My medical skills add experience

Chapter 299 County Hospitals Are Not Necessarily Weak
Eating raw meat and drinking blood like hair is the way of life of primitive humans.

After millions of years of evolution, humans have already adapted to eating cooked food and drinking boiled water.Although foreigners eat steak and barbecue, they often only eat medium rare, and even eat some raw fish.In fact, their food is fundamentally different from wild meat.

For example, the beef they eat will undergo a series of tests before it is sold on the market.

It is necessary to ensure that many tests such as hormones, bacteria, viruses, and parasites meet the standards before they are allowed to be sold on the market.

Just like the white mice used for medical experiments, they are expensive because of the strict quality requirements in all aspects.

This eight-year-old boy was too naughty to eat a small fish raw.

"Little friend, what kind of fish did you eat at that time?"

"It's a goldfish bought from the market! At that time, I made a bet with my good friend, but I lost. A man, a real man, must do what he says! So I ate a live little goldfish as agreed."

The boy seemed weak when he spoke.

But it also amused Zhou Can and others.

It's amazing that such a young child knows how to keep promises.

"Little man, where did you get that goldfish?"

Zhou Can asked with a smile.

"We caught them with nets when we went to the park! We caught six in total, and I ate one, and my good friend and I took the rest home to raise. But they all died within two days."

When the boy mentioned that all the goldfish were dead, he showed a regretful expression.

"Oh! Then when you eat goldfish, do you chew it up and swallow it, or just swallow it alive?" Zhou Can continued to ask.

In fact, no matter which way, the goldfish will not survive.

The purpose of the inquiry is to further judge the problem of parasitic infection.

The oral environment is completely different from the gastric environment.

The mouth is a breeding ground for bacteria, but the stomach is a crematorium for killing all kinds of bacteria.It is almost impossible for viruses and bacteria to escape the killing of gastric juice.Most parasites also cannot survive in the stomach.

But there are exceptions.

Such as sparganosis, tapeworms, roundworms and so on.

If he chews the goldfish first and then swallows them, the parasites may take the opportunity to hide between the teeth, etc., and then quietly invade the head along the nasal cavity, or invade the lungs along the bronchi.

Parasites are highly survivable and very cunning, quick to grab any chance of survival.

"I... was afraid of it jumping around in my stomach, so I bit it into pieces and swallowed it with my eyes closed. It felt fishy and bitter at the time." He recalled the scene of eating that fish, still feeling uncomfortable feel good.

The bitter taste he tasted probably broke the fish gallbladder.

Bile is bitter.

There is also the possibility that fish feces may be bitter.

Zhou Can finished asking what should be asked, and continued to look down at the information.

The patient reported nausea and vomiting repeatedly after eating the goldfish alive.It often occurs within seven or eight hours after eating, and diarrhea will also occur at the same time.I have diarrhea four or five times a day.

The first hospital he visited was the local County Maternity and Children's Hospital.

The hospital tested the patient's vomit and confirmed it was stomach contents.Diarrhea is yellow watery stool.

The results of the first blood routine showed that WBC (that is, white blood cells) was 2.2*10 to the 9th power/L, and EOS% (that is, eosinophils) was 12.3%.

These two indicators of the blood test are an important reference for doctors.

If the white blood cells are abnormally high, it means that the possibility of infection with viruses and bacteria increases.Eosinophils are an important indicator of parasitic infection.

The County Maternal and Children's Hospital performed a gastroscopy on the patient, which showed mild reflux esophagitis.

It seems that the county maternity and children's hospital is not bad.

Hospitals that can perform gastroscopy and colonoscopy are all capable.

At least for a county-level hospital, it is quite good.

Abdominal Doppler ultrasonography revealed a small amount of fluid in the peritoneal cavity.

Zhou Can looked at the B-ultrasound examination report, and there was indeed a small amount of peritoneal effusion.

At the same time, the patient's spleen can also be seen to be enlarged.

Generally, the spleen is enlarged, either enlarged or with a tumor in the spleen.

However, if there is a tumor, it can be judged by low and high density images.

The density of most tumors is different from that of normal organs.

Continue to look down, the urine routine results show urine protein (+++).

This means that the patient's urine protein is strongly positive, that is, there is a large amount of protein in the urine, indicating that the patient's kidneys have serious damage.

These were the examinations done by the County Maternal and Children's Hospital. The patient was given treatment such as protecting the gastric mucosa and antiemetic. The patient's condition improved and he was discharged.

But less than a month later, the patient relapsed, vomiting, low-grade fever, and diarrhea.

The family members may be worried about the limited medical skills of the County Maternal and Children's Hospital, so they dare not take their children to see a doctor again.Instead, he decisively took the child to the Provincial Children's Hospital for treatment.

In fact, judging from the examination, treatment methods and other information of this county-level maternal and child hospital, its strength is not bad.

