My medical skills add experience

Chapter 531 Neck palpation can identify venous artery disease, tissue necrosis stage
"I heard that you cured a disease that even the top hospitals in the imperial capital couldn't cure. We came here specially to see you this time." The son of the veteran cadre said beside him.

These people are well-informed, so they can naturally learn about Zhou Can's legendary story from some channels.

Especially for this kind of powerful family, those who want to flatter them will try their best to find a world-renowned doctor for them.

"Thank you for your trust and love, but I'm not that good, I'm just an ordinary doctor. Let me check your body first!"

Zhou Can is not used to this kind of occasion where people are touting.

He is a more down-to-earth person, and he likes to concentrate on studying medicine or treating patients.

The patient's biochemical examination results, urine routine, stool routine, all normal.

Because of the patient's lower extremity pain, blackened toes, and gangrene.Worried about renal function problems, such as uremia, he also specially gave the patient a renal function test.

The patient's renal function was found to be normal.

Later, I was worried that the patient had diabetes, and checked the fasting blood sugar, which was still normal.

He even doubted the existence of liver function problems.

Unfortunately, after checking the liver function, it is still normal.

Diabetes, uremia, and hepatitis, which are likely to cause this kind of gangrene of the lower limbs, have basically been ruled out.

Diagnosis here, basically deadlocked.

It was precisely with this in mind that Zhou Can asked to come over to see the actual situation of the patient.Physical examination is a general examination. It seems that everyone’s examination content is similar. In fact, a high-level doctor can find many clues from the physical examination, which is of great help to the diagnosis.

It's perfectly fine to at least provide some food for thought.

The patient himself and his family members are very cooperative and willing to let him help with the physical examination.

He first lifted the quilt to check the patient's right foot.

Some disinfection and other treatments have been done above, mainly to prevent severe decay and further infection after partial necrosis of the foot occurs.

Gangrene refers to special morphological changes such as necrosis and blackening of local tissues.

It is mostly caused by blood circulation disorders caused by diseases, trauma and other factors.

Cause local tissue large-scale ischemia, necrosis, and secondary putrefactive bacteria infection.

Gangrene can be divided into dry and wet. Dry gangrene manifests as symptoms such as blackening, dryness, and necrosis of the extremities.Not to mention wet gangrene, pus bursts, rots and stinks.

In general, dry gangrene is slightly better.

But this is not absolute.

After some patients have wet gangrene, it looks very scary, but it may be easier to treat.

The main thing is to find the cause of the disease, improve local blood supply, resist infection and so on.

Through observation, Zhou Can found that the fourth toe of the patient's right foot had become quite black.Significant signs of gangrene developed.

And there is no obvious junction with normal tissue.

This means that gangrene can progress and spread upwards.

No wonder the doctors in the previous hospitals said they would amputate their limbs to save their lives.

After Zhou Can looked at it, he began to check the patient's neck.

Because of lower extremity pain and gangrene, after excluding common causes such as diabetes and uremia, there are basically only two possibilities left.Either bacterial and viral infections, or blood vessel problems.

The patient underwent anti-infection treatment in the first two hospitals, but the effect was not obvious.

It also failed to stop the progression of the disease.

This means that a viral or bacterial infection is less likely.

And the patient's biochemical examination was basically normal.There are no problems with liver and kidney functions, and the most likely problem is blood vessels.

The most prone to problems in the lower extremities are the veins.

If it is a car accident injury or the like, you need to be particularly vigilant about femoral artery damage.In particular, crush injuries can easily cause rupture of the femoral artery and cause massive hemorrhage.

This veteran cadre is obviously more in line with vein lesions.

Zhou Can didn't touch the patient's right foot, but touched the patient's neck. What's going on?
First of all, part of the veins of the lower extremities are deep veins, which cannot be felt or seen.When he observed the patient's right foot just now, he had already checked the superficial veins on the patient's right foot.

No obvious abnormality was found.

So it went straight to the largest vein that can be felt on the body surface, the jugular vein.

The birthplace of human blood is the heart, whether it is an artery or a vein, all originate from the heart.

But when the doctor examines the patient, there is no way to open the patient's chest to see if the veins are normal.The most common and effective method is to feel the jugular vein.

Of course, this requires a doctor with extensive experience in diagnosis and examination.

Through palpation, Zhou Can did not find the patient's jugular vein distended, nor did the carotid artery pulse abnormally.The trachea is in the middle and is also normal.

Neither the cervical lymph nodes nor the thyroid gland were enlarged.

There was no neck stiffness or the like in the neck.

After checking the neck, he put on a stethoscope and began to examine the patient's chest and abdomen.

