My medical skills add experience

Chapter 262 This is a malignant tumor, sent to prison

"The patient's abdominal lymph nodes were enlarged, coupled with cervical lymph node tuberculosis, I think the diagnosis of concurrent splenic tuberculosis in the second hospital's reexamination has a certain basis."

Zhou Can thought about it and said.

"Does Dr. Zhou also think that it is concurrent splenic tuberculosis? I also think this diagnosis is tenable, and anti-tuberculosis treatment should be continued. Because tuberculosis is a chronic disease that is difficult to treat, it takes a long time to take medication to see the effect."

Attending physician Huang Xinggui spoke.

The treatment cycle for many diseases is very long, and tuberculosis generally takes more than half a year to take medicine.Some patients are even seriously ill and need to take medicine for one or two years.

"Uh... I just think that the second hospital's re-examination and diagnosis results have some basis, but I don't agree with this result. The patient's initial examination result is very similar to tuberculosis, but the patient now reports that there are occasional pains in the bones and joints of the whole body. This symptom In fact, it is very worthy of vigilance. When I was in orthopedic training, I came across two cases of bone and joint pain for which the cause was unknown, and both were finally diagnosed as malignant tumors."

Zhou Can was trained in multiple departments, and all of them were mixed with the chief physician, and the benefits gradually began to appear.

The so-called see a lot to know a lot.

He followed the chief physicians to diagnose diseases, operate and treat patients together, and so many chief physicians taught him everything.

Despite the fact that the total training time is less than two years, the accumulation of various medical knowledge and clinical experience has already been considerable.

Especially in the diagnosis and treatment of difficult and miscellaneous diseases, the comprehensive diagnosis and treatment experience and knowledge of multiple departments make his diagnosis level far surpass that of ordinary doctors.Even many deputy chief physicians and chief physicians couldn't compare with him in this advantage.

This is why many chief physicians still try their best to go to other departments or even other hospitals for advanced studies after they become famous.

Because they will obviously feel their lack of knowledge in daily diagnosis and treatment.

In particular, the lack of medical knowledge and clinical experience in certain fields will become a shortcoming for them and seriously lower their level of diagnosis and treatment.

"Doctor, are you saying that my disease may be a malignant tumor?"

The patient's nerves tense immediately.

"This is not necessarily true. I just think it is necessary to do a CT and check the spleen area. The B-ultrasound you did in the last hospital can show multiple solid masses. In fact, judging from the film, there should be low Echoic areas or areas of low density, it's just less obvious."

Zhou Can explained.

Without the final examination basis, he would not dare to talk nonsense to the patient.

If it is suspected that it may be a certain disease, then there is nothing wrong with it.

When a doctor diagnoses a patient, it is to eliminate the false and preserve the truth.Suspected diseases are investigated and screened one by one, and finally the real cause is left, and then symptomatic treatment is given.

B-ultrasound uses ultrasound for inspection and imaging, while CT uses radiation to perform multi-layer scanning tomography on the human body.

Different tissues and organs of the human body have different degrees of absorption of X-rays, and finally can form images with different densities. CT is using this principle to examine various organs of the human body. Compared with ordinary X-ray examinations, it has a higher resolution of various organ diseases, obtains more imaging information, and has a greater role in disease diagnosis.

Many people think that CT examination is an upgraded version of X-ray examination, but it is not completely correct.

X-ray scan is a planar projection examination of a certain part of the body, while CT is a continuous multi-layer scan of a certain part of the body.The imaging principle is different.

To check whether there is a low-density area in this organ, CT is a very good means of examination.

In medicine, considering the economic affordability of patients, doctors often choose B-ultrasound and CT, two low-cost examinations for clinical diagnosis.The results of the two examinations can be referred to each other, which is very meaningful for medical diagnosis.

