My medical skills add experience

Chapter 191 Junior Brother Zhou, Incurable Crohn's Disease

From her description, the possibility of chronic ulcerative colitis is relatively high.

The risks of bowel polyps and bowel cancer also exist.

Considering that she is still very young, in her 20s, at the same age as Huaer, the risk of bowel cancer is relatively low.

In addition, she was diagnosed and treated in a local hospital, and the diagnosis was enteritis.

But the effect is not good after taking medicine.

In addition, she is now experiencing vomiting symptoms, even if it is really enteritis, it is an extremely dangerous type.

"Qiu Hong, give her a physical examination first."

Director Jia may have considered that the other party is a female patient, so he asked the female doctor Qiu Hong to give her a physical examination.

In fact, in the eyes of doctors, there is really no distinction between men and women.

Female patients have a high probability of encountering a male doctor when they take an electrocardiogram.There are also breast diseases, and there are many male doctors attending consultations.During the physical examination, the female patient will be asked to lift up her blouse, and then the doctor will perform palpation and visual inspection.

According to the requirements of the hospital, there will be a female nurse or a female doctor present.

If there were only male doctors and female patients, if the patient said that the male doctor molested her, he would jump into the Yellow River and be washed away.

Also, female patients can ask their husbands or other relatives to accompany them when they see a doctor.

Family members can enter the outpatient room.

Only the operating room, examination room, and intensive care unit are not allowed for family members to enter.

The emergency room depends on the situation. In principle, family members are not allowed to enter, but after the rescue is completed, or the doctor feels it is necessary to let the family members around to encourage the patient and stimulate the patient's desire to survive.

Will take the initiative to invite family members to come in.

Physical examination is actually more complicated than imagined.Including armpit body temperature measurement, calculation of respiratory rate, blood pressure measurement of the right upper extremity for more than three times, observation of the patient's complexion, development, nutrition, auscultation of bowel sounds and other items.

It is by no means simply pressing twice on the painful part of the patient on TV.

Taking advantage of Qiuhong's time to give the patient a physical examination, Zhou Can picked up the patient's examination report to check.

The first thing to look at is the blood test results.

After a disease occurs in the human body, at least 70% of the disease will be more or less reflected in the blood picture.

The white blood cell count of this female patient was significantly increased, and the red blood cell and hemoglobin were lower than normal.There is also a significant decrease in hematocrit and an increase in erythrocyte sedimentation rate.Mucin increased and albumin decreased.

Just the blood test results were enough to confirm that she was sick.

There are so many blood abnormalities, from the doctor's professional point of view, this disease will not be a minor disease.

Enteritis can only be regarded as a minor disease.

So, what could be a more serious disease than enteritis?
Intestinal perforation should be ruled out because intestinal perforation is often accompanied by intra-abdominal infection, which is much more severe.

Patients also experience severe pain, high fever, and even chills.

Zhou Can then checked the stool examination, red and white blood cells were seen, and the occult blood test was positive.

Most of the disease is in the intestine.

On CT examination, no obvious abscess was found in the abdominal cavity.

According to these examinations to diagnose, the patient is common enteritis.The treatment plan and diagnosis results prescribed by her local hospital were all correct.

"Zhou Can, did you find anything?"

Director Jia's address to Zhou Can changed unknowingly.

Changed from Xiao Zhou to Zhou Can.

I don't know whether it is because Zhou Can is disrespectful to call him in front of the patient, or because Zhou Can discovered the hidden disease of the patient in the third bed, and feels that Zhou Can should be given some respect.

All in all, this is a good sign.

At least when Director Jia called the beautiful doctor Qiu Hong, he didn't call her Xiao Qiu, but called her by her name directly.

"It's hard to say now, there are too few examination data. It can only be roughly inferred that the disease should occur in the intestinal tract. It may be enteritis, not ordinary enteritis."

Zhou Can gave his diagnosis opinion.

It must be difficult for him to give the diagnosis result directly.

He can narrow down the scope of the disease again and again, which is already very good.

"Not bad, your diagnostic thinking is not as impetuous as most young people, but very down-to-earth. You are better than I imagined."

This is the first time Director Jia praised him.

And in front of the patient.

It shows that he is very satisfied with Zhou Can's performance.

"Her specific cause of disease must be confirmed by a colonoscopy." Director Jia also said this to the patient.

"Can I skip the colonoscopy? I heard that it's scary. I'm afraid of the pain, and I'm even more afraid that the colonoscopy will pierce the intestines!" The patient was very repulsed by the colonoscopy.

At the local hospital, the doctor may have discussed with her and asked her to have a colonoscopy.

"You are going to have a colonoscopy, and there is a little risk. If you really don't want to have a colonoscopy, then give you a barium enema! But I personally suggest that a colonoscopy is more intuitive."

Director Jia said to her.

"Well... No, no. One of my little sisters had a colonoscopy in the hospital, and it was painful for several days. Unless you give me a painless colonoscopy, then it can be considered."

She looked childish.

In fact, most of such girls are kind-hearted, self-motivated, and cheerful.

