Auto chess in the operating room

Chapter 111 Diagnosed, Master Tang!

Song Yang and Qingping looked at Tang Lou in surprise.

"Bullshit."

Song Yang was about to leave, but when he heard Tang Lou talking nonsense, he scolded him directly.

"Tang Lou, what do you mean?"

Qingping also asked in puzzlement, Tang Lou's remarks were indeed somewhat unexpected.

On the contrary, Ma En came to his senses, wondering why Tang Lou would make such a conclusion.

Tanglou ignored Song Yang's scolding, went directly to the computer, and pulled up the initial medical records.

"Doctor Qing, Doctor Song, listen to me speak slowly, I can say that, of course, it is not aimless."

After Tang Lou adjusted it, he grabbed a laser pointer and moved the red dot to the patient's abdomen.

"Doctor Song, since it's a consultation, let's listen to Tang Lou's analysis."

Qingping waved towards Song Yang, who frowned and sat down, wanting to hear what constructive suggestions this Tanglou could offer.

"Presumably everyone has noticed the 6cm surgical scar on the patient's abdomen."

Looking at the projection position of Tanglou's laser pointer, Qingping nodded. Naturally, he had asked before: "The patient had a right oophorectomy before, but it has been 20 years, so I judge that there is no direct connection with this appendicitis. .”

"Then Doctor Qing, have you ever wondered why the patient has been suffering from repeated stomach problems for the past two years?"

Tang Lou raised another question.

"The patient is 48 years old, and he has several chronic diseases that are not very normal. Maybe he had an irregular diet before, and it has been repeated for two years. And the rebound pain and tenderness in the stomach and right lower quadrant have nothing to do with each other. We are now in To solve the problem of acute appendicitis, chronic stomach problems are not within the scope of this operation. Moreover, I don’t think it has anything to do with acute appendicitis.”

Song Yang couldn't listen anymore, Tang Lou was too far away.

"Does it really matter?"

Tang Lou raised his head and looked straight at Song Yang, his eyes sparkling brightly.

Song Yang was slightly taken aback. Naturally, he didn't dare to say 100% that it had nothing to do with it. After all, there is no absolute in medicine, so he was at a loss for words.Then he was a little annoyed, and said loudly: "Then what does it matter if you talk about it?"

Being teased by an intern, as the attending physician, Song Yang naturally lost his temper.

Seeing the tense atmosphere, Ma En shrank his neck in fright. This tenement building is too steely.

Qingping was also a little helpless, this Tanglou is really a worry-free owner, but he was also a little curious, and urged: "Tanglou, then you can talk about it."

"The patient's self-reported pain transfer route described by Dr. Qingping just now, I don't think the patient's description is wrong like what Dr. Song said. Instead, we are confused by conventional thinking. When we think of rebound tenderness, tenderness is considered acute Symptoms of appendicitis."

"Rebound pain and tenderness alone are not enough to prove it, but the color Doppler ultrasound is very clear."

Unconvinced, Song Yang pointed to the key evidence.

"Is this one?"

Tang Lou switched the picture to the color ultrasound page.

"Yes, the patient's words may be true as you said, but they may also be false as I said. But color Doppler ultrasound can't lie."

Song Yang held the teacup in a menacing manner.

"What you see with your own eyes is not necessarily true."

Tang Lou shook his finger, turned to the first page of the medical record again, and used a laser pointer to walk a few times on the words "the main cause is metastatic right lower quadrant pain".

"We now throw away all the diagnosis of appendicitis and return everything to the starting point of the patient's pain."

While talking, Tang Lou got up and walked the path of the pain in his abdomen, but the direction was exactly the opposite of Qingping's.

"What do you mean?"

Qingping frowned slightly, and there was an indescribable thought in his heart, which was also the reason why he held this consultation in the first place.

Song Yang was also a little baffled, but he also felt that Tang Lou's movement track had a feeling of deja vu.

"What if the trajectory is not the appendix itself, but something that actually flows?"

"You mean it's possible that some kind of seepage from the liver has drained into the lower right quadrant?"

