"Dr. Fang, we also understand the basic information, why don't we go see the patient together."

Qingping suggested.

"Okay, let's go see the patient again, maybe we can make new discoveries."

Fang Qing nodded. After all, the information has limitations. Only by communicating with the patient in person can we understand the condition more comprehensively.

And sometimes, due to the patient's personality, illness and other reasons, the doctor only answers one question after asking a question, ignoring many details. And these small details, for experienced doctors, are often life-saving.

key.

The three attending doctors stood up. Qingping took a few steps and hesitated: "Wait a moment."

Yan Ruoyun was a little confused: "What's wrong?"

Qingping touched his nose and said, "Let Tanglou follow us, maybe we can help."

Yan Ruoyun thought for a while and nodded in agreement. Tanglou was indeed very clever in diagnosis. In today's confusing situation, it is always good to have more hope.

When Qingping called Tanglou over, Fang Qing was a little surprised. Of course he had seen Tanglou, but he didn't have much contact with him, and he wasn't in the same department. In fact, he didn't really want to bring Tanglou with him. After all, he was too

Younger.

However, he originally wanted to seek general surgery, and Dr. Qing and Dr. Yan suggested it. He couldn't lose face and just bring an assistant to record medical records.

Soon the group arrived at the ward.

Seeing three attending doctors followed by a young doctor, the contrast was particularly strong. The patients' family members were a little surprised and looked at the tenement building a few more times, but only for a look.

After all, it was the three senior experts in front who really solved the problem.

"Doctor Fang, my father still has a high fever and has persistent pain in his upper abdomen."

The patient's daughter complained to Fang Qing, her tone very anxious.

"The dull pain in the upper abdomen should be caused by heart problems left over from the old myocardial infarction bypass surgery, sinus tachycardia, and left heart enlargement. There will be persistent dull pain, which can only be relieved by prescribing medicine."

Fang Qing explained the cause of the pain in the lower and upper abdomen. As for the high fever, naturally there was no particularly consistent cause.

Qingping took out the patient's chest X-ray and looked at it, auscultated the patient's chest, and discussed with Fang Qing: "There is a reaction on the left pleura. You can see it is a bit white here. The breath sounds in both lungs are thick, and there may be a lung infection."

.”

"Pulmonary infection has not been considered, but the patient has no nausea, vomiting, or diarrhea, and only has some yellow sputum. If it is pneumonia, it does not make sense."

After all, Fang Qing is a physician and very experienced. He immediately ruled out pneumonia infection.

When the three attending doctors were arguing, Tanglou directly used diagnostic techniques on the patient:

[Patient: Wu Qingxuan, male, 63 years old

Symptoms: poor eating in the past 2 days, persistent pain in the upper abdomen (blockage), swelling in the back, a small amount of yellow phlegm, less drinking water, and excessive urination. No fever, chills, nausea, vomiting...

Diagnosis: type 2 diabetes, diabetic ketosis, coronary atherosclerotic heart disease, old myocardial infarction, coronary artery bypass surgery, sinus tachycardia, left cardiomyopathy, acute cholecystitis

Special reminder: Because the patient had previous myocardial infarction surgery, diabetes, and old myocardial infarction, it was easy to ignore the real cause of upper abdominal pain. The patient ate more greasy food at night 3 days ago, which caused acute cholecystitis.

Because the patient has many symptoms and poor physical condition, he cannot withstand cholecystectomy, so it is recommended to undergo percutaneous transhepatic gallbladder puncture and drainage]

After knowing the reason, Tanglou breathed a sigh of relief, but he had a headache again. How could he explain the cause to the three bosses?

Tanglou really wants to imitate Conan and directly stun Qingping.

However, he has no place to hide his strong and slender body, and secondly, he does not have the talent to imitate Qingping's speaking skills.

While Tanglou was deep in thought, Qingping noticed Tanglou's abnormality and asked directly: "Tanglou, what do you think of the cause of this patient's illness?"

Yan Ruoyun also looked at Tanglou, feeling a little expectant in his heart. After all, Tanglou had given him several surprises.

Only Fang Qing frowned slightly, but he also moved his body to the side, giving Tanglou a chance to get closer to the patient and observe him.

When Tanglou heard what Dr. Qing said, he shrugged helplessly: "Many of this patient's symptoms are from the field of endocrinology, and I don't know much about them."