"Xiao Zhou's diagnostic level is getting higher and higher! It's basically the same as my diagnostic conclusion. This is an application for CT examination, you can use it to pay for this examination. After you get the result, you don't have to wait in line, just come in and look for it. I'll be fine. I'm not here in the afternoon, if time passes, you can find me in the inpatient department of the Gastroenterology Department. If I'm absent, you can find Dr. Zhou as well."

Director Shang, this is the rhythm that completely pushes Zhou Can to the front line.

Such an honor, Zhou Can wanted to protest a few words, but finally moved his lips and swallowed the words back.

Seeing the inspection application form written by Director Shang, Zhou Can realized that Director Shang had already checked it out.It is to deliberately exercise the diagnostic ability of several of their students.

"Okay, thank you! Thank you, Dr. Zhou!"

The family members took the inspection application form, thanked Director Shang, and thanked Zhou Can alone.

The two families are too realistic.

In fact, Huang Xinggui also contributed to this diagnosis, but they did not thank Huang Xinggui.

People always only care about the things closest to their own interests.

Director Shang said that if he was absent, the patient would have to bring the test results to Zhou Can.

Therefore, the family members must have a good relationship with Zhou Can.

After the patient left, Huang Xinggui was still a little puzzled and asked, "Director Shang, the patient's symptoms and existing examination results clearly suggest that it is tuberculosis! Why do you and Zhou Can both suspect that the patient may have a tumor?"

The other three graduate students were also quite puzzled.

Qiu Chengyu looked at Zhou Can with complicated eyes.

He watched Zhou Can climb from the position of "door boy" on the first day to the current position step by step.

Today, Zhou Can's status has even surpassed that of Huang Xinggui, the attending physician.

Whether Zhou Can was sent to the Department of Cardiovascular Medicine to replace Director Shang, or if the patient could not find Director Shang just now, he could directly take the test results to Zhou Can for further diagnosis.It all shows that Zhou Can's status in Director Shang's heart has far surpassed that of Huang Xinggui.

You know, before Zhou Can came, Huang Xinggui was Director Shang's most important arm.

Xie Lin and Luo Jingyi, two female graduate students, will consult Zhou Can in private whenever they encounter difficult problems.

Not for anything else, just because Zhou Can is about the same age as them and easy to talk to.And every time they can help them answer their doubts.

"Xiao Zhou, please explain to them."

Director Shang picked up his teacup and drank tea.

Teachers are very lazy, and they usually don't do things that their doctors can do for them.

Perhaps it was Zhuge Liang in ancient times who did everything by himself, and the example of being exhausted to death left a deep impression on the world.

"My diagnostic thinking has three points! First, the patient's B-ultrasound showed a low-density area in the spleen. Although it is not obvious, it is a bad signal for tuberculosis patients and deserves vigilance. The first Second, the patient reports occasional bone and joint pain throughout the body. This kind of unexplained general bone and joint pain is also dangerous, and it is often a precursor to leukemia and malignant tumors."

Zhou Can didn't hide it, and shared his diagnosis ideas with everyone.

"The last point is that the bone marrow of the patient is obviously hyperplastic and active, and the ratio of grain to red is 7 to 1. This value is slightly higher than the normal value, and it is easy to be ignored. However, many malignant diseases only develop to a severe stage, and the grain to red ratio will be high. Scary. Much less obvious early on."

After saying three diagnostic points in a row, everyone was convinced.

Huang Xinggui suddenly realized, "I see, I see. Dr. Zhou not only has solid medical knowledge, but also has a meticulous heart. He is also able to comprehensively apply medical clinical experience in multiple fields. I am convinced today."

"Hehe, Dr. Huang's ecstasy soup made my feet lighten a few times!"

Excessive modesty equals pride.

Sometimes blind humility is easy to be offensive.

An occasional dose of humor is also quite nice.

Some people praised Zhou Can's solid medical knowledge, which seemed to be the first time.

It also shows that Zhou Can has achieved good results in supplementing medical knowledge in the past two years.

After the patient left, he continued to see new patients.

The number given by Director Shang is basically fixed every time he visits the clinic, but there are always some patients who have great powers. After knowing that he is in the clinic, they try to find ways to add numbers.

