This Doctor is Great

Chapter 165: Diagnostic error! Zhou Mo's first rollover!

If the patient has a liver abscess, it can explain why the clinic's medicines don't work for the patient.

Because the outer layer of the liver abscess has a protective film, it is difficult for antibiotics to enter.

And there are so many bacteria in it, even if antibiotics can get in, how can that amount be enough.

So why does the patient have no effect after taking antibiotics (prescribed by the clinic for hepatitis).

However, it is not yet known whether it is a "bacterial liver abscess" or an "amebic liver abscess".

Further confirmation is required!

Zhou Mo returned to the ward,

"My tentative consideration is - liver abscess!"

Zhou Mo took the examination report and told the patient and his wife his answer.

The patient Duan Zhang was stunned: "What is this abscess, what is it?"

Zhou Mo explained it again: "The liver has a very rich pipeline system, such as the hepatic portal vein, the proper hepatic artery, the left and right hepatic ducts, the hepatic veins... which makes it easy to be invaded by bacteria, fungi, etc., and then... Balaba..."

The patient and wife listened: "..."

I probably understood some.

The patient's wife shook her dizzy head: "Then what should I do?"

Zhou Mo: "Leave blood for culture to see if you can find bacteria in the blood..."

If it's a bacterial liver abscess, keep a blood culture to see if you can find the bacteria.

If it is an amoebic liver abscess, check for amoebic antibodies.

Or the most direct, direct puncture, the pus is drawn out, sent to the laboratory for examination, and everything comes out.

"puncture?"

The patient Duan Zhang hesitated for a moment.

It sounds terrifying.

"Forget about the doctor, my fever is not very serious now. I'd better draw blood for examination first..."

Zhou Mo nodded: "Okay, then follow your choice."

The next step is to draw blood for testing.

In addition, suppress the patient's fever with antibiotics to relieve the condition. In addition, there are liver protection, anti-yellowing and other drugs.

…

In a flash, at 16 o'clock in the afternoon,

The results of the patient's blood draw came out:

- Liver abscess bacteria, not found. (Not every time, it will be found many times)

—Amoeba antibody, negative.

In other words, this time the blood was drawn, and there was no result.

Zhou Mo told the patient Duan Zhang and his wife: "At present, no corresponding cause has been found... My personal suggestion is to do a puncture."

puncture,

It is to use a long, thin needle, under the guidance of the B-ultrasound image, to pierce the inner cavity of the liver abscess to extract the pus.

Duan Zhang started to burn again at this time, 38.5 degrees, his mental state was not very good, and he felt a little more serious than a few days ago.

The wife looked worried: "Doctor, is the puncture dangerous?"

Zhou Mo: "There are also complications in the puncture. For example, the core of the liver abscess was not successfully punctured by a puncture, and the pus was not drawn out...or it is possible that the blood vessel was punctured, resulting in bleeding. These are all possible...or...( Barbara a bunch of complications)…”

To do this puncture, you need to sign a consent form, and you need to give a lecture.

So Zhou Mo spoke out about the complications, even though it sounded dangerous.

The wife was horrified to hear that there were so many complications.

She hesitated: "Doctor, why don't you wait and continue with the blood test in the morning?"

Zhou Mo nodded: "You can continue to wait... But what I want to say is that one of your husband's liver abscesses is as big as 2.5*3cm, and it has reached the standard of puncture and drainage. In the end, in order to cure, puncture and drainage still needs to be done. of."

"Also, this kind of operation is done once. After it's done, you don't need to have a fever and feel uncomfortable... It's better than surgery..."

Then explain why you need puncture and drainage.

I said before,

It is not enough to use antibiotics alone to deal with liver abscesses, because antibiotics cannot enter the abscess.

Therefore, we must find a way to puncture the abscess and let the pus drain out, so that the abscess site can be cleaned as soon as possible and the infection can be controlled.

The wife is still hesitating: "However, piercing seems to be dangerous..."

Zhou Mo: "Don't worry, this technology has been developed for many years. It is a relatively mature technology in our department, and it is generally not dangerous."

At last,

The patient's wife agreed, and after the husband's fever had subsided a little, he sought his opinion.

The patient Duan Zhang was also tormented by repeated fever, and finally agreed.

"I agree…"

Duan Zhang finally signed his name on the consent form.

After signing it, Duan Zhang was already a little impatient.

"Doctor, when can the puncture be done?"

Zhou Mo looked at his watch.

16:58.

"It's almost time to get off work. It may be difficult to find a doctor for puncture now... Wait for tomorrow?"

"Ah? Have to wait until tomorrow?"

The husband and wife looked bitter.

They were ready to "die", but Zhou Mo told them that there was no chance to "die".

What a pain in the ass!

the next day,

After the ward round, Zhou Mo found Mr. Zhang Luojia, and finally Mr. Zhang Luojia performed puncture and drainage for the patient Duan Zhang.

anaesthetization,

One needle down,

"????"

Teacher Zhang Luojia, as soon as the needle was taken, I felt something was wrong.

On the one hand, it is not easy to wear.

On the other hand, she found that the needle went in, and it seemed that she could not draw any fluid.

It's not what she imagined.

Imagine a 2.5*3cm abscess cavity, there will definitely be a lot of pus in it.

But this pumping, why is there no pus?

"has a problem!"

Teacher Zhang Luojia frowned.

The wife looked nervous: "what's the matter?"

Teacher Zhang Luojia said: "The pus I drew is only a little bit..."

Zhou Mo was also a little confused at this time.

No, it should be a liver abscess, how can there be no pus?

I overturned?

At last,

Teacher Zhang Luojia felt that there was a problem, so he discussed it with the patient and changed "puncture and drainage" to "puncture biopsy".

That is, near the abscess cavity, take some liver tissue for biopsy.

The patient Duan Zhang was a little angry, but thinking about his trust in the hospital and his wife's persuasion, and the fact that he had a 2.5*3cm hole in his liver, he was a little panicked... In the end, he agreed to the "puncture biopsy" .

remove tissue,

Send for inspection.

The next step is to wait for the biopsy results, still empirically use antibiotics + liver protection + yellowing + fever reduction...

The effect is still not very good.

Zhou Mo was stunned at this time, thinking that he should have overturned the car.

The condition of the patient Duan Zhang may not be a liver abscess.

But if it's not a liver abscess, what is it?

…

By the afternoon,

The results of the needle biopsy are out!

really!

Zhou Mo rolled over!