanted to ask whether it was dull pain or sharp pain, the pain interval and duration and so on. However, patients cannot distinguish between dull pain and sharp pain, so they can only let the patients describe it themselves, and then they as doctors will make the judgment.

But, you know what, this is really rewarding.

A piercing pain?

"Where did the pain start? In the middle, on the left or on the right?"

"Here, yes, it's here."

The patient pointed to his stomach and said.

Outside the clinic.

Wu Xiaofu and the others looked at Cheng Shi's clinic. Some of them were already beginning to wonder, "This gallbladder cancer is very obvious. Could it be that Cheng Shi can't even see this? He's been dawdling for so long. Doesn't he know that the sooner he finishes, the more points he can get?"

“I didn’t say that.”

Wu Xiaofu said softly, and the doctors who heard this couldn't help but shook their heads, thinking it was too bad.

They said that these eight interns were taking so long on the last patient and none of them were willing to finish early, as if they could see a flower on this last patient.

"Director Wu said this case is difficult? Could it be that this is not gallbladder cancer?"

Lin Dongping knows how to grasp the key points. He can also read abdominal MRI. Of course, after so many years, he is used to seeing specialists. He is definitely not as good as general surgeons like Wu Xiaofu, but he is not worse than some young people. Therefore, after watching the film, he feels very confident.

But Wu Xiaofu just said that this case is difficult. If it were just gallbladder cancer, it really couldn’t be called difficult.

Everyone reacted and realized, yes, if it was just gallbladder cancer, this case would not be considered difficult, but what other disease could it be?

Is a single hilar infiltration sufficient to exclude alternative diagnoses?

Could it be liver cancer or bile duct cancer?
It doesn't seem to be such an image, right?

The problem with the gallbladder was also obvious, but they were no longer in a hurry to say anything and continued to take a closer look. No one dared to question Wu Xiaofu's ability to treat diseases.

(End of this chapter)