I was busy until it was almost twelve o'clock at noon, and I was ready to get off work here, and the patient with splenomegaly rushed over after the examination.

"Professor Shang, the CT results are out, please take a look."

This patient is really amazing, and he even queued up for the CT scan in about an hour.

Director Shang took the film, and the CT result was much clearer than the B-ultrasound.

Multiple low-density areas of the spleen can be seen at a glance.

"The situation is not very good. I suggest a laparotomy for further diagnosis. It is very likely that the spleen needs to be removed to save life."

What Director Shang said this time is very serious.

His tone was quite serious, and his face was a bit dignified.

At his level, it is not easy to tell a patient to have a certain organ removed.Only do it if you think it is very dangerous.

"Professor Shang, may I ask what's wrong with my mother-in-law?"

The patient's daughter-in-law seemed relatively calm, while the patient's son was nervously supporting his mother, and seemed to be in a panic.

"Basically, it can be concluded that there is a tumor in the spleen, and there is more than one tumor. It is only because it is concealed and the tumor is covered up by lymphatic tuberculosis, so the previous two hospitals failed to find it. Taking advantage of the small tumor now, surgical solution is the best Life-saving method. The spleen is surrounded by important organs, and the lymph is dense, and the malignant tumor cells are very easy to transfer. Once it spreads, it will be troublesome."

Director Shang tried his best to persuade the family and the patient to agree to the laparotomy.

The spleen was removed directly if necessary.

This operation will definitely have a certain impact on the patient's body, but it is much better than dying from cancer in the future.

Without this operation, the tumor in the spleen may spread to the whole body within two to three years at most.

At that time, the patient will not only live in great pain, but also lose the opportunity for surgery.

We can only use medicines as much as possible to relieve pain and improve the quality of patients in the later stages of life.

"Isn't my mother-in-law tuberculosis? How did it become a spleen tumor?"

Families still find it difficult to accept this fact.

"It is also very possible that tuberculosis has caused genetic mutations in malignant tumors. The older the patient, the more likely the gene mutation will occur. Now she has two diseases, tuberculosis, and a large number of small tumors in the spleen."

Director Shang explained to her.

Doctors generally do not directly say the word cancer in front of patients.

Replace it with malignancy or bad, bad, etc.

Oncogene mutation is an important cause of cancer.

Cells are constantly renewed throughout a person's life.Every time a new cell is produced, it is bound to be accompanied by the replication of DNA and the transmission of genetic information.

We human beings newly produce more than 100 billion new cells every day, and a certain proportion of wrong cells will inevitably be produced.Some of the wrong cells died, and some of the wrong cells gained infinite life and the ability to replicate infinitely.This is the origin of "cancer cells".

When cancer cells appear, they do not necessarily develop into cancer.

Because our body still has a variety of protection mechanisms, the most important of which is the tumor suppressor gene.

Only when the tumor suppressor gene is lost or disabled, can cancer cells take up camp in the human body and eventually become a tumor.

Why are young people less likely to get cancer, while older people are at a higher risk?
Mainly because of the weakened immunity of the elderly.

In addition, the more times the cell is renewed, the higher the probability of error.

When the patient's spleen tumor appeared, no one knows.Some cancer cells can lurk quietly, develop insignificantly, and wait patiently like Sima Yi of the Three Kingdoms.It is not until the patient's body has deficiencies in defense that they take advantage of the situation and quickly grow into malignant tumors.

After listening to Director Shang's explanation, the two family members finally agreed to the diagnosis and treatment plan proposed by Director Shang to investigate first, and then decide whether to remove the spleen according to the situation.

Since surgery was involved, Director Shang directly recommended the patient to the general surgery department for further treatment.

Under normal circumstances, for such patients who have not been admitted to the hospital, when the treatment plan exceeds the scope of the department, it is usually recommended that the patient be directly transferred to the corresponding department for treatment.

