Chapter 492: The training journey of a famous doctor, what happened to Dr. Du?
This patient probably has more than just upper gastrointestinal bleeding, and there is a high probability that there is bleeding somewhere in the lower gastrointestinal tract.
And the major source of bleeding is most likely in the lower gastrointestinal tract.
When Zhou Can first diagnosed the patient, he used two Level 6 medical skills, hemostasis and pathological diagnosis, to determine that the patient's bleeding source was in the upper digestive tract, most likely the stomach. Now, after further diagnosis, it was found that the patient was likely to have multiple sources of bleeding.
This indicates that his initial diagnosis was a missed diagnosis.
However, even if he missed the diagnosis, he still gained a lot and figured out the diagnostic techniques of top doctors.
At most, his hemostasis and pathological diagnosis skills are still at a relatively low level, and there is still a big gap between them and the real top level.
Therefore, misdiagnosis may occur during diagnosis.
In any case, it is already very impressive that we can roughly identify the source of bleeding only through physical examination and the patient's medical history and symptoms.
You know, he is just a resident doctor now!
Moreover, he is just a junior resident, but he is already so impressive. As long as he studies hard and practices diligently, it is only a matter of time before he reaches the top level.
I don't know how many times luckier I am than those doctors who have been practicing medicine for most of their lives and haven't even reached the director level.
"Okay, I'll arrange for the patient's gastric juice to be drawn for testing right away. Doctor Zhou, you've worked hard, go eat! If you have any new ideas for diagnosis, feel free to tell me. In view of the severity of the patient's condition, I'll follow the procedure and ask the gastroenterologist to come for a consultation."
Ai Li's respect and concern for Zhou Can came from the bottom of her heart.
As a doctor myself, I understand best the hardships that doctors go through.
Zhou Can has been busy in the operating room for the whole morning and is now helping her diagnose patients on an empty stomach. This is a great kindness.
Ellie asked a gastroenterologist to come for a consultation. It would be best if the cause could be found, but if that is not possible, it could also help differentiate the risks. She is now very worried that the patient's condition will suddenly worsen and the patient will die.
…
Sitting in the cafeteria eating, Zhou Can was still thinking about the cause of the patient's illness.
Draw gastric juice for testing. If the test result is non-bloody, then the lower gastrointestinal tract must be checked.
Considering that the patient had a high fever reaction and suffered from excessive bleeding and shock, the possibility of acute hemorrhagic necrotizing enteritis was very high.
When Zhou Can was performing an abdominal tenderness examination on a patient, he pressed below the patient's xiphoid process and around the navel, and the patient showed obvious tenderness.
Acute hemorrhagic necrotizing enteritis often presents symptoms such as periumbilical and abdominal cramps, bloody stools, and even necrotic intestinal mucosa, and the stools will be particularly fishy.
Among the above symptoms, the patient meets the following conditions except for gastrointestinal bleeding and periumbilical pain, and no other symptoms have been found.
Therefore, acute hemorrhagic necrotizing enteritis cannot be ruled out and cannot be fully diagnosed.
The maximum probability of diagnosis is 50%.
This requires further observation and stool testing.
If this disease is ruled out, what ?
At this time, Zhou Can deeply realized that one only regrets not having read enough books when he needs them.
I searched my brains to select the cases I had seen and the knowledge points about digestive tract diseases.
He is already very capable, at least a hundred or a thousand times better than those medical students who have a lot of medical knowledge but have a blank mind when it comes to clinical practice and cannot use a single thing.
There are many doctors who are very good at talking on paper and always get high scores in exams, but become cowards when it comes to clinical practice.
This is how everyone comes here.
Gradually, with more practical experience, you will know how to apply what you have learned.
After one year of internship, three years of regular training, and nearly two years of residency, Zhou Can has gained a wealth of practical experience and is fully able to apply what he has learned.
At this time, he thought of a disease that was similar to the patient's symptoms.
Ulcerative colitis.
This is a nonspecific inflammatory bowel disease that usually develops slowly.
The patient's onset was also very slow, and the course of the disease has lasted for more than a month. This is very consistent.
The location of the lesion also matches.
The lower digestive tract includes the colon.
Moreover, Zhou Can learned that the patient's anemia symptoms did not change after using hemostatic drugs and transfusing 1000 ml of blood. He already suspected that the patient was very likely to have bleeding in the small intestine or upper colon.
Ulcerative colitis is often accompanied by symptoms such as diarrhea, abdominal pain, and then bloody stools, even bloody and purulent stools, as well as fever and weight loss.
