Tanglou looked at Wang Airen's past history again:

She complained of recurring upper abdominal pain and discomfort, belching, etc. She usually took Starasil and Motilium for symptomatic treatment.

Physical examination: T: 36.2 ℃? P: 72 times/min? R: 19 times/min? BP: 158/102 mmHg

Clear consciousness, low energy, flat abdomen, no bulging, no abdominal wall varicose veins, scattered tenderness throughout the abdomen, obvious tenderness in the upper abdomen, accompanied by rebound tenderness, local suspicious muscle tension in the upper abdomen, liver and spleen not palpable under the ribs, liver dullness

Present, bowel sounds were not heard, and shifting dullness was negative.

When checking the auxiliary examinations from five days ago in the tenement building, Ma Shuya also explained, pointing to the patient's abdominal CT and explained:

"Dr. Tang, look here. There is a small amount of free air at the front edge of the left lobe of the patient's lungs. It is initially speculated that the patient has perforation of the cavity organ, peritonitis in the upper abdomen, peripancreatic and colonic splenic flexure, and left paracolic sulcus area.

Liquid. Pancreatitis cannot be ruled out."

Tang Lou nodded and added: "We can enhance the scan to further check whether there is a possibility of necrotizing pancreatitis."

Ma Shuya agreed very much: "What Dr. Tang said is correct at all. We will also conduct enhanced scans later. You can see the films from three days ago later."

Ma Shuya pointed to the abdominal CT scan five days ago and told Tang Lou the conclusion of the first examination: "Dr. Tang, you see the strip-like high-density shadow in the patient's right hepatic duct and pancreatic duct area, with sand-like stones inside.

In addition, cholecystitis can be seen, the patient's bilateral renal pelvis is mildly dilated and hydrocephalus occurs, there may be cysts in both kidneys, and small stones in the left kidney are also found, suggesting coronary artery calcification."

Looking at this chest CT, Tanglou also frowned. There are many complications. This kind of case is really rare, and it can be published in a separate paper.

It can also be seen from here that the uniqueness of Zijingang Hospital is that it treats basically all the difficult and complicated diseases in the province. Such complex cases are very rare in Hecheng No. 1 Hospital.

Ma Shuya took out the patient's chest CT scan from five days ago: "Dr. Tang, look, from this film, we can see that the patient meets the symptoms of chronic bronchitis and emphysema in both lungs. At that time, Dr. Pan, the chief physician of our department,

A senior attending physician who studies the liver, biliary and pancreas suggested considering pneumonia in the lingual lobe of the left lung, middle lobe of the right lung and both lower lungs."

Ma Shuya then pointed to the upper and middle lobes of the patient's right lung: "Doctor Tang, these areas have calcified nodules."

Tanglou nodded solemnly, and at the same time looked at the patient's heart shadow, which was also slightly larger than normal. It was obviously caused by coronary artery calcification. At the same time, the aorta was slightly dilated and circuitous, and calcium plaques formed on the wall.

Tanglou looked at the following blood routine indicators again: C-reactive protein? 7.7mg/L↑, high-sensitivity C-reactive protein? 5mg/L↑, white blood cells? 12.37*10^9/L↑, neutrophil percentage?

94.80%↑.

"Based on the examination on the first day, Dr. Pan made a preliminary diagnosis that the patient suffered from hollow organ perforation and acute pancreatitis. He was given a fasting gastric tube, an intravenous channel was established for fluid replenishment, cefoperazone and sulbactam (domestic), and replacement

Nitrazole dual anti-infection, omeprazole to protect the stomach, rehydration and other treatments. Traditional Chinese medicine enema."

Since he has never seen the patient himself, Tanglou can only make inferences based on the case data. Obviously, Dr. Pan's diagnosis is very reasonable and comprehensive.