At least they are more open-minded when encountering difficulties.

The ability to withstand pressure is much stronger than that of ordinary girls.

"You girl, you are already sick now, do you still care so much about the little pain caused by the examination? Painless colonoscopy requires an appointment, and it will take at least half a year. Your disease can't be delayed for a day. Also, painless colonoscopy The cost of the mirror is also much more expensive, why bother."

Director Jia shook his head helplessly.

Today's young people have special personalities, and their thinking is too different from the older generation.

Finally, after the patient finished the physical examination, Director Jia gave her an application for a barium enema examination.

She dragged her weak body to pay the fee and go for the examination.

It's very worrying to watch, with such a serious illness, but no parents and family members to accompany the doctor.

I don't know what her family is like.

Some young people are very sensible. In order not to worry their parents and increase the burden on their parents, when they are working hard outside, whether they are sick or encounter major setbacks at work, they are all carried by themselves.

It looks pitiful and sad.

……

Around 10:30 in the morning, Qiuhong's cell phone rang.

"Doctor Tang, have the test results of the third patient come out?"

Qiu Hong took the initiative to ask.

It turned out to be a call from the treating doctor of the third patient.

"Ah...it's really gallbladder cancer! The new Dr. Zhou in our department is amazing." Her pretty face was full of shock, and she was extremely inconceivable that Zhou Can could discover the patient's hidden disease without knowing it beforehand. .

[Pathological diagnosis experience value +1.]

[You have successfully diagnosed a difficult recessive disease, pathological diagnosis experience +100.]

101 pathological diagnosis experience points were credited at once, which turned Zhou Canle upside down.

His efforts finally paid off handsomely.

The pathological diagnosis is now level four, and the indications are at the lower level.If you want to rise to the level of deputy chief physician, you need to earn 1 experience points.If he could only earn [-] point each time, he didn't know that it would be a year of the monkey to raise this medical skill to the level of deputy director.

After finishing the call, the way she looked at Zhou Can completely changed.

"Teacher, Doctor Tang just called and said it was..." Before she could finish speaking, Director Jia waved his hand. "I've heard it all. Zhou Can is really talented."

After he finished complimenting Zhou Can, he sighed slightly.

"Oh, gallbladder cancer is known as the king of cancers, and the prognosis is very poor. This patient's condition is really terrible, and I'm afraid he has lost the chance of surgery. I'll go see the MRI after I finish my outpatient consultation." Check the results!"

Director Jia felt sorry for the patient.

It would be great if gallbladder cancer could be detected earlier, by now, it is likely to have metastasized.

The prognosis of pancreatic cancer and gallbladder cancer is particularly poor.

These two cancers are known as the king of cancers, and each is more dangerous than the other.

They have a common feature, very easy to infiltrate surrounding organs and tissues.And all around it is vital body tissue.

As long as it is discovered later, it will directly cause the patient to lose the chance of surgery.

Cancer cells replicate themselves, allowing them to spread rapidly throughout the body.It's okay without surgery, but if the surgery is not clean, they will grow wildly.

The time from diagnosis to death is often very short.

Gallbladder cancer is a malignant epithelial tumor with a very high degree of malignancy.According to different pathological mechanisms, it can be divided into adenocarcinoma, squamous cell carcinoma, adenosquamous cell carcinoma, tumors of mesenchymal origin, and tumors of neuroendocrine origin.

No matter which type, it is a narrow escape.

The five-year survival rate for gallbladder cancer generally does not exceed 10%.

This patient is very old, in his 70s. If there is a mine at home, you can try to re-evaluate the surgical plan and risks.Otherwise, a conscientious doctor will basically tell the family members that if treatment is really needed, then be prepared to lose money and money.

"Junior Brother Zhou, I'm curious, how did you find out that the patient in the third bed had cancer?" Qiu Hong stared at Zhou Can with her beautiful eyes.

Her address to Zhou Can has changed from the unfamiliar Doctor Zhou to Junior Brother Zhou.

Only at this moment did she take the initiative to accept Zhou Can calling her senior sister.

"Just observe! During the ward rounds, I saw that the patient's complexion, eyes, hands, and face complexion were all wrong. At that time, I suspected it was cancer. Later, I asked Director Jia for leave. After carefully reading the inspection report, I used the process of elimination and finally locked the gallbladder."

Zhou Can generously shared his diagnosis experience.

"The main reason is that the patient's cancer symptoms were just covered by his liver cirrhosis and duodenal ulcer. Otherwise, it would be easy to find out."

Stealing director Jia's limelight, he naturally wanted to give him a step down.

Experts are human beings too, and there are times when they make mistakes or omissions.

"Qiu Hong, you don't know yet! Zhou Can was also very famous when he was trained in other departments. Those chief physicians praised him highly, and they all wanted to keep them in their own departments."

Director Jia's news is quite well-informed.

He actually knew all about Zhou Can's deeds in other departments.

To say that Zhou Can gradually became famous, he probably ended up training outside of God.At that time, it had already aroused the great attention of the vice president of Ye, so there was special care during the training of the intensive care medicine department.