Qingping and Yan Ruoyun were slightly disappointed, but it was expected. After all, even they couldn't see it. It was normal for Tanglou to be unclear.

Fang Qing nodded slightly. Indeed, this patient's symptoms all belong to the field of internal medicine. It is indeed difficult to find a surgeon.

Just as the three of them were about to continue the discussion, a sentence rang out from the bottom of the building: "So I may not think about it as comprehensively as Dr. Fang did. After all, due to my limited vision, I just follow the routine treatment of acute abdomen."

I guess based on the symptoms. Among the patient’s symptoms, I only noticed that one was persistent pain in the patient’s upper abdomen, and the other was the patient’s elevated body temperature.”

"In the upper abdomen, from the perspective of acute abdomen, it may be the liver or the gallbladder."

Fang Qing and others were also shocked by Tanglou's way of thinking. They ignored so many more important symptoms and treated it directly as an acute abdomen.

But then I thought about it, after all, Tanglou had only been an intern in general surgery for a few months, and he was only exposed to acute abdomen, cholecystitis, and appendicitis.

After all, I have a limited vision and cannot see the problem as comprehensively and comprehensively as they do.

"Tanglou, your opinion is quite interesting, but I still insist that the patient's persistent pain in the upper abdomen is caused by a heart problem. You see, the pain was slightly relieved after we applied Voltaren to the patient, and his blood ejection

The score is only 33%, which supports my conclusion."

Fang Qing still praised Tanglou for speaking out so boldly, but after all, Tanglou had little experience and didn't know much about old myocardial infarction and heart disease.

Yan Ruoyun and Qingping, speaking from experience, also support Fang Qing, but Tanglou's conjecture is not completely impossible.

If it is cholecystitis, it is also possible to have persistent pain in the upper abdomen, high temperature, and loss of appetite.

If Tanglou hadn't had a systematic diagnosis, he would have been convinced by Fang Qing. After all, patients with systemic diseases have too many interfering factors, and the symptoms they cause are very similar. The conventional thinking must be that the heart is easier to see and determine.

The problem is that the tape is off track.

After thinking for a while, Tanglou walked towards the patient again: "I would like to ask, how has the patient been eating in the past few days?"

The patient's daughter recalled: "I have eaten very little in the past three days. I only ate some noodles and drank very little water. Basically, I just kept my mouth moist."

Fang Qing nodded. He had confirmed this information several times.

"What about three days ago?"

Tanglou asked continuously, staring at the family members with very sharp eyes.

"I didn't pay attention to this." The patient's daughter looked at her father and lowered her head, "Dad, what did you eat three nights ago? Do you remember?"

The patient slowly turned his head to his daughter, then looked at the doctors Tang Lou and Fang Qing. He paused for a few seconds and said, "Fried shredded radish cake...braised pork intestine...braised pork..."

After finishing speaking, the old man slowly turned his head away, closed his eyes slightly, and fell into silence.

The expressions of Fang Qing and Qing Ping on the side changed.

The patient's daughter also remembered: "It seems that after eating that night, she started to feel nausea and vomiting. Then she started to have some upper abdominal discomfort the next day. After coming to the hospital, she had an old myocardial infarction and bypass surgery.

I was worried that it was a heart problem, so I went to the cardiology clinic."

"Why didn't you tell me before that you ate something so greasy at night?"

Fang Qing also didn't expect that there was such a detail.

The patient's daughter felt aggrieved: "Dr. Fang, you didn't even ask. Is this important?"

"Of course it is important. Because it is too greasy, it will cause the liver to secrete bile and the gallbladder to store and discharge it. Liver and gallbladder problems may occur."

Qingping said aside, then walked forward directly, lifted the patient's quilt, lifted the patient's shirt to his chest, put his hand on it, his face changed slightly: "The patient's abdomen is hot."

Yan Ruoyun also didn't expect that Tanglou's analysis might point to the truth. He was so excited that he said: "An abdominal ultrasound and CT will reveal the truth."

Fang Qing nodded and hurried to arrange the examination. The patient's family members were also anxious and somewhat expectant.

The next step is to wait for the results. Qingping, Yan Ruoyun and Tanglou all returned to the office.
Chapter completed!