Among these symptoms, the patient had four symptoms: abdominal pain, bloody stools, fever, and weight loss.
The slow course of the disease is also consistent.
So the possibility of ulcerative colitis is very high.
Zhou Can had already thought of two possible diseases, but he was not satisfied with that.
A truly top doctor must constantly expand his diagnostic thinking and take into account all possible causes of disease .
The more comprehensive the thinking, the better.
When diagnosing a disease, a doctor's knowledge in the relevant field and clinical experience are greatly tested.
This is also why experts are all "dedicated to one thing" and few people can flourish in multiple fields at the same time. Because a person's energy and time are really too limited.
Zhou Can has completed regular training in both gastroenterology and gastrointestinal surgery, and the training period was not short.
This also gave him the opportunity to accumulate more experience in the diagnosis and treatment of digestive diseases and learn more related knowledge.
At this time, two new diseases popped up in his mind.
Colonic diverticular disease often occurs in the sigmoid colon and cecum, often accompanied by fever, elevated white blood cell count, and signs of peritonitis.
The disease manifests itself as periodic small amounts of bleeding or acute large amounts of bleeding.
Another disorder is Meckel's diverticulum.
The basic symptoms are similar to those of colon diverticulosis, except that it is more common in the terminal ileum.
The patient had fever and acute massive bleeding, and these two points matched the diagnosis.
However, no signs of peritonitis were found.
There is a certain possibility of these two diseases, but the possibility is not very high.
Zhou Can has come up with four causes of the disease, but he is still not satisfied. He is still racking his brains to think about it.
"Hey, Xiaolan, you are eating here too!"
A magnetic male voice sounded, awakening Zhou Can from his thoughts.
"Yeah! We've been busy this morning, we just got out of surgery. Have you eaten yet?"
Ma Xiaolan responded with a bright smile.
"I happen to be a little busy today, so I was just about to come over for a bite to eat. Can I share a table with you, Doctor Zhou?"
The man who greeted Ma Xiaolan asked Zhou Can with a smile.
"Please take a seat! Doctor Du and Xiaolan have known each other for a long time?"
Zhou Can didn't expect to meet Du Leng here.
Because he was very busy at work, he often ordered meals to eat in the operating room and rarely came to the restaurant to eat. The number of times he bumped into Du Leng was also very few.
In addition , Zhou Can's current status has surpassed Du Leng by several streets, so even if they meet, Zhou Can still behaves like a king.
Du Leng tried not to greet him directly and avoided him.
Why?
It's so shameful that a PhD student who graduated from a prestigious overseas university was crushed by an undergraduate student from a domestic 985 university!
Although Du Leng is usually gentle and modest, he is actually similar to Yue Buqun in martial arts dramas. He is not only hypocritical, but also very concerned about his reputation.
What impressed Zhou Can the most was going to Xinxiang Women's and Children's Hospital with Du Leng for consultation a few years ago.
Zhou Can emerged like a dark horse, and Du Leng fell from the altar.
After the expert's consultation, Du Leng began to avoid him and started to work down-to-earth on basic clinical work. It is said that he learned everything from collecting patients' feces and urine, changing dressings, and inserting catheters.
As for Du Leng's current strength, Zhou Can really has no idea.
In terms of surgical talent, Du Leng can't compare to Zhou Can even if he can take a plane.
"I have known Dr. Du for about three months. It was fate. One day I got off work late and it was raining. I couldn't get a taxi, so Dr. Du offered to take me back to my residence."
Ma Xiaolan was full of gratitude when she talked about this incident.
At the same time, I feel a little embarrassed.
Women are often moved when they encounter difficulties.
For example, if they are robbed by gangsters, harassed by street thugs, or are sick and need care, when they are most helpless, if a man lends a helping hand, it will most likely leave a deep and good impression in their hearts.
Some wonderful connections often start from small things like this.
"Are you two dating now or are you just friends?"
After listening, Zhou Can asked with a smile.
"As the leader of the surgical team, Dr. Zhou really cares about his team members! He even asks about these personal matters in detail."
Du Leng quickly spoke up to help Ma Xiaolan out.
"Haha, everyone has a gossipy heart. I am also a vulgar person. Doctor Du thinks too highly of me. Doctor Du has a brilliant academic background and is also very handsome. He must have had many girlfriends. I have to greet him well and not let Xiaolan down, otherwise no one in our surgical team will agree."
Zhou Can said half jokingly and half seriously.
The main purpose is to remind Ma Xiaolan not to be fooled by others without knowing it.
Du Leng doesn't have a very good reputation.