Many people think that county-level hospitals must be worse than provincial and municipal hospitals. This is actually a wrong perception.

Every hospital has its own characteristics.

If a certain county-level hospital has a doctor with good medical skills, then bring together a team to specialize in a certain medical field.Perhaps the strength of this hospital in this medical field is no worse than that of provincial hospitals.

Inversions are also common.

Zhou Can has seen a township-level orthopedic specialty hospital, which is better than a provincial hospital.Patients from all over the country come to seek medical treatment. Its treatment costs are low, and the level of treatment in the field of orthopedics is very good.

Bone injuries that cannot be cured in many large hospitals, or those that require conservative treatment, can be treated there.

Although there are not many such sky-defying township hospitals and county-level hospitals, there are still some across the country.They have built their reputations on their solid merits.

Zhou Can then looked at the examination report and treatment plan of the second hospital.

After the provincial children's hospital received the patient, he first checked the patient's urine routine, which showed that the urine protein was still 3 plus.

Such severe proteinuria is usually caused by diseases such as lupus nephritis, glomerulonephritis, and nephrotic syndrome.This actually requires a high degree of vigilance.But the doctors at the first Maternity and Children's Hospital didn't know whether it was a misjudgment or what was going on, and they didn't seem to pay much attention to the test results.

The second Provincial Children's Hospital has significantly more experience in diagnosis and treatment.

After finding 3 plus urine protein, the patient was directly checked for ANA, and the result was negative.

ANA is antinuclear antibody, a general term for a group of complex autoantibody mixtures.

In medicine, it is mainly used to screen rheumatic diseases.

Such as systemic lupus erythematosus, scleroderma, Sjogren's syndrome, rheumatoid arthritis.

The test result was negative, and the possibility of wind-heat disease can basically be ruled out.

The experts from the Provincial Children's Hospital are quite powerful. After this ruled out, they immediately checked the patient's kidney B-ultrasound again.Estimates have begun to suspect kidney disease.

It's just a pity that after the B-ultrasound, no obvious abnormalities were found in the kidneys.

The experts from the Provincial Children's Hospital checked one by one, and checked the patient with a gastroscopy.

I guess I feel a little bit of contempt for that county-level Maternity and Children's Hospital in my heart.I don't believe in the gastroscopy technology of county-level hospitals.

Gastric mucosal biopsy was taken directly during gastroscopy, and the result was mild gastritis with occasional eosinophil infiltration.

As expected of the provincial hospital, they also do gastroscopy, and its inspection direction should be more in-depth and more targeted.

Zhou Can found it quite interesting to check the patient's treatment process in other hospitals, as well as the diagnostic thinking of experts in other hospitals.You can gain an in-depth understanding of the diagnosis ideas of other experts, and help Zhou Can improve his diagnosis level with the help of their diagnostic experience.

The receiving doctor of the Provincial Children's Hospital is definitely a very high-level expert.

You can see it by looking at his diagnostic thinking.

Each inspection has a very strong purpose.

It is not as imagined to check all the inspections first.But every inspection has a deep meaning.

Without a thorough knowledge of pathology and rich diagnostic experience, it would be impossible to achieve this step.

Only when Zhou Can's diagnostic level has improved can he see the level of other doctors through the examinations done by other doctors.In the past, as long as he saw other doctors repeatedly doing various examinations, he would first scold in his heart that this black doctor is here to make money.

It is obvious that the patient has just finished the examination for a few days, and it still has medical reference significance, so why do you have to do it again?
In fact, not every doctor is a black doctor.

It is not ruled out that a doctor like Du Leng who only understands theory and has no actual combat experience will do all kinds of examinations on patients.There is no purpose, just to check.

Specifically, whether it is the former or the latter, after Zhou Can's current diagnosis level has improved, he can basically tell at a glance.

For example, the doctor at the Provincial Children's Hospital is 100% a very high-level expert.

After checking the gastroscopy, the experts checked the patient with a colonoscopy.

The results indicated that there was no abnormality.

Experts tried to give nutritional support to patients, but the results were very poor.

After about a week or so, the expert found that the patient's treatment was ineffective, and may have invited other experts from the hospital to help with the consultation.

It's very interesting in the end.

After consultation with the experts from the Provincial Children's Hospital, the patient was given another renal B-ultrasound.

Zhou Can wondered, didn't he just check it more than a week ago and found nothing abnormal?Why do experts check again after consultation?

Hey, don't tell me, this B-kidney ultrasonography actually found a problem.

If it wasn't for the provincial children's hospital, Zhou Can would have thought it was a money-losing black hospital.

Because there was no problem in the last inspection, the problem was found again in the past few days.Isn't this nonsense?

The second B-ultrasound results showed that the patient's kidneys were slightly dilated, the bladder was not filled, the pelvic fluid was 2.6cm deep, the rectal wall was thickened, and a suspicious mass was found on the right side.