Next, there was the information from three days ago and the supplementary abdominal contrast-enhanced CT. Ma Yashu told Tanglou Doctor Pan’s secondary diagnosis:

1. Consider acute pancreatitis, mid-upper abdominal peritonitis, and scattered abdominal and pelvic effusion, and hope to combine it with clinical analysis.

2. Small cysts in the liver

3. Small cysts in both kidneys and small parapelvic cysts.

4. Reflective changes in both lower lungs. (Compared with the CT scan five days ago: no definite free air shadow was found in the abdominal cavity in this scan, peritonitis was worse than before, and the reflex changes in both lower lungs were increased. (Liver function was re-examined completely normal)

After Ma Yashu finished speaking, she handed Muzi's latest ward inspection information to Tanglou with some depression:

"Dr. Tang, under the treatment plan based on the previous diagnosis, the patient's overall pain level today has been significantly relieved compared to when he was admitted to the hospital, but he still feels pain. The pain is mainly in the upper abdomen and under the xiphoid process. The pain is persistent and worsens in episodes."

"Obviously, we still overlooked something, and we still haven't found out the key cause of the patient's disease."

Ma Yashu sighed, obviously there was no progress.

Tanglou was unable to do anything based on this information alone, and he had no good suggestions at the moment.

Seeing Tanglou's condition, Ma Shuya was not surprised. She stood up, took a few fruits and handed them to Tanglou: "Doctor Tang, even Dr. Pan has been studying this patient's condition for four or five days, and still can't find anything.

, you didn’t find anything, it’s normal.”

"Perhaps in Hecheng No. 1 Hospital, your department does not have this feeling, but in Zijingang Hospital, although it has the best doctors and the most advanced equipment in the province, it also treats various difficult problems that cannot be solved in the province.

Miscellaneous diseases, so the situation of this patient is very common."

Ma Yashu took a sip of tea, and then smiled sadly: "Sometimes, I really feel that being a doctor is boring. The patient came with high expectations, but after more than ten rounds of diagnosis and examination, we still couldn't come up with any constructive suggestions.

What do you think is going to support us?"

Muzi on the side seemed to have seen this side of Ma Shuya for the first time. After all, he had just started his internship and had not yet had such a realization, but he also felt a little sad.

He secretly hid in his bed, closed his eyes, and didn't dare to disturb me.

After all, even Dr. Pan, Dr. Ma, and Dr. Tang couldn't solve the difficult and complicated diseases, so she only added trouble to them.

It’s really hard to be a doctor!

Seeing Ma Shuya's frustration, Tanglou didn't know how to comfort him. He thought for a while: "Doctor Ma, how about we go to the ward to see the patient now, or maybe we can gain something."

"That's okay."

Ma Shuya just pretended to be out for a walk and had no expectations.

The two people soon arrived at the ward. The patient Wang Airen had already fallen asleep, and the patient's daughter was lying on a folding chair nearby with her eyes closed.

It's obvious that I've been suffering a lot these past few days.

"Doctor Tang, why don't we go in and ask again tomorrow morning?"

Ma Yashu walked to the door, thought for a while, and decided not to go in and disturb her. One reason was that she did not want to wake up the family members and the patient, and the other reason was that if the patient really asked, she would not be able to give the patient anything but disappointment.

Tanglou stood at the door and fired a diagnostic technique:

[Patient: Wang Airen, female, 75 years old

Symptoms: clear mind, poor energy, flat abdomen...

Diagnosis: 1. Acute pancreatitis, 2. Biliary ascaris, 3. Peritonitis, 4. Small cysts in both kidneys, 5. Pelvic abscess, 6. Rectal perforation caused by enema...

Special reminder: Bile duct roundworms are very hidden, so you need to re-examine the biliary tract with color ultrasound to confirm, and perform rectal angiography at the same time. Pay attention to secondary damage caused by enema during treatment.】

Seeing Tanglou still staring at Wang Airen in the ward, Ma Shuya reminded him in a low voice: "Doctor Tang?"
Chapter completed!