Chapter 1207

"The patient, a 22-year-old female with clear mind... Dysplasia and poor nutrition, went to the obstetrics and Gynecology Department of our hospital on February 14 with nausea, vomiting, abdominal pain and abdominal distention. No obvious abnormality was found after the improvement of relevant examinations and physical examinations in obstetrics and Gynecology, so the Department of Gastroenterology of our hospital was invited for consultation.

After consultation with the chief physician of gastroenterology department of our hospital, the patient's symptoms improved after giving antispasmodic and promoting gastrointestinal motility drugs. However, on February 16, the above symptoms of the patient worsened. After giving antispasmodic and promoting gastrointestinal motility drugs again, there was no significant improvement.

Therefore, after the patient was transferred to the Department of Gastroenterology, enteroscopy and gastroscopy were performed. Enteroscopy showed that there was obvious purulent mucus in the patient's intestine. Intestinal infection was considered. After giving anti infective drugs on the same day, the patient did not improve significantly.

Therefore, after three-level diagnosis and treatment, the Department of Gastroenterology decided to apply for consultation in the whole hospital. After reporting to the president, the president agrees, and the approver is president Zhang Fan! "

After Lao Chen picked up the microphone, he began to tell the patient's admission complaint and the diagnosis and treatment process, and the experts present already had a copy of the medical record and examination in their hands.

But with the examination and medical records in their hands, experts have begun to think about the diagnosis in their own mind according to their own discipline.

Ouyang looked at the report in her hand and put it down. In recent years, the old lady has either thought about the personnel structure of the hospital or fought with the contractors on the construction site. Professional cases, especially interdisciplinary cases, can't keep up.

"Have you ever seen such a case? Did you communicate with everyone before the meeting? "

"No!" Zhang Fan looked at the case and said softly.

Ouyang took a breath of air conditioning and his teeth were creaking“ You are too careless. If you can't get down today, you may lose your face and go to the capital! "

Ouyang is worried. After reading the case, Zhang Fan smiled at Ouyang, "it's all right!"

Then, I looked at the experts in the meeting and put down the cases in my hand“ Everyone has seen the case. OK, now let's talk about it. Since it was first received from the Department of Obstetrics and Gynecology, the Department of Obstetrics and Gynecology will talk about it first. "

Zhang Fan nodded to several experts in obstetrics and gynecology.

The director of Obstetrics and Gynecology gently said a word to LV Shuyan, and LV Shuyan stood up.

"After the patient was admitted to the hospital, my department first determined that the patient was in non pregnancy." Many people are particularly curious when they check in the hospital. When a girl reaches childbearing age and enters the hospital, whether it's a greasy general practitioner or a stout orthopedic doctor, after asking what's wrong with you, she will ask whether you're married or whether your menstruation is normal.

It's like parents urging marriage during the new year. In fact, this is a medical provision. School-age women must ask whether they are pregnant, because many tests and drugs can never be used during pregnancy.

"Although the patient's menstruation is intermittent, various data show that the patient's irregular menstruation is not the direct cause of abdominal pain, abdominal distention and nausea, but the patient's abdominal pain and abdominal distention affect the patient's gynecological system..."

LV Shuyan is practicing. The signs of patients are quite detailed. The gynecological director nodded with satisfaction.

If Zhang Fan is Ouyang's heart, now LV Shuyan is the crown prince of gynecology. At present, LV Shuyan is the director's assistant. Although she does not have the title of deputy director, others are responsible for the current scheduling, business learning and emergency surgery of the Department.

"This elder martial sister is so handsome and cold!" Among the interns, several single dogs secretly thought in the bottom of their hearts.

After the introduction of Gynecology, the introduction of Gastroenterology.

……

After the departments finished speaking, the experts began: "although I didn't see the patient, I think we can continue to observe. Ward rounds three times a day can be divided into ward rounds every two hours, and clues will always be found before and after her onset."

Experts from Marubeni state expressed their opinions. In Marubeni, the number of doctors managing beds is small. Therefore, they pay more attention to clinical observation.

"Infectious white pus was found in the intestine. Although the specific cause of infection cannot be determined at present, we can make a definite diagnosis by laparotomy."

Zhao Jingjin enlarges the move.

"No, the patient's current nutritional status obviously does not support the operation. Moreover, at present, the focus of the patient is not the infectious liquid secreted by the intestine, but what causes her obvious nausea and vomiting. "

Yan Xiaoyu opposed exploratory laparotomy.

This is the biggest difference between internal medicine and surgery. Surgery is simple and rough. If you can't, open your stomach and see. Internal medicine pays attention to mechanism and principle.

Internal medicine can't convince surgery, surgery can't convince internal medicine.

"Well, based on your current suggestions, my opinion is that we should conduct another systematic physical examination."

"OK, I agree!"

"I agree!"

……

"Hey, there is still no master who can make a final decision. If the disease is in our affiliated hospital, the boss of the digestive department can see it at a glance."

"I don't think so. I also saw this patient yesterday. I didn't have a clue at all, that is, I occasionally had irregular nausea and vomiting. My first reaction was pregnancy. After excluding pregnancy, I couldn't think of any other disease. All checks are normal! "

Several students are also discussing together.

Comprehensive treatment is becoming more and more popular in the world. However, the cost is too high. Some hospitals in China have also set up comprehensive departments, outpatient and ward, but the effect is really bullshit.

If comprehensive diagnosis and treatment are combined occasionally, the effect is quite powerful. But once it becomes a normal department, it will be in trouble. Either a group of mediocre doctors in this discipline hang out together, or a group of big winners quarrel every day.

At present, comprehensive diagnosis and treatment is better, that is, it is slightly better in pediatrics, and so is the development of comprehensive diagnosis and treatment in other disciplines.

"Well, at present, the general direction has been determined, that is, the gastrointestinal motility is insufficient. Now let's have a consultation with various departments. President Chen, please arrange a teaching classroom to explain to the patient's family members. We'll let the experts check the body on site. "

"It's ready, and the family agreed." Lao Chen has long been ready. People can become evergreen with this working attitude.

In the large teaching classroom, patients lie on the diagnosis and treatment bed accompanied by nurses.

Although the girl is in her early twenties, her height, weight and development look like a teenager.

Originally, the girl was afraid. Now she looks at dozens of people around her, and there are a group of young guys who look so young, which makes the girl afraid and shy.

To be honest, Chinese patients are really good. If I were abroad, people's patients would ask that I have privacy and can't let so many doctors come.

The little girl, although shy and a little scared, still took off her sick clothes and leaked her white abdomen and chest.

Zhang Fan looked at the girl's body and was filled with emotion. It is estimated that this disease has afflicted the girl for a long time.

Because the girl is a little delicate, she looks obviously like a little doll's figure, and her chest development is not comparable to that of some little fat people.

Physical examination begins.

"I'll come, everyone added!" Zhang Fan originally wanted all experts to show their hands to these interns, but when he saw that the patient was like a kitten, he trembled and suddenly said.

"Don't be afraid. We are all doctors. We will find your cause and make you healthy." Zhang Fan said softly.

The girl seemed to believe it. She bit her lips and nodded gently, and her originally tight muscles relaxed.

"OK, curl up your legs, yes, that's it!"

Physical examination begins