There is such a big difference in the results of the two renal ultrasound examinations.

There is only one possibility, the doctor who did the kidney B-ultrasound examination for the first time was a related family, and the test was a fake certificate.

The medical technology department of a large hospital is the hardest hit area for related households.

There really are 'amateurs' out there.

Any patient who encounters such an unprofessional examiner can only consider himself unlucky.

Who would have thought that a provincial hospital would have unprofessional doctors after a B-ultrasound check?
In itself, the requirements for professional knowledge in medical imaging examination are not particularly high.That kind of half-baked dandy can basically be competent as long as he puts a little effort into it when he was in college.

Of course, it is not only more professional, but also more likely to detect hidden lesions, if a doctor with dry goods in his stomach performs imaging examinations on patients.

During this examination, it was found that there was a mass in the right area of ​​the patient's kidney.

I believe the experts are very excited.

The patient underwent laparoscopic surgery directly, and the suspected tumor mass was removed.

Pathological examination was teratoma.

The experts from the Provincial Children's Hospital were full of expectations, thinking that the cause of the disease was finally found this time, and the tumor was surgically removed.The child's illness should be cured, right?
According to Murphy's Law, things tend to tend to develop in the worst direction.

The child's mass was removed, and the results of pathological biopsy suggested that it was indeed a tumor.But the child's symptoms did not improve, the vomiting was still vomiting, and the diarrhea was still diarrhea.

It is probably the first time this expert from the Provincial Children's Hospital has encountered such a wicked thing.

How to do it?

Zhou Can admired the leader of the provincial children's hospital expert very much, and he was not discouraged by this.Continue to treat the patient.

Shortly after the operation, the patient developed symptoms such as urgency, frequent urination, painful urination, and waist pain.

This means that the operation to remove the tumor not only did not cure the child's illness, but created a bunch of new symptoms.

The condition has obviously worsened, and the number of symptoms has increased.

The family members must have retreated in their hearts. Can this expert do it?
It is estimated that the family members may even suspect that the excised tumor is really a tumor?Could it be that the experts in the hospital couldn't communicate with each other, so they deliberately created a tumor to deceive people?

Although this is a large provincial hospital and it is a public hospital, it still makes the family members suspicious.

However, for family members, there seems to be no better choice than trusting doctors.

What's more, this expert still gritted his teeth and continued to treat their children.

The expert checked the child's abdomen for another plain film.

This time, it was found that there was a level of Qi and liquid in the patient's abdomen, and the expert gave the patient sesame oil, and the condition actually improved.

After such a long period of diagnosis and treatment, there was finally some effect.

In other words, after giving the patient a bunch of new symptoms after the operation, the symptoms were relieved.The enthusiasm of the experts has increased, and their confidence has returned a lot.

The expert began to change the way of diagnosis.

Considering that the sick child ate a live fish, and it was eaten raw, the possibility of parasite infection is relatively high.

Eosinophils in the patient itself were also elevated.

Therefore, experts from the Provincial Children's Hospital checked the patient's stool again, looking for parasites.

Patients with intractable diarrhea like this, as long as they are admitted to the hospital, they must have been checked and they will be routine.

This time, the experts specifically asked the laboratory to check whether there are parasites in the patient's stool.

For example, eggs, corpses of parasites, and even live bodies and larvae.

Unfortunately, the parasite was not found after exhausting all means.

Diagnosis is in trouble.

The means that this expert should use have basically been exhausted, and if the investigation continues, it is estimated that there will still be no results.

And during this period, the patient's condition deteriorated again.

Urinary protein still exists, and knee joint and elbow joint pain also began to appear, frequent urination and urgency became more serious.I have to urinate hundreds of times a day, and when I urinate a few drops, it will not exceed 30ml when it is too much.

Symptoms such as vomiting and diarrhea still exist.

At the same time, the patient continued to have a low-grade fever.

What is even more frightening is that the patient has already developed symptoms such as shortness of breath and palpitation due to long-term treatment and aggravated condition.

This means that the disease has affected cardiorespiratory function.

If the treatment continues, most patients will have to walk into the hospital, wrap them in a body bag, and carry them away.

The experts at the Provincial Children's Hospital were at their wit's end and couldn't think of a better way.

It is a large provincial hospital itself, and it is also a famous expert. It is really embarrassing to say such words directly to persuade patients to transfer to another hospital.

However, a large hospital like this has a lot of means to deal with various difficult problems.

For example, ask the doctor to pretend to be a family member or a relative of the patient in the same ward, pretend to be concerned about the patient's condition, and then enthusiastically tell the family member that your disease should not be treated here!You have to go to such and such a hospital, they specialize in treating this disease.

After hearing this, the family members must have been moved.

There is no need for the hospital to ask, and the family members themselves will directly ask for transfer.

(End of this chapter)