Auto chess in the operating room

Chapter 109 Rare patients with "typical" appendicitis

After the operation was completed, Ma En felt very happy. This laparoscopic surgery was thrilling and exciting. In fact, it broadened his horizons and gave him a deeper understanding of laparoscopic appendectomy.

Looking at Tang Lou in front of him, Ma En was in a complicated mood. After a long time, he sighed: "Tang Lou, Doctor Qing chose you as a helper. I am completely convinced."

After speaking, Ma En fled out of the operating room in a panic.

Tang Lou naturally didn't care. After washing in the changing room, he returned to the office.

Day two.

Tian Linsheng, Tang Lou, and Ma En are each in the office, busy with their own affairs.

Wang Daquan walked in very incomprehensibly, looking at the nonchalant Tanglou, with an ominous premonition, he quickly walked towards Ma En.

After calculating the time yesterday, he didn't answer the call to Ma En, and he didn't reply to the message. Could it be that the things that made things difficult for Tang Lou were exposed?

But looking at Ma En is also very calm.

"Doctor Horse"

Just as Wang Daquan spoke, Ma En picked up a cup, took a sip of tea, and looked away.

Realizing that something was wrong, Wang Daquan walked to the other side and called out kindly: "Doctor Ma!"

Ma En stood up directly and looked at Tang Lou: "Tang Lou, Dr. Qing called me just now. Half an hour later, he had a small consultation in the office. There was a patient with appendicitis who needed preoperative discussion. Dr. Qing probably I recognized the typical appendicitis, but I felt a little strange, but I couldn’t find it. So I’m going to watch it again.”

"You, me, Dr. Qing, and Dr. Song Yang will also come together. This is the patient's medical record, please read it first."

"Ok."

Tanglou came over and took the medical records.

Tian Linsheng on the side was a little envious. Department consultations used to be exchanges between attending doctors. Since appendicitis surgery is relatively small, Ma En, as a resident doctor, also had the opportunity to participate in the discussion.

And this time, another Tang Lou was added. Obviously, in Dr. Qing's mind, Tang Lou has been raised to the level of a resident doctor, and has the right to speak about appendicitis cases.

"Amazing."

After sighing, Tian Linsheng continued to work hard to type up the medical records.

"Cough cough."

Wang Daquan couldn't hold back anymore, coughing violently.

Only then did Ma En look at him, but his eyes were very cold: "Wang Daquan, after discussing with Dr. Qing, afterward, Dr. Qing and my surgery will all be assisted by Tang Lou. Of course, Tang Lou will also have his own Tian Linsheng is the first assistant for the chief surgeon. As for you, from now on, you will be responsible for the research on the use of laughing gas in the dressing change of burn patients before Tang Lou. In the past six months, you will go to the pharmacy to change the medicine."

Wang Daquan said with a bolt from the blue: "Doctor Ma, what happened yesterday? It shouldn't be him"

Wang Daquan glanced at Tanglou, meaning something.

Ma En didn't pick up the words, and didn't want to talk about what happened yesterday, so he scolded seriously: "Wang Daquan, do you want to listen to me again, or ask Doctor Qing to come and tell you again?"

"I"

Although Ma En is very kind on weekdays, he is a resident doctor after all, and he is one level higher than Wang Daquan. Under such strict conditions, Wang Daquan dared not talk too much.

After all, Wang Daquan couldn't be reconciled to the plastic friendship in the workplace: "Got it."

Watching Wang Daquan walk out of the office, Ma En shook his head, in the hospital, either you have superior technical strength, or you have a strong background.

It's a pity that Wang Daquan doesn't occupy any of them, but Tang Lou.
Ma En thought about it all night last night, and he has long since realized that it is the wisest choice to have Tang Lou's friendship in the general surgery department.

Moreover, Tang Lou's technology really benefited him a lot.

"Doctor Ma, I want to go to the ward first to prepare for the next consultation."

Tang Lou read the information carefully, only from the symptoms and color Doppler ultrasound, it was indeed very similar to the typical symptoms of appendicitis, but since Qingping's intuition smelled something unusual, it was worth visiting the patient himself.

"Then I'll go and have a look with you, just to get to know the patient's situation in advance."

Ma En picked up the medical records and stood up.