He had played with at least ten female doctors and nurses in the hospital. But one must admire Du Leng's ability, as none of the female doctors and nurses had made trouble so far.
I heard that when Du Leng chooses a girlfriend, his requirement for her face is only above average, but he pays special attention to her figure.
All I can say is that everyone has different hobbies.
Ma Xiaolan has known him for three months, but it is unknown how far her relationship with Du Leng has developed.
As the leader of the surgical team, Zhou Can can only fulfill his duty of reminder and will definitely not interfere with the love affairs of his doctors and nurses.
"Doctor Zhou, are you praising me or insulting me? I am not as fickle as you say. I believe in taking only one scoop of water from a drowning river. If one day I find a girl who makes my heart beat, I am willing to be like the love of a white swan, and never abandon her for the rest of my life."
Du Leng didn't know whether he was worried that Zhou Can would ruin his relationship or what.
Quickly express your serious attitude.
It was more like he was expressing his views on love to Ma Xiaolan.
I don't want to be mistaken by her as a playboy.
His hasty and angry explanation confirmed that the two were in love.
Judging from the fact that Du Leng cares so much about her, he probably hasn't won Ma Xiaolan yet. Of course, it's also possible that he has already won her over, and maybe he really likes Ma Xiaolan, so he cares so much about her.
Whether it is a man or a woman, when they meet someone they like, they tend to become infatuated.
Every thing has its own nemesis.
"Eat quickly, or the food will get cold!"
Ma Xiaolan smoothed things over between the two of them.
While eating, Du Leng did something very interesting. When he was almost done eating, he quickly got up, ran to the window and bought a few bottles of yogurt.
One bottle per person.
Zhou Can was incredulous. What was this guy trying to do? Bribery?
"Thank you, Dr. Du, for treating us to yogurt. It's getting late, and we have to go back to the operating room to work. Goodbye."
As the leader of the team, Zhou Can must show his performance.
"You're welcome! In fact, I admire you very much. I heard that your surgical skills in many areas are no worse than those of senior chief physicians. This is simply a miracle. I believe God must have touched you."
Du Leng didn't seem to be being hypocritical and polite at this moment, but spoke in a more serious tone.
"Haha, Dr. Du admires me, but little do you know that I admire you even more! Studying abroad is already amazing enough. There are definitely only one or two people who graduate from a prestigious overseas university among millions. Also, I never believe in God. My faith is Yanhuang."
Zhou Can never does anything that worships foreign things.
In terms of mythological system, how can foreign Athena, Statue of Liberty, God, and Satan compare with the Chinese mythological system?
China's Three Pure Ones, the Jade Emperor, the Star Gods, the Heavenly Kings, the Four Seas Dragon Kings, etc., is a very complete mythological system with complete division of labor and clear status and hierarchy.
Du Leng suddenly said that he admired him very much. What on earth was this guy up to?
Is this an attempt to take the initiative to shake hands and make peace?
In the past, Du Leng and he were like water and fire.
After coming out of the cafeteria and on the way back to the emergency department, Zhou Can began to think about what other possible causes of the patient's gastrointestinal bleeding might have?
Malignant histiocytosis of intestinal type.
He screened out another disease that was more consistent with the patient's symptoms.
This disease is often accompanied by fever and severe gastrointestinal bleeding, and antibiotic treatment often has little effect.
The patient's condition is highly consistent with this disease.
The best way to diagnose this disease is to give the patient a gastrointestinal barium radiography, or an emergency endoscopy.
However, the patient has just recovered from shock and is still very weak. There is also a high probability that there is a lot of blood accumulated in the intestines. The effectiveness of these two tests will be greatly reduced.
Giving the patient a routine bone marrow examination may be a good idea.
By this time, Zhou Can had already walked into the lobby of the emergency department.
"Doctor Zhou, Director Han wants you to go to the consultation room to discuss the condition."
When the nurse saw Zhou Can, she hurried forward to tell him.
When Zhou Can arrived at the consultation room, he found that Ai Li, Deputy Director Han, and Director Shang of the Department of Gastroenterology were also present with their two students.
"Hey, I haven't seen Doctor Zhou for a while."
When Director Shang saw Zhou Can coming in, he immediately stood up and took the initiative to walk over and shake hands with Zhou Can enthusiastically.
Look at Director Shang's attitude. He didn't treat Zhou Can as a resident doctor at all. Instead, he elevated him to the level of an old friend of the same level as him.
" Haha, it's been a while since we last met. Director Shang looks better now."
Zhou Can responded enthusiastically and even flattered the other party.
