Auto chess in the operating room

Chapter 248 A Bold Conjecture

After returning to the duty room, Tang Lou pondered and began to consider how to infer the patient's condition.

The rest of the symptoms can basically be deduced through previous examinations.Just the most important biliary roundworm symptoms, really hard to explain.

Usual biliary ascariasis manifests as sudden epigastric drilling-like pain, but the patient's abdominal signs are often mild, so it is impossible to think of it in the self-report.

Moreover, the usual abdominal color Doppler ultrasound is basically diagnosed when the real-time ultrasound sees wriggling live roundworms.

However, this patient had a long onset time, reported atypical symptoms and signs, and no roundworms in the biliary tract were detected by color ultrasound from other hospitals or our hospital. Therefore, according to conventional thinking, it is impossible to consider biliary roundworms. This is a very rare disease.

This patient had pathological relaxation of Oddi's sphincter due to previous repeated gallbladder inflammation attacks and other reasons, which caused roundworms to penetrate into the biliary tract, and repeated epigastric pain caused intestinal gas to form interference.

Therefore, conventional color Doppler ultrasound examination failed to find it.

Tanglou also had a headache. He knew the answer but couldn't tell him. It was really uncomfortable.

After all, Western medicine is rigorous, unlike Chinese medicine, which can be fooled by metaphysics, the more magic stick, the more master.

Tang Lou looked again carefully, hoping to find evidence that could deduce biliary roundworms from the inspection data of these few times.

After all, this is not the No. [-] Hospital of Hecheng City. If it is in its own department, with Tanglou's current status, it can operate independently and treat directly. But in other people's territory, especially Ma Shuya, there is also an attending physician In the case of responsibility, if you can't tell the reason, you can't convince him.

Unable to convince others, with his qualifications, it will only increase the laughing stock.

In particular, which of the attending physicians of Zijingang Hospital is not a bigwig in the industry, how could he listen to the random guesses of a small doctor from the No. [-] Hospital of Hecheng City?
Seeing Tanglou frantically starting to research the information, Ma Shuya was a little surprised and a little admired at the same time.

He obviously just borrowed his own rest room to rest for a night, but he cared about this patient as much as his own patient.

It is enough to show that Dr. Tang is really a very responsible and pure doctor.

"It's no wonder that such an achievement can be achieved at such a young age."

Ma Shuya was also infected when she saw Tang Lou being so serious, and her previous anxiety was swept away. Tang Lou's innocent heart and serious and responsible spirit towards patients were not the best way to support her going forward. power.

"Thank you for letting me know that there are still so many doctors who, even though they are painful, uncomfortable, and helpless, are still working hard on the front line, forgetting to eat and sleep to bring hope to patients."

Ma Shuya said something silently in her heart.

I don't know when, Muzi also got up from the bed. Although he couldn't help Dr. Tang and Dr. Ma, he could still pour water for them, pass on information, and keep them awake.

"Doctor Ma, I can't help you right now, but I will definitely work hard and specialize in research, and strive to share your worries as soon as possible."

Seeing Tang Lou and Ma Yashu who were studying medical records all night, Muzi also made up his mind: You see, being a doctor is actually quite good.

Early the next day.

Under Ma Shuya's request, Muzi had already fallen asleep.

Ma Shuya studied it, but still didn't have a clue. When she was squeezing her brows, Tang Lou suddenly put down the materials in her hand.

"found it!"

With a sudden sound, Ma Shuya directly looked up at Tang Lou. Although he stayed up all night, Tang Lou's face was full of energy at this moment.

"Doctor Tang, what did you find?"

"Doctor Ma, if there are no accidents, I think I have found the cause of the patient's illness."

"Really?"

Ma Yashu clenched his fist excitedly.

"Ah."

Tang Lou directly sorted out the three physical examination indicators, and then copied down a set of data:
"You can see that the liver function, obstruction index, and jaundice index of the patient have increased to varying degrees after admission, and the blood routine shows a slight increase in eosinophils. I suspect that the patient's common bile duct may be blocked by some unknown reason. Stem? At the same time, looking at this color Doppler ultrasound, the patient's external bile duct is slightly dilated, and the lower end of the common bile duct is a line-like low-signal shadow. Is it possible that it is a parasite?"

Tang Lou pieced together one of the most hidden symptoms, and pieced together a bold inference through several sets of data.

"Status low signal shadow, status? Parasites?"

A picture also flashed in Ma Yashu's mind, and he said with some surprise: "You mean the patient may have roundworms in the biliary tract?"

"Yes, very likely."

Tang Lou didn't dare to talk too much.

Looking at Tang Lou, Ma Shuya slowed down for a full minute, and then carefully read the data of the three inspections and the few easily overlooked data transcribed by Tang Lou.

"If it's really a biliary roundworm, that would be too crazy!"

There is no one who analyzes symptoms like Tang Lou, who can find so many of them from dozens of pages of information, which have nothing to do with each other, and there is no key data in the respective pages.

However, according to Tang Lou's inference, it is really possible to look at the patient's signs and indicators in reverse.

However, the attentive Ma Yashu soon raised his doubts: "But that's not right. If it is biliary roundworm, we should have discovered it during the first color ultrasound examination."

Ma Yashu watched it again, and recalled the first diagnosis by Dr. Pan. At that time, it was because of the color Doppler ultrasound that the biliary roundworm was directly ruled out.

"I don't know the specific reason. It may be that the patient's repeated attacks of cholecystitis lead to physiological or pathological relaxation of Oddi's sphincter, which allows roundworms to penetrate into the biliary tract, and the intestinal accumulation of gas interferes with the repeated pain in the upper abdomen. Therefore, color Doppler ultrasound cannot see It's also possible."

Tang Lou let out a haha.

Looking at Tang Lou's face, Ma Yashu became a little unpredictable.

Sensing Ma Shuya's suspicious gaze, Tang Lou laughed: "After all, I am very talented and have a lot of capital. Sometimes diagnosis is all about a flash of inspiration!"

"Do an MRI+MRCP, and there should be results."

Tang Lou didn't explain anymore, and directly gave Ma Shuya a testing plan.

"can."

Ma Shuya nodded, and was also very curious in her heart, whether it was possible, as Tang Lou said.

"Also, I would recommend having another rectogram."

Tang Lou made another suggestion.

"Proctography?"

Being able to become a resident doctor of Zijingang Hospital, Ma Shuya is naturally very capable, and quickly reacted: "You suspect that the Chinese medicine enema may have caused the secondary damage to the rectum during the first treatment."

"clever."

Tang Lou got up and looked at the time: "I will leave the next thing to you. I still have one operation to do, so I will leave first."

"If it is confirmed, let me know as soon as possible."

After Tang Lou finished speaking, he took another fruit from the table, gnawed it and walked out of the duty room, his spirits radiant.

(End of this chapter)