Qingping slapped the table violently, and his mind suddenly opened up.

"But it doesn't make sense. Where did the seepage come from for no reason?"

Qingping fell into doubt again, it didn't make sense.

Song Yang was also thoughtful, and quickly found Tang Lou's loophole: "Your brain hole is really interesting. But you forgot that the patient's appendix is ​​in the lower right abdomen, and according to your guess, it is gangrenous appendix exudate. Flow, the premise is that the appendix is ​​in the liver, and it can only be established from top to bottom."

Song Yang gestured on his abdomen, and stopped at the lower right abdomen, which is the position displayed by the color Doppler ultrasound.

It can't always be that the patient's appendix will teleport, leaving exudate in the liver area first, and then moving to the right lower abdomen.

Song Yang sharply pointed out Tang Lou's flaws.

"Yes, how do you explain this?"

Qingping is also stuck here, and it doesn't make sense, Tang Lou's explanation is contradictory.

"I have already explained at the beginning that what you see is not necessarily true. Have you ever thought about another possibility, that is, the appendix in the right lower abdomen is not the appendix at all, and the patient's appendix is ​​always in the lower part of the liver, that is, the patient often Where the stomach hurts."

Tang Lou stood up, walked to the projection screen, and put his finger on the patient's original surgical scar, which was the location of the pain this time, and also the place where the color ultrasound shadow was: "Is it possible that this is not the appendix at all, but the patient's 20 years ago, after the right oophorectomy, the lumen formed by the adhesion was mistaken for the blind end of the appendix by color Doppler ultrasound. And the patient’s appendix has always been under the liver, which is where the patient has been suffering from repeated stomach pains for the past two years .”

Tang Lou put his fingers on his upper abdomen, and his whole body was full of energy!
"You mean, the patient's repeated stomach pains were originally repeated chronic appendicitis, but this time acute appendicitis and gangrene caused exudate to flow to the right lower abdomen, triggering typical symptoms of appendicitis."

Qingping looked at Tang Lou in disbelief. This associative ability was amazing. Although it was bizarre, it perfectly explained the patient's strange path of pain transfer if he took a closer look.

Even, the source of the patient's recurrent stomach problems was found.

After hearing this, Song Yang was a little confused. He quickly took a sip of tea and calmed down. With his rich experience, he superimposed the various evidence pointed out by Tang Lou and the different symptoms of the patient before and after. It was indeed reasonable.

"This"

Song Yang didn't know what to say for a while, and looked at Qingping, who was also shocked.

"Actually, if you want to know whether what Tang Lou said is true, you need to do an examination of the liver area."

Qingping thought for a few seconds before coming up with the next response.

"Doctor Qing, before the consultation, I have already visited the patient with Dr. Ma. After the physical examination, I felt a lump in the patient's upper abdomen, and there was obvious tenderness when pressing the patient."

Tang Lou added one last sentence.

"really?"

At this moment, Song Yang and Qingping began to believe Tang Lou's conclusion about [-]% to [-]%.

If there is really a lump and tenderness in the upper abdomen, then Tang Lou's is not just a guess, it is justified.

The two big brothers exchanged eyes in disbelief, it was like a dream.

After digesting his emotions, Qingping opened his mouth:
"Tang Lou, you are doing very well. I will go to examine the patient now. If it is true as you said, then the best way is indeed to perform laparoscopic appendectomy."

Song Yang looked at Tang Lou with a complex expression for a few seconds, then stretched out his thumb: "Young people are awesome."

Without Tang Lou's suggestion, the consequences of hastily performing Mai's incision would be disastrous, and Song Yang was naturally afraid for a while.

An hour later, the ultrasonography of the patient's upper abdomen revealed it. Combined with the physical examination, Tang Lou's inference was more than [-]% likely.

After Qingping returned to the office, he made a summary and the operation arrangement:

"Department consultation conclusion: the patient has congenital colon variation, ectopic appendix, and acute appendicitis. Laparoscopic appendectomy is recommended. Chief surgeon, Tang Lou, first assistant, Marne."

(End of this chapter)