Doctor's Life Simulator

Chapter 210 Two senior doctors who are well-founded and convinced
"Bullshit."

Li Ming was about to leave, but when he heard Qin Lang's nonsense, he scolded him directly.

"Qin Lang, what do you mean?"

Director Pang also asked in puzzlement, Qin Lang's remarks were indeed somewhat unexpected.

On the contrary, Liu Peichun came alive, wondering why Qin Lang would make such a conclusion.

Qin Lang ignored Li Ming's scolding, went directly to the computer, and pulled out the original medical records.

"Director Pang, Dr. Li, listen to me speak slowly, I can say that, of course, it is not aimless."

After Qin Lang adjusted it, he grabbed a laser pointer and moved the red dot to the patient's abdomen.

"Doctor Li, since it's a consultation, let's listen to Qin Lang's analysis."

Director Pang waved at Li Ming. Li Ming frowned and sat down, wanting to hear what constructive suggestions Qin Lang could offer.

"Presumably everyone has noticed the 6cm surgical scar on the patient's abdomen."

Looking at the position of the Qinlang laser pointer projection, Director Pang nodded. Naturally, he had asked before: "The patient had a right oophorectomy before, but it has been 20 years, so I judge that there is no direct connection with this appendicitis. .”

"Then, Director Pang, have you ever thought about why the patient has had repeated stomach problems in the past two years?"

Qin Lang raised another question.

"The patient is 48 years old, and he has several chronic diseases that are not very normal. Maybe he had an irregular diet before, and it has been repeated for two years. And the rebound pain and tenderness in the stomach and right lower quadrant have nothing to do with each other. We are now in To solve the problem of acute appendicitis, chronic stomach problems are not within the scope of this operation. Moreover, I don’t think it has anything to do with acute appendicitis.”

Li Ming had a prejudice and a feeling of resistance, but he couldn't listen to it anymore, thinking that Qin Lang's talk was too far away.

"Does it really matter?"

Qin Lang raised his head and looked at Li Ming with a very oppressive tone.

Li Ming was slightly taken aback. Naturally, he didn't dare to say 100% that it had nothing to do with it. After all, there is no absolute in medicine, so he was at a loss for words.

In the general surgery department, he was used to the respect of little doctors. This Qin Lang made him feel a little embarrassed. Li Ming was a little annoyed, and said coldly:
"Then I want to ask Dr. Qin, what's the relationship between the two?"

Being bullied by a resident doctor who just became a full-time doctor, as an attending physician, Li Ming naturally lost his temper.

Seeing the tense atmosphere, Liu Peichun shrank his neck in fright, this Qin Lang was too rigid.

Director Pang was also a little helpless, the Qin Lang whom Director Zhuang valued was really a worry-free master, but he was also a little curious, and urged: "Qin Lang, then tell me."

"The patient's self-reported pain transfer route described by Dean Pang just now, I don't think the patient's description is wrong like what Dr. Li said. Instead, we are confused by conventional thinking. When we think of rebound pain, tenderness is considered acute. Symptoms of appendicitis."

"Rebound pain and tenderness alone are not enough to prove it, but the color Doppler ultrasound is very clear."

Unconvinced, Li Ming pointed to the key evidence.

"Is this one?"

Qin Lang switched the picture to the color ultrasound page.

"Yes, the patient's words may be true as you said, but they may also be false as I said. But color Doppler ultrasound can't lie."

Li Ming held the teacup in a menacing manner.

"What you see with your own eyes is not necessarily true."

Qin Lang shook his finger, turned to the first page of the medical record again, and used a laser pointer to walk a few times on the words "the main cause is metastatic right lower quadrant pain".

"We now throw away all the diagnosis of appendicitis and return everything to the starting point of the patient's pain."

Qin Lang said while getting up and walking the path of the pain in his abdomen, but the direction was exactly the opposite of Director Pang's.

"What do you mean?"

Director Pang frowned slightly, and there was an unspeakable thought in his heart, which was also the origin of his first consultation.

Li Ming was also a little baffled, but felt that Qin Lang's movement track had a feeling of deja vu.

"What if the trajectory is not the appendix itself, but something that actually flows?"

"You mean maybe some kind of exudate from the liver went down the right lower quadrant?"

