Doctor's Life Simulator

Chapter 254 Curious, How He Diagnosed It

Zhou Hengzheng led a group of his junior doctors to make rounds in the ward. He was also a little surprised when he saw Qin Lang's call.

However, after the video of Qin Lang's surgery before, as well as Professor Shen Xi, Dean Hang's cultivation of him, and the establishment of a separate laboratory, Director Zhou no longer looks at Qin Lang as an ordinary little doctor.

Moreover, just yesterday, Director Tong Jinshan of the Thoracic Surgery Department of Zijingang No. [-] Hospital asked himself to invite Qin Lang to participate in this weekend's academic activities.

There is no doubt that, no matter in terms of clinical talent, background resources, or personal image, Qin Lang will be a star doctor and a future star that the city's first hospital will focus on training.

After answering the phone, Director Zhou heard Qin Lang's report:

"Hello, Director Zhou, I'm Qin Lang. Dr. Liu and I received a patient in the emergency department. The initial diagnosis was early thoracoabdominal aortic aneurysm. Further diagnosis and examination are needed from your side."

Hearing Qin Lang's narration, Zhou Heng's eyelids twitched. He was very aware of the seriousness of abdominal aortic aneurysm. However, Qin Lang only diagnosed thoracoabdominal aortic aneurysm based on simple signs and inquiries. Also too exaggerated?

Even he would at least go through CT, color Doppler ultrasound or MRI before he dared to clarify.

Abdominal aortic aneurysm, which is a common disease in people over the age of 50.

Under normal circumstances, the change of arterial wall structure is accompanied by age. With the increase of age, the elastin fibers of the arterial wall are degraded, broken and calcified, and the aging aortic wall cannot resist the action of factors that cause aneurysmal expansion. , The destruction of the middle layer of the artery, the local or extensive permanent expansion or bulging of the arterial wall due to the inability to withstand the impact of the blood flow.

Smoking, inflammation, trauma, advanced age, high blood pressure and other risk factors can promote the occurrence and development of abdominal aortic aneurysm. Once an abdominal aortic aneurysm ruptures, the fatality rate is as high as 50%-80%.

However, an abdominal aortic aneurysm can only be diagnosed when the diameter exceeds 4cm. The early manifestations are only pain, and the location varies. Cutting pain.

The principle of pain is due to the increased tension of the aneurysm wall, which causes the traction of the adventitia and posterior membrane of the artery, compresses the adjacent somatic nerves, or is caused by the acute expansion of the aneurysm and tears the arterial wall.

Zhou Heng, according to Qin Lang's discussion of the patient's situation, even he would immediately consider gastrointestinal diseases, and it is difficult to think of thoracoabdominal aortic aneurysm, but after careful analysis, it is really impossible to rule out the aortic aneurysm. possibility of tumors.

However, these symptoms are very subtle, well concealed, and easily overlooked.

Zhou Heng glanced around. It happened that today was the director's rounds, so he was going to let his subordinate doctors try to see if they could diagnose the real cause of the patient based on the patient's basic situation.

If the doctors in the emergency department can diagnose this kind of thoracoabdominal aortic aneurysm through simple questioning and physical examination, it would be too shameful if the professional thoracic surgeons under him could not catch up.

After Zhou Heng put down the phone, he raised his voice to his little doctors:
"A patient was sent to the emergency department just now. The emergency doctor's preliminary diagnosis was a thoracoabdominal aortic aneurysm. We need further examination and diagnosis from our thoracic surgery department. It just so happens that you are all here, so let's try to diagnose the patient's condition."

Zhou Heng looked at Zhang Anyi, who was a relatively senior attending physician among the doctors under him.

Seeing Zhou Heng's gaze, Zhang Anyi didn't understand. Director Zhou wanted him to show his diagnostic skills to the residents, interns, and trainees around him.

However, without CT, color Doppler ultrasound, or MRI, how can it be possible to diagnose a vascular disease with an insidious onset such as thoracoabdominal aortic aneurysm by relying solely on physical signs and interrogation, palpation, and percussion?

After all, the thoracoabdominal aortic aneurysm does not grow on the vessel wall, but forms a dissection due to the tearing of the inner and outer membranes of the vessel wall.An aneurysm formed by expansion of the adventitia near the rupture, let alone an early diagnosis.

Soon the patient was sent from the emergency department to the thoracic surgery ward.

Zhang Anyi could only bite the bullet, and soon, she had a clear understanding of the patient's basic situation.

However, looking at these symptoms of the patient, Zhang Anyi was completely stunned, how could it be possible to diagnose an early thoracic and abdominal aortic aneurysm.

Obviously there was only a problem with the gastrointestinal tract. After physical examination, interrogation, percussion, auscultation, and palpation, Zhang Anyi judged that it should be incomplete intestinal obstruction.

