Chapter 1686

If I hadn't followed the director on the operation and saw the appendix cut off with my own eyes, I really suspected that it was an ectopic appendix.

I don't know if boss Zheng, the imperial capital of ectopic appendix, has ever done it. This kind of operation is fatal. Once you can't find it, the sense of helplessness on the operating table is enough to make people collapse.

Found the pain point, only tenderness, no rebound pain and muscle tension.

Percussion is also very standard. But there's nothing new. I'll do the same myself.

Auscultation

After physical examination, Zheng Ren restored his clothes to the patient and turned away from the ward.

"Boss Zheng, you..." Li Yong was nervous.

He looked at Zheng Ren's expression without sadness or joy. It seemed that he was holding the victory, and he seemed to be at a loss.

"Take 5ml Meilan from the urinary catheter and pump the peritoneal effusion 30 minutes later." Zheng Ren gave the doctor's advice as he walked.

"Ah?" The little doctor was stunned.

"If you can see blue liquid when pumping ascites, it proves to be bladder rupture. It may be caused by the rupture of surgical scar many years ago." Zheng Ren said as he walked.

“……”

"Boss Zheng, this......" the little doctor thought it was incredible.

"Young man, it is necessary to ask for medical history and physical examination in detail and seriously.

The medical records reflect the patient's collection of medical history at admission, especially the previous medical history is not detailed. For example, more than 20 years ago, the patient missed partial cystectomy due to bladder mass, resulting in missed diagnosis and mistreatment of important diseases. " Zheng Ren said gently.

Although the little doctor was more attentive, he didn't pay attention to too many details because he worked in the town hospital for a long time. Zheng Ren is just a kind reminder. There is no scolding tone at all.

"During the first appendectomy, it was found that the lesions were inconsistent with the diagnosis, the manifestations of appendicitis were atypical, and the amount of effusion was a little large. Did you consider whether it was caused by other reasons at that time?

No further exploration was made. It is unknown whether there was a large amount of ascites at the time of operation. It is estimated that there was a small amount of urine at the time of operation. But it didn't attract the attention of the surgeon, or you regarded urine as exudation. "

"..." the little doctor was sweating.

"Third, after the application of diuretic drugs, the patient's abdominal distension increased significantly. I remember you wrote this sentence in the medical record. As long as you think about it one more step, you will think of the truth." Zheng Ren smiled.

"The patient has no problem with renal function. After using diuretics, especially 40mg furosemide, 500-1000ml urine will be discharged. However, the light yellow urine from the urinary catheter does not increase, which is the biggest problem."

"To sum up, I think it's a bladder rupture. Hurry up to do the Meilan test. If you wear it on your abdomen and draw out the blue liquid, you'll be transferred to urology for surgery. The operation is not too difficult. It's done when you sew it."

"Boss Zheng, really?" Li Yong still felt incredible. He was a little confused when he saw Zheng Ren's green face.

"Hmm? What really?" Zheng Ren doesn't understand. He said it so carefully and thoroughly. Why can't he understand it?

"I'll go right away." Seeing that Zheng Ren was leaving, the little doctor summoned up the courage and asked, "boss Zheng, i... can I leave you a wechat?"

"Huh?"

"I'll do abdominal dressing in half an hour. If there is blue liquid, I'll report to you." The little doctor had an idea and found a reason.

Zheng Ren smiled.

He took out his mobile phone and opened the QR code of wechat for the little doctor. They added wechat.

"You are busy. I'll go back and see Lao Liu." With that, Zheng Ren left by himself.

The level of diagnosis, treatment and surgery in Xilin town is indeed the level of grass-roots hospitals. Simple and rough, right lower abdominal pain is appendicitis. I don't think about it anywhere else.

Differential diagnosis is not done, and abnormal conditions seen during operation are not handled. After the operation... Alas, I used furosemide. I didn't make much urine. I had no problem with my kidney function. I didn't notice such an obvious point.

Forget it, it has nothing to do with himself. Zheng Ren doesn't think much anymore when he goes out of the ward of general surgery.

Now Zheng Ren doesn't use the system panel of big pig hoof at all. First stroke the medical history, look at the test sheet and course records, and you can basically draw a conclusion along the clues.

Obviously, bladder rupture and peritoneal effusion are urine. Zheng Ren finally referred to the system panel of big pig hoof and gave the answer.

As for surgery, Zheng Ren was not interested in simply suturing the bladder.

In addition to laparotomy, the difficulty of this operation can't even compare with appendicitis. And running to Xilin Town People's Hospital for urology surgery is a little too much.

Back in the ward, I gossip with Liu Xuzhi about Li Yong's lover's condition. Liu Xuzhi's lover comes in with a lunch box.

She specially made hand rolling noodles for Zheng Ren in hot soup. The noodles were very strong.

"Boss Zheng, if Lao Liu can't support his family in the imperial capital, I'm going to find a small noodle shop to work." Liu Xuzhi's love and humanity.

"No, you can rest assured." Zheng Ren said with a smile: "nationwide, there are no more than 500 people who do better interventional surgery than Lao Liu."

500, that's a big number.

In fact, Zheng Ren wanted to say 100, but it was just tips surgery. Overall, 500 are relatively standard.

As a doctor, I can rank among the top 500 provincial hospitals in China and have the standard of leading professors.

And Lao Liu's daughter-in-law was so worried that Liu Xuzhi almost disappeared for 30000 yuan.

It's ridiculous.

A handful of bitter tears.

Zheng Renjian, Liu Xuzhi and his daughter-in-law have made preparations for a back-to-back battle, and they don't persuade much. When I went to the imperial capital, I had to work hard even if my level was high.

Lie down and live... It seems that you can now.

A tenured professor at Massachusetts General Hospital can enjoy life with a salary of more than 100000 dollars a month.

Tut Tut, I didn't even notice that I would come to this step so soon.

Seeing that Liu Xuzhi had no problem with his health, Zheng Ren ate noodles. When he was ready to finish the meal, he asked Feng Xuhui to book tickets and hurry back to the imperial capital.

Xilin town brought back Liu Xuzhi. It's over.

After Lao Liu rested for a few days and took his family to the imperial capital, he could carry out massive gastric fundus and left gastric artery embolization.

Knock him a few operations to see how much Lao Liu can master.

Zheng Ren already knows his talent. It belongs to the medium level. It is estimated that the height Liu Xuzhi can reach in this life will not exceed the level of Su Yunyan No. 1.

But as a man, you can't compare with Su Yun. Zheng Ren smiled.

Lao Liu probably won't be too bad. After all, he thinks that tips surgery can touch the threshold, which is much better than most people.

Before the noodles were finished, a stout man knocked at the door and came in.

When he saw Zheng Ren, he immediately showed a flattering smile, stretched out his hands and said, "boss Zheng, you miss me!"