Director Pang slapped the table violently, and his mind suddenly opened up.

"But it doesn't make sense. Where did the seepage come from for no reason?"

Director Pang fell into doubt again, which made no sense.

Li Ming was also thoughtful, and quickly found out Qin Lang's loophole: "Your brain hole is indeed somewhat interesting. But you forgot that the patient's appendix is ​​in the lower right abdomen. According to your guess, it is the appendix gangrene exudate Flow, the premise is that the appendix is ​​in the liver, and it can only be established from top to bottom."

Li Ming made a gesture on his abdomen, and stopped at the lower right abdomen, which is the position displayed by the color Doppler ultrasound.

It can't always be that the patient's appendix will teleport, leaving exudate in the liver area first, and then moving to the right lower abdomen.

Li Ming sharply pointed out Qin Lang's flaws.

"Yes, how do you explain this?"

Director Pang was also stuck here, it didn't make sense, Qin Lang's explanation was contradictory.

"I have already explained at the beginning that what you see is not necessarily true. Have you ever thought about another possibility, that is, the appendix in the right lower abdomen is not the appendix at all, and the patient's appendix is ​​always in the lower part of the liver, that is, the patient often where the pain strikes."

Qin Lang stood up, walked to the projection screen, and put his finger on the patient's original surgical scar, which was the location of the pain this time, and also the shadow of the color Doppler ultrasound:
"Is it possible that this is not the appendix at all, but the lumen formed by the patient's right oophorectomy 20 years ago due to adhesion, which was mistaken for the blind end of the appendix by color Doppler ultrasound. And the patient's appendix has always been under the liver , which is where the patient has been suffering from repeated stomach pains for the past two years.”

Qin Lang rested his fingers on his upper abdomen, his whole body was in high spirits!
"You mean, the patient's repeated stomach pains were originally repeated chronic appendicitis, but this time acute appendicitis and gangrene caused exudate to flow to the right lower abdomen, triggering typical symptoms of appendicitis."

Director Pang looked at Qin Lang in disbelief. This associative ability is too amazing. Although it is bizarre, if you look at it in detail, it really perfectly explained the patient's strange path of pain transfer.

Even, the source of the patient's recurrent stomach problems was found.

After hearing this, Li Ming was also a little confused. He quickly drank a sip of tea and calmed down. With his rich experience, it is indeed reasonable to combine the evidence pointed out by Qin Lang and the different symptoms of the patient before and after.

"This"

Li Ming didn't know what to say for a while, and looked at Director Pang, who was shocked.

"Actually, if you want to know whether what Qin Lang said is true, you need to do an examination of the liver area."

Director Pang thought for a few seconds before proposing the next solution.

"Director Pang, I have already visited the patient with Dr. Liu before the consultation. After the physical examination, I felt a lump in the patient's upper abdomen, and there was obvious tenderness when I pressed the patient."

Qin Lang added one last sentence.

"really?"

At this moment, Director Pang and Li Ming began to believe Qin Lang's conclusion with [-]% to [-]%.

If there is really a lump and tenderness in the upper abdomen, then Qin Lang is not just guessing, it is justified.

The two big brothers exchanged eyes in disbelief, it was like a dream.

After digesting his emotions, Director Pang spoke:
"Qin Lang, you did a good job. I will go to examine the patient now. If it is true as you said, then the best way is indeed to perform laparoscopic appendectomy."

Li Ming looked at Qin Lang with a complicated expression for a few seconds, then stretched out his thumb: "Young people are awesome."

Without Qin Lang's suggestion, the consequences of hastily performing the Mai's incision would be disastrous, and Li Ming was naturally afraid for a while.

An hour later, the ultrasonography of the patient's upper abdomen revealed it. Combined with the physical examination, Qin Lang's inference was more than [-]% likely.

After Director Pang returned to the office, he made a summary and surgical arrangement:

"Department consultation conclusion: the patient has congenital colonic variation, ectopic appendix, acute appendicitis, laparoscopic appendectomy is recommended."

Director Pang looked at the somewhat unpredictable young man, and thought of Director Zhuang's entrustment, so he planned to give him some opportunities for surgery and asked:

"Qin Lang, do you know how to do laparoscopic appendectomy?"

(End of this chapter)