Visually, the patient's thoracic and respiratory movements were symmetrical without abnormalities.Bilateral verbal tremors are symmetrical, and the breath sounds of both lungs are slightly rough, which is still normal.It may be that when the patient is examined, the patient himself is somewhat nervous.

He heard a milder crackle in the patient's right lower lung.

Now and then.

This is a new discovery, Zhou Can's expression changed slightly, and he went on to make a diagnosis.

When the patient's heart was auscultated, no pathological murmur and pericardial friction rub could be heard in the auscultation area of ​​each valve.

The heart should be normal.

It stands to reason that after checking this step, the patient can basically be pushed to other departments.

But Zhou Can didn't do that.

People come to him for diagnosis and treatment, even if the other party is just polite, he will go all out.

The reputation of cardiothoracic surgery needs to be continuously accumulated.

Zhou Can is also very interested in this difficult case.

He then auscultated the patient's abdomen and found no obvious abnormal bowel sounds.Try to palpate with your hands, the abdomen is flat and soft, there is no obvious tenderness response in the whole abdomen, and no mass is found.There is no percussion pain in the liver and kidney area.

After checking the thorax and abdomen, he found no major abnormalities. He also checked the patient's spine and found no deformities.

No obvious lumbar disc herniation was found.

Because it is considered that the patient walked too much when he was young, and had symptoms such as leg numbness and coldness.This allowed him not to rule out that the patient's spine had lesions that compressed the nerves and caused the above symptoms.

After Zhou Can's pathological diagnosis was promoted to the sixth level, he gained a deeper understanding and insight into the nine major systems and the three major circulations of the human body.

It was previously believed that the blood supply of the body was only directly related to blood vessels.

Now that his level has improved, he realizes that he was too superficial before.Nerves can also affect blood flow, and there are many other factors that can affect blood flow.

Such as heart failure, premature beats and so on.

After checking the upper body, Zhou Can focused on the patient's right leg again.

The fourth toe of the right foot turned black and showed gangrenous changes. When the skin temperature of the right calf was touched, it was obviously much colder than that of the left calf.

This means that there is likely to be a problem with blood circulation in the patient's right foot.

"I need to check the nerve reflexes of your feet to clarify the cause of the lesion. Just keep it in a natural and relaxed state. It will not cause any damage to your body."

Zhou Can said to the patient.

"Very good, I finally encountered a different inspection item from other doctors."

After hearing this, the patient was very happy.

After so many doctors examined and treated him, there was no effect.His inner pressure must be very great.

When he felt almost hopeless, a doctor suddenly played a new trick, which gave him a glimmer of hope.So rather happy.

"Come on, you sit, your legs are naturally bent and vertical."

After Zhou Can asked the patient to sit down, he signaled the family members to support the patient so as not to fall and cause an accident.

The percussion hammer hit the patient's left knee.

boom!
There was a pronounced knee jerk reflex in the left leg.The right leg was tried again, and the knee jerk reflex was also normal.

However, it is slightly weaker than the reflex of the left foot.

This is associated with a lesion in the right leg.

Next, a physiological nerve reflex test was performed on the patient's feet.Including the patient's right foot, there are nerve reflexes.

At this point, the possibility of poor blood supply caused by nerves is basically ruled out.

Zhou Can once again targeted the blood vessels in his right leg.

The femoral arteries on both sides of the patient were palpable, and the pulsation strength was normal.

Then check down, the left popliteal artery exists and is normal.The right popliteal artery showed no palpable pulse.

The problem is becoming clearer, and this is another major discovery.

Continuing to palpate, he found that the patient's left dorsalis pedis artery existed, and the right dorsalis pedis artery also had no pulse.

This is a typical manifestation of chronic arterial ischemia.

According to the patient's condition, the patient's right foot chronic arterial ischemia is at least the second stage, and even progressed to the third stage.

Chronic arterial ischemia, the first stage, mainly manifests as numbness of the affected limb, chills, fear of cold, soreness, and fatigue.If present in the foot, the patient may even develop a limp.

Especially after the patient walks a long distance, the symptoms are particularly obvious.

Pain and twitching of the calf or foot muscles may occur.

If this happens, the pain will worsen if you continue to walk.

At this time, as long as you rest in time, the pain can be relieved immediately.

The symptoms of veteran cadres when they were young are highly consistent with the first stage of chronic arterial ischemia.

Zhou Can was also more certain that the old cadre suffered from this disease.

As long as you find the cause, you can find a solution.

"If your disease could have been treated in time when you were young, maybe it wouldn't have developed to the extent it is now!"

Zhou Can sighed slightly.

