I can see the status bar

Chapter 768

"Why do I feel that you feel a little strange today?" At two o'clock in the afternoon, Sun Lien's first diagnostic team was invited by the Hepatobiliary Surgery Department for consultation.On the way from Zhou Xiufang Comprehensive Diagnostic Center to the Department of Hepatobiliary Surgery, Yuan Pingan finally couldn't help but asked, "The smile on your face today...looks a bit lacking."

"I think so too." Zhou Ce nodded and added, "It's that kind of grin that makes people hate it."

"Am I smiling strangely today?" Sun Lien touched his face inexplicably, and didn't feel that there was any major problem, "Is it your illusion?"

"It's definitely not an illusion." Yuan Ping'an emphasized, "Doctor Xu saw it too!"

"Maybe something good happened?" Xu Yourong obviously didn't want to speak ill of Sun Lien with her colleagues, but she was still curious about what happened, "Did the paper be published?"

Zhou Ce rolled his eyes undisguisedly, "Generally speaking, when good things happen, you probably think about the four great joys in life, right? Why do you still think about papers?

"Dr. Sun doesn't have much else, the paper is enough anyway." Yuan Ping'an teased, "I just don't know when he published another paper without telling us."

"I don't care about anything else, I'll assign a paper to me, and I'll just pretend I don't know about it." Bruen coughed behind him, "Can we hurry up? It's so cold outside, it's so cold that I want to eat hot pot."

Talking and laughing along the way, the four of them entered the emergency building through the corridor next to the helipad, and then came to the hepatobiliary surgery department.

"Today's case...we are a little uncertain." The doctor from the Department of Hepatobiliary Surgery saw the four people entering the meeting room, and began to cry out without any politeness, "Look, why don't you... Transfer to your department?"

It was not Zhao Chongxi, the director of the Department of Hepatobiliary Surgery who called for a consultation today—Old Comrade Zhao had an academic conference to attend these two days, and he was away from the department for a week.The person who asked for consultation was the current chief resident physician of the Department of Hepatobiliary Surgery.

"The patient was admitted to the hospital because of epigastric swelling and jaundice. Before admission, the outpatient hepatitis types were all negative. CT showed small cysts in the S4 segment of the liver, small spot calcifications in the right lobe of the liver, mild expansion of lymphatic vessels in the hilar area, and gallbladder. Calculus." The resident outside the liver and gallbladder directly omitted his self-introduction, and then began to recite various indicators of the patient like a mouthful.

"MRI was done, which indicated early liver cirrhosis, splenomegaly, gastric varices and multiple intrahepatic cysts, and a small cyst in the S4 segment of the liver... But in MRCP (magnetic resonance cholangiopancreatography), there was no cyst at the upper end of the common bile duct and pancreas Visualization. The wall of the upper end of the common bile duct and pancreas is suspected to be thickened.” The boss of the hepatobiliary surgery took out the inspection report, “We checked the patient for AIH (autoimmune liver disease), SSA/52KD antibody was positive, anti-gb210 antibody was positive, and anti-mitochondrion M2 antibody is also positive. The full set of immunization shows IgA4.29g/L, IgG28g/L, IgM 5.25g/L...the immune index is very high."

No wonder the Department of Hepatobiliary Surgery is so anxious to seek consultation.As a surgical department, they are not very good at interpreting these immunological indicators.

"Immunological questions...why don't you ask the Rheumatology and Immunology Department?" Sun Lien looked at the indicators, a little confused.Although these indicators are rather special, the clinical significance is still relatively clear-either it is an indication of infection, or it is an indication of autoimmune system disease.Considering that AIH is also checked for patients outside the liver and gallbladder, they obviously have considered this problem and have also tested it. "These three indicators are positive, coupled with elevated IgG, it is no problem to give the diagnosis of AIH?"

"The AMA antibody is positive, and the IgG antibody is elevated. These two indicators are no problem in judging autoimmune liver disease. But her other indicators can't explain it." The chief resident outside the liver and gallbladder sighed, "Let's contact the Rheumatology and Immunology Department After several days, they said that this is an autoimmune liver disease, which can be treated in our department. But we cannot explain other indicators..."

The current situation is relatively clear-a patient showed symptoms of liver injury and cholecystitis. After admission, he was admitted to the Department of Hepatobiliary Surgery as ordinary cholecystitis.However, the hepatobiliary surgery department felt that something was not right during the preoperative examination. After the examination along the way, it was found that the patient had at least AIH.

Simple AIH is not easy to discourage hepatobiliary surgery - after all, they have also dealt with similar patients.But the headache for Zhu Zong is that AIH plus gallstones cannot fully explain the reasons for the increase of IgG, IgM and IgA.

Although physicians have always despised surgeons for being simple and rude, they have a good point—surgeons are also very cautious when they should be cautious.After discovering the problem that they could not explain, the doctors of hepatobiliary surgery decisively stopped the treatment they were preparing.They don't want to risk operating on a patient until they figure it out.

"That is to say, there are still many methods that have not been used yet." Sun Lien pondered for a moment, and decided to start with the most direct method, "Has the nature of the cyst in the patient's liver been clarified?"

To "determine the nature of the cyst inside the liver", there is generally only one clinical method, and that is tissue biopsy.

"I haven't done it yet. If I want to do it, I can arrange it in the afternoon." The head of the Department of Hepatobiliary Surgery said, "This patient..."

Bruen suddenly said, "I think it can be sent to our department."

This statement surprised the doctors of the first diagnostic team.After all, Bruen seldom expresses his opinion on the treatment of patients.

"Tang Min lives alone in our department. She is in good condition now, and we have the ability to treat other patients." Bruen explained his opinion concisely, "Moreover, the problem of immunity can make the patient feel better. Pascal handles that. We just need to perfect the checks."

Within the four-hospital system, Pascale is recognized as the most experienced doctor in dealing with autoimmune diseases.Even if the old Pa is removed, Sun Lien has more experience in dealing with autoimmune diseases than hepatobiliary surgery.

"We are not very familiar with liver and gallbladder diseases..." Sun Lien frowned and thought for a while, and finally decided to accept Brune's opinion, "Forget it, anyway, there are still many beds, so let's take them first. He turned his head and said to the chief resident of the Department of Hepatobiliary Surgery, "You can make arrangements first to give the patient a liver biopsy, and then send it to our department."

Of course, there is nothing wrong with doing a biopsy in the liver and gallbladder surgery department, but Sun Lien also has his own little thoughts in how he handles it.

·
·
·
"Do you think there is something wrong with this patient's condition?" When walking back to the comprehensive diagnosis center, Sun Lien deliberately slowed down, and said to Brunn beside him, "Or do you think the extrahepatic and gallbladder treatment is wrong?"

"There's nothing wrong with what they're dealing with—it's surgery after all." Bruen shrugged his shoulders in a very American way, "I just think this patient is similar to a patient I've seen before."

"Have you seen it before?" Sun Lien was taken aback, "In the emergency room?"

"In the Caribbean." Bruen shook his head. "I saw a woman with similar symptoms when I was a visiting doctor, but at that time the conditions were limited and there was no MRI and CT. I took her blood samples several times and sent Go to the country for inspection. But before getting the results of IgG, IgM and IgA elevation, she died."

(End of this chapter)