Instead of using the medical resources of two departments, a multi-department joint operation is performed on the patient.

……

After the consultation, Zhou Can and his colleagues went to the cafeteria for dinner.

Compared with the busyness of surgeons, physicians, although busy, are not as busy.Surgeons often need to take turns eating, and often even miss meals.

The scene of eating together like a physician is simply a luxury for a surgeon.

In terms of the busiest department, the Department of Surgery is not ranked No.1.

The busiest is the Department of Critical Care Medicine, which is a department that races against life all the time, and the doctors and nurses are always under tremendous work pressure.When rescuing critically ill patients in emergencies, many doctors and nurses are often required to be busy and running.

That busyness and that nervousness can only be understood by doctors and nurses who have personally experienced it.

While eating, Zhou Can's operation vibrated twice.

His phone is usually on silent mode when he works in the hospital.

I took it out and saw that it was a message from my girlfriend Su Qianqian.

"Honey, Hu Wei called me just now. He asked me to meet at John's Western Restaurant."

After Zhou Can finished talking with Li Luo, Zhou Can looked at the negative news about Su Qianqian online.It kept popping up like mushrooms after rain, and most of the negative news was released by a person whose ID was 'former employee of Jinyu Interactive'.

The rest of the rumormongers are either reposting unscrupulously or making up fabrications to gain traffic.

Terrible.

Su Qianqian must have been under tremendous psychological pressure in the face of these rumors.

But she never took the initiative to mention it to Zhou Can.

When the two had a tryst together, she always reported good news but not bad news.

Zhou Can knew in her heart that she was worried that telling Zhou Can those things would affect Zhou Can's work.So she chose to bear it silently.

Of course, in the face of these rumormongers and the fierce pressure of public opinion, Jinyu Interactive will definitely not sit idly by.

In fact, Jinyu Interactive has already helped her secretly deal with those malicious slanders and rumors.

As her boyfriend, Zhou Can is fully obliged to protect his woman from harm.

Stand up when she needs it most, be her most solid backing.

For this reason, Zhou Can specially invited her to the dormitory two days ago, and had a good talk with her in his arms.

In addition to comforting her, Zhou Can even thought of a way to help her.

Tell her that as long as Hu Wei, the traitor who went out of Jinyu Interactive, calls her, he will notify Zhou Can immediately.

After waiting for so many days, Hu Wei finally couldn't help contacting her.

This also gave Zhou Can the opportunity to act as planned.

He wants to play a big game of chess, fighting against Hu Haikun behind the scenes.

What about the richest man?The foundation is not clean, and he is still making troubles everywhere, and even wants to play dirty to kick Zhou Can out of Jinyu Interactive, and now he has Zhou Can's girlfriend's idea.

Zhou Can's policy has always been not to cause trouble and not to be afraid of trouble.

Now that Hu Haikun has already stepped on his head to shit and piss, it is like cleaning up Mr. Qian of Beihai Wolf Star Media Company, and send this Hu Haikun to prison directly.

This person has a criminal history of being involved in evil and gangsters, and his crimes are too numerous to record. As long as he is found out, even if he doesn't get shot, he will have to go to jail.

"When do you guys meet?"

Zhou Can sent her a message back.

"In my opinion, I wouldn't meet this kind of person, but you let me be a false snake with this person, so I promised him to meet at two o'clock tomorrow afternoon."

She has great trust in Zhou Can.

After Zhou Can talked to her that day, she was very helpful in her heart.What woman doesn't want her boyfriend to protect herself?
Everything went according to Zhou Can's plan.

"Very good. If it's convenient, let Wei Fang come to my place, I have something for her to do."

"Okay! I'll ask her to wait for you downstairs in the dormitory after get off work."

"It's time for her to call me. Also, when Wei Fang is not by your side, don't leave the company! Hu Haikun does everything, so be careful."

Zhou Can told her.

In case Su Qianqian falls into the hands of this kind of person, he can imagine what will happen with his toes.

(End of this chapter)