Many illnesses start from childhood illnesses, and then become serious illnesses and serious illnesses.

"When I was young, the level of medical care was poor, and the doctors couldn't find any diseases at all. I didn't have time to be hospitalized, so I could only prescribe some medicine. Boy, do you know? The great opportunity in this life, maybe just that one time , If you don’t catch it, you will lose it forever. There were six people who entered the organ with me back then, and I was the only one who seized the opportunity to climb up.”

Speaking of the experience of this life, the veteran cadres are somewhat proud.

He even took the initiative to share some successful experiences with Zhou Can.

The other five people failed to seize the opportunity, and they might be just staff members when they retired.It's a stock chief who is dead.

Veteran cadres can hold high positions, compared with them, they must be very successful.

"Thank you for your willingness to teach me these valuable life lessons."

Zhou Can is sincerely grateful to this veteran cadre.

The communication between doctor and patient can be very pleasant sometimes.You can even learn a lot of useful and valuable experience from patients.

"Seeing a down-to-earth young man like you, I couldn't help but want to say a few words. Back then, I was just like you, eager to succeed and strive to make progress. You checked me just now, and I can feel that you The investigation was very careful, and the attitude of doing things seriously is very good."

Veteran cadres are used to being leaders, and how much they say now has the taste of leaders supporting subordinates.

Zhou Can responded with a modest smile, and continued to check up on the veteran cadres.

The second phase of the disease is called the dystrophic phase.

The affected limbs will experience numbness, chills, fear of cold, aggravated soreness, and significantly shortened walking distance.It takes a long time to rest for relief.At the same time, even in a state of rest, there will still be pain.

This kind of rest pain is very tormenting, especially at night, the pain is more obvious.

It will make the patient sleepless at night and suffer a lot.

In addition, the patient's diseased limbs will have obvious pale skin, even purplish spots, flushing, dry skin, and hair loss directly.

Some patients also have thickened and deformed toenails and muscle atrophy.

If it occurs on the hands, the thickening and deformation of the nails is more obvious. When the muscle atrophy occurs, it is like a patient with gradual frostbite.

It is not so easy to distinguish this disease from ALS, and there is a certain possibility of misdiagnosis.

Veteran cadres have gone through the second period, but unfortunately they still haven't been treated properly in time.

It is estimated that when it develops to the second stage, the patient himself has become accustomed to it because the course of the disease has been as long as more than ten years.Even though he has a certain status at this time and can enjoy high-quality medical services, he still only receives anti-infection treatment in the local hospital.

It wasn't until recently that my toes became necrotic and blackened, and I felt that the situation was serious, so I ran to a large hospital in the provincial capital to seek medical treatment.

First, he went to the Provincial People's Hospital to seek medical treatment, and he didn't know whether it was he himself who advocated that the doctor give him anti-infection treatment or what was going on.

In the Provincial People's Hospital, only anti-infection treatment was done.

There were no further therapeutic measures.

To be honest, in the eyes of Zhou Can, a professional, this is somewhat abnormal.

It also made him secretly vigilant. Could this veteran cadre or his family members be a big deal?
There are many patients who, when they first met, smiled and were very amiable.

When some treatment is not in place, or the effect is not obvious after treatment, they will immediately turn their faces and deny anyone.All kinds of abuse, complaints, and even asked the hospital leaders for an explanation.

When encountering such patients, everyone basically stays away from them.

If there is really no other way, then only defensive medicine can be used.

In this case, if you don't think of a way to protect yourself, are you really fools to be doctors and nurses?
The third stage of chronic arterial ischemia is also called the stage of tissue necrosis.

Unfortunately, this veteran cadre has already progressed to this stage.It should be just the beginning.In the late stage of development, the entire right leg will be necrotic, which is terrible.

The most obvious symptoms of necrosis are aggravated pain, cold limbs, and signs of necrosis and blackening from the toes.

Moreover, the skin on the feet will lose the luster it should have, and directly become dull, like the color of a dead body.

This is a sign of loss of vigor and vitality.

"Doctor Zhou, have you found out what's wrong with my father-in-law?"

The patient's daughter-in-law remained silent.

At this moment, seeing Zhou Can's frowning and serious expression, she asked aloud.

"It's a bit like chronic arterial ischemia in the legs. The stage of the disease is already very late. The specific cause of the ischemia needs further diagnosis. The most commonly used method in clinical practice is to establish collateral circulation and improve local blood supply. Symptoms Often can be significantly relieved, the condition can be significantly improved."

Zhou Can was basically sure of everything, so he dared to say that.

How to do the surgery depends on further examination of the arteries of the legs.

(End of this chapter)