Up to now, with the help of director Xueyan, Zhou Can is frantically making up for his shortcomings in basic medical knowledge.

In the past two months, the initial results have been achieved.

The gaps in knowledge in the fields of immunity and digestion have been made up a lot.

This time, the cancer of the patient in the third bed can be precisely located in the gallbladder, which shows that initial results have been achieved.

At this moment, two groups of patients walked into the consulting room at the same time.

The young female patient walking behind was the woman who was initially diagnosed with enteritis.

She has come back from the barium enema.

"Mr. Jia, the test results are out, please help me to look again!"

While handing over the test results to Director Jia, she smiled apologetically at another patient who came to see the doctor.

"The barium shadow shows a sign of jumping... This disease is troublesome!"

Director Jia frowned after reading it.

It shows that her disease is very difficult to treat.

Zhou Can's heart trembled slightly after reading the results of the barium dose. Her symptoms were highly similar to enteritis, but now the barium shadow showed jumping signs, which can basically be diagnosed as ulcerative colitis.

But combined with the results of her electrolyte test, this is by no means an ordinary ulcerative colitis, but possibly a very fatal Crohn's disease.

The clues can already be seen from the CT results.

A proliferative lesion that penetrates all layers of the bowel wall, has involved the mesentery and regional lymph nodes, and is limited to the small bowel and colon.

The lesions have a segmental distribution.

It is separated from the normal intestinal segment and has a clear boundary, showing the characteristics of a jumping zone.

All signs have pointed to what has been dubbed the 'green cancer' of Crohn's disease.

This disease is not a real cancer, but with the current medical technology, patients need life-long medication.The cost is also quite high.

If you use imported medicine, the cost is about 1.5 to 2.

It takes about two months to get a drip.

Such an expensive medical bill, and it has to come every two months, is definitely a disaster for an ordinary young girl.

"Just say it directly, I can bear it."

The girl was quite brave. Seeing Director Jia's expression and hearing his tone, she already knew that the result was bad.

Director Jia pondered, organizing his words.

Doctors communicate with patients, and most of them will take care of patients' feelings as much as possible.

"It's okay, just tell me! There is no one in my family anyway. My parents divorced when I was very young. My grandma and grandpa brought me up. Now my grandparents are no longer alive, even if I have to It's cancer, and I don't have anything special to miss in this world. So, I can accept any result."

It's unbelievable that these words came from a young girl in her 20s.

Hearing these words and looking at her expression, Zhou Can felt particularly sympathetic.

It's a pity that his medical skills are still very limited. So far, no doctor has been able to cure Crohn's disease.

The only way is to take medicine for life.

Western medicine has been developed for so many years, and it has been very advanced in many fields such as diagnosis, surgery, medication, and pathological mechanism.Traditional Chinese medicine that has lasted for thousands of years, as well as witch doctors in the Western world, were directly killed by it.

But many chronic diseases cannot be cured.

According to statistics, at least more than 80% of chronic diseases cannot be cured.

Are you shocked to hear this result?

Take a tumor as an example. After cutting it, it will grow back again.

Medically it is called relapse.

Why is it possible for cancer to be cured if it is detected early?That is not a cure, but relying on the body's immune mechanism to overcome the disease.

In the middle and late stages of cancer, it is like a fire in the mountains and forests, which has shown the tendency of starting a prairie fire. The immune mechanism of the human body is either destroyed, or it is no longer the opponent of the disease.

So at this time, surgery, radiotherapy and chemotherapy, the final result is basically resigned to fate.

Western medicine treats the symptoms, while traditional Chinese medicine treats the root cause.

The treatment principle of Chinese medicine pays attention to the balance of yin and yang.Maybe one day, the whole world will highly recognize Chinese medicine, and let Chinese medicine become the mainstream medicine in the world, and Western medicine become the auxiliary treatment method.

But when that day comes, Chinese medicine may no longer be the strongest in China, but may be a developed country in the West.

Because they are likely to perceive the value of Chinese medicine, they have already begun to make arrangements.

There are not many famous Chinese medicine doctors left in China, and many famous Chinese medicine doctors have been poached directly by foreign countries.

This makes people very helpless and lost.

Fortunately, the actions abroad have attracted the attention of relevant parties, and various policies to protect and develop Chinese medicine have been launched.

Compared with the serious decline and exclusion of Chinese medicine during the period from the late Qing Dynasty to the modern war, the current situation of Chinese medicine is much better.

"Girl, your disease is called Crohn's disease, which is an intestinal inflammatory disease of unknown cause. Theoretically, it can occur in any part of the gastrointestinal tract, but it mostly occurs in the terminal ileum and right colon. The clinical manifestations are abdominal pain, diarrhea, and intestinal obstruction, accompanied by extraintestinal manifestations such as fever and nutritional disorders. Your symptoms of anemia, constipation, and even the current vomiting after eating are all related to this disease."

Director Jia announced the diagnosis to her.

She had obviously never heard of this disease, and asked in a daze, "Then can this disease be cured? Is it cancer?"

(End of this chapter)