I really don't want to be a doctor

Chapter 54 Multiple Choice Questions

Yu Wenxing read the medical records carefully.

Xiao Liang.

Age 16 years old.

Chief complaint: abdominal pain for 3 years.

History of present illness: 3 years ago, the patient began to have abdominal pain without obvious inducement, showing intermittent dull pain and discomfort, accompanied by intermittent abdominal distension, accompanied by tenesmus, without chills, fever, nausea, vomiting, diarrhea, and blood in the stool. The patient was treated in several individual clinics Afterwards, the effect was poor, and she went to Sihe Provincial People's Hospital to see a doctor. After infusion therapy (specifically unknown), the symptoms were not relieved obviously, and she returned to our hospital for treatment.

Past history and personal history are nothing special.

"This patient is considering chronic abdominal pain. Abdominal color Doppler ultrasound, CT, enhanced CT, and abdominal MRI have all been done, but no abnormalities were found. I think an exploratory laparotomy should be done."

Liu Jun, the doctor in charge, first expressed his opinion.

Unexplained abdominal pain,

It was indeed a pointer to a laparotomy.

"Exploratory laparotomy is indeed a surgical indicator for abdominal pain with unknown cause, but this patient is only 16 years old. The large scar left by the large incision will definitely have some impact on the future. Can I suggest conservative treatment first?"

Zhang Qiang put forward different opinions.

Too,

16 year old kid.

His future is still very long,
A 20cm long incision was left directly on his abdomen, which seemed imperfect.

"Then how do you say conservative treatment?"

"Anti-infection, antispasmodic, symptomatic."

"But he has used these in the Sihe Provincial People's Hospital, and the effect is not good." Liu Jun retorted.

"Then what if no abnormality is found in the laparotomy? If it is a non-organic disease such as irritable bowel syndrome, or it is gastroenteritis, the laparotomy will not solve the problem at all."

"However, how do you know it's okay if you don't open it? If it's ischemic bowel disease, how can it be treated without surgery?"

The two were quite emotional, as if they were about to quarrel.

But everyone watched happily,

medicine
Isn't it just progress in the quarrel?
Li Xiaojun also joined the discussion.

His opinion is more inclined to Liu Jun, who needs a laparotomy.

After all, there is such a saying in general surgery: no matter what the disease is, open the stomach first.

But for a child who is only 16 years old, opening his stomach directly is indeed a bit cruel.

Everyone presents evidence and speaks their own words.

Those who think that surgery is necessary mostly consider the disease itself.

The party who thinks that there is no need for surgery is more concerned about humanities.

Even Zhang Qiang has moved out the [Guidelines for Primary Diagnosis and Treatment of Chronic Abdominal Pain], which clearly states: Chronic abdominal pain needs to be alert to psychological factors.

The quarrel among the crowd ended with no result.

Finally, it was time for Deng Liming to make a final decision.

"Let's go see the patient first."

After Deng Liming spoke, everyone stood up and followed Deng Liming to see the patient.

Talking about the operation method without the patient is undoubtedly playing hooligans.

However, most patients have relatively clear surgical guidelines, and there are not many patients to see during the preoperative discussion.

Liu Jun walked in the front with the medical record card and led the way.

31 beds.

When Yu Wenxing saw the patient, he was a little surprised.

He was obviously a 16-year-old child, but he looked very short, terribly thin, with distinct bones on his face, sunken eyes, and an extremely tired look.

The clothes on his body were clean, but it made those patches more conspicuous.

A woman was sitting by the patient's bed, her head was lowered, she raised her head when she heard someone coming, her hair was messy, and there were bloodshot eyes in her pupils.
can see,

She is the patient's mother and is exhausted.

"Teacher Liu."

she stood up,
Some humble, some timid.

"Well, this is our department director, Director Deng."

"Director Deng." She rubbed her hands again and looked at Deng Liming expectantly.

Deng Liming smiled kindly, and began to ask about the medical history,

The patient is also very shy, his voice is very low, and he can't remember some things clearly. The patient's mother will help to answer.

He also asked about the family situation, and when he learned that the patient's father had passed away, Deng Liming frowned slightly.

After the questioning, Deng Liming began the physical examination.

can see,

The patient's pain was not obvious, but the scope was not small. There was tenderness in the entire right abdomen.

"You guys rest first."

When Deng Liming left, he gave another warning, and then he left.

Everyone returned to the office without speaking.

They also saw it,
The patient has no money at home.

Without money, it means that patients cannot afford the consequences of treatment failure.
Probably this is also the reason why the patient came back from Sihe Provincial People's Hospital.

Yu Wenxing also clearly felt the power of the word money.

Make up your mind to complete the small goals quickly.

Seeing that no one spoke, Deng Liming spoke.

"The medical history of this patient is basically clear. The abdominal pain has lasted for 3 years. This kind of chronic abdominal pain, and the imaging examination did not find any problems. It is indeed a pointer for an exploratory laparotomy. But now there are several problems.
First, the general condition of the patient is poor. Although he is very young, recovery after surgery is a big problem. "

Postoperative rehabilitation has always been a problem for surgeons.
Laparotomy is a major operation, and the incision must be at least 20 cm. Because the intestinal tract is turned, it is impossible to eat directly in a short time, so intravenous nutrition is required.

Amino acids, fat emulsions, and albumin all need money.

"Secondly, the patient's family situation is relatively poor, and they cannot bear the consequences of treatment failure. If the laparotomy is opened and no problems are found and then closed, it will definitely be a very big blow to the patient's family."

This is also a problem for surgeons.

a surgery,
In fact, the surgery fee is not expensive.

But counting anesthesia, nursing, materials, and postoperative hospitalization,
These are money.

The patient's family is already in difficulty. If the problem is not solved after the operation, the money will be in vain.

"However, if conservative treatment is used, the effect will definitely not be good. This patient has been treated outside the hospital for 3 years, and even went to Sihe Provincial People's Hospital. The conservative treatment effect in that hospital is not good. I don't believe that the conservative treatment effect here is satisfactory. .”

Deng Liming took a sip from the thermos and sighed heavily. This kind of patient is very difficult and he has a headache.

This patient is different from that of Liu Lin.

In Liu Lin's case, surgery is necessary. We only need to discuss the surgical method, and everyone is sure that the surgical treatment can achieve the desired effect.

But this patient is different. We have to discuss whether it is necessary to have surgery, and we are not sure about the effect of surgery.

This is the doctor,
Doing multiple choice questions every day.

Some questions are very simple, and you can know to choose A at a glance.

Some questions are difficult. After looking at A, it looks a bit like but not like; looking at B, it looks a bit like but not like; looking at C, it still seems not quite right. I want to look at D again, but the answer is only ABC.

(End of this chapter)