Tian Linsheng hung his fingers on the keyboard, and tapped a few times from time to time, not daring to miss a line of conversation between Tang Lou and the others.

"Okay, don't pretend. Just tap the keyboard, you can, Tian Linsheng. Let's go together."

"Okay!"

Tian Linsheng smiled, and immediately leaned over, took the notebook and pen from Tang Lou's hand, as if guarding with a knife.

Tang Lou was faintly walking in the middle of the three of them. Looking over, Ma En and Tian Linsheng were holding notebooks and materials, while Tang Lou was relaxed.

Looking at it from the platoon, Tang Lou had the feeling that the chief surgeon was leading two younger brothers.

Soon the three of them arrived at the ward.

The patient is a 48-year-old middle-aged woman, accompanied by the patient's daughter.

"doctor."

Seeing Tang Lou and the others coming, the patient's daughter Hu Jingjing got up, said hello, and looked at Tang Lou between them, slightly surprised.

At first glance, of course, he is so handsome.

The second is that this doctor is so young, he looks similar to himself, and already has two assistants.

The third is to blush. After all, Tang Lou Zhang is so handsome, and with the addition of a white coat, it is natural that she can't take her eyes away.

After regaining her composure, Hu Jingjing stepped aside: "Dr. Qing came to see me just now, and the initial diagnosis was appendicitis. He said that we need to discuss whether to operate or not. You are here to check my mother's condition?"

Because Qingping's palliative work was done well before, the mentality of the patients and their families was relatively stable, and appendicitis was only a minor operation in the eyes of ordinary people.

Tang Lou didn't speak, and went directly to the patient.

Ma En originally wanted to speak, but seeing that Tang Lou had already walked up, he didn't deliberately try to steal the limelight, and he also wanted to see Tang Lou's ability.

Tang Lou naturally used the diagnostic technique directly:

[Patient: Wang Xiufen, female, 48 years old

Symptoms: He was admitted to the hospital for 1 day due to metastatic right lower quadrant pain.

There was no obvious cause for epigastric pain 1 day ago, and it shifted to the right lower quadrant several hours later. The abdominal pain was persistent and aggravated paroxysmal, accompanied by fever, without nausea or vomiting.There was a history of right oophorectomy for 20 years and a history of gastric disease for 2 years.

Vital signs: T 39.0 ℃, P 96 times/min, R 19 times/min, BP 120/80 mm Hg.

The abdomen was slightly distended, and a 6 cm longitudinal surgical scar could be seen in the middle of the lower abdomen; tenderness, rebound tenderness, and mild muscle tension in the McBurney's point area of ​​the right lower abdomen; no shifting dullness on percussion; bowel sounds were normal. WBC 18.6×109/L.

Special reminder: The symptoms of the patient's physical examination can easily be misdiagnosed as typical appendicitis.

The patient had a history of surgery and gastric disease before.The lumen formed by postoperative adhesions may be mistaken for the blind end of the appendix by the sonographer.

In addition, the exudate after appendix gangrene flows to the right lower abdomen through the paracolonic ditch, causing typical appendix symptoms such as tenderness and rebound tenderness in the right lower abdomen.

Diagnosis: The patient had congenital colonic variation. The ileocecal part of the patient was closely adhered to the liver, and the appendix was wrapped by omentum. The appendix could not be detected by conventional McBurney incision. Conventional laparotomy can only be found by expanding the wound upward during the second operation. To the appendix, there is a risk of infection after surgery, and the postoperative scar is too long.Laparoscopic appendectomy is recommended. 】

Tang Lou was also a little surprised after watching it. One was the patient's condition. It was such a coincidence. Who would have thought that the shadow seen by the color ultrasound was not the blind end of the appendix, but the bureaucratic cavity formed by the adhesion after the operation.

In addition, the patient had a congenital mutation of the colon, and the appendix grew under the liver. Unfortunately, the exudate flowed to the right lower abdomen. If the McBurney incision was performed according to the typical appendix, the consequences would be disastrous.

Tang Lou briefly checked the patient's lower body: "I already know the cause, let's go back and prepare for a consultation."

Tang Lou didn't want to waste time, so he turned around directly.

Before Ma En could react, Tang Lou finished the physical examination, a little in disbelief: "What can you tell from this?"

(End of this chapter)