According to his thinking, it should be given gastrointestinal decompression or soapy water enema.

However, with Director Zhou on the side eyeing him, Zhang Anyi could only continue to dig out the evidence for the diagnosis.

"Could it be the doctor in the emergency department, who made a mistake?"

Misdiagnosis is very common in hospitals.However, according to the judgment of the emergency department, thoracoabdominal aortic aneurysm is somewhat special. If it is really an aortic aneurysm, if it is not treated and operated in time, it will be life-threatening. Zhang Anyi dare not make a conclusion at will.

How to do?
After all, Zhang Anyi is a senior attending physician and has a lot of experience. Since he followed the deduction and couldn't come to the conclusion of thoracoabdominal aortic aneurysm, he made a reverse deduction according to the symptoms of thoracoabdominal aortic aneurysm.

If the patient is really in the early stage of thoracoabdominal aortic aneurysm, how to explain his current symptoms?

Zhang Anyi thought quickly: the patient first experienced pain in the left toe, and the tip of the toe turned purple, which was caused by thrombosis.

If the real cause is thoracoabdominal aortic aneurysm, it is indeed possible that the aneurysm forms a thrombus attached to the wall, and the embolus falls off and plugs into the arteries of the lower extremities, so that arterial embolism of the limbs occurs, and the pain of the left toe exists. This possibility exists. of.

As for the patient’s gastrointestinal problems, it’s better to explain. The gastrointestinal tract is also the most commonly compressed organ by an aortic aneurysm. Due to the low mobility of the duodenum, symptoms may appear early when it is compressed, such as abdominal discomfort, fullness, and appetite. Decline, severe cases nausea, vomiting, exhaust and defecation stop.

Of course, these symptoms were also the reason why Zhang Anyi judged that the patient had incomplete intestinal obstruction.

After careful deduction, Zhang Anyi really agrees with the emergency doctor's point of view, the patient may really have a thoracoabdominal aortic aneurysm.

Zhang Anyi, in the expectation of Director Zhou Heng and various residents and interns, reorganized himself according to the symptoms of thoracoabdominal aortic aneurysm and reversed the complex symptoms of patients, and made some inferences in a fake way. .

"The patient has abdominal pain, gastrointestinal tract compression, and symptoms of limb arterial embolism, as well as pulsating package around the abdominal umbilical cord, and ischemic symptoms of lower extremity chronic arterial embolism. Abdominal aortic aneurysm is suspected. It is recommended that further color ultrasound examination, CT Examination or MRI."

Zhang Anyi brought forward her own conclusion, but she felt a little admired in her heart, the doctor in the emergency department is also too good.It is possible to deduce bear abdominal aortic aneurysm through such subtle symptoms and combinations.

Regarding Zhang Anyi's conclusion, Zhou Heng also nodded slightly, which was not bad, but it was obviously a coincidence:

"It's just that, if there is no reminder from the doctor in the emergency department, can you all discover the real cause of the patient in a short period of time without being affected by the previous hospital's treatment plan and diagnosis conclusion?"

Hearing Director Zhou's words, all the junior doctors including Zhang Anyi changed their expressions slightly. It is very rare to be able to deduce that it is an incomplete intestinal obstruction. It is too difficult to think of an abdominal aortic aneurysm.

It is completely two kinds of difficulty to deduce the disease according to the conclusion and to really get the disease based on one's own observation.

"Director Zhou, can you invite the doctor from the emergency department over here and ask carefully how he came to the conclusion of thoracoabdominal aortic aneurysm?"

Zhang Anyi was in admiration, and wanted to know what the other party's skills and tricks were.

"After the results of the color Doppler ultrasound examination and CT examination come out, if the diagnosis is confirmed, I will invite that doctor over to perform surgery on the patient together. At that time, you will have the opportunity to ask questions."

In fact, Zhou Heng was also very curious about how Qin Lang did it. Being able to point out the disease so directly is not as simple as blindness, there must be his solid basis.

Half a day later, all kinds of physical examinations of the patient came out.

Zhang Anyi was very excited and reported to Director Zhou: "Director, the results are out. The diagnosis is confirmed. The patient is indeed a thoracoabdominal aortic aneurysm, but it is still in the early stage. If it is not targeted in advance, even conventional CT and color Doppler ultrasound will be difficult. Discover!"

Moreover, due to the early detection, the success rate of surgical treatment is still very high.If the treatment is really carried out according to incomplete intestinal obstruction, and the delay for a period of time leads to the rupture of the aortic aneurysm, then the patient is very likely to die.

Thinking of this, Zhang Anyi was also afraid for a while.

In my heart, I was full of curiosity and admiration for the emergency doctor.

(End of this chapter)